The following is an excerpt from my book The Value Of A Smile. Copyright July 1993 by Richard W. Cress; all rights reserved. GRIEF Grief, whether we choose to accept what is said here or not, is a healing process. Initially, we feel that grief has taken us to new levels of depression. When we understand the process, as one that promotes healing, we may then learn, that even from within severe throws of grief, there is also the possibility that we may grow from the process as well. There are Seven Classic Stages of Grief. I feel that you need to see them in list form as opposed to the normal case by case presentation. This format has been chosen, so that you can see both forward and backward, down the path that we call grief. There are probably those who might dispute the number of stages or some that might combine a few of them together. There is no set pattern to the grieving process. Each of us, predicated upon our ambient environment, will pass through every one of these steps often with differing intensities, although not necessarily in the same order, or time. Grieving, is an individualized process. Coming to terms with the loss or trauma to those we love and it is neither easy, simple nor of short duration. This discussion differentiates between the type of grief we suffered when Patrick was murdered and that when Katie died. Although they are the same, they are remarkably different. However, the process is much the same and the stages are identical. If you come to the conclusion that these elements contradict each other you are exactly right. These inconsistencies are part of what makes the problem so difficult. However, if we are to overcome it, we must first realize what it means to grieve. Then we need to understand the general process of grieving. We have no choice but to pass through each of these steps. Since the order of their appearance differs from individual to individual, the stages of grief as listed here, are in alphabetic order. The Seven Stages of Grief are listed and defined as follows: There are many different definitions of the stages of grief, among which are the common dictionary definitions. I shall however, try to supply the definitions as they apply to grief. Most of these words are self explanatory. Additionally these definitions depend upon the type of death by, violence or natural causes. 1...ACCEPTANCE: This term is largely metaphysical in nature. It is necessary for us to get beyond this point. We must accept the reality of death and its permanence. Unfortunately the nature of death often makes it difficult to admit that a death has occurred. 2...ANGER and rage in these cases can be directed toward: Other family members, [for not preventing the death], The victim, [for dying]. Doctors, [for not saving the life of the victim]. Law enforcement agencies, [for a variety of reasons such as lack of resolution of a criminal case]. In natural death, anger is not normally so severe. Anger can be because others are not grieving enough or too much, or your loved one for leaving you, and much more. 3...DENIAL: Denial is an escape from reality. In the second chapter I described to the day my son Eric was interviewed by a reporter who said to him, "What do you think about all of this?" His reply "Well now I'll have a room to myself." This was denial. I suppose denial is with me at this time too. Because I still wear the wedding ring that Katie put on my finger in 1971. However, above all else denial, is an unconscious defense mechanism, characterized by refusal to accept the reality of death. 4...DEPRESSION: Depression is a deep sadness at the loss often accompanied by hopelessness of the occasion. Depression results from an emptiness in your life that can't be filled. Some symptoms would be the inability to concentrate, insomnia. Depression often requires professional treatment. 5...FEAR: Adolf Hitler once said that "the weapon which most readily conquers reason: terror and violence" and J. A. Fruede said "Fear is the parent of cruelty." 6...GUILT: Many of us that work with victims classify guilt as the "What if's." What if I had taken him camping with me? What if she had not been out after midnight? Guilt wears many hoods. Very few of us escape feelings of guilt. For example, I will worry for the rest of my life whether something I did or didn't do, lead to Katie's death. 7...SHOCK: As it relates to violent or natural death, is a psychological mechanism, a fog, which allows us to function sometimes even efficiently, at a very devastating time in our lives. Much of what happens during this time we will never remember. This fog will protect us for days, weeks and sometimes even months. It is my belief that shock is the ally of the grief stricken. Shock is probably the only factor that prevents the onset of more serious mental problems, later during grieving. Each of these stages of grief is completely normal and like PTSD, are predicated upon the nature of the death, family dynamics and the individual. Grief, when associated with violent crime, is enhanced beyond the common conception of the process. Personally, in the case of violent crime, I like to add an eighth stage of grief. REVENGE: To the uneducated, this is shocking. That the victim or survivors could actually consider retaliation against the criminal, is an unacceptable pattern of behavior. However, like the seven steps above, this too, is both healthy and healing. What a victim does with these considerations is what counts. It is very rare that this form of revenge is ever carried out and all too frequently, these thoughts are often the only satisfaction that victims and survivors will ever experience. I said earlier that grief is a healing process. What I didn't say, was that it is an important process. There simply can be no healing without it. In my case [when Patrick was murdered], I went through Rage first, then shock followed by guilt, denial and acceptance. I forget any depression, but I am sure it was there. The fear, or a better word, paranoia remains with me today. Not that I fear so much for my own safety, but for that of my children and grandchildren. I rarely turn my back to others and I am not comfortable without my Colt handgun within arms reach. However, I would like to add that my work with victims has presented more than enough reason to carry this weapon. In the next section we will define Post Traumatic Stress Disorder. Which is often delayed for days, weeks, months or even years. It is a personality disorder that can, and often does have, catastrophic impact on the individual. Traditionally, one faith recognizes the stages of grief and has established a one year guideline as follows: "...it organizes the year of mourning into three days of deep grief, seven days of mourning, thirty days of gradual readjustment and eleven months of remembrance and healing."Death, the Final Stage of Growth." In the old Wild West days, when someone died, the widow or widower wore the black mourning cloth for one year. After this, they removed this cloth, and were expected "To get on with the rest of their lives." In reality, these two examples reflect what many expect of the victims and survivors, even in today's modern society. If each of us who must grieve, and inevitably we all will, were of the same physical and emotional makeup, if our ambient conditions were just like those of our neighbors; then I could probably accept these blanket, social proprietary protocols, as effective, proper and sufficient. However, just as each of us are individuals, even within the same family, each of us will grieve differently, at different times and with different severity. We do not all, grieve openly. It is also necessary to understand that, with what I have written here there is one additional factor, which will have an impact on our grief. Unfortunately, the manner and method of death of our loved ones will be a major contributing stressor and will, though we are unable to measure it, define our grief and what will follow. Homicide victim survivors will grieve differently than the survivors of suicide victims. My grief over the loss of Katie is much different from the grief of Patrick's loss. Please, do not read from these statements that either of these scenarios or any more that we could develop, is going to present harder or easier grief than any of the rest, it's just different. Some people are not capable of showing their grief, but that doesn't mean they don't grieve. In fact many of these victims of grief, will suffer more internally, than the rest of do openly. This is particularly true of many men and siblings. Most rarely show grief at all and are unable to discuss their grief or their problems. Most of the siblings I have worked with, deny the grief and its associated problems. If we are to help and support each other, then we must recognize that just because one, is experiencing the gut wrenching pangs of guilt, it doesn't mean that the other is experiencing the same feelings, or even different feelings at the same time. Perhaps, this irregularity in the grieving process, is more responsible for marriage breakups, suicides and other unhealthy, mechanisms we use for coping, than anything else. I have known husbands and wives that split up because one felt that the other was not grieving enough or severely enough. Or each blames the other for the tragedy that took their loved one. Before I begin to discuss stress and its impact on victims of violent crimes, it might be helpful to define 'STRESS.' However, I will include only that definition that applies to this book. The American Heritage Dictionary defines stress as follows: (stress) "...(6)(a) A mentally or emotionally disruptive or upsetting condition occurring in response to adverse external influences and capable of effecting physical health, usually characterized by increased heart rate, a rise in blood pressure, muscular tension, irritability, and depression. (b) A stimulus or circumstance causing such a condition . . . " The Academic American Encyclopedia adds additional insight to the definition of stress and portions are as follows: "Stress is a normal part of life, and such producers of stress as physical exercise, various emotional states, and creative activity are usually considered healthy. Prolonged and unwanted stress, however, can have undesirable effects on mental and physical health, although reactions to such pressure can vary greatly among individuals." "Mental states such as severe melancholic DEPRESSION are closely linked with stress-inducing ANXIETY, and the complex syndrome known as POST-TRAUMATIC STRESS DISORDER is produced by traumatic situations such as war and disaster." Physiological effects linked with stress include ULCERS, high blood pressure (see HYPERTENSION), and HEART DISEASE. Stress can also adversely effect the immune system, causing the body to be less resistant to a wide range of other health problems . . ." "In the human body, when danger is perceived (whether real or imaginary), the pituitary gland releases a hormone called ADRENOCORTICOTROPIC HORMONE. This in turn triggers the adrenal glands to release epinephrine . . . and various other hormones that speed up the heart rate, raise blood pressure, and increase muscle tension." There is probably not one doctor that will deny the serious effect upon the physical or mental health of those who suffer from this debilitating malady. Many doctors are, are certain that some day, a definite link between many forms of cancer and excessively high stress levels, will be found. POST TRAUMATIC STRESS DISORDER Beginning the discussion on stress and Post Traumatic Stress is difficult because much of what I think of this debilitating disorder comes, not from clinical trials, but from non clinical observation. First, "NO VICTIM, WANTS TO WALLOW IN THEIR PROBLEMS." Anyone who has not walked in the shoes of a victim, is simply not qualified to make such an observation. Unfortunately similar statements, apply to members of the same family. Parents can't identify with siblings and siblings cannot understand the parents. I feel that every violent crime victim suffers, in some way from PTSD. Some, more than others, some less. The severity with which PTSD affects crime victims is determined and defined by family dynamics. Additionally, I strongly believe that PTSD can mitigate or stall the grieving process. Early stages of PTSD and its causing stressors are, I think responsible for some prolonging of the grieving process. Families with a significant amount of financial resources will usually be able to seek professional help quickly and in doing so can in all likelihood avoid the serious pitfalls that those with limited resources must meet head on. This might sound like I am measuring the depth of PTSD as a function of the financial resources of a family. But this is not exactly true. It is the stability of the family, at the time of the stressor, which seems to control these problems. I doubt that there is any way to evaluate a family, to measure their Family Dynamics, with a goal of deciding how grief or PTSD will impact upon them. Although there are many ways that we can help others through these troubled times, both grief and PTSD are individually unique. That is to say that each individual's experience with grief and PTSD will be an experience shared by no one else. The trauma creates a block, in the sub conscious which often restricts access to long term memory and probably to some short term memory as well. However, the details of the stressor often remain vivid for days, weeks, months or even years. I know the sibling of a homicide victim for example, whose memory stops at a point, four years before her brother's murder. Memories of her first eleven and a half years, her childhood years, are no longer available to her. Like computers, our memories have a system of neural highways to specific memories when we need to locate them. Somewhere in our minds there is a system of road maps and directions to these memories, just like the File Allocation Table that computers use to locate their files and programs. Victims of PTSD are uncomfortable and nervous when meeting new people, with new surroundings and in an environment which they perceive as hostile, unfriendly or unknown. They are above all else, hypersensitive. The hypersensitive PTSD victim is not a ticking time bomb. Most of us would be satisfied to remain in our homes most of the time. Venturing out only as needed or necessary. It is unfortunate for the parent, because siblings are a very special part of the problem. I have known hundreds of them, in my years of working with victims but, I have never met one who would admit to having problems of any kind and yet the symptoms are prevalent and highly visible. Siblings will not discuss the crime or its events. They will not talk to others about it. I think most of them bottle it up inside. There, to fester for weeks, months and even years. The result is Chronic, Delayed Post Traumatic Stress Disorder. However, according to these children, they are very normal and have no problems at all. These siblings, and their parents, victims of PTSD, are in no way CRAZY or even moderately insane. We are presented with problems that no one wants or chooses. We are, as a local journalist once coined, "Members of a group no one wants to join." We did not choose the circumstance that controls our lives, nor do we choose to be victims. No mater how it comes out in the wash though, that's exactly what we are. Victimization extends beyond the crime. We are victims of a justice system that says we don't belong in the courtroom. We are the victims of both crime and judicial leniency. If that isn't enough, we are a society that treats our most serious and violent offenders much better than their victims. There is much wrong with a system that causes secondary and tertiary victimization in the name of fairness and justice to those who made us victims. For all intent and purposes, we are, a neglected element of society, easier forgotten than remembered. In addition when we seek help from medical professionals, there are very few capable of helping us resolve our problems. Some even admit that they are not qualified to help us. Those without experience, brave enough to try, often make matters much worse. I can put it no more plainly, than to say that I do not believe, that victims or survivors of violent crime fit within the standard Freudian Model if such a thing exists. We are a difficult group of people to work with, let alone help. As a normal course of events, we get more help from other victims than from anywhere else. It shouldn't be that way, but until something better comes along, we must make do with what we have. The following treatise of 404 words, is perhaps simplistic, but nonetheless it is one of the best descriptions of PTSD and its symptoms available. I have chosen to include it because of the value it has given Katie and me in our work with victims during the last ten years. I have modified the text slightly, to reflect appropriately upon its application to victims and survivors of violent crime. This article was written by James H. Shaw Ph. D. a Police Psychologist for the workshop on crime victim concerns. The date of the original article was October 26, 1983. POST TRAUMATIC STRESS DISORDER Post-Traumatic Stress Disorder is a high stress producing syndrome following a psychologically traumatic event. During the two World War's, this disorder was called 'Shell Shock.' These stressors, are usually not within the range of normal experience. For example the suicide or homicide of a loved one, or other crimes of violence and occasionally natural disasters. The stressors producing the syndrome, elicits significant symptoms in most violent crime victims and survivors and is outside the range of common experiences of simple bereavement, chronic illness, business loss or marital conflict. Stressors producing the disorder include natural disasters and accidental or man made events. Some stressors such as violent crime normally produce the disorder and others such as auto accidents and natural disasters produce it only occasionally. The stressor has proven more severe and long lasting when it is of human origin. Post-Traumatic Stress Disorder symptoms may begin soon after the trauma. However, it is not uncommon for them to emerge, after a period of latency, often lasting months or years after, the trauma. The symptoms, can show up in any order and some may not appear at all. Also many symptoms, associated with PTSD, do not appear in this list. COMMON SYMPTOMS: 1. SLEEPING PROBLEMS such as difficulty falling asleep and/or nightmares, in which the traumatic event is relived. [Sleep disorders] 2. ANGER-Can be directed or broadly based. Anger that is focused however, can be a mechanism that delays the onset of the disorder. I have not witnessed as much broadly based anger in victims as I have focused anger. Over the years, I now believe that directed anger, if controlled, can be a healthy, healing mechanism. 3. DEPRESSION. Depression is a deep sadness at the loss often accompanied by hopelessness of the occasion. Depression results from an emptiness in your life that can't be filled. 4. WITHDRAW-from family members, close friends and prior activities. This symptom stems from psychologically induced belief that they are safer in their own homes. We have become frightened of the hopping place and the people that inhabit this vital I believe that this withdraw, is a mechanism of self defense, very wrong but defensive nonetheless. 5. GUILT FEELINGS-These can take the form of "survival guilt." Fore example one sibling related, "If I had not run away my brother would not have been murdered," or "If I had not gone shopping, she would not have been home alone." This is a form of self blame that allows one to believe that maybe they could have prevented the crime. 6. BECOMING HYPERCRITICAL-of authority systems such as the government or criminal justice system for a lack of sensitivity, responsiveness or effectiveness. 7. EMOTIONAL INSULATION-The individual loses the ability to receive or give love. 8. ALCOHOL OR DRUG ABUSE. 9. FLASHBACKS-A reliving of the event. Often the flashbacks are in slow motion. In Katie's case, her flashbacks happened every time someone knocked on our door. Each occasion presented her with added stressors to assimilate and deal with. 10. ANNIVERSARY ANXIETY-Increased emotional problems during the approaching anniversary of the trauma or when experiencing related situations. 11. PHOBIAS OR FEARS-which significantly affect the freedom of movement or occupation of the individual. 12. COMPLAINTS OF IMPAIRED MEMORY or problems with concentration. Both long term and short term memories are altered significantly. 13. UNPREDICTABLE OR EXPLOSIVE BEHAVIOR with minimal or no obvious provocation. 14. IMPULSIVE BEHAVIOR such as sudden trips or changes in life style. PREVENTION AND TREATMENT: It is strongly recommended that any victim experiencing any of the above symptoms that disrupt the individual's life style, should seek treatment from a practitioner experienced in treating this disorder. Experience has shown that simply discussing or writing about feelings and events of the trauma situation, immediately following the trauma, may reduce or stall, but not eliminate, the development of long-term severe symptoms. Please understand that I have rewritten this article to underscore its connection to victims of violent crimes.