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Book Review   |    
In the Wake of Suicide: Stories of the People Left Behind
Curtis B. Flory, M.B.A.
Psychiatric Services 1999; doi:
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by Victoria Alexander; San Francisco, Jossey-Bass Publishers, 1998 (originally published by Lexington Books in hardcover in 1991), 238 pages, $22.95 softcover

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Victoria Alexander's In the Wake of Suicide describes the experience of 13 families who have lost a loved one through suicide. The book creates a compelling argument for an increase in support groups and counseling to assist individuals who are lost in the aftermath of suicide.

To the psychiatrist, a patient's suicide can represent a personal failure. It seems impossible to predict, let alone prevent, the final solution of a tormented mind. Unfortunately, the profession that uses all of its skill in protecting the individual contemplating suicide often is unaware of the plight of the survivors. The family and friends of the victim often experience great loss and grief, with little support or counseling. This book will provide valuable insight into the plight of family members following the loss of a loved one to suicide.

Alexander, who lost a parent by suicide, captures the essence of the burden survivors must bear and presents a well-written analysis of the grieving process and the long road to acceptance. She refers to three phases: suicide, grief, and storytelling. Her analysis and distillation of the stories from 13 families is excellent and well worth reading.

Alexander divides the book into three sections, each dealing with a phase of grieving and a gradual acceptance of loss. "Suicide is the end of one person's struggle, but just the beginning for many others, the survivors of suicide," she states. She goes on to say, "Suicide takes the survivors by surprise, and it is often a violent death. There is often a denial of suicide. It is not unusual to hear that the individual died suddenly of an unknown cause."

The funeral provides a framework for the first expression of grief. After a suicide, some survivors retreat from public exposure. Death is too shameful. Suicide is a taboo. It is a word that is often whispered or avoided. Suicide is often considered a sin. In earlier days, many suicide victims were denied burials, and their bodies were desecrated. Suicide was "the forbidden act." Many people, including friends and family of survivors of suicide, find it impossible to listen to accounts of or discuss suicide. This attitude creates a feeling of isolation for the survivor.

One of the most striking sections of the book is about "storytelling." It discusses the importance of recounting the suicide and describing the feelings of anger, grief, and loss to others. Until a survivor verbalizes his or her feelings, the survivor is unable to accept the loss and move on. Only individuals who have experienced a similar loss are able to understand and facilitate this healing process. The process may be a lengthy one, lasting several years. Although the author lists several organizations that deal with the loss of a loved one, the need for easy access to support groups for suicide survivors still seems to be unmet.

Having lost a son to a violent suicide, I can identify with much of the author's analysis of the grieving and recovery processes. However, I was disappointed by her selection of subjects; from a total of 40 survivors she originally interviewed, the 13 she presents in the book mostly experienced suicide by parents and other adults. In view of the preponderance of deaths by suicide of persons under age 30, more attention might have been paid to this younger, vulnerable group. These individuals often have a diagnosis of severe mental illness, such as schizophrenia.

I found myself skimming over the sometimes lengthy and detailed interviews. However, Alexander's analysis in In the Wake of Suicide is a valuable contribution.

Mr. Flory is president of the Zircon Company, Inc., in Peabody, Massachusetts, and codirector of the Long-Term-Care Research Project cosponsored by the National Alliance for the Mentally Ill.




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