Experiences of family members after a suicide

Journal of Family Practice, Oct, 1991 by Carol J. Van Dongen

Cognitive Changes

All subjects, except for those who perceived the deceased as chronically suicidal (n = 7, or 20%), reported experiencing tremendous cognitive dissonance. The fact that a family member committed suicide was in direct conflict with their former beliefs about the victim, their family, and the world in general. They questioned, "How can this be?" This cognitive dissonance stimulated survivors to question their overall belief systems and motivated them to seek information that would help to explain the suicide.

Changes in cognitive functioning were evident through survivors' reports of difficulty in concentrating and making decisions, particularly during the first few days after the death. There were many important decisions to be made related to the care of the body and plans for the funeral and burial. An immediate questions for survivors of gunshot suicides was how to deal with the physical aftermath or human residue of the death. They recalled smelling the lingering odor of gun powder and finding tissue and bone fragments of the victim. Most families used a professional cleaning service, but they still found it necessary to clean the area again. Another important decision was whether to see the victim's body. Eighteen (51%) of the subjects saw the victim after the death. Of those who did not, most later wished that they had seen the body because they felt it would have helped them to accept the death.

Twenty-two (63%) subjects described experiencing mental images, dreams, or flashbacks of the death scene as they cognitively struggled to accommodate the reality of the suicide. These were powerful experiences that often significantly disrupted sleep as well as daily activities. Four (11%) subjects, all women, provided vivid descriptions of recurrent episodes in which they "relived" cognitively, emotionally, and physiologically, the experience of discovering the victim's body. Following these episodes, which lasted 15 to 20 minutes, subjects described themselves as totally exhausted and unable to resume their daily routine.

The Social Context of Grief

Survivors expressed concern about their role as survivors of a suicide. They questioned how they were to behave and what other people thought of the victim and themselves. They were aware of the potentially stigmatizing nature of suicide and were uncertain about whether to reveal their status as survivors and how to answer potential questions related to the death. They described feeling estranged from people outside the family, because they perceived that persons who had not experienced the loss of a family member through suicide could not appreciate their pain. Twenty-four (69%) of the survivors, however, reported experiencing strong social support from others. They perceived that others did care and were concerned about them.

Changes in family functioning were evident postsuicide as subjects described the intense void left by the deceased in the family unit. Lengthy, emotional family discussions were held as family members tried to retrace the victim's actions and understand how the suicide could have happened; yet after the first few weeks, the death was not a major topic of conversation. Survivors explained that concerns related to the suicide persisted, but they hesitated to raise the subject because they wished to avoid burdening other family members who were seen as already emotionally exhausted. All survivors expressed great concern as to how the death was affecting other family members and how the suicide might affect each member's future health and adjustment.