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Grief
Macmillan Encyclopedia of Death and Dying, (2003) by ROBERT KASTENBAUM, KENNETH J. DOKA, JOAN BEDER, REIKO SCHWAB, KENNETH J. DOKA, REIKO SCHWAB, KENNETH J. DOKA, NORMAN L. FARBEROW, MARGARET STROEBE, WOLFGANG STROEBE, HENK SCHUT, LILLIAN M. RANGE
Children, even when young, should be told the truth about the suicide. Experience has shown that the efforts to keep the nature of the death a secret usually fail and that the truth, when revealed, is harder to integrate and to accept. Children and young adolescents can construct terrifying fantasies, such as unwarranted guilt for personally causing the death. The inevitable discovery increases the confusion if the secret emerges in childhood; if the revelation occurs in adulthood, the usual reaction is anger at the prolonged deception. The parent is most helpful when reassuring the child with words suitable to age and level of understanding, words that "normalize" the child's feelings of guilt, shame, anger, or sadness. If signs of emotional disturbance continue, however (i.e., truancy, fighting, exaggerated grief), intervention by a trained child therapist might be in order.
Professional Caregivers As Survivors
Research has shown that therapists whose patients commit suicide often experience the same feelings as family members: shock, numbness, denial, anxiety, shame, grief, guilt, depression, anger, and others. However, there are also feelings that are inherent to the role of therapist: failure, self-doubts about therapy skills, clinical judgment, professional competence, and fear of litigation and professional ostracism. Grief reactions were correlated with the length of time in therapy. The effects of such reactions often led to changes in professional practice, like limiting practice only to patients who were not suicidal, avoiding undertaking treatment of severely depressed patients, hyperalertness to a patient's suicidal ideas and/or self-destructive behavior, hospitalizing very low-risk patients, putting more inpatients on suicidal precaution, and canceling inpatient passes. For the therapist in training there is the additional stress that may stem from pressures of competition within the group, a feeling of being under constant observation and evaluation, and a desire to win approval from the faculty.
Research on clinician-survivors has been sparse, although it is not an isolated or rare event. Morton Kahne estimated that one out of every four psychiatrists will experience a suicide in his or her practice. Subsequent researchers have reported a frequency of patient suicides for therapists in private practice that ranges from 22 percent to 51 percent. Philip Kleespies found that one out of every nine psychology interns had to cope with a patient's suicide attempt. The older the psychiatrist and the greater the years of practice, the less the guilt and loss of self-esteem; for psychologists, there was no relationship between age or years of practice and intensity of reaction.
In-hospital suicide provokes the same feelings and reactions among the staff that have been reported for clinicians in private practice: shock, numbness, denial, guilt, insecurity, and so on. There is the added dimension of the impact on other patients, with anger frequently directed against the staff for not preventing the death and thus causing them to feel less secure and less protected against their impulses. Some showed a marked identification with the deceased and an assumption of inappropriate responsibility for the death.
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