| 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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