The Connection Between Grief and Trauma: An Overview
It is a warm, still summer evening. Peaceful quiet sits hand in hand with humidity. The air hangs heavily outside the window as a concerted effort is made to create an introductory chapter linking the unquiet, disruptive worlds of the gemini of chaotic sorrow: grief and trauma. Professionals in each of these domains, up until a short few years ago, spoke their own languages and failed to see the commonalities of their approaches, foci, and even their goals. Traumatologists looked at the enduring effect of crises and critical incidents on the individuals, families, groups, and communities who experienced them. Researchers of posttraumatic stress disorder (PTSD) studied those factors that might lead to more intense reactions, particularly aspects related to the traumatic stressor. Meanwhile, professionals working in the grief and bereavement fields, thanatologists (from the Greek thanatos, god of death), directed their attention toward loss, particularly losses due to death, and the repercussions of those losses upon their clients, students, and research participants. The sequelae of traumatic events, however, also include loss of property, home, a known and comfortable world view, innocence, and community. It is the last of these losses, or perhaps all of them played out on a larger social stage, which is the focus of this book.
Just as each chapter in this volume begins with the story of the traumatic event or events leading to community bereavement, grief, loss, adaptation, and change, so does this introductory chapter begin with a story of far-reaching trauma. Not long after the initial conception of this first chapter, TWA Flight 800 exploded in midair in July 1996. Over 230 persons met their deaths. Sixteen of the victims were teenagers from Montoursville, Pennsylvania, members of their high school French Club on their way to Paris for an extended field trip.
The community of Montoursville still weeps deeply for these children and for the five adults who accompanied them. Persons who are regular travelers on international flights might recognize that at the time of the explosion the passengers were just settling in. Those in first and business class seating perhaps had had their first glass of champagne, orange juice, or a mimosa. Those in tourist class were probably adjusting seats, checking out the movie selection, and thinking of the exciting adventures ahead. It is doubtful that those 16 teens would have gotten much sleep on their transatlantic flight. It is more likely that their excitement, youth, and vitality would have carried them through the 7+-hour flight with enough energy to greet Paris with astonishment and joy. Instead, their parents and others waited in hotels in New York for word of the coroner’s report, each person thinking about the words but resisting the question: Was the latest body found and identified my loved one?
And what of the community those teens left behind? During the first few days after the disaster, many Montoursville citizens appeared on television. The high school principal and guidance counselor talked of debriefings, availability of counselors, memorial services, and loss. Media people placed classmates in front of cameras and asked intrusive questions: “____was your date at the prom. How do you feel?” or “How do you feel now that____is dead?” Soon a new school year began. Sixteen desks remained empty. Families who were to have celebrated homecomings and the beginning of a new school year for their children, instead, grieved and mourned.
That was the summer of 1996. Today, at the time of writing this paragraph, it is December 1997. The agony from TWA Flight 800 continues as new hearings begin about what caused the explosion. The report from Redmond (1989), a family and grief counselor who works with survivors of loved ones who were murdered, provides what seems to be a parallel with the family members of those who died on Flight 800. Homicide cases can take up to 7 years to litigate. Families reexperience an acute grief reaction each time the case arises in court. The survivors report that they have to put their grief “on hold” because dealing with each court proceeding takes more emotional energy than they have. Perhaps the family survivors of Flight 800 find themselves in similar positions. There have been numerous hearings, reports, and television “documentaries,” and now, 17 months later, a new round of hearings has begun. When and how can the wounds of grief heal?
Janoff-Bulman (1992) and others, in describing the impact of traumatic events, recognize that such events shatter the survivor’s world view. When a tragedy such as that of TWA 800 occurs, nothing makes sense. A community, as well as the individual members of that community, recoils in shock and anguish. Questions are asked over and over: “Why?” “How could this have happened?” “What was the purpose?” The answers are slow to come, if they come at all. Trauma destroys life’s long-held meanings; daily living is no longer predictable or safe; those directly affected no longer see themselves as invulnerable to harm. If the comforting belief that “bad things happen only to bad people” can no longer be sustained, then what or who controls destiny? How can justice exist and be meted out? We see, far too frequently, that bad things do happen to good people, and to individuals, families, and groups. Communities must face the impact and consequences of tragedies in their lives and in their social networks.
It is the task of this chapter to examine the theoretical framework of grief and loss, trauma, and healing as it affects groups of individuals. This is the essence of group survivorship. This book examines how communities that are in existence prior to a traumatic event or are created during or in response to an event react and respond, recoil or recoup. Each chapter examines a specific traumatic event or series of events. Some of these events are natural in origin (e.g., the Kobe and Armenian earthquakes). Others are of manmade origin (the Estonia ferry disaster, a bombing in Ireland, a bus crash in Australia). Still other chapters focus on the loss of an individual life whose death touches many in the broader community (the assassination of Prime Minister Rabin or the death of Mickey Mantle). The groups associated with these events may be geographical (Kobe, Japan), temporal (passengers on the Estonia; rescue workers brought together to respond to the sinking of the ferry), recreational or social (baseball lovers), national (residents of Israel), or organizational (employees of NASA; a small Israeli kibbutz). Their responses may also vary in time perspective, ranging from short-lived rescue interventions to the creation of long-term family support communities. Some of the communities have natural support systems that are ready to respond to a crisis. In other instances, support systems become the community itself.
Several terms appearing in this and other chapters require definition. Some terms will be expanded in other sections. Bereavement is the state of deprivation or loss (Switzer, 1970). Loss is the separation of an individual or group of individuals from a loved or prized object; the object may be, for example, a person or group of persons, a job, social position or status, an ideal or fantasy, or a body part. Grief is the set of responses to a real, perceived, or anticipated loss (Kastenbaum & Kastenbaum, 1989); responses usually include physical, emotional, cognitive, and psychological components (see Rando, 1984). Mourning is the cultural response to grief (Rando, 1984). Trauma, according to various dictionaries, is serious injury, wound, or shock to the body or to the mind, often resulting in psychological and behavioral disorders. Posttraumatic stress disorder [American Psychiatric Association (APA), 1994] results from personal “exposure to an extreme traumatic stressor” (p. 424) including, for example, actual or threatened harm or death to oneself; witnessing a death, injury, or threat to another; or learning about a death, injury, or threat to another.
Existing communities can experience traumas and grieve. Trauma and loss may lead community members to create new communities of grievers in response to those events. Further, those in existing communities who did not personally sustain a loss resulting from the traumatic event but who resonate sufficiently to the traumas and losses of others can become members of the newly created communities. Trauma does not necessarily accompany bereavement; bereavement does not necessarily produce trauma. These statements pertain to both the individual and the community. However, when bereavement and trauma coincide, the individual and/or the community situation often becomes quite complicated.
Trauma often occurs within an emergency situation. An emergency, by definition, is a serious situation or occurrence; it usually happens unexpectedly, but sometimes it can be anticipated; it also demands immediate attention. Each of these three dimensions is strong in its impact upon people. Taken together, these dimensions exert a powerful force which propels people into fear, disorientation, uncontrollable behavior, or immobility. Psychological trauma may or may not reveal itself immediately. When in does occur, trauma—physical or mental or spiritual—impedes grieving.
A natural bridge between the two fields of grief and trauma is that of group survivorship. Large-scale social disasters have been of clinical and research interest to traumatologists, many of whom came to their field of work via their interactions with Vietnam veterans. Social disasters bring with them thousands of individual tragedies that are the focus of the work of grief counselors and grief researchers. A parallel set of questions addresses issues of appropriate intervention from both perspectives.
Group survivorship is a concept that encompasses the behavioral and emotional reactions of a defined, socially recognizable group experiencing the loss of one or more group members. The question of group survivorship could also arise for organized groups experiencing significant changes that pose a challenge to group identity and structure. For the purposes of this book, member loss focuses upon significant losses incurred due to the deaths of individual group members, be they expected or unanticipated and/or from natural or human agent causes.
The significance and meaning of a loss depend upon the survivor’s valuing of the object (person, place, thing, idea, etc.). One’s loss and concomitant grief are unique. This applies in large measure to a community. Those who would intervene in the trauma and loss of an individual or community can take their preformed formulas, tightly held assumptions, or references to the most recent person or group they have helped and place those ideas aside, not near the person or group in need of help now. Education, training, and information can be instructive and guiding; but they are not necessarily prescriptive. Effective helpers allow those they help to instruct them about what or who was lost and the meaning of the loss. Effective helpers learn from their observations of the scene of crisis and from those affected by the crisis what interventions may be helpful for the moment. Our assumptions can easily seduce us away from the requisite path.
Outsiders to a community who come in, by invitation or intrusion, to assist those affected may rush survivors to overcompensate and to normalize too quickly; outsiders may urge community members to return to predictable routines that are not appropriate for the circumstances (Garrison, 1996). Other outsiders may prematurely emphasize discussions of feelings, thereby disrupting the survivors’ abilities to function on the job, in their family unit, or within that community. Still others speak “about” the event in a manner of false knowledge, alienating survivors who can speak knowledgeably “from” the event. Effective intervention comes in part from the science of human behavior and in part from the art of interacting therapeutically with others.
Communities may be natural or transitory. Natural communities are bonded together through time and any number of characteristics, for example, geography or profession. Transitory communities are bound together situationally and only at one point in time (Young, 1994). Whatever their origin or purpose, members of a community have a common focus which brings them together. Within this context, a traumatic event may threaten the community’s existence, purpose, focus, or goal. If the event is one around which the community measures time—for example, anniversaries or centennials—it takes on a symbolic meaning of its own. An event may increase or lessen community connectedness and bonding. If the scale of the event is particularly large, it may have exceptionally widespread and long-lasting effects.
Traumatic events within communities can lead to different outcomes. Some communities rise in anger following tragedy; others collapse in grief. Still others may become almost catatonic out of fear of confronting the event and its outcome. But what phoenix may rise from the ashes of a community’s grief? What new roads are explored and what new meanings found? Consequences realized in the wake of a community trauma depend upon whether the community’s caretakers can provide the leadership necessary to direct physical and emotional recovery efforts. This leadership is impossible if caretakers themselves have been injured, violated, or traumatized. If their world has also been compromised or challenged, order as it previously existed may not be possible (Garrison, 1996).
According to the DSM-IIIR (APA, 1987), a traumatic event occurs out of the range of usual human experience and is markedly distressing to almost anyone. The most serious reaction may be persistently reexperiencing the event in one of a variety of ways, including recollections, dreams, flashbacks, and sensitivity to cues. The event survivor has persistent symptoms of heightened arousal, including anger outbursts, concentration difficulties, hypervigilance, and sleep difficulties. The DSM-IV (APA, 1994) changed the definition of a traumatic event to involve a response of fear, helplessness, or horror, and to include the importance of a victim’s perception and appraisal in that response. There is no listing of what constitutes trauma in the DSM-IV; generic trauma is discussed under the rubric of PTSD.
Green (1996) proposed eight aspects of a stressor event that may be perceived as contributing to the assessment of an event as traumatic. These included: (a) threat to life or bodily integrity; (b) severe physical harm or injury; (c) intentional injury; (d) exposure to grotesqueness; (e) witnessing or learning of violence to loved ones; (f) learning of exposure to a noxious agent; (g) causing death to another; and (h) causing severe harm to another. Other factors include lack of preparedness for the occurrence of the event, lack of controllability of the event, lack of warning, greater lack of chaos accompanying evacuation efforts, cumulation of trauma losses, duration of the trauma, and the greater number of unresolved past traumas (Green, 1996). Only recently have researchers recognized that these aspects are similar to those that researchers report as leading to a more prolonged grief reaction and complicated bereavement. Parkes (1985) identified sudden or unexpected or untimely death as factors placing the griever at significant risk of complicated grief. Knapp (1987) added the death of a child to the above factors as generating increased risk. He also noted that grief after a homicide is frequently delayed. The research of Lehman, Wortman, and Williams (1987) found grief the unexpected loss of a child or spouse continuing 4–7 years after the death. These factors are quite similar to those risk factors noted in traumatic events.
Community tragedies frequently involve the death of a member or many members of that community. If the extent of the loss is large and involves a large number of dead and/or injured, the tragedy will most likely affect a larger segment of the community (Young, 1994). If the tragedy involves massive dislocation or relocation, long-term unemployment, and/or widespread property destruction, the catastrophe may challenge the identity and even the structure of that community. As in the case of an individual trauma or grief reaction, the more unexpected and unanticipated the loss, the more serious the consequences and the challenge to coping abilities. Other community risk factors leading to more intense grief and/or traumatic reactions include prolonged exposure to traumatic events, repetitive events, intentionality of traumatic events, events that are physically damaging or threatening to life and physical integrity, and events damaging to the community support system (Kulka et al., 1989). However, communal perception of the stressor event as being traumatic to the group is also necessary for that event to have severe impact (APA, 1994). As Young (1994) noted, “if this is the worst thing” that has happened to the community and there “have been no pre-existing disasters, it may be perceived as a legitimate ‘end of the world’” (p. 152).
The grief a community experiences after a traumatic event may become either a developmental crisis or opportunity for that community. It may stagnate a community’s future development or propel a community into new areas of growth. The crisis may be one of attachment and identity as it disrupts stability and structure. The first task of healing after a crisis is to acknowledge what has happened to the fullest extent possible. The second task is to try to restore community equilibrium. This latter task has many parts in meeting its goal, including experiencing group loss and finding meaning. Only over time will the crisis become interwoven into the history of the community to become a part of that community’s narrative record. With time, perhaps depending on its attributed significance, the event may evolve as a pivotal event in the life and world view of the group.
As community members seek to restore functioning, they must transform themselves and their relationships with community organizations, neighbors, political structures, and other groups as they try to find a functional and socially acceptable meaning in what has occurred and in an altered community identity. The community itself, depending upon the level of pain and disruption, may or may not be able to respond in a supportive manner during the attempts to regain homeostasis or a steady state. However, if and when homeostasis is achieved, it may include a new community definition of stability and a new normal state.
In addition, community intervention may differ depending upon how the community defines the event: as a challenge needing intervention or as a traumatic crisis best handled by avoidance, denial, or escape. Eventually the goal of the community within the context of group survivorship is to intervene in acceptable ways that are supportive and functional to the community as a whole.
Shapiro (1994) noted that communities have a variety of social supports available to them. Social networks may be based on kinship, religious practices and beliefs, sociopolitical systems, mutual interests, and cultural practices. The meaning of the traumatic event is frequently influenced by the social context in which it occurs. If leaders or the general membership view support as soothing and as a means of regaining footing, then the support will be more accepted and more effective. If the event becomes a catalyst for social change and the community takes adaptive action, healing may occur more quickly and pervasively. However, if communities do not move past intracommunity struggle and blaming and cannot find positive meaning in catastrophic events, stagnation or regression may occur. Communities and individuals want life to be predictable and orderly (McFarlane & van der Kolk, 1996). Finding a way to reestablish these cherished attributes is the goal of successful group survivorship.
MODELS OF BEREAVEMENT AND GRIEF
Bowlby’s (1973) model of grief examines interactional factors of attachment fractured by loss or by significant life changes engendered by a traumatic event. Throughout life, individuals attach to others for survival. Disasters and other types of traumatic events cause severe disequilibrium for individuals and communities by severing those attachments. Bowlby’s description of grief responses includes times of protest, despair, detachment, and personality reorganization. Parkes and Weiss (1983) noted that loss causes childlike fears of loss of attachment while individuals and communities try to regain a sense of personal and environmental safety. Thus, recovery is both an intrapsychic and an environmental process of resecuring attachment. Initially, communities may feel a sense of numbness and blunting before they begin to pine for lost persons, possessions, and meanings. Once the pain sets in, however, communities, too, may experience despair and disorganization. Reorganization may occur more slowly within communities in which large numbers of individuals were affected or felt vulnerable to traumatic circumstances.
Early bereavement paradigms offered stage models which provided macro descriptions of dominant emotional and cognitive characteristics of responses over time. Parkes (1985) postulated stages of denial/shock; protest (searching/seeking); disorganization/despair/disorientation/suffering; and resolution/reintegration/transformation/adaptation. Elizabeth Kubler-Ross (1969) was an early writer about death and dying who formulated five stages of dying. Unfortunately many practitioners mistakenly believed she wrote about grieving and not dying. Therapeutic goals for a dying person are quite different from those of a grieving person. Worden (1991) identified four necessary tasks of the griever for achieving resolution of the grief: I. accept the reality of the loss; II. work through the pain of grief; III. adjust to an environment in which the deceased is missing; IV. emotionally relocate the deceased and move on with life. Worden’s model seems to emphasize the considerable overlap and linearity of bereavement efforts. However, he states that grievers do not necessarily proceed in tidy steps.
Rando (1993, 1996) was among the first clinicians to summarize and organize the theories of various researchers and to write in detail about types of complicated grief. Complicated grief might include avoidance response, chronic grief, and repressed grief. Patterns of complicated grief frequently are similar to the various aspect of PTSD. Avoidance responses and repressed reactions to grief parallel the avoidance phase of PTSD. Chronic unresolved grief may include intrusive thoughts and/or physiological reactivity, similar to the symptomatology describing PTSD (van der Kolk, McFarlane, & Weisaeth, 1996).
In addition to the above models, there are many others. Those cast in stages are frequently misinterpreted to be linear. This probably occurs because the printed page is only two-dimensional, and any attempts to show real life movement could result in a jumble of crossing lines and arrows. In real life, grievers and sufferers of trauma do not move toward resolution in a linear fashion. Anyone observing nature must eventually realize that, during development, all growing people (individuals and groups) and things experience some regression, retreat, or pauses on a plateau. Many models do not directly acknowledge secondary losses (for example, property, home, schools, neighborhoods) which occur following a disaster and may even occur after incidents have been resolved. Most do not acknowledge the impact of variables of culture, gender, religion, social support, past experiences with loss and death, prior history of trauma, and other variables. Additional and unrelated losses occurring during the bereavement period complicated recovery and are never addressed in theoretical models.
For the community and the individual, resolution of grief is a process that may be conceptualized from a variety of theoretical models which look at attachment, loss, and coping. Grief, as well as resolution of trauma, occurs within a sociocultural context fashioned, in part, by the community’s general conceptualization and specific assessment of loss and trauma. Communities and individuals have personalities affecting their grief and the intrapsychic process of the resolution of grief.
Community grief may take months to years to resolve fully, even though public expression of mourning through ceremony and ritual may be limited to a few days, weeks, and/or special anniversary dates (Cook & Dworkin, 1992). Only when community grief is resolved does the acceptance of the loss become a cognitive and emotional reality within the community’s identity. The loss is then recognized as permanent, and accommodations are made. Certainly, community memory of the loss may continue to involve pain, but, conversely, the event may become part of the communal history shared by all group members (Wolfelt, 1987), an event that may become an important source of pride and positive group identity, if only in the surviving of catastrophe.
The core of PTSD often is unresolved grief stemming from repressed emotions (Widdison & Salisbury, 1990). PTSD in one sense is a form of grief reaction. Redmond (1989) was the first grief counselor to link PTSD with mourning in families of murder victims. In recent conversations on the Internet between members of the Traumatic Stress Forum, the question was posed as to what constitutes a traumatic event. Brisk dialog included comments that “Events are either traumatic or they are not …; we cannot add up non-traumas to make traumatic damage …; [trauma] … falls within the perceived context of the individual” (Dennert, August 8, 9, 1996). “Both the duration and the intensity (of the event) are factors that go into the mix” (Gottschalk, August 9, 1996). An additional comment was that any event “must pass through perceptual filters. The word trauma can be used to describe an event and the consequences of an event” (Dalenberg, August 13, 1996) and trauma “always hurts and it always scars” (Michaels, August 13, 1996).
To what extent factors predictive of a particular PTSD outcome vary depending upon the type of exposure, type of event, and the cultural context of the event is not known (Marsella, Friedman, Gerrity, & Scurfield, 1996). The definition of what constitutes a traumatic event as well as symptoms of trauma may change among individuals, families, groups, communities, and cultures. Issues of timing of assessments of traumatic impact, identity of target populations, dosage of exposure, and vulnerability (for example, due to socioeconomic conditions), are still in need of examination. Cultures and communities within cultures interpret trauma and loss differently.
The impact of a traumatic event is even greater when the loss is the result of an individual or group hostile action; for example, the assassination of Rabin and the Oklahoma City bombing. The impact may also increase if the event had been preventable and preventive measures were not taken, for example; if the Estonia ferry been going slower in the rough seas or if better safety checks had been done. Further, when the event kills large numbers (as in the Estonia sinking), destroys massive amounts of property (the Armenian earthquake), involves prolonged suffering (the Challenger astronauts who are now thought by some to have stayed alive until their capsule hit the ocean; earthquake survivors who died slowly in the rubble of Kobe), or happened suddenly without warning (the Oklahoma City bombing, the explosion of TWA 800), the reactions of the community (whether natural or temporal) may be greater (Doka, 1996; Williams & Nurmi, 1994).
As the chapters in this book demonstrate, if a traumatic event suddenly destroys property and life (Kobe), rips apart an entire community by taking away its livelihood (Armenia), or shows how quickly and unpredictably life can be extinguished even in a moment of glory (the Challenger disaster), it becomes more difficult to find meaning.
Different types of traumatic events may lead to differing types of reactions and patterns of community healing. The social context of an event, the community perception and conceptualization of the meaning of that event, and the method of community coping (cognitive or affective) can influence outcomes.
The various authors in this book look at community response to tragedy from a variety of perspectives and chart various courses of healing. Do community members seek to suppress/repress or avoid grief and the impacts of trauma, trying to act as if nothing happened? Do they seek to live with the impact of the event, allowing grief, anxiety, and traumatic impact to take over, but without open expression or acknowledgment? Do members live the trauma fully, expressing pain and grief without reservation through a variety of means and rituals in order to move on (as in Oklahoma City)? Or, do members seek to transform their pain, shock, anger, and depression into a cause (for example, increased organ donation awareness as in the case of family and friends of Mickey Mantle; Grant, 1995)?
While many community members may have both acute and long-term stress reactions or eventually suffer from PTSD, the majority are often resilient. Learned resourcefulness rather than learned helplessness marks their recoveries. Communities and individuals who are resilient are able to delay gratification as they rebuild, use more problem-focused coping skills and strategies, and are more able to self-regulate. Antonovsky (1990) referred to a learned resourcefulness model of healing as a salutogenic model based on a sense of coherence. The coherent community has made sense of what has happened and has found comprehensibility in the traumatic event. Interventions after the event have contributed to making the event manageable; and resources for recovery are sufficient to the need. In addition, the community has found, or is trying to find, meaningfulness by transforming or reframing the event into a challenge.
Within communities, different groups and individuals may coexist and recover at different levels of healing. Groups may be cohesive or may split apart into fragments. Groups may offer focused services to those most affected, while other groups or individuals victimize those weaker than themselves. Community and group leaders may use power wisely or may misuse power to further themselves.
Many models for healing exist. The majority of these are based on healing within individuals; however, it is possible to apply them to communities as well. Some of these were described earlier. Everly (1995, 1996) designed a model that he terms the SAFE-R model. The first step in this model helps individuals in charge of the community to step back from the scene of the traumatic event and take a visual break. This break may occur at a command center outside the perimeter of the event, at a retreat center, or at a debriefing center. Community leaders then need to acknowledge the crisis event by giving information to the public. This information provides a cognitive framework, helping to calm the community and encourages appropriate emotional expression. Community members also need facts that are presented openly and honestly. A community’s ability to “come through” a traumatic event can be facilitated when the community receives accurate explanations that can be tapped directly into community resources. Responsible media coverage, appropriate debriefings by trained persons, community meetings, and organization interventions can be used to encourage controlled ventilation.
Community leaders next facilitate an understanding of symptoms of acute stress that frequently appear within the community. However, the identity of “trusted providers of information” varies among communities. Is the source of information the media? The police? A governing body? A business organization? The medical community? Media spots, on-site interventions (e.g., defusings and individual counseling by trained and certified professionals and peers), walk-in clinics, and hotlines can all assist in the healing.
Help can be more effectively given if help-giving mechanisms and structures are in place prior to a traumatic event. Then, procedures can be activated more easily and follow-through can be ensured. These explanations and interventions are employed to normalize and to explain crisis and stress, develop plans for intervention within the salutogenic framework of resilience, and help to restore at least minimal functioning within the community as members stabilize. Triage can also occur at this stage to identify persons and organizations needing more intensive intervention. Support groups may also form to promote a new sense of community among survivors, helping them to find meaning in what happened.
Kalayjian (1996) presents a seven-stage model of community healing that may be applicable to many of the events described in this book. Preassessment prior to intervention involves investigating the nature, extent, and dynamics of the community. In other words, what event occurred and to whom? Who are the survivors and what is the economic, political, sociocultural climate of the community? Were members prepared for the event or was it a shock?
On-site assessment occurs next (Kalayjian, 1996). Community leaders, intervention teams, response teams, and others begin to collect data. Analysis of data and identification of community strengths, deficits, resources, motivation, phenomenology of symptoms, and readiness for change occur next. Questions asked at this stage are: What meaning does the community place on the event? Has responsibility for the event’s occurrence been given, assumed, or assigned? This step is followed by an analysis of the community’s response to the event and community planning for needed service delivery. A comprehensive plan with centralized leadership, perhaps through a local comprehensive trauma center, can be indispensable at this point (Williams & Nurmi, in press). The plan would prioritize service delivery to meet acute and long-term community needs, organize resources, request outside assistance if necessary, and determine how to achieve those goals.
The sixth stage (Kalayjian, 1996), implementation, puts the crisis plan into effect. The seventh stage evaluates the interventions, quality of care provided, changes that have occurred in the community, and future needs. Recommendations for additional clinical, educational, political, philanthropic, and other interventions are included in this stage. The final stage, remodification, reevaluates and reprioritizes problems and interventions.
Having a plan of action can empower a community. Offering enough information to community members so they can understand what happened and can evaluate possible alternatives for action lessens the impact of traumatic events. Supportive messages from community leaders need to convey information re-framing what happened, providing instruction, reassuring verbally and non-verbally, and suggesting how to ventilate (Albrecht & Adelman, 1987a). As Miller and Steinberg (1975) noted, having options, a plan of action, or a knowledge of how to cope gives strength to an otherwise traumatized community.
Many supports that a community offers come in the form of “weak ties” (Adelman, Parks, & Albrecht, 1987). Weak ties are supportive groups and individuals found beyond the family and close friends. They may number in the hundreds and offer help to individuals who do not have or cannot develop close, intimate relationships. Weak ties also may offer support when stronger ties are disrupted by trauma. Exchanges between weak ties tend to be more instrumental, as means to ends, and may have interactions limited to specific geographical locations, for example, a debriefing group, a hotline staff, or a support group. The cognitive functions of support are to provide interpretations of events, to reduce uncertainty, and to provide a sense of control or mastery over events that have occurred (Albrecht & Adelman, 1987b).
As the reader assesses how the communities described in this book met the challenge of traumatic events, it will be helpful to reflect on the following questions:
• Has the community had a history of similar losses?
• What was the history of the community?
• What losses did the event entail?
• What secondary losses (hopes, dreams, property) occurred?
• How did the community perceive the event and losses involved?
• What relationship did the community and its members have to those losses?
• What expectations for resolution did the community have?
• How was the event normalized?
• What impact did the event have on the community?
• What conditions of the event made it unique? Generalizable?
• What community-based interventions worked or did not work?
• What was the extent of community support?
• What cultural practices, beliefs, rituals, and customs helped or interfered with healing?
• What legacy of loss has remained within the community?
• How has the community grown and/or found positive meaning from the event?
One major goal of this book is to examine actual community responses and strategies for coping with traumatic events. Chapters investigate how various communities responded cognitively (through discussion, planning, and education), physically (action rituals, rest periods), emotionally (through rituals, expression of feelings), spiritually (through funeral ceremonies), creatively (through the arts), and practically (through legal action, relocation, and physical resource development).
Another goal of this book is to explore how communities rebound, reflect, and recover from the events they have experienced. Communities are never “the same” after catastrophic events. Advocacy for airline safety and better bomb detection do not bring back the hundreds of victims killed. Uprooted members whose homes have been destroyed by earthquake or flood may never return to their neighborhoods. Yet, by joining together, by developing rituals and ceremonies, and by talking about the event over and over and thereby finding a forum for pain, survivors and their communities begin to heal (Lord, 1996; Wortman, 1983). As many of the authors in this volume demonstrate, rituals are frequently used to create a context and container for the expression of community feelings and to provide a focus on community healing. Rituals also provide a way for communities to bring closure.
To return to the disaster identified at the beginning of the chapter, now in the chill of December 1997, the “official” word continues to be that no one yet knows for certain what happened to TWA Flight 800. Most of the bodies have been recovered. The grief and mourning continues; questions go unanswered. Cliches say “only time will tell” or “patience is a virtue.” But as the community of families of the dead of TWA Flight 800 know and as neighborhoods and communities directly touched by this one trauma will tell you, the pain is only beginning. It is up to them, the family and community survivors, to acknowledge their deep loss, pose their questions of how and why, create strategies and rituals for coping, and try to heal. Perhaps, in time, they will.
Adelman, M. B., Parks, M. R., & Albrecht, T. L. (1987). Beyond close relationships: Support in weak ties. In T. L. Albrecht & M. B. Adelman (Eds.), Communicating social support (pp. 126–147). Newbury Park, CA: Sage.
Albrecht, T. L., & Adelman, M. B. (1987a). Communicating social support: A theoretical perspective. In T. L. Albrecht & M. B. Adelman (Eds.), Communicating social support (pp. 18–39). Newbury Park, CA: Sage.
Albrecht, T. L., & Adelman, M. B. (1987b). Measurement issues in the study of support. In T. L.
Albrecht & M. B. Adelman (Eds.), Communicating social support (pp. 64–75). Newbury, Park: CA: Sage.
American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., Revised). Washington, DC: Author.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Antonovsky, A. (1990). Pathways leading to successful coping and health. In M. Rosenbaum (Ed.), Learned resourcefulness: On coping skills, self control, and adaptive behavior (pp. 31–63). New York: Springer-Verlag.
Bowlby, J. (1973). Attachment and loss: Separation (Vol. II). New York: Basic Books.
Cook, A. S., & Dworkin, D. S. (1992). Helping the bereaved: Therapeutic interventions for children, adolescents, and adults. New York: Harper/Collins.
Doka, K. J. (Ed.). (1996). Living with grief after sudden loss: Suicide, homicide, accident, heart attack, stroke. Washington, DC: Hospice Foundation of America.
Everly, G. S., Jr. (Ed.). (1995). Innovations in disaster and trauma psychology, Vol I: Applications in emergency services and disaster response. Ellicott City, MD: Chevron.
Everly, G. S., Jr. (1996). A rapid crisis intervention technique for law enforcement, the SAFE-R model. In J. T. Reese & R. M. Solomon (Eds.), Organizational issues in law enforcement (pp. 183–191). Washington, DC: U.S. Government Printing Office.
Garrison, W. (1996). Organizational triage: Restoring the state of the organization altered by trauma. In J. T. Reese & R. M. Solomon (Eds.), Organizational issues in law enforcement (pp. 193–205). Washington, DC: U.S. Government Printing Office.
Grant, A. C. (1995). The healing journey: Manual for a grief support group. Long Branch, NJ: Vista.
Green, B. L. (1996). Cross-national and ethnocultural issues in disaster research. In A. J. Marsella, M. J. Friedman, E. T. Gerrity, & R. M. Scurfield (Eds.), Ethnocultural aspects of post-traumatic stress disorder (pp. 341–362). Washington, DC: American Psychological Association.
Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: The Free Press.
Kalayjian, A. S. (1996). Disaster and mass trauma: Global perspectives on post disaster mental health management. Long Branch, NJ: Vista.
Kastenbaum, R., and Kastenbaum, B. (1989). Encyclopedia of death. Phoenix, AZ: Orgx Press.
Knapp, R. J. (1987). When a child dies. Psychology Today, 21(7), 60–63, 66–67.
Kubler-Ross, E. (1969). On death and dying. New York: Macmillan.
Kulka, B. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. A. (1989). Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
Lehman, D. R., Wortman, C. B., Williams, A. F. (1987). Long-term effects of losing a spouse or child in a motor vehicle crash. Journal of Personality & Social Psychology, 52(1), 218–231.
Lord, J. H. (1996). America’s number one killer: Vehicular crashes. In K. J. Doka (Ed.), Living with grief after sudden loss (pp. 91–102). Washington, DC: Hospice Foundation of America.
Marsella, A. J., Friedman, M. J., Gerrity, E. T., & Scurfield, R. M. (1996). Ethnocultural aspects of posttraumatic stress disorder: Issues, research and clinical applications. Washington, DC: American Psychological Association.
McFarlane, A. C., & van der Kolk, B. A. (1996). Trauma and its challenge to society. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body and society (pp. 24–46). New York: Guilford Press.
Miller, G. R., & Steinberg, M. (1975). Between people: A new analysis of interpersonal communication. Chicago: Science Research Associates.
Parkes, C. M. (1985). Bereavement. British Journal of Psychiatry, 146, 11–17.
Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. New York: Basic Books.
Rando, T. (1993). Treatment of complicated mourning. Champaign, IL: Research Press.
Rando, T. (1996). Complications in mourning traumatic death. In K. Doka (Ed.), Living with grief after sudden loss (pp. 139–160). Washington, DC: Hospice Foundation of America.
Redmond, L. M. (1989). Surviving when someone you love was murdered: Professional’s guide to group grief therapy for families and friends of murder victims. Clearwater, FL: Psychological Consultation and Education Services.
Shapiro, E. R. (1994). Grief as a family process: A developmental approach to clinical practice. New York: Guilford Press
Switzer, D. (1970). The dynamics of grief. Nashville, TN: Abington Press.
van der Kolk, B. A., McFarlane, A. C., & Weisaeth, L. (1996). Traumatic stress: The effects of overwhelming experience on mind, body and society. New York: Guilford Press.
Widdison, H. A., & Salisbury, H. G. (1990). The delayed stress syndrome: A pathological delayed grief reaction? Omega, 20(4), 293–306.
Williams, M. B., & Nurmi, L. A. (1994). Death of a co-worker: Personal and institutional responses. Helsinki, Finland: Poliisin Oppikirjasarja.
Williams, M. B., & Nurmi, L. A. (in press). Creating a comprehensive trauma center: Choices and challenges. New York: Guilford Press.
Wolfelt, A. D. (1987). Resolution vs. reconciliation: The importance of semantics. Thanatos (Winter), 10–13.
Worden, J. W. (1991). Grief counseling and therapy (2nd ed). New York: Springer-Verlag.
Wortman, C. B. (1983). Coping with victimization: Conclusions and implications for future research. Journal of Social Issues, 39(2), 195–221.
Young, M. A. (1995). Crisis response teams in the aftermath of disasters. In A. R. Roberts (Ed.), Crisis intervention and time-limited cognitive treatment (pp. 151–187). Thousand Oaks, CA: Sage.