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Is growth possible after losing a loved one to suicide?

By Melinda Moore, The Catholic University of America

For centuries, historians, writers, and philosophers have been chronicling the epic journeys of individuals who have triumphed in spite of personal tragedies and self-defeat. More recently, psychologists and researchers interested in these struggles have begun exploring the search for meaning and experience of growth that those who suffer sometimes encounter on this road. Psychiatrist Viktor Frankl, memorialized his own search for meaning in the suffering he witnessed and experienced first-hand while interred at Auschwitz during the Holocaust. Frankl observed, “Even the helpless victim of a hopeless situation, facing a fate he cannot change, may rise above himself, may grow beyond himself, and by so doing change himself. He may turn a personal tragedy into a triumph” (p. 146). Years before Lawrence Calhoun and Richard Tedeschi pioneered the concept of “Posttraumatic Growth” (1996), Frankl described a process of personal transformation inspired by internal processes that are initiated under unfair and unjust circumstances. To a person who loses a loved one to suicide, there can be no greater injustice.

While clinicians who work with survivors of suicide agree that the grief process for suicide survivors is different and more difficult than for those mourning a loved one through other causes of death (Jordan, 2001), questions about the nature of suicide bereavement still exist. In Grief After Suicide: Understanding the Consequences and Caring for the Survivors, a compendium of the existing research, Jordan and McIntosh (2011) write that more research and clinical attention is needed in order to increase our general understanding of the effects of suicide bereavement, but more importantly, to be able to assist survivors in the aftermath of this devastating loss. I have been personally and professionally inspired by this admonition and, as a survivor and burgeoning suicide researcher myself, sought to investigate what was the potential for growth in the aftermath of this experience of suicide bereavement. I knew that I had grown and I knew many others who had as well, but was it measurable? Was it quantifiable meaningful growth? What were the differences between those who grew and those who did not grow from this experience? Was it an all or nothing experience of growth or was it parceled out in quantifiable and measurable pieces through time?

While the limited research and literature on suicide bereavement has focused on the psychopathology associated with this experience of loss, a new area of Positive Psychology offers another vehicle for investigating the possibilities of personal growth within the context of this distressing and traumatic event. Calhoun and Tedeschi (2006) pioneered the concept of Posttraumatic Growth (PTG), a construct of positive psychological change that occurs as the result of one’s struggle with a highly challenging, stressful, and traumatic event. Five areas are contained within the larger construct of PTG, including Relating to Others, witnessed in greater intimacy and compassion for others; New Possibilities, suggesting that new roles are taken on and new people are introduced and accepted into one’s life; Personal Strength or feeling personally stronger; Spiritual Change or being more connected spiritually; and a deeper Appreciation of Life (Tedeschi & Calhoun, 2004).

The theory underlying Posttraumatic Growth does not suggest that there is an absence of suffering as wisdom builds, but rather that appreciable growth occurs within the context of pain and loss. In fact, some measure of significant distress may be necessary for growth to occur, although too much distress may impair the bereaved and render them unable to engage in the growth process (Butler et al., 2005). Along with growth or wisdom-building, the fruits of PTG may also include a preparedness or “resilience” for future events that may otherwise be traumatic (Calhoun & Tedeschi, 2006; Meichenbaum, 2006). George Bonanno, whose research has been instrumental in challenging our assumption that the bereaved necessarily moves through “stages” of grief, has characterized resilience as an adaptive process that occurs in the wake of a traumatic event, such as the suicide of a loved one, to be able to maintain “healthy levels of psychological and physiological functioning . . . as well as the capacity for generative experiences and positive emotions” (2004, pp. 20-21). Some researchers speculate that PTG is a kind of resilience, while others suggest that resilience plays an important role in the development of PTG (Lepore and Revenson, 2006). Calhoun and Tedeschi conceptualize a complicated relationship between PTG and resilience. Studies have shown an inverse relationship between PTG and resilience where highly resilient people experience less PTG than less resilient people do (Tedeschi & McNally, 2011). Highly resilient individuals may have stronger coping skills and are less likely to struggle with the psychological consequences of trauma, but are also less likely to experience as many opportunities for change that proceed from the emotional wrestling with trauma.

What makes growth more likely in some individuals and less likely in others?  Personality traits and mood states, such as extraversion, optimism, positive affect, openness to experience have been positively associated with PTG, while personality traits, such as neuroticism, have been negatively associated with PTG (Linley & Joseph, 2004; Stanton, Bower, & Low, 2006; Costa & McCrae, 1985). Other demographic variables, including gender and socioeconomic status, are also associated with this process (Calhoun & Tedeschi, 2006). These characteristics may play a central role in how an individual manages the interruption of one’s life goals or plans through a personal crisis or a trauma (Tedeschi & Calhoun, 2004).

My research on PTG among parent survivors of suicide has produced mixed results. Understanding Posttraumatic Growth and variables that may contribute to or undermine PTG, such as cognitive processes, personality traits, positive or negative mood, prolonged grief, and resilience, have not been previously studied in the suicide bereaved. Recently, I elected to test the PTG theory that this kind of growth is likely to occur closer to the traumatic event than farther away (Calhoun & Tedeschi, 2006) and recruited parents who have lost a child to suicide within two years to be studied. I was looking for what set those who had more PTG apart from those who had less. I was also looking for what predicted higher PTG. Was it optimism or positive affect or openness to experience that set individuals with more growth apart from those who had less? Were more neurotic individuals less likely to have PTG than those who were less neurotic?

Contrary to predictions set forth at the outset of this study, none of the study variables predicted PTG except resilience. Consistent with previous research (Tedeschi & McNally, 2011), there was as inverse relationship between PTG and resilience. That is, as PTG increased, one’s resilience decreased and, PTG decreased, one’s resilience increased. This further supported the notion that highly resilient individuals have stronger coping skills and may not struggle with the psychological consequences of trauma and experience positive life changes (e.g. Posttraumatic Growth) as a result. Resilience was also the only predictor of the first area of PTG, Relating to Others. Resilience demonstrated an inverse relationship with Relating to Others. What this means is that those who are more resilient are less likely to have an increased sense of closeness to others, especially significant others, and greater compassion and empathy toward others. So, while resilience has distinct positives, it may not make an individual more empathic or compassionate toward others going through a similar experience or have greater feelings of closeness to those they are intimately connected to in these times of difficulty.

The second area of PTG, New Possibilities, was predicted by levels of openness to experience, resilience, and neuroticism. Openness to experience showed a positive relationship with this area of new responsibilities and new relationships, while resilience and neuroticism had an inverse relationship with this domain. That is, as openness to experience grew among these suicide bereaved parents, New Possibilities grew, but as resilience and neuroticism decreased, New Possibilities increased. These relationships suggest that dispositional openness to experience nurtures this tendency to seek out “new possibilities,” even in the midst of trauma and loss.

So what does all this mean? Well, it means more research. While Tedeschi and Calhoun (2006) hypothesize that the growth occurs closer to the traumatic event, rather than farther away from it, does this necessarily hold for the suicide bereaved? Marilyn Koenig, founder of Friends for Survival, a California-based suicide bereavement nonprofit that helped recruit participants for this study, has pondered the relationship between length of time from the suicide, the internal processes that this manner of death spurs, and potential growth as a result. “Due to the sheer trauma of this experience, the terrible shock and, sometimes, the PTSD experienced by family and friends, it takes months and years for suicide survivors to gain perspective on this experience. It takes a long time for survivors to appreciate how this death has affected their lives, in both positive and negative ways” (personal communication, June 9, 2011). 

Because this current study asked participants to participate in future research, perhaps, a longitudinal study of Posttraumatic Growth of parents bereaved by suicide will render different results including higher PTG consistent with previous research. In future research, it is also possible that PTG will vary based upon different relationships that will be taken into consideration, recruited, and carefully studied. Additionally, the quality and closeness of the relationship between the decedent and the bereaved may also be taken into consideration in future research. This will be accompanied by an investigation of the suddenness of the death and whether or not the death was after multiple previous attempts or after a long struggle with mental and/or physical illness and the suicide was seemingly out of the blue. These questions are for future studies. The current study is the first of its kind among the suicide bereaved and more research, longitudinal in nature, is necessary before any definitive statements can be made about the nature of the relationship between this form of trauma, suicide bereavement, and the potential for growth as a result.

References

Bonanno, G.A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologists, 59, 20-28.

Butler, L.D. Blasey, C.M., Garlan, R.W., McCaslin, S.E., Azarow, J., Chen, X.H., . . . Spiegel, D. (2005). Posttraumatic growth following the terrorist attacks of September 11, 2001: Cognitive, coping, and trauma symptom prediction in an Internet convenience sample. Traumatology, 11, 247-267.

Calhoun, L. G. & Tedeschi, R.G. (2006). Handbook of Posttraumatic Growth: Research and Practice. New York: Erlbaum.

Costa, P.T., Jr., & McCrae, R.R. (1985). The NEO personality inventory manual. Odessa, FL: Psychological Assessment Resources.

Frankl, V.E. (2006). Man’s Search for Meaning. Boston, MA: Beacon Press.

Jordan, J.R. (2001). Is suicide bereavement different? A reassessment of the literature. Suicide and Life-Threatening Behavior, 31, 91-102.

Jordan, J.R. & McIntosh, J.L. (2011). Is suicide bereavement different? A framework for rethinking the question. In Jordan, J.R. & McIntosh, J.L. (Eds.) In Grief After Suicide: Understanding the Consequences and Caring for the Survivors (pp. 19-42). New York: Taylor & Francis.

Lepore, S. & Revenson, S. (2006). Relationships between posttraumatic growth and resilience: Recovery, resistance, and reconfiguration. In L.G. Calhoun & R.G. Tedeschi (Eds.) Handbook of Posttraumatic Growth (pp. 24-46). New York: Lawrence Erlbaum Associates.

Linley, P.A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17, 11-21.

Meichenbaum, D. (2006). Resilience and posttraumatic growth:  A constructive narrative perspective. In Calhoun, L.G. & Tedeschi, R.G. (Eds.) Handbook of Posttraumatic Growth (pp. 355-368). New York: Erlbaum.

Stanton, A.L., Bower, J.E., & Low, C.A. (2006). Posttraumatic growth after cancer. In L.G. Calhoun & R.G. Tedeschi (Eds.) Handbook of Posttraumatic Growth (pp. 138-175). New York: Lawrence Erlbaum Associates.

Tedeschi, R.G. & Calhoun, L.G. (1996). The Post-Traumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455-471.

Tedeschi, R. G. & Calhoun, L.G. (2004). The foundations of posttraumatic growth: new considerations. Psychological Inquiry, 15, 93-102.

Tedeschi, R.G. & McNally, R.J. (2011). Can we facilitate posttraumatic growth in combat veterans? American Psychologist, 66, 19-24.

Comments

09/09/2014 at 11:57 AM
denise griffin
I wrote yesterday but forgot to ask if I could put this in our newsletter for Survivors of Suicide Lost, San Diego CA chapter.plz advise.562.225.5886. Thank You.
05/15/2014 at 12:14 PM
Susan Love
Hi Melinda. Can't wait to meet you in Ohio in September. Glad I found this site. Always looking to read anything you write.
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