The death of a child -- The death of a child runs contrary to our belief that children will outlive their parents and that the innocence of childhood will protect them. Parents grieve for both the loss of the child and a loss of self. In failing to protect their child, parents may feel they have failed to carry out the most central role of their lives. Children also hold the promise of the future and serve as the legacy that parents hope to leave behind. Children should not predecease their parents and, regardless of their age, the death of one's child may be one of the most traumatic losses that can occur in adult life.

           Sudden death -- A death for which there is little or no preparation results in a more abrupt and difficult grieving process. This is because, in addition to the grief of the loss, there is the sudden shock of loss and the sense of being overwhelmed. There is no opportunity to anticipate and/or begin working on any aspect of the loss and grief process.There is also no opportunity for a final (or any) resolution of differences with the person who has died.

           Ambivalence in the relationship -- This may be developmentally normal conflict or it may be a life-long interpersonal struggle. I would include the factor, identified by Rando, of conflict in the relationship. Again, this may be tied to a long-standing conflictual relationship. If a death occurs after an argument, the survivor may struggle with the fact that they did not "part on good terms" and can now never resolve their differences. Although this was mentioned above under sudden death, a lack of successful resolution of an ambivalent relationship may occur with any type of loss.

           Pre-existing factors -- This can include unresolved grief that resulted from other or pervious losses. Earlier in the semester, we discussed the problems of unresolved grief from losses that took place in childhood and the recurrent nature of the grief from those losses.  This recurrence of grief also takes place for adults with unresolved losses that took place earlier in their adulthood. Concurrent mental and physical health problems can add to the impact of the loss and can be exacerbated by the loss.

           Perceived preventability of the death -- The more preventable the loss is perceived as being, the greater the impact. In particular, if the bereaved person feels as though he or she should have been able to prevent the death or the deceased should have been able to prevent it, the likelihood of complications are higher. Interestingly, I found that people I've interviewed who emphasized personal responsibility for one's health and safety (and, among parents, for their children) experienced greater distress at their "failure" to protect their child.

           Centrality of the relationship to the bereaved person's life -- As with preventability, so too, the more central the relationship to the bereaved, the greater the impact of the loss. This would explain the impact of a child's death on parents and the impact (particularly on children) of the death of their parents.

           Lack of diversity of social roles -- The more rigid and restricted the social roles of the bereaved are, the more intense the grief. If options are available and the bereaved can focus on roles other than the ones they traditionally held, they then may see themselves as having more options. The ability for family members to step into (or share) the role previously played in the family by the deceased is also helpful.

           Concurrent crises -- Any additional stressors that run concurrently with the grief will add to it, simply by reducing the resources available. As we particularly noted in Unit 4, normal developmental transitions and behavior normally associated with different developmental stages, could add to the impact of a loss.

           Lack of social support -- Social support, is essential to successful grief reconciliation. As we discussed in the unit on relationships and on ambiguous loss and disenfranchised, the support that is needed is not necessarily available. The intensity of the traumatic loss is so great that it frightens people away from the bereaved. One suggestion that was made to me by a grief therapist was that people, in a non-rational, primitive response, avoid the bereaved because they fear contamination.

Perhaps they feel they are not up to the task of supporting the bereaved, or they are uncomfortable with the intense emotions and unpredictability of the griever. Whatever the cause of their avoidance, the result is a perception of the bereaved that they are unsupported and alone and that they experience their grief as disenfranchised. This sense of isolation is also reported among people experiencing traumatic stressors.

Others have looked at traumatic aspects of grief.  Attig (1996) includes violent, mutilating, or random death that shock, horrify and traumatize those who are left to cope with the loss.  Parkes (1997) included the following factors in traumatic bereavement:

           sudden, unexpected, and untimely bereavements

           witnessing horrific events

           possible personal culpability

           bereavement by murder or manslaughter

           bereavement by suicide

           multiple losses

           personal long-term care of dying person

Especially as it relates to loss that takes place as a result of a disaster, I would include human-made vs. natural causes -- If the cause of death is the result of a human-made disaster rather than one that is naturally occurring, it has a much more negative impact (The bombing in Oklahoma City would have had a much greater impact than, say, a tornado or earthquake, because a human being made the choice to inflict harm and death on other humans. More clearly, we can see this in the immediate and long-term aftermath of the attacks in the U.S. on 9-11 ).

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