The loss of a loved one to suicide is often experienced as “devastating.”1 While survivors of suicide loss may be able to move through the grief process without clinical support,2 the traumatic and stigmatizing nature of suicide is likely to make its aftermath more challenging to navigate than other types of loss. Sanford et al3 found that more than two-thirds of suicide loss survivors sought therapy after their loss. Further, when individuals facing these challenges present for treatment, clinicians often face challenges of their own.
Very few clinicians are trained in general grief processes,4 and even those specifically trained in grief and loss have been shown to “miss” several of the common clinical features that are unique to suicide loss.3 In my professional experience, the intensity and duration of suicide grief are often greater than they are for other losses, and many survivors of suicide loss have reported that others, including clinicians, have “pathologized” this, rather than having understood it as normative under the circumstances.
Although there is extensive literature on the aftermath of suicide for surviving loved ones, very few controlled studies have assessed interventions specifically for this population. Yet the U.S. Guidelines for Suicide Postvention5 explicitly call for improved training for those who work with suicide loss survivors, as well as research on these interventions. Jordan and McGann6 noted, “Without a full knowledge of suicide and its aftermath, it is very possible to make clinical errors which can hamper treatment.” This article summarizes what is currently known about the general experience of suicide bereavement and optimal interventions in treatment.
What makes suicide loss unique?
Suicide bereavement is distinct from other types of loss in 3 significant ways7:
- the thematic content of the grief
- the social processes surrounding the survivor
- the impact that suicide has on family systems.
Additionally, the perceived intentionality and preventability of a suicide death, as well as its stigmatized and traumatic nature, differentiate it from other types of traumatic loss.7 These elements are all likely to affect the nature, intensity, and duration of the grief.
Stigma and suicide. Stigma associated with suicide is well documented.8 Former U.S. Surgeon General David Satcher9 specifically described stigma toward suicide as one of the biggest barriers to prevention. In addition, researchers have found that the stigma associated with suicide “spills over” to the bereaved family members. Doka10,11 refers to “disenfranchised grief,” in which bereaved individuals receive the message that their grief is not legitimate, and as a result, they are likely to internalize this view. Studies have shown that individuals bereaved by suicide are also stigmatized, and are believed to be more psychologically disturbed, less likable, more blameworthy, more ashamed, and more in need of professional help than other bereaved individuals.8,12-20
These judgments often mirror suicide loss survivors’ self-punitive assessments, which then become exacerbated by and intertwined with both externally imposed and internalized stigma. Thus, it is not uncommon for survivors of suicide loss to question their own right to grieve, to report low expectations of social support, and to feel compelled to deny or hide the mode of death. To the extent that they are actively grieving, survivors of suicide loss often feel that they must do so in isolation. Thus, the perception of stigma, whether external or internalized, can have a profound effect on decisions about disclosure, requesting support, and ultimately on one’s ability to integrate the loss. Indeed, Feigelman et al21 found that stigmatization after suicide was specifically associated with ongoing grief difficulties, depression, and suicidal ideation.
Continue to: Traumatic nature of suicide