| In
the aftermath of tragedy, individuals, families,
responders, schools, workplaces, neighborhoods
and the community reverberate in grief. Creative,
powerful tools for group and individual healing
make the difference in the long road of creating
a "new normal." These techniques need
to be individually tailored to provide each person
with a safe and comfortable venue to explore the
pain and begin the process of rebuilding life.
Families and loved ones - the circle of survivors
are often forgotten in the aftermath. They are
in every waiting room of hospital ERs and ICUs
across our country. They are in the schools, the
workplace, in our communities, on our freeways
and turnpikes and shopping malls in our lives.
Grieving people carry an invisible burden. It
is the weight of the trauma they have survived.
Each person has a heavy heart of missing the one
they have loved. They are we. We are everywhere.
Immediately after a death, loss, separation, trauma
(a few days to a few weeks), we can receive an
overwhelming wave of support and attention. Then,
it is like entering a desert of isolation, or
dropping off a cliff where the excruciating memories
haunt us. Suddenly, we are expected to move on
with our life - continue business as usual. About
the time the shock wears off, the numbness that
has comforted us and helped us to survive the
initial trauma, has faded away. We are left with
the raw reality of anguish.
When I founded the Centre for Living with Dying
over 25 years ago, my motivation came from surviving
the suicide of my first husband, who took his
life on the morning of Mother s Day in the living
room of our home. I was 21 years old and we had
two small children. In the dawn light, imprinted
with the horror of blood, flesh, bone and brain
matter, the sanctuary and safety of my home was
violated. Earlier, I learned in the confession
of his suicidal feelings, that he had stood over
my bed and put the rifle to my temple and then,
our children, because he didn t want to leave
his young family behind. With that gunshot blast,
my life was irrevocably changed. I subsequently
found out I was pregnant and delivered that baby
nearly to term. That baby died two days after
he was born.
As the nightmares, the nausea, difficulty eating
and sleeping, anxiety and fear of the dark permeated
my life, I sought help. I went to my physician
and I was given Seconol. When I went to my priest,
I was told to pray. Years later, after my second
husband s death, I went to a psychiatrist, who
wrote on a yellow pad, and suggested that I get
a hobby to keep my mind off of the reoccurring
flashbacks. It wasn t until much later that I
realized that these individuals whom I had looked
toward for solace and comfort, were ill-prepared
to deal with this young woman.
For the next 15 years, trauma permeated my life,
during a time when this notion of "trauma"
was not even acknowledged or defined. My father
died in my arms, while I was giving CPR. I was
widowed again at the age of 28, when my second
husband died of heart disease. After I started
the Centre, I thought death was behind me. But
loved ones continued to die. Again, I was only
married for three months, and my third husband
suffered a major heart attack and survived three
bypass surgeries.
I was conducting a Critical Incident Stress intensive
training for The Centre, when I received the news
that my 19 year old son, Scott was severely burned.
For the next 20 days, my reality became the burn
unit. As a result of the intensity of the fire,
he lost his facial structure and his arms were
amputated. I was told that if he had lived, his
appearance would be sub-human. Even to this day,
in the long road of healing, it is still unbelievable
that what I witnessed in his dying happened. And
it happens everyday to those we love.
Our 25 years of experience at The Centre for Living
with Dying has demonstrated the need for aftercare
for as long as the need exists. Initial intervention
is vital and it is in the long-standing relationships
we build with other survivors, caring professionals
and peers, that will sustain our healing process.
When a critical incident strikes, the aftershocks
of grief and trauma can reverberate through our
world. When complicated grief occurs overlaid
with horror, we can expect the normal process
of grief to take longer. The immediate impact
can cause family survivors to be exposed to unbelievable
violence and unimaginable loss. The grief is intensified
by current or past losses sustained by the individual.
For each person, this can carve unique roadways
in heart, mind and memory.
There are several factors that can complicate
or facilitate grief. These can include past history,
previous unresolved grief, family and relationships,
coping patterns and support systems. Even present
life situations and beliefs, hopes and dreams
can also be vital factors in the recovery process.
In observing the deaths of astronauts in the Shuttle
Accident or the recent deaths of Mother Teresa
and Princess Diana, we can see the profound impact
upon people who did not know those individuals
personally. Around the world, the news of their
deaths resonated with our own pain. In some cases,
in children as well as adults, this resurrected
old wounds that had not completely healed. We
were told by our clients at The Centre that they
felt compelled to stay up to watch the funeral
in actual time. It became a way to express their
shock and sadness and to lessen the isolation
of the grief by being part of a public process.
The long road of grief is often fraught with secondary
trauma. Not only are individuals and communities
forced to acknowledge the impact of their loss,
but are also required to get back to "normal"
as soon as possible. There are still places in
the world where it is difficult to acknowledge
this trauma.
Recently, through our Spirit of Hope International
Program, we were privileged to work with survivors
of the Bloody Sunday Massacre and the more recent
Omagh bombing in Northern Ireland. Many families
have carried not only the pain and trauma of their
grief, but also the fear of expressing their feelings.
For many, the fear and danger of retaliation had
left them wounded and silenced. For some, the
trauma occurred years ago. In the safety of the
Critical Incident Stress Management (CISM) workshops,
it was not uncommon for individuals to cry and
release the pain for days. Many individuals had
received periodic intervention and support at
the onset, but most did not receive long-term
follow-up. The workshops and grief support groups
enabled the participants to release the pent-up
feelings of isolation, sadness, anger, guilt and
worthlessness.
Other types of secondary trauma include:
1) Other s reactions to the grieving person,
school or community. For example, high school
students who had witnessed a drive-by shooting
at their school stated that it was more traumatic
having to defend their school s reputation in
response to people s questions and accusations,
than to survive the trauma of the incident.
2) Media, police and court proceedings and hospital
stays. In the aftermath of the Oklahoma City
bombing, Timothy McVey s trial and sentencing
re-opened the wound of grief for many in that
community.
3) Resuming work and school activities. One
young police officer involved in a shooting
stated that it was difficult to come back to
work and face his co-workers. No one knew what
to say, and some people actually physically
avoided him.
4) The daily memory triggers sensory experiences
that remind us of loss. We often refer to these
as "landmines" because they can hit
without warning. Something as simple as a song
on the radio, a holiday or anniversary date,
going to the supermarket or seeing a person
who looks like our loved one can thrust us back
into the deep pit of pain.
How can we as professionals respond to this multi-faceted
aftermath of trauma? The first step is to provide
immediate intervention, both in a group and individual
basis to those most affected.
It is vitally important to let people know that
they are normal in the aftermath of abnormally
traumatic events. They may be harboring the "invisible
wounds" of witnessing, imagining, grieving
the loss of person, loss of safety, loss of relationship,
loss of hope or loss of meaning, as well as issues
of secondary trauma.
The next step is to give surviving loved ones
a "safe place" to express the details
of the pain, optimally, with others who are also
grieving. When tools and education about grief
and trauma are explained, people facing the aftermath
are empowered to move forward in a concrete and
positive way.
Finally, taking an action step, such as a candle-lighting
ceremony, a celebration of life, a tree planting,
the building of a memorial or an outreach to help
others, acknowledges the loss. It also can honor
the lives of the people who have died. Action
steps can help to bring some closure and restore
a sense of trust in the enduring power of love.
Whether in the corporation, school, neighborhood
or with the emergency responders, it is important
to use language and group process techniques that
are comfortable for the participants. And it is
important for all of us to remember to have a
"safe place" to express our pain, be
together and take the steps to begin the process
of healing.
Individuals and groups also need a sense of continuity
that they will not be abandoned. Follow-up creates
a safety net. At our Centre, we work with people
in grief for as long as the need exists, in group
or individual settings. Follow-up meetings for
communities in crisis also help to strengthen
the understanding for each other. Together, as
professionals, survivors and people in our community,
we can create meaning in the aftermath of pain
and a network of support for one another.
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