Meaning Reconstruction After Suicide Loss

Abstract

Suicide loss is an example of traumatic loss, as suicide loss survivors face unique challenges in processing the loss. Consequently, in this conceptual paper, meaning reconstruction will be defined as a theoretical paradigm beneficial for clients navigating suicide loss. The aim of this manuscript is to provide a general overview of meaning reconstruction theory and to offer concrete suggestions on implementation of the meaning reconstruction theory as it relates to suicide loss. Further, the authors will utilize a hypothetical case study to illuminate the integration of meaning reconstruction for suicide loss survivors.

Keywords

grief meaning reconstruction traumatic loss paradigms disorientation

Meaning-Making after Suicide Loss 

Traumatic loss is a unique grief experience marked by impairment, anxiety, prolonged duration of suffering, and yearning behavior (Levinson & Prigerson, 2000; Prigerson et al., 1995). Moreover, traumatic loss is often sudden, unexpected, and beyond the scope of “normal loss” (Kozu & Gibson, 2021; Neimeyer et al., 2006, 2008). One specific example of traumatic loss is suicide loss (Kozu & Gibson, 2021). Suicide loss is unique: shocking, painful, unexpected, stigmatizing, and confusing (Feigelman et al., 2009). Suicide loss survivor and memoirist Rachel Dickinson (2022) described suicide loss as dissociative, unimaginable, and fragmented.

Tragically, suicide deaths have increased approximately 5% in the United States in 2021 and further increased in 2022, rising from 48,183 deaths in 2021 to an estimated 49,449 deaths in 2022, an increase of approximately 2.6% (CDC Newsroom, 2022). It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors (CDC Newsroom, 2022).

Suicide loss survivors face a wide range of challenges and are often left disoriented, needing to reframe assumptions that they may have had previously about the world (Neimeyer, 2000). Shattered assumptions, a term developed by Janoff-Bulman (1992), describe the disorientation that occurs after a traumatic loss such as suicide loss. Janoff-Bulman (1989) asserted that there are three foundational schemas or assumptions that contribute to psychological well-being. These include seeing the world as benevolent, the world as meaningful, and seeing oneself as worthy. These assumptions are challenged (or shattered) when sudden loss occurs. As a result, a large chasm between previously held assumptions and the current reality occurs. Violent or sudden loss creates increased dissonance in survivors (Neimeyer et al., 2008). Clients who encounter this type of loss may experience doubt, anxiety, and a loss of social support (Captari et al., 2021; Van Tongeren & Van Tongeren, 2020).

The increasing prevalence of suicide loss and the confusion and disorientation associated with suicide loss have resulted in a proliferation of contemporary grief theories. Meaning reconstruction is one contemporary grief theory that aligns with research attesting that the deleterious impact of traumatic loss can be mitigated through meaning-making (Bonanno et al., 2004). 

Defining Meaning Reconstruction Theory

Meaning reconstruction theory is a social constructivist bereavement theory in which the interpretation of the grief experience is seen as unique, and different for everyone (Hibberd, 2013). Meaning reconstruction involves both meaning-making and meaning-finding (Attig, 2001). According to Neimeyer (2000), meaning reconstruction involves finding new meaning for both the life of the survivor as well as maintaining connections with the loved one who has died; stating that this involves both a process of working out the meaning of the loss and integrating that meaning into the present moment.

Neimeyer (2000) believed that the attempt to make sense or craft meaning after death is normative and central to the grief process. Meaning is a broad term that describes how an individual understands their experience and is fundamental to being human (Barboza et al., 2022; Van Tongeren & Van Tongeren, 2020).  According to Hibberd (2013), meaning can be hard to define and is something experienced differently by individual grievers. Neimeyer (2001) proposed three elements that those who have lost a loved one are most likely to engage in as they reconstruct meaning following the loss: sense-making, benefit finding, and identity change. All three elements of meaning reconstruction theory attempt to help describe how a grieving individual searches for coherence and accommodation of a new reality (Hibberd, 2013; Janoff-Bulman, 1992, Neimeyer, 2001).

Sense-Making

Sense-making is the first activity grieving individuals may engage in as they attempt to find answers to: (a) what (b) how, and (c) why the loss happened (Neimeyer, 2001). Individuals who have trouble with sense-making often have experienced the most difficult losses (Folkman, 2001). Sense-making might occur in a suicide loss survivor who looks for a letter that might explain why a loved one decided to end their life and might involve recursive storytelling where the grieving individual talks about their loss repeatedly (Neimeyer, 2001). According to Hibberd (2013) and Janoff-Bulman (1992), the need for a coherent narrative leads a grieving individual to demand an answer to the “why” behind the loss. Wolfelt (2006) in his work on companioning suicide loss survivors emphasizes the importance of the sense-making process with suicide loss survivors.

Benefit Finding

The second element of meaning reconstruction, benefit finding, refers to building new meaning structures and perceiving benefits from the loss (Gillies & Neimeyer, 2006; Hibberd, 2013; Neimeyer, 2001). Benefit finding may come years after the loss and like sense-making, it is a unique experience for each bereaved individual (Neimeyer & Anderson, 2002).  Benefit finding may involve a suicide loss survivor who decides to spend time volunteering for a suicide loss or prevention organization.

Identity Change

The last element of meaning reconstruction is identity change, which refers to the process in which the bereaved individuals reconstruct themselves (Neimeyer et al., 2002). Post-traumatic growth, resilience, independence, vulnerability to secondary losses, existential growth, and confidence are some potential reconstructions associated with identity change (Tedeschi & Calhoun, 1996, 2006).  In addition, identity change can be cultivated through strengthening emotional bonds with others as well as bolstering social support resources (Neimeyer et al., 2002). A suicide loss survivor may engage in identity change by reflecting on how they have personally changed because of the loss.  

Integrating Meaning Reconstruction  

Meaning reconstruction can occur in a myriad of ways and can be integrated into counseling sessions with suicide loss survivors. Ritual and expressive arts can be concrete ways to integrate the process of meaning reconstruction with suicide loss survivors (Torres et al., 2014).

Engaging with Rituals

Rituals help suicide loss survivors find meaning by providing intentional space to be broken open and put back together in a mutually held space (Weller, 2015). In a study conducted by Mitima-Verloop et al. (2021), personal and collective rituals remain important after a loss; reporting that in the 3 years after the loss of a loved one, around 85% of participants performed individual rituals and more than 50% engaged in collective rituals. Communal ritual is a way in which safety and social support are facilitated after a significant loss (Mathew, 2021). Overall, rituals can be used in sense-making, benefit finding, and identity changes that define meaning reconstruction theory and can be woven throughout the duration of a counseling relationship (Mitima-Verloop et al., 2021). Clients can engage with rituals at the beginning, middle, and termination of counseling services. At the outset of treatment, discussion on examples of rituals such as prayer, meditation, music, art, and journaling can be discussed. Next, mental health professionals can assess what rituals clients have employed throughout their lives. These rituals can be woven into treatment planning. For example, a client may indicate that prayer is an important part of how they are coping with loss. This can be used under a general treatment goal of coping skills.  Rituals can be used to conclude a therapeutic relationship when the relationship between counselor and client ends. Examples of rituals useful in processing suicide loss may include memorial services, memory crafts such as memory boxes, and designated times to share stories (Doka, 2014).   

The specifics of rituals can vary and can be associated with traditional religious structures or associated with informal practices (Mathew, 2021). These practices have been found to be useful and meaningful immediately after and years after the loss (Mitima-Verloop et al., 2021). Weller (2015) stated that the presence of a supportive other and the support of ritual is needed before a grieving individual can fully encounter their loss.

As previously stated, rituals can be woven into treatment planning. Sample prompts on integration of rituals in counseling sessions are described below and were developed by the manuscript authors, including: How do you define “ritual,” have you found rituals to be helpful to you in the past, and what rituals might you like to integrate into our work together? Bidwell-Smith (2023) described four ritual categories including: Rituals of continuity (used to enhance connection with the loved one who has died), rituals of transition (used to mark a change in the grief process), rituals of affirmation (used to process emotions associated with the loss), and rituals of intensification (used to mark the passing of time).

Examples of specific rituals that are helpful in processing suicide loss can be provided to clients (Doka, 2014). Rituals also do not have to be formal and can be conducted informally, daily. Examples of informal daily rituals are depicted below and were listed and provided by Bidwell-Smith (2023).

Read a poem or passage from the client's choice of holy text, such as the Bible, Quran, or Torah, that provides solace.

Engage in deep breathing before starting the day.

Have a small area in your home where a few pictures and mementos honoring loved ones are displayed.

Listen to your loved one's favorite music or songs.

Create art.

Create a memory book.

Carry a special item that belonged to your loved one.

Plant a tree or garden.

Volunteer for something in your loved one's honor.

Create a scholarship in your loved one's name.

Incorporating Expressive Arts Modalities: Photography and Digital Storytelling 

Photography and digital storytelling can help bereaved clients find meaning after the death of their loved one (Bee Choo et al., 2020; Jiménez-Alonso & Bresco, 2022). In a study conducted by Jiménez-Alonso & Bresco de Luna (2022), photography was seen as a helpful tool for bereaved individuals to preserve continuing bonds, regulate emotions, and scaffold narratives of the loss. One way to use photography is through digital storytelling. However, digital storytelling is not limited to photography. Digital storytelling is relatively easy to access and learn and incorporates expressive art artifacts such as songs and text messages (Rolbiecki et al., 2021). In addition to helping bereaved individuals to regulate emotions and actively work on meaning-making, digital storytelling can also encourage the use of social support (Rieger et al., 2018). Digital storytelling can be shared on digital platforms to enhance community building for grieving individuals (Bee Choo et al., 2020; Moyer & Enck, 2020). Overall, photography and digital storytelling are two examples of expressive art modalities that can help a grieving individual facilitate meaning.  

Applying Meaning Reconstruction Theory

The Case of Gemma: A Snapshot of Suicide Loss

Suicide loss often engenders an intense urgency for those left behind to find an explanation and to create some sort of understanding. According to Barrett and Scott (1990), suicide survivors have more types of issues to navigate; suicide loss is often viewed by the survivors as “avoidable,” and survivors are confronted with the sudden nature of the loss. Moreover, in one study conducted by Rudestam (1987), funeral directors reacted differently to suicide loss survivors than other bereaved persons. Suicide loss survivors also often withdraw from others and do not reach out for help, as they encounter stigma (Allen et al., 1994; Rudestam, 1987).

The manuscript authors seek to illuminate the application of meaning reconstruction theory by using a hypothetical case study. This case study will work through the tenets of meaning reconstruction as they relate to suicide loss. In this case, Gemma, a suicide loss survivor, struggles to find meaning after the loss of her son and seeks professional counseling to move forward with her loss.

Gemma a 45-year-old cisgender Caucasian female begins counseling to process the loss of her 19-year-old son, Luke, to suicide. Gemma begins the initial counseling session tearful and struggles to share that her son died by suicide 8 months ago. Gemma has been married for 20 years and has two other children who are 15 and 17. Gemma shares that she wanted to start counseling sooner but found it difficult to find the courage to begin the counseling process.  Gemma explains that she finds herself spending a lot of time wondering “why” and has spent a lot of time looking for a suicide note that would explain the reason Luke died by suicide. Gemma wonders if this is normal and shares that her husband has suggested that she needs to stop asking “why.” As her counselor, you desire to explore therapeutic rapport by developing safety. You do this by asking Gemma to share more about her son. You don’t use past tense and simply state, “Gemma, would you tell me about Luke?” As Gemma begins to share, you encourage her to continue sharing Luke's story asking questions listed below:

Tell me about Luke.

What did he like to do?

What kind of music did he listen to?

Lastly: What is a story you’d like to share about Luke?

Gemma tearfully relaxes and shares that people have stopped asking about Luke. Gemma then asks if she can share a picture of her son, which she has on her phone. She shares the picture and states that he had a wonderful sense of humor. Gemma laughs as she recalls how her son always had something to say or a joke to share. Gemma spends time in this initial session sharing a wide range of emotions and expresses anxiety that the 1-year anniversary of Luke's death is coming up in 3 months.  She is unsure how she wants to spend the day but does share that it has been comforting for her in the past to spend time in nature. Additionally, Gemma reveals that it is helpful for her to talk with Luke's friends and allow them to share memories with her.  She shared that soon after the death, Luke's friends shared with her, via email, stories about Luke.  Overall, the case of Gemma exemplifies the complexity of traumatic loss.  

Putting it All Together

Meaning-making is difficult and relies upon therapeutic rapport. In this case study, the counselor focuses on allowing Gemma to feel safe by non-judgmentally approaching Gemma's experience of asking “why?”.   Next, the counselor creates space for Gemma to share stories and a picture of her son, which creates rapport and begins the process of using narrative storytelling to help Gemma craft meaning from the loss. 

Sense-Making

Gemma engages in sense-making through asking questions. Her questions are an effort to find the “why” behind Luke's suicide. In the process of sense-making, Gemma is not likely to receive satisfactory answers to her questions. However, the process of asking the questions should be honored in counseling sessions as normative. The goal of sense-making is not tidy resolution but a space for authentic expression of the existential questions that emerge from loss.

Benefit Finding

Gemma may additionally be challenged to see the suicide loss as having any sort of benefit. It is important to note that it is not the job of the counselor to insist on a silver lining, engage in toxic positivity, or dismiss the pain of grief (Devine, 2017; Wolfelt, 2006). However, as Tedeschi and Calhoun (2006) shared, growth can result from suffering. In the case of Gemma, the counselor could gently encourage conversation surrounding how life has changed. Consequently, this invitational posture could facilitate an opening for Gemma to explore the ways in which her relationships, spirituality, or engagement with the world around her have deepened in positive ways.

Identity Change

Grief changes many areas of a person's life (Devine, 2017; Wolfelt, 2006). Below are some questions the authors constructed that might encourage Gemma to consider all the ways her identity has shifted because of the loss.

How do you handle it when someone asks you how many children you have? What has been helpful to navigate the question?

How do you identify or not identity with the label “bereaved mother?”

How have you found your personality shift after the loss? For example, some parents have shared that engaging socially is hard after loss. Is that true for you?

Conclusion

The search for meaning after suicide loss is normative and important, as those who make sense of their loss experienced lower rates of complicated grief (Lichtenthal et al., 2010; Neimeyer, 2000, 2008). Spirituality can be a mechanism by which meaning-making occurs (Neimeyer, 2000). Meaning-making is a process that is time-consuming, difficult, and ultimately crafted and directed by the client (Neimeyer, 2000, 2008; Van Tongeren & Van Tongeren, 2020; Bidwell-Smith, 2023). According to Bidwell-Smith (2023), finding meaning is an individual process and it does not mean letting go or moving on from a loss, and does not mean that the death was okay or must be accepted. Finding meaning through spirituality and/or religious activities and rituals are often important to suicide loss survivors and can be validated and encouraged by the mental health professionals.

In a memoir about sudden loss, Chening-Han (2023) described her grief as a quest to define herself alongside the absence of her friend. Meaning reconstruction theory is a framework for grief that attends to the needs of the grieving individual traversing the shifting terrains of loss. Overall, this manuscript sought to define the theory followed by a case study that exemplified ways suicide loss could be addressed in counseling, using tenets of meaning reconstruction theory. Integration of the case was sought by showcasing how three tenets of meaning reconstruction theory fit the case of Gemma, who was highlighted as a bereaved mother navigating suicide loss. In conclusion, no grief theory is perfect, as grief is wildly unpredictable (Weller, 2015) and as Chening-Han (2023) affirmed there is no right way to mourn despite cultural pressure to be stoic and to grieve properly.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Ibrahim Akmese

Kristin Chamberlain

Author Biographies

Kailey Bradley earned her MA in counseling from Ashland University. She is currently a licensed professional counselor, with supervision designation as well as a nationally certified counselor. Kailey is also a fellow in thanatology and has an extensive background in bereavement, having spent 5 years as a hospice bereavement coordinator.

Kristin Chamberlain earned her Ph.D. in Counselor Education & Supervision from Ohio University. She earned a MSE in School Counseling from the University of Dayton and a BS in Nursing from Michigan State University. Dr. Chamberlain previously worked in a high acuity neonatal intensive care unit, caring for critically ill neonates. Dr. Chamberlain has experience working with counseling clients across the lifespan. Prior to coming to Ohio University, she was a tenure-track professor in the Department of Psychology at the University of Rio Grande. Dr. Chamberlain teaches professional school counseling, multicultural counseling, and doctoral courses in Counselor Education and Supervision. Dr. Chamberlain is deeply committed to student success through holistic education.

Ibrahim Akmese is a licensed professional counselor in the state of Ohio. He holds an M.Ed. in Clinical Mental Health Counseling and Rehabilitation Counseling from Ohio University and is currently pursuing his Ph.D. in Counselor Education and Supervision at Ohio University. He is interested in grief and loss, including complicated grief, ambiguous loss, and counselors’ grief competence.

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