Much of our clinical knowledge of how to evaluate and treat survivors of terroristic attacks and kin, friends and coworkers of victims must be adapted from work with analogous cases of traumatic bereavement, such as family members of victims of serial murder, workplace homicide, and school shootings.
Murder of any kind is the ultimate violation that one individual can inflict upon another--a brutal, purposeful assault on an unwilling victim. The murder of a family member shakes survivors' trust in the existence of fairness, justice, faith, and the very meaning of life. The especially cruel and purposeful nature of terroristic murder compounds the rage, grief, and despair of the survivors. Unlike the relatively controlled, decorous demise of a relative with a progressive illness, bereavement by sudden and unanticipated violence robs the family of the inoculatory effect of anticipatory grief. Added to this is the stark confrontation of the survivors with their own mortality and vulnerability, as the illusion of safety and order in the world is shattered.
For many survivors, the first news of the terroristic homicide strikes a mortal blow to the self, evoking their own sense of personal loss. Family members are typically preoccupied with the nature of the injuries inflicted on the victim, the brutality of the killing, the types of weapons used, and the victim's suffering. Families may clamor for information about the identity of the murderers and any possible relationship to the victim they may have had. Any kind of murder, including terrorism, always involves a human perpetrator, and the greater the perceived intentionality and malevolence of the killing, the higher the distress in the survivors.
Survivors may be seized with an impulse to "do something--anything." A deep and justifiable anger toward the killers alternately smolders and flares as investigations and official actions drag on. Even where the terrorists are identified, caught, and convicted, the anger may persist for years. A common coping mechanism for dealing with rageful feelings and impulses consists of ruminating on fantasies of revenge. Actual vengeful attacks by family members on perpetrators are extremely rare, probably due in large part, first, to the sheer impracticability of getting at the killers, who, especially in high-profile terrorist cases, are invariably sequestered and protected; and, second, to the basic moral values and common decency of most families, who are typically not looking to correct one atrocity with another. Many families may direct their energies toward efforts to aid in the apprehension and prosecution of the killers, which can be seen as either a help or hindrance by investigators.
Even more common than anger, a pervasive "fear of everything" begins to loom in the survivors' consciousness, beginning with their first awareness of their loved one's death, and persisting for several years or more. Survivors' heightened sense of their own vulnerability may spur them to change daily routines, install house and car alarms, carry weapons, refuse to go out after dark, or to shun certain locales. There may be phobic avoidance of anything related to the trauma, including people, places, certain foods, music, and so on. Survivors may experience psychophysiological hyperstartle responses to such ordinarily nonthreatening stimuli as crime shows on TV, shouting in the street or among family members, the sound of airplane engines, news stories about terrorism or any, even unrelated, accident or tragedies.
The survivors' usual range of territorial and affiliative activity becomes constricted as the home is turned into a protective fortress, strangers, and unfamiliar surroundings are avoided. All family members may be outfitted with pagers and cell phones, and may have to submit daily schedules of activity, as there develops a compulsive need for family members to be close at hand or reachable at a moment's notice. Older children and adolescents may resent this "babying" restriction of their autonomy and independence.
Survivors may overidentify with the victims, sleeping in the dead relatives' bed, wearing their clothing, or even assuming their vocal and behavioral characteristics. Many survivors feel like pariahs, cast out of the normal existential comfort zone that the rest of us take for granted to assuage our sense of vulnerability, but which is no longer a coping option for survivors of violent terroristic homicide: "We know better--the world is a cruel and ugly place." Survivors may have frequent nightmares of the imagined horrifying death of the victim, or wish-fulfillment dreams of protecting or rescuing th to keep their loved one safe.e victim. Their grief may be compounded by guilt if they feel they should have foreseen the attack or "done more"
Everybody's health suffers. Common psychophysiological disorders include lack of appetite, sleep disturbances, gastrointestinal problems, cardiovascular disorders, decreased resistance to infectious disease, and increased anxiety and depression. A significant number of family members die within the first few years of any kind of violent criminal homicide. Those who appear to adapt best to stressful experiences in general typically have a range of available coping strategies and resources that permit greater flexibility in dealing with the particular demands of the traumatic event.
- Miller, Laurence; Psychotherapeutic Interventions for Survivors of Terrorism; American Journal of Psychotherapy, 2004, Vol. 58 Issue 1, p1-16
The article above contains foundational information. Articles below contain optional updates.
Reflection Exercise #4
The preceding section contained information
regarding children’s post traumatic stress reactions to terrorism. Write
three case study examples regarding how you might use the content of this section
in your practice.
How might older children who are trauma survivors react to a parent’s post traumatic compulsive need for family members to be close at hand? Record the letter of the correct answer