Guest Writer: Claudia Bouma, reflecting on her lived experience of suicide stigma

Many thousands of families lose a loved one to suicide each year. The stigma experienced by family survivors threatens to further burden families and impede the grieving process. According to Goffman (1963), stigma consists of a discrediting attribute that leads to mistreatment. Two types of stigma can be distinguished: public or associative stigma and self-stigma.

Public Stigma

Associative stigma occurs when the community extends negative attitudes and actions toward the friends, family members, or other associates of the stigmatized person (van der Sanden, Bos, Stutterheim, Pryor, & Kok, 2015). Family stigma, a special case of associative stigma, may manifest interpersonally through gossip, patronizing remarks, criticism, unsolicited advice, or avoidance toward family members of the stigmatized group (Larson & Corrigan, 2008; Moses, 2014). Family members may even distance themselves from the individual to avoid the associative stigma (Pryor, Reeder, & Monroe, 2012). Although sometimes it was difficult for family members to know whether these avoiding and shunning experiences were due to suicide stigma or general discomfort with responding to death, this experience of social exclusion seemed a very common occurrence (Sheehan et al ., 2016).

After a suicide, families report a variety of stigma-related experiences including reduced social support and strained communications with extended family and with the community (Dunn & Morrish-Vidners, 1988; Feigelman, Gorman, & Jordan, 2009; Ostman & Kjellin, 2002; Provini, Everett, & Pfeffer, 2000).

Self Stigma

In self-stigma, individuals are aware of public stigma and internalize that stigma into their sense of self, believing that they possess the negative attributes that people assume them to have (Corrigan & Rao, 2012). While not all individuals are affected by self-stigma, when stigma is internalized, it threatens self-esteem, leading to depression and loss of self-efficacy (Corrigan, Larson, & Rusch, 2009).

According to a study by Sheehan et al. (2016), focus group participants talked about being avoided or shunned after the death of their family member. They talked about relationships breaking off, friends and neighbors avoiding them, and parents forbidding their children to visit their house. The study also highlighted how many admitted that they avoided telling others about the suicide.

These results are in line with previous findings that stigma acts as an additional burden for bereaved families (e.g., Chapple et al., 2015; McMenamy, Jordan, & Mitchell, 2008; Ostman & Kjellin, 2002; Provini et al., 2000).

Personal Experience

As a child growing up it didn’t take me long to figure out that my father was different from other fathers. The neighbours avoided us, the kids at school teased my twin brother and me, but the worst part was the fact that family members had shunned us for as long as I can remember.

My father first tried to take his life when my brother and I were babies. I didn’t find out until my father suffered another major nervous breakdown and started talking about suicide when I was 16 and my mother finally told me. I was shocked. Why hadn’t she told me sooner? And how did I feel about this devastating news?

Slowly but surely, the puzzle pieces started to come together. My dad had never worked, like all of my friends’ dads, and now I understood why. I also finally realised why we had become estranged from the extended family. Aunties and uncles had stopped coming to our birthdays and communication became non-existent. When I asked my parents, they wouldn’t give me a straight answer. This was stigma in action.

Life went on as normal, as if nothing had ever happened. We didn’t talk about my dad’s mental illness or his suicidal thoughts. As a teenager I felt I had nowhere to turn. The unspoken message was that it wasn’t okay to talk about what was affecting our family or me personally. Help was available for my dad but there was no support for my mum or us kids.

It has taken many years for me to come to grips with my father’s mental illness, his suicide attempt and struggle with suicidal thoughts. I finally ended up seeking counselling as a young adult but this was not well received by my own family as I was breaking the silence and bringing family secrets into the open.

There is no doubt in my mind that public and self-stigma complicated my personal issues and affected my self-esteem. Thankfully, there is help available and today I am a confident woman who enjoys life and can share with others who have experienced a similar journey.

A message from Carmen ~ I would greatly like to acknowledge the courage and heartfelt thought that has been shared with us through this writing. We hope that through sharing such experiences, we can see the fears, worries and strengths in ourselves and each other – where together we find new and supported ways of being together. Thank you Claudia.

References

Chapple, A., Ziebland, S., & Hawton, K. (2015). Taboo and the different death? Perceptions of those bereaved by suicide or other traumatic death. Sociology of Health & Illness, 37, 610–625. doi:10.1111/1467-9566.12224

Corrigan, P. W., Larson, J. E., & Rusch, N. (2009). Self-stigma and the ‘‘why try’’ effect: Impact on life goals and evidence-based practices. World Psychiatry, 8(2), 75–81. doi:10.1002/j.2051-5545.2009.tb00218.x

Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. Canadian Journal of Psychiatry, 57, 464–469.

Dunn, R. G., & Morrish-Vidners, D. (1988). The psychological and social experience of suicide survivors. Omega—Journal of Death and Dying, 18(3), 175–215.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.

Larson, J. E., & Corrigan, P. (2008). The stigma of families with mental illness. Academic Psychiatry, 32(2), 87–91. doi:10.1176/appi.ap.32.2.87

McMenamy, J. M., Jordan, J. R., & Mitchell, A. N. N. (2008). What do suicide survivors tell us they need? Results of a pilot study. Suicide & Life-Threatening Behavior, 38(4), 375–389. doi:10.1521/suli.2008.38.4.375

Ostman, M., & Kjellin, L. (2002). Stigma by association. The British Journal of Psychiatry, 181(6), 494–498. doi:10.1192/bjp.181.6.494

Provini, C., Everett, J. R., & Pfeffer, C. R. (2000). Adults mourning suicide: Self-reported concerns about bereavement, needs for assistance, and help-seeking behavior. Death Studies, 24(1), 1–19. doi:10.1080/074811800200667

Pryor, J. B., Reeder, G. D., & Monroe, A. E. (2012). The infection of bad company: Stigma by association. Journal of Personality and Social Psychology, 102(2), 224–241. doi:10.1037/a0026270

Sheehan et al., (2016). Behind closed doors: The Stigma of Suicide Loss Survivors. Omega — Journal of Death and Dying 0 (0), 1-20.

van der Sanden, R. L., Bos, A. E., Stutterheim, S. E., Pryor, J. B., & Kok, G. (2015). Stigma by association among family members of people with a mental illness: A qualitative analysis. Journal of Community & Applied Social Psychology, 25(5), 400–417. doi:10.1002/casp.2221