I have lost someone

Grieving following a suicide

Phase 1 : Numbness and denial

Phase 2 : Protest

Phase 3 : Disorganization

Phase 4 : Reorganization

The manifestations of grief

Specific reactions associated with grief following a suicide

Factors that can help in resolving the grieving process: Resilience

Criteria in the healing process

Grieving following a suicide¹

Loss is part of life. Everyone agrees that when we experience loss, we grow and evolve in the various aspects of our lives. However, how can we grow when we suddenly lose someone dear? How can we grow when we’ve lost someone to suicide? How can we grow when we feel involved in the other person’s act?

Grief following a suicide is normally more intense and complex than grieving for someone who died of natural or accidental causes. This type of bereavement is different because the death was not part of the normal life cycle; the person took her own life. As author M. St-Louis has stated, ² what distinguishes suicidal bereavement from other situations of grief is the feeling of being linked to the other person’s death: «I should have known!», «Why did I say those things?», «Had I only taken the time to... maybe..?»….

Consequently, in addition to experiencing mood swings ranging from sadness, helplessness, anger, guilt, confusion, insecurity and intense soul-searching caused by the loss of someone close, the individual must also at times deal with rejection and feelings of abandonment. As well, survivors must deal with some of the stigma that often complicates the grieving process.

¹   Model inspired by the four stages of grieving established by John Bowlby and adapted to the reality of people grieving following a suicide.

²   St-Louis, M. Ta vie j’m’en mêle! Guide d’aide à l’intervention,Table de prévention du suicide de l’Université de Montréal, Montréal, 1994, vol. 3,  pp. 13-14.
 

Phase 1 : Numbness and denial (“No, this is not happening!”)

The first phase of grieving is marked by denial of the loss. The person grieving has difficulty accepting the reality of the loss and how the death happened. Denial serves as a temporary protection mechanism, allowing the person to slowly absorb and integrate the loss as an actual fact. Normally, total denial (denial of the reality of the death) is brief: from a few hours to a few days. In grieving following a suicide, this is quickly replaced by a partial and temporary denial (a few weeks to a few months), i.e. the denial of the cause or type of death.

Denial of the cause of death is brought on by psychological shock and is greatly influenced by social considerations (stigma, dishonour, shame, rejection). Looking to lay blame or for a cause of death is a type of denial. Denial of the way the death happened is characterized by a refusal to accept that the death could have been suicide. The grieving individual desperately tries to convince himself that the death was accidental.

Denial can take several forms:

• Denying that the loss was due to suicide (« No, no… it was an accident. »)
• Selectively forgetting memories or significant comments related to the loss
• Mummification (everything stay the same, ex.: setting the deceased person’s place at the table)
• Denying the impact of the loss (minimizing what is happening)

When one is grieving following a suicide, the initial emotional shock is often greater than in other situations, because of the circumstances surrounding the death. The denial of the cause can be relatively strong, impeding the grieving process.

This phase may also be characterized by:

• Lack of reaction (emotional numbness) or functioning mechanically
• Signs of distress: moaning, hyperactive behaviour, yelling
• Feeling of disbelief
• Idealization of the suicide by transforming it into a noble or ideological gesture
• Devaluation of the deceased to minimize the loss.
   

Phase 2 : Protest “Why me?”

The second phase of grieving is characterized by the near-constant search for the deceased, since the loss has not yet been fully accepted as being permanent. This search is initially focused on objectives, locations, events and memories the person grieving associates with the deceased. It quickly changes to seeking to make sense of or find the reason for the suicide and continues throughout the grieving process.

The protest phase is characterized by two elements:

The first is linked to the expression of emotions. When someone who is grieving enters the protest phase, it is not rare for this person to act differently than he normally would. The individual may fear losing control and letting his emotions take over.

It’s impossible not to suffer when we lose someone or something significant. However, we don’t all feel or express our suffering in the same way.

If we deny our reactions and emotions, we don’t feel the loss or experience the grieving process. This can be dangerous because we then put our mental and physical health at risk, which may result in any of the following: burnout, changing jobs, psychosomatic problems, fits of anger or sadness, loss of emotional control, substance abuse or depression. Yet society is not open to the expression of suffering and conveys messages to that effect: crying only worsens the pain, it’s morbid and demoralizing, it’s not good to feel sorry for oneself, we should be strong, not show our emotions, etc. When we deny our emotions, they are likely come out in physical or psychological ways.

The second element is linked to questioning the reason for the change. As the reality of the loss gradually emerges, despite an unconscious search for the lost object, the grieving person seeks to understand and bring meaning to his loss (the famous WHY): «Why is this happening to me? » The person’s task, throughout his grieving process, will be to try and bring meaning to the loss (intentional death). He will thoroughly examine his entire relationship with the deceased person to distance himself from the intolerable idea that he is responsible for the suicide. Fear of society’s reactions, isolation and guilt can be heightened if the grieving person was aware of the deceased’s intentions.

Denial turns to pain, distress, depression and memories of the person who has died. This often manifests itself through various intense physical and psychological symptoms: sadness, anger, shame, a sense of helplessness, guilt, looking to lay blame, incomprehension, auditory and visual hallucinations, and insomnia. The intensity of these emotions is largely due to the individual’s feelings of involvement and the responsibility he feels for the deceased’s decision to end her life.
 

Phase 3 : Disorganization (“I don’t know anymore”)

The disorganization phase gradually emerges when the person finally accepts the reality of the suicide. Attempts to find the deceased result in persistent failure. The individual experiences feelings of anger, rage, anxiety, and fear. He recognizes the permanency of the loss but cannot accept it. The resulting pain and despair lead to feelings of disorganization in terms of the individual’s personality and entire universe. Despair takes the shape of a profound existential crisis. During this phase, even if the individual is progressing through the grieving process, he usually has the impression that he’s regressing because his emotions are so intense.

The person grieving begins some soul-searching and questions his relationships with others. This often complete self re-evaluation leads the individual to redefine himself based on new values, goals, objectives, ideals, and priorities in life. However, redefining oneself in this case often involves loss of self-esteem, self accusations and suicidal thoughts. The person is vulnerable to using suicide to alleviate his suffering or as a solution to his problems.
 

Phase 4 : Reorganization

The final phase of the grieving process involves gradual acceptance of the loss. The intense pain lessens. Memories are less frequent and less painful. The person regains interest in the outside world and begins once again to invest in new relationships and projects. It becomes possible to live with the loved one’s suicide. The individual restructures her life without the deceased. She situates the deceased in a given context and learns to live in this reality.

The grieving individual redefines herself as a person and re-establishes her values and needs. She is better able to function and begins to once again find pleasure in life. However, she may be cautious about getting involved in new relationships.

The manifestations of grief

Experiencing grief involves different reactions of varying intensity. The typical manifestations of grief are listed below. There are four potential types of reactions following a death:¹

1. Emotional reactions
2. Psychological reactions
3. Behavioural reactions
4. Physical reactions

POSSIBLE MANIFESTATIONS OF GRIEF
EMOTIONAL REACTIONS	Distress Anxiety Sense of helplessness Anger and rebellion Loss of control Guilt Fear Insecurity	Hopelessness Sadness and sorrow Relief Lack of emotion Shame Feelings of incompetence Contradictory feelings
PSYCHOLOGICAL REACTIONS	Nightmares and dreams Suicidal thoughts Mood swings Memory loss State of shock Solitude	Visual or auditory hallucinations Confusion Sensing the deceased is present Searching for the deceased Identifying with the deceased Distraction
BEHAVIOURAL REACTIONS	Excessive need to blame someone and to search for explanations Difficulty staying in one place Psychological withdrawal Social withdrawal (isolation) Inability to remain alone Avoidance behaviour through work, sleep or other activities Disruption in eating habits	Dangerous behaviour (alcohol, drugs, accident through negligence) Crying, sighing, moaning, verbalization Avoidance of or attachment to objects symbolizing the deceased Aggression Trouble sleeping
PHYSICAL REACTIONS	Lack of energy Loss of appetite	Muscle tension Difficulty breathing

¹   ROGERS, C. R., The Necessary and Sufficient Conditions of Therapeutic Personality Change, Journal of Consulting Psychology, No 21, 1957, pp. 95-103.

Specific reactions associated with grief following a suicide ¹

Suicidal bereavement elicits specific emotions attributed to the circumstances surrounding the death, from feelings of being involved in the other person’s death to the social reactions that it provokes and the questions it makes us all ask about the meaning of life.

• “Why?” questions (denial)
• The search for meaning
• Guilt and self-accusation
• Anger
• Stigma and shame
• Shock and morbid images
• Risk of suicide among survivors
• Lack of social support

¹ National Task Force on Suicide in Canada, Suicide in Canada, Ottawa, Health and Welfare Canada, 1994, 212 p.

 
Factors that can help in resolving the grieving process: Resilience

Resilience is one’s personal capacity to deal with difficult events that occur throughout one’s life. Resilience is often compared to an internal spring that allows each person to bounce back and find a sense of balance following a situation that affects us. The ability to bounce back differs for each person and depends mainly on two personal aspects: a person’s internal and external resources.

Internal resources refer to personality and individual characteristics. In the case of suicidal bereavement, certain personal elements will influence the grieving process:

• Way of perceiving sorrow, emotions (anger is liberating)
• Accepting the reality of the loss
• Rituals surrounding grieving (that highlight the reality of the loss)
• Health
• Not having to make important decisions
• Accepting a new way of working
• Time as an ally

External resources refer to the people (family and friends) and events surrounding the grieving person:

• Helpful and compassionate family and friends
• Leisure activities
• Employment
• Professional help

Criteria in the healing process

• Acceptance of the loss
• Empowerment
• Internalization of the loss (memories no longer needed)
• Complete disappearance of the symptoms
• Development of new models of functioning (new limits)
• Improvement in quality of life
• Ability to once again see meaning in life and in one’s own life
• Ability to reinvest oneself emotionally and socially (work, relationships)

 

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