Traumatic Grief
By Dr. Smith
If you are reading this article, then you or someone you know is likely experiencing a tremendous amount of pain from the loss or anticipated loss of a loved one. My heart truly goes out to you during this time. It is my hope that this article may provide you with a greater understanding of grief so that you are better able to navigate these dark waters.
Grief
The death of a loved one is one of the most acutely painful things that we can experience in our lives. Even in situations where we have time to recognize that our loved one will succumb to death, there is no way to prepare ourselves mentally, emotionally, and spiritually for the glaring absence of that person from our day to day lives. Grief is a very personal response to death, and as such, will look different from individual to individual and culture to culture. Therefore, it is important to understand that there is no one right way to grieve nor is there one right amount of time to grieve. This overwhelming sense of loss is something that can persist from months to many years.
Those grieving often find it difficult to express what they are experiencing emotionally. It is important to understand that grief is not best defined as a single emotion, but as an experience involving a wide range of intense emotions. Grief is characterized by a tremendous sense of loss combined with powerful feelings of longing or yearning for the deceased loved one. Often, the griever feels a deep sense of emptiness or that a part of them has died and that they will never be the same. The loss of a loved one may leave grievers disoriented about who they or confused as to their purpose in life. Depression and a loss of hope about the future often accompany grief. The things that characterized life prior to the loss of the loved one lose meaning and significance. Many persons experiencing grief complain of physical ailments, such as feeling pressure in their chests, generalized pain, stomach discomfort, and headaches. Furthermore, they may cry easily, experience restlessness, and lose interest in eating.
How long does the grieving process last?
A considerable amount of time is often required for the grievers to accept that reality of the death of their loved one. Although grievers may understand intellectually that their loved one is deceased, they may experience themselves expecting to see their loved one in familiar places, such as specific rooms of their homes or to walk through the front door. It can be especially difficult to part with or even disrupt the loved one’s possessions. The loss of a loved one can deeply challenge the griever’s religious faith or beliefs about meaning in life.
In an ideal situation, the suffering accompanying intense grief changes over time into a sense of loss that is less overpowering and less emotionally raw and agonizing. There may remain an aching soreness in thinking of the loved one, but the grief can transform into a way of remembering or honoring the loved one without being immediately overwhelmed by intense sorrow. This process may begin as pockets of time following the preliminary shock of death where the griever is able to experience the pain less powerfully and is able to concentrate on other issues. These periods of time gradually increase in length and the griever will experience both good days and bad days. It should be noted that the griever may be triggered to experience more painful grief at times, even during good periods, perhaps by a reminder of the loved one or by meaningful dates or times of year, such as birthdays, the anniversary date of the date, holidays, and other various times that carry meaning.
Because survivors of the death of a loved one must often come to terms with not only the death itself, but the manner of the death (e.g., painful; drawn out) as well as all the day-to-day consequences of being without the person, it can take many months for the most painful feelings and thoughts to diminish. It is common for survivors to agonize about what their loved ones experienced during their final moments of life.
When to seek professional help
However, in the case of complicated grief, sometimes the griever remains deeply distraught for months or years after and the grief becomes an impediment to going through with daily life. Things previously considered easy to do and enjoy, such as social interactions, work, and family relationships, become especially difficult, which has much to do with a loss of meaning in the present and a loss of hope for the future. If you or someone you care about is experiencing this degree of grief, professional support from a psychologist or mental health counselor may be needed to help the griever adjust to moving forward with life after the loss.
Although each individual’s way of grieving should be respected, there are potentially serious complications to grief that can be helped. If the intensity of the grief is unrelenting after six months or if you or loved ones are experiencing a continual inability to function for weeks to months after the death (including normal functioning such as holding a job or caring for children), asking for assistance from professional can be helpful. Furthermore, if you are experiencing symptoms of major depression (such as hopelessness about the future), persistent suicidal ideation, substantial feelings of guilt, uncontrolled rage, increasing use or abuse of alcohol or drugs, or symptoms of posttraumatic stress disorder, then you should seek professional help immediately. The next sections include further descriptions of major depression and posttraumatic stress disorder.
Some factors that may lengthen or complicate the grieving process, include the griever having previously dealt with mental health issues (e.g., major depression), having previously experienced trauma or traumatic loss (particularly if the previous loss is similar to this loss), having limited emotional and social support, and having to cope with other serious stressors at the same time (e.g., major health problems, work stressors, relational stressors, etc.).
When it comes to time passed since the loss of the loved one, there is no such thing as too little or too much time having passed to seek professional support from a therapist who is experienced in treating both trauma and bereavement. Individual psychotherapy and support groups are available to provide effective treatment and support. When depression or PTSD is present, psychotherapy (sometimes with the aid of medication) are effective treatment approaches. Additionally, medication is sometimes prescribed temporarily to provide relief to those grievers who are experiencing intense anxiety at first or who are finding it difficult to sleep at all. You can often find referrals for professional help from a variety of resources, such as from your insurance provider, from religious leaders or organizations, from online searches, or from a therapist directory such as Psychology Today (which allows you to search by your area, insurance, and presenting concern).
Major Depression
There are many ways in which the normal grief process resembles major depression. The help of a skilled therapist or psychologist can help the griever determine if he or she has begun to suffer from depression in addition to the grief. As such, it should not be automatically presumed that the griever is having a normal reaction, as depression can be a serious complication that is treatable with professional help. Survivor guilt is commonly reported by grievers; however, grievers experiencing major depression or traumatic grief may have excessive or unreasonable guilt in which they blame themselves for the death or for not somehow anticipating or protecting the deceased loved one somehow. The following are symptoms of major depression. If the griever is experiencing five or more of these, he or she may be depressed. It should be noted that the type, severity, frequency or duration of symptoms vary from person to person.
Persistently experiencing sad, anxious, or “empty” feelings (may be experienced primarily as irritability in children and teens)
Loss of interest or enjoyment in activities or hobbies once found pleasurable
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Irritability, restlessness
Fatigue and decreased energy
Difficulty concentrating, remembering details, and making decisions
Insomnia, early-morning waking, or excessive sleeping
Overeating or appetite loss; unexpected weight gain or weight loss
Somatic symptoms such as aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
Recurrent thoughts about death or suicide
Post-Traumatic Stress Disorder
Many grievers have trouble healing and experience symptoms of post-traumatic stress, which goes beyond the normal grieving process. Some symptoms overlap with grief, yet are more severe and persisting in nature. It should be noted that it is very normal to have some of the below symptoms after the death of a loved one. Often, grievers have very serious symptoms that go away after a few weeks. However, if all three clusters below are present, then the griever may be experiencing traumatic grief and the assistance of trained professional should be sought. There are three groups of symptoms that indicate that the griever is experiencing Post-Traumatic Stress Disorder (PTSD):
Re-experiencing symptoms – Painful, intrusive thoughts or recollections of the death; distressing dreams or nightmares related to the dying process or death of the loved one; a feeling of reliving events related to the death of the loved one. Re-experiencing symptoms may create problems in a person’s everyday routine. They may feel like they occur out of the blue, as they can originate from the griever’s own thoughts and emotions. Additionally, words, objects, or situations that are reminders of the dying process or death of the loved one (or sometimes just reminders of the loved one) can also trigger re-experiencing.
Avoidance symptoms – Purposely avoiding activities, places or things related to the loved one’s death; feeling emotionally numb or having difficulty feeling positive emotions; physically or emotionally distancing oneself from friends and loved ones; feeling emotionally detached from other people; having trouble remembering the dying process or death of the loved one; losing interest in activities that were enjoyable before the death of the loved one; changing one’s personal routine in order to not engage with the reality of the death of the loved one.
Hyperarousal symptoms – Feeling tense, “keyed up,” or “on edge”; having difficulty feeling like your body is calmed down; feeling stressed; feeling easily startled; feeling “on guard”; having difficulty falling or staying asleep; having increased irritability or angry outbursts; difficulty concentrating. Hyperarousal symptoms are typically constant, rather than being triggered by things that act as reminders of the death of the loved one.
What can grievers do to help themselves?
Grief can negatively affect physical health. Therefore, it is important for grievers to attempt to uphold sufficient nutrition, exercise and sleep. In particular, individuals with chronic health issues (e.g., heart disease) should be monitored by a physician. Additionally, grievers should attempt to be more aware of their surroundings in order to prevent accidents, as they are often so preoccupied by their grief that they do not pay sufficient attention to their surroundings. Additionally, grievers should watch out for the rise of unhealthy coping behaviors such as abusing or becoming dependent on substances, such as alcohol or pills.
Grievers will benefit from finding a strong support system, including safe people to confide in about the loss. This may be a grief support group or it may be a friend, family member, religious leader, or someone else who has experienced a similar loss. The important characteristic to look for is for someone who can listen well and empathically. Many friends and family mean well, but are uncomfortable with the grief and unsure of what to do or say to be helpful. As such, they often inadvertently say insensitive or hurtful comments without being aware that they are doing so. Due to this, some grievers withdraw socially to avoid these comments from people who do not understand what they are going through. This is protective in a fashion, but unfortunately prevents the griever from having the opportunity to heal through the relational support of others.
There are many aspects of the grieving process that can lead to the griever feeling as if they cannot possibly take any more. Therefore, finding ways to take care of oneself and to calm oneself can be helpful. Some grievers have noted the benefit of positive coping skills, such as taking a walk or other forms of exercise, being around safe people, participating in a distracting activity, taking a relaxing bath, reading, or journaling.
In summary, grief is an extremely painful, individual experience and can be very difficult to cope with; when grief persists and impairs daily life, it becomes an issue that indicates the need for help from a mental health professional. My heart goes out to you in the midst of your grief. My hope is that this article has provided you with a map by which to better understand your grief and that it leads you to seek professional help if you recognize that your experience of grief calls for it.
Internet resources
You may find the following resources helpful:
1. www.nctsn.org/trauma-types/traumatic-grief – this site is particularly helpful for child and teen siblings of the child who has passed away; this organization can help you find therapists who are trained to treat traumatic grief in children and teens
2. www.bereavedparentsusa.org/ – this site provides info for grieving parents
3. www.compassionatefriends.org/ – this site provides info for grieving parents and will allow you to find grief groups near you for parents who have lost children
4. www.griefshare.org/ – this site will allow you to find more general grief groups near you
