“I sadly lost my boy, 18 years old, in a car accident…”

Dear Dr. Neimeyer,

A few months ago, I sadly lost my boy, 18 years old, in a car accident. I have been having bereavement counselling but struggling to build up a rapport.  So a friend suggested this site. Since it happened, I have been struggling with anxiety and panic attacks, something I have never suffered with before.  Is this normal, and why does it happen? Stephen wasn’t just my boy, he was also my best friend.  We rarely argued but when we did it was normally because I was worried about him for one reason or another. He was a hard-working boy and had many friends. He was kind hearted and loved by many. So, why can’t I remember any of the good times, holidays etc.  When I try to remember them, the bad things overshadow them, such as imagining the accident and reliving the police knocking at the door. I constantly feel on the edge of tears, and I torture myself by sitting in his bedroom and smelling his clothes. I want to know that wherever he is, he is happy and understands what’s happened.

I know no one can probably answer any of my questions but I would really like to hear how people have coped in similar situations. I’m a paramedic and the thought of going back to work and having to deal with similar jobs fills me with dread. I know Stephen wouldn’t want me to leave my job and I hope in time I will be in a better position and the thought of going back to work won’t scare me quite so much. I look forward to hearing from you.

Ellen

Dear Ellen,

First and foremost, being only a few months beyond the death of your death son, much of your anguish and anxiety is easily understandable, and altogether normal. Your world has been ripped apart by a tragic loss, and your heart with it.  In the wake of such an experience it is important to be patient with yourself, and also with others who are touched in their own ways my Stephen’s death; no one—least of all yourself—should expect you to have put back together the pieces of your old world, something an eternity will not do.  But here, let me offer a few answers to your questions in the form of principles that could serve you as you gradually find a way to move toward an entirely different future than the one you had imagined.

Find the right guide.  If you are still “struggling to find rapport” with your grief counselor after a couple of sessions, you are seeing the wrong person.  Just as each of us gravitates toward different people for friends or mates, so too we need to find the right match with our therapist.  I commonly tell people who consult me that they will know by the end of a single session if the connection won’t work, and they will know within three if it will.  If after a few sessions you still don’t feel understood or helped, simply decline to reschedule, and look for another therapist for a single session of “consultation.”  If that goes well, schedule a few more.

Accept the anxiety.  You are now living in a world made alien by loss, and a certain level of anxiety is an appropriate response.  Moreover, we have evolved as a species to form natural bonds of caregiving to our children, and when we are separated from them we experience an internal sense of alarm that cues us to restore the bond.  Grief is in large part separation anxiety, and given the impossibility of saving your son from his fate, it calls for reestablishing a new kind of bond that is feasible now, as noted below.

Cultivate friendship.  We all need support in our grief, and in our changed lives.  Your need for friendship did not end with your son’s life.  Cultivate connections with caring others, even as you also honor your son’s memory and impact on the world.  Opening your heart to others does not mean closing it to him.

Integrate the trauma.  When someone we love dies suddenly and violently, we often relive images of the death, even when we were not there to witness it.  Trauma therapists can help us safely revisit, take in, and make sense of the story of the dying, which if not integrated in this way can continually intrude into and eclipse memories of a more restorative, positive kind.  Note that many grief counselors will not have been trained to provide this sort of intervention, which goes beyond emotional support for grieving, per se.  When seeking a therapist, look for one specialized in trauma, ideally with expertise in grieving as well.

Rebuild the bond.  The image of your sitting in the bedroom smelling his clothes speaks powerfully to your maternal urge to reconnect with your son.  Slowly his smell will fade, but your need to build a bridge to him will not.  So don’t limit it to the small space of his bedroom; carry this intention into the bigger world.  Find the people and places that will let you speak his name, share his stories, keep his memory alive. Some of these may be with family, some with friends, some in internet support groups for bereaved parents.  Still more, seek dedicated actions that you can engage to honor his kind heart—perhaps carrying forward some purpose or interest you shared with him, or performing acts of kindness or altruistic social action in his name.  By living your life well, you can carry his forward in good ways.  Grief therapists can also help you have healing symbolic conversations with your son, as you speak the words in your heart, and then pause to sense how he would answer.

Return to work, one step at a time.  Especially given your work as a paramedic, you face the same sort of trauma triggers that a returning police officer would after being shot in the line of duty, or a soldier in combat would face going back on patrol.  So get the trauma-informed care that can help you step gradually back into this important but challenging work, usually by prolonged exposure in imagination or virtual reality to the sights, sounds and smells accident sites, and then a partial return to the workplace, collaborating with your supervisor to visit the hospital, then sit in the ambulance, then accompany colleagues on a call, etc., as you learn to breathe through the fear at each step.  Simply returning to work without this preparation can be re-traumatizing, but attempting to avoid all of the triggers could not only cost you your career, but also require a claustrophobic seclusion to avoid exposure to driving, TV shows and movies, and the myriad other reminders that life is fragile, and of the great loss you have suffered.  Think “approach” rather than “avoid,” and with patience you can re-enter life with less fear.

Dr. Neimeyer