Po koncu: žalovanje in reintegracija bližnjih po samomoru

Suicide is one of the biggest social and public health problems. Every year about 450 Slovenians and about 800,000 people around the world die by suicide. Suicide represents a significant proportion of the global burden of disease, being the tenth leading cause of death, accounting for 1.5% of all deaths. The most direct consequences after death are borne by the suicide survivors. These are people who had a significant relationship with a person who died by suicide, and the event of the suicide changed their life or had a significant negative impact on them. Typically, suicide survivors are family members, friends, colleagues, co-workers, classmates, teachers, as well as medical professionals or other experts who were involved in a person's treatment. The main theme of the book is understanding their experiences, grief and the process of their reintegration after the event of suicide. The death of a family member is often considered a critical life event in our culture; the outcome of such an event depends on the interaction of several factors: personal characteristics and background, situational circumstances, coping skills, cognitive appraisals, adaptive skills, and the physical and social environment of the person experiencing the event. The death of a loved one not only affects grieving individuals, but also has a social component that is reflected in rituals around the death. Rituals help the grieving person navigate a new situation and express their intense emotions in a socially acceptable way. Rituals also encourage mutual support and frame the behaviour of the bereaved in the environment and in the social network. At the social level, habits and rituals encourage a return to daily routines. Rituals help to restore the social order that was interrupted with the death. Theories of grief originating in psychology and medicine, on the one hand, usually examine the intrapsychic experience of an individual without consideration of his or her life or social circumstances; on the other hand, anthropological studies focus primarily on social processes. We lack an integrated understanding of the individual's experience of suicide or death with the interaction of his or her narrower and wider social network. Therefore, the aim of this study was to examine how suicide was experienced, how the suicide event affected the lives of bereaved, and how they dealt with their grief. In particular, we wanted to answer the question of how different factors that influence the process of mourning and reintegration in a specific form of death can be understood as part of a unified model. The study was based on qualitative research principles. Sixteen semi-structured in-depth interviews were analysed with suicide survivors who differed in demographics, relationship with the deceased, time since death, and coping with the experience. The average length of the interview was 113 minutes. Following the principles of grounded theory, we analysed the data using initial, focused, and axial coding. We merged the 2631 quotes, 263 direct codes (with more than 3 quotes), and 30 supercodes into 15 main concepts. Two of these dealt with the time before the suicide: Explaining ”reasons” for suicide, Relationship deceased-bereaved and their life before suicide, three the time around the death: : The event of suicide, Funeral and bereavement rituals, Participants’ experiencing of suicide. Participants’ experiencing themselves after suicide, Guilt, Reactions and experiencing of social network and society, Relationships in the family and with others suicide survivors, Reactions and experiencing of help-systems, Understanding suicide and death, Attachment and relationship after death, Spirituality, dreams and parapsychological experiences, Reintegration after suicide, and Meaning making of suicide and the impact on the future. The study had a focus on the post-death period. We synthesised the concepts into a grounded theory that goes beyond simple thematic analysis. It provides a framework for how we can understand the concept of reintegration of suicide survivors over time, and the model includes both risk and protective factors that influence this process. The Growing flower model includes four levels of reintegration after suicide: the levels of the survivor or bereaved, family, society, and systems. These levels can be represented as concentric circles, with the bereaved person in the innermost position; the spacing of the circles represents the social distance of each level. The levels are also interrelated, as the bereaved person may encourage their interaction with the social network or isolate themselves. The people in the different social networks or levels can also either help or hinder the process of grieving. The quality and quantity of interactions differ according to the stages of reintegration. All levels play a role in the content of the reintegration phases. These are: ((i) the event of the suicide, (ii) funeral and rituals, (iii) expression of emotions, (iv) feelings of guilt, condemnation or other negative reactions, (v) search for “explanations” of suicide, (vi) support during the process, (vii) the importance of spirituality and (viii) meaning making, personal growth and identity changes. The themes emerge throughout the stages, but the process is not linear. The goal of reintegration is to experience the content with the mutual support of all (social) levels involved in the process. Each content is therefore relevant to all levels and can be represented as petal spread across the concentric circles mentioned earlier. The suicide survivor integrates the experience of the suicide and the changes in the relationship with the deceased into his or her personal account of self, others and the world. In the model, attachment to the deceased is also important: suicide survivors do not experience a loss of the relationship, but rather a distancing from it. In the model, the attachment after death is represented as the stem of the "flower" and the deceased person is represented as the "earth" or "soil" that is connected to the "petals" and to all the layers of the "flower." At the time of death, the bereaved person feels closely connected to the deceased. Over time, he/she experiences distancing, but the distance may seem shorter at certain moments such as anniversaries, birthdays, holidays, important life events, or a visit to the grave. This study provides a holistic understanding of grief and reintegration after suicide. Reintegration is understood as a non-linear but "growing" process. In each phase, the content and tasks emerge at a different level. The time frame of the phases is difficult to determine, as it depends not only on the situation, but also on the attachment to the deceased. The aim of this process is for the suicide survivor to integrate the experience of suicide into his or her changed relationship with the deceased and his or her representation of self, others and the world, with the support of all the social networks involved. The growing flower model provides novelty to the grief and bereavement theories and provides an additional insight into the processes of mourning after suicide. Moreover, model explains how the process of reintegration after death occurs not only at the intrapersonal level, but also broader social network of family, friends, and systems. We used a detailed research design and systematic analysis process to ensure the credibility of our findings. This is one of the most important steps to ensure the validity of qualitative studies. The use of grounded theory is an original methodological contribution on how to study complex phenomena. We also confirmed that the participants of the study could identify with the results and with the final model. In conclusion, this is also a way to understand and design interventions for the bereaved.