I. Traumatic Grief - The Initial Impact

A. Symptoms of Trauma often Experienced After Suicide

1. Shattered sense of order and trust
2. Increased feelings of vulnerability
3. Difficulty sleeping and eating
4. Disorientation - feeling like you are in a fog
5. Flashbacks or intrusive recollections of the trauma
6. Nightmares
7. Uncontrollable crying or intense anger
8. Feeling numb
9. Denial and disbelief

View White Paper on Traumatric Grief

II. Coping with Suicide Loss - Complex Healing Process

A. Beyond Surviving

No two people will grieve in the same way. Some will find support groups helpful; others may rely on friends' support. Some may turn to books; others may go to therapy. Some may take weeks to get back to "normal life"; others may find that life as they remember it no longer exists and they need to redefine themselves. Our response to the aftermath of suicide is shaped by a number of things - past experiences with death and loss, other current life stressors, our mental health, our family cultural traditions, our relationship with the deceased (e.g., strength of bond, presence of conflict, etc.), the circumstances surrounding the death, our support system, and our personality.

People feel a range of emotions in the aftermath of suicide - not everyone will go through all of these experiences and the length of each may differ, but these are common emotional reactions that often come like a tidal wave unexpectedly and repeatedly.

· Guilt and self-blame for not being able to prevent the suicide
· Anger at the person who died, at the world, at God, at yourself
· Experiencing suicidal thoughts yourself
· Depression and incredible sadness triggered by anything from major life milestones to a song on the radio

During the healing process, it is important to be patient with yourself and take each day as it comes. Surround yourself with caring people who do not try to fix things, but just listen without judgment. Set limits and postpone any major decisions if you can during this time. Basic self-care - eating, sleeping, hydration - are very important to feeling more stable and better able to handle the intense emotions. Avoid alcohol abuse and other mood altering substances - while they may alleviate the pain in the short-run, they tend to exacerbate depression and pain in the long run.

B. Coping with Holidays, Anniversaries and Birthdays: New Traditions and Healing Rituals

With an empty chair around the table, important celebrations can be particularly hard for suicide survivors. Before the holiday arrives, talk with the family about the expectations and consider creating some new traditions. For some, it may be better to be all together while others might prefer to be by themselves. Usually the anticipation of the holiday is worse than the actual day. There is not a right way to approach these days - find a way that works for you.

The death anniversary can also be a difficult time for survivors. Many find comfort in participating in some form of healing ritual of remembrance to honor the life of the loved one. Rituals serve many purposes for the suicide survivors. They make changes manageable and mark transitions. Rituals communicate values and beliefs while providing containment for strong emotions. The power of rituals comes from the fact that they often provoke deep emotional experiences that hold a level of meaning that words cannot capture. These practices may be done alone or with others: · Plant a memorial garden or tree. · Dove release or balloon release. · Candle lighting ceremony. · Write a poem or letter and release it to the universe by burning it.

III. Types of Survivors

A. Young Children Survivors

Children often experience the same range of emotions that adults do; however, children have fewer tools for communicating their feelings. They may act out their feelings through play, art, and other nonverbal communication. Even older children often lack a firm concept of death as an irreversible process. Children are especially vulnerable to feelings of guilt and abandonment; they may feel that their bad behavior caused the deceased to leave. Caretakers should work toward assuring them that the death was not their fault and that care and love will continue. Often people feel that they need to protect children from the truth about suicide - this may cause further complications. Honest explanations (though not necessarily detailed) about the situation and age-appropriate responses are recommended. Allow them to memorialize the deceased by letting them participate in funerals and memorial services. Routines are very stabilizing for all children; especially those dealing with trauma. Try to stick to normal meal times and bed times and allow children to see their friends and engage in regular activities and let others who care for the children know of the suicide.

B. Parent Survivors

Children are not supposed to die before their parents - this is a worldview held by most, and when it is shattered, it is devastating. The suicide of one's child raises difficult questions, doubts and fears. Many parent survivors are filled with feelings of failure knowing that they were not able to save their child. "If only" is a phrase that may reverberate in the parents' mind. It is not uncommon for parent survivors of suicide to experience thoughts of taking their own lives. The stigma of suicide may lead some parents to try to keep the cause of death a secret; however, this may further complicate the healing process and isolate parents from helpful support resources. Rather, families can benefit by talking about death with one another and with support systems. Some find it helpful to write a letter to the deceased child, expressing all the things they were not able to say before the death. Support groups for parents and other survivors can help provide on-going support when the initial rally for help begins to fade.

C. Sibling Survivors

"Sibling survivors are often called the forgotten mourners, " says author of "Do They Have Bad Days in Heaven: Surviving the Suicide Loss of a Sibling" Michelle Linn-Gust.

· Siblings living at home will often "lose" their parents for sometime as the parents try to cope with the loss of the child that died.

· The sibling bond is often the longest relationship we'll have in our lives, and thus, we witness more life events with our siblings that anyone else.

· With 31,000 suicides per year, 24,800 people become sibling survivors annually.

· Most siblings will carry this loss through their lifetime as presence is missed for the remaining life milestones we anticipating sharing with them. For more information: (www.siblingsurvivors.com)

IV. Getting Support

Support from other suicide survivors is one of the most powerful connections one can make in the aftermath of a suicide. Many people find great relief in being able to talk openly and honestly about the range of complicated experiences they are going through with people who really understand. Survivor support groups offer a safe haven to share and build new healing relationships. Some survivors go weekly; others go when they need it most - around birthdays, anniversaries and other difficult times.

V. Helping Survivors of Suicide:

What Can You Do? Suicide survivors often suffer in silence. People often feel uncomfortable dealing with death in general, and helping someone through the aftermath of suicide often increases these feelings manifold. Helping your friend or family member through this tragedy may be the most important thing you can do - by taking action you will help lessen the social stigma the survivors are experiencing and move them toward eventual healing.

Things to consider when helping suicide survivors:

· Ask the survivor what you can do to help and do it. During the acute aftermath phase you can help them in many concrete ways:
- Keep a list of phone calls, visitors, and people who bring food and gifts
- Help keep the mail straight - bills, cards, newspaper notices
- Offer to make calls to people they wish to notify
- Help with errands - walk the dog, shop for food
- Offer to help with documentation - for insurance, newspapers, services
- Write down a story or create a collage of photos about the deceased

· The emotional intensity of the grief is great. Survivors may need to talk, cry, scream, or sit silently for hours at a time. Repetition is part of healing.

· Listening with your heart and without judgment is most helpful. You do not need to take the pain away; your presence helps contain it.

· Use the deceased's name and ask for and tell stories - hearing the name and remembering can be comforting to the survivor.

· Don't worry about saying the wrong things; just concentrate on what is being shared with you. Think of yourself as someone who is walking with the survivor not in front or behind.

· Give them permission to grieve.

· Clichés such as "Everything has a reason" and "Time heals all wounds" are not helpful at this time.

· Be patient - grief takes its own course and may go on for a long time. Often the support is most needed after the initial chaos of the trauma has diminished.

· Be mindful of holidays, birthdays and anniversaries.

· Offer to help find support groups or other resources such as books and pastoral care. The American Association of Suicidology has a Survivors of Suicide Kit complete with literature and a directory of suicide support groups.

· Avoid statements like, "I know how you feel" - everyone goes through this in a different way.


References:
American Association of Suicidology
American Foundation for Suicide Prevention
www.survivorsofsuicide.com
"Beyond Surviving: Suggestions for Survivors" by Iris Bolton