Surviving Suicide Stigma

6/7/2024

One of the greatest challenges to surviving a suicide death loss and moving forward in one’s grief is the prevalent and damaging stigma that continues to be associated with this cause of death. This stigma is complicated by public misunderstanding of suicide, long-held myths about suicide, and the problematic language used to talk about suicide and the deceased. Moving forward with a suicide death loss is one of the most difficult experiences we may face in our lives, but if we can begin to unpack and understand the roots of the stigma that clings to suicide in our culture, we may become more empowered to challenge them and attain some healing in our personal bereavement.

In my own scholarly work on suicide, I have identified what are perhaps the four most common cultural myths that are imposed on survivors of suicide loss, which reinforce stigmas and harm our individual grieving processes. Exposing these attitudes for the myths they are may allow us to better honor our loved ones’ lives while also reinforcing facts over fiction to others who are also affected by suicide.

Myth 1: Suicide is always the result of clinical depression.

Not all suicide deaths are resultant of what we clinically term “depression.” It is also important to remember that while everyone may feel depressed from time to time, perhaps following the loss of a loved one, the loss of a job, the end to a romantic relationship, or other losses, clinical depression is not the same as situational depressed feelings, nor does one necessarily grow out of the other. Today, we must recognize that not all suicide deaths are linked so easily to clinical depression or, even for persons suffering from clinical depression, to that depression alone. Leading to a suicide attempt, there are a multitude of pressures at work on an individual, both social (including cultural, environmental, and interpersonal) as well as psychological (including one’s personal and familial mental health history, one’s losses, and one’s coping mechanisms for responding to suffering and trauma), and often biological (including chronic or life-threatening medical conditions, chemical imbalances, and effects of medications).

If your loved one died of suicide, it is natural for you to try to trace the components of their life that may have impacted their suicidality and led to their death. We want answers, and we may think that we need those answers to move on with our lives. Coming to terms with the impossibility of fully answering the question of “why?” is a hard realization, but it can begin to allow you to accept that you will never know fully exactly why the death occurred.

Myth 2: The suicide death was a “quick fix” for problems that could easily have been solved.

Because suicide continues to be an act surrounded by attempts to place blame, whether on the deceased, his or her family or romantic partner, or the medical community, if we seek less to find an outlet for blame and more to identify contributory forces on the individual, we may recognize that someone who has died of suicide was trapped in their pain and unable to see any other way out of their pain. Suicidal people do not want to die; they want to end their suffering. To treat suicide as a “quick fix” or “easy way out,” as is often done, is a failure to recognize the pain from which our loved one suffered. While we all experience pain, loss, and obstacles in our lives, individuals who die of suicide were not able to respond to their pain in healthy ways – often due to the same biopsychosocial forces that led to their suicidality.

After a suicide loss, we might become frustrated by all the options we believe that our loved one had to receive help. We might become angry at them or others for not getting the help that we think could have kept them alive. Recognizing that suicide is the product of a mind that isn’t working right can help us understand that while we can identify objective sources of assistance, in late-stage suicidality, our loved one’s mind genuinely could not see those possibilities anymore.

Myth 3: If we talk about suicide, or about our loved one who died of suicide, we may risk becoming suicidal or causing another person to become suicidal.

Historically, it was believed that if one spoke openly about the suicide death of a family or community member, they would risk “infecting” themselves or others by presenting suicide as an option. We still see effects of this misguided theory today; for example, we rarely, if ever, see the word “suicide” in an obituary or hear it at a memorial service for one who has died of suicide. Similarly, school communities are divided between communicating effectively with their students about the loss of a student to suicide and remaining fearful of romanticizing the death and presenting it as a possible “way out” for other students. Although this theory has been reexamined over the last decade and the idea that suicide is “infectious” is well on its way to being disproven, the idea that one can contract suicide from another person, as one would a virus or bacterial infection, still circulates in our contemporary culture.

We need to resist remaining silent about suicide and our own suicide losses. It is not contagious, and without open and accurate conversations about it, including in memorialization, silence will continue to function as a way of shaming survivors and cultivating more silence around these deaths. The suicide death of your loved one was the endpoint of their unique and extraordinary life, not the totality of their life. They deserve that their pain be acknowledged along with their accomplishments. Additionally, other people living with suicidality need to know that they can break silences about their suffering. Talking about suicide is more likely to lead to those people seeking help rather than suffering in silence.

Myth 4: Suicide is an act of cowardice or personal weakness; while everyone feels badly sometimes, suicide is “wrong,” “selfish,” or “weak.”

One of the most dangerous ways in which we bar understanding of those who have died of suicide is to treat their means of death as a personal failure. Historically-inherited cultural norms teach members of our society that a person who died of suicide was weak, cowardly, and uncaring about their loved ones. In reality, as the result of many social, psychological, and biological factors that have nothing to do with “giving up” or “choosing death,” suicide is not about cowardice; it isn’t about weakness. Representations of people who die of suicide as being less strong or less caring of others are not only false but harmful to their survivors and to their own legacy.

No one asks to become suicidal; no one hopes that suicidality will develop in them, just as no one wishes for a cancer to develop in them. Persons who attempt and die of suicide often report beforehand feeling ambivalent toward life and death, due to their suffering. Many cannot see or understand the impact their death will have on their loved ones, much in the same way that they cannot see options other than suicide in ending their pain. Anyone who lives for any length of time with exacerbating suicidality in a culture that shames suicidality is anything but a coward.

The Role of Language

While the above myths are but a few of the many that suicide loss survivors face, sometimes on a daily basis, we also need to confront the ways in which our culture reinforces stigma through the language used to refer to suicide and those who suffer from it. Let’s consider conventional terminology: people say that “John killed himself” or “John committed suicide”; both of these statements show nothing but ignorance for the complexity and devastation of suicidal pain, rendering someone who died of a life-threatening condition a virtual criminal. Within our cultural context, we “commit” crimes – murder, theft, robbery. If we “kill,” our cultural values demand that we ought to be punished. Criminalizing suicide through language is a barrier to understanding the pain of the suicidal individual.

Your loved one did not commit a crime; they do not deserve cultural or interpersonal degradation in language. They died of suicide, which is a cause of death that can be acute, chronic, or life-threatening, like many other causes of death. Their death was not an act of free will produced by a healthy mind but a tragic result of complex pain.

November 23, 2024 is International Survivors of Suicide Loss Day. To find events and additional resources, or to read and share stories of suicide losses, I encourage you to visit the American Foundation for Suicide Prevention’s website at www.afsp.org.

988 Suicide and Crisis Lifeline
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org. Veterans, press 1 when calling.

There may be no cause of death more silenced, stigmatized, and misunderstood than a death of suicide. Back by popular demand, Sara Murphy, PhD, FT, takes the stage at CANA's 106th Annual Cremation Innovation Convention this September 11-13, 2024. Dr. Murphy's invaluable session will teach how to differentiate between myths and realities of suicidality, recognize the signs for suicide risk and develop responses to prevent suicide death loss within the profession to better care for ourselves and our colleagues.. See what else we have planned and register to attend: cremationassociation.org/CANA24

Plus, Dr. Sara Murphy and Aaron Pelchat, LCSW, lead an interactive workshop to bring professional education and support of mental health in funeral service professionals. In The Silent Problem: Talking about Mental Health and Funeral Service, attendees will learn about common mental health issues like compassion fatigue and burnout, how to unpack challenges to self-care, and gain tools for improving mental health in themselves and their colleagues. Register for this special pre-Convention workshop alone or add it to your CANA Convention registration.

This post was originally published in the Remembering A Life blog on November 18, 2020.

Sara Murphy, PhD, FT is a death educator, Certified Thanatologist and Fellow in Thanatology (Association for Death Education and Counseling), and suicidologist with eighteen years of scholarly, pedagogical, and professional experience in the field. She is a faculty member at the University of Rhode Island and affiliate faculty in the Thanatology Graduate Program at Marian University. Publicly, Dr. Murphy conducts diverse and dynamic professional development and educational workshops and seminars on specialized topics of death, dying, and bereavement nationwide for businesses, schools, and professional organizations. Dr. Murphy is also a suicide and bereavement consultant, an expert witness on disenfranchised grief and on suicide, and a contributing writer for the National Funeral Directors Association.

State Cremation Rate Milestones

6/6/2024

The national cremation rate has grown steadily and predictably for the last 50 years. Nothing has interrupted this pattern, neither recessions nor a pandemic, at least on the national level. CANA has tracked this national data for more than a century but has collected state level data just for the past 25 years. As we first reported in 2017, cremation growth rates follow a similar pattern that varies by region of the country and some demographic factors. These patterns emerge as S-curves, a common framework in statistics, representing growth in cremation over time. CANA’s consultant, Arvind Singhal, took this research further and created a model that projects cremation rate growth by state through the end of the century.

Cremation and death numbers will vary and that's important to track for business planning: case volume influences staffing and capital investments. However, these projected cremation rates – percentages of the total – describe long-term trends. Besides being an interesting intellectual exercise, these predictions can also be useful in business planning. Though, if it seems like science fiction, you would be right. Projecting out further than 5-20 years introduces many demographic and other variables that make the projections less reliable, but still fascinating. CANA's Milestone Report, originally published in 2021, suggests a picture of continued cremation growth in a predictable shape.

The Cremation S-Curve

S-curves are a line on a graph that starts off rising pretty slowly and then ramps up quickly before eventually leveling off. This shape appears everywhere, often representing an innovation or adoption of new technology. Picture the invention of cars, televisions, or smart phones: just a few early adopters, it catches on and everyone starts using it, then the population that will adopt it does and there’s nowhere to grow. The S-curve looks more like a lazy, stretched S, but is distinct from other growth shapes such as straight-line or stair step. There are five phases to a trend that is depicted as an S-curve:

Early period or long tail. For cremation, that was the 96 years between 1876 and 1971 until the cremation rate reached 5% nationally.
Early adoption or the beginning of the end. This is the turning point phase that will determine if something is likely to succeed in the long run (take S shape) or see its demise (head downward toward lower values). When cremation rates started rising faster than a linear graph could predict, it signaled the S-curve and has become a defined trend. For products like Betamax and BlackBerry, their curve continued back down and failed to catch on, ultimately representing a blip.
Rapid growth, which is the period we are currently experiencing in the US. The cremation rate has grown from 5% in 1972 to 60.6% in 2023. Here, too, new products or services can fail if they don’t continue to innovate to be more useful or more available to the population that would choose it.
Deceleration is the next stage. Growth slows and begins to form the upper curve of the S. States with cremation rates approaching or exceeding 70% are in this phase. CANA’s 2023 Annual Report suggests that the US nationally and individual states could be approaching this phase but does not have actual data that proves deceleration or plateau. These are represented in the image as speculative projections.
A persistent plateau occurs after a slow down. The rapid rise of the S-curve is complete and growth has leveled off. We know that the cremation rate will never reach 100% as a straight-line analysis would predict. But that upper boundary can vary and is largely dependent on the growth trajectory—or middle part—of the S. A few states have already begun to slow down, though none have quite plateaued yet.

State Cremation Rate Growth

S-curves describe adoption of a trend or technology. When did cremation stop being a curiosity and start becoming a trend? In 1972. When did cremation become the majority of consumers’ preference? Nationally, the rate topped 50% in 2016—but, of course, it varies state by state. Some states hit the mark even earlier, before 2000, when CANA wasn’t yet collecting state-level data.

Our first chart shows when individual states reach 50% cremation rate – reporting existing data or projecting forward. Since this report was first published in 2021, the cremation rate in Arkansas, Virginia and West Virginia have each surpassed 50% as predicted by the chart. By 2033, cremation is predicted to be the preferred form of disposition in every state.

For 2023, CANA added a new color to the national heat maps to highlight the six states where the cremation rate is now above 80% – these states also predicted in the chart from 2021. The farther out a projection is, the more room error there is – we can’t account for world events, demographic change, culture shifts, etc. However, CANA statistics predict that more than half of the country will join these early-adopter states and surpass 80% before 2040 – less than 20 years from now.

This CANA research shows each state’s projected cremation growth patterns as they reach two milestones: 50% (top) and 80% (bottom) cremation rates.

Disposition Disruption

As we conducted research for this article, we learned that trends are borne from trends. For example, the adoption of personal computers led naturally to smart phones as the next improvement of the technology. Personal computers plateaued when they were integrated into nearly all types of business, personal, and education use. Then smart phones somewhat leapfrogged over computer use in some areas of the world and in some professions.

Turning to death care, it will be interesting to observe how new and existing forms of disposition may grow out of the adoption of cremation. Is alkaline hydrolysis an S-curve building on top of cremation? What about natural organic reduction? Only time will tell. For now, these new forms of disposition are difficult to track. That’s because half of the states offering alkaline hydrolysis do not differentiate between AH and flame cremation. If the legalization trend continues to redefine cremation to include AH and NOR, it will continue to be difficult to track these dispositions separately from flame cremation.

Are You Ready?

Are you persuaded? Now’s the time to embrace cremation. CANA has the tools to support your own growth as the cremation rate grows around you.

Education

Ready to get to work? CANA’s Online Education Courses are on-demand and filled with practical takeaways you can put to work right away. Here are a few to consider.

Cremation Arrangement Conference Best Practices – $30, 2.0 CEUs
Learn how you can communicate with cremation families during the arrangement conference to ensure they walk away with peace of mind, knowing their loved one will be memorialized in a way that best represents the life that person lived.

Cremation Phone Shoppers: Your Best First Impression – $15, 1.0 CEUs
When you answer the next cremation phone shopper call, do you know what to say to convert them to a customer? Or will you turn them away by not giving them the right information? This course will teach you how to effectively answer and handle the next phone shopper call.

The Cremation Choice – $30, 2.0 CEUs
Cremation is a form of disposition—but also so much more in the minds of funeral professionals and consumers. This course explores the latest research from CANA to better understand consumer and professional attitudes toward cremation. Taking this class will help you understand the cremation customer, challenge your biases, and find new ways to serve your community's needs.

CANA-Certified Cremation Specialist – $465 for CANA Members, $615 for all other funeral professionals, 11.0 CEUs – Registration closes July 1, 2024
Anyone can claim they are a cremation specialist. What sets a CANA-Certified Cremation Specialist apart is the training they receive to ensure everyone is treated with the same level of care, service, and compassion.

106th Annual Cremation Innovation Convention – $860 for CANA Members, $1060 for Nonmembers, 7.0 CEUs – Chicago: September 11-13, 2024
CANA’s 106th Convention is your opportunity to get to know your peers from funeral homes, crematories, and cemeteries and explore all Chicago has to offer. Industry experts will take the stage to share practical ways that you can address today's challenges to meet tomorrow's demand with sessions on cybersecurity, memorialization, leadership, the role of women in funeral service, and much more!

This original research from CANA was first published in 2021 in Volume 57, Issue 4 of The Cremationist. Access to CANA research and magazine and archives are resources available exclusively to members. Not a member yet? Your firm can join for just $495 and gain the benefit of more than a century of cremation expertise.

CANA Research takes the stage at the 106th Annual Cremation Innovation Convention this September 11-13, 2024 in Chicago. CANA President Robert Hunsaker will share how The Answer is in the Numbers and identify strategies to remain profitable in today's market. See what else we have planned and register to attend the CANA Convention!

Like the CANA's Annual Cremation Statistics Report, the statistical analysis and projections in this post were conducted by Arvind Singhal of Singhal LLC. Arvind earned his Bachelor of Engineering from IIT, Roorkee, Master of Science in Engineering from Western Michigan University, and an MBA from Kellogg School of Management, Northwestern University.