Although Freud laid the theoretical groundwork, it is generally agreed that the systematic study of grief did not begin until the Coconut Grove fire in 1942. Following a football game, the Boston nightclub was packed beyond its legal capacity. A busboy accidentally ignited a decorative palm, and by the time the flames had been extinguished, nearly five hundred people were dead. From his work with the bereaved families, Erich Lindemann, chief of psychiatry at Massachusetts General Hospital, wrote a groundbreaking paper, “The Symptomatology and Management of Acute Grief.” He found that it was normal, indeed healthy, to experience such reactions as guilt, hostility, physical distress, preoccupation with the image of the lost loved one, and a sense of merely “going through the motions” of daily living. Grief that is delayed or repressed, suggested Lindemann, is morbid or abnormal. Only through the proper “grief work,” preferably aided by psychotherapy, can someone emancipate himself from “bondage to the deceased” and move forward with life. Lindemann’s observations have served ever since as the psychological model clinicians use to describe and treat grief.
Over the last several decades increased interest in issues of death and dying, spearheaded by the work of Elisabeth Kübler-Ross and her concept of a “good death,” has sparked a corresponding interest in bereavement and the concept of “good grief.” At “grief institutes” and “bereavement centers” psychologists and social workers offer help to people who have lost loved ones. Researchers study physiological factors in grief and the biochemistry of tears, while clinicians analyze the grief process. Under this renewed scrutiny Lindemann’s model of normal grief has been refined. Rather than the relatively straight line Lindemann proposes, the path of grief is now described by various experts as a circle, spiral, double-back, or zigzag. While they agree that mourners go through periods of shock, intense grief, and recovery, they have defined a variety of models. Some have adapted Kübler-Ross’s five stages of dying—denial, anger, bargaining, depression, and acceptance—to grief. Others have cataloged as few as three or as many as twelve different stages. “There’s a tendency for the novice to take the stages too literally,” writes psychologist William Worden. “After her first book, On Death and Dying, many people expected dying patients literally to go through the stages she had listed. Some of them were disappointed when the stages were not passed through in some neat order.”
Freud was the first to distinguish between grief and depression, which can have nearly identical symptoms. It is indeed difficult to draw the line beyond which mourning slips into depression. Many clinicians have tried to prescribe a length for normal mourning, and their estimates range from three months to six months, to “four full seasons,” to two years, to forever. The NAS report suggested that professional intervention may be needed for those who show as much distress a year after the death as they did during the first month. As Lindemann suggested, the only sure sign of abnormal grief may be the absence of visible grief. “Sooner or later,” wrote English psychoanalyst John Bowlby, “some of those who avoid all conscious grieving, break down—usually with some form of depression.” A psychiatrist at Massachusetts General Hospital has estimated that 10 to 15 percent of the people who come to its mental health clinics are suffering from unresolved grief. Mere time, say grief experts, does not heal everything; the feelings must be talked out. “Give sorrow words,” as Malcolm advised Macduff. “The grief that does not speak / Whispers the o’er-fraught heart, and bids it break.”
Mourning is among the most primal and universal of responses, as researchers have found in observing grief reactions in animals from dolphins to ostriches to gorillas. One of the most haunting evocations of mourning ever written is Konrad Lorenz’s description of bereavement in the greylag goose:
The first response to the disappearance of the partner consists in the anxious attempt to find him again. The goose moves about restlessly by day and night, flying great distances and visiting all places where the partner might be found, uttering all the time the penetrating trisyllabic long-distance call. . . . The searching expeditions are extended farther and farther, and quite often the searcher himself gets lost, or succumbs to an accident. From the moment a goose realizes that the partner is missing, it loses all courage and flees even from the youngest and weakest geese. As its condition quickly becomes known to all the members of the colony, the lonely goose rapidly sinks to the lowest step in the ranking order . . . the goose can become extremely shy, reluctant to approach human beings and to come to the feeding place; the bird also develops a tendency to panic which further increases its “accident-proneness.”
Lorenz has succinctly described some of the reactions commonly experienced by grieving humans: denial, searching, panic, loss of hope, vulnerability, social alienation, and isolation.
While any death is traumatic for survivors, some deaths may be more traumatic than others. A sudden death may be more difficult than a death in which there has been some preparation, some chance to say good-bye. A violent death may be even harder. Murder, which is both sudden and violent, is more shattering still. But because it is sudden, often violent, and freighted with the added burdens of guilt and stigma, perhaps the most difficult of all deaths to resolve is suicide.
Suicide survivors pass through many of the responses common to all survivors, beginning with shock, numbness, and denial. Like Merryl they may have difficulty eating, sleeping, concentrating. They may have nightmares or anxiety attacks in which they endlessly replay scenes in their mind—particularly if the death was violent or if the survivor discovered the body. “The amount of blood hounded me,” says a woman who found her lover after he had shot himself in the mouth. “I had dreams for a long time about red checkerboards, about typewriters with black and red keys. I had dreams where I was the blood pouring out of his head. I couldn’t get that image out of my mind.”
While survivors may deny that a suicide has occurred by hiding notes or insisting it was an accident, other forms of denial are less obvious. When one man returned home after the funeral of his younger brother who shot himself, he was reluctant to alter anything in any way. “Every time I moved something, even just a dirty dish on the table, I’d think, ‘This is the way it was before he died. If I move this chair or make this bed, he’ll be even more dead. Everything I do is making him more dead.’” A woman who had not seen her husband’s body after his suicide called his office repeatedly without identifying herself. “I needed to hear, ‘No, I’m sorry, he’s passed away,’ because I couldn’t believe it.”
The pain may temporarily be deadened by shock. Some grief experts compare this phase to the “disaster syndrome” of emotional dullness, unresponsiveness, and sense of worthlessness experienced by survivors of earthquakes, plane crashes, and other mass catastrophes. Psychiatrist Robert Jay Lifton, in his study of survivors of the A-bomb at Hiroshima, described it as “psychic numbing,” a turning off of emotions, “in which the survivor’s responses to his environment are reduced to a minimum—often to those necessary to keep him alive—and in which he feels divested of the capacity either to wish or will.” This sounds much like one Ohio high school teacher’s description of the first few months after her son hanged himself: “I was unable to function. I would drive the three miles to school, but I would forget how to get home. I would have to park the car until I could remember. I would go to the supermarket, but when I came out, I could never find my car. Eventually, I gave up going to the store. I was indifferent to stop signs and red lights. I blocked out sound and sight. I became perfectly mute. And no one could penetrate it.”
But eventually, like a patient coming out of anesthesia, the survivor awakens to the relentless enormity of the pain. “It was like a fist reaching into my stomach and closing tight,” says one. “I feel as if he shot a hole bigger than me,” says another. “I felt as if my heart had been torn from my chest and that I was bleeding to death as surely as my husband,” says another. Others: “I felt like a skinned animal.” “I felt as if my insides were nothing bu
t smashed glass, and if you could peel my skin away, I would sift down into a pile of tinkling shards.” “I am curdled with grief.”
Feelings of guilt, common after any death, are vastly intensified after a suicide. Like a child poking his tongue in the hole left by a missing tooth, a survivor examines every interaction with the dead person, from the last contact back to the first. In light of the suicide, every moment becomes evidence of failure. The guilt leads to what grief counselors call the “what ifs” and the “if onlys”—the words or actions they feel might have prevented the death: “If only I’d told her I loved her.” “What if I hadn’t gone out that night?” Survivors may feel guilt if they saw signs and did nothing, guilt if they saw signs and bent over backward to help, guilt if they failed to see any signs at all. Guilt may be especially intense for parents of suicides. Parents are supposed to die before their children. In a society in which the “success” or “failure” of a child is often seen as a reflection of his parents’ worth, a suicide may seem the ultimate evidence of bad parenting. Says one mother, “You tend to say, ‘I have three children. Two are very successful; they did it all themselves. I have one child who killed himself; that was my fault.’ “
If the suicide occurred during a time of conflict between the suicide and the survivor, guilt may be particularly acute. Suicide can be an act of anger directed at others, with the intent of producing remorse. The circumstances of the act—method, location, note—can be indelible expressions of that rage. “There’s no way we can resolve it. He had the last word,” says a woman whose son left a three-word suicide note: “Fuck you all.” Another woman received a series of annoying phone calls from her husband after their separation. One day he telephoned to say he had a gun and was going to kill himself. Exasperated, the woman said before she hung up, “Go ahead.” He did. Today, agonizing over the words she can never take back, the receiver she hung up, she says, “I feel as though I put down a revolver.”
“Guilt is a way of bringing control back into a situation that seems out of control,” says one grief counselor. “It comes from the perception that you could have done something to prevent it. There’s something narcissistic about that because it suggests that you could single-handedly have changed the outcome. It’s not rational because you don’t take that kind of responsibility for anyone’s life while he is alive—otherwise, you don’t allow him to be a person. But when someone kills himself, you feel you should have been around him every waking minute. Everyone does. Everyone suddenly takes one hundred percent responsibility for that person’s life.” In an article in the Village Voice, Sheila Weller described how after a suicide thirty friends gathered to discuss the death. All thirty admitted that they felt in some way responsible. In that unanimity their guilt was eased, and they were able to realize that no one person can make someone die or stay alive.
Survivors of suicide may feel more anger than other mourners: at the deceased for rejecting and deserting them; at God for allowing it to happen; at themselves, their family, or the mental health profession for not preventing it; and at the world for not coming to a halt. “I see people who had far more problems than my brother did, and I get so angry,” says a young man whose brother shot himself. “Why are they alive and my brother isn’t?” Guilt, in fact, may be helpful, say Edward Dunne and Karen Dunne-Maxim, sibling survivors and therapists who have worked with more than two thousand survivors over the past four decades. “Guilt is a way of making the world less chaotic,” they write, “and some guilt is probably important to counteract the feelings of helplessness a suicide may engender.”
In the ancient Hebrew ritual of atonement, a live goat was driven out into the wilderness each year, symbolically laden with the sins of the people. Similarly, after a suicide, survivors often select a scapegoat. The target may be unemployment, drugs, alcohol. It may be a psychiatrist, a boyfriend, a clergyman. Or it may be a member of the family. “There is an especially distressing tendency for the survivors of a suicide to look for a scapegoat,” wrote Erich Lindemann and Ina May Greer. “And, as is the fate of most scapegoats, the victim is usually one of their own members and frequently the one least able to bear the added burden.” Sometimes the scapegoat may even be the suicide himself, who is held responsible for all the family problems.
Anger at the dead person may be the most difficult to express. “I would be so full of rage if somebody killed my brother. And I would be enraged if my brother killed someone. But he’s both those people—and I have both those feelings,” says a man whose brother shot himself. At a meeting of survivors in Minneapolis a woman whose son killed himself blurted, “I’m so angry at him. . . . I could just kill him.” Realizing what she had said, she burst out laughing. A woman whose seventeen-year-old son shot himself five years ago says, “My anger is with myself.” She is quiet for a moment, then she adds, “And at God for letting my child die. And at the family for not seeing it . . . and at his friends, who didn’t tell me he’d talked of suicide.” Her voice begins to boil. “And at the school, who knew he was withdrawing but never called. I know it wasn’t their fault. I know there’s no one to blame.” Her voice shakes. “But it’s one thing to resolve anger in the mind, and it’s another to resolve anger in the gut.” She pauses, and when she speaks again, she is calm, apologetic. “I guess I need someone to place the blame on—anyone but him.”
The suicide of an alcoholic, an abusive parent or spouse, a particularly troublesome child, or someone who has made repeated threats or attempts may be the culmination of an exhausting struggle for both the suicide and the survivor. Perhaps it should not be surprising that one in ten family members confesses to a sense of relief that suicide has brought an end to that struggle. “We all felt some relief,” says one young man whose older brother’s suicide followed four attempts, numerous hospitalizations, and a decade of manic depression that seemed impervious to drug therapy, electroshock, psychotherapy, and the love of his family. “He had been so unhappy, and now he was out of his pain. My mother said, ‘He’s at peace now.’ I felt my brother had finally taken some sort of initiative and been successful at something.” Arnaldo Pangrazzi, a hospital chaplain in Milwaukee who leads survivors’ groups, writes, “Some feel guilty about experiencing relief, which implies neither a lack of love for the deceased nor happiness that he or she died. Rather, relief is the awareness that the tension, the waiting, the fear are over.”
But merely to describe the shock, guilt, anger, and relief is to make them sound as if they were separate emotions with distinct boundaries. In grief they circle back endlessly on one another. A survivor feels angry for feeling guilty, guilty for feeling angry, worthless for feeling guilty, angry for feeling worthless.
Through all these emotions the suicide survivor may be propelled by the question “Why?” Finding a reason for the suicide can become an obsession. Survivors search for notes, read books about depression and suicide, interview friends, talk to therapists, consult fortune-tellers, and endlessly ask themselves questions, trying to make sense of a senseless act, to solve what centuries of professionals have been unable to solve. Survivors often believe that the pain would recede if they could only find an answer. They may latch onto a reason—the lost girlfriend, the unemployment, the alcoholism—but ultimately it dissolves under scrutiny into more questions. Says one grief counselor, “Even if there is a reason, that’s never answer enough.”
In the year following her husband’s suicide one young woman looked everywhere for answers: counselors, survivor groups, suicide symposiums, books on suicide, workshops on holistic medicine, and psychics. She studied her husband’s journal for an answer and stared at the next blank page, thinking that if she waited long enough, the answer might somehow appear. She drew up a two-page summary of possible factors, as much for herself as for friends who, baffled by the suicide, kept asking her, “Why?” Yet even her synopsis listed more reasons “why not.” And she searched for answers in her dreams. “I’ve had dreams where I couldn’t get his att
ention. I’ve had dreams where he’d say he was really alive, and I’d say, ‘No, you’re dead.’ I’ve had dreams where I’m with him, and we have a wonderful time, and afterward I ask, ‘But you died—aren’t you going to tell me what happened?’ But he’d go or I’d wake up. I’ve had dreams where he told me what happened and I forgot. One week for four nights I asked for favors. The first night I asked that he come and visit me in my dreams, and he did. The second, I asked that he come and talk. He did. The third night I asked that he come and make love to me, and he did. The fourth night I asked that he tell me why he killed himself. He didn’t. He refused.”
On the other hand, survivors may try to bury their questions and feelings along with the suicide. “A common response to suicide is to say, ‘Let the dead lie,’ “ says family therapist Monica McGoldrick. “And when a suicide occurs, families tend to close down.” Families may participate in a “conspiracy of silence,” a kind of cold war in which communication is cut off, and each family member suffers alone, behind closed doors, avoiding mentioning the name of the departed, avoiding one another’s gaze. After the suicide of one nineteen-year-old boy, an awkward, troubling silence settled over his parents and surviving siblings. “For months no one talked about him,” says the boy’s mother. “It was as if he’d never existed. Christmas came and went, and no one talked about it. That began to worry us.” The family eventually decided to seek help. “In therapy we found out everyone had wanted to talk about it, but they didn’t want to make other people unhappy.”
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