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Arcus: Helping children when trauma complicates grief
By Doreen
Arcus
Thursday, February 9, 2006
"A sunset is a
beautiful thing. But it doesn't make sense in the middle of a bright and
sunny day."
Thirty-five
years later, I can still hear those words spoken to my high school
classmates as we gathered in assembly following the tragic death of one of
our own.
Arlington
is reeling from an untimely sunset. We are overwhelmed with sadness and
feel a loss so profound that it is trivialized by the inadequacy of
language when we try to describe it.
In
the midst of tragedy, many of us are searching for guidance on how we can
best support our sons and daughters cope with shock and loss.
Grief
takes many forms. It is as a natural a part of loss as breathing is of
life.
In
1969, psychologist Elisabeth Kübler-Ross first described mourning as a
sequence of emotions and beliefs: denial, anger, bargaining, depression,
and, finally, acceptance.
More
recently grief counselors have used the fitting acronym TEAR to describe
the life altering aspects of grief and mourning: To accept the reality of
the loss; to Experience the pain of the loss; to Adjust to a new life
without the lost person; and eventually to Reinvest in a new reality.
In
contrast to "stiff upper lip" or "get over it and move
on" approach, we now understand grief as a process and not a singular
event. Grieving takes time. People will not proceed in lock step, but will
vary in their processing rates and in the depths of their emotions. There
is no formula to predict how soon or how neatly anyone will move through
the process.
How
loss and emotion are expressed also varies from person to person. Children
and adolescents may have problems eating or sleeping. They may be
irritable, may withdraw from others, and may have trouble concentrating on
tasks or schoolwork. They may think a great deal about death. They may have
physical symptoms, such as headaches. They may become clingy or regress to
earlier behavior patterns for comfort.
For
many who knew Cameron O'Connor, grieving his loss will be a marathon and
not a sprint. Even as they are able to move their lives forward, reminders
and anniversaries and unanticipated occurrences will prompt another cycle
of grief and mourning. Sometimes these will be microcosms of the larger
loss and barely perceptible to others; other times these will be more
overwhelming and demand time, space and understanding.
For
some, typical types of outreach and support - talking about the deceased,
memorializing him and finding comfort in shared memories - will be helpful
in navigating the stages of grief. For others, grieving may be particularly
complicated and warrant some specialized types of support.
Traumatic
grief may occur when loss co-occurs with trauma. When the cause of death is
sudden, shocking, and horrifying, children or adults may become so
overwhelmed by the traumatic aspects of the death that it limits their
abilities to remember their lost person's life and engage in healthy
mourning.
In
traumatic grief, thoughts of the lost person become inextricably linked to
the horror and violence of their death. Mourners become "stuck"
on the person's traumatic demise rather than being able to remember the
myriad of life experiences - even joyful ones - they had shared. People who
are coping with traumatic grief often shut off all activity that reminds
them of their lost loved one because it inevitably reminds them of the
terrifying way that person died.
By
shutting off these thoughts and feelings, children and adolescents
suffering from traumatic grief place not only healthy bereavement, but also
their own healthy development, at risk.
How
to know if your child is suffering from traumatic grief? It can be
complicated. The warning signs sometimes overlap with aspects of healthy
mourning and there is no timetable.
According
to the National Child Traumatic Stress Network (NCTSN), some signs of
traumatic grief include:
·
Intrusive memories about the death including recurring thoughts and
pre-occupation about the manner of death.
·
Numbing or emotional-constriction; the child may act uninvolved or
nonchalant to hide his or her pain.
·
Avoidance of anything connected to the deceased, the manner or death
or any associated activities or events.
·
Withdrawing from important areas of their lives or seeming to have
"lost purpose."
·
Symptoms of increased arousal, including irritability, acting out,
headaches, increased fearfulness, "jumpiness" or vigilance.
A
mental health professional who is experienced at working with children and
adolescents and who has expertise, specifically, in grief and in trauma may
be best able to help those dealing with traumatic grief. Treatment for
children typically involves their parents as well. Adolescent treatment
often occurs in a group setting, but there are a number of evidence-based
models available. Regardless of format, the goal of treatment is to help
the child manage his or her trauma-related reactions and become better able
to engage in remembering, mourning and moving forward.
We
can all help each other by some simple steps too. Again, according to the
NCTSN, it is helpful to provide accurate information to the best of our
ability and in answer to our children's questions. We should not force any
child to talk about the loss if he or she does not want to. Arranging
predictable schedules and routines may help offset the chaos of the traumatic
loss. We should be aware of behaviors or reactions that may be
manifestations of grief, and interpret and respond to them as such.
Finally, we should manage expectations of our children with flexibility.
In other words, listen,
respond, and be there - steady but not unbending. Keep the lines of
communication open and remember that children often speak with their
behavior as much as with their words. You are not alone.
Additional
information on trauma, grief and mental health for both parents and school
personnel is available through these organizations:
·
American Psychological Association, http://www.apahelpcenter.org
·
International Society for Traumatic Stress Studies (ISTSS),
http://www.istss.org/publications/pamphlets.htm
·
The National Child Traumatic Stress Network, http://www.NCTSNet.org
·
The Trauma Center at JRI, Brookline, http://www.traumacenter.org
Doreen Arcus is an Arlington resident and mother
of an Arlington High School lacrosse player. She is an associate professor
of Psychology and director of the Honors Program at the University of
Massachusetts Lowell, and a member of the International Society for
Traumatic Stress Studies.
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