Isolation Very Often Follows a Tragic Loss : Death: Doctor recounts his experience with ‘the pariah syndrome’--when people avoid a friend who has lost a loved one. The bereaved begin to feel abandoned.

It’s known as “the pariah syndrome”--the tendency many of us have to suddenly shun even old friends who have a fatal or disabling illness. It can equally be applied to those who have suffered some tragic loss. All of us who at some time experienced such a loss know the pain we felt when we never heard from treasured friends, in contrast to the warmth and support we received from others.

William Rubin is editor of a group of national medical newspapers--Internal Medicine News, Family Practice News and others--published in Rockville, Md. As a medical journalist, he was familiar with the pariah syndrome as applied to the seriously ill or dying. But in April, 1989, his 33-year-old daughter, Joan, committed suicide, and--”a surprise to me,” he says--”many people treated me the same way.”

A year later, he has written of this experience in his occasional column, “Notes of a Sometime Patient.” His words can instruct all of us who have put off or avoided a painful encounter because we didn’t know what to say.

Rubin writes: “ ‘I didn’t know what to say, so ended up saying nothing’ is how too many people react when a friend, patient or business associate loses a loved one. . . .

“The death of someone’s aged parent usually isn’t that difficult to deal with. ‘She had a full life.’ ‘At least he’s relieved of his suffering.’ People are supposed to die when they’re old; that’s the natural course of events.

“It’s the untimely death of a loved one, especially the death of a child, that makes people uncomfortable around the survivors.”

And “suicide in particular scares friends away. It makes them worry about their own children, and they don’t want to think about things like that.”

Rubin is of course aware that “I didn’t know what to say” is not the real culprit: “We survivors know that manifestations of grief can be upsetting to others. We are embarrassed by our own sobbing and wailing. That’s why we cry in the shower so frequently that turning on the faucet seems to set off the tears.”

Even more basic, “Anyone’s death is an unwelcome reminder of our own mortality.”

The effect of this shunning on survivors?

“Those of us who lose a loved one begin to feel as though we have some loathsome, contagious disease. After the Emily Post proprieties--and the flowers, cakes and fruit baskets of the official mourning period--the friends disappear. . . .

“If I had a broken leg or were recuperating from hepatitis, friends would call occasionally and ask, ‘How are you doing?’

“Not so with grief. ‘I didn’t know what to say’ or ‘I thought he’d rather be alone’ are too often the rationalization for not saying anything. Whether we’ve lost a mother on whose guidance we depended or a lifelong spouse”--or, in Rubin’s case, “a child’s suicide, the ultimate rejection”--”we feel lonely or abandoned.”

The answer? “Avoidance by our friends isn’t what we need. We know about the support groups and therapy to help us with grief. That isn’t what we’re asking from friends.

“Perhaps we need the reassurance of continuing contact with the non-grieving world. Some of us might want to talk about the decedent, others might not. And different situations and relationships would evoke different reactions. But that isn’t really what I’m talking about. A simple ‘How are you holding up?’ or ‘Are you doing OK?’ would serve as the reaching out.”