(MayoClinic.com) The death of a loved one is heart-wrenching and painful. But when the death is because of suicide, those left behind face even more difficult challenges in coping and healing.

Suicide can affect partners, children, parents, siblings, friends, colleagues and medical providers. As a survivor of suicide, overwhelming emotions can leave you reeling. It may seem like your support system has vanished. And you may be consumed by guilt, wondering if there's something you could have done to prevent your loved one's death.

Bereavement after a loved one has taken his or her own life is often more complicated, intense and prolonged than it is with a death from natural causes. Although as a survivor of suicide you may never fully recover and always feel a loss, you can learn how to cope better and eventually move forward in a way that's healthy.

It's common for a wave of powerful emotions to wash over you when you first learn of a loved one's death by suicide.

The immediate emotional response after a suicide often includes:

• Shock. Disbelief and emotional numbness may set in. It's hard to accept a sudden and traumatic death, even if it may have been preceded by suicidal behavior or talk. You may think that this couldn't have happened, that it's not real, or that it's only a nightmare and when you wake up, things will be OK.
• Confusion. You may not understand why your loved one died this way. Some people who take their own life don't offer any signs that they're considering suicide, so you may find it hard to reconcile the person you knew with the actions he or she took. You may repeatedly ask, "Why?"
• Anger. It's natural to feel anger about many different things after a suicide. People who were in contact with your loved one near the time of the suicide — doctors, police, emergency workers, therapists, friends or family — can become objects of your anger or rage. You may feel that they let your loved one down, missed clues about suicidal intentions, or could have prevented the death. You may direct your anger at yourself, too. And you may also become angry with your loved one, feeling cheated, abandoned or left with a legacy of suffering and inconsolable grief.
• Despair. Sadness, depression and a sense of defeat or hopelessness can grip you. You may even consider suicide yourself.
• Grief. Sorrow and anguish run deep as you mourn the loss of your loved one's life, and mourn for yourself, as well.
• Guilt. Survivors often initially think they could have done something to prevent a suicide. You may replay "what if" and "if only" scenarios in your mind, blaming yourself for your loved one's death. You may also feel guilty about your interactions with your loved one, regretting an angry phone call, long-ago childhood teasing or postponed get-togethers. You may also feel embarrassed and ashamed that a loved one has committed suicide.

Along with the intense emotions can come a variety of physical or behavioral reactions to news of a loved one's suicide. These perfectly normal reactions may include:

• Crying
• Screaming
• Angry outbursts
• Physical collapse

You may continue to experience intense reactions in the weeks and months after a loved one's suicide. Sometimes these reactions may even resemble symptoms of post-traumatic stress disorder (PTSD). These reactions may be especially intense if you witnessed the suicide or found your loved one. These reactions may include:

• Nightmares
• Flashbacks
• Social withdrawal
• Avoidance of people who remind you of your loved one
• Repeated visual images of your loved one
• Sleep problems
• Concentration difficulties
• Lack of motivation
• Loss of interest in daily activities or hobbies
• Family conflicts
• Denial of emotional pain

If you try to ignore your feelings, deny yourself the opportunity to mourn, or you don't find the support you want and need, your emotional wounds may not improve, and other problems related to grief and complicated grief can develop. Suicide survivors are at higher risk of depression and suicide, for instance. And families that don't find healthy ways to cope can be torn apart by unresolved issues, finger pointing or a breakdown in communication.

The physical and emotional aftermath of a loved one's suicide can wear you down physically and emotionally. Family, friends and even support groups for survivors of suicide may be sources of comfort, understanding and healing.

Some bereavement groups are specifically intended for survivors of suicide. Because stigma — perceived or actual — can accompany suicide or mental illness, you may find it easier to share your experiences with others in a support group who are struggling with the same issues. You're less likely to feel shame, embarrassment or a need to hide the truth. You may benefit from the empathy, understanding and guidance that support groups offer. And you may find purpose or strength in reaching out to others trying to cope with their own loss.

But if the tragedy of your loved one's death causes intense or unrelenting anguish or physical problems, consider asking your doctor or mental health provider for help, especially if you have thoughts of suicide yourself or symptoms of depression. Unresolved grief can turn into complicated grief, where painful emotions are so long lasting and severe that you have trouble accepting the death and resuming your own life.

Both psychotherapy and medications can help you cope. You may only need short-term treatment to get you through the worst of the crisis. Therapy can help even if the death was years ago. Family therapy with children or your partner can help if normal functioning and interaction have been displaced by blame and withdrawal.

There are many resources to help you cope with the tragedy of a loved one's suicide. You don't have to go through it alone.

A suicide can be devastating. In addition to reaching out to family, friends, support groups and professional help, these strategies can help you get through it in a way that safeguards your own mental and physical well-being:

• Keep in touch. Your inclination may be to withdraw into isolation. Avoidance may seem easier than confronting painful emotions, reminders or situations. But the support of family, friends, spiritual leaders or your faith community can soothe your distress and even offer a healthy distraction.

• Share your story. Talking about your experience in the safe and comfortable environment of a support group first can make it easier to tell others about your loved one's death later. You may initially struggle with what or how much to reveal. Do what's comfortable for you. Many survivors of suicide find it easiest to be forthright and honest, simply stating that their loved one died by suicide, while others choose to keep it private.

  You may encounter people who don't know what to say to you — they might not even mention your loved one's name, for instance. Or they may seem to avoid you. But that's usually because they don't want to risk saying something inappropriate and wounding you further. Decide whether you want to take the initiative and share your feelings.

• Do what's right for you. Grieve in your own way, not someone else's. You may find it too painful to visit your loved one's gravesite, for instance, while someone else may want to go every day.
• Be prepared for painful reminders. Birthdays, anniversaries, holidays and other occasions you normally would celebrate can become painful reminders of your loss. This is a normal reaction, so don't chide yourself for being sad or mournful. If it helps, change or suspend family traditions that are too painful to continue.
• Don't rush yourself. Losing someone to suicide is a tremendous blow, and healing must occur at its own pace. You may, for instance, want to take more time off work than a standard bereavement leave allows. And don't be hurried by a friend's expectations that it's been "long enough."
• Expect setbacks. Some days will be better than others. And some days, when you thought things were improving, you may find yourself overwhelmed by powerful emotions once again. The death of another loved one even years later may reawaken memories of the suicide, for example. But know that healing doesn't often happen in a straight line. There'll be bumps, and your coping strategies will help you get over them.

It's OK to start enjoying your life again, to find laughter in funny movies or in a child's antics. Pursuing hobbies, socializing and having fun aren't a betrayal of your loved one's memory. They're a sign of your healing.

In the aftermath of a loved one's suicide, you may feel like you can't go on or that you'll never enjoy life again. In truth, you may never completely get over the loss. You may always wonder why it happened, and reminders may trigger painful feelings even years later.

But eventually, the raw intensity will fade. The tragedy of the suicide won't dominate your days and nights. Perhaps you'll find meaning and purpose in activism, or you'll begin recalling moments from happier times and smile to yourself. Understanding the complicated legacy of suicide and how to cope with palpable grief can help you reach inner peace and healing, without forgetting your loved one.

E-mail to a friend

Share this on:

Mixx Facebook Twitter Digg del.icio.us reddit MySpace StumbleUpon

| Mixx it | Share

More features from MayoClinic.com

• Coping with pregnancy loss
• Grieving process: Is crying required?
• Complicated grief
• Infant death: Grief and the path to loving remembrance
• Grief: Coping with reminders after a loss