Definition: The American Association of Suicide Prevention defines suicide postvention as the “provision of crisis intervention, support and assistance for those affected by a completed suicide.”
Traumatic Grief – The Initial Impact
There are many symptoms of trauma that suicide survivors often experience in the immediate aftermath of a loved one’s suicide:
- Shattered sense of order and trust
- Increased feelings of vulnerability
- Difficulty sleeping and eating
- Disorientation – feeling like you are in a fog
- Flashbacks or intrusive recollections of the trauma
- Uncontrollable crying or intense anger
- Feeling numb
- Denial and disbelief
A person dying of suicide, dies as does the victim of physical illness or accident, against his or her will. People die from physical heart attacks, strokes, cancer, AIDS, and accidents. Death by suicide is the same, except that we are dealing with an emotional heart attack, an emotional stroke, emotional AIDS, emotional cancer and an emotional fatality.
Support for Survivors of Suicide
Survivors of another’s suicide often fall into one of three clusters:
- Quick recovery. Those who recover quickly without assistance and can return to functioning as before. Some of these people are not impacted because they had only superficial contact with the deceased, while others are often internalizing and suppressing pain, anger, or guilt. Often times, in the latter case, maladaptive strategies of coping emerge such as substance abuse or workaholism.
- Modest support needed. Most people who were functioning well before the suicide need only a modest level of support for a period of time that might span a month to a couple of years. This level of support might include outpatient therapy or support groups.
- Psychiatric disability. Some people may develop a mental disorder in reaction to the trauma and loss and may require extended or intensive treatment.
Support from other suicide survivors is one of the most powerful connections one can make in the aftermath of a suicide. Many people find great relief in being able to talk openly and honestly about the range of complicated experiences they are going through with people who really understand. Survivor support groups offer a safe haven to share and build new healing relationships. Some survivors go weekly; others go when they need it most – around birthdays, anniversaries and other difficult times.
The Goals of Suicide Postvention
Why Should We Consider Postvention on Campus?
The true essence of leadership and the real character of a campus are often revealed when faced with adversity. When a campus’ coping skills have been overwhelmed by a critical incident, such as a suicide, an effective well-organized response can restore a campus to a state of well-being and bolster a sense of trust that fosters resiliency against future dark times.
- To stabilize the campus community and help people at all levels of the organization (and related family/community) cope with the trauma and grief. The emotional pain and disruption of suicide is significant in any system. Suicide survivorship, if not supported well, may lead to other psychological conditions such as depression, post-traumatic stress disorder, anxiety, and substance abuse. The initial hours and days following a suicide can make a big difference for survivors and their subsequent emotional healing; however, longer-term support may also be needed.
- To prevent further suicides. Suicide contagion, or the copycat effects of suicide, are often seen in younger high-risk adolescents, but can also happen among vulnerable adults. Postvention practices work toward minimizing the factors that might make copycat suicide more likely.
- To help the campus return to normalcy and the pursuit of its mission.
Rumors, second guessing, and blame can create critical rifts in the campus family; thus, containment is needed to help reassure people and give them appropriate means to express their feelings. A balance is often needed between providing support for those who need it and letting people get back to their regular lives. For most, after an initial expression of grief, a campus may be able to return to a normal routine more quickly than for campuses that are denied an opportunity to express openly.
The contagion effect (otherwise known as the copycat effect) of suicide is real. Several studies have documented cases of suicide clusters that have been partially explained by imitative behavior. Contagion is defined as suicidal behavior by additional people that are influenced by a previous attempt or completion. The contagion effect is more common in younger people who are more prone to impulsive behavior. Contagion behavior while rare is a central concern in suicide postvention work; many strategies are cognizant of trying to reduce identification with the victim and discourage modeling of suicide behavior. Practices that help prevent the contagion effect are:
- Providing appropriate and accurate information about suicide
- Avoiding glamorizing or romanticizing suicide
- Avoiding idealizing the person who died by suicide or by offering simple explanations for the death.
Because cultures vary in their beliefs and levels of acceptance regarding suicide, those directing suicide postvention must possess a degree of cultural competence and sensitivity. Some cultures believe that suicide might be permissible under some circumstances (e.g., in instances when honor is at stake or at the end of life when the pain of living is intolerable). Other cultures may regard it as a sin or even as a crime. Some cultures may be very open in the grieving process, while others cultures might need more privacy. For cultures that have strict moral sanctions against suicide, bereaved families may feel isolated in their grieving process; however, with these strong values against suicide comes a diminished risk for the contagion effect. On the other hand, cultures that are less stigmatizing of suicide may provide more comfort for a bereaved family, but may also communicate permissiveness that increases the risk for the contagion effect. If in doubt about the best way to bridge cultural differences, consult with someone more familiar with the culture to help guide you through the most appropriate aftermath process.
Suicide on Campus
In the aftermath of a suicide on campus, special care must be taken to assess the impact on friends, witnesses, responders (especially public safety professionals internal to the organization who might know the deceased), and campus stakeholders (those who need to respond to the campus and community at large). As the organization becomes the first to know in a situation such as this, an appropriately appointed person should notify family members in a timely way. Clean up of the death scene should be handled by an external organization with extreme sensitivity to those who knew the deceased and without the expectation that it will appear as if “nothing ever happened.”
At the same time, memorializing the death site should be avoided. One campus decided that the room where a student hung himself was not suitable as a living space, so they turned it into a library. Several years later when the collective memory of the student body was new again, students wondered why there was a library in the residence halls and the story of the suicide resurfaced in an inappropriate way, when it could have subsided with the passage of time. Likewise, the planting of trees or any permanent markers of suicide may be misinterpreted as glorifying the act and thus could encourage a vulnerable student to make a similar decision to be thus remembered.
People often forget that these horrific crimes were often caused by a suicidal avenger who may not have taken others’ lives if he did not feel he had anything to lose himself. Emotional distress under these circumstances is often contagious and self-amplifying. For these reasons, rapid and honest campus-wide communication is needed to discourage damaging rumors.