Coping with Suicide Loss—and How to Help a Grieving Friend

Coping with Suicide Loss—and How to Help a Grieving Friend

Coping with Suicide Loss—and How to Help a Grieving Friend

Finding the words to describe what it’s like to lose a loved one to suicide is exceptionally difficult. For those who have navigated the trauma of suicide loss, however, finding those words and expressing them might be one of the most powerful tools for working through intense pain, says clinical therapist Jack Jordan, PhD.

Jordan, the author of After Suicide Loss: Coping with Your Grief, has worked with suicide-loss survivors in individual and group counseling for decades. And he’s found that interpersonal connection—whether that’s in a support group, on a therapist’s couch, through a friendship, with family, or in a community of faith—is often the key that unlocks not only healing but also the potential for growth.

We got on the phone with Jordan to ask how to talk about suicide, what makes it a unique kind of loss, and what can help people cope. What he wanted us to know is that while losing someone this way is horrible and scary and presents a number of risks, there’s also so much hope. “I have known and worked with enough loss survivors,” Jordan says, “to know that they can rebuild their lives, move on with their lives, and even become stronger, wiser, more compassionate people as a result of their loss.”

A Q&A with Jack Jordan, PhD

When we’re talking about suicide, what are some foundational things to know?

The language around suicide has evolved the way that language evolves: not necessarily in an intentional way. Calling someone a “suicide survivor” is pretty common in North America, but not so much in Europe or other parts of the world. It can be a confusing term. Does it mean somebody who is grieving, as in “Mr. Jones was survived by his wife and children”? Or does it mean somebody who’s attempted suicide and survived the attempt? What we’re trying to do is use more-precise language. Here, I’ll use “suicide-loss survivor” to mean somebody who’s grieving or having a strong negative reaction to the loss of a loved one by suicide. Then a “suicide-attempt survivor” is somebody who has attempted suicide and survived the attempt.

Another language change is around the word “commit,” which has a lot of negative connotations in the English language. Human beings commit crimes, sins, adultery. It implies a completely voluntary action of bad behavior. So those in the suicide-loss community use different language and encourage others to do the same: A person died by suicide, ended their life, killed themselves, or took their life. They did not commit suicide. And we especially don’t want to use the term “successful suicide”—most suicide-loss survivors don’t find that suicide is a successful thing and use “completed suicide” instead.

What are the ways in which grief after suicide might be different from grief after other losses?

The human mind wants explanations when bad things happen. Suicide can be a frightening, mysterious cause of death that cries out for an explanation. Two questions—the why question and the responsibility question—are very prominent for suicide-loss survivors. The former is about trying to make sense of the death. Why did this person do this? This is particularly true if people were blindsided by the suicide. How could I not have known my child was thinking about killing themselves? How could I not know my husband was thinking about killing himself?

And there’s not one answer to that. Suicide is a very complex, multidetermined phenomenon. Suicide isn’t the result of just one thing in a person’s life. But the general public, especially in the throes of grief, doesn’t understand that. When suicide happens, people are often frightened—particularly if there are multiple suicides in a community and particularly when there are several suicides of adolescents. People in the community start to feel as if there’s a plague going on. What is wrong with us? What’s wrong with our community?

“The grieving process after a suicide tends to be longer—but that’s an idea hinging on the myth that grief is something you get over.”

We don’t, collectively as a society, have very clear explanations about why people kill themselves. So when people want answers about what’s caused someone they love to take their own life, they often have a strong tendency to want to blame somebody or assign responsibility for the death. And people tend to blame themselves.

In addition, the grieving process after a suicide tends to be longer—but that’s an idea hinging on the myth that grief is something you get over. Most Americans really expect grief to be short-lived, as if it’s unpleasant experience but then you get over it and just resume your life. That’s not true for people who have a transformational loss experience—there are aspects of the suicide-loss grieving process that people may struggle with for the rest of their lives.

And then there’s the social isolation that suicide loss produces. Many people don’t know how to respond to the news of a death when it’s a suicide. So what happens is that suicide-loss survivors tend to be avoided, either physically (people avoid the person going through the loss) or by subject (people talk to the suicide-loss survivor but avoid the subject of the death). It can be a very isolating grief experience. That’s part of the reason talking to other people who are going through the same experience is comforting to survivors.

How can suicide-loss survivors move forward without answers?

It differs from one person and one suicide to another. Usually, over time, people develop partial answers. The problem with suicide is that the only person who could really say, “Here’s what I was thinking right before I did this,” or “Here’s the state of mind that I was in when I did this,” is gone.

Sometimes people leave notes, but we know the majority of people who die by suicide do not leave a note. And sometimes the note is very jumbled or psychotic or doesn’t make any sense. Sometimes a note is an explanatory thing; it can be helpful. Or it can be disturbing or distressing, or it could be both helpful and hurtful.

So how do people move on? It’s a process of surrendering and making your peace with the fact that you may never fully know why this happened. And that’s a long, slow, difficult process. That’s part of why grief after suicide typically is more prolonged than grief after other kinds of losses—people often have this extra psychological work to do to make sense of it and assign causality for it.

“So how do people move on? It’s a process of surrendering and making your peace with the fact that you may never fully know why this happened.”

People don’t have to do that nearly as much after most other kinds of loss. If someone dies of cancer or heart disease and they were a smoker, we have a medical explanation for it. Most people who die by suicide, at the time of their death, do meet criteria for having one or more psychiatric disorders, but they’re usually undiagnosed and not in treatment.

There’s a procedure called a psychological autopsy, which is an attempt to reconstruct the state of mind of the person before they died. Psych autopsies usually can show that most people, at the time of their death, would have met criteria for having a psychiatric disorder—most often a mood disorder: depression, bipolar disorder, etc. Other psych disorders are common as well, like PTSD, and for young women especially, bulimia and other eating disorders.

A psych autopsy is a formal research procedure, but most suicide-loss survivors end up doing their own kind of personal psychological autopsy to try to get answers as best they can. They often talk to people who knew the person well and people who had contact with the person right before they died. But they often also have to accept what a colleague of mine calls “the blind spot”—the fact that you’re not going to know everything. That letting go is necessary, but it’s not easily done.

Does suicide loss put survivors at risk of health issues of their own?

Losing someone you love to suicide is a major stressor, and like other major stressors, it affects your physical, mental, and even spiritual health.

These days, we’re using public-health language to talk about the risks of exposure to suicide. There’s pretty robust evidence that when people have lost someone important to them to suicide, the chance that they will also die by suicide increases. I’m not saying that people with a suicide in the family are doomed to die by suicide themselves, but we know that it increases the risk of an additional suicide on a statistical basis. Also, at a statistical level, people who have lost a loved one to suicide have higher rates of cancer and heart disease. Their social relationships often get disrupted. They have higher rates of unemployment. Higher rates of diagnosable psychiatric disorders: primarily depression and, to a lesser extent, anxiety and posttraumatic stress disorder.

How can we reduce the mental health risk for suicide-loss survivors?

It’s a gigantic question. In suicidology, we talk about a tripartite organizational division in what people are working on in the field: There’s suicide prevention, which is things that we do to help keep people from becoming suicidal; suicide intervention, which is things that we do once someone has become suicidal to try to reduce their risk of dying by suicide; and then there’s suicide postvention, which is the collection of things we do after a suicide to mitigate the potentially negative effects on the loved ones of the deceased. There are many things that can be done on a community, state, and national level to provide support infrastructure for people who are bereaved by suicide. (See the National Guidelines on suicide postvention posted at the American Association of Suicidology.) There are things we can do to help suicide-loss survivors cope better, heal better, and recover faster. Part of this effort is destigmatizing suicide.

“In the shorter term, one of the things that helps suicide-loss survivors is to be able to be public about their loss.”

Suicide has been so stigmatized for so long that, historically, when people have lost someone to suicide, it’s often been kept underground. Families would try to hide it. Communities would refuse to talk about it. Now many communities are beginning to develop resources for suicide prevention and postvention and have those resources available before they’re needed. That’s a long, slow cultural shift, but it’s happening.

In the shorter term, one of the things that helps suicide-loss survivors is to be able to be public about their loss. Instead of feeling that we have to hide our loss from people, suicide-loss survivors can be supported to be open about it and receive the same kind of support that people who lose someone to any other cause are able to receive.

How can we build community around grief, and how can that help survivors?

There was a point in my private practice when I was doing a lot of grief therapy and was seeing, by chance, a number of suicide-loss survivors all individually. I had a kind of epiphany one day: I realized that these people should be talking to one another, not just to me. So I started a survivor support group in my private practice.

That group was transformational for me, certainly professionally and in some ways personally. I was blown away by the intensity of the grief in the room, and I was also inspired by the resilience I saw. When I do clinical trainings, one of the first things I say to clinicians is that I have come to really believe very deeply that if you provide the right kind of interpersonal context for people—which could be a support group, a therapy relationship, a friendship, a close family relationship, a relationship with a clergyperson—survivors can integrate what can be an extremely profound and life-changing loss.

Why is suicide loss considered a transformational experience?

I’ve known many people, whether I’ve worked with them as patients or just have come into contact with them through other parts of my work, who have truly had their life transformed by the suicide of a loved one. Sometimes—usually in various injurious ways, but sometimes also in very positive, growthful ways.

The phenomenon of positive change after dramatic loss now has a name: posttraumatic growth. It refers to the ways in which people become wiser, more compassionate, stronger, and more resilient after undergoing this kind of traumatic experience. It’s a catalyst for change. People who have gone through a suicide loss often put more emphasis on relationships and how they value them, more freely expressing love and affection for others. Sometimes they decide it’s time to get out of bad relationships. They may become an activist, trying to help others survive suicide loss or helping the suicide prevention movement. Often these people develop a different sense of purpose about why they’re here and what they’re doing in the world—and for them, that’s a direct, clear result of having lost someone to suicide.

It’s not unusual for someone to say to me, “If you would’ve told me five years ago that I was going to lose my son to suicide and that I would survive that, I would have said you’re crazy. I would’ve thought it was unimaginable that I could survive that, but it’s now five years later, and I have somehow survived. I didn’t know I had that in me.”

What are some ways to support someone who has lost a loved one to suicide?

What’s most helpful for an individual suicide-loss survivor is going to differ from person to person. But what seems valuable to most people—and this is true not just with suicide bereavement but also with other traumatic losses, which are losses that are sudden and unexpected and often violent in nature—is to have nonjudgmental companions. That means genuinely communicating that you want to understand what this loss feels like and what it means for your friend. It means asking honest questions and being a deep, tactful, and empathetic listener. If you can walk with people without trying to offer platitudes or advice or trying to fix it prematurely, that’s genuine and usually effective support.

True supporters are also people who support for a long time. Typically, people get flooded with support right after a death and, particularly in American society, that support evaporates pretty quickly. Often, somebody will come to the funeral and offer their help but then just go on with their life. But someone who, one year later or five years later or longer, remembers the anniversary of their friend’s loss and calls to ask how they’re doing or see if they’d like to grab lunch—that kind of longer-term support often means the most to many survivors.

What also seems to help most survivors is being able to talk to other people going through the same experience, such as in a support group or in online survivor communities. It helps reduce the sense of isolation and stigmatization.

Jack Jordan, PhD, is a clinical psychologist who has specialized in significant losses, including loss of loved ones by suicide. On top of forty years of clinical practice, Jordan has been involved in suicide bereavement research, policy guideline development, and clinician training.