The Effects of Grief
Sadness is the dominant emotion. Grief feels real. Talking about grief can help. Pain is related to the loss. Anger is nonviolent. Guilt involves unfinished emotional business with the deceased Your self-image and confidence generally remain intact. You dream about the person you lost. Symptoms lessen naturally over time.
The Effects of Trauma
Terror is the dominant emotion. Trauma feels unreal. Talking about trauma is difficult or impossible. Pain involves not just loss but terror, helplessness, and fear of danger. Anger often involves violence towards yourself or others. Guilt includes self-blame for what happened or thoughts that it should have been you who was harmed. Your self-image and confidence are distorted and undermined. You dream about yourself in danger. Untreated, symptoms may get worse.
When you child dies from an accident and you are a witness to it, you can find yourself in both grief and trauma categories.
How Can Trauma Affect the Grieving Process?
Grief tends to be mixed with trauma when a loss is sudden and unexpected - a fatal heart attack, an accident, a murder - or it's perceived as being outside the normal cycle of life, as in the death of a child. For example, someone who nurses a spouse through a long illness will grieve when the spouse is gone, but the person who witnesses the sudden death of a spouse in a car crash will likely be traumatized as well.
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A sudden loss can be even more difficult to deal with if you don't have a socially recognized outlet for mourning, as in a miscarriage or stillbirth.
While trauma always incorporates grief, the two states are very different in how you experience them and what they can do to you. Grief is a normal reaction to loss, with its symptoms diminishing on their own over time. On the other hand, trauma is a disabling reaction that can block the grieving process, disrupt your life, and leave you psychologically vulnerable. If you are coping with a traumatic loss, you may want to think about turning to a counselor or other professional for help.
No matter where the support comes from, accept it and do not grieve alone. One of the key elements of healthy grieving is allowing your emotions to surface in order to work through them. In the long run, trying to suppress your feelings in the hope that they'll fade with time won't work. Blocking the grief process will just block your eventual recovery from grief.
If people don't know what they can do to help, tell them, whether it's to go with you to a movie, cook you a meal, or just hold you as you cry. If someone is uncomfortable with your displays of emotion or need to talk about the person you lost, gently let him or her know that talking out your grief is part of your healing process.
Other Things You Can Do to Help You at a Time of Grief
Express your feelings in a tangible or creative way. Write about your loved one in a journal, or write the person a letter saying the things you never got to say. Create a scrapbook or artwork about the person; create an appropriate memorial in his or her honor (for example, if the person loved flowers, plant or fund a garden); get involved in a cause or organization that was important to him or her.
Take care of yourself physically. Get enough sleep, eat sensibly, and get regular exercise. Do not use alcohol or drugs to numb the pain of grief or lift your mood artificially. (That may even apply to antidepressants meant to ease the sadness of grief; because grief, unlike depression, is not a disorder, masking the pain with meds may be less productive than working through the sadness.) Healthy habits will help you recover from grief, but substance use will impede recovery and can lead to long-term dependence
Don't let other people tell you how to feel, and don't tell yourself how to feel, either. Your grief is your own, and no one else can tell you when it's time to "move on" or "get over it." At the same time, it's okay to be angry at the person who died, to cry every day if you need to, to yell at the heavens without being embarrassed. Conversely, it's okay to laugh, too. If watching the entire oeuvre of the Marx Brothers helps you heal, no one has to right to tell you it's inappropriate.
Plan ahead. Anniversaries, holidays, and milestones in life bring particular challenges. Be prepared for an emotional wallop, and know it's completely normal. If you're sharing a holiday or lifecycle event with other relatives, talk to them to find out what their expectations are and come up with strategies together to honor the person you loved and meet the challenge.
Managing Traumatic Stress: What Happens Next?
Shock and denial are typical responses to disasters and other kinds of trauma, especially shortly after the event. Both shock and denial are normal protective reactions. Shock is a sudden and often intense disturbance of your emotional state that may leave you feeling stunned or dazed. Denial involves you not acknowledging that something very stressful has happened, or not experiencing fully the intensity of the event. You may temporarily feel numb or disconnected from life.
As the initial shock subsides, reactions vary from one person to another. The following, however, are normal responses to a traumatic event:
Feelings become intense and sometimes are unpredictable. You may become more irritable than usual, and your mood may change back and forth dramatically. You might be especially anxious or nervous, or even become depressed.
Thoughts and behavior patterns are affected by the trauma. You might have repeated and vivid memories of the event. These flashbacks may occur for no apparent reason and may lead to physical reactions such as rapid heartbeat or sweating. You may find it difficult to concentrate or make decisions, or become more easily confused. Sleep and eating patterns also may be disrupted.
Recurring emotional reactions are common. Anniversaries of the event, such as at one month or one year, as well as reminders such as aftershocks from earthquakes or the sounds of sirens, can trigger upsetting memories of the traumatic experience. These 'triggers' may be accompanied by fears that the stressful event will be repeated.
Interpersonal relationships often become strained. Greater conflict, such as more frequent arguments with family members and coworkers, is common. On the other hand, you might become withdrawn and isolated and avoid your usual activities.
Physical symptoms may accompany the extreme stress. For example, headaches, nausea and chest pain may result and may require medical attention. Pre-existing medical conditions may worsen due to the stress.
How Do People Respond Differently Over Time?
It is important for you to realize that there is not one 'standard' pattern of reaction to the extreme stress of traumatic experiences. Some people respond immediately, while others have delayed reactions - sometimes months or even years later. Some have adverse effects for a long period of time, while others recover rather quickly.
And reactions can change over time. Some who have suffered from trauma are energized initially by the event to help them with the challenge of coping, only to later become discouraged or depressed.
A Number of Factors Tend to Affect the Length of Time Required for Recovery, Including:
The degree of intensity and loss. Events that last longer and pose a greater threat, and where loss of life or substantial loss of property is involved, often take longer to resolve.
A person's general ability to cope with emotionally challenging situations. Individuals who have handled other difficult, stressful circumstances well may find it easier to cope with the trauma.
Other stressful events preceding the traumatic experience. Individuals faced with other emotionally challenging situations, such as serious health problems or family-related difficulties, may have more intense reactions to the new stressful event and need more time to recover.
How Should I Help Myself and My Family
There are a number of steps you can take to help restore emotional well being and a sense of control following a disaster or other traumatic experience, including the following:
Give yourself time to heal. Anticipate that this will be a difficult time in your life. Allow yourself to mourn the losses you have experienced. Try to be patient with changes in your emotional state.
Ask for support from people who care about you and who will listen and empathize with your situation. But keep in mind that your typical support system may be weakened if those who are close to you also have experienced or witnessed the trauma.
Communicate your experience in whatever ways feel comfortable to you - such as by talking with family or close friends, or keeping a diary.
Find out about local support groups that often are available such as for those who have suffered from natural disasters, or for women who are victims of rape. These can be especially helpful for people with limited personal support systems.
Try to find groups led by appropriately trained and experienced professionals. Group discussion can help people realize that other individuals in the same circumstances often have similar reactions and emotions.
Engage in healthy behaviors to enhance your ability to cope with excessive stress. Eat well-balanced meals and get plenty of rest. If you experience ongoing difficulties with sleep, you may be able to find some relief through relaxation techniques. Avoid alcohol and drugs.
Establish or reestablish routines such as eating meals at regular times and following an exercise program. Take some time off from the demands of daily life by pursuing hobbies or other enjoyable activities.
Avoid major life decisions such as switching careers or jobs if possible because these activities tend to be highly stressful.
Become knowledgeable about what to expect as a result of trauma. Some of the 'Additional Resources' listed at the end of this fact sheet may help you with this learning process.
How Do I Take Care of Children's Special Needs?
The intense anxiety and fear that often follow a disaster or other traumatic event can be especially troubling for children. Some may regress and demonstrate younger behaviors such as thumb sucking or bed wetting. Children may be more prone to nightmares and fear of sleeping alone. Performance in school may suffer. Other changes in behavior patterns may include throwing tantrums more frequently, or withdrawing and becoming more solitary.
There are several things parents and others who care for children can do to help alleviate the emotional consequences of trauma, including the following:
Spend more time with children and let them be more dependent on you during the months following the trauma - for example, allowing your child to cling to you more often than usual. Physical affection is very comforting to children who have experienced trauma.
Provide play experiences to help relieve tension. Younger children in particular may find it easier to share their ideas and feelings about the event through non-verbal activities such as drawing.
Encourage older children to speak with you, and with one another, about their thoughts and feelings. This helps reduce their confusion and anxiety related to the trauma.
Respond to questions in terms they can comprehend. Reassure them repeatedly that you care about them and that you understand their fears and concerns.
Keep regular schedules for activities such as eating, playing and going to bed to help restore a sense of security and normalcy.
When Should I Seek Professional Help?
Some people are able to cope effectively with the emotional and physical demands brought about by a natural disaster or other traumatic experience by using their own support systems. It is not unusual, however, to find that serious problems persist and continue to interfere with daily living. For example, some may feel overwhelming nervousness or lingering sadness that adversely affects job performance and interpersonal relationships.
Individuals with prolonged reactions that disrupt their daily functioning should consult with a trained and experienced mental health professional. Psychologists and other appropriate mental health providers help educate people about normal responses to extreme stress. These professionals work with individuals affected by trauma to help them find constructive ways of dealing with the emotional impact.
With children, continual and aggressive emotional outbursts, serious problems at school, preoccupation with the traumatic event, continued and extreme withdrawal, and other signs of intense anxiety or emotional difficulties all point to the need for professional assistance. A qualified mental health professional can help such children and their parents understand and deal with thoughts, feelings and behaviors that result from trauma.
"... it is not the will of your Father which is in Heaven, that one of these little ones should perish."
