Suicide and Cancer: My brother’s passing x

Dear Dr. Neimeyer,

My brother died a few months ago from suicide.  He shot himself in his bed after fighting cancer for two years.  The last time I saw him he looked like a skeleton, and the police said he was so dehydrated that there was almost no blood on the sheets.  I’ve been able to manage okay in my daily life, and at least I am retired so I don’t have so many demands.  But I can’t seem to get the pictures of him out of my mind–both my last memory of him wasting away, and what I imagine his deathbed scene looked like.  His wife doesn’t want to talk about it, so I feel so alone with this.

I’ve started going to a suicide loss support group, and it is good to feel understood by other people who “get it.”  But I am reluctant to share these troubling images with other group members out of fear of overwhelming them.  As a result, I stay silent, or just talk generally about how bad I feel and how I can’t sleep very well.  I feel almost like I am keeping a secret from them by holding back on sharing the imagery, but I tell myself it is for their own good.  Some of the people seem so fragile, and others seem like they are “over it,” after being in the group for a couple of years, and really there just to help other people out.  I trust the couple who runs the group, but don’t know if I should say something to them or not.

My question is, should I say something about the pictures in my head that torment me, or will they just fade away over time?

Charlene

Dear Charlene,

In some ways, it seems like the circumstances of your brother’s death presents you with the worst of both worlds–watching helplessly as he was slowly reduced by the cancer, and then receiving the traumatic news of his self-determined death.  And the images of both, unlike more typical grief-related sadness and missing of a loved one, may not simply dim with time.  In fact, the attempt to suppress intrusive thoughts and images can actually prompt their unbidden return at times when your guard is down, as during sleep and dreaming.  So how can you best use your suicide support group to help you through this?  Here are a few ideas.

1. Acknowledge your needs. In some ways, intrusive thoughts can be seen as intruding for a reason–to receive the attention they require.  Being able to invite them in–on your terms–represents a first step.  Asking your group leaders for some time to focus on this with the group is appropriate, especially if the group members are genuinely compassionate and understanding.

2. Ask permission. With the help of the group leaders, ask the group for some time–perhaps 15 minutes–to share some of the more troubling aspects of your memory of your brother’s death.  The leaders will probably want to caution members that some of the images may be graphic and difficult, and may involve not only what you saw in reality, but also what you saw in your fearful reconstruction of the scene in your own mind.  If the leaders are comfortable with this, one leader can accompany members who do not feel ready for this explicit discussion to accompany him or her to another room, while remaining group members bear witness to your account, listening, asking questions, and providing support.

3. Set a timer. In advance of the sharing, agree with the group leader on a certain amount of time to spend with this, with 20 to 30 minutes usually offering enough time to let you tell the story and receive what the group has to offer you.  Note that the most helpful thing is likely to be the opportunity to speak about what had previously been a silent story, as the group guides you in just “sitting with it,” rather than trying to offer simple advice on how to “solve the problem.”  Setting a time after which the leaders will steer the conversation to others or reconvene the whole group can help make the telling “safe enough” for both you and other members, avoiding the feared possibility of an unbounded, overwhelming traumatic account.

4. Consider if more is needed. If your group leaders seem uncomfortable about accommodating your request, recognize that it may say more about their lack of training for handling the retelling of traumatic stories than it does about the legitimacy or your request.  If the group seems like the wrong place to address the haunting images, consider consulting a trauma-informed grief therapist, who likely will be familiar with exposure-based treatments of the kind described above.  Whether with the support of a group or a private therapist, you can gradually come to master the troubling imagery surrounding your brother’s death, so that you can turn fuller attention to mourning a beloved sibling whose memory you want to recover from the traumatic circumstances of his death.

Dr. Neimeyer