12 12“The death of a significant other by suicide is a stressor
of unparalleled magnitude in most people’s lives, and
even the most psychologically mature individual may
encounter difficulty in responding to it.”
—Edward Dunne,
Suicide and Its Aftermath: Understanding and Counseling the Survivors
We start out as perfect strangers in a group. Eighteen people go around the room telling their stories and we are linked. We have been there. We all deal differently with suicide—some have rage, some have sorrow, some have utter forgiveness and understanding. We all have loss.
It is seven months since my husband killed himself; I have been coming to these support meetings for six months, half of one year. I have also been going to individual therapy twice a week. I am reading every book possible on why people kill themselves. I continue to search through the literature—both popular and professional—for publications directed to those of us who have lost a loved one to suicide. Although our needs have been described as the “greatest among all groups affected by suicidal behavior” (John McIntosh, Suicide and Its Aftermath: Understanding and Counseling the Survivors), the material available to us offering support and assistance is remarkably meager.
I am also surprised that in New York City, with a population of eight million people, there are so few support groups for suicide survivors. I attend the meetings held by Samaritans, an organization primarily concerned with suicide prevention. Led by volunteers, these groups are offered free of charge two evenings each month. At some meetings, the room is crowded with almost twenty people; other times, fewer than ten of us show up. Where is everyone else, I wonder.
Ever since Harry died, I have found great comfort in these groups. Although I am fortunate to have a therapist who can discuss suicide without getting tangled up in rigid orthodoxy or frightened by the relentless talk of death, the meetings satisfy my intense desire to connect with others who are going through the same experience I am. My therapist is enthusiastic about the groups; she is not threatened by the “self-help” nature of their structure but views them as an essential ingredient in my healing process.
Getting help is imperative for all survivors of suicide—whether we find it through support groups, individual therapy, family counseling, or spiritual comfort. Unfortunately, the interest of the mental health profession centers on the people who commit suicide, not on those of us who are left behind to deal with its consequences.
“Little has been done by the current mental health system in terms of developing treatment models for working with survivors either individually or as family systems,” writes Dr. McIntosh. “In fact, survivors themselves have brought the issue to the fore and have pointed out the inadequacies of the mental health system in dealing with this issue.”
Not every person who suffers the loss of a loved one to suicide needs a powerful intervention to deal with their problems, according to Dr. Edward Dunne. “There are plenty of people who do fine without therapy,” he explains. “If they’re wounded, they heal. Yet, others need a great deal of help.” Dr. Dunne also points out that some people who have experienced the suicide of someone close to them often do not seek help from the mental health profession because they are angry at the profession for having been unable to save the life of the deceased, or they fear that they will be stigmatized as a mentally ill person if they seek professional counseling.
“I tried going to a psychiatrist right after my sister died, but it was a terrible experience,” explains Lois, a forty-year-old investment banker from Boston. “The doctor was highly regarded for his work in the field of suicide, but he seemed more interested in the circumstances surrounding my sister’s suicide than in how I was feeling. It rapidly became apparent to me that he considered my sister to be his patient, not me. Every time I talked about my guilt or the nightmares that were keeping me awake, he would bring the topic back to her. It was all about my sister’s pain, not mine.
“I was in a state of shock when I went to see this doctor, so it was impossible for me to determine if the problem was with me or with him. I felt incapable of making an objective assessment of him. During my third session, I told him I felt like killing myself. His immediate response was that if this were true, he would have to institutionalize me. Instead of helping me with my suicidal feelings and severe panic attacks, he was punishing me by threatening to commit me to a mental hospital.
“This psychiatrist did not tell me that my reaction was typical among survivors. There was no reassurance. I knew I could never mention again that I felt like killing myself—the reason I was going to him in the first place. Ironically, suicide had become a taboo subject.
“Instead of talking to me, the doctor put me on Prozac. But I had a bad reaction—the medication filled me with a constant feeling of foreboding. Then he told me the pills weren’t working because I wasn’t ‘depressed’ enough. This after he threatened to put me in an institution! I constantly felt as if he were blaming me for not getting better. Finally, after three months, he told me there was no purpose in my continuing treatment. He didn’t even recommend another therapist. I was very angry and I wouldn’t pay the bill for my last session.
“At that point, I decided to go to my general practitioner, a doctor whom I trusted very much. He told me I was depressed and had every right to be. He put me on Tofranil, an older, well-known antidepressant. He also recommended that I join a support group.
“I could not have survived without the groups. The people there were the only ones who could understand the pain, guilt, horror, and fear I was experiencing. We all had self-destructive thoughts after the suicide—I wasn’t crazy after all. I also felt compassion for everyone at the meetings. I cried for them and cried for myself. Once I realized there was still a part of me that could care for others, I knew I would be okay.”
The intense interaction among participants is what distinguishes suicide support groups from twelve-step programs, according to Rick, a volunteer who has facilitated survivors groups in San Francisco for the past five years. “The format I use in the meetings has evolved through trial and error,” he explains. “We sit in a circle, with each person giving a brief introduction: first name, who was lost, when it was, and how it happened. I then ask the people who are attending for the first time to begin, because they usually have an urgent need to talk. The rest of the group reaches out to them by describing their own experiences and how they are feeling. The new people realize they are not alone with their nightmare. By comparing their situations with others’, they also begin to understand that they don’t have a monopoly on pain.
“In all my years of conducting these groups, I must say that I have never heard any participant express judgment against another person. The members of the groups are always very forgiving—of everyone else but themselves. Eventually, when they realize that they do not blame the others, they stop blaming themselves.
“Comparison is the best medicine. There is such an air of mystery surrounding suicide. People are looking for closure and answers, wanting to know what has really happened. This is especially difficult with suicide because we can’t ask the people who killed themselves why they did it. The one common denominator among the people who come to the meetings is pain. With some, recovery is slower and the bitterness deeper; others are able to compartmentalize their feelings.
“The groups never become depressing to me, just the opposite. When I was younger, my life was troubled. Along the way, I was helped by different people who literally redirected my course. It is very important for someone to be there to listen. I believe that life is a journey and there should be sentinels along the way to hold out their hands to you. You, in turn, should then hold out your hand to others. There is enough real suffering. If someone has been there, he or she can help alleviate another person’s pain. I will do that for the rest of my life.”
Some survivors are uneasy about seeking out support groups because of the personal and public stigma surrounding suicide. “I thought everyone there would look like crazed maniacs,” relates Marie, the wife of the California politician who shot himself six years ago. “It took me one and a half years to go to my first meeting. I felt like damaged goods and didn’t want to be associated with other people in my situation. No way did I want to join a circle of losers. To my surprise, the people in the group were normal human beings who were dazed and hurt, not freaky. Within a short time, I grew to respect and care for them.
“My first meeting really blew me away. People were throwing around the S word so casually—suicide this and suicide that. To me, suicide was like a curse word; I would only say my husband killed himself, never that he committed suicide. I had felt so isolated but, all of a sudden, I saw that there were other people who knew exactly what I was going through.
“I attended the meetings for more than a year. Now I go occasionally—on the anniversary of my husband’s death, during the Christmas holidays, on my wedding anniversary. I think the people who go to these groups have a lot of courage. When someone says to me that my husband must have been very brave to take his own life, I get furious. The real heroes of this drama are those of us who are trying to put our lives back together, piece by piece. We are the ones who have to face straightening up the mess and making sense of the insanity. We cry, we laugh, we hang on to each other for dear life, but we do survive, thank God.”
There are many excellent suicide support groups throughout the United States and Canada (see listings, Chapter 18), and their numbers are growing. These peer support groups are offered free of charge and are organized on a community, grassroots level. Survivors should be wary, however, of any group that is conducted by someone with no personal connection to suicide or with no ties to other local groups concerned with providing support services for people who have lost a loved one to suicide.
“The process of recovery, or learning to trust again, is hard enough without being exploited and betrayed by someone who passes himself off as wanting to help,” says Maureen, a fifty-one-year-old corporate lawyer from Washington, DC. “When my father died two years ago, I was completely devastated. He was a well-known journalist who shot himself because he feared that he was developing the first signs of Alzheimer’s disease. When a friend of mine told me about a support group run by a psychologist, I jumped at the chance to be able to talk to other people who were in my same situation.
“When I called the doctor to find out details about where the meetings were held, he told me he would first have to interview me in his private office. Even though I was still numb—my father had killed himself only five weeks before—it struck me as unusual that I had to be ‘accepted’ into the group. When I went for my appointment with him, he began asking extremely specific and personal questions about the exact circumstances surrounding my father’s suicide. During the interview, which lasted almost two hours, he took copious notes. He prefaced our talk by stating that everything I was telling him was strictly confidential.
“The doctor had been conducting his support group for more than a year. The meetings were held in the classroom of a local high school; even so, he asked for a ten dollar ‘donation’ from each participant to cover his expenses. Many times, people in the group would ask him why he was taking time out from his practice to do this, and he would always answer that he felt a lot of empathy and concern for us, that he truly wanted to ‘help’ us.
“One day, around six months after I started going to his group, I was reading an article in one of those throwaway newspapers about how some Gulf War veterans are suffering from post-traumatic stress disorder. The reporter included a quote from the doctor, citing him as an expert, based on a book he was writing about suicide survivors. I literally began shaking. This man had not only lied to us about his reasons for holding the meetings but also was betraying our confidence to make a quick buck for himself.
“I immediately phoned the doctor, who confirmed that, yes, he was hoping to publish a book about the experiences of the group members. When I asked him why he had not informed us about his plans beforehand, he answered that he did not want us to become ‘self-conscious’ during the meetings. He added that no one would be recognizable since he was writing a fictionalized account from a suicide survivor’s point of view. Remember, this man is not a suicide survivor himself, so all his research was gathered from group members who, in addition to being ripped off financially, were also being exploited emotionally.
“During our phone call, his attitude was both cavalier and arrogant. I guess he thought because there is such a silence surrounding suicide, the members of the group would just swallow his betrayal and shut up. But we didn’t. We lodged complaints against him with governmental agencies and professional societies. We also made sure that his use of our pain and anguish for his own monetary gain was communicated to other survivor groups in the area.
“The effect on me personally was extremely destructive. I am in private therapy and, as my psychiatrist put it, this experience substantially undermined my healing process. It was even more painful for me to witness the reactions of the other group members to this man’s breach of faith. People I had come to know and care for were crushed by his behavior. One had to return to a therapist’s care after months of relative peace; another began to suffer panic attacks on a regular basis.
“This doctor’s actions clearly violated the ethical considerations of a psychologist’s relationship with his clients. He abused the trust of those of us who thought he was offering a safe place for sharing the pain we were hiding from the rest of the world. I truly believe that he was counting on the very shame that suicide survivors suffer to ensure that his actions would not be made public. Yet, even though I fought back, the whole episode affected me greatly. Eventually, I joined another support group but I still feel slightly wary. I hope that our experience is an isolated one. Suicide survivors have been to hell and back—we should not be made to feel even more vulnerable than we are.”
Dr. Dunne believes that the challenge to the therapist treating a person who has lost a loved one to suicide is twofold: (1) to examine his or her own attitudes about suicide and survivors as a means of eliminating any vestiges of archaic attitudes and beliefs, which can seriously undermine the therapeutic work, and (2) to become aware of the need survivors have for competent yet compassionate handling by mental health professionals.
Yet, even with such enlightened experts as Dr. Dunne beginning to reshape the present attitude toward mourning a death by suicide, there still exists a widespread resentment among many survivors against the mental health profession for its perceived insensitivity or even ignorance in offering appropriate support. In addition, survivors often feel their needs are overlooked because the emphasis on suicide research and prevention within the medical community overshadows their concerns.
“I recently went to a conference for suicide survivors sponsored by a national health care organization,” describes Seth, a thirty-seven-year-old basketball coach from New Haven whose older brother shot himself last year. “All these so-called experts were on stage talking about their research, their insights, their experiences. The survivors were sitting in the audience, most of us still raw with our live-wire emotions, listening to speaker after speaker drone on about scientific studies, statistics, and psychological observations about why people kill themselves. One doctor even asked us—her captive audience—for contributions to help her continue with her research. We each sat there, lost in our separateness, asking ourselves what the hell these people were talking about. Finally, the only survivor on the program gave her presentation. As she related her compelling and moving story about losing her son, I began to cry. At last someone was talking about what I was feeling, not what my brother might have been feeling.
“Later, we broke up into support groups according to our relationship to the person we had lost. Around fifteen people showed up for the sibling meeting. We began by going around the circle, introducing ourselves and giving a short synopsis of what had happened. One of the people in the circle introduced himself as a psychologist specializing in depression. He said that he was there as an observer because he wanted to gain insights from our experiences so he could better understand his suicidal patients. I was incensed and insulted. Once again, the focus was shifting away from us. I spoke up, saying that I didn’t pay sixty dollars to come to this conference so that someone could use my pain to increase his private practice. After a short discussion, the group members asked him to leave. We wanted to be together with people who were living the pain, not studying it.
“I spent my whole life in the shadow of my brother’s manic depression. Everything centered around his mood swings, his hospitalizations, his sickness. Because I was the ‘healthy’ child in the family, my parents left me alone to my own devices. This conference reminded me once again that my problems were secondary to my brother’s illness. It’s pretty hard to compete with something as dramatic as suicide. I hope the medical establishment gets it through its head that there are lots of us who are affected by suicide and we also need help. It’s like we’re the forgotten victims.”
During any crisis, it is often difficult to admit that we need outside guidance to assist us in working out our problems. For many survivors, this reluctance to seek help is often intensified by the belief that conventional support systems failed in preventing the suicide of a family member.
“I was so disillusioned by how my wife was treated that going to a psychiatrist after her suicide was the last thing on my mind,” explains Saul, a seventy-eight-year-old former businessman who lives in a retirement village in Florida. “My wife suffered from long-term depression, which no treatment or medication seemed to alleviate. One Friday night, twelve years ago, she was having a particularly bad episode. She turned to me, saying that she thought she should be hospitalized. I called her doctor, who said that it would be difficult to get her admitted over the weekend and she should come see him on Monday. That night, she took a whole bunch of different pills. When I woke up in the morning, she was dead beside me in the bed.
“I believe that my wife was written off because of her long history of suicide attempts. At the very least, the doctor could have told me to take her to the emergency room. The greatest myth is that if people talk about suicide or if they have had several unsuccessful attempts, they’re not going to do it. Of course they are. I’m not saying that if my wife had survived that weekend she would not have killed herself eventually, but she was desperately asking for help and she didn’t get it.
“During her funeral, I found great comfort from the rituals and prayers. I was never a very religious person but I started going to church every Sunday after my wife’s death. The minister was very sympathetic, as were the other parishioners. I never felt they held me accountable for the suicide; just the opposite—there was a wonderful outpouring of support. My spiritual faith has helped me accept the mystery of her illness and her decision to end her life.”
Coming to terms with the suicide of a loved one is confusing enough for an adult; for children, the loss is complicated by parents or others trying to explain the dual concepts of death, then death by choice.
“When my daughter was two, she asked me if she had a daddy,” says Carol, the Minneapolis magazine publisher whose husband drowned himself when she was nine months pregnant. “She had just started going to play groups, where she could see that other children had fathers. I answered no, that her daddy had died. She began repeating the phrase over and over, ‘My daddy died,’ singing and chanting it. Obviously, she had no idea what it meant. Then, when she was three, she began showing her father’s photograph to everyone who came to the house, explaining that her daddy was not at home because he was dead.
“There had been other deaths in my family since my daughter was born—a cousin died of AIDS and an uncle of a stroke—and eventually she asked me how her daddy had died. She loves to swim and I didn’t want her to be afraid of the water. How could I tell her that her father had drowned himself? Initially, I sought advice from a child psychiatrist who, unfortunately, had absolutely no insight into the phenomenon of suicide. If you ask me, she seemed very uncomfortable with the topic. She told me I should tell my daughter that her father had suffered from a mental illness. To me, this seemed awfully heavy for a young child to absorb.
“My own therapist then recommended a psychologist who was a suicide survivor himself. He was absolutely wonderful. He explained to me that I should never lie to my daughter but that I didn’t have to tell her all the details about her father’s death in chronological sequence. I owned the story, he emphasized, and should shape my responses as her ability to assimilate the facts matured.
“She now understands that her daddy died while he was swimming because he was not feeling well and became tired. As she gets older, I’m sure she’ll ask more questions and I will try to be as honest with her as I can. I will not make anything up; I will just cushion my description accordingly. In any case, I have to accept that her father’s suicide will deeply affect her life in one way or the other. Last month, we were at the community center where she takes her swimming lessons. After finishing her laps, she got out of the pool and came over to me. She wanted to continue swimming but thought she should use a life jacket. When I asked her why, she said she was feeling a bit tired. I was so sad as I watched my daughter swim back and forth in her little orange jacket. Who knows what she was thinking? Yet, I feel it’s in her best interest if I am honest with her. If she has one constant in her life, it will be that she will always be able to trust me.”
Some children who are brought up on half-truths or outright lies regarding the suicide of a family member try to reconstruct the specifics of what happened by making contact with their relative’s therapist. “I understood that if I didn’t achieve some kind of closure about my mother’s suicide, I would also self-destruct,” explains Phil, a college student at a large Midwestern university. “When I was ten, I came home from school to find my mother dead on the living room sofa. There was an empty bottle of sleeping pills near her but no note. My mom had been very sad since my little brother was born. She told me she was seeing a doctor to make her happy again but I knew something was wrong with her.
“My father wouldn’t talk to me about her suicide. Forget about sending me to therapy: He would rant and rave at psychiatrists, calling them witch doctors or rip-off artists. One year later, my father remarried and sold our house. It was as if my mother had never even existed. I got along with my stepmother and we all seemed to be okay. But in my senior year of high school, I began to get heavy into drugs. By the time I was in college, I was snorting cocaine on a daily basis.
“My girlfriend kept begging me to stop, telling me I was going to kill myself one day. On some level, I knew my behavior had to do with my mom’s suicide. I promised my girlfriend I would see the drug counselor at school. He basically saved my life. It was his suggestion that I try to find my mother’s doctor in order to begin to put her death to rest.
“My aunt gave me the name of the psychiatrist who had been treating my mother. I was surprised at his openness with me. He took out my mother’s records and explained that she was suffering from postpartum depression. He also gave me some articles to read on the subject. Then he told me how much my mom had loved me, how she talked about me all the time and was very proud of me. I could see that he felt very bad about her death, like he had failed her. Yet, for some reason, I didn’t blame him. He wasn’t defensive, just sad. I went to see him a couple of times. Talking to him made me feel more connected to my mother, less alone. Reality might be more painful than numbing-out on drugs, but it’s easier to deal with than secrets and lies.”
Like Phil, many survivors seek support as part of an instinctive desire not to be pulled down by the tragedy and senselessness of their loss. “The more obsessed I became about my brother’s suicide, the more I knew I needed help,” says Betsy, a forty-two-year-old housewife from a small town in Oklahoma. “My brother shot himself four years ago, leaving behind three small children. After his death, I thought I had lost my mind. For the first couple of months, I couldn’t think of anything else, even neglecting my own family as a result. Finally, I called a local mental health organization to see where I could get help. The only places they had listed were for people who wanted to kill themselves. Obviously, they were of no use to me.
“I then decided to research the subject of suicide at the library. There was an article written by a professor at the state university. I looked up his telephone number in the directory and called him up cold. I just blurted out what my brother had done, adding that I was at the end of my rope. It was the most painful thing I have ever done in my life—not only asking for help, but asking for help from a total stranger.
“I will never forget that man as long as I live. He talked to me on the phone for more than an hour. He reassured me that my feelings were normal, that I was not crazy. He gave me information on suicide support groups in my area and told me to call him whenever I felt like it. The nearest group was two hours from my home but I didn’t care. I drove there the first Wednesday of every month for almost three years, and those meetings were my lifeline. I found incredible power from listening to all the different stories. It’s much easier to forgive other people—you hear their stories and you know it’s not their fault. Then you ask, ‘Why should I be so hard on myself?’ Gradually, my guilt over my brother’s death began to recede. I can honestly say that I cared for each and every person in that group. I pray that they’re all well.”
Like Betsy, I, too, feel a permanent bond to all the people I have met in suicide support groups. Some of them have become my closest friends; others I will never see again. But their stories remain with me, their courage inspires me when waves of regret and sadness about my husband’s suicide unexpectedly wash over me.
Presently, I attend support groups once or twice a year, usually near the anniversary of Harry’s death. It is a difficult time of year, falling between Thanksgiving and Christmas, and the groups are usually quite full. As always, within minutes of going around the circle, I am as connected to these former strangers as I am to my own family.
At the last meeting I attended, a woman spoke whose husband had recently shot himself after a long and, what she considered to be, happy marriage. I recognized my earlier self sitting before me. Seven years ago I had sat in the same room, with the same look of numb disbelief and dazed bewilderment. Yet, now when I told the group my story, I could sense a distancing of emotion that only time can create. After the meeting ended, several people came up to me to thank me for my words. I went over to the woman who had lost her husband. She was pulling on her coat, as if on automatic pilot.
“I’m so sorry for your loss,” I told her. “But it will get better.” I reached out to hug her and she embraced me like a drowning person. We cried together, grieving for each other’s pain and our own unique anguish. I knew her more intimately than most people in my life. I also knew—even if she did not—that she would heal. I remembered seeing Hal from the bus only months before. He had wanted desperately to get on with his life. With the flow of time he—and the rest of us—were able to do so. For survivors, help comes in many forms. Every one of them reassures us that we are not alone.