Description of the chosen topic Rationale for choice Professional considerations Common Theories and literature utilized Reference list

Possible Impacts on the Bereavement Process for Adult

Survivors of Suicide

Examine the impact of bereavement when a loved one has died as a result of a completed suicide.

The impact of death by suicide on the grieving process as an adult experiencing the loss of an adult loved one.

This presentation excludes suicide in relation to knowledge of a fatal illness, specifically euthanasia.

Impact of Suicide on Bereavement

The World Health Organization (2007) considers death by suicide to be an epidemic claiming the lives of hundreds of people daily and impacting the lives of thousands of people for years after the suicide of their loved ones.

“Suicidal deaths are different from other modes of death, since factors like expectedness of death, family functioning, and quality of the relationship may vary considerably.” (Ellenbogen & Gratton, 2001, p. 88)

Barrett and Scott (1990) propose that suicide prevention is not the biggest concern. It is the alleviation of the effects on the survivors.

Rationale for this Topic

In Canada alone, over 3800 people died by suicide in one year (Statistics Canada, 2009). Imagine how many survivors are impacted by this loss.

There are marked differences in the grief experienced by those bereaved by suicide versus those bereaved by other modes of death (Barrett & Scott, 1990; Ellenbogen & Granton, 2001).

“Death, any death, is an outstanding example of a traumatic event which so threatens the equilibrium and safety of a group that its members become sufficiently vulnerable that they, too, may become victims of physical, emotional, or behavioral disorders.” (Lindemann & Greer, 1953, p. 10).

Rational for this topic continued…

As a professional it is imperative to understand the meanings behind an individuals world view regarding

suicide and it’s relation to the grief process.

Some bereaved may be irritable without apparent cause, impatient, withdrawn and isolated from others, “living in a world which is drained of its color and its significance” (Lindemann & Greer, 1953, p. 10).

In contrast Ellenbogen and Granton (2001) suggest adult bereavement may be comforted by thoughts of a loved one finding freedom from deep emotional and psychological agony.

Professional and Personal considerations

Views and meanings of practice and process are deeply embedded in the assumptions of an individual’s perspective including the client and the professional (Brown & Strega, 2005).

“Reality is about the meaning that people create in the course of their social interactions; the world is not about facts but about the meaning attached to facts, and people negotiate and create meaning” (Brown & Strega, 2005, p. 215).

Waldegrave (1998) posited that people give ‘‘preferred meanings’’ (p. 405) to events occurring in the physical world, and that those meanings depend on values. Thus, ‘‘if there is no objective meaning, but simply explanations of meaning, then we have to start assessing our values and ethics in relation to these meanings particularly when we work with individuals or with a family’’ (p. 405).

Professional and Personal considerations continued…

Understanding the “reality” of an experience or process or phenomenon is contextual and must be grounded in the experience of those who have had the experience or process or phenomenon.” (Brown & Strega, 2005, p. 215).

When I engage with others the context and lived experiences of that individual must be explored to enhance and more accurately reflect understanding and connection.

The exploration of interpretations, assumptions and actions are imperative to further explore bias and ‘lens’ through which the world is viewed.

Professional and Personal considerations continued…

Meaningful shifts in understanding and in support of the innate worth of all peoples must challenge not only my assumptions of meaning but also the epistemological foundations of these interpretations. If the social norms surrounding suicide bereavement are to be addressed. ◦ Epistemological assumptions: meaning we must collect

different levels of proofs not only of observable behaviours but of different ways that people interpret the world(Brown & Strega, 2005)

Understand more than the theories and professional practices of grief counselling.◦ Understand the meanings and context of the individual

Professional and Personal considerations continued…

Elizabeth Kobler-Ross’s (1969) five stages of grief◦ Denial◦ Anger◦ Bargaining◦ Depression ◦ Acceptance

The stages were originally framed for an individual facing death.

Many practitioners currently use the five stages in relation to people facing the death of a loved one (Ambler Walter & McCoyd, 2009).

Common Theories and Literature on Grief

William Worden (2009) developed the four tasks of grieving. This framework provided a structure allowing the bereaved to understand grief work by outlining an active way to move through grief. The four tasks of grieving are: ◦ 1) to accept the reality of the loss◦ 2) to feel the pain of the grief◦ 3) to adjust to a world without the deceased◦ 4) to invest in a new world without the deceased.

These tasks of grief could be revisited and worked through again and again over time if needed (Worden, 2009).

Common Theories and Literature continued…

Robert Neimeyer (2000) moved away from the stages and tasks idea of grief and believed the bereaved must create meaning in the death.

◦ He differentiated between the bereavement experience of a traumatic loss and normal loss indicating meaning making of the death as an essential part of the bereavement journey.

◦ Suicide is considered to be a traumatic loss therefore complicating the grieving process.

Common Theories and Literature continued…

The research indicates commonalities of suicide bereavement are highlighted by social stigma, trauma, and intense feelings of guilt, shame, embarrassment, rejection, and isolation (Barrett & Scott, 1990; Lindemann & Greer, 1953; Thornton, Whitemore & Robertson, 1989).

Death by suicide brings another dimension to those who loved or quarreled with, or hated, or ignored the now dead person (Lindemann & Greer, 1953; Thornton et al., 1989).

The shame of suicide for many cultures can exclude the surviving family members from the rituals dedicated to death (Ellenbogen & Granton, 2001; Lindemann & Greer, 1953).

Common Theories and Literature in Relation to Suicide

“Suicidal deaths are different from other modes of death, since factors like expectedness of death, family functioning, and quality of the relationship may vary considerably.” (Ellenbogen & Gratton, 2001, p. 88)

The bereaved by suicide are often more isolated because suicide tends to immobilize those who would normally support and comfort them in their time of morning (Worden, 2009).

Common Theories and Literature in Relation to Suicide Bereavement continued…

Grief is a process that each person struggles to incorporate into their understanding and essence of their being.

Grief is unique to each individual and occurs in relation and in interaction with others; including the social worker.

Creating connection and reducing the stigma for those bereaved by suicide may mitigate disenfranchised grief.

As a Social worker ...

Grief is a process of acceptance, appreciation of the present, personal growth and the deep understanding that we are “part of the ocean” (Albom, 1997, p.181). ◦ Acceptance is the realization that death is imminent and

loss may be deeply painful but attached to life. ◦ Appreciation of the present: when the mind focuses on

what is at that moment and life is present within it. ◦ Personal growth is feeling the pain within so deeply that

clarity is vividly enhanced. ◦ We are deeply and innately connected too each other and

the universe. ◦ Nature and the universe are much grander than what we

are as individuals.

As a Social worker ...

Albom, M. (1997). Tuesdays with Morrie. New York: Doubleday.

Ambler Walter, C. & McCoyd, J. (2009). Grief and loss across the lifespan: A biopsychosocial

perspective. New York: Springer.

Barrett, T. & Scott, T. (1990). Suicide bereavement and recovery patterns compared with

nonsuicide bereavement patterns. Suicide and Life Threatening Behavior, 20(1), 1-15.

Brown, L., & Strega, S. (Eds.). (2005). Research as resistance: Critical, indigenous, and anti-oppressive approaches. Toronto, ON: Canadian Scholars’ Press.

Ellenbogen, S. & Granton, F. (2001). Do they suffer more? Reflections on research comparing

suicide survivors to other survivors. Suicide and life-threatening behavior, 31(1), 83-90.

References

Freeman, S.J. (1991). Group facilitation of their grieving process with those bereaved by suicide. Journal of Counseling and Development. 69(4), 328-331.

Kübler-Ross, E. (1969). On Death and Dying. New York: Macmillan. Lindemann, E. & Greer, I.M. (1953) . A study of grief: Emotional responses to suicide. Pastoral psychology, 4, 9-13.

Neimeyer, R. (2000). Searching for the meaning of meaning: grief therapy and the process of reconstruction. Death Studies, 24, 541-558.

Statistics Canada. (2012). Suicides and suicide rate, by sex and by age group. Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth66a-eng.htm. Thornton, G., Whittemore, K.D., & Robertson, D. R. (1989). Evaluation of people bereaved by suicide. Death Studies, 13, 119-126.

References continued…

Waldegrave, C., Tamasese, K., Tuhaka, F., & Campbell, W. (2003). Just therapy – a journey: A

collection of papers from the Just Therapy Team. Adelaide, Australia: Dulwich

Centre.

Worden, J. W. (2009). Grief Counseling and Grief Therapy: A Handbook for the Mental Health

Practitioner. Fourth edition. New York: Springer Publishing Company.

World Health Organization. (2012). Mental health: Suicide prevention (SUPRE). Retrieved from

http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html

References continued…