QQQ 38 December 18, 2019: Unresolved Trauma as A Predictor of Death by Suicide: QPR Theory Part III

QPR Quick Quotes: December 18, 2019 Unresolved Trauma as A Predictor of Death by Suicide QPR Theory Part III

December 18, 2019

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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 undetected
     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.

    Survivor guilt 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 complete.


    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 recovery.

    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 Pact

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 by suicide.

About QPR

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 cheri.johnson@aviem.com

Upcoming Gatekeeper Trainings

QPR Gatekeeper and Train-the-Trainer Training 

Anchorage, Alaska 

October 2020

Other trainings will be offered when additional dates & locations for Foundation Member-Partner Meetings are announced.

© 2019 QPR Institute Inc./Family Assistance Education & Research Foundation

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