Multiple Loss

The experience of multiple loss, (2 or more significant deaths) can complicate the bereavement process and result in a grief response which is:

• Chronic (extended or excessively intense)
• Absent (fending off usual grief-associated emotions, "I’m fine")
• Delayed (normal symptoms arise after a long period of absence)
• Distorted (isolation, excessive irritability, avoidance, other changes in interpersonal dynamics)

Complicated bereavement is likely to show up as:

• Social withdrawal
• Preoccupation with details of the deaths
• More difficulty accepting the reality of the loss(es)
• More disorganisation through life
• Anxiety
• Pessimistic future outlook

Beginning to deal with multiple losses can feel overwhelming, and often a person feels bewildered about where to start. It can be very tempting to just decide that it is all too much; however, not addressing what is going on may lead to the following:

• Chronic Denial – "No big deal, shit happens, so what?" this attitude is often accompanied by complete emotional shutdown and/or hyperactivity
• Depression – feelings of hopelessness, helplessness, sadness, cognitive impairment, body symptoms, and problems falling asleep, staying asleep, and waking early.
• Anhedonia – The inability to do things "just for fun", watching my life without feeling like I am participating, just "going through the motions".
• Powerlessness – bringing feelings of inadequacy. Grief is often accompanied by feelings of shame "I am flawed" and guilt "I behaved wrongly". These feelings feed the sense of inadequacy.
• Suicidal and death thoughts – the question here is "What part of the self needs to die?" Each loss brings a death of a part of self, a part of identity. Therapy can help bring clarity to what is lost in terms of the self.
• Anxiety – a normal accompaniment to terminal illness, with multiple losses, anxiety increases
• Alcohol and Drug abuse – Although emotional responses may seem to be more accessible, or feel more manageable when drunk or high, the attribution to the substance "it was the booze talking, not me" does not allow for the integration of the mourning experience. Multiple losses are often accompanied by "self-medicating" behaviour. The more losses, the greater the consumption to attempt to "numb the pain".
• Social Withdrawal – a common response in single loss, in multiple losses there may seem to be no possibility of the need to withdraw to subside with time. Each potential new relationship is entered into with a sense of extreme caution, caring about someone new involves the risk of future losses.
• Diffuse Anger – while a single loss response is accompanied by anger, multiple grief events bring multiple angers, including:
  • Anger that values and beliefs seem empty and unhelpful
  • Anger that losses are beyond any normal expectation
  • Anger at being left alone
  • Anger at family of choice or origin
  • Anger at those dying and deceased
  • Anger at medical personal and caregivers for being ineffectual
  • Anger at society
  • Anger arising from personal helplessness

Unexpressed anger may be turned inward and manifest as depression

• Survivor Guilt – "Why not me?" may be accompanied by sorrow for the survivor’s survival (this does not need to be rational).
  Guilt provides a form of control in that it creates meaning and therefore decreases anxiety. The desire to make meaning of the experience of multiple loss is intense "there must be some reason I am still here". When there appears to be no way of making sense of the experience, the mind will fall back to a time when it made meaning of the world in very simple ways. Often to a time in life when trust and separation issues were present. Multiple losses in present time will bring up core loss issues, usually from childhood. Working with a therapist can help identify the core loss and begin to work through it (see Grief and Loss). This then provides a sense of mastery in terms of the ability to process losses.
  Guilt is problematic in terms of grief resolution because the sorrow and anger are self-focused, continuing the attachment and blocking the grieving of the person or thing that is gone. Therapy can help shift the focus of the emotional work so that feelings are directed outward, and no longer self-destructive.
  
  For more on multiple loss click here (adobe PDF)