In 2005, in a small town in upstate New York, a teenage boy committed suicide. Students in the community were baffled as to how he could do such a thing. No one understood why he would allow himself to perform such a heinous act. Within a week, another teenage boy had killed himself. Known to be best friends, the two boys’ suicides caused the school to go into a panic, wondering how many other friends would attempt, or possibly complete, another suicide.
After the first suicide, not enough was done to make sure that those who were friends and/or family with the boy were coping with the loss. As a result, his best friend soon took his own life, resulting in the beginnings of a cluster suicide – one of the results following the crisis of suicide.
Every eighteen minutes in the United States, a suicide is committed (Joiner, 2005; Shneidman, 2004). Families lose a sibling, a parent, a grandparent, a friend. More than 30,000 suicides occur within the United States every year (Shneidman, 2004). Worldwide, an estimated half-million people kill themselves each year, accounting for 3% of all world deaths (Beautrais, et al., 2007; Joiner, 2005; Shneidman, 2004). In 2001, suicide was the 11th leading cause of death overall in the United States (Joiner, 2005). So why does suicides happen? And how do those who are left behind deal with the loss of their loved one in such a manner? How do we help those who have experienced the loss of someone by suicide?
According to Henry A. Murray, a Professor at Harvard, “‘Suicide is functional because it abolishes painful tension… [it is a form] of relief from intolerable suffering’ and ‘given intense and irremediable sufferings, there is nothing irrational about the act of suicide. It is irrational only to those who stand outside of it’” (in Shneidman, 2004, p. 103). There are more than 50,000 suicide attempts in the United States each year, which leaves more than 200,000 survivor-victims (Shneidman, 2004). Suicide is a response to a problem for the one to commit it, but it causes many more problems for the bereaving (Shneidman, 2004). Suicide affects those left behind like family, friends, and community members.
"To commit suicide… is to escape by taking one’s own life from a situation sensed by the subject to be intolerable” (Shneidman, 2004, p. 111). There are three indicators of a suicide crisis, and they usually occur in groups of two or three in a single person. These indicators include: “a precipitating event; intense affective states apart from depression; and certain behavior patterns – speech or actions suggesting increasing suicidal preoccupation, deterioration in social or occupational functioning, or increasing substance abuse” (Hendin, 2004, p. 386).
“Suicide among children and young adolescents under the age of 15 is very rare, and accounts for less than 2% of all suicides” (Beautrais, et al., 2007). Children suicide rates have increased120% since 1970 (Parrish, et al., 2005). Children who attempt to and complete suicide can suffer from many things. They can have a learning disability, or psychosomatic disorders with psychotic and neurotic conditions. They may show fetishes, start fires, or sleepwalk. Children most likely will be obese, be delinquents, and repeatedly run away are at a higher risk for suicide (Shneidman, 2004). Suicide risk is greater within families where there is parental violence, abuse (physical, emotional, and sexual), neglect, substance abuse, and depression (Beautrais, et al., 2007).
For adolescents, the risk is higher. Suicide is the third leading cause of death for people aged 15 to 24 years (Parrish, et al., 2005; Shneidman, 2004). Deaths that are marked as “unknown causes” may also be attributed to suicide. Suicide accounts for 11-12% of all adolescent deaths (Parrish, et al., 2005). Adolescents who commit suicide are more vulnerable to personal crises, like relationship problems, disciplinary actions, and trouble with the law or other authority figures (Beautrais, et al., 2007). In schools, there may be several suicides within days or hours of each other. These are known as suicide clusters. If two students die by suicide within four days of each other, within 18 days, seven others will have either attempted or completed suicides (Joiner, 2005). “Young people are especially vulnerable to imitative suicidal behavior, and this may be encouraged by funeral and memorial services that eulogize the young who die by suicide” (Beautrais, et al., 2007). It is believed that glamorizing a suicide can cause more to follow.
In most countries, the adult population accounts for nearly half of all suicides. They seem to be more affected by mental-health factors, life circumstances and stress (Beautrais, et al., 2007).
The elderly may also attempt suicide. Those at the highest risk are elderly white males (Joiner, 2005). The elderly believe that they have the right to die on their own terms, and some may take it into their own hands. They are less likely to survive suicide attempts. The elderly may be depressed, suffering from physical illness, and divorced or widowed. They might be socially isolated and retired (Beautrais, et al., 2007). Many times, after a suicide of an elderly family member, families may project guilt onto the health care workers who were caring for the elder (Jacobs, 1999).
There are certain risk factors to suicide, involving family histories of suicide. Those under the age of thirty that are at risk of suicide include a history of previous attempts, mood disorders, substance abuse, delinquent/semi-delinquent behavior, and a presence of firearms. Males have a higher risk of completing suicide. Native Americans are also at a higher risk. If the person is over thirty, divorcees have a higher risk, especially if they lack social supports. If they are unemployed, alcoholics, widowed, or schizophrenic, they also have a higher risk of committing suicide (Jacobs, 1999).
Some medical disorders also have a high comorbidity with suicide. If a person has a mood disorder, they have a lifetime risk of 15% of committing suicide. Panic disorders are at a 7-15% lifetime risk, schizophrenia has a 10% lifetime risk, alcoholism has a 3% lifetime risk, and borderline personality disorder has a 7% lifetime risk (Jacobs, 1999). Impulsivity is also a major risk factor for suicide (Parrish, et al., 2005).
“I believe that the person who commits suicide puts his psychological skeleton in the survivor’s emotional closet; he sentences the survivor to deal with many negative feelings” (Shneidman, 2004, p. 154). It is estimated that at least six people are extremely affected by a suicide (Begley, et al., 2007; Hawton, 2003). Those affected after a suicide include parents, partners, children, siblings, friends, colleagues, and clinicians (Hawton, 2003).
Bereavement after a suicide is similar to bereavement after traumatic deaths like sudden infant death syndrome (SIDS), AIDS, or accidents (Begley, et al., 2007). The psychological processes that survivor-victims go through involve the “ongoing search for meaning, blame, guilt, rejection, and a perceived lack of social supports” (Begley, et al., 2007, p. 26). They continue to search for the meaning of life and tend to feel humiliated about it (Begley, et al., 2007).
The most affective state experienced with all those bereaving is desperation, especially trying to find the answer to the question “why?” (Hendin, et al., 2004; Parrish, et al., 2005). Hopelessness, abandonment, rage, and self-hatred/guilt are also experienced by mostly all those affected by suicide (Hendin, et al., 2004). People who are affected by suicide experience guilt because they question themselves on whether or not they played a part in the suicide (Hawton, 2003). For all survivor-victims, the guilt may be so intense, that it may cause depression, masochism (sexual gratification through physical/verbal abuse), obsessions, and rebellious behaviors within the bereaved (Shneidman, 2004). Most survivor-victims believe that they could have done something. They believe that they should have seen the signs and been able to stop it. These feelings intensify if the bereaved feel that they treated the deceased badly (Jacobs, 1999). Sometimes, these feelings last for years and within families, these feelings can extend through generations (Beautrais, et al., 2007).
Sometimes, survivor-victims feel immense betrayal after a suicide. They may feel betrayed by the deceased, feeling that the deceased did not think about their feelings. They might experience psychological abandonment, feeling that they were left abruptly without the necessary resources. The bereaved might also feel betrayal by therapists and/or other doctors treating the deceased, who should have been able to see the signs (Jacobs, 1999). They might believe that “the suicide was a breach of trust” with the deceased (Begley, et al., 2007, p. 30).
Survivor-victims believe that there will now be a negative stigma cast upon them by friends and the community after a suicide. People seem to ignore the situation, being careful to not bring it up. This is likely to cause a breakdown of social support systems for the bereaved, leaving them feeling alone (Hawton, et al., 2003).
Survivor-victims might try to avoid behaviors, like rage and guilt, by using scapegoats. They might take the blame out on someone else, or keep themselves busy as to avoid the pain. The surprise element of suicide leaves the bereaved unable to tolerate feeling of dysphoria (depression-like symptoms), which can lead to feelings of betrayal, helplessness, anger, distrust, blame, and acts of litigation (Jacobs, 1999).
Many times, these feelings are displaced by some other action, like a lawsuit for malpractice against a therapist (Jacobs, 1999). This could be because suicide is defined as a malady behind hushed whispers. It’s a tragedy, and it is not often talked about, because most would just like the incidence contained and reduced (Shneidman, 2004). Many people bereaved by suicide claim that many people within the community seemed to turn their backs on the survivor-victim. “…friends abandoned them and acted uneasy around them” (Begley, et al., 2007, p. 31).
Intervention is critical for families in which suicide has occurred. They may struggle with feelings of remorse, guilt, and misunderstanding. Survivor-victims have a 25% chance of experiencing depression, a 40% chance of PTSD, and a 31% chance of suicidal ideation. Without immediate intervention, the risk for any one of these increases (Jacobs, 1999). Parents whose child commits suicide may experience a sense of “ultimate failure and rejection” because they “were expected to raise, nurture, and protect their children” (Parrish, et al., 2005, p. 89). Families may experience a sense of abandonment, and “find themselves avoided, if not shunned by friends, other parents, and even relatives following a suicide” (Parrish, et al., 2005, p. 90).
Children who experience the suicide of a loved one might not be able to cope correctly. Suicide is often hidden from children. Some fear that the news of a suicide might be too much for a child to comprehend and that the suicide will be harder on a child (Shneidman, 2004).
Children often blame themselves for suicides, especially those within the family or of very close friends (Shneidman, 2004). Those that are affected by a suicide may fear that another will take place. They might avoid discussing or expressing feelings to others, for fear of upsetting those around them. The younger the child, the harder it is for them to cope with the pain caused by the suicide, and some might engage in self-injurious behaviors (Begley, et al., 2007). When a child commits suicide, it is viewed as a “compounded loss, with the tragedy of an unavoidable youthful death, the loss of a future, and the stigmatized trauma that death being self-inflicted” (Parrish, et al., 2005, p. 89).
It is very necessary to intervene within school systems if a student or teacher has committed suicide. Both the faculty and the student body may need support and help to overcome the emotions they are experiencing (Jacobs, 1999). “…the suicide may have something of a ‘ripple effect’” causing the friends and teachers of the deceased to be affected (Parrish, et al., 2005, p. 82).
Suicide is viewed differently around the world. In some countries, like China and Japan, it was once a custom to take your own life if you in any way dishonored the family. “[In Japan], suicide had become a spectator sport; on a day when several hours had passed without a death, a tourist, laughingly shouted, ‘I dare someone to jump!’ A man ran forward and threw himself into the crater” (Shneidman, 2004, p. 187).
“Postvention is prevention for future generations” (Begley, et al., 2007, p. 27). Those working with people bereaved by suicide must work to intervene with issues that may arise after the crisis of suicide. They must help the person overcome feelings of anguish, guilt, anger, shame, and perplexity (Shneidman, 2004). Intervention must be used immediately; otherwise, intense pain, distress, and turmoil will persist. It is important to acknowledge that suicide changes lives in order to help those dealing with the suicide cope better with the upcoming issues that may arise (Begley, et al., 2007). Social workers and crisis counselors will have to work in several settings, from hospitals to schools to mental health centers and homes (Parrish, et al., 2005). Help can come in several different techniques, like individual, group, or family counseling and therapy (Hawton, et al., 2003).
One must educate people after a suicide to help them cope with the tragedy. Education about suicide and grief, improving coping skills, and encouraging the development of new relationships are good techniques to help survivor-victims overcome the crisis of suicide (Hawton, et al., 2003). Debriefings may be used in junior/senior high schools in order to educate the students about suicide (Parrish, et al., 2005).
In order to avoid such things as cluster suicides and copycats, one needs to prepare people for the bereavement process by alerting them to the fact that suicidal intentions is one of the morbidities of depression. They must know that what they are feeling is indeed okay for them to feel. Also, if there are any known firearms within a household, they need to be removed immediately, because having access to firearms increases the risk of copycats and cluster suicides (Jacobs, 1999).
Support groups are a useful tool to let those who are bereaved come together with others and share their feelings. “…Peter joined the Living Links suicide healing support group and this resulted in him feeling less vulnerable as he could identify with people” (Begley, et al., 2007, p.31). Support groups help the bereaved create “mental bonds with the deceased”, allowing them to continually have the influence of the deceased with them (Begley, et al., 2007, p. 31).
Other interventions, like psycho-educational meetings allow people to better understand why a suicide happens. They learn that the feelings they are experiencing are normal, and they learn better ways of coping with them (Jacobs, 1999). Letting the survivor-victim know that those around them will avoid discussing the situation helps the bereaved better prepare for this. Martin, a survivor-victim was better able to cope with people avoiding him because he was warned beforehand. “…I thought it was very important to be made aware of it” (Begley, et al., 2007, p. 31).
Therapists must also use intervention measures to ensure their safety. “…professionals have few opportunities to resolve the grief experienced upon a client’s or patient’s death by suicide” (Parrish, et al., 2005, p. 89). Those working with a client that has committed suicide experience the same feelings as the loved ones do. “About 20% of psychologists and over 50% of psychiatrists are estimated to have had this experience” (Hendin, et al., 2004, p. 115). Some therapists may feel a sense of guilt or blame because they feel that they failed to recognize the severity of the situation (Hawton, et al., 2003). Also, therapists must prepare themselves for any sort of malpractice lawsuits that might be brought on by the family of the now-deceased (Jacobs, 1999).
According to English historian Arnold Toynbee, “There are always two parties to a death; the person who dies and the survivors who are bereaved… The sting of death is less sharp for the person who dies than it is for the bereaved survivor” (in Shneidman, 2004, p. 154). For every 50,000 committed suicides each year, there is a minimum range of 200,000 to 400,000 survivor-victims left behind to cope with the crisis (Parrish, et al., 2005). “Making sense of the suicide [is] a complex process and not necessarily undertaken in a linear fashion” (Begley, et al., 2007, p. 30).
Without intervention after a suicide crisis, several things can occur. Survivor-victims can feel guilty for allowing their loved one to commit such a heinous act. They can continue to place the blame on themselves and others for years after the crisis. Survivor-victims may feel helpless, hopeless and alone after a suicide, which can lead to other suicides.
After a suicide crisis, friends of the deceased may make pacts to kill themselves together. This can lead to cluster suicides and cause even more issues and problems as a result of the suicide. Therapists must intervene in order to ensure that this does not happen, and cause an even bigger crisis.
Therapists must ensure that those affected by the suicide crisis are emotionally taken care of, and able to cope with the loss of the one they loved. Without this intervention, more crises may arise, some lasting for years or generations.
WORKS CITED
Beautrais, Annette and Mishara, Brian. (2007). Suicide Prevention across a Life Span. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 28(2), 57-60.
Begley, Mary and Quayle, Ethel. (2007). The Lived Experience of Adults Bereaved by Suicide. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 28(1), 26-34.
Hawton, Keith, and Simkin, Sue. Helping People Bereaved by Suicide. British Medical Journal, 327(7408), 177.
Hendin, Herbert, Maltsberger, John T., Pollinger Haas, Ann, Szanto, Katalin, and
Rabinowicz, Heather. (2004). Desperation and Other Affective States in Suicidal Patients. Suicide & Life-Threatening Behavior, 34(4), 386-94.
Hendin, Herbert, Maltsberger, John T., Pollinger Haas, Ann, Szanto, Katalin, and Rabinowicz, Heather. (2004). Recognizing and Responding to a Suicide Crisis. Suicide & Life-Threatening Behavior, 31(2), 115-128.
Jacobs, Douglas G. (1999). Harvard Medical School Guide to Suicide Assessment and Intervention. San Francisco: Jossey-Bass.
Joiner, Thomas. (2005). Why People Die by Suicide. Massachusetts: Harvard Unity Press.
Parrish, Margarete, and Tunkle, Judy. (2005). Clinical Challenges Following an Adolescent’s Death by Suicide. Clinical Social Work Journal, 33(1), 81-99.
Shneidman, Edwin S. (2004). Comprehending Suicide: Landmarks in 20th-Century Suicidology. Washington, DC: American Psychological Association.
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