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Suicide has a long history of being perceived as sinful or criminal by others, which lead to a stigma that is still felt by those bereaved from suicide. This stigma impacts a grieving process that is already complicated due to its’ sudden nature. It can also prohibit loved ones from sharing their grief stories with the friends, and family. Stigma disrupts social interactions, especially in faith communities, denying them validation and expression needed in the grieving process, and ultimately placing them at higher risk for complicated grief. Education of mental illness and awareness of stigma, that comes with suicide, is essential in helping those bereaved by suicide.
A journal about the complicated nature of loss by suicide, discusses intensified reactions to these often unexpected losses. An interesting statistic is highlighted, an “estimated 85% of people in the United States will know someone personally who has committed suicide.” (Tal, 2012). Tal explains that complicated grief results from a disruption in acute grief, often prolonging this painful first stage of grief, which can stay with the person longer than usual or cause disturbance in daily functioning. The pain of suicide loss can put survivors at risk of avoiding discussing the deceased with others, creating a complicated grief response, which has been found to impair social, and occupational functioning. It was concluded that a need for clinicians to understand these stigmas and often complicated grief reactions, especially in terms of comorbidity with PTSD and major depression, for survivors to be able to find comfort in remembering their loved one (Tal, 2012).
Spiritual and community involvement are considered in a study I reviewed about the history of inherited biases and how they can put suicide bereaved at risk for disenfranchised grief. The church has a history of negative held belief towards those who choose to die by suicide. Staley, attributes this to what is now a lasting stigma, possibly due to a lack of understanding of why a person chooses suicide (Staley, 2017). Nevertheless, past events of churches denying deceased the right to funerals, or community support provided with funeral rituals, can put the suicide bereaved at risk for disenfranchised grief.
Disenfranchised grief is the result of a loss that is not socially understood, in turn affecting the support that mourner does or does not receive. Worden, author of “Grief Counseling and Grief Therapy”, explains that there are generally two types of disenfranchised losses, socially neglected and socially unspeakable losses like: death by suicide (Worden, 2009). Staley explains that once the church had decided that those lost to suicide “were lacking in faith, had committed an unforgivable sin, and died without repenting; therefore, they were beyond the reach of salvation and condemned to hell.” (Staley, 2017). This denial of humanization for the deceased continues to affect loved ones left behind to cope and adapt. Also, the lack of validation from the community interferes with, “The ‘right to grieve’, and a ‘right to claim social sympathy or support’. These are the rights of any person who experiences a loss. Empathetic failure of those mandated to offer support in their deepest, darkest hour of need, diminishes the worth of the person who has died by suicide and further serves to complicate the bereaved’s grief journey.” (Staley, 2017).
Isolation from others or from a faith community has negative implications on mourners. In regards to the importance of community support, funerals can provide grievers with assistance of coming to terms with grief (Doka, 1989). In studies of African American grief, family support and participation of spiritual leaders during funeral process is crucial because “in the Black experience funerals additionally represent the great worth of the deceased within the community.” (Barrett). In African American communities, loss is a spiritual event and the pastor’s presence and support is of major importance. Those relationships are important in receiving “spiritual, emotional, and practical care” just as much as support from family and friends. It’s important for mourners to have loss validated by friends, family, and community members by showing up to the funeral for support and to pay respects to the deceased. However, longstanding biases surrounding suicide still somewhat present in pastoral care can affect relationships with spiritual leaders and others in the faith community, which causes issues in the healing process, like finding meaning in the loss.
Pitman utilized a qualitative study to explore the nature of how sudden death survivors perceive reactions from friends, family, and community members. He compared stigmatization of loss by sudden deaths, unnatural death, and suicide by listening to people’s stories. Suicide was found to be the most stigmatized. In his interviews with those bereaved by suicide, people commonly experienced feelings of: social awkwardness, blame, pity, and disrupted interactions with others (Pitman, 2018). This can lead survivors to distance themselves from the deceased, including: avoiding talking about them, or concealing the cause of death in order to protect themselves from pain. Stigmatization of sudden or unnatural death often leaves loved ones with feelings of unsatisfying support from others, and can even inflict this stigma upon themselves, causing them to not reach out for support or failure of others to offer support. Feelings of shame because of stigma can result in prevention of the griever acknowledging their need to mourn and heal, “Because of the intensity of the guilt, people may feel the need to be punished, and they may interact with society in such a way that society, in turn, punishes them.” (Worden, 2009).
Another qualitative study, ‘People look down on you when you tell them how he died’, found four themes are found among those bereaved by suicide. The themes are feeling: blamed/ shamed/ judged, isolated/ rejected by friends and community, silenced, and burdens of others discomfort (Peters, 2016). It was explained that this experienced stigma could result in a disturbance in relationships, and help seeking behaviors. Survivors lack of connection to others by talking about loss also can complicate the grieving process. This isolation from others is described as a “self-imposed process”, and can deny loved ones from experiencing happy memories of deceased and being able to make sense of the loss. (Peters, 2016).
Worden’s Four Tasks of Grieving include: accept reality of loss, process pain of grief, adjust to world without deceased, and find connection with deceased (Worden, 2009). In the first stage, shock and denial play a huge role in ability to move forward in grief, dependent on the type of loss. Funeral rituals can help actualize the loss so that pain can be processed and a new reality can start to be constructed. The first stage leads people to feel out of control and finding support and faith in something can reduce future complications. In complicated grief, anxiety of not having control is prolonged and interferes with the next step in grief, processing the pain of grief.
In the second stage, Worden explains that it’s necessary to go through the pain of loss as a natural adaption to change. Suicide bereavement results often in intensified feelings of guilt, anger, confusion, and rejection.” (Tal, 2012). However, in suicide related deaths shame from stigma can deny the mourner in acknowledging their feelings or ability to open up and discuss loss. Also, due to the already uncomfortable feelings society has towards death, known as the death taboo, it can prohibit friends and families from knowing how to provide solace (Pitman, 2018). This is intensified for those grieving from suicide. People may not acknowledge the person that died or avoid the term “suicide” (Pitman, 2018). Others may pity the deceased and their loved ones, and may avoid discussing the deceased to not upset the grievers. Pitman’s interviews with suicide bereaved individuals highlights how this made grievers feel, “I just really don’t like the whole stepping on eggshells around me or being careful; I’d just rather they act as normal” (Pitman, 2018). This could also impose guilt on those in mourning because they feel the burden of others discomfort, and can make them feel responsible for making others feel better, even when they aren’t the ones in need (Pitman, 2018).
Before being able to adjust to world without deceased and find a new connection with deceased, the pain has to be processed. Discussing grief and your own story about it helps those in grief process pain and express it. Hindrance of grief stories, or not being able to talk to others and validate the need to receive help, also leads to complicated grief, “The conspiracy of silence causes great harm to the surviving person, who may need to communicate with others to resolve his or her own grief.” (Worden, 2009).
After reviewing the studies and other professional sources, the idea of how to address this stigma and complicated grief was interesting. Is there a way to reduce the complicated matter of grief from suicide or will there always be stigma around it? Tal discussed the need of health professionals to be informed of risk factors for this disenfranchised population, focusing on traumatic stressors revolving loss, and the role of pharmacology and psychotherapy (Tal, 2012). Cognitive Behavioral Therapy can help reconstruct negative feelings brought about with mention of deceased to ones of better merit. Worden mentions intervention strategies for working with the suicide bereaved and notes that addressing negative stigma is a crucial consideration, “Use the phrase ‘died by suicide’ rather than ‘committed suicide’, which connotes a more criminalized stigma.” (Worden, 2009). There should be awareness of the importance of reestablishing connection with deceased in order to remember them in a positive manner. This is possible with trusting relationships of friends, family, and health professionals, when stereotypes are deconstructed and person is able to tell grief stories and process the validated pain. Tal also mentions the importance of same help support groups for coping, as it may be the only place survivors can discuss loss without judgement (Tal, 2012).
Survivors of suicide loss who struggle with intensified grief reactions are in need of additional support. However, due long held stigma they receive less, both reasons attributing to complicated grief reactions. Those bereaved by suicide need to make sense of the death and their own emotions typically of guilt and anger, with validation from others. There is a need for awareness and education of stigma surrounding mental illness and suicide.
- Barett, Ronald Keith. (n.d.). Sociocultural Considerations for Working with Blacks Experiencing Loss and Grief. 83-95.
- Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, Mass: Lexington Books.
- Peters, K., Cunningham, C., Murphy, G., & Jackson, D. (2016). ‘People look down on you when you tell them how he died’: Qualitative insights into stigma as experienced by suicide survivors. International Journal of Mental Health Nursing, 25(3), 251-257. doi:10.1111/inm.12210
- Pitman, A. L., Stevenson, F., Osborn, D. P. J., & King, M. B. (2018). The stigma associated with bereavement by suicide and other sudden deaths: A qualitative interview study. Social Science & Medicine, 198, 121-129. doi:10.1016/j.socscimed.2017.12.035
- Staley, A. (2017). Identifying ingrained historical cognitive biases influencing contemporary pastoral responses depriving suicide-bereaved people of essential protective factors. Religions, 8(12), 267. doi:10.3390/rel8120267
- Tal Young, I., Iglewicz, A., Glorioso, D., Lanouette, N., Seay, K., Ilapakurti, M., & Zisook, S. (2012). Suicide bereavement and complicated grief. Dialogues in Clinical Neuroscience, 14(2), 177.
- Worden, J. William 1932- (James William). (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th ed.). New York, NY: Springer Pub. Co.
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