PARADOX REQUIRES CAREFUL SCRUTINY OF HELP FOR SUICIDE BEREAVED

By Franklin Cook

A recent blog post on Grief After Suicide argues (convincingly, I hope) that suicide bereavement is unique because suicide itself is a unique way to die. Yet, at the same time, an abundance of research -- not to mention the universality of the human experience of grief -- points to a paradox, namely, that all bereavement over the death of a loved one shares a great deal in common. In other words, grief after suicide is, simultaneously, both different than and similar to bereavement following other means of death.

Understanding and accounting for this paradox is important because, as is stated in recently released national guidelines on responding to suicide, created by the Survivors of Suicide Loss Task Force of the National Action Alliance for Suicide Prevention:*

Suicide grief support is an emerging field of practice poised to gain strength from newer understandings of bereavement adaptation in thanatology [the study of death and bereavement].

This emerging field would benefit tremendously from looking more closely at -- and acting more collaboratively with -- the field of grief counseling (as well as other fields, such as traumatology, mental health crisis response, and disaster response). Doing so would enrich and strengthen suicide grief support through the application of evidence-based and promising practices that are already proving to be effective with a variety of bereaved people. Taking this multi-disciplinary approach would prevent responses to suicide grief from evolving based on narrow or monolithic ideas centered primarily around what is unique about suicide bereavement.

Consider, for instance, what Chris Hall, the newly elected president of the Association of Death Education and Counseling (ADEC), says in the introduction to his excellent summary of the topic (2014):

Long-held views about the grief experience have been discarded, with research evidence failing to support popular notions which construe grief as the navigation of a predictable emotional trajectory, leading from distress to 'recovery' ... Recent research evidence has also failed to support popular notions that grieving is necessarily associated with depression, anxiety and PTSD or that a complex process of 'working through' or engagement with 'grief work' is critical to recovery ..."

In addition to moving away from the "stage theory" of grief, away from closely linking grief with pathology, and away from the idea that one must interact with grief in a particular way, a number of other modern ideas about grief surely apply to suicide bereavement:
   • The goal of grieving is not a return to "normal." A goal of the medical model of healing is to return an organism to homeostasis (physiological stability), which equates with normal functioning. After a major loss, bereaved people often say there is no "normal" to which one can return, because that state is irretrievably damaged or lost. An alternative goal that resonates with many people is to seek a new normal, which refers to a fresh sense of stability and meaning in one's life, even if it is quite unlike the "old normal."
   • There is a great deal of individual variation and complexity in grief processes. Worden transforms a dictum of one of his professors into this observation: "'Each person's grief is like all other people's grief; each person's grief is like some other person's grief; and each person's grief is like no other person's grief'" (2008, p. 8) [emphasis in the original].
   • There are differences in grieving styles that it is important to understand and take into account. Martin and Doka elucidated two grieving styles: intuitive, which is more emotional and focused on reflection, and instrumental, which is more cognitive and oriented toward action (1999). These two styles, initially closely linked to gender (intuitive to female and instrumental to male), provided the starting point for a more subtle view of grieving styles that are seen as existing on a continuum and are rather independent of gender (Doka & Martin, 2010).
   • Bereaved people commonly benefit from an ongoing relationship with the deceased. "The resolution of grief involves continuing bonds that survivors maintain with the deceased and ... these continuing bonds can be a healthy part of the survivor's ongoing life" (Silverman & Klass, 1996, p. 22). The quote is from the introductory chapter of the book that countered the long- and strongly held tenet that severing bonds with the deceased was necessary to free bereaved people to reinvest in new relations and "move on" with their lives (Klass, Sliverman, & Nickman, 1996).
   • Major (or traumatic loss) can damage a person's sense of identity, prompting the need for restructuring of self-identity as a part of recovery. Janoff-Bulman wrote that traumatic loss can damage a person's assumptive world, especially three fundamental assumptions, that the world is benevolent, the world is meaningful, and the self is worthy (1992).
   • Grief is bound to culture in the broadest sense. "There is no death that is not experienced within cultural categories and no grief that is not felt and expressed within cultural guidelines and expectations" (Klaas & Yin Man Chow, p. 342). (It also can be helpful to view grief from the point of view of categories or subcultures of the bereaved, e.g. suicide grief.)
   • The journey through the experience of grief for many people is very well supported by their resilience. Bonnano has identified three patterns of grief, including resilience, and concludes, "for most of us, grief is not overwhelming or unending. As frightening as the pain of loss can be, most of us are resilient" (2009, p. 7) [emphasis in the original].
   • Posttraumatic growth is a possible outcome of bereavement. The term posttraumatic growth describes benefits that result from "people's struggle with trauma ... [namely,] self-confidence, enhanced personal relationships, and changed philosophy of life" (Tedeschi & Calhoun, 1995, p. 77).
   • Grief is both individual and relational, and it is entertwined with the dynamics of families. "Grief within the family ... consists of the interplay of individual family members grieving in the social and relational context of the family, with each family [member] affecting and being affected by the others" (Gilbert, 1994).

The outline above represents only a portion of the hard-earned insights over the past 20 years that have come from other fields directly related to suicide bereavement support. Insights such as these (as well as the evidence that supports them and their applications in practice) underpin the call to action in the new national guidelines,* which challenges suicide grief support practitioners to the following:

It is essential to advance purposeful communication and collaboration among all disciplines working to support the bereaved -- especially those focused on addressing the effects of every manner of sudden or traumatic death.

*Introductory material from Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines (Table of Contents, Executive Summary, Acknowledgements, Preface) is available at bit.ly/excerptsosl, and the complete document is available at bit.ly/respondingsuicide.

This blog post is available as a free PDF document to read online, download, and share with others at bit.ly/paradoxessay).

Please see the list of references for this post.