Take the light, and darken everything around
meCall the clouds and listen closely, I'm lost without you
Call your name every day when I feel so helpless
I'm fallin' down but I'll rise above this, rise above this
~“Rise
Above This,” Seether
The lead
singer for the rock band Seether wrote those lyrics in the aftermath of his
brother’s suicide. The video for the song depicts what many people feel upon
hearing the news that their loved one has died.
A mother, a father, a sister – all going about their normal daily lives --
are suddenly blown completely off their feet by an unseen force.
The
course of a complicated bereavement, like the process that often follows
suicide, usually does not follow the straightforward path outlined by Elizabeth
Kubler-Ross so many decades ago, but rather twists and turns and circles back
on itself through mazes of denial, sadness, anger, shame, blame, and multiple
physical reactions. Several authors have
described an “oscillating process” in complicated bereavement – a moving back
and forth between loss-orientation and restoration orientation[1],
between growth and depreciation[2]. In
this oscillating process survivors of suicide loss can move closer to some
people and further away from others. They may simultaneously experience
increased symptoms of distress and feelings of adaptation as these states
appear to be independent dimensions.
As
survivors of suicide loss learn to adjust to the empty chair and redefine life
without the physical presence of their loved ones, they can feel like they have
lost a part of themselves. Not everyone
is debilitated by this loss, however, and the bereaved
often fall into one of three clusters:
- Quick recovery. Those who recover quickly
without assistance and can return to functioning as before. Some of these people are not distressed
because they had only superficial contact with the deceased, while others
are often internalizing and suppressing pain, anger or guilt. In the latter case, maladaptive strategies
of coping may emerge such as substance abuse or other compulsive
behaviors.
- Modest support needed. Most people who were
functioning well before the suicide need only a modest level of support
for anywhere from a month to a couple of years. This level of support might include
outpatient therapy or support groups.
- Psychiatric disability. Some people may develop a mental disorder, such as
post-traumatic stress disorder or depression, in reaction to the trauma
and loss and may require extended or intensive treatment.
For the first couple of years after my brother Carson’s death, I
moved in and out of these three states. Sometimes I would feel like I was
functioning well, other days I would get through with a call to a friend or a
visit to a support group, and some days I would be so consumed with the sadness
of what had happened that I would benefit from periods of counseling.
In the aftermath of an
unexpected death, especially suicide, traumatic grief is a common
reaction. When this occurs both trauma
and grief reactions are experienced together, and elements of this combined
level of psychological distress are often debilitating and complex.
A number of circumstances
about a suicide death may influence traumatic grief reactions[3]:
- Suddenness or lack
of anticipation. The
unexpected death offers no opportunity for goodbyes, unfinished business,
resolution of conflict, or answers to questions. Very often the bereaved are left with
endless “whys” and “what ifs.” When
loved ones die from a prolonged illness, by contrast, we have time to
prepare ourselves for their absence.
- Violence,
mutilation, and destruction.
Deaths that involve suffering or extreme pain may cause horrifying
traumatic imagery and intrusive thoughts – whether or not the bereaved
actually witnessed the death or the body. If the death occurred in a
familiar or personal space of the bereaved, that space will most likely
continue to trigger traumatic reactions.
- Preventability or
randomness of death. The randomness of such a loss can trigger a
greater sense of vulnerability and anxiety. This is often the case when
there were no apparent warning signs before the person died.
- Multiple deaths
(bereavement overload) or multiple losses. In addition to the
primary loss of the person, secondary losses may include loss of an
income, loss of a home, or loss of all things familiar. The resulting disorganization can strain
the family and social system.
- Contact with first
responders or the media. Sometimes the reactions of first responders
– who need to rule out homicide in every suicide case – can increase
confusion and distress among those bereaved. If the events surrounding the
death were newsworthy, the bereaved may also be dealing with the intrusion
of the media.
Trauma reactions and
grief work are often at odds with each other. On one hand, the trauma experience leads to continual
intrusion of the death event. That is,
survivors of suicide loss can’t stop thinking about the death scene (even when
they are dreaming), and disturbing images may flash before the mind’s eye when
they least expect it. The horror can be overwhelming and the natural impulse is
to stay away from anything that
reminds them of the trauma. Sometimes
survivors develop post-traumatic stress disorder (PTSD) in the aftermath of a
violent or unexpected death.
When I first started reading about trauma as a
graduate student in the 1990s, I was moved by Ronnie Janoff-Bulman’s book Shattered Assumptions.[4] Her
basic premise is that traumatic events shatter three world views that all
people tend to hold:
·
Benevolence
of the world – people are generally good
·
Meaningfulness
of the world – good things happen to good people
·
Self-worth
– I am good and can keep myself and those who love me safe and healthy.
All three of these assumptions are usually
deeply challenged, if not shattered, after a suicide death. The traumatic
responses of re-experiencing intrusive thoughts through flashbacks and
ruminations are the mind’s way of rebuilding new world views about the self and
the world. When Randy and I were in Hawaii just months after Carson’s death, we
were hiking along the Napali Coast – one of the most beautiful places on Earth
– and I could not stop ruminating about the horror of my brother’s suicide. I
remember saying to Randy, “In the last hour, I have imagined Carson’s final
moments at least 40 times and have only thought of our children once. What is
wrong with me?”
On the other hand, the grief experience works in phases as
survivors of suicide loss come to accept the reality of the loss, and the
tendency is to move toward things
that remind them of the deceased. The intense sadness can feel like it will
never go away; and I like to reframe this grief reaction as honoring our loved
one. Kahlil Gibran once said, “When you are
sorrowful look again in your heart, and you shall see that in truth you are
weeping for that which has been your delight.”
The alternating cycle of
horror and loving memories, of avoiding and embracing things related to the
loved one, makes traumatic grief complicated.
Not everyone is incapacitated, however, and many find unexpected twists
in the journey can lead them to “rise above it” and integrate their experience
into a deeper understanding of themselves, their purpose, and their world.
For more information on getting support in the
aftermath of a suicide death, please visit: http://www.suicidology.org/suicide-survivors/suicide-loss-survivors
About the Author
Sally Spencer-Thomas, Psy.D., is CEO and co-founder of the Carson J
Spencer Foundation, a Colorado-based nonprofit established after the suicide of
her brother. The foundation is known for “sustaining a passion for life” by
developing innovative and effective approaches to suicide prevention among
working aged people, coaching youth social entrepreneurs to be the next
generation of suicide prevention advocates, and supporting people bereaved by
suicide. www.CarsonJSpencer.org
[1] Stroebe, Margaret & Schut, Henk (1999).
The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197-224.
[2] Baker, Jennifer, Kelly, Caroline, Calhoun,
Lawrence, Cann, Arnie & Tedeschi, Richard (2008). An examination of
posttraumatic growth and posttraumatic depreciation: Two exploratory studies. Journal of Loss and Trauma, 13, 450-465.
[3] Ambrose,
J. T (n.d.) Traumatic grief: What we need to know as trauma responders. Retrieved
October 30, 2005 from http://wwwctsn-rcst.ca/Traumaticgrief.html
[4] Jannoff-Bulman, R. (1992). Shattered Assumptions: Towards a New
Psychology of Trauma. New York: Free Press.
