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Section 3
Denial in Suicide Survivors

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In the last section, we discussed emotional reactions clients may experience following a teenager’s suicide.  We also discussed the "Identifying Supportive Others" technique for helping clients coping with a loved one’s suicide strengthen their support networks.

In this section, we will discuss five concepts regarding denial following a teenager’s suicide.  These five concepts are, the initial reaction, layers of insulation, benign denial, blame as denial, and conscious denial.  At the end of the section, we will discuss the identifying strengths technique.

5 Concepts of Denial

♦ 1. Initial Reaction - A first concept regarding denial following a teenager’s suicide is the initial reaction.  Beth, 46, initially refused to accept the news of her daughter Melissa’s death.  When the police called to tell Beth that Melissa had committed suicide by an overdose of painkillers, Beth stated, "What do you mean she killed herself? She had an accident, that’s not the same as killing herself!"

♦ 2. Benign Denial - A second concept regarding denial following a teenager’s suicide is benign denial.  As Beth and her family came to terms with Melissa’s death, they clung to the hope that the coroner’s conclusions were mistaken.  Beth stated, "I know Melissa must have taken those drugs deliberately.  But she must have accidentally overdosed!  She would not have tried to kill herself!" 

However, this point of view dialed to take into account the fact that Melissa had left a suicide note.  As you know, in most cases this kind of benign denial gradually fades over the next few days or weeks.  No harm is done, but facing the truth is delayed.

♦ 3. Blame as Denial - In addition to initial reactions and benign denial, a third concept regarding denial following a teenager’s suicide is blame as denial.  Beth directed her anger and blame at the doctor who had treated Melissa, who she firmly believed could have saved her daughter with appropriate treatment.  Clearly, blame of this kind can evolve into years of legal wrangling that prevents the survivors from dealing with their loss realistically. 

Have you found, as I have, that while legitimate anger tends to diminish over time, anger as the result of blame as denial tends to continue unabated.  Of course, it is particularly difficult when family members blame each other for a teenager’s suicide, as this can poison the most immediate potential form of support for the surviving family.

♦ 4. Conscious Denial - A fourth concept regarding denial following a teenager’s suicide can be conscious denial.  Beth and her family initially avoided all discussion of Melissa’s death with each other.  When asked how Melissa had died by outsiders, Beth stated the cause of death was an accidental drug overdose of a prescribed medication.  Beth felt that that she was protecting Melissa’s memory. 

Clearly, this conscious denial also avoided letting outsiders know that there had been troubles in the family.  Beth also consciously denied that she needed help when her husband Robert asked her to seek therapy. 

I stated to Beth, "It makes sense to think of mourning  as a series of tasks.  It takes time and effort in order to accomplish each tasks, but if you avoid them, healing may not be complete.  Think of it like getting a splinter in your finger.  The thought of digging around in an already sore spot may lead you to just clean it and wrap a bandage around it, which hides your wound from others.  The spot is render, and you protect it, but the wound will likely become infected and keep getting worse.  Unless you remove the splinter with a needle, the wound is unlikely to heal properly." 

To help Beth and her family begin initially addressing their conscious denial, I encouraged the family to make a joint memorial project for Melissa.  The family chose to work together on a scrapbook celebrating Melissa’s strengths and achievements.

♦ 5. Layers of Insulation - A fifth concept regarding denial following a teenager’s suicide is layers of insulation.  Beth stated, "I understand now that I need to work on mourning Melissa and come to terms with her suicide.  But even though I know she’s dead, I keep hearing her moving around in the room, or I find myself driving to the high school to pick her up after classes.  If I’m so weak that I’m imagining things, how can I possibly do all this hard work?  I feel like I’m going crazy!" 

I emphasized to Beth that her behavior and experiences were normal for a suicide survivor.  I stated, "Finding yourself doing something odd can be a very natural response when coping with the trauma of death, especially with the uniquely devastating trauma of suicide."

♦ Identifying Strengths Technique
Because Beth felt that her unconscious denying behavior was a sign of weakness, I encouraged her to try the Identifying Strengths technique to remind herself of the unique qualities that could help her begin to address the trauma of the loss of her daughter. 

I stated to Beth, "The purpose of this exercise is to help you identify what you did and what strengths you displayed despite the negative event that happened to you." 

3 Journaling Questions
I asked Beth to take some time on her own to journal responses to the following questions:
-- 1. What strengths did you display immediately after learning of Melissa’s suicide that helped you to survive and to function? 
-- 2.  Despite the trauma and the reactions you have had, what strengths have you displayed, and what have you achieved since?  I encouraged Beth to recognize that her ability to maintain her relationships with her family, care for her physical needs, and keep her job by arranging for a leave of absence were examples of positive strengths and achievements.
-- 3.  In which of your current relationships are the trauma-related strengths you just identified useful?

Think of your Beth.  Would the identifying strengths technique be helpful to him or her?

In this section, we have discussed five concepts regarding denial following a teenager’s suicide.  These five concepts are, the initial reaction, layers of insulation, benign denial, blame as denial, and conscious denial.  We also discussed the identifying strengths technique.

In the next section, we will discuss three types of bargaining survivors of a teenager’s suicide may use to cope with the trauma.  These three types of bargaining are the long goodbye, scapegoating, and cutting off.  At the end of this section, we will discuss the Rescripting technique.
Reviewed 2023

Peer-Reviewed Journal Article References:
Bartik, W. J., Maple, M., & McKay, K. (2020). Youth suicide bereavement and the continuum of risk. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication. 

Braun, M., Till, B., Pirkis, J., & Niederkrotenthaler, T. (2020). Suicide prevention videos developed by and for adolescents: A qualitative study. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication. 

Hill, R. M., Oosterhoff, B., & Kaplow, J. B. (2017). Prospective identification of adolescent suicide ideation using classification tree analysis: Models for community-based screening. Journal of Consulting and Clinical Psychology, 85(7), 702–711. 

Howard Sharp, K. M., Russell, C., Keim, M., Barrera, M., Gilmer, M. J., Foster Akard, T., Compas, B. E., Fairclough, D. L., Davies, B., Hogan, N., Young-Saleme, T., Vannatta, K., & Gerhardt, C. A. (2018). Grief and growth in bereaved siblings: Interactions between different sources of social support. School Psychology Quarterly, 33(3), 363–371.

Kaslow, N. J., & Gilman Aronson, S. (2004). Recommendations for Family Interventions Following a Suicide. Professional Psychology: Research and Practice, 35(3), 240–247. 

Michel, K. (2005). David Lester--Denial in Suicide Survivors. Crisis, 25 (2004), 78-79. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 26(1), 36–37. 

QUESTION 3
What are five concepts regarding denial following a teenager’s suicide? To select and enter your answer go to Test.

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