Recent events: loss, grief and trauma

I was asked to speak on Radio FIVEaa recently about loss, grief and trauma following the death of a well-known South Australian. The community was hit hard by his loss, and having some knowledge about these areas might assist. We may experience loss which is death-related (death of a person or pet), or non-death-related (divorce, loss of one’s job or health). ‘Attachment’ between individuals develops to maintain a state of balance in life and loss and grief disturbs this balance – people often describe a sense of their ‘whole world being thrown upside down’ (Bowlby, 1980). There can be a roller-coaster of emotions, from sadness to numbness, anger, guilt or anxiety.

Grief is the response to loss, and affects many aspects of the individual: physical, emotional, behavioural, cognitive (such as memory and concentration), social and spiritual. It involves adaptation to the loss, and as loss threatens our inner assumptions about the world, it takes time to re-adjust (Corr, 1998; Parkes, 1988). Loss may be hidden by individuals, particularly if there is stigma or shame involved. Loss may be gradual, such as adapting to dementia in a parent.

Adjusting to loss takes time and effort. It can be very useful to talk with your GP, therapist or a friend. It is important to find someone who is a good listener and someone whom you trust. There has been a lot written about grief work, and there are a number of different approaches to grief therapy. This (Worden, 2008) involves understanding the process of grief, and that it is normal to have positive as well as negative feelings about the lost person or object. It is important to share thoughts and feelings about the loss and reviewing what it means to the individual. We eventually move forward – but this does not mean giving up on the lost person or object, but rather ‘finding an appropriate place’ for them in our emotional lives.

Dr Sheila Clark, a GP with expertise on grief and author of ‘After Suicide Help for the Bereaved’, advises:
1. Allocating grief time each day – say 15 to 20 minutes in which to have a cry or write about the loss (such as in a journal).
2. Naming the problems – emotional or practical.
3. Looking after general health – endeavouring to eat regularly, and avoiding
overindulgence in alcohol or smoking.
4. Taking time out to walk in the nature.
5. Sometimes spoiling yourself, for example, having a coffee with a friend, or
relaxing in a hot bath.
6. Not making any major decisions before at least one year has passed.
7. Continuing existing relationships, seeking support.
8. Getting some advice on dealing with practical issues, or dealing with special occasions such as Christmas or the anniversary of the loss.
9. Understanding that your ability to think and remember is reduced – don’t be too hard on yourself, and use reminder lists.
10. Considering whether you need some time off work or to negotiate reduced working hours (Clark, 1995).

Sometimes thoughts can be intrusive in grief. Sometimes you need to challenge them, but at other times you may not want to deal with them at the time. Work on imagining putting the thought aside, perhaps into a box on a shelf, or letting them float away down a stream. You can then come back to the thoughts later, such as in your grief time. If possible, focus on finding some meaning out of the loss and grief. Narrative therapy speaks of ‘saying hullo again’ to the deceased, rather than saying goodbye (White and Denborough, 1998). This refers to incorporating what has been lost into the present, for example, holding on to the influence (or some other aspect) of that person that is meaningful. Robert Neimeyer has done some research and writing on ‘continuing bonds’ with loved ones who have died. This involves continuing the attachment with the person who has died in some ways.

When there is trauma as well as loss, it is important to remember that the effects, even though they can be very distressing, are normal, and they can last for days or weeks. Here are some tips to help coping:
1. Recognise that you have been through a very distressing experience, and focus on feeling safe and secure in the first instance.
2. Avoid overusing alcohol or other drugs to cope.
3. Don’t bottle up your feelings – share them with people close to you if you are able to or write them down. If you are a person who expresses yourself through action (e.g. gardening), then do these things.
4. Let key family and friends know about what you need, whether practical or emotional support.
5. Maintain a normal routine, and do some things you usually enjoy.
6. Rest when you can, and use relaxation techniques (e.g. relaxing each muscle group in the body, breathing effectively – you can download phone apps or borrow CDs from a library).
7. Eat well and do some exercise.
8. Problem-solve what you need to be doing – seek help with this from family and friends.
9. Be aware that a recent trauma may stir up memories from past traumas. Focus on keeping these memories separate in your mind – you can only process so much at one time.
10. Seek professional help if need be.

Further information is available at www.grieflink.org.au or if you wish to speak with someone about your grief, you can contact Lifeline on 131114 or Beyondblue on 1300224636. You may choose to seek assistance from your GP or a grief counsellor.You can find out more information on PTSD on the Beyondblue website (www.beyondblue.org.au), or The Australian Centre for Posttraumatic Mental health (www.acpmh.unimelb.edu.au). Again, please seek help from your GP.

References:

• Bowlby J. Attachment and Loss. Vol. 3: loss, sadness and depression. London, UK: Hogarth Press; 1980.
• Clark S. After Suicide: help for the bereaved. Melbourne, Vic: Hill of Content; 1995.
• Corr C. Enhancing the concept of disenfranchised grief. Omega: J Death Dying. 1998; 38: 1–20.
• Howell, C. (2010). Keeping the blues away: The ten step guide to reducing the relapse of depression. Radcliffe, Oxford.
• Neimeyer, R. A., Baldwin, S. & Gillies, J. (2006). Continuing bonds and reconstructing Meaning: Mitigating complications in bereavement. Death Studies, 715-738.
• Parkes CM. Bereavement as a psychosocial transition: processes of adaptation to change. J Soc Issues. 1988; 44(3): 53–65.
• Parkes CM. Coping with loss. BMJ. 1998; 316: 1521–4.
• White C, Denborough D. Introducing Narrative Therapy: a collection of practice-based writings. Adelaide, SA: Dulwich Centre Publications; 1998.
• Worden J. Grief Counselling and Grief Therapy: a handbook for the mental health practitioner. 4th ed. New York, NY: Springer Publicati