Bereavement by suicide carries something with it that is unique when it comes to loss. It sits within the grieving process and experience of loss but it also stretches beyond it due to the tragic, traumatic and sudden nature of it. People can find themselves trying to live alongside questions that do not settle and responses from others that do not quite understand them. One’s internal landscape changes in ways that are difficult to put words to. Research has tried to describe the experience with one early study finding that those bereaved by suicide spoke of an “overwhelming need to ‘make sense of the death’” and a parallel experience of “social uneasiness” in the aftermath.
The tension a person can experience when bereaved by suicide is very real and can take up much internal space in the body and the mind. The mind can turn repeatedly towards the question of why, while the social world can feel altered and the body may experience all manner of challenges from sore shoulders and back pain to upset stomachs and tightness in the throat. The question of why is not one of curiosity as it quite often carries a sense of responsibility within it. People bereaved by suicide can experience this tiring question of ‘why’ alongside feelings of guilt, blame and anger. It is not unusual for people to replay conversations, to reconsider moments that once seemed ordinary and/or to search for something that might have been missed.
In 1969, Elisabeth Kübler-Ross, a Swiss-American psychiatrist, described grief as a process involving five stages, being denial, anger, bargaining, depression and acceptance, in her outstanding book ‘On Death and Dying’. In bereavement following suicide, these can appear in ways that feel somewhat chaotic and difficult to anticipate. Denial may take the form of a disbelief that the death has happened at all or a sense that it does not fit with what was known of the person who is no longer with us. Anger can emerge towards the person who has died, towards others or towards oneself, often intertwined with love and a resulting confusion. Bargaining may be felt in the repeated returning to moments that now carry new meaning alongside thoughts about what might have been different “if only”. Depression, in this context, speaks to the depth of the loss and the absence that follows, rather than our day -to-day understanding of depression. Acceptance is sometimes described as a form of coming to live with the reality of the death, even when it remains painful and incomplete. These stages are not linear or chronologically arranged. She later clarified that these stages were “never meant to help tuck messy emotions into neat packages” in her book ‘On Grief and Grieving’.
In suicide bereavement, this is particularly important. The processes she described do not unfold in order and, although this may be hard to read, they do not conclude. They move in and out of one another, sometimes within the same day or across days, months, years or lifetimes. I often think of any bereavement or loss as being similar to a knot in a beautiful piece of wood. The knot itself is forever there, tight, messy and not going anywhere. However, the beautiful piece of wood, which features the knot, is a result of growing around the knot over time. With the unique type of grief encountered when bereaved by suicide, it is not that the grief ever ends. It is that, as a person continues to experience their own living, they grow around the grief. It will always be painful; anytime you look at a picture or think about a time in the past, the grief can and often will come back, as if it was yesterday that the loss occurred. The ‘Five Stages of Grief’ framework can offer language for experiences that might otherwise feel disorganised but it does not set a path that must be followed.
What remains central is the relationship with the person who has died and the ongoing work of carrying that relationship in a life that has been altered. What does this mean? Well, if our grief was removed or done away with then it would be a dishonour to the person and the relationship we had with them. To feel the grief fully is to honour that person. To weep and feel physical pain at the thought of who that person was and could have been is a testament to the love held for them. It is unfortunate that due to the human condition we cannot experience that love without the potential to experience the grief of loss in some format.
In 1897, Émile Durkheim described suicide in terms of social forces suggesting that levels of connection and regulation within society are key. His work points towards the importance of belonging and social context, without locating responsibility in any one relationship. Edwin S. Shneidman, in his 1993 book ‘Suicide as Psychache’, wrote that “the common stimulus in suicide is unbearable psychological pain”, which he termed ‘psychache’. This idea can sometimes offer a way of understanding suicide as an attempt to escape suffering rather than as a rejection of others or a wish to die. In 2005, Thomas Joiner proposed that suicide emerges when a person experiences both a sense of not belonging and a belief that they are a burden. This is known as the interpersonal theory of suicide. It also suggests that suicidal behaviour is not simply a wish to die, but something that develops over time through exposure and habituation to pain or fear.
Similarly, in 2011, Rory O’Connor developed the Integrated Motivational Volitional model, which distinguishes between the emergence of suicidal thoughts and the transition to action. Within this model, feelings of defeat and entrapment, also interpreted as feeling powerless or helpless in one’s situation, can give rise to suicidal thinking, while factors such as access to means or impulsivity can influence whether a person acts on those thoughts. Again, these ideas do not explain a single death. They offer a language for thinking about how complex and layered these experiences can be.
Apart from theories that can help in understanding, there is often a felt difference in how this loss is held by others. Suicide bereavement is many times influenced by the social responses that follow. Research consistently identifies stigma as a central feature. This can show up in silence, in avoidance or in use of language as people may not know what to say or sometimes they say nothing at all.
If the person who died by suicide was young then there can be a sense that the life that was unfolding has been interrupted in a way that feels difficult to take in. Developmental expectations are disrupted and an imagined future becomes something else entirely, as the absence is not only of the person as they were but of who they were becoming.
There is also the presence of trauma within this kind of grief. Bereavement after suicide can involve intrusive thoughts, images or bodily responses that are not always associated with other forms of loss. The mind can return to the circumstances of the death in ways that feel involuntary which can make restorative rest difficult. It can make everyday life feel less predictable.
At the same time, it is important not to separate suicide bereavement too sharply from other forms of grief. There is a risk that in emphasising difference, the shared human aspects of mourning are lost. Certainly shame and self-blame can be present. However, grief remains grief and love remains present in the loss. Grief theorists have long tried to describe how people live with loss. Accepting the reality of the loss and processing the pain of grief can be the ultimate challenge and these tasks are not steps that are completed in order. They can be returned to repeatedly, especially when the death carries unanswered questions. Meaning making and honouring the person who died by suicide can be deeply challenging but ultimately supportive in living one’s own life. Talking about this and opening up to loved ones is the best way to go about it. Of course, Psychotherapy and Counselling is also an appropriate place to do this if doing it with loved ones feels too much to start with.
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