IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB

Unit 12 -- Traumatic Loss and Grief

Grief in a Family Context --HPER F460/F560

IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB---IUB

Goals for this Unit

In this unit, we will look at the characteristics of the grief of people who have experienced a traumatic loss, that is, one that overwhelms the resources of the bereaved, leaving them feeling helpless, with their view of the world shattered.

Preliminaries

The grief that results from a traumatic loss is particularly difficult to deal with.  The readings and lecture address both the forms of loss that would generally be seen as traumatic for almost everyone to whom it occurs.  We will also look at the idea of loss as a personal disaster.  For this, I would like you to think of characteristics of losses that you believe would contribute to their being experienced as traumatic.  I would also like you to think of ways in which families could best cope with a traumatic loss.

Readings

Anthology

Eisenbruch, M. (1991). From Post-traumatic stress disorder to cultural bereavement: Diagnosis of southeast Asian refugees, Soc. Sci. Med., 33, 673-680.

Gilbert, K. R. (1997). Couple coping with the death of a child, in C. R. Figley, N. Mazza, & B. Bride (Eds.), Death and trauma: The traumatology of surviving. Washington, DC: Taylor & Francis.

Zur, J. (1996), From PTSD to voices in context: From and "experience-far" to an "experience-near" understanding of response to war and atrocity across cultures, The International Journal of Social Psychiatry, 42, 305- .

Read the Eisenbruch and Zur articles together.

Web Resources (the final two are specific to children)

Do not feel that you have to read all of these, I want you to choose topics that are of particular interest to you. David Baldwin's pages have a tremendous range of materials. the others are more specific.

"Lecture"

In many ways, regardless of the nature of the loss itself, the loss of someone we love may well be experienced as a traumatic loss. Even though I want to make a point of acknowledging that, I want to look, this week, at a more narrowly focused definition of traumatic loss and look at the grief resulting from this type of loss. These are losses that are so intense that they profoundly overwhelm the resources of the bereaved.  They are, as one might expect, almost guaranteed to result in complicated grieving. When seen as stressors, they are those that most commonly result in post-traumatic stress disorder, a long-term psychiatric condition, described in the APA's "Warning signs of trauma-related stress." There has been an evolving understanding of PTSD and, in the DSM-IV, and one that has relevance for this class, is that the event no longer needed to be markedly disturbing to almost anyone.  According to the DSM-IV, the event must be markedly disturbing to the individual.  This is a significant change in the definition. Particularly relevant to this course are the discussions about the cultural specificity of this diagnosis, as you can see in Eisenbruch and Zur.

Figley and McCubbin (1983) looked at the literature on traumatic events, defined by them as sudden, unexpected, life-threatening, leaving the survivors with feelings of helplessness.  They found these events share many of the following characteristics:

When looking at these characteristics, keep in mind that they are a starting point for thinking of traumatic loss.  The simple presence of these characteristics, even a majority of them, may lead to traumatization, but is not a guarantee.

Bereavement as a "Natural Disaster"

McKissock and McKissock (1991) described bereavement as a "natural disasters" and identified factors that complicate the grieving process. As you can see, many of these were echoed in the article by Rando that you read earlier this semester. These complicating factors are:

Others have looked at traumatic aspects of grief.  Attig (1996) includes violent, mutilating, or random death that shock, horrify and traumatize those who are left to cope with the loss.  Parkes (1997) included the following factors in traumatic bereavement:

Especially as it relates to loss that takes place as a result of a disaster, I would include human-made vs. natural causes -- If the cause of death is the result of a human-made disaster rather than one that is naturally occurring, it has a much more negative impact (The bombing in Oklahoma City would have had a much greater impact than, say, a tornado or earthquake, because a human being made the choice to inflict harm and death on other humans. More clearly, we can see this in the immediate and long-term aftermath of the attacks in the U.S. on 9-11 ).

Why me? -- Making Meaning of the Meaningless

As we've discussed before, what we recognize as grief is a combination of dramatic psychological, emotional, and somatic changes that result from a devastating loss of meaning dependent on a significant relationship. The loss results in intense conflict between the need for an orderly world in a chaotic reality and an agonizing search for an explanation for the loss. This explanation is intended to allow the bereaved person to see the world as predictable and controllable as well as allow them to comprehend why such a loss should have occurred. Parkes (1997) refers to the process of revising "basic assumptions, habits of thought and behavior that have been learned over many years and which we tend to take for granted" (p. 246) as psychosocial transition (PST).  But what does one use to move through this process?

Throughout the grief process, the bereaved develop a story that helps them to make sense of their loss. Figley has called this a "healing theory" and I wrote about this in my chapter I assigned for this unit. This story/theory can then act as a sort of bridge between what was seen as normal before the loss and what makes sense afterward. The healing theory  must account, in some way, for thoughts and feelings that are inconsistent with their world view prior to the loss. It also incorporates elements of their experience as well as those borrowed from the experiences of others. Information from cultural and family myths as well as religious or philosophical beliefs will be tested for inclusion in the modified view. The grieving individual may find him or herself turning to the person who has died throughout this process and some of the odd experiences of grief (labeled as hallucinations or delusions) may be understandable parts of the development of a healing theory and a new sense of normal that results from the grief process.The underlying goal of this process is to find some sort of understanding and new sense of stability in life as well as to gain a sense of mastery and control with regard to the end products of the death.

Traumatic losses confront what appears to be a basic belief of our Western culture that present the world is fair and just. The loss that is unfair or unjust can only be described as a loss of balance between the linked processes of action and result in their lives (" If I am good, good things must come to me") .

Janoff-Bulman (1992) has proposed that social laws are used to answer the "why" questions that result form a death. These are laws centered on justice and control, which allow us to see a pattern of cause and effect and legitimate ends that results from previous behavior. The initial response to this imbalance is to look to previously held meaning structures for guidance and then, if they are lacking, to search elsewhere for answers. Those grieving may look for a religious or spiritual explanation, a physical or medical one, a social or psychological one. Ultimately, they may find that the only answer is that there is no answer, or they may reach a point where, rather than asking "Why me, why us?" they ask "Why not me, why not us?"


Anger as a Part of the Grief Process

The process of grief is not an easy one and this is even more so when the loss is a traumatic one.  The intensity of some emotions and thoughts, which may recur repeatedly, often surprises and frightens the bereaved and those around them. In particular, an intense anger of a power many had never experienced before may stay with the bereaved or he/she may experience episodic bursts of anger and rage. One woman whose daughter had been raped and murdered said she would experience waves of anger so intense that she feared they would knock her to the floor. A normally easy going man, months after he and his wife had experienced their third pregnancy loss (this time, late in the pregnancy), found himself almost out of control with rage when a neighbor was making noise early in the morning. It was only his wife's quick intervention that stopped him from confronting and possibly killing his neighbor.

In some instances, the anger is unfocused, sometimes so overwhelming as to be incapable of being focused. In some cases, it may be expressed as a generalized sense of frustration and unfairness at being "angry at the whole world." They might target a particular individual or individuals (e.g., the perpetrator, God, the medical staff) or a particular institution (e.g., the court system, the medical establishment). It may also be accompanied by a powerful urge toward revenge. Anger may be directed toward the individual who has died and this may lead to intense feelings of guilt at such thoughts.

The Interminability of Traumatic Grief

One issue we have gone back to, over and over, is the idea of grief as an ongoing, although varying phenomenon.  What this means is that grief does not completely end, as some might expect, but will become a part of who that person is, sometimes intense and sometimes existing as a type of "background noise" in their lives.  The grief remains, but the intensity of it is manageable.  People who thought they could never laugh and feel joy do so.  They may be surprised, uncomfortable, and guilty at the thought of feeling joy, but they do. They may even feel the same emotions they felt before.  With traumatic loss, the time until these life affirming emotions are felt will be extended and they may never feel them to the same intensity or they may forever after be experienced through the filter of grief.

Given the characteristics of the loss itself and events surrounding it may mean that a traumatic loss is irreconcilable, and is interminable, that is, never ending (Think of parents whose child has been murdered by a drunk driver and their resulting, ongoing grief). As we have discussed in class, a powerful belief about grief in our western world is that grief should be resolved in a reasonable period of time and that the bereaved should be able to move on to new relationships. This last part has been interpreted to mean that they should be able to "abandon the deceased" and, after heaving him or her behind, form new relationships independent of the previous one. If we think of our experience of grief as a story, the grief of traumatic loss may seem like some horrible never ending story. In this, the bereaved are unable to reconcile themselves to their loss and thus are unable to achieve a sense of closure (Note: remember that it is possible to have a sense of "closure" on some aspects of one's grief without abandoning the relationship with the deceased. Also as you know, there is controversy over the casual use of this term and, if and when it is used, should be at the discretion of the bereaved.).

I'd like to direct you specifically to the web readings on children's issues as they are related to children and grief. Think back to Unit 4 and ways in which children's grief is unique. In particular, think about issues of their continuing development and how that might act as a trigger of recurrent or revisited grief.

Families Coping with Traumatic Loss

In a similar process to the one they used to explore the literature on traumatic loss, Figley and McCubbin (1983) identified 11 functional coping strategies for coping with trauma. They proposed that, after a trauma, certain behaviors in families are functional while their opposites are dysfunctional. They indicate that, in order to successfully cope with loss, families should take the following approaches:

Although Figley and McCubbin present this as an opposition dichotomy, you might find it best to think of each factor as appearing on a continuum of functionality, particularly if you present these to families. Faced with a traumatic loss, many (sometimes all) family members will face periods of time when they will be overwhelmed by the loss and its meaning. There will be times when individual family members will need to step back from their participation in family processing of the loss and focus on their own needs. They may simply be overwhelmed by their own pain, unable to maintain their role in the family. By viewing the family's response on a continuum, the tendency to view this "self-focus" as inevitably dysfunctional for family recovery may be reduced.

In my chapter, I wrote about the ways in which couples dealt with the loss of their child. The factors I identified as functional for the maintenance of their relationship were:

One concern expressed to me, and something you may wish to discuss in class, is that these coping efforts focus more on the maintenance of families or relationships within families. It may be that these do not facilitate the grief of individual family members and may be contrary to the needs of more individual, cognitive, solitary grievers.

General Conclusions

Traumatic losses are overwhelming and are highly likely to complicate the grief process.

A wide variety of factors contribute to this. These include, but are not restricted to, the following: the death of a child, sudden death, ambivalence in the relationship, pre-existing factors, perceived preventability of the death, centrality of the relationship to the bereaved person's life, lack of diversity of social roles, concurrent crises, lack of social support, and human-made vs. natural causes.

The process of making meaning is made more complicated in the case of traumatic loss by is intense and surprising emotions, especially anger. Of particular issue, here and elsewhere, is that of human development. 

Certain family patterns of behavior and family resources appear to be effective in helping families and their members to cope with traumatic loss. Caution should be taken to remember that there is a range of performance of these patterns, and that families should not be dichotomized into either functional or dysfunctional.

Questions for Discussion

Post your response to the following questions on the Class Discussion..
  1. It certainly seems that traumatic loss will overwhelm our ability to make the loss meaningful. Yet we need to be able to make the meaningless meaningful. What are your thoughts on this and how would you help someone else make meaning around a traumatic loss? Any thoughts on what non-Western cultures might teach us about making meaning? In what ways does the family help to make the meaningless meaningful following a traumatic loss?
  2. What are the unique characteristics of children's response to traumatic loss? What can we do for them?
  3. What can be done to help families cope with a traumatic loss?  

Course Main Page.
Course Sitemap.

Page created: 3/96. Last updated: 8/26/10.
URL: http://www.indiana.edu/~famlygrf/units/traumatic.html
Copyright 1996-2010, Kathleen R. Gilbert, Ph.D.

For information about this work, please contact Kathleen Gilbert at gilbertk@indiana.edu. Permission is hereby granted to reproduce and distribute copies of this work for non-profit educational purposes, provided that copies are distributed at or below cost, and that the author, source, and copyright notice are included on each copy. This permission is in addition to rights of reproduction granted under Sections 107, 108, and other provisions of the U.S. Copyright Act. Before making any distribution of this work, please contact Kathleen Gilbert to ascertain whether you have the current version.