Handbook of Traumatic Loss

A Guide to Theory and Practice

Neil Thompson, Gerry R. Cox, Robert G. Stevenson, Neil Thompson, Gerry R. Cox, Robert G. Stevenson

• Publisher: Routledge
• Year: 2017
• eBook ISBN:
  9781317237532
• Topic: Medizin
• Subtopic: Psychische Gesundheit in der Psychologie

The Handbook of Traumatic Loss adopts a broad, holistic approach that recognizes traumatic loss much more fully as a multidimensional human phenomenon, not simply a medical condition. Initial chapters build a foundation for understanding traumatic loss and explore the many ways we respond to trauma. Later chapters counterbalance the individualistic focus of dominant approaches to traumatic loss by highlighting a number of thought-provoking social dimensions of traumatic loss. Each chapter emphasizes different aspects of traumatic loss and argues for ways in which clinicians can help deal with its many and varied impacts.

PART ONE

MAKING SENSE OF TRAUMATIC LOSS

INTRODUCTION TO PART ONE

In this first part of the book our focus is on making sense of the complexities involved in traumatic loss. Our intention is not to provide a comprehensive review of the subject; even a whole book would not be sufficient to do that, as it is such a broad area of study. However, what we can offer is a foundation of learning to be built upon – a platform of understanding that can offer useful insights and food for thought.

Part One comprises eight chapters. In the first we find an exploration of how existentialist thought can be drawn upon to cast light on experiences of trauma. Critical of conventional approaches that have a tendency to medicalize trauma, Neil Thompson’s analysis shows how existentialist concepts can be useful in providing a more sophisticated understanding of what happens when a traumatic situation is encountered. As a field of study, traumatic loss lends itself well to being investigated in light of existentialist concerns.

The second chapter dovetails well with this, in so far as it focuses on the spiritual dimensions of traumatic loss. Kim Sangster and Aoife Lee provide a clear and helpful overview of a range of important spiritual issues that can be to the fore at a time of trauma. The authors make it clear that spirituality is not simply a dimension of religion. They see it more broadly as a matter of finding meaning, purpose and direction – each of which can be severely disrupted by the destabilizing effect of a traumatic experience. This thoughtful and enlightening chapter raises some very important issues that are well worth considered reflection.

The third chapter, by Erica Srinivasan, examines the significance of bereavement experiences in situations involving assisted death, sudden death, and suicide. In the next chapter Susan Adams offers an interesting perspective on attachment patterns and the role they play in circumstances involving crisis and traumatic loss. It also raises important issues in relation to the role of psychiatric diagnosis in shaping responses to traumatic situations.

This is followed by Janet Buntrock’s exploration of nightmares. The author focuses on the impact of trauma on dreams and on nightmares in particular. Her aim is to provide a bedrock of understanding to help clinicians respond to the challenges involved. The insights offered, however, can also be of value for researchers and policy makers, who, in certain circumstances, will also need an understanding of the relevant issues.

The sixth chapter, by Mary Walsh and Neil Thompson, focuses specifically on children by proposing a three-part model of understanding – and responding to – childhood trauma. Children who have been abused can be adversely affected by trauma in ways that are often not recognized or probed in the literature relating to adult experiences of trauma.

Next comes a chapter that offers another perspective that is often missing from the mainstream literature, namely the idea that trauma can arise from ongoing “assaults on the self,” rather than just from a single definitive incident. Sue Thompson shows how ageist attitudes can produce a form of disenfranchised trauma by constantly undermining identity and positive self-image in older people. This chapter challenges us to think differently about traumatic loss and not to restrict our attention to circumstances involving a single traumatic event.

In the final chapter of Part One, Andy Ho and his colleagues offer a detailed analysis of suicide in developed Asia, focusing on both ends of the life course – young people and elders. This highly informative chapter ends with a plea for greater compassion.

Across these eight chapters we have a wealth of stimulating ideas and insights from a broad range of disciplines, subject areas, perspectives, countries and contexts. What they have in common are a high level of scholarship and a refreshing degree of clarity.

1

TRAUMATIC GRIEF

An Existentialist Perspective

Neil Thompson

Introduction

Existentialism is a philosophical approach that seeks to make sense of what it means to be human. This will therefore include trying to make sense of traumatic grief, our response to those losses that are significant enough to “wound” us in some way. This chapter explores how existentialist concepts can be useful in providing insights into traumatic grief and therefore provide us with a better-informed understanding to serve as a basis for professional practice.

Grief, Crisis and Trauma

Before highlighting the significance of various aspects of existentialist thought I want to clarify the subject matter that we will be focusing on. In an earlier work (Thompson, 2012) I made the point that grief challenges our coping resources; crisis overwhelms our coping resources; and trauma devastates our coping resources. It is important to be clear what I mean by this.

Our ability to cope with our day-to-day pressures will be challenged by loss as we make the necessary adjustments as part of our grieving. However, some losses will be of such a magnitude that they overwhelm our coping resources and produce a crisis situation. Such circumstances can be highly stressful and problematic, but they also present opportunities for growth, development and learning (Thompson, 2011a). In many ways, traumatic losses can be seen as crises, but they also go beyond this, in so far as they are likely to not only overwhelm coping resources, but also devastate them. This is highly significant from an existentialist point of view, as it means that our fundamental sense of who we are and what our life is all about can be severely disrupted, temporarily at least.

This raises important practice considerations when it comes to managing situations involving traumatic loss; a failure to appreciate how disruptive the trauma has been could make matters worse – for example, by giving the message that we do not understand what the person(s) concerned might be going through.

Existentialism

In a classic work of existentialism (Sartre, 2003), this philosophy is described as “phenomenological ontology.” It is worth exploring each of these two key terms in order to get a fuller sense of what existentialism is all about.

Ontology is the study of being; it is concerned with matters relating to the nature of reality and what it means to exist. There are a number of important concepts associated with the existentialist approach to ontology, but I shall be limiting myself here to three in particular: flux, temporal ekstases and the progressive-regressive method.

Flux

This refers to the recognition that human existence is characterized by constant change and a degree of fluidity. Because many forms of change appear very slow in occurring there is a common misperception that no change is taking place. The significance of flux can therefore often be missed. This can make the drastic changes brought about by a traumatic loss all the more difficult to take.

Flux echoes the concept of “impermanence,” widely use in eastern philosophies to denote the constantly evolving nature of human experience. While this helps us to understand that change is a fundamental part of life, we also need to be aware that this is generally of a gradual nature and therefore far more manageable. Loss, as generally understood, involves unwelcome changes that generate a need for adjustment in a number of ways. Traumatic losses create a sudden and enormous amount of change that not only generates a need to make major changes, but also undermines much of the coping ability we would normally be able to draw upon in responding to such a loss (see the discussion of biographical disruption below).

Temporal Ekstases

The significance of flux is, of course, related to the importance of the passing of time. The Greek word “ekstasis” (plural “ekstases”) literally means to stand outside oneself (it is the root of the term “ecstasy”). It is used in philosophy to refer to the dimensions of time: past, present and future. In one sense, we live in a perpetual present, in so far as the past has gone and the future is yet to be.

However, this fails to recognize the influence of past events and experiences on the present, and indeed the influence of the future (in terms of plans, hopes and aspirations) on the current situation. This is an important consideration when it comes to understanding human experience in general, but is particularly insightful in relation to traumatic loss. This is because, at such a time, the future (as envisaged up to now) has been radically altered by the loss, and the meaning of aspects of the past can also be radically transformed (for example, if there are elements of betrayal involved in the traumatizing event). Assessing a situation involving traumatic loss can therefore benefit from exploring all three temporal dimensions and not just the present.

The Progressive-Regressive Method

This is a means of analyzing and making sense of complex situations developed by Sartre (1973). It draws on the concept of temporal ekstases, with “progressive” referring to the future and “regressive” referring to the past. It is a complex notion, but in simple terms it involves trying to make sense of the present circumstances by taking account of how:

1.past events and experiences have shaped the current situation and how it is perceived by the person(s) concerned – for example, how previous losses have been dealt with;

2.the future dimension (plans, hopes, fears and so on) is also influencing the present and how it is perceived – for example, career aspirations shaping current learning goals;

3.past and future dimensions influence each other – for example, past experiences of being supported in a time of need may have played a key role in shaping an ambition to work in the caring professions, while a fear of, say, being physically assaulted (at some point in the future) may well lead us to accentuate, and keep focusing on, experiences of being assaulted in the past.

When a traumatic loss occurs, the present can be so painful and difficult because of the extent of (future) losses and the destabilizing of our understanding of the past – for example, where a traumatic loss destroys our confidence and self-esteem that have been built up over many years (past).

Ontological considerations are therefore clearly highly relevant when it comes to trying to make sense of traumatic loss experiences.

Phenomenology

Phenomenology can be understood as the study of perception and is therefore concerned with how people develop different perspectives and meanings. Existentialism, as a form of phenomenological ontology, therefore addresses the meanings associated with human existence and can be particularly helpful in making sense of the crises of meaning that arise at a time of traumatic loss.

Much has been written about meaning in relation to loss and grief (for example, Marris, 1996; Neimeyer and Anderson, 2002), including, from an existentialist perspective (Thompson, 2007; Tomer et al., 2008).

Such meanings are often understood primarily, if not exclusively, in individual terms. However, it is helpful to understand meaning in wider terms. Individual perspectives are important, of course, but it would be a significant mistake to assume that meaning is an entirely individual phenomenon. It is important to recognize that, although each person’s perspective will be unique to him or her, all perspectives will be viewed through cultural lenses – that is, they will exist in the context of the frameworks of meaning that are generated by various cultural formations. These formations include cultures associated with, or arising from, religion, class, nationality, ethnic group, linguistic group and so on. What makes an individual’s set of meanings (their “biography”) unique is not that it is set apart from wider social and cultural factors, but, rather, that it is (i) a unique combination of those factors and their interplay; and (ii) the individual’s own unique “take” on those factors, their own perspective.

Within these cultural formations there will also be discourses operating. These too are frameworks of meaning, but ones which are rooted in power relations (and which, in turn, perpetuate those power relations). For example, there can be professional discourses which generate and sustain power relations. Furedi (2003), for example, is critical of professional “therapeutic” discourses that can, at times, be disempowering by standing in the way of individuals and groups taking charge of their own challenges.

Existentialist thought revolves around attempts to explore the implications of adopting a phenomenological perspective on ontology – that is, mapping out how frameworks of meaning construct our sense of who we are and how we fit into wider society. As we shall note below, these are precisely the things that can be so strongly disrupted at a time of traumatic loss.

A Holistic Approach

In its attempts to make sense of human existence, existentialism (particularly in the work of Sartre) seeks to be holistic, to adopt a perspective that takes into account the various influences on human experience, rather than focusing on one in particular.

Human experience can be understood to occur holistically at biopsychosocial and spiritual levels (Thompson, 2012). It is worth exploring each of these areas in turn.

Biological

Existentialism recognizes the significance of biology – for example, Merleau-Ponty’s (2002) work on “embodiment.” However, a fundamental part of existentialism is the rejection of “essentialism,” the idea that individuals have a fixed essence that determines how we behave and how we respond to situations. It is therefore important not to confuse a recognition of the role of biology with an acceptance of biological determinism.

A helpful way of understanding this is to see biology as the “vehicle” through which we live our l...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of contents
• List of figures
• Editors of contributors
• Foreword
• Preface
• Acknowledgments
• Introduction
• Part One Making Sense of Traumatic Loss
• Part Two Responding to Traumatic Loss
• Part Three Societal Issues and Responses
• Afterword
• Index