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Traumatic Grief


Traumatic Grief

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									                                     WHITE PAPER
                               Suicide and Traumatic Grief

                                  Sally Spencer-Thomas
                                     Clinical Director
                               Carson J Spencer Foundation

   In the aftermath of an unexpected death, especially suicide, traumatic grief is a
common reaction. When this occurs both trauma and grief reactions are experienced
together, and elements of this combined level of psychological distress are often
debilitating and complex.

A number of circumstances about the death may influence reactions:
    Suddenness or lack of anticipation. The unexpected death offers no opportunity
     for goodbyes, unfinished business, resolution of conflict, or answers to questions.
     Very often the survivor is left with endless, “what ifs.”

      Violence, mutilation and destruction. Deaths that involve suffering or extreme
       pain may result in heightened risk of horrifying traumatic imagery and intrusive

      Preventability or randomness of death. The randomness of such a loss can
       trigger a greater sense of vulnerability and anxiety. If the death was related to a
       crime there may be a trial involved or the body may not be available for viewing.

      Multiple deaths (bereavement overload) or multiple losses. In addition to the
       primary loss of the person, secondary losses may include loss of an income, loss
       of a home, or loss of all things familiar. Family and marital strain can result from
       such disorganization.

      Mourner’s personal encounter with death involving significant threat to his
       or her personal survival or a massive and shocking confrontation with the
       death of another. If the events surrounding the death were newsworthy, the
       family may also be dealing with the intrusion of the media.

Clinicians are discovering that co-existing trauma in these circumstances impairs grief
work. On one hand, the trauma experience leads to continual intrusion of the death event
and the traumatic response is often to avoid things that trigger that recollection. That is,
survivors can’t stop thinking about the death scene – they dream about it, obsess about it,
and images flash when they least expect it. At the same time, a natural impulse is to stay
away from anything that reminds them of the trauma. Sometimes survivors develop post-
traumatic stress disorder (PTSD), in the aftermath of a violent or unexpected death.

The traumatic element of this form of death also shatters the survivors’ worldview – their
sense of order and trust are forever altered. Consequently, survivors often feel incredibly
vulnerable and disoriented during the shock period of a suicide aftermath.

On the other hand, the grief experience works in phases as survivors come to accept the
reality of the loss, and the tendency is to move toward things that remind them of the
deceased. The continual alternating cycle of horror and loving memories, of avoiding
and embracing things related to the loved one, makes traumatic grief complicated. Is
appears that post-traumatic stress responses appear to take emotional priority as a means
of managing the horror and helplessness of the survivor. Rather than process “normal”
expressions of grief, traumatic grief survivors must first manage intrusive thoughts,
nightmares, flashbacks, and other traumatic symptoms.

The grief response is intensified after a suicide because there is no ability to prepare for
the loss. Grief is further complicated by tremendous feelings of guilt, anger, shame and a
very confusing existential examination of why someone would chose suicide. Suicide
survivors often find themselves like a broken record asking “Why, why, why” to try to
make sense of what has happened. Because of the stigma surrounding suicide, survivors
may be further traumatized by hurtful or uncompassionate responses to their loss.

Interventions following traumatic grief should be “wave” oriented. That is, at first
practical assistance and crisis intervention are often needed. Survivors need to re-
establish a sense or order in their lives – a routine and basic self care. After the initial
period of shock has past, trauma mastery and assistance with the initial phases of
mourning are usually indicated. In the long run, support through listening is most
appropriate, and it is helpful to remember grieving on difficult dates like the holidays, or
the birthday or death day of the person who died.

Sources: Ambrose, J. T (n.d.) Traumatic grief: What we need to know as trauma
responders. Retrieved October 30, 2005 from

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