Managing Grief After Suicide
Psych Central posted this article on managing grief after a suicide. The article was placed in September as part of National Suicide Prevention Month. There are a couple of points this article made which extends to all of us who have been in or are in the throws of grief.
Dr. Raab the author offers up Kubler-Ross's five stages of grief. I am familiar with those stages and in my experience and reading the reality is we all grieve differently. The stages of grief for most of us is not a straight line. It is complex and ebbs and flows. That being said I am not minimizing Dr. Raab reference to Kubler-Ross just presenting it in a broader context. Grief is bouncing around those stage randomly.
Dr. Raab addresses the very real emotion of survivor guilt after a loved one commits suicide. There is no doubt that that exists. Survivor guilt is not limited to the extreme nature of suicide. I experienced survivor's guilt following Donna's death from cancer. I feel I do not deserve to have the home we created, be able to travel, be able to have joy that Donna is not having, and being alive. Survivor's guilt is real and my companion.
There are tools that Dr. Raab offers up:
Live in the present
Seek support
Write (Totally agree with this one)
Engage in activities that relax
Self-care
Be patient with one's self.
This article is a fair grief 101.
The Comfort of the Ordinary — On Dying as We’ve Lived
This is a very important opinion article that I found in the New England Journal of Medicine written by Caroline Wellbery, M.D., Ph.D.
Dr. Wellbery opens with some startling statistics about death in the US. US death rate is 7,452/day or one death every 12 seconds. She correctly points out with this number of deaths there is a lot of grief happening all around us.
Dr. Wellbery continues with the single most important point she offers, "people die as they've lived". She presents examples of how those who are dying are who they always were. As expected there are those who facing death go into truth telling, atonement, or expressions of love. Yet she offers that there are many others who at that time of approaching death choose to live life on their terms just as it was.
The observation that patients with terminal illness don’t want to discuss their prognosis or life after a terminal diagnosis becomes normal with the normal responses to life. Palliative care experts call this "dual framework". Which is described:
“As patients develop a greater awareness of the likely outcome of the illness, they cope less by swinging back and forth between optimistic hopes and realism and more by holding these ideas simultaneously.”
The day Donna received the diagnosis of terminal cancer and told that she had six months to live she was very clear as we sat and talked. I mostly listened. Her response to her impending death was "Take me to Oregon. Put me down. All that I have is yours." She cried. That was the last time she cried for three plus years. Near her final weeks she broke down once more.
In between those tears Donna gave me her disease. I managed her appointments, made pill packs, cooked, and more. I became the docent for her death. Her goal was not to allow the disease and the terminal diagnosis pull her from how she lived her life before cancer. In fact she was so much her this exchange took place in hospice two weeks prior to her death.
“Now would be a good time to have end-of-life discussions with Donna,” the Hospice Rabbi said. “What does she want for her funeral? What are her regrets? Did she find joy in her life?”
Joy? I failed her. She is dying and I am alive. All I could do was think of that.
I hesitated for a day. Then next afternoon, alone in the room with Donna, I looked at her in the bed and said, “Donna, do you want to talk about your funeral.” “Do you want to talk about your life?”
She looked over at me and said, “Don’t be a maudlin pussy.” Then she rolled onto her side and fell asleep.
I smiled. That was the woman I married 28 years ago, life and death on her terms, her way, take no prisoners, do not tolerate fools gladly, with no doubt about what was needed. She was not dead yet.
Donna is an example of Dr. Wellbery's premise in which I found much comfort. I struggle to believe I did as much as possible to keep Donna alive. What I learned was that because of Donna my caregiving allowed Donna to be herself till her death.