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The destruction of the whole body would also mean the destruction of each of its parts; "if the whole [body] is destroyed there will not be a foot or a hand" a And just as a hand is not able to survive without being attached to a functioning body, so too an individual cannot survive without being attached to a city.

Presumably Aristotle also means to imply that the reverse is not true; a body can survive the loss of a foot or a hand, although not without consequence. If the history that he has described is correct, Aristotle points out, then the city is natural, and not purely an artificial human construction, since we have established that the first partnerships which make up the family are driven by natural impulses: "Every city, therefore, exists by nature, if such also are the first partnerships.

For the city is their end…. From the very first partnerships of male and female and master and slave, nature has been aiming at the creation of cities, because cities are necessary for human beings to express their capacities and virtues at their best, thus fulfilling their potential and moving towards such perfection as is possible for human beings. While most people today would not agree that nature has a plan for individual human beings, a particular community, or humanity as a whole although many people would ascribe such a plan to a god or gods , Aristotle believes that nature does indeed have such a plan, and human beings have unique attributes that when properly used make it possible for us to fulfill that plan.

What are those attributes? Man, the Political Animal That man is much more a political animal than any kind of bee or any herd animal is clear. For, as we assert, nature does nothing in vain, and man alone among the animals has speech For it is peculiar to man as compared to the other animals that he alone has a perception of good and bad and just and unjust and other things of this sort; and partnership in these things is what makes a household and a city a8.

Like bees and herd animals, human beings live together in groups. Unlike bees or herd animals, humans have the capacity for speech - or, in the Greek, logos.

Here the linkage between speech and reason is clear: the purpose of speech, a purpose assigned to men by nature, is to reveal what is advantageous and harmful, and by doing so to reveal what is good and bad, just and unjust. This knowledge makes it possible for human beings to live together, and at the same time makes it possible for us to pursue justice as part of the virtuous lives we are meant to live.

Other animals living in groups, such as bees, goats, and cows, do not have the ability to speak or to reason as Aristotle uses those terms. Of course, they do not need this ability. They are able to live together without determining what is just and unjust or creating laws to enforce justice among themselves.

Human beings, for better or worse, cannot do this. Although nature brings us together - we are by nature political animals — nature alone does not give us all of what we need to live together: "[T]here is in everyone by nature an impulse toward this sort of partnership. And yet the one who first constituted [a city] is responsible for the greatest of goods" [a29]. We must figure out how to live together for ourselves through the use of reason and speech, discovering justice and creating laws that make it possible for human community to survive and for the individuals in it to live virtuous lives.

A group of people that has done this is a city: "[The virtue of] justice is a thing belonging to the city. For adjudication is an arrangement of the political partnership, and adjudication is judgment as to what is just" a And in discovering and living according to the right laws, acting with justice and exercising the virtues that allow human society to function, we make possible not only the success of the political community but also the flourishing of our own individual virtue and happiness.

Without the city and its justice, human beings are the worst of animals, just as we are the best when we are completed by the right kind of life in the city. And it is the pursuit of virtue rather than the pursuit of wealth or security or safety or military strength that is the most important element of a city: "The political partnership must be regarded, therefore, as being for the sake of noble actions, not for the sake of living together" a1.

Slavery Having described the basic parts of the city, Aristotle returns in Chapter 3 of Book I to a discussion of the household, beginning with the matter of slavery, including the question of whether slavery is just and hence an acceptable institution or not.

This, for most contemporary readers is one of the two most offensive portions of Aristotle's moral and political thought the other is his treatment of women, about which more will be said below. For most people today, of course, the answer to this is obvious: slavery is not just, and in fact is one of the greatest injustices and moral crimes that it is possible to commit. Although it is not widely known, there are still large numbers of people held in slavery throughout the world at the beginning of the 21st century.

It is easy to believe that people in the "modern world" have put a great deal of moral distance between themselves and the less enlightened people in the past, but it is also easy to overestimate that distance. In Aristotle's time most people - at least the ones that were not themselves slaves — would also have believed that this question had an obvious answer, if they had asked the question at all: of course slavery is just.

Virtually every ancient Mediterranean culture had some form of the institution of slavery. Slaves were usually of two kinds: either they had at one point been defeated in war, and the fact that they had been defeated meant that they were inferior and meant to serve, or else they were the children of slaves, in which case their inferiority was clear from their inferior parentage.

Aristotle himself says that the sort of war that involves hunting "those human beings who are naturally suited to be ruled but [are] unwilling…[is] by nature just" b What is more, the economies of the Greek city-states rested on slavery, and without slaves and women to do the productive labor, there could be no leisure for men to engage in more intellectual lifestyles. The greatness of Athenian plays, architecture, sculpture, and philosophy could not have been achieved without the institution of slavery.

Therefore, as a practical matter, regardless of the arguments for or against it, slavery was not going to be abolished in the Greek world. This is not to excuse Aristotle or those of his time who supported slavery, but it should be kept in mind so as to give Aristotle a fair hearing.

Before considering Aristotle's ultimate position on the justness of slavery - for who, and under what circumstances, slavery is appropriate — it must be pointed out that there is a great deal of disagreement about what that position is. That Aristotle believes slavery to be just and good for both master and slave in some circumstances is undeniable. That he believes that some people who are currently enslaved are not being held in slavery according to justice is also undeniable this would apparently also mean that there are people who should be enslaved but currently are not.

How we might tell which people belong in which group, and what Aristotle believes the consequences of his beliefs about slavery ought to be, are more difficult problems. Remember that in his discussion of the household, Aristotle has said that slavery serves the interest of both the master and the slave.

Now he tells us why: "those who are as different [from other men] as the soul from the body or man from beast - and they are in this state if their work is the use of the body, and if this is the best that can come from them — are slaves by nature…. For he is a slave by nature who is capable of belonging to another — which is also why he belongs to another — and who participates in reason only to the extent of perceiving it, but does not have it" b Those who are slaves by nature do not have the full ability to reason.

Obviously they are not completely helpless or unable to reason; in the case of slaves captured in war, for example, the slaves were able to sustain their lives into adulthood and organize themselves into military forces.

They are incapable of fully governing their own lives, and require other people to tell them what to do. Such people should be set to labor by the people who have the ability to reason fully and order their own lives.

Labor is their proper use; Aristotle refers to slaves as "living tools" at I. Slaves get the guidance and instructions that they must have to live, and in return they provide the master with the benefits of their physical labor, not least of which is the free time that makes it possible for the master to engage in politics and philosophy. One of the themes running through Aristotle's thought that most people would reject today is the idea that a life of labor is demeaning and degrading, so that those who must work for a living are not able to be as virtuous as those who do not have to do such work.

Indeed, Aristotle says that when the master can do so he avoids labor even to the extent of avoiding the oversight of those who must engage in it: "[F]or those to whom it is open not to be bothered with such things [i. This would seem to legitimate slavery, and yet there are two significant problems. First, Aristotle points out that although nature would like us to be able to differentiate between who is meant to be a slave and who is meant to be a master by making the difference in reasoning capacity visible in their outward appearances, it frequently does not do so.

We cannot look at people's souls and distinguish those who are meant to rule from those who are meant to be ruled - and this will also cause problems when Aristotle turns to the question of who has a just claim to rule in the city.

Second, in Chapter Six, Aristotle points out that not everyone currently held in slavery is in fact a slave by nature. The argument that those who are captured in war are inferior in virtue cannot, as far as Aristotle is concerned, be sustained, and the idea that the children of slaves are meant to be slaves is also wrong: "[T]hey claim that from the good should come someone good, just as from a human being comes from a human being and a beast from beasts.

But while nature wishes to do this, it is often unable to" b3. We are left with the position that while some people are indeed slaves by nature, and that slavery is good for them, it is extremely difficult to find out who these people are, and that therefore it is not the case that slavery is automatically just either for people taken in war or for children of slaves, though sometimes it is b In saying this, Aristotle was undermining the legitimacy of the two most significant sources of slaves.

If Aristotle's personal life is relevant, while he himself owned slaves, he was said to have freed them upon his death. In Chapter 8 of Book I Aristotle says that since we have been talking about household possessions such as slaves we might as well continue this discussion.

The discussion turns to "expertise in household management. Aristotle uses the discussion of household management to make a distinction between expertise in managing a household and expertise in business. The former, Aristotle says, is important both for the household and the city; we must have supplies available of the things that are necessary for life, such as food, clothing, and so forth, and because the household is natural so too is the science of household management, the job of which is to maintain the household.

The latter, however, is potentially dangerous. This, obviously, is another major difference between Aristotle and contemporary Western societies, which respect and admire business expertise, and encourage many of our citizens to acquire and develop such expertise.

For Aristotle, however, expertise in business is not natural, but "arises rather through a certain experience and art" a5.

It is on account of expertise in business that "there is held to be no limit to wealth and possessions" a1. This is a problem because some people are led to pursue wealth without limit, and the choice of such a life, while superficially very attractive, does not lead to virtue and real happiness. It leads some people to "proceed on the supposition that they should either preserve or increase without limit their property in money. The cause of this state is that they are serious about living, but not about living well; and since that desire of theirs is without limit, they also desire what is productive of unlimited things" b Aristotle does not entirely condemn wealth - it is necessary for maintaining the household and for providing the opportunity to develop one's virtue.

But Aristotle strongly believes that we must not lose sight of the fact that wealth is to be pursued for the sake of living a virtuous life, which is what it means to live well, rather than for its own sake. So at b1 he agrees with those who object to the lending of money for interest, upon which virtually the entire modern global economy is based.

Someone who places primary importance on money and the bodily satisfactions that it can download is not engaged in developing their virtue and has chosen a life which, however it may seem from the outside or to the person living it, is not a life of true happiness. This is still another difference between Aristotle and contemporary Western societies. For many if not most people in such societies, the pursuit of wealth without limit is seen as not only acceptable but even admirable. At the same time, many people reject the emphasis Aristotle places on the importance of political participation.

Many liberal democracies fail to get even half of their potential voters to cast a ballot at election time, and jury duty, especially in the United States, is often looked on as a burden and waste of time, rather than a necessary public service that citizens should willingly perform. In Chapter 11, Aristotle notes that there is a lot more to be said about enterprise in business, but "to spend much time on such things is crude" b Aristotle believes that we ought to be more concerned with other matters; moneymaking is beneath the attention of the virtuous man.

In this Aristotle is in agreement with the common opinion of Athenian aristocrats. He concludes this discussion with a story about Thales the philosopher using his knowledge of astronomy to make a great deal of money, "thus showing how easy it is for philosophers to become wealthy if they so wish, but it is not this they are serious about" a Their intellectual powers, which could be turned to wealth, are being used in other, better ways to develop their humanity.

In the course of discussing the various ways of life open to human beings, Aristotle notes that "If, then, nature makes nothing that is incomplete or purposeless, nature must necessarily have made all of these [i. Though not a directly political statement, it does emphasize Aristotle's belief that there are many hierarchies in nature, as well as his belief that those who are lower in the natural hierarchy should be under the command of those who are higher.

Women In Chapter 12, after the discussion of business expertise has been completed, Aristotle returns to the subject of household rule, and takes up the question of the proper forms of rule over women and children.

This means that it is natural for the male to rule: "[T]he relation of male to female is by nature a relation of superior to inferior and ruler to ruled" b And just as with the rule of the master over the slave, the difference here is one of reason: "The slave is wholly lacking the deliberative element; the female has it but it lacks authority; the child has it but it is incomplete" a There is a great deal of scholarly debate about what the phrase "lacks authority" means in this context.

Aristotle does not elaborate on it. This question cannot be settled here. I will simply point out the vicious circle in which women were trapped in ancient Greece and still are in many cultures. The Greeks believed that women are inferior to men or at least those Greeks who wrote philosophy, plays, speeches, and so forth did.

These people, of course, were all men. What Greek women thought of this belief is impossible to say. This belief means that women are denied access to certain areas of life such as politics. Denying them access to these spheres means that they fail to develop the knowledge and skills to become proficient in them. This lack of knowledge and skills then becomes evidence to reinforce the original belief that they are inferior. What else does Aristotle have to say about the rule of men over women?

He says that the rule of the male over the female and that of the father over children are different in form from the rule of masters over slaves. Aristotle places the rule of male over female in the household in the context of the husband over the wife female children who had not yet been married would have been ruled by their father. Marriage for girls in Athens typically took place at the age of thirteen or fourteen.

Aristotle says at a40 that the wife is to be ruled in political fashion. We have not yet seen what political rule looks like, but here Aristotle notes several of its important features, one of which is that it usually involves "alternation in ruling and being ruled" b2 , and another is that it involves rule among those who "tend by their nature to be on an equal footing and to differ in nothing" b5.

In this case, however, the husband does not alternate rule with the wife but instead always rules. Apparently the husband is to treat his wife as an equal to the degree that it is possible to do so, but must retain ultimate control over household decisions. Women have their own role in the household, preserving what the man acquires.

This is not the same as that of a man, but as with a man nature intends her to achieve virtues of the kind that are available to her: "It is thus evident that…the moderation of a woman and a man is not the same, nor their courage or justice…but that there is a ruling and a serving courage, and similarly with the other virtues" a Unfortunately Aristotle has very little to say about what women's virtues look like, how they are to be achieved, or how women should be educated.

But it is clear that Aristotle believes that as with the master's superiority to the slave, the man's superiority to a woman is dictated by nature and cannot be overcome by human laws, customs, or beliefs. This is the case because both women and children "must necessarily be educated looking to the regime, at least if it makes any difference with a view to the city's being excellent that both its children and its women are excellent.

But it necessarily makes a difference…" a The reader should keep in mind that if the word "constitution" is used this does not mean a written constitution of the sort that most contemporary nation-states employ. All of these things depend on the group that holds political power in the city. For example, sometimes power is held by one man who rules in the interest of the city as a whole; this is the kind of regime called monarchy.

If power is held by the wealthy who rule for their own benefit, then the regime is an oligarchy. We will have much more to say later on the topic of regimes.

See a Problem?

Here Aristotle is introducing another important idea which he will develop later: the idea that the people living under a regime, including the women and children, must be taught to believe in the principles that underlie that regime. In Book II, Chapter 9, Aristotle severely criticizes the Spartan regime for its failure to properly educate the Spartan women and shows the negative consequences this has had for the Spartan regime.

For a monarchy to last, for example, the people must believe in the rightness of monarchical rule and the principles which justify it. Therefore it is important for the monarch to teach the people these principles and beliefs.

The Politics, Book II "Cities…that are held to be in a fine condition" In Book II, Aristotle changes his focus from the household to the consideration of regimes that are "in use in some of the cities that are said to be well managed and any others spoken about by certain persons that are held to be in a fine condition" a This examination of existing cities must be done both in order to find out what those cities do properly, so that their successes can be imitated, and to find out what they do improperly so that we can learn from their mistakes.

This study and the use of the knowledge it brings remains one of the important tasks of political science. Merely imitating an existing regime, no matter how excellent its reputation, is not sufficient. This is the case "because those regimes now available are in fact not in a fine condition" a In order to create a better regime we must study the imperfect ones found in the real world.

We should also examine the ideal regimes proposed by other thinkers. As it turns out, however fine these regimes are in theory, they cannot be put into practice, and this is obviously reason enough not to adopt them. Nevertheless, the ideas of other thinkers can assist us in our search for knowledge.

Keep in mind that the practical sciences are not about knowledge for its own sake: unless we put this knowledge to use in order to improve the citizens and the city, the study engaged in by political science is pointless. We will not consider all the details of the different regimes Aristotle describes, but some of them are important enough to examine here.

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What Kind of Partnership Is a City? Aristotle begins his exploration of these regimes with the question of the degree to which the citizens in a regime should be partners. The citizens of a particular city clearly share something, because it is sharing that makes a partnership. Consider some examples of partnerships: business partners share a desire for wealth; philosophers share a desire for knowledge; drinking companions share a desire for entertainment; the members of a hockey team share a desire to win their game.

So what is it that citizens share?

Aristotle has already said that the regime is a partnership in adjudication and justice. But is it enough that the people of a city have a shared understanding of what justice means and what the laws require, or is the political community a partnership in more than these things?

Today the answer would probably be that these things are sufficient - a group of people sharing territory and laws is not far from how most people would define the modern state. The citizens, or at least those in the ruling class, ought to share everything, including property, women, and children.

There should be no private families and no private property. But this, according to Aristotle, is too much sharing. While the city is clearly a kind of unity, it is a unity that must derive from a multitude. Human beings are unavoidably different, and this difference, as we saw earlier, is the reason cities were formed in the first place, because difference within the city allows for specialization and greater self-sufficiency.

Cities are preserved not by complete unity and similarity but by "reciprocal equality," and this principle is especially important in cities where "persons are free and equal.

In this way, then, it results that all rule…" a This topic, the alternation of rule in cities where the citizens are free and equal, is an important part of Aristotle's thought, and we will return to it later. There would be another drawback to creating a city in which everything is held in common. Aristotle notes that people value and care for what is their own: "What belongs in common to the most people is accorded the least care: they take thought for their own things above all, and less about things common, or only so much as falls to each individually" b Contemporary social scientists call this a problem of "collective goods".

Therefore to hold women and property in common, as Socrates proposes, would be a mistake. It would weaken attachments to other people and to the common property of the city, and this would lead to each individual assuming that someone else would care for the children and property, with the end result being that no one would.

For a modern example, many people who would not throw trash on their own front yard or damage their own furniture will litter in a public park and destroy the furniture in a rented apartment or dorm room.

Because the bulk of the information available on loss of a child of any age remains anecdotal rather than systematic, current ideas regarding this type of loss must be considered tentative rather than definitive.

More empirical data are needed before any firm conclusions can be reached. Problems in Grieving for a Child Having a child die can have a devastating effect on a marriage. For couples with a history of good communication and for those able to develop these skills, a child's terminal illness or sudden death may strengthen the relationship.

It is not uncommon, however, for marriages to break down under the strain imposed by a child's illness and death. Marital discord and divorce have been reported in 50 to 70 percent of families whose child died from cancer. One potential factor that can exacerbate marital difficulties may be the different styles of grieving among family members. In a study of parents whose children died of cancer, Martinson and her colleagues 45 found that "fathers were nearly twice as likely as mothers to reply that the most intense part of their bereavement was over within a few weeks to one month after the child's death," although their responses may have reflected the social expectation of fathers to "take it like a man.

Nevertheless, DeFrain and his colleagues did note some variations in the responses of fathers and mothers, with fathers reporting more anger, fear, and loss of control than mothers, as well as a desire to keep their grieving private. The mothers responded with more sorrow and depression. Lack of synchrony may make it difficult for couples to support or understand each other. As one grieving mother in DeFrain's study 18 reported, "I was an open, throbbing wound, and he wanted to have sex.

It was very hard for me to understand that he was also in pain and that he felt our closeness would be healing. In relationships lacking a pattern of stable communication, help from friends, relatives, or mental health professionals may be needed to facilitate mutual understanding. Another potential complication involves the discrepancy between a parent's real feelings for his or her child and the feelings he or she believes should exist.

As with any human relationship, feelings for a child are marked by ambivalence. But as Raphael 57 points out, "societal attitudes strongly suggest that all parents must be perfectly loving, and all [children] are perfectly lovable. Parents who depend heavily on a child for need-fulfillment can also experience complicated responses. Some women with negative selfconcepts may be able to stabilize an acceptable sense of self only by being "good mothers.

A death in this type of case, especially of an only child or of a child who had been unconsciously singled out to "care for" the mother, will disturb the mother's view of herself. For a parent whose relationship with a child had added meaning because of the parent's painful past, death brings an additional strain.

In cases where the parent used the relationship with the child to rework relationship conflicts from his or her own childhood, the child's death may be experienced as the loss not only of a son or daughter, but of some other relationship from the past as well.

Parents may also feel particularly threatened by the sense of vulnerability and helplessness associated with a child's death. A feeling expressed by a significant number of parents in the study by DeFrain et al. When a child dies, parents realize the limits of their protective powers and may feel haunted by this realization. When children who have significant roles in existing parental conflict die, the bereavement process may take a pathologic course. Orbach 50 conceptualized one mother's unresolved grief as follows: "When the irrational jealousy of her husband reached a peak of accusations, she [had] prayed for her son to become ill on the premise that this would lead to increased marital unity.

The advisability of having another child soon after a child's death is controversial. In a study of six replacement children in psychotherapy, Cain and Cain 11 found that "the parents' relationship with the new, substitute child [was] virtually smothered by the image of the lost child. Lewis 40 warns that replacement pregnancies can be used to deny the fact of the first child's death and may interrupt grieving. Poznanski 55 has observed clinically that the gradual giving up of a dead child prepares parents to "reinvest their energies in other relationships.

While a number of clinicians e. Being treated as a replacement is certainly apt to be burdensome to a child, but waiting until there is recovery may not be the solution either, especially since it is often observed that grieving for a lost child never entirely ends. In their study of life events in 2, persons matched for demo graphic characteristics to U.

Despite the relative frequency and universality of the event, very little research has been done in this area. In contemporary Western society, the loss of a parent in adulthood is not expected to produce serious effects, although some studies have shown a higher tendency to thoughts of suicide, an increased rate of attempted suicide, and higher rates of clinical depression. Empirical data regarding continuing effects of parental loss experienced during childhood are discussed in the next chapter.

In a study of 35 persons seeking treatment following the death of a parent, compared with 37 field subjects who had also lost a parent but who had not sought treatment, Horowitz et al. When the second parent dies, some adults may mourn the loss of having "parents. They had families, jobs, and daily responsibilities which allowed little time to dwell upon the deceased parent.

In most cases, attachment feelings have for some time been di rected toward other figures, such as mates and children. Such feelings, although briefly redirected toward parents following their deaths, usually turn back toward current figures after a relatively short time. The death of a parent may have many meanings for an adult child. For some, who perceived their mothers and fathers as caretakers, providers of praise, and permission-givers even after the parents had to be physically cared for themselves, the death may mean the loss of security.

A subtle role change often occurs when an adult child's parent dies. The death is often experienced as a "developmental push," propelling the adult into the next stage of life. It is well known anecdotally that many adults, upon the loss of their parents, suddenly feel the weight of responsibility as the oldest generation in the family.

This, coupled with the awareness that there are no longer parents to fall back on, may effect a more mature stance in parentally bereaved adults who no longer think of themselves as children.

Presumably, this type of loss has been ignored because it is viewed as having less impact than the death of a spouse, child, or parent. In most cases, adult siblings no longer live together and they may not even have much social contact. Nevertheless, it is rare to find adult siblings who have completely severed ties with one another. As in other types of bereavement, the quality of the preexisting relationship with the deceased is likely to color an individual's perception and experience of the loss.

The seeds of the sibling relationship are planted in childhood, but the same characteristics that were salient then continue to affect the nature of the adult tie.

In an exploratory study of adult sibling relationships, Ross and Milgram 60 found that shared childhood experiences and critical life events including parental deaths influence the level of sibling closeness in adult life. Geographical proximity can increase either closeness or distance, depending on other factors, but complete lack of closeness is unusual.

Sibling rivalry, a variable that may contribute to postdeath feelings of guilt, was found to continue throughout life in varying degrees of intensity, with rivalrous feelings peaking during early adult years.

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In addition, sibling relationships assume great importance among the elderly, probably making sibling loss in old age a particularly significant event. Some of Bank and Kahn's 3 observations regarding childhood bereavement could also apply to adult sibling ties. For example, they noted that sibling death may be difficult to resolve if previous identification with the deceased sibling was too close or fused, or if it was too polarized and rejecting.

Although the intensity of such closeness or hostility would probably be attenuated by the time siblings reach adulthood, such feelings could complicate grief reactions.

Another factor that may influence the response to sibling loss is the cause of death. A surviving sibling may find it more difficult to accept a loss if the sister or brother died of an illness to which the survivor may also be genetically predisposed or be a carrier, which would place the bereaved's children at risk. Anxiety following a sibling's death may be particularly acute among the elderly if it exacerbates an already present fear of one's own impending death.

Bank and Kahn 3 assert that, regardless of age, death of a sibling forces brothers and sisters to reorganize their roles and relationships to one another and to their parents. Under certain circumstances, a death can jolt surviving siblings into becoming more alert, sensitive, and concerned—particularly if they conclude that they could have prevented the death had they been more caring.

Death of "the most responsible" sibling can force survivors to face their need to contribute to their parents' well-being now that the deceased sibling no longer assumes this role. As with formerly traditional wives who can mature through the bereavement experience, siblings who had previously considered themselves less capable can grow through this imposed need to become a caretaker. All these types of bereavement are important and merit comparative study.

In this report, however, only suicide will be discussed as an example of an especially difficult loss. It is estimated that more than 27, people commit suicide in the United States each year. Men are three times more likely than women to commit suicide, and whites are almost twice as likely as blacks.

Even given this conservative figure, however, suicide leaves in its wake a sizable number of survivors who must deal with a complex set of feelings and social problems. Survivors of suicide have long been thought to be at greater risk for physical and mental health problems than individuals who are bereaved from other causes of death.

Indeed, as discussed in Chapter 2 , there is some evidence to suggest increased mortality among the widowed whose spouses committed suicide. There also is good evidence that children whose parent committed suicide are at risk for enduring adverse consequences and for suicide itself Chapter 5. While the death of a close relative by any cause may leave the survivor with feelings of abandonment and rejection that may be irrational, the feeling of rejection following suicide is almost universal.

As one survivor put it: "He could not have loved me; he did not think I was worth living for. And, as is the fate of most scapegoats, the victim is usually one of their own members and frequently the one least able to bear the added burden. The surviving spouse, parents, or even child may be blamed for not seeing the signs of the impending suicide or for not meeting the needs of the deceased. Bereaved individuals also often blame themselves for the death, resulting in what is often called "survivor guilt.

Survivors may question what they did to add to the deceased's stress or may wonder whether they could have foreseen and stopped the act. As suicide researcher Henslin 28 points out, "When one can exercise control over events and in so doing prevent harm to others, our culture demands that it is one's responsibility to do so. Therefore, if one could have acted to have prevented the suicide, one feels that he or she should have done so.

Menninger 46 has clinically observed that a typical response is "overwhelming bitterness" at having failed in the task of keeping the vulnerable one alive coupled with a sense of relief that the ordeal is finally over.

Children, especially, who have been warned that they are "upsetting Mommy" or accused by the parent of "driving me crazy" are especially vulnerable to feelings of guilt following a suicide. In Bowlby's 7 clinical experience, repeated threats often leave the survivor frightened and frustrated, finally wishing that the other person would just "go ahead and do it. Feelings of anger and relief are generally unanticipated and misunderstood under the circumstances and so may lead to a sense of shame and a denial of their existence.

Finally, survivors may feel anxious after the death—worried that they may mimic the deceased's self-destructive act. The nature and intensity of the survivor's reactions will depend largely on cultural factors, the prior relationship with the deceased, the age and physical condition of the deceased, the survivor's individual personality characteristics, and the nature of the death. Henslin 28 has found that, in some ways, suicide shares with accidental death the qualities of "suddenness, unexpectedness, and violence.

For example, in the case of a terminal illness, especially among cancer patients, the sick person may have made a clear decision to abbreviate a life of pain. Communications before the death or suicide notes that blame the survivors directly may place those left behind at even higher risk for problems with guilt and shame. Some clinical observers infer that many suicides are motivated largely by the hostile intent of producing problems, especially guilt, for the family.

In a study of suicide notes, Jacobs 32 described two types that clearly made the suicide a hostile act. In one, there is an attempt to hide the intent by claiming that the suicide is aimed at "relieving" or "freeing" the survivor, whereas the other is overtly hostile. Following suicide, denial is frequently used to mask feelings of guilt, rage, relief, and shame. Resnik, 59 in a study of nine families in which an adolescent child committed suicide, found that this denial may take the form of hostility towards the medical examiner, police, or anyone who calls the death a "suicide.

In his research, Warren 73 found that some survivors created a "family myth," a rationalization of the true nature of the death, that is used not only for the outside world, but also for the family itself.

These forms of denial serve a definite purpose for the bereaved. As Augenbraun and Neuringer 2 have observed, "if the survivor does not accept the possibility that the deceased took his own life, he can avoid facing the notion that the suicidal person willfully abandoned him," allowing him to avoid the pain associated with the deliberateness of the death.

A decision to call suicide an "accident" or to attribute it to an illness is often quite conscious, however, and is sometimes told to "protect" children from the truth. Complicity by health care personnel aids this denial, although, as discussed in Chapter 5 , fabrications can frighten and confuse children who may already know the real cause of death or sense that what they have been told is untrue.

This undermines confidence in adults and reinforces the idea that suicide is a valid source of shame. A common fear among survivors concerns the "heritage of insanity," leading people to wonder whether others in the family are now "doomed" to kill themselves someday. Indeed, there are data that show a far higher than chance incidence of prior suicide in families of individuals who commit suicide.

This feeling of inevitability is usually unconscious, becoming more manifest as the [survivor's] age approximates that of the parent at the time of the suicide. The very fact that the taboo was broken by someone close may serve to legitimize the act, perhaps suggesting to the survivor that he or she will be vulnerable when overwhelmed later in life. In summary, there are many interacting factors that influence the response to suicide.

Feelings of being rejected, guilty, responsible, and socially stigmatized appear to hamper the resolution of bereavement.

The Social Stigma of Suicide In many cultures, the social stigma of suicide has historical roots. The early Greeks, believing that those who committed suicide must have been greatly wronged to have wanted to die, considered their ghosts to be extremely revengeful, dangerous, and frightening.

Suicide has also been illegal in many places, including the United States. Most modem Western civilizations no longer adhere to such beliefs and practices, but suicide is still regarded by many to be a moral rather than a mental health issue. Roman Catholics, regarding suicide as a mortal sin, used to forbid memorial mass and last sacraments for a Catholic who died in this way and insurance companies continue to deny benefits to families of people who commit suicide within two years of downloading life insurance.

These social stigmata compound the problems of suicide survivors. Whether from shame or anticipation of blame from others, people are often sensitive about and reluctant to discuss the event. Those who would usually be available for support following the death of someone close may find they are unable to comfort the survivor of a suicide.

Possibly threatened by the idea of being powerless to prevent a suicide, they may join in the search for a cause and may even blame the survivor for the death.

This failure of the informal support system leaves many survivors socially isolated and dealing with their complex feelings and problems alone. Some find that they can escape feeling ostracized and condemned only by moving, 12 but they are then faced with the isolation and insecurity of a new home and neighborhood that can make the bereavement process more difficult.

Given these circumstances, the decision of some families to deny the fact of a suicide seems understandable. Assisting Survivors of Suicide Survivors of suicide, more than any other bereaved group, may require some form of professional help.

Based on his observations of families of adolescent suicides, Resnik 59 has found that "an early interview after the death is a therapeutic and cathartic experience" that allows the interviewer to establish rapport before defenses have been established. This allows him to provide appropriate subsequent help as the grief work progresses. In her clinical experience, Silverman 65 has found that suicide survivors are often initially wary of those who offer help.

They are generally so isolated by the experience, however, that they may need more formal opportunities to ventilate their feelings and more reassurance than other bereaved persons.

In recent years, mutual support groups, such as "Survivors of Suicide" and "Seasons," have been developed to bring together survivors of suicides to clarify their understandings of the loss and to find ways of dealing with the often confusing and traumatic aftermath.

Freedman et al. Augenbraun and Neuringer 2 have found that "there is little need for therapy [when] the previous relationship between suicide and survivor was positive, minimally ambivalent, and where the fact of the suicide can be ascribed to circumstances outside the control of the survivor. Research Issues As with so much of bereavement research, what is known about suicide survivors comes primarily from clinical case reports of small numbers of patients in treatment.

The reports have not systematically examined and controlled for demographic heterogeneity of the sample, time course following suicide, possible psychiatric disorders in family members, or differences in the intensity, duration, and symptomatology of the bereavement. Yet these clinical accounts can provide the basis for further systematic investigation. Both clinical cases and systematic investigations are needed.

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Unusual methodological problems create particular difficulties in designing systematic studies of bereavement associated with suicide. Ideally, suicide bereavement should be compared with bereavement following deaths that share some of the same characteristics in order to know of any unique contributions of suicide as distinct from some of its attributes.

For example, suicide is a sudden death that should be compared with bereavement following other sudden deaths such as motor vehicle fatalities. As a "volitional" death, suicide is more similar to drinking oneself to death cirrhosis or smoking oneself to death after heart disease has been discovered than it is to deaths caused by conditions over which individuals have no control.

And comparisons of survivors of other "socially unacceptable" deaths, such as Acquired Immune Deficiency Syndrome AIDS , might permit the effects of social stigma and suicide to be separated. In addition, the effects of suicide in different types of relationships— such as parents-to-child, sibling, conjugal, and child-to-parent—should be studied.

Further research is also needed on the meanings and responses to different types of suicides, for example drug overdoses in adolescents or suicide among the terminally ill and elderly. More information on the coping styles of suicide survivors could help others deal with the loss through suicide of someone close.

Comparative studies of all these variations and characteristics of suicide are difficult, however, because of the relative infrequency of the event. As pointed out in Chapter 2 , studies of relatively rare events require very large samples. More data are needed on the response to loss of various types of relationships, and under various conditions of death. Much attention has been paid to responses to conjugal bereavement in adults, but there is relatively little information on other types of losses, such as the death of siblings and parents.

As the average age at death continues to rise and as medical technology allows the prolongation of lives that previously would have ended naturally, an increasing number of people will have to deal with issues raised by elderly and ailing parents, including the thorny issues surrounding assisted suicide. Responses to loss under all these circumstances deserve exploration in order to provide appropriate assistance to the bereaved.

Aspects of pathological grief and mourning. International Journal of Psychoanalysis , Augenbraun, B. Helping survivors with the impact of suicide.

In: Survivors of Suicide Cain, A. Springfield, Ill. Bank, S. The Sibling Bond. New York: Basic Books, Benfield, G. Grief response of parents to neonatal death and parent participation in deciding care. Pediatrics , Birtchnell, J. Psychiatric breakdown following recent parent death. British Journal of Medical Psychology , Blachly, P.

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