Years ago, our next-door neighbor, a pleasant, engaging, friendly, middle-aged woman hanged herself from the rafters under her screen porch. We were saddened and shocked by what appeared to us as a most terrible event.
Several weeks later, her husband dropped in to talk. “All day,” he said, “I walk around a hole left by my wife. At night, I fall into the hole. It is the worst I have ever felt.”
Our neighbor’s wife had been in treatment for depression, wanted to see her therapist the day of her death, but no appointment could be scheduled.
Grieving the loss of a loved one is complex, challenging, and protracted when the cause of death is suicide. No matter how difficult, normal / healthy grieving is essential to the eventual return to mental health and a fulfilling life.
Clinical Depression may be conceptualized as a potential terminal illness. As Dr. Aaron T. Beck emphasizes in his book, Cognitive Therapy of Depression, the disorder impairs thinking, and it is the cognitive errors in thinking that cause the impaired emotions.
Few victims of suicide leave a note, but when the notes are examined they are characteristic of people who are not thinking normally at the time of death. The family of a suicide victim may be reassured by comparing depression to cancer. In some cases, both depression and cancer can cause death. Self-blame and “only if” questions distract people from grieving.
Suicide has always been on the list of the 10 most common causes of death. For those between 18 and 24, at least until the recent pandemic of substance abuse deaths, suicide is the second cause of death. When tire skid marks are measured in motor vehicular accidents, short lengths of skid marks combined with other evidence sometimes indicate the “accident” was a suicide.
A loving married couple with a fine healthy son, wanted to have a second child. The wife had no major complications during her pregnancy, but this was before medical imaging. Her daughter was a stillbirth. “I felt sad,” the mother said, “but it was only bad at first. I felt nothing at the funeral. We kept the nursery just as it was even though I was told I could have no more children. My son asked why I went into the nursery so often. He even said the doll baby I had placed in the crib looked real.”
This woman had not grieved. It reminded me of a game we played as children: a Bear Hunt: numerous obstacles are encountered on the hunt and we all shouted, ”You can’t go over it; you can’t go under it; you can around it!” Grief follows every loss. We must go through it.
The price we pay for avoiding grief is extremely costly. Grieving for the loss of a life that could have been is emotionally and cognitively challenging. None but the mother of the lost infant can understand this painful loss. Self-blame, and “what if” questions in miscarriages and infant deaths, as in suicidal deaths, add to raw reality of grief, the price we pay for loving the one who is lost.
Feelings of helplessness commonly experienced by family members and friends of those who are grieving may be lessened by knowing their presence is appreciated more than their words. Compassionate silent presence conveys your understanding. “To be understood is to be immediately comforted.”
Twenty-five years after the death of his young wife, a colleague told my UVA Mental Health class that “the one thing that helped me the most was the presence of my friends, some I had not seen for years, and some travelled many miles. They came, hardly said anything, stayed at my home with me for a week or longer, and saw that my needs were met. It was love without words.”
Teddy bears, stuffed toys, even blankets highly valued by toddlers are called “Transitional Objects.” They serve important purposes as young children begin the slow but significant journey away from the mothering person in to the process of individuation. Vamik Volcan, MD, UVA Professor of Psychiatry Emeritus, one of my mentors, made an amazing contribution to our understanding of grieving with his concept of “Linking Objects,” tangible objects, similar to linking objects, but not used to move away from a relationship, but to keep a deceased person “alive.’
While lecturing in Oxfordshire, England, on “Linking Objects” I stressed that Linking Objects were more than objects of mere sentimental value, but were invested heavily with meaning, creating a substitute for the decedent. A man in the audience stood up ridiculing the concept. “I find it hard to believe what you are saying. My father recently died back in the States. I went home, took care of all the affairs, spoke at the funeral, returned here, and, doctor, I am perfectly fine.”
“Did you cry?” “No,” he said proudly. “Do you have anything that belonged to your dad?” Smiling, “No,” he promptly replied. “Do you have anything on your person that belonged to your dad?” “No…,” placing his right hand on his left wrist, he said, “I have my father’s watch.” He burst into tears without shame. Until he discovered he was keeping his dad alive with a substitute or Linking Object, he had no need to grieve; he still had his dad as close to him as possible.
A fellow classmate in a Zoom Bible Class complained over the past few months about word-finding difficulty and memory loss. A biblical scholar and devout Christian, he and his wife accepted their son’s invitation to move to another state to be nearby. Once settled in, he saw a neurologist, learned he has an advanced brain tumor, and made a rational decision to decline treatment.
“I have no fear about death. I’m looking forward to meeting Jesus. I love my wife and family, and I look forward to meeting them in heaven when they arrive later.” My classmate knows in his heart, mind, and soul that Jesus, “the Lamb of God,” is the incarnate God in the flesh, who keeps his promise never to leave or forsake those who accept his divinity. No greater promise has been made than Jesus’ promise to prepare a place for us with Him in heaven for life without ending
Yes, it is normal and difficult to grieve for those we love. Grief is essential. There is “Good Grief” for all who believe the promises of Jesus. Grief need not be everlasting.
Funerals today are often called “Celebrations of Life,” but the real merriment begins, as we are reminded in the by lyrics of one of my favorite hymns written in 1867: “There’s a land that is fairer than day. And by faith we can see it afar. For the Father waits over the way to prepare us a dwelling place there. In the sweet by and by, We shall meet on that beautiful shore; In the sweet by and by, We shall meet on that beautiful shore.”
In the Sweet By and By.
Robert S. Brown, MD, PHD a retired Psychiatrist, Col (Ret) U.S. Army Medical Corps devoted the last decade of his career to treating soldiers at Fort Lee redeploying from combat. He was a Clinical Professor of Psychiatry and Professor of Education at UVA. His renowned Mental Health course taught the value of exercise for a sound mind.
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