- Survivors of sudden loss are "heartbroken and traumatized," expert says
- Loved ones have no warning and no time to say goodbye
- Counselor advises being "present without judgment" as people grieve
- Those left behind may be more conscious of living in the moment
Editor's note: Former CNN correspondent Pat Etheridge is a journalist specializing in children's health and family issues. She previously hosted CNN's "Parenting Today."
(CNN) -- A young woman loses both her baby and her mother in a massive Washington state landslide. Halfway around the world, an elderly woman cries alone on the floor of a Beijing hotel, not knowing the fate of a loved one aboard missing Malaysia Airlines Flight 370.
These extraordinary, tragic events present profound, not-well-understood challenges for those who are survivors of sudden loss.
"They're not just dealing with loss. They're also dealing with personal traumatization," said Therese Rando, a clinical psychologist at the Institute for the Study and Treatment of Loss in Warwick, Rhode Island.
"It affects the ability to get on with grief and mourning, to bend your mind around what has transpired. There is no warning, no time to prepare and gradually start to take on the notion."
Increasingly, counselors caution that grief -- particularly in the case of sudden loss -- is far from a standard process.
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In fact, the widely publicized "five stages of grief," introduced by psychiatrist Elisabeth Kubler-Ross in 1969, is not a complete list of emotions. There may be feelings other than denial, anger, bargaining, depression and acceptance -- and they may occur in any order.
"A person is not just heartbroken when they lose someone suddenly," Rando said. "They're heartbroken and they're traumatized, then they're put in a situation where the conflicting needs of dealing with the heartbreak and trauma simultaneously can impede their forward process for a while."
Out of the blue
Comprehending recovery for sudden loss survivors is difficult for anyone who has never been there.
Counselors are careful not to diminish any loss, but they make clear that there are experiential distinctions -- for example, when someone dies after an extended illness or old age -- as opposed to when death occurs as the result of an acute medical condition, accident, disaster, suicide, homicide, terrorism or war.
A longtime friend recently shared how different it was to experience the recent death of her 85-year-old mother after years of poor health and the loss of her father decades ago from a sudden heart attack.
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"With my mom, we spent time together and said our goodbyes. She lived a full life," she related. "My dad didn't get that chance. I was just a teenager. For years, I was shaken and traumatized."
Rando, who was orphaned as a teen when both her parents died within a year, has channeled the trauma she experienced into her life's work and has written several books on specific areas of grief.
"Loss is not loss is not loss," she said. "In the end, many people can see their loved one at peace, relieved from suffering. We reconcile it by saying, 'it was time; the suffering is over.'
"All of that is robbed from someone who had no expectation of what was coming. There is no opportunity to take care of unfinished emotional business, to make sure to say 'I love you.' "
When there are no words
On the ground in China, therapist Paul Yin responded to the woman sitting on the hotel floor, crying.
"I simply sat down next to her. A minute later, she gave me her hands. Another minute later, I started to cry with her. That act provided an ounce of comfort," Yin told the Employee Assistance Professionals Association (PDF). "A few days later, she recognized me and walked over to hug me. This isn't exactly typical behavior from an elderly Chinese woman from the countryside, so this act told me that the support I gave her was valuable."
Yin opened up a safe space simply by being there and coming back. Atlanta family psychiatrist John Lochridge believes that was the perfect way to handle the situation.
"You have to be very gentle and patient. Be present without judgment. In this case, it may be too soon to talk because the person doesn't want or need to relieve the trauma," he said.
It's human nature to operate under basic assumptions, such as: people are good, children grow up to replace their parents and the world is an orderly place.
Then, a Malaysia Airlines jumbo jet carrying 239 passengers disappears into the night without explanation. And in the soft morning light, a huge hillside in Washington state collapses, devouring dozens of homes and a still undetermined number of people who lived there.
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When terrible things happen, those expectations are shattered. The trauma is magnified even more when there is no confirmation of death or no physical remains recovered.
"There's a great reluctance to relinquish all hope if there's no proof, until (survivors) have the evidence," Rando said. "It's wrong in their minds, with official statements saying this and then that, how can they have any confidence? It's not denial; it's disbelief. A few weeks into this -- let them have their hope."
How to go on after sudden loss
Early on, survivors of sudden loss are at high risk for suicide and other self-destructive behaviors. Responses can range from total numbness to hyper-agitation.
"This doesn't mean they have to stay like this forever and they are never going to make progress. But they are given challenges, right from the get-go, that people who've seen the death coming don't go through," Rando said.
Her own recovery has instilled qualities Rando believes are common, positive outcomes among sudden death survivors.
"Tomorrow is promised to no one. I am more conscious of living in the moment. I have to make sure I don't have unfinished business or unresolved disagreements," she said. "Because all we have is the here and now."
CNN's Gary Tuchman asked Natasha Huestis, the young mother in Washington state, what she would do next in the wake of the landslide.
She said she would go to the aid of responders who helped recover the bodies of her first and only child, a 4-month-old girl, and her mother, "Go and help them. Go and help the people who helped me."
"She realizes the preciousness of life," Lochridge said. "With evidence, painful and shocking as it may be, it's important that she grasps the finality and is able to keep going."
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