A note about trauma:
Just a little more talk of subjectivity (sorry for those of you who like things black-and-white); it’s important to note that it isn’t necessarily the specific nature of the death that makes it traumatic, rather how the event is interpreted and experienced by the individual. One cannot underestimate the impact of personal factors like emotional regulation, cognitive responses, secondary stressors, coping style, prior history of trauma, and access to support and resources in determining how a person responds to an event.
It is true that certain types of death happen in a way that they are more likely to be experienced as traumatic, but it isn’t a given. So, for example, it is not a fact that a loved one’s death by homicide or car accident will be experienced as traumatic, only that it potentially could be. Ultimately, one must allow for a wide range of variability when it comes to potentially traumatic events. All deaths have the capacity to overwhelm, shock, terrify, and shatter worldview. PTSD symptoms are not only found in those who survive violent and sudden deaths, but also those who experience the death of a close person to terminal illness.
Okay, so what is traumatic loss?
There’s variation in how traumatic loss is defined in the research, but for our purposes, I think this definition from Wortman & Latack (2015) does the trick:
“A death is considered traumatic if it occurs without warning; if it is untimely; if it involves violence; if there is damage to the loved one’s body; if it was caused by a perpetrator with the intent to harm; if the survivor regards the death as preventable; if the survivor believes that the loved one suffered; or if the survivor regards the death, or manner of death, as unfair and unjust.”
That’s a pretty broad definition, and we should also add circumstances in which the survivor witnessed the death, when their own life was threatened, and when the mourner experiences multiple deaths.
In addition to the nature of the death, other trauma risk factors include:
- Having to make medical decisions about life support, organ donation, etc
- Uncertainty about whether the person has a died (ex. they are missing; information about their condition has not been disclosed)
- Media attention
- Limited opportunities for social support
- Being blamed for the death
- Prolonged court proceedings
- Having a prior history trauma
What is the impact of experiencing a traumatic loss?
Generally speaking, it has been shown that traumatic death, especially violent deaths, lead to increased distress. For example, a 2003 study looking at the bereavement trajectories of 173 parents who experienced the death of a child by accident, suicide, homicide, or undetermined causes found that five years after the violent death 27.5% of mothers and 12.5% of fathers met the diagnosis for PTSD. These rates were significantly higher than those in the general population.
When someone experiences a traumatic death, their challenges become two-fold. One, they must cope with the trauma and two, they have to cope with their grief. The experiences of trauma and grief are two different things unto themselves, yet after a traumatic death, they get thrown into one big emotional blender. Things get tangled, thoughts and emotions get fused, and people sometimes find themselves utterly stuck. Understandably, it is not uncommon for people who’ve experienced a traumatic death to experience significantly more intense, pervasive, and prolonged symptoms.
After a Traumatic Loss One May Experience:Shattered assumptions about the world, themselves, and others: Many people live with the assumption that the world is a predictable, fair, and just place. They believe that they are in control, that they are generally safe and secure, and that other people can be trusted. Experiencing a traumatic death, something that feels profoundly meaningless and unjust, can shatter each of these assumptions and lead to a sense that the world is unsafe and unpredictable, that others are malicious and evil, and that one is powerless in protecting themselves. Going along with this, it is also common for one to question their faith and to feel abandoned by God after experiencing a traumatic event.
Ruminations: It is common to ruminate about a death regardless of the circumstances. However, someone who has experienced a traumatic death might experience increased rumination as they seek to answer questions such as…
- Why did this happen?
- Who is to blame?
- Did my loved one suffer?
- Could their death have been prevented?
- Did they know they were going to die?
- Were they afraid?
- What is the meaning, reason, or purpose for all of this?
Unfortunately, many people fail to find the answers they are searching for and they continue to struggle with the randomness and senselessness of the death as well as the pain of imagining what it must have been like for their loved one at the time of their death.
Feelings of guilt and blame: Even when a person is clearly not at fault, it is common to struggle with feelings of guilt and self-blame. For example, one might feel guilty for circumstances that preceded the death but which could have played a part in the chain of events. A person might make appraisals about the inadequacy of their own actions, feelings, and behaviors at the time of the death or even ruminate over actions and conflicts between the mourner and deceased well in the past. Negative thoughts about guilt and self-blame can impact how a person adjusts to bereavement and are often associated with feelings of depression and anxiety.
Fear of grief and trauma reactions: After a death mourners often feel as if they are going crazy, and, as noted, those who have experienced a traumatic loss often experience intensified and prolonged grief/trauma reactions. If a person interprets their symptoms as dangerous, threatening, or indicative of a larger mental or physical problem, they are more likely to fear and inhibit their reactions. Concerns about one’s own reactions following a death add to existing emotion by causing additional anxiety, depression, anger or shame. Those who are fearful of their reactions may also engage in maladaptive and persistent avoidance of triggers or reminders which can contribute to the development of posttraumatic stress disorder and which prevent the mourner from finding meaningful ways to continue their bond with their loved one.
Poor social support: Evidence suggests that social support can reduce the impact of stressful life events. Sadly, after a death, many people don’t receive effective support for a number of reasons. This is especially true after a traumatic death when the enduring impact of acute grief can last much longer than society has been taught to expect it. A few reasons why people do not receive effective support after a death include:
- People don’t know how to provide grief support
- People make comments that minimize grief, discourage expression of grief and discussion of loved ones, and push mourners to move on
- The bereaved may be inclined to physically and emotionally isolate, especially when they feel misunderstand by others
- The bereaved may feel they feel ashamed, abnormal, or weak because they continue to struggle
- The bereaved may seek support from therapists who are not trained in grief and/or trauma
- Avoidance of trauma and/or grief related triggers prevent the bereaved from engaging with others
How do I cope after a traumatic death? After a traumatic loss, it is important to find ways to process and cope with complicated emotions and reactions regarding the death and the trauma. I encourage you to seek out grief counseling. If there is not one in your area i provide counseling via Skype.