Suicide Survivor -- Feeling of Rejection & Understanding of the Deceased

Nonetheless, one common theme for suicide loss survivors is to perceive the death as a rejection, abandonment, or even a betrayal by the deceased. Note that how the act of suicide is experienced is “in the eye of the beholder,” and for some survivors, there may be little or no feeling of disloyalty or duplicity by the deceased. But for many people, the death is perceived to be a choice with a critical interpersonal message for the survivor from the deceased about the lack of worth or value of the relationship. All of this can add to the feeling of alienation and estrangement from the deceased. Continuing bonds theory, as well as common clinical experience, suggests that this kind of sudden breaking of a relationship extracts an even heavier toll from survivors of suicide loss in their mourning process. Correspondingly, an effort by clinicians to help the mourner to reinstate and repair the relationship with the deceased, and to make their peace with the “unfinished business” in the relationship, is often a necessary task of healing after a suicide loss. In my experience, this work often needs to be accomplished by some form of dialogue with the deceased – a dialogue that might have happened if the deceased had betrayed the survivor in some other way, and then was willing to make amends for the damage. The form this dialogue takes can include letter writing to the deceased, empty chair enactment of conversations with the deceased, and other forms of communication between the deceased and the mourner that are experienced as authentic and healing for the bereaved survivor (Jordan, 2012; Neimeyer, 2012, 2016; Botkin, 2014; Neimeyer, in press; Valdez et al., in press). • Development of a Durable Biography of the Deceased Walter (1996) has suggested that one of the important tasks of mourning is to create a “durable biography” of the deceased. A durable biography is a narrative of who the deceased was, what they had accomplished, and what they have left behind from their life. He argues that this process is accomplished primarily by a process of shared remembering and storytelling amongst people who knew the deceased. This process typically begins immediately at the time of death (e.g., at the funeral), and may continue on for years, or even generations within family systems. It is a universal and natural way for the community around the deceased to share their grief, and to combine and enrich each mourner’s personal narratives of interaction with the deceased over the course of their life. Suicide, however, may present special problems for the accomplishment of this important task of mourning. More specifically, because suicide is both a relatively rare and a socially stigmatized cause of death, establishing the communal narrative about the life of the deceased can become either taboo, or alternatively, almost exclusively focused around the mode of death itself. In other words, when someone dies by suicide, that fact may become the only “important” thing about their life story. Thus, mourners who wish to remember the entirety of the life of their friend or relative, not just the manner by which Frontiers in Psychology | www.frontiersin.org 5 April 2020 | Volume 11 | Article 766 Jordan Lessons Learned they died, often need to make an extra effort to share (and request that others share) memories that predate and highlight other important aspects of the deceased’s identity and life story. And they also must overcome the social discouragement about talking about and remembering the deceased that comes from others in the interpersonal network, who may view the suicide as a shameful and dishonorable form of death. This implicit prohibition of the “social remembering” aspect of the mourning process can add to the emotional distress and difficulty of the survivors in integrating the loss into their own life narrative as an associate of the deceased.

Predicting Suicide: 2% of Depressed and 1.6% of Population Die by Suicide

The big question that often arises for many of us is what can we do to prevent suicide? Sadly, not much, according to experts.  We've known that much since at least 2016 when researchers studied risk factors depression, previous suicide attempts, stressful life events and substance abuse and expert's ability to predict suicidal thoughts and behaviors over long periods of time.

Predicting if someone will attempt to take his or her own life is only slightly better than chance and has not significantly improved during the last five decades.  Those findings still hold true, said Joseph Franklin, an assistant professor of psychology at Florida State University and lead author of the study.

Franklin and his colleagues conducted a meta-analysis of 365 studies conducted within the last 50 years.  The analyses, he said, showed a suicide expert who conducted an in-depth assessment of risk factors would predict a patient's future suicidal thoughts and behaviors with approximately the same degree of accuracy as someone with no knowledge of the patient.  "It's basically on par with flipping a coin," he said. "It turns out, for example, things like depression don't predict much better than random guessing either."

Franklin said, for instance, just 2 percent of people who are severely depressed will die by suicide. But 1.6 percent of the general population around the world and in the U.S. will eventually die by suicide.  "There are thousands of things relevant to suicide, but there's no one thing among those thousands that stand out as being particularly important for prediction," he said.

Still, Franklin said the findings do not necessarily mean that widely used risk guidelines are invalid or useless, or that therapists should abandon them.  "We recommend that these guidelines remain in use, but emphasize that there is an urgent need to evaluate these guidelines within longitudinal studies," he said.  Nadine J. Kaslow, a tenured professor in the Emory University School of Medicine and past president of the American Psychological Association, agreed traditional risk factors such as depression, substance abuse, stress or previous suicide attempts aren't adequate predictors of suicide by themselves.

What's happening in a person's life at the moment a job loss, relationship break up, or mental health or substance abuse problems combined with some current stressor might be, she said. At a time when people are desperately searching for ways to tell if a loved one is in trouble, Kaslow said it's important that people not blame themselves if they weren't able to prevent someone from dying by suicide.  "To convey that there is nothing that can be done, will scare people even more and make them feel more helpless," Kaslow said. "We're not saying that people do nothing. It doesn't mean we don't keep trying to figure out what to do. If someone is struggling, we need to reach out to them. We do know that strong social support protects people from attempting suicide or dying by suicide."

Franklin is hopeful a new approach to predicting suicide is in our future.  For instance, he said, multiple groups have begun working on developing "machine learning algorithms" the same things that drive the Google Search algorithm, make your email spam filter effective and show you relevant advertisements to combine tens or even hundreds of risk factors together to predict suicidal behaviors.  "The preliminary results are promising, with algorithms predicting suicidal behaviors with 80-90 percent accuracy," Franklin said. "The big catch though is translating that to clinical practice will take a few years, and based on current studies, we can tell who will eventually die by suicide but not when."

Meanwhile, he said, the only things that consistently reduce risk are large-scale preventative measures, such as reducing the availability of guns, putting pills in blister packs, or erecting fences around certain bridges.

2022 Suicide Rates by Age & Race and by County

 2022 Suicide Rates by Gender

Suicide Rates by Age

More work is necessary to reach women 25-34, she said. They were the only group of women for which suicide rates increased significantly in 2022.   (So sad.)

Suicide by Race/Ethnic Group

Suicide Rates by County (Year not Given)

(1) Amazing Maps (@amazingmap) / X