I was the newcomer to the group, along with Elizabeth. I guessed she was in her late forties, but sorrow has a way of making age indeterminable. Elizabeth had just lost her son, Charlie, that month. She found Charlie after he hanged himself in her garage. (All names used in this story have been changed to protect subjects’ privacy.) Before the meeting, we were both escorted into a side room off the hall, away from the group. A counselor explained to us how the system worked, and asked about our loved ones and ourselves. Elizabeth had a hard time speaking through her tears. We were given name tags and ushered into the group. Everything I had anticipated and concocted in my mind about what was next to come turned out to be wrong.

I have known five people who have committed suicide. The first was a college friend who hanged herself when we were both in our early twenties. She was the ultimate overachiever, never satisfied with her performance. In my thirties, my boyfriend’s brother jumped off a bridge, and I lost a roommate and a friend from the music scene to overdoses of heroin and pills. Those of us who knew both of them understood that these overdoses weren’t accidental. Then there was Karen.

Five cannot be a normal number; but then there is nothing normal about suicide. Our natural instinct as humans is to survive. Thrown into water, we will fight to keep from drowning until the last breath. To kill ourselves is to go against every natural instinct we are born with; to commit suicide, one must be broken on the inside. One of the counselors that night shared this insight with me and it resonated.

It has been ten years since my best friend, Karen, shot herself. She was seven months pregnant, and killed both herself and her unborn child with her husband’s gun. It was a gruesome end to a beautiful person. At group, survivors learn that saying out loud how your loved ones killed themselves is an important step in the grieving process. I am a suicide survivor. Mistakenly, many think the term refers to people who have unsuccessfully attempted suicide. The term actually refers to a family member or friend who has lost a loved one to suicide. According to the Centers for Disease Control and Prevention, 38,364 people committed suicide in the United States in 2010 (the most recent statistic available)—a figure greater than the number of people in the U.S. who died in car crashes that year. It is generally estimated that every suicide leaves behind six suicide survivors. The New York State Office of Mental Health says this may be a low estimate, and quotes numbers closer to 28 suicide survivors per suicide victim. When those numbers are compounded, “since, on average, 1,200 New Yorkers die by suicide each year, the latter estimate means approximately 60,000 people qualify as suicide survivors each and every year. This is equivalent to the population of the city of Utica.”

I’d read about twelve-step programs, known people who have attended them, and seen them portrayed in films and on TV. I tried to draw parallels in my mind on the train ride that evening, but it got me nowhere. I anticipated my first Suicide Survivor Support Group might go something like this:

Step One: Try to gain insight into why people I knew and loved took their own lives.

Step Two: Share my feelings of guilt over not being able to stop them.

Step Three: Listen to others’ heart-wrenching stories.

Step Four: Cry.

Steps Five through Twelve: Repeat steps one through four.

After ten years of the same questions running on a loop in my head, and sorrow following me around like a needy cat, I didn’t really factor “healing” into the support group process.

I have survived Karen’s suicide by telling myself that my friend—my beautiful, gentle friend, a mother with a wonderful teenage son who worked with children all her life—did not do that to herself. My kind, loving friend did not kill her unborn child, did not take her own life in this brutal way. She would never willingly leave her son without a mother. Someone, something else, performed that horrible act. But the truth is, Karen did do it. She suffered from a mental illness that developed in her thirties. She had it under control while medicated, but went off her medicine during her pregnancy.

For suicide survivors, after the initial shock of learning of the death, the “whys” begin—terrible, unending “whys” that we play over and over in our head. The first being, “Why did she do it?” Only a third of those who commit suicide leave notes. Even then, nothing written on a piece of paper or in an email can truly answer that question, because suicide is nonsensical. No “reason” makes sense because all of us left behind know there were alternatives—why did she not see them? Another why.

Next why: “Why did I not see this coming?” Suicide survivors often tell stories of having a perfectly ordinary conversation with their loved one only an hour before they commit suicide. Often plans are even discussed for the next day, week or even that night. One son had just put a deposit down on a month-long writing program only that week.

Everything about that last conversation is normal. Sometimes after the suicide, survivors find evidence that the act had been planned for months or longer. One mother pondered whether it had been a recent change in medication that had triggered the suicide until she realized her son had ordered the helium tank a year earlier. No signs had been apparent. Not a hint.

The “whys” then get more specific and often turn to blame. In my case, the first “why” I asked: “Why was there a gun in the house, given her history?” Followed rapidly by, “Why weren’t doctors more aware of the danger of her mental state?” “Why didn’t her husband see warning signs?” And of course, the “why” question that is most haunting for all suicide survivors, many for the rest of their life: “Why wasn’t I able to stop it?”

The moment Peter picked me up at the train station, I erected barriers to protect myself. Incessant chatter filled up time. While Rebecca and Peter packed up cookies and tissues at their home to bring to the support group, I became a rock. I knew, if I opened myself up even a crack, I might crumble. I was not a person keen on “crumbling” in front of a room full of strangers. Deep inside, I was only kidding myself. I desperately wanted the group to magically make me spend more time remembering Karen for her life and our friendship, and allow me to stop dwelling on the way she ended her life. Ten years felt like way too long to still feel so raw inside.

The expression “time heals everything” does not often apply to suicide survivors. The bereavement process is complicated not only by the natural feelings of grief and loss, but by the guilt and the stigma associated with suicide. There is also this: the person you are most angry with for taking your loved one away is your loved one. They are, in a strange way, the only one to blame. This incongruent despair mixes with destructive self-blame and blame directed at anyone we feel responsible—for not seeing the signs, not being home at the time, not making sure our loved one took their medication, not keeping medication locked up. There are as many ways to blame as there are ways to commit suicide. It’s daunting. I blamed Karen’s husband, I blamed her doctors, and of course, I blamed myself.

On the drive over, Rebecca and Peter told me that most people attending the group will have lost a child or spouse. They explained there were approximately sixty members in the group, but attendance varies greatly from month to month, and they never know who or how many will show up. Some members had been attending for years, but Rebecca and Peter warned that for others it would be their first time, and they would be dealing with a very recent suicide. From the car, Rebecca returned a phone call to a parent who recently lost a child. While she was on the phone, Peter explained why they like to return calls promptly. There is no stronger sign of a dysfunctional group than an unreturned phone call or full answering system, unable to receive a survivor’s voicemail. I was struck by the thought that there could be so many survivors seeking support that group message systems across the country were filled to capacity. Rebecca hanged up and told us that this particular survivor wouldn’t be attending tonight’s session after all. She wasn’t ready; she still hadn’t shared with anyone how her child had died. Her shame was too great.

Feelings of shame devastate many suicide survivors. Judgment comes not only from society, but also from friends and family. There appears to be no greater “blame game” than the one that surrounds suicide. I had some experience with this already. I watched a boyfriend’s family implode with his brother’s suicide. His devastated parents turned their eyes to his wife and the whys began. “Why didn’t you see he was depressed? Why didn’t you take it seriously when he said he felt like killing himself?” The blame game drove the family irreconcilably apart. I heard similar stories at the support group that night, stories of blame and shame. In-laws blamed Tina, a young mother, for their son’s suicide, and Raine was unable to attend a family funeral because she and her children were considered “bad luck” after her husband committed suicide.

In the United States, at least the stigma of suicide is being addressed by the acknowledgment that it’s a mental health issue. In some countries, mental illness carries such a heavy stigma that it compounds the problem. South Korea currently has the highest suicide rate per capita, according to The World Health Organization. South Koreans, like residents of many Asian countries, rarely seek support for mental illness or depression, the leading precursor to suicide. In Japan, suicide survivors are often forced to pay for expensive purification rituals, or even the remodeling of an apartment, because a loved one’s suicide has made the property un-rentable.

Rebecca and Peter’s home is filled with family photographs. They celebrate their son’s life and the time they spent with him. For them, helping other suicide survivors deal with grief and educating the public about suicide has been part of their healing process. They spend a great deal of time immersed in writing and lecturing on suicide, yet they are warm, affectionate, and full of life.

Rebecca and Peter decided to form their support group after attending another group for several years following their own child’s suicide. While the first group helped them, they had disagreed with the policy of not discussing methods and details of the suicides.

Sitting around a large folding table maneuvered into a square, the first thing we did as a group was go around the room, introduce ourselves, and share how our loved one had killed himself or herself. Tom and Samatha’s daughter Ruby jumped off a building. Charlie hanged himself, as did Peter and Rebecca’s son. Tina’s husband Ron shot himself in front of her. Liz’s daughter Fay and Raine’s husband Stan committed suicide with overdoses of medication. Two mothers, Sheila and Patricia, shared that their sons had both killed themselves by suffocation with helium tanks, a method I never even knew existed until that night. Suffocation is the third leading cause of suicide in this country. There are websites dedicated to teaching people various methods of committing suicide. Researching for this article, I found this particularly disturbing description on Google: “Do You Want To Commit Suicide? Join friendly people sharing 542 true stories in the I Want to Commit Suicide group. Find forums, advice…”

A screenshot of a Google search result regarding suicide.
A screenshot of a Google search result regarding suicide.

Elizabeth and I were the last to introduce ourselves. Everyone shared their loss calmly, with appropriate details, and sometimes matter-of-factly. We sobbed our way through naming our loved one’s method of suicide. I had rarely shared the details of Karen’s death with anyone over these past ten years. The power of saying the “how” out loud to the safety of a room full of people who understood that the “how,” in the end, was irrelevant, hit home immediately. “How” was a fact to accept and move past in order to get to the real work of letting go of the “whys,” the guilt and the blame.

I had the choice to stop, get out of my car and speak with Karen a week before she killed herself. I didn’t take that opportunity. I didn’t know it would be the last time I would ever see her: from a distance, sitting in a chair on her front porch, staring peacefully up at evening stars. I am haunted by that choice. I rarely speak of the guilt I carry for not getting out of my car that night, as though I could have heard in her voice a warning of the future and stopped her from killing herself.

William Feigelman, Ph.D, is a suicide counselor who himself lost a child to suicide. When studying the stigma related to a child’s suicide he found that “53% of suicide survivors reported harmful responses from one or more family member groups following their loss, and 32% reported harmful responses from at least one non-kin group.” These responses were divided into seven types: 1) Avoidance: “People who I thought would be at the funeral or send a sympathy card didn’t show any acknowledgment of the death.” 2) Unhelpful Advice: “Haven’t you grieved enough already?” 3) Absence of Caring Interest: “If I started talking about my lost child, they quickly changed the subject.” 4) Spiritual Advice: “He’s in a better place now” or “It was meant to be.” 5) Blaming the Victim: “That was a cowardly thing he did.” 6) Blaming the Parent: “Didn’t you see it coming?” 7) Other Negative Comments: “Well at least he didn’t kill anyone else when he died.”

If you find yourself thinking of saying any of the above things to a suicide survivor, DON’T. Trust me. In group, Rebecca said she found it particularly disturbing that every birthday, holiday and special event in her family is greeted with a card sent from a close friend, but that this same friend never drops a note or calls on the anniversary of her child’s suicide to let her know they are thinking of her. Avoidance is probably one of the most hurtful responses for a suicide survivor. It makes them feel like the rest of the world wants to forget that their child, spouse or loved one ever existed. Many people mistakenly think, “I don’t want to stir up emotions, or make them think about the suicide.” But a survivor does not forget their loved one or mourn their death any less than someone who loses a loved one to illness, accident or crime. All support, even a simple hug, can make a world of difference to a suicide survivor.

The suffocating sorrow I had braced myself for leading up to the support group was not to be found in the room that night. Grief and sadness were there, and shock was evident in Elizabeth, but I found that these suicide survivors were strong. Each of them owned their loved one’s death and understood that it occurred because their son, daughter, husband, wife or loved one was ill and made a bad, irreversible choice. Rebecca and Peter discussed the many reasons our loved ones might have felt suicide was the only option. Feelings of worthlessness, or being a burden to others, depression mixed with other factors such as medications, drugs or environmental situations, all combined for a feeling of hopelessness with no reprieve.

I lost a friend to suicide, but everyone else in the group that night had lost family. They discussed not only emotional pain, but the harsh realities of how suicide, like any sudden loss, can leave a family in financial upheaval and caught up in bureaucratic red tape which only compounds the grief and hinders the healing process: debts left unpaid, loss of income, home foreclosures, and angry, confused and resentful children. It was often difficult for the survivors in the room to even find time to deal with the emotional aftermath. Tina recently discovered hidden notes her children wrote about the loss of their father. Raine confessed that her children have voiced resentment towards her because she expressed feelings of anger at their father for killing himself. But with the beginning of school just around the corner, both mothers agreed practical things came first and they hoped they would find time before the next session to address these issues. Their worlds felt held together by very thin tape.

The survivors had encyclopedic knowledge of how to deal with probate, insurance policies and coroner’s reports, which they freely shared with each other. It was a crash course in dealing with the aftermath of suicide that didn’t go away just because the survivor was emotionally devastated. I learned it was important to open and clean out any safe deposit boxes belonging to your family member right away because once the probate process begins, access isn’t allowed until probate is completed. I learned that life insurance policies don’t have to pay out benefits for suicide if the policy was taken out less than two years before the death. Many in the room were involved with suicide prevention organizations, and the discussion turned to current state and federal legislature designed to prevent suicide, such as digital tracking of prescription fulfillment and insurance laws regarding mental health coverage and benefits. The depth of information was impressive and overwhelming. I often wondered that night how Elizabeth was taking it all in. Her son John, Charlie’s brother, had accompanied her, and I could see them gripping each other’s hands under the table throughout the meeting. I hope Elizabeth returns next month.

Sheila, a veteran of the group, shared some wisdom—“You find your joy where you can”—and made us all laugh when she confessed she’d baked ten of the same kind of pie for the holidays that year because it made her happy. She didn’t “give a damn” if people were sick of pumpkin pie. “Let them throw them out,” she said. This even made the tear-stained Elizabeth smile, a feat I would have thought impossible at the beginning of the night. I don’t know if there are actually twelve official steps to grief, but I’m pretty sure that the first step is remembering that, through all the sorrow, there is still joy in life. “Elizabeths” need “Sheilas” to survive.

As Rebecca, Peter and I pulled out of the parking lot, Rebecca commented on Tina and Raine lingering and chatting with each other by their cars.

“Its good they found each other,” she said. “They have similar backgrounds, and both lost husbands and have young children. They share many of the same problems and sorrows. That helps.”

To find a Suicide Support Group near you contact the American Association of Suicidology.

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Amanda Lin Costa is a writer and documentary filmmaker living in New York City. You can follow her on Twitter at @TheLoneOlive or visit her at theloneolive.com.

James Hindle is an illustrator, cartoonist and designer living and drawing in Northampton, Massachusetts.