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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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