Grief After a Violent Death

I recently attended the 10th Biennial Bereavement Conference presented by Baylor Scott & White Health Care System.  The conference was titled “Coping with Bereavement Complications,” and among the invited speakers was Dr. Edward K. Rynearson, M.D. who presented on the treatment of traumatic grief after violent death.

On a yearly basis in the U.S., violent deaths (suicide, homicide, and most accidental deaths) total between 180,000 to 200,000 and comprise about 5 to 7% of total deaths.

In 2014 for example, about 2.6 million people died in the U.S.  Of these, about 130,000 deaths were caused by unintentional injures from accidents (4th leading cause of death), 42,000 suicides (10th leading cause of death), and about 16,000 homicides.  In 2014 then, about 198,000 deaths, or about 7% of all deaths, were unnatural, sudden, violent, and in many cases, preventable.

These types of violent losses give rise to a grief process that is more likely to be complicated.  To be bereaved by such a loss is to feel helpless, powerless, and to question “why” this happened. It is also to feel deep pain over the thought that our loved one died in such a horrific manner, alone, without our presence nearby. This is to say that there are some unique dimensions to grief after the loss of a loved one to a violent death.  Violent dying defies reason.  One can’t make meaningful sense out of it by thinking about it over and over again.  This is a death that never should have happened, and mourners are likely to be plagued by intense, highly disturbing visual imagery of what they imagine happened to their loved one.

To get a sense of the scope and intensity of the pain of these types of losses, 30 to 50% of mourners will experience depression or significant anxiety in the first year after such a loss.  Those at highest risk are mothers who have lost a child (a full 30% of whom will display PTSD symptoms a full five years after the loss).  Excruciating suffering is normal (for a time) after such a loss.

A particular form of grief therapy is helpful to many bereaved people in such a situation.  Initially, interventions are designed to assist in the reduction of acute distress.  In this phase, attention is paid to creating coping strategies to manage one’s own emotional and body-focused expressions of distress (i.e., self-regulation).  After self-regulatory skills are more readily available to a person, the narrative of the person who died, their relationship to the bereaved, and the manner of dying is processed, including commemorating the person for whom they were while they were alive.  Over time, the focus shifts to reengaging in life in ways that are personally meaningful.

Medications may be helpful for the depressive features and anxiety, but they will not help much with the grief component underlying the distress.

Despite the shock, horror, agony, despair, and utter shattering that occurs in individuals and families after the death of a loved one to a violent death, experience teaches that one can (and most likely will) prevail in the long run.

Dr. Rynearson’s website (vdbs.org: Violent Death Bereavement Society) has a tremendous amount of valuable information, including research findings and grief and bereavement resources.

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