INTERVIEW WITH CLINICAL PSYCHOLOGIST JOS DE KEIJSER
Psychologist examined the mourning of MH17 survivors: 'Mourning does not pile up. At a certain moment you are full'.
Clinical psychologist Jos de Keijser examined the mourning process of MH17 survivors. 'Mourning often takes much longer in the event of an attack.'
Wil Thijssen 16 July 2019, 5:00
The survivors of the MH17 air disaster not only share a sudden, violent loss, but also ignorance about the last moment of their loved ones, inaccessibility of the place where it happened and the lack of an intact body to say goodbye to.
This complicates the grieving process, says clinical psychologist Jos de Keijser. "Of all those who lose a loved one due to, for example, cancer or a heart attack, 90 per cent will be back above a certain internationally agreed standard after one year. But in the case of survivors of an attack or murder, mourning often takes much longer."
Together with colleagues, De Keijser investigated the grieving process of these next of kin. In 2.5 years, they surveyed 173 of them four times. Of these, 66 people answered all four rounds of questions. The results will be announced on Tuesday at the memorial service in Nieuwegein, with the booklet
'Something in my life is broken'. The research shows that most of them, 80 percent, after a year struggled with complex mourning (PCRS), post-traumatic stress syndrome (PTSD), a depression, or several disorders at the same time. Two-thirds of this group lost more than one loved one as a result of the disaster.
What makes grief different after a murder or attack?
"The MH17 disaster is a
man-made disaster - caused by humans. You can draw a line from natural disasters to man-made disasters and attacks. With a natural disaster, you don't look for a culprit. In the case of
man-made disasters, such as a shipwreck or airplane disaster, you do this in part: sometimes it is an accident, sometimes bad luck, or someone's fault. But in an attack, someone has deliberately killed your loved one. That is more difficult to deal with. This causes anger and feelings of revenge. This frustration causes additional stress and complicates the normal process of coping with it."
MH17 lies between
man-made death and an attack, says De Keijser. "It was an attack, but not deliberately directed against these passengers. This was also evident from 9/11 in New York: that attack was not directed against the officials in the WTC towers, but against the entire West. With Breivik on the Norwegian island of Utoya there was a very specific attack. He hated progressive, left-wing people and knew exactly how many social-democratic children were there at that time. This is reflected in the mourning of their parents who are even angrier than the relatives of MH17 on the four suspects who have now been charged."
Actually, MH17 was not a nasty, painful death, says De Keijser: you go on holiday in a cheerful mood and all of a sudden - pop - you're gone. No suffering, no misery, no hospitalizations. But those who stay behind experience this as very traumatic. They can get all kinds of psychological complaints.
One year after the disaster, the psychologist distinguished three groups. First of all, there were the 'resilient' people. They have a lot of grief, worry much and sleep badly, but after a year they function quite well again. A second group had complex mourning. After a year, they still haven't got their lives together but 'they'll get there'. In addition to complex mourning, the third group suffers from problems such as PTSD or depression. These next of kin often need professional help, says De Keijser, otherwise nothing will change.
What characterizes complex grief?
"That is mourning that lasts longer than an average of one year. These next of kin have an extreme longing for the deceased - so strong, for example, that you have to sleep under your child's duvet, go to the cemetery every day or smell the scent of your loved one every day. That you can't get loose of it."
"Other symptoms of complex mourning are feelings of emptiness and avoidance. They avoid talking about a person or go to certain places, to protect themselves from the pain. And that protection is at the same time maintaining the grief."
And how does PTSD characterize with next of kin?
"If something bad happens, you make a mental picture of it. The next of kin I spoke to formed images of what exactly happened, they dream about children flying through the air, or they always see images of wreckage or body parts."
One of the findings of his research is diametrically opposed to what has been assumed so far: professional literature reports that mourning 'stacks' when a person loses more than one person at the same time, but that does not emerge from this research at all, says De Keijser. "There are survivors who have lost four or five loved ones, and they have it easier to pass through their mourning process than some others who have lost one loved one. You'd expect them to have complex mourning more often, but we don't see that."
How can that be explained?
"Mourning does not add up. At some point you are full. In professional literature this is called bereavement overload; you are overloaded with grief, your working memory is full, you can't take in any more of it. In such situations it's not the case that you have to process one death first and then the other. Rather, it seems as if, with the one you are also taking the grief for the other into account simultaneously.
So why do some get complex mourning and others don't?
"The resilient, self-sufficient next of kin do not avoid, they take on all confrontations. They have looked at body parts and identified their loved one. They go to see the reconstruction of the plane in Gilze-Rijen. They talk about the deceased, seek support and take up their lives again. This is not because they are better than the others, but a matter of disposition and character."
The next of kin who took part in the research were offered psychological treatment. Thirty-five people took advantage of this. They received eight sessions of cognitive therapy, 'exposure' and EMDR.
With cognitive therapy, we 'search' for negative thoughts, says De Keijser."Sometimes the next of kin suffer from a feeling of guilt: I was a bad partner, or: I have done too little together with my daughter. I will never say that what someone thinks is wrong, but I try to understand
why someone thinks something. If the reaction is: it goes on its own, then these are automated thoughts. Those you can turn into conscious thoughts that you control yourself. And when someone says: I'll never be happy again, you can challenge that thought. It says something about the future, but you don't know the future. So you also don't know if you'll ever be happy again."
'Exposure' includes confrontation with painful things that are avoided. "A form of avoidance is called de-realization; something becomes unreal, it's kind of a film; you think: my lover is just in Malaysia and will come back later. You don't want to go to that pain. We have asked these people to write about things they find difficult, to visit places they would rather not go to, or to identify their child's trousers, for example. By confronting them with reality - yes, it was that plane and yes, everyone is dead - you stimulate the grief to get going, so that they can come to terms with it."
EMDR was then used to get rid of PTSD images. "As you think about the event, such as the falling down of your lover's body there in Ukraine, you are asked to recall that film image and at the same time look at the therapist's finger or listen to a device. Then that film image is re-stored in your working memory, but less well because you are distracted. If it is stored less well, your memory processes the information better at night and those images fade away."
The research also shows - 'very remarkable' - that PTSD does not block mourning, but that complex mourning can actually be the cause of PTSD. "So far, the assumption has been that you treat PTSD first, so that someone can mourn normally. However, we have indications that you have to treat that grief first, otherwise the PTSD images will not go away."
The participants benefited greatly from the treatment, says De Keijser. After the last survey it turned out that the symptoms had decreased or disappeared. But next of kin who also suffer from depression appear to be much less interested in such a treatment. "In addition, we are also looking for a middle-way-treatment: longer grief processing coupled with the activation of the person by, for example, offering daytime activities. An important conclusion, therefore, is that in the case of traumatic mourning we need to look more closely at what is good for whom. Although they have all experienced the same loss, the treatment is about differentiation, about customization."
Little research has been done into complex losses. "We know very little about how we can help those left behind after suicide, murder, loss or an attack. That's a pity, because good guidance pays off," emphasizes the psychologist. "You get people back to work more quickly, the quality of life improves again."
A number of the examined next of kin are still not working fully or not at all. Mourning is not in itself a reason to discard work, says De Keijser, but it can be taken into account to a greater extent. "One of the next of kin I spoke to worked in shifts in a factory. He lost his child in the MH17 disaster. When he went back to work, he was only allowed to do day shifts because he slept so badly. But after six months, his employer said: it's time for you to start working night shifts again. He couldn't do that at all yet."
Mourning receives too little recognition in the system of being ill, according to the psychologist. "It may not be a disease but it is very bad, a reason to adjust the job. I'm not for sitting at home; working gives structure. But adjustments are sometimes necessary. For instance, you have to think of mourning leave in collective agreements. I think that far too little attention is paid to this."
Together with colleagues Paul Boelen and Lonneke Lenferink, Jos de Keijser wrote the workbook
Mourning after plane crash MH17 for the next of kin in 2016, and at the end of last year, together with Geert Smid, they published the
Handbook on Traumatic Mourning for social workers. They were invited to various meetings of next of kin and were asked whether they would like to provide them with psychological support.
That was not always easy, says De Keijser. "We were not always received in a friendly manner. You soon have the image that you are pedantic, that you just come to explain the state of their emotions. I had trouble with that once in a while. But you do it, because it's your job and you think it's important to do it."
He was also accused: you only come because you want to do research so badly. "I can understand that. These people have experienced something terrible. A lot is coming at them - grief, unsolicited media attention, a lot of arrangements - and then we also arrive with our painful questionnaires. However, with the conclusions we hope to be able to help the survivors of such a disaster better in the future."
Does this explain the low response rate to your investigation?
"In part. Many of the survivors think after such an event: it's a kind of fate, this has happened to me. If you are ill, you go to the doctor, but if you have a lot of grief, people think: I have to learn to live with that. Or: with a treatment I won't get my loved one back anyway. Though it has been shown that it helps. Sorrow is unavoidable, that's what you need to be able to overcome the grief. A psychologist can't help you get rid of that pain. But they can help you overcome the hampering circumstances surrounding it."
ADDITIONAL INFO
(Note: all links go to articles in Dutch)
"I WANT TO EXPLAIN WHO WE'VE LOST; THEIR NAMES MUST BE MENTIONED."
On 9 March 2020, the MH17 process will start: a case with 298 victims from 10 countries, presumably conducted without suspects and without a defense. A case that will be a focus for all the eyes of the world.
What does that mean for the next of kin? "I don't have to look these suspects in the eye."
Family detectives are usually the link between an investigation team and the victim's family in murder and vice cases. But the MH17 disaster is so unique:
106 family detectives throughout the Netherlands went to work for the next of kin in one fell swoop. What are their experiences? And how are their efforts appreciated?
The Belgian forensic dentist Eddy De Valck is one of the people who managed to make names out of numbers again:
he helped to identify the 298 victims of the MH17 disaster in the Corporal Van Oudheusden barracks in Hilversum. "This is the very last thing we can do for them."
The repatriation of the victims of the MH17 disaster in Ukraine was widely admired. Who were the people responsible and how did they work?
Reconstruction of almost a year of risky, precise and empathic human work.
The investigation into the circumstances of the MH17 disaster was anything but regular police work.
De Volkskrant spoke to three main players. They give a special insight.
The former Volkskrant-correspondent Olaf Koens was at the crash site one day after the crash of MH17.
He spent the night there with the rescue workers, between wreckage and bodies. "All you have to do is think about your work," says the men from the rescue service. "Not about the dead. They are just lying here. Here, have another drink."
Translated with
www.DeepL.com/Translator
https://www.volkskrant.nl/nieuws-ac...t-betekent-dat-voor-de-nabestaanden~b8cc8e72/
I couldn't agree more.
