The Difference Between Grief & Traumatic Grief
When someone we love dies, it is always a painful adjustment and sometimes a shock, as well. How well we manage to negotiate the process of acceptance and moving forward depends on our stage of life, the circumstances of the death, how important the person was to our identity and security, and what supports we have, as we mourn.
For children, death is frightening and the death of a close relative or especially a parent, can be overwhelming.
Whereas grief is defined as deep sorrow and distress over the loss of a loved one, mourning is the process of adapting to the loss and finding new meaning in life. Traumatic grief is grief that prevents or interferes with the mourning process, and in children, traumatic grief can interfere with their social, emotional, and cognitive development.
Children experience loss depending on their developmental level.
Infants and toddlers 0-2 experience a sense of ‘gone ness’ that manifests itself in sleep, eating, and bowel distress. Preschoolers 3-6 might worry that the dead person is cold or hungry or might want to go to heaven to visit them. Children 6-10 might be preoccupied with worries about other people dying, or themselves dying.
Older children understand the permanence of death, and may feel life is unfair, why did this happen to me? They may be extremely sad or angry, have sleeping and eating problems, and difficulty concentrating which are all typical of adult mourning.
Many children, even from a young age, may worry that they were somehow responsible or contributed to the death of the person they loved, or that they could have prevented them from dying, which adds considerably to their distress.
The process of mourning
Being able to mourn successfully, which means being able to move forward with life, is a complicated process. A child has to be able accept the loss which means tolerating the pain of the loss when thinking about the person who has died. A child must also be able to tolerate the guilt or regret or anger about things said or done in the relationship that can never be unsaid or undone.
In order to transform the living relationship into a loving and supportive memory requires integrating positive aspects of the deceased’s personality into one’s own identity – my mother was a great listener and I‘m like her in that way. My dad was ferociously competitive and I’m like that too.
Trauma interferes with mourning
Many experts say that the loss of a parent by any means during childhood is traumatic but whether that trauma leads to traumatic grief such that the child is unable to mourn and unable to move on with life, depends on many factors.
Being unable to say goodbye, witnessing a violent death, shame or self-blame such as in a suicide, are all situations that could contribute to a child experiencing traumatic grief. It is not the ‘objective’ facts surrounding the death that are important in terms of trauma but rather the child’s experience of the events that matters.
When children experience traumatic grief they may experience intense fear and helplessness, have horrifying recollections of the event, nightmares and other panic symptoms, or they may put all their energy into avoiding thoughts and feelings about the death, become numb, unable to recall details of the event, and feel detached from activities and people.
The more trauma symptoms a child experiences, and the longer they persist, the less the child is able to mourn. If a child cannot think about a parent’s death because she can’t tolerate the image of the mutilated body, if the child can’t identify with the dead parent for fear of coming to the same fate, if preoccupied by revenge fantasies, or shame or guilt, the child will be unable to negotiate any of the tasks of mourning.
The role of parents
Parent’s responses can have a huge impact on whether or not a child develops traumatic grief. Sometimes surviving parents’ distress can make them irritable or depressed. Sometimes parents are avoidant and unable to mourn which can result in their being unable to tolerate their child’s grief; the child senses it and withdraws. Children monitor their parent’s reactions very closely and don’t want to add to their upset and anxiety. Sometimes, when a child loses a parent, he or she loses both parents.
Children do better when the surviving parents are better able to cope, and when there are close extended family members who can step in and provide support. It doesn’t have to be the surviving parent but someone needs to help the child make sense of the death, relieve them of any feelings of guilt, answer their questions, and listen to their pain. And someone needs to help the surviving parent.
Studies of families who have endured war and relocation have concluded that mother’s states of mind are most predictive of how the family members will cope in the short and longer term. Mothers who are able to manage their stress and grief, and adapt to their new roles and communities have children who manage and adapt, as well. Mothers who are depressed or anxious, living in the past, or unable to adapt are more likely to have children who struggle. It isn’t clear whether mothers who cope and adapt are modelling effective strategies for their children or whether resilient mothers are able to attend better to their children’s psychological needs. Probably, both are important.
How to recognize traumatic grief
Typically, children who are grieving are distressed for periods of the day but they are also able to play and to engage with friends and activities during other periods of the day. They cry and have anger outbursts but they also laugh. They may have trouble sleeping or concentrating but those difficulties tend to subside after a month or so. They usually want to talk about the person who died, to ask questions, and to participate in memorializing that person by creating a scrapbook or planting a shrub. They are able to recollect both positive and negative aspects of the deceased.
Children who are experiencing traumatic grief are distressed or disengaged most of the time. They have lost interest in activities and friends and have a much more constricted range of emotion than previously. They tend to be agitated and fearful, or withdrawn and apathetic. They avoid talking about the person who died or are consumed with the circumstances of the death rather than recalling happier, less disturbing events.
For young children, it is their play which is often most revealing of their psychological state. Normal play is exuberant, spontaneous, and creative. Themes may be consistent but there is always experimentation, revision, new expressions and new resolutions. Traumatic play, however, has a repetitive, uncreative quality that doesn’t provide either emotional relief or a resolution of trauma themes. One therapist describing the play of a young, traumatized child said, “It’s like we’re on a train but going nowhere- we never get out of the station.”
It’s very important to ask specific questions about a children’s thoughts, feelings, and motivations to understand whether the child is actually mourning or avoiding mourning. For instance, when a child insists on spraying her pillow with her mother’s cologne, she might be pretending that her mother is still alive or she might be remembering her mother more vividly with the help of the evocative scent. The former would be in the service of avoiding mourning while the latter would be in the service of furthering the mourning process in a soothing way.
An example of traumatic grief
Robert Redford’s film, Ordinary People, tells the story of Conrad, a teenage boy from a privileged white family whose brother drowned while the two of them were sailing.
The brother was buried, life moved on, and no one discussed his death. The mother was very private and didn’t like to talk about feelings, particularly negative ones. The father was busy working and didn’t like to upset his wife. Conrad quit the swim team, avoided all his friends, who were also his brother’s friends, and spent most of his time alone.
About four months after the funeral, Conrad slit his wrists in the bathroom when his parents were out. They discovered him close to death. The film is about the unravelling of Conrad’s acute distress, his guilt that he survived, that he hadn’t saved his brother, his rage that his brother was careless and hadn’t returned to shore when the storm began to blow up, his all-consuming, vivid image of his brother’s hands slipping away from the boat, and his conviction that his mother wished he had been the one to die.
The intolerable feelings festered and then exploded. Traumatic grief doesn’t always lead to suicide but it always causes pain and interferes with development. It presses the ‘pause’ button on life. In this case, it might have ended it.
What contributed to Conrad’s development of traumatic grief?
No opportunity to process the death of his brother, to talk about his guilt, rage, and fear, and to develop a trauma narrative.
His parent’s withdrawal into their own pain and loss which meant he was alone.
Conrad’s belief that he could have/should have saved his brother.
Conrad’s belief that his mother wished that he had been the one to die.
Conrad’s isolation from friends and potential sources of support and self-esteem.
Conrad’s ambivalent feelings about his brother that he hadn’t had the opportunity to express.
Treatment approaches:
Most interventions involve education about grief and trauma, helping children express their thoughts and feelings, finding ways to manage trauma reminders, resolving ambivalent feelings and unfinished business with the deceased, and transforming the relationship with the deceased to one of memory through activities such as the creation of ‘memory books.’ All approaches assist children to develop a ‘trauma narrative,’ a coherent, meaningful story about the death of their loved one.
When in doubt, consult the family doctor
Because traumatic grief interferes with all aspects of a child’s development, as well as creates great suffering, it is critical to have the child assessed and treated, sooner rather than later. Any number of symptoms are ‘normal’ in the weeks after the death of someone important but if the child is consistently distressed or withdrawn, unable to talk about the deceased, or focused on details about the death, is fearful or engaged in excessive self-blame, it’s important to consult the family doctor. Regardless of the role he or she plays, if any, the family doctor should always be in the loop because emotional distress in children often shows itself in physical symptoms.
Accepting that mourning may never end
Because death and mourning are painful for those involved and unsettling for bystanders, people are often in a hurry to ‘get over it’, to ‘move on.’ People offer such advice as, “the first year is the hardest and then it will get better” or “keeping busy is the best way to forget,” or “think about the future, not the past.”
Although well meaning, such advice is offensive and alienating to those in the process of mourning. What it says to them is, “please don’t be sad in front of me and please don’t talk about your loss anymore.” Mourning often takes a lifetime, as people negotiate each new stage without their mother or father or sibling or partner.
Their success in dealing with the loss at an earlier stage in life is often reflected in the nature and quality of subsequent relationships. The effort to ignore or forget the loss interferes with people’s ability to enjoy new relationships and new possibilities for happiness. Children want to feel reassured that they won’t be leaving mom or dad behind, as they move forward with life.
Resources
NOTE: See the earlier article on the website: Helping Children Cope with Death.
Alan D. Wolfelt, Finding the Words: How to talk with children and teens about death, suicide, funerals, homicide, cremation, and other end-of-life matters, Companion Press, 2013.
Judith A. Cohen, Anthony Mannarino, Tamra Greenberg, Susan Padlo & Carrie Shiply, “Childhood Traumatic Grief, Concepts and Controversies,” Trauma Violence & Abuse, Vol. 3, No. 4, October 2002, 307-327.
Jeffrey N. Wherry, Lindsay P. Huffhines, and Desiree N. Walisky, “A Short Form of the Trauma Symptom Checklist for Children,” Child Maltreatment, 2016, Vol. 21 (1) 37-46
About The Author
Janet Morrison, M.A., C. Psych Assoc. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.