The Dawn of a New Mourning: To Comprehend the Full Impact of Mass Bereavement, Both Psychologically and Physiologically, We Need to Find the Link between Personal Feelings of Loss and the Collective Experience of Grief

Article excerpt

THE ATTACKS OF SEPTEMBER 11 were not the first events that forced us to re-examine our conceptualization of grief. We had been shaken before, by incidents like the 1985 explosion of Air India Flight 182 over the Atlantic Ocean, the 1995 bombing in Oklahoma City, and the shootings at Columbine High School in 1999. For many years before these tragedies, perhaps since Doctor Elisabeth Kubler-Ross, a psychiatrist, wrote her famous 1969 book, On Death and Dying, grief was popularly thought to be a process that occurred in a lock-step, hierarchical fashion. First, there would be denial ("this is not happening to me"), then anger ("why is this happening to me?"), followed by bargaining ("I'll be a better person if ..."), depression ("I give up"), and acceptance ("I am ready for whatever awaits me"). Only more recently did we learn that many people do not go through all of these phases and that these phases can and do occur in different orders. As a result, the grief process has become much more individualized. Yet the 9/11 terrorist attacks forced us to focus on bereavement and the associated sense of loss, or grief, as they occur on a much larger scale.

"Bereavement," the actual life event of learning that someone close to you has died, is different from the response of "grief," which is the specific form of distress we suffer during the process of adapting to the occurrence of bereavement. Historically, grief has been considered a form of depression, but studies conducted over the past ten to fifteen years have shown that it is just as accurately conceived of as a form of trauma.

Traumatic bereavement distress differs in a number of ways from what we normally think of as depression. When we say we are "depressed," we usually mean we feel sad, are losing our appetite or weight, are agitated or slowed or lethargic, are feeling worthless or excessively guilty, and are having recurrent thoughts of death or suicide. Traumatic distress, on the other hand, is characterized by persistent, intrusive, and disturbing recollections, in images or thoughts, of the death of a loved one. There may be recurring dreams of the deceased, episodes of reliving the experience of their death, and intense reminders of the death, with severe physiological as well as psychological reactions. Other symptoms include an ongoing state of arousal that leads to irritability and angry outbursts, over-vigilance of one's surroundings, and an inordinately startled response to rapid changes in one's environment. These symptoms can be accompanied by attempts to avoid reminders of the loss; an inability to recall major aspects of the event; and, at the extreme, a feeling of detachment from the world, restricted emotional expression, and a sense of impending doom.

Certain symptoms, such as decreased interest in daily activities and difficulty sleeping and concentrating, are common to both traumatic and depressive types of psychological distress. Yet "grief" is not fully captured by either of these types of distress, or by any specific combination of their characteristics. A set of elegant research studies in the mid-1990s by Holly Prigerson, an associate professor of psychiatry at Harvard Medical School, and her colleagues showed that grief is explicitly and qualitatively different from trauma and depression because only those who experience grief suffer from "separation distress," a yearning and longing for the person who has died. This means that a conglomeration of three types of distress--depression, trauma, and separation--is required to properly define grief.

How do we begin to understand such grief at the level of multiple individuals, of communities, of a nation, as the bereavement of so many following 9/11 requires?

One of the most difficult types of loss to adapt to, we know, is the loss of one's own child. Not only do the father and mother grieve at the individual level, but they also grieve at the "dyadic level," meaning the couple experiences a specific aspect of grief that exists only within the context of their relationship. …