Understanding the Aftermath of Suicide Loss
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experience in suicide bereavement revealed three prominent themes for how their grieving was similar and different from other types of loss and grief . These phenomena or themes are related to sorrow and grief , trauma , and complicated bereavement .
Over the years , the metaphor for these three themes can be likened to the mythological three-headed dog / beast named Cerberus , who represents ceaseless and unrelenting aggression . Hercules was even challenged to fight Cerberus , and the dog / beast is featured in other myths , such as the story of Psyche . She was a mere mortal challenged by Aphrodite to go deep into Hades to retrieve a treasure , knowing that she would have to encounter Cerberus . Psyche knew to take three honey cakes to give to each head of the dog , distracting Cerberus to clear her passage and survival .
We have vast epidemiological data on who dies from suicide , who are at higher risk , who are in geographic regions with greater incidence of suicide , and more . Despite the well-researched public health data about risk factors and incidence , anyone can die by suicide at any time for any reason using any method . Public health researchers tend to surveil large demographic groups , while mental health professionals work with individuals , couples , families , and small groups . The person or persons in counselors ’ offices tend to be a “ one-person sample ” or a sample of a small group of persons represented by these abbreviated case studies related to suicide loss :
• Deborah : She attended the Survivors of Suicide loss group for the first time at age 50 . When she was 4 years old , her dad died by shooting himself in the front yard where she was playing . She was whisked away from the rescue efforts and the commotion , and her dad ’ s death by suicide was never mentioned again until she was in treatment for a Substance Use Disorder at 50 . Forty-six years had elapsed before anyone ever provided her with care and attention for this traumatic loss .
• Molly and Stan : This happily married couple had just had a baby . Stan was five minutes away from home after work when Molly shot their six-week-old baby and then herself in their backyard . When Stan arrived home , he attempted to provide CPR until the medics arrived . After they took over , he was taken to the police station and questioned as if he were a homicide suspect . In retrospect , Molly was found to have had postpartum depression .
• Reggie : The intake form that 19-year-old Reggie shared with his mental health provider stated clearly that he was currently having thoughts of suicide . There was no formal suicide risk assessment conducted , nor was a safety plan developed . The provider left their practice for about 10 weeks for an out-of-state course and provided Reggie no back-up provider or provisional clinical care during that time , in addition to other significant omissions related to standards of care . Reggie ’ s parents presented for bereavement counseling , and their bereavement turned into both enlightenment and anger as they began to realize how inadequate their son ’ s care had been . Their grieving was complicated and forestalled by difficult questions about whether to hold the practitioner accountable through possible litigation .
• Walter : He was a middle-aged man who lost his job due to the recession . When all he could find was a retail job at a “ big-box ” store , he became increasingly depressed and was hospitalized for two weeks . The day after his discharge , the medical provider told Walter at a follow-up appointment , with his wife present , that “ he was worth more dead than alive .” Walter went home and shot himself .
• Gene : Gene had been diagnosed with an inoperable brain tumor , and his family had been preparing for his imminent death . Though he was unable to walk without assistance at the time of his death , he somehow got out of bed , retrieved his gun , loaded it , crawled out to the deck of his house , and shot himself . This was devastating to his family , and they were utterly baffled about why he would deny them the last few precious days of his life .
These are but a few of the complex suicide narratives that the survivors of suicide loss shared at their bereavement group . As one can surmise , Cerberus , metaphorically , can dispatch its three aggressive heads into the bereavement experiences … sorrow , trauma , and complicated bereavement .
‘ NORMAL ’ SORROW VS . TRAUMATIC LOSS
When my 84-year-old father-in-law died from a sepsis infection years ago , he was in the hospital . He was provided with maximum care , support from the family , and perfectly arranged accommodations between the hospital and the funeral home two hours away . The professionals told his wife , my mother-inlaw , that they would handle everything . The services were “ normal ” or typical for a man of his age , held in the place that he had planned for . Though a sad time for the family , it was a normative type of death , with a traditional set of arrangements to celebrate his life and place him at rest in his selected burial spot . In contrast , deaths from suicide hold many different challenges .
We LCMHCs , and all who grieve following a loss of any kind , know that a death can have a profound impact on emotional , physical , spiritual , cultural , familial , and even financial or vocational functioning . It may take months or even longer to return to the level of pre-death functioning . continued on page 13
12 The Advocate Magazine 2023 , Issue # 1 American Mental Health Counselors Association ( AMHCA ) www . amhca . org