Behavioral Health Brief: The Intersection of Grief and Trauma
By Lisa S. Zoll, LCSW, and Leslie Davila, MS
Social Work Today
Vol. 22 No. 4 P. 26

Traumatic grief occurs when a loss or death is sudden, tragic, and unexpected. The traumatic event that led to the loss or death can impact the grief reactions of individuals, families, and communities. It can cause intense fear and a feeling of helplessness that engulfs the individual’s immediate ability to cope.

In the aftermath, those affected are left to identify ways to reorder their lives. These events are explored through the lenses of trauma and grief and how they intersect under the definition of traumatic grief. Clinical approaches and concepts can be applied to traumatic grief.

Individuals, families, and communities may experience traumatic grief when a death causes distressing preoccupation with the way the person died. Common reactions include shock, irritability, anger, yearning, disbelief, and numbness.

There is clinical debate about whether trauma and grief are individual events or entities that should be treated as such or whether there is an intersection or connection between trauma and grief and, therefore, they are not mutually exclusive.1

The following case study examines the intersection between trauma and grief in the aftermath of the death of a first responder in the line of duty by applying the concept of order, disorder, and reorder to the event.2

Case Study
Order: The daily rhythm, routine, and structure of our lives.

From the age of 14, Connor wanted to be a firefighter. His uncle, who was a firefighter, inspired him to serve the community and help the people around him. Connor was hooked by the excitement of riding on a fire truck, hanging out at the firehouse, and being part of the brotherhood of first responders.

He moved through the ranks, eventually becoming a captain. He took a job at the county’s 911 dispatch center because it was connected to the fire service. He wanted to see “the big picture,” from the beginning of a call when the pagers went off to the end when the first responders returned to their respective firehouses.

Connor moved into the firehouse and was bunking with his best friend Jerome, who had a similar dedication to the fire service.

Disorder: An event that disorders the order of our lives. The notification of an event is the catalyst for disorder.

On March 9, 2020, at approximately 1:30 am, Connor, Jerome, and a driver were on the first engine responding to a house fire with entrapment. The house was fully engulfed in flames; it was impossible to enter.

“You take the front, and I’ll take the rear,” Connor said to his friend. They fist-bumped as they always did on calls.

“I ran toward the back of the house and dropped the nozzle where I wanted to stand with the hose,” Connor says. As he ran to the side of the house, he could see Jerome on his knees 25 to 30 yards from the front of the house waiting for water. “We couldn’t get any closer due to the intensity of the heat,” Connor says.

Soon after arriving on the scene, the chief noticed that the porch had collapsed, and the handline was under it. A firefighter’s helmet lay on the ground. The chief shouted, “Mayday, mayday, mayday, firefighter down, side A.”

Connor says, “Shortly after the mayday call went out, a firefighter from another company came to the back of the house and took over my hose line and told me that I needed to go to the front of the ladder truck with the rest of my company. At that point, I asked what was going on. Someone said that the roof of the porch had collapsed on Jerome, he was unconscious, and they were doing CPR on him.

“I remember walking to the front of the ladder truck … seeing the medevac helicopter crew walk by the ladder truck and everybody seemed to be in shock. Someone told my fire chief that there was nothing further they could do to resuscitate Jerome. Then the fire chief told the company, and everybody broke down, and that is when I went numb.”

While Connor remembers one of his good friends from his company hugging him and crying, he says, “I felt no emotion.”

Reorder: The new order of life after the event that caused disorder.

In the following weeks, Connor remembers, “I was still feeling really numb. … I didn’t sleep. Since I was living at the firehouse with Jerome, all his stuff was there. Basically, I went through the motions.”

Reordering life after a traumatic event takes time. Connor decided to move out of the firehouse four months after the fateful call. “I moved back into my parents’ house where everything wasn’t staring me in the face, and I wasn’t looking at all the reminders every day,” he says.

Connor has done several things to reorder his life. He sought treatment for the trauma he experienced that night, he moved out of the firehouse and minimized his time there, and he took time off from work and began to play golf and hike. He became engaged to be married. On the day Connor got married, his oldest son carried Jerome’s picture down the aisle with the other groomsmen.

Connor says that not being as involved in the firehouse has made his life less stressful. He feels calmer. He has reordered his priorities. Where once he put the firehouse first, he now places family above all.

Applying the Three Ds to Trauma
There can be a variety of responses to trauma that create disorder. These may vary in intensity, frequency, and duration. Consider the three D responses: disorientation, distress, and devastation. The event can cause disorientation and leave an individual in shock, feeling confused or lost, or in an altered mental state. Grounding is a type of coping strategy designed to anchor individuals in the present moment, the “here and now,” by using the five senses of sound, touch, smell, taste, and sight when their capacity to cope has been overwhelmed by the circumstances.3

A psychological reaction associated with emotional suffering, distress includes a wide range of emotions such as sadness, despair, uncertainty, anxiety, and fears that can be difficult to cope with and are often out of the ordinary demands of life. Clinicians can help provide emotional regulation to a client’s psychological distress by using active listening, validating the perception of the experience, providing education about responses, and offering support and validation to assist in normalizing their responses to the experience.4

Devastation is defined by Oxford Languages as “severe and overwhelming shock or grief.” After a traumatic event, many factors can disrupt the normal grieving process, raising the risk for traumatic grief. It will be important to process the precipitating event through interventions that allow the client to form a cohesive narrative of the impact of both grief and trauma. This involves finding ways to absorb the event, doing the work needed to adjust to the new reality of life following the event, and accommodating the impact of the event while moving forward.5

Posttraumatic Growth (PTG)
A theory that explains the transformative growth following trauma, PTG can take place because of the struggles and challenges faced after a crisis or a traumatic event. Human beings can be changed in a positive way after experiencing a devastating loss. Individuals have different levels of resiliency—some will have trouble recovering after experiencing trauma because their core beliefs about their world may be challenged. Individuals who experience PTG may struggle psychologically to make sense of what has happened to them. It is through the processes of struggle that we see areas of growth.6

Tedeschi and Calhoun posit that PTG tends to occur in five general areas: appreciation of life, relationship with others, new possibilities in life, personal strength, and spiritual change.7 Clinicians can help clients connect with their internal resources and strengths to deal with challenging situations. Clinicians can also help clients reframe the priorities in their lives and, where possible, highlight their growth in those areas. It is more than bouncing back; it is living forward into a positive life after a traumatic experience. We can grow through what we go through.

Clinicians doing grief work must be aware of trauma. Clinicians doing trauma work must be aware of grief. When we are focused on just one or the other, we may fail to address how both may be impacting our clients.

— Lisa S. Zoll, LCSW, the founder and owner of Grief Relief, LLC, specializes in helping individuals challenged by loss and grief. She holds a master’s degree in social work with a clinical concentration from Temple University and has published several articles and spoken on the local, state, and national level about loss and grief and how they can impact individuals, families, communities, and organizations.

— Leslie Davila, MS, has a master’s degree in criminal justice from Saint Joseph’s University and a Bachelor of Arts in sociology and criminal justice from La Salle University. For 23 years, she has committed her career to advocating on behalf of children and victims/survivors of crime. Appointed director of the Office for Child and Youth Protection of the Archdiocese of Philadelphia in 2011, Davila oversees the Archdiocesan commitment to protect children and young people and its efforts toward healing and reconciliation for those who were sexually abused as minors.

References
1. Regehr C, Sussman T. Intersections between grief and trauma: toward an empirically based model for treating traumatic grief. Brief Treat Crisis Interv. 2004;4(3):289-309.

2. Rohr R. The Wisdom Pattern: Order, Disorder, Reorder. Franciscan Media; 2020.

3. Tull M. Grounding techniques for post-traumatic stress disorder: using the five senses to cope. Verywell Mind website. https://www.verywellmind.com/grounding-techniques-for-ptsd-2797300. Updated April 16, 2021.

4. Zoll L, Schwartzman J, Shiner L. Drew and the Grief Thief: A Story for Children and Adults Experiencing Loss and Grief. CreateSpace Independent Publishing Platform; 2018.

5. Zoll L, Shiner L. A grief trajectory. Social Work Today website. http://www.socialworktoday.com/news/pp_063017_5.shtml. Published 2017.

6.Collier L. Growth after trauma: why are some people more resilient than others—and can it be taught? Psychol Today. 2016;47(10):48.

7. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471.