After a Tragedy in a Community

1. After a Tragedy in a Community Diane Moran 781.632.0401 www.griefeducation resources dianemoran@comcast.net

2. STIMULUS RESPONSE Stressor Stress (stimulus demand) (response) “ Men are disturbed not by things, but the views which they take of them.” Epictetus

3. Environmental Event (stressor) Cognitive Interpretation (meanings are assigned) Affective Integration (emotional arousal) Stress Response Target Organ Activation Excessive activation or Coping Stress-related disease Return to homeostasis

4. NATURE OF DEATH • Suicide • Homicide • Violence • Mutilation • Young • Multiple losses • Sudden • Ambiguous (no body)

5. COMMON TRAUMA REACTIONS PRE-SCHOOL Crying Whimpering Screaming Immobility Aimless wandering Fear Facial expressions Excessive clinginess Regressive behaviors Modeling parents Completely ignoring the situation

6. COMMON TRAUMA REACTIONS 6 – 11 YEARS OLD Extreme withdrawal Disruptive behavior Poor attention Regressive behaviors Sleep problems Bad mood Don’t want to go to school Somatic distress Irrational fears Anxiety Depression Feelings of guilt Emotional numbing

7. COMMON TRAUMA REACTIONS 12-17 YEARS OLD Flashbacks Consumed by event Nightmares Depression Substance use/abuse Hopelessness Helplessness Suicidal thoughts Guilt Revenge fantasies Academic decline Idealization of dead Anti-social behavior Nervous laughter

8. COMFORTING WORDS • “I’m sorry for your sadness.” • “This may be pretty hard for you.” • “If you want to talk, to me or someone else, just let me know.” • “I can’t imagine how you feel.” • “Tell me about her.” • “It’s okay to ….” • “I can just sit here for awhile with you if that’s okay.”

9. Everyday Life Experiences Regular World Grief World Grief work Attending to life changes Dual Process Model of Understanding Bereavement Stroebe and Shut, 2001 Intrusions of grief Doing new things Breaking bonds/ties Relocation of the deceased Distractions from grief Denial/avoidance of any restorative changes Denial/avoidance of grief New roles, identities, and relationships

10. Factors influencing children’s and teens’ adjustments to lossDr. Robin Goodman, NYU School of Medicine • Type of loss • Physical and emotional functioning of support systems • Cognitive development of child • Child’s personality and temperament • Quality of the relationship, if applicable • Concurrent life stressors

11. GRIEF vs. TRAUMA Grief generally does not attack or disfigure identity. Trauma generally attacks, distorts and disfigures our identity . In grief, guilt says, “I wish I would/ would not have …” In trauma, guilt says, “It was my fault. I could have prevented it. It should have been me.” In grief, dreams tend to be of the person who died. In trauma, dreams are about the child herself or a loved one in place of the deceased. Generalized reaction … Sadness. Generalized reaction … Terror! Grief reactions can stand alone. Trauma reactions generally include grief reactions. Grief reactions are generally known Trauma reactions, especially in kids, are largely to the community unknown to the community. In grief pain is related to the loss. In trauma, pain is related to the tremendous terror and an overwhelming sense of powerlessness and fear for safety. In grief, a child’s anger is generally not destructive In trauma, a child’s anger often becomes assaultive (even if the trauma is non-violent). SOURCE: The National Institute of Trauma and Loss in Children

12. FACTORS THAT MAY INHIBIT A GRIEF RESPONSE • Feels alone in her sorrow • Adults cannot tolerate the pain of the child and therefore don’t allow a response • Lack of a caring, safe environment • Confusion about the event and any responsibility • Ambivalence towards the deceased or event

13. FACTORS THAT MAY INHIBIT A GRIEF RESPONSE • Unchallenged magical thinking • Developmental issues that conflict in trauma and mourning • Instability at home • Reassignment of an inappropriate or unwanted role as a result of the event

14. THE NATIONAL DATA • Suicide is the third leading cause of death for teens. • Suicide is second leading cause of death in colleges. • For every suicide completion, there are between 50 and 200 attempts. • CDC Youth Risk Survey: 8.5% of students in grades 9-12 reported a suicide attempt in the past year. • 25% of high-school students report suicide ideation. • The suicide attempt rate is increasing for youths ages 10-14.

15. “Guilt is perhaps the most painful companion of death.” Dr. Elizabeth Kubler-Ross

16. GUILT • A person feel that she either did or didn't do something that led to the suicide • “If only”: the woulda, coulda, shouldas • A person believes the tragedy is due to a wrongdoing she committed • A person feels they’re not entitled to any happiness in life. • A person thinks she isn’t grieving correctly • A person feels guilty for reason she can’t even mention or think about • A person feels guilty about continuing on. Source: Miles and Demi, 1986

17. ANSWERING THEIR QUESTIONSRESPONDING TO THEIR EMOTIONS • “I knew he was going to kill himself.” • “Nothing will ever be the same.” • “It’s my fault.” • “This just can’t be.” • “Why am I so upset? I hardly knew him.” • The “I wish …” • “My parents don’t understand.” • “I can’t stop thinking about it.” • “I’m afraid someone else is going to commit suicide.”

18. THE REACTIONS • Anger with potential for rage • Extreme denial • Escapism • Suicidality

19. SUICIDE PREVENTION KNOWLEDGE IS POWER! • Know the warning signs • Each person is responsible for his/her own actions • Suicide is often evidence of a mental illness • There are alternatives to ending your life • Survivors reactions are normal • Social media … THERE IS NOTHING BENEFICIAL ABOUT ROMANTICIZING A SUICIDE OR IDEALIZING THE ACT BY PORTAYING IT AS HEROIC.

20. “You can clutch the past so tightly to your chest that it leaves your arms too full to embrace the present.” Jan Glidewell

21. COMMUNITY ASSISTANCE Parents School staff and faculty Therapists, counselors, psychologists Clergy Red Cross Community patrons

22. MEMORIALS Get this policy established and have it apply uniformly. “The ______Board of Education will disallow any and all memorials initiated, donated or purchased in memory of a student or staff member on school property.”

23. Don’t curse the darkness – light a candle • Volunteer for an organization • Start a support group • Help someone you know • Learn about your grief • Download a favorite song of the person who died • Write a poem or in a journal

24. OTHER CONSIDERATIONS • Graduation ceremonies • Student in-services (car crash) • Books • College Boards • Siblings • Triggers • Anniversaries • Changing curriculum • Gym and meditation

25. SELF CARE • Support system • Humor • Meet with each other • Continue to be educated about pfa • Exercise • Good food