Traumatic Loss

Laurie Anne Pearlman, Ph.D.

Trauma Research, Education, and Training Institute, Inc.

This material may be used or reproduced by others, with appropriate citation of its source: http://www.heal-reconcile-rwanda.org/lec_trau.htm.

Sudden, Traumatic Loss

The sudden or unexpected loss of loved ones can be shocking or traumatic. This is especially true if their death is violent and was caused intentionally, as was the case in the genocide. Survivors of such losses may experience both problems and symptoms related to trauma and problems related to bereavement, or the death of a loved one. When a loved one dies suddenly and in a shocking way, the survivors often find the mourning process complicated or unnatural. In such cases, survivors will need to recover from both trauma and loss. While the symptoms overlap, they are not entirely the same.

What is Psychological Trauma?

Psychological trauma is the experience of stress and distress that are too much to handle emotionally and psychologically. During a traumatic experience, one feels like one is going to die or come apart. Examples of events that can lead to traumatic stress include group violence, rape, other assault, accidents, natural disasters, traumatic losses (like the death of someone you love), and severe illness. It is likely that most people who were in Rwanda during the genocide are experiencing traumatic stress.

Survivors of certain chronic life experiences may also experience traumatic stress.

Conditions like poverty, discrimination, and deprivation, and experiences like childhood abuse or neglect may lead to traumatic stress.

To feel traumatized, one doesn't have to be a direct victim of an event. Witnessing violence can also lead to traumatic stress. The essential ingredients are being overwhelmed emotionally and feeling like death or disintegration is inevitable.

Secondary traumatic stress comes about when something awful happens to people we love or care about. We may have all sorts of terrible feelings and changes in the way we experience the world and ourselves when someone we love is traumatized. So even people who weren't in Rwanda during the genocide and people whose families were not killed may be experiencing traumatic stress.

Perpetrators too may experience traumatic stress. Killing other people or participating in violence in other ways is unnatural and dehumanizing behavior. Those who did so in Rwanda may have symptoms of trauma.

What are the Signs and Symptoms of Trauma?

People experience trauma in many ways. Some of the most common symptoms include re-experiencing the traumatic event, avoiding things that remind people of the traumatic events or circumstances, and "physiological hyper-arousal," which is an unpleasant, biologically based, sensitivity. These are symptoms of post-traumatic stress disorder(PTSD). So, for example, a person with PTSD may have nightmares or flashbacks, the feeling that the traumatic event or experience is happening again right now. That person might try not to go to places or see things that remind him or her of the genocide or of specific people who were killed. "Physiological hypersensitivity" can take a variety of forms: difficulty sleeping, a "startle response," meaning a person is likely to jump when he hears a loud noise or when someone surprises him, difficulty concentrating, emotional difficulties, and somatic problems (problems with health, bodily pain, etc.) with no apparent physical basis.

But post-traumatic stress disorder describes only a few of the many problems people can have after a traumatic event or experience. Let's look at some of the other problems.

Biological (bodily) problems

Sleep difficulties

Somatic problems (bodily pains, illnesses)

Fatigue, exhaustion

Startle response

Emotional (feeling) problems

Anxiety

Grief

Depression

Numbing

Irritability

Low self-esteem, or loss of respect for oneself

Shame

Fear

Cognitive (thinking) problems

Intrusive thoughts about traumatic experiences

Nightmares

Difficulty concentrating

Confusion

Constant thoughts (obsession) with death

Dissociation (disconnection between one part of one's experience and other parts, like thinking about terrible things without any feelings or having awful feelings without knowing what you're thinking)

Depersonalization or feeling "unreal"

Memory problems

Flashbacks ("reliving" the traumatic events)

Behavioral (doing) problems

Substance abuse (overuse of alcohol or other drugs)

Aggression toward others

High-risk behaviors (taking chances)

Self-destructive behaviors (harming oneself)

Suicide

Sexual "acting out" or getting involved sexually with inappropriate partners

Change in eating behavior (stopping eating or overeating)

Interpersonal (relating) problems

Inability to trust others

Social withdrawal

Inability to feel connected to other people (friends, family, community)

Inability to engage sexually with partner

Inability to feel safe with others

Need to control others

Loss of respect for other

Social problems and their psychological consequences

Poverty (no money and despair)

Lack of housing (no place to live and a feeling of homelessness)

Lack of food (hunger and fear)

No jobs or way to support oneself (no way to structure one's time and no way to feel good about oneself)

Spiritual (meaning) problems

Loss of faith in God

Cynicism

Loss of sense of meaning and hope

The hallmark of traumatic stress is disrupted spirituality. That is, when a person is traumatized, the greatest loss of all may be changes in that person's relationship to God. Most people find themselves reevaluating the old, pre-trauma, ways of making sense of the world and finding meaning in life.

Social disruption is the context for many people's lives after group violence such as war, mass killing, or genocide. We cannot ignore the importance of social problems such as poverty, lack of shelter and food, and disrupted community. When people have no place to live or no food, it is difficult for them to think about their emotional problems. Yet they are often unable to solve their social problems without understanding and beginning to address their emotional and other psychological problems. Sometimes people find it easier to talk about their social problems than their psychological problems. This may be because it's more acceptable in the culture to talk about social problems. The culture may not have words for emotions or the culture may regard people as weak if they talk about emotional problems. Yet after mass violence, just about everyone has these problems. So the culture will need to shift over time to develop a language and an acceptance of talking about such problems.

Signs and Symptoms of Sudden Traumatic Loss

In addition to the trauma symptoms described above, people who have lost loved ones through intentional violence may experience traumatic grief or complicated bereavement. Some of the symptoms beyond those of trauma include strong reactions to experiences of separation or loss, anxiety about the possibility of death of oneself or loved ones, and persistent thoughts or preoccupation with the deceased.

What do Traumatized Children Look Like?

Children who are traumatized may become withdrawn, quiet, shy, reserved, or "moody." Other traumatized children, in contrast, may become aggressive, hitting or biting others, calling names, bullying, provoking fights with adults or other children, or abusing younger children or animals. A formerly obedient child may become willful and difficult. Some traumatized children turn their aggression against themselves and injure their own bodies.

Children may express fears, especially fears at night or bedtime, fear of being alone, or fear of new experiences. They may have nightmares. They may play out scenes of horrible events they have witnessed, experienced, heard about, or imagined. They may return to behaviors they had "grown out of," like wetting the bed at night, sucking their thumbs, talking "baby talk," or other, younger, behaviors. Children who have been molested sexually or who have witnessed sexual assaults may become prematurely active sexually. These behaviors are thought to be a child's efforts to make sense of what she/he has experienced.

Some children try to adapt to their traumatized state by using some of the same "behavior" or "doing" problems we listed above including the use of alcohol.

Trauma, Needs, and Relationships

Lists of symptoms only describe certain aspects of the way traumatized people feel every day. Traumatized people's relationships change. They find it hard to meet their most basic psychological needs in constructive ways. These basic needs include:

Safety: the ability to feel that oneself and loved ones are secure and protected

Trust: the ability to rely on one's own judgment and to depend on others

Esteem: the ability to feel good about oneself and to value others

Intimacy: the ability to feel and understand one's own experience and to feel connected to others

Control: the ability to feel a reasonable level of control over one's own behaviors and to feel effective with others

Meaning: the ability to understand one's world and experience

Trauma disrupts these needs. So people may find it hard to relate to other people the way they did before they were traumatized. They have to work to meet these basic needs and they don't always do so in constructive ways. Their actions may not make sense to those around them. When a group of people or a whole society is traumatized, as in Rwanda, everything can feel alien.

Nothing seems to make sense. There can be a collective denial of what happened so that people don't talk about the past or agree that it wasn't that bad. "Life as usual" doesn't exist anymore. Many people may not have the energy or desire to create a new life. And yet that is exactly what must be done.

Patterns and Determinants of Problems

Anyone who has lived through the genocide or other traumatic events may have any or all of these problems. Sometimes a person will have some problems for awhile, and then develop different problems. Sometimes problems shift from morning to evening. The specific problems each person develops depend on:

1. who that person is (his or her previous life experience, his or her genetic and biological make-up),

2. the particular circumstances surrounding the traumatic experiences, and

3. the kind of support that is available before, during, and after the traumatic event or experience.

The people who will have a harder time are those who:

1. were physically closer to traumatic events when they occurred,

2. were victims of intentional harm (as in the genocide),

3. have had previous traumatic experiences,

4. have less support or fewer meaningful connections with others before or after the events, and

5. have personal or family histories of depression or other psychological difficulties.

Symptoms are Adaptations

Every symptom that people have as part of traumatic stress is an attempt to solve some dilemma. Even things people do that are destructive are based in a need to solve a problem. The solution may cause other problems for the person and sometimes for other people. When it does, we call it a symptom. Often symptoms are an attempt to deal with the overwhelming feelings of grief and rage that go along with traumatic stress. So, for example, when traumatized people shut down emotionally or drink too much, usually it's because they can't stand the pain of what they have experienced. These adaptations aren't always in the person's best interest, but they are usually the person's best effort to manage.

Important Points to Remember

1. The hallmark of traumatic stress is disrupted spirituality.

2. The context for traumatic stress following group violence is social disruption.

3. There are individual differences in traumatic stress. Specific events or aspects of events that are traumatic or most distressing for one person may be different from events/aspects that are most distressing for another person. What's most important about traumatic experiences depends on each person. Furthermore, one person's expression of traumatic stress may differ from others'.

4. People's responses and needs will vary across time and situations. A person may be struggling with one thing today and another next week. What is painful for someone today may be different from what he or she felt yesterday.

5. Symptoms are adaptations. Every problem that people have as part of traumatic stress is an attempt to solve some dilemma. This is true even when the "solution" creates more problems.

This material may be used or reproduced by others, with appropriate citation of its source: http://www.heal-reconcile-rwanda.org/lec_trau.htm.