Staff Perspective: The Lingering Why
Any parent would tell you the “why” questions start when we are young, usually around two- or three-years-old. The constant need to know the reason behind function, choices, and existence is inherent in us. We want to understand, and maybe if we can understand something, we feel more comfortable with it. The question of “why” helps us understand our surroundings, and this curiosity keeps us learning and growing. As we get older our “whys” tend to become more existential or morality based. Questions like why do people act the way they do, or why do I struggle with right and wrong? These create an opportunity for personal growth and introspection. But what about when we cannot explain things? What if there is no ability to answer, “why”? The loss of a loved one to suicide can create this eternal, uncertain “why”.
When we can answer a “why” question we feel more in control, perhaps more certain. But there are many situations in life where we cannot find these answers. Why do bad things happen to good people? Why do we experience suffering? Why do we exist? The lack of certainty or answers for these questions can cause significant emotional distress or internal turmoil. When thinking about suicide, we are faced with many unanswered “whys”. Why didn’t they tell me how they felt? Why didn’t they ask for help? Why was there no other option? For surviving family members, these “whys” can complicate, elongate the grief process, and even impact their ability to return to some resemblance of normal. How do we as clinicians, or even as friends or family help people navigate this vexing cycle of the unknown?
As a provider, when someone comes for help after the loss of a loved one to suicide, we may assume a normal grief and loss process. We can work through Kubler- Ross’s stages, we can tell them there is no right timeline for grieving, we can process emotions, but what we cannot do is answer their question of “why.” Because we really do not know why people die by suicide. We have theories of suicide, we know risk factors, we can identify warning signs, but this is one of life’s “why” questions that we cannot answer with firm scientific data. The reality is, even with insight into stressors and symptoms, even if a note is left, we never know what that final thought was. We need to be able to support our clients in their struggle to understand why, and also assist them with accepting the lack of resolution.
So how can we start this process of addressing the lingering why questions? At the core of all therapy is positive unconditional regard. Suicide can carry a stigma that other losses, like terminal illness or accidental death, do not. Family and friends may even question if it is acceptable for them to openly grieve. Normalizing this concern, and providing the supportive environment to grieve is a key component for processing. Addressing the existential piece can be more complex and difficult to navigate. Sometimes the unknown can help provide comfort, if reframed in a useful way. While we do not have a definite answer for why, this allows us to create our own narrative that brings peace. We get to decide how we understand the circumstances and accept them. For example a family member may be able to emotionally accept a death by suicide when put in context with physical suffering, loss of job, or other extreme stressors, even if these factors were only a piece of the situation. When we choose to write the narrative of understanding, we get to assign the meaning. We accept the view that helps us cope and brings understanding.
With acceptance of the unknown, or creating a narrative that helps with coping, we can focus on addressing the other complexities that arise after a loss from suicide. A suicide can cause post-traumatic stress disorder symptoms, and trauma focused treatment may help with processing. Families may benefit from systems therapy, particularly as the system has been altered. Cognitive therapy can be utilized to address unhelpful thought patterns and work to increase resocialization. When someone is able to reach a point of acceptance, they can move into more targeted therapies.
Working with our patients, we can focus on finding the narrative that brings enough resolution that they can start to think about the future, and what forward movement looks like for them. These lingering questions of “why” may continue to arise, but with support, understanding, and a narrative that brings solace, surviving family members may start to see a path forward.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kristyn Heins, Ph.D., is a Licensed Professional Counselor serving as a Military Behavioral Health Counselor for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she supports the CDP’s efforts of training clinicians in evidenced-based practice focused on suicide prevention.
Any parent would tell you the “why” questions start when we are young, usually around two- or three-years-old. The constant need to know the reason behind function, choices, and existence is inherent in us. We want to understand, and maybe if we can understand something, we feel more comfortable with it. The question of “why” helps us understand our surroundings, and this curiosity keeps us learning and growing. As we get older our “whys” tend to become more existential or morality based. Questions like why do people act the way they do, or why do I struggle with right and wrong? These create an opportunity for personal growth and introspection. But what about when we cannot explain things? What if there is no ability to answer, “why”? The loss of a loved one to suicide can create this eternal, uncertain “why”.
When we can answer a “why” question we feel more in control, perhaps more certain. But there are many situations in life where we cannot find these answers. Why do bad things happen to good people? Why do we experience suffering? Why do we exist? The lack of certainty or answers for these questions can cause significant emotional distress or internal turmoil. When thinking about suicide, we are faced with many unanswered “whys”. Why didn’t they tell me how they felt? Why didn’t they ask for help? Why was there no other option? For surviving family members, these “whys” can complicate, elongate the grief process, and even impact their ability to return to some resemblance of normal. How do we as clinicians, or even as friends or family help people navigate this vexing cycle of the unknown?
As a provider, when someone comes for help after the loss of a loved one to suicide, we may assume a normal grief and loss process. We can work through Kubler- Ross’s stages, we can tell them there is no right timeline for grieving, we can process emotions, but what we cannot do is answer their question of “why.” Because we really do not know why people die by suicide. We have theories of suicide, we know risk factors, we can identify warning signs, but this is one of life’s “why” questions that we cannot answer with firm scientific data. The reality is, even with insight into stressors and symptoms, even if a note is left, we never know what that final thought was. We need to be able to support our clients in their struggle to understand why, and also assist them with accepting the lack of resolution.
So how can we start this process of addressing the lingering why questions? At the core of all therapy is positive unconditional regard. Suicide can carry a stigma that other losses, like terminal illness or accidental death, do not. Family and friends may even question if it is acceptable for them to openly grieve. Normalizing this concern, and providing the supportive environment to grieve is a key component for processing. Addressing the existential piece can be more complex and difficult to navigate. Sometimes the unknown can help provide comfort, if reframed in a useful way. While we do not have a definite answer for why, this allows us to create our own narrative that brings peace. We get to decide how we understand the circumstances and accept them. For example a family member may be able to emotionally accept a death by suicide when put in context with physical suffering, loss of job, or other extreme stressors, even if these factors were only a piece of the situation. When we choose to write the narrative of understanding, we get to assign the meaning. We accept the view that helps us cope and brings understanding.
With acceptance of the unknown, or creating a narrative that helps with coping, we can focus on addressing the other complexities that arise after a loss from suicide. A suicide can cause post-traumatic stress disorder symptoms, and trauma focused treatment may help with processing. Families may benefit from systems therapy, particularly as the system has been altered. Cognitive therapy can be utilized to address unhelpful thought patterns and work to increase resocialization. When someone is able to reach a point of acceptance, they can move into more targeted therapies.
Working with our patients, we can focus on finding the narrative that brings enough resolution that they can start to think about the future, and what forward movement looks like for them. These lingering questions of “why” may continue to arise, but with support, understanding, and a narrative that brings solace, surviving family members may start to see a path forward.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kristyn Heins, Ph.D., is a Licensed Professional Counselor serving as a Military Behavioral Health Counselor for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she supports the CDP’s efforts of training clinicians in evidenced-based practice focused on suicide prevention.