“The Ripple Effect”

Written by Dr Elaine Richardson, Senior Clinical Psychologist.

Death by suicide is a tragedy that has profound impacts on those who are left behind.  Sadly, this is a far from uncommon experience.  Around 6 thousand people a year in the UK end their lives by suicide[i].  It is estimated that, for every death by suicide, ten people are directly affected[ii], though the “ripple effect” means that many others (such as friends, colleagues, professional carers and people in the wider community) are also likely to be impacted. 

People who have experienced this kind of loss sometimes say that it can feel as though the pain that led to their loved one taking their own life has been passed on to them.  Grief arising from such a loss can be long-lasting and complicated.  Those experiencing suicide bereavement describe their confusion, sadness, guilt and anger.  They can find themselves endlessly ruminating about what they feel they would have, could have and should have done.  They may find that they struggle to cope at work and in their personal relationships.  People bereaved by suicide commonly experience a range of difficult emotions such as sadness, guilt and anger in the aftermath of a suicide bereavement.  They often also experience physical symptoms such as headaches, stomach pains and sickness.  

Suicide can also bring feelings of stigma to the surviving family members.  This can be particularly marked in certain cultures that regard suicide as immoral and shameful, but any survivor may feel that a suicide death in the family casts the shadow of stigma over them.  This is not helped by the way suicide has been regarded in the past – for  example the word “committed” (so commonly unthinkingly used in relation to suicide) resonates with its history of being defined as a criminal act.  “Completed suicide” has been proposed as less shaming and stigmatising terminology.  Suicide survivors may find that people in their community avoid them for fear of not knowing what to say, or saying the wrong thing.  They may feel that they are being judged or even blamed for not having succeed at protecting their love one from suicide and may find themselves withdrawing from society. Alongside their own self-blame, this perception of being negatively judged can result in a toxic cocktail of feelings, beliefs and behaviours that negatively impact on the mental health of those coming to terms with this kind of loss. 

Suicide deaths are often sudden, unexpected, shocking and sometimes violent.  As a result, post-traumatic stress symptoms may arise, particularly for those witnessing the death or discovering the body.  Even those who didn’t witness it may experience intrusive imagery about the death as they imagine it to have been for their loved one.  As well as flashbacks and intrusive imagery, other symptoms of post traumatic stress disorder include numbness, avoidance of certain situations, an altered sense of the future, sensitivity to certain triggers that remind the person of their loved one and their passing; and strong emotional reactivity when exposed to these triggers. 

Sadly, those who have experience suicide bereavement are at higher risk of themselves suffering a suicide death in the aftermath of the suicide bereavement[iii].  Statistics show that 9% of people affected by suicide will also attempt to take their own life and 8% will drop out of work[iv].   Having access to appropriate and timely support for those bereaved by suicide is therefore essential. 

Sandra[v] lost her sister to suicide some years ago.  She explains: “Even though her death didn’t come entirely out of the blue – she had suffered severe and long term mental ill health – it nevertheless came as a huge shock to be told she had ended her life.  I could never have understood before it happened just how agonising such an event is. I was inconsolable.  I remember crying so hard that it created a “bruise” of broken capillaries around my eyes.  I experienced waves of intense distress every day for the first few months.  I was lucky to have access to some counselling sessions through my employer’s Employee Assistance Programme in the early months following the bereavement.  I recall how difficult it was to make that first call and how uncertain I felt about whether I could hold it together long enough to have any kind of conversation about my loss.  Breaking through that mental barrier was the best thing I could have done  – although it was difficult and painful to start speaking, I found I could do it and it was good to receive the counsellor’s support.  With this new confidence that it was possible for me to speak about my feelings, I felt it would be most helpful for me to be able to go on to speak to others who were also “suicide survivors”.  I therefore started looking for a suicide bereavement support group.  At that time, there wasn’t any such group available locally, so I had to drive 25 miles once a week to another city to access this.  It was worth it – hearing from others that they were experiencing similar thoughts and feelings to me was very helpful.  I also joined a couple of online support group, and this further reinforced the message that I needed to hear – that I wasn’t alone in my suffering, that others were also consumed by misplaced guilt and that others also felt conflicting emotions such as sadness and anger.  However, I continued to struggle and after speaking with friends I decided to seek therapy.  My therapist felt I was suffering from post traumatic stress disorder and she suggested a therapy called Eye Movement Desensitisation and Reprocessing therapy.  By the end of this therapy, I noticed that, although the loss of my sister was still in my thoughts every day, it was no longer dominating every waking minute as it had done previously.  The pain, although still difficult, was not leading to the daily breakdowns that I had been suffering previously.  After another year or so, I heard about a new support group in my hometown run by my local Samaritans and I decided I would benefit from attending this.  I attended the sessions and found that I was a little further along on the bereavement journey compared to some of the other group members and I was able to offer them encouragement and support based on my own experiences.  It is nearly seven years now since I lost my sister to suicide.  I continue to live with the impact of this every day and I know that I won’t ever “get over it” but I am learning to live “my best life” alongside this pain of suicide bereavement.  I would encourage others going through suicide bereavement to seek whatever kind of support feels right for them, whether that is group support, therapy or online forums.  You don’t have to struggle with this on your own.

Organisations that specialise in offering support and advice to those bereaved by suicide include:

Survivors of Bereavement by Suicide (SOBS) https://uksobs.org/

The Samaritans https://www.samaritans.org/about-samaritans/research-policy/bereavement-suicide-services/

Support after Suicide https://supportaftersuicide.org.uk/

The NHS provides a free online booklet: https://www.nhs.uk/Livewell/Suicide/Documents/Help%20is%20at%20Hand.pdf


REFERENCES

[i]  https://www.samaritans.org/about-samaritans/research-policy/suicide-facts-and-figures/

[ii] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/590838/support_after_a_suicide.pdf

[iii] Pitman AL, Osborn DPJ, Rantell K, et al (2016). Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults. BMJ Open 2016;6:e009948. doi:10.1136/bmjopen-2015- 009948

[iv] https://www.gov.uk/government/news/suicide-bereavement-support-to-be-made-available-across-england

[v] We have changed her name to protect her anonymity