From PTSD to Grief: What Are We Still Not Getting About First Responder Treatment?

Suzz Sandalwood | Why healing can’t happen without grieving what’s been lost.

Written by Suzz Sandalwood | Seeking Veritas Columnist | | Sankarsingh-Gonsalves Productions

Grief and trauma are not the same but they are connected

Not all grief involves trauma, but all trauma involves grief and that distinction matters, especially in clinical spaces where we’re trained to categorize, and treat individuals. Grief can exist in the absence of trauma. Someone might mourn the death of an aging parent, or the loss of a long-held dream, without it becoming a traumatic imprint. There’s pain, yes, deep, aching, life-altering pain, but it doesn’t necessarily shatter the nervous system or threaten one’s sense of safety in the world.

Trauma, on the other hand, always carries grief in its shadows. You cannot experience something that overwhelms your capacity to cope, something that dismantles your beliefs about safety, control, or fairness, without also experiencing loss. The loss of innocence. The loss of trust. The loss of control. Sometimes the loss of who you were before an event.

So when we treat trauma and don’t tend to the grief inside it, we’re only doing half the job. We’re trying to regulate the body without acknowledging what the heart has lost. It’s like fixing the foundation of a house without noticing that the entire family inside has changed. That’s why first responder treatment that excludes intensive grief support can feel incomplete.

And if we miss that, we miss them.

Trauma protocols are not enough

“We keep sending people to trauma treatment like it’s a reboot button. But unprocessed grief doesn’t reset.We’ve built entire systems around trauma.”

We have protocols. We have clinical pathways. We have acronyms, assessment tools, and a rotating carousel of evidence-based interventions like EMDR, prolonged exposure, somatic reprocessing, CBT, and the latest, greatest trauma-informed care models that get added to PowerPoint decks faster than they get integrated into practice. But for all our trauma talk, there seems to still be limits of intensive PTSD treatment to address the grief embedded inside it.

But grief and trauma aren’t separate.

In fact, for many first responders, trauma can’t be metabolized until grief is acknowledged. The persistent sense of guilt over what they should have done, the resentment over what the job took from their families, the strange mourning that comes with retirement; these aren’t peripheral issues. They are the issue. They show up in sleep patterns, in moral injury, in intrusive thoughts, in relationships that quietly deteriorate. We keep sending people to trauma treatment like it’s a reboot button. But unprocessed grief doesn’t reset. It leaks. It sabotages. It manifests in cynicism, emotional exhaustion, and in some cases, the tragic decisions that make headlines and leave departments shattered.

Why grief gets overlooked

So why are programs still sidelining grief? I think because it’s harder to quantify. It doesn’t always look dramatic enough for a diagnosis and cannot be pathologized. Grief asks us to sit with what cannot be fixed and in a field built on action, solutions, and saving lives, that kind of sitting still can feel intolerable.

If we truly want to offer healing, we need to stop expecting first responders to grieve in silence, in secret, or in the margins of their therapy plans. We need to make space for their sorrow, not just their symptoms.

What integrated care could actually look like

Integrated care would mean treatment protocols that include loss histories, not just trauma timelines. It would mean helping responders name not only what happened to them but what they’ve had to let go of, identities, relationships, parts of themselves they no longer recognize. It also means training clinicians who understand the culture, who won’t flinch when someone says they laughed at a crime scene or couldn’t cry at their own child’s recital. Who can hold space without preaching and who know that sometimes, the bravest thing a client will say in session isn’t about the worst call, it’s “I miss who I used to be.”

This isn’t about turning trauma centers into grief retreats. It’s about integration. If we’re going to talk about healing, let’s actually mean it. Let’s stop treating grief as an optional sidebar and recognize it for what it is: the emotional marrow of every traumatic experience. We can do this with intelligence, with structure, with clinical excellence.

Not just recovery- recognition

Grief doesn’t clear on a schedule. It’s not a symptom to manage. It’s a response of connection, of meaning, of being human in a system that demands compartmentalization. If we’re serious about trauma-informed care, then grief literacy has to be part of the foundation, not an afterthought. Otherwise, we’re not treating the whole person, we’re just helping them function well enough to keep breaking. That’s not care, that is the illusion of recovery built on untreated wounds.

Next Week in 911 COMMUNITY

If grief is often a silent partner in trauma, how do we recognize it in order to meet it where it is at? I recently found a note tucked away, scribbled after a call in 2008 from my late husband who was a police officer and a paramedic. He struggled with addiction. He never shared this note with anyone, but it says something about grief I think too many still don’t know how to talk about.

Next week, I’m reading the note out loud, because if we don’t start talking about this kind of grief, we’ll keep losing people to it in addiction, in life.

Be sure to subscribe so it comes right to your inbox next week.

About the Author: Suzz Sandalwood is an RSW/MSW Therapist, Advanced Certified Clinical Trauma and Addiction Specialist and a Certified Grief Counsellor. She has extensive professional and lived experience in first responder, addiction, and grief communities. | Connect with the author: https://suzzsandalwood.com

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