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A Piece of My Mind
November 13, 2018

Grief After Suicide

Author Affiliations
  • 1School of Medicine, Deakin University
  • 2Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  • 3Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
JAMA. 2018;320(18):1861-1862. doi:10.1001/jama.2018.15664

Thirty years ago, I lost my brother to suicide. A talented athlete, a gifted photographer, a deeply compassionate man. A lonely act as he tried to shake off the demons of psychosis. The end of a 3-year battle with schizophrenia.

A month ago, my closest friends lost their son. Another suicide. A wonderful, charismatic, clever young man with no known mental illness. Another lonely act, in the early hours of an ordinary weekday. A family left piecing together an incomplete jigsaw of “why” through an impenetrable cloud of loss. An endlessly branching map of possible futures extinguished. Different young men with different lives, joined only by the nature of their death, and the devastation in the lives left behind.

I have seen a lot of death in the decades between these two tragedies. As a father, husband, son, and friend, a stuttering intermittent exposure to grief and suicide at a range of emotional distances. Some far enough to only disturb my balance for a few days. Some close enough to change life forever. As a physician, I have cared for thousands of patients and families in the last hours and days of life. I have listened, watched, and learned.

At the end of my friends’ son’s funeral, I sat at the cemetery with my young adult son, and we talked. About the loneliness of grief, the loneliness we thought must precede suicide. About the outpouring of love never witnessed by those who die. About the sense of helplessness we felt. About what I have learned over time. And about what we can do to help those left behind.

We can appreciate the natural timelines after sudden unexpected death. The first days an unbearable explosion of confused pain that engulfs family and friends. Then funeral preparation. Days of stunned loss and disbelief, the start of the long process of asking why, mixed with the erosive guilt of finding missed warnings. The distracting logistics of navigating medical examiners, funeral directors, wakes, and burials. The funeral itself, hopefully an overwhelming affirmation of a life stopped, a focus of love and loss.

Then the fall.

We do not often talk about the landscape of grief after the immediate loss. When the crowds disperse, the world starts turning again, and those most distressed are left behind. When the questions remain, when the enormity of loss grows with each day of absence. The realization that life has changed forever. When the air is sucked out of bubbles of normality by moments of sharp memory.

We can show up. Almost universally, we are unsure if we should enter the homes and lives of those who are grieving. For those we love, we should swallow the knot in our stomach, compose ourselves, knock on the door, and give whatever is needed at that moment. If we watch carefully, we will know when to provide space. It is easier for the grieving to send us away than ask us for help.

We can keep showing up, in the weeks and months that follow. Remember the milestones that tick by carry both happiness and pain. My friends have already traversed their son’s 21st birthday without him. Cancelled the party they were handing out invitations to on the day he died. The birthdays of his siblings. My brother has been absent from every milestone since I was 20 years old. He never met my wife, attended my wedding, met my children, celebrated my successes, shared my failures, or attended our father's funeral. He has been absent from every family photo for three decades. He has always been present in our minds.

We can listen a lot, talk a little, and advise rarely. We cannot solve grief. Our well-intentioned desire to heal the suffering around us is a mirage. There is no elusive mix of words or actions to take away the pain of loss. We can simply be there and travel alongside those we love. So when they look up, they see a trusted friend who will listen, who is there to lean on.

We can stay for the tears while not adding to them. We don't need to walk away from distraught friends unless asked. We can share sorrow, sit quietly, cry with them, provide a shoulder when needed. We can make sure it is not about us and never end up with grieving friends consoling us.

We can patiently sit through the process of asking why, listen carefully as they piece together events and emotions. Refrain from bland reassurances when they express their fears and regrets. We can try to appreciate the impossible pain of never being able to understand the combination of long-term and immediate thoughts that occupied the mind of someone we love just before they end their life.

We can cook, clean, pick up kids, run errands. We can help when they need to restore some normality and routine to their lives.

We can recognize the journey is different for each parent, sibling, friend, family. I don't know the depth of loss my friends are feeling for their son. I do remember the pain of watching my brother's battle with mental illness, and the anger, confusion, and loss I felt after his suicide. I remember the guilt I felt after physically restraining him during his first episode of psychosis and hospital admission while he accused me of betraying his trust. The fear I carried until my late twenties that I was genetically predestined to follow his path. I know we must all confront different versions of grief.

We can remember to care for the circles of community that are supporting and suffering. We forget how much young death sends shock waves through a community. We can be kind to each other.

We can remember joy. It is absent at first, a garden scorched. Yet even in the early days, the smallest shoots can be found. Fleeting moments of laughter as eulogies and remembrances are assembled, photos and memories shared. We can follow their lead and protect these glimpses of respite. If we are patient, if we nurture these moments, we can take pleasure in a changed happiness that returns in the years to come.

I am about to turn 50, ready to celebrate another major milestone. I will be surrounded by the people I love, and I will feel the absence of these two men. I will know we feel the worst of grief when alone and recover best when together. I will know family and friends can fill an injured life with love over time. I will wish my brother, my friends' son, were still here, to share all this with us. To know they were never alone.

Section Editor: Preeti Malani, MD, MSJ, Associate Editor.
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Article Information

Corresponding Author: Neil Orford, MBBS, FCICM, Intensive Care, University Hospital Geelong, Barwon Health, Geelong, 3220, Victoria, Australia (orfords@me.com).

Conflict of Interest Disclosures: The author has completed the ICMJE form and none were reported.

Additional Contributions: I thank my friends for granting permission to publish their story.

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