Death can be experienced as traumatic, whether it occurs suddenly or after a period of illness.

By Lene Larsen, Psychologist and Grief Researcher, Aliasoqatit, The National Grief Center

WHEN LOSS IS SUDDEN

When a sudden loss occurs, for instance in an accident, when someone goes hunting and doesn’t return, or through suicide or murder, one is unprepared for the loss. This can lead to a crisis situation where one may be quickly overwhelmed by shock, severe emotions and reactions, or where one might not feel anything at all and have difficulty understanding what has happened. Some bereaved experience intense physical reactions, feeling physically unwell and collapsing. Others have difficulty inhabiting their own body. Some may scream and start crying immediately, while others become quiet, trying to comprehend what has happened. There might be a sense of unreality, as if one is in a dream, unable to believe the truth of what they have been told. These reactions are all natural when one has lost someone suddenly under difficult and traumatic circumstances.

Sometime after receiving the devastating news, a torrent of emotions and questions typically arises. One may feel miserable, desperate, angry, and scared while also feeling powerless, helpless, and insecure. There might be self-blame, with thoughts about what could have been done to prevent the death.

Trauma Reactions and Powerlessness

In the days following a sudden death, it is normal for the bereaved to experience trauma reactions. These may involve intrusive images or thoughts over which one has no control, such as images of the accident site or imaginings of what occurred. One might become preoccupied with avoiding things that trigger these images and thoughts, such as avoiding hospitals or taking detours to not pass by the accident site. Alternatively, one might engage with their phone late into the night to exhaust themselves to sleep. For most people, these reactions will subside on their own over time.

A sudden and perhaps violent death can also trigger many thoughts and considerations that are difficult to manage. For example, one might feel powerless and alone, perceive life as meaningless, unjust, and unsafe, and lose hope and belief in feeling secure and happy again.

A Lack of “Goodbye”

When someone dies suddenly or disappears, the bereaved do not have the opportunity to say goodbye. They did not get a chance to say the things they wanted to say—perhaps a last “thank you,” “sorry,” or “I love you.” A sudden death also means that one is deprived of the opportunity to resolve conflicts or improve difficult relationships, which can trouble the bereaved. They may end up feeling guilty and remorseful, needing help to process these difficult emotions.

How Can Others Provide Support?

When facing a situation of sudden loss, many need to be met with support, understanding, and care to some degree. When the death has just occurred, it is beneficial not to be alone but instead to be with people one knows well and feels safe with. For example, it’s best not to go home alone to an empty house after visiting the hospital and seeing the deceased for the last time. In the days that follow, one may also need others to share thoughts and experiences with, i.e., people who can listen and be there. It can also be comforting to meet others who have experienced something similar.

WHEN LOSS OCCURS DUE TO ILLNESS

Some might think that it is easier to lose someone to illness than to lose someone suddenly. However, this is not necessarily the case. It doesn’t really make sense to compare or rank different types of loss (prolonged illness or sudden death by accident, suicide, etc.), as the way a loss is experienced and its consequences for the bereaved depend on many factors. We have previously described, for example, that whom one loses, how the relationship was, what significance the person had for one, where one is in life, and what resources one has, influence how grief is experienced and impacts one’s further life. It is probably most important to try to understand grief as a personal experience, shaped by both whom one lost and who one is, where one is in life, instead of discussing who suffers the greatest or most difficult losses.

Throughout the course of a long illness, relatives may witness their loved one in pain, subjected to invasive treatments, and progressively worsening, perhaps almost becoming someone entirely different from who they were. Such experiences can be immensely draining, burdensome, emotionally demanding, and debilitating. When death finally occurs, the bereaved may also experience a crisis reaction, as described above, with shock, emotional and physical reactions. Additionally, not all those who lose someone to illness have the opportunity to say a meaningful “goodbye” to their loved one. They can find themselves in the same situation as those who experience sudden loss.

Anticipatory Grief: Mourning Before a Death

Some relatives find that their grief process begins before their loved one has died. This type of grief is often called anticipatory grief. It is the grief experienced while waiting for the inevitable loss of a seriously ill or dying person.

Anticipatory grief shares many similarities with the grief experienced after a death. It can involve psychological and physical pain, feelings of unreality, loneliness, concentration problems, sleep disturbances, and social isolation. Moreover, the relative also experiences the ups and downs of the illness, and the challenge of maintaining hope while simultaneously preparing for the loss. Many feel guilty when they catch themselves wishing it would soon be over. Some feel guilty about being the one who continues to live when the other is dying. Those in anticipatory grief find that uncertainty and constant worry become a daily condition, filled with thoughts about death, how the illness will progress, how long the patient will suffer, and what the future will be like without their loved one.

Not all relatives experience anticipatory grief, and those who do may not necessarily have an easier time of grieving after the death. However, anticipatory grief can be seen as a natural part of the grieving process. For some, it may be helpful to talk with others about what they are experiencing and feeling, so they do not have to carry it alone on top of everything else difficult they are dealing with during their loved one’s illness.

How Can Others Provide Support?

When someone has lost a loved one to illness or to a natural death due to aging, most people need some degree of support, understanding, and care from others. Everyone, from hospital staff, family, and social networks, to clergy, workplace colleagues, or school personnel, can play a crucial role in supporting the bereaved both immediately after the death and throughout the grieving process. They need to understand that people react differently to loss. For some, the death may trigger a crisis reaction, while for others, relief and sadness may predominate. The network should be aware that individuals within the same family may react very differently, and there can be a significant variance in how long it takes each person before they can manage their grief in a bearable way.

Many bereaved find it helpful to share their grief with others, meaning their thoughts, feelings, and experiences. Others can help by listening and being present in a non-judgmental way—by giving space to, accommodating, and validating what the bereaved person says, and not trying to minimize their experience or encourage them to “move on.” Others can also provide support by helping with practical tasks such as cooking, cleaning, and picking up children, or by taking the bereaved on walks or to other activities that can provide tranquility or positive experiences. It can also be supportive for some to meet others who have experienced something similar, for example, by participating in a grief group or other groups for mourners, such as grief café evenings.