Dying to Talk: Dealing with sudden death

The below section covers sudden death by suicide, miscarriage. murder and manslaughter:
Bereavement by suicide:

When we are bereaved by suicide the ‘normal’ grieving process may be more complex, intensified and prolonged, although the actual tasks and experiences may be the same. When someone close to us dies we experience grief and go through a process of mourning. The experience is both emotional and physical.

Death by suicide is particularly shocking, because it goes against the norms of our natural survival instinct that we should live and thrive. The suddenness and nature of the death can be extremely traumatic and hard to make sense of. There is also a social taboo around suicide, which can mean it is hard to talk about. We still associate the words ‘committed suicide’ with sin and crime even though today most people’s view is more understanding and supportive towards families bereaved in this way. How we respond to suicide will be influenced by our own beliefs and culture, our family and our environment.

When responding to people wanting explanation or a definition of suicide, one that can be helpful and is informed by mental health experts is that it is like ‘a heart attack of the brain’. In the same way that our heart as an organ can break down, so the brain can too. Being based on a more medical model might help alleviate some of the historical taboo associated with suicide.

The person who found the body may be particularly shocked and traumatised. Was there a note? And if so, this, or other material, may need to be taken away as evidence. Families are entitled to a photocopy of the note before it is taken away.

 

There may be interest from the media which a member of the family might feel they want to respond to, but they should feel no pressure to do this. What matters is that they do whatever feels right for them as a family. There are also likely to be police and coroners involved depending on the circumstance of the death, and families may need to partake in an initial hearing to obtain an interim death certificate.

Suicide evokes particularly strong feelings which are often conflicting, including shock, anger, despair, guilt, shame, blame, relief, betrayal, isolation, confusion, exhaustion and low self esteem. There is a desperate ‘need to know’ and searching for an understanding of why, in addition to all the more usual grief responses to sudden death.

 

Whatever our default ‘coping mechanism’ is, whether it is to switch off or to open up, this is likely to come into operation when we hear the news that someone close to us has died by suicide. If we tend to close down, we may feel very numb and find it hard to believe that the person has died. The more shocking the news, the more prolonged the disbelief can be.

As much as our instinct may be to protect ourselves and our children from seeing the person who has died, and seeing how they died, this isn’t usually helpful. However difficult it is, the truth can be more bearable than what we don’t know, because our imagination can haunt us in a way that facts and real images are unlikely to. But it is important to take time over decisions like seeing the body, and to prepare for the viewing, preferably getting verbal information first. Different cultural norms and beliefs will also have an important part to play in the decision making process. It is not helpful to go against a very firm view expressed by a family member, as long as it is informed, so if someone really does want to see the body it is important to respect this wish.

The days leading to the funeral can be extremely busy and confusing but this is also an important time because the decisions made cannot be unmade. It is important to think carefully about the funeral. If there are no cultural and religious imperatives, it helps to really take time to decide how the family want the funeral to be – time to make a decision, change  their mind and come to a conclusion they are more confident about.

 

The first instinct may be to have a very small private funeral, but they may later wish they had organised the type of funeral you might have done if the deceased had not died by suicide. If families feel they have been fully informed and have explored all the options available to them, but subsequently regret their choice, they are much more likely to accept that choice and forgive themselves, than if you feel they rushed it all because it was so painful and so difficult.

Family members bereaved by suicide are likely to grieve in many different ways, and many factors will influence their response. Grief behaviour will reflect the relationship they had with the deceased; the experience of a spouse will differ to that of a parent, the grief of siblings and friends can be hidden or may feel overwhelming. Family structures can be radically disturbed. The nature of the death, and whether it was completely out of the blue, or the result of long term mental illness will have an impact.

 

The extent of the shock of suicide is often underestimated. It is physically exhausting and can be experienced as a physical wound. Because we tend to live in the blissful belief that bad things happen to other people, when something as traumatic as suicide happens it can shake our confidence and feeling of security in the world. It can be all consuming psychologically, leaving almost no mental space for any other activity. Thinking can become circular, endlessly trying to find answers to the ‘why?’ and ‘what if?’ questions, searching for a way to make sense of what has happened and come to terms with what feels unbearable. Often our greatest longing is to go back and put right the terrible wrong of death by suicide, to rewind the film and have a different ending. We don’t want to accept what has happened and want to change the unchangeable.

 

Our minds can be full of questions that seem unanswerable. How can we find a place in our hearts and remember with love the person who has died when they killed themselves? How can anyone else understand the depth of pain we are experiencing? What do we do with the ambivalent feelings of fury and loss and longing? It can feel that no one else can fully understand, which can lead to a sense of isolation and despair. This can be further intensified when feeling the pain of our loss can be a way of keeping close to the person who has died.

 

Many people’s grief will stay ‘on hold’ until after the full inquest, which may be many months ahead.

 

Communication can be one of the most difficult aspects, within families as well as within their wider support group. The grieving process can be hindered by the (often unspoken) feelings of blame, insufficient information and understanding about suicide, and others not knowing what to say or how to help. “If you loved me, how could you do this to me and leave me with this mess?”.

 

The loss of ‘what might have been’ has an even more powerful impact when a death is by suicide because of the decision to die.

Finding ways of expressing thoughts and feelings is widely regarded by families as the thing that helps most.

  • Rituals: Rituals allow the expression of complex and abstract emotion. Use of ‘traditional’ rituals is often not possible for those bereaved by suicide because of the pain associated with the circumstances of the death. Try creating a new family ritual – it could be as simple as lighting a candle or reading a poem.
  • Reminiscing: for those bereaved by suicide, sharp, scary images associated with the traumatic nature of the death may block the sadder/softer memories of the person. Attempts to avoid memories can impede the grieving process. Bringing to mind different and positive parts of the life of the person who has died can be done through photographs, story telling or use of a memory box or memory book.
  • Important activities include: finding ways to express our feelings - this is most commonly done through talking and can be done with friends, in counselling, or in one of the many support groups available. Other ways are by keeping a journal or through creative activities such as painting or gardening.
  • It also helps to look after yourself: eat well, and make time for the things that give you pleasure. We feel grief physically in our body, and it can be releasing and calming to exercise, and a good walk can be as helpful as a major workout in the gym! Physical activity or a sport like kick-boxing is also a good way of expressing and releasing anger and can help children avoid hurting either themselves or others – a punch bag can be invaluable in helping children release angry feelings in a healthy way. And as much as the idea of relaxation may seem the hardest thing to do, it really can help, particularly after exercise.
  • Families often say they don’t get over the death or move on, as is often expected of them (itself an added pressure), but that with support they learn to live with it, to manage it, and to live and love again. There is no timescale for this, but often it takes longer than anyone would wish or expect.

As with adults, children will experience similar feelings as in any close bereavement, and also different ones. Children may feel vulnerable, angry, frightened and fearful, at the same time as having the ability to play and love and have fun. Sensitive, truthful and loving responses that are appropriate for the age and level of understanding of each child will best allow them to grieve. This is the ideal, but where the parent or parents are grieving themselves, it is not always easy. Prents making use of the support available to them will, in turn, help them to support their child.

 

David Trickey suggests that some of the things that most help children and families are:

  • Being able to make sense of the death helps to be able to fit a death into your ‘world view’. For those bereaved by suicide, it can be difficult to make sense of, because the ‘why?’ is unknown. For children it can be especially difficult, and they may blame themselves. It is important to reassure them that they are not responsible.
  • Having information although the first instinct may be to protect a child from the horror of the truth, you help build trust by telling children the truth and being as honest as you can in response to their questions.
  • Understanding ‘what’ and ‘how’ have to come before being able to deal with ‘why?’ and ‘why me?’ If details are withheld from a child bereaved by suicide, then: 
  • What they are told doesn’t tally
  • Their fantasy is often worse than reality
  • They may find out the truth in an unhelpful way
  • There may be inconsistencies in what adults tell them, leaving them confused

Having opportunities to talk it through is the way most of us make sense of difficult things. But for those bereaved by suicide, opportunities to talk are often lacking because of the stigma, not knowing what to say and not wanting our own view of the world to be challenged. And telling the story is not a one-off event; it goes on for a long time and children need to regularly update their knowledge to fit in with their growing and changing understand of the world.

 

Coping strategies: with the highest statistic for deaths by suicide being young people (men) and because anyone who is bereaved by suicide is at higher personal risk of dying by suicide, it is very important that children and young people are given the right support and information in order to help them understand, grieve and learn coping strategies that enable them to deal with life’s difficult situations. There may be a real fear for them and others that they may also become suicidal, particularly if they are of the same gender as an older sibling or parent/family member who died, or when they get to the same age.

 

Miscarriage bereavement:

When a new baby is expected in a family, most young children will be looking forward to the birth as much as everyone else. Having to explain the loss of an expected baby brother or sister is an incredibly hard thing to do. When deep in their own grief, parents might feel it’s just too much to have to start and think about what to say to a toddler or young child. However, children have a much greater capacity to deal with the truth than most adults realise; it is the unsaid and the untruthful that they struggle with.

Children are all individuals and each will react to what you are about to tell them in their own way. Some will be upset, others will carry on as if nothing has happened, but all will be affected to some degree. An explanation will enable them to start to try to make some sense of the situation. Without this, young children may start to feel anxious and insecure, unsure of what is going on and what is the cause. What they are not told they often make up, their imaginings being harder for adults to manage than a sad reality. This is when children can start to blame themselves by believing in some way they must be responsible for what has happened.

 

A child may not fully understand what has happened but they will certainly have picked up on parent’s distress and be very aware that things are “not right”. A simple explanation as to why they are upset will reassure that parents are OK but feeling very sad because that it is how people are when something upsetting happens.

 

Children are often involved in preparations for the new baby and along with the rest of the family may have talked about things they are going to do with their new baby brother or sister. They therefore need to understand why this is not going to happen to help them cope with their own, and everyone else’s disappointment. Even children who have appeared ambivalent about a new baby will still have had some expectations around being a big brother or sister.

It may feel unprotective, but children need to hear the news as soon as possible. The longer it is left, the greater the likelihood that they will overhear a conversation or find out in some other inappropriate way. Children are naturally curious and learn by asking questions. If a child is asking a question, it is usually because they need to hear, and are ready to hear, the answer.

If the baby died early on in the pregnancy, other children may not be aware that a baby was on the way. However, they will be aware that something is not right and that adults are behaving differently. Young children have a tendency to think that they must be the cause, even when nothing has been said or done to imply this. Some appropriate words to explain adults upset will reassure them that they are not the reason for it.

 

Try to use simple words appropriate for the child’s age and understanding. It is important to use the real words such as “dead”. Euphemisms including “lost” or “gone to sleep” may appear kinder but for a child can cause complication and confusion as they take them literally.

 

Every child is different and some will need more information than others. How much you say will be influenced by the child’s stage of development, personality and temperament. Parents know their child better than anyone and are therefore the best judge as to how much to say.

 

Give just enough information to deal with the question asked. When a child is ready to hear more, they will ask another question. There is a fine line between being honest and overloading a child with information they do not want or need. The following words are only suggestions to help you answer the question “What happened?“.

 

Initially this may be all you need to say. “I have some very sad news to tell you. Your little baby brother was not as strong and healthy as we thought he was and unfortunately he has died.“

 

Young children will not necessarily understand what being dead means. “Being dead means that he isn’t breathing, his heart has stopped and his body has stopped working. We are feeling very sad because we are going to miss him very much.“

 

On hearing the news young children will need reassurance. “It is very unusual for this to happen but sadly it sometimes does. When you were inside mummy’s tummy you were fine.“

 

Some children, because they are older, or are just more curious, might ask more questions. There is no timescale for this and it may be days, weeks, or months after the baby has died. The following are just suggestions to give you ideas for words that feel right for you and the child.

 

Agree beforehand with other adults around the child what you are going to say so that children hear the same explanation from all adults. A child’s reactions on hearing the news that their expected baby brother or sister has died will probably be the same regardless of at what stage of the pregnancy it happened. The term “born too early“ may feel easier to use than an adult word such as “miscarriage“; it is up to you.

“Sometimes babies are born too soon because there is something wrong with them and they have not grown properly when inside their Mummy’s tummies. Because they are not ready to be born, and are so very very tiny, they cannot live. Sadly, this what happened to our baby. We don’t always know why this happens and we wish very much that it had not happened to ours.“

 

The Miscarriage Association has other suggestions in their leaflet “Talking To Children About Miscarriage.“

 

Words that might help you to talk to a child about a stillbirth

  • A very few babies sadly die before they are born while still inside their mummy’s tummy.
  • While still in Mummy’s tummy the baby‘s body was not growing properly. There was something wrong with the baby and this meant that he died before he was born which is very sad.
  • This means that the baby will not be coming home to live with us or grow up to be big like you. How very lucky we are to have you.

I have some sad news to tell you. You know that we are expecting your baby brother/sister to be born in July. When mummy went to see the doctor today they took a special photograph ( scan) of the baby because they thought that there might be something wrong. When they looked at the photograph (scan), they could not see his heart beating. This is because it had stopped working. Your heart needs to work to stay alive so the doctor knew that he had died inside Mummy’s tummy. This means that when he is born he will be dead. This is a very sad thing to happen and we wish very much that he was still alive.

 

We will still give the baby a name, would you like to help choose one? We will say a special goodbye ( have a special service a bit like a funeral) after ………… is born.

“Sometimes babies are born with an illness, or something wrong with their body, that is so serious that they die very soon after they are born.

The doctors might be able see there is something wrong on a special machine that takes a photograph of the baby before it is born. This is called a scan. Not all problems can be seen this way and sometimes no one realises that there is something wrong. This is what happened to your little brother.

(Sometimes babies are born too soon. Because they are not ready to be born and are so very very tiny, they cannot live. Their heart and lungs are too small to work properly. This is what happened to your baby brother.)

Sadly, you got to know him for only a very short time but we will all remember him. I thought that his nose looked just like yours and he definitely liked your present of the bunny rabbit.“

Children need reassurance. Their sense of security may be shaken by what has happened and this can make children feel anxious. They may need extra cuddles or resort to soothing behaviours, such as thumb sucking, more than usual.

 

Try to keep to your usual routines as much as possible. Daily routines are probably disrupted and familiar people are behaving in unusual ways. Young children will find this unsettling and disturbing. Sticking to what you usually do will help to give a child a sense of safety and everything being OK.

Maintaining your usual levels of discipline will help children to feel secure,

With the permission of parents, tell any adults the child comes into contact with about what has happened. This will help them to understand if the child is behaving out of character and be ready to respond.

 

Adults act as a role model so it is helpful if everyone can take the same approach. Whether at home, in day care, or at school, children need an accepting and supportive environment where they feel safe to ask questions and share feelings. If the adults around them can express their emotions, a child will know it is OK to do the same.

 

Encourage and help them to express how they are feeling. Very young children use play to help them understand what has happened. Messy painting or drawing can help a child who is struggling to express themselves with words. Children of all ages enjoy books.

 

Supporting Children and Young People bereaved by murder or manslaughter

Supporting a child or young person around the death of someone important to them is one of the hardest things for any adult to do. When the death was brought about by a murder or manslaughter, this adds yet more pain and trauma to what is already a devastating situation. The emotional impact of such a sudden, violent loss for all family members is enormous, but especially so for children.

Having to deal with the police, the coroner, lawyers and the media all add to the stress. The requirements of the criminal justice system can cause lengthy delays to rituals such as the funeral which may hinder or complicate grief and grieving. Trying to meet the needs of any children affected, while dealing with a parents own grief, confusion and exhaustion, is an enormous and challenging task.

Every child is different and their response will be influenced by their age, any previous experiences of death, their relationship with the person who died and also with the accused. The expected reactions to a death by natural causes will still be there but intensified and amplified.

 

To a child, the world can now feel like a very unsafe place where the natural order of things is completely disrupted. Without a secure foundation to life, a child’s emotional development and psychological health can be affected. They can become fearful of the future and see no point in investing time and commitment to any aspect of their lives.

 

With this type of death, children can be at significant risk of developing post traumatic stress disorder, particularly if they witnessed the crime or were involved in some way - for example having to call the emergency services. It is more likely that a child bereaved this way will need professional support in the immediate aftermath and the longer term. If reactions include disturbing and intrusive flashbacks, suddenly being startled, acute anxiety or anything which is preventing a child attending school or taking part in their usual routines, it is important for parents to speak to their GP or seek other professional advice.

 

The death is also likely to be reported in the local or national news. There may be intrusion from the media or questions from people about what happened. For children, and often adults, this can feel intrusive and difficult to manage.

When the person responsible for the killing is known to the child this can complicate responses and reaction. Government statistics state that 75% of victims aged under sixteen knew the main suspect. Family relationships may be adversely affected as everyone tries to deal with the resultant turmoil of confusing emotions.

 

A family member may be a suspect, but to a child they are still a parent, brother or sister. A child may continue to love them as part of their family, but mixed in with conflicting feelings of shock and horror at what has happened. Because of this family bond, a child may consider themselves responsible in some way for the death, or feel they could have, or should have, done something to prevent it. This sense of self-blame can create deep-seated feelings of guilt.

 

When one parent has killed another, in effect a child has lost both parents in a manner that is both sudden and shocking. The death may mean that a child has to move from their home and be looked after by relatives or someone they are not familiar with, or don’t know at all. This can add to feelings of insecurity and confusion.

Children can deal with the truth, no matter how difficult or traumatic. What they find hard are the untruths. When circumstances surrounding the death are particularly distressing, it may be tempting to withhold information. However, a death by murder or manslaughter tends to be picked up by the press and the local grapevine. The chances are that a child will overhear a conversation, or be told by someone at school. It is much better that they are told in a controlled way, in a safe place, by someone they trust.

A child is going to find what they hear difficult. In their helpful booklet “Hope Beyond the Headlines“ Winston’s Wish make some recommendations on ways to tell children that someone has died in these circumstances. The approach is one of a sandwich made up of difficult bits layered in-between anything that is reassuring or that might help the child to feel safe. Think carefully about the actual words you use. With young children try not use emotive language such as “stabbed” or “murdered.” Saying “hurt” and “killed” still gets the message across but puts more focus on the death of someone important to the child, rather than the violent circumstances.

 

The words below are not meant to be a script, more ideas to give you the confidence to go with what feels right for you and the child or children that you are with.

 

Start by explaining that someone has died. Let’s sit down together in the kitchen, I have something difficult I need to speak to you about. I am very sorry to have to tell you that Dad died last night.

 

This may be all you need to say at this stage but if they have already picked up information from the media, you may need to say more. Overheard conversations, or use of social media, will speed up the need to know, particularly with adolescents and teenagers. If you suspect this is the case, check it out by asking what they think has happened; this will give you a clue as to how much they already know. It is important to correct any wrong facts.

 

Although Dad is dead he is not hurting. Dad was attacked by some people and they had a very big fight. The doctors tried their best to make him better but he was too badly hurt and he died.

 

When a child is ready to hear more, they will ask a question. Try to answer only the question asked with just enough information to enable the child to start to put together a story that makes some sense to them.

 

The people who attacked Dad had a knife and hurt him a lot. The police are working really hard to find whoever it was who did this.

 

More information should be given in stages, each stage being prompted by the child. Some children will pass through these stages faster than others. The timescale may be days, weeks or months, dependent on each child’s readiness for further detail. Space and time will be needed to absorb the information, ask questions, or talk about how they are feeling should they want to.

 

For children, receiving this news will be no less of a shock than for an adult but ways in which they think about the victim, feel about the murder and express their grief will differ.

It is not unusual for a child to ask to see the person who has died. Children are naturally curious and provided they are well prepared, viewing a body can help them to understand what being dead means. Thinking through how to meet this request can be difficult and understandably adults may have reservations. Children sometimes choose to view a body to say goodbye and gain reassurance that it looks peaceful. This may not be achieved when the cause of death has resulted in damage to the body which could be distressing to witness, particularly for children. It needs to be thought through carefully. If a face is unrecognisable, it may be appropriate to view, or even touch, an undamaged part such as a hand. The body being covered up and only the hand exposed. However, there is a risk that the young person will ask to see the rest of the body and adults will need to think how they will answer this request. Again very careful preparation is essential. Providing a clear but sensitive explanation can help. Because of the way your Dad died, his body is damaged and you might find that upsetting to look at but you can see or hold his hand if you would like to.

  • Try to be available to talk and answer questions. Children of all ages have told us that having time and space to acknowledge what has happened is something they need. Children often worry about saying things that might upset people. This can make them reluctant to talk about what has happened or feel uncomfortable about asking questions. Reassure them that you will listen, without making judgements, about anything they feel they need to say. This makes it easier for them to approach you.
  • Explain the role of the media and the criminal justice system. It is likely that the death will be reported in the media and that children may have to speak to police or other professionals about what happened. It may help to explain that this occurs because what happened was wrong and people need to find out what happened in order to help make sure it doesn’t happen to anybody else.
  • Rehearse managing difficult questions. Children can find it difficult to answer questions from others about what has happened. Work out together what they might choose to say in the face of difficult questions and practise beforehand. This will help them to feel more prepared.
  • Give lots of reassurance. For a child or young person who feels that they are somehow responsible for what happened, a clear, factual explanation provides solid evidence that nothing that they thought, did or said caused the death. Also emphasise that there was nothing they could have to done to prevent it. Children can find this difficult to take in at first so you may need to repeat the reassurance so that over time they gradually come to believe you.
  • Children may also start to worry about themselves or others close to them being hurt. Although you cannot offer definite reassurance that this will not happen, it can be helpful to say something like “there are some very bad people in this world but not many, most are good and kind”. Being heavy users of social media, adolescents and teenagers are more aware of the realities of life, and much of what they hear about is skewed towards the bad. A death by murder or manslaughter reinforces the feeling that the world is a scary and dangerous place. Try to talk about anything positive concerning people or places familiar to them. This might help redress the balance.
  • Remembering the person who has died and saying goodbye. Because of the circumstances surrounding the death, the usual rituals that help people say goodbye to the person who has died may be delayed due to post mortems and criminal investigations. It may be helpful in the mean time to acknowledge the death in another way. You could think about laying flowers in a special place.
  • Not all family relationships are good ones and the bereaved child may have ambivalent feelings towards the person who died. It helps to paint a realistic picture, the good bits and bad bits, so that the child can grieve for the real person.
  • Try to give them a sense of control. The young people bereaved in this way tell us the sudden nature of the death and the disruption and uncertainty caused by the legal processes exacerbate a sense of powerlessness and lack of control. The criminal justice system will restrict what can and cannot happen but try as much as possible to involve a young person in any major decisions that will affect their lives. For example, involving them in planning the funeral or discussing with them different options for support rather than making a decision on their behalf.
  • Time to have fun. As with any death, it is important that children and young people feel able to continue with activities that they enjoy and give themselves permission to have fun. Don’t be surprised if one minute younger children are very distressed but the next they are laughing and playing. Teenagers may appear to be totally focused on their social life but in reality are using it to blot out difficult feelings.
  • Speaking to others. The young people we work with who have been bereaved by murder or manslaughter, say that support from peers who have been bereaved in the same way is vital. The shared experience creates an understanding and empathy they feel no one else can offer.
  • Look after yourself. In order to look after children at a time like this it is important to look after yourself. Seek support from people close to you including friends and family. Sometimes people can find it difficult to know how to help so letting them know what you need may help them to support you.
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