Psychiatry

Interpersonal and Biological Processes

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Children of Suicide: The Telling and the Knowing

Albert C. Cain

To cite this article: Albert C. Cain (2002) Children of Suicide: The Telling and the Knowing,
Psychiatry, 65:2, 124-136

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Psychiatry 65(2) Summer 2002 124

Children of Suicide: The Telling

and the Knowing
ALBERT C. CAIN

Amidst the still limited literature on survivors of suicide, and the particularly scanty
literature on children of parental suicide, little focal attention has been given to
the special issues surrounding surviving parents telling the children that their
deceased parent’s death was a suicide. Those few papers that deal with this topic
have primarily emphasized the destructive consequences of not telling of the suicidal
nature of the death, with imperatives to tell the children the whole truth and do
so promptly post-death. Based primarily on clinical and preventive work with
children of suicide, this absolutism and one-size-fits-all approach is questioned,
the difference between being told and knowing accented and illustrated, and the
nature and effects of surviving parent explanatory frameworks for the suicide—the
‘why’ of it—explored.

In spite of the compelling human trag-
edy involved, the sheer numbers involved, and
the high public profile of some of those af-
fected, the impact of parent suicide upon sur-
viving children remains of minimal interest to
the mental health field. Many multifaceted
studies of suicides—including otherwise rich
demographic data—provide no indication
whether the suicided individuals had children,
or their age or number or gender, much less
address the question of the impact of parent
suicide upon surviving children. A compre-
hensive review of a recent decade of suicide
survivor literature revealed but one published
Albert C. Cain, PhD, is Professor of Psychol-
ogy, University of Michigan; Director, The Family
Styles Project; and Director, The Sadye Harwick
Power Program for Children and Families Under
Stress.
Address correspondence to Professor Albert
C. Cain, Department of Psychology, University
of Michigan, 525 E. University, Ann Arbor, MI
48109–1109. Fax: 734-615-0573.
systematic empirical study of children of sui-
cide1 (McIntosh 1996).
Earlier studies began to map out a num-
ber of general themes and specific config-
urations frequently found among the child
survivors, their bereaved families, and their
communities. Much remains to be done. Here
we turn to a relatively unexplored aspect of
the transactions of families “left behind” by
suicide, namely, The Telling, that is, matters
pertaining to the surviving parent informing
the children that the deceased parent commit-
ted suicide. There are a small number of pa-
pers that include some basic recommenda-
tions specific to informing children of their
parent’s suicide (e.g., Dunne-Maxim, Dunne,
and Hauser 1987; Goldman 1996; Grollman
1
Since that review, Pfeffer’s study including
12 children of parental suicides has been published
(Pfeffer et al., 1997), and Cerel’s two studies of 26
children from 15 parental suicide families (Cerel,
Fristad, Weller, and Weller 1999, 2000) have been
published.
ALBERT C. CAIN
1971, 1990; Hammond 1980; Hewett 1980,
Jewett 1982), some recent pop psychology
self-help writings which do the same, and an
American Suicide Foundation–sponsored pam-
phlet including such recommendations among
other valuable guidance (Perkin and Dunne-
Maxim 1995). There is not yet a single paper
seeking to describe the actual multifaceted
phenomena of telling, the study of which surely
must constitute one necessary foundation for
formulating such recommendations. This pa-
per attempts a first sketch of the complexities
of those phenomena. It addresses the varied
explanatory frames of reference employed in
parents’ communication to their children about
suicide, children’s affective and cognitive reac-
tions to being told, and the difference between
being told and knowing. The data discussed
here are derived from multiple sources: from
prior clinical studies of 45 outpatient and inpa-
tient children of suicide (Cain and Fast 1966,
1972), decades of short-term preventive par-
ent guidance and longer term outpatient ther-
apeutic work with postsuicide families,2 and,
most recently, structured research interviews
with the initial five parent suicide survivor
families from an ongoing longitudinal study3
of a community sample of bereaved children
and their surviving parents. As such, cautions
are in order about generalizations to be drawn
2
All quotations throughout, other than those
attributed and bibliographically referenced to spe-
cific sources, are derived from these clinical con-
texts.
3
This study, conducted by the Family Styles
Project of the University of Michigan, funded by
the American Foundation for Suicide Prevention,
explores the impact of parent suicide on surviving
spouse and children in a community sample, using
multiple standardized objective measures and com-
prehensive interviews, including measures of adjust-
ment and foci on processes such as communication
about the death, identifications with the deceased,
the role of guilt, traumatic elements, and the vicissi-
tudes of continuing attachment to the deceased,
with most of the measures identical to and thus
permitting comparisons with those of a preexisting
longitudinal child bereavement project (Saldinger,
Cain, Kalter, and Lohnes 1999).
125
from primarily though not exclusively clinical
samples and the heavily clinical focus of the
inquiry exploring the materials from which
this paper is drawn.
Early reports (Cain and Fast 1966, 1972)
on the children of suicide were initially de-
rived from a clinical sample of 45 such chil-
dren, ages 4–14. In great part they focused
rather on the striking findings of children not
being told of their parents’ suicide, and the
consequences thereof. That report indicated
the following:
• The overwhelming majority of the
children were not told initially, or for
some time thereafter, that the death
was by suicide.
• Approximately one quarter of the chil-
dren directly witnessed some aspect of
the suicide but were told that the death
was not a suicide, that it was due to an
accident or illness.
• Another major mode of response was
surviving parents’ simple, unelaborated
refusal to discuss any aspect of the death
with their children.
• A significant implicit parental message
to many of these children was that they
should not “know” of the suicide, and
must not tell of it.
While this précis captures the essentials, it
cannot do justice to the raw phenomena. Ex-
amples included children who witnessed the
suicidal act only to be told within hours by
the surviving parent that they had confused
what they thought they saw with something
they had actually seen on TV or at the movies,
and surviving parents who would not affirm
the suicidal nature of the death in spite of
their children providing full details of the sui-
cide and pleading that their parent simply con-
firm that the suicide was a suicide. The damag-
ing sequelae of surviving parent avoidance of
reasonably honest communication with the
children of suicide were revealed in distortions
of already compromised mourning processes
and generation of developmental interfer-
126
ences. Reports ranging from autobiographies
to clinical case reports to interview studies of
small “at risk” groups have indicated similar
forms of parental secrecy or stonewalling and
their damaging effects on children (Demi and
Howell 1991; Hammer 1991; Webb 1993).
In spite of many such confirmatory re-
ports, one must be concerned by certain ex-
trapolations from the findings. First, at the
clinical level, especially in so-called “grief-
counseling,” one hears in advocacy and prac-
tice that parents Should Tell Them Every-
thing. Even from quarters richly sophisticated
in the phenomena of postsuicide bereavement,
one finds such absolute statements as “Helping
children grieve a suicide involves informing
them about suicide itself in a way that is honest
and straightforward. Children, even very young
ones, should be told of the suicidal nature of
the death from the beginning” (Dunne-Maxim,
Dunne, and Hauser 1987, 241).
In direct clinical work with surviving
spouses or consultation with other clinicians,
one finds mental health professionals who re-
ject working with children of suicide if the
surviving spouse insists on the initial condition
that the clinician not mention the suicidal na-
ture of the parent’s death to the child. Some
children’s grief support group leaders will not
accept children of suicide in their programs
if the surviving parent refuses beforehand to
tell the child the true nature of the death. No
doubt the clinicians involved feel they are, in
principled fashion, refusing to participate in
what Beall (1972) keenly described in other
contexts as a “corrupt clinical contract.” But,
alas, they are also buying into a dichotomy of
knowing/not knowing, telling/not telling, a
dichotomy that is as dangerous as it is psycho-
logically false. That dichotomy violates what
we know about children’s complex states and
ways of knowing. It ignores what we know
about the children of suicide. It also stereo-
types these children’s needs.
Worse yet, that dichotomy is increas-
ingly wrapped in an imperative that children
must be told—and told immediately—of their
parent’s suicide. The rationale for that imper-
ative is of course phrased in psychological
CHILDREN OF SUICIDE
terms. Yet it is hard at times not to catch the
whiff of a moralistic force embedded in the
imperative as well, one that can even further
blind us to the complexities and contextual
influences that surround “telling.” Let us turn,
then, to question this imperative.
First, in a rigid focus on telling the child
that her or his parent’s death was a suicide,
lost is the fact that immediately following a
parent’s death—and for some time there-
after—children’s needs are multiple, and of-
ten urgent. The most pressing questions can
be about meeting basic needs. Who will walk
me to school? Who will make our dinner?
Who will help me get dressed and do my
braids in the morning? Will we have to sell
the house and move? What will happen to his
body? Won’t he come back later? Will I still
be able to go to my private school? Who will
take care of my tummy-aches? . . . In brief,
with children—and more so with younger
children—our needs or parental needs to
share truthfully with the child the specific na-
ture of a parent’s death must not be confused
with the child’s current needs. At times know-
ing the exact nature of a parent’s death is well
down the list of bereaved children’s felt needs
and concerns.
In addition, for many, especially the
younger children, understanding of any form
of death, indeed death itself, is clouded, bewil-
dering, fragmentary. This is not the place to
review an extensive if methodologically flawed
literature on children’s developmentally evolv-
ing conceptions of death (cf. Chasin 1997;
Kenyon 2001). Though there are a few dis-
senters, virtually all the systematic empirical
studies indicate that children typically do not
achieve, until the ages of 7 or 8 to 10 or 11,
what we choose to call a mature, realistic un-
derstanding of death—its finality, irreversibil-
ity, and universality, as well as the recognition
that the dead are insensate and the cause of
death not necessarily violent. This consensus
in turn must be further qualified by the strik-
ing findings of Orbach, Weiner, and Har-even
(1994–1995). Their data indicate that when
children are confronted (even in distanced,
artificial, psychological test materials) with the
ALBERT C. CAIN
concept of death linked to someone affectively
meaningful to them, as contrasted with the
concept of more distant victims’ death, chil-
dren’s understanding of death significantly de-
teriorates. More specifically, it regresses to
more distorted, cognitively primitive modes
of (mis)understanding death. Add to this the
more convoluted issues for a child—and not a
few adults—in comprehending suicide death,
and one recognizes how deceptively simple is
the phrase “tell the child it was a suicide” or
any assumption that the child has compre-
hended the communication as intended.
But there were other grounds for initial
silence among one cluster of surviving parents
who, by passive default or active determina-
tion, did not explain the death as a suicide
to children for a period ranging from many
months to over a year. They reported that the
delay “bought time.” It permitted them to
approach the initially dreaded telling in far
better control of their emotions, adapted to
their new circumstances, with more perspec-
tive and returning confidence in their parent-
ing. “God knows some of the things that I
might have said to my three, especially Jennie,
if we talked about it back when I was . . .
drowning.” “Much as I and the kids loved her,
I hated her guts that much, maybe more, doing
that just a day before our oldest’s birthday.
I’d have told the kids back then what she really
died of, what she did to us, I’d have wiped her
out—they’d either hate her forever, or me,
or both.” Defensive as some parents are in
discussing their prolonged delays in these
“heart-to-hearts” with their children, one
would be hard put to deny or even underrate
the value, perhaps the virtual necessity of the
period of delay for these parents. It is also a
reminder for those of us committed to preven-
tive interventions with survivors that we dare
not assume initial suicide survivor rejection of
caregivers’ efforts to deal with their children
regarding their spouse’s suicide is necessarily
immutable. Just as with many anguished, over-
whelmed, newly bereaved who reject all op-
portunities for bereavement services, that re-
jection may stem from their experiencing
massive overload. Their initial state is of such
127
precariousness, such a strained, imperiled
equilibrium that outside forces—no matter
their benevolent intent or official imprima-
tur—can only be perceived as threatening, de-
stabilizing.
It is also the case that some parents
clearly do try to tell their child of the specific
(suicide) nature of the death, only to meet
with uncompromising resistance from the
child. The form of resistance reported varies.
In some instances, as the parent tells it, the
child hears out the account, then insists it is
not true, or even calls the parent a liar. Some
children, unable to counter the surviving par-
ent’s statements, simply flatly deny that the
suicided parent did it, could have done it.
They cannot effectively defend their denial
with words, yet they are adamant. Others ar-
gue specifics (“You don’t know he didn’t fall
asleep in the car”), jump on seeming inconsis-
tencies (“He said he was going to Traverse
City, like always, not Port Huron”), or insist
upon some other construction entirely—usu-
ally a story of murder (“They broke into his
hotel room to rob him. They shot him.”). Still
others bolt the room each time the surviving
parent raises the topic. While obviously there
may be parental projections infused into such
accounts, and at least mutual avoidances, chil-
dren’s refusal or inability to hear can exist
quite independently of parents’ refusal or in-
ability to tell. Direct clinical evidence is visible
in individual child therapy sessions as a sui-
cide’s children replay and attempt to repeat
parent telling/child repelling confrontations
in the relationship with the therapist. It is
even more directly palpable in family therapy
sessions and at later developmental stages in
autobiographical accounts as well as in therapy
sessions with adult children of suicide.
From a different perspective, parental
not telling at times is child-specific rather than
suicide-specific. Some surviving parents selec-
tively tell one or more of their children, while
not telling others. Data from Shepherd and
Barraclough (1976) highlight an obvious source
of selection, the age of the child. Of the 36
children studied (exclusively through inter-
views with surviving parents), half were said
128
to have been given an explanation that re-
flected the parent’s intention to be completely
open with the children about the nature of the
other parent’s death by suicide. Seven received
no explanation, with 11 given explanations not
indicating the death was by suicide. The mean
age of those told of the suicide was reported
to be10; mean age of those given false explana-
tions was 8; mean age of those given no expla-
nation was 4. But there were significant varia-
tions.
Age is not the sole determinant. Indeed,
adolescents and even young adults have been
given utterly false explanations of their par-
ents’ suicide deaths. At times the decision
regarding which sibling is told, which not,
heavily accents the feasible and the prag-
matic—which child witnessed the suicide or
unmistakably absorbed the truth in the imme-
diate aftermath, or which child was away at
camp, for instance. But psychological vari-
ables, conscious and otherwise, are also to be
found. Key variables have included perceived
qualities of maturity and easy coping of the
children selectively told, prior role as the co-
alition partner or confidant of the surviving
parent, the child’s own overt interest/disinter-
est in knowing more, the surviving parent’s
assessment that the child who was the dead
parent’s acknowledged favorite (or “spitting
image”) just could not handle the notion of
that parent having killed himself or herself.
In a few instances, the surviving parents un-
consciously re-created a sibling dynamic from
their own history, setting up a situation that
almost inevitably will divide the siblings, even-
tually precipitating near-unforgivable feelings
of treachery and collusion.
Telling but one of a sibling group usu-
ally is yoked with the command that the recip-
ient of the secret not tell the other children,
not talk about it when the other children are
around. Over time, it means that the secret-
bearing child comes to struggle with the same
dilemma that earlier occupied the surviving
parent, to tell or not. It also means that the
other siblings, when and from whomever they
do eventually learn of the suicide will likely
feel multiply betrayed, with even broader
CHILDREN OF SUICIDE
spreading of distrust (cf. Lukas and Seiden,
1987, p. 114).
KNOWING AND/OR
NOT KNOWING
The dichotomy of knowing versus not
knowing, and related assumptions that being
told equals knowing and not being told equals
not knowing, violate psychological reality and
mislead us in clinical and research efforts alike.
First, the statement, usually quite genuine, by
surviving parents that their children do not
know the death was a suicide (translation: the
parent has not told them, and the children are
not to be told) must not be taken at face value.
By way of compressed examples, consider the
following three children of suicide. In each
instance, the surviving parent was rightly con-
cerned about significant symptomatology that
erupted in their bereaved child in the 6 months
subsequent to the death. In each instance the
parent’s request for a diagnostic evaluation
carried the explicit condition that the child,
who “did not know,” was not to be told any-
thing suggesting the suicidal nature of the par-
ent’s death. In the diagnostic sessions, each
of the children spontaneously—and in stark
specifics—spoke of their respective parent’s
suicide.
Max, age 9, described the particular
pills, their number, shape, (slightly distorted)
name, and color . . . and how this was the third
time she did it “to die and get out of this
world.” Susan, 11, graphically described the
savage cuts her mother inflicted upon herself,
giving me a brief accurate lecture on how
much blood a person can lose before he or
she dies, and how fed up her mother had been
with her, her brother, her Dad, and even their
sweet if occasionally incontinent springer
spaniel. Steffi, 12, shifting to whisper except
when she forgot herself, was believed to know
what she had been told—that her father died
in a hunting accident up north. In our first
session, she laboriously drew a picture of a
figure, labeled with her dad’s initials, jumping
out a window from the ninth floor of a tall
ALBERT C. CAIN
building, its name in bold letters, with an
arrow suggesting the figure’s descent path to
the ground, where it was portrayed landing
partly on a car next to people standing on
the adjacent sidewalk. Correct floor, correct
building, correct depiction of landing area,
and, of course, correct as to his act of jumping.4
There is much to be said in this context about
the costs of such guilty knowledge, knowledge
about matters these children have virtually
been “ordered” not to know. For our pur-
poses, though, the vital point is that these
children are externally believed not to know
of their parent’s suicide.
Conversely, there are children who, if
we exercise only the surface criterion of having
been told of the suicide as such, do know. But
in any meaningful realistic sense they as-
suredly do not. Some are simply too young to
have the cognitive equipment to understand.
For others the sheer affective intensity over-
whelms any cognitive readiness. They have
the words but not the music, so to speak, and
those words if/when used have the same rote,
parroted quality seen in youngsters prema-
turely given earnest polysyllabic sex education
talks. Little harm seems done thereby except
that the surviving parent or others for a while
mistakenly assume their task is accomplished,
with the child now knowing the harsh truth.
For still other children who have been told,
there is a basic understanding of what they
were told, of the facts, and a passive acquies-
cence to the message. They were able, upon
inquiry, to refer to their parent having com-
mitted suicide. Yet as a young adult put it 12
years later, “it did not compute.” Suicide was
4
A similar situation is cited in Campbell’s
(1997) spirited “call to arms” for survivor postven-
tion programs. A mother, seeking psychotherapy
for her 7-year-old daughter, stipulates that Camp-
bell could not tell the girl that her father died by
suicide. In a session, the girl says, “You know my
daddy killed himself?” proceeding to provide more
accurate details than her mother, and to tell how
she learned of this, then cautioning her therapist,
“Don’t tell my mommy, though, because she thinks
he died in a car accident” (p. 330).
129
more than just a word to them: In a very formal
sense it was understood. But there was no
sense of the meanings, moral or psychological,
with which the term is imbued by adults and
will come to be by the child at a later develop-
mental point.
Still other children had been told and
told clearly, and they understood fully. How-
ever, they did not believe, did not accept the
facts and/or their explanation. More than
doubt, they vehemently rejected what they
had been told. Communicated to surviving
parent or others in overt defiance, their insis-
tence makes for prickly interactions or spo-
radic angry standoffs in the family. But at least
the issue remained open, discussible.
By contrast, there were various ways in
which clear parental statement of the specifi-
cally suicidal nature of the death became lost
to these children’s awareness. Some of these
forthrightly informed children within months
completely repressed the fact of the suicide or
substantially rewrote the nature of the parent’s
death. In demonstration of the complexity and
ambiguity of “knowing,” others later spoke of
having been told and accepted the fact of the
suicide, yet never realizing it was a Suicide
until years later, when a middle school friend
spoke of it to them, or they read a passing
reference to it in a hometown newspaper, or
stumbled upon an old letter or insurance doc-
ument referring to it. All had difficulty putting
into words the difference between being told/
knowing earlier and the knowing occurring
later, but each attested to it in their own
fashion.
Lukas and Seiden (1987) describe viv-
idly an instance in which a child is told directly
by his mother of his father’s suicide, but when
a schoolmate mentions it at a later point the
child is shocked to “learn” it was a suicide. A
concerned father insists to us “I’ve pointedly
told her three times. Each time I was sure she
got it. Now, five years later, her aunt mentions
her mother’s suicide to her while preparing
for Yortzheit and she reacted like she was
slapped in the face. She came at me like a
chainsaw about how I could of not made sure
she really understood it was a suicide.” Carole
130
Buksbazen was raised by her grandparents.
When she was seven, her grandfather died—
of a heart attack, she was told. “However, I
remembered or fantasized that on the day he
died he was in the garage and I heard a loud
noise and thought ‘He’s shot himself.’” As
time went on, she accused herself of trying to
dramatize his death, felt ashamed of this
“crazy idea,” felt that in any event there was
no way she could check the reality. But in a
college class decades later she learned of death
certificates, and sent for and received her
grandfather’s death certificate, which referred
to suicide by self-inflicted gunshot wound in
the head. She reports being stunned, guilty,
flooded with emotion, and yet accents how
“difficult, even when presented with a factual
document, to accept the reality of my mem-
ory.” She adds that now “I feel I can really
start trusting my own perceptions and sanity
for the first time” (Buksbazen 1976,
p. 121).
Beyond “knowing” wherein the know-
ing is not integrated, or is not imbued with a
sense of reality or conviction, or serves only to
stimulate forceful countermeasures of denial,
are additional complications of knowing that
bespeak the ambiguity and multidimensional-
ity of knowing. Perhaps the most striking form
was seen in children described elsewhere
(Cain and Fast 1972), with a set of utterly
contradictory but compartmentalized beliefs
or “knowledge” of their parent’s death, each
belief with its own associated fantasies, defen-
sive configurations, and symptomatic conse-
quences.
Bob, an eleven-year-old whose father had
committed suicide two years earlier had three
such quite separate beliefs, all eventually ac-
cessible. He believed as he had been told: he
knew his father had died of a heart attack.
Around this centered some hypochondriacal
preoccupations and a transient conversion
reaction; a recently developed subdued, in-
hibited quality related to his notion that his
over-active noisiness had caused the heart at-
tack; and a strong desire to become a doctor
with a special talent for performing emergency
operations. He believed his father had died in
a car accident: around this centered specific
phobias, sporadic counterphobic plunging
into physically dangerous situations, recurrent
CHILDREN OF SUICIDE
nightmares, and constant collecting of small
injuries. He also believed (correctly) that his
father had killed himself, was convinced that
he caused it with his arguments and dawdling
and school trouble, loathed both himself and
his father over the suicide, had begun to make
verbal threats of suicide when disciplined,
and would not trust or obey any man. Such
parallel sets of beliefs, fantasies, defenses and
behavioral consequences, were far beyond
these children’s integrative capacities. (p. 104)
In brief, there is knowing and Knowing.
It is not at all clear that these phenomena
can be adequately captured by either current
cognitive development concepts of vertical de-
calage (Flavell 1963), fragile knowledge (Gel-
man and Baillargeon 1983), or conceptual co-
herence (Wellman and Gelman 1992), or by
psychoanalytic concepts of denial, isolation,
and ego-splitting as explicated initially by
Freud (1958, 1961), and later by Wolfenstein
(1966, 1973) and others in the context of
childhood bereavement. But surely dichoto-
mous parsing of knowing versus not knowing
will not suffice.5
THE “WHY” QUESTION:
EXPLANATORY FRAMES
With the telling and the eventual know-
ing comes the question of the content of those
communications. Here we begin to initially
sketch the explanations given to children of
suicide, the “rationale,” the answer to the al-
most inevitable “why” question—especially
prominent in adolescent survivors—and at
points indicate some of the psychological ben-
efits and unintended “side effects” of these
explanations. The major forms of explanation
5
Note Bowlby’s (1979) similar groping to-
ward new ways of conceptualizing such phenomena
in his paper “On Knowing What You Are Not
Supposed to Know and Feeling What You Are
Not Supposed to Feel.” Similarly, Karmiloff-Smith
(1992), in her proposed four level “RR” model of
cognitive development, suggests “multiple levels at
which the same knowledge is represented,” and
described knowledge stored at one level but not
linked to similar knowledge at other levels.
ALBERT C. CAIN
described here will no doubt be supplemented
by subsequent investigations and eventually
yoked to studies that trace how such explana-
tions are absorbed and reconfigured across
development.6
Surely the wide variations that exist in
cultural constructions of and attitudes toward
suicide and the suicided individual will shape
the surviving parent’s mode of explanation, as
will regnant theological doctrines. As research
in this realm broadens cross-culturally, we will
undoubtedly recognize the diversity and power
of those differing constructions. (Douglas 1967;
Farberow 1975; Johnson and McGee 1991;
Minois 1999). Yet even now we can also recog-
nize their limitations. Sociohistorical reviews
remind us of the shifts, even reversals, over
time of sanctioned, widely shared “official”
meanings of and attitudes toward suicide.
They also underline simultaneous divergent
values, perspectives, and prohibitions for dif-
ferent social classes, special subgroups, gen-
ders, or circumstances within a given society,
and, as visible currently in the Islamic world,
utterly contradictory messages about suicide
derived from the same key texts of the same
religion. Just as social groups or movements
can thus actively choose or fit to their own
6
Systematic empirical studies are clearly par-
amount, including but far broader than the issues
of telling and knowing as delineated here. Commu-
nity as well as clinical samples are vital: Given the
stigma and concealment still frequent in this realm,
suicide survivor studies will have to surmount even
more obstacles in recruitment and sampling than
those typical of bereavement research (Stroebe and
Stroebe 1989; Stroebe, Stroebe, and Hansson 1993).
Recognizing the evolving impact of newly emerg-
ing information, new cognitive capacities, and new
meanings often evoked by children’s subsequent
developmental phases, such studies will optimally
be longitudinal and stretch well beyond the usual
boundaries assumed for the trajectory of bereave-
ment. Surely they must focus equally on resilience
and successful coping in these children as well as
developmental intereferences—and their determi-
nants. Yet as McIntosh (1996) has reminded us in
one of his excellent reviews of the suicide survivor
literature, at this early point there is need for a
wide rather than narrow range of types of research
contributions.
131
purposes a particular interpretation of rele-
vant scripture regarding suicide, so too a (sui-
cide-bereaved) individual may selectively choose
from diverse explanatory domains to construct
his or her understandings of that suicide. In-
deed, recognizing both the essential enigma of
suicide, and the lack of clear shared doctrinal
guidance regarding suicide in our relatively
secular heterogeneous society, observers of
modern U.S. society note that most Ameri-
cans have both the particular burden and li-
cense to construct their own individual expla-
nations and meanings for the suicide of a loved
one.
Thus, in working with suicide suvivors,
one frequently experiences bereaved parents
who, in spite of actively denying religious be-
liefs and notions of an afterlife, couch explana-
tions to their children in terms of the deceased
parent being in heaven with God, or con-
versely, parents who in their fury commit their
suicided spouse before their children’s eyes to
rot in hell; one also encounters parents who
define suicide among the gravest of sins, de-
serving tortures near equivalent to those of
Dante’s fevered imagination, yet who reframe
the matter for the bereaved child in terms
utterly avoiding moral condemnation of the
act or its afterlife implications, as well as indi-
viduals and groups who have transformed cul-
turally proscribed suicides from the profane
and prohibited into acts of heroic proportions.
As noted earlier in reference to surviv-
ing parents whose communications regarding
the suicide were markedly uneven, there is
what appears to be a quite small group who
are relatively quick and clear in letting their
children know the death was a suicide, yet
who refuse any further discussion. They re-
ported that they met questions from their chil-
dren with stern if not angry rebuffs: “I don’t
know, I wasn’t in her head . . . ,” “Don’t ask
me, we’ll never know,” “There’s no use think-
ing about it, we have to get on with our lives,”
“He’s dead, and he has all those answers.”
Ordinarily a few brief, charged exchanges like
these put an end to overt questions, leaving the
child to his or her own constructions, patching
together fragments of information and fantasy
or joining in an alliance of suppression. These
132
surviving parents would later say that their
children did not seem to much care; that after
a question or two, they never brought it up
again.
Another subset consisted of those sur-
viving parents whose sole response to their
children’s “why” questions was that the sui-
cidal parent simply wanted to: “I told them all
I knew; he just wanted to”; “She just didn’t
want to live, and that was that.” While the
parental answer in its curt, uninformative na-
ture seems almost identical with the previously
described outright refusal to discuss the sui-
cide, there is a strong difference in content,
perhaps in intent, and surely in impact. The
wanted to exudes fog, but also accents volition,
deliberateness, desire. In so doing, it an-
nounces to the children loudly that the sui-
cided parent preferred death to being with his
or her children and spouse, wanted to be away
from them. The children react accordingly,
feeling thrown away, disowned. That reactive
interpretation by children fits a developmen-
tally normative egocentric mode of relating
events and action to themselves. It is also a
widespread reaction among spouses, and other
adults as well, to suicide as an ultimate per-
sonal rejection. Even when the explanations
provided for the suicide are far gentler, chil-
dren and adults alike are quite vulnerable to
perceiving the suicide as a fierce personal re-
jection, beyond redemption.
Of a quite different fabric are an array
of benignly intended explanations provided
the children of suicide. One cluster of these
explains the parent’s suicide as being or re-
flecting a sickness, a special different kind of
sickness (“brain illness”) to be sure, but a sick-
ness nevertheless. The obvious, kindly intent
is at one and the same time to phrase the
explanation in terms familiar and unthreaten-
ing to the children and to render the suicidal
individual (and others, too) blameless, denud-
ing the act of any speck of intentionality. Un-
fortunately, if left unelaborated, the references
to sickness or illness can leave a legacy of
misconceptions and dread. Children know
that they and their surviving parent all have
illnesses, get really sick sometimes.
CHILDREN OF SUICIDE
Leslie (age 8) was told that his father’s suicide
was due to a “brain illness.” Previously of
excellent health, Leslie abruptly manifested a
set of distressing symptoms. He complained
that some things he looked at would turn
pink, his eyelids were burning, he now had
headaches, and his ears were ringing. When
this was immediately explored in a psycho-
therapeutic session, he volunteered an expla-
nation for his symptoms, specifically that
when he was 5 years old, he was pushed off
a teeter-totter “ . . . and hit my head, very
hard, against an iron post.” He added fear-
fully that “maybe he had a brain illness like
his Dad did.” (Cain and Lohnes 1995, p. 283).
The close cognitive, seemingly causal
link between being sick and dying can ignite
fear, sharp and continuous. By contrast, it is
heartening to behold the sensitivity and imagi-
nation with which some surviving parents
work within this sickness metaphor. To exem-
plify, one parent explains Dad’s killing himself
due to his sickness as much like when her
daughter was sick with the flu and vomited;
she didn’t want to vomit—she tried hard not
to—but it just came out involuntarily. An-
other reminds her son of his chicken pox and
how at its worst he scratched even when he
was trying so hard not to.
Basically separate but sometimes phrased
in overlapping fashion is the quite frequent
parental explanation of the suicide as an act
of mental illness: “craziness,” “not in his right
mind,” “didn’t realize what he was doing.”
Long before broad acceptance of mental
health ideology and professionals, the concept
and label of insanity was used in legal and
religious contexts to absolve suicides of in-
tentionality, of responsibility for their “self-
murder,” thereby releasing their souls and
their families from punishment. Here the ef-
fort by surviving parents and others once again
is to remove the sense of intent and active
desire to die from the suicide as well as to
rebut the implication of rejection of family
and friends. Sought thereby is avoidance of
the stigma still widely accompanying suicide
and far more resistant to banishment than the
earlier legal or religious sanctions. But the
children of suicide, including the adult chil-
dren of suicide, reveal a quite different ef-
ALBERT C. CAIN
fect—an insidious side effect. For adolescents
in particular, the seeds are sown of quite con-
scious fear or conviction that they too are fated
to be the victims of mental illness, that insanity
runs in their family. Jeff, age 16, puts it,
“That’s it then, I guess I’m next.” Similarly,
Ross tells of a teenager, whose father suicided,
saying “I feel tainted, as if I have inherited
bad blood” (Ross 1987). But this reaction can
take root well before adolescence. Steve’s fa-
ther shot himself in the woods: The shared
family explanation was that of insanity. Steve,
age 8, is asked in a bereavement research inter-
view over a year later, “‘What things might a
kid be worried about or afraid of after his dad
has died?’” The answer: “‘Well, if he could
get good grades? Will he go on welfare? If
they’re going to move? If I’m going to go
insane.’” (Lohnes 1995, p. 347). Though it
can be softened in the abstract with various
reassurances (about probabilities, opposite
sex, generational skips, etc.), again and again
we see evidence of the specter, the shadow
that this benevolently intended mental illness
explanation of suicide can create.
Grollman (1971) states the case at its
harshest, “Telling the survivors that the per-
son was crazy does not add to their social
status. It only brings the fear of inherited men-
tal disease” (p. 114). Others add their adult
testimony to the propagation of such fears and
their corrosive effects over time (Lukas and
Seiden 1987). Yet that is not the end of the
story. There are many methods of coping in
this context, including successful repression or
active suppression (until a trigger is touched),
driven supranormal behavior or vigilant avoid-
ance of stress.
Explanations of depression as the cause
of the suicide have the virtues of unvarnished
simplicity and easy comprehension, and are
almost always couched in sympathetic rather
than blaming words and tone. Where parental
depression was quite palpably present, refer-
ence to the parent’s presuicide depression was
concretely demonstrated to the children: the
sadness, withdrawal, pessimism, lack of inter-
est in things once enjoyed, and the like.
Clearly it is a mode of explanation that chil-
133
dren can and do get their minds around. Yet
there is a downside that must be recognized.7
Given the frequency and inevitability of times
of sadness for children and the unnuanced
intensity of affects for the younger child, the
associative linkage of sadness, depression, and
suicide is dangerously tight. The children are
not always alone in constructing this danger-
ous association.
Following a mother’s suicide, her husband
reports that the family physician told him
that he and they “must realize depression is
a disease. It can be hereditary, so if the girls
ever feel out of sorts as they age, they should
go to their doctor or an emergency room.
Tell them how they’re feeling and what hap-
pened (the suicide) to their mother and
grandmother. . . . ”
A final cluster of benignly intended ex-
planations revolves around a focus by the sur-
viving parent on severe stresses having lead to
the suicide: “her mother’s death,” “loss of the
store,” “being saddled with all that debt and
then the car being totaled,” “so down when
even that job went out the window.” The
stresses or burdens specified were quite varied,
but the key communication to the child was
that (1) the emotional burden had been over-
whelming, (2) the suicide was a straightfor-
ward, understandable though drastic response
to such a burden, and (3) the surviving parent,
though devastated, sympathizes with the sui-
7
Beardslee and colleagues (Beardslee 1998)
have in a parallel context provided a model of how
a spouse and parent’s depressive disorder can be
openly discussed by professionals with family mem-
bers to quite useful preventive purposes. In the
wake of parent suicide, some would advocate out-
lining to the children the moderate probabilities of
a depressive path for themselves while emphatically
reassuring them as to the treatability of the condi-
tion should it develop (in spite of the fact that for
a number of these children, their suicided parent
had been/was being treated for that very condition).
Whether such information will be absorbed in the
manner intended, or will be misconstrued given
normal limitations of children’s cognitive develop-
ment, and more worrisomely, be harshly internal-
ized in damaging self-concepts, is an open question.
134
cide’s plight. Phrased thusly, the explanation
in such circumstances veers worrisomely close
to legitimizing suicide as a solution for the
children down the road when they too inevita-
bly experience low points or crises in life.
Emotionally generous as it is, in itself and in
assisting the children to maintain a relatively
positive, sympathetic picture of their dead par-
ent, the risk generated—in an already high-
risk context for intergenerational transmission
of suicidal behavior (Hendin 1995; Kreitman
1986)—must not be overlooked. Neverthe-
less, these caring, empathic explanations often
not only insist on maintaining the least dam-
aged/damaging image of the suicided parent
as an individual but also as a parent. “If she
had been herself, if she had been the mommy
you always knew, she never would have done
this, wouldn’t have left us like this.” “He just
couldn’t take it anymore, and he felt he was
making things worse and worse for all of us,
and he loved you two so much.”
Almost polar opposites were those in-
stances in which the act of telling was saturated
with vengeful anger. Most obvious was the
venting of furies felt toward the deceased, fury
over the desertion, the implicit (or explicit)
rejection, the shattering of ongoing life, the
cloud of shame, the battery of consequent
pragmatic problems. Accordingly, the core of
the surviving parent’s communication about
the suicide’s death to the children (and to
many others) was less an explanation than an
indictment, a bill of particulars against the
deceased. It assaulted, and for children may
irretrievably besmirch, the image of the dead
parent. The intent is clear even when cloaked
in the garb of a need for honesty. Such expla-
nations—to the extent explanations were em-
bedded—centered on cowardice, selfishness,
weakness, being a quitter, and “just desserts.”
Fortunately rare is the situation in
which the surviving parent’s “explanatory” in-
dictment and aggressivized blaming focuses
exclusively upon a child. The most iron-willed
version of this encountered was an instance of
maternal suicide occurring amidst a prolonged
postpartum depression late in her infant’s first
year. The infant by all accounts had been irri-
table and difficult to soothe, with long crying
CHILDREN OF SUICIDE
spells, diagnosed as a “colicky baby.” The fa-
ther, in spite of numerous family and pediatric
efforts to dissuade him, blamed his wife’s tor-
ment and suicide fully on the infant, vowing
never to let his infant son forget that he was
responsible for his mother’s death. Well into
his son’s adolescence, he was still doing so.
The one other major framework en-
countered in the communication with chil-
dren about their parent’s suicide was explicitly
religious. The divergent uses to which religious
belief systems or orientations were put was
striking, though surely no surprise. Some
made it absolutely clear to the children that
their suicided parent was destined for hell now
and forever. They persevered in this with the
stricken children in the face of leavening alter-
native interpretations by their own priests.
Conversely, others sought to absolve everyone
of responsibility and allay possible dark after-
life images of the suicided parent’s fate by
insisting “God took him,” “God called him,”
“It was God’s will,” “It was just his time to
join God.” Both the affective tone and the
phrasing of submission to the Lord’s higher,
if unknown, purpose did not discriminably dif-
fer from such explanations given for a wide
variety of natural and accidental deaths. Be-
nevolent in intent, it also risked leaving these
children a legacy of either anger at this kidnap-
murder of their parent or a bewildered sense
of vulnerability to the Lord’s capriciousness.
Yet other surviving parents, less to protect
God’s good name than to angrily pin responsi-
bility on the deceased “deserter,” contradicted
any such explanation: “No, your mother’s not
an angel in heaven now. She’s just dead. If she
loved us, she would have stayed with us, not
copped out. God didn’t do it, Mom did.”
CONCLUSION
Few would contest that optimally, fol-
lowing a parent suicide, the surviving parent
candidly inform their children in a timely fash-
ion of the nature of that parent’s death, doing
so in a manner reasonably matched to the
children’s developmental capacities, with no
more detail than necessary, and a form of ex-
ALBERT C. CAIN
planation least likely to damage the children’s
positive image (if extant) of the suicidal parent.
But the preceding discussion suggests that one
size does not fit all, that there can be substan-
tial damage done in and from the telling, as
there can be by not telling. There are children
of suicide for whom being told the suicidal
nature of the death is—for a significant period
of time—of low priority or beyond compre-
hension. Surviving parents’ motivations or ra-
tionale for not telling vary widely, may prove
transient, and at times can be compelling.
Their wisest course sometimes does involve
significant delay in telling, and there are in-
stances in which, given the only spirit in which
the surviving parent can do the telling, it is
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