Trauma

Acute Stress Reaction/Disorder

Acute Stress Reaction sometimes also referred to as an acute stress disorder or psychological shock, is a psychological condition that occurs after an individual experiences a traumatic event or is a witness to a traumatic event. Either experiencing the event or witnessing the event results in a sudden and intense emotional and physical reaction. Examples of an acute stress reaction are being involved in a terrible automobile accident, involvement in a robbery in a bank, a takeover home invasion, or any situation where the individual perceives/experiences severe injury or death to themselves or someone else. If an Acute Stress Reaction is left untreated it can turn into PTSD (Post Traumatic Stress Disorder).

One who has an Acute Stress Reaction will often experience some disassociation, such as feeling numb or detached from emotional reactions. They will often feel physically disconnected from themselves as if they are watching their bodies and their emotional responses to the event. One becomes hyper-vigilant, easily startled, and very aware of their current environment. One may avoid the place or situation where the first trauma occurred and may experience anticipatory anxiety that they will have an additional acute stress reaction. Symptoms of this type of anxiety usually last only a month.

Individual cognitive-behavioral treatment with breath meditation and imagery are most effective. Helping the individual feel empowered and in control is key to recovery. Bank tellers who take self-defense courses, women who carry mace, or families who prepare for an earthquake are examples of helping individuals regain a sense of control.

Posttraumatic Stress Disorder (PTSD)

Posttraumatic stress disorder is a psychological and physical reaction to a severely traumatic event. If you have been a victim of sexual abuse, sexual assault, or have been in combat or any situation where your life has been threatened you may experience PTSD.

Individuals who develop PTSD have reoccurring thoughts and images related to these events.

They may feel as if they are reliving the trauma. Symptoms include flashbacks, hypervigilance and hyper startle response. Sounds, smells, or anything that reminds them of the trauma may trigger the mental and physical distress. Often people will have vivid dreams about the injury. The trauma often alters individual's thought processes and what they feel on a day-to-day basis. There is an increased fight or flight response and their symptoms last for more than a month. PTSD is more common in women than in men. There is an increased risk for suicide and intentional harming of oneself for those who have PTSD.

A combination of individual and group therapy along with the use of a specific type of antidepressant (SSRI- Selective Serotonin Reuptake Inhibitors) has been found to be the most effective treatment strategy. Benzodiazepines (Ativan, Xanax, Buspar, etc.) are contraindicated for the treatment of PTSD and actually may exacerbate one's symptoms. Drug abuse and alcohol abuse often co-exist with PTSD.

Loss By Homicide

Unlike the death of a loved one from Cancer or another long-term illness, the loss of a loved one by homicide makes the loss a complicated bereavement. Sudden violent death is reverberated across familial generations and often within the community. Even if the perpetrator is caught those grieving experience shock, disbelief, denial, and rage. If the perpetrator(s) are not captured, it prolongs the period of grief. The trial and the publicity also exacerbate the grief.

Other symptoms include "survivor guilt" for being alive or not being able to save the individual's life. With this, loved ones yearn to see the deceased person and may have reunion fantasies to join the deceased. There is a significant decrease in concentration, loss of appetite, and an inability to eat. Individuals may have extended periods of uncontrollable crying; they may experience panic attacks and feel exhausted from lack of sleep. Grief causes a roller coaster of emotion. It is very physically draining.

Individual therapy is the treatment of choice for this complicated bereavement. Often individuals will need a combination of anti-anxiety medication and an anti-depressant. Group therapy is usually not helpful unless is it specifically for those suffering a loss by homicide. The duration of treatment is at least a year and often more depending on the trial and sentencing. If the perpetrator is not found for years or never found it is difficult for individuals to have a sense of closure.

I have 25 years experience in working with individuals, couples, and families who have experience complicated bereavement. In 1995, I started the first Parents Of Murdered Children's Group in the greater Los Angeles area. I worked with LAPD to set up critical incident debriefings when one of their officers was murdered. Individuals who have experienced complicated bereavement  need to work with someone like myself who has years of experience with this population.

Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS) is a tragic, sudden, unexpected death of a child less than one year of age. There is no known specific cause for SIDS, but we do know that there are specific risk factors that make a child more susceptible to this sudden demise. The risk factors include some type of susceptibility, the child's time of development, and environmental contributions. These contributions include sleeping on the stomach or the side, exposure tobacco smoke and overheating. Accidental suffocation may occur from bed sharing or soft objects that may contribute to the suffocation. Being born before 39 weeks of gestation is another risk factor for SIDS. The most effective preventative measure is having the child sleep on his or her back in a cool environment with no loose bedding or blankets. The use of a pacifier, having the child in a smoke-free environment, immunization, and breastfeeding may also be preventative actions. Baby monitors and assisted positioning instruments have not been helpful to prevent SIDS.

Parents who lose a child to SIDS experience sudden death, without being with their infant and without other witnesses. Because of this isolated death, there is often an investigation. Parents often experience Survivor Guilt that "there must have been something that they could have done to prevent this death." The therapist needs to reassure the parents that this type of response is normal, but by its definition, Sudden Infant Death Syndrome is sudden, unexpected, and the initial response is shock, disbelief, and guilt. Individual and group therapy specifically for SIDS has been the most effective treatment. According to the National Institute of Child Health and Human Development  "About 90% of cases happen before six months of age, with it being most frequent between two months and four months of age. It is more common in boys than girls."

Missing In Action

One of the significant factors for those who have a loved one that is "Missing in action" (MIA) is the lack of a known death. There is no recovered body; there are no documents stating how the deceased died, all of the factors that define a known death are missing with those who are MIA. This type of loss is similar to those who are missing after a natural disaster and are never found. In the latter example, family members can assume after time that their loved one is dead. Similar people in the same location did not survive a flood or a plane crash so there is known deaths, not just for a few family members.

With those who have someone Missing In Action, there is never a known death. We have all heard of servicemen/women who have been missing in action, possible presumed dead and turn up years later. At the time that the family receives the news of a loved one Missing in Action, there is always a little hope that s/he will be found or at least identified as a prisoner of war (POW). As time goes on and they are not found, or there is no POW status, the hope begins to dwindle, and they begin to experience the shock, the disbelief that they're loved one may not return. The parallel process for these grieving individuals is that they do not want to give up hope, and they can't begin to have closure because there is no known death. The paradoxical reaction of the bereft is often feelings of guilt for "abandoning" their loved one. They are in a suspended animation where the grief process goes on forever, and they are not able to move forward and have closure.

It is important to realize that your roller coaster of emotion with a loved one missing in action may be more severe and prolonged. Remember there is no right or wrong way to grieve. If someone tells you (Including) a therapist that "you should be over this by now and you need to move on with your life," you probably need to move away from the friend or the therapist. Because of the suspended animation or bereavement limbo some spouses, parents, and other family members want to have closure in the midst of no closure.

To have this closure the family of the MIA will have a Memorial Service often on a particular date, (birthday, anniversary) and will gather together objects of the MIA (often referred to as linking objects). They will find a place that was special to the MIA and have a prayer service, a gathering of family and friends, and utilize some ritual to have closure around the person's absence. Examples include a time capsule in which the linking objects are placed and buried, letting go of the number of balloons equal to the MIA's age, writing notes and tying them on balloons and releasing them.
pow-miafamilies.org

Multiple Losses of Family/Friends Suddenly or Over a Period of Time
(Complicated Bereavement)

When my wife was thirty-five her younger brother who was a hemophiliac died from AIDS after receiving a tainted blood transfusion. When my wife was thirty-six, Doug was thirty-years old. Six months after Doug’s death, my wife’s sister Mary Carol died in her sleep.  She was thirty-seven years of age. Twelve years ago on February 25th, her Mom died of a massive stroke due to complications of diabetes. Her 85-year-old father survives her. In the course of my years of providing therapy for individuals and families who have experienced multiple losses all at once or who have experienced multiple losses over time, these have been the most difficult and tragic cases. My wife has said, "I only have my Dad left and when he is gone my whole family is gone!" I worked with a young woman whose family was killed in a plane crash. Her father was the pilot; her Mom, twin sister, and younger brother were flying to California after picking her sister up at William and Mary two days before Christmas. When I met with her, she said: "I'm it! There are no more Connors; the Connor family was wiped from the face of this earth!" How do you respond to the intensity of such an overwhelming loss? I was there, I was present, and I listened with all of my heart. I she left I said: "I know it doesn't feel like this, but you are going to survive this and get through it." She told me years ago after she introduced me to her husband and her four-year-old twins that what I said to her that night was at times the only thing that kept her going.

When someone experiences multiple losses all at once or over time they have to prioritize their grief. Sometimes this is done on a conscious level, and at other times it is done on an unconscious level.  For Claire, the most important person was her twin sister, her Mom, her brother, and then her Dad. When there are multiple losses over time those, who are grieving often live from one anniversary to the other of the death of their loved ones. Often individuals will complain that they never get a break from the grief. I will permit them to take a "break from their grief." I may have them write the names of the individuals on slips of paper and put it in a little box or envelope and give it to me." I will place it behind books in a glass-enclosed case and will "hold their grief for them." I instruct them that they can compartmentalize their grief and not focus on their sad feelings. I asked Claire if her twin were still here today what "fun thing" would they do? "Go to the beach!" That was her homework assignment for the week. In doing this, I did two things, I gave her a break from her grief, and I returned her internal locus of control. Instead of feeling like the grief was controlling her she was in control of her grief.

It's important to know that our aging grandparents or parents may experience multiple losses over time. I have facilitated Alzheimer's Caregiver's Support Groups for 25+ years. The spouse who cares for their spouse with progressive dementia experience the "ongoing funeral" or "the long good-bye." They see their spouse losing primary activities of daily living, loss of memory, and even not knowing whom their spouse is. Along with the ongoing loss, caregivers will experience the deaths of siblings, family and friends, as well as their pets. The loss of their furry friend can be very traumatic because their pet has often been by their side during the months or years of caregiving. They may also suffer the loss of their health because of caregiver's burnout. These ongoing losses need to be identified and addressed. Your local Alzheimer's Association (alz.org) will be able to give you a list of Support Groups.

Parents of Murdered Children (POMC)
(Complicated Bereavement)

In 1992 Charon D'Aiello Sandoval and David Sandoval came to see me after their son Ochari was tragically shot and killed at age 16 while on a summer educational trip to Morehouse College. On October 23, 1993, Jack Scott was the President of Pasadena City College.

That morning as Dr. Scott was getting ready to attend Pasadena City College's homecoming a Los Angeles County Sherriff came to his Altadena home and informed he and his wife Lucretia that their son, Adam, a promising 27-year-old attorney had been shot by a friend while attending the friend's dinner party. I was the Employee Assistance Director for Pasadena City College and knew Jack & Lucretia in their involvement with PCC. In November of 1993, I began the first Parents of Murdered Children's Group in the Pasadena/Altadena area. Six couples including Charon & David and Jack & Lucretia met for the next three months each Thursday evening. If you have experienced this tragic type of loss, it is essential that you meet with a therapist who has significant experience in working with this population. Couples often need individual as well as group therapy. The grief becomes even more complicated if the perpetrator is known but not found as in the case of the Markowitz couple whose son Nicholas was murdered for drug money owed by his stepbrother. Jesse James Hollywood was on American's Most Wanted List for over three years. The film Alpha Dog and Susan Markowitz's book My Stolen Son capture the tragic prolonged period of grief that the Markowitz's experienced until they found Jesse James Hollywood and he was found guilty of the abduction and murder of Nicholas Markowitz.
http://www.pomc.com