Preventing after a suicide death

The WHO lists suicide as the fourth cause of death in young people between 15 and 29 years old.

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Preventing after a suicide death

Written by Laura Casamitjana

The WHO states that 280 million people suffer from depression globally, there are more than 700,000 suicides per year, and it is the fourth leading cause of death in young people aged 15-29. With the present interconnection between depression, mental health and suicide, a particular population group becomes vulnerable: they are the relatives of people who have committed suicide, also called “survivors. “Postvention”, a crucial form of prevention, focuses on those affected by a self-inflicted death.

This report contains sensitive content. If you have suicidal thoughts, remember that help is available 24 hours a day in the UK: In a life-threatening emergency, remember to dial 999 first / To speak with us, dial 0800 689 5652 (National Suicide Prevention Helpline UK). If you are in a process of mourning for suicide, there is also support available: 0300 111 5065 (Survivors of Bereavement by Suicide)

The Real Academia Española or RAE (Royal Spanish Academy) is an institution that catalogues language, describes the meanings of words and, in general, is attentive to the changes that language itself may undergo. It is therefore an entity that has the power to set the standard for something as important as what we use to express ourselves, communicate and define things to give them a form of existence. According to the RAE, the word prevention has the following meanings:

Prevention

From the Latin praeventio, -ōnis.

  1. f. The action and effect of preventing.
  2. f. Preparation and provision made in advance to avoid a risk or to execute something.

However, when searching for the concept postvention, the RAE gives the following information:

Note: The word postvention is not in the dictionary.

As the anthropologist Lluis Duch used to say, “to make the world our condition”, and that is why, although the word postvention does not have institutional recognition, it exists, because postvention exists. And that is why, although the word postvention does not have institutional recognition, it exists, because postvention exists. What happens after prevention?

Amapola is a young woman who, during the pandemic, had to begin her grieving process for the death by suicide of her sister at the end of November 2019. She spreads the word on Instagram (@asi_canta_el_amaranto) where she spreads awareness of the concept, and through her own story helps survivors (people close to the deceased loved one) to find networks of support and understanding. “Postvention, in simple terms, is the prevention of people affected by a death by suicide. It consists of therapeutic, organisational, and educational activities with the aim of reducing the negative consequences of a death by suicide (emotional stress, symptoms associated with trauma, depression, etc.), lowering the risk of death of the so-called ‘survivors’ and allowing a healthy elaboration of the mourning process,” explains Amapola. Regarding survivors, the young woman stresses that this concept involves not only family members or those close to them who have lost a loved one, but all those who feel negatively impacted by the death and adds that some research suggests that for every suicide there are around 135 survivors who will suffer that loss.

Care and support

The Asociación de Investigación, Prevención e Intervención del Suicido y Familiares y Allegados en Duelo por Suicidio (RedAIPIS-FAeDS) or Association for Suicide Research, Prevention and Intervention and Bereaved Family and Friends of Suicide is an organisation that, in addition to offering support to survivors, provides awareness-raising activities so that teachers, parents and adolescents can learn to detect warning signs linked to possible suicidal behaviour. Javier Jiménez is a psychologist and founding member of the association and has been dealing with these types of cases for three decades.

“There are many different cases, but the most extreme of all is when the person in the environment commits suicide after the suicide of their loved one,” says the professional. As Amapola points out, survivors see their chances of dying by suicide increased, making them a vulnerable group that requires attention and containment. According to Jiménez, suicidal ideation in a person who has experienced the suicide of someone close to them is multiplied, although it is another matter whether it actually happens. But the ideation is there in many cases, especially when it comes to parents who have lost a child to suicide, and more specifically, if it was an only child. Another recurrent case would be spouses who have lost their partner. “The first thing to help a survivor is to see what their main feelings and emotions are. Although each person may experience it in different ways, the most recurrent and common among these people is guilt”, says the psychologist, who mentions as a point of value the fact that today in Spain there are more than 20 Survivors’ Associations where they can seek help.

Carles Alastuey, psych pedagogue and vice-president of the association “Después del Suicidio – Asociación de Supervivientes” (DSAS) or After Suicide-Survivors’ Association, is of the same opinion. The Catalan organisation was a pioneer in Spain in terms of setting itself up as a channel of help for survivors and an opportunity to listen and generate a support network, and the mission of DSAS focuses on, in addition to offering information and shelter to those affected, generating support groups among them: “The work we do in the organisation is work among equals, who, although they are people who a priori do not know each other, have that solidarity of having gone through something similar”. He agrees that guilt is a recurring element among survivors: “Guilt, anger, lack of understanding, absolute despair are among the most common feelings, and they tend to last for a long time”.

She explains that the working procedure in DSAS is first of all to authorise the expression of feelings that cause so much disturbance because they are considered negative: “we are hurt with that person because they have abandoned us, they have done it that way, we are angry, we are sad because we think that we did not know how to see, interpret or help that person. We are in very intense pain because in the case of a death of this type, it is usually in very violent, very traumatic situations. People don’t take their own lives easily. All of this involves death by suicide in a traumatic experience that professionals have compared to the experience of a concentration camp, to a war”.

Killing Werther

God only knows how many times I have fallen asleep with the desire and the hope of never waking up again. And the next day, I open my eyes, see the sunlight again and feel the weight of my misery.

In 1774, Johann Wolfgang von Goethe published his greatest success, the novel “The Sorrows of Young Werther”. In the epistolary work we can see how Werther expresses more and more explicitly his lack of longing for life. He is in love with Lotte, an engaged young woman. The book ends with the suicide of the protagonist. The magnitude of this novel generated a fashion in which young people dressed like the character, and there was even a wave of suicides. These events led the sociologist David Phillips, two hundred years later, in 1974, to baptise this phenomenon of imitation as the “Werther effect”, promoting the belief that talking about suicide led to an increase in suicides. Years later, it has been considered that this happens when the media, public opinion and cultural products talk about suicide in an irresponsible, sensationalist, morbid, even romanticised way, and without any pretence of caring for the mental health of the population or offering resources to those who are in a vulnerable situation.

Talking about suicide, talking about it properly, can prevent it. While we have the theory of the “Werther effect” (or copycat suicide), we also have the theory of the “Papageno effect” – named after the bird-man character symbolising the struggle between the powers of light and darkness in Mozart’s operetta “The Magic Flute”. Amapola defines it as follows: “this effect is based on the fact that, in the media, news or reports associated with mental health and the problem of suicide are communicated in a safe way and with a preventive effect”. He cites examples such as warning in public news stories detailing a death by suicide that the content to be covered is sensitive, so that people can decide whether to watch it at that moment or do so when they feel safer.

Regarding media and social awareness, he explains that it is important “to be careful about the language we use and not to reduce suicide to a single cause. We must remember that it is a multi-causal phenomenon where genetic, social, family, and cultural factors are intertwined, and that the central point is to end indescribable suffering. Therefore, avoid using labels such as ‘brave’ or ‘cowardly’, or saying that the person committed a sin or assuming that they did not think of others when committing the act. Value judgements only create more pain.

Alastuey, vice-president of the DSAS, on Werther and Papageno, stresses that we now know that silence is not the right thing to do: “there is an imitation effect, but not if we inform in a pedagogical way and place it on the same level as a health problem. It is crucial not only to inform, but also to offer resources”. In addition to this, he says that the approach and media treatment often goes to the superficiality of the problem: “The most important thing about suicidal behaviour is to understand that it is multifactorial, and the media tend to simplify it (through ignorance) and associate it with a specific phenomenon. For example, the economic phenomenon, ‘he commits suicide because he is being evicted’. It is true that there are social and economic phenomena that can be an element that triggers the behaviour, but in no case does it explain it”.

Beyond the cemetery walls

“For 1500 years, the church, or what could be called the state, punished both the person who committed suicide and his or her family members severely. Only thirty-nine years ago, the person who committed suicide was considered to have a psychological problem, a mental disorder. And mental pathology is also highly stigmatised”. Javier Jiménez is clear about some of the main satellites that revolve around survivors: guilt, taboo, and silence. “One of the main things that the professional must try to do is to break down the guilt of the person affected; guilt is not rational. Guilt can be by action or by omission: ‘if I had done/said this maybe…’, or ‘if I had not done this maybe…’. In many cases survivors are left with the last thing they have done. You must make them see that they have supported that person, that they have been attentive, that they have cared”.

For Amapola, guilt is the prelude to silence:

“families hide what happened because we still live in a society that stigmatises suicide and produces feelings of guilt and shame in survivors. It is this fear of being singled out and blamed that often leads those close to them to keep quiet about the real cause of death”.

The psychologist Javier Jiménez explains that in addition to social silence, sometimes, in addition to not expressing what has happened outwardly, there is an attempt to hide it within the family nucleus: “very often the survivors themselves have a tendency to hide it, I refer to a case in which a son committed suicide and the mother tried to hide it from the siblings, from the other children”, he comments.

Cultural factors are, as Jiménez says, one of the main reasons for the taboo, and he says that 1500 years ago, property was taken from the relatives of those who had committed suicide: “real savagery was done with the body of the suicidal person. So many years of punishment and stigma carry a lot of weight”, he concludes. The vice-president of DSAS, Carles Alastuey, adds that during the 18th and 19th centuries the families of people who committed suicide in various European countries were condemned, punished and even had their property expropriated: “today there are some countries on the African continent where people who have survived a suicide attempt are sentenced to prison, and the relatives of people who have died by suicide are expelled”.

In religious terms, the Council of Trent established that “God gave life and only God can take it away”, so that a suicide became someone who attempted against the divine power, reason for, among other punishments, being condemned to not being able to be buried in the cemetery.

Someone who wants to listen

For Carles Alastuey, the root of the issue lies in a double taboo: “suicide is accompanied by stigma, but not only suicide, but also mental health issues”. As she points out, for Amapola it is also a crucial issue: “to break down the stigma we have to talk about mental health and we have to talk about suicide, but in a responsible way. It is a task we must do as a society as a whole: to destigmatise going to therapy, to support access to effective treatment and to have a support network. More psychoeducation in educational establishments, more accompaniment. Listen more and give opinions less, be more empathetic and be willing to educate ourselves not from myths but from information that can save lives and improve the quality of life”.

“We are homo sapiens because we are homo narrans. Our nature is narration”, says the author José María Merino. “Nothing in the human condition is more fragile and ‘more human’ than that which is sustained by the practice of discourse,” stated  Hannah Arendt. “We are constantly self-narrating, in thinking, in feeling, in being-existing: language makes my subjectivity ‘more real’, not only for my interlocutor, but also for myself”, say the sociologists Berger and Luckman.

Silence is not an option for survivors or for society. As RedAIPIS-FAeDS psychologist Javier Jiménez says, survivors have to go through a process of putting a name to what has no name, of generating a narrative, of understanding the mental process of the person who has committed suicide. For his part, the vice-president of the DSAS insists that being able to share this pain is fundamental. To normalise the whole range of uncontrolled, contradictory, and unbalanced feelings after the loss by suicide. To do so without fear of judgement or condemnation. Educate about the process and also explain that, although it may seem that there is no evolution, it is necessary to work with the pain in a committed way: “we are not going to forget, we are not going to prevent that death from probably marking a before and after in our lives. But we are going to manage to redirect a good part of those toxic feelings that can lead to a very negative, even pathological evolution of grief”, he concludes.

Amapola stresses that “in order to elaborate this process in the best possible way, it is necessary to create a safe space where survivors can share their pain, talk about what happened and be listened to without judgement or blame, in order to lay the foundations for the process of recovery and resignification of the tragedy”.

Again, she says, the key is postvention: “having a safe space to ask for help in a critical situation such as suicide can save lives despite the irrecoverable loss that such a death entails. But to talk, we need someone who wants to listen to us”.

complementary activities

EASY

Preventing after a suicide death

Written by Laura Casamitjana

The WHO states that 280 million people suffer from depression globally, there are more than 700,000 suicides per year, and it is the fourth leading cause of death in young people aged 15-29. With the present interconnection between depression, mental health and suicide, a particular population group becomes vulnerable: they are the relatives of people who have committed suicide, also called “survivors. “Postvention”, a crucial form of prevention, focuses on those affected by a self-inflicted death.

This report contains sensitive content. If you have suicidal thoughts, remember that help is available 24 hours a day in the UK: In a life-threatening emergency, remember to dial 999 first / To speak with us, dial 0800 689 5652 (National Suicide Prevention Helpline UK). If you are in a process of mourning for suicide, there is also support available: 0300 111 5065 (Survivors of Bereavement by Suicide).

The Real Academia Española or RAE (Royal Spanish Academy) is like the “boss” of the Spanish language. It is in charge of telling us what words mean and it is always watching how our language changes. It is like the guardian that defines how we use words to speak, write and understand things. According to them, the word “prevention” can mean different things:

Prevention

From the Latin praeventio, -ōnis.

  1. f. The action and effect of preventing.
  2. f. Preparation and provision made in advance to avoid a risk or to execute something.

However, when searching for the concept postvention, the RAE gives the following information:

Note: The word postvention is not in the dictionary.

As the anthropologist Lluis Duch used to say, “to make the world a mess is our condition”, and that is why, although the word postvention does not have institutional recognition, it exists, because postvention exists. And that is why, although the word postvention does not have institutional recognition, it exists, because postvention exists. What happens after prevention?

Amapola is a girl who during the pandemic had to deal with the death by suicide of her sister in November 2019. On her Instagram (@asi_canta_el_amaranto), she shares her story and spreads the concept of postvention. She does this to help people like her, who lost someone close to them, to find support and understanding.

According to Amapola, postvention is basically what is done to help people affected by the death of someone by suicide. It is therapeutic, organisational, and educational activities to reduce the emotional impact, trauma, depression and other things that can arise after such a loss. They aim to help the “survivors”, who are all those who feel affected by the death, not just family members or close friends.

Amapola also mentions that for every person who commits suicide, about 135 more people will feel the pain of that loss.

 

Care and support

The AIPIS-FAeDS Network is a group that helps people who have lost someone to suicide. Not only that, but they also teach teachers, parents and children to recognise signs that might indicate that someone is thinking of committing suicide. Javier Jiménez, a psychologist who has worked there for a long time, says that when someone close to them commits suicide, the people left behind are more likely to do the same. It’s as if the idea sticks with them, although not everyone does it. But the idea is there, especially in parents who lose a child or those who lose a partner.

Jiménez says one of the most common feelings among survivors is guilt. But there is help. In Spain, there are more than 20 groups where they can seek support.

Another psych pedagogue, Carles Alastuey, from the organisation “After Suicide – Survivors’ Association” (DSAS), speaks from the experience of his association in Catalonia. His group also helps survivors of suicide. They give them a place to talk and support each other. For them, the most important thing is to accept those difficult feelings, such as anger, sadness, and guilt. They know that it is a very intense and long-lasting pain.

Both groups strive to understand and support those going through this. They know that the impact of suicide can be like living through a very traumatic experience, difficult to overcome.

Killing Werther

God only knows how many times I have fallen asleep with the desire and the hope of never waking up again. And the next day, I open my eyes, see the sunlight again and feel the weight of my misery.

In 1774, Johann Wolfgang von Goethe released “The Sorrows of Young Werther”, a novel that caused a huge stir. In this story, Werther, the main character, increasingly shows his lack of will to live because he is in love with Lotte, an engaged girl. It ends tragically with the suicide of the main character. The book was so popular that young people started to dress up as Werther and there were even more cases of suicide! This phenomenon was christened the “Werther effect” (or copycat suicide) in 1974, when sociologist David Phillips identified it, thinking that talking about suicide could lead to more suicides.

But there is another theory, the “Papageno effect”, named after a character in a Mozart opera. Amapola explains that this effect is when the media talk about suicide in a safe and preventive way, helping to prevent it. She suggests that when talking about suicide in the news, they should warn that it is sensitive content so that people can decide whether they want to watch it or not.

It is key to talk about suicide with care. Amapola insists on avoiding labelling those who commit suicide as “brave” or “cowards”. Suicide has many causes, such as family, social, cultural, and other problems, and simplifying it only increases the pain.

Alastuey, vice-president of DSAS, says that keeping quiet is not the solution. Talking about it can have consequences, but if done in an educational and supportive way, it can help. He believes that the media often simplifies suicide by associating it with a single problem, such as economic problems, when in reality it is much more complex.

Beyond the cemetery walls

For 1500 years, the Church and the State severely punished those who committed suicide and their families. But it was only 40 years ago that suicide began to be seen as linked to mental problems, that the person was suffering from a psychological disorder. However, the stigma about mental health remains strong.

Javier Jiménez, an expert on the subject, identifies common feelings among survivors: guilt, taboo and silence. He stresses that undoing guilt in those left behind is fundamental. Many times, they blame themselves thinking “if I had done or said this, maybe…” or “if I had not done this, maybe…”. It is important to make them see that they did support the person and that they did what they could.

Amapola adds that guilt leads to silence. Families often hide suicide because of the social stigma surrounding it. Fear of being judged causes them to keep the true cause of death a secret.

Jiménez adds that the taboo has long been rooted in cultural factors. For centuries, the families of those who committed suicide were punished and stripped of their property, which has left a deep mark on society.

DSAS vice-president Carles Alastuey mentions that in the past, in several European countries, the families of those who committed suicide were punished and even expropriated. Even today, in some African countries, survivors of suicide attempts can be condemned, and family members of those who commit suicide can be expelled.

In religious terms, the Council of Trent considered suicide as an act against divine power, so suicides were punished and were not allowed to be buried in the cemetery.

Someone who wants to listen

Carles Alastuey highlights a double taboo at play: “Suicide comes with a stigma, but so do mental health issues”. According to Amapola, this is key: “To remove the stigma, we must address mental health and suicide, but in a responsible way. It is a collective task: destigmatising therapy, facilitating access to effective treatment, and creating support networks. We need more mental health education in schools and more support. Listen more, judge less, be empathetic and willing to learn, not based on myths, but on information that can save lives and improve quality of life.

 

“We have been called Homo sapiens because we are Homo narrans. We tell stories, that is our nature”, said José María Merino. Hannah Arendt, for her part, stressed that “nothing in the human condition is more fragile and ‘more human’ than what is sustained through the power of discourse”. For the sociologists Berger and Luckmann, “we narrate ourselves constantly, in our thoughts, emotions, in our existence. Language makes my subjectivity ‘more real’, not only for the listener, but also for myself.

Silence is not an option for survivors or for society in general. Javier Jiménez, psychologist at RedAIPIS-FAeDS, stresses that survivors need to name what is difficult to name, create a narrative and understand the mental process of the person who committed suicide. The DSAS vice-president underlines the importance of sharing grief, normalising uncontrolled and contradictory feelings after suicide loss. It is crucial to do so without fear of judgement or condemnation. Educating about this process is fundamental, explaining that although the path may seem stagnant, engaging with grief can help to avoid negative and pathological consequences of bereavement.

Amapola stresses the need to create a safe space where survivors can express their pain, speak without judgement or blame, thus laying the foundation for their recovery and redefinition of the tragedy. For her, the key lies in postvention: “Having a safe space to ask for help in critical situations such as suicide can save lives, despite the irremediable loss it entails. But to talk, we need someone who is willing to listen.

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