Losing someone we love is always painful, and always, to some extent shocking. No matter how expected the death is, we can nevertheless struggle to accept that the person has finally gone. Traumatic or Complicated grief can arise for all sorts of reasons, including our relationship with the person who has died, our early experience of loss, other traumatic experiences, and the way the person died.
A sudden and/or violent death can take the shock of loss to a whole new dimension, adding a sense of fear, disorientation and disbelief, which means the loss can be far more difficult to navigate, and may result in a more intense and complex grief reaction. When a person has taken their own life, the ramifications for those of us left behind are extremely far-reaching. Not surprisingly, numbness and disbelief are more prevalent in the early days of loss, and symptoms of Post-Traumatic Stress Disorder (PTSD) are also more common; these factors can obstruct our ability to process and ultimately adjust to what has happened.
Paradoxically, although we may be constantly thinking about, even obsessed by the death itself, it can simultaneously continue to feel unreal to us. Added to the shock and grief, we are more likely to feel a sense of responsibility or guilt when we lose someone to suicide. We ask ourselves what we missed and what we could have done to prevent the tragedy occurring; we torment ourselves by asking questions that have no answers. We may get stuck in cycles of negative thinking that create constant rumination; we go over and over events in our mind which often does not give us any clarity; rather the ruminating feeds itself in a never ending loop that can add to our feelings of desperation. It can be helpful to differentiate between episodes of remembering our loved one, and actively grieving, which can facilitate adjustment, and periods of rumination which may feed depression and prevent integration of the loss.
Anton died without any perceivable warning. Nobody; not we as his parents, his brother, his friends, his work colleagues, had any inkling that suicide was even on his mind. To say that we were shocked when we received the news is a colossal understatement. The first year after he died was for me dominated by feelings of horror, alongside panic, fear and terror. This may seem strange, as the event had already happened; what was I actually afraid of? The only answer I can give is that I was terrified of 'knowing' what had happened; the idea of Anton's death being an indisputable fact, something I would have to find a way of accepting, was extremely frightening. My mind refused to believe that it was true. Although it may sound ridiculous, sometimes I feared that I would literally die if I allowed myself to believe it. Its easy to see why this would prevent me being able to emotionally process Anton's death, and therefore prolong the grieving process.
Whether or not you agree with pathologising, categorising and labelling emotional distress, it can be helpful to understand the reasons and processes behind this. Diagnostic manuals, which classify groups of symptoms into what are usually known as diseases or disorders, exist to inform treatment (the World Health Organisation publishes one and the US another). In other words, disorders are classified and allocated a set of symptoms so that clinicians or therapists can more easily recognise what they are working with, and understand how best to treat those afflicted.
Whilst we may not like the terminology, and may not consider ourselves to have a disorder (the obvious objection is that we are simply having a normal response to an abnormal event) labels can be useful if we need some form of intervention. And it can also help us to be able to put words to the chaotic emotional mess we are navigating; giving a name to something turns it from being "something" to "this thing I am experiencing" and describes a set of characteristics that "this thing" comprises.
The word "trauma" is Greek, originally meaning a physical wound or injury, and since expanded to incorporate wounds of a psychological and emotional nature. Traumatic Loss describes what has happened to us. Prolonged Grief (Prolonged Complex Bereavement Disorder in the US) is a new diagnostic term for what we may suffer as a result of Traumatic Loss. The symptoms of Prolonged Grief overlap with those of depression and PTSD, but do not preclude an additional diagnosis of either, or both of these. They include:
- Persistent and pervasive grief response, exceeding social/cultural/religious norms (6 months minimum)
- Longing/yearning for and preoccupation with the person who has died
- Intense emotional pain
- Feeling that one has lost a part of one's self (particularly challenging for parents who have lost children)
- Emotional numbness, inability to experience positive mood
- Difficulty engaging with social or other activities
- Being unable to acknowledge the death (disbelief)
- Finding it difficult to connect emotionally to others
The good news is that this area of work is being highlighted, and that treatment protocols are now being developed within Cognitive Behaviour Therapy (CBT), accelerated by the COVID Pandemic that has caused the premature deaths of so many people worldwide. The less good news is that this is still in the process of development and many CBT therapists have not yet been trained in this work. But this is not to say that there are not highly effective grief therapists and counsellors out there who are able to help with traumatic loss, complicated grief, prolonged grief or whatever label you care to give it. Just because there's no CBT protocol doesn't mean Traumatic Grief has only just made its appearance! As I've described in an earlier post, finding a therapist who is right for you can be tricky, but is definitely worth pursuing if you find you are constantly struggling to cope with intense feelings and this situation is not improving many months or years after your loss.
For me, keeping a journal has helped enormously because I have been able to see what changed at different points in my Grief Journey, from the journal I could see that there was clear progress being made. I also compared my emotional responses to similar events, for example we attended a family wedding about 18months after losing Anton, and I found it extremely difficult. A year later we had two family weddings, both of which I was able to enjoy. This journal recording gave me hope; despite the changes being very small, I had these little scraps of evidence that they were indeed happening.
NHS offers free psychological therapy in England
Cruse offers free grief counselling and support
At a Loss lists bereavement support by area
The Compassionate Friends supports bereaved parents, siblings and grandparents
Suicide&Co offers counselling to those bereaved by suicide
Duffy, M & Wild, J (2017). A cognitive approach to persistent complex bereavement disorder (PCBD) The Cognitive Behaviour Therapist vol. 10, 1-19
Dr Michael Duffy, Queen's University Belfast. One Day Workshop (February 2022). New approaches to trauma and traumatic grief. Responding to unexpected and traumatic grief: A cognitive approach to traumatic and complex grief.
Murray Parkes, C & Prigerson, H.G. (2010). Bereavement: Studies of grief in Adult Life 4th Edition