How People Respond to Trauma and Bereavement – Part II

How People Respond to Trauma and Bereavement – Part II

 

Grief, our natural response to bereavement or the loss of a loved one, has traditionally been defined by Kubler-Ross in five stages: denial, anger, bargaining, depression, and acceptance. The framework became foder for pop culture that has caricaturized it in movies and television to the comic relief of audiences.

In its exaggerated form, the biggest criticism against it became all the more glaring: humans aren’t machines with a uniform, programmed set of reactions. The stages fail to account for personal idiosyncrasies which can impact the way a loss is handled. Critics assert that not everyone will undergo all of the stages, just as not everyone will be able to move on and return to their normal life.

Although the emotional upheaval that follows bereavement can cause varied, healthy reactions, like depression and withdrawal, grief becomes unhealthy and “problematic” when the same conditions persist. Some experts peg the normal mourning period between three to six months; others argue that it can last to a year or more.

a27Certain symptoms, however, are generally acknowledged to be signs of problematic grief: long-term loss of interest in work, social interactions, and other routine functions; an excessive preoccupation with activities, behavior that may be accompanied by self-blame.

For prolonged period, the person rigorously avoids any reminder of the deceased, sometimes removing all photos from sight and steering clear of the people who were close to him. By contrast, someone who’s unable to accept reality might refuse to throw away any of the departed’s personal possessions. (In an extreme, macabre form of attachment and obsession, Dr. Carl von Cosel preserved for years the corpse of a patient he loved but couldn’t treat, using piano wires to keep the skin together.)

Grieving tends to be more problematic when the death was sudden or violent. When the mourner’s sense of purpose is defined by the departed—for instance a home-bound mother who devotes her time to raising her child—the loss creates a vacuum in the person’s sense of identity. The person gets stuck in the grieving process, unable to move forward, unable to let go.

Sometimes the difference between recovery and limbo depends on the status of the relationship, especially if it had been ambivalent or fraught with conflict and unresolved issues. One of lopez’s patients had difficulty coming to grips with her perished in a shipping disaster, she remained steadfast against the children’s proposal to discontinue the search for his body; the family couldn’t even begin to mourn. “I put her under hypnosis, which actually just gave her a chance to feel like she was still talking to her husband,” the doctor explains.  “She saw him peering through the porthole of the ship, talking to her, saying goodbye, and forgiving her,” since the couple had parted under bitter terms.  Once she resolved her feelings for him, the family could finally grieve and start their journey of healing.

Drivers of recovery

Harrowing events, from death to loss of home, are the turning points in life, the forks in the road that lead to either despair or hope, to isolation or renewed faith in life, to living or merely existing. What makes one person rise above the tragedy, while another sink to defeat?

Experts say it’s confluence of factors, including social support. When family and friends show sympathy or empathy, it invites a level of security and trust that opens up communication, and discourages the person’s tendency to withdraw and shut others out.

a28“Social support is how much understanding you were able to receive from those whom you expected to understand. There are certain forms of trauma which do not elicit sympathy. You’ll be surprised that rape, for example, does not easily elicit sympathy even from loved ones. I have patients whose greatest fear is how their husbands or boyfriends, if they were sexually assaulted. It’s the fear of being blamed. My old patients had decided to come out in public, only to be questioned about their character,” laments Lopez, who is also a board member of sexual violence Research Initiatives of the World Health Organisation.

Citing the high-profile case of one of her patients, Nicole, who accused a US marine for raping her, she says, “Reaksyon ng mga tao (Reaction of the people) was maybe she was a commercial sex worker—what was she doing with the Amirican—while having little understanding of the background that the American who brought her to Manila with her sister was a family friend. Ang (The)  tendency is scrutinize the victim rather that the victimiser in certain forms of trauma. If you’re a rape victim, they’ll look at you and see maganda ba iyon, paano ba ma-rerayp iyan e ang pangit-pangit naman niya. O baka ang sexy niya magsuot, (is she pretty, how come she get raped she’s not even beautiful, or maybe the way she dress is too sexy) so she deserved or she was asking for it.”

The Nobel Peace Prize nominee for advocacy in human rights and anti-violence against women empathizes that the biggest support anyone can offer a victim is to curb the blaming—avoiding accusations, and helping her from censuring her feelings and herself over what had transpired. Because the family serves as a “cushion,” in most trauma causes, Lopez counsels the members on those key points even before beginning the patient’s treatment proper.

The nature of the trauma also influences the chances, speed, and degree of recovery. Losing one’s limb in an accident, for instance, would be harder for anyone to bounce back from than losing one’s home. “There are already studies which show that different kinds of trauma have their inherent, unique impact on the individual regardless of how normal you are, like rape. No matter how normal a woman is, any form of sexual assault has its inherent severe traumatizing long-term effect on the person. And if you compare rape by a stranger and rape by a person she knew, especially in the content of a trusting relationship like incest, predictably and there are studies to show that incest is worse than rape by a stranger,” the psychiatrist says.

[pq]Trauma caused by nature are also less emotionally devastating than one caused by the violence of man. While natural disasters can be attributed to divine acts[/pq]

 

—“Filipinos say, hindi man natin maiintindihan, kagustuhan iyan ng Diyos” (we may not understand, its God’s will)—the latter impacts on a deeper, gut-wrenching level. Lopez describes it as a sense of betrayal, a shattering of one’s assumption that the world is safe; as people man beings simply do not do that to fellow human beings.”

 

– Sunli Coo, Medical Observer

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