"Recovery From Unnatural Death," Edward K. Rynearson, MD
"...when someone close dies an unnatural death, you not only mourn their loss but are forced to adjust to the unnatural way that they died. It is a double blow: not only have they died, but the way they died is senseless. Unnatural dying is abrupt, and traumatic. There is no time for goodbye."
"Violence-The dying is injurious and often mutilating.
Violation-The dying is transgressive. Except for suicide, unnatural dying is forced upon the deceased who has no choice in avoiding or preventing it.
Volition-The dying is a human act of intention (with homicide or suicide) or some degree of negligence or fault with accident."
"There seems to be at least two distinct reactions to unnatural dying: the first and most primary is traumatic distress to the unnatural dying and a second, underlying response is separation distress to the loss of the relationship. To illustrate the descriptive differences, the distress patterns are listed below.
Thought-Reenactment of dying
Behavior-Avoidance of reminders of the dying, Protection of self and others
Thought-Reunion with the deceased
Feelings-Pining and Sorrow
Trauma distress is the stronger and more immediate response. In the initial days or weeks after an unnatural death, it is common to avoid the reality of the dying—to be enveloped in a numbness that cannot admit to what has happened. This protective numbness is challenged by a reconstruction of the way that the person died. Often, our minds construct events in the form of a story with a beginning, middle, and an end. The story of an unnatural dying, even though it was not witnessed, may become an intense and terrifying reenactment. This reenactment story of the dying often includes the last thoughts, feelings and behaviors of the person who died. Even though you weren’t there, your imagination of what your loved one experienced may become a dreaded replay or reenactment. During the initial weeks of adjustment, these reenactment fantasies may occur on a daily basis, and also recur as nightmares at night. These reenactments make it difficult to concentrate because of the accompanying terror that you and other family members are now at risk for an unnatural dying as well. It is the persistence of this traumatic story of the unnatural dying for many months that may distort your view of the world as no longer safe, trustworthy, or caring.
Intertwined with this initial response of trauma distress are waves of separation distress. In most instances, the permanent loss and separation from the relationship is a major disruption. A close friend or family member is an important part of your own identity and in losing them, you lose a part of yourself. It is difficult to begin accepting the finality of this loss until your mind is less preoccupied with the terrible fantasies of the dying. Acceptance of the loss will be delayed until your mind is able to calm and divert itself. Separation distress follows the realization that your friend or family member will never return as a tangible, physical presence. If you have an established religious or spiritual belief system, the permanency of this loss will be softened by the promise of continual spiritual existence and reunion at the time of your own spiritual release with death. But that belief system will only serve to soften the despair, and place it in a more hopeful context. It will not allow the total denial of your loved one’s "here and now" absence. Just as the mind composes stories of the trauma of the dying, so it creates stories about separation. With separation distress, the theme of the story is different from traumatic reenactment: most commonly, the theme involves an intense fantasized reunion with the lost person. The image of the deceased becomes a persistent figure in one’s mind and there is a strong yearning for their return and a reconstructive fantasy of rescue and repair. The yearning often involves an active "searching"—to places (including the grave site) associated with the deceased and an involuntary visual scanning for their face in a crowd, or an anticipation of hearing their voice when you return home. Your mind is acutely alert for any sign of their presence and the fantasy that once found, you will comfort them and protest that they no longer put you through something so traumatic again!"
Intense Reenactment Imagery-There are several studies that suggest that persistence of intense traumatic distress (daily occurrence of reenactment imagery or thoughts) beyond two or three months from the time of the death is associated with dysfunction and the need for treatment. The daily repetition of the reenactment story and the accompanying feelings of terror and anger will make it increasingly hard to concentrate at work or to communicate meaningfully with friends and family members."