GRIEF AND TRAUMATIC GRIEF
One of the inevitable things in life is loss and the following grief process.
To understand the traumatic grief, we should first look at the the concept of grief. Grief is a natural reaction of all to loss, it’s universal. Along with being a reaction to the death of our loved one, we should not take it as one person’s death. Grief can be related to the loss of any valuable object.
Grief is a personal and unique process. Each person grieves in “their kind of way” and they react uniquely.
What is Normal Grief Process?
It is the combination of the physical, emotional, intellectual and social reactions to any loss. It is the process of getting used to a new life where the person (object) won’t exist anymore.
Stages of Grief;
1. Shock/Denial: It includes the first reaction to the lost. Denial, rejection, shock, indifference, insensitiveness, freezing etc.“No, this is not true” “It can’t be true”, “I can’t believe that he/she’s gone.”
2.Confrontation and Anger: The person starts to realise the loss. “Why me?”, “Why?” “What did I do to deserve this?”. Anger may be directed to himself/herself, to the world and to the person who died.
3.Bargaining:It is a period full of “I wish”es and feelings of guilt. In this period, the person accepts the facts but he/she puts some conditions. “If I’d done this, he/she wouldn’t have died”, “If I’d spend enough time, it would have…”
4. Acceptance and Depression: The person has faced with the loss and started to investigate how to cope with it and how to move on with her/his life, and to try reversing the damage done. Sadness dominates this period.
5. Recovery: This period includes coming to terms with the loss, getting his/her life together and moving on to his/her life. Along with being surprising, moving on creates a reality.
These stages are generally full of ups and downs, they are not straight forward. Sometimes these stages engage together and cannot be separated sharply.
Grief Process and Adaptation;
Grief period needs to be completed. Grief period is actually an adaptation process. The person needs time and space to accept the loss and to mourn. However, after all of these, the person can recover, become stronger, reintegrate into life as a healthy person, and readjust.
Accepting the loss and standing it does not mean forgetting about the loss. There are some rituals or traditions to ease this acceptance process. Funerals, 40th day ceremony, and praying are some of them. These rituals are some kind of saying goodbye and acceptance.
Avoiding these rituals restrains the completion of the grief period and it extends the process.
Give sorrow words; the grief that does not speak knits up the o-er wrought heart and bids it break
Jacob (1999) defines traumatic grief as the whole of symptoms and reactions of whom suffering from sudden and violent death of a loved one.
It differs from ordinary grief in terms of being unexpected and violent.
Natural disasters, accidents, domestic violence, terror and wars cause many sudden and unexpected deaths in Turkey.
The term traumatic grief is used to differentiate due to its similarity of the symptoms such as denial, anger, avoiding, insensitiveness, thinking that there’s no future for them and losing a feeling of security caused by the grief with Post-Traumatic Stress Disorder.
Doubled effect of trauma and loss on an individual is a psychological burden for the individual and by disturbing values, expectations, world view of that individual; it causes incompletion of grief reactions and extension of the period. In addition, the individual who lives through traumatic grief may develop post-traumatic stress disorder. The word “trauma” here refers to the traumatising effect (reminiscing the trauma) of the separation. Therefore, it is thought that the term “traumatic grief” covers both traumatic symptoms and symptoms caused by the separation in pathological grief.
Jacobs has put forward 4 main criteria in relation to Traumatic Grief and upon being reviewed, these criteria has been published in DSM.
Traumatic Grief Diagnostic Criteria
The person has lived through the death of a loved one. In response to this loss, 3 out of 4 symptoms have to be endorsed as least “sometimes true”:
-Challenging thoughts about the lost one
-Yearning the lost one
-Seeking for the lost one
-Loneliness after death
Four of the eight responses to death have to be endorsed as at least “mostly true”:
-The feeling that future is useless and in vain,
-Having difficulty in accepting the death,
-The feeling that life is useless and meaningless,
-The feeling that a part of the individual in grief has died,
-The world view of the individual in grief falling apart and the feeling of losing control and security
- Displaying the symptoms and destructive behaviours of the lost person
-Over-temperament, or feeling pain or anger about death
The duration of the disorder (specified symptoms) are at least two months.
It causes clinically severe disruption in functionality in social, professional and other fields.
GRIEF AND TRAUMA COMPONENTS OF TRAUMATIC GRIEF
||Focus on the lost one, the image of the lost one
The focus on the death, the image of the terror
||Yearning the lost one, separation anxiety, anger, sadness
Yearning for trust, anxiety of the danger, anger, impatience, apathy
||Searching for the lost one
||Protecting from danger
It’s harder to grieve upon traumatic deaths. The way the person died being tragic brings the burden of the traumatic stress along with the grief (Rynearson and friends 2006; Worden. 02).
Factors such as loved one suffered during his/her death and the possibility of him/her being scared and someone else with bad intentions trying to harm the loved one are some of the extra stressors. The reasons such as constant interruption by medical and legal institutions due to the way of death, the impossibility of grieving in accordance with the some people’s religious beliefs like self-destruction or trying to avoid traumatic environments may prevent someone from grieving in conformity with his/her culture and it makes it harder to get over the grief. (Rynearson and friends., 2006)
It has been pointed out that the traumatic grief symptoms in individuals adapting avoiding strategy are more severe (Boelen and friends., 2003). The same researchers have also found out that having negative opinion of others’ behaviours upon the death of a loved one may also aggravate the symptoms. Natural disasters are large-scale trauma environment where many people are subjected to trauma and also many people lose their loved ones into a sudden and tragic death. The research conducted by Tural and friends in which they have examined the disorders accompanied by PTSD on Victims of Marmara draws attention to diagnosis of traumatic grief in the event of losing someone from the immediate family (Tural, 2001). Besides, traumatic grief is a risk for physical and mental disorders (Sezgin, 2004).
It aims to solve the unsolved emotions in relation to the loss and to increase coping skills of individuals and to reintegrate individuals into life. Traumatic grief is a severe condition where non-functional behaviours can be observed (e.g. avoiding) and it’s also condition that prevents someone from going to completion period. In grief therapy, it is aimed at making individuals give the meaning to their grief and solve separation conflict.
PTSD Psychosocial Practices Participant Book
Sezgin, U., Yüksel Ş.Topçu Z, Genç Dişçigil, “When to Diagnose Traumatic Grief” essay 2011