“NOBODY TALKS ABOUT SUICIDE, EXCEPT IF THEY’RE KIDDING”: DISENFRANCHISED GRIEF, COPING STRATEGIES, AND SUICIDE SURVIVOR IDENTITY IN PEER SUICIDE GRIEVERS
By
TANETTA E. ANDERSSON
Submitted in partial fulfillment of the requirements
For the degree of Doctor of Philosophy
Dissertation Advisor: Susan W. Hinze, Ph.D.
Department of Sociology
CASE WESTERN RESERVE UNIVERSITY
August, 2012
CASE WESTERN RESERVE UNIVERSITY
SCHOOL OF GRADUATE STUDIES
We hereby approve the thesis/dissertation of
Tanetta E. Andersson
candidate for the Doctor of Philosophy degree*.
Susan W. Hinze, PhD
Chair of Committee
Dale Dannefer, PhD
Brian Gran, PhD
Atwood Gaines, PhD
May 2nd, 2012
*We also certify that written approval has been obtained
for any proprietary material contained therein.
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ACKNOWLEDGEMENTS
I thank Professors’ Daniel Berardinelli, Ph.D and David Odell-Scott, Ph.D of Kent State University for restoring my love of learning. At Case Western Reserve University, I am especially grateful to the late Coach Bill Sudek whose assistance made it financially possible to complete my undergraduate studies. I thank other track and cross country coaches, Coach Jason Hudson and Coach Dennis Harris. I thank other members of my CWRU family including Janice Eatman Williams; Curtis T. Jewell, my friend in arms, and our mentee Frank “Nova” Polk. I am also very grateful to have received the Ruth Barber Moon Scholarship and the Patricia B. Kilpatrick Case Service Award during my studies. I am especially grateful to the Baton Rouge Crisis Center Foundation for awarding this project a dissertation research grant.
The first sociology class I took as an undergraduate was taught by my dissertation advisor, Susan W. Hinze, Ph.D. I am forever grateful to her for her intellectual guidance, generosity, and belief in me. I am also deeply thankful to Dale Dannefer, Ph.D for his insight and encouragement on this journey. Brian Gran, Ph.D and Atwood Gaines, Ph.D also guided this project. I could not have completed this project without the help of Frank Campbell, Ph.D. Over the course of my graduate studies, I am grateful for the influence of Rachel Chapman, Ph.D, Angela Woollacott, Ph.D, Gunhild Hagestad, Ph.D, Rhonda Williams, Ph.D, and Sarah Toman, Ph.D. Thank you, Bertice Berry, Ph.D for the Matrix- style pearl of wisdom: “Stay in peace, on task, and immoveable. Free your mind.” Nadra Williams, Donté Gibbs, Allison George, and Aaron Perine are students whom I treasure for many reasons. I thank several graduate school peers including Dawn Aliberti, Casey Schroeder, Joshua Terchek, Adam Perzynski, Ph.D., Lynn Gannon Falletta, Ph.D, and Noah Webster, Ph.D.
I thank the members of my equestrian family—a wonderful cast of eclectic characters: Kara Erdos Andrew and family; Bill and Carol Erdos; Jody Srsen, Jan Engle and I remember Jane Core, my fellow Bob Dylan fan, “Let us not talk falsely, the hour is getting late.” I acknowledge the equestrian teachers from whom I have borrowed in becoming a teacher myself. I thank Joan Iversen Goswell for receiving the United States Eventing Association’s Worth The Trust Scholarship during my doctoral studies. Most of all, I am profoundly grateful to my parents, Judith and Ben Andersson, and my brother, Mark Andersson. This work is dedicated to my study participants who courageously shared their stories of loss and those advocates who work, volunteer, or walk in aid of suicide prevention and suicide loss.
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TABLE OF CONTENTS
LIST OF TABLES ...... 6
ABSTRACT ...... 7
CHAPTER ONE: REVIEW OF THE LITERATURE ...... 9
Specific aims ...... 9
Bereavement literature: origins and horizons...... 14
Suicide and suicide bereavement...... 22
Young adult and adult peer suicide bereavement ...... 28
CHAPTER TWO: RESEARCH METHODS AND SAMPLE DESCRIPTION ...... 39
Procedure for collecting data...... 45
Issues of data quality...... 47
Analysis...... 52
Sample description ...... 53
Demographic characteristics of participants ...... 54
Bereavement characteristics ...... 54
CHAPTER THREE: ANALYSIS OF DISENFRANCHISED GRIEF IN PEERS BEREAVED BY SUICIDE ...... 57
Peer relationships as disenfranchised relationships ...... 58
Relational disenfranchisement: On the outside looking in? ...... 59
Relational disenfranchisement and social support contexts: “Should I really be here?” ...... 73
Relationships among co-survivors and social support...... 79
Suicide and disenfranchising social forces ...... 82
3 Memorial services, religion, and disenfranchisement...... 82
Media, disenfranchisement, and suicide grief...... 92
Schools and disenfranchised suicide loss: “And let’s all pray for her ‘cause she had more problems than any of us could understand.” ...... 95
Disenfranchising language and silencing in suicide loss: “Nobody talks about that [suicide], except if they’re kidding.” ...... 101
CHAPTER FOUR: COPING AND RE-ENFRANCHISING EXPERIENCES OF PEER SUICIDE ‘SURVIVORSHIP’: INDIVIDUAL, INTERMEDIARY, AND GROUP-BASED STRATEGIES...... 108
Individualized Coping Strategies ...... 110
Intermediary Coping Strategies ...... 119
Psychological counseling and coping...... 119
Interpersonal advocators...... 124
Group-Based Coping with Peer Suicide Loss ...... 136
Support group participation as externalized coping ...... 137
Suicide prevention advocacy, activism, and re-enfranchised grief. .. 142
Suicide survivor identity: “I’m a survivor. This is what I went through. I lost my best friend.”...... 169
CHAPTER FIVE: ADVANCING THE DISENFRANCHISED GRIEF FRAMEWORK, RE-ENFRANCHISEMENT IN THE CONTEXT OF SUICIDE LOSS, AND SUICIDE SURVIVOR IDENTITY FINDINGS ...... 179
Expected study findings: Returning to study aims ...... 180
Study findings: Advancing and challenging the disenfranchised grief model in peer suicide loss, re-enfranchisement contexts, and survivorship identity status 184
Advancing and challenging the disenfranchised grief framework by analyzing peer suicide loss...... 184
Suicide loss disenfranchisement...... 188
Re-enfranchising suicide loss: Group-based coping contexts and suicide survivorship...... 189
4 Understanding peer suicide griever re-enfranchisement at the macro- level: Out of the Darkness fundraising walks...... 190
Understanding peer suicide griever re-enfranchisement at the meso- level: Local Outreach to Survivors of Suicide (L.O.S.S.) Volunteer Programs...... 205
Micro-level understandings of re-enfranchisement and identity: Suicide griever versus suicide survivor?...... 208
Implications of Suicide Loss Findings: Scrutinizing Commodification and Medicalization of Grief ...... 220
Commodifying grief by selling closure...... 220
Medicalizing suicide grief? ...... 223
Conclusion and future directions...... 226
Study limitations...... 229
REFERENCES ...... 235
5 LIST OF TABLES Figure 1: Summary of Study Sample Information ...... 56
6 “Nobody Talks About Suicide, Except If They’re Kidding”: Disenfranchised Grief, Coping Strategies, and Suicide Survivor Identity in Peer Suicide Grievers.
ABSTRACT
by
TANETTA E. ANDERSSON
Since Durkheim’s (1897/1979) classic study, sociologists have understood that while suicide appears to be a highly personal and private act, it is also a social act. In 2009, nearly 37,000 Americans died by suicide (American Association of Suicidology, 2012).
Experts estimate that every suicide intimately affects at least six individuals, both family members and friends, connected to the suicide decedent (Shneidman, 1969). A central question in the field of suicide bereavement is how suicide grief differs from other types of loss (Jordan, 2001). However, such a focus has restricted suicide grievers studied to next-of-kin relationships, despite emphasis that suicide grievers constitute several populations (SAMSHA, 2010). By investigating suicide loss in peer relationships through a qualitative study, this dissertation serves to diversify scholarly inquiry of suicide grief.
Moreover, employing the disenfranchised grief framework (Doka, 1989; 2002) as a theoretical lens emphasizes the sociality of suicide loss, especially in terms of relational status and stigmatized dimensions of death by suicide (Charmaz & Milligan, 2006).
Twenty-six peers were identified through chain referral sampling strategies (Berg, 2007) and in-depth, semi-structured, face-to-face and telephone interviews were conducted.
Results identify several new variants of disenfranchised grief in terms of stigmatized loss and relational status. A continuum of intrapersonal, intermediary, and group-based or extrinsic coping behaviors was developed to conceptualize and understand participants’
7 varied re-enfranchisement experiences. In particular, participants’ involvement in suicide prevention advocacy such as fundraising walks and programs contributes insights into the process and meanings of re-enfranchisement among peer suicide grievers. At the macro- level, this impetus towards advocacy for suicide prevention among participants is considered through the lens of the health social movement literature within medical sociology (Brown et al., 2004). Alternatively, at the micro-level, findings suggest that a suicide survivor identity is a collaboratively-based identity whereby group contexts influence how this status is defined, signified, affirmed, and even policed (Schwalbe &
Mason-Schrock, 1996). Moreover, the existence of these group-based remedies for suicide grief raise the question of whether recently proposed changes to the upcoming
DSM-V medicalizing (Kleinman, 2012) and privatizing grief under a depression diagnosis will indirectly foreclose suicide grievers accessing these resources.
8 Chapter One: Review of the Literature
Specific aims
Sociologists are very familiar with thinking about suicide in the vein of
Durkheim’s (1897/1979) classic work. By using macro-level data, his approach underscored that suicide is a social act, even though it appears to be a highly personal and private act. Sociologist Monte Bute points out that Durkheim’s classic study, somewhat paradoxically, created a disciplinary blind spot in studying death and dying within sociology. “Because Durkheim emphasized macro-level data to create an invariant model of research; he wasn’t interested in individual cases or motive or intention,” explains
Bute (as cited in Smajda, 2011). He continues that this has to some extent thrown the baby out with the bath water in terms of sociologists studying meaning and process related to death, dying, and loss. Yet, suicide does not occur in a vacuum and the effects of suicide continue after the act.
In 2009, nearly 37,000 Americans die by suicide. It ranks as the tenth leading cause of death in the United States. By contrast, in the same year, over 16,799 Americans died as a result of homicide. This comparison is not made to diminish the loss of lives to homicide, but to foreground the scale of suicide as a public health problem on a societal level (United States Public Health Service, 1999). Further, it is estimated that at least six individuals are intimately affected every time such a loss occurs (American Association of Suicidology, 2004; Colt, 1991; Shniedman, 1968). For example, from 1984-2008, that equates to 4.5 million or one in every sixty-five Americans. In contrast to Durkheim’s work, my research seeks to identify social patterns in suicide’s aftermath.
9 Scholarly literature on grief has primarily been conducted in the context of familial and spousal relationships, in particular widowhood (e.g., Lindemann, 1944;
Bowlby, 1980; Glick, Weiss, & Parkes, 1974), with significantly less attention given to social bonds outside the family of orientation or procreation. Similarly, the same sampling stricture also predominates in bereavement studies specific to suicide. In this literature, whether bereavement resulting from suicide represents a distinctive loss has been the overarching question (Jordon, 2001). Consequently, study designs which address this question are largely quantitative and comparative by nature, often contrasting grief outcomes from accident, homicide, and suicide losses, thereby limiting the population of those most often studied to family members as a consequence of study design (i.e., to control for the relationship to the suicide victim). Thus, the meaning and contours of suicide grief outside familial bonds represents an understudied area, yet policy makers recognize the presence of multiple populations of suicide survivors. For instance, the National Strategy for Suicide Prevention calls for researchers studying suicide survivors to understand how the experience and burdens of suicide survivors is conditioned by age and the place in the life course of the survivor, and their relationship to one another (Substance Abuse and Mental Health Services Administration, 2004). Yet, the suggested relationships listed in this publication are all familial in nature (e.g., parent survivor-child victim; parent victim-child survivor, spouse victim-spouse survivor, etc).
Consequently, the primary research question of this study asks: What are the inter- subjectivities of suicide loss among peer suicide grievers? This investigation captures these inter-subjectivites through several study aims outlined below:
1. To explore the content of suicide grief among peers of suicide decedents.
10 By examining suicide grief experiences in peer relationships, the primary aim of this study illuminates meanings and social contours which shape the grief experience of peer suicide grievers--a long overlooked but sizeable population. Although broad, this core question is a necessary starting point given the paucity of qualitative research concerned with suicide bereavement among peers. Consequently, this study addresses a key gap in not only the scholarship of grief but also suicide grief in particular.
In her sociological study of motherloss during adolescence, Davidman (2000) points toward a methodological dilemma presented by the very nature of studying grief.
Davidman explains she began the interview process with the intention of asking “a bare minimum of questions” in accordance with principles of grounded theory which informs narrative analysis; she soon discovered that grief is not a topic which simply unfolds on its own. As such, her research highlights that accounts of loss do not reflect a coherent, linear narrative model. Instead, as she writes:
Most accounts, in fact, traced a spiraling circle in which the tellers’ memories and images of the disruptive event resurfaced in old and new ways throughout their lives, presenting them with the need continually to revise their sense of their early motherloss in light of later life events. My interviewees’ experience of their mother’s premature death reverberated throughout their lives, shaping narratives that circled, spun around, and included past, present, and future in any number of configurations that helped them to make sense of their experiences. (Davidman, 2000, p. 167)
While some scholars conclude that there is no significant empirical evidence to indicate that suicide bereavement does not impact survivors more than other modes of death (Cleiren & Diekstra, 1995; McIntosh, 1993). Other scholars argue that some questions remain open. For instance, Jordan (2001) points to the absence of studies which address the long term, existential imprint of suicide loss in the suicide bereavement
11 literature. He writes: “For example, suicide (as well as other forms of trauma) may disrupt the assumptive world or cognitive schemas of survivors about their sense of safety, efficacy, and personal worthiness” (Jordan, 2001, p. 98). This hunch is borne out in other research on death and dying (Young, Seale, & Bury, 1998).
2. To understand whether suicide grievers maintain a continuing bond with their deceased friend or peer. The dissertation aims to advance understandings about the nature of friendship bonds after bereavement and after suicide. For example, after bereavement, if friends report an ongoing attachment with their deceased peer, then this study contributes further evidence for the continuing bonds model of grief. Most recently, the continuing bonds model of grief has gained momentum because it challenges the
Freudian prescriptive imperative to detach from decedents. Therefore, this study investigates this model of grief in peer suicide loss because we know little about this understanding of grief in this loss context. For example, given the strong emotional content of suicide loss, especially anger, shame, and guilt, it could be argued that suicide grievers have a strong incentive not to maintain a continuing bond with their decedent.
3. To investigate whether peers experience grief resulting from suicide as disenfranchised grief. A third aim of this study relates to grief’s ‘sociality’ in peer relationships and broader social implications (Valentine, 2006). The disenfranchised grief perspective (Doka, 1999; 2002; Corr, 1998) stresses that in addition to the intrapersonal aspects of grief, social dimensions shape the grief experience, thereby individuals experience disenfranchised grief following a bereavement or loss “that cannot be openly acknowledged, publicly mourned, or socially supported” (Doka, 1999, p. 4). Indeed, peers who have suffered a suicide loss may potentially experience disenfranchisement
12 along two dimensions specified by this grief framework: 1) peers’ non-kinship relationship is less socially recognized vis-a-vis kin relationships, and, 2) the social stigma related to the nature of suicide death. This aim, then, addresses the extent to which social forces like stigma and interactions between self, individual, and society might impact bereavement experiences following a peer’s suicide.
4. To examine if peer suicide loss represents a counter transition in life course. To enrich the study of loss, some grief scholars call for research to incorporate heuristics from interdisciplinary sources work to capture the full spectrum of social forces which influence grief. For example, Neimeyer (2005-2006) argues for grief understandings which take into account social phenomenon ranging for transcendental, cultural discourses and symbols, communal, and phenomenological factors which influence and possibly invalidate a sense of self after bereavement. Because the life course perspective emphasizes the intersection in time of biography and history on all levels of social contexts, it offers several concepts or heuristics with disciplinary cross- fertilization potential. Viewing grief through the life course framework suggests new applications of key concepts such as off-time counter transitions, linked lives, and the role of life course consociates. In particular, such insights might elucidate the social consequences of a non-normative loss like suicide across the life course. Other principles central to life course paradigm related to age, cohort, period, and timing of life events, may also inform the study of suicide loss.
Background
Grief is a complex phenomenon with myriad causes and consequences.
Psychology, anthropology and, more recently, nursing have made disciplinary
13 contributions to the academic study of grief, with sociologists entering this discussion only relatively recently. First, this section begins with a clarification of conceptual language and then proceeds to situate the preceding study aims within bereavement scholarship drawn from psychology, anthropology, and nursing disciplines. Second, scholarly literature which specifically addresses suicide bereavement and peer bereavement is considered.
Bereavement literature: origins and horizons. Though commonly used interchangeably bereavement, grief, and mourning are employed distinctly by most scholars studying experiences of loss. Indeed, the etymological origin of the word grief stems from “grever”—to harm or aggrieve in old French, while bereavement or bereft, means to deprive, rob, strip, dispossess (Oxford English Dictionary). According to the
Handbook of Bereavement Research, bereavement refers to “the objective situation of having lost someone” (Stroebe et al., 2001, p.6) or event of loss, while grief refers to the reaction to the loss (DeSpelder & Strickland, 2002). Further, grief is not limited to emotional reactions (e.g., disbelief, anxiety, and sorrow) alone but may include physical
(e.g., sleep and appetite disturbances), behavioral (e.g., restlessness and crying), and spiritual reactions. For instance, London historical city records dating back to 1657 demonstrate early connections of grief with ill-health, or what is commonly accepted as
“dying of a broken heart,” whereby “griefe” was accepted as an officially-recognized cause of death (Parkes, 2001). For grief scholars outside the Freudian tradition, mourning captures the social nature of grief and reflects “the social expressions or acts expressive of grief that are shaped by the practices of a given society or cultural group” (Stroebe et al., 2001, p.6). For those whose work is anchored in the Freudian tradition, the term
14 ‘mourning’ is used in place of grief in recognition of Freud’s (1917/1953) distinction between depression and grief in his classic work on Mourning and Melancholia.
Within the discipline of psychology, two different general strands of theory are broadly observed in the bereavement literature. Evolving from the psychoanalytic tradition, the depression model of grief stems from Freud’s work but has been further articulated by Lindemann (1944) and Bowlby (1980). Theories and research within this line of inquiry approach grief as an emotional reaction and elucidate psychological responses following the event of bereavement. Alternatively, grief has been understood through the stress model (Lazarus & Folkman, 1987; Lieberman, 1996). This approach views bereavement as a stressful life event, emphasizing the consequences for physical health; it highlights sequelae possibly overlooked by depression models of grief which focus on intra-psychic mechanisms (Stroebe, Stroebe, & Hansson, 1993). However, critics argue that approaching bereavement as a “stressor” lacks specificity in the range of loss and its consequences (i.e., secondary stressors) and may ultimately obscure studies of grief (Stroebe & Schut, 1999). Most recently, as will be discussed in subsequent sections, the continuing bonds model of grief is gaining ascendancy because it offers what the authors’ call “durable biographies” in place of the imperative of overcoming grief by cessation of attachment to the decedent—the hallmark of psychoanalytical and attachment theories of grief (Cavanaugh, 2005). Further, these sections explore the sociological literature on grief and bereavement which represents a growing subfield.
Focus on social contexts, these approaches introduce fresh interpretations of bereavement and challenge prior premises and omissions.
15 Many grief scholars trace the academic study of bereavement to Freud’s influential text entitled Mourning and Melancholia (1917/1953) published during the grip of World War I when human loss was at a height across Europe. Although a number of early anthropological accounts of mourning practices represent notable forerunners too.
However, as Valentine (2006) underscores, these forerunners are problematic because of their tendency to ‘exoticize’ grief and mourning customs, thereby espousing the cultural bias of early anthropological scholarship. By contrast, Freud’s paper draws on his clinical observations arguing that mourning or grief may lead to mental and somatic ailments. In
Mourning and Melancholia (1917/1953), Freud compares and contrasts the nature of mourning (i.e., grief) with melancholia (i.e., depression). Freud writes, “In mourning it is the world which has become poor and empty; in melancholia it is the ego itself,” thereby couching grief within his psychoanalytical framework. This is also evidenced by his characterization of detachment from the object of a lost loved one as “decathexis,” or deconnecting psychic energy from an object—the essential process within Freud’ s conceptualization of “grief-work” (Shaver & Tancredy, 2001). More significantly, though, his work forged the link between so-called “pathological mourning,” characterized as either an excessive grief or failure to grieve, as the catalyst of many psychiatric illnesses. Thus, medicalizing grief and framing it within the depression model of grief. Moreover, by associating pathological grief with concepts within the psychoanalytic tradition, his text overlooks the task of developing the normal model of grief introduced at the beginning of this now foundational piece.
More recently, Lussier (2000) offers a critical re-evaluation of Freud’s text identifying the internal (i.e., biographical) and external sources and citations (i.e.,
16 anthropological, religious, psychiatric, and psychoanalytic) from which Freud actively drew to support his ideas. In her investigation of Freud’s influences, she highlights the work of Edvard Westermarck (1863-1939). While he famously mentored the anthropologist Malinowski, Westermarck was also trained as a sociologist. Lussier
(2000) notes that Westermarck focused on historical and cross-cultural studies of marriage and family, morality, and religious institutions in his scholarship. Therefore, his approach to the nature of grief was steered by his broader interest in social bonds. In his consideration of cross-cultural mourning practices and the relationships of the dead to the living, Westermarck suggests, most interestingly, that mourning differs according to the social position (e.g., marginalized versus non-marginalized) of the deceased. For example, a bachelor in comparison to a woman or child would likely elicit varied mourning responses of “sympathy, respect, or fear” because women and children were conferred an inferior social status compared to adult males in the early 1900s
(Westermarck, 1906-1908, p. 549). Lussier (2000) observes that Freud overlooks
Westermarck’s insights into the social nature of mourning because his observations did not square with the internal forces undergirding Freud’s conceptual framework. Lussier
(2000) continues, “Nowadays, our distinctions would be based on affective rather than social criteria” (p. 674) because of Freud’s narrowed focus. Yet, her remarks indirectly illustrate that Westermarck’s early observations into the social nature of grief reflect presentiments of the disenfranchised grief approach (Doka, 1989; 2002) emphasized by sociological understandings of grief nearly a century later (Charmaz & Milligan, 2006).
Freud’s view of mourning would stand alone until the era of World War II.
Working within the depression model of grief, Lindemann’s (1944) studies of patients
17 seeking help following a Boston night club disaster are significant because he compares
“normal” grief reactions and “various deviations from the norm” triggered by the same tragic event. Interestingly, in respect to grief resulting from suicide, Lindemann (1950) characterizes this type of bereavement as a “triple loss,” whereby the survivor must simultaneously contend with, “the death itself, the implicit rejection by a loved one who preferred death to ongoing companionship, and disillusionment about a person whom the survivor had admired (as cited in Ness & Pfeffer, 1990, p. 281). Thus, his work offers a detailed and more systematic description of acute grief not articulated in Freud’s work.
Subsequently, Bowlby’s (1973) attachment theory of grief developed from studying children’s reactions to separation from their mothers during stressful situations.
After learning of Marris’s (1958) research highlighting bereaved widows, Bowlby noted parallel reactions between separation anxiety and widow’s grief reactions. According to
Bowlby, the phases of grief share and reflect the same behavioral stage model observed in childrens’ separation from their mothers: 1) numbness, 2) yearning, searching, and anger, 3) disorganization and despair, and 4) reorganization. As an approach, then, his attachment theory of grief emphasizes an evolutionary view of bereavement which serves a biological function on a level with other instinctual human behaviors such as mating and parental behavior (Klass, Silverman, Nickman, 1996). Similarly, Bowlby’s attachment theory of grief shares with the psychoanalytic tradition the central tenet that, ultimately, the purpose of grief is to sever the bond with the deceased in order to invest in new relationships. Yet, as Silvernman & Klass explain, “Bowlby grounded psychological theory in the actual events of childhood, not in the psychic trauma linked to the Oedipal conflict, which was the center of psychoanalytic theory.” (1996, p. 10)
18 Parkes and his colleagues (Glick, Weiss, & Parkes, 1974; Parkes, 1972; Parkes &
Weiss, 1983) have extended Bowlby’s attachment theory of grief. For Parkes, grief is
‘ethological’. As such, grief is understood and studied as a, “preprogrammed series of behaviors cued by specific environmental stimulus” (Klass & Silverman, 1996, p.11). To illustrate this conceptualization, Klass & Silverman (1996) offer the example of nest building among birds as an instinctual behavior precipitated by the environment which parallels Parkes’s notion of grief. Klass & Silverman (1996) use one finding in particular from Parkes and his colleagues’ study of London widows. Here, they argue that experiences of visual and auditory hallucinations reflect the searching behavior which is brought on by separation from the object of attachment. According to this theory, such interactions with inner representations of the lost loved one serve to only frustrate the griever and will inevitably lead grievers to surrender their attachment to the deceased.
Yet, Silverman and Klass (1996) note instances where Parkes and his colleague’s data belie their conclusions. Some of their findings indicated that widows in their sample maintained a continuing attachment to their deceased spouses. Further, they report that fully forty-seven percent of their sample agreed in the thirteen month post-bereavement interview with the item asking: “I have the feeling that my husband watches over me”
(Glick, Weiss, & Parkes, 1974, p. 146). The nagging presence of such data demonstrates that the authors’ guiding theoretical framework is unable to account for such antithetical findings in their analysis of the first year of bereavement. Additionally, in their concluding section on the impact of loss, Glick, Weiss, & Parkes (1974) discuss significant sex differences between widowers and widows. Yet, with complete data four years post-bereavement on just seventeen widowers, the authors caution that their sample
19 cannot be viewed as representative. Nevertheless, Glick, Weiss, & Parkes (1974), perhaps unwittingly, make an argument for the influence of social position in the experience of grief.
Similarly, sociologists introduce another important critique of bereavement studies at this point of development. Valentine (2006) contends that, taken together, the findings of Freud, Bowlby, and Parkes have been subject to a process of prescription, whereby the view of grief as a fixed and linear series of states has eclipsed the view of grief as a process in popular and professional discourse. Valentine observes: “His attempt to understand certain mental states has, through professional usage, been translated into a generalized prescription by which grief can be managed and normalized” (2006, p. 60).
This pattern of prescription is also witnessed in Kübler-Ross’s (1970) stages of dying, whereby denial, anger, bargaining, depression, and acceptance have been adopted and generalized into a similar stage model of grief by professional discourse. That her celebrated stages of dying did not escape the pull of this “universal prescription” is further evidence of this trend’s pervasiveness. Ultimately, as Valentine (2006) argues, focus on prescriptions for grief has dramatically shifted attention away from the role of social context in the study of bereavement to the detriment of the field.
However, the emergence of the disenfranchised grief perspective (Doka, 1989) signals an advancement in bereavement studies which foregrounds the role of social context, especially stigmatizing and marginalizing social status in grieving experiences.
Recognizing that some losses are validated and legitimatized by the larger society, while others types of grief are not, Doka connects the social nature of the attachment which preceded bereavement with the grieving experience that follows. For example, those
20 marginal, hidden, or less socially-visible attachments are more likely to experience disenfranchised grief or “loss which cannot be openly acknowledged, socially validated, or publicly mourned” (Doka, 1989, p.xv).
Doka (1989) explains that his perspective originates from a 1984 conference paper presentation which compared the grief experiences of homosexual and heterosexual lovers. Subsequent chapters evolved from others sharing parallel experiences and relationships, losses, and grievers. Grief of foster parents caring for children with AIDS, the friend-griever, employee grief, grief resulting from divorce, grief among clergy, nurses, hospice workers, and health workers of persons with AIDS, perinatal death, and even loss of animal companions are all elaborated. These aforementioned grief experiences all share, “the inability of grievers to receive social support and validation,” writes Doka (1989, p. xvi). However, conspicuously missing from this catalogue is a discussion of disenfranchised grief resulting from suicide. Further, Doka argues that disenfranchised grief is particularly salient in complex societies where social rituals marking death have shifted from the communal to familial realm. According to Doka, this shift restricts the expression of grief to a privilege of kinfolk over non-kin relationships such as peer attachments.
Currently, sociologists of grief challenge both prevailing theoretical and empirical approaches in the literature. Valentine (2006), a contemporary bereavement sociologist, assesses shifting academic constructions of bereavement by highlighting conflicting discourses between science and nature. On the one hand, due to Freud’s powerful influence, scholars working from a psychological background frame grief through the lens of depression, thereby disciplinary approaches have tended to “psychologize and
21 medicalize” grief in modern Western societies (Engel, 1961). According to Stroebe and
Schut (1999), this view runs the risk of narrowing the grief experience down to:
….something that needs curing, needs to be overcome, is bad. There is the implicit assumption that, after the death of a close person, one must return to a positive state of mind and well-being as soon as possible. The danger, following this line of reasoning, is that human suffering, integral to grief as we know it, will be considered bad, and that the human condition should only, ideally, encompass positive states and emotions, a view that is far from universal. (p.203)
While, on the other hand, anthropological approaches studying the mourning or ritual grief behavior of pre-modern or non-Western cultures have tended to “exoticize and romanticize” the grief of these “others” (Valentine, 2006, p.62). Despite a pattern of sequestration of grief existing within sociology, Valentine (2006) holds that the nature of grief is “profoundly social” by highlighting recent research investigating the continuity of bonds by individuals with their lost loved ones (Klass, Silverman, Nickman, 1996).
Having considered the bereavement literature in general, the following section now focuses on grief resulting from suicide. First, the scale of suicide and bereavement in the United States are presented. Second, major findings among those bereaved by suicide are discussed and larger debates surrounding the significance of unanticipated mode of death (i.e., suicide, accident, homicide) are highlighted including the question of whether suicide represents a distinctive loss.
Suicide and suicide bereavement. Currently, suicide is the tenth leading cause of death in the United States, and the third leading cause of death among the young. Today, nearly 37,000 Americans die by suicide annually (American Association of Suicidology,
2012). Globally, the World Health Organization (WHO) estimates that nearly one million people die by suicide (World Health Organization, 2012). In the U.S., firearms rank as the leading method of self-inflicted harm, followed by suffocation/hanging, poisoning,
22 cutting/piercing, and drowning. Moreover, the estimate that every suicide intimately affects at least six survivors is the most significant statistic for this project. Thus, it is conservatively estimated that 1 of every 65 Americans have lost a family member or friend to suicide. All told, suicide exacts a significant human toll when lives lost, harmed, and bereaved by suicide, are taken into consideration (American Association of
Suicidology, 2012). However, as will be considered later, death by suicide as a health problem represents a pall which rarely enters public discourse because of the myths and stigma which have historically been associated with mental illness and suicide. Despite these shocking statistics, Colt (1992) reveals a historical dearth of attention by scholars regarding the impact of suicide, “A bibliography on suicide from 1897 to 1970 lists only fifteen articles relating to survivors” (p. 429). Thus, the following section highlights both psychological and social outcomes for suicide survivors in this growing body of literature.
Research demonstrates an elevated presence of complicated grief in those bereaved by suicide (Mitchell, Kim, Prigerson, & Mortimer-Stephens, 2004).
Complicated or traumatic grief syndrome is characterized by symptoms of separation distress (i.e., intrusive thoughts about the deceased, yearning for the deceased), and traumatic distress such as feelings of disbelief, a fragmented sense of security and trust, feeling that part of oneself has died, and subjective sense of numbness persisting for 6 months or more (Latham & Prigerson, 2004). Further, Latham & Prigerson (2004) highlight that while symptoms of bereavement-related depression seem to subside with time and medication (e.g., tricyclic antidepressants), complicated or traumatic grief
23 persists. Studies find that complicated grief is associated with a greater risk for suicidal thoughts and actions among those not bereaved by suicide (Latham & Prigerson, 2004).
Recently, similar research among suicide survivors indicates that the association between complicated grief and suicidal ideation is also evident in this population. For example, in an exploratory study with a sample of sixty adult suicide survivors where the victim was either a family member or significant other were surveyed one month post- bereavement, Mitchell et al.(2005) found participants experiencing syndromal complicated grief exhibited 9.68 (CI: 1.036, 90.417) times greater likelihood of suicidal ideation with adjusting for the effect of depression. Having reviewed intrapersonal consequences for suicide survivors, the following section highlights interpersonal or social factors associated with death by suicide.
Alternatively, Stillon and Stillon (1999) stress social attitudes towards suicide,
“Suicidal behavior is embedded in the culture and the historical moment in which it takes place. The meanings that average citizens in a culture ascribe to suicidal behavior at any point in time, therefore, become critical elements in understanding life-threatening behavior” (1999, p. 78). For example, until the nineteenth century, suicide was considered both a mortal sin and crime in most Western societies. Historical records indicate that following their death, suicide victims were prosecuted in court for murder, treason, and heresy; once “convicted” of suicide their remains were subsequently removed from cemeteries or, worse, dragged through the streets of the city and abandoned in the sewer (Aries, 1981; Colt, 1992) By the same token, repercussions for survivors included being unable to inherit an estate form a suicide victim; their goods and
24 property forfeited to the Crown (Stillon & Stillon, 1999). Even in present times, some survivors continue to experience “the mark of Cain”:
But while suicides are no longer buried beneath mountains to trap their restive souls, their survivors are still struggling against the weight of centuries of stigma. More than a hundred years after confiscation of property was abolished, many life insurance companies continue to deny benefits to families of people who commit suicide within two years after buying a policy. (Colt, 1992, p. 430)
Thus, in the context of disenfranchised grief (Doka, 1989) discussed earlier, specifically the type of death involved in bereavement, next of kin were and still are, in some instances, literally disenfranchised as a result of their loved one’s suicide. Such accounts suggest that the stigma historically associated with suicide persists to this day.
Of course, reactions to suicide seem less extreme nowadays. However, contemporary research on the question of suicide survivors’ experience of social stigma and/or rejection indicates mixed results. For example, Range and Martin (1990) assessed social attitudes toward suicide victims and their bereaved families. In this study, the experimental group was exposed to eight varying descriptions of extenuating circumstances including psychological pain (e.g., bankruptcy, incarceration, bereavement), physical pain (e.g., burns and arthritis) or terminal illness (e.g., AIDS and terminal bone cancer). The control group received no information about extenuating circumstances and the sample consisted of 180 participants. Their findings indicate that participants were least tolerant of suicide when the victim had been suffering from psychological pain, more tolerant of physical pain, and the most tolerant of the terminally ill. In turn, this pattern of decreased tolerance was also associated with greater blame towards the bereaved family members of the hypothetical suicide victim suffering from psychological pain. Similarly, decreased tolerance of the psychological victim was also
25 associated with the view that such a family was in need of professional help (Range &
Martin, 1990).
To compare the type of death with post-bereavement experience and treatment by others, Range and Calhoun (1990) conducted semi-structured interviews in a sample of fifty-seven participants. Types of death included suicide, accident, homicide, natural anticipated death, and natural, unanticipated death. However, relationship to the deceased was not controlled for in their analysis, thus groups consisted of both family and non- family members. The authors note, though, that for participants bereaved by suicide
(n=11), the majority were friend relationships. In their findings, they report that those bereaved by suicide experienced heightened expectations to explain the nature of the death. This is underscored by the outcome that nearly half or forty-four percent of the suicide group reported lying about the cause of death.
Finally, in reviewing the literature to date on the relationship of social stigma experienced by suicide grievers, Cvinar (2005) offers mixed evidence on this question.
Some studies suggest that social stigma towards suicide grievers’ is negligible and dissipates after two years, while other studies support more lasting effects. Such outcomes indicate that there are both psychological and some social factors experienced by suicide survivors which combine to support this type of bereavement being consistently hypothesized as distinct from other losses. Hence, the field of suicide bereavement has been occupied with addressing this central question.
In a comprehensive review of this literature, Jordan (2001) finds mixed evidence for differences between suicide and other modes of bereavements. Upon examination of methodologically-rigorous studies conducted among this population, a cadre of
26 researchers assert that, “there may be few, if any, empirically documented differences between suicide bereavement and other types of mourning” (Jordan, 2001, p. 91). This stalemate reflects one of two possibilities: that, categorically, there are no differences or that we are asking the wrong questions. Yet, on the other hand, accounts from suicide survivors themselves and practitioners suggest that loss resulting from suicide is different from other types of loss. Consequently, Jordan (2001) outlines key areas, including the content of grief and social processes around survivors which suggest distinct outcomes for suicide survivors. Further, past research indicates that the struggle for meaning is magnified for suicide survivors (Jordan, 2001; Grad & Zavasnik, 1996; Silverman,
Range, & Overholser, 1994-1995; Smith, Range, & Ulmer, 1991-1992). For instance,
Ness and Pfeffer (1990) highlight the example of a psychiatrist whose wife took her own life, and his use of the term “existential sequestrum” to describe his ongoing struggle with this content, in particular, the fact that her life ended by her own hand (Rynearson,
1981).
Whether bereavement resulting from suicide represents a distinctive loss is the dominant focus of this growing suicide bereavement scholarship. Yet, study designs which address this question are largely quantitative and comparative by nature, often contrasting grief outcomes from accident, homicide, and suicide losses. Thus, the population of those bereaved by suicide most often studied is limited to family members in order to control for the relationship to the suicide victim through study design. The following section focuses on assessment of peer relationships or attachments in grief resulting from suicide.
27 Young adult and adult peer suicide bereavement. While most prevalent among older adults over the age of 65, suicide is a leading cause of death for the young. For adolescents and young adults ages 10-24, suicide is the third leading cause of death after accidents and homicide. On average, one young person every two hours is lost to suicide
(American Association of Suicidology, 2012). Also, suicide is the second leading cause of death among college students. From 1980 to 1996 youth suicide rose significantly; however, suicide rates for young adult males have fallen sharply in the past decade
(National Adolescent Health Information Center, 2006). Because mood disorders are the single greatest predictor of suicide, this recent downturn corresponds with the introduction the tricyclic class of anti-depressants.
Bereavement has been historically examined in the context of familial or spousal relationships, with the grief of peers and friends remaining an understudied area. This may be in part due to the field’s concentration upon the central question of whether suicide represents a distinctive loss. Therefore, the population most often studied of those bereaved by suicide is limited to family members in order to control for the type of relationship. Very few qualitative studies have assessed peer suicide bereavement.
In bereavement research, peers and friends represent a hidden population (Sklar &
Hartley, 1990). Sklar and Hartley (1990) argue that horizontal ties such as close friendships, may serve a function of equal importance to that of the family, sometimes substituting for family, or as a “safety valve” providing a realm where the pressures of family life may be relieved. Indeed, friends might be aware of confidences which may not have been shared with family. In prior sociological work on friendships, Wallace and
Hartley (1988) find such bonds correspond with religious elements elaborated in
28 Durkheimian theory. Durkheim’s study of the integrative nature of religion is widely known, however Wallace and Hartley (1988) draw attention to early work on friendships done by Durkheim, including the influence of a close friend and classmate, Victor
Hommay, who killed himself. Some state this experience catalyzed Durkheim’s empirical study of suicide (Wallace & Wolf, 1995). For instance, Wallace and Hartley (1988) write:
In this chapter we argue that friendship can be seen as another functional alternative to religion in modern society because it provides the type of integrative element Durkheim proposed in his discussion of secondary groups. We view friendship as a quintessential sociological phenomenon. It necessarily involves an orientation to another individual, for friendship is an intimate relationship between two human beings which results in a social bonding. In addition we assume that close friendships, like religion, can offer a solution to the problem of meaning for the individuals involved. (Wallace and Hartley, 1988, p. 94)
Thus, Wallace and Hartley identify three dimensions in friendships which align with the functions of religion proposed by Durkheim: the building of rituals, a commitment to self-sacrifice, and the experience of sacred and transcendental aspects (Wallace &
Hartley, 1988).
Sklar and Hartley (1990) recognize this attachment being ruptured by bereavement and the subsequent grief experience by referring to this population as
“survivor-friends.” According to Sklar & Hartley, this term may encompass such relationships as adolescents and young adults, dyadic partnerships similar to conjugal relationships (i.e., heterosexual and homosexual couples, couples engaged to be married, etc), and older adults. Given that this project is informed by a life course theoretical orientation, Sklar & Hartley make an argument for the adolescents and young adult age group experiencing traumatic “off-time” grief. They write:
It is the age group most likely to experience sudden deaths rather than deaths from natural causes: automobile accidents, other accidents, homicide, and suicide are the leading causes of death among this group. As is well established, sudden death
29 is typically more traumatic for survivors than anticipated death. We have, then, an age group surrounded by sudden, violent, and highly disturbing deaths (Sklar & Hartly, 1990, p. 105).
Interestingly, Sklar & Hartley (1990) argue that, like friendships formed during young adulthood between exiting the family of orientation and entering into a family of procreation, older adults maintain close friendships or horizontal ties which function with a similar importance to family.
Since the publication of Sklar & Hartley’s work, a handful of empirically-driven studies conducted among peer suicide survivors suggest some preliminary findings for this group. For example, Prigerson, Bridge, Maciejewski, Beery, Rosenheck et. al. (1999) report that subjects exhibiting syndromal levels of traumatic grief experienced approximately five times greater likelihood of suicidal ideation, after controlling for depression. The original study from which follow-up measures were obtained consisted of 122 friends of 26 adolescent suicide victims in metropolitan Pittsburgh who died between the years of 1988 and 1991. It should be noted that study participants were nominated by family members of the victim after being asked which peers they considered to be closest to the victim. In their study, the mean age was 23.8 years
(SD=1.8). Of the original 122 peer suicide grievers, 76 participants completed follow-up interviews. Surveys were completed with a mean time of 6.3 years (SD=0.6) since their friend’s suicide. Thus, 15 of the 76 follow-up participants were found to exhibit syndromal levels of traumatic grief. The authors indicate that three of the original 132 participants (2.3%) reported an attempted suicide, but there were no completed suicides.
Thinking in the context of suicide loss, these findings suggest that a peer’s suicide can potentially have deep and lasting impact within a peer network.
30 Interestingly, the researchers also explored the possibility of a network effect in their follow-up group (n=76) derived from 23 of the originally-identified social networks, but found no evidence for such an effect. However, with the use of more advanced statistical techniques using the same sample as the above study (6, 12-18, and 36 months follow-ups after the suicide), Melhem, Day, Shear, Day, Reynolds III, & Brent (2003) report that a network effect was identified. In other words, this research found that complicated grief was more likely to occur in members of certain networks than others.
Additionally, complicated grief correlated with a closer relationship to the suicide victim.
It is significant to note that in examining network effects, this study did not include
(likely due to statistical limitations) other social statuses associated with a high risk of suicide like American Indian and LGBTQ youth. For example, D’Augelli (2002) finds that more than one third of LGB youth report attempting suicide. Researchers should be attuned to the presence of such marginalized statuses within peer networks which might elevate suicide risk through similar network effects. Overall, these findings alert us to the complex picture that adolescent and young adult peers encounter in the wake of suicide.
Theoretical orientations
The following section situates this study’s research question and aims within theoretical frameworks which illuminate the sociological nature of the proposed study. In particular, symbolic interactionism and the life course framework broadly inform this project. Both the social nature of peer attachments and loss due to suicide will be examined through this theoretical lens (Simmel, 1950). In particular, adaptations to grief drawn from understandings of chronic illness within this paradigm will be highlighted
(Bury, 1980; Davidman, 2000). Although many synergies appear between the study of
31 grief and the life course paradigm, very few applications of this theoretical lens to grief experiences exist. For example, the work of Hagestad (1988; 1990) suggests concepts of the life course framework might translate and enrich the study of suicide grief.
Symbolic interactionism. In contrast to macro-level theoretical systems, symbolic interactionism attends to the social nature of phenomenon at the micro-level, focusing on, “the individual ‘with a self’ and on interaction between a person’s internal thoughts and emotions and his or her social behavior” (Wallace & Wolf, 1995, p. 183).
Central thinkers in this tradition include Mead, Blumer (1969), Goffman (1959), whose work in examining the interface between self and society elaborates core principles of symbolic interactionism. Moreover, leading scholars of death, dying, and bereavement literature call for continued exploration of the theoretical contributions to this field from both psychology and sociology, and especially, symbolic interactionism (Corr, Doka, &
Kastenbaum, 1999). As such, both peer relational status and suicide death will be explored through this overarching perspective.
Within the symbolic interactionist paradigm, Simmel’s work is viewed as a significant forerunner to central theorists as Weber, Cooley, Mead, and Park (Frisby,
1994). For Simmel, interaction serves as the bridging social process through which sociologists may understand how society shapes individuals and, in turn, how individuals shape society. Interaction, or in Simmel’s terminology “sociation,” represents a core principle throughout Simmel’s diverse explorations of social life. Wolff writes that
Simmel characterized all of these interactions, “the whole gamut of relations that play from one person to another and that may be momentary or permanent, conscious or unconscious, ephemeral or of grave consequence,” as the “atoms” of society (1950, p.
32 10). Here, it is worth noting that the “grave consequences” corresponds with the risk of heightened levels of traumatic grief and possible suicidality of peer suicide grievers.
In Simmel’s work, the dyad and the triad represent some of the simplest forms of sociation and highlight Simmel’s explorations of small group dynamics. Drawing on the
Greek word signifying “pair,” Simmel described dyads as a social group with two members (Macionis, 2006). As such marriages and close friendships are examples of dyads. Yet, dyadic relationships are not limited to two individuals, even states and families too may comprise a dyad (Wolff, 1950). Triads consist of three members and are typically less intense than dyads but more stable because, for example, if relations are strained one member may act as mediator. Because the dyad depends on each of its elements alone, Simmel maintained that if either member seceded, having one member, the whole or dyad would be destroyed. If a member dropped out of triad, however, the group would continue to exist because of the sociation of the third triad member. As discussed earlier, evidence from the continuing bonds model of grief contradicts
Simmel’s assertion of the dyadic relationship ending upon the death of a member (Klass,
Silverman, & Nickman, 1996). Instead, in Simmel’s framework, it suggests the existence of an even smaller unit of social syntheses. For instance, Simmel writes:
Yet if we examine “individuals” more closely, we realize that they are by no means such ultimate elements or “atoms” of the human world. For the unit denoted by the concept “individual” (and which as a matter of fact, perhaps is insoluble, as we shall see later) is not an object of cognition at all, but only of experience. The way in which each of us, in himself and in others, knows of this unit, cannot be compared to any other way of knowing. What we know about man scientifically is only single characteristics. They may exist once, or they may stand in a relation of reciprocal influence to one another; but each of them requires its special investigation and derivation, which leads to innumerable influences of the physical, cultural, and personal environment—influences that come from everywhere and extend infinitely in time. Only by isolating and grasping them and by reducing them to increasingly simple, covert, and remote
33 elements do we approach what is really “ultimate,” that is, what is real in the rigorous sense of the world. This “real” alone must form the basis for any higher intellectual synthesis. Color molecules, letters, particles of water indeed “exist”; but the painting, the book, the river are syntheses: they are units that do not exist in objective reality but only in the consciousness which constitutes them. (Wolff, 1950, p. 6-7)
Another example of Simmel’s levels of sociation is witnessed in the celebrated example of the ‘Association of the Broken Dish’. Here, Simmel explains that because of their organic or number structure, dyads will eventually cease to be, suggesting that an awareness of mortality, consciously or unconsciously, also influences the individual members of a dyad. Recently, work by sociologists reflects Simmel’s classical intimations on the nature of mortality in the context of dyadic relationships. For example,
Young, Seale, and Bury (1998) highlight the renegotiation of friendship between family, healthcare professionals, and close friends in palliative care settings in which, for example, friends are nominated to ‘next of kin’ status on final directives, etc. In their retrospective bereavement study of sixty-seven ‘close friends’ or ‘friend/neighbors’, they consider the question of consequences for self-identity in dyadic relationships when death of one member is imminent. Here, the authors introduce Gidden’s (1991) concept of
‘ontological security’ as capturing the dimension of self-identity which comes under threat when a dyadic relationship is exposed to the presence of death. Young, Seale, and
Bury (1998) understand this concept as, “the possession on the level of the unconscious and the practical consciousness, of the ‘answers’ to fundamental existential questions which all human life in some way addresses” (1998, p. 40). Similarly, some argue that suicide represents a similar threat to these core beliefs about our assumptive world and call for further research which explores the “existential sequestrum” (Rynearson, 1981)
34 noted earlier in the content of grief resulting from suicide (Jordan, 2001; Lieberman,
2003).
Within medical sociology, the imprint of symbolic interactionist perspective is also evident in many subfields including work on chronic illness. In particular, the work of Bury (1980) in the context of living with arthritis elaborates symbolic interactionist concepts through his conceptualization of ‘biographical disruption’. Building on this elaboration, Davidman (2000) adapts and pushes this concept through grief contexts, specifically motherloss. In her study, Davidman conducted fifty in-depth interviews with respondents borrowing Bury’s (1980) conceptualization of ‘biographical disruption’.
Instead of chronic illness, though, Davidman applies notions around interrupted biographical flow to the event of bereavement and views adults’ experiences of motherloss during adolescence through this lens. For example, Davidman explores the initial loss and years afterward, relationship prior to loss, relationships with other members of family, views of motherhood prior to loss, life story after mother’s death, and, finally, broader cultural representations of motherhood. In sum, Simmel and
Davidman’s work foreground the strengths of the symbolic interactionist framework in the study of both grief experiences and social groups, specifically peer dyads.
Life course framework. This section highlights life course concepts which offer theoretical insights into understanding loss in the context of lives over time. The life course framework is a multidimensional framework which emphasizes historical events and personal choices which are age-graded and embedded in biographical and historical time (Quadagno, 2002). Although many synergies appear between the study of grief and the life course perspective, very few applications of this theoretical lens to grief
35 experiences exist. Among key life course concepts, linked lives, trajectories and counter transitions, and age norms in bereavement will be emphasized in the following section.
Central to the life course perspective is the understanding that our trajectories are linked with the life course trajectories of others resulting in ‘linked lives’. For example, we know much about the chain of interdependencies that exist in vertical ties within the family, but know very little about the horizontal linkages along life course trajectories over time. And, as grief scholar, Weiss (2001), argues, “we can better understand social relationships by the study of grief,” highlighting that the event of bereavement signifies an “interruption” in a bond (p. 61). To highlight the interdependencies among horizontal ties such as peer or close friend relationships, Hagestad (2003) foregrounds sociologist,
Schutz’s (1971) notion of ‘consociates’. This concept captures the nature of affiliation of those around us whose lives run close and parallel to ours. Consociates are usually family members, but they can also be found in other long term relationships formed by friendship or work roles.
Hagestad and Neugarten (1985) suggest that work and family careers can be significantly impacted by the life course choices of consociates in the workplace who might, for example move or retire, thus “dramatically” altering the lives of those they leave behind. More importantly, Plath (1980) observes that the individual’s opportunities and constraints hinge on the uncertain progress of others in their own life-stage tasks.
Additionally, ‘consociates’ also reflects the process of reciprocation between identities mentioned earlier. For example, this mutually-constitutive nature of relationship is implicit in such sayings as the African notion of “Ubuntu” which is understood to mean:
36 “I am because we are” (Ladson-Billings, 2000). For example, Hagestad and Neugarten
(1982) write:
A number of investigators have recently pointed to the importance of studying lives, not as monads or single identities but as co-biographies. For example, a collection of papers by scholars from different countries and different disciplinary backgrounds (Bertaux, 1982) calls for a co-biographical approach in pursuing various sociological and historical questions, as, for instance, analyzing the life “stories” of groups interrelated individuals.
Another principle of the life course related to linked lives is the conceptualization of transitions and countertransitions. The life course perspective understands that human lives are composed of many interlocking trajectories (i.e., work, family, health, leisure, etc) which, in turn, are linked by social institutions such as the family to others’ lives.
Within the family realm, Hagestad (1988) defines transitions as life changes produced in the social roles and identities occupied immediately by the individual which are self- initiated, whereas countertransitions refer to shifts in role or identity that occur as a consequence of status changes in other family member’s lives. For example, countertransitions include experiencing grandparenthood, becoming a mother-in-law or daughter- in-law as a consequence of intermarriage between families, and “ex- relationships” resulting from divorce.
Though Hagestad couches her examination of family patterns within declining mortality and fertility conditions, it is her discussion of marital patterns (especially in societies with increased divorce rates) which highlights potentially problematic consequences of these changing demographic patterns that will be underscored here. To be sure, there is no “good” time to experience the loss of a close friend, especially to suicide. Because of the rise in life expectancy and the demographic transition witnessed
37 during the twentieth century, death and bereavement in young and middle adulthood is increasingly an off-time experience in industrialized societies. For example, Hagestad
(1988) understands the transition from high to low conditions in mortality and fertility parameters on the “complexion” or “pulse” of family life (including marital patterns) through the life course framework. Hagestad argues that the vicarious experience of unanticipated or “off time” countertransitions juxtaposed against the backdrop of an increasing theoretical emphasis on life course predictability serves to amplify the individuals’ distress within this social position. Because the occurrence of peer suicide grief is nonnormative, individuals will find themselves without a cultural reference point, or “consensus information” relative to their experience. In turn, therefore, their likelihood of receiving social support will be limited and the likelihood that they will internalize blame is increased. Similarly, Sklar and Hartley (1990) make an argument for the “off- time” nature of traumatic deaths occurring to young adult peers which was highlighted earlier.
In sum, the life course perspective emphasizes the intersection in time of biography and history on all levels of social contexts. Arguing for heuristics which elucidate the forces which “invalidate” grief, Neimeyer (2005-2006) points to the salience of the life course framework, in particular concepts such as linked lives, “off- time” countertransitions, for expanding our understandings of grief:
….insofar as we necessarily rely on the intimate validation of our sense of self by particular others, as well as communal and cultural discourses of identity that define our social roles both before and after bereavement. Thus a broadly narrative framework can provide a helpful heuristic for identifying sources of invalidation that arise not only within the experience of the bereaved person, but also in family, communal, and perhaps even larger contexts of transcendent meanings. (Neimeyer, 2005, p. 44)
38 Chapter Two: Research Methods and Sample Description
The nature of research questions points to and is connected to the type of methodology adopted by a research study. As such, some questions are better suited to specific methodological strategies than others. Padgett (2004) offers rationale for dissertation projects which are best pursued utilizing qualitative methodology by arguing that investigations of “hidden populations” represent optimal or “self-evident” opportunities to employ qualitative research methods. Because these populations are largely unknown in the research literature and in the broader society, methods of inquiry which are exploratory by nature and incorporate rapport and prolonged engagement with respondents are integral to advancing knowledge of such populations. The specific aims of this study will be carried out by a qualitative analysis of semi-standardized in-depth interviews with peer suicide grievers.
In his work on the sociological nature of depression, Karp (1997) highlights that one of the glaring silences around this topic is the absence of depressed individuals’ own voices in the knowledge base for this mental health outcome. He terms this lopsidedness of the scholarly literature, “statistics without tears” (Karp, 1997, p. 12). Similarly, this same imbalance can be said to exist in the literature on suicide bereavement and is a strong argument for increased qualitatively-driven investigations. For example, a leading grief scholar observed that the last twenty years in bereavement research has yielded over four thousand scholarly and scientific papers in the interdisciplinary field of death, dying, and bereavement, with most being empirically-based studies (Neimeyer, 2004). This points to the paucity of qualitative work foregrounding the actual voices of those dealing with dying and bereavement.
39 Demographic parameters
The original demographic parameters for participation in the study were: 1) type of relationship: study participants will have had a non-familial, non-conjugal, close or best friend relationship with a suicide victim of any gender (i.e., friendship must pre-date the bereavement by a minimum of two years), 2) age at bereavement: study participants must have been between the ages of sixteen and twenty five years at the time of bereavement, 3) time since bereavement: at the time of the research study, participants must be between three and fifteen years post-bereavement, 4) catchment area: participants must reside within 50 mile radius of Cleveland, Ohio.
However, these original parameters were too conservatively specified, thus successfully identifying possible participants within these stated parameters proved much harder than expected. Consequently, the type of relationship or affiliation was expanded to include peers or co-workers, for example. Further, the age at time of bereavement requirement was widened to any age over the minimal of sixteen years (given that time since bereavement was revised also to a minimum of two years with no maximum age).
Finally, as telephone interviews were added to data collection strategies, the possible catchment area for recruitment was expanded to include the continental United States.
Sample recruitment, fieldwork, and analysis
The following two sections consider sample recruitment, procedures for collecting data quality, and issues of data quality. A nonprobability sample of thirty individuals who lost a peer or close friend to suicide was outlined. To attain this sample goal, recruitment strategies followed a snowball sampling or chain referral sampling strategy (Berg, 2007).
According to Berg (2007), the first phase of this technique involves identifying several
40 people with relevant characteristics and interviewing them. These subjects are then asked for the names of other people (referrals) who meet the study’s sample parameters.
Possible recruitment settings originally identified which might provide initial contacts in this chain of subjects included local coroners’ offices, funeral homes, and other social service agencies in the study catchment area. Indeed, these entry points successfully provided the sample for the study of peer suicide survivors discussed earlier (Melhem,
Day, Shear, Day, Reynolds, & Brent, 2003; Prigerson, et al, 1999).
The following paragraphs outline the project’s recruitment strategies and fieldwork. The original sample recruitment strategy was supplemented several times because identifying possible study participants proved more difficult than expected. First, recruitment began at eight local suicide bereavement support groups affiliated with a regional suicide prevention and education alliance. This alliance granted access to the investigator to attend meetings of each of these support groups and at a designated time agreed up on with the group facilitator, briefly described the research study and criteria for inclusion in the study. All groups agreed to allow the researcher to attend except one.
The facilitator of this particular group rejected the investigator’s request to recruit potential participants for this study with the justification that researchers treat suicide grievers as “freaks.” Although written recruitment materials did indicate that the investigator was also a suicide survivor, the response to this facilitator reiterated this piece of information but access was still not granted. Instead, a list of other suggested recruitment avenues was sent to the investigator. This negative recruitment event suggests the interpretive power of the disenfranchised grief framework in the following analysis chapters.
41 Another issue that arose during the support group recruitment stage was the investigator being asked by support group members to self-disclose and share a little about her experience with suicide loss. Rowling (1999) sets forth guidelines about conducting in-depth research interviews on grief and advocates for a compromise position between ‘being in” and “being out” as a researcher/griever with participants which Rowling characterizes as “being with.” In the interests of this latter research guidepost, the investigator elected to share a brief summary about her suicide loss.
Unexpectedly, though, the identity of this suicide decedent was recognized, thus the investigator asked for confidentiality after sharing this information.
Second, additional recruitment sites added to the research strategy include several regional conferences sponsored by area suicide awareness or education advocacy groups and non-profit suicide prevention and awareness fundraising walks. Here, recruitment involved displaying flyers describing the project and requests for potential participants were made during announcements at these events. For example, the investigator was granted permission to recruit at several Into the Light™ suicide awareness walks. In year’s past, some After submitting the necessary Institutional Review Board permission materials, the investigator was granted a small space near the registration tables at this event to display study recruitment flyers. This strategy revealed that numerous difficulties exist in approaching strangers at an event which explicitly addresses such a traumatic loss as suicide. For example, while approaching participants in this recruitment context one spouse-griever angrily remarked that her spouse’s friends had been totally unsupportive, so she “didn’t want to hear anything about how rough friends have it grieving after suicide!” Nevertheless, it was hoped that recruitment announcements made before and
42 after the fundraising walk would generate interested study participants. Similar to the
level of interaction with participants in other therapeutic contexts, it was important to be
involved in these events as both a suicide survivor and researcher.
In this chapter, it is worthwhile to describe the growing phenomenon of these events.
Such walks were first begun in 2002 with an overnight, sunset-to-sunrise, twenty-four
mile charity walk which raised funds to benefit the American Foundation for Suicide
Prevention (AFSP). Walks at which the investigator recruited for this project featured
speakers and singing performances at the beginning and end of the walk. Speakers often
share their survivor stories and parts of the suicide quilt similar to the AIDS Memorial
Quilt are displayed and participants can wear the names of their decedent(s) pinned on
their back while walking. It is very poignant to move through the groups of participants
during these walks and read the names of lost loved ones. In the final stretch of the walk,
participants funnel through small electric candles illuminating small memorial paper bags
inscribed with personal messages. The Suicide Prevention and Education Alliance
(SPEA) walk is the only regional walk of this kind. This group raises and spends funds
on local suicide prevention efforts (i.e., high school programs on mental illness and
suicide). Thus, this group is outside of the national organization possible recruitment
framework which is also likely a contributing factor to recruitment difficulties
encountered by the investigator. Indeed, the American Foundation for Suicide Prevention
(AFSP) was contacted for assistance with study recruitment but no response was
received.
Third, the investigator mailed over three hundred study introductory letters to area Figure 1: Out of Darkness Walks funeral homes requesting their assistance in identifying family members who lost a loved
43 one to suicide. Reflecting a snowball sampling strategy, it was hoped that through family members’ nomination of non-family, co-peer suicide grievers would be interested in contributing to this study. However, only a handful of funeral home directors responded.
When reached by phone, funeral directors expressed deep reluctance to suggest family members of suicide victims which was due to fears about breaching family members’ privacy, especially in regards to suicide death. Fourth, permission was obtained to display flyers for participant recruitment on the investigator’s university campus.
Fifth, this recruitment work generated several important contacts for the study, namely, The Baton Rouge Crisis Intervention Center (BRCIC) in Louisiana. The BRCIC granted the investigator permission to recruit peer suicide survivors from the BRCIC database of suicide survivors. This internationally-respected program, Local Outreach to
Suicide Survivors (L.O.S.S.), was developed by Frank Campbell, PhD and began at the
BRCIC over twenty years ago. Research and outreach through this program has generated a database containing some five hundred suicide grievers (Cerel & Campbell,
2008). In this database, peer suicide grievers are the fifth most frequent relationship to a suicide victim in this database.
The strength of BRCIC’s L.O.S.S. program and its close cooperative relationship with the coroner’s office points towards barriers which stand in the way a similar program’s existence in Cleveland. For example, a number of regional and local suicide prevention and advocacy groups exist in the investigator’s home city, but they do not work in tandem with the Coroner’s office as the BRCIC does. Thus, the organizational network and resources provided through the L.O.S.S. program which were utilized to identify peer suicide survivors do not exist in Cleveland. Additionally, the Cleveland
44 Coroner does not rule a death as suicide for some six weeks, whereas the Baton Rouge
Coroner is immediately in contact with the L.O.S.S program volunteers (whose role is to support family members and others at the scene after the police leave, if suicide is suspected).
Finally, in addition to conducting face-to-face interviews, the investigator was granted permission to conduct telephone interviews with participants. With this expanded strategy, recruitment was also conducted through two email listserves: 1) the American
Psychological Associations’s (APA) suicidology listserve, and 2) a listserve begun by members of the American Association of Suicidologists. The APA listserve generated several participants from Indiana, Wisconsin, New Mexico, New York, and California.
Also, to be aware of current issues related to suicide, the investigator joined the American
Association of Suicidologists and American Foundation for Suicide Prevention’s (AFSP) e-network for suicide survivors.
Procedure for collecting data. Institutional Review Board (IRB) permission was obtained for all of the above procedures. Upon submittal of the initial research protocol, the IRB asked the investigator to specifically address: 1) concerns around risk for actual or perceived coercion between family members and peers of the same suicide decedent in the recruitment process, 2) past investigator experience interviewing on sensitive topics such as bereavement, and 3) possible negative effects for respondents after interview completion. After these concerns were addressed, the research protocol was approved.
The investigator was the sole interviewer during the study and conducted all of the study interviews. The data was stored in digital audio files using a digital audio recording device. These files were then stored on two separate USB drives for back-up purposes
45 and participant confidentiality was protected by the use of code numbers and date of interview in file names. Face-to-face interviews were conducted in cafes, bookstores, offices (that of both respondents’ and the researcher), a local bereavement center, The
Baton Rouge Crisis Intervention Center in Baton Rouge, Louisiana, a hotel lobby, and participant friend’s homes. Interviews ranged in length from forty- six minutes to two hours and eleven minutes and were conducted from May, 2008 to November, 2009.
Finally, study interviews were transcribed by a professional transcriber1. Because one of the sampling methods was ‘chain referral’ technique, the investigator would ask respondents at the conclusion of the interview to pass along contact information to other suicide survivor friends, if they thought other survivor friends in their network would be interested in participating in the study. This method was helpful in generating further participants for the study’s sample, but this process also highlighted there were some peer suicide grievers in their networks for whom speaking about their grief experience would be too overwhelming.
Recruitment efforts yielded willing respondents in Illinois, Wisconsin, Louisiana,
New Mexico, New York and California, telephone interviews were added to data gathering strategies. These interviews were conducted using Skype software in order to digitally record the interviews for transcription. Reviewing the scholarship, a very small literature comparing telephone to in-person interviews exists and only a handful of studies considered open-ended questions (Sturges & Hanrahan, 2004). Shuy (2001) weighs the advantages and disadvantages of each approach and highlights reduced interviewer effects, greater cost-efficiency and fast results as advantages of telephone
1 Payment for transcription services was provided through a generous research grant of $2,800 from the Baton Rouge Crisis Intervention Center Fund, Louisiana.
46 interviews. Weiss (1995) argues “it’s better to be there, but telephone interviews are the next best thing” (p. 59). Also, Sturges & Hanrahan (2004) note that respondents interviewed about sensitive topics may prefer the relative anonymity of telephone versus face-to-face interaction. In sum, given the distant locations of subjects and financial constraints of a graduate student investigator, telephone interviews helped to achieve the project’s sample goal.
Issues of data quality. Concerns around data quality matter for qualitative researchers in similar ways to concerns related to validity and reliability for quantitative researchers. Thus, where quantitative researchers speak of generalizability, validity, and external validity, qualitative researchers speak of ‘trustworthiness’ and ‘member checking’ in their concerns around the credibility of their data (Carverhill, 2002).
Because validity has come to be overspecified in the quantitative domain some qualitative scholars argue that the term validity does not lend itself well to the qualitative domain. For example, Janesick (2000) writes:
Validity in qualitative research has to do with description and explanation and whether or not the explanation fits the description. In other words, is the explanation credible? In addition, qualitative researchers do not claim that there is only one way of interpreting an event. There is no one “correct” interpretation. (Janesick, 2000, p. 393)
She highlights a number of member checking strategies utilized by qualitative researchers which include having study participants review their narratives after they have been written-up by the researcher; another variation of member checking incorporated by sociologists and anthropologists is to have outsiders read their field notes and interview transcripts. For instance, Davidman (2000) shares that she used outsiders to review the transcripts of her interviews, however she did not explicitly refer to this qualitative
47 strategy in her research process description. Davidman, like Janesick (2000), challenges the use of psychometric language in the qualitative domain. For example, she argues that the “trinity” of validity, generalizability, and reliability be replaced by a lexicon that accurately reflects the “complexity and texture of qualitative research” (Janesick, 2000, p.
393).
Scholars of qualitative research define interviewing as a “conversation with a purpose” (Berg, 2007, p. 89). According to Berg (2007), semi-standardized interviews offer a compromise between the rigidity of standardized interviews and the unstructured nature of unstandardized interviews. For instance, semi-standardized interviews are still structured with the interviewer following an identified set of questions and probes, yet questions may be reordered allowing for emergent content. Similarly, wording of questions along with the level of language is adjustable and the role of the interviewer is not entirely passive whereby, for example, the interviewer may answer questions posed by the interviewee, and vice-versa, for example, if clarification is necessary.
Davidman (2000) indicates that respondents, when asked to reflect on their experience of motherloss, saught open-ended questions to guide the articulation of their stories or narratives. She writes that it became clear in her early interviews that her original interview strategy based in the grounded theory approach did not lend itself well to an experience like loss that is, by its very nature, very fragmentary. In other words,
Davidman found that grief narratives did not emerge with a “hands-off” or unstructured approach, thereby her work suggests that a semi-standardized interview format consisting of open-ended questions is the optimal approach to studying similar themes in the context of other losses.
48 Speaking about the suicide loss of significant peers is a sensitive topic because it involves potential “psychic costs” for research participants (Lee & Renzetti, 1993, p. 4).
Consequently, the nature of the research interview and questions might prompt participants to experience a range of negative emotions. Past qualitative research with suicide survivors demonstrates that the emotional content of their grief may also include significant feelings of anger, shame, and guilt (Jordan, 2001). However, other qualitative work on sensitive topics such as marital rape indicates that with an action plan for post- interview negative reactions, participants described the interview as “cathartic and said they were grateful to have a sympathetic listener” (Bergen, 1993, p. 209). Therefore, risks posed by possible “psychic costs” associated with speaking about suicide grief may be off-set by the anticipated benefit of the opportunity to speak about suicide survivorship in an empathetic context.
Procedures to minimize risks, discomforts, and/or inconveniences to research participants included an action plan, if participants experience inordinate levels of grief and discomfort as a result of speaking about their suicide loss. To meet IRB concerns on this issue several measures were put in place during and after the interview: 1) Per IRB recommendations, the beginning of the interview included description of questions and stating that the interviewee may end the interview at any time, if they might become too upset 2) the investigator asked if respondent would like to take a break or discontinue the interview, 3) if it was elected to halt the interview because of excessive stress, participants would be provided with referral contacts including hotlines, local chapters of support groups, and relevant literature for those bereaved by suicide. To the investigators knowledge, no respondents sought out these resources and, in fact, many said they
49 appreciated having the opportunity to speak openly about their suicide loss. It should be noted, too, that the investigator had prior training and experience conducting interviews with bereaved caregivers of veterans and advanced cancer patients and has conducted extensive telephone bereavement surveys using the After-Death Bereaved Family
Interviews (Teno, 2000). With this prior work, the investigator had a strong response rate and was positively received, providing valuable training for the present study.
Researchers conducting qualitative work on grief experiences grapple with how to ensure the trustworthiness of their data. For instance, too much or too little emotional distance might jeopardize data quality. To be sure, speaking about loss and grief are deeply personal. When conducting interviews, Davidman (2000) relates that many of her participants (over fifty percent of female participants and thirty percent of male participants) cried as the relayed their experiences of mother loss. In her in-depth interviews with women about eating disorders, Thompson (1994) explains that her work was broadly guided by a multiracial feminist standpoint, whereby she practiced “an ethic of care,” which emphasizes personal expressiveness, emotions, and empathy as integral over a performance or dramaturgy interview style (Berg, 2007). Elucidated by sociologist, Patricia Hill Collins, an ‘ethic of caring’ reflects an alternative epistemology which stresses that knowledge-bearers cannot separate themselves from the ideas in which they are engaged and articulate. According to Hill Collins, “the ethic of caring suggests that personal expressiveness, emotions, and empathy are central to the knowledge-validation process,” otherwise claims to knowledge run the risk of hypocrisy.
Rowling (1999) wrestles with this same dilemma around the level of artifice, performance, and, ultimately, distance called for by the role of interviewer/researcher
50 encountered when conducting qualitative work on grief experiences. She points out that most qualitative manuals offer the researcher guidelines around technical interviewing skills (cf. Berg, 2007) without exploring such “feeling rules” when they might affect issues of data quality (Rowling, 1999; Sword, 1999). She writes of this dilemma:
Distance could imply detachment—indifference and coldness to emotional responses of participants. Yet participants’ emotions were the data I wanted, to help understand their experiences. I believed that being detached would not elicit this data (Rowling, 1999, p.170).
Reflecting on her analysis of disenfranchised grief among teachers, she weighs the advantages and disadvantages of “being in” (e.g., being involved and not conducting interviews with detachment), “being out” (e.g., conducting interviews with detachment), and finally “being with” or positioning oneself (the researcher) “alongside” respondents.
According to Rowling, “being with” respondents strikes this delicate balance between the opposing risks of confounding data vis-à-vis limited or missing meaningful data that was not elicited in the research process. To avoid such pitfalls during interviews, Rowling employed, “compassionate analysis which intertwines the researcher’s and participant’s emotions, as long as the emotions do not interfere with ‘real listening’…. being in and being out of the research is a fine line” (Rowling, 1999, p. 177).
Drawing on Davidman’s (2000) semi-structured interview guide, open-ended questions and probes in this study will address general background questions, initial loss and years afterward, friendship prior to loss, relationships with other members of peer network, views of suicide prior to loss, life story after friend’s death, and, finally, broader representations of friendship and suicide. Accordingly, probes for each of these categories were developed which encourage participants to explore their suicide bereavement experience in line with the specific aims of this study.
51 Analysis. As indicated earlier, interviews were transcribed from digital audio files by a professional transcriber and then manually coded by the investigator. Saldaña (2009) stresses that while “codes” and “themes” are often used interchangeably by some researchers and research texts, it is important to understand that they are distinct. Saldaña
(2009) writes, “A code in qualitative inquiry is most often a word or short phrase that symbolically assigns a summative, salient, essence-capturing, and/or evocative attribute for a portion of language-based or visual data” (pp. 13), while a theme is an outcome of coding. My data analysis included manual precoding (circling, highlighting, or underlining significant participant quotes or passages), first cycle coding, and second cycle, categorical coding. First cycle or initial coding generated some fifty-five general codes which broadly reflected psychological, somatic, and social realms in participants’ suicide loss experiences. This cycle of coding also included distinguishing between heuristic and factual coding whereby facts such as years since bereavement, participant’s age, participant’s gender, were separated from heuristic data and recorded in an Excel database (Silverman & Marvasti, 2008). Analytical memos were developed and maintained by the investigator to stimulate reflexivity about possible conceptual categories signaled by the codes generated during the coding process. After this initial cycle of data coding, a second cycle of coding was conducted focusing on axial coding to explore emergent relationships between analytical memos and larger, abstract-level categories (Saldaña, 2009). To further illustrate the way qualitative researchers conceptualize the relationship between first and second cycle coding in qualitative inquiry, codes are likened to “bones,” while categorical or axial coding forms the “spine” of one’s data.
52 Drawing from the investigator’s reflections in analytical memos developed during the initial coding phase, participants’ data cleaved along several important categories at this higher level of abstraction including disenfranchising experiences, coping methods or strategies following suicide loss which reflected participants efforts to re-enfranchise themselves, the interrelationship between group-based suicide loss contexts and suicide survivor identity development processes. Because qualitative research emphasizes telling an analytic or mystery story over a hypothesis-testing story in the narrative macrostructure (Silverman & Marvasti, 2008), the concept of disenfranchised grief was chosen.
Sample description
A nonprobability sample of twenty-six individuals who have lost a peer or close friend to suicide was achieved. Bernard & Ryan (2010) discuss sample size goals in nonprobability sampling and note that it is “not quite as well understood” in the qualitative realm; however, they point towards “growing evidence that 20-60 knowledgeable people are enough to uncover and understand the core categories in any well-defined cultural domain or study of lived experience” (p. 360). For example, in a qualitative study of sex workers in Nigeria and Ghana researchers conducted thirty interviews in each country and found that 80 of the 114 identified codes from the full corpus of interviews are present in the first six interviews. By the twelfth interview the curve of newly identified codes flattens out with only five new codes being added after this threshold point (Guest, Bunce, & Johnson, 2006).
To attain this study’s sample goal, recruitment strategies followed a snowball sampling or chain referral sampling strategy (Berg, 2007). According to Berg (2007), the
53 first phase of this technique involves identifying several people with relevant characteristics and interviewing them. These subjects are then asked for the names of other people (referrals) who meet the study’s sample parameters. As discussed earlier, recruitment settings identified for this study which might provide initial contacts in this
“chain of subjects” included local coroners’ offices, funeral homes, and other social service agencies in the study catchment area.
Demographic characteristics of participants. Seventeen women and eight men participated in the study. Of the male study participants, two self-identified as African
American and one female identified as African American, while the rest of sample identified as White. Current age of the participants ranged from twenty –two years old to late sixties. Initially, peer suicide loss during young adulthood was a study focus, but recruitment difficulties of this age group necessitated widening study parameters, thus this line of inquiry was dropped. Occupations of participants included several social workers, two psychologists, two retirees, three master’s students and a college student, a researcher, a high school teacher, legal aid worker, a suicide awareness organizer, a college football assistant coach, college residence life administrator, youth camp advisor.
As mentioned earlier, respondents resided in Ohio, Illinois, Wisconsin, New Mexico,
New York, Louisiana, and California. Finally, religious affiliations varied from Baptist,
Catholic, Unitarian Universalist, Many respondents met their peers during their school years, church activities, and work settings.
Bereavement characteristics. Respondents age at time of bereavement ranged from as young as eight years old to mid-sixties. The quality of most friendships was close and went beyond “just friends.” It is important to note that four respondents had more
54 than one suicide loss, so they spoke to these multiple losses in their interviews. Suicides included several by gun shot, and also hanging, drug overdose, immolation, carbon monoxide poisoning, and jumping from a bridge. Also, a suicide shared by two study participants was a homicide-suicide.
55 Figure 1: Summary of Study Sample Information
56 Chapter Three: Analysis of Disenfranchised Grief in Peers Bereaved by Suicide “But I think on a lot of levels or with a lot of different people, suicide is so far out of their realm of even possibilities that it’s almost like, ‘I’ve got to look that word up in the dictionary,’ you know ….It’s not… Nobody talks about that except if they’re kidding…And I always wondered why we had to have that disease, you know the depression that led into suicide. Why couldn’t we have something that lots of Americans have? You know what I’m saying?....Why did we have to be in a minority?”
--Beth, 52-year-old, lost three loved ones to suicide including her husband of twenty- five years who took his life seven years ago.
Drawing on the literature reviewed in earlier chapters, a central study aim for this investigation asks: to what extent do non-family status and/or stigma around suicide affect the social support outcomes of peer suicide grievers? Scholars of qualitative inquiry observe that this type of research is cyclical in nature, while quantitative research proceeds in a linear fashion. During this iterative and circular process, an analytical ‘red thread’ related to disenfranchised grief gradually emerged (Silverman & Marvasti, 2008).
According to Doka, individuals experience disenfranchised grief following a bereavement or loss “that cannot be openly acknowledged, publicly mourned, or socially supported” (Doka, 1999, p. 4; Corr, 1998-1999), Doka, 2002). In Disenfranchised Grief:
Recognizing Hidden Sorrow, Doka (1989) introduces disenfranchised grief as a concept and proposes that disenfranchised grief may occur along three dimensions: 1) in the context of disenfranchised relationships (friends, colleagues, ex-spouses, or former lovers), 2) disenfranchised losses (i.e., miscarriage and companion animal loss) and, 3) disenfranchised grievers (i.e. grandchildren, older adults). A second anthology,
Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice (2002), added two additional dimensions of disenfranchisement to the original typology, including circumstances of the death and ways individuals grieve. This category does
57 explicitly include stigmatized losses such as suicide whereby circumstances around the loss inhibit either grievers from garnering support or disrupts others offering support
(Attig, 2004; Doka, 2002).
According to Doka, suicide, execution, AIDS-related, or alcohol-related deaths may be understood through this category of disenfranchised grief. In each of these realms, grievers might experience their relationship, type of loss, style of mourning, and their identity as a griever being socially marginalized, trivialized, stigmatized and/or rendered less invisible by others on an interpersonal and societal level (i.e., workplaces, health care practitioners, the media, etc). Thus, in this chapter, findings are divided into two sections: 1) disenfranchised peer relationships (in regards to family members, in social support contexts, and fellow peer co-survivors), and 2) suicide as disenfranchised stigmatized loss (in the contexts of religion, language, media outlets, and schools).
Indeed, as friends of suicide decedents, participants in this study may potentially experience disenfranchisement through both of these categories simultaneously.
Peer relationships as disenfranchised relationships Focusing on the relational dimension of disenfranchised grief, friends of the suicide decedent can experience disenfranchisement because a peer relationship is less socially-recognized in comparison to familial or blood ties (Doka, 1989). Doka explains that disenfranchised grief is particularly salient in complex societies where social rituals marking death have shifted from the communal to familial realm. As such, this trend privileges the expression of grief to kinfolk and limits the acknowledgement and expression of grief associated with peer attachments. Yet, research on peer relationships, especially adolescent and young adults, suggests peers’ level of intimacy with their
58 suicide decedent may be as deep as that of family members. Given this accentuated distinction in modern society between family and nonfamily in “grieving rights,” peer suicide survivors social support needs may go unrecognized or underestimated by those around them (Wagner and Calhoun, 1991-92; Cvinar, 2005). In the following paragraphs, peer suicide survivors discuss experiences in which they felt both actual and perceived disenfranchisement due to their friend-griever status. Related to this, some peer suicide survivors expressed how being a nonfamily member complicates marshaling social support following their bereavement.
Relational disenfranchisement: On the outside looking in? This section considers how peers view their relationships with family members and co-survivors of the suicide decedent. In particular, whether they experienced disenfranchisement due to their relational status is considered, and, in turn, if this affected the level of social support they received after the loss of their friend. Taken together, these participants’ accounts demonstrate that negotiating relationships in the aftermath of suicide is a complex task for peer grievers—their expectations for social support may be either thwarted or foreclosed by the nature of society’s treatment of suicide.
Megan, a 36 year-old female, lost her best friend, Michelle, nineteen years ago.
Megan and Michelle were best friends since middle school until Michelle took her life during Megan’s second year of college. In hindsight, Megan realized that Michelle was suffering from bipolar disorder during their high school years together. When asked to sum up her experience at the close of her interview, after answering probes about being included in memorial services and getting enough support, she explains that her experience was sometimes one of being “on the outside looking in”:
59 Megan: As a friend, the grieving process begins quite differently from that of a family member. A family has the right to choose when, where, and how people will grieve publicly. They choose the venue, the information shared with others, and, in a sense, who will be included or excluded. They have the ultimate right in the decision making process. They choose how to begin the grieving process via the wake, funeral, general arrangements, and overall progression of events. Friends, on the other hand, are left with a much different task. They must find a way to accept the arrangements and the limited role they are often given. Oftentimes, they are excluded from grieving with the family in the way they need to grieve. In a sense, they are on the outside looking in - though it is not a purposeful exclusion. There are two different grieving families. One is biological while the other is psychological. While the feelings are the same, the grieving takes two different paths.
To understand why Megan concluded her interview with this sentiment, some background information on her relationship with the decedent’s family provides insight.
From her perspective, Megan points to two significant disconnections with Michelle’s family which are behind her statement regarding ‘being on the outside looking in’. First,
Megan describes a sometimes stormy but very close relationship with Michelle. In hindsight, Megan now realizes Michelle was suffering from bipolar disorder. She remembers when Michelle was hospitalized two or three times during their high school years, but Michelle’s parents would not disclose this information and Megan was left to wonder why her friend wasn’t at school. She remembers calling Michelle’s parents to try to find out what was going on with her friend. Further, in another part of her interview,
Megan made a point of saying that she disagrees with Michelle’s mother about
Michelle’s intent to kill herself. Specifically, she believes Michelle did not mean to take her life. Because Michelle had a prior history of several suicide attempts in which she
60 self-harmed but never went so far as to end her life, Megan still strongly believes that
Michelle really didn’t mean to kill herself.
Megan: And her mom and I just disagree. She’s like ‘[Megan], she took it all. She meant to die,’ but knowing [Michelle] and everything else… Interviewer: It was just kind of the same scenario. Megan: Yeah, ‘cause [Michelle] could push the limit. I mean for her to have taken all that medication, she was the type, she’d always been saved every other time. I really don’t believe she thought that that time was going to be any different, I mean because she had pushed the envelope so many times before and nothing really awful had happened, you know, and like I said, I love her mom to say, but that’s one of the things we disagree on, so we really don’t talk about a lot.
In particular, Megan describes this disagreement surfacing in the context of a suicide survivor support group which she attended with Michelle’s mother. Here, while this context is meant to be explicitly supportive towards suicide survivors, Megan recalls it being a fairly negative experience because of this difference in perspective surrounding
Michelle’s death raising its head during the support group discussion.
Megan: It is, and I actually would never with her mom, I mean I don’t think we ever would’ve gone down that road, except she got me one night to go to that group she runs and started bringing stuff up and I was sitting there like ‘I really don’t agree with this,’ and I was sitting there. I really had, though, I was listening to what she was saying and I was sitting there thinking to myself, ‘Wow, I really don’t agree with this at all,’ and then she said something about ‘Don’t you think, Megan?’ and I’m going ‘Oh, hmm.’ Interviewer: Well but you know but so you spoke and you spoke differently than what she expected. Megan: I think what she expected, and she looked at me, and you know a couple of times it’s been brought up since then. Interviewer: Maybe that’s insight that, you know. Megan: Well she and I are never… Honestly I don’t think we’re ever going to agree.
61 When probed about if she would ever seek support in similar settings, Megan response is not positive. In the next chapter, she does highlight circumstances in which she experiences as re-enfranchising:
Megan: Right. It’s her choice. Yeah, and you know with Michelle’s mom, it’s hard for me to go to the group. I mean she’s come full circle. Interviewer: Would you go to a different one where you know…? Megan: I might. I hate to say I’m kind of with the whole thing, kind of become… Interviewer: Reached a peace. Megan: No, not even. Honestly, there are still days I am so angry or so sad. I guess it’s just one of those things I kind of feel on my own with.
Finally, Megan returns to this topic again at the close of her interview explaining that
Michelle’s family did not tell her the full details of her best friend’s death until recently.
Megan: Her family at the time, were very closed off, and her dad, very tough guy to get to know. He’s very nice to me, but I am still not completely comfortable around him, and I’ll always be super nice to him. I felt like they gave me information on a need to know basis, and I really didn’t see her dad a lot.…. I was [Michelle’s] best friend and that’s just how it was left. You know what I mean? But it was funny, her mom at one point really reached out and got the name of this psychic guy out in like [city] or something and wanted to go. I’m like ‘All right, I’ll go,’ and that was about four years ago, and there were certain details of [Michelle’s] death I didn’t know until the drive home from here and she gave me the details of how everything went down you know out at the lake, you know, but we both like… One day we were sitting in [Michelle’s] room, like maybe a year after [Michelle] had died and a shadow, we were the only ones in the house and a shadow went by and we both turned around and were like “Michelle,” and it was just like really, not crazy, but it was just like Michelle’s presence was there and just little things we’ve been able to share, but she’s really come out of her shell a lot, a different
Above, these vignettes from Megan’s interview explain why Megan would express relational disenfranchisement. Notably, Megan invokes the notion of “rights” in the
62 grieving process similar to Doka’s findings, and asserts that friend-grievers, while not intentionally excluded, are left with a narrower set of choices in regards to acknowledging their grief.
Another participant, Diana, a 68-year old retired social worker, lost her church friend, Joan, three years ago. Diana was thirteen years older than Joan, but they shared interest in church activities and Diana’s husband and Joan were close because they both struggled with mental illness.
Diana: Well that’s interesting ‘cause I did think about this recently is that I’ve not heard back from her son or his father, and who I felt close to at the time that all this happened, and I don’t know. I think some people aren’t able to talk about it, and that may be why… You know I reached out a couple of times. And interestingly enough the father of her child has a Counseling background. Interviewer: Oh, a Counseling background. Yeah. Diana: Yeah. So anyway, here she is with a good friend with you know a Mental Health background and that father also, and so I’m sure that there must be, you know maybe there’s some you know unsettled feelings for them. And then her son was diagnosed after her death with melanoma, and so I would like to know how they’re doing, but you know…
Yet, Diana describes dismay that Joan’s family members do not keep in touch, especially since her son is dealing with a serious illness and Joan expresses concern about her son but there is no contact, despite Joan reaching out several times. Her words,
“maybe there’s some, you know, unsettled feelings for them,” suggests that there is an asymmetry between the level of closeness that Joan’s family feel toward Diana and
Diana’s desire for continued contact after Joan’s memorial service. Together, Megan and
Diana’s examples point towards relational disenfranchisement experienced by peers.
Some participants, too, shared examples of peer relational disenfranchisement vis-à- vis family members of the suicide decedent’s family that may be aggravated by the nature
63 of their loss being suicide. Other cases were less straightforward and involved not only peer status but were also complicated by circumstances of suicide death. In the scholarship on disenfranchised grief, few, if any, studies have investigated the effects of occupying one or more disenfranchised category within Doka’s typology. Yet, data from peer suicide grievers’ interviews in this study indicated that such conceptualizations are necessary to account for these complexities, or a double burden, experienced between their relational position to the decedent and the circumstances of suicide death. The following sections explore these new intersecting variants of disenfranchisement revealed in peer suicide grievers’ accounts.
For example, Andrea, is twenty-four years old and lost one of best friends, Andrew, seven years ago when she was seventeen years old. Andrew was nineteen years old when he took his life. Andrea was in the seventh grade when her friendship with Clayton
(Andrew’s best friend) began in an internet chat room, as both Clayton and Andrew lived on the West Coast of the United States. Andrea is quick to say she’s aware of how meeting through an internet chat room sounds but she describes her friendship with the boys as “really good long-distance pen pals.” Indeed, she brought pictures of the decedent and his obituary to the café where the interview was conducted. When asked about her friendship with Andrew being validated and supported, she pointed to several instances of relational disenfranchisement with Andrew’s family:
Andrea: That’s Clayton, yeah. This was actually a picture that they cut Andrew out because he was like leaning over against the car with his ex-girlfriend and he didn’t like it anymore. Yeah, but they, he, like to this day Clayton hasn’t gone to [Andrew’s] gravesite. He refuses to go to the graveyard. He instead went home and called me, and I guess [Andrew’s] family, which had pretty much blown him off for the last five, ten years, ignored him, treated him like crap, told him what a failure he was and
64 how ashamed they were of him for no reason. I mean he was probably like the most established of all the kids and yeah, he drank and did weed, but like his sister was on coke. His brother was on heroin and they had poor… Like his family, his parents were just never around, and I guess at the funeral they were just sobbing uncontrollably and like acting so out of character. Interviewer: Andrew’s family? Andrea: Andrew’s family, and Clayton was just like you know for all the times they told him they didn’t love him and they didn’t care, for them to act like that was just, it just angered him and to this day he’s still angry about it. He refuses to have anything to do with them. They tried to contact him.
Though she never actually met Andrew in person, she describes a very close friendship in which they were in contact by phone nearly every day or couple of days.
She also got to know Andrew’s close friends through telephone contact and developed friendships with them too. Since Andrew’s passing, Clayton has visited her home in the
Midwest and she visited with Clayton on the West Coast the following year. Below, she suggests that even her own family were not entirely encouraging about her friendships with Andrew and Clayton:
Andrea: I never visited. I never got to meet Andrew in person. There were only things where like they had all their stuff going on and then like we had the horses and my parents weren’t exactly okay with it. Three months after Andrew died, Clayton came here and then the following summer I went there, and we haven’t seen each other since, but I mean we still talk every day. Like I was just talking to him right before you came in. Every day.
When probed about the recognition of their friendship and the social support she received, Andrea articulates a complicated picture of supportive and non-supportive behavior. She explains that Andrew and Clayton were friends since preschool and that
Clayton’s mother offered to pay for her flight to the West Coast to attend Andrew’s memorial service and be with Clayton and Andrew’s other friends. However, with her
65 parents, it was decided that she would not attend Andrew’s memorial service because it was on the West coast and they believed the experience would be too traumatic. Most significantly, she learned from Clayton that Andrew left her a note before his death and his family has not allowed her to see it:
Andrea: [Andrew’s] family, and Clayton was just like you know for all the times they told him they didn’t love him and they didn’t care, for them to act like that was just, it just angered him and to this day he’s still angry about it. He refuses to have anything to do with them. They tried to contact him.….Yeah, and there’s like more to it like with his family, because Andrew had written letters to some of us. Like there was a letter to me. There was a letter to Clayton, and there’s a letter to our other friend. Interviewer: So that came after? Andrea: That came after when they were like cleaning up his stuff. Like he had an apartment separate from his family, so… Interviewer: So those were notes. Andrea: Yeah, he had written to us. Clayton got his letter because he fought for it. Well his mom fought for it. She went over there and she like started yelling at people, his mom, and she was like ‘You know it’s meant for them. You need to give it to them.’ So the boys got their letters, but because I live in Ohio, and his mom didn’t think I was worthy of it, so I never got it, and like for a long time I was really angry and like when I went there I had said something to [my sister] about going over and trying to get it and she’s like, you know, and she’s like ‘Just wait. You know what’s in that letter. You know what Andrew had to say and you don’t really need to fight with them about it to get it,’ and I agreed with her on that, like you know I didn’t push it.
Here, Andrea highlights difficulties with Andrew’s family resulting in reverse relational disenfranchisement, whereby both Andrea and Clayton have ended contact and their relationships with Andrew’s family.
Other participants whose suicide loss experiences illustrate similar relational disenfranchisement include Christy, who is forty-six years old, and lost her friend,
Candace twenty-six years ago during Christy’s undergraduate college years. They had
66 been close during childhood and after Christy’s family moved away they kept in touch through letters and would try to see each other a couple times a year. Their last visit was a trip to Yosemite National Park. When Candace’s twin, Rachel, called to tell Christy that
Candace had taken her life she thought it was a joke because she had no idea that
Candace had been suffering from manic depression. While Christy remains friends with
Rachel, she describes a non-relationship with Candace’s mother, made fraught by a family background of mental illness. After Candace’s death, Christy learnt that the twins’ birth father also took his life and after this the twins’ mother remarried.
Christy: And that made sense to me once I learned more, and you know but it wasn’t mine to know, you know. They had no reason to tell me and that’s their own privacy, but it would’ve been nice to know, you know, ‘cause I think I would’ve been… You know well you could always look back and say ‘I would’ve been different.’ But and so I didn’t know about her mental illness. She was bipolar, and I didn’t know. Actually I mean bipolar has changed in the last 30 years, so it’s probably more that she…
Further, Christy recalls not being able to attend her friend’s memorial service because she wasn’t made aware of it by Candace’s family and being the only co-survivor to which her friend’s surviving twin can talk to about her sister’s suicide:
Christy: I’m not even sure there was one. I’m sure because her mom was…..so. A lot of it is their family dynamic, which is very secretive and didn’t want to talk about it and to look like she didn’t have a daughter. Oh, but sometimes Rachel would say her mom wouldn’t talk about it, so it was almost like her mom is not a support for her. It’s almost like—I’m Rachel’s twin in a way; I’m not Candace’s replacement—we are kind of sisters in that and in a way it’s kind of hard for me to really describe I think.
Later on in her interview, Christy explains that it was probably for the best because her friend’s mother would be “very upset and very irritated” with how much Christy
67 “knew,” but affirms that being included in a memorial service of some sort was still important to her.
Christy: But that’s also a very optimistic view. It could’ve been awful because I know her mom, their mom is a real denier, very. Everything has to be in order. Everything has to be in ordered, you know getting out… People knowing that… She knew that I knew as much as I did about it, she would be very upset and very irritated, so I’m not sure if in reality… Maybe there’s a few of us who could’ve done something, even just to get together to talk. So I absolutely think that that is an important part….so I’ve come from thinking memorial services are a waste of time to now totally believing that they are critical….It’s like it means more to me now, the strangest thing, but I think it would’ve definitely helped.
While Christy still remains friends with Candace’s twin, Rachel, their mother did not invite her to Candace’s memorial service and acts as if “she didn’t have a daughter,” in
Christy’s words. Thus, Christy’s experience reflects stratified relational disenfranchisement whereby peer grievers experience disenfranchisement by some members of the suicide decedent’s family but not all.
Christy’s experience with Candace’s family history illustrates how mental illness can complicate peer suicide grievers’ relationships with decedent’s families. For example, at the close of her interview, Christy expresses there are complicating relational factors which when coupled together, “never let the grief every go away.” Christy and
Rachel’s relationship is still strong but Christy worries for Rachel who can exhibit manic depressive behaviors that are similar to her twin sister but not as severe. Further, on the topic of social support, Christy is one of only two or three people with whom Rachel can remember Candace because Candace’s mother will not talk about her. Moreover, in other parts of her interview Christy suggests that the support between them is asymmetrical with Christy acting as more of a support for Rachel than vice versa:
68 Christy: You know I just, I can’t help but think, I was thinking that there’s again that complication of having an identical twin that never lets the grief ever go away completely for me, and it never ever is really totally grief either. You know I just can’t… It’s almost like there’s a lack of resolution, which is both a good and a bad thing to me, but I never thought of it any other way. You know I just can’t imagine it any other way. I mean so figuring out how she’s incorporated into my life is what you’re asking. Interviewer: Yeah. Yeah. Christy: Is like I think through Rachel. I think she still is… Interviewer: Yeah, I get it. Yeah. Christy: I think that’s why I can’t even really grasp what you’re saying, because she is… It’s just so about Rachel and I. Interviewer: Ah, I get it. Yeah. Christy: And like the last time I saw her or whenever I emailed her a birthday wish I always say, ‘I always think of you and Candace,’ because there’s nobody that she talks to, and she can’t even talk to her mom about Candace at this point, so I’m like one of two or three people that knew Candace, loved Candace, wanted to kill her too, that she can really talk about it. We go through pictures together, and it’s really pretty hard on her, but it’s probably also a relief that she doesn’t have to keep it inside. So I mean I think it’s that Candace is still so alive through her.
Other participants also expressed that worry and also guilt influenced the support equation between them and family members of decedent. Abby, 23 years old, is a college student and was 20 years old when her best friend’s younger brother took his life. Adam was 17-years old at the time of his death. Abby and Emily have been best friends since Abby’s sophomore year of high school. Further, Adam and Abby shared an affinity for music and became closer friends after working together at the same part-time job. Abby recalls, “he was just like her goofy little brother, which felt like my goofy little brother.” When asked if she was aware that he struggled with his state of mind,
Abby reflects: “He would get dark sometimes, but it wasn’t to the point where I thought it was something that was serious. Like I just figured it was normal high school stuff to
69 get dark about things. I didn’t know that he was getting bullied as badly as he was at school.”
Indeed, it was in the context of supporting Adam’s family that Abby was recruited while she was attending a suicide awareness walk:
Interviewer: So I met you at the march, and so how did you come from that place to being at the march and participating in that? I mean that’s a pretty, that’s a good step I would say. Abby: Yeah. Interviewer: How was that journey? Abby: Hard. Interviewer: Yeah. Abby: I lost a lot of myself in the process of losing Adam because I was so guilty like in my head for being on the phone with Emily and not being able to help her when she found him. So I like made promises to Adam to take care of his family. That was how I coped with it. So when [Adam’s family] initially came to me and they were like ‘We’re going to do this suicide prevention educationalized walk,’ I said ‘I’m totally onboard for it.’ Interviewer: Yeah. Yeah. Abby: You know I raised money from campus. We have a rock on campus that everyone paints their things. I painted the rock pink and wrote ‘I miss you, [Adam’s nickname],’ ‘cause that was his nickname. I did what I could to be there. I was terrified to go, because they were such a mess and [Adam’s family] are some of the strongest people I’ve ever met in my life, so it was hard to see them be so broken and not know what to do for them, but I knew I had to be there for Emily ‘cause she’s my best friend.
Above, Abby shares that she was indirectly present when Adam took his life because she had called Emily at home and was talking with her when Emily heard the gunshot which ended Adam’s life. As Abby indicates, it was especially traumatic for her to hear Emily find her brother’s body and then to hear her call to emergency services. Additionally,
Adam’s high school handled his suicide very poorly, thus causing his family more pain.
Because of these circumstances, Abby felt she should participate in a suicide prevention
70 and awareness walk for Emily even though she was “terrified” by the thought. Focusing on the question of support for peer suicide survivors, this subgroup of participants experiences seem to signal that their supportive efforts of decedents families carries extra emotional valence such as a sense of obligation or guilt. This discussion suggests there are sometimes emotional costs to peers involved in their supportive work towards family members but it also highlights questions regarding social support for peers. This delicate balance of mutual support between co-survivors of the same suicide is discussed more extensively in a subsequent section of this chapter.
A further complicating factor in the relational landscape between friend grievers and suicide decedents’ families is the decedent’s possible estrangement from their family due to mental illness. This set of circumstances was brought to light in Courtney’s suicide loss experience. She is a 24-year old social worker who lost her friend and ex-boyfriend,
Christopher, two years ago to suicide. She and Christopher worked together and developed a close friendship and then dated for six months before his death. In her interview, though, Courtney explains that she broke up with Christopher because he became increasingly depressed and at one point held her hostage in his apartment for several hours:
Courtney: You know when we were friends, he was very kind and the most generous and gracious and giving person. He was a wonderful friend, but in our dating relationship it was absolutely awful: very nasty, very rude, and I blame a lot of it on the mental illness.
Courtney continues that due to Christopher’s estrangement from his mother and ex- fiancée, she was left out of helping to make funeral arrangements and from his obituary notice:
71 Courtney: It was very, very, kept very secret, but no one in his family… He had isolated himself from his mother and his brother, who were really the only people in his family he had any contact with and he had isolated himself from them, so they didn’t know about me. No one at work knew about me. I had a friend at work who I had told about our relationship, but she you know was very, kept it very confidential. Interviewer: Yeah, discreet. Yeah.
In addition to experiencing relational disenfranchisement with the decedent’s family, she expresses that other friends withdrew from relationships with her because they misunderstood her suicide grief. She describes:
Courtney: Right. I can kind of place where people fit and who gets to know what based on where they fit, and I know that at the core there are only a certain number of people who know everything about me, and then going out from there, there are people who know less and less. And I think I’m more aware of that now, whereas I think before I used to kind of categorize everyone together and it’s like if you were a friend, I, you know, let you know everything and you were just, you were a friend, whereas now it’s like I know who I can trust with what information and who I need to be selective in telling information to. It’s just I do think that my relationships with people have changed a bit, especially because I think… Like in particular dating has been interesting because I had one guy in particular who after we broke up had said that, he said to a mutual friend he felt like he was being compared to a ghost, and like I you know compared him to Christopher, and I don’t know that I was necessarily comparing him so much as just needing to talk about it, like I need, especially the people that I’m supposed to be closest to or people that I’m closest to, I want people… Interviewer: Right, ‘this is part of my biography.’ Courtney: Right Interviewer: Yeah Courtney: It’s a huge part
Here, at the end of this vignette, Courtney expresses her sense of loss following
Christopher’s suicide was invalidated by a dating partner. Focusing on these feelings of disenfranchisement, she continues that she wants people with whom she is close to
72 recognize that Christopher’s friendship and loss represent, in her words, “a huge part of her life.” This is also evidenced by the fact that Courtney volunteers her time to serve as a suicide survivor support group facilitator. Here, Courtney’s experience illuminates another variant of relational disenfranchisement in the context of suicide loss, secondary relational disenfranchisement. This type of disenfranchisement captures the experience of unsupportive friends (i.e., non co-survivor friends) who invalidate participants’ suicide loss.
On the other hand, it is important to note that while some participants reported disenfranchisement in their relationships with suicide decedents’ families, other participants have maintained strong and enriching bonds with family members. For example, Bill and Betty are a couple who both participated in the study because they share the same suicide losses. Bill has lost three friends to suicide and Betty shares in the loss of two of those friends. For them, the loss of their family friend, Kim, is particularly painful as Kim took her life and that of her young child who had Downs Syndrome. Yet, they maintain a rich and mutually supportive relationship with Kim’s husband (who passed away from cancer some years after Kim’s death) and their daughters who are now adults.
Relational disenfranchisement and social support contexts: “Should I really be here?” In Doka’s disenfranchised grief framework, a key consequence of a disenfranchised relationship is diminished social support. This section considers peers expectation and support-seeking experiences in settings including support groups, conferences and workshops for suicide survivors, and suicide awareness walks. Within these contexts, peers bereaved by suicide reported experiencing perceived and/or actual
73 diminished support in association with their relational status to the suicide decedent.
Some peers described their engagement in these activities using ambivalent language around their “belongingness” in direct reference to their relational status to the decedent.
For Lisa, 28 years old, it has been five years since she lost her friend, Jim, who was dating her sister, Linda. Lisa met Jim through her ex-fiancé as they were both in rock bands. At the time of his death, he and Linda had been talking about marriage and he had just finished building his own recording studio. Lisa expresses that his suicide came as a huge shock, “I mean he was always the one that was cutting up and laughing and seemed like everything in his life was going great.” She and Linda had just returned from shopping for Lisa’s maternity clothes when Linda discovered Jim’s body in their garage.
Jim’s bandmates wrote and performed a song at his memorial service which Lisa says affected her deeply; it helped give her insight into all the anger she was feeling. Since then she has increased her knowledge about suicide and her empathy for other suicide grievers has led her to volunteer in a support program for suicide survivors.
Lisa reports that her sister was diagnosed with PTSD following Jim’s suicide and realizes she had similar symptoms because she too witnessed the suicide scene.
Consequently, Lisa sought help for her grief and anger through a support group.
Remembering her experience in this support context, she expresses feelings of solidarity with other suicide grievers (whose decedents shared the same method of suicide) but questions in her mind if she really belongs because of her peer relational status:
Lisa: I found too even through like through the support group and stuff and meeting people that have different relationships, you know, I still feel like I can relate a little bit to each of them, and it’s different ways, you know…..But then they, you know and they had the people talking about like you know their daughter or whoever had done it and the whole you know process and all
74 that kind of stuff, and you know like I found myself relating to the method. Interviewer: Ah, so like the process or… Lisa: Well like, no, like how the person did it. Interviewer: Oh. Ah, I see. Lisa: I found myself relating to those people more so than their relationship with the person that…. Interviewer: Hmm. And so would you say that overrode, you didn’t feel less important because you were up here? Right? So that canceled out because there are other people who share the same exact type of loss with you, that made you feel part of that group, you know even though they may have been family members, would you say that? Lisa: Yeah. I would say yeah, but also though when I would, a lot of times when I’m in like the group setting or whatever, there’s a lot of times where I’d feel like ‘Should I really be here?’ because here you have the mother that’s there that’s lost their son or their daughter or their you know brother or somebody like that. Interviewer: You feel sort of second tier. Lisa: Yeah.
Following this exchange, the researcher probed Lisa by asking more questions, including if she felt this sense of not belonging was her perception or the reality of the situation. She responds by qualifying that she only perceives this sense of relational disenfranchisement when she is in the company of other suicide grievers. But, as she subsequently relates, these grievers in her group are quick to dispel this perception and emphasize their support group’s inclusivity regardless of relational status:
Lisa: Yeah, and I think, I think it is just me. I think it’s my perception in that specific group. But I think in normal life, though, in everyday life I think people that that it affects me less. Interviewer: Right. Okay. Lisa: I do, but I think because the whole focus of the support group that I’m in has been you know everybody keeps an open mind and everybody listens, you know. Interviewer: Right, and that’s the ethos, yeah. Yeah, and the ethic. Lisa: Yeah, and I think that you know I never feel like when I… And another good thing too is like the person that kind of facilitates it a lot of times asks me about my experience and I think it’s
75 because they know that I’ll say whatever, I’ll talk, and they can bother me, you know……And it was good too because one of the first people that I met through the group was a woman who lost her ex-husband. So she was having the same sort of feelings like ‘Should I be here?’ and after like the second meeting we started talking and we talked a little bit about that, and then somebody else overheard us and said ‘You know, no, we don’t feel like that,’ you know, ‘It doesn’t feel like that. It’s not like that at all,’ you know. Interviewer: Yeah. Right. Lisa: ‘You were close to this person.’ And I think but you know but it’s such a small group too. Interviewer: Yeah. Lisa: And I think that probably helps. I don’t know what it would be like if I was like when there’s probably more people or whatever, you know.
Here, though, at the close of her train of thought, she speculates that her perception might change if the support group’s composition changed and more people were introduced.
Accordingly, Courtney, who lost her coworker/friend/ex-boyfriend to suicide explains she too feels reticent among other suicide survivors due to her relational status. She relates an experience at a training conference for survivor support group facilitators sponsored by the American Foundation for Suicide Prevention. She emphasizes that her solidarity with other suicide survivors seemed canceled out by her status as a friend versus family member:
Courtney: And it’s really hard ‘cause like I said, a lot of people don’t recognize… You know it’s just… Actually I went to, AFSP had put on a training for Facilitators of Suicide, survivor groups, and I had gone to that back in March, and I was in one of the groups ‘cause we actually did, like the first day it was kind of talking about group facilitation and all that, and the next day was actually experiential. We did groups and we had little practice as Facilitators, and I literally sat quiet the entire day because it was the most bizarre feeling to be in a room of people who had lost siblings, parents, spouses, and I’m like I just lost my friend, but I hate using the word “just,” because it’s not “just.” Interviewer: Right. Exactly.
76 Courtney: It’s that the relationship is just as significant, it’s just as meaningful, and it’s just as painful as someone losing their parent or their child or their spouse. You know any time it relates on that front it’s equally painful, but I just sat silent because I just felt really out of place, and it was weird being out of place in a room full of suicide survivors.
Both Lisa’s and Courtney’s comments suggest that grievers experience a kind of double jeopardy whereby relational status possibly counteracts feelings of belonging in support settings which are intended to unite participants around their type of loss. Though it seems counterintuitive that some peers’ feelings of disenfranchisement might be amplified in the very settings meant to help suicide survivors, Lisa and Courtney relate that they experienced a sense of internalized relational disenfranchisement when they participated in suicide support contexts. This is illustrated by Lisa’s question to another friend-griever, “should I really be here?” After being overheard by a family griever who explained that family members do not perceive friend-grievers in that manner at all, Lisa understood such internal feelings to be a false perception. Because expert facilitators make a point of including all participants in group discussion, thereby “enfranchising” her and she is able to fully join in once this internalized relational disenfranchisement is dispelled. With this gesture, she is able to help a family member recognize that, indeed, friends grieve too:
Courtney: …..and at the end of the day I finally said, you know I said ‘I’ve been very quiet today, and there’s a reason,’ you know and I explained the fact that I’m an introvert and I said, ‘You know also it’s just an odd feeling sitting here being…’ and I explained what my feelings were about my friend, and one woman, after I was done talking, she had tears running down her face and she was really upset. She had lost her stepfather to suicide, if I’m not mistaken, and she (hmm, if I’m remembering that correctly) was really upset. She felt really moved by that because there was one person in particular who was really close friends with
77 her stepbrother, and she said that person had reached out to her once or twice, and she wasn’t ready. She didn’t want to talk to them ‘cause she didn’t want to deal with it and had kind of shut them down, and she felt really guilty about it. She felt really bad because she said ‘I, you know I see it from your perspective that friends grieve too.’ …. But the problem is, and I said this at the end of our last meeting, I said ‘That’s a good way to identify family members who need support.’ However that completely overlooks the whole issue of friends, and I’m very, very sensitive to that because I feel very, I do feel disenfranchised and I do feel like no one recognizes my grief, and I do feel like it’s kind of…
Unlike Lisa, though, Courtney goes on to describe that her sense of disenfranchisement extends beyond support settings and includes social environments with non-survivors.
Courtney: And there’s no one that I can really talk to about it. There’s no one, even in the group. I mean I like the group a lot, but it’s hard because it’s a different loss. It’s very, very different and it’s hard because you know if it’s your mother or if it’s your child, you have people who will, you would hope, who are going to recognize that and offer you continued support, whereas a friend, like I said at work really that’s the only place where people kind of recognize your friendship. Within the first month, people stop talking about it. That was the end of that. You know no one ever… Interviewer: Yeah, I know what you mean, no man’s land. Courtney: Right. Yeah, I had someone call me. Last week we had group and one of his best friends had suicided mid-April and he didn’t find out until like ten days later after everything, all the services had happened, because it wasn’t, I guess it wasn’t a really close friend, but the man who called me was gay and his friend was also gay and he said that it was that this person was the first one to kind of introduce him to the gay community and offered his support. Interviewer: Are these good to you know imagine me talking to someone else and you know people would have, you know can speak to them? Courtney: Yeah. Yeah, I definitely think those questions are relevant, and I think in particular I find myself thinking I think differently about our friendship loss, because a lot of times I think it’s just from society you know it’s kind of standard that the family is the one who’s hit the hardest, and thinking about it, you know and I
78 think I just kind of accept that and feel, you know just feel my own feelings without really having anywhere to put them or anyone to talk with them you know about those feelings. But you know thinking about the fact, and thinking about like especially in teams, you know their friends are really their second family and… Interviewer: Critical. Yeah. Yeah. Courtney: Yeah, and even thinking about myself and like I explained, you know my family is really a very small part of my life and they know a very small part of my life, whereas there are friends who I let know a lot more about me and… And thinking about, even his family hadn’t talked to him for months before he died. Those were not the people closest to him at the time he died. Not to say that their loss wasn’t significant, but it’s just I’m thinking differently about friendship loss now because it’s like now it’s part of validating. Interviewer: I’m sure. Sure. Okay. All right. Courtney: Right, it’s very validating to talk about it, and I think I’m kind of realizing now how significant that loss is, whereas I think society really invalidates the friendship loss.
Relationships among co-survivors and social support. The previous sections have examined relational disenfranchisement issues between peer suicide grievers and suicide decedents’ families. However, during coding and analysis of interview data another important relational dimension emerged: participants’ relationships with their co- survivors. Their discussions included issues related to solidarity, estrangement, worry, and mutuality of support. This section considers the range of relationships between peer suicide grievers. Most importantly, their experiences reveal that looking to co-survivors for support in suicide loss may prove a blocked avenue of support. For example, in an earlier section, Andrea relates instances of relational disenfranchisement upon losing her close friend, Andrew, after becoming close friends over the internet. In the statements below, she describes her concern for Clayton and his well-being. After losing his best friend, he withdrew for days and will only talk to Andrea about the loss on days that are
79 symbolically tied to Andrew. Andrea highlighted Clayton’s deep sense of grief in the previous section, by indicating Clayton has never visited Andrew’s grave. Here, it is also significant to note that efforts were made to recruit Clayton as a study participant but
Andrew’s suicide is still too painful for him to discuss. In talking about Clayton, Andrea opens up about the strain in their friendship after Andrew’s loss:
Andrea: I asked if he would be willing to be involved and he said no. When Andrew died, we talked about it the day he died and we talked about it on the day of his funeral, and we talked about it when his ex-… Well when his ex-girl… The girl he was dating at the time was pregnant, so when she had his baby, Clayton went to see the baby and that was the last time we talked about it. Otherwise, he’s not willing to talk about it. I mean he feels responsible and he’s the one that found him. Yeah. And I mean to this day like Clayton won’t talk about it. I think he… It was really rough for him, and it put a strain on our friendship or what happened with us.
Further, Andrea’s expresses regret about not being able to talk freely about Andrew with Clayton. This represents another variant of relational disenfranchisement termed peer co-survivor disenfranchisement. Given additional dimensions of guilt and shame often involved in suicide deaths (Jordan, 2001), the potential for social support offered by fellow survivors-friends is an important one. Yet, these bonds may be especially vulnerable to the trauma of suicide loss, if denial, blame or other negative emotional content characterizes the circumstances of the death.
Carrie, 30-years old, lost one of her very best high school friends, Thomas, around nine years ago. Neither she nor his other close male friends were aware that Thomas had been suffering from bipolar illness and had been briefly hospitalized around a month before his death. Below, she describes feeling set apart from Thomas’s other close friends
80 who are mostly male. Although they share the same suicide loss, she explains they have not dealt with their grief as actively as she has dealt with suicide loss:
Carrie: You know it’s been a long road and it’s been very different for all of us, because there were a group of us that were very close, and it’s been very different for all of us and it’s been very unique for me you know to kind of handle it in my way, whereas you know I’m dealing with it with the other boys, and the boys have dealt with it all in very, very different ways and very unique and special to them and the relationship that they had had. And so I think I’ve handled it the best and I handle it you know kind of in strides and taking it, but as soon as it happened I wanted to. I wanted to understand what happened because I instantly had that ‘Why? Why did this happen? I don’t understand. I don’t get it?’ And so I started researching it, and for me when they said, you know, when they told us that he was bipolar, it just made sense for me. I didn’t question that. I didn’t have to understand what that was or exactly what it meant. They said ‘He’s bipolar,’ and it was like ‘Oh. Okay, I get it.’
Further, Carrie’s efforts to seek out formalized social support for suicide grievers has resulted in a career change whereby she now works as a suicide prevention and advocate professional. However, building this involvement and knowledge-base in suicide prevention and advocacy has influenced her understanding of the time before Thomas’s death. This differing view about Thomas’s condition creates a low-level of tension between Carrie and her co-survivors whom she refers to as “the boys”:
Carrie: But you know you don’t know what you don’t know and so you’re back on it and you know so it wasn’t until we looked back at it later and we went… You know for me I went ‘Well you know it was all right there and we just didn’t see it,’ and you know and the boys kind of have always just thought well you know the same ole, same ole, you know ‘It would’ve happened anyway,’ and I don’t believe that. You know I don’t believe that necessarily we could’ve saved him, but I believe that if we had known the warning signs, because just one of those things for the four boys and me, one of those things for the five of us would have been a signal. If any, if any of his close friends, if
81 somebody had said, ‘He hasn’t been to Structure. He hasn’t been shopping,’ we all would’ve been like, ‘Wait a minute,’ and the thing that was hard for us was that his girlfriend, she didn’t know him. She didn’t know him at all, you know?
Having explored relational aspects of disenfranchisement in suicide grief, the following sections explore the nature of suicide in the disenfranchised grief framework.
Suicide and disenfranchising social forces
The concept of disenfranchised grief was introduced by Doka in Disenfranchised
Grief: Recognizing Hidden Sorrow, (Doka) in 1989, followed by a second edition,
Disenfranchised grief: New directions, challenges, and strategies for practice (Doka,
2002). However, an explicit analysis of the disenfranchised grief model focusing on suicide loss is absent from either of these editions and the grief literature. Indeed, this omission in the literature is arguably a consequence of the degree of invisibility and stigma that still persists in our society related to suicide. Thus, having addressed relational disenfranchisement related to peer suicide loss, the following section deals with suicide as a disenfranchised loss. Specifically, this section considers how peer suicide grievers’ experiences were marginalized, trivialized, stigmatized and/or rendered invisible by others on an interpersonal and societal level.
Memorial services, religion, and disenfranchisement. With the participant interview schedule being structured temporally (i.e., describing friendship prior to loss, initial loss, and time since loss), the first disenfranchised suicide loss experience participants reported often involved the decedent’s memorial services. Religious doctrine and historical practices towards suicide decedents by the Church have played a strong role in perpetuating the social taboo and stigma surrounding suicide. For example, past religious injunctions in many Western societies like Great Britain included denial of a
82 Christian burial and civil penalties. In her book, Leaving You: The Cultural Meaning of
Suicide, Liberman (2003) describes this historical legacy, “By the end of the Middle
Ages, instances of profane burial and posthumous legal prosecution had become rare in
England, though the crime of self-murder would remain a punishable offense until 1823”
(Liberman, 2003, p. 13). However, in our present society, it is also true that members of the clergy are often the only support provider that suicide grievers encounter after a suicide death. Religious contexts, then, have the potential to be an extremely contradictory social setting through which many suicide grievers must inevitably navigate, often with the decedents’ suicides being suppressed or silenced altogether.
Adding to this conundrum is the fact that many suicide survivor support groups hold their meetings in Churches. Indeed, of the several suicide survivor support groups serving as study recruitment sites for this study, several of these groups met in regional churches.
Memories of winding one’s way through Church hallways to be introduced to a group of suicide grievers and listen to their stories vividly symbolize this juxtaposition.
Yet, the taboo associated with suicide stubbornly persists and manifested itself in a variety of ways through the recruitment process. For instance, after contacting over fifty area funeral home directors by letter, asking for their assistance with study participant recruitment, the mailing yielded only three responses. A phone call with one of these funeral home directors revealed a deep reluctance to contact families of suicide decedents with information about this project. This funeral director intimated this is the same reason so few funeral homes responded to the study mailing. Thus, this section traces the full spectrum of participants’ stories, including both validating and invalidating experiences of suicide loss in religious contexts.
83 Participants also interlaced their thoughts and reactions about the historical relationship between religious sanctions and suicide. Indeed, several participants touched upon this cultural contradiction between suicide and religion. This was the case with
Diana, 68-years old, a retired social worker, who lost her church friend, Joan, three years ago. Although Diana was thirteen years older than Joan, their shared interest in the
Unitarian Universalist church and other interests helped to solidify their friendship. Also, having a background in counseling, Diana was able to be supportive of both Joan’s physical (a foot handicap) and psychological issues (depression). Like Joan, Diana’s husband also has depression so Diana was especially sympathetic towards her illness.
Diana describes them as bonding around their common illness experience. They were
“buddies,” she recalls, and both shared a wicked sense of humor. According to Diana,
Joan’s memorial service was a positive experience and was very inclusive which allowed her to talk freely about Joan’s passing.
Diana: Oh well the Minister friend and I spent a large part of that weekend when she was here together, also a gay woman, and I that was a wonderful support to me to spend time with her. We put up her up at [local hotel]. Interviewer: Oh yeah? Diana: Yeah. You know it was convenient. Well the church was off of [road] where we had it, so it just seemed to work out, and she, you know she enjoyed it. So we would walk around, and you know she had other friends here too that she was going to visit, but you know I spent some good time with her and that was helpful. And you know both of us you know spent a lot of time talking about how we felt about it, so you know I really was lucky to have those kind of supportive people in my life that I could feel free to talk about it with.
Yet, Diana still signals her awareness of religious disenfranchisement a few minutes later on in the conversation:
84 Diana: Well you know the big reason why Catholics don’t. Interviewer: Yeah. Yeah. Diana: ‘Cause they consider it a sin… Interviewer: Yes. Yes. Diana: …and they won’t be buried through the Catholic Church. Interviewer: Right. Diana: Now that has changed, I’m sure, but it’s interesting. Interviewer: Yeah. Yeah. Diana: And I think that’s true, that you know even today that idea of it being bad and I know people have always said to me, ‘Oh I’m Catholic. I’m not going to do it,’ and I don’t trust that either, but there seems to be a stronger pull towards not doing it with Catholics. You’re right.
In particular, participants who are members of Catholic congregations or who were raised in the Catholic tradition talked explicitly about how they and their church reconciled this contradiction. Bill, for example, is a sixty-one year old social worker and
Vietnam veteran who lost three friends to suicide in the past seventeen years. Of these, the most traumatic was the loss of Lauren and her youngest child born with Down’s
Syndrome in a homicide-suicide. Lauren and her husband were close friends with Bill and his wife, Betty, and both couples would often socialize together. In the following vignettes, Bill articulates some of these complexities related to suicide loss for Catholics.
First, Bill describes that he and his wife go to church every week, yet formal religions don’t make any cognitive sense to him and he has remained Catholic simply because he likes the structure and routine. Below, Bill describes his belief system and explicitly links it to his reaction to suicide loss:
Bill: I think it’s kind of, you know I believe that there’s a spirituality. I believe that there’s something more than we know, but manmade churches don’t make it because you know their explanations for how the Lord lives and works, you know I can’t believe in a God who would condemn some people to hell when they’re still trying their best.
85 He continues that he has little respect for church leaders after experiencing disenfranchising attitudes from a parish priest who argued that Lauren should not be buried in their Church’s cemetery
Bill: When Lauren killed herself… The church we belong to is a large parish. They have like four or five priests. One of the priests was really horrified that she had done this and fortunately he didn’t get to have say in it, but he pretty much was saying, ‘Well she can’t be buried out of the church and she can’t be buried in the cemetery and you know this is an unnatural act,’ and so I say fortunately he’s not in charge of the parish. Several years later when the whole thing came to a head about priests molesting their children, he was one of the people that was named and he committed suicide. Maybe there is justice. Yeah, and he had, I don’t know if there was any basis to the fact, but apparently there were allegations that he had molested a girl. So it just reinforces my opinion of church leaders, because here he is being so sanctimonious.
At the close of his interview when asked about broader views about suicide, Bill returned to suicide loss in religious contexts. He argues for kinder treatment of suicide decedents by the Catholic church, an understanding of suicide as an illness rather than a sin.
Bill: Yeah, I would’ve probably come to that conclusion anyway if I’d be in a different field. I mean I can’t… If there is a God, he certainly could not punish and condemn somebody to hell (as it’s currently described by most religions) because of the mental state that they were in when they did this. If that’s the kind of God there is, well I’d rather be in hell with the other people.
Sharing two of the same suicide decedents with her husband Bill, Betty, sixty years old, also highlighted the same suicide proscription in response to the question of whether suicide loss was acknowledged or suppressed during Lauren’s memorial service.
During the mass, she recalls the priest reading a list of their donated organs and emphasizing that five lives were saved as a result. Yet, as Betty notes at the end of this
86 passage, while their organ donation was foregrounded by clergy members, the fact that
Lauren was gone seemed to be overshadowed:
Interviewer: Was it, in the service, was like the word “suicide” mentioned? How was it sort of understood? Was it understood through sort of religious underpinnings, or was it kind of like ‘We’re going to separate the two’ or do you recall? Betty: You know I don’t recall, but I do know this, that in the Catholic religion, if you commit suicide, you were not allowed to be buried in the church, and they, you know it’s like everything else. They play their little games. If they feel you were sick and weren’t responsible for your actions, then it’s okay, because you cannot be buried in consecrated ground if you kill yourself. You know nobody in their right mind is going to kill themselves, number one. I really don’t think so. You have to be I think in some type of desperate situation that you feel you can’t get out of, and so you know being buried in the church, they you know faced… I don’t know if they really… I know I remember… Interviewer: Were they buried in…? Betty: Consecrated ground? Oh absolutely. Absolutely, and the little boy was buried on top of his mom in the same grave. Interviewer: Yeah. Betty: And they talked about, and I remember Father describing the donation of the organs, and he actually read a list of where those organs went and whose lives they saved at the Mass. So you know that always sticks in my head too. There were five people that were given life. Interviewer: Yeah, see I don’t know if that happened in my case. Yeah. Betty: Yeah, but you know and that was thanks to our priest talking Lauren’s husband into donating those organs. Interviewer: Yeah. Betty: And so five people are alive today because of that. But Lauren, she was dead. There was no, you know…
Elsewhere in interview, Betty describes that she and Bill acted as secondary caregivers to Lauren’s two older daughters to help Lauren’s husband. She emphasizes that Lauren’s name is still mentioned in the everyday conversation of their household and their children still gather together for family events and Christmas parties. Similarly,
Andrea also struggles with reconciling suicide loss in the Catholic tradition. Again,
87 Andrea, 24-years old, lost one of her best friends, Andrew, seven years ago. She reports that the idea that suicide decedents are denied entry into the afterlife has a chilling effect on her:
Interviewer: So in thinking about like you know an after-life or you know the way, you know that specific part of religion, what are your thoughts on that Andrea: Well the way I was raised in Catholicism, it’s if someone commits suicide then the go into Purgatory forever. They never have a chance to go into heaven, and that was really difficult to handle, especially because Andrew wasn’t a bad person. He didn’t have a mean spirit. He had just reached the end of his rope and he just couldn’t hold on anymore. And it’s really, it’s haunting for me to think that like say I die and I go to heaven and I’ll never see him there. I mean he was such a big part of like my adolescence and my growing up and my maturing. I can’t imagine like not…It’s chilling having that thought.…And I have it like, you know, TV version vision of heaven where like you walk through the fog and like there’s that person and like they’re like hanging out and just chillin’ like in between and then like me having to leave. Like I just feel like I’ll see them and then I’ll have to leave him to go on. Interviewer: Oh, okay. Andrea: And I’m like would I pick to stay there just so that he wouldn’t be alone? Interviewer: Yeah. Andrea: And I’d probably would. I’d probably pick to stay in Purgatory just so that he wouldn’t be alone there, but I mean that’s, I don’t know. But then I’d like be giving up like seeing my sister and seeing everyone else that meant so much to me. Am I like ‘Is it worth his mistake to stay there with him and hurting everyone else I love?’ I don’t know, it’s I try not to think about it ‘cause it’s just a little too much for me.
Besides dealing with issues of spiritual invalidation of their loved ones, some participants experienced memorial services as traumatic on other levels. For instance,
Beth, fifty two years old, is a triple suicide survivor. Of these suicide losses, her most significant is her husband, Jim. Jim was a recovered alcoholic and he and Beth had been married twenty-five years with two teenage daughters when Jim took his life seven years
88 ago. She remembers having a visceral sensory reaction while at her husband’s memorial service. Jim was a military veteran, so a military salute was organized and shots were fired during his service. However, Jim had taken his life with a shotgun, so hearing this sound is extremely traumatic for Beth. Below, she explains that suicide was not explicitly discussed during either of the two services held for her husband. Moreover, at her husband’s memorial service, she experienced such a negative event that she sought grief counseling immediately following the service. She explains:
Beth: About four or five, I think, you know, and I decided… I was by myself. You know I drove by myself to the graveyard, so I decided ‘This is, I’m not in a good place. This is not good for me and I have all kind of anxiety,’ and it’s like a Friday afternoon. I came straight to the Center here and said ‘I need to see someone now.’ And so after I talked to a Counselor for about 15, 20 minutes, the anxiety started going down. What to this day does bother me, if you hear, if I hear a car backfire, or if I hear… I’m trying to think of what you call these things. I could’ve told you before we sat down, and I’ll know tomorrow.
One wonders, if suicide had been explicitly addressed during the service, whether empathetic others might have intervened realizing that firing guns at the gravesite of a decedent (who died by gunshot) might be upsetting to suicide grievers. Additionally, what information is made public or kept private about suicide deaths also complicates peer suicide grievers’ experiences. As Beth describes elsewhere in her interview, she was frustrated with the degree of public attention husband’s death was given by the media in their community. A subsequent section deals explicitly with suicide loss disenfranchisement and the role of the media. In particular, this section considers how public discussion of suicide or media coverage might intrude or infringe upon suicide grievers ability to receive support in private settings.
89 Foreshadowing this public-private connection in the context of suicide loss, Courtney expresses regret that information about Christopher’s death was shared publicly, but directly contrasts this event with the lack of discussion about suicide during Christopher’s memorial service. Indeed, at the end of her statement, she relates that she would have had “no problem talking about it”:
Courtney: Talking about, you know like talking about it, just not the funeral? Interviewer: Yeah, and I mean just, I mean it’s one of the things that interests me. Courtney: You know it has actually, I told my boss and then apparently his mom had called HR, an agency, and told them that he had passed away but asked that they not tell anybody, and then I guess it was probably the next day, that Thursday, there was a staff meeting and the Executive Director of the agency announced that it was a suicide and said ‘There’s probably going to be some rumors going around in the community. We want you guys just to know,’ and I thought that I was really angry about that because the family had asked specifically that it be kept private, and I don’t, I don’t know. I just… Christopher was a very private person, you know just very private, and I was really kind of angry about the fact that it was his private information. Now I mean and granted he’s dead, but his private information about how he died was… Interviewer: Um hmm, now public domain. Courtney: …was public domain, exactly, and that was really frustrating to me. But the suicide was never mentioned anywhere in the funeral, the viewing. You know the Memorial Service, it was never, never mentioned at all. There was no discussion about it, and I don’t have a problem talking about it.
Megan, 36 year-old female, lost her best friend since middle school, Michelle, nineteen years ago. Similarly, Megan remembers that the nature of Michelle’s passing was not discussed at her wake or memorial service, however she suggests that everybody sensed the taboo surrounding Michelle’s death by suicide too:
Interviewer: I wanted to ask when people ask you about the suicide, how do you sort of, linguistically, how do you talk about it? What
90 phrases do you use, if it’s ever talked about? Like at the funeral, for example. Megan: You know at her funeral, it wasn’t really brought up. Everybody knew, but it was like this big taboo. I mean my friends were there. We didn’t really all sit together. I think everybody was just… When we came out of the pews kind of together at the same place, one of the Nuns came up and she had been a Guidance Counselor, and she didn’t mean it the way it came out, but she goes, ‘Well girls, it’s just the first one in a very long line,’ and I think she meant deaths of like through your life there are going to be a lot of deaths in your life, like friends. That didn’t go over very well and I had talked to her later on and she said (and I’ve used this before, and I use this phrase a lot; it came from her), she, I just couldn’t grasp you know Jen having committed suicide and why she wasn’t here and she said ‘Some people are just too beautiful for this world,’ and it’s one of the things when people you know say ‘Well but really, what, why do you think this happened?’ or I won’t… It was a suicide. I don’t believe it was… I think it went way too far and it was a suicide.
At the close of this passage, Megan also highlights comments by a nun which she
experienced as disenfranchising because she felt Michelle’s intent was ultimately not to
kill herself, as discussed in an earlier section. Also, the supportive words offered by the
nun did nothing to help Megan work through the complex emotions of Michelle’s death.
Though Michelle took her life nineteen years ago, young peer grievers more recently
bereaved by suicide reported similar treatment of suicide deaths during memorial
services. For instance, Abby, 23 years old, is a college student and was 20 years old when
her best friend’s younger brother, Adam, took his life.
Interviewer: …and so the suicide was never explicitly mentioned. Abby: Not at his Memorial Service. I mean like I said, I think everyone that was there knew what happened and that they were all kind of too much in shock to like go talking about what actually happened. I know… Interviewer: Say the s-word wasn’t uttered? Abby: Yeah. I know it was hard for me to be there and not lose it. Interviewer: So what kind of information was kept private and what was made public? Do you remember any sort of…?
91 Abby: In his Obituary, it didn’t say that he committed suicide or that he took his life. It just said that he passed away.
Media, disenfranchisement, and suicide grief. Another social institution which can play a powerful role in framing suicide to suicide grievers and the general public is the media. Indeed, media coverage of suicide has been shown to influence suicide rates through the contagion effect (Sonneck, Etzersdorfer, & Nagel-Kuess, 1994). Done incorrectly, media coverage can also be disenfranchising to suicide survivors. In their recommendation for informed coverage of suicide by the media, for example, the
American Foundation for Suicide Prevention (American Foundation for Suicide
Prevention, 2011) explains that coverage tends to overemphasize a recent painful or stressful event in the decedent’s life, over the understanding that the suicide of an individual is invariably much more complicated and usually involves mental illness. The effect of this pattern is to understate the role of mental health problems which is the greatest factor underlying suicide. Though not highlighted by the AFSP recommendations on behalf of suicide survivors, news coverage of a suicide may reach suicide survivors before being informed in a personal manner by others close to the decedent.
Sadly, these two factors coalesced in Betty’s suicide bereavement experience.
Betty’s loss of a close family friend was highly publicized by local media because it involved a homicide-suicide. On her lunch break at work, she was watching the television and learnt about her friend’s passing through the local news:
Interviewer: So they had the name? You recognized the house? Betty: Oh yeah, the house, the name, everything. Everything was on the news. It had happened like maybe four hours earlier, and no
92 one had had gotten, you know gotten a chance to get a hold of me, and that’s where it was. That’s where I saw it. Interviewer: Wow. So describe that. You know when you say you went… Betty: Ballistic? Interviewer: Yeah. Yeah. Betty: I was screaming hysterically in the lunchroom and there was another lady who happened to be there with me you know and they were trying to calm me down, and you know I just had to get out of there. There was no way. I mean I had to get a hold of somebody to talk to, you know, and so they drove me home from work. Well first before I even left work, I called Bill you know he says ‘Calm down. Calm down,’ you know ‘cause I was screaming at him on the phone. ‘Calm down, calm down,’ and I said, ‘They’re taking me home,’ you know and then I called our other best friend whose husband saw it on the news…And our friend’s husband, all he kept saying is ‘I’ve got to get a hold of the [family] and the [family]. They can’t find this out on television. You know, they can’t.
Below, Betty expresses her anger with the media’s distorting focus on what they believed to be the cause of Lauren’s actions, stress from caregiving to her handicapped child:
Betty: Because of the situation, not only the suicide, but killing her son because she, you know possibly she couldn’t cope with you know his illness, that the media was out there ‘Please parents, if you have a child with a handicap, here are the numbers to contact for help.’ I mean this was all over the news, every station you know seeking help for parents who might be in desperate situations like this, which none of us knew she was in a desperate situation, but they were trying to prevent more of this happening. So it was on the news for days, and you know then we were trying to protect the kids from the news so you know they wouldn’t be exposed to all of that.
In their recommendations for the media, the AFSP cautions that in such cases, “the tragedy of the homicide often masks the suicidal aspect of the act.” In her previous comments related to religious treatment, Betty observed that Lauren’s suicide evinces this pattern, whereby her passing is downplayed by the Priest’s emphasis on the lives which
93 were saved as a result of organ donation. Betty recalls, “And so five people are alive today because of that. But Lauren, she was dead. There was no, you know.” Suicide grievers like Betty object to such treatment because it reduces suicide decedents to the mode of death and serves to devalue their loved ones and their resulting grief. Most suicide grievers find this insulting because it does nothing to change their deep sense of loss, it only helps to reduce others discomfort in having to deal with suicide.
Another participant, Beth, elaborates her frustration with the intrusive nature of the media’s coverage of her husband’s suicide death:
Beth: My husband was a public official here and had been for eighteen years, so this was a high profile suicide. Interviewer: Ah, that’s one of my questions, like was it kept private? Was it made public? Beth: No. Interviewer: Right. Beth: It was public. The TV cameras were at the house in the street. It was on… Let’s see, he died 11-something, 5:00 news. Six hours later it was on the news, the radio. The next morning it was in the newspaper. The cameras was at the… Interviewer: Oh, I’m sorry. Beth: The cameras you know followed the procession to the grave. They stood far off with the cameras. I didn’t have an option. It was very out there, but what I did do is I closed myself in and kept myself around safe people, people I felt safe with, because there were rumors all over.
Above, Beth emphasizes that the media coverage violated her right to grieve in the way she wished.
Indirectly, the media may also act to disenfranchise suicide grievers too. For example, media outlets are often used in suicide prevention outreach, but these efforts can backfire when suicide survivors are not taken into account as part of the campaign’s audience. While attending meetings of a regional suicide prevention task force during the
94 field work stage of this project, the investigator learnt of a local suicide hotline campaign in which billboards and bus advertisements were recalibrated after receiving negatives feedback from suicide grievers (Oliver et al., 2008). “Suicide is preventable. Its causes are treatable,” read the text of these public service announcements. However, suicide survivors reported feeling disenfranchised because they felt the message implied that, as family and friends of the suicide decedent, they had somehow not done enough to prevent their loved one’s suicide. By implication, too, the original message eschews or masks the complex nature of mental illness which peer suicide grievers echoed in the previous section. Consequently, the tagline, “Do you know someone thinking about suicide?” was substituted to appear along with the suicide hotline telephone number.
Schools and disenfranchised suicide loss: “And let’s all pray for her ‘cause she had more problems than any of us could understand.” As highlighted in a preceding section, members of the clergy are oftentimes the only formal support provider that suicide survivors encounter after a suicide death, especially for family members. In the following section, peer suicide grievers who were high school age or younger at the time of their loss, discuss their grieving experience in the context of schools. For better or for worse, suicide is often framed by teachers, guidance counselors, and school administrations in educational contexts. Such representation of suicide is often driven by concerns about social contagion effects spurring more student suicides or liability issues, yet these decisions may also disenfranchise peer suicide survivors in the process.
Accounts from several participants offer insights into how schools and their personnel have fared in dealing with suicide in student populations over time. In particular, Abby’s
95 negative experience stresses that school administrations must proactively deal with student suicides and address precipitating forces in their student bodies like bullying.
Donald, 60-years old, is a triple survivor and a psychologist who has devoted much of his professional career to helping those bereaved by suicide. He experienced his first suicide loss at the age of eleven when his best friend from elementary and middle school took his life just before summer break in 1961. He describes that he and his classmates were gathered by their teacher in the playground at the end of the last day of classes and informed that their class mate had gone home the day before and shot himself. He emphasizes that he “didn’t have anybody to talk to about it” or to answer his questions:
Donald: When he died, and it being at the end of the year like that, there was no more connection over that summer with other… So I didn’t have anybody to talk to. I didn’t have anybody. So for me it just kind of got sealed over, and even though the next year we went to high school and his brother was a year older, none of us ever asked his brother, and only occasionally would we even mention his name, because the belief we had, which was reinforced for us, ‘You just don’t talk about the dead. You don’t talk bad about the dead.’ So you know the message was ‘Just don’t talk about it,’ but I can remember every time I saw his brother wanting to ask about it.
Moreover, in the passage below, he remembers specifically that the word “suicide” was not used and struggling to understand the euphemisms and silence around suicide as an adolescent:
Donald: But it was suicide. It was a while before I actually could put that together. What I kept doing in my mind was saying, ‘Okay, he went home and shot himself. He must’ve been cleaning his dad’s gun or pulled it off a shelf or…’ because see they didn’t use the word “suicide;” they just said he went home yesterday and shot himself and he’s dead, ‘He died.’ So that was also a time in history where routinely in the paper, if there was a death, it
96 would’ve said by you know ‘cleaning his gun,’ or ‘accidental discharge of firearm.’ There were these euphemisms. For suicide they were still used a lot, and so I was in that place where I think most people who read those wondered ‘Was this intentional or not?’
Donald continues by describing school reunions some forty years later, that day will return in a whispered conversation between his fellow students. Donald states in his interview later on that he believes this day left an indelible imprint on them because of the lack of closure and silence in respect to suicide.
Megan, a 36 year-old female, lost her best friend, Michelle, nineteen years ago during her college years. At Michelle’s memorial service, she remembers that a high school teacher whom she had been close to intervened in a negative exchange with another of Michelle’s friends.
Megan: ….when the teacher pulled me out of there, it was the second half of the Wake. It was in the evening, and she was like ‘We’re going to go get coffee or something,’ and she was really great too. Like I said, I love my parents. They went to pay their respects, but they just didn’t get it. It was like ‘All right, now move on,’ and that’s just not how I am.
Above, Megan emphasizes that a sympathetic teacher played an important supportive role, helping her through a very difficult day when her parent’s support fell short. Yet, at the same time, her sister who is still enrolled in their high school informed her that the principal, a nun, announced over the public announcement system that a recent graduate had died. The announcement concluded with the principal asking the student body to
“pray for her because she had more problems than any of us could understand.” For
Megan, these sentiments were not consoling:
Megan: Yeah, and then after it happened my sister was really, my sister was still in high school and she was at
97 Michelle died. I guess the Principal got on the PA and made an announcement that we had lost an alumni from the year before and said who it was and said ‘And let’s all pray for her ‘cause she had more problems than any of us could understand.’ I’m sure she thought that was being caring, kind and loving as a Nun, but that sure wasn’t endearing to me, and my sister was really afraid that I would do something to myself, which I didn’t, and it took me a while. There were times I just went through this dark period.
Finally, Abby, 23 years old, is a college student and was 20 years old when her best friend’s younger brother took his life. Adam was 17 years old at the time of his death and they all attended the same public high school at the time of his death. Abby discusses at the length the role of bullying in Adam’s suicide death. She explains that because Adam was smart, had a thin physique, and played in the high school band, he endured a constant climate of harassment and taunts like “fag” from other boys. These boys would throw paper at him in their math class and were threatened with athletic team suspensions but never received these repercussions.
Interviewer: …pick on him. And was it like fairly constant? Did it kind of go or…? Abby: From what we found out from the school, it happened all the time. Like the Math teacher would threaten to give them detentions if they didn’t stop picking on him, or like pull them from whatever sports team game was coming up that they were involved in and that was it, but they never got any repercussions for their actions.
However, Adam’s family and friends were not aware that the bullying was so extreme until they met with school officials after his death. Further, the school would not allow any remembrance ceremony for Adam to take place at the school. Abby speculates that this is likely due to concerns about contagion effects. Instead of addressing bullying, school officials mailed a letter to parents suggesting that an internet suicide pact was to
98 blame for students’ suicides. Yet, as Abby indicates administrators’ attempts to shift blame to a suicide pact instead of understanding the bullying problem in their midst is the source of great anger for Abby. It was also disenfranchising because her distress over multiple suicides being “covered up” bythe school prevented her from seeking support from counselors:
Abby: I think some of his friends went to talk to them, but I didn’t. I was so mad at the school that I sat there gripping my chair to keep myself from yelling because I was so angry that the Principal wouldn’t do anything and wasn’t comforting his family at all. Like the school just made it into this big mess and tried to cover it. Interviewer: I think they were doing that out of kind of legal worries that there might be… Abby: I think so. I think they didn’t want to be responsible for it. There had been a couple suicides before Eric’s and there were a couple afterwards. Interviewer: Okay, so he was right in the middle. And do you remember how they handled those? Abby: Not very well. They ended up sending out this letter to every resident in the community about like how it was a suicide pact. That was one of the letters. They sent another letter about how…about how like you know it was because of the Internet, it wasn’t about bullying. They did everything they could to cover the fact that these kids got bullied. Interviewer: Wow. So in a way they were just actually… What is that term? Cover your own, you know. So the school wasn’t going to allow any kind of Memorial or tribute or remembrance.
Abby’s experience is very important because it sheds light on how school unresponsiveness to factors associated suicide (i.e., mental illness and bullying) can compound peer suicide grief reactions. About a year after Adam’s suicide, the issue of bullying and suicide was brought up in one of Abby’s college psychology classes, but because of her disenfranchising experience with this topic she describes being very distressed and silently overcome by the class discussion that day. She remained quiet
99 about her experience until she wrote an assignment in which she conveyed that the topic was a very personal to her. Further, in her interview, Abby reports being familiar with the case of a young girl in Massachusetts who took her life after being relentlessly bullied. In response, the State of Massachusetts has passed strong anti-bullying legislation under which defendants can be criminally prosecuted.
Within several months of Abby’s interview, the national media turned the spotlight on bullying and suicide after a wave of teen suicides associated with gender- based and anti-gay bullying took place across the country. Within a matter of weeks, five teens took their own lives after being subjected to harassment and ridicule because they were gay, thought to be gay, or behaved in ways that didn’t conform to stereotypical gender norms for boys (McKinley, 2010). Finally, as a result of this rash of suicides, the
United States Secretary of Education issued a memo to state leaders outlining best practices for anti-bullying policies pooled from the twenty-nine states which have existing anti-bullying laws (U.S. Department of Education, 2011).
Increasingly, too, more high schools are addressing teen suicide by emphasizing mental health awareness in their student populations. For example, the State of Illinois recently passed legislation which promotes prevention training for teachers and staff.
Consequently, freshman students at Oak Lawn Community High School were surveyed with questions designed to indicate students who might be struggling with depression and/or thoughts of suicide. At the close of the day, some fifty students were seen by counselors (Keilman, 2011). In this section, peer suicide grievers who were high school age or younger at the time of their loss express that “framing” of suicide should be mindful of peer-student grievers. Teachers, guidance counselors, and school
100 administrations should be especially aware that concerns about contagion effects or liability issues should be weighed with the disenfranchising consequences of such choices as highlighted by Abby’s suicide loss experiences. Clearly, these preceding sections illustrate institutional/bureaucratic disenfranchisement which refers to experiencing suicide-related stigma in the institutional realms of religion (memorial services), education, and the media. Alternatively, the following section illustrates similar experiences at the micro-level of society through linguistic dimensions.
Disenfranchising language and silencing in suicide loss: “Nobody talks about that [suicide], except if they’re kidding.” Peer suicide grievers experience of negative exchanges in which suicide was obfuscated, diminished, or trivialized was borne out in the data. The following section draws on several of these examples to highlight the continuum of language about suicide which study participants found disenfranchising.
As the section title reflects, many of these expressions of speech were manifested in jokes about suicide. By the same token, participants’ reflections on their own use of language and ways of communicating their suicide loss are also examined. Megan, 36 year-old female, lost her best friend, Michelle, nineteen years ago reflects on the longevity of her grief related to suicide loss. For instance, she notes that her sister has observed she was never the same after Michelle’s loss. But it has also impacted her life in other ways, in particular, she shares examples of her suicide activism (elaborated in greater detail in the following chapter) with her high school students motivated by having lost two of her students to suicide in recent years. In her eyes, the incidence of suicide and suicide loss seem to be increasing, given the people she has known who have died by suicide. Yet, it troubles her that society’s awareness of this public health issue doesn’t appear to be
101 mirroring this trend. Here, she remembers an interaction with a coworker which highlights the continuing stigma towards suicide:
Megan: One of the former Administrators here was going to a Wake for a kid who had committed suicide, and my friend is the guidance counselor here and said to her, you know made a comment about the kid probably, ‘Well we’ll go even though you know the kid is probably going to hell,’ and I just thought, ‘Who do you think you are?’
This is an example of language that is directly or overtly disenfranchising of suicide. Yet other participants also suggested that other cultural statements like jokes about suicide indirectly disenfranchise peer suicide grievers. As noted in an earlier chapter, it is estimated that for every suicide there are six people are intimately affected by the loss (Schneidman, 1969). For several of the suicide grievers in this study, such careless expressions of speech or gestures trivialize or eschew the reality of suicide and thereby diminish their loss. For example, on her first day back on the job after discovering Jim’s body hanging in their garage, Lisa endured witnessing a coworker making a hanging joke gesture during a meeting:
Lisa: Exactly. And yeah, and then and then in that I never noticed how much people joke around about like saying that ‘Oh I’m just like…’ or you know not even come in to that extent, but say like ‘Oh, if somebody does that, I’ll just shoot myself right there,’ or something like that. Interviewer: Yeah. Right. Lisa: Or like and you know what? My very first day back to work afterwards, and like I said, and my very first day back to work a coworker of mine, we were in a meeting and the boss was rambling on about some I don’t know even remember what it was, but he was sitting like kind of across the table like looking towards me and he does one of these [hanging gesture], you know like, and that was just kind of like… Interviewer: Oh when people gesture like, like that? Lisa: Yeah. Yeah, but he did the whole hanging thing, all of that, and you know…
102 Interviewer: Oh. Lisa: And then and you know but it was like I mean he had absolutely no idea, but it was just one of those things, and I think people don’t think about it, you know.
Here, Lisa echoes the notion that these gestures or comments are unwittingly made in the presence of suicide survivors. “People don’t think about it,” reflects Lisa on when people mimic or joke about suicide. For Beth, one of the most disenfranchising statements related to suicide which she remembers is a rumor among her husband’s acquaintances that he was murdered because the notion that he took his own life was too implausible. In addition to dealing with others’ denial of suicide, Beth observes rather poignantly, that the only time she hears people talk about suicide is in the context of a joke:
Beth: But I think on a lot of levels or with a lot of different people, suicide is so far out of their realm of even possibilities that it’s almost like, ‘I’ve got to look that word up in the dictionary,’ you know. Interviewer: Right. Right. Beth: It’s not… Nobody talks about that except if they’re kidding. Interviewer: Yet 40,000, you know 30 or over 30,000 Americans take their lives every year. Beth: Yeah. Interviewer: And yeah, I think yeah, trying to sort of… Beth: And I always wondered why we had to have that disease, you know the depression that led into suicide. Why couldn’t we have something that lots of Americans have? You know what I’m saying? Interviewer: Right. Beth: Why did we have to be in a minority? Interviewer: Because then there’s a vocabulary that you can access, you know sympathy. They have some sort of frame of reference so you don’t have to come up against that ignorance, or the possibility of it …. Above, Beth’s comments clearly express feelings of disenfranchised loss—her sense of being a minority—related to the suicide death of her husband. Moreover, to
103 illustrate this she draws a comparison between suicide and other more frequent causes of death which, in her eyes, seem to be more widely acknowledged and understood by the general public because of their greater incidence. Adding to these voices, Andrea relates that she battles with how to react to these disenfranchising expressions of speech— whether she should voice her objection to an expression of speech like, “I’m just going to shoot myself” or let it go?:
Andrea: Well it’s like my twin sister says a lot ‘Oh I’m just going to shoot myself,’ and I’m just like ‘Aw,’ and like she doesn’t realize it, but she just says it and I just let it go because I don’t want to like, I don’t want to say something and have it upset her, like she’s already upset obviously, but yeah, it’s…. I hate it. It just hits a spot with me to this day.
The degree of distress caused by these expressions of speech varied across participants from very little to substantial distress. Indeed, one or two participants will invoke these same expressions of speech themselves, as highlighted in following section.
However, for others, these expressions of speech represented disenfranchising views towards suicide and in some cases retriggered their suicide grief, as Abby describes below:
Abby: Initially I would say I received support. I haven’t dealt with it very well over the past three years, and at first everyone was really open to making sure that I was okay, but like there would be things that would trigger me to be upset. Like I remember I think it was the semester after it happened or towards the end of the semester that it happened. Someone in the hallway at school was talking about you know ‘I’m going to go kill myself if I don’t get an A on my finals,’ and I just like lost it.
Above all, participants’ remarks point towards a cultural logic regarding suicide which is pervasive in our society: the assumption that suicide affects the suicide victim solely. By this logic, the joke is then acceptable. But, on a normative level, these
104 expressions invalidate the existence of suicide loss. What this communicates to peer suicide grievers is that their grief experiences simply do not exist—a profoundly disenfranchising realization. Moreover, this puts suicide grievers at a distinct disadvantage when it comes to marshaling social support because they are faced with a normative landscape in which the only instance in which their grief experience is acknowledged is in the form of a joke.
It is important, too, to examine the other side to this coin: how do peer suicide grievers themselves talk about suicide loss? Does this view tell us about their efforts to cope with disenfranchising language associated with suicide loss? Here, participants’ responses clustered into three general groups. First, this group consisted of those who do not mince words when indicating their loss was a result of suicide. Diana, for instance, epitomizes this group by describing herself as being very “upfront” about her loss. Other participants described contingencies in their choices to name and talk about their loss.
Betty, for example, doesn’t think twice about expressions of speech like, “I could have killed myself” in conversation. Indeed, she will use them herself;
Betty: No, no, I’ll say to myself, ‘Oh my god, just get me a gun. You know I’m ending it today,’ you know, but that’s, I say that all the time, you know. Not even… Even though that’s the way J killed herself, I don’t, that doesn’t even come into play when I say that, you know if I had a horrible day at work and these customers are driving me crazy and it’s like ‘Oh god, get me out of here,’ you know; or like I told my daughter one time… I hate the Wal-Mart. I hate the Wal-Mart, and I said to my daughter, ‘You know what, A?’ I says, ‘If I’m ever going in the Wal-Mart again,’ I said ‘take a gun and shoot me.’
105 However, when reflecting on this question her husband, Bill, observes that when talking about their loss with other fellow co-survivors they do not use the word “suicide.”
Instead, they use descriptive language of the decedent’s actions:
Betty: Well thinking back on the group with us, “suicide” isn’t generally the word that’s used. Either people talk about what she did without having to detail it because everybody knows, or the term they use is that “when she shot herself” or “when she shot
Finally, some participants actively strategize about language to protect themselves from potentially disenfranchising encounters. Beth, 52-years old, a triple survivor whose most painful loss was her husband, describes actively developing “clichés” to exit encounters with others who don’t “get it”:
Beth: This is what I found. When I would say ‘He committed suicide’ or ‘He completed suicide,’ it’s like it’s such a shock, that word, to the outside… Interviewer: Yeah, you’re about to dump a boulder. Beth: …um hmm, that they can’t… They’re speechless. Interviewer: Yeah. Beth: Okay. So if I say ‘He took his life,’ within, there is a period of time there that their mind is reeling and you can see it, and they’ll go, ‘Oh, she means suicide.’ Interviewer: Right. Right. Beth: You know? And so you know it gives, instead of… You know it’s almost like a little mind game. Interviewer: It is! That’s what I’m trying to get at… Beth: It’s almost like a little mind game. Interviewer: …these sort of contortions that we do to…
106 Beth: Yeah. I just feel more comfortable saying that in most cases….and I just kind of kept myself and the girls in a very protective area, you know, with people that would not do that kind of stuff with us… Interviewer: Yeah. That’s a problem, isn’t it? Beth: …and kept the rest of them kind of at bay, and then learned clichés that I could use with people that did get ignorant with me, and that I could come back with in speaking with them.
In this section, participants’ accounts highlight suicide loss disenfranchisement in the linguistic realm whereby gestures, jokes, or expressions of speech convey negative attitudes towards suicide loss. Thus, language which trivializes or diminishes suicide loss reflects linguistic disenfranchisement.
In sum, the preceding sections have illustrated disenfranchised grief, both in terms of peer relational complexity and distorting or stigmatizing forces associated with suicide loss in multiple social contexts. It provides an explicit analysis of suicide loss in the disenfranchised grief framework which has been pointedly absent from the grief literature. Based on these accounts, it is easy to see why such an omission in the literature might be driven by the stigma of suicide. Moreover, Doka (2008) has called for grief scholars to extend the disenfranchised grief framework by studying what experiences might serve to counteract the type of disenfranchisement described above. By broadly describing processes and experiences at the individual and community levels for peer suicide grievers, the following chapter tackles the question of support and coping in peer suicide grievers, and, in particular, re-enfranchisement.
107 Chapter Four: Coping and re-enfranchising experiences of peer suicide ‘survivorship’: individual, intermediary, and group-based strategies
“I don’t think of myself as a suicide survivor, which is kind of interesting, ‘cause I am a suicide survivor, but there were three key people in my background that did suicide….I guess to a certain extent I’ve kicked these suicides out of my closet, so to speak, and maybe that’s why I don’t consider myself a suicide survivor even though I clearly am….and I guess, and maybe it’s just my makeup but my undergraduate background is in Developmental Theory, and so I know that you know we all go through these stages, and I studied a lot about stages and understand that if you come to grips with them, yeah, when you put them to rest, they tend to stay at rest.” --Bill, 61-year old, lost three friends to suicide
“…just looking around at all the people you know that were affected and it’s like you’ve got to think ‘This is just this one small area in the country in the world you know, and these are the people that know about the walk, and that feel comfortable coming out and doing it.’ You know it’s just a small representation of the people that are out there. It’s amazing.” --Lisa, 28- year-old, lost her future brother-in-law five years ago
Because the disenfranchised grief framework postulates that those experiencing disenfranchised grief will encounter decreased social support, the questions of, if, and, if so how or where peers develop coping strategies in the context of suicide loss then is a significant one. This chapter explores the different ways in which peers of suicide decedents cope with their losses. To be sure, there is a great amount of idiosyncrasy in how one copes with suicide grief: what works for one may not work for another. The vignettes of data highlighted above signal a range of coping behaviors and contrast the role of individual and group-based dynamics within suicide loss. This chapter considers several questions related to the broad experiences of support participants shared about their suicide loss: what coping mechanisms do peer suicide grievers engage in to deal with their suicide loss? Do participants experience a lack of support? If so, do they marshal support and how? What are the key social contexts where positive social support
108 occurs and how do suicide grievers describe such contexts? Is suicide survivor identity important in this process? At what point in the process might survivor identities emerge?
What supports or detracts from the process of identifying as survivor? In this chapter, findings are explored along a broad continuum of coping experiences and behaviors, including individual behaviors in which peers engage in to support themselves, inter- personal support, psychological counseling, suicide bereavement support groups, suicide prevention charity walks and conferences, and volunteer programs which help suicide grievers. An analysis of themes related to coping, reveals three cleavages along which strategies of coping emerge: 1) intrapersonal coping (i.e., study subjects keep pictures and keepsakes but do not usually identify as a suicide survivor), 2) intermediary coping
(i.e., study subjects engage in informal outreach in either their personal or professional realms and may or may not identify as a suicide survivor, and 3) group-based or extrinsic coping (e.g., subjects participate in formalized mutual support or outreach to suicide grievers and usually identify as a suicide survivor). Most significantly, findings in the latter group capture various ‘re-enfranchising’ strategies in the context of suicide grief— these findings are one of the theoretical contributions of this inquiry. Finally, the closing sections of this chapter explore the extent to which participants identified with being a suicide survivor and what this identity process means to them. Although suicide survivorship identity cuts across these categories and will be discussed in each section, the closing section of this chapter emphasizes this suicide survivor identity process. Nor are coping strategies conceptualized as mutually exclusive, therefore some stories told by individual participants contain examples of both intrinsic and extrinsic coping processes.
109 Individualized Coping Strategies To develop the continuing bonds model of grief, investigators have crafted questions related to attitudes and behaviors which reflect this model. For instance, Field,
Gal-Oz, and Bonanno (2003) included in their eleven-item questionnaire questions which ask grievers about keeping items or reminders closely associated with a lost spouse, having inner conversations with lost spouse when in need of comfort or advice, or taking on their lost spouse’s habits, values, or interests. However, also included are questions which might elicit ambivalent responses from suicide grievers because of the traumatic nature of suicide (i.e., enjoying reminiscing with others about spouse and having fond memories that bring respondents’ joy). Because such prompts highlight a failure to account for traumatic losses such as suicide, a qualitative exploration of continuing bonds among suicide grievers is a valuable contribution to contemporary grief studies
Many of the intrinsic or intra-individual personal coping methods exhibited among peer suicide grievers such as displaying pictures, letters, and other keepsakes, obtaining a tattoo, and visiting places associated with the decedent offer evidence that suicide grievers maintain a continuing bond with their suicide decedents. In addition, another expression of coping revealed in the data includes ongoing nurturance of emotional bonds (e.g., talking to the decedent, memorializing the anniversary of the death), and including the decedent in significant family gatherings. Findings indicate that most participants acknowledged an ongoing connection with their suicide decedent either through keepsakes or emotional expressions similar to the conceptual domains discussed above.
Several participants exhibited tangible evidence of a continuing bond with their peer suicide decedents. Indeed, one participant, Andrea brought a photograph and other
110 keepsakes to the interview. Andrea is twenty-four years old and lost one of best friends,
Andrew, seven years ago when she was seventeen years old. Andrew was nineteen years old when he took his life. Andrea was in the seventh grade when her friendship with
Clayton (Andrew’s best friend) began in an internet chat room as both Clayton and
Andrew lived several states away from Andrea. Though they never met in person, they spoke on the telephone every other day for several years and she felt very close to
Andrew. The next few examples illustrate usual ways participants maintaining bonds for peer suicide grievers, thereby exhibiting intra-personal coping strategies.
Below, Donald, 60-years old, a psychologist and triple suicide survivor who has devoted much of his career to helping those bereaved by suicide discusses a photograph at his desk of his best friend who took his life at the end of their eighth grade term.
Notably, he closes by indicating that this work helps him to be more at peace with the loss of his friend which remains to some extent inexplicable because it occurred at such a young age:
Donald: We were best friends. I mean couldn’t wait to see each other every day. Played together on the playground. Liked, you know had girlfriends that we thought were cute and you know we would talk about our girls. So we talked about that kind of stuff. We shot marbles together, all those things that at that time were the bonding activities of that age group. If you saw one of us, you saw the other, and had each other’s back, all that. So I know that as I try to recall my reaction, it’s all just gone. It’s as though I have no memory of anything after her telling me. I suspect I was in shock for quite a while. That’s what I suspect… Interviewer: Sounds like it, yeah. Donald: …but I don’t know more about it. Interviewer: Yeah. Now I mean you’ve got the insight and the consciousness to be aware of yourself looking at yourself, you know. Donald: Yeah. I know that I would often go back to photographs of all of us standing on the playground when he was alive and glance at his picture. I’d just look at him out of the five or six of us in the
111 photographs. Didn’t have a lot of photographs of us as kids back then, but I had a few little like black and white photographs that I had a print of that were like at a school play or when we were to dress up for something, and he and I were always right by each other in every picture, so I remember one of him wearing a straw hat that I used to… and that would be one I would go to a lot, I had at my desk at home, and I would pull it out and look at it. Interviewer: And do you still have it? Donald: I do. Interviewer: Yeah? Donald: I still have it. Interviewer: Do you find yourself… you know and it sounds like you know you do, you still reach out to him, you know the whole question about in a sense maintaining that bond? Donald: Yeah, I do I find especially when I do workshops on suicide and talk about him. There’s a TV show called Cold Case. Interviewer: Yeah. Donald: I don’t know if you’ve ever seen it. Interviewer: Yeah, I’ve seen it, yeah. Donald: But you know how there will be times when they end the show where the deceased kind of appears and then fades away? Interviewer: Um hmm. Donald: There are times when that’s how his loss is for me: it would appear and then fade away. He is laughing or joking. You know it’s never tragic stuff. It’s just good memories. Interviewer: Yeah. Okay. Donald: So I think for me the work I’ve done today has put me more in touch with him being at peace.
Beth is 52-years old and a triple survivor. Her most significant loss was her husband and describes her daughter’s wish to have a slide show with pictures of her father and family at her wedding. However, Beth and her daughter chose to omit the customary bride and father dance. At the close of this passage she re-iterates that they still talk openly about their father and husband:
Beth: What we did do on both of their weddings in remembrance, one girl wanted to have a slide show with pictures of her daddy and her family, and we did that during the ceremony. At Jim’s funeral, someone gave us handkerchiefs with our initials on
112 them, and the girls and I had decided that we would each have our handkerchiefs with us the day of the wedding, and they had their handkerchiefs wrapped around their bouquets, and so that was one way that we remembered and it included him, and I had a large picture of my husband at the reception, and we did that. We did not do, neither one of the girls wanted to do the dances with the parents, you know the girls with the daddy. I had told them “I will dance with you in place of your daddy,” but they both chose “No, we don’t want to do that,” and I think that also had some to do with their spouses’ families too. They just didn’t want to do all of that. They just didn’t want to do that. So anyway, that all worked out. It worked out real… You know that worked out real good. I’ve apologized to my sons that they’re stuck with just me, you know. ‘There is no man, that when you come over here and you know you’re stuck with your mother-in-law. You know, you’re stuck with me,’ and I’m… We talk very openly about Jim with the, you know I do with the four kids.
The above examples offer typical ways suicide grievers reach out to and maintain an ongoing bond with their suicide decedents. However, for other suicide grievers, there are complicating factors related to the mode of death that accompany such momentos. For example, Jonathan, keeps reminders which encourage him to let go of his anger and remember the mother of his son fondly. Jonathan is in his fifties and lost the mother of his son over five years ago. He explains in the following paragraphs that one of the reminders he has kept illustrate her struggle with chronic depression. For instance, she is included in the photographs their son has collated into screen saver digital photo album but he also keeps one of the post-its she had around her apartment to help herself when her mental illness would become incapacitating. In his words, such items underscored that she fought really hard and the he “can’t be mad at her”:
Jonathan: Yeah, we kept little things. She didn’t own a lot, but you know she didn’t have a lot of possessions ultimately, because she was on Disability for a long time, but the post-it notes would read things like ‘When it gets bad, get up and move to the windows
113 where there’s sunlight. Take a shower. Brush your teeth.’ This card, she wrote this: ‘Things to do when not getting things done. Break them into smaller pieces. Wash your face. Brush your teeth. Think of alterative things to do.’ There are a number of… There are more cards that I have at home, and this got here almost randomly ‘cause I was looking for some index cards and I grabbed them and I thought this was a plain one at first when I brought it from home, but there are a number of these kind of things that were in her apartment that showed us her daily struggle. Interviewer: And so you keep, you kept those as for
Here, Jonathan words suggest that he keeps such tangible items which specifically address the mental illness of the decedent and his feelings of anger. In addition, scholars studying the continuing bonds model of grief inquire about photographs as keepsakes or reminders. However, questions regarding photographs might be problematic for suicide survivors for many reasons. For example, the participant below, Lisa, twenty eight years old, was with her sister when they discovered her sister’s fiancé’s body, therefore photographs serve to remind her of that scene which was very traumatic for her.
Lisa: No. I mean I have some materials, but I actually don’t really like to look at things so much ‘cause I think part of it reminds me or brings that vision back, you know, because my focus, the focus of my vision was his face, and you know… Interviewer: But so unlike his usual face. Yeah. Lisa: Yeah. Interviewer: But still the same face. Lisa: Yeah. Interviewer: That kind of… Lisa: And so I don’t… No, I don’t think so. I’m not really a person that…Yeah, and I’m not really one that keeps memorabilia of anything anyways, you know, but pictures, that’s about it, is about what I keep of really anything.
114 Another participant, Christy, reports that displaying photographs of her lost friend is problematic because her children might ask about her friend and she doesn’t want to broach the subject of suicide because they are still young. Christy is forty-six years old and lost her friend, Candace, whom she had known since grade school and whom she kept in touch with through college after moving to a different city. However, Candace is survived by her identical twin, Rachel, which has created relational complexities for
Christy as she has dealt with Candace’s suicide loss:
Interviewer: You mentioned like keeping those letters and they were important. Any other sort of like keepsakes and what they mean to you? Christy: I have all of the letters somewhere. Oh they mean… But I’m that way. I’m just really, really sentimental and I keep everything. Interviewer: Yeah. Do you have pictures? Christy: I don’t. I don’t have any pictures of her, no. I don’t. I have some stored away, but I don’t have them displayed. Interviewer: No? Christy: It’s too private. Interviewer: Really? Christy: Yeah, it’s too private, because part of it too is that I’m not ready for my kids to know, and so they know Rachel, but they don’t know the details yet and it’s not time for them to know yet, ‘cause I don’t want questions, ‘Who’s that other? Who’s that one? What’s that picture of Rachel doing… Who’s that other person who looks like Rachel?’ It’s not… Maybe it’s me not being ready for them, but I just don’t want them… I don’t want them to know. I don’t know what that is.
Another complication for Christy, who doesn’t display pictures of her childhood friend mentioned earlier, is that her friend was a twin. She stresses that her connection, or ongoing bond, is complicated (repeating the word several times) by her childhood friend having a “double” with whom she remains close. This point foreshadows the complexity
115 of social support for both friends and family in the context of suicide bereavement which will be explored in a later section of this chapter.
Interviewer: Well that’s one of my questions is like do you still sort of, it sounds like do you reach out to that individual, maintain sort of like a continuing bond? Christy: Yes, I would say so, but it’s so complicated by having her twin, you know because I feel like I have access to her, but I am still close. You know it sounds like you’re not that close, so because I’m still… “So close” is not a good word. We’re so connected in a way that’s not daily, right? It’s just so deep and it’s so understood that you know if she were to walk into my house tomorrow it would be as if you know time had passed, and so it’s complicated what that means to how I relate to Candace, because she is alive through Rachel, and yet she’s not. So it’s just, it’s so complicated. So I would say, yes, I maintain a bond with her and I think about her especially when… Interviewer: Yeah, when, when, when does that happen? Christy: Always on her birthday, and usually almost on the… Their birthday is May 17th, so almost 17th, whatever month that is, I’m always thinking about them. It’s always around the time of year she killed herself, which was springtime, like around this time. I don’t know. I don’t know if there are actual patterns besides those; or certain things might happen that might spark something. It is so complicated by the relationship we had, that it was stormy.
And, at the close of her interview, she returned to her point about the complexity of relating to the surviving twin that, in her words, “never lets the grief go away”:
Christy: You know I just, I can’t help but think, I was thinking that there’s again that complication of having an identical twin that never lets the grief ever go away completely for me, and it never ever is really totally grief either. You know I just can’t… It’s almost like there’s a lack of resolution, which is both a good and a bad thing to me, but I never thought of it any other way. You know I just can’t imagine it any other way. I mean so figuring out how she’s incorporated into my life is what you’re asking. Interviewer: Yeah. Yeah. Christy: Is like I think through Rachel. I think she still is… Interviewer: Yeah, I get it. Yeah.
116 Christy: I think that’s why I can’t even really grasp what you’re saying, because she is… It’s just so about Rachel and I. Interviewer: Ah, I get it. Yeah. Christy: And like the last time I saw her or whenever I emailed her a birthday wish I always say, ‘I always think of you and Candace’ because there’s nobody that she talks to, and she can’t even talk to her mom about Candace at this point, so I’m like one of two or three people that knew Candace, loved Candace, wanted to kill her too, that she can really talk about it. We go through pictures together, and it’s really pretty hard on her, but it’s probably also a relief that she doesn’t have to keep it inside. So I mean I think it’s that Candace is still so alive through her.
Other respondents were more upfront with additional emotions that complicate their bereavement when asked about continuing to reach out to their suicide decedent. Betty, a sixty year old female who is a double survivor of suicide, the latter being a homicide- suicide in which she lost a family friend and the friend’s young child, explains:
Betty: It’s now that I guess most of the anger has gone away. You know sometimes I get even the word “frustrated” that you know ‘Why did she do this? Look what she’s missing?’ but I think more now we concentrate on the happy times and you know talking about you know things that they’ve done in the past that made us laugh and you know were, I don’t know if you… We’re not blotting out what she did, because we all know that, and but I guess to dwell on it constantly now, like I said, we still do have some serious conversations, but it’s more… Interviewer: They have a rhythm and it’s natural…..otherwise, then that’s maybe not sort of the healthiest place to be, but like you say, you know they come up, but they have a, you know a rhythm. So you say that it’s still you know mostly the good memories….. Betty: Yeah, but I do. I try and remember, you know, and most of the time now I do. It’s the fun stuff, you know like mixing the potato salad….But I mean they’re, both of them you know will always have a special place with me because you know they were very good friends and you know and I miss them. I, you know, like I said, there’s lots of times I think ‘Lauren, look at what your daughters accomplished. You know look at this. Look at that,’ you know. I’ll just talk to her, you know, ‘Look,’ so…
117 Both the above participant, Betty, and her spouse, Bill, participated in the study. They both lost two family friends to suicide, including one who took her life and also her youngest child with hers leaving behind her husband and two older daughters. Bill, sixty one year’s old, a triple survivor, describes pictures they keep around the house, especially pictures with both couples children and supporting the two young daughters left behind by their mother’s suicide. He emphasizes:
Bill: Well particularly with Lauren and through the girls. I mean every time we’re involved somehow with the girls it’s like an extension of Lauren. Interviewer: And did you keep any pictures, gifts? Bill: Oh yeah, we have… Interviewer: Keepsakes? Bill: Probably the least we have is of [3rd suicide decedent]. We do have, all of these people we have in photos, and Lauren will forever be in most of the photos because with the number of group gatherings we have with the kids and stuff, back from when the kids were infants all the way through to when they both departed.We have pictures that involve all of them. As a matter of fact, the mantels in all of our houses have joint pictures with all six of the kids together. So they’ve, you know though it’s been sometimes close, sometimes not so close, but all six of them remain in touch and aware of each other, even though the kids are spread all over the place now, you know all over the place, but there’s still that connection. Interviewer: Yeah. So then the impact isn’t defined. The totality isn’t defined for you through the final… Bill: No, I don’t think it is. I don’t even think of it that way. When I think of [2nd suicide decedent], I don’t think of her death. When I see her in my visions in my mind… Interviewer: Doesn’t overshadow. Bill: Yes. Interviewer: Yeah. Bill: I mean I can see her sitting across the desk from me and talking about various clients and some of the things we experienced together. When I think of Lauren, I think of her sitting in her living room and her bounce and her voice lilt, and you know I don’t think of them as victims.
118 In sum, participants’ vignettes demonstrate that nearly all peer suicide grievers have not ended their attachments to their loved ones even in the context of suicide. However, participants’ stories reveal that these ongoing bonds do not exist without complications.
For example, keeping and displaying keepsakes of their deceased loved ones such as photographs may risk questions from others about the nature of their death. These responses serve to inform and broaden scholarship on the continuing bonds model of grief discussed earlier.
Intermediary Coping Strategies Coalescing between the individual- and group-based coping strategies outlined in this chapter is an intermediary group exhibiting interpersonal coping behaviors.
Participants’ coping strategies in this cluster demonstrate implicit but not explicit characteristics of both intrapersonal and group-based coping groups. For example, on the one hand, this group of participants discussed instances of reaching out and advocating around depression and suicide awareness within their personal or occupational spheres.
But, on the other hand, they did not seek out group-based advocacy settings which other peer suicide grievers found so helpful. Nor, in most cases, did these participants explicitly identify as being a suicide survivor. This section, then, elaborates this intermediary group and explores social support and re-enfranchising resources for these suicide grievers.
Psychological counseling and coping. Surprisingly few study participants sought counseling for their grief and, of those who did, their experiences were mixed. This pattern is also supported by a handful of studies in the literature. For example, in a telephone survey study of 144 next-of-kin suicide grievers, only twenty-five percent indicated that they received any help since their bereavement, while seventy-four percent
119 reported a desire for help (Provini, Everett, & Pfeffer, 2000). Other studies report that suicide grievers seem to encounter difficulty initiating or searching for formal assistance with their grief (McIntosh, 1993). These findings suggest that there is a potential mismatch between desired support in peer suicide grievers and available mental health or services. This disjuncture was present in study participants’ reflections on the social support they experienced. Indeed, for peer suicide grievers, this asymmetry may be further amplified by their non-familial relational status, as indicated by some participants in the paragraphs below.
For Lisa, 28 years old, it has been five years since she lost her friend, Jim, who was dating her sister, Linda. Along with her sister, she found Jim’s body. When asked about seeking support she indicated she had sought out formal support from two different counselors, but was met with a bureaucratic wait time which angered and discouraged her. She explains:
Lisa: Well you know I had called shortly afterwards, like after the funeral. I called to try to get in with a Counselor, and when I told them what had happened, you know basically said you know I was with my sister and we found her fiancé, and they’re like ‘Well, we can’t see you for like…’ it was like taking until the next month, you know, and so I called another one and I got the same sort of deal and I finally just said ‘You know what? Forget it,’ and I got really angry with that too because I was like ‘Are you kidding me? What if I was the one calling and saying…? What if I was the one that was having these thoughts or…?’ you know, and I thought… Interviewer: Yeah. Lisa: But I don’t know what that was all about, if that was they felt that…
Above, Lisa was frustrated by the lag time between reaching out for formal social support and actually receiving help being much longer than she expected. Her
120 description indicates that this was a disenfranchising experience for Lisa because it signaled that counselors are unresponsive to suicide grievers and, possibly, even to suicide more generally. After this experience, she tells of finding a support group and talking with other suicide grievers which has helped her deal with her own grief.
In hindsight, another participant, Abby, relates that she “should” have sought formal help for her difficulties with suicide loss, but never took the steps to do so. Her remarks capture the conundrum many others face by dealing with suicide loss in isolation. Abby is 23-years old and a college student. She was 20-years old when her best friend’s younger brother, Adam, took his life. Abby and her friend, Emily, have been best friends since Abby’s sophomore year of high school. Abby knew that Adam was teased by older boys while at work, but she did not know the extent to which he was bullied at school. Looking back on the time since his death, Abby remembers that she threw herself into working three part-time jobs and went to school full-time, but her college grades dropped dramatically and she remarks that she has “been spending the last three years trying to clean up everything.” When asked what helped to foster more positive ways of dealing with her grief, she discusses participating in suicide prevention charity walks and also reflects on factors which stood in the way of actively seeking formal help and support for her grief:
Abby: I think the SPEA [Suicide Prevention and Education Alliance] walks definitely helped me, because I was around a lot of people that had gone through the same thing. I didn’t feel so isolated like I do here….I had a couple of classes where professors would bring it up. Like I took a sociology class and one professor brought up about you know ‘How many of you have lost someone to suicide?’ And seeing other people raise their hand, so like to know that I wasn’t alone in it kind of helped, but it was I didn’t, like I didn’t take care of it the way that I should’ve. I should’ve gone to a counselor. Interviewer: Yeah.
121 Abby: I spent the better part of the last three years feeling like I was responsible for Emily falling apart, which in turn I think has pushed her away and then you know we have like this/that weird dark thing in between us now.
Abby’s reflections highlight how young suicide grievers might be especially vulnerable to the disjuncture between passive coping methods and passive outreach efforts described earlier.
On the other hand, Megan, relates that she had a positive experience with seeking help through psychological counseling while away at college, but her decision to seek help was met with resistance by her parents. Megan and Michelle were best friends since middle school until Michelle took her life during Megan’s second year of college. She expresses that she sought help, in part, because her parents did not understand her grief reaction. This was further evidenced by her recollection of her father’s angry reaction to her counselor calling their home when Megan was “having a real bad time”:
Megan: Yeah. Well I wrote a letter that went in her casket. I don’t think even if they had asked me, and they didn’t ask. There’s no way. I don’t think I could’ve gotten up in that church. It was rough and, like I said, my parents just didn’t quite understand and you know I ended up seeing a Counselor at school, which my dad really didn’t understand, and that really made him angry. And the Counselor called the house one time I was having a real bad time and my dad got on the phone and he was… He’s a very nice guy, don’t get me wrong. He just, I don’t think he knew how to handle everything……Yeah, and it was you know he was ‘Who are you on the phone with? And you don’t need to be doing this,’ and you know it was just basically a ‘Grow up’ type of thing and I’m thinking ‘This has nothing to do with…’ It was a lot, and you know I have a couple of friends who have been through a bunch of stuff earlier this year.
Megan also participates in SPEA walks, but explains in a later section that feels strongly that only other suicide grievers can truly understand suicide loss.
122 In contrast to Lisa’s experience with marshaling formal social support, Beth experienced formal social support from the day she lost her husband through a program designed to help suicide grievers in her area. Beth, 52-years old, is a triple suicide survivor whose most significant loss is that of her husband, Jim, seven years ago. Jim was a military veteran so his funeral service incorporated a gun salute at his gravesite.
However, hearing the sound of gunfire triggered a powerful anxious reaction for Beth because all of her loved ones’ suicides involved guns. When asked about support, she recalls having immediate access to a counselor through the local crisis and bereavement center following Jim’s memorial service. She expresses that being able to talk to a counselor so quickly after experiencing an overwhelming trigger event helped to lower her anxiety level significantly:
Beth: …And it, none of that ever entered my mind that day, but I grabbed the chair in front of me and my knees just went like spaghetti and I would start…..as I just shook every time the guns went off... Interviewer: Hmm, how many times did they fire them in the salute or whatever? Beth: About four or five, I think, you know, and I decided… I was by myself. You know I drove by myself to the graveyard, so I decided ‘This is, I’m not in a good place. This is not good for me and I have all kind of anxiety,’ and it’s like a Friday afternoon. I came straight to the Center here and said ‘I need to see someone now.’ And so after I talked to a Counselor for about 15, 20 minutes, the anxiety started going down. What to this day does bother me, if you hear, if I hear a car backfire, or if I hear… I’m trying to think of what you call these things.
Later in her interview, Beth explains that her involvement in a suicide loss support group and L.O.S.S. program (Local Outreach to Suicide Survivors) through the bereavement center has been a key source of social support in helping her deal with her husband’s suicide. Indeed, immediately after her husband’s suicide, volunteer suicide
123 survivors in this program remained with her after police and other authorities duties were completed.
Interpersonal advocators. Within this intermediary group of interpersonal copers, a subset of participants expressly described ways they tried to help others dealing with depression whom they encountered in their personal or occupational spheres. When asked about seeking support, for example, Andrea explains that she has some awareness about depression issues as her mother has bipolar depression and she also took psychology and sociology classes in college on mental health. Andrea is 24-years old and lost one of best friends, Andrew, seven years ago when she was seventeen years old.
Andrew was nineteen years old when he took his life. Andrea was in the seventh grade when her friendship with Clayton (Andrew’s best friend) began in an internet chat room as both Clayton and Andrew lived several states away from Andrea. Though they never met in person, they spoke on the telephone every other day for several years and she felt very close to Andrew. Yet, her way of dealing with suicide loss was to engage in a favorite pastime of horseback riding and she did not seek out formal social support:
Interviewer: Did you seek any support beyond you know like the other friends, counseling sort of help you? Andrea: I was interested in it afterwards, but a part of that is my mom battles with bipolar and depression, so like I was already interested in it because of that, and then it was just like another thing, and so I took like Psychology in school. I took Sociology in high school. In college I took, we had a class at Northern about Suicide and Depression. I took like classes, but I never went to like counseling for it. Like the way I dealt with it is I hopped on a horse and went for a 10-mile trail ride, like that’s…
Above, Andrea affirms that she was interested in support resources and was open to this knowledge in college classes. Most significantly, later on in her interview, she indicates
124 that her course of study and career choice of being a pharmacist was significantly influenced by losing her friend to suicide:
Andrea: Yeah. If Andrew had never died I wouldn’t have gone into Pharmacy. Interviewer: Really? Andrea: At the time that he died I was looking into going into Engineering. I was looking into teaching, just because it was just one of those things I was like ‘Oh, everyone wants to be a teacher.’ And then after he died I just remember thinking ‘Well what’s something that I could do that won’t take like forever to get through college, but I can make a difference in people’s lives that can actually be like help people and make their, and just make a difference? Like actually know that I make a difference in someone, that I made things better for someone. Then I was like ‘Well Pharmacy. Because like I think my big thing was with Andrew was like why couldn’t I make a difference? Why couldn’t I have made it better? And so every day I go to work and I try to make it better for somebody, and a lot of, most of our patients are patients who have severe depression. There is a couple. I used to work up in [city] where I go to school, and there is a couple who had a son who committed suicide his senior year of high school, and when they came in it was like I didn’t know their pain, but I understood to an extent. Like I knew where his friends were coming from, and like they wrote a letter to my boss and they’re like ‘You know she really made a difference because she really cared and she really tried.’ If he was still here I’d be in Engineering. I’d be an Engineer. I’d be riding horses somewhere. Like I don’t know. Like I would have never thought about going to Healthcare. So that just like gave me, it made enough difference for me to change.
Here, Andrea emphasizes that she valued opportunities which allowed her to make a difference for those dealing with depression or at risk for suicide because she feels she was not able to make a difference for her friend, Andrew. Indeed, in her occupational sphere, her kindness and sensitivity towards parents who lost their son to suicide prompted them to write a letter of appreciation to her employer which is described below.
In her work, Andrea describes having a heightened awareness of others stigma towards
125 depression in family members of clients she serves in her capacity as a pharmacist. Also, she notes that clients will submit their prescriptions for anti-depressant medication across the counter facedown and she picks up on the sense of shame conveyed in this gesture:
Andrea: I’m like, I’m just more aware of it. Like I’m more aware of the emotions of the people around me and the, I don’t know. I’m just more aware at work of like what people are taking for medication and who are showing the signs more. I make a point to notice, and a lot of people don’t. There’s a girl here in town that she has severe depression and her parents completely ignore it. They just blow it off, it’s like so it doesn’t exist. Like it’s that stigma that like people just… Like I’m more aware of like of the way like families interact and families treat it, and what I can do to affect that. It’s like ‘Oh, I’m here to pick up my daughter’s medication.’ I’m like, ‘Well what medication are you getting?’ They’re like ‘Oh just her happy pills,’ and I’m like ‘That’s not really the way to say it.’ I’m just more aware of how society treats it and how people feel about it themselves. Like when people bring in prescriptions for it, like for like depression medication or like Bipolar Disease, they almost like slide it across the counter, like they hold it over so it’s upside down so I can’t see what it is and like slide it across the counter and like looking around like ‘No one sees me doing this,’ and it’s like they’re ashamed. Like there’s just so much shame put on it and there’s nothing to be ashamed of. There’s absolutely nothing to be ashamed of. I mean I try to make people more aware that it’s nothing to be ashamed of it’s nothing to feel less of yourself for. And I’ve done a hill of things with work like with having like a “Mental Health Awareness Day,” and I went and did a project with a couple of other students and went to a high school and talked about the signs and symptoms and issues with just like mental depression and the different kinds of mental illnesses that are around and already I feel like it’s better for society to be more aware that it’s not such a bad thing.
It is notable that her discussion of stigma and disenfranchising forces is followed directly by thoughts which foreground her efforts at informal advocacy like participating in
“Mental Health Awareness Day” and speaking to high school students about mental health awareness. Though she did not participate in a formalized advocacy setting, her
126 career choice and desire to assist in such awareness programs suggests that, for suicide grievers, the social forces involved in disenfranchisement and re-enfranchisement are deeply intertwined with the latter seeming to counteract the former.
Andrea also highlights another implied dimension of ‘survivor’ status which is unclear to her. In Andrea’s eyes, survivor status seems carry with it the message that those who claim the status have resolved their grief, while she feels that she is still dealing with it:
Interviewer: Would you ever go around at the, you know the Suicide Awareness marches that I mentioned? You know would you identify yourself as a suicide survivor to people in conversations? Andrea: I don’t know. I don’t really like, until my sister brought it up to me, I try not to… I don’t know, for a long time I just tried not to think about it. Like it wasn’t that I was like ashamed of it, but I just, I don’t know if I feel like I’m a survivor or if I’m just still dealing with it. Interviewer: Yeah, again sort of issue of language. Andrea: Yeah. There’s not like… Interviewer: I think if you’re here, you’re a survivor. Andrea: Yeah, true. Like I really think it’s one of those things where I would go if I could get Clayton to go with me. It’d be one of those things where it’d be like ‘If it’s important for me to go, I think it’s even more important for you to go.’ I think it’s something that would be so good for him.
Significantly, she mentions that she would find such group-based suicide survivor support contexts meaningful, if she could participate alongside her co-survivors, which also points to a relational contingency in her interpretation of suicide survivorship. Her perspective on this identity status suggests that claims to survivor status are connected to peer co-survivors or those who share the same suicide loss.
Another participant that can be viewed in this intermediary group is Christy.
Asked about the social support she experienced, Christy, forty-six years old, who is a
127 researcher and lost a close friend, Candace, whom she had known since grade school describes her family as being supportive because they had previous experience with the suicide loss of another family friend. Beyond her immediate family, however, there was a dearth of social support from non-family members. Christy directly connects this lack of support and, in some cases, negative support with the nature of suicide being “hugely” stigmatized in our society:
Interviewer: How, you know how was it talked about? You know what was good to talk about it, and what was, you know, like the example you shared of you know stuff that you experienced as a very negative. Christy: People thinking they’re being supportive when what they’re doing is really just sort of not pretending, but not asking you what you need, you now, but just make assumptions about what you need or just make assumptions about things. Interviewer: And that’s kind of like where…. I’m sort of jumping ahead to the, you know the cultural factors about suicide…. Christy: There’s a huge stigma to it. Interviewer: Yeah, and that sort of complicates you know whether folks offer support and you know and for you know survivors to receive it. Christy: You know I think for me part of the support piece for me was understanding the why. It was very much a concern of why. So I was angry at Candace a lot, but I was also mad at myself for not recognizing it or seeing that there was something organic going on, and I was mad ‘cause I had never been given the opportunity to help her. So yeah, all those feelings in the beginning really came back and forth. I don’t think I have the anger. I’ve had some frustration with her surviving twin over the years and her maybe not noticing that she had some of these characteristics, or maybe she notices it but just deals with it. I mean I spent about five days with her about two years ago and it was like shocking. I mean she sometimes doesn’t sleep all night, so she’s got some… so I get worried about that. So I’ve got sort of anger and all that’s replaced with worrying about her when I don’t hear from her for a long time, and not wanting to push myself onto her too much.
Above, Christy also elaborates that the support she experiences is complicated by her concern for her co-survivor, the decedent’s twin, Rachel. Moreover, this complex
128 relational contingency extends into Christy’s view of herself as a ‘suicide survivor’ when she is asked about this identity. She explains that she hasn’t really thought of herself as a
‘survivor’ until she was asked about it in our interview because of her peer relational status to her suicide decedent.
Interviewer: You mentioned the word “survivor.” Do you, you know in your sort of how you, you know, think of yourself, do you identify as a suicide survivor? Christy: I never did until you mentioned it. Interviewer: No? Christy: Never. Interviewer: No? Christy: Um umm. I felt like I was more peripheral to it. I thought Rachel was a survivor of it and their family. I never really thought about myself. Absolutely I do now, but I never did. Interviewer: So yeah, ‘cause there’re some folks I talk to and they do the marches that are for suicide awareness, and identify very strongly with that and other folks not, and I think you just answered it with the ‘No, not until now.’ Christy: Yeah, absolutely. Not until now. I was just another one of people who knew someone. Yeah, absolutely I do now.
Above, Christy clearly expresses that if suicide survivorship were a more salient identity status in terms of who can claim it, she would also view herself as a ‘suicide survivor’. Moreover, in the passages below, she conveys that she would be inclined to participate in group-based coping activities which recognize suicide survivorship as a positive identity status after talking with another peer suicide survivor (the investigator):
Interviewer: And that you don’t think of it sort of as a group with a, yeah. Would you ever go to one of those events? Christy: I probably would. Yeah, I would love to go to one with Rachel. Yeah, I would love to do that. That’s, and when I see her next I would… I’m not sure if she’s there, if that’s what she would be good about, if she’d want that. Yeah, I’d consider doing that. Interviewer: Yeah, and you wouldn’t be like ‘No, that’s going to awaken…’? Christy: No, no, no. I’m all about getting that stuff out. Interviewer: Okay.
129 Christy: Yeah, ‘cause I mean you know some day I hope I won’t well up with tears, but maybe I will, so that’s okay too. You know I wouldn’t avoid it, um umm. No, but I’m all for that kind of self- help and that kind of… Interviewer: Yeah? Christy: Yeah. Definitely, and I would not be opposed to it at all.
Below, Wendy also echoes the same relational contingency in response to being asked about suicide survivorship identity as expressed by Christy. She is a 26-year old pharmacy assistant and was twenty-one when her friend, John, whom she had known for twenty years, took his life. She also lost another school friend when she was twelve. She did not encounter any explicit disenfranchisement in her bereavement but relays that suicide was not mentioned during his memorial service. For Wendy, the identity of being a suicide survivor is defined by the relational realm or dimension:
Interviewer: Do you identify with the term “suicide survivor”? Do you ever describe yourself as that? Wendy: No. Interviewer: How come? Do you think people would misinterpret it as if… Wendy: That I, myself, tried to do it? Interviewer: Yes. Wendy: Yeah, I can see that, but no, I don’t. I guess if it had happened… I mean we were close, but we weren’t I mean as close as family. You know what I mean? And I mean had I been actual family or like his sister or a cousin or something like that, then… Interviewer: Or if he’d been sort of… Wendy: I may be more… Interviewer: …impacted by it, like you know if he was sort of thinking about top five best friends or something... Wendy: Right. Interviewer: …would your, your reaction would’ve been different? Wendy: Yeah. Yeah. Interviewer: Yeah, based on… Wendy: And then I would probably be more likely to use the term, but I mean not with him.
Another participant, Diana also strives to be an agent for change through her occupational experiences and church volunteer work. Diana is a 68-year old retired social
130 worker who lost her church friend, Joan, three years ago. Diana was thirteen years older than Joan, but they shared interest in the Unitarian Universalist church activities and
Diana’s husband and Joan were close because they both struggled with mental illness.
Like Andrea, Diana identifies the lack of public awareness of depression symptomology is a strong concern for her too which has been amplified since she experienced suicide loss.
Interviewer: And do you find that you connect with her when you know, like part of your, being that she was a person who, you know, could articulate and teach about it and do those workshops, do you feel a closeness to her? Diana: Well yes, you know I guess I do, but I also feel that how she died and what her life was like… Interviewer: Are two different things? Diana: Well no, no. It was something people need to hear, and I like to throw in stories when I teach anyway. But I think people just aren’t used to hearing much talk about it, so like I think when I can give examples and be you know okay about it, I think it’s helpful for people to see that. And I don’t know, just different like students I taught my one semester, that was about the only time at least so far in my journey at school than anyone had been very open about suicide, you know. So they seemed to be interested more in that topic than some of the other stuff. I do think it’s an important topic obviously. You know before even this happened I’d been interested in suicide.
Further, Diana notes that in some of her interactions with medical personnel including physicians there is a deficit of knowledge and awareness—some are obtuse to the signs of severe depression. Thus, she views her various speaking engagements on depression awareness as contributing to mental health awareness in medical settings:
Diana: …I deal with it as best I can, you know, and I have helped a lot of people go to the hospital over the years, you know, and I will plan to continue to do that, you know, but it’s interesting, or maybe I just hear it, you know, and take it more seriously than some other people do you know because of my training, but you know I’m still glad that I’m there you know. But and that’s why I
131 think there are so many gatekeepers that do need to be trained at so many different levels because a lot of different people hear things. Interviewer: Right. I mean, yeah, and you’d be in that situation and be able to hear those sort of… They might be trying to open the conversation and ask for help… Diana: Um hmm. Sure. Interviewer: …and you’ve got to be able to recognize those indicators, ‘cause they come in you know all shapes and sizes. Diana: But most people are totally oblivious to those. Well you know when I was a very heavy Social Worker in the ‘60s I was working a case where I was worried that the woman was suicidal, and the nurse that was on the case (in a place that will remain nameless) said to me ‘Well you know if they talk about it, they’re not going to do it.’ Well you know I eventually got her into care. It took me a while, but the lady was apparently suicidal, you know. So it just amazes me how professional people will, and doctors. You know I did a workshop with a nurse friend about that oh about five or six years ago. It was for doctors about Mental Health, and we did talk about the depression indicators and some easier tests to do that, and the agency I used to be with is now working at [hospital], at least the indicators for depression which I think was on the way to suicide obviously, but so I think there’s some beginning steps for this, but I just think so many you know teachers need to know more, and I think we are getting more education
By contrast, Bill explains that he engages in many of the same advocacy strategies in his occupational sphere as Diana but he does not identify as a suicide survivor. Bill is a
60-year old professional social worker who has experienced triple suicide loss (e.g., homicide-suicide of a close friend, a family friend, and a coworker). Of these, the most traumatic was the loss of Lauren and her youngest child born with Down’s Syndrome.
After describing his experience of triple suicide loss, Bill states that he not only drew support from being able to attend the services of his coworker but also being able to advocate for his decedent’s widower by marshaling Alzheimer’s care when the need
132 arose. He also draws support from participating in local National Alliance on Mental
Illness (NAMI) activities:
Interviewer: Okay. So we answered the seeking support. Did you look for you beyond….utilize any sort of the formal services? Bill: No, because I’m pretty well defended by this time, and after being in Vietnam and after raising a couple of kids and going through most of the stuff that I went through, you know I think I had a lot of tools and have a lot of tools to be able to do that, and besides, I understand that one of my chief defense mechanisms is intellectualization, and so I tend to buffer my feelings and let them in slowly, so that I can deal with them, and that’s how I get by and so I usually do a pretty good job of that. Interviewer: Would you have ever like attend the, you know that we were talking about the walk at the Taskforce meeting. Ever thought about doing something like that? Bill: I have, and it’s not that I’m biased against that, but I also have a lot of other irons in the fire and one of the things I’m associated with is the NAMI walk and what I identify with. Interviewer: Yeah. One of my friends did that too. Bill: Yes. I guess I would not be opposed to it, but in terms of where I would choose to put my other, my energies and my focus, yeah, it’s kind of already been spoken for. Interviewer: Okay, got you. Bill: It’s not that I find it unappealing.
Further, in response to the question about survivor identity status, Bill underscores his age and Vietnam Veteran status, and training in psychology keep him “well-defended” at this stage in his life:
Bill: There were, and I don’t think of myself as a suicide survivor, which is kind of interesting, ‘cause I am a suicide survivor, but there were three key people in my background that did suicide….I guess to a certain extent I’ve kicked these suicides out of my closet, so to speak, and maybe that’s why I don’t consider myself a suicide survivor even though I clearly am….And I guess, and maybe it’s just my makeup but my undergraduate background is in Developmental Theory, and so I know that you know we all go through these stages, and I studied a lot about stages and understand that if you come to grips with them, yeah, when you put them to rest, they tend to stay at rest. I
133 know that the next you know stage comes up, we tend to relive all those other previous stages. But so I’m pretty good about putting developmental stages. I wouldn’t want kids again.….and I think to a certain extent these suicides came up. I don’t consider them any different than, though they are, but I don’t consider them any different than the loss… To me the tragedy is just as much for Lauren’s husband as it was for Lauren. He died of cancer and she died of suicide, but they’re both gone, and the aftermath on the kids and the people that survived them, you know it’s just as bad whether it’s suicide or not. They’re gone. Interviewer: Yeah. Bill: And as much as, you know maybe yes, because if we knew what the person that suicided was thinking, we might be able to change it, but like for Lauren’s husband, they tried everything and they just couldn’t do anything. You know I mean he was just destined to die and he’s gone and his absence is just as big of an impact in my mind as the suicide. I’ve thought about it. I don’t think there was anything else I could’ve done with Lauren. We were as good friends to her as we could’ve been. People even closer to couldn’t pick up on it.
Above, Bill de-emphasizes the nature of suicide death of his losses by explaining that their impact upon him was similar to other types of tragic loss. In his eyes, the impact of cancer loss and suicide loss are ultimately the same. Indeed, Bill himself observes it is
“interesting” that even though he has three suicide losses, this identity status holds no salience for him. Given that Bill’s coping strategy is very intrapersonal, his lack of participation in any suicide-identified activities and thinking of himself as a suicide survivor can be interpreted through the continuum of coping strategies offered in this chapter. Thus, Bill’s experience suggests that the salience of suicide survivor identity status is less related to the number of suicide losses than participation in group-based suicide survivor activities. Further, Bill’s spouse, Betty, does not identify as a suicide survivor either. She is 60-years old and shares two suicide decedents with Bill, including the same homicide-suicide of their close friend, Lauren, and her young child:
134 Interviewer: How about do you identify with the term “suicide survivor”? You know would you, did you ever seek out sort of other people who have… Betty: No. Interviewer: …dealt with the same…? Betty: Misfortune? Interviewer: Yes. Yes. Betty: No, I did not. Interviewer: Um hmm. Betty: I never have. Never thought about doing it. Interviewer: No? Betty: No. Interviewer: Yeah.
Similar to Bill’s account, Betty’s statement in regards to the lack of salience of suicide identity status contributes to another evolving pattern within this section’s coping typology, whereby the manner in which participants’ deal with suicide loss is dynamically connected in several ways to their co-survivors.
In sum, this intermediary group characterizes the liminal nature of suicide loss coping strategies. Most participants did not seek out any the group-based advocacy settings which other peer suicide grievers found so helpful, while only one or two utilized formal support services. Yet, several participants within this group share a desire to advocate for suicide prevention and mental health awareness as witnessed by such patterns within their personal or occupational spheres. Participants also express nascent and contingent responses to a suicide survivorship identity. Questions of who and when is one a suicide survivor suggest that peer suicide survivorship is a complicated process with both relational and achieved status contours. In particular, Andrea, Christy, and
Wendy all described contingencies around claiming a ‘survivor’ status in connection to their non-family relational status to their suicide decedent. In addition, Andrea, Christy, and Betty imply that their identification and participation in group-based suicide
135 prevention activities is also tied to their co-survivors. This intermediary coping group is valuable because participant’s reflections capture the inner-workings of this identity process. It illustrates that grief literature and resources aimed at suicide grievers should acknowledge that this identity status encompasses both peers and those who are still coming to terms with their loss. Otherwise, suicide bereavement resources run the risk of ruling out potential recipients because of the perception that sources of social support do not apply to them.
Group-Based Coping with Peer Suicide Loss Having considered coping styles that are intra-individual or symbolic in nature and somewhat more solitary, the following section examines the dynamics of group- based or extrinsic coping practices among study participants. In particular, it highlights what peer suicide grievers actively do to ‘re-enfranchise’ themselves. The interplay between suicide survivor identity and group-based social contexts such as support groups and/or suicide prevention and outreach organizations is also explored. In his most recent scholarship, Doka (2008) emphasizes that research on disenfranchised grief should advance the framework by moving beyond merely cataloguing which losses reflect the disenfranchised typology. Instead, groundbreaking work will delve much deeper into specific losses identified as disenfranchised to illustrate the processes and outcomes behind the emotional content of the loss. The goal of such work is to identify how disenfranchised grievers can be assisted and supported. Doka (2008) writes that investigations should:
…provide a base on which to assess the ways grief reactions vary among different types of losses regarding intensity of reactions as well as the process and outcomes of grief. Such research will expand our understanding of grief and avoid
136 trivializing loss and, most critically, it will offer a background to acknowledge, assist, and enfranchise the disenfranchised. (p. 237)
By offering accounts from several participants engaged in suicide prevention advocacy or suicide grief outreach group activities, this section outlines a response to Doka’s call to advance the disenfranchised grief framework in the context of suicide loss, and, in particular, peer suicide loss.
Aside from support groups, what does re-enfranchisement look like in peer suicide grief? Where did participants find such experiences? What are the key characteristics which are not only supportive but re-enfranchising experiences in these settings? Is there a relationship between these group–based outreach and advocacy social contexts and the likelihood of identifying as a suicide survivor? Subsections explore numerous participants’ attendance and involvement in suicide bereavement support groups and suicide prevention or mental health advocacy activities. Most importantly, the discussion of re-enfranchising experiences represents the theoretical contribution of this study to the field of suicide bereavement research.
Support group participation as externalized coping. A number of participants were involved in formalized, group-based supportive contexts with other suicide grievers.
During the recruitment stage of this study, the investigator attended several local suicide bereavement support group meetings. All of these groups gather in meeting rooms of local churches and are organized by family members and peers who have suffered a suicide loss. Over these visits, many heartbreaking stories of parental, child, sibling, spousal and friend loss were witnessed. Notably, the investigator was not granted access to one of these support groups because its group facilitator argues that researchers treat
137 suicide survivors as “freaks” despite written recruitment materials being mailed which indicated that the investigator was also a suicide survivor. This reaction supports the disenfranchising forces of social stigma towards suicide loss described in the previous chapter. Study participants highlighted involvement in suicide bereavement support groups as a key step in dealing with their grief. For instance, Lisa, 28-years old, lost her friend Jim five years ago and describes her experiences with her support group as very positive. This experiences stands in stark contrast to her first support-seeking efforts of having to wait three weeks after calling a psychologist to schedule an appointment. Lisa enthusiastically describes her experience participating in a support group context and likens this key change in dealing with her loss to ‘a switch being turned on’ because it has led to further fulfilling advocacy roles:
Lisa: Yeah, I am. I think really the big starting point with me was when I got into, I would say when I got into the support group and then I found out that ‘Okay, there’s a support group. There’s the Prevention Coalition. Now they’re trying to do this Loss Team,’ and then I was like yeah, full force, ‘Let’s go. Whatever, whatever you need me to do, let’s do,’ you know, and it was just like the switch turned on to me and was like ‘Let’s get it done,’ you know, ‘Let’s do it.’
Here, Lisa explains that being part of the support group has been very important because of its restorative role in her life. She continues to attend, though, in the hopes that she can help others who have suffered a suicide loss which is a strong theme in hers and other stories of suicide loss:
Lisa: Um hmm. Yeah. Oh yes. So I would never have thought to do it probably otherwise at all, you know, and going to I think to the support groups, you know I’ve been… They started a support group just this year, and you know of course I wasn’t, and I didn’t have any of this stuff, like it was new for me, you know, and I feel pretty good now. Like I feel pretty good, you know and
138 stuff like that, but you know there’s days that I’m like ‘You know why do I even go, because I, you know I don’t need this,’ but then I’m like ‘You know but maybe somebody else needs to hear what I have to say,’ you know, and so I’ll go. You know so but yeah, and those are the types of things, you know, and sharing that, and I think you know like we did the, we went and did the walk.
Indeed, Lisa remarks that she feels “pretty good now.” She also conveys that she hopes her continued participation helps others struggling with suicide loss. This desire to help like-others suffering with suicide loss is a strong theme throughout many of the participants in this category of coping strategies. Another participant, Beth, 52-years old, is a triple suicide survivor whose most significant loss is that of her husband, Jim, seven years ago. The region where Beth resides has an excellent Crisis Center for Mental
Health including a suicide bereavement support group and L.O.S.S. program, both of which have been central to Beth’s adaptive coping with suicide loss:
Beth: And then I was ready to quit going to group, or I didn’t need group, and I want to say it was probably around four years I didn’t need it as often and you know I don’t have to, I’m not needing to come as much, you know only when something comes up or something, and it was at that point that they asked me if I would help co-facilitate the group. So I never really quit coming. Interviewer: You just, your role… Beth: My role changed. Interviewer: …has changed. Yeah. Beth: And yes, there are times that I have turned around and you know needed to have my time in group when certain things in my life have happened, and you know I can still share and… Interviewer: Yeah, that movement is possible. Right. Right. Beth: Yeah, I can be a co-facilitator, and I can be just a person in the group that needs support from the other members. So and I think that both of those have been very healing for me. Interviewer: Right.
139 Most significantly, this positive context has propelled Beth towards an active role in helping other’s deal with suicide loss through volunteering in her area L.O.S.S. program.
This program relies on suicide survivors and other volunteers to be with loved ones and family of suicide decedents in the time immediately following a suicide (this program will be discussed in greater depth in the subsequent section of this chapter). Additionally,
Beth describes being able to help an extended family member bereaved by suicide to use the same support group she attends as a support group also.
Beth: No, he’s on my side of the family. It was my mother’s uncle. He had had a heart attack, was doing well, and fell into depression, and that happens with the heart attack and strokes. Fell into depression and killed himself quickly. I immediately said when I heard about it, ‘I’ve got to go to my aunt.’ I was not, though, I was not close to him, you know, and neither were my aunts. We got along… You know I loved him, but we didn’t see them often in my life, but it was so close to my husband’s death, I knew what my aunt was going to be feeling, and I didn’t know if she knew anyone else. Well of course she knew about me, but if she knew of anybody else in her circle where she lived that had lost anybody to suicide, and I immediately went to her. I mean immediately, and told her how I had gotten help here at the Center, and she did choose to come.
But if suicide bereavement support groups are as beneficial as these participants describe, why didn’t more peer suicide grievers in this study attend them? Because of real and perceived stigma around suicide, it is hard for suicide grievers to reach out for help.
This is borne out in the few studies investigating social support in suicide loss, whereby researchers note several roadblocks on the path to helping those dealing with suicide loss.
First, as emphasized in the previous chapter, disenfranchising forces such as social stigma and negative societal norms towards suicide often impede mourners and can hamstring them from reaching out for social support and mental health resources (Calhoun & Allen,
1991; McIntosh, 1987). In particular, traditional attempts to reach suicide grievers with
140 information about support resources are passive in nature and rely on suicide grievers to initiate social support from outside sources. Another downside to this strategy is that a long lapse time between the bereavement and establishing contact with support providers is often involved. Accounts from suicide grievers in this section support these findings.
Moreover, these findings reflect Doka’s (2008) assertion that if disenfranchisement occurs, grievers’ position to claim or receive social support from others will subsequently be foreclosed or diminished.
One participant, for example, discussed why support groups “don’t do it” for her.
Carrie, 30-years old, lost one of her very best high school friends, Thomas, around nine years ago. Neither she nor his other close male friends were aware that Thomas had been suffering from bipolar illness and had been briefly hospitalized around a month before his passing. Because she remains very close with her fellow peer grievers and Thomas’s family, Carrie suggests that she has enough survivor support and is skeptical about how else she could benefit from a support group setting:
Carrie: ….You know and so we do, we have a lot of that kind of stuff going on. They’re survivor meetings like in twice a month in [her area]. I actually have never ever been, ever. You know I went to go to one class on you know facilitating a survivor group, which I knew I would never do, but I thought it would be interesting to learn it and would be worth a visit, but there’s just something about a survivor group that has just never ever appealed to me. It’s like I don’t want to hear other people’s stories. Interviewer: I didn’t go to one until I went there with my… Really? Carrie: It just doesn’t, it does not do it for me and I’ve never understood why and it’s just something that’s just never appealed to me. You know I’ve always had the boys. You know to some extent I’ve always had the close relationship with Thomas’s parents, and again like I’ve always felt like when they said bipolar I was like, ‘Oh, okay, I’m good now. I get it,’ and I could move on, and you know so I’ve never had like a lingering you know something. But the boys, they didn’t understand that when they said it was
141 bipolar, you know they were like ‘Oh you know he was going to do what he was going to do,’ and I was like, ‘You know that’s not the way this works.’ Like for me, when I looked at it, it was like he’s bipolar, you know and I try to explain and it’s like you know if your eyes are closed you can’t see anything. Well bipolar is like your brain is closed and you cannot think logically.
Carrie suggests that while her peers are supportive, she points to important discontinuities between her and her peer co-survivor network. Taken together, Carrie’s statements regarding support groups and her emphasis on bipolar disease being the cause of
Thomas’s death, signal a desire for something beyond bereavement support groups which would serve as a re-enfranchising for Carrie. It is no surprise, then, to learn that her efforts to deal with her grief have steered her towards a strong role as an advocate for suicide prevention.
Suicide prevention advocacy, activism, and re-enfranchised grief. The following section explores the beneficial enfranchising activities beyond suicide bereavement support group involvement in which study participants dedicated their time and energy. For example, Donald, 60-years old, a psychologist and triple suicide survivor has devoted much of his career to helping those bereaved by suicide. His suicide losses include a middle school classmate, a coworker, and a friend. An expert in the field of suicide grief, Donald observes that group-based contexts offer a powerful social milieu which affirm suicide loss experiences and may counteract societal isolation:
Donald: That’s been my observation too that when people come together from other places and for if they go to a Healing Conference for example, and there are people there from all over the world… Interviewer: Yeah. That’s a good point. Donald: …and they get up and learn all the different ways in which people grieve around the world. On one hand they often just feel happy about what they’ve got, ‘cause that’s all they know, but on some cases they learn that there are some other ways
142 they might grieve that they hadn’t thought of that are very accepted in certain cultures. So it’s really a fine thing I think when people realize that not only other people in their community but in their state and in their country and in the world. It becomes more global and it’s less alone on a global sense.
In a similar pattern to other ‘survivors’ who have lost loved ones to cancer or other physical illnesses, Carrie has channeled her energies into awareness and education of mental health issues in her region, carving out a new full-time suicide prevention advocacy position for herself in the process. Thus, in answer to questions around how she sought out support, Carrie passionately describes how this work evolved from her desire to talk to young people about recognizing the signs of depression. She explains that after raising these concerns with her younger brother’s teachers at her own former middle school, she was invited to speak to a number of classes. This hit a chord with one of her brother’s teachers because he lost his fiancé to suicide some thirty-four years ago when there was no such suicide awareness and suicide survivor advocacy among suicide grievers:
Interviewer: So in part, is that what drew you to the local organization there? Do you seek support there? Carrie: Kind of. About a year after it happened was kind of when it hit me that this little girl was 12 years old and my brother was 12 years old, and my brother was a 7th grader in middle school at the middle school I had gone to and I went back and I talked to a couple of teachers there and one of them who said to me, ‘You should come in. You should talk to his class,’ and I went in and I talked to one of his classes and I stayed for the day and I talked to three of his like four classes and we kind of went around the room, we were just asking, you know we were talking about it because he is a teacher who had lost a fiancé 34 years back, and he was like, ‘You know you should talk to the kids about what you went through and what it was like,’ and I stood in a class of like 48 kids and you know we asked you know ‘Have you ever known anyone who has died by suicide? Did you ever know
143 anybody who’s talked about suicide? Do you know anyone who has ever attempted it?’ and by the time we asked those three questions, 12- and 13-year-old kids, every single kid in the class had their hand raised for at least one of the three: had either known somebody who’d done it, tried it or, and it was just crazy to me to see that. So I started speaking in a bunch of the middle schools and high schools, you know just kind of hearing their… in very pieced portions, talking to kids about what I had gone through losing my best friend and ‘how painful it was, and nobody really expected it and we weren’t paying attention and we didn’t know the signs, and here are the signs and here are the warnings and this is you know, and you know don’t ever be afraid to lose a friendship and call a parent, because you might have saved their life.’ And that was kind of hard.
Thus, speaking about her experience and raising awareness about suicide prevention is what “does it” for Carrie. Thus, taking an active and instrumental role in advocacy work is what Carrie pursues to experience re-enfranchisement:
Carrie: So and I had done that for about a year or two, two years, and then I’d taken probably almost six months off working a new job and I got into the new job and it was a new hotel that we have in town and they wanted us to network, to meet people in the community, and they said you know, ‘Go out. Join something. Anything you want, just find something and join it,’ and so I was kind of thinking about it trying to figure it out and they said that on a Friday. Sunday morning the cover of the Sunday Journal was on suicide in [State] and was about this show that had been produced that was going to air on like Channel 5, Public Access Channel, it covered the front page, this big story about it, and they talked about the Suicide Prevention Program, so then I went ‘There you go. I’m going to join that,’ you know, because when I went back in to work on Monday I went you know, ‘What exactly are you looking for us to join? You know specifications? Are you going to approve it, my doing this?’ And they said, ‘No, you can join anything you want, and I said, ‘Anything?’ and they said ‘Anything,’ and haha, this is what I’m doing. And so I joined the Coalition and started going to meetings, which was great because my job told me to join, so when I came to them a week later and said ‘Hey, I’m going to be out next week because I’m going to this meeting,’ and they went ‘Well…’ and I said ‘You told me to join,’ and so I got a lot of leeway out of the hotel
144 because they were the ones that kind of pushed me into it, which has worked out because through it you know and through my different hotels, you know when I go into a hotel, I’ve been able to say ‘I’m a volunteer for this organization,’ and they go ‘Okay.’ So then when I come to them for our conference and say ‘Hey, will you donate a box of Kleenex?’ the hotel is more than willing to just throw one out the back door and say ‘Go get it.’
Above, Carrie also indicates that her workplace was indirectly re-enfranchising because she was encouraged to pursue this volunteer work around her suicide survivor identity.
Her comments, though, suggest that she anticipated that her choice might encounter some disenfranchisement related to suicide, she was pleasantly surprised when her employers did not balk at her choice, thereby supporting and galvanizing her re-enfranchisement efforts.
Below, she explains that what propels her in this work is the belief that knowing the signs of depression and suicidality and then acting to get help for those individuals at- risk for suicide is a critical step in suicide prevention efforts.
Carrie: Yeah, well and I really got into it because the more I looked at it, I mean I kept remembering myself. We didn’t know. We now have this 20-20 hindsight, but we didn’t know the signs. We didn’t know the risk factors. We didn’t know the warnings, and now that I know them, you know what I mean, I’ve seen them, you know, in a friend, in another group of friends. I’ve seen those risk factors and now I know to say something. So I have the other friends kind of like ‘These are the problems’ and so we’re able to kind of better organize around this friend now who is going through a hard time, but I wanted other people, other youth and other kids to be able to know those things, because I feel like not knowing really hurt our situation. It may not have prevented it or stopped it completely, but I feel like not knowing anything about it definitely was a problem. And then if everyone had at least a basic understanding of what to do and what to say, and you know what I mean? Interviewer: Just to be on the same page. Carrie: Then it would help.
145 Furthermore, Carrie explains that she jumped at the chance to put her skills to use when a professional opportunity arose in a non-profit organization. She emphasizes that education policy needs to go beyond just awareness and should be tailored to suit the differing, at-risk populations in her state. In her understanding, the one-size-fits-all style of suicide prevention policy that has been in place is partly to blame for her home state reporting one the highest suicide rates in the nation. Again, when asked about what helps to assuage her sense of grief after Thomas’s death, she reaffirms it comes from the work she does.
Yet, Carrie explains that she is frustrated by others she encounters who characterize her work as being “so depressing,” rather than recognizing the intrinsic value it holds for a survivor like her and the extrinsic value her time and effort represents in helping to reduce others’ risk of suicide. By highlighting meetings over coffee, telephone calls, presentations, and television appearances, she views her work as directly combating the assumptions and ignorance in the media and public perception around suicide which serve to disenfranchise suicide grievers. For her, it is doubly disenfranchising to hear her work described in such a way when it may, indeed, be a central factor in counteracting the negative effects of suicide loss:
Interviewer: So for you on an individual level working on sort of that at societal level gives you comfort and…? Carrie: Yeah, it’s moving, like I really do love my job. I really do. It’s got its moments and it’s got its difficulties, but I think the thing that bothers me the most is I tell people what I do and they go ‘Ooh, that must be so depressing,’ and I go ‘No, it’s actually great and I love it. You know you talk to people and tell them about the clues and…. Interviewer: And even that reveals their assumptions, and they don’t even know… Carrie: Well they think I’m sitting at a phone answering crisis calls, and I’m like ‘I don’t answer calls from people who are that alone and
146 desperate and sad and at that place. I don’t deal with that. Very rarely.’ Interviewer: That’s telling about people’s assumptions and stigma. Carrie: But everybody says that, ‘Oh but that job is so depressing,’ and I’m like, ‘No, my job is great. I fight with Legislators. I’m still screaming with somebody in the press. I’m taking everybody I can out for coffee and saying ‘Oh you know that fantastic piece you did last weekend it the Journal about that woman whose husband died from the antifreeze on the front page of the paper, that was trashy and tactless.’ You know what I mean? Interviewer: Yeah. Carrie: It’s a very different job (you know what I mean) that we have. We really are telling people, ‘So that’s great, but you know…’
As noted in the previous chapter, Carrie describes her fellow peer co-grievers as supportive of her endeavors, yet “the boys” do not usually ask about her work:
Interviewer: So on a personal level, you’d say that that’s been a big positive? Carrie: Yeah, I think it’s been fantastic for me, and the boys have been really supportive. Well I say that they’re really supportive, but they’re really supportive for them. You know what I mean? Interviewer: Yeah. Yeah, yeah. Carrie: They won’t ask about my job. They don’t ever want to know what I’m doing or what’s going on, but I gave them fair warning before it did my first TV interview about my survivor story. I gave them warning and said ‘I’m going on Channel 7 News and it’s going to air all Thanksgiving weekend long. This is what I’m talking about. This is what I’m saying, and I don’t want you to see it on the news at 5:00 and be surprised. This is what I’m doing because this is what has to be done. …. I did a series of radio interviews as Public Service Announcements that they air on all the radio stations talking about what I have been through as a survivor and you know just the dynamics of it, and I warned them again. It’s like ‘I’m doing a series of radio interviews. I hope you all can stand by it and support it. If you want to know when it comes on, you can ask me and I’ll tell you, but you probably won’t be able to get it,’ because I was pretty sure that they wouldn’t just run into it, but it was like ‘If you want to know, I’ll give you a copy, but this is what I’m doing.’
It is important to note that while Carrie’s experience is one of individual advocacy and “fighting,” she still fiercely identifies as a suicide survivor and even has ‘suicide
147 survivor’ tattooed on her arm, one of several tattoos related to her suicide loss. The final section of this chapter explicitly unpacks the salience of this identity for her and others participants who engage in group-based coping strategies.
Suicide prevention fundraising walks. Of those who highlighted re- enfranchising experiences in their interviews, several participants discussed attending nearby Out of the Darkness™ Community Walks. These are a relatively recent phenomenon in the struggle for mental health awareness. Beginning in 2003 with an overnight walk to raise funds for the American Foundation for Suicide Prevention
(AFSP), the AFSP have since expanded this concept to include some 240 community walks across the United States in 2011. From New Orleans, Philadelphia, to Mayhoning
Valley in Ohio, participants garner sponsors and then gather to walk two or three miles together to raise funds for the AFSP.
A local area organization, Suicide Prevention and Education Alliance (SPEA), has developed a similar suicide prevention and fundraising walk which directly supports local area efforts to prevent youth suicide. This nonprofit reinvests funds raised from their charity walk and other fundraisers into a high school program called Recognizing
Adolescent Depression and Suicide Prevention which is delivered by a team of trained instructors in health classes across eighty one high schools in the area. Moreover, the program emphasizes training peers to be able to recognize the symptoms of depression, the most significant predictor of suicide. This emphasis recognizes that young people are more likely to tell their peers rather than family members, if they are feeling depressed or have a suicide plan. SPEA’s charity walk is unique because it also encourages high school teams to fundraise together which is both potentially preventative (i.e., raising
148 awareness about the signs of depression) and re-enfranchising for adolescent and young adult suicide grievers.
Abby, 23 years old, is a college student and was 20 years old when her best friend’s younger brother took his life. Adam was 17 years old at the time of his death.
Abby and Emily have been best friends since Abby’s sophomore year of high school and she was very close with Adam also. Before relating her reflections on attending the SPEA walk and how it helped her, it is helpful to remember the ways in which her grief met with disenfranchisement. First, Abby encountered significant disenfranchisement at work with unsympathetic bosses. In the passage below, Abby reflects back on how she coped with Adam’s suicide loss and understands that throwing herself into three jobs and working all the time was a negative way of dealing with her grief, as previously highlighted. On the related topic of social support, she recounts how her efforts to seek social support were often thwarted in other contexts and by other’s expectations that she should be “over it.”
Interviewer: And did you receive support from your own family, from his family, from your friends? How did that go? Abby: Initially I would say I received support. I haven’t dealt with it very well over the past three years, and at first everyone was really open to making sure that I was okay, but like there would be things that would trigger me to be upset. Like I remember I think it was the semester after it happened or towards the end of the semester that it happened. Someone in the hallway at school was talking about you know ‘I’m going to go kill myself if I don’t get an A on my finals,’ and I just like lost it...At first I would talk to other people. I would talk to my mom. You know my mom’s very, she’s very just like ‘Get over it,’ like ‘Box it up and put it away and be done with it’ kind of person and so… Interviewer: Compartmentalizer kind of? Abby: Yeah. So that didn’t work. And then I would talk to all of my friends at school about it, probably to the point of exhaustion for them because it was so fresh in my mind and I was so frustrated.
149 Interviewer: Yeah, yeah. And did any of them sort of pull away, or they kept being supportive? I mean you said sort of point of exhaustion. Did any of them say…? Abby: I had a lot of them pull away and I think I ended up losing a lot of friends because I needed to talk about it and I was seeking out people to talk to. Interviewer: And they had no idea. Abby: They had no idea how to deal with that. Interviewer: Yes. Right. Right. Yeah, no, I hear you on that …‘Cause it’s hard. Abby: Oh yeah. Interviewer: Yeah. You never sort of get over it. Abby: No. That’s the hard part is that everyone thinks you should be able to just move on from it like it’s a normal death. They think that you should be able to be like ‘Okay, so and so’s time was then, and they passed,’ but it’s not, especially when you know that they’re young and they’re ambitious about what they want to do with their life and it’s cut short.
Abby continues by explaining that being around others who had gone through the same loss made her feel less isolated. Indeed, Abby was recruited to be a participant in this study at the SPEA walk. She also describes benefiting from suicide being discussed and made visible in some of her college classes and raising money among her college peers for SPEA’s program. This encouraged her to engage in other rituals to help herself channel her grief in more positive ways:
Abby: I think the SPEA [Suicide Prevention and Education Alliance] walks definitely helped me, because I was around a lot of people that had gone through the same thing. I didn’t feel so isolated like I do here….I had a couple of classes where Professors would bring it up. Like I took a Sociology class and one Professor brought up about you know ‘How many of you have lost someone to suicide?’ And seeing other people raise their hand, so like to know that I wasn’t alone in it kind of helped…. Interviewer: So I met you at the march, and so how did you come from that place to being at the march and participating in that? I mean that’s a pretty, that’s a good step I would say. Abby: Yeah. Interviewer: How was that journey? Abby: Hard.
150 Interviewer: Yeah. Abby: I lost a lot of myself in the process of losing Adam because I was so guilty like in my head for being on the phone with Emily and not being able to help her when she found him. So I like made promises to Adam to take care of his family. That was how I coped with it. So when the [decedent’s family] initially came to me and they were like ‘We’re going to do this suicide prevention educationalized walk,’ I said ‘I’m totally onboard for it.’ Interviewer: Yeah. Yeah. Abby: You know I raised money from campus. We have a rock on campus that everyone paints their things. I painted the rock pink and wrote ‘I miss you, [nickname],’ ‘cause that was Adam’s nickname. I did what I could to be there. I was terrified to go, because they were such a mess and the [decedent’s family] are some of the strongest people I’ve ever met in my life, so it was hard to see them be so broken and not know what to do for them, but I knew I had to be there for Emily ‘cause she’s my best friend. Interviewer: Yeah. Yeah, and she was there that day? Abby: Yeah.
In her interview, Abby closes with expressing that her relationship with Adam’s sister, Emily, has since buckled. This unfortunate negative occurrence within her co- survivor network highlights the importance of supportive contexts outside of the social network (peers and family) of those connected to a suicide loss provided by these group- based coping contexts. Here, peer suicide grievers can seek out alternative network of grievers, if the network of grievers which share the same suicide loss becomes problematic.
Similarly, Lisa, describes her participation in a suicide walk alongside her sister, and other members of her family as a “really good,” albeit an emotional experience. For
Lisa, 28 years old, it has been five years since she lost her friend, Jim, who was dating her sister, Linda. Lisa and her sister were the first to discover Jim’s body which was especially traumatic for both of them:
151 Lisa: We did that walk. It was October, just this year. That was the first one. Well the first that we had heard about it, and it was just kind of like a chance thing. It wasn’t like advertisement or anything like that, you know. It’s just like it was word of mouth. Somebody found out about it in some other town and told my sister, you know, and said ‘Hey, they do this…..So you know so we went and it was good. It was really good, you know…It is. It’s really good, but yeah, it brings up a lot of feelings though, too, you know….as we were kind of walking over to where everybody was you know getting together and gathering and stuff, and you know and she was the one that saw me and you know and hugged me and stuff, and of course then that makes me cry more and that makes her cry…. But yeah, there were points that I think everybody got to that point or something. There were different things that triggered everybody, and I had talked to… One of the other people we walked with too was just, you know how like everybody has like shirts and stuff made up and like just looking around at all the people you know that were affected and it’s like you’ve got to think ‘This is just this one small area in the country in the world you know, and these are the people that know about the walk and that feel comfortable coming out and doing it.’ You know it’s just a small representation of the people that are out there. It’s amazing.
Here, at the close of her reflections, Lisa characterizes the experience of walking with others like herself as “amazing.” Indeed, many of the participants in these walks have lost a family member, friend, fellow student, or coworker to suicide. In particular, witnessing other suicide grievers’ ease with signifying their suicide loss, suggests she found this event re-enfranchising because it imparts positive benefits which countervail the disenfranchising forces of suicide loss. Below, Lisa adds that the meaning of participating in the suicide prevention charity walk was amplified by not only her sister’s suicide attempt following Jim’s suicide but also the act of signifying how suicide has affected her life by almost taking two people she cares deeply:
Lisa: Yeah. Well my sister attempted too after this happened, so like it kind of had two meanings to go, and she was the one that actually organized our family to go, which was good, and so she,
152 you know when we got there, I think like the most emotional part for me was when I got there and I signed in, it didn’t bother me and all that stuff, but then when we walked over to where they do the beads, the relationship beads, that’s when I like, that right there got me, you know because it made me really like think about who he was to me, you know, and I think that was… Interviewer: Did you have to write those little, you know that you’re in walking in memory of…? Lisa: That was the second thing that really got me.
Another participant, Megan, has participated in her local suicide prevention charity walk for several years. Megan is 36 year-old female, who lost her best friend,
Michelle, nineteen years ago. Michelle took her life during Megan’s second year of college. Indeed, Megan has taken on volunteering for the suicide prevention organization and passes out tee shirts during the walk:
Megan: Hey, I’m usually passing out tee shirts, so but you know I just, the one thing I always said is I don’t want a kid to ever have to go through this because it’s been a long struggle for me with this. You know I really… Interviewer: So you would say you know it’s made you more integrated rather than sort of unraveled you? Megan: Yeah, you know, and I try to be more in tune with that, and like I’ve lost two of my students the past two years to suicide, and you know I have had the kids come in and talk a little bit about it, and that’s been a really, really nice… and kind of helpful to me too, but I guess all of this, between Michelle’s stuff and then the death of these two students has really made me realize, ‘Something needs to be done.’ Instead of ‘This subject is just taboo. Let’s not talk about it,’ or this, that, or the other, for God’s sake, it’s getting… Interviewer: Right, ‘How many more?’ Megan: Yeah, and that’s what I keep saying every year because it seems the problem seems to be getting worse, and you hear more about those deaths than anything.
Unlike Carrie’s positive experience with her workplace, Megan expresses frustration with her educational setting which will not sanction students’ participation in such charity walks. Megan has asked several times to take students who have been
153 impacted by suicide loss. To her dismay, her efforts to re-enfranchise some of her students are met with administrators’ fears that the walk might promote negative suicidal thoughts in students rather than provide a positive re-enfranchising context:
Megan: You know it makes me kind of try to watch a lot more, and I notice I do it with my students. Like it made me a lot more aware of what’s going on in other people’s lives and maybe to take the time, even when I don’t want to, to pay a little bit more attention or I’m a very detailed person, so to pay attention a lot more to those details and try to actually do a little more to make a difference, because you never know who’s going to be here today and gone tomorrow or what you could’ve done. And my fellow teacher and I run the Volunteers Club and we do like stuff for hospice and everything else. Every year I ask, ‘Can we take them to the Walk?’ ‘No.’ ‘Why not?’ ‘Well we don’t want them to get… Interviewer: The idea. Megan: …yeah, that they would want to commit suicide,’ ‘Yes, because that’s so what the walk is for,’ and it’s kind of bad. I’ll ask it again this year you know .
Nevertheless, Megan feels strongly enough about the positive benefits she and students affected by suicide loss gain from participation, she will try again next year.
Similarly, Tony, received a great deal of social support from his co-survivors and continues to seek out such re-enfranchising experiences (i.e., Out of Darkness Suicide
Prevention and Awareness charity walks), but does not view himself through the lens of suicide survivor identity. Tony is forty-six years old and lost his friend, Stephen, three years ago. Tony got to know Stephen through his wife’s workplace because they were co- workers. Tony and Stephen enjoyed each other and Tony felt like Stephen was like a younger brother. They would see each other about once a month and Stephen would housesit for Tony and his wife. However, he describes that Stephen was struggling with his career path and often drank too much. When asked about his sources of social
154 support, he explains that he derived a great deal of social support from his co-survivors at
Stephen’s memorial service, many of whom were Stephen’s co-workers.
Interviewer: You raised like support structure and for yourself, when you, in dealing with his loss and then initially when you heard about his suicide, did you have enough support? Were there folks there for you? Tony: Well we had a lot of people, I mean the one thing that was positive was there was this whole community of people (mostly related to their office) that just loved this guy, and that was really helpful. I mean I can’t even imagine what it would’ve been like… I mean we all got to be sad together, and you know there was certainly something helpful about that. Had this been just somebody that was just somebody that I knew in an isolated way and there was nobody else that we could share that experience with, I think it would’ve been much more difficult, because you know the fact that like 200 people came together at this Memorial party and were able to kind of share that feeling together, you know it didn’t make any of us happier, but I think we felt the community, you know, and it didn’t, like I said, that didn’t make anybody happier, but we felt like we were going through this thing together.
Tony discusses that he continues to seek out this sense of “togetherness” or community which he found among his co-survivors in other group-based coping contexts.
Following his description of the community he felt with Stephen’s co-workers as co- survivors, he shares that he has participated in two Out of the Darkness™ Overnight charity walks for suicide prevention organized by the American Foundation for Suicide
Prevention (AFSP):
Tony: So there’s this huge group of people that it was a great release to hold this one big event that we did, and it’s been a release when we’ve gotten together with those friends and had the opportunity to talk again. There’ve been no sort of planned happenings to do that, but when we have all gotten together for different events, we end up talking about Stephen and we are compelled really to go there, and you know, so there is something, there’s a need there that you know that I think, that certainly I can’t speak for the other people, but certainly that I
155 felt, which is the reason why like I’ve done things like you know the Suicide Prevention Walk, “Out of the Darkness Overnight.” I’ve done that walk twice, and… Interviewer: Yeah, me too. Tony: …..Yeah, I just walked it in Chicago and… Interviewer: That’s great. Tony: …but I haven’t been able to get in… I did it two years ago when this was all really fresh and one other person walked with me, and this time I walked by myself, and it does something, but it’s also an opening up of the wound. You know you see all these people with their tee shirts of you know ‘We miss you,’ the person who we loved who decided to leave, and that’s hard. That’s hard, too, because it’s like everybody, you know there’s this communal feeling of ‘Yeah, we’d like to help other people, but it’s too late to help the person that we really wanted to help,’ and so you know there’s a real bittersweet part of the whole thing is that everybody wants to help, but there’s also this hopeless feeling that we didn’t help enough, you know, with the person that’s already gone.
Even though these walks create mixed emotions, Tony expresses that he traveled a great distance to participate in the twenty-six mile overnight walk which funds suicide prevention research. In Tony’s eyes this is an important cause the AFSP but does not view himself through the lens of suicide survivor identity.
Interviewer: Yeah, for me I get those mixed feelings too, and I wanted to ask you do you identify with the sort of term being a “suicide survivor”? Does that carry you know valence for you? When you think about you know in mentioning sense of community, do you think about it in those terms of being a suicide survivor? Tony: I’ve never really put you know that label on it, and that’s why I think it’s sort of hard to, in the “Out of the Darkness Overnight” thing it’s hard to you know really have this complete group thing because I think you have all these subsets. You know all these subsets of people who cared about a particular person, and the thing that is very satisfying is to be raising money that you can see that does concrete things that could’ve perhaps actually reached someone like Stephen, and so that’s very, very satisfying. But you know I guess that it’s done all sorts of things to me, but I don’t know if I ever would’ve labeled that as “because I’m a suicide survivor.” I mean that was certainly the…
156 but to me it’s so personalized, you know. It’s so about this one person. It’s not about the generalized idea of someone you know close to you dying or killing themselves; it’s about Stephen killing himself. You know what I mean? Interviewer: Right. Tony: And for all those people with their tee shirts on the walk, for then that’s what it’s about too. It’s not about somebody who you know killing themselves; it’s about the specific person killing themselves and what that, you know how that rolls through your life. Interviewer: Yeah. So do you think like sort of the placement of, you know and this gets to kind of explicitly you know suicide versus other types of loss, you know when you put that “suicide” into the mix…completely different, a totally different survivor experience, because of the nature of the choice. When somebody makes a decision to go away, they’re making the decision to leave you. They’re making the decision to leave everybody else, and it’s not just this sad thing that happened; it’s a rejection of all of us and it’s a rejection of this world.
Significantly, participation in these walks seems to impart a sense of re- enfranchisement to peer suicide grievers, in particular, the exposure to other suicide grievers gathering en masse lessen peer suicide grievers sense of isolation. Also, if the network of grievers which share the same loss becomes problematic, these contexts can function as an alternative source of support for peer suicide grievers as highlighted by
Abby’s experiences. Thus these contexts seem to offer re-enfranchisement in regards to both the type of death and relational status.
L.O.S.S. Team participation and re-enfranchisement: “If I can do anything that would help one person get through this grief, I will do anything to help them.” In addition to participating in prevention charity walks and being among other suicide grievers, a handful of participants foregrounded their involvement in Local Outreach to
Suicide Survivors (L.O.S.S.) as an enfranchising experience. In contrast to the passive interventions described above, this pioneering program developed in Baton Rouge,
157 Louisiana represents an Active Postvention Model (APM) which aims to deliver immediate support to suicide grievers at the time of death through the L.O.S.S. team.
Working with the local Coroner’s Offices, the team travels to the scene to sit and talk with family and friends after police and medics have left. “The L.O.S.S. team reaches out to survivors to let them know that they are not alone, provides immediate contact and support, informs them of the resources available to them in the community, and provides an installation of hope that they, too, can survive this traumatic loss.” (Campbell,
Cataldie, McIntosh, & Millet, 2004, p. 30) The team consists of a mental health professional and other para-professional volunteers who are also suicide survivors themselves. Moreover, it is important to note that the L.O.S. S. program was developed and grows because of the efforts of suicide survivors. Indeed, suicide survivors play a pivotal role throughout the organizational structure of this program—as program recipients, participants, and leaders—who begin L.O.S. S. programs.
Among study participants volunteering through L.O.S.S. programs, Lisa expresses that her own healing is assisted by her involvement with helping other suicide grievers. For Lisa, 28 years old, it has been five years since she lost her friend, Jim, who was dating her sister, Linda. She and her sister were the first to find Jim’s body which was particularly traumatic for both of them.
Lisa: and everything else I figured you know like my ongoing healing is trying to help other people. You know that helps me, you know sharing my… Interviewer: Do you want to be a part of that and do… Lisa: Yeah. Interviewer: …do that program? Lisa: I think so. I haven’t went to one yet. Interviewer: And so you, you want to give the Loss a go and view that as sort of still connecting to Jim…and kind of keeping him with you but
158 not when the angry you know, ‘Errr, I’ll knock your block off the next time I see you.’ Lisa: Yeah, like in a more positive way, yeah, than an angry, angry way. Yeah.
From Lisa’s viewpoint, embarking on being part of the L.O.S.S. team and volunteering to share her story to other suicide survivors will help her to deal with her grief in a positive way, especially with quelling her anger. Elsewhere in the suicide grief literature, it has been noted that feelings of anger, often directed towards the suicide decedent are common among suicide grievers. However, the idea of expressing anger especially towards a deceased loved one is very discordant with the social mores and folkways surrounding death in our society. Although such feelings are an honest reaction, suicide grievers may feel they must mute or stifle their expression, thereby heightening their chances of experiencing disenfranchised grief due to the nature of the death being suicide
(Barlow & Morrison, 2002). As she brings her survivor experience to the table, Lisa anticipates being a valued and integral part of her local L.O.S.S. team:
Lisa: But so I don’t know. but it sounds like if things go as planned with the Loss Team, then I’ll probably be going to a lot more, because they want, they’d like to have at least one survivor on the team that goes to all of them, and there’s only two of us on the whole team, so
159 Lisa: And we’d just had a meeting Wednesday, our first meeting that we really kind of pulled it together and actually got a little bit organized. Interviewer: Yeah.
Having attended suicide prevention charity walks and become a L.O.S.S. volunteer, Lisa is a study in what such re-enfranchising experiences can offer suicide grievers, and, in turn, how suicide grievers can assist others struggling with suicide loss.
Moreover, when asked about if she views herself as a suicide survivor, she affirms that this identity status is salient for her:
Lisa: Yeah, I don’t see the group that much, but there are still, there’s a close–knit group of them that still get together, but there are certain things that they won’t do and places they won’t go and stuff like that, but my big connection as time went on was with my sister through, you know, went through my sister, so really the friends that he grew up with that he stayed close with, I never got close. Although I knew them, I never really got close to them to where like part of their group, but you know all… And that’s pretty much it. He didn’t have, you know he was one of those people that he knew a lot of people but didn’t have a lot of close friends, so… Interviewer: Yeah, and they… Yeah. Lisa: But he, you know, and then like you know as far as on, you know the people that were close to him that you know I knew was my family, so you know of course we stayed together, you know. But there really wasn’t you know a group of people. Interviewer: Do you think they identify as suicide survivors? Lisa: I think I don’t know. I don’t know if they do or not really. Interviewer: You would say for yourself that you do? Lisa: Yeah. Interviewer: Yeah. Lisa: Yeah, I do, and I think probably some of them probably do, but I think…
Another participant, Beth has been part of the L.O.S.S. program in her region for some time. She is fifty-two years old and is a triple suicide survivor. Of these suicide losses, her most significant is her husband, Jim, who took his life seven years ago leaving
160 behind Beth and their two teenage daughters. Indeed, she recounts that she had been to the scene of a suicide the weekend before her study interview. In the following interview segment, Beth explicitly steers the conversation back to her L.O.S.S. team involvement.
In the passage below, she explains that her dedication to volunteering on the team comes from having been an immediate beneficiary of the L.O.S.S. team during her suicide loss.
She emphasizes that she “cannot fathom” being without their support following her major suicide loss. Even though her involvement will bring up painful memories, she explains that she deals with this by continuing to attend suicide bereavement support group meetings
Beth: Okay, you said something about the LOSS Team. The day that he died will come up for me when I go out on a LOSS call, and but you know what? That’s what made me want to be on the LOSS Team, because I had a member of the LOSS Team come to me and I cannot even fathom, I can’t fathom not having that, and so I knew pretty early on… Interviewer: It made a huge difference. Beth: …I wanted to do that when I was ready and when I chose…And yes, there are times that I have turned around and you know needed to have my time in group when certain things in my life have happened, and you know I can still share and… Interviewer: Yeah, that movement is possible. Right. Right. Beth: Yeah, I can be a co-facilitator, and I can be just a person in the group that needs support from the other members. So and I think that both of those have been very healing for me. Interviewer: Right. Beth: And usually during our debriefing after a LOSS call, almost all of the time, whoever I’m with, our loss comes up. Something, you know something that we’ve seen or done… Interviewer: Right, like here in this interview between us, yeah.
On her L.O.S.S. team experience, Beth underscores that the experience “works for me” because she finds mutual nature of the support group setting is “very healing.” She continues:
161 Beth: …yeah, triggers that past, and so we just sit there and say it, ‘Ooh, that reminded me of my’ whatever, you know ‘on how it was for me that day,’ or something and we’ll talk a little bit and then we switch back to well filling out our forms or whatever we’re doing, and I don’t know, I just, and it works for me. Interviewer: Yeah. Yeah, yeah, ‘cause you know I imagine doing that, and so listening to some of those stories that [L.O.S.S. team leader] shared about like the deaf woman who there was someone on the Team who knows sign language and so was able to sign in her hand ‘I’m sorry to be here to tell you that your son is gone,’ and then in the next breath or sign saying ‘My son did this too,’ and the old woman just clasped like this and ah, you know, and thinking… Beth: Those are God moments.
After the interviewer recounts a L.O.S.S. team story that was described at a Suicide
Prevention Conference, Beth intones that such parallels are “god moments.” In other segments of her interview, Beth indicates that her belief in God has played a strong role in her healing too:
Interviewer: God moments, yeah. Beth: And most of the time it works. Not all the time, but most of the time it’s a husband that’s killed himself, then there’s another spouse that goes out and you know… Interviewer: Right, oh, so that you align the relationship. Beth: No, we don’t. Interviewer: No? It’s just…? Beth: And that’s that God thing. Interviewer: Oh, okay. Beth: Or if there’s a child… Interviewer: So it just works out that way who’s on the schedule. Okay. Beth: That’s strange, you know, and it’s just like…
Given this correspondence of relational loss between L.O.S.S. volunteers and recipients, it might appear that the program deliberately strives to match survivors’ relationships, but there is no such guideline. Nevertheless, Beth marvels at how often relational status aligns in the team’s work as they help those who have suffered a suicide loss. Through the sense of sacredness Beth invokes in her words, the value which Beth
162 derives from her participation in the L.O.S.S. program is clear. Yet, despite the level of importance her re-enfranchised role carries for Beth, she expresses that her extended family do not understand her involvement in L.O.S.S. or the role it has played in her life:
Beth: My family doesn’t under… I’m not talking about my five- member family. They probably don’t understand, but you know they’ve just accepted ‘This is what Mama does.’……You see? And my sister, even with my husband, she doesn’t talk much about it, but she was with my husband, but she was very supportive. Now me going on the LOSS, being on the LOSS Team and doing the things that I do here at the Center, they don’t get it… Interviewer: No?....Does that affect you?.... Beth: No, it don’t matter. Interviewer: Yeah. Beth: I just look at it, well you know they just don’t understand. Interviewer: Yeah. Yeah. Beth: They just don’t understand, and that’s okay because I’m not doing it for anybody to give me a pat on the back or for them to praise me or to think ‘Oh, look what she does now.’ Interviewer: Yeah, yeah. It’s not about that. Beth: It never has been about that, you know. ‘I wish that you would’ve been able to have a LOSS call when your loved one died.’ Interviewer: Yeah.
Here, Beth expresses again that the rewards of her L.O.S.S. team involvement are very intrinsic in nature and she wishes that others could experience the type of support she has received through the L.O.S.S. program
In addition to Lisa and Beth, two other participants discussed their leadership roles in L.O.S.S. team organizing. Donald, 60-years old, a psychologist and triple suicide survivor has devoted much of his career to helping those bereaved by suicide. His suicide losses include a middle school classmate, a coworker, and a friend. Donald is an example of a suicide survivor whose advocacy efforts have served to re-enfranchise hundreds, if not thousands, of suicide grievers. He highlights one poignant story to show how the
163 program helped a grieving mother who, in turn, has become a dedicated member of their
L.O.S.S. team. He also emphasizes that the program counteracts disenfranchisement due to suicide death by facilitating communication between first responders and suicide grievers. For instance, Donald describes how organ procurement has not historically taken place among suicide decedents because health professionals are often very reluctant to approach suicide decedent’s next-of-kin. Donald illustrates, however, that L.O.S.S. team members who are versed in empathetic communicating about suicide can facilitate communication between medical or police personnel and suicide grievers. Thus, a suicide victim’s mother was able to feel that part of her son lived on and is bringing light into to someone else’s life.
Donald: So the mother said ‘Oh absolutely.’ So Organ Procurement came out and we got all the paperwork done. So a couple of weeks later she comes in for her assessment and to start group and all that and she says, ‘Do you remember talking to me about my son’s eyes?’ I said ‘Yeah, I do,’ and she said, ‘I want you to know that that night I never went to sleep, and I stood on the porch still staring out into space when I got home, and as the sun rose, the only thought I had was that someone will get to see sunrises because my son’s eyes will go forward in time. Someone else will benefit. He’s not gone. He’s still there shedding light, ‘cause he was a really wonderful…’ and I said ‘That’s amazing.’ I said ‘Within that few hours that came…?’ She said ‘Absolutely. Something good came out of such a tragic loss so quickly,’ and today she’s on the LOSS Team, been an active member for years, and she said ‘You know I always wanted to be able to do for somebody else what the Team gave me that night, which was for something good to come out of something so tragic. She said ‘I had some hope I could hold on to right there at the beginning.’ Now the Organ Procurement people have never been able to come up with why it is survivors don’t get asked in the hospital, but hospital nurses are the ones that approach typically. So more of that’s happening since we started asking out in the field, but it really has been an interesting thing to me to see how quickly something good can come out of that tragedy if people are open to giving that opportunity there. And I never
164 forget that when I see a sunrise. I think about what she said, and that’s a beautiful legacy for her. She said sunrises mean so much more to her today than they ever did before, and so do sunsets…
Though Donald’s example applies to mainly family members, such re- enfranchising benefits or, as he calls it, “legacy” derived from a L.O.S.S. team’s presence at the scene of a suicide could also extend to close friends and peers too. Given these positive attributes, it is not surprising that the L.O.S.S. team model is being implemented in other communities by suicide prevention advocates whose lives have been impacted suicide loss (Lange-Kubick, 2011).
Similarly, another participant, Daniel, 63-years old has suffered three suicide loses including his wife, a girlfriend, and male friend over the past twenty years. He describes himself as floundering until he found a role in the L.O.S.S. program and he continues to participate in his local suicide bereavement support group along with Donald and Beth. He credits the program as “saving his life” because he suffered tremendous guilt over his former wife’s suicide:
Interviewer: And how has it been being a volunteer and giving support you know and being you know at the, you’ve been at the scenes, right? Daniel: Oh yeah. Oh yeah. Interviewer: How does that sit with you, and how do you, you know, cope with that? Daniel: Some of it’s hard. Some of it’s very hard. I think it gives me a sense of well being to know that I’m at least offering help to people that I wish I’d had 20 odd years ago. Maybe I wouldn’t be sitting here today if I had it 20 years ago. Like I say, some of it’s hard. I can very vividly remember some and can’t remember others at all. The one that sticks with me the most is a 21-year-old LSU co-ed who had a fight with her boyfriend at a vigilant and went out to the car, locked the doors, pulled a gun from under the seat and while he’s pounding on the window, points the gun at her chest and shoots herself. Beautiful girl. I mean just beautiful.
165 Long, blond hair. I was still at the scene when they took her body out of the car and just laid her out in the parking lot, and she looked like she was sleep. No blood, no trauma. Just looked like she lying inside the car you know passed out or sound asleep. And when I finally got to the boyfriend, he just literally fell into my arms, just almost screaming he was sobbing so hard. That one sticks with me. The others have either been old men, young men, big family gatherings, small family gatherings, one person, 12 people. It just varies, but it makes me feel good, like I say, to know that I may be giving some hope to people and letting some people know that there are some options. They don’t have to sit on it like I did for 20 years. You can start getting help and not have to live with the shame and the guilt all by yourself.
Daniel continues that his family is very supportive of his participation in the L.O.S.S. program—his wife even helps him look up locations on Mapquest of scenes he must travel to when he is called to volunteer at a suicide scene.
Also, Courtney describes her efforts as a suicide survivor to combine her mental health background with her desire to advocate for other suicide survivors by developing a
L.O.S.S. program in her area. Courtney is 24-years old and lost her co-worker and ex- boyfriend, Christopher, two years ago to suicide after his behavior had become very erratic struggling with depression. Currently, she volunteers her time as a facilitator of a suicide bereavement support group in her area. However, she expresses that even though she “likes the group a lot,” she doesn’t feel completely re-enfranchised through her work with the group because her suicide loss was not an immediate family member:
Courtney: And there’s no one that I can really talk to about it. There’s no one, even in the group. I mean I like the group a lot, but it’s hard because it’s a different loss. It’s very, very different and it’s hard because you know if it’s your mother or if it’s your child, you have people who will, you would hope, who are going to recognize that and offer you continued support, whereas a friend, like I said at work really that’s the only place where people kind of recognize your friendship. Within the first month,
166 people stop talking about it. That was the end of that. You know no one ever… Interviewer: Yeah, I know what you mean, no man’s land. Courtney: Right.
Courtney continues by explaining that she is working with others to develop a team based on the L.O.S.S. model but is experiencing a logistical roadblock because the coroner will not allow a suicide to be declared a suicide, even if it is an “obvious suicide.” Courtney is clearly frustrated that bureaucracy is given priority over the needs of suicide survivors which she attributes to the taboo of suicide:
Interviewer: Do you think they’ve caught on to that, and do you see any sort of effort to be more inclusive of non-familial relationships? Courtney: In? Like in the group? Interviewer: Yeah. Was there an acknowledgment of that? Courtney: Well here’s the other thing. I’m actually working on a project in the County right now, ‘cause I sit on this Task Force as a survivor and also as a Facilitator…. It’s a very interesting program, but the problem in [area] county is that we can’t get the Coroners to agree to tell us when there’s been a suicide, because LOSS, this program in Baton Rouge, they go out. They get phone calls immediate from the Coroner’s Office saying ‘Hey, we’re at the scene of a suicide. Can you come? Can you offer support?’ and they just, they go with the family to view the body. They sit with the family during the funeral arrangements, all of it. So the hold up has been that the Coroner’s Office doesn’t rule on the cause of death, especially suicide, for weeks or months after the death and they refuse to… Even if it’s an obvious suicide, they still won’t say anything because it’s not official, they haven’t ruled on it. Interviewer: Oh. Courtney: So I actually had a meeting recently, ‘cause I’m trying to pull together all the people who I think are key players, ‘cause I asked if I continue that because I think it’s really important and I think our County needs to have more, well anywhere needs to have a more coordinated… Interviewer: Like Baton Rouge, yeah. Courtney: Yeah, but everyone needs that. I think part of the problem that it’s not more coordinated and it’s not talked about more is because suicide is so taboo. People just don’t talk about it.
167
Below, Courtney stresses relational re-enfranchisement once more, explaining that she is motivated to develop the L.O.S.S. team in her area because she hopes to extend its reach to include not only family members but peer suicide survivors like herself:
Courtney: Right, and I think the hard thing is, ‘cause we talked about this in a meeting that we had. We did a Planning Meeting recently and we kind of talked about ‘Okay, the Coroner’s Office isn’t working with us. Let’s go to the next best thing, the funeral homes, because the funeral homes you know 90% of the time they’re going to know whether or not it was a suicide. You know the family is going to report, or just the nature of the body and the way that it looks. They’re going to know that it was, that it was a suicide. So let’s go that route and have them provide…’ First of all what we want to do is have a packet of information to say ‘These are the groups that are offered in the County for survivors. These are counseling services. These are other supportive services,’ and then couple that with having an Outreach Program where within the first week people are going to be at a funeral home, and if they choose to have the support, that we would be able to do outreach to them. Interviewer: And intervene there. Courtney: Right. Exactly, instead of you know six weeks, two months, three months, ten years later when they say ‘I need help.’ So we can offer it right away, and that way you know great value.
Below, by mentioning that she had spoken with a recently-bereaved peer seeking support just days before our interview, Courtney underscores that peer suicide survivors should be included in outreach efforts.
Courtney: Right. But the problem is, and I said this at the end of our last meeting, I said ‘That’s a good way to identify family members who need support.’ However that completely overlooks the whole issue of friends, and I’m very, very sensitive to that because I feel very, I do feel disenfranchised and I do feel like no one recognizes my grief, and I do feel like it’s kind of… Interviewer: You’re on the sort of outer orbits. Courtney: Right. Interviewer: Yeah, I applaud you for that, with that work. That’s awesome.
168 Courtney: I think it’s good stuff. I just, I hope it works and I hope that we can do something to reach more people. I actually had someone call me. Last week we had group and one of his best friends had suicided mid-April and he didn’t find out until like ten days later after everything, all the services had happened, because it wasn’t, I guess it wasn’t a really close friend, but the man who called me was gay and his friend was also gay and he said that it was that this person was the first one to kind of introduce him to the gay community and offered his support.
Courtney’s statements about recognizing all of those impacted by suicide loss point towards the issue of suicide survivorship as an important group identity associated with suicide loss.
Suicide survivor identity: “I’m a survivor. This is what I went through. I lost my best friend.” For study participants, questions around their status as a suicide survivor elicited manifold responses. For some, it is an identity status which they embrace, one participant even has “suicide survivor” tattooed on her arm; while others expressed reluctance in claiming this identity. Others said it is important because only fellow suicide survivors can comprehend their suicide grief. Through the analysis phase of this project, it became clear that this is a salient identity for suicide grievers, but it appears to have a number of contingencies as described in an earlier section. This section addresses the following questions: what does it mean for study participants to view themselves as a suicide survivor, and who counts as a suicide survivor? Moreover, this section considers if participants view of themselves as ‘survivors’ corresponds and perhaps underpins the type of coping they engage in (i.e., individual versus group-based coping methods).
In the traditional outreach strategies discussed earlier in this chapter, digital and print materials often use the term ‘suicide survivor’ to refer to those who have suffered a
169 suicide loss. But the suicide grief literature supports that few suicide grievers are familiar with this term and possibly confuse if it refers to those who have suffered a suicide loss or those who have attempted suicide (Cerel & Campbell, 2008). A number of participants supported these findings by expressing the concern that use of the term, “suicide survivor” to describe themselves to others, might mistakenly suggest that they had attempted suicide themselves or that they could not claim this identity because of their peer status. Of this group of study participants, the majority exhibited individualized or intrinsic coping strategies.
One exception to this pattern was Abby. She sees a different possible misinterpretation of the term based on relational status. Abby, 23-years old, is a college student and was 20-years old when her best friend’s younger brother took his life. Adam was 17 years old at the time of his death. Abby and Emily have been best friends since
Abby’s sophomore year of high school. According to Abby, the misunderstanding about being viewed as possibly having attempted suicide herself doesn’t influence her choice against identifying as much as the relational claim or entitlement it involves:
Interviewer: Do you identify with the term “suicide survivor”? Do you ever describe yourself as that? Abby: No. Interviewer: How come? Do you think people would misinterpret it as if… Abby: That I, myself, tried to do it? Interviewer: Yes. Abby: Yeah, I can see that, but no, I don’t. I guess if it had happened… I mean we were close, but we weren’t I mean as close as family. You know what I mean? And I mean had I been actual family or like his sister or a cousin or something like that, then… Interviewer: Or if he’d been sort of… Abby: I may be more… Interviewer: …impacted by it, like you know if he was sort of thinking about top five best friends or something... Abby: Right.
170 Interviewer: …would your, your reaction would’ve been different? Abby: Yeah. Yeah. Interviewer: Yeah, based on… Abby: And then I would probably be more likely to use the term, but I mean not with him.
For Abby, the identity of being a suicide survivor is defined by the relational realm or dimension. Her statement has powerful implications: it illustrates why peers who have suffered a suicide loss might fall through the cracks of intervention efforts because of the perception that such resources are reserved for close friends and/or family members of the suicide decedent.
Donald, too, echoes the relational dimension raised in Abby’s words and also contours it further by adding his own experience of “clinician survivor” to these affiliation concerns. Donald, 60 years old, is a psychologist and triple suicide survivor who has devoted much of his career to helping those bereaved by suicide:
Donald: Well I do think that my losses wouldn’t be the ones that would be considered being one in the traditional sense, but they definitely match up with the frequency of people who seek help. So the loss of a friend, which are two of my losses, would qualify based on frequency, and the Clinician as a survivor is the one that fewer people come forward, but more and more are. So I do think that from a suicidology perspective I fit, but I don’t think most survivors would really understand that, and I would say talked with me. So if they just heard what my experience was, they might not assume that I then was “a survivor.”
Similarly, the stigma and taboo associated with death by suicide is also a factor in dimension of disenfranchised grief plays thereby both dimensions of disenfranchisement stressed in this investigation are implicated in the identification process of suicide survivorship.
171 Another barrier to receiving social support that participants identified was the distinct nature of suicide loss, whereby some participants felt that only other suicide survivors could really understand their experience. For example, Megan, a 36 year-old female, lost her best friend, Michelle, nineteen years ago. Megan and Michelle were best friends since middle school until Michelle took her life during Megan’s second year of college. When asked about sharing her suicide loss with others, she expresses that her perception is that others “can’t relate.” To illustrate this assertion she shares an example of how she was able to support one her students who was having a difficult time dealing with the suicide loss of a fellow student. Because of their shared identity as suicide survivors, Megan feels that their talks were mutually helpful:
Interviewer: Do you share with the folks who are your kind of inner circle, do you share with them about [Michelle]? Megan: Little bits and pieces, but you know they didn’t know her and I hate to say people aren’t interested. It’s just they can’t relate, and I had some students this past year who had a hard time after our student committed suicide and…I’d had her at the middle school, too, so one of the kids was really having a rough time, and she ended up going down to Florida for a few months and doing like some schooling down there and she came back and she started coming in at lunchtime and we talked and I was able to share with her, which was really nice and it kind of helped us both a little bit.
Discussing how views of suicide are culturally influenced, Lisa describes overhearing many hardened and misinformed beliefs about suicide in her professional sphere as an
Emergency Medical Technician (EMT). Lisa is twenty-eight years old and it has been five years since she lost her friend, Jim, who was dating her sister. She recalls her own views about suicide prior to her loss were colored by this same ignorance, but since she has experienced losing a loved one to suicide, she wonders if the experience of suicide loss is an example of “it takes one to know one”:
172 Lisa: Like negative you know, because people have the impression that I did before, you know, and probably because they have no connection to the person that did it, but they see what that family is going through and they respond, you know, and all that, and I don’t know if that’s part of it or just, you know, and I really think that it’s not, it’s because they haven’t had anything happen to them close to them, you know, and I almost wonder if it takes that to really understand that. Interviewer: Move, yeah, have that shift. Lisa: To truly get over there, yeah.
Also, when asked about identifying as a suicide survivor, Lisa emphasizes that this identity status is important to her and those who interact with her on a daily basis know her “her story” and she does not eschew this newly important side of herself in her occupation or social life:
Interviewer: Does it affect work, your health, other areas of your life. What were those effects that you can identify? Lisa: I would say other than… I don’t know…. I’m a talker, you know, so when people ask me about it or sometimes I’ll just bring it up you know and start talking about it, and like you know and you can tell… Interviewer: I’m that way, too, yeah. Lisa: ….And so I think you know most of the people that I’m involved with on a daily basis know my story and know I stand on it.
Another participant, Jonathan, describes his identification as a suicide survivor and explicitly links it to both his advocacy in his occupational sphere and group-based coping contexts like the suicide prevention charity walks. Jonathan is in his fifties and lost the mother of his son over five years ago:
Jonathan: Well I do identify. I’ve had other suicides in my life and I think that they came at really you know an earlier life when I was a teenager, and they were very upsetting. I felt very guilty about one of them in particular, but I should’ve known, should’ve stop it, I could’ve. You know, should’ve, would’ve, you know all of the things that I think you are suggesting that you went through as well, or you know ‘I should’ve known,’ or something, and I…
173 Interviewer: Right, ‘ ‘cause you two were so close.’ Jonathan: Yeah, yeah, you know. So but as I matured and I got older and I could see this as being real and it’s my life’s work, I more identify as being someone who help people survive suicide or depression or what have you, but for one day out of the year when I go to that march and I wear a shirt or I have her name on my back, I walk and I identify, and I also do it as a… Like I wish my son would do it someday, but I don’t think he will.
Furthermore, at the close of his interview, Jonathan returns to the issue of suicide survivorship by underscoring his own survivor identity as a positive strategy in dealing with suicide loss and expresses again his concern for his son’s somewhat stalled status in this identity process:
Jonathan: Let’s see. No, I don’t think so. I think we covered it all, and I really, I think your question about being a survivor makes me clarify or makes me think about yeah, I might be, but I more so think of my son and his… where he is in surviving and I don’t know, and that is a puzzle to me and I don’t know. Maybe, I hope someday we’ll be able to talk more about it. Perhaps that’s why I texted him, just to see if I can open the door some time and talking, but that’s one thing that I, the legacy of a suicide and the impact on others can be really costly, as you know. And if it locks him up, if it makes him distant from being intimate and close, then I could get mad, but for the time being I don’t have that answer. I don’t. I give him, I hope for him to have a relationship that he will share this. It may not be with me, but if I know he’s sharing with some other person, then I’ll feel a lot better about it.
Again, Jonathan’s comments emphasize the existence of available support contexts for suicide grievers which are outside the circle of co-survivors who share the same suicide loss. Similarly, Daniel explicitly connects his status as a survivor to his participation in the L.O.S.S. program:
Daniel: Yeah. Oh gosh, yeah. And a guy I work with, his brother-in-law attempted suicide one day last week and the first thing he did
174 was call me to find out what to do. Well I, you know, ‘Take him to the Emergency Room. Call 9-1-1,’ and but everybody thinks that I’m an expert on suicide and I’m not. I’m just somebody that was lucky enough to survive 20 odd years now almost. Golly, 31 years. I beg your pardon, 31 years. So yeah, just you know society is not. They don’t want to hear it. They’re too busy, until it happens to them, and then they want to know. And everybody to a person in this group, everybody that’s wanted to come on Tuesday night, ‘You give me the magic formula, give me the pill, let me go home and be over with.’ Well it don’t work that way. You know I’m sorry, it takes time and a lot of it, and that time was awfully slow to begin with. Interviewer: Yeah. Yeah. Daniel: And this is all things I’ve heard from other survivors that have taught me you know what I needed to know, and everybody that comes in the group that’s new, I tell them the same thing. I said ‘It’s going to get better. I just can’t tell you when. It takes time and it takes too damn much time, but it will get better,’ and nobody believes me until it does. Interviewer: Yeah. Daniel: And there comes a day when the survivor will laugh for the first time, and they feel so guilty, oh my gosh, or they go a whole day without thinking about their loved one that completed suicide and they feel so guilty, but they shouldn’t. I mean you know how that is.
For another participant, Carrie, suicide survivor status was extremely salient, to the extent that she has “suicide survivor” tattooed on her arm. Carrie, 30-years old, lost one of her very best high school friends, Thomas, around nine years ago. Neither she nor his other close male friends were aware that Thomas had been suffering from bipolar illness.
As highlighted in an earlier section, Carrie’s passionate advocacy for suicide prevention has become her career and she tells her story of suicide survivorship in television and radio spots which air across her home state. Below, her statement, “I’m a survivor. This is what I went through. I lost my best friend,” offers a strong claim to this identity status by a peer. However, after this statement, she mentions that her co-survivors (“the boys”)
175 are more apprehensive towards her advocacy work, while Thomas’s family fully support her efforts:
Carrie: From the very beginning Thomas’s parents have always been very okay with it. If I’m going to talk about what I went through to help somebody else, they say fine. You know they’re, ‘Go out and talk about it, if it’s going to… Fine. Fine, fine, fine.’ It’s not like I go on the Channel 7 News and say ‘My friend Thomas,’ you know what I mean? I just say ‘I’m a survivor. This is what I went through. I lost my best friend, and this is what you can do, and this is what you should know and this is what you can go about,’ and Thomas’s friends have always been very supportive of that in saying you know ‘We don’t mind. If it gets around and helps with something, then do it.’ But the boys have always been a little bit more apprehensive about it and a little bit kind of skittish.
Below, Carrie discusses how her tattoos, especially one on her arm which reads, “suicide survivor” are linked to Thomas and her suicide loss experience:
Carrie: I have, yeah, I have a ribbon “I’m a suicide survivor,’ so I have ‘Suicide Survivor’ tattooed on my arm, and then on the back of my neck I have a green shamrock with a yellow ribbon tied around it with a little bow, because yellow ribbons was how we started talking about suicide. You know so it took me a long time to understand that Yellow Ribbons is a great project, but it’s kind of like a cherry on the top of a comprehensive project, you know that it can’t stand alone on its own and work, but it was a great place for me to start talking about it and kind of getting to that point. I have another one on my back and the Chinese symbol for happiness that I got one year afterwards. Interviewer: So they’re all tied to Thomas? Carrie: Those three, yeah.
Above, Carrie’s case offers unique insights into the meaning of a suicide survivor identity among suicide grievers. In particular, her experience demonstrates how deeply this identity is integrated into her biography, her interactions with others, her work, and her self-concept.
176 On a final note, participants in this group would often relate stories of other suicide survivors in order to illustrate part of their story of loss. Of course, knowledge of such stories is predicated on contact or exchanges with other suicide survivors which speaks to the value of community versus isolation among those who have suffered suicide loss. Most significantly, these ‘stories-within-stories’ demonstrate that contact with like-others matters and is a resource upon which suicide grievers draw to articulate their own suicide loss experience. Though extemporaneous in nature, knowledge of other survivors’ stories or narratives also represents an important link between this identity and group-based contexts where such stories may be shared without fear of being reproached.
In sum, this chapter has illustrated strategies which suicide grievers described for coping with suicide loss. It has weighed several questions related to the broad experiences of support participants shared about their suicide loss. Findings were conceptualized along a broad continuum of coping experiences and behaviors, including individual behaviors in which peers engage in to support themselves, inter-personal support, psychological counseling, suicide bereavement support groups, suicide prevention charity walks and conferences, and volunteer programs which help suicide grievers. Three significant cleavages in the data emerged after data analysis.
Intrapersonal coping strategies inform the continuing bonds model of grief by highlighting contingencies which suicide grievers experience in their loss experiences.
Alternatively, intermediary coping strategies underscore efforts by suicide grievers to engage in informal re-enfranchisement by informal and individual means. Thus, this group of participants discussed instances of reaching out and advocating around depression and suicide awareness (within their personal or occupational spheres), but on
177 the other hand, they did not seek out the group-based advocacy settings which other peer suicide grievers found so helpful. Nor, in most cases, did they explicitly identify as being a suicide survivor. In particular, this intermediary coping group is valuable because participant’s reflections offer insights into contingencies which some peer suicide grievers identified around claiming ‘survivor’ status. Most significantly, findings in the group-based or extrinsic coping strategies capture various means of ‘re-enfranchisement’ in the context of suicide grief—one of the theoretical contributions of this inquiry.
Because the disenfranchised grief framework postulates that those experiencing disenfranchised grief will encounter decreased social support, findings illuminate how and where peers develop coping strategies in the context of suicide loss and advance the disenfranchised grief framework in significant ways. The other theoretical contribution of this analysis is found in the emergent interrelationship between suicide survivor identity and group-based coping contexts foregrounded by the closing section of this chapter. The extent to which participants identified with being a suicide survivor and what this identity process means to them reveals that ‘suicide survivorship’ is an important identity process embedded within the above contexts. The following discussion chapter considers the implications of this identity process and group-based coping strategies not only in the scholarship of grief but also sociological understandings of medicalization, and, finally, social mechanisms which link individual, self, and society.
178 Chapter Five: Advancing the disenfranchised grief framework, re-enfranchisement
in the context of suicide loss, and suicide survivor identity findings
The fascination of qualitative research lies in setting out with one set questions as recounted in this introduction, and then witnessing how these change and are recalibrated through the research process. This study began with Freud’s influential work, Mourning and Melancholia (1917) in which he distinguishes grief from depression and has moved through the academic study of grief and bereavement up to contemporary understandings of loss. After introducing investigative questions in the study of peer suicide grief, subsequent chapters outline research methods employed and detail analytic findings focusing on disenfranchisement and re-enfranchisement in peer suicide loss. Intriguingly, this narrative ultimately returns to take up issues in Freud’s key work of nearly a century ago which has been newly recast by modern medicine and contemporary mental health experts.
This chapter now broadly discusses the results of this inquiry. The first section revisits study aims articulated in the first chapter and considers anticipated findings before the analysis stage. The second section addresses findings yielded during analysis and also explores emergent theoretical themes around re-enfranchisement at the macro-, meso-, and micro-levels of society against a backdrop of relevant sociolgical knowledge.
Among the sociological literatures for which these findings hold implications are the study of Health Social Movements (HSM), symbolic interactionism and identity,
‘closure’ marketing, and the medicalization of grief. The chapter concludes with an examination of study limitations and suggestions for future research on embodied health
179 movements (e.g., Out of the Darkness Community Walkssm) and suicide loss survivor identity.
Expected study findings: Returning to study aims
To present the results or findings of qualitative research, experts describe different styles or modes of telling the ‘story’ or through-line of their work (Alasuutari, 1995).
Silverman and Marvasti (2008) explain how these various ‘stories’ relate qualitative outcomes through either a hypothesis testing, analytic, or mystery narrative macrostructure. A hypothesis testing story includes a statement of hypotheses, testing these hypotheses against study data, and, implications raised by the process are then discussed. This model, however, is usually told in a passive voice and copies the dominant three-part structure of academic journals based in quantitative research. Like quantitative research, qualitative inquiry shares an adherence to scientific rigor and data quality, but qualitative excellence also departs from quantitative research in significant ways, thereby mimicking a quantitative hypotheses-testing format in elaborating qualitative study findings is viewed as somewhat problematic.
Alternatively, telling an analytic story is somewhat more complex and challenges qualitative researchers to think about relationships between key concepts and their data.
With this new analytical panorama in mind, investigators return to their original research problem and the attendant literature and consider how it has been recast (Strauss and
Corbin, 1990). Finally, a mystery story tells the results of qualitative research approaches with the audience following study findings as a detective would follow clues to solving a mystery. Indeed, Silverman and Marvasti (2008) observe that this model more accurately represents how qualitative research studies actually unfold (Becker, 1998). Because the
180 disenfranchised grief framework reflects the most robust and complex analytic landscape of conceptual study foci, this chapter weaves an analytic story using this conceptual framework as the red thread of this inquiry.
Before the data collection and analysis stages of this project, expectations for findings did indeed reflect the aforementioned hypothesis-testing story whereby the sociality of suicide grief was articulated in several specific aims to be tested against in- depth interview data. Because so little research has been conducted among suicide grievers, especially among non-family members of suicide decedents, the first study aim is to explore the content of suicide grief among peers of suicide decedents. While broadly conceived on purpose, this aim was certainly accomplished and, in many ways, it is exceeded. As such, findings discussed in this chapter contribute to grief studies by not only extending the disenfranchised grief model to include suicide loss but also its theoretical advancement by illuminating new intersectional dimensions and emergent findings which capture ‘re-enfranchisement’.
In regards to the second study aim, understanding whether suicide grievers maintain a continuing bond with their suicide decedent, it was expected that despite suffering the stigmatized loss of suicide and strong emotional content like anger and guilt, study participants would indicate their continued attachment to suicide decedents.
Previous quantitative research attempts to empirically operationalize the continuing bonds model of grief are problematic in the context of suicide loss because questions may elicit ambivalent responses from suicide grievers. For instance, one scale item asks if respondents enjoy reminiscing with others about spouse and having fond memories that bring respondents joy (Field, Gal-Oz, & Bonanno, 2003). This spotlights attempts to
181 advance the continuing bonds model of grief do not account for traumatic losses like suicide. Though not the main analytical narrative developed in this chapter, this study confirms evidence for continuing, albeit complicated bonds among peer suicide grievers.
For example, some keep pictures of their decedents but will hide them on purpose, if they believe they might encounter difficult questions related to the nature of death. Such findings provide a timely analysis for contemporary grief researchers, challenging them to recognize suicide loss and capture it empirically in their models of grief.
Third, a key aim of this study was to investigate whether peers experience grief resulting from suicide as disenfranchised. The disenfranchised grief framework (1999;
2002; 2008) holds that grief is disenfranchised when it cannot be, “openly acknowledged, publicly mourned, or socially supported” (Doka, 1989, p.4). Again, it is important to note that the disenfranchised grief framework has not been explicitly analyzed in the context of suicide loss—this study remedies this gap in the work which catalogues the range of disenfranchised grief. Though, in his second anthology on disenfranchised grief, Doka
(2002) refines the framework by specifying two further categories. To the existing categories of disenfranchised relationships, disenfranchised losses, and disenfranchised grievers, he adds ‘ways individuals grieve’ and ‘circumstances of the death’. This latter category specifically relates to stigmatized losses like suicide, AIDS, and alcoholic deaths, for example (Attig, 2004; Doka, 2002). As is evident in the preceding chapters, this study finds that peers suffer disenfranchisement related to relational status and the circumstances of death and identifies new conceptual subcategories to capture these experiences. Further, even fewer studies investigate disenfranchised grievers who might simultaneously occupy one or more of these categories. This study undertakes such an
182 investigation and identifies new subcategories by analyzing when overarching categories, in this case, disenfranchised relationships (peer) and circumstances of the death (suicide) conflate together.
In place of adding to the catalogue of disenfranchised grief, this study advances
Doka’s framework through examining processes which ‘re-enfranchise’ grievers who have suffered a suicide loss. Here, findings parse out intrapersonal, interpersonal, and group-based processes and outcomes. In particular, study results focusing on group-based coping and support coping processes are discussed in greater length in the forthcoming sections because they illuminate complex outcomes at the macro-, meso-, and micro- levels.
Finally, the last aim of this study was to examine if peer suicide loss represents a counter transition in the life course (Hagestad, 1988). This aim was not positioned as a key focus, but its inclusion represents an attempt to ascertain if peer suicide loss is representative of a life course counter transition, whereby suicide grief is viewed as an off-time life event. Scholars of the life course understand countertransitions as a life event which is not shared with age peers, consequently social support resources and consensus information from age peers are scarce. This study did not find direct results in respects to this aim, but as the next section makes clear, this aim is arguably indirectly related to the disenfranchising aspects of experiencing a loss that is not likely to be openly shared amongst one’s age peers. Thus, alternate sources of social support and consensus information amongst like-others within and outside of one’s age cohort hold significant value. For example, according to 2008 data compiled by the American
183 Association of Suicidology, suicide is the third leading cause of death among 15-24 year olds with 4, 298 young lives lost to suicide (American Association of Suicidology, 2012).
Study findings: Advancing and challenging the disenfranchised grief model in peer suicide loss, re-enfranchisement contexts, and survivorship identity status
Having reviewed expected aims above, this section considers anticipated and unanticipated study findings in greater detail. To illuminate study findings, an analytic story is told through the disenfranchised grief conceptual framework. By identifying re- enfranchising social contexts which offer coping and social support to peer suicide grievers, this analysis extends the disenfranchised grief model. In particular, the connection between such group-based coping contexts and suicide survivor identity processes is discussed.
Advancing and challenging the disenfranchised grief framework by analyzing peer suicide loss. This section illustrates findings in regards to categories of disenfranchised relationships (peer) and circumstances of the death (suicide) and reveals new intersecting dimensions within these parent categories which serve to theoretically advance the disenfranchised grief framework. Findings from this study confirm that peer suicide grievers do experience disenfranchised grief, not only in respect to their relational status but also clearly related experiences in which their suicide loss could not be,
“openly acknowledged, publicly mourned, or socially supported” (Doka, 1989, p.4).
While under-acknowledged and under-supported losses like abortion, AIDS, or pet loss have been understood through the disenfranchised grief model, the nature of suicide loss is absent from this corpus of work. This omission is telling because it signals that the social invisibility and stigma surrounding suicide are still very powerful. Correcting this
184 analytical oversight in the types of losses analyzed through the disenfranchised grief framework, then, is a necessary first step.
Relational disenfranchisement. While disenfranchisement related to the nature of suicide death was an anticipated finding, the complexity of relational status and disenfranchisement was not expected and yields several new variants of disenfranchised relationships. As specified in chapter three, this dissertation identifies six new variants of relational disenfranchisement. Here, the circumstances of death resulting from suicide complicate and aggravate relational ties between peer suicide grievers and family members of suicide decedents, other peer suicide grievers who share the same loss, and friends of peer suicide grievers who don’t share the suicide loss. For example, Megan likened friend grievers to the psychological family of a suicide decedent while family members are the biological family who set the parameters for funeral arrangements and events recognizing the loss. Diana wonders why the family of her decedent does not respond to her attempts to remain in contact.
Other cases were less straightforward and involved not only peer status but were also complicated by circumstances linked to suicide death. In the scholarship on disenfranchised grief, few, if any, studies have investigated the effects of intersecting disenfranchised categories within Doka’s typology. Yet, data from peer suicide grievers’ interviews in this study indicated that such conceptualizations are necessary to account for the complexities experienced between their relational position to the decedent and the circumstances of suicide death. Thus, peer suicide grievers encounter a kind of “double burden.” Consequently, several new variants are identified by this study including: stratified relational disenfranchisement, reverse relational disenfranchisement, bilateral
185 disenfranchisement, secondary relational disenfranchisement, co-survivor disenfranchisement, and peer relational disenfranchisement.
Stratified relational disenfranchisement refers to disenfranchisement of peer grievers by some members of the suicide decedent’s family but not all. For example,
Christy still remains friends with her friend’s surviving twin, Rachel, but Rachel’s mother did not invite her to the memorial service and acts as if “she didn’t have a daughter” in
Christy’s words. By contrast, reverse relational disenfranchisement captures when peer suicide grievers end their relationships with suicide decedents families as Andrea and
Clayton did with Andrew’s family. In bilateral relational disenfranchisement, peer suicide grievers are disenfranchised by their own family members, in addition to their relationships being invalidated by suicide decedents’ families. For instance, Andrea’s experience of her own family discouraging her from going to Andrew’s memorial service reflects the experience of their friendship being invalidated by not only Andrew’s family
(they did not share the note left by Andrew for her) but her own family also.
This secondary relational disenfranchisement is evident in the cases of Courtney, Abby,
Megan, and others whose family and friends (i.e., non co-griever friends) were unsupportive, thereby invalidating their grief. Also, this exploratory finding demonstrates the absence of “consensus information” for griever-friends, particularly those of the young adult age group suggests that the life course approach offers concepts which might capture this experience foregrounded by Sklar and Hartely’s (1990) exploratory study.
This finding speaks to the backgrounded final study aim which sought to ascertain if peer suicide loss is as an off-time life event and representative of a life course counter transition.
186 Alternatively, some peer suicide grievers experienced relational strain and withdrawal of support among their survivor-friends which illustrates peer co-survivor disenfranchisement. Taking into account the added dimensions of guilt and shame often involved in suicide deaths discussed earlier (Jordan, 2001), the potential for social support offered by fellow survivors-friends is an important one. Yet, these bonds may be especially vulnerable to the trauma of suicide loss, if denial, blame or other negative emotional content characterize the circumstances of the death. Therefore, in such situations where relationships with co-survivors and/or family members have buckled, alternate sources of support like Local Outreach to Survivors of Suicide (L.O.S.S.) and
Out of the Darkness Community Walkssm assume additional value for suicide grievers, peers, and family members alike. Finally, some participants like Lisa and Courtney relate that they experienced a sense of internalized relational disenfranchisement due to their peer relationship when they participated in suicide support contexts. This is illustrated by
Lisa’s question to another friend-griever, “should I really be here?” being overheard by a family griever. This griever convinced Lisa that such perceptions are a false perception— most family members do not perceive friend-grievers in that manner at all. Though it seems counterintuitive that some participants’ feelings of disenfranchisement might be amplified in the very settings meant to help suicide grievers, it is important that researchers and applied professionals be attuned to these group dynamics. Of course, if a similar analysis were undertaken with family members, it is very likely that relational complexities exist in the context of suicide loss akin to the newly-identified variants of peer relational disenfranchisements illustrated above. Lastly, it is important to note that while some participants reported disenfranchisement in their relationships with suicide
187 decedents’ families, other participants maintained strong and enriching bonds with family members as illustrated by Bill and Betty’s ongoing bonds with both Kim’s grown daughters and Kim’s widower up until his passing.
Suicide loss disenfranchisement. The cover of Bloomburg’s Businessweek recently featured a cover illustrating various methods of suicide of a small animated blue bird, the twitter icon, including a gun in its mouth and in a birdbath with a toaster. The accompanying article title read, “Twitter: The company that couldn't kill itself has finally turned a corner.” Sadly, examples such as this which trivialize, distort, or render suicide loss invisible stubbornly persist in not only the media, but schools, workplaces, and religious institutions. They also continue to foster disenfranchised grief through implicit messages which tell suicide grievers their loss amounts to either a joke, a marketing ploy, or, alternatively, nothing at all. In this study, participants told of many ways their loss could not be openly acknowledged, and if their loss was openly acknowledged, the nature of death was problematic. This section, then, foregrounds findings related to suicide loss disenfranchisement, highlighting the enduring taboo or stigma of suicide loss within the disenfranchised grief model. Additionally, two new variants of such loss institutional/bureaucratic and linguistic disenfranchisement are outlined in the following section.
At the macro-level, in the institutional realms of religion (e.g., memorial services), education, and the media, participants experienced suicide-related stigma identified as institutional/bureaucratic disenfranchisement. An example which best highlights this new category is witnessed in Betty’s harrowing account of finding out her friend had taken her life in a suicide-homicide by watching the news on her lunch break
188 at work. For both Betty and Beth, the local media sensationalized and distorted circumstances around their suicide losses. In educational settings, Abby, Megan, Nancy, and Donald shared accounts of disenfranchisement. Indeed, Abby, Nancy, and Megan’s experiences are relatively recent cases of suicide disenfranchisement in high schools and college settings. On the one hand, these examples indicate that little progress has been made in acknowledging and supporting suicide grief in institutional settings like schools and universities. Yet, on the other hand, pioneering programs which educate high school students, teachers, and administrators about depression and suicide prevention like that of the Suicide Prevention Education Alliance (SPEA) in the Cleveland-area underscore that positive interventions do exist. Such programs need wider support so their enfranchising benefits and awareness-building of the causes and consequences of suicide may reach more individuals.
At the micro-level, participants noted similar disenfranchisements in the linguistic realm which convey negative attitudes towards suicide loss. Verbal slights, jokes about suicide, and other language that trivialize or diminish suicide loss reflect linguistic disenfranchisement. To highlight this sub-dimension, Beth’s words sum up this disenfranchisement most poignantly, “No one talks about suicide, except if their kidding.” In sum, this section has foregrounded disenfranchising experiences discerned in participants’ accounts linked to their peer relational status and circumstances of suicide death.
Re-enfranchising suicide loss: Group-based coping contexts and suicide survivorship. As previously emphasized, in his most recent scholarship, Doka (2008) stresses that disenfranchised grief researchers should move beyond cataloguing which
189 losses reflect the disenfranchised typology and advance the framework by delving into the processes and outcomes behind these identified losses. According to Doka (2008), the next goal in the evolution of the disenfranchised grief model is to illuminate how grievers can be assisted, supported and, most of all, enfranchised. By evaluating a broad continuum of coping and support experiences and behaviors, this research addresses the
‘re-enfranchisement’ underscored in Doka’s assertion as the next step in advancing understandings of disenfranchisement and grief. Along this continuum, continuing bonds data was interpreted as representing intrapersonal coping strategies. Alternatively, those participants who advocated for others dealing with depression or suicide loss in their personal networks or spheres, but who did not engage in group-based coping or re- enfranchising strategies are understood as interpersonal coping strategies. Of most importance to this chapter, though, are the final group of participants along this continuum who did engage group-based re-enfranchising or coping strategies which are detailed in the following section at the macro-, meso-, and micro-levels.
Understanding peer suicide griever re-enfranchisement at the macro-level: Out of the Darkness fundraising walks. An analysis of themes in the previous chapter identified intrapersonal, intermediary, and group-based or extrinsic coping strategies shared by study participants in their accounts of suicide loss. Many participants underscored the importance of combating depression and suicide as an important issue or cause in either formal or informal social networks like suicide prevention advocacy or suicide grief outreach group activities. Significantly, not only did the group-based coping participants demonstrate this desire to help others affected by suicide and depression, but also study participants in the interpersonal advocators group indicated a strong desire to
190 help others dealing with mental health issues. This section compares and contrasts these group-based re-enfranchisement strategies and considers how they square with similar mobilizations around other health issues like breast cancer and AIDS. It sheds light on the work of sociologists and social psychologists who offer both macro-level understandings of similar contemporary organized social action around physical and mental health issues.
As described earlier, the Out of the Darkness Community Walkssm are a relatively recent phenomenon in the struggle for mental health awareness, suicide prevention and outreach. Before these group-based events, suicide grievers could seek out social support through suicide survivor bereavement support groups. Spencer-Thomas and Jahn (2012) trace the precursors of such groups to the founding of the Los Angeles Suicide Prevention
Center in 1958 which began the first crisis hotline and provided support services after increased inquiries from the community. In 1978, the first survivors of suicide support groups were formed in New Mexico, Massachusetts, and Texas (Spencer-Thomas &
Jahn, 2012). Prior to these groups, sympathetic clergy were the only source of support for suicide grievers. Interestingly, this pattern points to how suicide grief has moved from private to public contexts in the last three decades.
The Out of the Darkness Community Walkssm began in 2003 with an overnight walk to raise funds for the American Foundation for Suicide Prevention (AFSP). In the following year, twenty-five community walks took place involving around 4,000 participants. Since then, the number has ballooned with some 230 being held in forty nine states across the United States last year. In 2011, the American Foundation for
Suicide Prevention reports that more than 90,000 participants have walked in their
191 communities, “to raise over $6.5 million to support suicide prevention research, local prevention and educational programs, advocacy, and survivor loss programs” (American
Foundation for Suicide Prevention, 2012). On balance, this growth curve of social action centering around suicide prevention and mental health is noteworthy.
For example, Mothers Against Drunk Driving (MADD) and breast cancer activism (Susan G. Komen Race for the Cure®) are health-related social movements of a similar scale. For the sake of comparison, MADD has won several important legislative and social victories like raising the legal drinking age to twenty-one years and integrating the term ‘designated driver’ into our cultural lexicon. Too, MADD has begun its own walk to raise awareness about drunk driving and underage drinking. Alternatively, the first Susan G. Komen Race for the Cure® race took place in Susan G. Komen’s hometown of Dallas, Texas in 1982 with eight hundred runners registering for the road race. Since then, the Susan G. Komen Foundation’s webpage reports that in 2010, the race drew 1.6 million participants and 100,000 volunteers. Races were organized in 140 locations across the United States and overseas. In comparison to the L.O.S.S. walks, an interesting question would be to assess how many of these participants have been directly affected by breast cancer loss or drunk driving. Overall, the breast cancer movement and the Race for the Cure has played a crucial role in lessening the degree of stigma and invisibility associated with breast cancer.
Some sociologists view the rising popularity of charity fitness fundraising events like The March of Dimes, Susan G. Komen Race for the Cure®, and AIDS Ride as a new mechanism fostering social integration. They observe that these events have a wide draw and include participants engaging in charitable behavior who have not been directly
192 impacted by the health issue for which they ride, run, or walk. In response to Putnam’s thesis of declining civic engagement detailed in his book, Bowling Alone, Hart-Brinson
(2011) suggests that the types of civic recreation above represent an area in which
Americans’ public engagement has increased in recent years. “There may be fewer people in bowling leagues today, but bowlers might be raising more money for charity than ever before,” states Hart-Brinson (2011, p. 29). According to Hart-Brinson, fitness fundraisers originated in the late 1960s with walkathons to fight hunger and continued to grow in popularity with the inaugural Susan G. Komen Foundation’s Race for the Care in
1982 and the American Cancer Society’s Relay for Life in 1985. Drawing on the work of sociologist Schudson (1998), Hart-Brinson observes that the emergence of such fitness fundraisers coincided with a key period of social upheaval which witnessed Civil Rights,
Women’s Liberation, and Anti-War activism and protest. This mobilization was characterized by a new “rights-bearing” consciousness among its citizen activists.
Undergirding their rallying, protesting, and demonstrating across these movements was this age-cohort’s internalization of the ‘personal is political’ ethos.
After participating in a 400-mile bicycle ride for AIDS, Hart-Brinson (2011) reflects on fitness fundraisers in his Context’s article titled, New Ways Of Bowling
Together? and contrasts this new type of health advocacy with other charitable events like playing kickball for Tibet. He argues that the bike ride was a qualitatively different experience and represents a new kind of public engagement:
…I was standing hand-in-hand with strangers, people I had just met, listening to the sounds of lone bagpiper, watching a solemn procession of people and objects that symbolized AIDS as they moved down an aisle of weeping humanity. By the time of those Closing Ceremonies—after six days of riding, eating, sleeping together—I knew there was a deeper reason I had chosen to ride my bike. It was
193 expressed in the narrative of suffering, fitness, and determination that we constructed collectively. (p. 32)
Similarly, for the Out of the Darkness Community Walkssm, participants garner sponsors and then gather to walk two or three miles together to raise funds for the AFSP.
The previous chapter clearly illustrates the importance of being with other suicide grievers in collective settings among participants who engaged in such re-enfranchising activities. In these setting, there are a number of ways for suicide grievers to commemorate their suicide loss. One booth invites walkers to write the name(s) of their decedent(s) on a large piece of paper after, “In honor of” or “In memory of” prompts. The paper is then pinned to their clothing and they walk with this visible indicator of their suicide griever status displayed on their backs. Another nearby booth usually offers walkers the opportunity to write a message or memory on a small, opaque paper bag.
Volunteers then place candles within each bag and these flickering heartfelt sentiments are lined along the final stretch of the walk. At the close of the walk, time is allowed for walkers to linger and read these messages. Indeed, several study participants in the group-based coping category emphasized that they found such rituals deeply moving.
Before and after walking together, there is usually a ceremony which allows participants to mingle with others and there are usually poignant speakers featured during these ceremonies who share their own experience with suicide loss. A quilt with pictures of loved ones lost to suicide is sometimes displayed in the gathering and refreshment area of these walks. Further, a search on YouTube reveals many poignant video and photograph montages taken by participants at these community walks, suggesting that
194 such rituals are widely shared amongst walkers across the country2. For example, the Out of the Darkness Community Walkssm website has nearly 25,000 Facebook likes on its landing page indicating there is a considerable symbolic community behind these walks.
Most recently, these walks have branched out to college campuses with some fifty walks taking place across the country in 2012 (American Foundation for Suicide Prevention,
2012). This signifies a direct effort by the AFSP to educate young adults about suicide awareness but also represents a path to re-enfranchisement for suicide grievers in this age group.
Alternatively, a local Cleveland area organization, Suicide Prevention and
Education Alliance (SPEA), has developed a similar charity walk which directly funds local area efforts to prevent youth suicide. This nonprofit reinvests funds raised from their charity walk and other fundraisers into a high school program called Recognizing
Adolescent Depression and Suicide Prevention which is delivered by a team of trained instructors in health classes across eighty-one high schools in Northeast Ohio. Moreover, the program emphasizes training peers to be able to recognize the symptoms of depression, the most significant predictor of suicide. This emphasis recognizes that young people are more likely to tell their peers rather than family members, if they are feeling depressed or have a suicide plan. SPEA’s charity walk is unique because it also encourages high school teams to fundraise together which is both potentially preventative
(i.e., raising awareness about the signs of depression) and re-enfranchising for adolescent suicide grievers (Suicide Prevention Education Alliance, 2012).
2 See: http://outofthedarknesswalks.tumblr.com/tagged/Out-of-the-Darkness
195 Although study participants did not explicitly articulate their involvement in these group-based contexts as part of a social movement, this groundswell of some 90,000 suicide prevention community walkers does shares several characteristics with other health social movements. During the research stage of this project, a thread on the
American Psychological Association’s suicidology listserve solicited suggestions to create a timeline for the suicide prevention movement. This effort evolved into a publication in the journal, Suicide and Life-Threatening Behavior. Here, several community advocates, researchers, and other listserve subscribers (including suicide grievers) traced this movement from its beginnings with the opening of the Los Angeles
Suicide Prevention Center in 1956. According to this community of informed actors, other key events along this timeline include the National Institute of Mental Health establishing the Center for Studies of Suicide Prevention in 1967; in 1968 the first national conference on suicidology was held in Chicago and the American Association of
Suicidology (AAS) was founded in 1968; In the 1980s, the American Foundation for
Suicide Prevention is founded and the Suicide Awareness Voices of Education (SAVE) holds their first national suicide awareness memorial at the State Capitol in St. Paul,
Minnesota; In 1998, The Trevor Project was founded, this is a toll-free hotline for gay teens, following year, the Surgeon General’s Call to Action to Prevent Suicide is issued.
In 2004, the Garrett Lee smith Memorial Act is signed and represents the first significant federal grant program aimed at preventing suicide (Spencer-Thomas & Jahn, 2012).
Indeed, during this email listserve exchange, the study investigator added the many suicide prevention community walks to this timeline (personal communication,
July 15, 2010). However, in their article, Tracking a Movement: U.S. Milestones in
196 Suicide Prevention, Spencer-Thomas and Jahn (2012) did not include the Out of the
Darkness walks in the list of key suicide prevention markers in their timeline (because of too few nominations) which were then ranked by twenty-seven leaders, advocates, and practitioners in the movement. This is most likely due to the fact that the investigator being the lone sociologist on an APA listserve was the only member to nominate the Out of the Darkness walks because such mobilization of this scale characterizes a mass social movement. It is troubling that such a grassroots social mobilization around a health issue is overlooked. Given that key actors like advocates, researchers, and interventionists among other listserve subscribers coalesce around viewing their activities as part of a suicide prevention movement, how do sociologists understand this type of large-scale social action? This is an important question because few of those studying health social movements are using an explicit sociological lens (Brown et al, 2004).
Brown (2004) and his social movement colleagues observe that health social movements (HSMs) are under-theorized in the sociological literature because surprisingly few sociologists have focused on this type of social mobilization. Yet, there is a strong history of health social activism beginning with occupational health concerns during the industrial revolution through the women’s health movement and activists and
AIDS activism. To counteract this pattern, they elaborate their theoretical a conceptualization of health social movements by unpacking one subgroup of these movements, Embodied Health Movements (EHMs). First, Brown et al. (2004) define health social movements as:
…collective challenges to medical policy and politics, belief systems, research and practice that include an array of formal and informal organizations, supporters, networks of co-operation, and media. HSM’s challenges are to political power, professional authority and personal and collective identity.
197 HSMs, as a class of social movements, are centrally organized around health, and address issues including the following general categories: (a) access to, or provision of, health care services; (b) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality; and/or (c) disease, illness experience, disability and contested illness. (p. 52)
Above, Brown et al. (2004) identify three broad areas in their health social movements typology, but emphasize that this distinction should not be viewed as a
‘definitive heuristic’, but rather as ideal types because the aims or actions of HSMs may reflect more than one type. Embodied Health Movements (EHMs) reflect the third category identified through which the authors choose to discuss in detail in order to unpack their conceptual framework. This category also reflects the type of mobilization and action detailed in the suicide prevention movement timeline outlined in the previous paragraph. Broadly, they describe embodied health movements as, “organized efforts to challenge knowledge and practice concerning etiology, treatment, and prevention of disease…As such diseases tend to result in the mobilization of disease groups, a better understanding of these groups is essential” (Brown et al., 2004, p. 54).
With the Out of the Darkness Overnight and Community Walkssm having raised over $6.5 million towards research, prevention, and survivors of suicide loss programs, these activities can be understood through the parameters of Brown et al.’s EHM heuristic. For example, it is clear that the suicide prevention movement (SPM) shares these same ends in terms of “medical recognition, treatment, research, and expanded funding,” as other EHMs (Brown et al, 2004, p. 55). The proceeds donated for research on suicide from the Out of the Darkness Overnight and Community Walkssm indicate the same desired results in suicide prevention. One key dimension differentiating movements is whether they critique the biomedical paradigm through their mobilization. In their
198 framework, Brown and his colleagues conceptualize EHMs relationships to the medical establishment along a continuum: On the one hand, EHMs like Gulf War Syndrome or
AIDS activist illness groups do explicitly challenge dominant science in regards to their disease. Though suicide prevention mobilization (SPM) does not overtly challenge the medical establishment, it does challenge belief systems in regards to the stigmatized nature of suicide which is similar to AIDS activists whose mobilization has included de- stigmatization, greater visibility, and advocating for increased research funding.
On the opposing end of the continuum are “advocacy-orientated social movement organizations,” which the authors articulate as groups, “that work within the existing system and biomedical model, use tactics other than direct, disruptive action such as educational campaigns and tend not to push for lay knowledge to be inserted into expert knowledge systems” (Brown et al, 2004, p. 55). It is true that the Out of Darkness
Community Walks do reflect the dominant scientific explanation as speakers at these events tend to underscore scientific knowledge about mental illness as the leading cause of suicide death. This tactic, though, is deliberately employed to dispel stubborn, damaging myths about suicide such as suicide death results from weakness of character.
Here, it is important to consider that other forms of suicide prevention mobilization such as L.O.S.S. programs (Local Outreach to Survivors of Suicide) represent indirect grass- roots challenges to the passive suicide grief outreach model as discussed in the following chapter section.
Above all, the common denominator across this continuum of health social movements which signifies their ‘embodied’ nature is how activists frame their involvement through a “personal awareness and understanding of their experience.”
199 Moreover, Brown and his co-authors go on to connect this health and illness sense of the
‘personal as political’ as key contributing factor to a ‘collective illness identity’ which is often politicized (Brown et al, 2004, p. 53). Indeed, contemporary social movement scholarship is increasingly attending to micro-level phenomenon like individual meaning in social movement participation and adherents felt experiences. Of this new direction,
Brown et al. (2004) write:
This emphasis on the transformation of personal experiences into collective action opens up many new vistas in social movement theory. Our focus on embodied health movements meshes with this interest, since participants in such movements have arrived at their activism through a direct, felt experience of illness. Their identities are often shaped by these experiences. (Brown et al., 2004, p. 55)
By examining the Susan G. Komen Race for the Cure®, Women and Cancer
Walk, and Toxic Tour of the Cancer Industry, Klawitter (1999) traces three distinct
‘cultures of action’ in activist groups’ responses to breast cancer during the 1990s in San
Francisco. Klawitter’s approach also reflects a wider turn towards understanding the role of culture in analyzing social movements. Until recently, culture in social movement research has been conceived in Weberian terms. In this view, culture encompasses “the thoughts, ideas, and worldviews of individual activists” (Klawitter, 1999). For Klawitter and others, however, culture is found in extrinsic expressions such as performances and practices present in social mobilization. This new wave of social movement thinkers ask: how is culture, “enacted, enunciated, and emoted” in these public settings? (Klawitter,
1999, p. 106). Klawitter contrasts how activists in each of these breast cancer movement strands enact or “do” gender differently through their mobilizing events and ation (West
& Zimmerman, 1987). Also, these varying cultures of action evince opposing appraisals of biomedicine. Whereas Race for the Cure® uncritically endorses biomedical
200 understandings of breast cancer etiology and treatment, San Francisco’s Women and
Cancer walk culture of action expresses strong criticisms of biomedicine’s power (i.e. biotech companies reluctance to grant “compassionate use” of breast cancer drugs in clinical trials exhibiting favorable results) and its failure to adequately acknowledge the role of environmental carcinogens in disease etiology.
Though Klawitter (1999) focuses on breast cancer activism, her work invites parallels across other embodied health social movements because of the public enactment of emotion and discourses of survivorship described in her analysis. Of course, in the ten years since Klawitter’s study’s publication, the Susan G. Komen Race for the Cure’s® popularity and attendance has grown substantially. First held in 1982, the race drew by
800 runners. By 2010, 1.6 million participants and 100,000 volunteers participated in 140 races in the United States and abroad. To be sure, the breast cancer movement and the
Race for the Cure has played a crucial role in lessening the degree of stigma and invisibility associated with breast cancer. Here, it is worth remembering again that the
Out of Darkness walks began in 2003 with an overnight walk to raise funds for the
American Foundation for Suicide Prevention (AFSP). In the following year, twenty-five community walks took place involving around 4,000 participants. Since then, the number has risen sharply with some 230 being held in forty nine states across the United
States last year. In 2011, the American Foundation for Suicide Prevention reports that more than 90,000 participants have walked in their communities, “to raise over $6.5 million to support suicide prevention research, local prevention and educational programs, advocacy, and survivor loss programs” (American Foundation for Suicide
Prevention, 2012).
201 Of relevance to this discussion in Klawitter’s analysis of San Francisco’s sixth annual Susan G. Komen Breast Cancer Foundation Race for the Cure® is how loss and grief are framed and publicly emoted. She underscores that her work traces the “the narrative conventions and discursive practices that feature prominently within them and I observe the ways in which these rituals function to produce and transform the emotions that create solidarity and strengthen participation” (Klawitter, 1999, p. 109). Notably, at the New York City race in 1991, the first pink ribbons were included in event proceedings for breast cancer survivors to be visibly recognized (Susan G. Komen Race for the Cure, 2012). Klawitter describes other rituals which reflect breast cancer survivorship, especially the distribution of pink visors which signal survivor status with the words, “I’m a survivor,” written in black on the front:
As each woman dons her visor and mingles with the crowd, she proudly, voluntarily, and publicly marks herself as a breast cancer survivor, visually embodying an identity not otherwise apparent. This is an act of social disobedience—a collective “coming out,” a rejection of stigma and invisibility, and a simultaneous appropriation of the traditional color of femininity for the survivor identity. (Klawitter, 1999, p. 111)
Here, while Klawitter identifies how wearing pink visors emphasizing that breast cancer survivors are not defeminized and thus reinforces traditional femininity, her analysis also grasps how identifying survivor status disrupts “the cultural code of silence and invisibility” which has characterized breast cancer.
Similarly, when suicide grievers visibly identify themselves collectively, they seem to be disrupting and disobeying powerful cultural codes which have silenced their grief or rendered it invisible. For study participants like Megan, Lisa, Jonathan, Abby,
Christy, and Tony, it is easy to hear why they gravitate towards and find re- enfranchisement through involvement in the Out of the Darkness Community Walkssm.
202 Lisa’s words clearly capture the symbolic re-enfranchisement of wearing beads and signs to publicly commemorate and signify suicide loss. In the following vignette, she explains that although she had been the stoic one among her co-survivors, the symbolism of wearing tee shirts and beads was cathartic to witness and moved her to tears during her participation in her regional Out of the Darkness Community Walkssm:
…You know how like everybody has like shirts and stuff made up and like just looking around at all the people you know that were affected and it’s like you’ve got to think ‘This is just this one small area in the country in the world you know, and these are the people that know about the walk and that feel comfortable coming out and doing it.’ You know it’s just a small representation of the people that are out there. It’s amazing.
Above, Lisa’s words echo the function behind similar signs or emblems signifying loss for breast cancer survivors which are “at once painful, brave, and hopeful”:
The practice of wearing a sign is a way of enacting community, including oneself, in this sea of runners who have suffered at the hands of this disease and who are working together to raise awareness of breast cancer and money for mammograms and a cure. They are powerful visual reminders of the pervasiveness of this disease. These signs, like the visors, signify the public display of private losses and triumphs. Wearing them is an emotional act at once painful, brave, and hopeful. (Klawitter, 1999, p. 112)
Indeed, perhaps another way to understand these acts of social disobedience in the context of suicide loss is as public enactments of continuing bonds, writ large by the nature of their group expression enjoining those who have suffered suicide loss in a deeply meaningful ways.
To these survivorship rituals, Klawitter adds another which shares commonalities with how suicide loss is publicly emoted. She highlights “The Breast Cancer Quilt” which represents another way in which breast cancer is “coded, packaged, and displayed” within the Race for the Cure® culture of action (Klawitter, 1999, p. 112). First, among these displays is a tall vertical banner of cloth upon which pink ribbons are pinned and
203 attendees are invited to write names on the ribbons in commemoration. Second, she highlights the Breast Cancer Quilt on display which is fashioned after the AIDS
Memorial Quilt, however each patch in the Breast Cancer Quilt is dedicated to a breast cancer survivor and the individual patches are somewhat smaller than the AIDS
Memorial Quilt. Displaying the AIDS Memorial Quilt in its entirety across the National
Mall in 1987, 1988, 1989, 1992 and 1996 has generated awareness, solidarity, and fundraising resources (raising over $3 million dollars). In total, over 14 million people have visited the Quilt which is now under the care of the NAMES Project Foundation
(The Names Project Foundation, 2012). Of the quilt and its symbolism of publicly emoting grief and loss, Frank Bruni writes in a recent New York Times article: “The breadth and beauty and horror of the AIDS quilt, spread out across the National Mall, a thread of grief for every blade of grass beneath it…” (Bruni, 2012).
Too, the American Foundation for Suicide Prevention (AFSP) supports a similar program which encourages survivors of suicide loss to submit a tribute of their loved one to a collaborative quilt project. The Lifekeeper Memory Quilt program was founded by a mother who lost her only child to suicide in 1997. According to the AFSP, Sandy Martin was moved to such action because “she believes survivors have an opportunity to use their experience to do good, to work to dispel the myths, and to educate about suicide and its prevention” (American Foundation for Suicide Prevention, 2012). Drawing on the health social movement literature discussed earlier, Brown et al. (2004) suggest that such commonality between the way loss is emoted between social movement reflects ‘social movement spillover’ which is especially common among Embodied Health Movements
(EHMs).
204 Applying Klawitter’s comparative cultures of action approach to social movements also helps us to think about how EHM’s, “construct and celebrate a particular symbolic community” (Klawitter, 1999, p.115) and which groups of people are present and absent in movement participants or the “body politic.” For example, she highlights how the Susan G. Komen Breast Cancer Foundation Race for the Cure® does gender and reinscribes hegemonic femininity. By contrast, though attendance only numbers only around 800 participants, Klawitter describes that the Women & Cancer Walk supports,
“the work of a multicultural set of grassroots women’s health and advocacy organizations” (Klawitter, 1999, p. 115). Thus, the body politic witnessed at this walk for breast cancer is multiracial and more inclusive in regards to gender, class, and sexual orientation. Turning Klawitter’s culture of action lens onto the Out of the Darkness and
Suicide Prevention Education Alliance (SPEA) walks, brings into focus the body politic plurality of these walks. Having recruited participants at these events, if one looks around the audience during the opening and closing speaker sessions at the SPEA walk, the body of participants is mostly white and middle to upper-middle class (Suicide Prevention
Education Alliance, 2012). To foster greater inclusion, speakers at these events might discuss the role of gender policing or gay baiting and the risk for suicide among LGBTQ youth and adults. Also, the rate of suicide among veterans has risen sharply in recent years. Resource materials, events, and speakers which at address this diversity of constituents and their suicide grief experiences is a vital component in efforts to widen outreach to all suicide grievers.
Understanding peer suicide griever re-enfranchisement at the meso-level: Local
Outreach to Survivors of Suicide (L.O.S.S.) Volunteer Programs. Borrowing further
205 from Klawitter’s ‘culture of action’ lens in the above section, it is clear that involvement of other study participants like Beth, Courtney, Donald, Lisa, and Daniel in L.O.S.S. programs represents an analogous but not synonymous ‘culture of action’ within the suicide prevention movement. Grief interventions for suicide grievers like psychological counseling, support groups, and even the Out of the Darkness Walks are all still passive in nature because they rely on suicide grievers to initiate support seeking process. On the other hand, the L.O.S.S. program is an Active Postvention Model (APM) which aims to deliver immediate support to suicide grievers at the time of death through the L.O.S.S. volunteer team.
The Baton Rouge Crisis Intervention Center first opened its doors in 1970 with a local a 24-hour crisis line and now offers extensive bereavement resources including informational and referral services which are free. Begun in 1999, the L.O.S.S. program coordinates with the local Coroner’s Offices, and when a suicide occurs the team is alerted and travels to the scene to sit and talk with family and friends after police and medics are finished with their duties. The team consists of a mental health professional and other para-professional volunteers who are veteran suicide survivors. “The L.O.S.S. team reaches out to survivors to let them know that they are not alone, provides immediate contact and support, informs them of the resources available to them in the community, and provides an installation of hope that they, too, can survive this traumatic loss,” write Campbell, Cataldie, McIntosh, & Millet (2004, p. 30).
By highlighting alternate strands of breast cancer activism and advocacy,
Klawitter’s work sheds new understanding on community suicide prevention initiatives like Local Outreach to Survivors of Suicide (L.O.S.S.) Volunteer Programs. One way to
206 understand L.O.S.S. is to view it through Klawitter’s comparison between the dominant model of Race for the Cure® and the Women & Cancer Walk in San Francisco. This volunteer group diverges from Race for the Cure’s model in several key ways, including contesting hegemonic breast cancer survivor discourses and promoting local social services and “treatment activism” (Klawitter, 1999, p. 104). Unlike the Out of Darkness
Community WalksSM, the L.O.S.S. program indirectly challenges the medical establishment’s knowledge and practices regarding suicide prevention and treatment, by providing greater treatment and social support for suicide grievers. This is witnessed through L.O.S.S. volunteers’ active prevention model in assisting suicide grievers.
Another way that L.O.S.S. programs affect change in the treatment of suicide within the medical establishment is seen in Donald’s account. He describes how L.O.S.S. volunteers are able to facilitate organ donation between suicide decedents’ family members and hospital staff. He notes that before the L.O.S.S. programs, medical personnel were extremely reluctant to engage family members in this conversation, but the presence of L.O.S. S. volunteers serves to help both parties make decisions around the most difficult conversation. Further, Donald argues this change in procuring organs also aids suicide grievers in mean-making after the loss of their loved one. To illustrate this point, he shares the example of a suicide decedent mother who agreed to donate her son’s corneas helps her to feel part of him lives on and assists her grieving process.
To conclude, the preceding sections have understood study outcomes through the interplay between the group and societal levels, while the following sections now address findings which arose from turning the analytical lens in the other direction to between group- and individual-levels. These newly-formed advocacy contexts where suicide
207 grievers gather with like-others have important consequences at the individual-level fostering suicide survivor identities, in particular. However,
Micro-level understandings of re-enfranchisement and identity: Suicide griever versus suicide survivor? Findings from the previous chapter signal that suicide survivor identity status holds significant salience for some participants and very little for others.
For example, one participant identified so strongly with the suicide survivor identity status, she has several tattoos to commemorate the loss of her friend including the word
‘survivor’ tattooed on her arm. By comparison, for example, Bill did not identify as a suicide survivor despite having lost two friends and a co-worker to suicide. These two examples represent opposing ends of a survivor identity continuum identified in participants’ responses, still the presence or absence of this identity status across participants’ accounts warrants attention. Social processes related to ‘suicide survivor’ identity seem interrelated with group-based suicide prevention advocacy and re- enfranchising volunteer work. By spotlighting group contexts where such identity processes are defined, signified, affirmed, and also policed, this inquiry offers linkages between self, identity, and society drawn from the micro-sociological literature.
Indeed, study participants themselves raised some important questions in regards to this emergent identity like: who is a survivor? This is an especially relevant question given the relational and suicide loss disenfranchised grief which surfaced in participants’ accounts. Other attendant questions include: Is there a point in suicide loss when a survivor identity is most likely to emerge? If so, are there contingencies in this process similar to reaching a sense of closure as suggested by another participant. What other factors support or detract from the process of identifying as survivor? Finally, what are
208 the group processes which give rise to this identity? This last question addresses study findings in the previous chapter which point to a dialectical process between individuals and others who are enjoined by common interests or experience with suicide loss. In particular, an interrelationship seems to exist between the likelihood of identifying as a suicide survivor and re-enfranchising group-based suicide prevention advocacy and volunteer work re-enfranchisement (i.e., Out of the Darkness Community Walkssm and the L.O.S.S. program).
Education scholar Beverly Daniel Tatum writes that, “Identities are the stories we tell ourselves and the world about who we are, and our attempt to act in accordance with these stories” (2007, p. 24). In her work on racial identity development, Tatum unfolds a complex view of identity which incorporates intra-individual, group, and society influences. Yet, Tatum’s approach to identity—the view that it is a “joint accomplishment”—is increasingly atypical of psychologists because of “disciplinary myopia” (Schwalbe & Mason-Schrock, 1996). However, this dialectic understanding of identity which the role of society, groups, or other individuals is deeply rooted in the work of many sociologists, especially symbolic interactionists like Blumer (1969),
Goffman (1959) and Strauss (1959). Further, contemporary work by social psychologists and sociologists analyzes the joint accomplishment of identity and how it is created through talk or language, storytelling, signaled by dress, or can reflect when gender, masculinity or femininity, is “done” between an individual and others (West &
Zimmerman, 1987). These various vehicles through which identities are conveyed foreground how identity work represents an semiotic exchange and is rooted in how
“selves are signified and affirmed, both to others and reflexively to one’s self” (Schwalbe
209 & Mason-Schrock, 1996, p. 114). In particular, studying this type of identity-making necessitates focusing on people’s actions or, “anything people do, individually or collectively, to give meaning to themselves or others.”
Schwalbe & Mason-Schrock (1996) introduce the concept of subcultural identity work as a means to capture such actions which involve the exchange of symbolic resources to affirm self-concepts with or even against a group of like or different others
(i.e. oppositional identity work). They explain that their conceptualization extends beyond talk, dress, and other actions, encompasses a wider-semiotic view of identity through all the symbolic vehicles the self may be signaled and reflected. Schwalbe &
Mason-Schrock (1996) then situate their concept within the literature on identity and articulate the basic components of subcultural identity work through their own empirical work on men’s mythopoetic groups (Schwalbe, 1995, 1996) and transsexuals (Mason-
Schrock, 1995). Previous work on collective identity- making in social movements is noted, the authors draw an important distinction between this kind of collaborative identity and subcultural identity work which is especially relevant to this investigation.
While the suicide prevention movement was analyzed through the lens of embodied social movements heuristic in the preceding section, many suicide survivors may not view themselves as part of a clear social movement. Instead, they associate their identities with the subcultural identity work achieved together with other suicide grievers in suicide prevention advocacy and activism settings. The authors tease out this important distinction below:
We call it subcultural rather than collective identity work to avoid confusion with the notion of collective identity found in the social movements literature. To call it subcultural also takes us beyond the realm of social movements to include any group wherein people create or redefine an identity to which they all lay claim.
210 Subcultural further suggests, more accurately, the creation of a body of meanings, signs, and signifying practices that are distinct from, yet linked to, a larger culture. A further sociological point is implied by the emphasis on a subcultural, rather than simply a group process: identity-making is simultaneously a making of culture (Schwalbe and Mason-Schrock, 1996, p.121).
In particular, they identify four key parts to subcultural identity work which individuals engage in with others to influence identity creation: 1) defining, 2) signifying,
3) affirming, and 4) policing. The authors state that these parts may not necessarily take place in the above order, but each should be observable if subcultural identity work is present in the construction of collaborative identities. According to Schwalbe and Mason-
Schrock (1996), the first part of subcultural identity work involves defining. Here, “a symbol, image, or name” is created which the group collectively holds to represent them.
“The representation may encompass people who share a physical trait, behavior, attitude, activity, place, history, language, or social location,” write Schwalbe and Mason-Schrock
(1996, p.123). For those affected by suicide loss, ‘defining’ applies to the creation of their shared identity as suicide survivors. This representation or identity then is widely recognized among those in the group and enables them to signify their status as possessing this shared characteristic to others both in or outside the group and to themselves.
In the case of suicide survivor identity, subcultural identity work defining has been tackled, sometimes contentiously, by both experts and in the suicide bereavement literature and lay members of the group. Indeed, Schwalbe and Mason-Schrock (1996) remark that defining frequently involves contention. For example, Andriessen (2005) writes to the editors of the academic journal, Crisis: The Journal of Crisis Intervention and Suicide Prevention, entitled “A Reflection on “Suicide Survivor,” in response to
211 another psychiatrist’s letter. This letter proposes that instead of “suicide survivor,” the term “relic” is better suited for those bereaved by suicide (Seager, 2004). Andriessen acknowledges that suicide survivor does connote a double meaning, but in the field of suicidology the term suicide survivor is so widely agreed upon in reference to those bereaved by suicide that it is not a source of confusion. Moreover, Andriessen asks, if
“relics of suicide” is the more accurate term, would those impacted by suicide loss who are involved in suicide grief support groups and various other advocacy efforts meaningful connect with this term? To support his argument further Andriessen compares the New Oxford Dictionary of English (Oxford, 1998) definitions for both these terms, emphasizing the description of “survive”: “Continue to live or exist, especially in inspite of danger or hardship; remain alive after the death of a particular person” (Andriessen, 2005, p. 38). In conclusion, Andriessen does not see any advantage in exchanging these terms and, eloquently argues, “The many archaic and passive ways in which the word relict is used strongly contrasts with the nature and the dynamics of suicide bereavement, which is often a struggle (to stay alive) and a long journey to find new meaning in life” (Andriessen, 2005, p. 38).
More recently, a series of posts on the American Psychological Association’s
Suicidology listserve scrutinizes this question further by considering the difference between suicide griever and suicide survivor (personal communication, October 19,
2009). Because membership of the list includes international subscribers, it was noted that the term ‘suicide survivor’ predominates in the United States but in other countries like Australia or Norway the term ‘bereaved by suicide’ is more common. To resolve the ambiguity around survivor being misinterpreted as an attempt survivor, one renowned
212 researcher introduced ‘suicide loss survivors’. Also, some listserve members argued that the term ‘bereaved’ more accurately describes the time period immediately following suicide loss when grief is more acute. One listserve member writes that ‘survivor’ better captures her current status since losing her brother to suicide fifteen years ago:
The main reason the term “survivor” resonates for me is the distinction between what is connotes—resilience, a perspective that understands both the pain of the trauma and what it takes to transcend this, and a fierce desire to go on living in a way that turns this tragedy into something meaningful….To me, the use of the term “survivor” is the antithesis of victimization, and carries hope that this transformation can occur (personal communication, October 20, 2009).
This subscriber’s comments seem to echo Andrea’s words suggesting there is a time component associated with claiming a survivor identity in the context of suicide loss.
Indeed, another subscriber explicitly suggests that survivor may come to replace bereaved as individuals’ progress through the stages of grief. Thus, suicide survivor identity appears to be defined by its symbolic or figurative meaning rather than its literal meaning.
Many of these same questions about defining what or who is a suicide survivor were borne out in study data herein, which suggests that lay definitions of suicide survivorship are not as concretely defined as experts and advocates might think. For example, in their accounts, participants wondered whether there is a relational dimension to the definition of suicide survivor and if this term includes peer suicide grievers. For instance, Lisa’s underscored the option to wear beads signifying her griever-friend status was important to her and part of the re-enfranchising experience in participating in her
Out of the Darkness Community Walksm. Also, Lisa, asked the question earlier in the disenfranchised relational grief discussion whether she should be at a conference for
213 suicide survivors because of her peer griever status. Further, Donald’s comments may be added to the relational continuum of survivorship; he wondered in his interview whether a clinician-survivor was also within the bounds of a survivor identity. Alternatively,
Andrea introduced a temporal aspect to the notion of ‘survivor’ as she felt as if the term assumed a sense of closure with time which she has yet to reach. This notion of closure in connection with grief in general and suicide grief specifically will be taken-up in the final chapter section addressing implications of these study findings.
Second, after an identity is defined, Schwalbe and Mason-Schrock (1996) explain that a set of conventions must be agreed upon and built by individuals sharing the identity in order for it to be signified. “We will call these rules identity codes, the idea being that each identity has its own local code. To make successful claim to an identity—to signify it properly—an individual must know, and know how to use, the code,” write Schwalbe and Mason-Schrock (1996, p. 125). Similarly to defining, coding identities can be contentious also. For suicide survivors, such codes are embedded in the language they use and in their openness about their suicide loss as in the case of Lisa, Tony, Courtney, and Megan. For example, Jonathan’s public claim to his suicide survivor identity sharply contrasts with that of his son who rarely speaks of his mother’s loss and captures this distinction. Also, spending time with suicide survivors, one learns there is specific language and vocabulary which reflects suicide prevention advocacy, such as
‘completed’ versus ‘successful’ suicide example which is highlighted in a subsequent section. In regards to materially-coded expressions, Carrie’s tattoo of ‘suicide survivor’ may be viewed as communicating her identity status to others through the lens of subcultural identity work. Of course, those study subjects who participated in the Out of
214 the Darkness Overnight and Community Walkssm each engaged in symbolic displays of their survivor status.
Third, Schwalbe and Mason-Schrock (1996) stress that groups will create opportunities to affirm collaborative identities. They write: “People who wish to claim an identity must have chances to signify, to be seen signifying, to have their acts of signification interpreted as they wish, and to have their claims affirmed by an audience that matters” (Schwalbe and Mason-Schrock, 1996, p. 126). Here, it is clear that group settings like the Out of the Darkness Overnight and Community Walkssm, L.O.S.S. programs, and suicide bereavement support groups, offer such settings for suicide survivor identity to be affirmed. Interestingly, Mason-Schrock’s (1995) previous work on identity work among transsexuals highlights how this group asserts a moral element in affirming their identity as acceptable. For instance, at support group meetings group members drew comparisons between their experiences of discrimination with other subordinated racial groups and lesbians or gays. By positioning themselves alongside other such groups marginalized by society, transsexuals affirm their identity and align it with other group’s moral claim to equality and fairness. A corollary to this in suicide survivor identity work is observed in Beth’s account in which she invokes “minority status” to illustrate her thoughts on the position of mental illness and suicide death alongside other less-stigmatized losses:
But I think on a lot of levels or with a lot of different people, suicide is so far out of their realm of even possibilities that it’s almost like, ‘I’ve got to look that word up in the dictionary,’ you know ….It’s not… Nobody talks about that except if they’re kidding…And I always wondered why we had to have that disease, you know the depression that led into suicide. Why couldn’t we have something that lots of Americans have? You know what I’m saying?....Why did we have to be in a minority?
215 Also, the authors spotlight the use of rhetorical strategies amongst the work which take place in subcultural identities that, “are forms of talk used to assert, protect, and repair situated identities” (Schwalbe and Mason-Schrock, 1996, p. 116). Below, Beth’s description of learning clichés as a means to counter linguistic disenfranchisement and deflect any ignorant speech about suicide from others she encounters mirrors such protection strategies within this dimension of subcultural identity work:
So if I say ‘He took his life,’ within, there is a period of time there that their mind is reeling and you can see it, and they’ll go, ‘Oh, she means suicide.’….You know? And so you know it gives, instead of… You know it’s almost like a little mind game. I just feel more comfortable saying that in most cases….and I just kind of kept myself and the girls in a very protective area, you know, with people that would not do that kind of stuff with us…and kept the rest of them kind of at bay, and then learned clichés that I could use with people that did get ignorant with me, and that I could come back with in speaking with them.
Moreover, Jonathan explicitly connects his identity status with a setting where he has the opportunity to affirm it, even if only once a year, it is still very important for him to attend:
….So but as I matured and I got older and I could see this as being real and it’s my life’s work, I more identify as being someone who help people survive suicide or depression or what have you, but for one day out of the year when I go to that march and I wear a shirt or I have her name on my back, I walk and I identify, and I also do it as a… Like I wish my son would do it someday, but I don’t think he will.
Beth’s and other participants’ emphasis in their interviews about group settings like the
Out of the Darkness Overnight and Community Walkssm, L.O.S.S. program, and other suicide prevention advocacy and support work, suggests these contexts provide important cultural spaces in which their identities as suicide survivors may be affirmed. In particular, Jonathan’s references in his comments to commemorative shirts and “walking
216 in memory of” his lost loved one, points to the ‘semiotic bricolage’ of signaling and affirming a survivor identity available to participants at group suicide prevention advocacy events. This was also true in Lisa’s case too.
Finally, Schwalbe and Mason-Schrock (1996) complete their typology of subcultural identity work with the concept of policing. Here, the authors make an important distinction between the creation of an identity highlighted earlier and the activities employed in the interests of preserving it as a “social reality.” The emphasis on a restorative transformation from acute grief to a state of hope has become a definitive characteristic of a suicide survivor identity. Policing in the context of suicide survivorship identity work is observed in challenges from suicide attempt survivors’ greater visibility and claim to a survivor identity. In part this may be a consequence of the suicide prevention movement efforts which have not only diminished the stigma of suicide loss, but also for those with a history of attempted suicide.
Although there were no examples of policing within the group of suicide grievers interviewed for this study, an illustrative example is witnessed in a popular 2011
TEDActive conference talk. In it, JD Schramm argues for breaking the silence for suicide attempt survivors. In this four minute and fifteen second video with 269, 396 views,
Schramm describes a depressed man who despite being outwardly successful throws himself from the Manhattan bridge into the East River, but miraculously lives. Yet, as
John recovers from a broken body and spirit, he finds there are scarce resources for those like him. “I know John’s story very well because I am John,” he reveals to the audience and states that this is the first time he has publicly spoken of his suicide attempt.
217 Notably, though, Schramm speaks about suicide in terms of failure and success.
Framing suicide in such terms is deeply problematic language in the suicide prevention field (many of whom are suicide loss survivors) because there is no such thing as a successful suicide in the eyes of those left behind. Rather, ‘completed’ is used in reference to a suicide death over ‘successful’ and parasuicide in place of ‘failed attempt’.
Using the subcultural identity work lens, the title of his talk indirectly claims a survivor identity but his talk’s content violates the codes of this identity. Of course, from the standpoint of suicide attempt survivors, the term ‘parasuicide’ may be devoid of meaning and, indeed, demeaning, representing a corollary to describing suicide loss survivors as
‘relics’, as discussed earlier. Reading the feedback on his talk on TED’s Facebook page, a handful of comments by suicide attempt survivors towards suicide loss survivors are quite contentious. If the suicide prevention movement continues to grow at its present rate, these frictions may build and challenge the distinction between ‘suicide loss survivor’ and suicide attempt survivor. Consequently, this dilemma may represent itself in the future and continued policing or re-negotiating of who may claim a survivor identity may occur.
In teasing out these subcultural identity practices, this scholarship reveals how,
“people work together to create the signs, codes, and rites of affirmation that become shared resources for identity” (Schwalbe and Mason-Schrock, 1996, p. 121). Moreover, insights from subcultural identity work shed illuminate how suicide grievers engagement in public advocacy and activism like the Out of the Darkness Overnight and Community
Walkssm and/or L.O.S.S. program represent opportunities to engage in survivor identity work in group-based settings.
218 Yet, this analysis would fall short, if it did not also consider those participants who did not experience any re-enfranchisement: What differences set these study participants apart from those engaged in the type of group-based suicide griever coping discussed in the preceding sections? While this group of participants offers very little data with which to assess this question, some tentative observations may be put forth.
Several losses within this group were very traumatic in nature because of the suddenness of the death and, second, because the bereavement occurred at a young age in which the stumble factor discussed earlier influenced participants seeking any kind of formal support. Conversely, another possible explanation in regards to age at time of bereavement is the suicide loss occurred at a later age in which participants had adequate intra- and interpersonal coping strategies to deal with their loss, without needing to seek formal sources of support.
Overall, though, not only do study findings clearly advance the disenfranchised grief framework by identifying new variants of relational disenfranchisement resulting from this type of stigmatized loss, but this research also departs from Doka’s framework in significant ways. This departure is due to the application and value of bringing a sociological lens to bear on the disenfranchised grief framework whose origins are in the academic discipline of psychology. Consequently, re-enfranchisement or advocacy for suicide prevention was understood through the growing field of health social movements within medical sociology. Further, by examining suicide ‘survivorship’ at the micro- level, this inquiry traces linkages between self, identity, and society and illustrates how such group settings offer places where a suicide survivor identity may be defined, signified, affirmed, and even policed. As such, sociological viewpoints reveal several
219 important insights into the dynamics of re-enfranchisement which may have been over- looked by psychologically-orientated inquiries.
Implications of Suicide Loss Findings: Scrutinizing Commodification and
Medicalization of Grief
Having moved from the macro-level to the micro-level of analysis in previous sections, the final section of this chapter considers the implications of these findings.
Specifically, this section steps back and addresses broad, big picture questions pertaining to not only suicide grief but grief in general. First, questions about the commodification of grief, especially the rise of the idea of ‘closure’ following traumatic loss are considered. Second, medicalization of suicide grief through proposed changes in diagnostic criterion for depression by the American Psychiatric Association is weighed too. Using Freud’s (1917) Mourning and Melancholia as a starting point, this study has traced theoretical understandings of grief forward to contemporary bereavement studies.
Now, this discussion of study findings returns to his influential paper by focusing on two key ideas, those pertaining to closure and the distinction drawn between depression and grief. Revisiting these concepts at this stage is important because they are undergoing troubling transformations by contemporary social forces: On the one hand, we are witnessing an escalation in the commodification of closure after grief, and by contrast, on the other hand, the longstanding distinction between depression and grief established by
Freud’s work is being collapsed by the push to medicalize grief.
Commodifying grief by selling closure. In the previous section, Andrea’s words drew attention to the assumed closure embedded in the identity status of ‘survivor’. The sociologist, Berns (2011) cautions us about the commercialization or selling of closure in
220 respects to grief in her article, Chasing “closure.” Earlier chapters traced the idea of closure or decathexis to Freud’s groundbreaking work and the continuing bonds model of grief has evolved as a direct challenge to this grief imperative. Instead of Freud and other thinkers emphasizing this idea, now it is market and political forces which stress closure in cultural narratives of grief. For example, Berns points to the funeral home industry’s reliance on popular notions of closure to sell their products. The idea of closure has purchase in other industries outside of those dealing directly with death, Berns notes that wrongful death attorneys, private investigators, psychics, and even divorce party businesses invoke closure to help their clients “bury the past.” It has become a dominant cultural narrative and is perceived as the closing chapter of a whole range of grievances, its achievement allows people to move on in their lives: “Now a central part of narratives of loss in realms like politics, media, and advertising, closure in some ways limits our empathy, failing to capture the varied experiences of many who grieve a death or other losses” (Berns, 2011, p. 51). By exposing these cultural and economic manipulations of closure, Berns asserts that we must understand it as social construction—it is in itself a product or invention of social forces—and, ultimately, detrimental because it distorts our understandings our grief. “Closure talk frames grief as bad and therefore something that need to end. This rhetoric implies that closure exists and assumes it is possible, good, desired, and necessary,” explains Berns (2011, p. 51).
Bern draws on other sociological scholarship to support her argument, invoking
Hochschild’s work on feeling rules. Hochschild conceives of feeling rules as forms of pre-action, and likens them to scripts individuals’ sense or experience when what one actually feels and what one should feel are discordant (Hochschild, 2003, p. 57). For
221 Berns, feeling rules represent a concept which can theoretically elucidate the disconnect people feel when their feelings are out of sync with the prescriptions of cultural narratives telling them what they should be feeling. Berns writes, “We attempt to manage our emotions in different situations in an effort to look and feel the way we think we are supposed to look and feel in any given context. This means there are problems when one’s experience fails to live up to the promise of closure” (Berns, 2011, p. 52). Closure narratives of grief are problematic because they encourage a disjuncture between grievers’ actual experiences which might fail to meet expectations of closure and cultural perscriptions. Indeed, many grievers who have suffered a traumatic loss express that closure is neither possible nor, indeed, desired. When talking about the long-term consequences of suicide loss many study participants echoed these assertions. In regards to the latter, study participants did not desire to severe bonds with their suicide decedents in spite of the traumatic nature of their loss, as indicated by findings on intrapersonal coping in the previous chapter. In the case of peer suicide grief, closure may be even further out of reach due to complexities of suicide-related grief.
A final note of caution raised in Bern’s (2011) discussion of chasing closure relates to mental health criteria which attempt to distinguish between “normal” and
“pathological” grieving. Here, Berns is referring to complicated grief syndrome, a cluster of enduring and detrimental grieving symptoms that some researchers argue represents a distinct mental disorder. According to diagnostic criteria, complicated or traumatic grief is characterized by symptoms of separation distress (i.e., intrusive thoughts about the deceased, yearning for the deceased), and traumatic distress such as feelings of disbelief, a fragmented sense of security and trust, feeling that part of oneself has died, and
222 subjective sense of numbness persisting for 6 months or more (Latham & Prigerson,
2004). However, Berns argues that such formalized and medically-endorsed expectations involve the very same socially constructed dictates which shape appropriate and inappropriate ways of grieving as do feeling rules. Therefore, if complicated grief is granted a diagnostic status, such feeling rules would become legitimized not only through commodification but also medicalization.
Medicalizing suicide grief? Drawing on the social constructionist perspective, medical sociologists make a critical distinction between disease and illness; the former relates to biological processes and the latter reflects social meanings of a diagnosis and the experiential aspects of being sick. While many view illness, disease, or the production of medical knowledge to be “natural,” this perspective reveals the role of cultural and historical aspects in these taken-for-granted phenomenon. Conrad and Barker (2010) foreground three key areas in which the social construction of illness sheds light on how such historical and cultural forces influence health and illness:
First, some illnesses are particularly embedded with cultural meaning—which is not directly derived from the nature of the condition—that shapes how society responds to those afflicted and influences the experience of the illness. Second, all illnesses are socially constructed at the experiential level, based on how individuals come to understand and live with their illness. Third, medical knowledge about illness and disease is not necessarily given by nature but is constructed and developed by claims-makers and interested parties. (p. S67)
In particular, within this social constructionist frame, medicalization is a key concept for sociologists studying health, illness, and medicine. “Medicalization describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorders,” writes medical sociologist, Peter
Conrad (2007, p.6).
223 Medicalization brings to bear important questions to recently proposed changes to the upcoming DSM-V which would broadly subsume grief under a depression diagnosis.
Historically, an exclusion for normal grieving has been affixed in the diagnosis criteria for depression in the Diagnostic and Statistical Manual of Mental Disorders (DSM) which originates from Freud’s foundational work on Mourning and Melancholia. This exclusion has guarded against possible over-diagnosis of depression in bereaved individuals. By contrast, in recent years, researchers have raised concerns about the risk of under-diagnosis in regards to prolonged, acute grief. Here, researchers advance the case of complicated grief syndrome outlined above. In the past year, the stakes of this debate have been significantly raised by the omission of the grieving exception in the diagnostic criteria of depression in publicly-available drafts of the DSM-V. “The manual is the standard reference for the field, shaping treatment and insurance decisions, and its revisions will affect the lives of millions of people for years to come,” observes the New
York Times in an article detailing this proposed revision (Carey, 2012).
Given these implications, critics of this change are now entering the debate. For instance, the prestigious medical journal, The Lancet, recently published a piece which argues that, “medicalising grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed” (The
Lancet, 2012). As such, The Lancet disputes previous research which claims that bereavement-related depression is generally equivalent to symptoms of complicated grief which undergirds the DSM-V’s rationale for omitting the bereavement exclusion
(Wakefield & First, 2012).
224 To reveal the complex nature of grief, The Lancet article highlights renowned
Harvard anthropologist, Arthur Kleinman’s critical essay titled, “Culture, bereavement, and psychiatry,” which is also published in the same journal volume. Kleinman notes that the recommended time which counselors should wait to classify persisting grief as depression in the DSM-III was one year. In the subsequent 1994 publication of the DSM-
IV, this time window dropped to two months. Looking at this diminishing diagnostic time window, Kleinman reminds us that, “In fact, there is no conclusive evidence to show what a normal length of bereavement is” (Kleinman, 2012, p. 608). Also, from an anthropological perspective, Kleinman stresses that the time period sanctioning grief varies across cultures, in some societies, for example, the time window for normal grief is one year, but in others it can stretch to a lifetime.
In Kleinman’s eyes, such cross cultural variation casts doubt on the DSM’s path in the opposite direction of shrinking these time prescriptions down to nothing. Using the lens of medicalization, Kleinman explains this pattern of reframing the normal experience of grief as a mental disease because grief, like other experiences, is framed by meanings and values. Indeed, he calls attention to how omitting the bereavement exclusion boosts numbers of potential patient prescriptions for psychotropic medications and the dominance of new cultural frames associated with biotechnology: “The political economy of the pharmaceutical industry, the transformation of American medicine into big business, and the infiltration of bureaucratic standards and regulations ever more deeply into ordinary life” (Kleinman, 2012, p. 609).
To illustrate his argument, Kleinman explores the consequences of blindly adopting the medicalization logic of grief pushed these larger social forces. He asks what
225 it would mean to reframe the recent loss of his own wife from a deeply moral and religious experience of loss to a medical experience which is labeled as a disorder? He ponders what other realms of our lives this shift to medicalize grief would ultimately negatively impact. Here, Kleinman shares the same sentiments with another author,
Malcolm Potts, whose remarks are also highlighted along with Kleinman: “Grief is an astonishing emotion. It is the tally half of love and it has to be….Anguish, body-shaking weeping, grief: a biological behavior that had been latent and unused in my brain….I would not and could not forgo it. Grief has to be,” (as cited in The Lancet, 2012, p. 589).
Finally, Kleinman suggests if medicalizing grief becomes a reality, physicians should remember that the mirror has two faces. Inasmuch as culture plays a role in the background or demographic data gathered from a bereaved patient, culture may enter and frame such diagnostic criteria utilized by doctors.
Conclusion and future directions. With constituents on either side of this debate weighing in, what ramifications does this sweeping mental health diagnostic change hold for suicide grievers? Proponents argue that recognizing this change increases the availability of resources like medications and psychotherapy for grievers experiencing bereavement-related depression for catching those at risk for severe negative mental health issues following loss. Yet, given what we know about suicide grievers help- seeking behaviors, this logic is flawed because it still depends on suicide grievers initiating contact. Campbell, Cataldie, McIntosh, & Millet (2008), for example, report that the elapsed time window or ‘stumble factor’ before suicide grievers sought support from a regional bereavement center was on average nearly three years. Over the same four year period, other grievers receiving an active L.O.S.S. program postvention, in
226 which a first response volunteer team provides immediate services at the time of a suicide death, sought follow-up support services, on average, in thirty-nine days,
Findings from this study cast doubt on whether subsuming grief under a depression diagnosis will be beneficial for suicide grievers seeking to alleviate their bereavement in the long term. Given the findings highlighted in this chapter, this change risks privatizing suicide grief through biomedically-rooted treatments to the exclusion of re-enfranchising experiences embedded in public and group-based advocacy settings and suicide survivor identity processes. While it is true that there is a deficit of support interventions for survivors of suicide loss, medicalizing suicide grief is not the best outreach for this bereaved group.
This research underscores several drawbacks of this approach which favors medicalizing suicide grief, including overlooking valuable re-enfranchising opportunities in varied social support contexts. In particular, this chapter illuminates how Out of the
Darkness Community Walks reflect a health social movement and Local Outreach for
Survivors of Suicide programs (L.O.S.S.) represent supportive cultures of action for suicide grievers to enact and emote suicide loss in group-based contexts. Most importantly, this study indicates that greater visibility of suicide loss as a public loss and recognizes that fellow survivors (who do or do not share the same loss) may be the greatest resource and sources of support for suicide grievers over solutions which privatize suicide grief. Proponents for such individualized fixes must be made aware of the uniquely disenfranchising forces (both relational and due to type of loss) to which suicide grievers are exposed in their bereavement experiences and the counteractive effect such re-enfranchising contexts seem to give many struggling with suicide loss.
227 Indeed, the $6.5 million raised by Out of the Darkness Community Walks towards research, prevention, and survivors of suicide loss programs is a positive trend, but suicide grievers still encounter a poverty of resources in regards to support. Here, the
L.O.S.S. programs represent the type of intervention better matched to suicide grievers over the long term. Because L.O.S.S. programs do not rely on suicide grievers to initiate the support process (i.e., are an active intervention program), offer immediate support to those bereaved by suicide, and also provide veteran suicide survivors with on-going advocacy opportunities, their value in terms of long term support exceeds those of proposed by medicalizing grief.
Another drawback under these new changes is that suicide grievers would be labeled as ‘mentally ill’. This study has shown that suicide grievers already experience social disenfranchisement, pathologizing suicide grief with another negative label risks further marginalizing suicide grievers. By contrast, L.O.S.S. programs or the Out of the
Darkness Community Walks facilitate suicide grievers with the positive label of
‘survivor’. In particular, findings from this study highlight that identity discourses and processes are a salient aspect of suicide grievers’ experiences. For some suicide grievers, adopting a suicide survivor identity is another re-enfranchisement strategy which these public and group-based settings assist in defining, signifying, and affirming. Yet, this identity status also has its complexities as evidenced by a suicide survivor identity not being as salient or clear cut among peer suicide grievers study participants as it seems to be to suicide prevention experts and advocates. This finding has implications on a practical level for organized suicide loss interventions and programs. As many of these outlets disseminate support materials and resources which invoke the term, “suicide
228 survivors,” it is important to include explicit language in which ‘survivor’ is understood as broadly inclusive. This signals to non-family members, peers, coworkers, clinicians, and others impacted by suicide loss that this identity and attendant support resources are available to them also.
Study limitations. Weaknesses of the present study should be taken into account when thinking about conclusions. First, this sample of participants is not randomly selected and cannot be considered representative, thus any generalizations to the peer suicide griever population must be made with caution. Still, among participants in this study there is wide variation by gender, age, location, and occupation and religion, albeit to a lesser degree. Indeed, several deviant cases are observed throughout the data chapters in regards to suicide survivor identity status, for example.
Second, another possible limitation relates to recruitment strategies possibly skewing the study sample, increasing the proportion of participants whose coping strategies included engagement in group-based re-enfranchising contexts. In total, twelve study participants’ experiences fell into this category along the peer suicide griever coping continuum elaborated in the previous chapter. Here, re-enfranchisement was defined as engagement in group-based coping methods such as suicide prevention fundraising walks, involvement in the L.O.S.S. program or other advocacy or outreach of this nature. Because of difficulties identifying peer suicide grievers, the original study parameters were widened to include many social events in which peer suicide grievers might be involved. Outside of group settings like suicide survivor conferences and suicide prevention fundraising walks, few places or social contexts exist in which suicide grievers may be identified because of the scarcity of formal resources to assist suicide
229 grievers, especially peer suicide grievers. Consequently, several study participants utilizing group-based coping strategies were identified in these contexts; on balance, however, numerous study participants’ whose experiences did not reflect re- enfranchisement were identified through recruitment that did not involve group-based coping or suicide survivor outreach resources (i.e., snowball sampling strategies through suicide griever support groups and on-line listserves). Of these participants, eight experienced no type of group based re-enfranchisement and six participants engaged in advocacy in their own personal social networks. Thus, participants’ accounts from this latter group highlighted experiences of peer suicide loss disenfranchisement in the absence of group-based re-enfranchisement, but the interpersonal advocators characterize a nascent potential or inclination towards engagement in re-enfranchisement. Also, the recruitment process suggests a group of peer suicide grievers exists who are so deeply affected by this loss that they simply cannot talk about their loss. For example, in talking to participants about their peer co-survivors, a handful of study participants indicated that among their friends who shared the same loss, some would not be likely interview candidates because their grief experience was too painful to share in an in-depth interview.
Third, because of Institutional Review Board concerns about the interview process re-triggering participants’ grief, a two-year post-bereavement study parameter was specified in study recruitment parameters. However, this post-bereavement time decision ruled out the opportunity to study participants’ experiences closely following suicide loss. Indeed, participants’ observations from this time period might have spoken to the issue of medicalizing all grief, including suicide grief, discussed in this final
230 chapter. Advocates for medicalizing grief, including suicide grief, should take note of several important questions raised by this study concerning the nature of the first few months following suicide loss. In particular, the distinction between depression and grief among peer suicide grievers appears to be most relevant during this time window, although suicide grief scholars have also called attention to studying long term, sleeper effects in suicide grief (Jordan, 2001).
Given that grief medicalization proponents’ arguments are rooted in reaching grievers in the short term following their loss, deeper knowledge about this time period in relationship to suicide loss is needed. Some of these lingering questions include: to what extent do suicide grievers suffer depression as a consequence of their loss? For instance, only one or two study participants talked about their own mental health issues resulting from bereavement; reference to their suicide decedents’ mental health was far more common. Of these references, participants’ thoughts differed according to whether decedents had been open about mental health struggles. A categorical code was developed to capture this content reflected by the notion, common in suicide survivor contexts, that suicide decedents “leave their psychological skeleton in survivors’ emotional closets.” For peer suicide grievers, this category contained a constellation of emotions including not only sadness but also anger, guilt, and shame, in addition to disenfranchised grief.
Further, if a depression diagnosis assists in gaining health insurance, to what extent would this diminish the stumble factor or grievers reluctance to seek help? What other external barriers to care do suicide grievers experiences during this time period?
Here, it is important to note that few counselors and social workers have specific training
231 in suicide bereavement. What efforts would be made to increase professional training and tailor counseling with the type of grief encountered in their places of practice.
Conversely, what are the internal barriers which suicide grievers encounter in initiating help, if they are struggling in the aftermath of suicide loss? For both short and long term suicide grief, would the pharmacological and one-on-one psychotherapy proposed by medicalization proponents still be the universal solution?
Finally, at a comparative level, it is important to take into account suicide grief experiences vary by culture also. Studying grief cross-culturally widens our understanding of the “cultural regulation of grief” and how notions of the private/public dichotomy intersect with expressions of loss. For example, anthropologist, Abu-Lughod’s work highlights how Egyptian Bedouins invoke a seemingly a public expression of grief that is characterized by indifference, whereas, in private, emotions of sadness and loss are culturally sanctioned in the expression of song poems (as cited in Charmaz & Milligan,
2006).
Therefore, study findings and discussion outlined in this chapter point to important gaps in our knowledge which future research might address. Future research comparing outcomes between one-on-one psychotherapy and/or medication interventions and group-based re-enfranchising experiences among suicide grievers is necessary to make informed choices about medicalizing grief, including suicide grief. Given this potential change to the DSM-V, directions for future research include gathering data about the scale of suicide grievers utilizing these group-based re-enfranchising contexts and, if they identify as suicide survivors, what this means to them and others? Also, more specifically, subsequent qualitative research might focus directly on these re-
232 enfranchising settings for suicide grievers. For instance, in-depth ethnographical research focusing explicitly on the Out of the Darkness Community Walks contexts will help suicide bereavement scholars to better understand why and how some suicide grievers experience their participation in these fundraising activities as re-enfranchising.
The interrelationship between survivor identity processes and group contexts using the subcultural identity work should be further examined to help us to understand the important dynamics between the individual-, group-, and society-levels. We need to know how this identity helps suicide grievers’ move past their grief: how is expressing a suicide survivor identity empowering? Conversely, is there a darker-side of suicide survivorship? Given the role of identity policing within this complicated status, an important issue to bear in mind is the potential for this status to become prescriptive like past models of grief. Furthermore, is the oft-used statement in suicide survivor circles regarding suicide decedents leaving their psychological skeletons in grievers’ emotional closets a way of expressing victimhood similar to the way other survivor groups evoke this notion? Or is it an expression of disenfranchisement?
Reviewing the questions raised in this final section underscores the sense that the impact of suicide as a societal issue is undergoing profound shifts. On the one hand, the issue of suicide and its legacy of loss now have public champions who are also suicide survivors. These include cable news CNN newsanchor, Andersson Cooper, who speaks openly about the suicide loss of his brother and, the actress, Mariel Hemingway.
Moreover, thousands have organized around this issue, highlighting the value of community responses to social issues. While on the other hand, suicide grief is in jeopardy of being deeply privatized as a result of medicalization. In regards to its
233 treatment of this profound loss, these signs point to our society being at the crossroads of an ‘historical moment’ in which we must move forwards rather than backwards.
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