How to help ‘underserved victims’ of violence

Editor’s Note: Joan Cook is an associate professor at Yale University and president of the American Psychological Association’s Division of Trauma Psychology. She is an Op-Ed Public Voices Fellow. The opinions expressed in this commentary are her own.

Last Thursday, the world watched as yet again terrorism struck, this time in the southern French city of Nice, where at least 84 people were killed. And on Sunday, we were forced to bear witness to the killing of three Baton Rouge police officers and the wounding of three others – shocking violence afflicting a community already grieving the killing of Alton Sterling.

Whether it is hate-filled terrorism or killings of or by police, these horrific events sadly seem to have no end in sight. The inevitability of another act of sudden violence is always present. It is understandable that people in our country and around the world feel jacked up – with a mixed bag of intense fear, outrage and sadness. We’re all struggling to find our way, to manage the anticipation of future threats while still trying to live happy, productive lives.

But what about the individuals who are directly impacted by such traumatic loss? The mothers, fathers, spouses, children and close friends whose loved ones are struck down in places like Nice and San Bernardino, in Baton Rouge and Dallas? They always seem to be the ones forgotten in the aftermath of tragedy.

As a psychologist, I’ve assisted people in holding their intense pain after the direct experience of horrific events – combat, captivity, rape and other forms of interpersonal violence. In working with survivors who escaped or were first responders to the burning inferno of what used to be the World Trade Center, I saw some of the direct mourning that comes from such violent loss.

But in my work I have also seen the toll of traumatic loss. Losing a loved one – by any means – is often painful. Even when it’s expected and one has had time to prepare, it can weigh heavy on the hearts and minds of those left behind. But losing one to traumatic death, whether through terrorism where many people are taken at one time or an individual shooting, can leave an even bigger hole for the survivor.

When people lose a loved one due to violent causes such as terrorism, homicide and fatal accidents, they must contend not only with the distress of separation but with the pain associated with the circumstances surrounding the death. They feel cheated or robbed. They often replay the senselessness or violence of their loss over and over in their mind.

Indeed, violently bereaved individuals report greater and more complicated grief than individuals bereaved by natural death. Complex grief involves prolonged concern over the loss, through intense yearning for the deceased or rumination about their death, and it interferes with the survivor’s other relationships, work and health.

In a national sample of almost 2,000 young adults, those who lost a family member or close friend to a drunken driving accident or slaying were at higher risk for post-traumatic stress, major depression and drug abuse than those who hadn’t experienced a traumatic loss. Additionally, research shows that almost 45% of adults who lost a loved one in the September 11 terrorist attacks still had significant protracted grief years later.

After post-traumatic loss, parents are typically at greater risk of developing emotional difficulties compared with other relatives. The feelings of anger toward God, of spiritual abandonment or questioning God’s power are also strongly related to complex bereavement.

Sometimes one path through complicated grief and post-traumatic loss is to find sense or benefit in the experience. Not an easy thing for sure. And typically the last thing most people want to do after the tragic death of a loved one is to attempt to rise above and make sense of their loss. But successful meaning-making in the early months of loss predicts well-being years later.

In an analysis of responses of bereaved individuals to questions about how they engaged in meaning-making, the replies were rich and varied. Some gained a new respect for the value of life, taking advantage of the time they had left with renewed strength, maturity and changed priorities. Some people find meaning or benefit in maintaining a sense of connection to the deceased – comforting memories, imagined conversations, grief diaries, blogs or memorial websites.

Unfortunately, despite these findings, we offer only limited attention to family members or close friends who lose loved ones by violent means. There’s still comparatively little research devoted to this population and its needs. And, in my opinion, society doesn’t give them much positive attention either. This is why I often refer to them as underserved victims.

Anguished and questioning, traumatic loss survivors wonder how could this happen? How can they live without their loved one? Another haunting question that can prolong and complicate recovery is whether the person(s) who killed their loved one will go unpunished. All the things not said or said but regretted hinder recovery as well. It’s the unfinished business with the deceased that haunts a person and is one of the biggest risk factors for chronic, severe grief.

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There are societal rules of grieving – beliefs we hold about how long and how much one should grieve before it’s considered problematic. But how do we give each other the support and space to engage in such sense-making? As a trauma psychologist, I say if you choose to keep a stiff upper lip, or yell and beat your chest, that’s your business, your call. The best support we can provide one another is not to call in the grief police for something that is a private, inner process.

Let us recognize – with greater support, recognition and research – these underserved victims of racial and police killings, terrorism and other forms of violent loss. They are left behind to deal with what may seem an unbearable grief and loss.