Key Takeaways

    • Grief and bereavement are influenced by previous trauma.
    • Cumulative trauma and bereavement leave people prone to mental and physical illness, addiction, and prolonged grief.
    • Providing support, understanding, and services to those grieving is critical.
    • Healthcare provider awareness of this gap in healthcare is an important issue.
How do I adjust to this new grief while I am still dealing with my old trauma?

Cardiac arrest and the death of a loved one are devastating, traumatic life events that leave people reeling. Bereavement and one’s ability to cope can be significantly compounded by prior loss, trauma, or lack of resources or therapy.

I am a bereaved mother who lost my son to cardiac arrest. But that’s not the only loss I have had in my life. My sister was taken from our family in the summer of 1971. Even as a two-year-old, she was funny and feisty and the third daughter of four. I saw her looking at us and sobbing as the people who took her drove away. After they left, I remember tears on Dad’s face as he walked away to climb onto the tractor. I asked Mom why Dad was crying. She simply said, “Because he is sad.” I was 5 and the oldest of those four little girls. 

I did not know at that time that it was my “sister’s” real mom that was taking her. I just knew my little sister was suddenly gone, my parents were devastated, and I was scared. I was left with invisible scars that took years to uncover. That trauma was followed by being bullied in school, physical and sexual assaults as a teen and young woman, the death of my child, my mom’s suicide, and domestic violence.

What is cumulative or collective trauma?

Adverse childhood events set the stage for our coping threshold as we grow into adults. When we are re-traumatized, we don’t know what a “normal” stress response feels like. Our lives are framed or influenced by heightened states of anxiety or mental distress. Additionally, what we use to cope may be unhealthy, addictive, ineffective, or fatal. 

In March of 2016, four years after my son’s sudden cardiac arrest death and two years after my mom’s suicide, I too tried to end my life by suicide. In a strange stroke of fate, my teenager interrupted my desperate efforts and seized the rifle. I look back at that time with remorse and shame, deeply regretting the additional suffering added to my children’s already traumatic life experiences. While there are still times that I hover on the edge of that frantic desire to escape, my resilience is profoundly improved.

Post-traumatic stress disorder (PTSD), anxiety, depression, and so on

Since my son’s death, I have spent thousands of dollars on counseling and meditation retreats, working to find help for depression and PTSD, and attaining higher levels of education. I sometimes feel lost, spinning in circles, doing more and more for others, adding more to my plate of duties so I feel valued. I believe that trauma lives in our blood and bones. It lurks in secretive spots under our skin and in our minds, wreaking havoc when we experience additional distress. It strikes again when we are frail and most vulnerable.

I read in The Psych Collective ( that “Traumatic events accumulate behind a wall of resilience. The wall of resilience has hidden cracks. Those cracks are our hidden vulnerabilities. Events that traumatize us get through these cracks. What traumatizes us depends upon our innate resilience and our unique vulnerabilities. That’s why a given event will traumatize one person, but not another. As we accumulate trauma, a pressure accumulates which increases our sense of tension and makes us more irritable and fragile – until something smashes our wall of resilience. When the wall is smashed, we are no longer resilient and are overwhelmed with symptoms of traumatization. With that loss of resilience comes a painful loss of identity accompanying the flood of PTSD symptoms.”

While some people can weather trauma without suffering the effects of PTSD symptoms or mental or physical illness, others are significantly impacted. We need to do a better job of recognizing and treating the symptoms and warning signs of cumulative or collective trauma. Treatment must happen before it has long-term impacts on our brain and heart health and damages relationships with our families. 

Studies have shown that exposure to traumatic events throughout the life course has a cumulative impact. These cumulative events contribute significantly to PTSD in older adults, above and beyond other known reasons for PTSD. But that is only one negative outcome. There is also addiction, anxiety, depression, and other forms of emotional disturbances such as extreme anxiety, anger, sadness, survivor’s guilt, dissociation, and the inability to feel pleasure.

Sharing, researching, and learning

I believe by sharing our own journey, we may provide a safer space for others to also share. It is important to recognize the risks inherent in experiencing cumulative trauma and to be able to find ways of repairing the damage. Trauma-informed care treats the whole person and recognizes past trauma and the maladaptive coping mechanisms that the individual may have adopted to survive their distressing experience. Together, we can use these tools to work on building a roadmap to help others on the journey to find themselves again.

Is there something such as post-traumatic growth?

I read that sometimes you can experience growth in terms of personal strength, stronger relationships, and new possibilities that reach beyond what you had prior to the trauma. As I learned how to better experience life with an open and compassionate spirit, I felt a deep appreciation for the reward of loving someone so much that I miss them so greatly. The parts of my life that have been the hardest to deal with have provided me with gifts of resilience, empathy, compassion, and understanding. I continue working to re-discover that self that I had feared was lost. Post-traumatic growth is something you have to experience yourself.

Things that may help 

There is little shared about the effects of cumulative trauma, and we are not provided tools to help those suffering. This is a huge gap in our healthcare systems and one that could potentially help people avoid years of poor decisions, addiction, and long-term health impacts. It has been over a decade since my son died, and I have a list of things that I wish I would have known – things that may have helped soften the edges of this tremendously difficult journey.

    • Advocate for your mental and physical health. Explain to healthcare providers if you suspect you have suffered multiple traumas that are causing emotional distress.
    • Find a counselor that you connect with (not every therapist will be a great fit).
    • Don’t rely on drugs and alcohol to fix you.
    • If you begin to think of suicide or self-harm, reach out immediately.
    • Recognize triggers that cause anxiety or irritability.
    • Learn the signs and symptoms of PTSD – for example, the National Center for PTSD cites feeling distant or detached, feeling jumpy or easily startled, and avoiding people, places, and things related to the event as some common reactions. Others include worry, anxiety, fear, sadness, anger, numbness, and guilt.
    • Explore things that help with mental distress, such as meditation, art, exercise, nature walks, etc.
    • Be aware of signs of phobias, panic disorders, eating disorders, and obsessive-compulsive disorders.
    • Community members can work to become trauma-informed, sharing what they learn with their families, coworkers, children’s teachers, and others within their social networks. It is critical after traumatic events.
    • Our medical system must do a better job of researching and asking key questions in physical and mental health screening appointments so that we may find those who are at higher risk of suffering poor health outcomes from multiple traumatic events. 

As I work on these grief writings, it brings back those feelings from the days when my son died and was cremated. There is never a time that I don’t miss him. Sometimes the loss lives quietly, sore and still under my skin, while at other times it stares directly back at me, hurting my heart and stopping my breath. I still struggle with PTSD. Sometimes I am unable to sleep for more than a couple of hours a night. I often get re-traumatized at my X-ray job. But my work gives me a sense of giving back, of living in service and love. I have learned so much about gratitude. And while collaborating with others who support this work, who have walked this road, who understand and hold me up – I have found my tribe.


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Thank you to our contributors

Kim Ruether & Sachin Agarwal

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