Because of the many varied outdoor work situations and the wilderness spirit that drives many of us to spend our free time playing in mountains or on the water, Juneau and nearby communities experience a number of accidents and tragedies related to these activities. As small communities, we are often personally touched by others' sudden losses though we may not know the individuals directly. With sudden losses and tragic accidents, there are circumstances which complicate the grief process.
Though people tend to most often think of deaths as the type of loss being grieved, there are many other unwanted sudden changes that have severe impacts, such as the sudden loss of one's health, one's previous abilities, income, sense of security in the order of life, homes and businesses. The responses to these unwanted changes or losses can be experienced and expressed in as many unique ways as there are human beings. Sometimes loved ones, friends and co-workers misunderstand normal grief and become frightened by the intense emotions as someone is mourning. There are no ordered steps to go through in grief nor is there a timetable for completing it. Experiencing loss emotionally (with all types of emotional reactions) as well as physically, spiritually, mentally and behaviorally is a part of normal grief.
Complicated grief affects the person's ability to directly experience or express the emotional responses to the loss, often intensifies the reactions and may cause some responses to be altered or displaced into other reactions. It can prolong the duration of the grief process, and can create both unnecessary suffering and harm to the person. Those loved ones who witness the responses often feel uncertain how to support or help.
Both internal and external reasons complicate grief in the experience of sudden losses. Initially, factors that complicate and stress grief responses include abruptness of the loss, traumatic losses and multiple recent losses. Observing trauma or death as well as traumas that are self-inflicted (accidental or intentional) intensify and complicate grief. Often when people are waiting for official notifications about the severity of the situation, there can be intrusive outside influences creating a barrier between loved ones (medical, law enforcement or media), and there are times in deaths when the body is unable to be recovered or cannot be seen. When an accident or natural disasters causes death, injury, or loss (of a home/business) for some and others have been spared, there can often be survivor guilt. Stigma can sometimes be attached with the loss which can create shame or embarrassment and isolation with one's grief. When litigation is involved there are prolonged repetitions of receiving information about the event, putting some aspects of grief on hold. Secondary losses can be extensive in all of these situations.
Internal factors such as unfinished business with the deceased or reduced coping resources can also influence an individual's response to sudden loss and can complicate grief. These might include: having unrealistic expectations of the grief process, lacking a support system, a history of unexpressed losses, depleted resources due to multiple recent losses or recent stresses, an ambivalent, strained or abusive relationship with the injured or deceased, compulsive behaviors or addictions, and consuming guilt or blame. Guilt can take several forms such as, unrealistic guilt (``if only I-'' or ``I should have been there instead of being-''), survivor guilt (``why did it happen to them and not me,'' ``why was I spared'') and causation guilt (``it's my fault, I-'').
When grief is complicated by the factors listed above, meeting with a counselor trained in both trauma recovery and grief/bereavement can prevent undue or prolonged suffering. If grief is not experienced or expressed within the emotional dimension, it will be expressed in the physical, mental and spiritual dimensions in ways that may be harmful. Often with violent tragic events and sudden deaths, a bereaved may experience an initial state of numbness or inability to feel the acute pain that can last months. This is the body's natural response to protect us from pain too overwhelming. Processing the loss at this time can look to others like staring into space, repeated thinking of the accident or event, and automatic pilot with life's daily demands. Months later the person may find it very difficult to manage the pain that is just appearing and supporters may be unprepared for this delayed onset. Family members who have lost a loved one violently may find themselves re-stabilizing in basic ways 18-24 months afterward.
Bereavement supports for individuals, families, organizations and groups are offered through individual support meetings, groups, referrals, library resources and with trainings at Hospice and Home Care of Juneau. Talking about one's loss, in a safe caring place can begin the healing process and can transform a person's suffering to a journey of growth and peace.
Lauren Champagne is a social worker with Hospice and Home Care of Juneau.