Living on after a loved one commits suicide by Chong Siow Ann

                  The Straits Times  December 11, 2018


         It is common to ask why when a loved one kills himself or herself. But with time it is good to leave the search for the unknowable behind.


Some time ago, someone I knew professionally killed himself. I had no inkling that things were not good for him: He had, until then, been unfailingly good-natured as well as efficient and good at his work, which could be demanding, but he seemed to be holding everything together.

As a psychiatrist, suicide among patients is an occupational hazard and when it happens, it is invariably difficult and painful. We sometimes take cold comfort in the saying that there are only two types of therapists: the ones who have already experienced a patient's suicide and those who will.

But this suicide was in some ways, more intimate and cut more keenly and deeply to the bone.

Many people think the term "suicide survivor" refers to those who have tried unsuccessfully to kill themselves, but it actually refers to family members, friends, co-workers and mental health workers who have lost someone, with whom they had a close relationship, to suicide, and whom the suicide has also traumatized in various ways and to varying extent. Studies have suggested that in the wake of a suicide, there would be at least six suicide survivors who would be adversely affected and distressed.



When I first received news of my colleague's death, I had a momentary sense of disbelief. Shock is the stock description for this initial reaction - and what else can it be?

After all, the death is both unnatural and unexpected, and there is no time or opportunity for any anticipatory and preparatory grief, as with a death from a terminal illness.

This is followed by a loop of self-questioning: the "whys" that play over and over in my head and in the head of any other survivor. "Why did he do it?"

Even if it is depression and it often is - depression is the mental illness most commonly associated with suicide and those afflicted are 25 times more likely to take their own

population - and even as we might understand the psychic pain the person had to endure, we feel anguished because we know it could have been treated and there were alternatives - and why did he not consider them and give himself and us a bit more time? Another why.

Our mind will circle back and painstakingly go over the days and the circumstances leading up to the suicide, re-examining the relationship and the last conversation with that person to look for clues and hints that would provide some sort of explanation.

         And we engage in that questioning with a swirl of conflicting emotions: The surge of sadness and regret also bring in its wake an anger, and it is an anger that has a twist of irony because the person that you would perhaps be most angry with for taking the person's life is that same person.

That act of self-destruction is, after all, also an act of abandonment and rejection and a reproach that somehow you were not powerful enough, had not loved enough or were special enough to keep that person from choosing death over everything and everyone else.

This anger also goes in search of something or someone to blame. In the days that followed, I found myself - admittedly unreasonably and even grandiosely - blaming myself (as a psychiatrist) forr not seeing the signs.

Dr Edwin Shneidman, suicidologist and founder of the American Association of Suicidology, once wrote that "the person who commits suicide puts his psychological skeleton in the survivor's emotional closet - he sentences the survivor to deal with many negative feelings and to become obsessed with thoughts regarding his own actual or possible role in having precipitated the suicidal act or having failed to abort it".

I also thought about the psychiatrist who had attended to my colleague and wondered if he or she had not been vigilant enough. Then I thought about my colleague's workplace and wondered if he had been overworked. I also thought about his family and wondered darkly and unkindly if they had not taken his fatal distress seriously enough. Just as there are many ways to kill oneself, there are just as many ways to lay blame elsewhere and often that directing of blame is a means of assuaging our sense of guilt.



The cliche that "time heals everything” does not often apply to suicide survivors. Many struggle interminably for years to make sense of that suicide, if ever, and might even take longer to come to terms with it - if at all.

Celebrated American writer David Foster Wallace who had been described by a fellow novelist as "polymathic, ironic, brilliant, damaged, and under intense pressure to perform" killed himself at the age of 46.

His wife Karen Green came home to find that he had hanged himself on the patio of their house. "When the person you love kills himself, time stops," she said. "It just stops at that moment. Life becomes another code, a language that you don't understand."

         She also said: "It is hard to remember tender things tenderly." Unlike death from an illness or accident, where some happy memories can still be salvaged and treasured untarnished and even burnished with time and nostalgia, it is not so for suicide survivors. They question the authenticity of their memories, even of happy times, and start to doubt if they were really that good and happy, or whether it was all pretence.

Their grief is also complicated by the stigma associated with suicide. Family members who would be interviewed by the police often feel the shame that comes from the perception that they would be judged, and conscious that they would be the object of gossip, morbid curiosity and speculation. Understandably, some survivors would refuse to talk about or may engage in half-truths about the suicide: One study found that about half of suicide survivors would hide the cause of death from friends or acquaintances, and nearly one-third sometimes lied about it.

Even when the details are known, well-meaning friends may not know what to say or how to offer support. Most people would also avoid talking about it, or if they can't dodge it, would raise it with embarrassed awkwardness and usually end up mouthing well-meaning but unhelpful and maladroit comments and giving unsolicited advice.

The avoidance by others could make suicide survivors feel like the rest of the world would rather obliterate the memory and existence of their child, spouse or loved one. Many people would think it is best not "to stir up emotions" and risk invoking painful memories, but a survivor does not forget his loved one or mourn the death any less than someone who has lost a loved one to illness, for accident or crime.

This avoidance and lack of support could have a host of detrimental consequences. Research has shown that suicide survivors are more prone to developing symptoms of depression and post-traumatic stress disorder; they are more liable to get into accidents and develop alcoholism, physical illness and a variety of problems.

I will probably never know why my colleague killed himself, and I'm not sure if his family will either. I have lost a valued and respected colleague - someone I felt affection for - but I cannot imagine what it is like for his family who would probably continue to wrestle with that question for a long time and who have to wake up every morning in a house filled with an unseen painful presence and somehow find the means to keep going.

Perhaps one day they will be able to give up this floundering search for the unknowable and when they do, I hope it will lose its hold over them and relinquish part of that awful legacy.

And we should continue to talk openly and widely about mental health and what is it that makes us despair and question the meaning of life to the point of wanting to end it, and more importantly, how we can pull ourselves and others from the edge of that abyss.


Professor Chong Siow Ann, a psychiatrist, is vice-chairman of the medical board (research) at the Institute of Mental Health.