In New Zealand about 500 people are lost due to suicide every year. If we estimate that for each death, at least 6 others are closely impacted, we are seeing, each year, a minimum of 3,000 additional people affected.
Loss affects everyone. However, for some, loss is grievous and a death by suicide may fall into this category. Those left behind can find themselves toppled into a desperate search to make sense of the loss and find meaning. They may battle feelings of rejection and abandonment, responsibility and guilt, and may suffer the shame and social stigma associated with suicide. Some become socially isolated as they withdraw to nurse their grief. There may be additional problems relating to physical health status, and the grieving are at some risk of suicide themselves. Some may even experience positive feelings (for example, relief from suffering and worry). Adverse outcomes for some suicide bereaved may include increased risk of adjustment problems and psychiatric disorder, so they have a particular need for support (including practical assistance with police processes, funeral arrangements and Coroner’s hearings), counselling, and sometimes psychological treatment.
Mostly, grief follows a moderate, non-pathological course and gradually resolves over time. The individual usually returns to previous levels of functioning within a year or two. The pattern of grief is thought to follow phases during which various emotional and thought tasks are accomplished. There is a range of processes associated with grieving for the loss of a beloved person. Mourners may experience a degree of thought disorganisation and a sense of lost identity associated with the lost relationship and uncertainty about the future. There can be an intense preoccupation with the loss and a desperate search to make sense of the loss. People commonly yearn for the loved one, and experience a wide range of emotions including sadness, fear, anger, guilt, irritability, and loneliness. These emotional responses are all within the normal range. Physiological or bodily distress is typical within the first months, with temporary changes to the immune response resulting in a vulnerability to infection. Some people report respiratory and digestive problems. Behaviourally, there may be withdrawal from social contact and past roles and activities, increasing the sense of isolation and loneliness.
A very small minority may fail to recover; the course of grieving being markedly extended. Those suffering loss due to suicide may be especially vulnerable to this complicated grief reaction. Without treatment, there may be persistent impairment in many aspects of their lives. Some describe the sense of ongoing shock, having difficulty accepting the loss – almost as if this information can’t be absorbed by the mind. For others, it’s as if the loss event is unreal and the loved one is only temporarily gone.
Resolution occurs when the loss event is incorporated into the life story of the survivor, unhelpful beliefs adjusted, and hope and meaning rekindled. As one mother put it, “I can no longer talk to or touch my son, but I can still love him”.