Grief, Traumatic Grief -Alliance of Hope

The Survivor Experience

It has been said that suicide is like a “grenade going off within a family or community,” In the aftermath, survivors are left profoundly wounded and deeply distressed.  Many grapple with debilitating emotions, altered relationships, and challenging responsibilities. Each situation is unique, but some issues are commonly shared by survivors.

Research tells us that it is helpful to know about common survivor reactions.  Being informed does not make the reactions disappear.  That will take time … and probably a good deal of grief-work.  It will help though, to know that what you are feeling is commonly felt by other survivors and that it is possible to survive and go beyond just surviving.  On this page, you will find information about common survivor issues.

Why?

Survivors inevitably search for a reason, perhaps because having a reason might restore some small sense of control in a seemingly unpredictable world.  Trying to understand “why” can occupy our minds for a long time.  Ultimately many realize they may never know.

When survivors talk about their loved ones, it becomes evident that there is no one path or cause for suicide.  Each story is unique.  Some who take their lives have struggled long and hard with previously diagnosed mental illnesses such as Bi-Polar Disorder, Depression, Schizophrenia or Borderline Personality Disorder.  Others have never been diagnosed, but in hindsight, had many traits that fit these diagnoses.  Some have spoken of suicide at various points in their lives.  Others never spoke of suicide or gave any indication of depression.  Some suicides appear to be impulsive following a significant disappointment.  Others seem more-planned.  Many people who take their lives have alcohol or drugs in their system.  Others do not.  Some leave notes.  Others do not.

It appears that each person who dies by suicide has reached a point where they can no longer tolerate their pain and suffering.  Most don’t intend to leave behind a wake of pain and destruction.  They are simply searching for a way out of an unbearable struggle.

Traumatic Grief & Post-Traumatic Stress

Traumatic losses such as the death of a loved one by suicide are far outside of what we normally expect in life.  The reactions of suicide survivors often include and go beyond normal grief reactions in severity and duration.

Many survivors experience symptoms of post traumatic stress. Many counselors would say “these are normal responses to abnormal events.”  Recovery from these symptoms is a gradual process. Most survivors find that as time goes on, reactions become fewer and less intense.Common reactions include:

• Distressing recollections of the death
• Distressing dreams about the event
• A feeling of reliving the experience
• Feeling numb
• Feeling emotionally detached from other people
• Always feeling “on guard”
• Difficulty working
• Difficulty in social situations
• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance

Some survivors have a more difficult time healing.  They develop more severe and lasting symptoms which are diagnosed as “Post Traumatic Stress Disorder.” (PTSD)  There are many positive ways to cope with symptoms of trauma.  A trained professional, experienced in suicide loss or treatment of traumatic grief, can be very helpful.

Post Traumatic Stress Disorder

Post Traumatic Stress Disorder is defined in DSM-IV, the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual. For a doctor or medical professional to be able to make a diagnosis, the condition must be defined in DSM-IV or its international equivalent, the World Health Organization’s ICD-10.

The diagnostic criteria for Post Traumatic Stress Disorder are defined in DSM-IV as follows:

A. The person experiences a traumatic event in which both of the following were present:

  1. the person experienced or witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
  2. the person’s response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently re-experienced in any of the following ways:

  1. recurrent and intrusive distressing recollections of the event, including images, thoughts or perception
  2. recurrent distressing dreams of the event
  3. acting or feeling as if the traumatic event were recurring (e.g. reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those on wakening or when intoxicated)
  4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
  5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by at least three of: 

  1. efforts to avoid thoughts, feelings or conversations associated with the trauma;
  2. efforts to avoid activities, places or people that arouse recollections of this trauma;
  3. inability to recall an important aspect of the trauma;
  4. markedly dimished interest or participation in significant activities;
  5. feeling of detachment or estrangement from others;
  6. restricted range of affect (eg unable to have loving feelings);
  7. sense of foreshortened future (eg does not expect to have a career, marriage, children or a normal life span.

D. Persistent symptoms of increased arousal (not present before the trauma) as indicated by at least two of the following: 

  1. difficulty falling or staying asleep;
  2. irritability or outbursts of anger
  3. difficulty concentrating;
  4. hypervigilance
  5. exaggerated startle response

E.  They symptoms on Criteria B, C and D last for more than one month.

F.  The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning. 

Stigmatization

There is still a stigma related to suicide, born of hundreds of centuries of misinformation and misunderstanding of mental illness.  Many people find the subject of suicide difficult and will make every effort to avoid it.  Many survivors struggle with what to tell others.

In the past, many survivors felt isolated, without the opportunity to speak about their loved one.  Today, survivors generally are able to acknowledge that their loved one died by suicide and be listened to with compassion.  Courageous survivors who have shared their loss, have paved the way for others to share long-concealed stories of suicide in their own families.  Ultimately, each survivor must decide what feels right to share with others.

One remaining source of stigma is the stereotyping and misunderstanding of mental illness and suicide.  Many people mistakenly conclude that mental illnesses stem from severe family dysfunction or weakness of character.  In most cases, nothing could be further from truth.  Mental illnesses typically develop in the same way as other genetic illnesses like cancer, diabetes or heart disease.  Sadly, sometimes in retrospect, we see that our loved one suffered from a terminal mental illness.

Raising Consciousness by How We Speak

There is currently a movement to raise consciousness about the language we use to describe suicide. Some believe expressions such as “committed suicide” and even “completed suicide” perpetuate an historical stigma that is irrelevant to our understanding of brain and biochemical illnesses such as depression. They suggest “died by suicide” or “died from suicide” are better choices.

A similar concern exists for the idea and wording that an individual “chooses to die by suicide.”  In question is whether, given our current paradigm of mental illness as a leading factor for suicide, the word “choice” is appropriate.  If a person is suffering a deep depression or other mental illness is he or she really “choosing.?”

Shock

Suicide is a shocking event.  It shatters our world and sends us reeling. We have no defenses that prepare us for the horror of losing a loved one by suicide.  When it happens, we frequently feel confused, numb or empty of emotions.

For many survivors, the shock is exacerbated by additional traumas like searches, rescue attempts, discovery of the body or witnessing of the death.

During periods of shock, events seem unreal.   We struggle to get out minds around what has happened.  Confusion, disbelief and numbness are common.  It may become difficult to eat, sleep or do routine tasks.  This is a time to be gentle with oneself and let others help.

The duration of shock and confusion varies by survivor and is probably influenced by the degree of trauma as well as the individual makeup of the survivor.  For some it lasts only days but it may go on for weeks or months.

Members of the Alliance of Hope Community Forum, frequently describe a sense of shock, disbelief and difficulty remembering key aspects of events:

“My 15-yr old son shot himself 10 days ago.  My precious little man died in my arms with no reasoning as to why he did this.  I’m not quite sure what world I’m in at this moment, but I hurt and ache all day every day. I think of him all the time, but I don’t think I have really accepted the fact that he’s gone.  It feels like he’s at school or just at a friend’s house.  We have moved out of our home where it happened and it makes me feel as though I’ve left him behind.”

“Is is normal to feel like you are just existing, no feelings at all, kind of numb? I feel as though I’m still in shock.  I don’t think it has really hit me yet.”

“My husband hung himself two weeks ago.  He told me he felt depressed 2 weeks before he died.  I feel very, very sad at present and still cannot believe what he has done.”

“I ran out of my car, leaving my purse and hot coffee, and she ran out of the house screaming, he’s dead!  he’s dead — and that moment is freeze-framed in my mind.  the most horrifying moment.  and i don’t remember feeling anything.  i only cry in privacy.  … i know every gory detail.  … i replay it in my mind, the whole day.  and i don’t feel a thing.”

“It has been 2 months since my husband hung himself in the back woods.  … There were no signs and the circumstances are so surreal.  I can’t talk about it to anyone and have trouble even thinking about why he killed himself.”

“I know this sounds strange, but … even though my husband shot himself about ten feet away from me, I don’t remember the details.  I remember things like the blood soaking into his clothes and I can sometimes hear the shot but I don’t remember what it looked like.  I remember people talking to me but I don’t remember what they were saying.  I have thought about this before but again sometimes I get these flashes of my husband’s body but it doesn’t seem real.”

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