Grief as Trauma Recovery

-a dispatch from the grief process

Grief resembles a trauma recovery process in many ways, especially if the death of the loved one is sudden and unexpected, and even if it’s not.

Some sources list the first reaction to such news as shock, the kind of shock that one receives when one undergoes a trauma situation. Reactions to trauma are fairly well documented. These are the kinds of reactions one sees in PTSD situations as well. They may all be present or perhaps only a few of them. A reaction to a traumatic event is post-traumatic. It is stressful. Hence we get post-traumatic stress. When it goes on for a very long time it becomes something of a disorder which cannot be coped with. Hence PTSD.

One doesn’t often see things like the death of a family member, partner or even friend as a potential trigger for traumatic reaction. “Normal” grief has been exempted from inclusion for some reason and I think that’s a mistake.

For example in some listings of potentially traumatic experiences we see things like this:

Situations and events that can lead a person to experience psychological trauma include:

  • Acts of violence such as an armed robbery, war or terrorism
  • Natural disasters such as bushfire, earthquake or floods
  • Interpersonal violence such as rape, child abuse, or suicide of a family member or friend
  • Involvement in a serious motor vehicle or workplace accident.

Other less severe but still stressful situations can also trigger traumatic reactions in some people.

There is mention of violent death of others but nothing about any other kind of death. Why not? A sudden natural death, like a heart attack, can be just as shocking and unexpected to those in the person’s life as a death by car accident. The lives of those who remain is thoroughly disrupted. They’ve had no time to prepare, as one might if the person were diagnosed with a terminal illness. Even with a loved one dying of a terminal illness, there is still the time immediately after their death in which “normal” life is no longer so. We cannot anticipate all the changes that will arise even when a loved one’s death is immanent and we are aware of that. There will be surprises and they will be discomforting, unpleasant, and in some cases maybe even shocking.

So there is a lot of overlap between the grief process and traumatic reaction.

In the aftermath of trauma there are many reactions that have been documented. Here are some of them:

Many people have strong emotional or physical reactions following experience of a traumatic event. For most, these reactions subside over a few days or weeks. For some, the symptoms may last longer and be more severe. This may be due to several factors such as the nature of the traumatic event, the level of available support, previous and current life stress, personality, and coping resources.

Symptoms of trauma can be described as physical, cognitive (thinking), behavioural (things we do) and emotional.

Physical

  • Excessive alertness, on the look-out for signs of danger
  • Easily startled
  • Fatigue/exhaustion
  • Disturbed sleep
  • General aches and pains

Cognitive
(thinking)

  • Intrusive thoughts and memories of the event
  • Visual images of the event
  • Nightmares
  • Poor concentration and memory
  • Disorientation
  • Confusion

Behavioural

  • Avoidance of places or activities that are reminders of the event
  • Social withdrawal and isolation
  • Loss of interest in normal activities

Emotional

  • Fear
  • Numbness and detachment
  • Depression
  • Guilt
  • Anger and irritability
  • Anxiety and panic

As long as they are not too severe or last for too long, the symptoms described above are normal reactions to trauma. Although these symptoms can be distressing, they will settle quickly in most people. They are part of the natural healing process of adjusting to a very powerful event, making some sense out of what happened, and putting it into perspective. With understanding and support from family, friends and colleagues the stress symptoms usually resolve more rapidly. A minority of people will develop more serious conditions such as depression, posttraumatic stress disorder, anxiety disorders, or alcohol and drug problems.

~Australian Psychological Society, Understanding and managing psychological trauma

Another thing that needs to be cleared up is the idea that grief and depression are the same. They are not. They are often mistaken to be so however. I have certain view about depression which I’ll write about at a later time but for now I just want to talk about some of the grief reactions in terms of trauma that I have outlined above.

I was reading an interview with psychologist and grief counselor Sameet Kumar, Q&A with Sameet Kumar, PhD, Part Two on Mindfulness for Prolonged Grief and he made a very interesting observation in one of the questions.

Do you believe there to be a distinguishable and diagnosable difference between symptoms of grief, and those of major depression?

One of the most consistent experiences people share in grief are the “supernatural” ones. This is very different from depression criteria. People do very often have visions, sensations, and experiences they struggle to explain, and often attribute them to their deceased loved one or loved ones. The most common ones I hear about are people hearing their loved one calling their name or laying down next to them in the middle of the night, or causing electrical malfunctions. All of these phenomena are very normal no matter what your belief system is, but they can feel strange when they occur, and sometimes even more distressing when they don’t occur. This is unique to grief. Something else unique to grief is yearning for someone who has died and the relationship to a loved one’s belongings that results. Every therapist working with grieving people should ask them where they sleep. I think many might be surprised at how few people return to the bed or change sheets after the death of a spouse. These sorts of things distinguish grief from depression.

In the list above we have seen some of the trauma reactions that include things like visual images and intrusive thoughts and so on. Here Kumar writes about some of the cognitive dysfunction that accompanies grief and how people misattribute the causes of that. That is also common in traumatic reaction.

I will tell you about a few of the things that have been happening to me that are in this vein. I do not attribute them to any supernatural cause, but to cognitive and emotional adjustments I am undergoing at a subconscious level through the grief process.

-One afternoon I was looking out the window and I thought I saw him through the fog in the alley across the street. There was a man standing with his back to me. He had a similar build and posture to Manoj. For a moment I thought is was him. This is of course impossible.

-On another day, and this has happened a few times, I thought I saw a cat in my house. I don’t keep a cat. It was maybe part of the memory of the feral cat that used to sneak into our place if we’d leave the door open too long. We could never catch it. The first time this memory appeared as a hallucination here it was caused by the shadow of a passing bird that moved on the floor as the bird passed the window. I don’t know what triggered the notion the second time. These all occur in peripheral vision and not directly. That’s kind of a clue that they are hallucinations. Hallucinations generally occur that way except in major psychotic episodes or as a result of taking hallucinogenic drugs. Most people have a hallucination or a few in their lifetime but they get dismissed as “imagination” or something like that. They are really common. That’s something a lot of psychologists and psychiatrists don’t tell you. Most people will recognize them if they appear in the context of hypnogogic or hypnopompic imagery. That’s the time when you’re just drifting off to sleep or just waking up. You think you see a flash of light or hear a noise in the house, or feel something touch you or something like that. It is a neurological phenomenon.

Mental phenomena that occur during this “threshold consciousness” phase include lucid dreaming, hallucinations, and sleep paralysis.

~Wikipedia, Hypnogogia

In grief they can become more apparent and specific regarding the dead person and can occur at times not just related to sleep.

-Yesterday as I walked down the hallway in my apartment I was sure I heard a kind of sigh very softly in my ear as if someone were whispering from behind me. It was a little bit unnerving. It could have been air movement in the plumbing, or the refrigerator making a noise that I misinterpreted or all kinds of things.

When these things happen it’s “different”. I know it’s a misperception or misinterpretation on my part and I know why (aka grief process). It’s not really annoying. It just gives me pause for a while after it happens which is maybe why it happens. Some unattended fragment of memory, desire, emotion emerging into consciousness looking for some attention. OK. I’ll give it the attention so it can be fully processed. It’s going to keep happening for a while, maybe a long while.

Here’s a thought on that from Sameet Kumar. Or at least that’s the way I’m choosing to interpret his statement.


Miscellaneous further notes:

I’ve been reading more of Sameet Kumar’s work on grief. It’s very good. He works with people dying of cancer. Here’s a few links:

Q&A with Sameet Kumar, author of Mindfulness for Prolonged Grief, Part One

Q&A with Sameet Kumar, PhD, Part Two on Mindfulness for Prolonged Grief

His blog is Mindful Synergy and he’s on Twitter and Facebook. He has a couple of books out. I’ve not read them yet but might.

I also read a fairly recent interview done with Joan Halifax, who also has worked with dying people, Roshi Joan Halifax on compassion, women in Buddhism, and altruism There’s a few statements she makes that I find pertinent:

what we try to do to prepare for dying is to develop the qualities of the mind that allow us to be with whatever is arising.

I think that moral outrage is not a bad thing, but you have to understand that if you get in too outraged a state, then you go into distress, and that has outcomes which are not wholesome. On the other side of the equation, it can fuel you to move forward in terms of taking action.

I learned to accept the unacceptable.

So the practice, for me, is about creating the kind of resilience or buoyancy where you can be present to bear witness to the truth of suffering.

She mentions something regarding an illness she had as a child and frames it as “a blessing”. I’m not going to pick on her interpretation of her own experience. That’s a common framing for a lot of people.

In a larger, more general social way I’m uncomfortable with thinking that characterizes sickness, death, or tragedy as a blessing. That removes it’s power and downplays it’s significance. I’ll write about that more fully in some future post because it relates to the whole positive psychology movement, what Barbara Ehrenreich calls being “bright-sided”. One doesn’t have to be either a hero or victim. That’s a false dichotomy. There are thousands of other options.

But I really like her phrase, “I learned to accept the unacceptable.” That is a good part of what the grief process entails.

Dostoyevsky isn’t wrong in my opinion. Though I’d phrase it differently about the God part being an atheist and all.

“The darker the night, the brighter the stars,
The deeper the grief, the closer is God!”
Fyodor Dostoyevsky, Crime and Punishment

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