CHAPTER 3

LOSS AND TRAUMA

Walking on Broken Bones

Loss and trauma are an inevitable part of life, and their effects are often devastating. Losing a loved one, being victims of violence or crime, becoming disabled, developing a chronic or life-threatening illness, being exposed to terrorism or war, or living through other life-threatening and traumatic experiences can derail our lives and leave deep psychological wounds. Healing such wounds usually involves an extended process of readjustment and recovery that can be different for each of us. Much like broken bones that need to be set correctly, how we go about putting the pieces of our lives back together after loss or trauma makes a huge difference in how fully we recover from such events.

Some of the losses and traumas we experience are so deeply scarring they require the skills of expert mental health professionals and probably extended psychotherapy. As such, this chapter is not intended for those who’ve suffered extremely adverse impacts, and such readers are strongly advised to seek help from a trained mental health professional if they have not already done so.

However, many of the losses and traumatic experiences we sustain in life are not severe enough to cause long-term psychological or emotional damage. For example, when we lose our job, when our best friend drops us after a bad argument, or when an elderly grandparent dies, we go through a period of sadness and adjustment but we usually return to our previous level of psychological and emotional health. However, the same loss can have different subjective meanings to different people. For example, if losing our job caused our family to become homeless, if our best friend was also our only friend, or if our grandparent raised us and had been in good health, the loss we experience and the impact it has on our lives can be far more substantial.

Whatever differences we might exhibit in how we cope with loss and trauma, we all face similar challenges when it comes to rebuilding our lives and achieving a full emotional and psychological recovery. We have to reset our broken psychological bones—reassemble the pieces of our lives back into a well-integrated and fully functional whole. Treating the psychological wounds loss and trauma inflict can not only accelerate our recovery but in some cases make it possible to emerge from such experiences with meaningful changes in our priorities, a deeper appreciation of our existing relationships, an enhanced sense of purpose, and greater life satisfaction—a phenomenon known as post-traumatic growth.

While many of the variables that determine whether we emerge from loss and trauma with diminished or enhanced emotional well-being are not in our control (such as the severity of the events, our basic psychological makeup, and our previous exposure to hardships), some are. In order to best utilize the emotional first aid treatments in this chapter we will need a clear understanding of the psychological wounds loss and trauma inflict and the challenges they present to our mental health and emotional well-being.

The Psychological Wounds Loss and Trauma Inflict

In addition to the severe emotional distress they cause and the real-world changes we have to contend with in their aftermath, loss and trauma inflict three psychological wounds, each of which represents a different set of bones that need to be reset. First, loss and trauma can create such havoc in our lives that they threaten our self-perceptions, our roles, and our very sense of identity. Second, tragic events often challenge our fundamental assumptions about the world and our place in it, such that we struggle to make sense of the events or to integrate them into the larger framework of our belief systems. Third, many of us find it difficult to remain connected to the people and activities we used to find meaningful and we might even feel as if reengaging in our lives would represent a betrayal to those we’ve lost or a discounting of the suffering we’ve experienced.

Emotional pain engulfs all who experience loss and trauma but the extent to which we encounter these three psychological wounds can vary dramatically. Some of us might experience them only in mild form while others might find their lives profoundly impacted by them for years and even decades. Let’s examine each of them in greater detail.

1. Life Interrupted: Overwhelming Emotional Distress

The emotional distress we experience in the first torturous days following loss or trauma can be utterly paralyzing. We might lose the ability to think straight or to perform even the most basic functions of self-care, such as eating or bathing. Engulfed in emotional pain, we often experience every detail of our lives anew as we are forced to live through a wrenching series of “firsts.” Our first meal without the person we lost, our first night alone after being victims of violent crime, our first look in the mirror after the events that altered the course of our lives. This endless array of “firsts” can keep coming at us for weeks and months: our first trip to the supermarket after separating from our spouse without buying his or her favorite foods, our first Christmas after losing our job without money to buy gifts for our children, or our first Thanksgiving without our recently deceased parent.

Every “first” evokes memories, painful longings, and deep yearnings for that which we’ve lost, and we might find it hard to care about anyone or anything else. Plunged into the depths of despair, our feelings might be darker even than those experienced by people suffering from the most severe clinical depression. However, grief is a normal psychological response to extreme circumstances, not a mental disorder. Regardless of how searing our initial emotional pain, it almost always subsides with time. As we begin to absorb the reality of our loss or trauma, the visceral pain begins to dull, even if by the most minute of measures.

Indeed, time is a hugely important factor in our recovery. We often move past the most acute stages of grief and adjustment after six months—although such timetables are obviously dependent on the nature of the loss or trauma and its tangible as well as its subjective impacts on our lives. But when we do not, whether because the loss or trauma we suffered was too significant or because circumstances prevented us from moving through the healing and recovery process as we should, we risk allowing ourselves to become defined by our experiences. The most unique aspects that made us who we are can become lost, subsumed by our grief, hidden from view such that even we no longer glimpse them. Our interests, our creativity, our joy and enthusiasm can all become obscured by sadness, pain, and endless rumination about the past, and our lives become truly interrupted in every sense of the word.

2. Identity Interrupted: How Loss and Trauma Challenge Our Roles and Self-Definition

Grant was a sales rep with a promising career and a love for shooting hoops with his friends when he wasn’t on the road. One winter evening, Grant and two colleagues were driving to the airport after a long business trip when snow and icy conditions contributed to their driver losing control of the car. Grant was dozing off in the middle backseat when it happened.

“I went straight through the windshield, landed in the road, and lost consciousness. I came to a few minutes later. I opened my eyes and saw one of my colleagues lying right in front of me, dead. I tried to get up but I couldn’t. I looked down and saw I was covered in blood. And my legs ... my legs were missing.” Grant swallowed hard. This was our first session and, judging by the emotions on his face, these were not events Grant spoke of often.

“Next thing I remember is the hospital and the surgeries, many, many surgeries.” Grant spent over a year in various hospitals, where doctors treated his massive injuries and started him on a long road of intense physical rehabilitation. He also attended psychological counseling sessions. Grant’s broken body slowly began to heal but his mind did not.

“I can’t tell you how many times I wished I had died that night. It would have been easier. People wanted to visit, but I couldn’t stand the thought of seeing anyone. I couldn’t stand the thought of seeing myself either. Six years later and I still can’t look in a mirror. When I do catch a glimpse of myself, all I see is a stranger. The person I used to be died that night. This new person, this broken-bodied cripple, is not me!”

My heart ached for Grant, not just for the horrible injuries he sustained but because six years later he was still in such terrible emotional distress. The psychological wounds inflicted by the loss and trauma he experienced were as raw as ever. His broken psychological bones had never been reset correctly and as a result, he never adapted to the new realities of his life.

Loss and trauma often force a new reality on our lives that, depending on the severity of the events we’ve experienced, can completely redefine our identities as well as the narrative of our life stories. Before the accident Grant had defined himself by his career, by his outgoing personality, and by his athleticism. But those three pillars of his identity were now completely absent and played no role in his life at all. Grant desperately needed to redefine his identity, to reconnect with the aspects of his personality and character that remained buried beneath his grief, to decide what his life could be about.

The challenge of redefining ourselves and our identities accompanies many experiences of trauma and loss. We might have defined ourselves by our careers and lost our jobs, we might have defined ourselves by our couplehood and lost our partner, we might have defined ourselves by our athletic ability and lost our health, or we might have defined ourselves by our parenthood and seen our last child leave home. In each of these situations we need to take the time to rediscover who we are, to search within for things we find meaningful, and to find new ways of expressing aspects of ourselves that lay dormant, buried under an avalanche of sorrow. When we fail to do so we are left with a terrible void that only amplifies the extent of our loss, fragments our basic sense of self, and sets us adrift in the stormy seas of self-doubt and self-loathing.

3. Beliefs Interrupted: Why Loss and Trauma Challenge Our Perceptions of the World

One of our most compelling human drives is the need to make sense of our experiences in life. We each have our own way of understanding how the world works (even if we’ve never articulated it to ourselves explicitly), and we filter most of our experiences through that lens. Our beliefs and assumptions about the world guide our actions and our decisions and they often provide us with a sense of meaning and purpose. One person might view everything that happens in life as “God’s will,” another might believe “We reap what we sow,” some might believe “Everything happens for a reason,” and others believe “Things happen for no reason at all.” Some of us feel the world is generally fair while others are convinced the opposite is true, and some of us believe life is largely predictable while others revel in their belief that events are entirely arbitrary.

Whatever thoughts and perceptions we have about such things, loss and trauma can challenge our basic assumptions about the world and how it operates and cause us significant additional emotional distress as a result. Our struggle to make sense of what happened often compounds our initial shock and sends us on a desperate quest to integrate our new realities into a framework of fundamental beliefs that no longer provide us with the security they once did. Indeed, such “crises of faith” are common. We become flooded with questions and doubts and we often embark on a search for answers.

This intense need to make sense of things can leave us ruminating incessantly about how the events occurred, why they happened the way they did, and what we could have done to prevent them. We might analyze each of a thousand small decisions and moments that, if altered, might have spared us the painful realities we now face. As a psychologist working in New York City during and after the events of September 11, 2001, I heard many such questions expressed by my patients. “If only she had left a few minutes later she would have missed her train and not been at her desk when the plane hit the building,” “If he hadn’t moved to Boston he would not have been on that plane,” and “If I hadn’t stopped to look up, the falling debris would have missed me,” are all examples of the thoughts and ruminations shared by many people on and after that horrific day.

We often spend months dwelling on such questions as we search for ways to make sense of the events. While many of us begin making sense of tragedy within six months of it occurring, many others fail to do so even years later. Yet, the sooner we reconstruct our worldviews in ways that integrate our experiences of the loss or trauma, the quicker the intensity and frequency of our ruminations will diminish, the better our psychological adjustment will be, and the less likely we will be to exhibit poor emotional well-being and symptoms of post-traumatic stress disorder.

4. Relationships Interrupted: Why We Struggle to Connect to Those Who Remain

Maxine came to psychotherapy to deal with her looming fiftieth birthday. Ten years earlier she had promised her husband, Kurt, she would celebrate the milestone with him by flying to Africa and going on a safari. Maxine had never left the country before, despite Kurt’s many pleas for her to do so over the years. “It was ten years in the future, but it still wasn’t a vow I made lightly,” she explained. “I fully intended to keep it.”

A few months after she turned forty, Kurt began to get severe headaches. “They gave him one test after another, but they couldn’t figure it out,” Maxine explained. “Then they did a brain scan. The doctor told us he had a tumor. They would try to remove as much of it as they could, but basically, they gave him three years at most. We cried each other to sleep for nights. Kurt was terrified of the surgery. He knew there was a lot that could go wrong. Right before they wheeled him into the operating room I promised him that as soon as he recovered from the operation we would go on the safari and that we would travel as much as we could in whatever time we had left together. He smiled for the first time in weeks.”

Maxine paused to wipe tears from her eyes. “He died in surgery two hours later,” she said, her hands trembling, tears now streaking down her face. “I miss him ... so much! I still talk to him every day: when I get home from work, when I get up in the morning. I know this sounds crazy, but I even make his favorite dinner once a week. It comforts me, makes me feel less alone.” Maxine gathered herself and continued. “I’m here because my fiftieth birthday is coming up in six months ... and I don’t know what to do. A part of me feels as though I have to keep my promise and go on the safari. But to do that without Kurt, to go without him, I’m not sure I could stand it.”

Maxine and Kurt had no children, but they had enjoyed a thriving social life organized primarily around their love for camping and the outdoors. However, in the years since Kurt died, Maxine had lost touch with most of their old friends and she had given up camping and even hiking altogether. Her social network consisted of a sister who lived on the west coast and a few casual friends from work with whom she had dinner every few months. When I asked her if she ever considered dating again she dismissed the notion immediately and explained that doing so would feel as though she were betraying Kurt.

Many of us respond to profound loss by withdrawing into ourselves, obsessing about the person who died, talking to the person in our heads, and imagining his or her thoughts and reactions to our experiences. However, such phases are usually temporary. In time, we begin to let go of the person we’ve lost and move on, either by re-engaging with the people and activities that populated our lives previously or by finding new people or experiences in which to invest our emotions and energies. But some of us become stuck. We maintain vivid representations of the person we lost, we hang on to the person’s memory, and we keep investing our emotional resources in the dead instead of the living.

As another example, Sean, a young man I worked with in the summer and fall of 2001, lost his first cousin and best friend, a firefighter who died when the North Tower collapsed. In the months that followed, Sean became obsessed with the Twin Towers themselves. He spent all his free time watching hours of documentaries and films about their construction, reading everything he could find about their history, and researching various aspects of the buildings’ maintenance and operations. Meanwhile, he withdrew from his large family. He refused to attend family gatherings and generally avoided the very people who shared his loss and grief the most.

While such coping mechanisms are reasonable in the aftermath of tragic events, when they continue too long we risk getting stuck in the past as Sean and Maxine did. In many cases, such habits represent a breakdown in our grieving process. Instead of resetting our broken bones, healing, and redefining ourselves and our lives anew, we end up adrift in our memories, relating more to what no longer exists than to what does. When left untreated, such patterns can persist for years and even decades, putting our lives on hold and keeping our futures tethered to the loss and trauma that have come to define us.

How to Treat the Psychological Wounds Loss and Trauma Inflict

Loss and trauma can shatter the pieces of our lives, ravage our relationships, and subvert our very identities. To put the pieces back together—to reset our broken bones—we first need to recover from the overwhelming emotional distress we feel in the immediate aftermath of loss or trauma. While the treatments in this chapter can help, if the tragedy you’ve suffered is profound, if years have passed and you have yet to recover from the events, or if you experience symptoms of post-traumatic stress disorder, such as intrusive flashbacks, nightmares, emotional numbness, or jumpiness and agitation, you should seek the counsel of a trained mental health professional. Let’s open our psychological medicine cabinet and review our treatment options.

General Treatment Guidelines

Loss and trauma create four psychological wounds. They cause overwhelming emotional pain, they undermine our basic sense of identity and the roles we play in life, they destabilize our belief systems and our understanding of the world, and they challenge our ability to remain present and engaged in our most important relationships.

The treatments in this section are presented in an order that roughly mirrors the sequence of psychological adjustment and recovery we go through as we heal from loss and trauma. Treatment A (soothing emotional pain) suggests guidelines for how to manage emotional pain and discusses common fallacies that can delay our recovery. Treatment B (recovering lost aspects of “self”) is focused on reconnecting to aspects of life that might have gotten lost and reestablishing a sense of identity, and should be administered only once we’ve returned to normal functioning within the home, at work, or in school. Treatment C (finding meaning in tragedy) is focused on making sense of the events and moving closer to finding meaning and even benefit in them. Treatment C should be reviewed first and then completed only after enough time has passed for our initial emotional pain to subside and we feel emotionally strong enough to do so.

If you feel as though any of the exercises and treatments in this chapter would be too painful to complete, please review the section at the end of the chapter that discusses when to seek help from a mental health professional.

Treatment A: Soothe Your Emotional Pain Your Way

Working in New York City during and after the events of September 11, 2001, I found that the majority of my patients, as well as those of most mental health professionals, were personally affected by the tragedy in some way. One of my patients was killed when the plane struck the South Tower, some were injured in the attacks, others’ homes were destroyed when the buildings collapsed, and several lost close friends or family members. While many of my patients spent weeks processing their loss and trauma, some of those who were most affected by the attacks chose not to discuss their experiences in therapy at all. For example, one young man who was injured by falling debris clearly stated he preferred not to think about what happened to him that day ever again.

Although many of us believe it is essential to talk about traumatic events after they occur in order to minimize the risk of psychological complications, such is not the case. Indeed, a wave of recent research has demonstrated that many of our most cherished notions about coping with loss and trauma—well-known theories such as the five stages of grief (denial, anger, bargaining, depression, and acceptance) and common wisdoms such as the importance of expressing our feelings and the danger of keeping them bottled up—are largely incorrect.

For example, a technique called critical incident stress debriefing (CISD) is used by both the military and the Federal Emergency Management Agency (FEMA). The technique requires people who experience traumatic events to discuss them in great detail as soon after the events as possible, under the assumption that expressing what happened and how they feel about it should minimize the incidence of post-traumatic stress disorder. However, we now know much more about how memories (including traumatic ones) are actually formed in our brain. Specifically, the mere act of recalling an event changes our actual memory of it in minor ways. When we recall traumatic experiences while we’re still flooded with intense emotion, we are inadvertently cementing the link between the memory and our intense emotional reactions to it. By doing so we are making it even more likely the memory will continue to evoke intense emotions going forward. As a result, we risk getting vivid flashbacks and making the traumatic memories themselves even more psychologically central and emotionally impactful than they otherwise would be.

However, that is not to say we should try to repress such memories or that we should refuse to discuss them. Indeed, most experts now believe there is no “right” way to cope with the aftermath of loss and trauma. The best each of us can do is to deal with such experiences exactly as our proclivities, personality, and worldview dictate. If we feel the need to talk, we should, and if we don’t feel the need to share our thoughts and feelings with others we should not push ourselves to do so. For example, because my patient who was hit by falling debris on September 11 felt such a strong reluctance to think about the events, choosing not to discuss them was the correct course of action for him. Indeed, there is evidence to suggest that those who find it less pressing to discuss traumatic experiences might benefit from their natural tendency to avoid talking about their thoughts and feelings.

One online study began following over two thousand people in, as it happened, August 2001. Once the tragedies of September 11 occurred, the researchers realized they had a huge subject pool at their disposal. They decided to give the study participants the option of posting their feelings and thoughts about the events on the study website should they wish to do so. Three-quarters of the subjects chose to share their thoughts and feelings and one-quarter did not. The researchers continued to follow the subjects for two years and were able to examine their emotional well-being over time. For people geographically closest to the attacks, those who chose not to express their emotions had fewer symptoms of post-traumatic stress disorder two years later than people who had shared their thoughts and feelings online. Furthermore, the more people wrote (i.e., the longer their posts), the poorer they fared two years later.

These results by no means suggest we should avoid discussing our feelings if we feel the need to do so. The best course of action we can take in the aftermath of tragic events is to do exactly as our feelings dictate. Those who feel the need to share their thoughts and feelings with others should do so, and those who feel the need to remove themselves from such discussions should avoid them as best they can.

Following our natural inclinations might be advisable, but it can also be challenging at times. Those of us who prefer to discuss our feelings and experiences might find it difficult to do so if we lack sources of social support, while those who prefer not to discuss their feelings might find it equally difficult if they find themselves surrounded by vivid reminders. It was practically impossible for those affected by the events of September 11 to avoid thinking about their experiences, as reminders of the tragedy were everywhere. For months one could not step into the streets of Manhattan without seeing evidence of the attacks: the ruined buildings, the dust, the stench of burning materials, and the pictures of missing loved ones that were plastered on every wall, bus stop, and street sign along with heart-wrenching pleas for information about their whereabouts.

My patient avoided these reminders as best he could at the time, by burying his head in a magazine when he was on the subway, stepping away from water-cooler conversations when he was at work, and letting his close friends and family members know they should refrain from discussing the topic in his presence. Indeed, it is always best to let those around us know whether we wish to discuss tragic events or avoid such conversations so they know how best to conduct themselves around us.

For those who feel inclined to share thoughts and feelings with others, doing so can help us come to terms with the realities of our loss or trauma. Indeed, many religious rituals around grieving have exactly such a purpose in mind. For example, both Jewish shivahs and Irish wakes involve the gathering of friends and family to provide an outlet for the bereaved to express their feelings, thoughts, and memories while surrounded by sources of social and emotional support (not to mention copious quantities of food and alcohol).

When sources of social support are lacking or if we prefer to do so, we can also write about our experiences or compose letters to the people we’ve lost. Expressing thoughts and feelings we had not been able to share with the person before they died can give us comfort and even provide a measure of closure.

Regardless of how we choose to soothe our emotional pain in the immediate aftermath of loss or trauma, the most effective treatment—and one that is available to all of us—is time.

TREATMENT SUMMARY: SOOTHE YOUR EMOTIONAL PAIN YOUR WAY

Dosage: Administer as soon after the events as possible. Make sure to communicate your preferences with regard to discussing your feelings and experiences to those around you.

Effective for: Managing and reducing emotional pain.

Treatment B: Recover Lost Aspects of Your “Self”

When Maxine lost her beloved husband, Kurt, to brain cancer, she lost substantial parts of herself as well. Her life after Kurt died was completely different from what it had been when he was alive. She and Kurt had been extremely active and enjoyed a thriving social circle, frequent camping and hiking trips, and countless evenings spent with good friends. But Maxine stopped participating in all such events after Kurt died and, as a result, she lost touch with the friends and the activities that had been a substantial part of her life.

Many of us are inclined to avoid people, places, or activities associated with the person we lost or with the traumatic events we faced in the first weeks and months after such events occur. But maintaining such avoidance for extended periods of time is problematic when doing so involves cutting out significant aspects of our lives. Maxine lost touch with many of the very experiences and relationships that had defined her, and consequently lost touch with important parts of herself. Relinquishing so many meaningful roles and functions altered her very sense of identity and these losses were never replaced. She found no new interests and passions to fulfill her and she made few new friends. The void her husband’s death left in her life was still as large as it had been almost ten years earlier.

Maxine desperately needed to fill these gaps either by going back to previous activities or relationships or by finding new ones. Many of us face similar challenges. We go through our lives feeling empty and incomplete even years after the tragic experiences that changed us.

EXERCISE TO RECOVER LOST ASPECTS OF YOUR “SELF”

The following writing exercise will help you identify aspects of yourself you might have lost by finding new ways to express these missing parts of your identity and identifying new ways to recover meaningful roles you might have forsaken. I’ve included Maxine’s responses to each of the questions for illustration purposes.

Caution: If the events are still fresh and the emotional distress you feel is still extreme, do not push yourself to complete this exercise unless you feel psychologically ready to do so.

1. List your qualities, characteristics, and abilities that you valued in yourself or that others valued about you before the events occurred (aim for at least ten items).

Maxine’s list included the following: loyal, passionate, adventurous, curious, intelligent, leader, outdoors lover, expert camper, bonfire storyteller, compassionate, considerate, supportive, enthusiastic, loving, caring, and communicative.

1. Which of the above items feel most disconnected from your life today or tend to be expressed less today than they had been previously?

Maxine indicated the following: adventurous, leader, outdoors lover, expert camper, storyteller, considerate, enthusiastic, loving, and caring. (Note that Maxine’s list clustered around two aspects that had been central to her life before her husband died: her love of camping and the outdoors, and her close bond with the circle of friends who shared her passions.)

1. For each quality you listed, write a brief paragraph describing why you feel disconnected from the attribute in question or why the quality is no longer expressed as extensively as it had been previously.

For example, Maxine wrote the following about why she rarely felt “adventurous”: “I never thought of myself as a lone adventurer. For me, adventure was always about sharing new experiences with Kurt. What made it exciting was having the adventure together. Having them without him doesn’t seem worthwhile and it even seems sad.”

1. For each quality you listed, write a brief paragraph describing possible people, activities, or outlets you could pursue that would allow you to express the quality in a more substantial way than you are able to do currently.

When I asked Maxine to do this she struggled. She simply couldn’t figure out how she might express her adventurous spirit without Kurt there to share the experience. “You think I should reconnect to my spirit of adventure by going on the safari, don’t you?” she said, quickly adding, “But I can’t, I really can’t!”

“Actually, that’s not what I was thinking at all,” I responded. “I believe in taking small steps and a safari is hardly a small step. Actually, what caught my attention about your lists was that you stated adventures were experiences to be shared with Kurt. But it wasn’t just Kurt. You were both part of a larger group of people who shared the same interests and passions, people with whom you might still share adventures, even if small ones. So here’s what I was thinking,” I said. “Which of your old camping friends would be someone you could see yourself going on a short hike with?” Maxine exhaled noticeably. She had been so convinced I was going to press her to go on a safari, she was happily willing to discuss taking a short hike with one of her old friends.

As another example, Grant had been very athletic and loved basketball before losing both his legs in a car accident. I pointed out that basketball was an extremely popular wheelchair sport and suggested he get information about local amateur leagues he could join.

1. Rank the items from the previous question according to which of them seem both doable and emotionally manageable.
2. Set yourself the goal of working through the list as best you can and at whatever pace seems most comfortable (taking into account that taking action on each of the items is likely to cause at least some emotional discomfort at first). By working through the items on your list you will begin to reconnect to meaningful and valuable aspects of yourself and your personality, and by doing so, move forward.

TREATMENT SUMMARY: RECOVER LOST ASPECTS OF YOUR SELF

Dosage: Administer once you have returned to normal functioning (e.g., within the home, at work, or in school).

Effective for: Restoring important aspects of one’s identity and rebuilding disrupted relationships.

Secondary benefits: Reduces emotional pain.

Treatment C: Find Meaning in Tragedy

Since Viktor Frankl wrote Man’s Search for Meaning,it has been accepted that finding meaning in loss and trauma is essential for coping effectively with such experiences, and thousands of studies have confirmed these assumptions. Finding meaning was a crucial factor in recovery from every kind of loss and trauma studied, from those with spinal cord injuries to bereaved parents of young children, from victims of violence and abuse to frontline veterans of wars. To recover from our tragic experience we need to set our bones correctly and put the pieces of our lives back together in ways that lend meaning and significance to the events by weaving our experiences into the larger fabric of our life stories.

But the question that arises for many of us is how to do so. We might be aware that people with similar experiences reached conclusions such as “I came to accept that it was God’s will,” “I realized I could help others who went through what I went through,” or “I figured out what mattered to me and made big changes,” but that doesn’t tell us how these people reached their insights or how we might go about attaining our own epiphanies.

Scientists who examined how people go about finding meaning in loss and trauma realized the process includes two distinct phases, sense making and benefit finding. Sense-making refers to our ability to fit the events into our existing framework of assumptions and beliefs about the world so they become more comprehensible to us. We are usually able to begin making sense of tragic events within six months of experiencing them (although completing the process of sense making can sometimes take months and even years). Once we do, we are likely to have far better emotional and psychological recoveries.

Benefit finding refers to our ability to wrestle whatever silver linings we can from our experiences. We might gain a greater appreciation of life and of our own strength and resilience, we might realign our priorities and identify new purpose, and we might recognize new paths that have opened before us as a result of our new realities. Benefit finding occurs only in later stages of our recovery, as it is not something most of us can or should do when still in the grips of severe emotional pain. That said, once sufficient time has passed, people who are able to identify benefits in their loss or trauma tend to display greater emotional and psychological well-being than those who are unable to do so.

How to Find Meaning in Tragedy

Once of the most common ways in which people derive meaning from tragic events is by taking action in ways that are directly related to the loss or trauma they sustained. Family members of someone who died of a rare disease might start a foundation to increase awareness of the illness that took their loved one. A survivor of sexual or physical assault might decide to speak out and educate others about how to avoid such experiences or how to cope with them if they occur. Veterans who’ve lost a limb in war often volunteer to help recently wounded soldiers adjust to their injuries and support them through their long process of rehabilitation. Many people who lost loved ones in the attacks of September 11, 2001, became involved in planning memorial sites in New York; Washington, DC; and Pennsylvania. Of course, not every loss affords us these options, nor are they appropriate for everyone.

The following exercises will help us identify new avenues of thinking that could make our individual explorations more productive. Two exercises facilitate sense making. The first should be completed only once we’ve begun to recover from the initial assault of emotional pain. The second should be applied slightly later, when we are emotionally able to contemplate potentially painful “what-if” scenarios. The third exercise facilitates benefit finding and should only be considered once we feel substantially recovered and stronger emotionally. If any of the following exercises are too painful to complete, please refer to the section at the end of the chapter that discusses when to seek the advice of a mental health professional.

Make Sense of Tragic Events by Asking Why, Not How

We often struggle to accept the basic reality of tragic events when they first occur and we replay how things happened over and over again in our minds. For example, Maxine frequently replayed memories of her last conversation with Kurt. Natural as it is to do so, when such ruminations persist, they become unproductive and serve only to reactivate our emotional pain. Going over how things happened and replaying similar scenes tends to add no new insights and does not help us make sense of the events. But tweaking one important aspect of these ruminative thoughts could make them more conducive to attaining new insights and to fostering sense making.

Specifically, numerous studies demonstrate that asking ourselves why events happened as opposed to how they happened is sufficient to trigger a qualitatively different and more productive thought process. Difficult as it is to answer such questions, by asking why instead of how we widen the scope of our thinking and of our associations and are forced to consider the larger existential, spiritual, or philosophical implications of the events. Such bigger-picture thought processes are more likely to help us find meaning in the events in time, and to reach a greater measure of internal peace as a result.

Almost ten years after losing her husband, Maxine never asked herself the big questions about why Kurt died and whether she could derive any meaning or purpose from losing him. In fact, such questions were so foreign to Maxine’s way of thinking that she seemed momentarily confused and disoriented when I first asked them. However, once she was able to begin giving thought to the question of why Kurt died she found that she spent much less time replaying the events of his last weeks and months. For Maxine, asking why opened the door to fresh and meaningful thought processes that helped her move forward in her mourning after being stalled for many years.

Make Sense of Tragic Events by Asking What Might Have Been

Another feature of the obsessive thoughts we experience in early stages of loss or trauma is they are often characterized by fantasies about alternate outcomes. We ponder such questions as “What if the person who died in an accident had taken a different route?” “What if the cancer had been found earlier?” or “What if our attacker had chosen a different victim?” Some of us might feel that pursuing thoughts of “what might have been” can only focus us on the randomness of the events and thus make it more difficult for us to accept what is. But studies have found the opposite. Rather than eliciting a sense of randomness, thoughts that consider alternatives to the factual realities we’ve experienced (known as counterfactuals) can help us feel like the events were predestined and meant to be, thereby lending them greater meaning.

Much like asking why instead of how, counterfactual thoughts force us to think more abstractly, to make connections between different parts of our lives, to utilize our analytic abilities, and to see the bigger picture. All of these are essential aspects of the meaning-making process. Such exercises can help us break out of rigid perspectives that limit our ability to consider the larger context of our lives so we can arrive at fresh comprehensions and new perspectives.

Our natural tendency is to employ counterfactual thoughts to explore how we might have avoided the loss or trauma, but we can also direct our thoughts to how things could have been worse. Some experts believe the best way to extract meaning from tragic events (again, once we’ve recovered sufficiently) is to combine both types of counterfactual thinking and consider both what our lives would have been like had the events not happened and the ways in which things could have been worse.

THOUGHT EXERCISE: “WHAT MIGHT HAVE BEEN”

Caution: Readers should be advised that counterfactual thought experiments can be emotionally painful. Review the exercise and complete it only if you feel emotionally ready to do so. Further, those who do not believe in fate or predestination might not benefit from this exercise as much as those who do, and therefore they should not complete it if they feel that doing so will be either unhelpful or too emotionally distressing. For those who feel ready, it is best to complete this exercise in one sitting. Written responses are strongly recommended.

1. How would your life be different today if the events had not happened?
2. In what ways could the outcome of the events have been even worse than they were?
3. What factors prevented these worse outcomes from occurring?
4. How grateful are you that these worse outcomes did not occur?

Once you’ve completed this exercise, give yourself time to recover and to absorb any thoughts, insights, or fresh perspectives it might have evoked (at least a day or more) before moving on to the benefit-finding exercise. You may also choose to wait weeks or months or to skip the benefit-finding exercise entirely if you feel unready or unable to complete it.

How to Identify Benefits in Loss

Finding benefit in loss and trauma once enough time has passed is an important way to ascribe meaning and significance to the events so we can put them in their place and move on with our lives. Although it can take time to identify any such “silver linings,” doing so can open doors to paths and opportunities that can become sources of both meaning and life satisfaction later on. Helping others who’ve had similar experiences; creating awareness about diseases, societal problems, or other dangers; starting foundations in memory of those we’ve lost; writing about the events and creating art and performances about them; and becoming para-athletes are all examples of ways in which people have extracted benefit and purpose from tragic events.

While identifying potential pathways for deriving benefit from tragedy can have a positive impact on our recovery it is the real-world application of these benefits that does our emotional and psychological recovery most good. Therefore, we need to find ways to put any benefits we identify into action. For example, we might come away from a tragedy with a greater appreciation of our family, but if we don’t take action based on these insights, the benefit we derive from our new perspective will be limited. However, if we make changes that allow us to spend more time with family members or increase the quality of the time we already do spend with them, we are much more likely to have truly gained from our loss and reap the psychological blessings of doing so.

EXERCISE TO IDENTIFY POSSIBLE BENEFITS

When completing the following exercise, make sure you have the time and space to relax and let your thoughts explore various possibilities without feeling rushed or pressured.

Imagine yourself ten years in the future. You have been able to achieve something meaningful and significant (not necessarily “Nobel Prize worthy” but meaningful to you). You have a quiet moment to look back and reflect about your journey and how it has led you to this current moment in (future) time. Complete the following sentences.

1. I never imagined back then that such tragic events would lead me to:
2. What I did was significant and very meaningful to me because:
3. The first step of my journey toward the achievement was when I:
4. My achievement was possible because I changed my priorities such that:
5. Changing my priorities led me to make the following changes in my life:
6. Along the way I realized my purpose in life is:

TREATMENT SUMMARY: FIND MEANING IN TRAGEDY

Dosage: Review the treatment and administer it only when you feel you can manage the emotional pain or discomfort it might evoke.

Effective for: Reducing emotional pain, recovering lost aspects of our identity, and reconstructing damaged belief systems.

Secondary benefits: Restores and rebuilds damaged or neglected relationships.

When to Consult a Mental Health Professional

When the loss or trauma we’ve sustained is significant or when it impacts our lives in extreme or fundamental ways, we should always seek the counsel of a mental health professional. If you think you might be experiencing symptoms of post-traumatic stress disorder, such as intrusive flashbacks, nightmares, emotional numbness, or jumpiness and agitation, seek the counsel of a trained mental health professional who specializes in trauma. Further, if you’ve applied the treatments in this chapter but doing so has not helped your emotional or mental state or you have not been able to make changes to better your situation or resume your life fully and productively, you should also seek the help of an experienced mental health professional, preferably one who specializes in loss, trauma, or bereavement.

If at any point after tragic events occur you feel as though you are in too much emotional pain and have thoughts of harming yourself or another person in any way, you should seek immediate help from a mental health professional or go to the nearest emergency room.

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