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Suicide has been the focus of a large body of psychiatric and psychoanalytic literature. Its relationship with depression, its underlying psychodynamics, and the indicators that could predict its occurrence take the center stage of this literature. Less attention is paid to the aftermath of the tragedy. The fact, however, is that a completed suicide deeply affects the bereaved family as well as the clinician in charge.
The clinician is left with “conflicting tensions between maintaining patient confidentiality, providing support to the suicide survivors, and implementing risk management principles that limit liability exposure” (Simon, 2004, p. 191). Since the duty to maintain confidentiality of the patient records follows the patient in death (unless a specific court decision or statute indicates otherwise), written authorization from the executor of the patient's will needs to be obtained before releasing the patient's medical records. In unclear situations, legal counsel might be necessary. Besides such medico-legal concerns, there is the issue of dealing with the family members. The therapist must not refuse to meet them, unless they are bringing a legal charge against him. As far as possible, he should provide factual answers to their questions without revealing too many painful details of the patient's inner life. The immediate priority should be to console the family, witness their grief, and empathize with their sense of loss. At times, arranging on-going care for one or more of the survivors might also be indicated.
However, such outward focus must not lead to ignoring that a patient's suicide can have serious effects upon the therapist himself. Feelings of guilt, shame, anger, and doubts about one's professional competence are common under such circumstances (Gitlin, 1999; Hendin et al., 2000). Mourning reactions can be protracted and alter one's views about life in general and the psychotherapeutic enterprise in particular. Foster (1987), an analyst who los