by Ciara O’Mahony
All grief is traumatising to some degree, and you’d be hard-pressed to find anyone out there that has lost a significant loved one and not suffered some form of trauma as a result.
However, there is a spectrum and depending on a person’s circumstances – the pendulum can swing in any direction.
Speaking from experience, trauma often operates like liquor – out of nowhere, it creeps up on you.
There are many different forms of grief – and each grief manifestation holds varying degrees of trauma. It’s also important to make the distinction between grief and trauma. Two markedly different emotions that (in the case of bereavement) very often link to the same thing; the death or ‘possible’ death of a loved one.
What is grief?
According to grief recovery experts John W. James and Russell Friedman, grief is the conflicting feelings caused by the end of or change in a familiar pattern of behaviour. With that in mind, it wouldn’t be entirely unreasonable to think that most of us (to some degree) are grieving without any proper acknowledgement or support. According to James and Friedman, there are many situations that can actuate feelings of grief including:
- Loss of a job or dream (or career ambition)
- Separation from a friend/lover/family member
- Pet loss
- Moving house
- Going on vacation
- Illness (mourning the ‘old’ self and adjusting to the ‘new’ self)
- Death of a loved one
There is a silent belief that grief is only permissible under particular circumstances (i.e. the death of a loved one) and even at that – we are ill-prepared to deal with loss (our own and other people’s).
Throughout my mother’s eight-month hospitalization, I lost count of the many times I heard the words ‘’at least’’ spoken to me by (well-meaning) friends and family members. At the time my mother’s body had completely shut down and the only thing keeping her with us was a life-support machine.
‘’At least you can be there with her. That must account for something.’’
‘’At least she’s still alive, oh boy she’s a fighter!’’ ‘’At least you get to spend all this time with her. Some people are not as lucky.’’
And on it went, platitude after platitude – until I became so hurt by their dismissiveness – that I either agreed to ‘save face’, or disengaged from the conversation to preserve my mental health. Loss, it seems, incurs more loss and this often results in a griever turning to substances to cope.
What is trauma?
If you were to ask a trauma expert to define trauma, they’d likely tell you that there are many different forms and manifestations. There is also a wide range of trauma implications.
For example, in childhood trauma – Complex Post Traumatic Stress Disorder (CPTSD) is prevalent and is a common condition in those who endured painful or disturbing early life experiences.
Trauma is defined as ”a deeply distressing or disturbing experience.” There is a wide range of different traumas including:
- Trauma from an injury
- Emotional trauma (psychological or emotional damage)
- Childhood trauma (often a result of physical, emotional and sexual abuse)
- Birth trauma
- Psychic trauma (a psychologically upsetting experience that produces an emotional or mental disorder and has lasting effects on a person’s thoughts, feelings and behaviour).
Traumatic grief versus grief
Many researchers believe that traumatic grief is triggered by an unexpected loss and that such a loss induces post-trauma survival mechanisms (as well as dealing with the loss itself).
Month’s before my mother’s eventual death, she became seriously ill unexpectedly – one minute we were eating dinner, the next she was in a hospital resuscitation unit surrounded by a team of doctors attempting to save her life.
That night, I discovered what it felt like to feel ‘outside of myself’, almost as if what I had witnessed somehow peeled me out of my own skin. According to trauma experts, this is the body’s natural coping mechanism known as ‘dissociation.’
The physiology of trauma
As well as being emotional, trauma is inherently physiological and can produce emotional, spiritual and physical misalignment. There are two main types of trauma; event trauma (known as single-event trauma or incident trauma) and childhood trauma. For the sake of this article, I will be focusing on single-event trauma.
Single event trauma as defined by the National Centre for Biotechnology Information is a trauma that happens to one person in a single event. Examples include being attacked and/or incurring a physical injury. Single event trauma can also be induced by the death of a loved one.
Those who develop single event trauma due to bereavement often feel deep shame for not being able to help their loved one or not doing enough to support them. People who continue to experience this level of shame often feel isolated, alone and in some cases, victimized.
If left unaddressed, trauma can result in a negative spiral leading to both physiological and emotional discomfort and/or dysregulation where using substances to numb the pain seems to be the only solution.
Trauma can very often become trapped within the brain and the Sympathetic Nervous System (SNS). Our bodies are clever vehicles and know exactly what to do to protect us in times of great stress. Essentially, the body stores stressful experiences in the cells so that we have the necessary components to get through an ordeal.
It is important, therefore, for people to recognise the signs of unresolved trauma so that the trauma can be released from the system thus ridding the body of any unpleasant symptoms.
Peter A. Levine, Ph.D., gives an insightful explanation of trauma:
Symptoms of unresolved trauma include:
- Anxiety and/or panic attacks
- Chronic or ongoing depression
- Flashbacks, nightmares and painful memories associated with a traumatic event
- Sleep disturbance
- Detachment and feeling as though you are ‘dead inside’
- Hypervigilance (feeling as though you are constantly alert)
- Irrational fears and phobias of places, people or things
- Suicidal thoughts
- Dissociation – feeling disconnected in situations and conversations
About a year after my mother’s death – I experienced my first ever flashback.
I was on a short vacation with a friend in Italy, and as we scanned the breakfast menu one morning – an upsetting image unexpectedly flashed into my mind. The memory was of a painful incident that occurred during my mother’s hospitalization.
Interestingly, the feelings that accompanied these flashbacks included intense guilt, after all, what kind of daughter could go on vacation while her mother doesn’t get to live at all?
I discovered that at the heart of the painful memories, was a combination of shame, guilt and unresolved trauma.
Therapies such as EMDR (eye movement desensitisation reprocessing) can help an individual to ‘reprocess’ painful memories with the help of rapid eye movements. This involves focusing on a particular memory whilst moving the eye in a particular way (guided by a therapist). Cognitive Behavioral Therapy (CBT) and Trauma Recovery are also extremely beneficial.
Different types of grief
Ambiguous loss is defined as a loss that occurs without closure or clear understanding and often occurs in circumstances such as the disappearance of a family member, death of an ex-spouse and termination of a pregnancy – ambiguous loss also includes a family member being physically alive but in a state of mental and/or physical decline.
Many informal caregivers and family members whose loved ones’ are critically ill often fall into this grief category. The complexities of ambiguous loss are rife – particularly in circumstances where a death hasn’t occurred (or been confirmed) and yet the grief is as intense as if it had. Essentially, ambiguous loss spurs people into a state of ‘’grief limbo’’.
The biggest challenge for people within this group is the invalidation associated with their grief, and even the grievers themselves are likely to be bewildered by the intensity of their emotions – after all, society has taught us that we should only grieve the dead – it certainly doesn’t make sense to grieve those who are still alive, irrespective of how life-threateningly ill they might be!
Ambiguous loss can also be applied in cases of addiction. Under these circumstances, the addict (and the addict’s loved ones’) are likely to be mourning the way the addict was before they started using.
Disenfranchised grief refers to any grief that goes unacknowledged or invalidated by social norms. Disenfranchised loss often occurs in the following scenarios:
- A loss that is labelled ‘’less significant’’ such as a loved one’s mental health declining, or a family member who has dementia, loss of mobility through ill health, loss of safety and independence of years of your life to abuse or neglect
- Unacknowledged relationships: those who have lost an ex-spouse, a secret partner, or the death of someone they might not have met such as an estranged sibling or parent
- Stigmatized loss: Losses that come with a stigma attached such as infertility, suicide, abortions, estrangements with loved ones’ suffering from addiction, or severe mental health issues
Those who fall under this category very often learn that their grief doesn’t align with ‘’social norms’’ and tend to isolate themselves as a way of coping.
Other self-destructive behaviours such as addiction can also occur as a result of disenfranchised grief.
Anticipatory grief is a type of grief that occurs before death (or another great loss). In many ways, the loss is anticipated, for example – when someone is terminally ill, or someone can predict the loss of a job, relationship or even a career aspiration or lifelong dream.
Experts say that anticipatory grief is ’’the total set of cognitive, affective, cultural, and social reactions to the expected death felt by the patient and family.’’ Survivors of anticipatory grief are known to experience the following:
- Heightened concern for the dying person
- Attempts to adjust to the consequences of the death (often before the death has occurred)
There are several other grief types including absent grief, chronic grief, delayed grief, inhibited grief and unauthorized grief. Some would argue that it’s possible for a person to experience grief types simultaneously. Unbeknownst to me at the time, I experienced both ambiguous and disenfranchised grief in varying degrees, in an attempt to adjust to my mother’s illness (and to her subsequent death).
Traumatic Grief and Addiction
Research shows that some forms of grief increase the risk of developing a substance misuse disorder. Other researchers believe that grief and addiction are interconnected. Losing a significant loved one is perhaps one of the most painful experiences and the human brain can only handle so much before it begins to shut off.
This ‘’shutting off’’ period may be temporary or long-lasting, and trauma experts have long spoken about the ‘’freeze’’ response, which is when the body freezes in an attempt to survive a traumatic ordeal.
During an attack, for example, a victim might hold their breath as a shock response, and very often, the body maintains the ‘’freeze’’ response long after the event has occurred. An individual might find that they still hold their breath or find themselves in a state of hyperarousal, even when there is no evidence of an external threat present.
Trauma often stores itself within the body and as a result, an individual’s emotional wellbeing is likely to be impacted. The unpleasant symptoms that accompany traumatic grief can also lead to addiction.
A study on bereaved men showed that they were twice as likely to have a substance misuse disorder in comparison to men who were not grieving.
Other studies surrounding complicated grief showed that people were more susceptible to develop an addiction in an attempt to rid themselves from the pain of mourning.
Brain studies have shown that complicated grief activates the nucleus accumbens (a part of the brain’s reward centre that plays a big role in addiction-related behaviours).
Brain scans taken during the study highlighted the activation of neural pathways in the brain that were associated with the longing of alcohol and drugs, suggesting that memories of the lost loved one, may lead to addictive behaviours in those suffering from complicated grief.
The way other people relate to a griever after a significant loss can trigger addiction and mental health problems.
Being dismissive of another person’s loss can also lead to a re-traumatisation of the loss. This often occurs in cases where a griever is ‘talked out of their grief’ or had their grief minimised by those they once trusted, leading them to isolate themselves further and incur more losses, known as ‘’secondary losses’’.
A secondary loss represents all the other losses that come after the primary loss. In many ways, this type of loss can be just as devastating and complex. Secondary loss often includes a variety of life situations and circumstances, such as:
- Loss of identity
- Loss of faith
- Loss of relationships
- Loss of support system
- Loss of home
- Loss of financial security
- Loss of hopes and dreams
- Loss of innocence (particularly when a child is orphaned at an early age)
I experienced several secondary losses after my mother’s death. The people I counted on to be there, either became dismissive about the severity of my loss or seemed completely remote in their contact.
Essentially, I could no longer relate to or maintain a connection to those that had been there for me before and during my mother’s illness. Almost all the dynamics in my relationships had changed along with my mother’s passing. The links in the bracelet were broken.
It was then that I began searching for something, anything that wouldn’t leave.
Short Term Energy Relievers
Short -term energy relieving behaviour (STERB) is continuously repeated (sometimes involuntary or compulsive) behaviour for releasing any stored energy caused by unresolved trauma or emotions.
Those who turn to short term energy relievers often turn to some form of addiction or behaviour in an attempt to conceal or distract themselves from their grief. Energy relieving behaviour doesn’t always involve substance addiction, but often touches the gaping hole of an addiction.
Common energy relieving behaviours include:
Within five months of my mother’s death, I withdrew from most of the people in my friendship circle and only kept in contact with a select few (such as close family members and work colleagues).
Fortunately, this withdrawal didn’t involve taking up substance misuse. However, I later learned that I ticked most of the boxes for several of the energy relieving behaviours such as excessive caffeine intake, over-exercising and social withdrawal.
When I wasn’t at work, my days included long hikes, obsessive exercise and a high intake of caffeine.
Instead of allowing the grief from the secondary losses to surface, I would distract myself with another aerobic exercise or I’d leave the house and go for another walk.
If I were to choose which of the energy relieving behaviours I used the most, it would likely be social withdrawal and caffeine intake. Hardly addictions, but behaviour that features some of the traits of an addiction.
Not one day could I go without having a takeout coffee in my hand. The stronger the better. I also struggled to be in the presence of close family members and friends for long as it proved too triggering.
Their presence acted as a mirror to my grief. Raw and painful.
According to research, short term energy relievers are not harmful in themselves, but since they don’t provide a long-term resolution to emotional pain, they can lead to damaging consequences in the long run.
It wasn’t long before I discovered just how consistent energy relievers were. When everyone else in my life had packed up and left the building, they remained the same. Coffee, for example, was the one thing that accompanied me on my visits to the hospital.
All-day every day, that warm cup of goodness gave me the energy I needed to survive another day of my mother’s illness.
Coffee never left me, and long after her death, I never left coffee.
In my eyes, secondary losses add another painful dimension to the grief experience, leading many grievers down the path of addiction.
On the bright side, my period of isolation helped me realise that I wasn’t looking for a way out of my grief, I was looking for a way in. I eventually honoured what my insides were screaming at me to do all along – to process my grief and establish a new sense of identity free from the distraction of others.
Going back to the spectrum, I can see (as someone who has experienced traumatic grief) just how easy it is to turn to addiction as a way of coping with loss. There are so many variables, and unexpected twists and turns to the bereavement experience.
The difference between energy relieving behaviours and substance addiction offers remarkable distinctions, however, in some cases, they are not that different at all (other than the fact that one substance causes more or less damage than the other).
And although addiction may provide grievers with temporary relief, in the long-term, it offers barely any solutions at all, only more problems that will eventually need to be dealt with.
To heal from grief, we have to go through it – not around it.
Trauma experts, counsellors and rehabilitation centres are valuable resources when it comes to managing grief and addiction.
Living with the trauma of grief doesn’t have to be a way of life. There are people out there that can help.
Take it from someone who has been there.