On Psychological Impacts: A Closer Look at Grieving and Trauma

Finally, it is also important to highlight the spiritual effect of grief on a person. Family Caregiver Alliance (2013) discussed that one starts to philosophize life and death when faced with the loss of a loved one. There are different reactions to this: some may seek further closeness with their faith to find solace, or there may be feelings of rage or anger towards the Supreme Being they believe in. In the current WoD situation, many individuals and families have sought help and support from churches, parishes, and other religious institutions. Their faith became one of the support systems they hold on to during these challenging phases of their lives.

25

This section will now delve on discussing trauma and grief in the context of EJKs happening in the country. This aims to give a better grasp on how individuals, and families who were left behind experience the disruption of their biopsychosocial wellbeing after the traumatic event that happened to them.

The event that they experienced is clearly life altering and has caused distress to most, if not all, of the affected individuals. Most of the studies, statements, and narratives from various sources that this study has collected from showed that most of the survivors have experienced trauma. Trauma, as per the definition of American Psychological Association (2020), is the “emotional response to a terrible event like an accident, rape, or natural disaster”; in this case, HRVs and EJKs. The APA (2020) also emphasized that it is usual to feel shock after the event, and the longer term impact of the trauma may cause physical manifestations such as being nauseous and experiencing frequent headaches. Erratic emotions caused by sudden remembrance of the event may also arise. Their experiences also fall on psychological trauma, which, according to MedicalNewsToday (2020), is the person’s response or reaction during a highly stressful event. As humans, it is normal for them to feel various emotions especially in response to an undesirable event. Trauma reactions are expected from individuals during distressing circumstances. However, the range of emotional, cognitive, and physical manifestations to release or cope with a traumatic event are expected to subside as time goes by (Northwestern Medicine, 2020). In cases where the severity of the reactions stated earlier fail to decrease, the trauma could potentially lead to a mental health disorder. If the trauma continues to impact the well-being of a person and there is no proper professional support provided, it is possible that they will develop a post-traumatic stress disorder (PTSD) (MedicalNewsToday, 2020). The long-term impacts that affect the biopsychosocial functioning of the affected individuals are the reasons why APA (2020) recommends and emphasizes

26

the importance of the intervention of psychologists who can help them constructively manage their emotions and facilitate their healing.

Aside from the general definition of trauma, there are various types of trauma that individuals could experience. According to MedicalNewsToday (2020), these are:

1. ACUTE TRAUMA

This is the result of a single distressing event to an individual who has experienced it (MedicalNewsToday, 2020). In the statements shown earlier from interviews conducted by PhilRights (2017), some of the surviving families decided to move to a different place to seek security and safety. The distressing event that caused trauma to them was the killing of their family member.

2. CHRONIC TRAUMA

This is the result of “repeated and prolonged exposure to highly stressful events” (MedicalNewsToday, 2020). This kind of trauma could apply to people dealing with the loss of their loved ones and reside in communities where violence continues to take place. One of the interviewees of PhilRights (2017) shared how nervous and restless they were due to the continuous killings in their community.

3. COMPLEX TRAUMA

This type of trauma is the result of experiencing several traumatic events (MedicalNewsToday, 2020). Complex trauma may be experienced by survivors who have gone through torture, harassment, etc., and have also lost their loved ones due to EJKs. There may have been multiple events that caused the traumatization of the affected individual.

4. SECONDARY TRAUMA OR VICARIOUS TRAUMA

This happens when “a person develops trauma symptoms from close contact with someone who has experienced a traumatic event” (MedicalNewsToday, 2020). This means that one may not be able to experience or witness the traumatic event but they could have secondary or vicarious trauma by listening to the narratives, reading others’ experiences, or having close contact with those who have experienced it.

As discussed above, trauma could be experienced by surviving families and loved ones of those that were killed by EJK.

Having established the definition of grief, trauma, and its several types, we move on to differentiating trauma from grief; the latter is the result of the death of a loved one, anticipated or not, or a wide range of emotions brought by a traumatic event. According to Northwestern Medicine (2020) it is crucial to learn the difference of trauma reaction and grief reactions as it would be helpful in understanding the persons who are going through it.

27

As trauma and its several types have been established, the discussion on grief is also essential since it sheds light on the reaction of a person who lost something or someone and how it affects the various aspects of their life.

MedicineNet (n.d.) comprehensively defined grief as the “normal process of reacting to a loss. The loss may be physical (such as a death), social (such as divorce), or occupational (such as a job).” During the grieving period, a person may lose appetite and may not be able to get enough sleep, and generally neglect to take care of themselves (Testa, 2020). This happens as the person is still adjusting to their new reality; however, this becomes alarming when the person becomes unable to cope with the loss of their loved one.

Based on Family Caregiver Alliance (2013), some of the biological or physical symptoms of grieving includes “crying, sighing, low energy/exhaustion/weakness/fatigue, headaches, stomach aches, loss of appetite, eating too much (particularly comfort foods), sleep disturbance (too much or too little), disturbed dreams, feelings of heaviness, aches, pains, being super busy, pushing yourself to do too much, and/ or reckless, selfdestructive activities such as drinking too much.”

These manifestations of grief on the biopsychosocial-spiritual well-being of an individual are a valid and normal part of grieving and trying to express themselves. However, due to the nature of the killings and limited access to professional support, individuals and families may experience prolonged and unresolved stressors that can lead to serious illnesses such as depression (Family Caregiver Alliance, 2013).

There are various types of grieving that could provide a better understanding as to why individuals react differently despite what seems to be a similar situation. Some of the types of grief according to Elizz (2020), a healthcare institution caring for the elderly, are as follows:

1. ANTICIPATORY GRIEF

This is usually experienced by the loved ones who expect the death of someone dear to them, possibly due to deterioration of health and other diagnosis of health-related complications. Grieving for them had started even before the person passed away. One could experience a sense of guilt or confusion as the person dear to them is still alive, yet there is already a feeling of grief due to anticipation of what could happen (Elizz, 2020).

2. NORMAL GRIEF

According to Elizz (2020), normal grief does not mean that there is a definitive way of grieving. Instead, this pertains to the people experiencing a gradual decrease of their emotions in terms of grieving. There is acceptance of the events and the grieving person is able to move forward and perform their roles and responsibilities, just like how they did them before.

28

3. DELAYED GRIEF

This focuses on the postponed response of someone dealing with the death of a loved one. Later in life, something may trigger suppressed emotions that could cause the person to feel intense emotions that could be associated with their delayed grief (Elizz, 2020).

4. COMPLICATED GRIEF OR TRAUMATIC/PROLONGED GRIEF

This is the type of grief that becomes severe for a period of time and already affects the biopsychosocial functioning of the grieving person. There are various factors that could have led to the person’s poor way of dealing with grief; this includes the dynamics of their relationship with the person who passed away, the nature of the death, their personal life experiences, and their personality, among others. There are manifestations that could help determine whether someone has been experiencing this kind of grief such as “self-destructive behaviour, deep and persistent feelings of guilt, low selfesteem, suicidal thoughts, violent outbursts, or radical lifestyle changes” (Elizz, 2020).

5. DISENFRANCHISED GRIEF (AMBIGUOUS)

This grief pertains to a person losing someone and experiencing invalidation as other people do not seem to understand or acknowledge the significance of the death. This happens when a person experiences loss, possibly of a pet, their previous partner, etc. (Elizz, 2020). Persons who experience loss from WoD-related killings may experience disenfranchised grief. There could be a judgment in the community, or stigma that tends to isolate the grieving family, making them feel invalidated as they grieve and mourn for someone branded by the state as a “drug addict” or “drug pusher.”

6. CHRONIC GRIEF

There are various manifestations to check if someone is experiencing chronic grief. This includes: Feelings of hopelessness, a sense of disbelief that the loss is real, avoidance of any situation that may remind someone of the loss, or loss of meaning and value in a belief system. At times, people with chronic grief can experience intrusive thoughts. If left untreated, chronic grief can develop into severe clinical depression, suicidal or selfharming thoughts, and even substance abuse (Elizz, 2020).

7. CUMULATIVE GRIEF

This type of grief happens when within a short span of time, a person experiences multiple loss. Oftentimes, this leads to the person not being able to process their thoughts and emotions from the first one as they experience another loss (Elizz, 2020).

8. MASKED GRIEF

A person experiencing masked grief may display behaviors or symptoms that are unusual from their personality. The person that exhibits this type of grief may not be able to recognize that these changes with their behavior are associated with loss (Elizz, 2020).

29

9. DISTORTED GRIEF

This refers to a person experiencing intense emotions, particularly anger and guilt due to the loss of a loved one. Some of the manifestations are having self-destructive or hostile behavior towards others (Elizz, 2020).

10. EXAGGERATED GRIEF

This may be confused with the distorted type of grief as there are similar manifestations of intense emotions and behavior of exaggerated grief. However, the latter is experienced by the person as time goes by. Compared to normal grief wherein a person can accept the loss and move forward, exaggerated grief worsens through time. Due to the severity of the grieving, this could result in a person battling “self-destructive behavior, suicidal thoughts, drug abuse, abnormal fears, nightmares, and even the emergence of underlying psychiatric disorders” (Elizz, 2020).

11. INHIBITED GRIEF

A person experiencing inhibited grief may consciously be wary of their behavior as they want to keep their grief private. Elizz (2020) suggests that this could hinder one’s healing since there is no space for the person to grieve and feel.

12. SECONDARY LOSSES IN GRIEF

This griefy explains that there are instances when a person experiencing loss and grief also feels subsequent loss. After the primary loss, one of the emotional responses is the feeling of secondary loss/es such as losing an identity, losing a job, and others (Elizz, 2020).

13. COLLECTIVE GRIEF

This grief is an experience of mourning collectively felt by a “community, city, or country as a result of a natural disaster, death of a public figure, or a terrorist attack” (Elizz, 2020).

14. ABBREVIATED GRIEF

Abbreviated grief happens when a person deals with loss in a short span of time. This could be due to the person’s attempt to be able to move forward immediately (Elizz, 2020).

15. ABSENT GRIEF

This type of grief occurs to a person who is not able to properly process the loss due to denial of the event. Most of the time, there are no manifestations of grief from them. Shock from the sudden death or loss may be one of the reasons that a person is struggling to acknowledge what happened (Elizz, 2020).

Families of slain victims of HRVs, particularly EJKs that happened during Pres. Duterte’s regime, experienced overwhelming emotions. These tragic events affected or are

affecting them differently, and the discussion of grief and its various types attempted to provide a better understanding on how complex each individual is, and the different ways (not exclusive to what have been mentioned) in which they grieve.

Upon establishing the definition of trauma, grief, and their different types, this table from Northwestern Medicine (2020) highlights the difference in the emotional, cognitive, and physical reactions of a person experiencing trauma and grief.

Table 1

Trauma Reaction vs. Grief Reaction

TRAUMA Preoccupation with the traumatic event itself; intrusive images of the scene replaying over and over GRIEF Preoccupation with the lost person; images of the person and re-experiencing the lost person’s presence

Questioning and rejection of religious beliefs, feeling betrayal or anger Reaching out for spiritual support

Guilt: “It’s all my fault,” “If I would have… then…” Guilt over regrets of things not said

Pain is related to the tremendous terror and overwhelming powerlessness Pain is related to the loss

Hypervigilance; constant scanning of the environment or searching for the deceased Insomnia; wakeful hours spent thinking of the deceased

Inability to visualize the future Dreams of the event; placing one’s self in the circumstances of the death Intense yearning Dreams of the person who died

(Northwestern Medicine, 2020)

30

31

Another essential subject matter that could encompass these experiences and processing of thoughts and emotions is through Kϋbler-Ross’ stages of grief. Before going deeper on her theory, it is important to consider the context on how she developed the concept.

The Five Stages of Grief was originally intended to facilitate and assist individuals who are terminally ill; however, Kϋbler-Ross expanded her stage model to fit and include individuals who have experienced loss through catastrophe (Holland, 2014); in this case, those who experienced loss through HRVs related to the WoD.

The stages of grief are composed of denial and isolation, anger, bargaining, depression, and acceptance. It is essential to bear in mind that these do not necessarily follow a specific timeframe or an acquisitive order (Axelrod, 2020). There are also instances that one may re-experience the phase that they already went through due to different conditions. This could be a helpful tool or guide to understand individuals who learned that they are terminally ill or have just experienced loss. People under these circumstances may tend to reject the reality of the situation. Their denial is used as a defense mechanism “that is unconsciously used to protect a person from anxiety arising from unacceptable thoughts or feelings.” It shields the person momentarily from the sudden surge of emotions (McLeod, 2019) and may try to rationalize what is happening through self-pretense and denial of the reality (Clarke, 2020). In contextualizing this concept on the current situation of the Philippines, a family or an individual that experienced sudden loss due to the ruthless killings under Pres. Duterte’s administration may try to reject the news that their loved ones are already gone. Some may reflect and reminisce about the most recent interactions with the person they lost and have trouble accepting the suddenness of the event (Clarke, 2020). The reality just will not connect with what they want to believe. There are questions on how the event could possibly happen to them, and why.

There is also a phase for anger upon losing someone. One may feel an overwhelming emotional discomfort while the mind and body are attempting to adjust with the changes brought by the event (Clarke, 2020). A grieving family or individual may feel a great sense of injustice, anger, or enragement towards various subjects, that could even include their deceased loved ones or themselves, as a form of emotional outlet. Since individuals grieve differently, this anger may result in feeling isolated and alienated. This emotion is of course a valid response from someone who is grieving and just had a traumatic and unjust experience. Anger is a normal response, but it also has to be processed properly so that the person can heal and adjust with the current reality (Clarke, 2020).

Kϋbler-Ross discussed the concept of bargaining as a shared experience for some people coping with loss. This exhibits the willingness of a person to try anything that

32

would lessen the pain. Most often than not, this phase pertains to a person bargaining to a higher being or someone that possesses more power than us. In the Filipino context, grieving families or individuals may resort to bargaining with religious entities for a different circumstance. The sense of helplessness shatters the reality of the person and, through bargaining, they try to have a sense of control. During this phase, there is an emphasis on the interactions the grieving family or individual had with the victim. There is a tendency to blame themselves and make grand assumptions that they could have done something to prevent the incident from happening or to avoid this painful event in their lives (Clarke, 2020).

Another stage that one may experience as part of grieving is depression. As the reality sinks in and the person is becoming more aware and grounded with the changes that happened, denial and bargaining may no longer make the person feel better. As Clarke (2020) put it, this is the phase where the person would face the loss of someone dear to them as the emotional fog starts to clear up and the space left by the person who passed away becomes more evident and difficult to ignore.

The stages discussed above are all valid and normal reactions of a grieving individual. However, those stages should be properly acknowledged and processed by the person grieving. This could be done with the help of their support system or professionals. Acceptance of the event is an important part of grieving as this activates the acknowledgement of emotions, thoughts, and events that are present and happening. The person is no longer struggling to accept the reality that they have lost their loved ones. They now tend to focus on things that they can change or control (Clarke, 2020). Healing and recovery is a journey to which a person is able to explore and learn more about themselves and their social environment.

There are various factors that contribute to a person’s journey towards healing, such as having a healthy support system that could facilitate their recovery. This support system could be a person they are comfortable to speak and share their experiences with, someone that they respect and could trust, and is supportive. Having a support system is crucial as they can directly and indirectly help the person manage and surpass different life challenges. A 2015 research survey has shown that the average stress-level of people who have a social support system was five, while the stress-level of people who receive minimal to no social support was 6.3 out of 10 (Mental Health First Aid, 2020). The support from friends, families, and other trusted institutions helps the affected individuals and families to regain trust with other people and to combat loneliness, feelings of isolation, and thoughts and emotions that could hinder them from their process towards healing. Grieving has no definitive timeframe and process but the support that the affected individuals and families receive from their trusted support system could go a long way to help them cope and facilitate their healing and recovery.