The Onion Effect: Understanding the Tears and Layers of Loss by Janelle Breese Biagioni

Loss after brain injury is like death

dark tunnel

Grief feels like a dark tunnel.

As an individual travels the journey of grief, the magnitude and impact of loss is revealed in layers. Much like peeling an onion, the deeper the cut, the more tears shed. Why? Loss is incredibly painful, life-changing, chaotic, and strikes without choice.

Traditional teachings state that loss results from death, divorce, and other life transitions. Today’s expanded list includes Alzheimer’s, chronic illness, and catastrophic injuries such as spinal cord and brain injury. A medical model, which is to assess, diagnose, and treat, was the typical approach to help the bereaved. It didn’t work. The pain and suffering resulting from loss is not time-specific, orderly, or predictable. Much more fitting is the Companioning Model, which is to be present for the person and walk alongside them for however long they need to explore and give expression to their feelings.

Historically there was little else to offer those suffering from loss. Erroneously, society believed that keeping a stiff upper lip or not talking or dwelling on what happened were the proper ways to cope. The truth was, the outside world didn’t know how to help people work through the devastation they struggled with. Thankfully, in 1969, Dr. Elisabeth Kübler-Ross wrote On Death and Dying. This ground-breaking book was like taking water to the parched. Until then, social workers and others in the helping profession were not equipped to facilitate the conversation about loss. Kübler-Ross opened the doors for that dialogue.

Having said that, her model, known as the Five Stages of Grief (Denial, Anger, Bargaining, Depression, and Acceptance), was interpreted as a list of emotions to be experienced in a specific order. Before her death, Kübler-Ross declared the model was not meant to be a list of absolutes but rather a list of potential responses.

Dr. Alan Wolfelt, of the Centre for Loss & Life Transitions, offers a much more expansive range of responses which include shock, numbness, disbelief, disorganization, confusion, anxiety, panic, fear, physiological changes, explosive emotion, sadness, and more. He teaches that ultimately the person works towards reconciliation and healing.

Don’t sidestep the journey of grief

Grief can be dark and lonely.

Grief can be dark and lonely.

As the layers of loss are revealed, it is not unusual for the person to resist and/or suppress feelings. That’s okay for a while—it’s actually

healthy to take a bit of a break from the sorrow. But when the pushing aside becomes an outright dismissal of the pain, then additional problems may set in. You cannot sidestep grief. There is no way to get to the other side of it except to go through it. Unresolved grief will take any opportunity to rear its ugly head.

I like to use the analogy of a yard flush with bright yellow dandelions. You can mow the grass and cut every head off. But before the lawn mower is tucked away, you witness the lemon-colored petals of another head pop up from the ground. Why? Because you only skimmed the surface with a blade—you didn’t get the root.

The work of grieving is the same. Unless you get to the root of how you feel and work through those feelings, grief will pop up again and again in your life. Much like the snowball effect, it will get bigger and bigger. Remember: the only wrong way to grieve is to not grieve.

As a person grieves, their loss morphs into a multi-dimensional journey which requires an unknown length of time to reconcile. The reason is that loss isn’t an event, it’s a process. It is not time specific. As time passes, the person discovers how what has happened impacts them personally and in their daily life, thus revealing the layers. This applies to loss through death, divorce, and separation, as well as developmental losses (such as empty nest or retirement), loss of external objects (such as a house fire), and a loss of self.

The latter—a loss of self—resonates the most for people with a brain injury. They are no longer the same person, and they no longer function in the same way as they had before being injured. This is painful and causes suffering.

Brain injury means loss for the whole family

The entire family experiences loss through their loved one’s brain injury. How can it be that the family suffers a loss when the person is alive and home with them? Isn’t it only the person who is living with physical and/or cognitive deficits who suffers? No, because often the roles and responsibilities shift in the family.

For example, after my husband was injured he could not return to work. Given there was little community support in place 23 years ago, his

Loss has special meanings for each person.

Loss has special meanings for each person.

care and supervision fell onto me. This meant that I could not work, as taking care of him was a full-time job. He was a police officer so we continued to receive his pay until he died. But I was self-employed, and if I wasn’t working there was no extra money coming in. This resulted in lifestyle changes for us.

My children suffered as well. Not only was their father unable to engage with them as he had prior to being injured, I was also not functioning as the mother that I had been either. They were still fed and clothed and went to school, but I had no time for extras like reading, playing games, or just spending time with them. Everything went into getting their dad through the day. Our children, as other children do, assumed responsibilities that were not theirs. They became equal caregiver with me, often having to help out with their dad instead of being outside playing with their friends.

It’s not fair, but it is the reality that many families live with. Each of us experienced a layer of loss and had to work through that.


Individuals and families living with loss have special needs. When loss is escalated by the impact of brain injury, these needs are significant, and they need help. The S.H.A.R.E. list provides ways to help:

Supports – people need short-term and long term supports from a variety of people.

Hope – an effect of loss is hopelessness. They want to know happiness will return in their life; however, they have little capacity to hear it. Gentle reassurance is important.

Acknowledge –help the person to express and acknowledge what it is they have lost. Don’t persuade, dissuade, or judge.

Reflection – healing requires turning inward. Personal reflection facilitates the searching for meaning and understanding of what has happened and how one will survive.

Engage in life – when the person reconnects with loved ones, friends, coworkers and community, it is a sign of healing.

Extended family, friends, and colleagues are capable of providing supports; however, professional counseling can also help. Counseling provides a safe place for people to give expression to their pain. It will assist in exploring feelings about what has happened and provide guidance to reconcile those feelings.

Remember, there is no sidestepping grief. You have to go through it to get to the other side. Doing the work will keep you safe from turning to drugs or alcohol, and it allows you to live the rest of your life to the fullest. Why? Because you deserve to … we all do!

About the Author

Janelle Breese Biagioni, RPC, is an author, speaker, and counselor with expertise in grief, loss, life transitions, and brain injury. She resides with her family in Victoria, BC. She is the author of A Change of Mind: One Family’s Journey through Brain Injury and the upcoming book, Life Losses: Healing for a Broken Heart. Visit her website at and follow her blog at She can be contacted at


Special Collection on Brain Injury Journey

Special Collection on Brain Injury Journey

 This article is posted with permission from Brain Injury Journey – Hope, Help, Healing, Vol 1, 2014.




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