Experiences of family members after a suicide

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

The findings lend support to Bugen's model of bereavement [6] and research by Demi and Miles. [7] Bugen proposed that the two dimensions of closeness of the relationship between the deceased and the survivor and the preventability of the death were major predictors of the intensity and duration of bereavement. Nearly all (n = 32) survivors described themselves as emotionally close to the deceased. Survivors who seemed to have the most painful experiences were those who felt the suicide might have been prevented through somehow identifying clues of suicide intent and intervening to stop the death. Subjects who perceived the victim as chronically suicidal reported more "normal" bereavement experiences. Demi and Miles [7] conducted research involving parents surviving the loss of a child through various modes of death and concluded that cause of death alone in not a good predictor of bereavement outcome. Instead complex situational and personal factors may be more influential in how survivors respond.

Survivors of suicide have often been described as stigmatized and social isolates. [8,9] Subjects in this study reported role uncertainty as to how they should behave as a survivor of suicide, but the majority also perceived concern on the part of others and the availability of strong social support. This is consistent with research, which has indicated that the majority of survivors of suicide are not rejected by other. [10,11]

Experts on suicide have emphasized the disturbed dynamics among families before a suicide, and the blaming and scapegoating behaviors after a suicide. [9,12] Data from this study suggest that suicides may well occur within families that appear to be quite healthy. Survivors appeared to be deeply concerned regarding the impact of the suicide on other family members and tried to comfort and protect each other. Descriptions of parents who have lost a child through suicide have indicated a high incidence of marital conflict and mutal blaming behaviors. [13,14] In contrast, parents in this study appeared to have supportive marital relationships. Definite marital strain was evident among adult children and siblings who had survived a suicide. The impact of suicide on this group of survivors may be more significant than has been recognized.

The experiences described by many survivors of suicides are similar to those of postraumatic stress disorder. Survivors' reports of recurrent and intrusive thoughts about the death, dreams, increased arousal as evident through sleep disturbances and difficulty concentrating, emotional anesthesia, social detachment, and irritability, sometimes even to the point of aggressive behavior, are all representative of posttraumatic stress disorder (PTSD). [15] Descriptions by subjects of flashback episodes in which the survivor relived discovering the victim's body are also consistent with PTSD. However, instead of the characteristic tendency in PTSD to avoid thoughts and stimuli associated with the traumatic event, survivors of suicide seem to dwell on the suicide as they struggle with the question of why the suicide happened.