I’ve been reading the book Lost Connections with the current Camp Aftermath group.

In this book, Johann Hari explores reasons for “depression” apart from the current medical model of a dysfunctional brain. Chapter 2 talks about “grief” as originally being an exception to the diagnosis of depression in the early versions of the DSM. And that got my brain going…

I wrote some time ago about grief and the brain and ways in which those we live with and have strong feelings for literally become part of us as our brains wrap themselves around them. When people describe feeling like they’ve lost part of themselves, it’s true - they have.

But this current discussion created wonderings for me around…what if trauma is a subset of grief? What if we are grieving losses of various sorts?: loss of personal connections/relationships, powerlessness to avoid some outcome or make some change, having to make some impossible moral choice, hopes for an expected future, faith in a past we thought we understood, the value of a mission we believed in, etc. etc.?

Pathologizing grief (and other emotions) discounts a huge part of human experience. It’s part of a worldview that reduces us to “programmable machines” that should experience only the “positive”. As a consequence, this worldview also diminishes developing ways to respectfully integrate the “negative”.

Handling grief respectfully might be more like trauma interventions, where we strive to manage the intensity of the feelings so that the brain can integrate the trauma — rather than let it keep endlessly being activated in some isolated cognitive-emotional loop. Perhaps trauma intervention needs not just ways to integrate traumatic events, but also to integrate ways in which trauma is forcing our brains to re-define who we understand ourselves to be.

I am reminded of the experience of a Master’s student who did a study with Egyptian women using a standardised protocol for mindfulness-based cognitive therapy. Of the select group she worked with, the ones who made little to no gains were those whose trauma related to the sudden death of a loved one. In post-treatment interviews, she found that they were reluctant to let go of the distress, since this felt like letting of their loved one — as if not living with intense pain meant their loved one mattered less somehow.

I’m wondering whether “grief” is distinct in that it is one form of loss we don’t want to let go of? It feels like losing the one we’re grieving (the person, the dream, the value, the choice) rather than releasing experiences such as images of a traumatic episode we wish we’d never seen and we’re keen to lose. Both need integrating in some way, but maybe differently.

Perhaps this is the way “reconsolidation therapy” is feasible and possible - by “disconnecting” the emotion from the event within the brain networks, it allows the cognitive integration to be done more easily. But would it work when the traumatic images involve a loved one? Or would a traumatised person consider it a “success” if the emotional intensity was significantly lessened?

So what if we had an additional way to approach trauma. What if we approached trauma as loss of something rather than intrusion of something? (Or at least as both.) If we could work with integrating the grief respectfully, would that make the intrusiveness less intense? Or would it increase the success of trauma interventions generally to address not just the intrusive recall, but explicitly address the losses - the grief-- as well?

Pause for research….

HA! I went searching for research along these lines and discovered I’m definitely not the first one to think this. Dr. Alan Wolfelt, of the Center for Loss and Life Transition, specifically addresses this idea in 2 of his many books:

Reframing PTSD as Traumatic Grief is for practitioners

The PTSD Solution is a book written for those living with symptoms of PTSD

And he has a wide variety of other books dealing with specific forms of grief, some very relevant to PTSD symptoms, such as anger, depression, etc. I’ll be reading the two above and letting you know what I think.

If you have thoughts about grief and PTSD, or have found ways to grieve losses associated with PTSD experiences or symptoms please do share. I’d appreciate hearing from you.