- The lived experience of traumatic grief differs significantly from that of nontraumatic grief.
- Anguish, rage, and shame mark the emotional terrain of traumatic grief.
- Recognizing the unique features of traumatic grief is vital for caregivers to support the traumatically bereaved.
In the last year, our country has suffered multiple, catastrophic events of violence. In national news, we’ve learned about or lived through tragedies in Uvalde, Buffalo, Highland Park, Colorado Springs, and Monterey Park. We are confronted with killings motivated by hate–against Black citizens, queer people, and those with Asian and other minoritized identities. Understandably, the horror of mass murders garners, as it should, widespread attention. Single-incident murders, sadly though, are even more common by nearly one hundred-fold. In the United States, there were 728 victims of mass murders in the years from 2003 to 2017. Victims of single-incident murders totaled 74,623 in the same period (Fowler et al., 2021). Our cities and towns are awash in anguish and loss.
It’s hard to make sense of the violence. Arduous work is needed to turn back these deadly trends. At the same time, we also must ask—What do we know about grief that involves this kind of trauma, and what the loved ones of those killed are now left to suffer? Is traumatic grief simply a more intense version of nontraumatic grief? What’s the lived experience of those with grief burdened by traumatic stress? In my experience, the nature of grief itself is radically different under conditions of trauma.
Grief Varies by Person and Situation
Most writing about grief first refers to Kubler-Ross’s 1969 book, On Death and Dying, because of its wide-sweeping, enduring influence. The work made popular the idea that grief follows a predictable sequence, unfolding in five stages. Much of the public still clings to the notion of stages even though research conducted over the past 30 years has found no support for the idea. As a therapist, I hear clients frequently make statements like “I guess I’m still in the denial stage” or “I haven’t reached acceptance yet.” I’ve heard even doctors ask such questions as, “She’s still bothered by that?” Health care providers are taught little about grief in general (Loudin, 2021). They’re taught even less about grief in the context of trauma.
Belief in the stage theory of grief may persist because of its simplicity. The model promises a readily understandable framework with which to contain emotionally chaotic situations. Yet grief is far more complex, varying by person and situation. What’s more, there’s no distinction in this model between traumatic and nontraumatic grief. For these and more reasons, stage theory promotes unfounded expectations for the bereaved and those who support them.
Unpacking Grief: How Trauma Alters the Feelings and Thoughts of the Bereaved
The theory has limits other than the lack of evidence for stages that progress (Stroebe et al., 2017). It confuses and collapses categories of experience. Anger, for instance, is a feeling, denial a thought process, and depression a syndrome. The original model didn’t even include sadness, which, for many, lies at grief’s center. We do, however, experience grief on many levels of functioning—in thought, action, physical sensation, and emotion (Worden, 1982). Understanding someone’s grief requires careful consideration of all.
Sadness is universal in nontraumatic states of grief. Disbelief is common as well. We don’t usually break with reality, though, as the label denial suggests. The loss may just not feel real. I lost my father, for instance, when he died in his sleep at age 84. Although his death was sudden, it wasn’t unexpected. While my heart was heavy with sadness, and his life ended in the most peaceful of ways, I still grappled to take in that he was really gone. Even under the kindest conditions of death and dying, it takes time for the bereaved to absorb the fact of a loss, the never again.
Guilt and regret are also common in nontraumatic grief. These feelings often relate to a sense of missed opportunities with a loved one. I’ve known people to share guilt or regret that they hadn’t spent more time with their loved one, or they wished they’d given them more comfort during the process of dying. While there is no timeline on grief, research finds that the intensity of sadness, guilt, regret, and anger diminish for most of us after about a year and a half. Likewise, people can usually return their attention to other parts of their present lives somewhere over the course of 6 to 18 months. Though we might long for the person we’ve lost for the rest of our lives, in nontraumatic bereavement, we can typically re-engage with the present after about a year and a half (Prigerson et al., 2018).
After a loss, our thought processes may be disrupted as well. We may ruminate about what happened to the person we loved. Our minds may seem cloudy as we experience confusion in our attempts to take in the fact of the loss. Our chests might feel tight or our stomachs hollow. We may be unable to eat, feel lethargic, and be slow to move about. These are common responses to the death of a loved one, even those that are anticipated, natural, or come at the end of a long life. When we lose a loved one to other traumatic situations such as murder, however, additional thoughts, feelings, and sensations may arise.
Our physiologically based stress response, called "fight, flight, or freeze," kicks in when a loved one dies from violence or without warning. Even in nontraumatic loss situations, we may be disoriented at first. Many of us experience a kind of cognitive fog soon after a loss. In situations of traumatic loss like homicide, however, the shock can leave our minds not just foggy but also blank. A freeze response sets in, that involuntary, automatic reaction to threat when thought and feeling shut down.
In nontraumatic grief, it’s common to swing between sadness, anger, and guilt, and to find our usually clear minds more forgetful. In traumatic grief, we shift between frozen and startled, overwhelmed to numb. In nontraumatic grief, we may be preoccupied with our loved one—our shared experiences or their possible suffering. With traumatic loss, we may have even less control over our thoughts. We may suffer intrusive mental images, whether or not we witnessed the violence. A preoccupation with perpetrators can get in the way of loving reminiscence. Known or imagined details of the crime can evoke painful physical sensations. I’ve heard clients in therapy express feeling they may vomit when they talk about the trauma associated with a violent death of a loved one, for example.
Sadness deepens to anguish under catastrophic conditions of loss. When we’re sad, our expressions hang or our posture may droop. In anguish, our faces contort. We’ve seen this in photos of loved ones of victims killed in tragedies like recent mass shootings and the crowd disaster in South Korea on Halloween this past October. Anguish, as tortured sorrow, feels very different from sadness.
In conditions of nontraumatic loss, we can feel anxiety as the loss of our loved one reminds us of our own inevitable death. In traumatic loss, anxiety becomes terror. In unsolved murders when perpetrators are unknown and still free, fear may never recede. The anger we naturally feel at the fact we all die may swell to rage when another person causes death.
Shame may displace common feelings of guilt or regret when homicide victims and co-victims are blamed, directly or by insinuation, for the crime that they’ve suffered. The stigma that attaches to crime is often felt by survivors as well. Shame can harden our loneliness to isolation as we feel outside a larger community. Jealousy or envy that we might feel in nontraumatic loss may be excruciating in traumatic situations. Much like the way colors combine to create a new hue, our feelings can blend into new forms of pain. We know now that grief is better described as a series of emotional states, not stages, that fluctuate and overlap in a multitude of ways. A bereaved person might feel disbelief, rage, and anguish all at the same time, with one particular feeling more intense than another at any given moment. And most of us don’t try to bargain for a different reality, as the stage model predicts. But we may yearn for the loved one who has died.
Grief after traumatic loss can leave us feeling in a plane of existence different from everyone else around us. After a loved one’s violent death, many feel as if submerged under water, bobbing for air only now and then. Sounds can seem muted. At other times, small noises seem unnaturally harsh. These are some ways that trauma inflects grief. Hypervigilance may run like a fiery thread through our cascade of emotions to keep us on high alert. A traumatically bereaved person’s own body may seem too small to hold all of the feelings that arise.
Recognition of the unique expressions of traumatic grief is vital for support and validation. The caring and knowing embrace of community—including health and mental health care providers, law enforcement professionals, and religious leaders, as well as families and friends—offers solace to carry what may be otherwise unbearable for the bereaved.
Fowler, K. et al. (2021). Examining differences between mass, multiple, and single-victim homicides to inform prevention: Findings from the National Violent Death Reporting System. Injury Epidemiology. 8.
Kubler-Ross, E. (1969). On death and dying. New York, NY: Scribner.
Loudin, A. (2021, Autumn). The profound sadness of prolonged grief. Harvard Medicine Magazine. Harvard Medical School, Boston, MA.
Prigerson, H. et al. (2022). Prolonged grief disorder diagnostic criteria - Helping those with maladaptive grief responses. JAMA Psychiatry. 79(4) DOI:10.1001/jamapsychiatry.2021.4201
Stroebe, M. et al. (2017). Cautioning healthcare professionals: Bereaved persons are misguided through the stages of grief. Omega: Journal of Death and Dying. 74(4). https://doi-org.ezp-prod1.hul.harvard.edu/10.1177/0030222817691
Worden, J. (1982). Grief counseling and grief therapy: A handbook for mental health practitioners. New York, NY: Springer.