Denial of suicide
From this study, the central attitude of those bereaved by suicide to suicide is an outright unwillingness to accept that the death of a relative was due to suicide. During each meeting with the pathologist, each of the 8 groups in various ways tried to persuade the pathologist not to report the cause of death as suicide. This position is summed up by one participant as follows:
Doctor, please don’t say he died by suicide. We cannot allow the world hear that. No, doctor, please, nobody must hear that. You can say anything but ... please just don’t say that. (Participant G5P1)
Though 3 (37.5%) bereaved families felt that they had good reason(s) to believe that their relation did not commit suicide, interestingly, neither they nor any other group made any attempt to hinge their denial of the suspected suicide event on a tangible evidence. Rather the main concern expressed by all the groups was that those bereaved be shielded from the life disruptions association with suicide bereavement. The following excerpts from participants highlight this fact:
We were not with him. We don’t know what he did or did not do....What is the use of creating more trouble...everybody will just suffer for what a person who chose to leave them did? (Participant G3P2)
Do you know what it can mean...to go tell everybody that our brother killed himself? If you knew...We cannot do that. (Participant G1P1)
Other authors (Tzeng et al. 2010; Avrami 2005) also reported denial of the event by participants in their studies. Nic an Fhaili et al. (2016) reported that some participants in their study though accepted suicide as a mode of their relative’s mode but preferred the use of the expression “died by suicide” rather than “committed suicide.” These relatives believe that “committed” implied a crime and therefore amplified the stigma they felt. Participants in this present study said their desire for a different diagnosis than suicide is also reinforced by the fact that the law will not hold anybody responsible for the act. One participant puts it this way:
If a man kills another, the law punishes him. What of the man who kills himself? The law does nothing but abandon the living to the punishment. Participant G5P1
Fear of stigma
Stigmatisation of suicide has always been with man. It is demonstrated through various combinations of the following practises namely denying the deceased proper burial, excommunication of the bereaved family from the community and appropriation of the property of such family as a whole or those of the deceased (Scocco et al. 2012). Stigmatisation is described as a social process that involves labelling, stereotyping and rejecting human differences with the intent to exert social control (Link and Phelan 2001; Parker and Aggleton 2003). Suicide stigmatisation in our culture is aptly captured by Achebe (1984) in his foremost novel “Things fall apart” when Obierika speaking to the District Commissioner about the suicide of his friend, Okonkwo, said, “We cannot bury him. Only strangers can. That man was one of the greatest men in Umuofia. You drove him to kill himself; and now he will be buried like a dog....” Fear of stigmatisation was a dominant theme in all the meetings with bereaved families/groups in this study. It was proffered by all eight families as the major reason they did not want a diagnosis of suicide pronounced on their relation. Groups however varied in the content of the stigmatisation they feared. This included denial of proper burial rites (n = 8; 100%), refusal to be accepted in marriage (n = 7; 87.5%) and non-acceptance into the traditional institutions of their community (n = 5; 62.5%). Additionally, 3 families each (37.5%) said that they feared shunning/denial of routine social contacts and banning from participating in economic activities respectively. These fears are reflected in the following excerpts:
If you commit suicide in our place, you will be treated like a dog...like you are a curse. They will just dig the ground under where you are hanging and cut you into it. And your family, nobody from you can marry anybody from there ever again. (Participant G2P3)
If it is believed in the community that my brother killed himself, I have 2 sons...People will take a long time before they can do anything with us again. We can’t take the Ozo title [admission into traditional society] ever again. (Participant G4P5)
This finding that fear of stigmatisation is a major concern for suicide survivors is also documented in a number of studies (Young et al. 2012; Pitman et al. 2016; Scocco et al. 2012; Peters et al. 2016). Also, all the participants in this study similar to those in other studies (Nic an Fhaili et al. 2016; Hanschmidt et al. 2016) said they would not accept any form of help with respect to the event. One participant (G3P1) put it succinctly as follows:
Help...for what? If you say, “I need help” what are you not saying? Give me all these side talks, finger pointing! It means that I agree that my relation hanged himself. (Participant G3P1)
Feeling of shame
Like the fear of stigmatisation, all participants said they already felt shamed by the suspected suicide and would face even greater shame if suicide is confirmed. This pattern of shame co-occurring with stigma in suicide bereavement has also been reported by other workers (Pitman et al. 2016; Peters et al. 2016; Asare-Doku et al. 2017). According to participants in this study, suicide would bring shame to their family for one or a combination of the following reasons:
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Confirmed suicide by a family member will suggest that their family relationships are dysfunctional (n = 4; 50%)
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They will be looked upon as a family that is cursed (n = 3; 37.5%)
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Confirmed suicide by a family member will suggest that they are a family of weaklings who are unable to endure the pressures of life (n = 6; 75%)
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The community shall start referring to them as “the family of people who kill themselves” (n = 3; 37.5%)
Shame appears to reduce the sense of being worthy of any help and, like fear of stigmatisation, appears to be central to poor help-seeking behaviour that was demonstrated by all participants in this study. Pitman et al. (2016) also found a positive relationship between feeling of shame and poor help-seeking attitude in suicide survivors. Participant G8P2 said that suicide shame would be far reaching.
With just suspicion, we are already the wastebasket of our community...Never be able to lift our voice at anybody or on any issue. Oh, they will just ignore you if you try to put your mouth into any issue... People will say, “No, don’t say anything to them. You won’t know what you say that will make them go kill themselves.” If any of us now will even go to the hospital for anything, people will say that another of their brother wanted to kill himself. (Participant G8P2)
Fear of economic repercussions
Six (75%) of the 8 families said that if people knew that their relative committed suicide, they would suffer definite and severe economic repercussions. All 6 families (75%) said that they would be required to carry out expensive rituals for the cleansing of the land. Five of them (62.5%) said that the property in which the suicide act was performed would be forfeited to ani, the earth goddesses, while 50% (n = 4) said that they will not be able to transact business in the community. Scocco et al. (2012) also reported that suicide survivors in their study reported similar economic consequences. However, not all economic repercussions are brought on survivors by the society. Two family groups (25%) said that they would not appropriate any material thing left behind by their dead relative if his death were pronounced to be due to suicide even if there is no traditional requirement for them to do so. In their belief, doing that could bring them economic difficulties or even lead to suffering similar fate as the deceased. Participant G4P2 said:
It is better you don’t know...what you know not doesn’t kill you. If you know...the man killed himself and you take his property? You can’t do that because it will bring curse upon your own. (Participant G4P2)
In contrast though, some studies (Yang and Lester 2007; Stack 2007) believe that suicide may indeed be beneficial to society citing savings from not having to treat depression and other psychiatric conditions in people who commit suicide, pensions, social security and nursing home payments and assisted suicide, though the studies reportedly did not consider the cost of the psychological pains and suffering of suicide survivors.
Religious concerns and beliefs about afterlife
All the bereaved persons in this study subscribe to the Christian religion. Members of the same groups differed in their perception of the place of religion in dealing with suicide. Most (n = 21; 77.8%) participants in the discussions believed that suicide was sinful while some (n = 15; 55.6%) believed that if their relation had committed suicide, he must have been driven to the act by some evil forces. Hagaman et al. (2013) reported similar sentiments by suicide survivors in Haiti while Manoranjitham et al. (2007) reported that Indians accept suicide as an option to escape life challenges even though their religions put high values on life. Participants (n = 5; 67.5%) in this study feared that potential consequence of suicide would be refusal by the church to accord the dead appropriate burial rights a sentiment similar to that reported by Peters et al. (2016). Another expressed fear was that since it is the gods that drive people into killing themselves they may do it again to other family members (n = 3; 37.5%). Asked how denying suicide can prevent that, one participant answered as follows:
When you accept something, your chi (personal god) will accept that too. Participant G2P2
However, 5 groups (62.5%) in addition expressed a conflict between wanting to appease the spirit of the dead and not wishing to desecrate the land. One family leader said:
We want to give our brother proper burial rights because otherwise his spirit will never rest; it will continue to stalk us. But we also don’t want to bury him if he committed the act lest we desecrate the land and incur the anger of the gods. It is our dilemma. (Participant G7P1)
No participant expressed any concern that there could be a direct repercussion on his religious life or that of the other survivors in general following a suicide act.
Survivors' anger against someone who died by suicide
Four (50%) of the families expressed various degrees of anger at the dead relative while the other 4 said they would not speak against the dead. Of the families that felt anger, there was no unanimity on being angry and on the reasons for such anger. Three specific areas were identified as the basis on which the bereaved would feel anger against their relation who committed suicide. These include that the deceased abandoned family responsibilities (general and personal), that the deceased brought shame to the family and that the deceased action amounted to economic loss to the family. Survivor anger has been reported in other works (Young et al. 2012; Asare-Doku et al. 2017) though the reasons for the anger were different namely that the deceased deprived the survivor the opportunity to help him go through their challenging experiences and that the deceased was cowardly, unable to face life challenges.