Bereavement under the spotlight

Bereavement under the spotlight

Supporting people suddenly bereaved in high-profile cases

This briefing is produced by Sudden. It aims to provide information on how the media operate when reporting stories of sudden bereavement.

After a sudden death, engagement with the media can offer bereaved families an opportunity to express their grief and commemorate their loved one. The media can also provide an outlet for families to campaign for justice and seek to make changes.

However, there can be negatives to media involvement. Intrusion from journalists, insensitive headlines and inaccurate reporting can be very upsetting for a grieving family.

This report will provide guidance on interacting with the media, and explore the pros and cons of media engagement.

This report will cover:

  • why the media reports stories of sudden deaths;
  • how journalists source stories and interact with bereaved families;
  • how the internal news process at a newspaper works; and
  • advice for bereaved families giving an interview.

This report is based on the research findings and recommendations of Dr Sallyanne Duncan (senior lecturer in journalism, media and communication, University of Strathclyde) at a webinar for victim support professionals.

Research and background to media reporting of sudden deaths

What makes a story ‘newsworthy’?

Journalists have to make a judgement on a potential story, based on what its news value would be. The news agenda of a publication, both on a certain day and more generally, will also affect whether an article is published.

Following a review of the UK press, previous literature and their own experience as journalists, Harcup and O’Neill (2001, 2017) developed a list of requirements that news stories generally satisfy. [1], [2]

Stories must feature: conflict, drama, exclusivity, the power elite, celebrity, entertainment, surprise, bad news, good news, magnitude, relevance, follow-up, audio-visuals, shareability or the news organisation’s agenda.

News stories generally satisfy one or more of these requirements. Stories of sudden deaths often fulfil many of the above categories.

Why are sudden deaths so newsworthy?

Sudden deaths are often considered particularly newsworthy because of their dramatic content. Stories of sudden deaths have a potentially wide-reaching impact, and can lead to emotional responses from the public.

Walter et al. (1995) state that the newsworthiness of sudden deaths can be defined as stemming from their “extreme negativity as interruptions to the smooth flow of the daily round.”[3]

What tends to feature in a story on a sudden death?

Journalists will normally base their story around an extensive interview with family members. This may include the bereaved family’s emotional response to the death. The story will also cover details of the deceased’s life, their character and include information about the events that resulted in the death.[4] Alongside the written copy, the piece will often feature a photo of the deceased. If the article is featured online, it may also include family videos, or content taken from the social media accounts of those close to the person who has died.

How do journalists interact with bereaved families?

An interview following a sudden death can be emotive and challenging, for both the grieving family and the journalist.

In traumatic circumstances, most journalists will proceed with the utmost caution. Their role is to try and gather the story, not to cause upset. Journalists from local newspapers may have a particularly strong understanding of the impact of the death on a family and the community.

The news process: how journalists report sudden deaths

This section is adapted from interviews Dr Sallyanne Duncan held with three journalists who work for a daily national Scottish newspaper. The findings from the interviews were presented during the webinar.

Why are stories of sudden deaths reported by the media?

  • By reporting the facts of a sudden death, journalists can prevent misinformation from spreading through social media and other forums.
  • Sudden deaths often occur in a public place. The public have an expectation that the facts will be made available, and journalists arguably have a duty to ensure that the community is informed.
  • By running stories on sudden deaths, journalists allow families to pay tribute to their loved one.

It has also been argued that families bereaved by a criminal act have a particular right to be included in media coverage. Media engagement can allow a family to campaign, get answers and seek closure.[5]

How do journalists report sudden deaths?

  • For journalists, the best source for a story is the immediate family of the deceased. After a sudden death, this is who they will try and contact.
  • Journalists reporting on a personal story after a death will generally not have a pre-planned angle in mind. The story will develop from memories and stories shared in the interview.
  • Most news editors will trust journalists to take this approach.

Where and how do journalists source their stories?

Journalists usually find out about sudden deaths through press releases distributed by the police. These releases are formal and factual, providing clear information about what happened. As the information is publicly available, newspapers will generally run a story if they feel it is newsworthy, even if the family doesn’t want to be involved in the coverage.

To source a story further, journalists should first approach the immediate family. This could be by turning up on their doorstep, phoning them to arrange an interview, or contacting them via social media like Facebook and Twitter. If the family does not initially want to talk to the media, the journalist should leave their contact details, to allow the family to get in contact at a later date if they wish. Good, ethical journalists will not follow up with a family who have indicated that they do not want to talk to the press.

In cases where a bereaved family does not wish to talk to the media, journalists will use secondary sources such as neighbours in order to write a story. These sources are generally more distant and less well acquainted with the family. This can be seen as intrusive by bereaved relatives because the media have given a voice to someone who may not have known their loved one well.

Advice on engaging with the media

Interviews

Bereaved families may not have any prior media experience. Relatives might agree to an interview, without knowing in advance what questions the journalist wants to ask, or how material from this will be disseminated.[6]

If the family feels able to, a face-to-face interview is recommended. This allows for a more natural rapport with the journalist, and for the family to be more comfortable.

At the interview, the journalist will probably be accompanied by a photographer, who will take a photo of the grieving person or family.

Journalists will also often ask the family for a photo of the deceased, sometimes from their social media sites, to use in the story.

By selecting a picture, families can ensure that their loved one is represented in the way they would wish to be. Generally, media in the UK will aim to use positive images of the deceased, with an aim of showing them as they lived.[7]

Before the start of the interview, bereaved families should confirm with the journalist:

  • what questions they will be asked, and what areas the interview will cover;
  • what angle the story will have;
  • how they and their loved one will be portrayed;
  • how long the story will be, and where it will feature in the newspaper; and
  • if the story will also be printed online and promoted through social media.

Families should be aware that journalists will need to know facts during an interview. Questions on circumstances of a death will be asked sensitively, but gaining accurate detail is important.

If a bereaved person says something in an interview that they do not want to be published, they should call the journalist and tell them. Journalists will also be happy to hear from the family about any developments on the story.

How will the interview take place?

The interview will generally consist of an informal conversation between the family and journalist. Questions that could be asked include: “Tell us about your relative,” “Tell us your fondest memories of your loved one,” or “Would you like to speak about…?”

It is likely that the journalist will record the interview, so they can accurately transcribe it. A journalist might ‘gently probe’ around the circumstances of the death, but a bereaved person will also have the opportunity to say no, and to let a journalist know if there is anything they do not want to talk about.

The internal news process at a print/online media outlet

Once a journalist has conducted and written up the interview, the copy (written content of the article) will be passed on to their newspaper’s production team. This team sub-edits the text and completes other tasks, such as headline writing and publishing the story online. Journalists have no control over the story once the copy has been handed over to the production team.

Sub-editing should identify spelling mistakes and any legal or factual errors. However, it is possible that errors will occur during the production process, which can be frustrating for journalists. An insensitive headline may be selected, or the story length may be reduced if there are space constraints. This could potentially lead to a quote from the family or other information being removed.

Editorial decisions can also reduce the length of a story. On a busy news day, the story may be shortened to just cover the facts of the case, with limited input from the family. If a newspaper is aware that a rival publication also plans to run the story, they may have to shorten a longer story so that they can publish the piece before or at the same time as their competitor. This can be upsetting for a grieving family.

The Editors’ Code of Practice

Many newspapers adhere to the Editors’ Code of Practice, a set of rules all publications regulated by the Independent Press Standards Organisation (IPSO) must follow. Within this code there are clear instructions for journalists working on stories involving bereavement.

This includes a clause on ‘Intrusion into grief or shock’, which states:

“In cases involving personal grief or shock, enquiries and approaches must be made with sympathy and discretion and publication handled sensitively. These provisions should not restrict the right to report legal proceedings.”[8]

The code also contains a clause on ‘Harassment’, which states that journalists:

“…must not persist in questioning, telephoning, pursuing or photographing individuals once asked to desist; nor remain on property when asked to leave and must not follow them.”[9]

Guidelines are also in place to regulate the reporting of suicide.

Publications themselves, rather than individual journalists, sign up to the Editors’ Code of Practice. Freelance journalists are also required to adhere to the Code when writing stories for a publication which is signed up to it. The editor of a newspaper holds responsibility for ensuring their journalists are adhering to the code.

In any cases where editors at a newspaper do not ensure their journalists are following the Code, they are in breach of it. A complaint can then be made.

Positives and negatives of engaging with the media

It is important that bereaved families are made aware of the potential challenges and benefits of engaging with the media.

Challenges

Non-participation

If families do not participate with the media, they will be excluded from news coverage, but the story will likely be run regardless. Journalists who gain information on a story from other sources will be free to use these details, without seeking permission from bereaved family or friends.

This can be particularly problematic if journalists use distant sources such as neighbours and acquaintances, who had limited relationships with the deceased. Non-participation may also reduce the family’s ability to refute incorrect or negative opinions about them.[10]

Exclusion

In some cases, particularly where a death occurred in traumatic circumstances, reporters may choose not to contact a family out of fear that this will cause further upset. However, the story will still be published. Although the media outlet may feel this is the ethical decision to take, it denies families the opportunity to participate in the reporting of their loved one’s death.

Issues may also arise if a family is expecting news coverage, but the media does not view the story as ‘newsworthy’. This can lead to families feeling neglected, and that their story does not have sufficient value to the press.

Intrusion

Deaths viewed as ‘newsworthy’ can receive widespread coverage. Families may be contacted by several journalists, and feel besieged by media attention. This extreme level of attention may not occur immediately, particularly if a story is originally covered by local media, and then picked up by national or international publications.

Social media

Journalists now frequently source content from social media sites, including comments and photos. Any publicly available material can be used in a story, and journalists may not feel that gaining content this way is unethical.[11] However, using content without permission can be very upsetting for bereaved families. Regulators, including the UK Press Complaints Commission and IPSO, have begun looking into this issue in recent years.

Inaccuracy

Journalists are constantly working to deadlines, and are under pressure to get stories produced quickly. This can lead to mistakes. Errors such as mis-spelling the deceased’s name can be very upsetting to a grieving family. The sub-editing process can also cause issues, if an inappropriate or sensationalist headline is selected for a sensitive piece.

Benefits

Personal input

Talking to a journalist allows families to have an element of control over the coverage. A family can personalise a story by sharing favourite anecdotes or by selecting a chosen photograph. Families also have the chance to correct any inaccuracies or misconceptions. By speaking to the media, a family has the opportunity to publicly acknowledge and discuss their loss.

Campaigning

After a sudden death, families may wish to campaign for justice, to raise awareness or to seek legislative changes. Through campaigning, families can aim to prevent other people from going through the same pain and loss that they have experienced.

The role of families can be important in achieving change.[12] Journalists may be able to assist with launching and publicising a campaign.

Helping overcome taboos

By discussing their grief, families can overcome societal taboos, helping to make conversation about bereavement easier.

Advice and conclusions

Sudden deaths are often, but not always, viewed as newsworthy by the media. This can provide both challenges and benefits to bereaved families. Being aware of how stories of sudden bereavement are reported, and the processes that lead to a story being published can help prepare grieving families for engagement with the media.

Key recommendations:

  • Journalists should provide their name, details of their publication and a business card to families. If they don’t, families should ask for this information.
  • Families can choose which publications they want to speak to. They do not have to accept every request for interview.
  • Most publications adhere to the Editors’ Code of Practice. Journalists should not repeatedly request interviews with a bereaved family.
  • It may be helpful for a trusted person, or intermediary organisation, to help manage a family’s liaison with the media.
  • It is completely understandable if a bereaved family does not want to speak to the press immediately. Journalists will be able to leave contact details for a family to get in touch when they are ready, although it is important to be aware that the story may only be covered at a later date if it still has ‘news value’.
  • Good journalists will be happy to have a short, initial chat with the family, and then follow this up with a longer conversation at a later date when they are ready.
  • Journalists work on the assumption that, through granting an interview, family members implicitly consent to the content being published.

About Dr Sallyanne Duncan

Sallyanne is a former journalist, and worked in the Scottish weekly press for a number of years. She is currently the programme director of the MLitt Digital Journalism degree at the University of Strathclyde. Her main research interest is in media reporting of trauma, death and bereavement. Sallyanne submitted evidence on media reporting of the bereaved to the Leveson Inquiry, and she has also revised the National Union of Journalists’ professional guidelines on media reporting of mental health and suicide. She has written a book on media reporting of death and personal tragedy, with her co-author Jackie Newton. It is called Reporting Bad News: Negotiating the boundaries between intrusion and fair representation in media coverage of death, published by Peter Lang in 2017.

References

[1] Harcup, T. and O’Neill, M. 2001. What Is News? Galtung and Ruge Revisited. Journalism Studies. [Online]. 2 (2), pp. 261-280. [Accessed 14/02/2019]. Available from: www.tandfonline.com/doi/pdf/10.1080/14616700118449?needAccess=true

[2] Harcup, T. and O’Neill, M. 2017. What Is News? News Values Revisited (Again). Journalism Studies. [Online]. 18 (12), pp. 1470-1488. [Accessed 1/03/2019]. Available from: https://doi.org/10.1080/1461670X.2016.1150193

[3] Walter, T. et al. 1995. Death in the News: The Public Investigation of Private Emotion. Sociology. [Online]. 29 (4), pp. 579-596 [Accessed 05/02/2019]. Available from: https://journals.sagepub.com/doi/pdf/10.1177/0038038595029004002

[4] Duncan, S. 2012. Sadly Missed: The Death Knock News Story as a Personal Narrative of Grief. Journalism. [Online]. 13 (5), pp. 589-603 [Accessed 05/02/2019]. Available from: http://journals.sagepub.com/doi/abs/10.1177/1464884911431542

[5] Rentschler, C. 2007. Victims’ Rights and the Struggle over Crime in the Media. Canadian Journal of Communication. [Online]. 32 (2), pp. 219-239. [Accessed 05/02/19]. Available from: www.cjc-online.ca/index.php/journal/article/view/1887/3167

[6] Muller, D. 2013. Black Saturday Bushfires and the Question of Consent. Ethical Space. [Online]. 10 (1), pp. 36-42. [Accessed 05/02/19]. Available from: http://communicationethics.net/sub-journals/abstract.php?id=00042

[7] Newton, J. and Brennodden, L. 2015. Victims at the Margins? A Comparative Analysis of the use of Primary Sources in Reporting Personal Tragedy in Norway and the UK. In: Thorsen, E. et al (eds.) Media, Margins and Civic Agency. Basingstoke: Palgrave Macmillan, pp.102-115

[8] Independent Press Standards Organisation. 2018. Editor’s Code of Practice. [Online]. [Accessed 05/02/19]. Available from: www.ipso.co.uk/editors-code-of-practice/

[9] Ibid

[10] Skehan, J. et al. 2013. Suicide Bereavement and the Media: A Qualitative Study. Advances in Mental Health [Online], 11 (3), pp. 223-237. [Accessed 05/02/19]. Available from: www.tandfonline.com/doi/abs/10.5172/jamh.2013.11.3.223

[11] Newton, J. and Duncan, S. 2012. Exploring the Ethics of Death Reporting in the Social Media Age. In Keeble, R. and Mair, J. (Eds). The Phone Hacking Scandal: Journalism on Trial. Bury St Edmunds: Arima Publishing.

[12] Duncan, S. 2012. Sadly Missed: The Death Knock News Story as a Personal Narrative of Grief. Journalism. [Online]. 13 (5), pp. 589-603 [Accessed 05/02/2019]. Available from: http://journals.sagepub.com/doi/abs/10.1177/1464884911431542

Supporting the supporter: vicarious trauma and support needs webinar report

Supporting the supporter: vicarious trauma and support needs webinar report

This briefing is produced by Sudden. It aims to spread awareness and understanding of the risks posed to support workers by vicarious trauma, and related conditions.

Vicarious trauma can have a debilitating effect on support workers, their family and friends. It is a condition that develops when counsellors and psychiatrists working with trauma victims are strongly affected by their work, to the detriment of their own emotional and cognitive wellbeing.[1]

This report will identify the signs of vicarious trauma and give an overview of vicarious post-traumatic growth.

This report will discuss

  • the impact that trauma work can have on support professionals;
  • how vicarious trauma can develop;
  • best practice advice on reducing the risk of support workers developing vicarious trauma; and
  • how to limit the impact for those already suffering from the condition.

This report is based on the research findings and support recommendations of Dr Keren Cohen (head of therapies and senior lecturer, Goldsmiths, University of London) presented at a webinar for victim support professionals.

Understanding trauma

Defining trauma

The DSM IV (Diagnostic and Statistical Manual of Mental Disorders) definition of trauma is widely used by health professionals.[2] This definition states that trauma can result from actions that threaten death or serious injury. It also recognises that an individual can become traumatised without witnessing an event – for example, after learning about a loved one’s sudden or violent death.

Traumatic events can also be defined as those that occur outside of our normal day-to-day experiences. Broader definitions of trauma could include the effects of an interpersonal experience (such as a divorce).

PTSD and the impact of trauma

Traumatic events can instigate a broad spectrum of reactions, and can cause post-traumatic stress disorder (PTSD) to develop.

Common symptoms of PTSD include:

  • Arousal, nightmares and intrusive thoughts
  • Hyper-vigilance
  • Significant changes to cognition and emotion
  • Several psychological impacts, including depression, reduced self-esteem, guilt and/or shame
  • An increase in aggression and aggressive behaviour
  • Difficulties in creating and/or maintaining intimacy in personal relationships.

The impact of PTSD can also have a ripple effect on an individual’s family, partner or colleagues.

The negative impacts of trauma work

Professionals who support people who have been traumatised are also at risk of developing a range of psychological conditions.

Burnout

Burnout is a motivational syndrome which can result from emotional exhaustion. The condition can affect people in any form of work.

There are three major aspects of burnout:

  • Emotional exhaustion. This can result in tiredness, a lack of motivation and being emotionally unavailable.
  • Lack of personal accomplishment, causing dissatisfaction with work performance and sense of a lack of achievement.
  • Depersonalisation. This could cause support workers to develop a cynical or negative attitude towards their clients.

Burnout usually develops from prolonged exposure to work-related stress, and can be a challenging condition to treat or recover from. It is important that support professionals are aware of the symptoms of burnout, so that they can address and mitigate its impact.

Using monitoring tools like the Maslach Burnout Inventory[3] can be a helpful way for support workers to assess whether they are experiencing burnout.

Compassion fatigue

Compassion fatigue is a condition specific to support professionals. People experiencing compassion fatigue may feel emotionally exhausted and numb,[4] and may lack empathy towards their clients.[5]

The effects of compassion fatigue can result in increased clinical errors, and the condition has been linked to depression, anxiety and mental health issues.

Secondary traumatic stress

Secondary traumatic stress occurs when an individual develops PTSD-like symptoms, without having directly witnessed or experienced a traumatic event. The symptoms instead develop through support work with a client who experienced the traumatic event.[6] While burnout or vicarious trauma develop over an extended period of time, secondary traumatic stress can present suddenly and unexpectedly.

Vicarious trauma[7]

Vicarious trauma does not necessarily cause psychiatric symptoms, and the effects may not be as severe as secondary traumatic stress; however, vicarious trauma can significantly alter an individual’s perception of themselves and the world.[8]

Unlike burnout and compassion fatigue, secondary traumatic stress (DSM V PTSD) and vicarious trauma are inherently linked to trauma.

Trauma response theory

Assumptive world and basic assumptions

The assumptive world concept states that people have a shared set of basic assumptions about the world, themselves and others. These tacit assumptions are the building blocks of cognition and form general attitudes and approaches to life.

Generally, people have a sense of self-worth, believe in a rational process of cause and effect, and feel that the world is benevolent. While people will recognise that traumatic events can occur, they do not feel a sense of overt vulnerability.

In the assumptive world, these basic cognitions tend to be stable across life. When negative (but non-traumatic) events occur, people will generally not change their basic assumptions; however, when a person has experienced trauma, the event will be so beyond their day-to-day experiences that they will start to question their understanding of the world.

Procession of trauma[9]

After a traumatic event, basic assumptions are severely challenged. To recover from the trauma, a person will need to change their previous assumptions or create new ones.

While trying to rebuild their assumptive world, people may experience contemplation, intrusive memories, flashbacks and other symptoms. During this process, a person will generally assimilate or accommodate the traumatic event into their system.

Assimilation and accommodation

Some people may be able effectively to process a traumatic event, without changing their basic assumptions – this is called assimilation.

However, in most cases, people will have to accommodate and change their basic beliefs to process the trauma.

Incomplete processing cycle

Some people are initially unable to reach the stage of accommodation or assimilation. Instead, they become stuck in an incomplete processing cycle. When this occurs and there is continuous activation of the trauma, PTSD symptoms will develop.

Avoiding emotional or physical connections to the trauma at this stage is understandable but can worsen the situation by further delaying cognitive processing.[10]

Theory and vicarious trauma

A support worker can experience a similar process with vicarious trauma. Prolonged exposure to clients’ traumatic narratives can have a strong influence on a support worker’s cognitive perceptions.

Potential impacts of undertaking trauma work can include:

  • Feeling less safe
  • Becoming less trusting
  • Reduced self-esteem
  • An inability to form intimate relationships
  • Becoming withdrawn and less engaged with the wider world
  • Feeling a sense of loss of control over life.

For vicarious trauma to manifest, changes to personal cognition need to be pervasive, cumulative and permanent.

Preventing vicarious trauma[11][12]

When developing a strategy to help support workers avoid vicarious trauma, it is important for organisations to consider factors that can influence and prevent its progression.

Coping strategies

Self-medication with alcohol or other substances (or withdrawal from these substances) can increase the risk of vicarious trauma.

Personal stress

A combination of work-related stress and domestic problems (e.g. a role as carer outside of work or a bereavement) can heighten the risk of vicarious trauma occurring.

Gender

Some studies have indicated that women experience higher levels of vicarious trauma than men;[13] however, this may be due to greater levels of reporting, rather than women being more likely to be affected by the condition.

Proportion of trauma work

Organisations should diversify the responsibilities of their support workers. Work with traumatised clients should be mixed with a combination of other, less-demanding tasks, such as administrative duties.

Personal trauma history

A personal history of trauma can increase the risk of a support worker developing vicarious trauma, particularly when this trauma has not been successfully processed.

Exposure

The more a support professional works with people who have experienced trauma, the more susceptible they are to developing a prolonged, negative outlook.

How can organisations help?

Organisations working with traumatised people must develop effective guidelines and protocols to identify and support workers showing signs of vicarious trauma.

A positive workplace culture that promotes tolerance and openness is very important. Staff should be provided with a support network and be able to disclose any concerns.

Additionally, organisations should encourage support workers to:

  • Engage with self-care. Support workers must be enabled to separate their work from their personal lives. Engaging with physical and social activities can help mitigate the emotional impact of trauma work.
  • Utilise any personal resources, such as spirituality, optimism and humour.

Post-traumatic growth

While trauma work can have negative effects, there can also be positive outcomes if professionals are fully supported.

What is (and isn’t) growth?

Growth is a separate concept to coping well with the stresses of work. It is also different to looking purposefully for positive aspects of work.

Instead, growth is a term used to describe naturally occurring cognitive changes. These can include post-traumatic growth and vicarious post-traumatic growth. Changes that occur from vicarious post-traumatic growth can be seen as alterations to who we are. It is important to consider how exactly these changes occur, and how trauma work can result in growth.

Vicarious post-traumatic growth

Vicarious post-traumatic growth occurs when a support worker:

  • is exposed to a client’s traumatic narrative and empathically engages with that narrative; and
  • experiences a fundamental shift in their assumptions, resulting in change to their understanding of the world.

There are two potential outcomes to vicarious-post traumatic growth:

  • A negative change, which can result in an individual withdrawing and developing vicarious trauma.
  • A positive change, which can result in a person becoming wiser, more empathetic and feeling more connected to people.

Understanding vicarious post-traumatic growth

This section of the report details three academic studies, which can help develop understanding of how vicarious post-traumatic growth develops.

Study 1

Brockhouse, R., et al. 2011. Vicarious exposure to trauma and growth in therapists: The moderating effects of sense of coherence, organizational support, and empathy.[14]

This study was undertaken in the UK and used qualitative data. It considered reported senses of coherence and control in counsellors and psychotherapists, and also what organisational and personal support these professionals received.

The study sought to identify the impact of trauma work and assess how this affects potential for growth. The investigation results were inconclusive and indicated the need for further research.

Study 2

Splevins, K., et al. 2010. Vicarious post-traumatic growth among interpreters.[15]

The second study also used qualitative data, to assess individual growth in interpreters working with refugees and asylum seekers.

Empathy and growth: The study aimed to determine whether an empathic connection with a client is required for growth. The qualitative data revealed that the interpreters felt empathy and a psychological closeness towards their clients. In some cases, this was due to a shared culture and history, as some of the interpreters were also refugees. A sense of closeness and identification between interpreter and client was facilitated through the required use of the first-person in translation.

Responding to trauma: The interpreters in the study reported two strong emotional impacts. The first reaction, distress, was experienced when hearing the refugee client’s story. After the client had received counselling, the interpreters had a second, more positive reaction. This was reported as a sense of amazement at the recovery and resilience of their client. The shock experienced when seeing this transformation was very similar to the disbelief they felt, when they first heard about the traumatic events. Both impacts caused the interpreters to challenge some of their previous assumptions about life.

Study conclusions: This study recognised that an empathic connection is required to facilitate vicarious post-traumatic growth. It also highlighted that exposure to a client’s growth and recovery can help trigger vicarious post-traumatic growth in a support worker. The study also raised questions about whether vicarious trauma and vicarious traumatic growth can occur together, whether they are mutually exclusive or if one needs to happen before the other.

Study 3

Cohen, K. and Collens, P. 2013. The impact of trauma work: A meta-synthesis on vicarious trauma and vicarious trauma growth.[16]

This study analysed data from pre-existing qualitative research, and aimed to determine the impact of trauma work and highlight any positive outcomes.

It also highlighted two strong reactions experienced by support workers – initial distress, and later amazement at the recovery of a client.

The study also considered changes reported by support workers, following trauma work.

Negative changes reported included:

  • A sense that the world was unsafe
  • Compassion fatigue
  • Reduced levels of trust/increased suspicion
  • Becoming distant or over-protective in personal relationships.

Positive changes reported included:

  • Great compassion, appreciation of life and human resilience
  • Increased self-awareness, self-worth and wisdom.

After trauma work, support workers who felt more engaged and open to life often experienced growth, whereas those who became more withdrawn were more likely to experience vicarious trauma.

Nature of the trauma experienced: The nature of a client’s trauma can influence the impact on the support worker. Professionals working with child sexual abuse survivors reported change in levels of trust and in their personal relationships.

Fields of trauma work: This study highlighted that a ‘resilience shock’ needs to be experienced, to facilitate vicarious post-traumatic growth. However, some fields of trauma work may provide limited exposure to client resilience: whereas therapists can work with clients through their journey, helpline workers may only experience clients at their most distressed. Experiencing a client’s traumatic narrative, but not their consequent recovery, can potentially have an impact on a support worker’s level of vicarious post-traumatic growth.

Distress and growth: The study found that further research is needed into the relationship between growth and levels of distress experienced. Studies of PTSD and post-traumatic growth had varying conclusions – some studies found that a lower level of PTSD is required to experience post-traumatic growth, whereas other studies rejected this. There were similar findings in relation to vicarious trauma.

Facilitating vicarious post-traumatic growth

Vicarious post-traumatic growth is a naturally occurring response to trauma. It only happens under certain conditions, and this can be difficult for support workers, their clients and their organisations.

Professionals who have already formed compassionate assumptions and approaches, which accommodate for the shock of human resilience, may not experience the major cognitive changes vicarious post-traumatic growth can cause. This does not automatically mean that they are coping poorly.

Conclusions and recommendations

It is natural that trauma work will have an impact on support workers; however, it is important that the difference between more general negative emotions and vicarious trauma is recognised. Vicarious trauma is a long-term, pervasive change to an individual’s cognitive schema.

Key recommendations

Organisations should:

  • Diversify employee workloads.
  • Create a safe work environment. Support workers should feel supported and able to disclose any issues.
  • Create safeguards to identify vulnerable support workers, and ensure they receive the help they need. Monitor and assess the risk of vicarious trauma by introducing tools that highlight the condition. The earlier that symptoms are identified, the sooner support can be provided.
  • Educate employees on how to identify the signs of vicarious trauma in themselves and co-workers.
  • Run targeted interventions that prevent or mitigate the impacts of vicarious trauma and promote post-traumatic growth.

Support workers:

  • Peer support can be an effective means of identifying and preventing vicarious trauma.
  • Aim to achieve a healthy work–life balance. Social activities and sport can be helpful.
  • Remain alert for periods of heightened stress in both work and personal lives.
  • Disclose any concerns to a trusted member of staff.

About Dr Keren Cohen

Keren was trained in psychodynamic psychotherapy, and works as a counsellor alongside her academic career. Her academic background is in clinical psychology, with a particular emphasis on trauma and wellbeing. Keren’s research interests include wellbeing and post-traumatic growth, and, more recently, she has begun to explore and develop the concept of vicarious post-traumatic growth.

References

[1] Trippany, R., Kress, V. and Wilcoxon, S. 2004. Preventing vicarious trauma: What counsellors should know when working with trauma survivors. Journal of Counselling and Development. [Online]. 82 (1), pp. 31-37. [Accessed 11/02/2019]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/j.1556-6678.2004.tb00283.x

[2] European Society for Traumatic Stress Studies. 2019. DSM IV PTSD Definition. [Online]. [Accessed 05/02/19]. Available from: www.estss.org/learn-about-trauma/dsm-iv-definition/

[3] Maslach, C. and Jackson, E. 1981. The measurement of experienced burnout. Journal of Organizational Behaviour. [Online]. 2 (2), pp. 99-113. [Accessed 05/02/19]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/job.4030020205

[4] Elwood, L., et al. 2011. Secondary trauma symptoms in clinicians: A critical review of the construct, specificity, and implications for trauma-focused treatment. Clinical Psychology Review. [Online]. 31 (1), pp. 25-36. [Accessed 05/02/19]. Available from: www.ncbi.nlm.nih.gov/pubmed/21130934

[5] Figley, C. 2002. Compassion fatigue: Psychotherapists’ chronic lack of self-care. Journal of Clinical Psychology. [Online]. 58 (11), pp. 1433-1441. [Accessed 05/02/19]. Available from: www.ncbi.nlm.nih.gov/pubmed/12412153

[6] Figley, C. 1995. Compassion fatigue as secondary traumatic stress disorder: An overview. In: Figley, C.R., ed. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in those who Treat the Traumatized. Brunner-Routledge; New York, pp. 1–20.

[7] McCann, L. and Pearlman, L. 1990. Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress. [Online]. 3 (1), pp. 131-149. [Accessed 05/02/19]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jts.2490030110

[8] Figley, C. 2012. Encyclopaedia of Trauma: An Interdisciplinary Guide. USA: SAGE Publications.

[9] Joseph, S. 2009. Growth following adversity: Positive psychological perspectives on posttraumatic stress. Psychological Topics. [Online]. 18 (2), pp. 335-343. [Accessed 05/02/19].

[10] Tedeschi, R. and Calhoun, L. 2004. Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry. [Online]. 15 (1), pp. 1-18. [Accessed 05/02/19]. Available from: www.jstor.org/stable/20447194

[11] Beck, C. 2011. Secondary traumatic stress in nurses: A systematic review. Archives of Psychiatric Nursing [Online]. 25, pp. 1-10. [Accessed 05/02/19]. Available from: www.ncbi.nlm.nih.gov/pubmed/21251596

[12] Sabin-Farrell, R. and Turpin, G. 2003. Vicarious traumatization: Implications for the mental health of health workers? Clinical Psychology Review. [Online]. 23 (3), pp. 449-480. [Accessed 05/02/19]. Available from: www.ncbi.nlm.nih.gov/pubmed/12729680

[13] Way, I., VanDeusen, K. and Cottrell, T. 2007. Vicarious trauma: Predictors of clinicians’ disrupted cognitions about self-esteem and self-intimacy. Journal of Child Sexual Abuse. [Online]. 16 (4), pp. 81-98. [Accessed 11/02/2019]. Available from: https://doi.org/10.1300/J070v16n04_05

[14] Brockhouse, R. et al. 2011. Vicarious exposure to trauma and growth in therapists: The moderating effects of sense of coherence, organizational support, and empathy. Journal of Traumatic Stress. [Online]. 24 (6), pp. 735-42. [Accessed 05/02/19]. Available from: www.ncbi.nlm.nih.gov/pubmed/22147494

[15] Splevins, K. et al. 2010. Vicarious posttraumatic growth among interpreters. Qualitative Health Research. [Online]. 20 (12), pp. 1705-1716. [Accessed 05/02/19]. Available from: http://journals.sagepub.com/doi/abs/10.1177/1049732310377457

[16] Cohen, K. and Collens, P. 2013. The impact of trauma work – A meta-synthesis on vicarious trauma and vicarious trauma growth. Psychological Trauma: Theory, Research, Practice, and Policy. [Online]. 5 (6), pp. 570-580. [Accessed 05/02/19]. Accessed from: http://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0030388

Viewing the body

Viewing the body

Note: This guidance is general only, and may be affected by COVID-19 rules at the time, prohibiting people from viewing a body.

Seeing a body immediately

Some people who are suddenly bereaved have no choice over whether they ever see the body or not, because they see the body at a very early stage due to circumstance.

Some witness the death. For example, people who witness the death of someone close to them in a road crash or a drowning or a sudden medically-caused death.

Other people arrive at the scene of the death just after that death. For example, someone discovers a loved one’s suicide, or is alerted by someone else to the death of a loved one nearby that has only just happened.

When recounting this experience later to researchers of sudden bereavement, suddenly bereaved people who witnessed a death or arrived at the scene shortly afterwards said they had an overwhelming desire to be beside the dead person; to hug and touch them and comfort them. They did not want the dead person to be alone and they wanted the dead person to be with someone who loves them. In other words, the bereaved person still felt their dead loved one had a “social identity” and needed nurturing [1]. Often suddenly bereaved people at this time will resist strongly any attempt by professionals or other carers to keep them away from their loved one’s body.

The bereaved person’s experience of seeing their loved one’s body at this time will be different to seeing their loved one’s body later. There will be no control at this early stage over whether or not they see any visible injuries or physical damage to their dead loved one’s body. There will be no ability to prepare for the situation they find themselves in. In the case of violent disasters, it is often a chaotic, fast moving experience.

Seeing a body later

After a sudden death there are usually opportunities to see the body in a more formal and usually much calmer setting, such as when it is laid out in a mortuary or funeral parlour. There are often many people who were close to the person who died, including children, who may wish to consider seeing the body at this stage, and who did not see the body at the time of the death.

The decision to view the body of a loved one is a big decision. It results in a suddenly bereaved person experiencing something that usually creates a strong memory, central to the experience of the bereavement. This can be a memory viewed positively or negatively, or both. However, the feelings that result from that memory may change over time.

The decision not to view a body is also a big decision. It can result in feelings of regret at not seeing the reality of the death with “my own eyes”. Arguably this is something that may be felt more often in cases of sudden death, due to the unexpected and unanticipated nature of the death, and therefore the feeling of unreality often associated with it.

Research by Oxford University published in the British Medical Journal [1] interviewed people suddenly bereaved about their experience of viewing or not viewing the body of their loved one.

It concluded:

  • Many people bereaved by a sudden and traumatic death think it is important to see the body of their loved one.
  • However, within a family there will be different attitudes; some bereaved relatives may want to view, but others will not, and some will find viewing helpful, but others may find it distressing.
  • Seeing a damaged body is inevitably distressing, but in the research was often not regretted. Clinicians should not assume that relatives will be harmed by seeing a bruised or damaged body.
  • Those who had mixed feelings or regretted seeing the body felt they had lacked choice or preparation.
  • The way that relatives refer to the body can be a strong indication for professionals about whether the person who died retains a social identity for the bereaved.

Therefore, while many suddenly bereaved people may find the experience helpful, it is inadvisable to encourage a suddenly bereaved person to view a body. To enable a bereaved person to make the choice that is best for them, you can help by asking them relevant questions and providing them with relevant information. The below guidance helps you to do this.

A body may be different in death than in life

Some people who have been suddenly bereaved may want to view the body of their loved one because they have had a positive experience of viewing a body previously, for example a grandparent who died in old age. If someone dies of old age then their body in death often looks fairly similar to their body in life. However, when someone dies suddenly in childhood or in mid life their body may look very different to how the person looked when alive. This is particularly the case if their death was violent, or they had urgent medical intervention such as a major operation prior to death.

A body may be different in death to life because:

  • injuries or surgical procedures have damaged the body. For example, skin has changed colour due to internal bleeding, or the body’s facial appearance has changed due to a broken jaw, or cuts, etc.
  • a mortician or funeral director has changed a body’s appearance through clothing, or hair arrangement, or cosmetics. Such “dressing” of the body may be very different to how the person in life would have done it.
  • the body smells different. For example, due to embalming processes, or antiseptics used during an operation.

Maggie says: “I had seen the body of my grandmother so I wasn’t worried about seeing my husband’s body. I knew that seeing my grandmother’s body had helped me come to terms with her death so I thought it would be the same when I saw Gary’s body. I just didn’t think how different it would be. Gary’s body was destroyed by the car crash. When he was in the Intensive Care Unit of the hospital the staff had wired up his broken jaw and not bothered to tell me it was broken because he had so many internal injuries and other broken bones so they felt his jaw was unimportant information; a minor detail. But when he died and I went to see the body I was utterly shocked that his face looked so collapsed. I thought he would look about the same in death as he had when he was on the life support machine. I remember screaming “That’s not my husband” and running out. It was horrible. I felt terrible, and I felt I had behaved terribly, with no self control. This left me with feelings of misery and some embarrassment.”

As someone helping a bereaved person, it is therefore useful to know what changes have occurred to a body, and, firstly, to tell a bereaved person that there have been changes, then, secondly, ask the bereaved person if they wish to know the details of those changes in order to assist them to make the decision to view a body or not.

Some bereaved people may not want to be told about any changes to the body and may not want to view the body. They may wish to remember the person how they were in life, and not have this memory intruded upon in any way, either by being told what the body looks like or by seeing the body.

Some bereaved people may want to be told the changes, but then choose not to see the body.

Some bereaved people may want to be told the changes and then choose to see the body.

Some bereaved people may want to discover the changes for themselves and not be receptive to being given information second hand.

The viewing experience

Charlotte arrived to view the body of her sister. She was taken into an empty room with no explanation. With no warning, a curtain was swept back and she found herself within a metre of her sister’s body, on a table behind the curtain

Charlotte says: “It was like a magician’s trick and a terrible shock. It made me want to run out of there straight away. I burst into tears and only stayed a few minutes. I really regret the way this made me feel and the whole experience.”

John went to view the body of his son in a hospital mortuary. He was taken into a small intimate room containing only his son’s body. While he was in the room a member of the mortuary staff stood solemnly in the corner. “It was very strange. I had been anticipating this time with my son’s body and wanted it to be special and private. Yet this man was in the corner the whole time. I remember it made me feel very self-conscious and left me feeling like he was a prison warden; there to check I didn’t do anything silly, such as run off with the body. It didn’t give me a good feeling. It was such a vivid experience that I remember every single detail. I remember that the man was wearing a white coat with a small enamel badge on it of a steam engine. I have no idea why; I presume he was a train enthusiast. But I remember thinking “Why are you interfering with my private experience of grief by being there and making me think about steam trains when I want to be thinking about my son?” It made me feel unreasonably angry towards the man at a very difficult time.”

Every detail about the viewing experience matters and every detail can be explained to a person who is going to view a body, before they view a body. As someone caring for the suddenly bereaved person, you can help by:

  • Talking to the bereaved person about what they want the experience to be like. Do they have any requests, for example they may want to be left alone, or only see the body at a distance or through glass.
  • Talking to the mortuary staff about what the experience will be like. For example, will it be possible for a bereaved person to touch the body? Sometimes this is not possible for forensic reasons. Will parts of the body be covered because they are too damaged? Are there any parts that the bereaved person is not advised to touch because they are fragile? What will the room look like and will anyone else be there?

Every word matters

Jane was only five when her father died. Her mother told her that “Daddy isn’t here anymore. His body is here, but the rest of him had gone away to heaven.” Jane, who is now an adult, remembers being shocked when she saw her dad’s body because it had a head, arms and legs. She had thought the word “body” meant his torso, so she thought she was only going to see his chest and stomach areas and that his head and limbs had gone up “into the sky to another planet”.

If you are giving information to someone who is considering whether to view a body it is important to ensure that your information is understood. This is particularly important to check when talking to children, or people who are communicating in a second language or have hearing difficulties.

Concentration is difficult when suddenly bereaved so important details may need repeating.

One way to ensure your information is understood is to seek consideration through continued conversation and repetition. For example, “I’ve told you a few things that I’m just going to list again now. I’ve told you that you won’t be able to touch your dad’s chest area, and that only his head and hands will be exposed, and that his eyes will be shut and his skin colour will be purple due to internal bleeding. I’ve told you that a mortician will be present. Do you have any thoughts about what this experience may be like for you if you decide to see him?”

Managing the experience

If more than one person wants to view the same body, have conversations with these people about whether they want to do the viewing on their own or together. Sometimes viewing rooms may be small and get crowded easily, reducing the quality of the experience. Children’s experiences have to be managed with particular care, ensuring they are accompanied by an adult helper who will assist them appropriately to understand what they are seeing.

It is also important for bereaved people to consider what they are going to do after viewing a body. Will they be able to sit somewhere safe and quiet and have a few minutes to themselves and an offer of a hot drink before facing the world again? What will their plans be for the rest of the day; will it be possible to do something relaxing, with people they trust and know, that doesn’t require extensive travel?

Religious rules and rituals

When managing the experience, it is important to be aware of, and consider the implications, of any religious rules or rituals that wish to be followed by a person viewing the body, such as touching and preparing a body through procedures such as washing and wrapping, or only allowing certain people to visit at certain times.

The importance of such rules or rituals to loved ones should be considered sensitively alongside any needs for post-mortem examination by pathologists and forensic scientists. Some families may object to the touching of the body by a non-faith member, but there is no rule for this in Hinduism, Islam or Sikhism in emergency situations. In Islam an invasive post-mortem examination (involving cutting open the body) is forbidden and it may, in some circumstances and in some countries, be possible to agree a non-invasive post mortem examination.

It is important to be receptive to cultural and religious differences and consult with the family to identify their particular needs. Although there are some general rules, it is important not to make assumptions based on a religious or cultural background. However, knowledge of other backgrounds may make communication and understanding easier.

Identification

Often, the police require identification of a body; however sometimes no-one wants to view the body. In this case, some countries allow identification through a photograph, or through glass.

Author note

This information was prepared by Mary Williams OBE, chief executive of Sudden and Brake, the road safety charity, with advice on religious rules and rituals by Yunus Dudhwala, Head of Chaplaincy & Bereavement Services, Newham University Hospital NHS Trust, UK


Reference

1. Viewing the body after bereavement due to a traumatic death: qualitative study in the UK, A Chapple, S Ziebland, 2010, BMJ

Grief support help

Grief support help


Grief, or mourning, is a natural process after the death of someone we love.

Grief is personal, and how you grieve is your choice. You may wish to spend time grieving alone, or grieve with the support of family, friends or others.

You may wish to grieve in different ways at different times, depending on how you feel and what is happening in your life.

Some people talk about grief as happening in stages. During these stages we work through what has happened. The final stage is when we feel acceptance of what has happened, we are able to lead a full and hopeful life once again.

Grief can feel particularly intense at times, for example on birthdays. Or it may feel hardest when you are least expecting it to. For example, if someone says something that sparks a memory of the person who died.



Some bereaved people feel that, over time, help from family and friends starts to fade away. You may find it helps to show family and friends this information and talk about how you can keep helping each other. Sometimes, something simple, such as a regular phone call, can make a big difference.

Some people have a regular get together to honour someone’s life, for example on their birthday.

Memorialising can help people grieve together. Some people plant a tree or erect a plaque. Some people fundraise for a charity in memory of a person who has died.


Grief support services

There are many grief support services, many operated by national and local charities.

Many services are appropriate to be accessed only after the early weeks of shock are over. To avoid disappointment, check when a service is meant to be accessed and if there is a waiting list.

Services often include:

  • phone, or face to face, grief counselling or support
  • groups of bereaved people helping each other, together, including online or socially

A service may help anyone grieving, or may specialise in:

  • helping people bereaved by a particular cause of death
  • helping particular kinds of people, for example families, children, youth, widows, older people or people with particular faiths


Seek help from your Sudden case worker finding services that best meet your needs. You may also choose to browse online directories of services. Try www.ataloss.org and www.thegoodgrieftrust.org.


Helping in the early days

Helping in the early days


People experiencing a sudden bereavement often have strong emotional and physical responses because of the shocking nature of the bereavement.

In recent decades, academics and practitioners have catalogued responses, and defined appropriate care.

The below basic guidance is based on this work, and also informs the approach of the Sudden service, which provides a down-the-line case worker for suddenly-bereaved people, from day one, onwards.

Use this form to refer someone into the Sudden service, or learn more about it.

Shock and responses during the first month

Immediately after finding out, suddenly bereaved people often display shock symptoms, often including disbelief that the death is true; a feeling that it is all just a bad dream. Screaming, shaking, an inability to talk or move, eat, drink or sleep, are all common and normal. Physical responses may include pains such as stomach ache or headache, diarrhoea, stuttering, heart palpitations, jumpiness, and exhaustion.

These symptoms are emotionally and physically draining, for bereaved people and their family and carers.

Shock symptoms can start to subside over the early days, but not always. Read Sudden’s guidance for suddenly bereaved people on shock reactions.

During the shock period, suddenly bereaved people are less likely to be reading this website, so it is helpful if you, as a carer, can communicate to the bereaved person what is happening to them.

During the early days of a sudden bereavement a number of additional thoughts and reactions are common too, such as painful and intrusive thoughts (regret, anger, fears), insomnia and nightmares, and a feeling no-one understands. You can help suddenly bereaved people to understand this is also normal, using the advice in Bereaved Adults.

Reactions may be extreme and distressing.

As a carer, the most important thing you can do during this time is to assist in providing safety and support.

In the first hours and weeks

It is important to have support for suddenly bereaved people during the first hours and weeks. The main functions of this care are to ensure a suddenly bereaved person:

  • Is safe from harm. When in shock, a person may be more liable to make mistakes, such as drive dangerously, or burn themselves. Potentially dangerous tasks such as driving and cooking should be done by someone else.
  • Has their basic needs met. This includes eating and drinking (not alcohol), housing, keeping warm, and attempting to sleep.
  • Has their responsibilities covered. This includes any responsibilities for dependents such as children and elderly people, but also responsibilities for pets. It may also be necessary to tell key people about the bereavement, such as an employer of the bereaved person.
  • Is provided with basic information that helps them make sense of what has happened. It may be necessary to repeat information several times.
  • Is not excluded from procedures and events that are happening that are relevant to their sudden bereavement and decision-making that needs to be done, but given support and information to enable them to make the best decisions for them. For example, decisions around viewing the body, return of belongings from the police, or funerals.
  • Is cared for in light of their pre-existing life situation, and any vulnerabilities around that. For example, complications such as domestic violence, family breakdown, depression or other chronic illness, or alcohol or drug addictions.

This can all be provided by a loving family member or friend, and, if not, by someone else.

Care professionals can provide this role if no one is available, or can help family members or friends to provide this care by advising them and relieving them at times.

Ongoing responses

It may be that after some weeks responses being displayed by someone suddenly bereaved are within the range of common grief responses that often follow any kind of death, including expected deaths.

The bereaved person is accepting the death, and starts to take steps to move forward with their life while still experiencing their bereavement with great sadness and many other emotions that are normal.

These responses don’t require any sort of specialist care to aid recovery, but some people find it helpful at this stage to access a grief support service.

However, it is not uncommon, or unusual, for someone bereaved suddenly to suffer more than this following a sudden death, and in that case someone can be described as having grief reactions that are complex or prolonged, or other reactions that can be described as due to traumatic stress.

Some reactions are described here and what to do about it if you notice such reactions.

In these cases, someone may benefit from a mental health diagnosis and appropriate treatment to aid fast recovery. 

If you are not in a position to escalate someone’s care and seek an assessment of their mental health, it is recommended that they talk to their Sudden caseworker to seek help. We employ a clinical advisor (a mental health nurse) who can organise assessment of need.

Why sudden bereavement is hard

Why sudden bereavement is hard

This page provides useful background to why a sudden bereavement can be very challenging. It is important reading for anyone caring for someone suddenly bereaved.

The loss of meaning

Sudden bereavement often removes people from our lives who are significant, close and central to us, who were not expected to die now; such as a life partner, father, son, brother, mother, daughter or sister.

People who are significant to our lives can provide us with immense security and purpose. When these people die, it can cause us to feel lost and directionless, as well as emotional pain and any practical difficulties due to the bereavement.

Bereavement specialist Dr Robert A Neimeyer [1] says our life stories and plans are often “interwoven, closely, with the life story of another”, so when that person dies, our own life story and plan for the future is shattered.

Suddenly-bereaved people are affected by their own life stories

Everyone is unique, with a unique life story. Anyone’s ability to cope with the sudden death of someone close is likely to be shaped by that life story. It is important, when caring for a person who has been suddenly bereaved, to have a basic understanding of their life story, to enable appropriate empathy.

Different life stories mean sudden bereavement can be hard to bear for different reasons.

People who had poor relationships in the past (for example, an unloving childhood, or failed relationship) may find it difficult to cope when someone special dies suddenly with whom they had a good relationship. They may find it hard to imagine having such a special relationship again, because their experiences have taught them that good relationships are hard to find.

People who have always experienced good relationships, and who have no experience of being suddenly bereaved, may find it challenging to make sense of the world any more, when someone special dies suddenly. They have no experience of such things happening, so the shock can be enormous.

People who have previously been suddenly bereaved, and then moved on, may find it particularly hard to bear if it happens again. Having to experience sudden bereavement repeatedly may mean these people find it hard not to have a depressive view of the future.

Every sudden death is unique and can be potentially traumatising

Every sudden death is different and can potentially traumatise. Here are some reasons why.

  • Witnessing: A death may be witnessed by the bereaved person, and the bereaved person may have been powerless to prevent the death; for example, a father forced to watch his child drown but unable to rescue his child because of strong waves.
  • Involvement: A bereaved person may have been involved in the event that caused the death; for example, a road crash. In such circumstances, the bereaved person may also be recovering from injuries, or caring for another injured family member. The bereaved person in some circumstances may have even caused the death of their loved one; for example by driving dangerously.
  • Not there: Alternatively, a bereaved person may not have been at the scene of the death. They may be told about the death second hand; for example, by a police officer telling them their loved one has taken their own life. Our imaginations regarding what happened may be vivid and cause great distress.
  • More than one death: A bereaved person may have suffered multiple bereavements at once. This is also not uncommon following a road crash, for example. Or may have suffered one sudden bereavement shortly after another sudden bereavement, for example due to illness.
  • A lingering death: A bereaved person may have suffered the sudden serious injury of a loved one, which then led to a lingering death in hospital, where there was intermittent hope of recovery and then death. This can, in itself, be a drawn-out traumatising experience if combined with medical interventions of a distressing nature.
  • A violent death: Another common defining factor of many sudden deaths is that the death was violent, or may have involved extensive pain, or fear, or all three.

‘The death matters to me, whether I was there, or not.’

Many people working in the field of trauma, and caring for people who are traumatised, define a traumatic event as an event that involves the traumatised person, or was witnessed by the traumatised person. In both cases, the defining factor is that the traumatised person was there at the event. Such descriptions of trauma exclude unfairly people who have been bereaved by a sudden death but who were not present.

In the case of sudden death, the defining factor that makes the death potentially traumatising, and the bereaved person’s response to that death potentially complex, is not that the bereaved person was present at the scene of the death.

The defining factor is that the death was sudden, unexpected, and someone very close.

Reference

1 Complicated grief and the quest for meaning: a constructivist contribution Robert A. Neimeyer, Ph.D. University Of Memphis, Tennessee

Bereavement challenges in a time of pandemic

After a death from COVID-19, and after a death from any cause in a time of pandemic, there are bereavement challenges that are new and hard, for both bereaved people and their carers. In this blog, Sudden chief executive Mary Williams OBE discusses the impact of death on families and bereavement services at this time of COVID-19 and applauds the efforts of the bereavement NGO community to offer support.

While governments still battle the spread of COVID-19, a new challenge is emerging: the challenge to help bereaved people in a time of pandemic.

A death from COVID-19 is a shocking, sudden death after a short and increasingly severe illness. To prevent infection, it is usually not possible for families to say goodbye in a normal way.

A death from any cause in a time of pandemic brings additional challenges for everyone who is bereaved. For example, it is ill-advised, or forbidden, for people to meet and hold a normal memorialising event such as a funeral. People whose normal cultural or religious practices involve washing or dressing a dead person’s body are now prevented from doing these things.

Governments are rightly concerned about the perils of isolating people through ‘lockdowns’ that aim to contain the virus, particularly the potential harm to people who are suffering major life challenges, such as poverty, addiction, and problems relating to mental health and physical health. There is also the enormous challenge of being both isolated and bereaved.

As we applaud our medical practitioners for saving so many lives, for those families who are bereaved by COVID-19 (and also by any other causes, particularly sudden causes) their challenges are just beginning.

For some people bereaved at this time, there are acute practical challenges that require immediate intervention from health and social services. For example, imagine the needs of an elderly person with dementia, perhaps also suffering from COVID-19, who was previously cared for by their partner who has died.

For all people who are suddenly bereaved at this time, there will be a range of challenges, compounded by the need for social distancing. Contact from family, friends, carers, and basic human needs, such as to have a hug, are prevented. Or these things are restricted to people with whom the bereaved are self-isolated.

Bereavement charities and mental health services around the world are working to ensure we help, as best we can, with the resources we have. A wealth of information is being published online and bereavement helplines are open.

Across the world, we are all having to help each other in new, and often virtual, ways. We are blessed with the power of phone lines and the internet to enable many people to access information, talk and share their feelings and thoughts online, at a time when, cruelly, it is not possible to say goodbye to someone who is dying, it is not possible to help prepare their body for a funeral event, it is not possible to safely hold a mass gathering of family and friends to mourn and celebrate.

We know, from the findings of academia and practitioners, that early care of suddenly bereaved people is very important. It can prevent the onset of serious conditions such as post-traumatic stress disorder (PTSD) that can blight lives for years.

People who have been bereaved suddenly need to be looked after in the early weeks. They need to feel safe. They need to be informed about symptoms of sudden bereavement so they are prepared. They need to feel supported, through simple tips regarding self-care at this time.

The good news is that meeting suddenly bereaved people’s practical needs and giving them information and support to enable self-care can really help make a difference to their mental health outcomes and enable a normal grieving process.

I applaud all bereavement services for rallying together, to help people bereaved by any cause, including COVID-19, in these very challenging times, and urge a focus on a straightforward approach that helps people through the early weeks in practical, simple ways that enable people to feel safe and supported.

About the author

Mary Williams OBE is chief executive of Sudden. Sudden is a global initiative to help people bereaved by any sudden cause and also to help the professional standards of their carers. Mary is also chief executive of Brake. Brake is a road safety charity providing the National Road Victim Service in the UK for families bereaved by death on the road, including an acclaimed and government-backed national helpline and information service. Brake also operates globally and has a domestic branch in New Zealand too.