Trauma, Loss and Traumatic Grief
Few things in life are as painful as the death of a loved one. Grief is simultaneously a universal and very personal response to loss that, even in the best of circumstances, can dominate one?s emotional life for many months and, frequently, many years. Ideally, the anguish of acute grief is gradually transformed over time into a way of remembering and honoring the loved one that is less emotionally painful and disruptive. Over time, the loved one can be remembered without being flooded with the pervasive heartache of acute grief.
But sometimes grief becomes complicated, and bereaved survivors remain shaken and acutely distressed for months or years after the loss. They may find it difficult to get through the day, to connect with others, to have hopes for the future; in short, grief-stricken people may find it exceptionally hard to move on with their lives. In many instances, these complications and additional problems indicate or impede adjustment to the death. Professional help may remedy this so that grief no longer presents an insurmountable obstacle to adaptation to life in the aftermath of the loss.
Sudden shocking losses can be particularly difficult.
(1) deaths that occur without warning, providing no opportunity to anticipate, prepare or say goodbye;
(2) the death of one?s child (some evidence it?s worse with young children than adult children);
(3) deaths that occur as the result of violence or of violent harm to the body;
(4) a death in which the body is never recovered;
(5) multiple losses deaths of more than one person; and
(6) deaths that occur as a result of the willful misconduct of others, carelessness or negligence. Causes of such losses include disease, accidents, suicide, homicide, war and terrorism.
What is the difference between normal grief and complications of grief?
It can take a significant amount of time to accept the reality of a death. Survivors may know intellectually that their loved one is dead, but find themselves expecting the loved one to walk through the door or call on the telephone. It can be particularly hard to part with the loved one?s possessions. The death of a loved one may provoke existential, spiritual or identity crises that challenge one?s faith or one?s assumptions about life?s meaning. Current research on grief and loss teaches us to respect an individual?s way of coping with a loss, while at the same time looking for signs and symptoms of potentially serious complications that could be alleviated. For example, plans to commit suicide, a persistent inability to function for weeks to months after the death, abuse of alcohol and drugs, or symptoms of severe major depression or posttraumatic stress disorder should all be addressed professionally and immediately, even if the person is grief-stricken.
Although grief resembles major depression in many ways, a skilled clinician can determine whether a bereaved person is suffering with depression. It is a mistake to assume that a bereaved person with major depressive symptoms is just having a ?normal? reaction, since depression is a serious but treatable disorder. When the death is particularly shocking in some way, there also can be symptoms of posttraumatic stress disorder (PTSD).
There are four groups of symptoms that indicate PTSD:
(1) re-experiencing of the traumatic event as indicated by painful, intrusive thoughts or nightmares about the death;
(2) avoidance or emotional numbing, as indicated by marked efforts to stay away from activities, places or things related to the loved one?s death;
(3) feeling detached from others and an inability to feel positive emotions; and
(4) increased persistent anxiety and physiologic arousal, as indicated by difficulty sleeping, irritability, difficulty concentrating and a tendency to become startled easily.
Although many of these symptoms also are common in normal grief, if all four clusters are present it is likely that the person is also experiencing PTSD.
Survivor guilt is common among bereaved persons, but may be excessive and unreasonable in those with major depression or traumatic grief. Survivors may blame themselves for the death or for not protecting their loved one somehow.
After loss, how long will the feelings last?
It also may take longer to deal with the loss if the survivor
(1) has previously experienced psychological problems, such as major depression or separation anxiety;
(2) was very dependent (e.g., practically, financially as well as emotionally) on the person who died;
(3) has experienced previous trauma or traumatic loss, especially if it is similar in some way to this loss ;
(4) has few friends or relatives who are supportive; or
(5) is simultaneously coping with other serious concerns, such as dislocation, major health problems, psychosocial stresses or other losses. Other factors which contribute to greater difficulty in recovery include loss of parent before age 16, physical/sexual abuse or serious neglect as a child.
As the initial shock of the death diminishes, there may be intervals when the survivor is able to focus on other issues and not feel the pain of the loss so intensely. Gradually, these intervals will become longer, and there will be good days and bad days. However, people can experience setbacks during the process. On a relatively good day, the bereaved person may encounter a reminder of the loved one, and this may cause the reemergence of painful feelings of loss. People often have difficulty dealing with occasions such as holidays, birthdays, the anniversary date of the death, or other times that have meaning.
Recent research suggests that if after about six months the acute grief reaction has not shifted into a set of feelings that is easier to bear, the bereaved person should consider taking extra steps to facilitate this process.
What can survivors do to help themselves?
Most experts recommend that survivors confide in someone about the loss and find a support system. This can be a friend, a member of the clergy or another person who has experienced similar loss. It may take some time to identify friends who can be good listeners. Not everyone knows what to say or do to be helpful. Some survivors withdraw from social contact to avoid hearing hurtful comments. This is unfortunate, because the bereaved person loses the opportunity to heal with the help of others.
Through the grieving process, the many memories that come to mind of the loved one may at times seem like more than the survivor can bear. It can be helpful for survivors to learn ways to calm themselves. These might include such things as taking a walk, being with people or participating in a distracting activity. Some survivors find it useful to write or to read.
When is it a good idea to seek professional help?
Treatment can help
For more information about psychological trauma or the International Society for Traumatic Stress Studies, call 847-480-9028.
2005 International Society for Traumatic Stress Studies. Traumatic Loss Revised.
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