chapter 4

Grief and Trauma

Often trauma and grief are intertwined because death or other loss can occur in a shocking way and a traumatic event also involves one or more losses. Both a traumatic event and the death of someone we love are severe stressors. When they happen together, we have to deal with both the affects of trauma and of grief.

What Is Trauma?

Trauma involves an event outside our normal experience that frightens us and makes us feel helpless. The traumatic incident overwhelms our normal ways of coping, pushing us into an emergency state. Whether we are involved in the event or witness it, the more shocked, terrified, and powerless we feel, the greater we will be impacted. The acute stress we undergo may adversely affect our physical, mental, and emotional well-being. Most of the time, our reactions last only a few days. But the effects may also last a lifetime.

Tracy had just bought a snazzy new sports car, which she loved. Then one night, a drunk driver hit her, totaling her beloved car. Although she cried, her tears were as much about anger as grief. She found herself making stupid mistakes that were unlike her, such as locking herself out of the house. Even her boyfriend complained that she “had lost her brain.” She had trouble sleeping for a few nights because, once she closed her eyes, she kept seeing the truck speeding toward her. She often replayed the incident in her mind. She broke out in tears the first time she had to get into the rental car because it made her miss her sports car. In addition, the first few days of driving, she felt vulnerable, imagining another accident. She knew she needed to buy a new car, but the research and decision-making seemed too overwhelming. It took several weeks before she felt normal again.

An ongoing painful and/or frightening situation such as physical, sexual, or emotional abuse; early childhood neglect; or the terminal illness of a loved one can also traumatize us.

Traumatic Events

When we experience a traumatic event such as a car accident, fire, assault, robbery, natural disaster, or seeing someone die, we have a hard time processing what’s happening. A traumatic incident can occur so rapidly that you don’t really understand what’s happened. One moment everything is normal, the next chaos has broken out. Often the complexity and (usually) unexpected occurrence makes it difficult to understand and absorb. Your thoughts have a hard time catching up with reality.

Some events, such as a robbery or an earthquake, may last only a few minutes. But while you’re in the middle of one, it can feel like it takes forever to get over. Other traumatic experiences can last for hours, days, or even months. In describing their initial reaction, people use words such as “stunned,” “disbelieving,” “dazed,” “overwhelmed,” “incredulous,” and “surreal.”

The way in which an individual deals with a crisis, both when it’s happening and afterward, is unique, and is based on that person’s training, coping ability, personality, values, life experiences, fears, expectations, beliefs, and support system. For example, if you work in a hospital or are a police officer or firefighter, you might not be affected in the same way a kindergarten teacher is. Also, the more traumatic events you experience in your life, the more impact it has on you. You might have a harder time recovering from subsequent ones.

War and Disaster

War or disaster is an extreme form of traumatic situation. Those who are caught in a war zone or experience a natural or human-made catastrophe must survive the event with all the fear and danger accompanying it. But they also have to live with the aftermath, which may be just as horrible (or even more so).

The terrorist attacks on 9-11, Hurricane Katrina, or the 2011 earthquake and tsunami in Japan are examples of disasters. The people involved lived through the catastrophe in fear for their lives, witnessed the horrors, and then had to keep experiencing the aftermath—destroyed buildings, bodies, and people searching for loved ones.

In war or disaster situations, you often witness destruction to most (or even all) of your surroundings or environment. In addition to the deaths of family, friends, and neighbors, there’s the loss of possessions, homes, and perhaps the entire neighborhood or community. Often people struggle with immediate survival because of the lack of food, drinkable water, or shelter. Lawlessness can make you fear for your life and/or your home and possessions. Many times, you’re so busy trying to survive or cope with the damage, you have no time to grieve. The grief might hit you later, when things have settled down, or it may come in the form of other reactions that you don’t recognize as grief.

For some, the external triggers from war or disaster—such as destroyed buildings—can last for years. The constant reminders make it harder for survivors to recover. For example, without the Twin Towers, many people glancing at the changed New York City skyline are jolted into remembering what happened on that day, perhaps bringing up traumatic reactions.

Even if you weren’t present during 9-11, Hurricane Katrina, or the earthquake and tsunami in Japan, you can still feel traumatized from viewing the images on television and experiencing intense emotions as you watch. Children are especially vulnerable. Limit your television watching during disasters and keep your children from watching. Read the newspaper (either the paper version or online) instead.

When in a war, both soldiers and civilians frequently fear for their lives. They are constantly on the edge, knowing danger could happen at any moment. They may not be able to trust anyone because it’s difficult to know who are the enemies and who are genuine, friendly people. Soldiers must be ready to kill others, which can be emotionally difficult to do, in spite of training, or knowing others are the “enemy.” The need to constantly be prepared to defend oneself or to actually kill someone takes a toll.

Because they don’t feel safe while at war, and usually experience trauma, soldiers carry those feelings and reactions home with them. It’s not uncommon for them to have a difficult adjustment back to civilian life. They may have multiple reactions, including flashbacks and nightmares. Not all flashbacks begin visually. Their mind and body can replay sounds and smells. They can also experience physical flashbacks, for example, from being grabbed or poked by a gun. They keep feeling the negative touch and then re-experience the trauma.

Research shows that soldiers who’ve returned home often speak less and become easily irritated. Even those with laid-back personalities can become angry. They may have difficulty feeling emotions, even with loved ones. Some are more debilitated by their traumatic reactions, causing a diagnosis of Post-Traumatic Stress Disorder (PTSD). Symptoms of PTSD last more than a month and interfere significantly with life. If untreated, they may continue for months, years, or even decades. Those with PTSD respond well to a combination of medication and psychotherapy.

Flashbacks are thoughts that jump back to a traumatic event. It may feel as though you’re re-living the experience. Post-Traumatic Stress Disorder (PTSD) is a medical diagnosis. The classic symptoms are flashbacks and nightmares. Sufferers can also experience irritability, angry outbursts, persistent fears, emotional numbness, and social withdrawal.

You don’t have to be a soldier to have PTSD. Ordinary citizens can receive the diagnosis, too. Trauma, or several traumas, can pile too much stress and pain on you, and you just can’t cope. It’s not uncommon for sufferers to go a while before going to a doctor or counselor. Usually this happens because they don’t understand what’s wrong, don’t know what to do, or are too ashamed to seek help.

Primitive Responses to Fear

During the traumatic incident, you’re under acute stress, and intense fear is a primary emotion. When that intense fear is accompanied by thoughts of, “I’m going to die!” or “I’m going to be hurt!” the body will respond by initiating what’s called the “fight-or-flight response.” This response is controlled by the more primitive part of our brain that harkens back to our caveman days. When ancient humans were afraid, it often meant something with sharp teeth and claws was headed their way. Their only choices were to fight—using rocks, sticks, or spears—or run away and hope they weren’t caught. Fast forward thousands of years, and our bodies still respond to acute stress in the same way.

The evolutionary fight-or-flight response is a prewired automatic survival reaction for dealing with dangerous situations. It prepares the body to fight or flee from real or perceived danger. The fear and perception of danger causes a chain reaction in our brain, and alters the brain chemistry, bypassing the part of the brain that controls rational thought. The chemicals adrenaline, noradrenaline, and cortisol are released into the bloodstream. These cause a rise in blood pressure and blood sugar, rapid heartbeat, fast breathing, and energized muscles. Our senses sharpen. Our pupils dilate. Endorphins, which are the body’s natural painkillers, are released. Unessential systems, such as digestion, shut down.

Most of the time in our modern society, we can’t fight. Nor can we run. Another primitive response to danger is freezing. Ancient humans would hide behind a rock or a tree and hope who or whatever was stalking them would pass by. Nowadays, freezing is a likely response to fear. That doesn’t mean you literally can’t move (although some people are affected to this extreme), but you tighten all your muscles and take shallow breaths. You may react and handle the situation well—your body just doesn’t have a chance to fight or flee, so you freeze the fear into your muscles.

Cardiovascular exercise that gets your legs moving helps to lessen the effect of traumatic reactions. Strenuous exercise activates your central nervous system and retrains your brain. It doesn’t have to be long; 20 minutes will do. Go for a brisk walk; jog; bike; swim; play soccer, tennis, or basketball; or put music on at home and dance around the room with your kids.

Thoughts, Emotions, and Trauma

It’s not necessarily what happens during the traumatic incident that makes the most impact on you, especially if you aren’t physically injured. When you experience a trauma, what you think and feel is as important (if not more so) as what actually happens to you.

In some frightening situations, such as robberies, we are preprogrammed through viewing movies, television shows, and the news that a robbery ends in injury or death. It doesn’t matter that statistics about shootings during robberies are actually very low; it’s what we imagine that makes the difference in our brain. Therefore, when you’re a victim of a robbery, your mind easily jumps to thoughts of, “I’m going to die.” Your brain plays a movie that involves shooting and lots of blood, detailing what’s going to happen to you.

When two gun-carrying men robbed the store where Nicole worked, her first thought was, “They’re going to kill me.” The robbers demanded the money from the cash register, and, with shaky hands, she tried to scoop it up. “Hurry!” one robber ordered, pointing the gun at her. Images of her baby son flashed through Nicole’s mind. “He’s going to grow up without me,” she thought. The robbers took the cash from the till and left. They’d been in the store for a total of 1 minute and 59 seconds. But the impact on Nicole lasted for months.

In circumstances like Nicole’s, where a scary and traumatic situation is coupled with intense emotion, the brain experiences what you think as real. It doesn’t matter that the robbers had no intention of killing Nicole, or that they actually did not harm her. In her mind, she was dead! In those seconds, she grieved the life she’d never have with her son, and she grieved for her son who’d have to grow up without a mother. Even though the horrible vision was only in her mind for a very short time, it registered on her subconscious as fact, and the effect on her body was as if it had really happened. As you can see by Nicole’s experience, the thought about the trauma can be as debilitating as the reality.

Personality and Trauma

People who are sensitive and imaginative are more apt to experience acute stress during what they interpret as dangerous situations. Because of their sensitivity, they tend to feel more frightened by encounters or experiences that would leave a less susceptible person unaffected. For example, sensitive children can feel scared when a parent raises his or her voice. A volatile parental argument might send the child scurrying under the bed for safety. A different child might continue playing with his or her toys and barely notice the fight.

Although Sherry didn’t witness the death of her co-worker, David, when he was hit by a company van, she heard detailed descriptions from the witnesses. Although she didn’t know David very well, she vividly kept picturing the van hitting him, sending his body flying. She found herself crying throughout the day, but tried to hide her reactions because her less sensitive colleagues (who also didn’t know David well) didn’t seem as affected.

Because of their vivid imaginations, sensitive people not only replay the incident as it happened, but imagine what might have occurred. Instead of focusing on the positive—“I’m safe”—they imagine the myriad things that could have gone wrong. For example, after a robbery, they keep thinking, “I could have died.” If they dwell on the fear fantasy they’ve created, they keep their anxiety level high and their body revved up in the fight-or-flight response. It’s like living in a horror movie that they replay over and over. They become stuck in what could have happened.

These “what could have happened” anxieties can be strengthened by others. It’s not uncommon for parents, spouses, and friends to make statements like, “You could have been killed!” If friends and family react in fearful, protective ways, they can reinforce the victim’s stress and fear. Luckily, this type of thinking is one of the easiest traumatic reactions to dissipate. Once people learn that they continue to stress their body by the negative fantasy they’ve “made up,” they can usually work on stopping their thoughts and calming their physical reactions when they begin to replay the “what could have happened.”

Reactions to Trauma

If we experience a traumatic event, it’s very common for us to have a wide range of emotional or physical reactions. These are normal reactions to an abnormal situation. Our mind and body can remain alert for danger, even after the danger no longer exists. Sometimes things remotely associated with the event (even if it’s just our thoughts) can set off the reactions (or over-reactions).

The amount you’re exposed to the event and the loss you suffer will make a difference on how adverse your reactions are. The timeline of your reactions to the traumatic stressor begins with your response to the event and continues as long as you have symptoms. When you know the common reactions, you can identify those that stem from your traumatic experience.

Physical Reactions

It doesn’t matter how strong you are or what shape you’re in, you can still have physical reactions to a traumatic event. Some of the most common physical reactions are these:

• Shakiness, weakness, or dizziness
• Heart palpitations, difficulty breathing, or panic attacks
• Being easily startled/jittery
• Nausea, headaches, sore muscles
• Difficulty sleeping, usually because of replaying the incident; waking up drenched in sweat
• On the verge of tears when thinking about the event, or wanting to cry, but can’t
• Appetite changes, not wanting to eat, or eating too much

Mental Reactions

When our bodies release a surge of adrenaline because of the traumatic event, it impresses the memory into our brain, which makes it difficult to forget what happened. Remembering the traumatic incident can make us anxious. The negative memory can easily be triggered, which is why people avoid places, objects, smells, and wearing certain clothes that remind them of the event. In addition to flashbacks and nightmares, here are some mental reactions:

• Intrusive thoughts
• Hyper-alertness
• Avoidance behavior that includes trying not to think of or feel about the incident, and avoiding the place where it occurred
• Feeling vulnerable, including unsafe at home
• Numbness, confusion, difficulty understanding the details of what has happened
• Wanting to isolate, or not wanting to be alone
• Difficulty with focus and concentration
• Replaying the event over and over

After Nicole was robbed, she was shaky and tearful. As soon as she arrived home, she hugged her young son and wouldn’t let go of him for a long time. She even took him to bed with her. That night, she couldn’t sleep, imagining that the robbers had followed her home. She’d doze off, then startle awake at every sound. It took a week before she was able to sleep without her baby.

The risk of traumatic reactions may increase from the severity of the trauma, childhood abuse, or a history of mental illness.

Emotional Reactions

After a traumatic event, people can struggle with various emotions. Sometimes, these are intense. The feelings may seem as if they come out of nowhere. You may be aware that the emotion is linked to the incident, but you don’t know why you’re feeling it now. You may have missed the subconscious cue that triggered your reaction. Some common emotional reactions are guilt, anger, helplessness, anxiety, irritability (a “short fuse”), depression, shock or numbness, and fear (which may feel irrational).

Those who were exposed to the traumatic incident may re-experience the trauma when they return to the place where the original event occurred. It may take the form of fear and anxiety, accompanied by thoughts of “I need to get out of here.”

Emotional stress can change brain function. Preliminary brain research is showing that a single exposure to acute stress affects information processing in the cerebellum, which is the area of the brain responsible for motor control, movement coordination, and learning and memory formation.

Although a few people may suffer acute reactions, such as depression, anxiety disorders, and PTSD, most people get better on their own. Their symptoms will usually subside after a few days, and disappear completely after a week or two. Knowing about these reactions will help you not feel crazy, especially when you have reactions that don’t feel like your usual ways of responding.

Delayed Reactions

Traumatic reactions may unexpectedly surface weeks or even months after the event. They may seem like they appear for no reason, and you can wonder what’s happening to you. By that time you may not think to relate your symptoms back to the trauma.

If you’ve experienced a traumatic incident, it’s important to remember you may have delayed reactions, so if you start to feel different in some way, you can link them back to the event. It also helps to educate close friends and family members about trauma. Sometimes they’re the ones to see the differences in you. They also might be better at remembering that what’s happening to you now may be related to your previous trauma.

The Double Whammy of Trauma and Grief

When you’re dealing with both trauma and grief, you’re hit with a double whammy. Your traumatic reactions might get in the way of your grief. Or you can feel impacted by both. For example, if you were present when your loved one died, then you might have flashbacks of the body. For some, it might be difficult to get that picture out of their minds. You can cry and grieve every time you think of the person as he or she looked in death. The more severe and sudden the cause of the death you witnessed, the more you may experience trauma symptoms. The combination of trauma and grief might feel incapacitating.

Jeff belonged to a bicycle group that met every Saturday. On one of their outings, the group rode around a corner, Jeff in the lead. He swerved out a yard too far, moving from the bike lane into the street, where he was struck by a car. All his friends witnessed the event and tried to help him, but he died at the scene, leaving everyone traumatized and grief stricken. They banded together for a group counseling session, which helped them understand their reactions and process their feelings. It still took time before all the friends were willing to ride their bikes again.

It doesn’t just have to be the loss of a person that can bring on grief and trauma. Traumatic events also involve the destruction of property and pets, and you may grieve their loss. You might also feel empathy and concern for others who are affected by the experience.

Let me relate a story that in a small way illustrates how trauma can color your grief. My cat Angel was 4 years old—middle aged in cat years. She was a delicate white Persian, with beautiful translucent blue eyes. One night I came home from work, and, as she walked toward me, her hindquarters collapsed. She dragged herself the rest of the way, terror in her eyes. I scooped her up and rushed her to the vet. Hours and several tests later, the vet showed me her X-rays, and pointed out a tumor on her spine. Gently, he advised me to euthanize her.

He led me to a room where Angel was brought to me. I cuddled her and cried, kissed her head, told her how much I loved her, and said goodbye. Then the vet came in, and I laid Angel on the table. The vet was very kind, and he told me that it would be over in less than a minute. I stroked her, and watched the life fade from her eyes.

For the next few days, I cried and grieved. But I also realized I had trauma symptoms. I kept having flashbacks to Angel’s empty blue eyes. I often felt shaky, and had some nightmares. I’d never been present when a beloved pet died, so I hadn’t known what to expect. Plus, I’m a sensitive person, which made me more vulnerable to the experience, although other, less sensitive people, might not have been as affected. I made sure to write about my feelings, which helped me feel better. I also talked to other pet lovers who understood.

If I hadn’t witnessed the death, I still would have had grief from Angel’s passing—sadness, missing her, tearfulness, and having a hard time sleeping without her customary presence next to my legs. But I wouldn’t have had the traumatic symptoms of flashbacks, nightmares, and shakiness. I’m not sorry I made the choice to be with her. I just had to pay a price for that decision. My traumatic reaction lasted two days, although I missed Angel for a long time.

Coping with Grief-Related Trauma

Traumatic stress and grief can affect your academic or work performance. It can make you distance yourself from friends and family. The reactions can cause problems in your relationships, especially if you have family members, friends, and co-workers who are also affected by the event.

The effects of trauma can have a severe impact on your grieving. It’s important to diminish (with help, if necessary) the traumatic reactions so you can achieve enough physiological stability to have energy available for grieving and adjustment processes. When you begin to confront your traumatic reactions, you might feel uncomfortable or frightened. You don’t like reliving the experience. But research shows that those who have experienced a trauma and avoided talking about it are more susceptible to a variety of illnesses. Talking about what you went through with others who are supportive is one of the best ways to cope. It helps you assimilate what happened. The more you process your emotions, especially during the first week after the trauma, the more improvement you’ll have in your long-term health and emotional well-being.

While intrusive thoughts of the trauma are normal and often outside your control, let them play out but don’t dwell on them. Try to switch your thoughts to a positive image, for example, your child laughing or you petting your dog or cat. Remind yourself that you’re safe. The intrusive thoughts might jump back in your mind, but, as much as possible, keep calmly switching them. For example, change, “I could have been killed!” to “I’m grateful that I’m safe.”

Breathe In, Breathe Out

One of the best tools we have to reduce stress and trauma is our breathing. When we’re afraid or stressed, our muscles tighten, causing our breathing to become shallow, and depriving ourselves of some oxygen at the very time we need it the most. Taking some deep breaths can calm and center us. Deep breathing during a stressful event (or during later recollections of the event) will help us cope with it better. For natural breathing, when you take a deep breath, your belly should expand. When you exhale, your belly should pull in.

Track your traumatic reactions in a notebook or journal. For each one, note the severity and how quickly it fades. They should lessen within a few days and disappear completely within a few weeks (although you might have one or more re-emerge for a short while). If the reaction(s) interferes with your normal life, or lasts more than a few weeks, you should seek help from a counselor who specializes in trauma.

A few years after the trauma of her parents’ death, Anne went to a psychologist and was diagnosed with PTSD. “It explained all the black holes in my memory and all my bad behaviors,” she said. Anne felt better, in part, because she could put a name on the cacophony of emotions and issues inside her.

Feeling alone or abandoned makes trauma harder. Having a social network and coping strategies appear to offer some protection from the acute stress reactions. Social support can give you resilience. Other things you can do to help yourself are these:

• Set limits with others during those times you don’t feel like talking.
• Rest, eat healthy, exercise regularly.
• You may find practicing yoga and meditation to be helpful.
• Take a good multivitamin and omega-3 (salmon or krill oil) supplement to support your body and brain.
• Avoid caffeine. You’re often jittery enough, and caffeine will only make it worse. (Remember, caffeine isn’t just in coffee and tea. It’s also in many soft drinks.)
• Avoid using drugs, alcohol, or sleeping pills.
• Engage in a mix of activities you’ve previously found satisfying and enjoyable.
• Choose your support system carefully. A buddy who thinks a night of drinking will fix you isn’t the best person for you to be around right now.

Those who survive a traumatic experience often feel a renewed appreciation for their lives. They may reassess what’s really important to them and make changes. Their self-confidence can increase because they’ve survived a horrible experience. They may feel stronger and more capable.

Essential Takeaways