Dear Dr. Neimeyer,
I have a friend who is a retired Obstetrician/Gynecologist from a world renowned medical group. He ruminates and is depressed about a patient he had many years ago. She suffered from postpartum depression after giving birth, and then died by suicide. He tells the story that she came to him, and he believed at the time she would be ok. Then her husband called him to relay that she had taken her life with a gun, leaving behind several young children. Dr. Neimeyer, is this Disenfranchised Grief, or Complicated Grief being that he has carried this with him for so many years?
Any advice for him to forgive himself?
Thanks for your compassionate outreach on the part of your physician friend grieving the tragic death of a patient so many years ago. When suicide strikes, it leaves many questions unanswered, and a great well of potential guilt for all those who knew and cared for the victim, including those who cared for him or her in a professional capacity. And guilt certainly complicates grief, reinforcing our rumination about the death as we seek to make sense of it or “undo” it in some fashion, or repeatedly engage in inner dialogues of self-blame for what we did or did not do that could have contributed to the tragedy. Physicians, who are often the first-line professionals having contact with the potentially suicidal person, may be especially prone to this, and the trauma of the death can be all the more shocking and horrific for specialties beyond psychiatry, whose members are likely to have less experience and training in evaluating and treating suicide risk, as well as in dealing with patient loss as an all-too-common occurrence across a long career.
You also ask if the grief of your friend could be considered disenfranchised, in the sense that it receives little social recognition, validation and support. The answer, of course, is almost certainly “yes,” as few consider professional caregivers legitimate “mourners,” and indeed may blame them for presumed negligence in insufficiently evaluating or treating the condition leading to the suicide. These responses on the part of much of the social world are understandable, even if they do not take into account the realities of time pressures in clinical practice, the difficulty in assessing suicide risk, the expectation that prescribed medication would reduce the symptoms of depression and attendant risk, etc. Alas, suicide prevention is an inexact science, and even with the best of efforts, tragedies will continue to occur.
So what might your friend do? Rational considerations of this kind typically have little effect, unfortunately, as the moral and emotional part of us that cultivates ongoing self-accusation and grief resides at deeper levels than our conscious consideration of these factual or logical responses. What might be more helpful is attempting to learn something of value from the experience, and translate it into action. This might take the form of visible action in the world, as in using one’s professional skills in retirement in a compassionate, healing way, perhaps speaking to relevant groups about depression as a form of community or professional education, or joining in suicide awareness walks or other attempts to make a difference through mitigating the risk of future tragedy or offering support to survivors. But this might also take a more inner form, as in meditating seriously on our own fallibility as human beings, our own provisional efforts to understand, predict and control events in life, and to practice humility and compassion in response to ourselves and others in our professional and personal lives. This is deep work, commonly reserved for our later years, when we can review life’s lessons and cultivate the wisdom they might yet confer.