Staff Perspective: Suicide and Stigma: A Review of the Literature and Personal Reflections

Staff Perspective: Suicide and Stigma: A Review of the Literature and Personal Reflections

Having recently participated in a local suicide prevention event in my local community, this article about suicide and stigma caught my eye.  I was invited by a group of individuals to help with a suicide awareness and prevention walk sponsored by the American Foundation for Suicide Prevention and to help with a community educational meeting about suicide about two weeks after the walk.  Most of the individuals who are a part of this group have had personal experience with suicide, losing one or more family members in this way.  I lost an uncle to suicide many years ago, but we were not close and I don’t consider that I have had much personal experience with suicide loss.   I was invited to join the community awareness efforts because they learned that I teach about suicide prevention and treatment and thought I would be an asset to the group.  I was honored to be asked, since I had been hoping to get involved somehow in suicide awareness in my community. 

Stigma about suicide is real.  As the authors of this article point out, there is stigma associated with some physical health problems and certainly with mental health disorders, but the stigma associated with suicide is even greater.  I have observed that in my work as a psychologist when survivors of a suicide of a loved one feel shame or make attempts to keep the cause of death of their loved one a secret.  I also have observed it personally, when noticing how people in a community respond to a suicide.  It is particularly hard to go through grief after a suicide because of the stigmatization, guilt, and other intense feelings that are unique to this situation.  The fact that feeling stigmatized is also added to the grief is an unnecessary burden and one that is thankfully improving, albeit slowly.

This article does a nice job of explaining stigma about suicide from three different authors’ perspectives.  The first author’s wife died by suicide 12 years prior to the publication of the article.  He describes feeling marginalized and stigmatized, even by his friends.  Being a healthcare professional who spoke professionally about suicide frequently made his guilt and shame worse and contributed to his decision to keep his wife’s suicide a secret when he could.  Eventually, however, a colleague encouraged him to attend a support group as a participant and not a professional, and this provided relief and support and helped him through his grief.  Dr. Sudak cited William Worden and gave the following tasks for therapists helping families cope with the aftermath of a suicide:

• to accept the reality of the loss
• to work through the pain of the grief
• to adjust to the environment in which the deceased is not present
• to emotionally relocate the deceased and move on with life

He also states that the clinician’s focus should pertain to the following areas when working with surviving family members:

• help the family normalize the mourning process
• help the family respect everyone’s grieving style
• connect the family with others who have lost someone to suicide
• encourage the family to not be secretive about their loss
• help the family plan ahead for important milestones (e.g., birthdays)
• provide education about suicide
• introduce the family to activities that have helped other survivors (e.g., support groups, art, fund-raising)

The second author’s personal experience with suicide involved the death of her 16-year-old brother.  Also a healthcare professional (a nurse), she experienced shame and felt like a less competent professional.  She moved to another city shortly after his death which made it easier to keep her brother’s suicide a secret, but in a supervision experience related to some clinical work, a supervisor noticed her discomfort around the topic of suicide and encouraged her to break her silence and engage in some healing activities.  Through this, she came to know other healthcare and mental health professionals who had been personally touched by suicide, and this experience led her to a path of regular talking and writing about suicide.  She ultimately became involved in suicide prevention efforts through the American Foundation for Suicide Prevention and the American Association of Suicidology.   She also became involved with Survivors of Suicide, Inc (SOS), a non-profit organization which advocates for the sharing of grief experiences and feelings as a means to recover.  Having experienced healing through this herself, Ms. Maxim strongly encourages survivors to seek out services provided by SOS.

The third author shares about her son’s suicide 20 years prior.  He was an adult at the time and had struggled with alcohol abuse for years.  He tried recovery, but could not maintain it after several significant losses and took his life when he was twenty six years old.   This author, too, experienced shame, guilt, and felt isolated and stigmatized.   She had no support groups in her local area and did not have the energy to travel to a large nearby city. Finally, she got some support by phone from the group facilitator who encouraged her to start her own group in her area.  Like the first two authors, she found that talking with others and helping others who had survived a loved one’s suicide helped her move through her grief process. 

Stigma associated with suicide still exists, although these authors note that it is less than in years past.  Nonetheless, stigmatization and marginalization of those who lose a loved one in this way is an unnecessary part of an already tragic situation.  Hopefully, more public awareness and education about suicide will continue to drive down the stigma associated with suicide.  Although mental health professionals often come into contact with survivors of suicide, many survivors do not seek professional help.  Therefore, the recommendations made by the authors of this article that are summarized here are helpful potential resources for anyone who knows someone who is touched by suicide.

Sudak, H., Maxim, K., & Carpenter, M.  (2008).  Suicide and Stigma: A Review of the Literature and Personal Reflections.  Academic Psychiatry, 32: 2, Mar-Apr. 

Dr. Regina Shillinglaw is a deployment behavioral health psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.