Jacob Butler was 16. Life, so he thought, did not treat him fairly. He did not make the high-school football team. His girlfriend broke up with him. For the most part he felt lonely and left out. One night, just past one o'clock in the morning, he took a loaded pistol, left his home using his father's car, drove around for several hours, drinking beer and calling friends on his cell phone. Then Jacob went to the high-school parking lot, pointed the gun at his head, and pulled the trigger. Janet and Kevin Butler were in shock and disbelief over the sudden and traumatic death of their only child. It was incomprehensible and horrifying. They were unable to read, watch television, or talk for more than a few minutes before the recollection of their son's death would impinge upon their thoughts.
For weeks, they found themselves looking into Jacob's bedroom, expecting that he had come back during the night. They felt as though they were just going through the motions of their daily lives and none of it could be brought to much sense.
After the funeral they told their pastor that they felt as if they were having a nightmare and that if only they could wake up from it, they would find that nothing had happened.
The process that follows an unexpected and violent loss of a loved one can take years. Sudden death is especially difficult for those who are left behind because there is no warning, no time to prepare for it. This is especially true in the case of suicide.
Approximately 30,000 people commit suicide each year in the United States. Assuming an average of four survivors in each immediate family, 120,000 new survivors are created annually, or 1.2 million each decade. If extend ed family members and close friends directly affected by the death are counted, the number of survivors is in the tens of millions. Every faith community contains someone who has been affected in a personal way by suicide. 1
Survivors' common emotions
Although each person's grief experience is unique, there are common emotions among survivors of suicide. The most immediate response is shock, numbness, and a sense of disbelief.
Many people experience dramatic swings from one emotional state to another. Feelings may include depression and anger at the deceased for dying especially for doing so through suicide. Then there is guilt about what the survivor might have done to prevent the death, along with irritability, anxiety, and extreme sadness.
In their intense grief and shock, some survivors say that they are afraid that they may go insane. Others become suicidal themselves as a result of their deep depression.
Some survivors may experience physical symptoms, such as gastrointestinal upset, lack of energy, sleeplessness, appetite disturbances, and pain in different parts of the body.
Parents, especially mothers, who lose a child to suicide are at risk of developing post traumatic stress disorder (FTSD), further complicating the grieving process. Intrusive thoughts, nightmares, reminders of how the child died, and distress at holidays and other family events are the most commonly reported parental symptoms.
In a study of mothers and fathers who lost a child in a violent death, 22 percent of the mothers and 14 percent of the fathers continued to have PTSD two years after the deaths.2
Denial, feelings of shock, guilt, anger, and depression are part and parcel of any grief reaction, but the self-inflicted death of a child greatly intensifies these responses in the experience of the surviving parents. A son or daughter's suicide raises painful questions, doubts, and fears. The knowledge that one's parenting was not enough to save one's child and the fear that others will judge one to have been an unfit parent may raise intense feelings of failure.
Suicide is different from other deaths in several ways. Surviving parents experience feelings of rejection and abandonment, which separate them from others who mourn the death of a loved one. It is common in the grief process for survivors to search for reasons for the suicide. Survivors attempt to piece together various reasons why a person chose to end her or his life.
Before they can begin to accept the loss, survivors must deal with the reasons for it and with the gradual recognition that they may never know what happened or why.
Talking about the death with others allows survivors to revise it in ways that make it more tolerable and to impose order on their experience this is part of the healing process.
Some suicides are associated with bipolar illness, schizophrenia, or psychotic depressions in which the disorder and the suicidal behavior are not the result of conscious intent or willful planning. In these circumstances, suicidal acts can be impulsive acts that occur in response to hallucinations (e.g., voices telling the person that they are worthless and must kill themselves).
These conditions are the result of severe neurochemical dysfunctions and should not be construed as being due to anyone's fault or even seen as the person's actual choice (much in the same way that an epileptic seizure is not a choice, but simply a malfunction in the nervous system).
In many instances, there are warning signs of a person's intention to commit suicide. However, some individuals disguise or code their plans so that even trained professionals miss the clues.
Occasionally there are no signs of suicide potential, and a person's decision becomes a puzzle that cannot be solved. The grip of the "what-ifs" of suicide can begin to loosen only as a survivor begins to accept the idea that the loved one's choice to kill himself or herself was that person's alone.
The primary reason young people kill themselves has to do with major depression one of the most pervasive emotional problems of adolescents. Experts estimate that about one in twenty teens has significant depressive symptoms.3 Such estimates are questionable because such depression is generally under-reported. Teenage depression is therefore under-treated and dangerous (about 15 percent of young people with an untreated major depression commit suicide).
Two-thirds of adolescents who take their lives use firearms. Individuals who take their lives are primarily trying to get rid of overwhelming emotional pain. At the time of the suicide, they have no hope that the hurt will ever disappear. The desire to eliminate their pain is greater than the will to live; this is by far the predominant motive behind suicides. A major depression can constrict awareness of the feelings of others to the degree that one focuses only on one's own intense inner pain. Those who take their lives seldom realize how much their death will hurt others.
It must, however, be acknowledged that at times suicides do occur as an act of anger directed toward another person (e.g., committed as a way to strike out at another person by way of inducing guilt). When this occurs, the suicide victim may leave a note that clearly reveals their intent. This, of course, creates the highest distress and conflict for the surviving family members.
Combating the stigma
Faith communities can play an important role in combating the stigma associated with suicide. Suicide is not a question of morality but a psychological and medical issue. There is increasing evidence that both depression and suicide have a biological component an imbalance in brain chemistry that significantly alters mood. Decreased levels of serotonin repeatedly have been found in the fluid that surrounds the brain and spinal cord of those who have attempted or committed suicide.4
Taking one's life may be understood in terms similar to addiction disorders, which has moved in public under standing from being seen as a moral weakness to being recognized as the medical and psychological problem that it is. A person commits suicide because he or she feels so desperate that this fatal act is seen as the only way to relieve the depression and intense emotional pain.
Unfortunately, suicide is often viewed merely as evidence of personal and familial failure. Society's judgment may be that the family some how provoked the death. Shame and stigmatization cause some family survivors of suicide to withdraw and isolate themselves. They may have difficulty sharing their feelings because of the fear of experiencing further pain and shame.
Researchers have found that family members who lose someone to suicide are blamed and avoided more often than are the relatives of people who have died under other circumstances. This attitude may reinforce the guilt and self-blame that may already affect suicide survivors, increasing their isolation and their difficulty in sharing their feelings.5
Clergy are called upon to play a variety of roles as persons move through the grieving process after suicide. They are often anchors of hope for survivors. Pastors must be supportive, nurturing, and helpful in the creation of rituals to deal with the grief. They also need a realistic and honest approach to the experience of loss as they help guide persons through this painful time.
There are special times when pas tors and members of the faith community need to give particular attention to survivors, such as the anniversary of the death and during the major holidays, especially during the first year of mourning. Clergy can also invite bereaved parents to get together from time to time simply to talk and share feelings. Pastors can mobilize other caring people to surround survivors with supportive, loving relationships. Additionally, clergy can encourage bereaved parents to participate in grief support groups.6
Pastors, church leaders, and others can educate a congregation by providing factual information about teen depression and other mental health issues. There is considerable societal bias against those with mental illness, which is one of the reasons adults and young people are reluctant to admit to being in distress or to seek help. Educating the faith community about adolescent depression can decrease bias and increase advocacy for mental health services for teens.7
It must be emphasized, however, that some of those who take their lives have been suffering from serious mental illness for a number of years. In a real sense, the factors over time that lead to a person taking their own life have been set in motion long before the suicide.
Preventing someone who has suffered for a long time from serious mental illness (e.g., major depression) can be like trying to stop a runaway train hurtling down a mountain. As the train reaches the bottom, it races at high speed, making the odds of stopping the tragedy very slim.
Many therapists and clergy encounter suicidal people who have been in deep anguish for years. At times, despite the best efforts of family, friends, pastors, and mental health workers, such individuals do kill themselves.
1 National Strategy for Suicide Prevention (NSSP), Summary 2001, www.mentalhealth.org 9/05/01.
2 S. A. Murphy, T. Braun, L Tillery, K. C. Cain, L. C Johnson, and R. D Beaton, "FFSD Among Bereaved Parents Following the Violent Deaths of Their 12- to 28-Year-OId Children A Longitudinal Prospective Analysis," Journal of Traumatic Stress 12, no. 2 (1999) 273-291
3 W. M. Reynolds, "Depression," in Handbook of Adolescent Psychopathology, V. B. Van Hasselt and M Hersen, eds., (New York' Lexmgton Books, 1995), 297-348.
4 J. Fawcett, and K. A. Busch, "The Psychobiology of Suicide," Clinical Neumscience 1 (1993): 101
5 D. Ness, and C. Pfeffier, "Sequelae of Bereavement Resulting From Suicide," American Journal of Psychiatry 147, no 3 (1990): 279-285.
6 D. C. Clark, Clergy Response to Suicidal Persons and Their Family Members (Chicago: Exploration Press, 1993).
7 D. A. Brent, K Poling, B. McKain, and M. Baugher, "A Psychoeducational Program for Families of Affectively 111 Children and Adolescents," Journal of the American Academy of Child and Adolescent Psychiatry 32 (1993): 770-774.