Literature Review
Grief is the price we pay for love, and a natural consequence of forming emotional bonds to
people, projects and possessions. All that we value we will someday lose.
The terms ‘grief’, ‘mourning’ and ‘bereavement’ are often used synonymously. For instance,
individuals who have suffered the death of a close family member may either be said to be
‘mourning the loss’, ‘grieving’, or ‘grief-stricken’, or may perhaps be described as being
‘bereft’ by the loss. (Ringdal, et al. 2001)
Bereavement refers to the objective situation of an individual having lost a significant person
by death. Bereavement is the cause of both grief and mourning. Grief is a normal affective
response to overwhelming loss, characteristically the death of a loved person such as
spouse, parent, child, which does not require therapeutic intervention if it runs an
uncomplicated course. After bereavement, the line between health and illness begins to blur.
For many people, grief is so painful and disabling an experience that it feels like an illness.
(Ringdal, et al. 2001)
When unanticipated or incongruous events such as the death of a loved one occur, a person
needs to redefine the self and relearn ways to engage with the world without the deceased.
The person cannot return to a preloss level of functioning but learns how to develop a
meaningful life without the deceased loved one. (Neimeyer 2001)
Death can challenge one’s assumptions about the world (spiritual adjustments) and one’s
personal identity (internal adjustments). Bereaved individuals have serious questions such
as: “What will my life look like now?” “What did the deceased’s life mean?” “How can I feel
safe in a world such as this?” and “Who am I now that this death has occurred?” (Neimeyer,
Prigerson and Davies 2002)
What is bereavement?
For most of us, the loss of a loved person is the most severe stress that we will experience,
yet the majority will come through this experience without suffering lasting impairment of our
physical and mental health. We are all vulnerable to bereavement, but some are more
vulnerable than others; all bereavements are traumatic, but some are more traumatic than
others; we all enter a strange and unpredictable world when we suffer a major loss, but
some worlds are more hazardous and unpredictable than others. (Parkes 2011)
Feelings of depression and despair are so common after bereavement. Bereavement is so
painful a stress that it can contribute to a wide range of psychiatric problems. It is personal
vulnerability rather than grief that determines why some bereaved people suffer anxiety and
panic attacks, others suffer major depression (MD).
Individual manifestations of grief are consistent with the bereaved person’s psychosocial and
cultural backgrounds, and are influenced by personality, the abruptness and importance of
the loss, the nature of the person’s relationship with the deceased and the existing social
support network.
One of the pioneers in grief research and clinical work in modern times, Parkes, has
underlined the importance of treating grief as a process, not a state: grief is not a set of
symptoms which start after a loss and than gradually fade away, it involves a succession of
clinical pictures which blend into and replace one another.
Despite these variations from individual to individual, most of those who have observed the
course of grieving propose models of the grieving process that include at least three,
partially overlapping but distinct, stages: an initial period of shock, disbelief and denial; an
intermediate period of acute mourning including somatic and emotional discomfort (crying
spells, guilt, shame, depression, anxiety, anorexia, insomnia, irritability, emptiness and
fatigue), social withdrawal, preoccupation with thoughts of the deceased, and identification
with the deceased (transient adoption of habits, mannerisms and somatic symptoms of the
deceased); and a culminating period of resolution, including a return to well-being,
acceptance of the loss, awareness of having grieved and an ability to recall the deceased
without pain.
As of this research I want to focus on suicide bereavement, I shall explore more about the
suicide which will help me have a further and deeper understanding in suicide.
For above part: I want to approach/critically engage with this part of lit review:
• Grief is a sense of loss, can be any type of loss, but bereavement is loss people
from death
• Everyone has their own way dealing of grief, there is not absolute answer how to
handle grief and bereavement
• Some study propose grief as a medical disorder and some researcher says it only
trigger mental disorder, not necessary be itself (I am lean towards that grief is an
emotional process and not a medical condition)

• Etc, please advise if something make it stronger

Why Suicide?
With so many ways of thinking, behaving, feeling, coping, (and failing to cope) in the
repertoire of any one person, why do certain people fatally opt for the ultimate act of self
determination? Even with all clinical acumen and decades of empirical suicide research, the
answer to this fundamental question remains remarkably elusive and is not as well
understood as we might otherwise assume.
Suicide is a critical public health issue. Each year, nearly a million individuals worldwide take
their own lives (WHO, 2009). These deaths leave in their wakes persons who are known as
survivors of suicide or the bereaved by suicide. Although it has long been known that suicide
can leave devastation in its wake (Cain, 1972). Suicide survivors have received relatively
little attention in suicidology compared to the focus on understanding and treating suicidal
individuals.
For suicide part I want to approach/critically engage with this part of lit review:
• Suicide is a complicated and no absolute cause for this
• Most of research are dedicated to prevent the suicide but only less that focus on
suicide bereavement for someone who lose someone from suicide
• The reason for this is understandable because people who suffer from this, might
want to try to invest their energy to prevent other people to not have to suffer like
they have but I think how to take care suicide bereavement also should be focused

as well.

So Suicide Bereavement Different?
The question whether and in what manner the mode of death changes the nature of the
bereavement experience has a long and sometimes contested history in thanatology,
including in our area of interest, which is survivorship after the loss of a loved one to suicide.
The personal narratives of many suicide survivors testify to the reality that the death of a
loved one to suicide can be an enormously difficult experience, one that may have lifetransforming effects on the mourner (Alexander, 1991; Jackson, 2004; Stimming &
Stimming, 1999; Wrobleski, 2002). Empirical and clinical study of survivors also offers
considerable support for this intuitive understanding that the loss of a loved one to suicide
may be a particularly difficult form of bereavement (de Groot, De Keijser, & Neeleman, 2006;
Jordan, 2001, 2008, 2009; Knieper, 1999).
McIntosh’s (1993) analysis of primarily quantitative studies that included comparison groups
led to the interpretation that suicide bereavement is generally nonpathological, and that the
research evidence shows more similarities than differences between suicide survivors and
the survivors of other modes of death, although some aspects of grieving may differ for
suicide survivors. In contrast, Jordan’s review (2001) identified specific “thematic” aspects of
suicide bereavement that differentiate it sufficiently from other modes of death to warrant
continued research and clinical programs for suicide survivors. These themes included a
greater need to make sense of or find meaning in the loss; greater feelings of guilt,
responsibility, and blame; and heightened feelings of abandonment or rejection by the
deceased, often coupled with greater anger at the deceased.
Sveen and Walby’s (2008) analysis did reveal evidence for some differences between
suicide survivors and other loss survivors for a limited number of grief variables. These
included higher levels for suicide survivors for feelings of rejection, shame, or stigma; for
concealment of the cause of the death as suicide; and for blaming with respect to the death.
When we consider the available empirical research (quantitative and qualitative), clinical
experience, and personal accounts of survivors, the following are the likely candidates as
common features of suicide bereavement—that is, we believe that many (but not all) suicide
survivors will manifest many (but not all) of these themes, reactions, and features in their
grief reactions.
Features supported by the existing quantitative research evidence—elevated levels of the
following:
• Abandonment and rejection
• Shame and stigma
• Concealment of the cause of death as suicide
• Blaming
• Increased self-destructiveness or suicidality
Features supported by qualitative studies, clinical experience, and survivors’ anecdotal
accounts—elevated levels of the following:
• Guilt
• Anger
• Search for an explanation or desire to understand why and “make
• meaning”
• Relief
• Shock and disbelief
• Family system effects, social support issues, and/or social isolation
• Activism, obsession with the phenomenon of suicide, and involvement with
prevention efforts
As Figure 1 illustrates, some aspects of bereavement can be understood as nearly universal,
regardless of the mode of death. For example, feelings of sorrow at the loss and the
yearning to have the loved one return are extremely common in almost all bereavement
situations, including, of course, after suicide (Balk, Wogrin, Thornton, & Meagher, 2007;
Stroebe, Hansson, Schut, & Stroebe, 2008). We might call these the normative and
universal aspects of the grief response. On the other hand, the grief responses and resulting
processes associated with unexpected and sudden death—as well as with sudden, violent
death—are perceived as nonnormative (i.e., not universal) in most societies. For instance,
the loss of a loved one to most illnesses allows for some degree of psychological preparation
or anticipatory mourning for what life will be like without the loved one. Conversely, the loss
of a loved one in a sudden manner may lead to a heightened experience of shock and a
sense of unreality about the loss. There is empirical support for the idea that unexpected
losses tend to increase distress in mourners and may produce more complicated grieving
pathways (Miyabayashi & Yasuda, 2007).
Additionally, the sudden and violent death of a loved one—whether to accident, natural
disaster, homicide, or suicide—carries with it an even greater risk of a complicated
bereavement trajectory and a higher potential for depression, PTSD, other anxiety
symptoms, and complicated or prolonged grief disorder (Armour, 2006; Currier, Holland,
Coleman, & Neimeyer, 2007; Murphy et al., 1999; Murphy, Johnson, Chung, & Beaton,
2003; Rynearson, 2006), as mourners react to the horrific nature of the dying process itself.
Of equal importance are the attributions made by the mourner about the responsibility for
and preventability of a violent death that are generally not present when a loved one dies
from an illness, even a sudden one. Traumatic losses appear to present a much greater
challenge to the assumptive world of the survivor (Kauffman, 2002). They require
considerable time and psychological effort to “make meaning” of the death or, alternatively,
to come to terms with the perceived senselessness of the event (e.g., Currier et al., 2008;
Currier, Holland, & Neimeyer, 2009; Holland, Currier, & Neimeyer, 2006; Neimeyer, 2005;
Neimeyer, Prigerson, & Davies, 2002; Sands, Jordan, & Neimeyer, 2010; see also Chapter
1). When viewed from this more complex perspective, bereavement after a suicide can be
understood as containing elements from all four types of losses represented in Figure 1.
Things I want to add before talking about the methodology
• How suicide bereavement was mentioned in the Counselling/Psychotherapy
context/paper
• What kind of qualitative research about this has been done (I want to show that
this piece come from first-hand experience will also benefit the counselling
industry)
Methodology
Referring to my dissertation topic, I am interested to explore myself, I shall focus on my story
and my thoughts around this and making sense of it. Therefore, I would like to use the mixed
of two methodology which is autoethnography and Hueristic Inquiry, they both methods have
an essence about self. For the primary act of exploration there is no separation between the
researcher and participant: the researcher explores her own experiences. However, the
researcher can also include additional data gained through literature research and
interviews.
• I want to highlight what is overlapped between two method, it is about the auto/self
for example, autoethnography is based on Constructivist / Interpretivism and
subjectivity of experience
• Heuristic is more self search process more like in phenomenology as to explore
something
Autoethnography is an approach to research and writing that seeks to describe and
systematically analyze (graphy) personal experience (auto) in order to understand cultural
experience (ethno) (Ellis 2004). This approach challenges canonical ways of doing research
and representing others (Spry 2001) and treats research as a political, socially-just and
socially-con scious act (Adams & Holman Jones, 2008). A researcher uses tenets of autobi
ography and ethnography to do and write autoethnography. Thus, as a method,
autoethnography is both process and product.
As a method, autoethnography combines characteristics of autobiography and ethnography.
When writing an autobiography, an author retroactively and selectively writes about past
experiences. Usually, the author does not live through these experiences solely to make
them part of a published document; rather, these experiences are assembled using hindsight
(Bruner, 1993; Denzin, 1989, Freeman, 2004). In writing, the author also may interview
others as well as consult with texts like photographs, journals, and recordings to help with
recall (Delany, 2004; Didion, 2005; Goodall, 2006; Herrmann, 2005).
When researchers do autoethnography, they retrospectively and selectively write about
epiphanies that stem from, or are made possible by, being part of a culture and/or by
possessing a particular cultural identity. However, in addition to telling about experiences,
autoethnographers often are required by social science publishing conventions to analyze
these experiences. As Mitch Allen says,
An autoethnographer must look at experience analytically. Otherwise [you’re] telling [your]
story – and that’s nice – but people do that on Oprah [a U.S.-based television program] every
day. Why is your story more valid than anyone else’s? What makes your story more valid is
that you are a researcher. You have a set of theoretical and methodological tools and a
research literature to use. That’s your advantage. If you can’t frame it around these tools and
literature and just frame it as ‘my story,’ then why or how should 1 privilege your story over
anyone else’s I see 25 times a day on TV? (personal interview, May 4, 2006)
Heuristic inquiry was developed by Clark E. Moustakas (Douglass & Moustakas, 1985;
Moustakas, 1990) and seeks
to explore questions that arise from a personal experience of the researcher. The goal of this
person-centered approach,
which is grounded in humanistic psychology, is to immerse into a self-searching process in
order to find a deeper meaning and insight about one’s personal “present-moment ongoing
living human experience” (Sultan, 2018, p. 7). Furthermore, the approach also invites
personal growth and transformation of the researcher and could therefore be relevant for the
therapeutic domain. According to Moustakas (1990) the process of heuristic inquiry is
accompanied by six phases. First, the researcher needs to have had a personal experience
and motivation to further comprehend this experience. In a second phase, the researcher
fully immerses in the selected experience of interest by e.g. recollecting past experiences,
journaling or interacting with co-researchers, who have encountered the same experience. In
a third phase, the researcher distances himself fromthe close engagement with the
experience so that gathered data can come to fruition. In a fourth state of illumination the
researcher can gain new insights and perspectives
about the research question. In a fifth state new insights in relation to the research question
are explicated and synthesized in a final phase. It should be noticed that heuristic inquiry as
proposed by Moustakas (1990) involves the additional study of co-researchers. In contrast,
Sela-
Smith(2002) suggested that heuristic inquiry should only comprise the researcher’s selfsearch and not include additional co-researchers. Overall, heuristic inquiry can be regarded
as an open-ended and autobiographical process, which unfolds in a non-linear way and
often leads to accidental discovery of novel aspects of experiences (Sultan, 2018).
Ethic consideration:
Autoethnography as a process and a product is saturated with ethical dilemmas. For
Delamont (2009: 59), “Autoethnography is almost impossible to write and publish ethically.”
Others are less negative, but equally concerned.
Early on, autoethnographers were rather naive about ethical issues and did not fully realise
the responsibilities their choice of genre placed on them. (Sparkes, 2018) Some people have
thought that there are no ethical issues involved as “The research is just about me.”
Autoethnography is a research genre dependent on relationships, and other people are
always woven into the stories we tell, some intricately and deeply so. Quite simply, our
stories are not our own. We always run the risk of making those we write about not only
recognisable to others but recognisable to themselves as our stories weave their way into
their lives in ways they might not feel comfortable with, or agree to, even if they have given
their “informed consent” for the story to be told. Allen Collinson (2013), therefore, argues that
autoethnographers must consider carefully if and how others are represented in their
personal narratives. There will be some unanswered questions that I couldn’t seek consent
from the dead person, therefore, I must think for any possibilities and any consequence how
I choose to share it to reader and what might upset or trigger the reader who may know the
dead person.
Up to this point, I am fully aware that this topic; suicide bereavement, would be such a
sensitive where it might put not only me, as a researcher, but also some people I might have
mentioned, in a very vulnerable position, expose to a variety of emotional when trying to
explore of what happen in the past. No one will know what might happen during my research
and how it might lead me to the dark place. I am also conscious that there might be risks
exposing my friend’s identity, who committed suicide, and/or other peers involved in this
incident.
Reflecting on this issue, Turner (2013) has asked some questions that have also arises in
me; should I seek permission from all those involved in my stories, or perhaps just some of
them? Should I be anonymising all other persons described within my cultural experiences,
or even changing descriptions of the stories themselves? I won’t know if my writing upsets,
hurts, offends, pleases, delights, causes anxiety or leaves the reader indifferent to my story
(unless they tell me), and what if the same piece of writing upsets one person, angers
another and comforts a third?