After the grief and guilt, life must go on.

Kate (the stories are true, but the names have been changed) will never forget a certain spring. Her twin, Laura, was home from college in the Northeast. Dinner was a family affair, and it seemed like old times, with all of them together again.

Later that night, Laura came into Kate’s room. They listened to La Boheme on the stereo and talked desultorily. Without warning, Laura burst into tears and Kate wordlessly held her in her arms. The twins were a study in contrasts: Laura-tall, dark, striking, a little withdrawn and serious, doing brilliantly in school; Kate-petite, blond, vivacious, fun-loving and very popular. The sisters sat silently together for a while. Kate remembers that the night was scented with honeysuckle. She felt very close to her twin but knew they were far along their separate paths.

The next morning, Kate got up early to fix breakfast for Laura. Over the busy sizzle and pop of the bacon, she heard Laura’s bath running. Then, a shot. Her heart pounding, Kate rushed upstairs, her parents close behind.

Laura, with the world at her feet, had killed herself. Two butcher knives gleamed wickedly in the bathtub, just in case. She had always been a success at everything she did, and Laura had wanted to make sure she didn’t fail at this, either.

Kate’s voice is filled with pain as she relives the incident: “It’s such a tragic waste. She had everything going for her. It still-after all this time-hurts just as much today as it did then.”

Every year, more Americans kill themselves than kill each other. In 1981, there were an estimated 26,080 suicides across the country and 23,310 homicides, according to the National Center for Health Statistics. On the local level, the number of suicides in Tarrant County in 1981 was 134, while in Dallas County, 262 people killed themselves.

The suicide rate in Dallas is about 20 percent higher than the national average. Dr. Charles Petty, Dallas County Medical Examiner, attributes Dallas’ high suicide rate to a number of factors. He says Dallas has an effective medical-legal investigative reporting system, which means more suicides are recorded. Compared to other big cities, Dallas has a relatively small black population, and this skews the statistics because traditionally fewer blacks commit suicide (although this is changing). Perhaps more significantly, Dallas has a high proportion of young people and a large transient population.

When a faceless drifter kills himself in a nameless boarding house in an indifferent city, few ripples are caused by his death. But most people who commit suicide are enmeshed in thick webs of relationships, and their deaths reverberate through the lives of those they leave behind. Their act is anything but private. “A man’s dying is more the affair of his survivors than his own,” wrote Thomas Mann in The Magic Mountain.

The study of suicide has historically centered on the internal problems of the suicidal person, as well as on the external resources available to help in the crisis. Only very recently has the scope broadened to include the survivors of a suicide. Most people who hear the phrase for the first time instinctively associate it with those who have survived a suicide attempt. It refers, however, to the family members and friends who have to carry on with the business of living once the suicidal person is dead. Dr. Edwin Shneidman, a pioneer in the field of suicidology, warns that in the case of suicide, the largest public health problem is neither prevention of suicide nor intervention during a suicide attempt, but “postvention.” He defines postvention as “the alleviation of the effects of stress in the survivor-victims of suicidal deaths, whose lives are forever changed and who, over a period of years, number in the millions.”

The loss of a loved one always precipitates a period of mourning. If the death is natural, one can curse luck or blame fate, but in the case of a suicide, one can only curse the person who is dead and blame oneself, often with disastrous consequences. The grief and sorrow that follow in the wake of death are compounded, if the death is self-inflicted, by a complex welter of emotions-guilt, anger, frustration, shame, depression, hurt, remorse and bitterness.

Families often destroy suicide notes and other evidence to try to make the death seem accidental because there is still a strong social taboo against suicide. Then, too, some insurance companies pay nothing for suicide but pay double indemnity for accidents. Perhaps, more than anything else, the denial of suicide is an attempt to lessen survivor guilt.

The guilt at having been unable to foresee or prevent the death is one of the more corrosive emotions for the survivors. Coupled with this feeling is the guilt of being the one left alive. Mixed with guilt is a tremendous sense of shame, which Dr. Florence L. Wiedemann, a clinical psychologist and Jungian analyst, likens to “the collective guilt that Dallas felt when Kennedy was assassinated here.”

Irrational as the guilt often is, it is usually accompanied by strong feelings of rage. It’s very easy to become angry with the person, even though he is dead. The family can become furious and bitter: “How dare he do this to us?” “Why did she have to take this horrible way out?” These emotions are intensified when the suicide is interpreted as an attack on someone close, which it frequently is.

Under these powerful emotions runs a riptide of regret. People reproach themselves for not having shown how much they cared before it was too late. Survivors often torment themselves with the words, “If only….” They become obsessed with the suicide, reliving each moment, running the tape through their minds again and again. The intensity of their anguish can often disrupt the mourning process, jeopardizing a survivor’s physical and mental health.

In the Middle Ages, suicides were buried at crossroads, sometimes with a stone over the dead man’s face and a stake through his heart, “as if there were no difference between a suicide and a vampire,” says A. Alvarez in The Savage God, one of the most thoughtful modern works on suicide since Albert Camus’ The Myth of Sisyphus. The heavy traffic at the crossroads, like the stake and stone, was meant to keep the suicide from rising as a ghost and coming back to torment the family. Figuratively speaking, the ghosts continue to haunt families even today. As Shneid-man puts it, “the person who commits suicide puts his psychological skeleton in the survivor’s emotional closet.”

For the survivor, suicide is the cruelest death of all. It can beget not only much suffering, but also suicide. The survivors of suicide are themselves high risks for self-destruction. The increased probability is explained by different theories. Some experts believe that there is genetic inheritance of self-destructive patterns; others stress that survivors learn a particular kind of coping behavior from their models; others explain it as an attempt to expiate the feelings of guilt that they were in some way responsible for the death. Whatever the reasons, experts agree that survivors of suicide are six times more likely to kill themselves than those who have not been close to a suicide.

German philosopher Fredrich Nietzsche called the thought of suicide “a great consolation: by means of it one gets through many a bad night.” For survivors who do more than sleep on the thought, the “bad night” is most likely to be a holiday or anniversary of particular significance. Petty recalls an incident where one of his employees had lost her son. He had committed suicide, and each year for a week or so before the anniversary date, she would become more and more melancholy. Her colleagues found a calendar on her desk with an “X” drawn through the date of his suicide. On it she had scrawled the words “Forget it!”. She killed herself the same day.

Though the danger of survivors following the deceased in suicide is greatest in the months shortly after the event, many people whose parents, siblings or other relatives have killed themselves may wait until a later stressful period in their lives to imitate the action as a way of coping with trouble.

Research has shown that of all life’s stress, the loss of a spouse is probably the greatest. Jean Thompson, who runs a Survivors of Suicide program at the Suicide and Crisis Center in Dallas, explains this in terms of the major life adjustments one has to make and the feeling of isolation and loneliness. It is commonly accepted that suicide threats and attempts are transactions or communications between husband and wife. A completed suicide is the most hostile transaction of all.

Anne, an exceptionally beautiful and intelligent woman, was estranged from her husband but remained in close contact with him. Their two children, who lived with her, were a strong bond between them.

Anne was worried and frightened by her husband’s increasingly self-destructive behavior. He was hurting himself professionally and personally by taking drugs- he was a physician and had easy access to them.

She fell responsible for her husband’s misery but at the same time realized that she had to let go and begin leading her own life. She went buck to college to get her Master’s and eventually met the man who would become her second husband. She got a divorce and remarried.

Shortly after her second marriage, her ex husband killed himself . As a doctor, he could have chosen a swift, painless, sure way to die. Instead, he shot himself in the chest with a handgun. His insides were ripped up, and the bullet lodged in his spine. He died in the hospital seven days later.

The night before he died, their son asked Anne if his father would go to heaven. “That just tore me up,” says Anne. “It was such a shock, and I hurt so badly for my kids, particularly my teenage son. He was in on everything and even had to help make funeral arrangements. I felt such anger- how could their father just leave the children? And so much regret that he wouldn’t see them growing up.

“I kept thinking it was all my fault. I had to remind myself that there have been other divorces, and the husband and wife pull through…but he was in so much pain.”

The surviving spouse has to face a lot of pain, too. In the process of mourning, the person has to face accusations, however implicit, of having driven the mate to this step or of having been unable to prevent the suicide. There is much covert speculation about marriage ended by suicide. The in-laws-an extended family that can provide much support at other times-are caught up with their own sorrow and guilt and tend to blame the surviving spouse. The widow is often made to feel like an outcast.

The death of a spouse can be very dangerous to the physical and mental health of the bereaved, much more so when the death is by suicide. Like other survivors, the widow is susceptible to a variety of physical and emotional problems after the tragedy: hypertension, ulcers, migraines, exhaustion, listlessness, increased smoking or drinking, insomnia, nightmares, loss of appetite, depression, apathy, crying spells, fear of being alone, guilt and suicidal feelings. There can also be much ; anger for the sake of the children, along with bitterness and resentment if the husband, for instance, has left his wife with children to rear and no money. It is very hard for the widowed to cope with the burden of responsibility and to carry on alone.

Bereaved spouses, like other survivors, sometimes become involved with suicide . prevention programs. As volunteers, they offer comfort to those in similar situations because they have been through the suffering themselves.

A less positive action the bereaved can take is to marry the same kind of person as the spouse they lost, in an effort to recapture the past. This can be disastrous, particularly if the first marriage was unhappy. In Dallas, the reason given for more than a quarter of suicides last year was marital discord.

Dallas is the divorce capital of the nation. Although it is impossible to establish a causal connection between the high divorce rate and the high suicide rate, Jim Hengstenberg, executive director of the city’s Suicide and Crisis Center, sees “the same dynamics at work in both cases. There is a sense of isolation, alienation, a loss of support from significant others.”

The surviving spouse shares the sense of isolation and abandonment. Among the widowed, suicide is more than twice as common as it is among the married, and the bereft spouse will often take the same way out in hopes of joining the loved one.

It has been well documented that the loss of a loved one is the most frequent precipitator of suicide. Next to the loss of a loved one, the most common precursor to suicide is poor health.

The thing that Karen remembers most about her father is his energy. He was very active and could hardly sit still. He was especially good with his hands, fixing everything around the house for his wife and fashioning amusing playthings for his grandchildren.

At the age of 53, he suffered a stroke and was cut off from the world. He could no longer speak, read, write, signal or in any way communicate with his wife and daughters. All of a sudden, he couldn’t do anything at all.

The real tragedy, Karen believes, is that he was alert enough to know exactly what was going on. He knew he would never get any better. That’s why he systematically planned his own death.

He waited until his wife would be out for the day. A friend was supposed to stop by at noon and check on him. Always considerate of his wife, he didn’t want her to be the one to find him.

Handicapped as he was, it took a great deal of doing to get his shotgun propped against the dresser. But he had always been good at rigging things up. Somehow, he managed to pull the trigger. His blood splattered on the carpet across the room. The blast had sprayed through his face, leaving it unrecognizable. The friend didn’t stop by. His wife found him.

When Karen heard that her father had killed himself eight months to the day after his stroke, it didn’t really come as a surprise. “Everything sort of fell into place. I know how frustrated and unhappy he must have been, “she says. “Still, I felt a lot of guilt and depression. He was such a gentle man, and the violence really bothered me. I went through a stage of denial and pretended he was still alive. Since I wasn’t living at home, that was easy for me to do. {finally had to accept it and come to terms with it. But at least I’m grateful that I know the reason. Some people never know. That’s the worst part.”

Some suicides are easier to understand and accept than others. The suicide of an elderly, ailing person or a prominent physician with a wasting disease who kills himself because he knows he will not be able to do so before long, are easier for survivors to deal with than the inexplicable suicide of someone who apparently had everything to live for.

Children are the largest group of survivors of suicide, but they are methodically excluded from the rituals of mourning. They arc either sent away or shielded from the event so that they don’t understand or accept the death. Sometimes they cannot even acknowledge the suicide because they are told it was an accident. It puts a further strain on the already bewildered child if he has witnessed some aspect of the suicide but is forced to believe that it was a heart attack or accident. To compound the problem, the surviving parent refuses to discuss the suicide with the child. Or he resorts to lies such as “Daddy’s gone away on a trip; he’ll be back soon.” This kind of evasion can be devastating for the child, according to Josef Caldwell, president of the board of directors of the Suicide and Crisis Center, and in private practice as a family counselor and therapist. “It leads to a magical kind of thinking on the child’s part, which is very far removed from reality.” The child is also likely to panic whenever Mommy leaves the house, fearing that she, too, may not come back.

The child is already vulnerable, and facing such a severe blow at such a young age will almost ensure emotional problems later. Children are particularly susceptible to guilt, and, as in the case of divorce, often feel that they are basically unlovable and that the loss of the parent is punishment for being naughty. Children will sometimes commit suicide to join the lost parent, either shortly after the death or many years later. The increased proclivity never goes away.

“Since he was a young boy, he has cared greatly for fishing and shooting. If he had not spent so much time at them…he might have written much more,” wrote Hemingway of himself in Portraits and Self-Portraits. “On the other hand, he might have shot himself.” The words are strangely prophetic. He eventually shot himself, as his father had done many years before.

However unwillingly, we all accept that in the natural order of things, our parents will die. But parents don’t expect to outlive then children When a child chooses to die. his death is doubly unnatural, defying comprehension and accceptance. The loss of a child takes the longest time to get over. As one grieving mother says, “You never get over it. You just get used to it.”

For the Johnsons, Alan had always been their angry child. He was rebellious as a teen-ager, and his anger never left him. He was also very intelligent and highly motivated, working in a demanding job in computer programming. Everything came easily to him-except going out with girls. He was very shy, and he had never had a girlfriend.

His parents were troubled by his moodi-ness. He begun drinking and smoking marijuana and complained of pressure at his job. He resented his parents saying anything to him. As he grew further away from them, Alan drew closer to Kevin, his younger brother. They were best friends.

Then Kevin got married. Alan withdrew, even though he knew he was always welcome at his brother’s place. His parents were concerned but thought he would get over whatever was bothering him. He always had before.

The last time they were all together as a family was at Alan’s birthday dinner, which was quieter than such gatherings usually are. His mother had baked a chocolate cake for him. He smiled at her, a charming, lopsided grin, and seemed more at peace than he had in a long time. In retrospect, his mother says, “I’m sure that’s when he made up his mind and crossed over to the other side.”

They didn’t hear from him again. At the end of the week, Alan drove a thousand miles to the small town where he had gone to college. On the outskirts of the town, he pulled into a rest stop. He connected a hose to the exhaust pipe, rolled up the windows and died of carbon monoxide poisoning, exactly one week after his 24th birthday.

Alan’s father recalls, “I was so mad at him. I kept thinking-how could he do this to us?” The anger was a way of coping with a tragedy that otherwise would have been overwhelming. “Finally, I realized that I was going to have to let Alan go. He took a lot of secrets with him to the grave – they’ll just have to remain secrets.”

His mother goes through each stage of Alan’s life every single day. “That’s the first thing that hits me when I wake up in the morning.” She knows the suicide note by heart and finds some comfort in the message he left behind: “All I can say is I’m sorry. I had the best possible family. It is I who failed. To my family: Go on, and try to forget about me.”

Their friends also urged them to forget. But, like most parents, the Johnsons treasure their son’s memory and are gladdened when someone recalls a childish prank or incident. These memories are one way of keeping Alan alive for them. “I love it when people talk about him. I can’t just pretend he never existed,” says his mother. “He’s 24 years of my life.”

The Johnsons found some consolation in the suicide note; other parents find accusation. Suicide is death with the strongest communication value, and the message is usually one of rebuke and accusation.

Parents are apt to deny the death. They find it very difficult to share the loss with family and friends and are hardly able to talk with each other about it. Fathers will seldom discuss a child’s suicide. The mother then suffers a double loss because she feels she has lost both her child and her husband.

Mr. Johnson was aware of that and went for counseling with his wife. “I wouldn’t have gone, but I felt my wife needed it. I wouldn’t admit that maybe 1 did, too. I went with her, somewhat be-grudgingly. You hear about the trauma of such a suicide breaking up a marriage because the parents tend to blame each other. I didn’t want anything to hurt our marriage.”

It is true that some families, particularly if they are already fragile, can disintegrate in such a crisis. In many cases, parents divorce, remarry and lose contact with the other partner. Many are emphatic about not wanting another child. Just as a suicide can tear apart a family, it may also bring forth positive family resources to deal with the crisis. The ordeal can bind the remaining family members closer together.

Although no one can give the bereaved the only thing they want right then-the dead person alive again-there are several support systems that are available to the survivors in the aftermath of a suicide. Family and friends, religion, Survivors of Suicide (SOS) programs, family counseling and therapy can all help the bereaved to better cope with the crisis.

Family and friends are normally a person’s most valuable resource. In the case of a natural death, they help and support the person through the period of mourning. In the event of a suicide, however, whether through embarrassment, pity, hostility or fear of encroaching on a private tragedy, people stay away. This only adds to the survivors’ feelings of isolation. “The most important thing for people who want to help is to rally around,” stresses Jean Thompson. “This is particularly needed after the funeral, when the shock has worn off, the pressing practical matters have been taken care of, and the real process of mourning is just beginning.” It’s very dangerous to leave the bereaved alone at such a time because it underlines their sense of being abandoned.

Most people confess that they don’t know what to say in such a situation. Conventional expressions of sympathy and condolence seem inadequate in the face of such a numbing tragedy. But saying almost anything to acknowledge the suicide and the pain the survivors must be going through is balm to their wounds. “To avoid mentioning the suicide is to treat it like something shameful, a dishonorable discharge from the army,” says Wiede-mann. By acknowledging the death, one takes the emphasis off the suicide and puts it on the loss, allowing the person to grieve.

It is important to talk about the suicide and even more important to listen. Expressing their feelings can be painful for family members, but it is far healthier than repressing them.

Time is usually the greatest healer. It’s ill-advised to try and speed up the mourning process by whisking the person away on a whirlwind vacation, for example. Trying to force false cheer upon the survivors only discounts their pain. Each person has an individual way of mourning, and one must respect that. “Be sensitive to what the person wants,” urges Wiede-mann. A young girl who was a guitarist with the high school band hanged herself. Her friends gave a concert in her honor. Although done with the best intentions, the gesture proved terribly distressing to her parents.

One can also help out on a day-to-day level, says Renée Williams, Cable Television Administrator for the City of Dallas and an active volunteer with the Suicide and Crisis Center. The family members may be too stunned and apathetic to think of everyday necessities like food and groceries, and friends can help out.

Besides family and friends, religion can provide succor to many mourners. While some react by railing against their god for allowing such tragedy to happen, others believe that their faith is strengthened by this test.

Father Judge of St. Andrew’s Catholic Church in Fort Worth points out that the Catholic position regarding suicide exists on two levels. “In principle, suicide is a mortal sin, and we cannot in any way condone the groups that advocate suicide as a basic human right. But, in practice, we also believe that God will judge the person with compassion and mercy for taking this step in a moment of clouded judgment. This is the comfort that we offer to the bereaved.” Karl Barth, a German theologian, expresses a firm conviction in his Church Dogmatics. “If there is forgiveness for sins at all.. .there is surely forgiveness for suicide.” Most churches now offer the formal rituals of a church burial for suicides, and the clergy are increasingly sensitive to the spiritual needs of the survivors.

For Christians, there is much solace to be derived from their faith that they will be reunited with their loved ones. But that is not always enough. Karen says, “I’ll see my father in the hereafter. That’s fine, but I have to live in the here-and-now for the next 50 years without him, and it hurts.”

Survivors of Suicide is specifically geared to deal with that hurt, and provides a warm, caring, non-judgmental atmosphere where survivors work in groups with trained counselors to come to terms with the tragedy. They realize that in the final analysis only the person who committed suicide was responsible for his actions, and this lessens the burden of guilt. “Seeing other people work through their grief gives us all hope,” says Jean Thompson.

The SOS program reaches families through the county medical examiner’s office, but many people fall through the cracks because they have moved after the suicide or because the suicide took place outside the Dallas County area. People who seek out the program seem to get the most out of it. Fort Worth has a similar program.

In addition, family therapists and counseling agencies, though not specifically set up for an SOS program, can offer help to the bereaved. Listed below are some of the agencies that families can turn to during the aftermath of a suicide:

Survivors of Suicide …828-1000

Survivors of Suicide, Fort Worth …(817)924-9201

The Compassionate Friends …521-7420

Center for Pastoral Care and Family Counseling …821-3680

Southwest Family Institute …521-6970

Pastoral Counseling and Education Center …522-1590

Family Guidance Center …747-8331

Community Psycotherapy Center …528-3722

The Dallas County Mental Health and Mental Retardation Center has a 24-hour information and referral line …330-7721

In his book, Le Suicide, French sociologist Emile Durkheim calls suicide “the ransom money of civilization.” For the survivors, it is a heavy price to pay. And, in a sense, we are all the survivors because what starts out as an individual tragedy, ends a universal one. “Any man’s death diminishes me,” wrote John Donne, “because I am involved in mankind.”


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