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Unresolved Trauma as A Predictor of Death by Suicide:
QPR Theory Part III
- Carolyn V. Coarsey, Ph.D.
QPR Assumptions for those at Risk to Death by Suicide:
Tend not to self-refer for treatment
Tend to be treatment-resistant
Often abuse drugs and alcohol
Dissimulate their level of despair
Go untreated (and remain at risk for suicide)
-Paul Quinnett, Ph.D.
Founder & CEO, QPR Institute
The past two QPR Quick Quotes discussed with the
subject of unresolved trauma as related to death by suicide. This third article
will provide examples where survivor guilt led to professionally diagnosed
Post-Traumatic Stress Disorder (PTSD), and in one case, a suicide pact—which professional
intervention prevented.In the
workplace, when disaster strikes, alert Gatekeepers may be able to save lives
by understanding how survivor guilt can impact those who live beyond a disaster.
occurs when a person has feelings of guilt because they survived a
life-threatening situation where others did not. According to a July 27, 2019
article of Medical News Today, while survivor guilt is not a diagnosis on
its own, mental health professionals now consider it to be a significant
symptom of PTSD. The list of those who may experience survivor's guilt is not
limited to war, disasters, or other more prominent sources of traumatic
stress, but also includes families who lose a member to suicide, cancer
survivors, and parents who outlive their children.
In the Foundation’s case study research, a cruise line
disaster resulted in multiple deaths and many examples where survivor guilt
played a role in their long-term recovery. Ironically, two of the examples
included survivor guilt over the same child who perished in the tragedy.
When the command to abandon ship finally came, Susan was able to focus
on saving her own life, as her primary duty: caring for the children was
A crew-member whose job involved caring for children recounted
her experiences the night of the accident. When unusual sounds and blinking of
overhead lights, not to mention a severe tilting of the ship began, Susan (not
her name) knew instinctively that all lives on board were in peril. Her only priority at that point, was to
deliver each child to the care of their parents--only after that could she even
consider her safety.
When the command to abandon
ship finally came, Susan was able to focus on saving her own life, as her
primary duty: caring for the children was complete.Several days later, the fatalities list was
published. To her devastation, one of the children who had been in her care had
died, along with her father. Susan had survived one of the worst cruise line
tragedies in modern times and was suffering symptoms of traumatic stress. Now
to learn that one of the children in her care had perished, complicated her
Fortunately, when I interviewed Susan a couple of years
after the tragedy, she had received the care and support she needed and had
returned to work. Susan had been given time off and by the time she began a
new job, she had begun healing from the painful memories of that night. Susan
had reached a point where she knew the child's death had not been her fault. As
difficult as it had been to return the children to their parents—she had done
that. Despite her fear, Susan had done her job.
To help resolve her symptoms of traumatic stress, Susan had
taken a position with a different cruise line and a land-based job. This story
provides an example of the importance of an employer’s role in providing paid
time off and counseling support for their employees following workplace trauma.
A Couple’s Suicide
My husband and I picked out the perfect tree on our property. He then
purchased the rope. I would go first, and then he would follow. Fortunately,
the mental health care came through in the nick of time, and we began to move
forward in our healing.
Several months after I interviewed Susan, I met Tracy in preparation
for a Foundation conference that we were hosting in Hong Kong. Tracy, a
resident of Australia, volunteered to share her story at the meeting. I
interviewed Tracy on video as part of our Foundation case study research in
advance of her presentation. I was surprised to learn that the death of the
child that Susan described was also a significant source of survivor guilt for
Tracy and her husband, Robert.
Tracy and Robert were among the survivors who escaped
several hours after the ordeal began. Since both were excellent swimmers, when
they realized how dire the evacuation, they focused on assisting others who
were calling for help.Two of the last
people to evacuate the ship, they both had full memories of helping others,
many who believed the trauma was un-survivable.
A psychologist diagnosed both Tracy and her husband with
PTSD. Not unlike many who have PTSD, Robert had difficulty with enclosed
spaces, and therefore unable to travel by aircraft—necessary for his
employment. Since he could not fly, he lost his job. Due to their symptoms,
both were unable to work and could not pay for the help they needed.
Within weeks, the depression and anxiety became unbearable.
Tracy and Robert began to experience the suicidal
trance.Dr. Richard Heckler, in his
book, Waking Up Alive, describes suicide trance as a temporary
dissociative state, or altered state of consciousness, similar to when someone
hallucinates during a high fever. To the traumatized couple, the only relief
from the intense survivor guilt they felt came from thoughts of dying. In
particular, their troubled minds focused on the guilt they felt about the young
child who died with her father. Tracy remembers telling the parents of the
young girl repeatedly that they should not return to their room for the
father's medication. By the details of their death, it was evident that they
had not heeded their warnings.
Fortunately, just in the nick of time, the cruise line company
provided the funding necessary for Tracy and Robert to obtain professional
help. The psychologist worked tirelessly with them, and eventually, they felt
relief that allowed them to work again and resume a healthy life.
The Gatekeeper Training provided by the QPR Institute
provides education and a researched-based approach for empowering family,
friends, co-workers, and everyone to save lives. The workplace programs
presented by the Foundation include stories like these where all in the
workplace may become sensitized to situations that may occur in their
organization where survivors of trauma need attention and support. Had the
employee and couple whose stories are told here gone without follow-up and
support, the effects of the unresolved traumas may have resulted in more deaths
QPR stands for Question, Persuade and Refer, and is a research-based intervention that anyone can learn. If you are interested in learning more about how to become a Gatekeeper and becoming part of a more extensive network that is dedicated to suicide prevention, please contact us. The Foundation works with the QPR Institute to customize this successful intervention for cruise lines, aviation companies, human resources professionals, and other workplace groups. To learn more about the training classes offered by the Family Assistance Foundation, and for information about upcoming Gatekeeper classes and how you can become a trainer within your workplace go to fafonline.org. You can also contact Cheri Johnson at firstname.lastname@example.org.
Upcoming Gatekeeper Trainings
QPR Gatekeeper and Train-the-Trainer Training
Other trainings will be offered when additional dates & locations for Foundation Member-Partner Meetings are announced.