International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: Maryann J. Gray, Ph.D.
On a beautiful spring day 44 years ago, when I was a graduate student living in Ohio, an 8-year-old boy named Brian darted in front of my car on a rural highway. I tried to swerve but I hit him, and he died before he reached the hospital.
Back in those days, there were no CISM teams. I spent most of that terrible afternoon alone in the back seat of a police car. Sometimes I prayed, sometimes I wept, but mostly I felt numb and disembodied. After a few hours, a neighbor convinced the police to let me wait in her house. We sat together in her kitchen, and she kept me company while I rode wave after wave of shock, grief, guilt and fear. Her daughter, about my age, joined us as well. When I look back on that day, I don’t think that it’s any exaggeration to say that the simple kindness this family showed me saved me from a complete breakdown. I don’t remember exactly what they said, but their compassion gave me hope that I could find understanding, solace and acceptance even after killing a child, which was about the worst thing I could think of. They also helped me stay grounded by encouraging me to drink water, wash my face, and call a friend to pick me up.
Many lives were forever changed on that day. Brian’s family was devastated. My parents were filled with sorrow about Brian’s death, empathy for his family, and worry about my well-being. Although I tried to assure them I was coping, in truth I was barely functioning.
Today I recognize that I was in the grip of acute and then posttraumatic stress disorder. Intrusive images, memories and flashbacks dominated my days, so that I was unable to concentrate on anything but the simplest of tasks. I was too scared to drive, terrified around children, and deeply depressed. In addition, I had what today is called moral injury – the unrelenting self-condemnation that follows our failure to live up to our moral standards. Even though no one blamed me for Brian’s death, I blamed myself and decided I was a bad and even dangerous person. Moral injury tends to make people withdraw from social contact, and I spent too much time alone. After two years, I moved to California for a fresh start. I didn’t tell my new friends what happened, so the accident became a secret. The gap between how I presented myself to the world and how I really felt created a lot of loneliness.
At least 30,000 people per year in the U.S. alone unintentionally kill someone, mostly in car crashes but also in gun accidents, mishaps at work or at home, and so forth. Hundreds of thousands more unintentionally cause serious injury. Most people who unintentionally cause serious harm to another are anguished regardless of their culpability or blameworthiness. PTSD and moral injury appear to be the most common psychological outcomes. Some are suicidal. Yet there is a dearth of resources to help us cope. The result is that many suffer alone.
To begin redressing this situation, I used my training as a social psychologist to create a website called Accidental Impacts and, some years later, founded a nonprofit corporation of the same name. Accidental Impacts is the only organization that offers information and support targeted to those who unintentionally kill or injure people. Because our society lacks a word or phrase for those who unintentionally kill, we coined the acronym CADI – Caused Accidental Death or Injury.
Over the past decade I have read and listened to hundreds of CADIs describe their experiences. These first-person narratives indicate that what happens at the accident scene and immediately afterwards carries great significance for months and even years to come. Comments posted to the Accidental Impacts website offer vivid examples:
I began rocking back and forth on the sidewalk. I started getting dizzy, [and] I couldn’t breathe. I was realizing what just happened. I will never forget [the witness’] screams… Everyone was looking at me like I was a monster. I was very grateful for the EMTs and officers that showed to the scene who were very nice and sympathetic with me. It helped calm me.
I heard someone saying, “Oh my god, oh my god” over and over, getting louder every time. The officer told me to go back to my vehicle and I realized I was the one screaming… I was hiding in my minivan in shame. I heard a woman come up to the line they had blocked off and say, “I’m her mother.” I broke down.
Three days ago. I hit a man on a motorcycle. I was coming up a hill and didn’t see him. I wasn’t on my phone or texting. He died on the scene. I am grateful that there were amazing people on the scene helping him and praying for us both and helping me.
At a time when someone feels they have done something unforgivable, even the smallest expression of empathy or caring can mean so much. A gentle word can give a CADI hope and save them from giving up and giving in to despair.
When CISM or other crisis response teams are called to an accident scene, they offer vital emotional first aid to both the victim and the perpetrator (CADI). Our participants have identified three kinds of support that they needed in the immediate aftermath of an unintentional killing. First is emotional support – assistance in managing their emotions (from hysteria to numbing) so they can think and function, including helping the police with their investigation. Second is practical support – they might need an immediate plan to get their children picked up from school, for instance, or they might need to contact their employer. They also need a plan for how to get home (if released to home) and what to do when they get there. Third is informational support. Specifically, CADIs need information about psychological trauma. They may be experiencing disturbing bodily sensations, strong negative emotions, or cognitive difficulties, and it can be reassuring to be reminded that such symptoms are normal responses to an abnormal situation. CADIs may also benefit from explanations about the legal process – what is happening at the accident scene and what will follow.
While supporting a CADI, it’s important for first responders to take care of themselves. A CADI’s distress can trigger feelings of helplessness and fear, as we recognize that we do not have complete control over ourselves and our world. Or CADIs can make us angry, especially if they seem unfeeling or self-protective. A number of crisis response team members have told me that they found dealing with the CADI more unsettling than dealing with the victim’s family.
If you are helping a CADI at an accident scene or soon afterwards, I invite you to inform them about Accidental Impacts. In this way, you give them access to online information and support. They will learn that others have survived similar traumas, that CADIs can and do feel better over time, and that there are peers who understand what they are going through. They will also get practical information, such as how to find a therapist or what the symptoms of acute and posttraumatic stress are. And we offer links to books, articles, podcasts, websites and other resources that CADIs have found helpful.
Accidental Impacts reminds new CADIs that they may be in a state of acute stress and encourages them to accept support from friends and family. We suggest some simple steps they can take to take care of themselves and manage their symptoms. Most of all, we emphasize that this tragedy does not have to forever define them.
At the same time, we do not minimize the significance of what happened by saying things like, “It was just an accident,” or “You didn’t mean any harm.” Compassion without accountability is empty. But we do encourage them to temper self-condemnation with self-compassion, so that they can ask for help, be effective parents, spouses, friends, and workers; and so they can live a life that feels meaningful.
When I started Accidental Impacts about ten years ago, I did so in Brian’s memory and to honor all those who grieved for him and suffered including his family, my family, and myself. Brian’s death reminds me that life is precious and fragile. Instead of letting guilt and grief constrain or isolate us CADIs, I want us to find the courage to make the world a better place, to develop and even celebrate our abilities and talents, and to show kindness to ourselves and others. The family that took me into their home at the accident scene is my role model. So, too, are all of you who render vital aid and support on the worst day of someone’s life.
When we turn away from the needs of those who have unintentionally killed, we only compound the toll these tragedies take. Thank you for your caring. You are making a huge difference. I hope Accidental Impacts will be helpful to you and to those you serve. We welcome your feedback, input and involvement.
Dr. Gray is a social psychologist, educator, and a CADI. She is the founder and president of Accidental Impacts. You can reach her at [email protected].
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