What if you become a suicide survivor?
There is, as yet, no significant body of scientific research on the particular needs of this growing population of people in pain. But through the small amount of scientific research and the much larger body of writings by individual suicide survivors, a general picture has emerged of the elements that can make grief over a suicide particularly devastating and lengthy. Here are some of the responses you may have to this shattering experience:
You may become preoccupied with understanding the reasons for the suicide. It is human nature to seek reason in all things, to reduce our sense of powerlessness over events. But the effort to rationalize suicide masks the essentially emotional nature of the act, and, more profoundly still, implies that emotions are somehow less “real” than the products of reason. Obsessing over the “why” of the suicide probably compounds and extends the grief that accompanies any death. That said, however, it is likely to be a necessary component in the early stages of the grieving process, even if an ultimate answer is never reached. Be patient with yourself. Find compassionate friends and relatives willing to serve as understanding, nonjudgmental audiences to your recounting of the circumstances of the death. In time you will come to some accommodation with the lost loved one’s act, even if it is simply that some human actions are unfathomable.
You may experience a protracted period of denial. Suicide is not a way in which we expect loved ones to die. Old age, accidents, illness, even war, are causes of death which are accorded a “naturalness” that suicide is denied, despite its frequency. Furthermore, faced with the reality that the deceased chose to die rather than continue your relationship, you may feel that you have been “divorced” – pushed into a state of conflict with the loved one and left to resolve it alone. To compound the emotional devastation still further, there is now an emotional ambiguity toward the deceased, who has become, at once, the slayer and the slain. Understandably, the resulting pain and anger may well prove to be more than you can immediately confront, leading to a retreat into denial or some other tactic for avoiding confrontation with the issues raised by the suicide.
You may try to assume responsibility for the death. No one who has experienced the self-destruction of a loved one escapes the regretful thought that he or she should have recognized the signs of impending suicide, should have intervened more overtly, could have done something to prevent it. But shifting responsibility for the act from the person who committed it both diminishes and misrepresents it. It assumes a degree of control over the actions of another that simply does not exist, and adds an irresolvable moral component to the pall of grief.
You may blame others for the death. The need to render the act comprehensible and bearable may lead you to blame others for the loved one’s death – a doctor who should have detected the suicidal impulse, a clergyman with whom the deceased talked some time before the suicide, family members or friends who somehow deserted him or her at a time of need. But, as with self-blame, this defense mechanism should, in time, give way to acceptance of the deceased’s own responsibility for the act.
You may withdraw from family and friends. There is still a social stigma regarding suicide. While no one with even a spark of compassion would intentionally mention that taboo, they may, nevertheless, express it by avoiding any reference to how your loved one perished or through inappropriate commiseration, e.g. “I don’t understand how he could do that to you.” The anger and pain caused by such implicit condemnation of the suicide may cause you to withdraw from people whose support you need, as well as those whose “support” is poisoned by ignorance and insensitivity. If there is a small consolation to be found in the pain of suicide survival, it is that you will discover who your real friends are. They are the people who support you emotionally without passing judgment on the suicide, those with whom you feel no need to be defensive in talking openly about what happened, those who will continue to listen to you after others have tired of the subject, those who will be there to welcome each milestone in your progress toward reconciliation, acceptance and healing. They will be, almost certainly, the first people with whom you will share a laugh without guilt.
You may experience suicidal thoughts yourself. This is a common occurrence, and something to be taken seriously. The incidence of suicidal behavior among relatives of those who have attempted or completed suicide is four times higher than in the general population. But the reasons for this are not well understood, and they definitely do not constitute a destiny, even for the survivor who is a close blood relative of the deceased. Research has identified both genetic and environmental factors in families with a history of suicide  . The genetic aspect generally manifests as a familial pattern of depression and/or substance abuse, stemming, perhaps, from an identified but not extensively explored genetic predisposition to chronically low levels of serotonin, one of the chemicals that serve as neurotransmitters – message carriers between brain cells.  Environmental factors include a history of childhood abuse, exposure to parental depression and/or substance abuse, family discord and violence and even the heightened “reality” of suicide stemming from the survivor’s loss  . All that said, however, unless you share the deceased’s major depression or other significant suicide markers, such as extreme impulsiveness or aggressiveness  ,  , you are not likely to act upon the dark, self-destructive thoughts that occur during your grief. If you find yourself pushing past suicidal ideation to something verging on suicidal behavior, however, you should seek competent professional help.
The Emotions of Grief
This time-honored list is often entitled “The Stages of Grief”, but that is somewhat misleading. Not everyone experiences all six of the emotional states it describes, or experiences them in the order of occurrence the list suggests. Nevertheless, these are the common emotional experiences of those who have lost a loved one.
· Shock. Like the pain-suppressing physical shock that sets in following a severe injury, the emotional numbness of shock permits you to function, at least minimally, while you adapt to the altered reality of life without the deceased.
· Denial. Accepting death is the most difficult challenge life poses. It is quite common to feel that what has happened is impossible – a sort of waking nightmare in which the order of the universe is violated. In time, this feeling fades as you come to view the event in a more realistic and rational way.
· Guilt. This emotion can prove especially durable among suicide survivors, as they seek to make sense of a loved one’s shattering decision to end his or her life. It is a normal response to the event – but a misguided one. You cannot predict the future, nor do you control the lives of others, even those close to you.. Guilt subsides with the realization that the decision was not yours to make or prevent.
· Anger. The sense of betrayal and abandonment brought on by the loved one’s choice to die rather than continue your relationship is a powerful goad to anger, either toward the deceased or, by transference, to others you may imagine had some power to prevent the death. It diminishes as you come to understand that the choice was driven by a profound inner pain and hopelessness, beyond anyone’s power to control.
· Sadness. Sorrow is the core emotion of the grieving process – the one that persists after time and increased wisdom have caused the shock, anger, denial and guilt to subside. Over time, it declines, returning, perhaps, at holidays or anniversaries, or when you are confronted with some reminder of the loved one you’ve lost. It may never entirely disappear, but it becomes increasingly bearable, a darker thread in the tapestry of your relation with the person who took his or her life. Happier memories come again to the fore.
· Acceptance. This is the goal – making peace with reality. You finally accept the suicide as the deceased’s decision, unembellished by speculation about how you or others could have prevented it. You allow yourself to move on with your own life. Hard as it may be to believe in the midst of your grief, this day will come. 
 Brent, David A., “Familial Factors in Suicide and Suicidal Behavior,” American Federation for Suicide Prevention, available at http://www.afsp.org/research/articles/brent.htm, accessed 6/1/2004
 Malone, Kevin, and Mann, J. John, “Serotonin and the Suicidal Brain,” American Federation for Suicide Prevention, available at http://www.afsp.org/index-1.htm, accessed 6/10/2004
 Brent, “Familial factors in Suicide and Suicide Behavior”
 Brodsky, Beth, et. al, “The Relationship of Childhood Abuse to Impulsivity and Suicidal Behavior in Adults with Major Depression,” American Federation for Suicide Prevention, available at http://www.afsp.org/index-1.htm, accessed 6/10/2004
 Qin, Ping, “The Relationship of Suicide Risk to Family History of Suicide and Psychiatric Disorders”
 This section is adapted from Jackson, Jeffrey, SOS: A Handbook for Survivors of Suicide, American Association of Suicidology, 2003, pp. 8-24