My 21-year-old sister ended her life on April 16, 1990. There isn’t a week that goes by that I don’t think of her. In my mind, she is as vibrant as the last day I saw her, and she is often in my dreams. She will always be 21, and I will always regret that she did not find a way to get help. I’m sure if she did, she would be alive today.
I argue with psychologists and thinkers who say that a certain kind of lasting grief is pathological. Now they have the medical establishment on their side. This past March, the American Psychiatric Association added an entry to the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5: prolonged grief, defined as intense pain lasting a year after a loss and an inability to resume past activities.
Calling prolonged grief a disorder is useful for insurance purposes, which may be a good thing for those who need treatment. But this paradigm has unintended consequences, suggesting that it is abnormal not to be able to return to daily life after suffering from loss.
I consider grief a forever thing. It returns in different waves of intensity, but it never fully goes away. In the initial years after my sister died, I suffered from post-traumatic stress disorder because of the shock of her act and the distress that ensued. As I’ve come to know more about the suicidal mind, and no longer carry the shame that results from the stigma of suicide and the sense of failure from not having somehow intervened, the grief has become integrated into my mind and body.
That isn’t to say that the acuteness doesn’t return. I can become suddenly devastated again and angry that the extremity of her despair and her suicidal impulses went unnoticed. Those of us closest to my sister knew she was suffering and in a difficult place in her life, but none of us imagined she would take her life.
An intense bout of sadness may arise after hearing or reading about a suicide. Or attending a wedding, as I did recently; I was reminded of when my sister was my maid of honor and the many milestones she did not have a chance to experience in her own life. Or seeing a film in which a character reminds me of her, or wishing she could meet my new puppy. Holidays and family gatherings are particularly difficult. I am seized with reliving the kind of pain my sister may have suffered, the hopelessness and futility she may have felt in the days, weeks, months leading to death. The worst is how much I miss her.
As survivors, we must figure out a way to go forward, but we must not dismiss those who need to hold on for as long as they need. Everyone’s path to acceptance is their own. “The existence of a diagnosis may encourage the misunderstanding that grief is something we need to get over.” writes Mary C. Lamia in Psychology Today. “It is not.”
For those suffering from the loss of a loved one to suicide, grief is complicated. Feelings of loss, sadness and loneliness “are often magnified in suicide survivors by feelings of guilt, confusion, rejection, shame, anger and the effects of stigma and trauma,” according to a study of suicide bereavement. These emotions can prevent people from moving on fully from the loss. Suicide survivors can also feel lonely and isolated. Friends and colleagues may avoid talking about the subject out of fear that it may cause more pain or that they may say the wrong thing. I take solace in International Survivors of Suicide Loss Day, which was earlier this month, a recognition of our enduring pain.
We feel a great need to understand why the person we love took his or her life, how to make sense of the death. We are left in the abyss of not only grief but bewilderment, too, and we hope to get some relief from the “why.” One day we think we understand what might have happened, and on another day we may distrust our judgment.
When I was trying to cope in the years after my sister died, I worked with Dr. Edwin Shneidman, the author of “The Suicidal Mind,” who, with colleagues, invented the psychological autopsy to determine the cause of death if it is uncertain. He helped me create a map of my sister’s inner reality to try to understand why she took her life. The process brought me some relief and lifted some of my guilt. Still, there remains a nagging sense that we could have done more.
I’m convinced more than ever that the person who takes her life tries to live and yet the pain and fog of despair ultimately become insurmountable. The person acts, perhaps, according to an inner narrative that no one else can fully comprehend, and we must be mindful of that and not judge or turn away.
If death takes one of us too soon, we must celebrate that life, and the life we have in their honor. We must also, as individuals and as a society, fight to redeem these losses by insisting on prevention and early detection of distress and make mental health care available to all who are suffering. We must lift the stigma of suicide, so that those who suffer this loss do not suffer alone in alienation and shame. And rather than judge them we must forgive those whose journey to acceptance takes longer than we want it to.
If you are having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources.
Jill Bialosky is a poet, novelist and best-selling author of “History of a Suicide: My Sister’s Unfinished Life.” A 10th anniversary edition of the book was reissued this month. Her new novel, “The Deceptions,” was published in September.
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