Mental Health Matters: Loss is Hard Enough

M. Regina Asaro, MS, RN, CT

There is usually a confusing jumble of feelings and reactions which result from loss after an air disaster.

While there are many normal reactions to loss, those who have lost a loved one in this way often find they need to deal with the trauma of the loss before they can even begin to grieve it. In fact, it is difficult for me to know which to discuss first since posttraumatic stress and grief reactions both feel so strong and it is sometimes hard to tell them apart.

While posttraumatic stress reactions, to be described and discussed in greater detail in a later column, often compound the complexity of the grief process, this column will focus only on some of the common grief reactions that people experience after loss.

Many years ago, Elizabeth Kubler-Ross talked about the “stages” that people went through when they were dying; she called these stages: denial, anger, depression, bargaining and acceptance. With greater reflection and insight came the realization that people who grieve do experience common reactions but that there is no linear direction. Indeed, people may experience many feelings at one time, often leaving them feeling overwhelmed, frustrated, and confused; as well, many people have expressed that the concept of “acceptance” is infuriating to them, especially when the death was intentional.

It should also not be surprising that the different degrees of closeness, affection and intimacy with the deceased will be reflected in the depth and range of reactions to the loss of that person, as well as in the length of time for the mourning process.

That said, we may divide the common reactions after a loss into a number of different areas: physical, behavioral, emotional, cognitive and/or spiritual. People often have a dominant style of response to stressors such as loss; for example, some might experience more physical symptoms than, say, behavioral symptoms. However, all the following may be seen.

Physical reactions might include a lump in the throat; tension headaches; neck, shoulder or back pain; changes in appetite, sleep and sexual patterns; feelings of exhaustion; or inability to catch one’s breath.

Behavioral reactions might include looking for the deceased (for example, following a car that looks like the one our loved one drove), pacing or restless over activity, withdrawing from other people or avoiding social situations previously enjoyed, or even just sitting in a chair all day because that is all one can do.

Emotional reactions might include shock and disbelief that our loved one has died, anger or rage, frustration, guilt, anxiety or panic attacks, fear, numbness, helplessness, a sense of emotional fragility, and/or tearfulness.

Cognitive abilities are affected when the mind tries to comprehend how such a terrible event could have happened, leaving survivors often feeling stunned and/or preoccupied. One cannot follow the thread of a conversation or maintain concentration; people very often feel as though they are going “crazy.”

Spiritual changes might be reflected by anger or rage at God for “allowing” the crash to occur or asking, “How could God let this happen?” People often feel reassured that, if they lead a good life, then nothing bad will happen to them or their loved ones. When bad things happen, it can easily cause people to feel shaken down to their core beliefs.


This column explored normal reactions to loss. Many people experiencing a traumatic loss fear that if they give into their feelings, they will fall into an emotional abyss or that they will drown in the depth of their pain. However, rather than trying to minimize or avoid the pain you are feeling (the drive to avoid the anxiety associated with remembering the event being a symptom of posttraumatic stress), it might be helpful to try leaning into some of these grief reactions, allowing them to wash over you and to pass. By feeling these strong and painful feelings and reactions, you are doing an important part of the work needed to get through the grief process.

Future columns will describe and explore the process of grieving as well as posttraumatic stress symptoms and how they can interfere with your ability to move forward. In the meantime, if you suspect that these posttraumatic stress reactions are making the grief process more difficult for you, bear in mind that many people have found that professional help made it easier for them to manage those feelings.

Finally, something you already know: griefwork is work. It is not for the faint of heart, nor can it be avoided. While this work is being accomplished, however long it takes, remember to take care and be gentle and patient with yourself. Build in extra time to take care of business. Don’t put things on unreasonable deadlines–don’t have too many “shoulds.” Above all, remember that, if you have lost someone you love in an air disaster, you are having normal responses to an “abnormal situation.” Know you’re not going crazy but do get the personal and professional help you need to get through an extremely painful time in your life.

Regina Asaro, Newport News VA (757) 833‑8093
Consultant on traumatic loss issues, and wife of retired Coast Guard

© Copyright 2003. The above article may be reprinted in part or in its entirety with acknowledgement of its source and the author.