Down the Long Road of Grief: Supporting Survivors, Families and Loved Ones in the Aftermath

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 included:

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.