Transcript Chinese Women Bereaved by Suicide: The Hong Kong Experience

Chinese Women Bereaved
by Suicide:
The Hong Kong Experience
Amy Y. M. CHOW, Ph.D., R.S.W., FT., CHt
Associate Professor, Department of Social Work & Social Administration,
and
Honorary Fellow of HKJC Centre for Suicide Research and Prevention,
The University of Hong Kong, Hong Kong
Acknowledgements
• Suicide Prevention Services,
Hong Kong
• 11 participants, who are
ex-service users of Project
BLESS, SPS
Suicide Intervention
Prevention
(Primary
Prevention)
Suicide
Ideators
Intervention
(Secondary
Prevention)
Postvention
(Tertiary
Prevention)
Suicide
Majority of
Suicide ResearchAttempters
Suicide
Survivors
 Incidence
 Incidence
 Adverse
Rate of
Suicide
Attempts
Rate of
Suicide Reattempts
Impact of
Completed
Suicide
Reflective Question …
• Is Suicide bereavement different
from other types of bereavement?
Reactions of Suicide Survivors
• There were no significant differences
between suicide survivors and survivors
of other modes of death in general
mental health, depression, PTSD
symptoms, anxiety, and suicide behavior
• But higher levels of rejection, shame,
stigma, need for concealing the cause of
death and blaming (Sveen & Walby, 2008)
Features Supported by the Existing
Research Evidence
• Abandonment and rejection
• Shame and stigma
• Concealment of the cause of death
of suicide
• Blaming
• Increased self-destructiveness or
suicidality
(Jordon & McIntosh, 2011)
Features Supported by Clinical
Experiences and Survivors’ Accounts
• Guilt
• Anger
• Search for explanation/desire to
understand why
• Relief
• Shock and disbelief
• Family system effects/social
support/ social isolation
• Activism, obsession with the
phenomenon of suicide and
involvement with prevention efforts
• (Jordon & McIntosh, 2011)
Reflective Question …
• Is Chinese suicide bereavement
different from that of other
cultures?
Chinese Cultural Attitude Toward
Suicide: Euphemisms of Suicide in
Chinese
•自尋短見 (Self searching for undesirable
choice)
•輕生 (Depreciating life value)
• 自盡 (Ending by self)
• 厭世 (Life is annoying)
•做傻事 (Doing insane things)
•早D上路 (Advanced moving to the path )
(Chow and Yip, 2011)
Chinese cultural values related to
Suicide
• Suicide as a means to teach others 死諫
• Suicide as a means to show one’s
innocence 以死表清白
• Suicide as a means to show one’s guilt
以死謝罪
• Suicide as a means to show one’s
loyalties 不能同月同日生，但願同月同
日死 、陪葬
• Suicide for love 願死也為情
(Chow and Yip, 2011)
Are these questions important?
“…the question about differences in
bereavement….may do nothing to
reduce that pain..”
“…the question has real importance,
considering that the answer has genuine
implications for how we understand the
journey of survivors and how we go
about offering help to those who must
walk this journey…”
(Jordon and McIntosh, 2011, p.21)
Objective
• To understand the experiences of
suicide bereavement among Chinese
Women in Hong Kong
Methodology
• Study Site:
– Project BLESS of Suicide Prevention
Services
• Participants:
– Service Users of Project BLESS of Suicide
Prevention Services
Methodology
• Sampling: Purposive sampling
– Different relationships with the deceased,
age group, social economic background
and religion.
• Data Collection Methods:
– Individual In-depth Interview
– Semi-structured with an interview guide
– All carried out by Principal Investigator
Background of the participants:
Case
No.
Deceased is the…
Time Since (Months)
Method
1
Son
3
Charcoal Burning
2
Husband
11
Drug Overdose
3
Son
5
Jump
4
Elder Brother
17
Jump
5
Son
11
Hanging
6
Son
36
Jump
7
Mother
10
Jump
8
Daughter
18
Jump
9
Boy Friend
12
Charcoal Burning
10
Mother
8
Jump
11
Son
2
Jump
Findings
• The Impact of suicide (our main
focus of this presentation in the
specific impact of suicide in the
family)
• The Challenge
• The Adjustment
Findings: The processual
challenges (Impact Phase)
Viewing the
body
Received the
bad news
Handling the
reporters and
different
professionals
• 咁佢同我講話你個囡囡暈低係街到，咁佢即
刻都唔敢同我講嫁….咁我當時其實我好驚，
咁我啦啦聲啦，又落雨喎，咁我啦啦聲即刻
去搵的士。去既時候呢啲雨落得好大，咁我
好心急，咁警察係咁樣打電話黎….
• “I got the call from the Police, telling
me that my daughter was fainted and
sent to the hospital…I was in great fear
and hurriedly got into a cab…It was
raining heavily outside and the Police
kept calling me…I know it should be
something serious…” (case 8)
• 嗰個女仔係歇斯底里咁喊，有記者，有其他
記者，佢係喊住唔俾佢吔影，因為佢嘅遺書
，佢嘅遺誌寫住，最後唔好見報，嗰女仔就
歇斯底里，我當時就掛住嗰住嗰女仔，挂住
我嗰老公，掛住來嘅人
• “His girl friend cried hysterically. Re
were reporters. We tried to stop anyone
taking photographs as it was my son’s
wish not to in the headlines of papers.
He stated it in his death notes…” (case
5)
Findings: The processual
challenges (Working Phase)
Revisiting
the scene
Arranging the
funeral
Notifying
other
members
• 地一日都喺屋企，即係我好似…亦都
唔敢出門口，諗緊點辦呢，點通知佢
屋企人呢…因為佢有阿爸阿媽呢
• “…I kept on thinking how to notify
other family members…He still has
his aged parents…” (Case 2)
• 有..咁當時呢,d人亦都叫我唔好去架啦
.你係佢媽媽,你唔好去啦佢話,叫我同
我先生都唔好去…所以既野都係我個
大女去搞, 因為呢,佢地呢就話如果我
地去搞呢樣野會令到我個仔好唔安落,
日後..個心唔舒服,佢已經揀左呢條路,
即係佢地d人話.
• “Other suggested me not to go the
funeral as we are parents…I left
everything to my eldest daughter to
arrange…Yet, I am unsettled…” (Case
1)
Findings: The processual
challenges (Adjustment
Phase)
To explore or
not
To move or
not
To share or
not
• 即但係果時我拒絕，因為果時我好驚
，我唔想去俾人知。其實到呢刻而家
呢刻我唔想俾人知，即除非果啲人…
有啲人都唔知，同埋呢我個女唔喺度
住呢，有啲人鄰居呀，啲人唔知我個
女自殺嫁，咁可能呢樣野都減輕左我
個壓力
• “ I don’t want other to know about
it…Not knowing about the death of
my daughter as well as her suicide…It
helps to reduce my stress….”(Case 8)
Findings: The processual
challenges (The Haunting
Experience)
Birthdays
Festivals:
Lunar New
Year, MidAutumn
Fathers’
Day or
Mothers’
Day
Public
Examination
Result
Dissemination
Aftermath Issues :
•
•
•
•
•
•
•
•
Digestion of Bad News
Dissemination of Bad News
Viewing of Body
Handling of Mass Media
Organ Donation
Autopsy
Police Investigation
Claiming of Body
(Chow, 2006)
Some thoughts: Components
of Suicide Bereavement
Trauma
Death of
Loved
Mysteries
One
SelfInflicted
Events
Death Through Suicide
Non-judgmental attitude, patience, and respect
STIGMATIZATION : Shame
TRAUMA
-suddenness, violence, &
preventability
Trauma Work
GRIEF
-relationship, role, and
Functions
Bereavement
Counselling
Findings: The impact of Suicide
in the family
• Pretense of being OK
– Do not want to upset others by
pretending to be OK
– Cries only at night time when no one sees
– Pretend to be strong and tough
Findings: The impact of Suicide
in the family
• Conspiracy of Silence
– Difficulties in breaking the bad news to
other family members
– No one wants to talk about it
– The name of the deceased is not
mentioned
– Highly avoidance of the word suicide and
death
– Other communications are reduced too
Findings: The impact of Suicide
in the family
• New roles to play
– Stronger role in caring for widowed parent
(for cases of parental death)
• Guilt-driven
• Worries that the surviving parent will commit
suicide too
• Self-blaming parent that need special attention
– Caring for younger sibling (parental death)
– Be a good child (for case of death of
siblings)
– Be a mom and be a dad (death of spouse)
Findings: The impact of Suicide
in the family
• Over concern about contagious effect of
suicide
– Will my family be cursed?
– Hyper surveillance with distressed signs of
other family members?
– Worries about one’s self-control
• Face of the family
– I wish he/she died of illness
– Newspaper report
– Avoidance of social gathering, feared of
being asked about the suicide
Discussions:
• Family Intervention in suicide
bereavement
– Working with reduced genuine
communication within family
• Facilitation of genuine communication
• Discussion of shared responsibilities in the
adjustment
• Family Education
– Stress Management: to reduce risk of suicide
Study 2: Clinical Data Mining
of 67 service recipients
Study 2: Clinical Data Mining
of 67 service recipients
Limitations
• Sample: restricted to self-selected
service recipients, small sample size
• Design: single group analysis and
cross-sectional, limited validated
measurements
Postvention as Suicide Prevention
• survivors themselves are potential attempters
of the future. It is evidenced that survivors’
own risk is usually higher than non-suicide
counterparts (Jordon, 2001) or higher selfdestructive impulses (Cain, 1972; Calhoun, 1982)
• survivors who can openly share their pain of
losing their loved one through suicide can be
great teachers for the potential attempters
who rarely think about of the impact of
suicide towards others.
References
Chow, A. Y. M. (2006). The day after: The suicide bereavement
experience of Chinese in Hong Kong. In C. L.W. Choan and A.
Y. M. Chow (Eds.). Death, dying and bereavement: The Hong
Kong Chinese Experience. (pp. 293-310). Hong Kong: Hong
Kong University Press.
Chow, A. Y. M., & Yip, P. S. F. (2011). Grief after suicide: A Hong
Kong Chinese perspective. In J. R. Jordon & J. L. McIntosh
(Eds.). Grief After Suicide: Understanding the Consequences
and Caring for the Survivors (pp. 427 - 466). New York, NY:
Routledge.
Jordon, J. R., & McIntosh, J. L. (2011). Is suicide bereavement
different? A framework for rethinking the question. In J. R.
Jordon & J. L. McIntosh (Eds.). Grief After Suicide:
Understanding the Consequences and Caring for the Survivors
(pp. 19 - 42). New York, NY: Routledge.
References
Sveen, C. A., & Waley, F. A. (2008). Suicide survivors’ mental
health and grief reactions: A systematic review of controlled
studies. Suicide and Life-Threatening Behavior, 38(1), 13-29.
Van der Wal, J. (1989-90). The aftermath of suicide: A review of
empirical evidence. Omega, 20(2), 149-171.