Friday, April 6, 2012

Disaster Survivors Grieving


            After the Oklahoma City bombing in 1995 I had an opportunity to work with first responders as part of a training program run in Oklahoma City.  It was made clear to me by the participants that the problems of the survivors who were in the building at the time of the explosion were different from those of the relatives and loved ones of those who were killed in the disaster.  This was confirmed on my many later trips into disaster areas around the world and as a result I developed a training program for helpers to specifically deal with the reactions of survivors who had lost a loved one, usually a family member in the disaster.

            Immediate survivors, that is, those who were subjected to the near death experience or the horrific scenes of a crisis would often have a double reaction.  That is they would be having a post traumatic stress reaction and also be suffering from the other reactions of grieving when they lost someone near to them.  The reactions to those loses needed to be approached as a separate issue.

 The Training Program

            The participants in the training program as I have run it here in America are usually law enforcement personnel, but when I ran the program in trauma zones the participants were doctors, teachers, and others who were in a position to be in contact with survivors.   I didn’t find it necessary that the helpers have any kind of professional degree which is rarity in most trauma areas of the world.

            My instructions to the group were:  “You are going to be put into work groups.  You are to consider that you are all experts on your culture and its ways of dealing with grief.  You will be given some of the critical issues that need to be dealt with and an illustration of how I might deal with it as therapist.  Research has shown that people in all cultures have to deal with the same problems of loss, but that the methods of resolving them may differ.  For each therapy problem, your work group is to develop two other helpful interventions you might make.”

  1. How do you help the individual or family get closure?
One way is through meaningful burial customs.  I had several experiences with funerals were I became angry because they were so impersonal, the deceased could have been any one.  As a result I have been involved in at a least a dozen funerals of friends and relatives to help turn them into a meaningful closer of that person’s life.

I feel funerals as a rite of passage serve the following purposes:

·        Chance for tributes to the recently deceased emphasizing the worth of that individual and establishing that he/she is worthy of the pain of grieving.

·        Draws the family members together by sharing the ritual of preparation

·        Permits the expression of sorrow

·        Crystallizes the reality of the death through contact with the body and performance of ritual

·        Provides opportunity for healing conflicts within the family by requiring agreement on the form of the ceremony

·        Permits acceptable disposal of the body

·        And for most people it is a religious ritual that gives hope for reuniting with the deceased

         This is one way of getting closure, how might it be handled differently in your culture?

2.  I very soon learned that special problems were created when the body of the deceased was not available.  In Bosnia, Kosovo, and Iraq victims were often buried in mass graves, and in other countries like Argentina and Russia victims simply disappeared.  In the two major terrorist attacks here in the US, bodies were vaporized.  In the Viet Nam War many bodies of our soldiers were not recovered.  For many survivors life cannot go on until they are positive the person is deceased, but they refuse to accept the death until a body or other solid evidence is produced. In Bosnia much expense was involved in doing DNA testing on bodies from mass graves to prove to the survivors that their loved one was dead. Short of DNA testing what might you do to help survivors accept the loss?

  • One method I have used is to conduct an imaginary funeral in my office with the client picturing the deceased in the coffin, saying goodbye, saying a prayer over the body, and then placing the coffin in the ground.
  • Another imaging technique I have used is to have the survivor have a conversation with the deceased who is imagined to be somewhere the after life, where the deceased informs the survivor that he/she is dead and in a better place.
  • The use of these techniques is conditioned on the survivors’ religious beliefs.  What might you do to help the survivor accept the finality of their loss?
3.  Anger is not unusual.  Sometimes the anger is toward the system or the government.  In America some people were angry at the government because they did not prevent the World Trade Center destruction by terrorists.  After airplane crashes the anger is often toward the airline.  

  • Some airlines have learned to handle the anger by notifying relatives before anyone else, bringing them to the place where the crash occurred, and doing a memorial ceremony.
  • For some people simply allowing them to vent the anger is sufficient, that is, don’t try to defend the actions that may have resulted in the disaster, just accept the expression of anger and recognize its legitimacy.
  • What might be some ways that you could help the survivor deal with their anger?
4.  It has not been unusual for me have clients where the anger is directed toward the person who has died.  There is unfinished business of one sort or another.  I have talked with women who were angry at their husbands because they died and left them alone and helpless.  “How could you do this to me?”  Or the deceased was a bad parent or an adulterous mate.

  • One method I have used is to have the survivor write a letter to the deceased pouring out all of their feelings about the unfinished business or other emotions they have.  The letter is then read out loud to me and then in a ceremony burned.
  • At this point the reader can conclude that I am very impressed with individual’s ability to imagine scenes or conversations in their mind’s eye that can be very helpful in their dealing with these emotional issues.  One imaginary scene I have used frequently is a conversation with the deceased where after the survivor has faced a chair in which they imagine the deceased to be sitting and told them what they are angry about, they move into the chair and give the deceased reactions.  This evolves into a back and forth movement of the client as the issues are worked out.
  • Consider you are working with a survivor who still carries a load of anger at the deceased.  What else might you do to help them become more comfortable with the loss?
5.  Survivors often feel guilty.  Was there more they should have done for the deceased?  Were there things they should have told them, such as I love you and respect you?  If the person died slowly and painfully was there a sense of relief at the death that the survivor feels guilty about?  Giving the survivor the opportunity to talk about their guilt is very important.

  • One of the most powerful techniques I used is to have the survivor close her/his eyes and imagine the deceased is in the room.  The survivor is to tell the deceased his/her concerns and feelings.  Then the survivor is to imagine that he/she becomes the deceased and tells the survivor his/her reaction.  Almost always the deceased in these situations is very understanding and forgives the survivor. 
  • Early in my career I found that doing good works or helping others without claiming credit did much to alleviate guilt.  I was as this was an atonement for what they felt they had done wrong.
  • I explain that relief at the death of a loved one is a normal response that almost everyone has, for some survivors just an explanation of this as a normal is sufficient to help them deal with the issue.
  • When faced with this guilt what might you do to help the survivor deal with it?
6.  Returning soldiers will often have strong guilt feelings that are difficult for them to discuss with someone who has not undergone the same experience. They often feel responsible far beyond what they should given their position and real power to influence the situation and take a hundred percent of the blame for the death of fellow soldiers, or civilians. 

  • Have a discussion of what percent of responsibility can be assigned to each of several groups involved in the action for the loss of life; the military, the enemy, the government, other soldiers, the dead person, the world situation, what ever factors look like they placed a role in the death.  The goal is to cut down on the sense of responsibility.
7.  Men and women in the United States differ in how they handle the death of a partner.  We know that for most people it is the most stressful thing, other than their own near death experience, that can happen to them.  What might you do differently for men than you would for women?

·        Men in our culture often lack support groups.  One thing you could do is encourage them to volunteer to work in an agency such as a soup kitchen where they could feel that what they are doing for others is highly significant.


8.  What might you do differently for women than you would for men?

  • Many older women in the United States have lost contact with their own special skills and abilities.  Some practical counseling about what roles they see for themselves and rediscovery of talents can be very important.  In our community there are many courses available to older persons to help them learn new skills.
9.  In conflicts around the world children are often victims.  In Bosnia the mothers who had lost children told me that memories of the happy times were very important to help them deal with their pain.   How can we help mothers deal with their loss?

  • Jot down favorite memories of the good times with the deceased.  Make a scrapbook of pictures and memorabilia to keep the memories alive.

10.  In the case of suicide or murder there is often special pain and confusion.  The survivor has a strong feeling that no one can possibly understand what they are going through.

  • Support groups of persons who have gone through similar situations can be very helpful.  It is especially good if some members of the group are further along in the grieving process.  It is also helpful if a leader can be provided who has been through a similar experience and the group members know that.
11.  Working with other people’s grieving can be very stressful.  At times you will be accused of not being able to understand what they are going through. How would you handle that accusation?

  • Reassure them that, “Your story is very important to me. Knowing what you are feeling and thinking will help me understand others who have had similar losses.”

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