or Traumatic Death
A sudden, accidental, unexpected or traumatic
death shatters the world as we know it. It is often a loss that does not
make sense. We realize that life is not always fair and that sometimes
bad things happen to good people. The sudden death leaves us feeling shaken,
unsure and vulnerable.
A Sudden Loss is one that occurs without
any forewarning. A Traumatic Death is one that is sudden, unanticipated,
violent, mutilating or destructive, random and/or preventable, involves
multiple deaths or one in which the mourner has a personal encounter with
Common examples of sudden deaths include: heart
attacks, strokes, ruptured aneurysms, accidents, post-operative complications,
anaphylactic reactions (bee stings, severe allergies), rapidly fatal acute
leukemias, sudden infant death syndrome and rapidly progressive infectious
diseases such as respiratory anthrax, certain pneumonias, Legionnaire's.
Sudden deaths also include suicide, homicide, natural disasters such as
the Loma Prieta earthquake and human-caused disasters such as the Oklahoma
City Bombing or the September 11th terrorist attack.
Special Problems for
Death due to a sudden or traumatic accident or
disaster can raise a number of complex issues for the survivors. The grief
process is often very different from an expected or anticipated death.
Homicide, suicide, or exceptionally tragic events can cause reactions such
as Post Traumatic Stress Disorder on the part of survivors and family members.
Sudden loss or death creates special problems for the survivors. Many of
these problems compound the grief response.
The grief response following sudden loss is often
intensified since there is little to no opportunity to prepare for the
loss, say good-bye, finish unfinished business or prepare for bereavement.
Families and friends are suddenly forced to face the loss of a loved one
instantaneously and without warning. This type of loss can generate intense
grief responses such as shock, anger, guilt, sudden depression, despair
A sudden tragic event shatters our sense of order
and thrusts us into a world forever changed. Survivors of sudden loss may
experience a greater sense of vulnerability and heightened anxiety. The
safe world we once knew, no longer exists. We fear for ourselves, our family
and friends. Survivors can become overwhelmingly preoccupied with thoughts
that such a random act of violence might happen again.
Along with the primary loss of the person, families
and loved ones may experience concurrent crises and multiple secondary
losses: lost income, loss of home, loss of social status. The role the
loved one held in the family is gone. It takes time for the family to reorganize.
Family may be left feeling in a state of perpetual disarray with a lingering
sense of unease and disorganization. Marital and other family relationships
can become strained.
Additional problems arise if the grieving survivor
was involved with the disaster or was physically injured. Memories of the
accident or the disaster may dominate the person's mind. They may be taken
up with feelings of numbness, unreality and fear. The bereaved person may
suffer from "survivor guilt," wondering why they survived when others have
died and believing that they could have or should have done more to prevent
The reaction to sudden deaths can be further complicated
if the death is due to a violent act. If there is a trial, the grieving
process may be unduly prolonged, stretching out to the time it takes for
the trial. It may be particularly difficult on the family if the killer
of their loved one is not be caught or goes unpunished.
Suicide is one of the most agonizing kinds of
death for surviving spouses or family members to endure. This type of death
can result in shame, anger and guilt if family members blame themselves,
or are blamed for the death. Suicide is also one of the disenfranchised
or publicly unacknowledged losses. Many times, it possible, the reason
for a death due to suicide is hidden. The threat of social stigma contributes
to family shame.
Families may feel unable to fully grieve and reach
closure in situations when there is no positive confirmation of the death,
when the physical body has not been recovered or if the body is available
but the family is unable to view it. This factor can make it difficult
to grasp the reality of the death has occurred as survivors continue to
hope. Only when the reality is fully grasped can survivors move past the
trauma to face the full realization and the pain of grief.
In public or particularly newsworthy events, survivors
may also have to deal with intrusion by the media. As we well know the
media can become an additional pain source—not respecting the families
privacy, replaying tragic events—such as the explosion of the Challenger
space shuttle or plane crashing into the World Trade Towers—over and over
again. With criminal incidents families and survivors must deal with the
police, investigators and lawyers.
Since the death was not anticipated, the deceased
may have left unfinished business which the surviving family members may
need to handle. These may be domestic concerns but could equally well be
work-related or legal matters. Legal and financial affairs following certain
types of death e.g. suicide, deaths in which the body is never recovered,
may be complex.
The search for meaning of the loss can challenge
a survivors religious and spiritual beliefs. Sudden losses in particular
can precipitate an existential crisis as the survivor searches for meaning.
They start questioning their internal belief system and values. Goals,
plans and purchases which were important the week prior to the event, abruptly
seem trivial in comparison. Survivors are forced to look at and re-evaluate
Factors Affecting the
Nature of a Sudden Loss
1. Natural vs. human-caused
Natural losses are illnesses and natural disasters—heart
attack, stroke, earthquake or hurricane. With natural losses the resulting
anger is directed towards the deceased or God. Human-caused losses include
homicide, bombings, or acts of war and may be due to individual hostile
actions. In human-caused disasters the survivor’s anger can be focused
on the responsible person(s).
2. The degree of intentionality
In accidental deaths there is no clear focus
of intentionality. There is a high degree of intentionality with deaths
such as homicide. Anger and blame for the death can be directed at a responsible
3. The degree of preventability
Illnesses like a sudden heart attack or ruptured
aneurysm and natural disasters earthquakes, hurricanes, tornadoes may not
be perceived as being preventable. Others such as homicide may be highly
preventable. When deaths are perceived as preventable, there may be a strong
sense of the "What if’s." Preventable deaths are likely to increase a sense
of guilt, especially if one feels responsible or a sense of anger or if
one holds others at fault.
With some losses, the death is instantaneous.
Immediate death may leave feelings that the person who died had no time
to prepare for the death. Many survivors find the knowledge of an instantaneous
death to be comforting. In others situations, there is a question whether
the deceased suffered pain or anxiety prior to dying. These memories, particularly
if the person's relative died in extremely distressing circumstances may
dominate the person's thoughts, rather than the memories of the person
themselves. This can become a diversion from grieving for the deceased
person disrupting the grieving process. Imaginings or memories of the traumatic
death may cause so much distress, that remembering the person who died
may be actively avoided.
The number of people affected by the loss can
affect the intensity of grief. When large numbers of people are involved
as with a devastating hurricane, the ability of others to offer support
maybe limited, because of the extent of those involved. Conversely, highly
public losses such as the September 11th tragedy, Littleton Shootings or
losses due to war can result in a greater community response and demonstration
of support, allowing survivors to bond and grieve together.
6. The degree of expectedness
Some sudden losses are still somewhat expected,
even if just retrospectively. The heart attack of someone at risk or the
sudden loss of someone struggling with a life-threatening illness, frequently
do not come as a total surprise. Other losses, such as accidents or random
acts of violence, offer little to no forewarning
and are a shock to the
Traumatic Grief &
Tragic events can be much more difficult to recover
from quickly, or at all, depending on the nature of the tragedy e.g. unnecessary
or accidental death, rape, loss through natural disasters, death during
war-time, unnecessary acts of violence.
Traumatic grief generally occurs when a death
A "traumatic" death predisposes the grieving person
to be at a much greater risk for suffering subsequent complicated mourning.
Sudden, unexpected - the result of natural causes
but without a history of illness.
Violent, Mutilating, Destructive - especially when
caused by the actions of another person, an accident, suicide, homicide,
or other catastrophe.
Is viewed as random and/or preventable.
Involves multiple deaths.
Results in the survivor’s (mourner’s) own personal
encounter with death.
Complicated Mourning is defined as a delayed
or incomplete adaptation to loss or failure in the process of mourning.
The grieving process with traumatic grief is complex,
intensified demanding even more than a normal response as the survivor
struggles to cope with the loss and the aftermath. Traumatic losses are
the ones that often require counseling and professional help from those
knowledgeable in the field to help the grieving better cope with the loss.
Human caused disasters such as the September
11th events catch us off guard. These acts are viewed as random acts of
violence, can be more frightening than natural disasters, often perceived
as " an act of God." Because the acts were committed by humans rather than
being an "act of God" there is the perception that "We should have seen
it coming," "We should have been more vigilant," "We could have prevented
this event from occurring." It is difficult for us to believe that fellow
human beings are capable of such atrocities. There are several differences
between human and natural disasters that make the event even more stressful:
There is no warning, therefore no time to prepare.
Unlike a hurricane or slow-rising flood, there is no way to get ready for
a human-caused disaster.
We don't expect this kind of disaster. Most of the
disasters in this country are weather related or accidents.
There have been few incidents of terrorist attacks
occurring in the United States. The last notable one was the attack on
Pearl Harbor, 60 years ago. Terrorist attacks happen somewhere else, not
in the "safety" of the United States.
It is difficult to comprehend how people could carefully
and deliberately plan and execute a mission that would cause so much death
and destruction and injuries.
Terrorists acts can lead us to question our fundamental
beliefs and values—what we know to the true, right and just in the world.
TV, radio, and newspaper coverage make us all feel
like part of the disaster. Many experienced the events "first-hand" watching
the live media coverage. Thus even more people became secondary victims
of the event.
To feel safe again, we have given up some of the
freedoms and life-style choices we have taken for granted in the past.
Witness the changes in travel, restrictions on what can be taken on a plane,
mail handling and increased security at public events.
Sudden Death leading
to the Unanswerable "Why?"
Trying to make sense of or understand sudden
losses can be difficult. Survivors are left asking "Why?" "Why did this
happen?" Yet events such as the September 11, 2001 tragedy and the Northridge
earthquake were beyond anyone's control; they are a sudden, unexplainable
It is human nature to want to answer the question
"Why?" yet it may be difficult if not impossible to find an answer. Instead
the question "Why?" is more of a plea for meaning and understanding. The
thoughts of Rabbi Earl Grollman provide a useful perspective for coping
with this difficult question:
Now death has
shaken your faith, "Why?" "Why must life be one of sorrow?" "Why?" There
are no pat answers. No one completely understands the mystery of
death. Even if the question were answered, Would your pain be eased, your
loneliness less terrible?
Asking "Why" may in actuality be counterproductive,
especially for the healing process. Perhaps it is better to ask "What can
I do about it now?" "How can I help?" or "How do I pick up the pieces and
go on living as meaningful as possible?" The following quote sums this
"Why" may be more than
a question. It may be an agonizing cry for a heart-breaking loss, an expression
of distress, disappointment, bewilderment, alienation, and betrayal. There
is no answer that bridges the chasm of irreparable separation. There is
no satisfactory response for an unresolvable dilemma. Not all questions
have complete answers. Unanswered "Why's" are part of life. The search
may continue but the real question might be "How [do I] pick up the pieces
and go on living as meaningful as possible?"
The three phrases that
I should let go from my mind, if I want to be serene
"What if?" "If only..."
and "Why Me?"
Basics on Coping for
It is important for the grieving person to take
care of him/herself following a sudden loss. He/she is dealing with an
event that is beyond his/her control. One way of helping is to do things
that help re-establish the person’s sense of control over their world.
It is also important to focus on the basics the body needs for day-to-day
How to Help
Maintain a normal routine. Even if it is difficult
to do regular activities, try to anyway. Putting more structure into a
daily routine will help one to feel more in control.
Get enough sleep, at least plenty of rest.
It may be helpful to keep lists, write notes, or
keep a schedule.
Try and get some regular exercise. This can help
relieve stress and tension.
Keep a balanced diet. Watch out for junk food, or
high calorie comfort food binges.
Drink plenty of water.
Drink alcohol in moderation. Alcohol should not be
used as a way of masking the pain.
Do what comforts, sustains & recharges.
Remember other difficult times and how you have survived
them. Draw upon the inner strength.
Take it one hour at a time, one day at a time.
Initially, be persistent and offer concrete help.
A grieving family may feel so overwhelmed by the loss that they may not
know where to start or what someone can do to help. Offer to prepare meals,
help with child care, answer the phone, run errands, or help make phone
calls or memorial arrangements. If the media is involved, it may be beneficial
to run interference for the family.
After a few months, support is most needed. Be
prepared to listen. Give the bereaved time to talk about their loss if
they want. Ask how you can help. You can offer to take them to or go with
them to a support group if it's feels appropriate.
Over time it helps to remember the grieving on
the difficult days—anniversaries, holidays, the birthday or the death day
of the person who died. People like to know that others still remember
their loved one.
Sudden losses, like all losses, are very distinct
and are likely to affect survivors in many different ways. One cannot compare
loss. The greatest loss is the one that the grieving person is suffering.
Each loss, whether sudden or not, creates its own unique issues. It is
important to allow survivors to grieve in their own individual way.
Sudden loss create distinct issues and problems
for survivors. It also shares many reactions common to the grief process—being
a process that survivors go through following a loss. Each type of sudden
loss, whether a heart or a terrorist attack, leaves survivors bereaved,
dazed and vulnerable.
Dyer KA. 9-11: United in Courage
& Grief. Why does my heart Feel so bad? October 7, 2001. Available
Red Cross. When Bad Things Happen.
2001. At: http://www.redcross.org/services/disaster/keepsafe/badthings.html.
Rando TA. Complications in Mourning
Traumatic Death. Chapter 11 in Doka KA (ed). Living with Grief After Sudden
Loss: Suicide, Homicide, Accident, Heart Attack, Stroke. Washington D..:
American Hospice Foundation, 1996.
Rando TA. Treatment of Complicated
Mourning. Champaign, IL: Research Press, 1993.
National Association for Loss &
Grief. Grief Reactions Associated with Accidental or Traumatic Death. Available
Paul BJ. Reactions to Sudden or
Traumatic Loss. 2001. Available at: http://www.aarp.org/griefandloss/articles/15_a.html.
Doka KJ. Sudden Loss: The Experiences
of Bereavement. In Doka KJ (ed) Living with Grief After Sudden Loss: Suicide,
Homicide, Aident, Heart Attack, Stroke. Washington D.C.: Hospice Foundation
of America, 1996.
Grollman, E. Living When a Loved
One has Died. Boston, MA: Beacon Press; 1995, p. 8.
Grollman RA. Why? Journeys Newsletter.
Washington D.C.: Hospice Foundation of America, March 2001 p. 3.
Anderson M. Newcastle Centre for
Family Studies: Death in the Family. Available at: http://www.ncl.ac.uk/ncfs/ncfs/document55.html.
Dyer KA. 9-11: United in Courage
& Grief. Ways of Coping then Helping. October 7, 2001. Available at:
Life is forever changed
and very different following a sudden loss.