Unfathomable
by Melinda Moore, Ph.D.
(Editor's Note: This article is part of our Suicide Prevention Month 2018 series in collaboration with the American Association of Suicidology.)
Given the recent research that for every person who dies by suicide there are 135 individuals exposed to the death, and about 30 percent of those will be seriously psychologically affected, it is likely that nearly every clinician in America will be working with a suicide loss survivor or “suicide bereaved” person at some point in time. As in working with suicidal individuals, most therapists will likely not know what to do when confronted with the opportunity to help the suicide bereaved.
Graduate training is insufficient, and awareness of suicide exposure and impact as a potential trauma is not commonly understood among professional communities. Many suicide bereaved will suffer in silence, guilt, and shame, and may experience depression, anxiety, suicidal thoughts, and, potentially, suicidal behavior as a result. All the while, communities of potential support, including medical and mental health professionals; faith communities; social, sports, and other organizations, hum along their merry way, unaware of their potential as safe harbors for these injured individuals.
As a therapist, I was trained to treat PTSD and other outcomes of traumatic experiences. Not once in my formal training was I presented with the notion that being seriously affected by a suicide loss was also potentially a trauma that may lead to PTSD-like symptoms. I once heard David Rudd describe suicide loss as a serious “cognitive scar,” and this furthered my appreciation of the heavy impact of suicide exposure. Years before I became a therapist, my experience as a suicide loss survivor taught me how traumatizing and destructive suicide impact could be.
It was also my specialized and informal training as a suicidologist that allowed me to arm myself along the way with tools for understanding and treating individuals who have this experience of loss. I read Jack Jordan and John McIntosh’s seminal book, Grief After Suicide. I also took Frank Campbell’s LOSS training as a graduate student. My learning curve is still vertical, and I sit at the knees of others in this field who have dedicated their careers to supporting, researching, and advocating on behalf of suicide loss survivors.
What I have learned about working with suicide bereaved individuals is that George Bonanno, Ph.D., a pioneering researcher on trauma and bereavement, is right. Our grief trajectories are varied, and there is no such thing as a “stage model” of grief. Grieving is not linear, but circular, and suicide loss survivors are often preoccupied with “Why?” and other apparently unknowable and minute details. These details are huge, however. Understanding every detail of the event itself, the individual who died, their relationship to you, the potential influencers in their life at the moment of their death, and a million other details is critical to this journey. Understanding the unbelievable and the unfathomable is sometimes critical to survival for the suicide bereaved. Listening to them repeat their stories and how they understand events, encouraging them to explore or not to explore, validating when necessary, and supporting them in their disbelief, providing them resources when they want to know more, is about the best I can do.
I journey with them, bearing witness to their pain, despair, and sorrow, “holding them” as best as I can. Recognizing the bodily held trauma, that the “body keeps the score,” and helping suicide loss survivors appreciate this and be kind to themselves has been critical to my own growth as a therapist. I have heard horror stories about therapists attempting to provide support to the suicide bereaved, but insisting too early that the bereaved are “stuck” or “unwilling to move forward” or questioning the suicide loss survivor’s “preoccupation” with their son's or daughter’s death.
Working with the suicide bereaved has been one of the greatest privileges of my life, but it still presents professional challenges and “growth edges” for me. As a clinical community, we have a lot to learn about working with suicide loss survivors. I invite you to join me on this journey.
Melinda Moore, Ph.D., is an assistant professor in the Department of Psychology at Eastern Kentucky University in Richmond, Kentucky. She serves on the board of the American Association of Suicidology as the chair of the Clinical Division and is the co-lead of the National Action Alliance for Suicide Prevention’s Faith Communities Task Force. She is the editor of The Suicide Funeral: Honoring Their Memory, Comforting Their Survivors (Wipf & Stock, 2017) and conducts suicide bereavement research at Eastern Kentucky University with an emphasis on posttraumatic growth.