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The Work of Mourning

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Physical, emotional, intellectual, financial, social, and spiritual aspects of ... We discussed two basic models of stages of dying (Kubler-Ross and Pattison) ... – PowerPoint PPT presentation

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Title: The Work of Mourning


1
The Work of Mourning
  • Chapter 4
  • Dusana Rybarova
  • 2007 Psyc 456

2
The Biological Roots of Grieving and Mourning
  • Grieving in graylag goose (Lorenz, 1952)
  • Grieving in dogs, hamsters, orangutans,
    chimpanzees, elephants
  • Grief marked by searching behavior, followed by
    depression, lack of appetite, apathy
  • Signs of ritualistic mourning in elephants,
    chimpanzees, baboons
  • Burying deceased animals with mud, earth, leaves,
    stones
  • Mourning sounds

3
Grief and Mourning
  • Grief
  • Immediate reaction to loss
  • Lasts a number of months or longer
  • Marked by sadness, anger, guilt, body sensations
    of hollowness in the stomach, lack of energy,
    shortness of breath,
  • Marked by following phases (Harvey, 1996)
  • shock, outcry, denial
  • tendency to review the loss obsessively,
    emotional and cognitive restructuring

4
Grief and Mourning
  • Mourning
  • Broader psychological process of adjusting to the
    changes following loss including our relationship
    with the deceased, our self, our world-views
  • Marked by reorganizing and reintegration of our
    lives in light of the loss, we are pulling our
    lives back together
  • Resolution and recovery, increased willingness to
    feel the pain of loss and the integration of a
    new self-concept
  • Includes behavioral, physical, cognitive,
    emotional, and spiritual dimensions
  • Influenced by predictability of the loss, nature
    and duration of our relationship to the deceased,
    self-confidence and coping skills

5
A Model of Mourning
  • Individual, social and cultural differences in
    mourning
  • Personality variables, anxiety about death,
    social support, death trajectory, ethnic and
    cultural background, spiritual/religious views
    etc.
  • The following four phases are not restrictive
    the mourning person can move back and forth among
    them, and can be modified by individual, cultural
    and social differences
  • Four phases of mourning we will focus on
  • Cognitive Restructuring
  • Emotional Expression
  • Psychological Reintegration
  • Psychospiritual transformation

6
The cognitive Restructuring Phase
  • We react to the news of a death of a loved one by
    denial, shock, outcry, panic, despair,
    helplessness, disbelief
  • Our cognitive schemas are challenged knowledge
    and expectations about how the world works
  • Accommodation of our cognitive schemas to fit
    the change following the loss is important for
    our coping with the event

7
Cognitive Restructuring PhaseWeeping and Outcry
  • Weeping, sobbing and uncontrolled crying reflects
    the cognitive restructuring process assimilation
    of the new information into our pre-existing
    schemas
  • This helps us to move from the cognitive denial
    and high arousal to lower arousal and
    accommodation of the change into our life
  • Account making
  • Coming to understanding of why, when, where and
    how the death occurred
  • Making sense of the death
  • Recalling, reflecting and analyzing information
    related to the deceased and his death
  • Communication about the account with family and
    friends starts the healing process

8
Cognitive Restructuring Strategies
  • Cognitive restructuring based on the past
  • Focus on the habits, behaviors, lifestyle,
    health-related practices of the deceased (e.g.
    he smoked too much, he drove too fast, he did
    not exercise enough or medical staff
  • Reinforces our belief that the death did not
    happen arbitrarily and was a consequence of some
    previous action
  • Cognitive restructuring based on the future
  • it could have been worse
  • Using the death as motivation for future
    accomplishments as a tribute to the deceased

9
Cognitive Restructuring Strategies
  • Cognitive restructuring based on the world
  • Restructuring on our beliefs about how the world
    works
  • Science-based accounts e.g. disease ran in the
    family
  • Religious beliefs Gods will, higher power etc.
  • Cognitive restructuring based on self
  • Self set of assumptions about who we are, what
    we value, how we fit in the social context, where
    we fit with respect to the world
  • Encompasses the other three aspects of cognitive
    restructuring
  • Need for integrity and continuity of the self

10
The Emotional Expression Phase
  • Grief reactions are often very intense
  • Protest reactions, intense anger, frustration,
    feelings of profound emptiness
  • tendency to blame ourselves for having treated
    the deceased badly or for not having done enough
    to prevent the death, for not telling them how we
    felt about them
  • Physical disturbances
  • Weakness, sleep disturbances, loss of appetite,
    headaches, back pain, indigestion, shortness of
    breath, heart palpitations, dizziness and nausea

11
The Emotional Expression Phase
  • Secondary Losses
  • Secondary losses coincide with the initial loss
  • Physical, emotional, intellectual, financial,
    social, and spiritual aspects of our life
    influenced by the loss
  • Psychic Scars
  • The loss often leaves scars just like physical
    injury
  • The scars are more painful under some
    circumstances (anniversary) and can result in
    feeling of loss of control, predictability,
    safety, and security and post-traumatic stress
  • Can lead to damaging ways of coping such as
    alcohol abuse or drugs

12
The Time to Heal
  • Its been 10 months since my teenage son was
    killed in an accident It is a sad time, but it
    is also a very sacred and healing time. It takes
    time. It is a uniquely individual process, and
    only a few people seem to understand and respect
    that its important that we be allowed to grieve,
    for that is the only way to heal. The tears have
    to be shed. The anger and frustration need to be
    experienced. Please dont be scared off by these
    stages. They are a normal and healthy process.
    There is incredible pressure from society, family
    and friends to get over this. You dont get
    over death and grieving, you go through it.
    Step by step, teardrop by teardrop. We dont
    want to be rescued from this healing work. You
    cant get our minds off it, or know what is
    best for us. Just be there with us It will be
    friends who are supportive, accepting and
    non-judgmental. Friends will allow for this
    journey to be healing.
  • Denise Anderson (1995). I hear you. Please
    listen. Thanatos, 20(1), 11.

13
The Psychological Reintegration Phase
  • Involves integration of new coping responses,
    behaviors, cognitive strategies, and assumptions
    to deal with the world without the deceased

14
The Psychological Reintegration Phase
  • Coping strategies
  • Problem-Focused Coping
  • Direct confrontation with the loss
  • Includes planning, active problem solving,
    engaging in activities directed at mastering the
    loss experience
  • Emotion-Focused Coping
  • Managing our appraisal and stress associated with
    the loss
  • Meditation and relaxation techniques combined
    with positive reinterpretation and reframing of
    the loss
  • Seeking Social Support
  • Turning to support people for guidance,
    assistance and emotional support

15
The Psychological Reintegration Phase
  • Reintegration and Self-Efficacy
  • Self-efficacy is related to self-confidence,
    motivation, and degree of control over
    circumstances
  • High self-efficacy associated with being activity
    in social, community, altruistic affairs
  • Low self-efficacy can be associated with
    reactions of withdrawal and giving up
  • Inner Representations of the Deceased
  • Keeping the lost person psychologically alive by
    talking or writing to him/her
  • Serves as a coping strategy to lessen the impact
    of the loss on our self and world-integrity

16
The Psychological Reintegration Phase
  • Marks of achieved psychological reintegration
  • More control in life
  • Fading of feelings of abandonment
  • A personal sense of recovery and higher energy
    levels
  • A new sense of respect for self and confidence in
    the ability to cope
  • Less fear of being alone
  • Times of peace
  • Growing interest in activities and beign with
    others

17
The Psycho-Spiritual Transformation Phase
  • A close death may trigger a profound,
    growth-oriented transformation that fundamentally
    changes beliefs and attitudes about life, death,
    love, compassion and the sacred
  • Human beings have natural drive towards
    transcendence, spirituality and religion
  • With honesty and time to address the complex
    cognitions and emotions involved, the experience
    of watching a loved one die can potentially be
    transformative

18
Spirituality and Meaning
  • Marks of a spiritual experience
  • Transcendence of the ego boundaries, feelings of
    unity with others, the world or with the divine
  • A person becomes aware of a higher power, a
    higher intelligence, purpose or order in the
    universe outside of hers/his control
  • The belief in afterlife might be the most common
    spiritual transformation observed in mourning
    people
  • Members of church groups viewed death
    significantly more frequently as a transformation
    of lifes meanings than did non-church
    participants viewing death more often as a
    barrier to lifes meanings
  • The ability to find meaning in suffering, to find
    a spiritual or transcendent purpose, is vital for
    optimal human functioning in the face of
    adversity (Victor Frankl, 1984)

19
Psychospiritual transformationCaregiving, Faith
and Joy
  • Caregiving
  • For some people the spiritual transformation
    phase of dealing with death may take on a form of
    philanthropic, political, or caregiving work
  • Faith
  • Acceptance of greater order, purpose, structure
  • Does not mean we give up our free will or desire
    to be in control exercising faith is a choice
  • Joy
  • After challenges of psychological reintegration
    and psychospiritual transformation many mourners
    are able to see the positive, joyful, and
    triumphant aspects of their mourning experience
  • Liberating aspects of the mourning process can
    lead to more strength, confidence, viewing things
    in a new perspective, more patience and
    compassion in everyday life

20
Complicated Mourning
  • Death of a loved one often the biggest stress
    situation we experience in life
  • Especially in cases of pre-existing psychological
    problems, death of a loved person can lead to
    marked and persistent cognitive disorganization
    and emotional turbulence
  • Three basic types of complicated mourning
  • Chronic grief reactions
  • Masked grief reactions
  • Exaggerated grief reactions
  • Chronic depression

21
  • Chronic grief reactions
  • Long duration (5-40 years) without reintegration
    and resolution
  • Marked by extreme cognitive confusion, repression
    of emotions leading to depression, apathy,
    illogical fears, panic attacks, hallucinations
  • Often results in neurotic or psychotic disorders
  • Psychological mummification cognitive denial
    and emotional repression leading to everyday
    activities as if the deceased did not die
  • Masked grief reactions
  • Complete absence of grief reactions
  • Repressed emotions resulting in psychosomatic
    problems headaches, insomnia, body pain or even
    heart attack and cancer

22
  • Exaggerated Grief Reactions
  • associated with repressed grief reactions from
    previous losses that erupt in response to a
    current loss
  • Manifest as phobias, panic reactions,
    psychosomatic symptoms, or psychiatric disorders
  • Clinical Depression
  • Mood disorder of deeper intensity and longer
    duration than the profound sadness and acute
    depression
  • Marked by sleep problems, loss of appetite and
    energy, feelings of hopelessness, guilt and even
    thoughts of suicide
  • Young children hyperactivity and aggressiveness
  • Adolescents and young adults negativism,
    antisocial behavior, and feelings of being
    misunderstood
  • Middle-age and older adults distractibility,
    confusion, memory loss

23
Individual differences in mourning
  • Adaptive denial
  • Can allow the individual time gradually handle
    and integrate a significant assault to their
    fundamental belief systems
  • Extended mourning
  • For some people there may not be an end to
    mourning and expecting all people to get over the
    loss in a certain time-frame does is not
    realistic
  • Absence of depression
  • Some people do not experience the distress of
    grieving and mourning, and are not in cognitive
    denial and emotional repression

24
EXAM 1 - SAMPLE QUESTIONS
  • Invisible Death
  • What does the term invisible death refer to?
  • Briefly discuss at least 3 factors that lead to
    the attitude of invisible death.
  • What are the three attitudes of invisible death
    through which the phenomenon manifests itself in
    our lives? Briefly outline an example for each of
    the three attitudes.
  • In class we discussed ethnic difference in
    attitudes towards death. Compare attitudes across
    two different ethnic groups of your choice.
  • How is the research in the field of thanatology
    and the death-education movement useful, if at
    all?
  • What are the three main causes of death in the
    USA?

25
  • What psychological attitudes can contribute to
    development of heart disease? How can emotion
    have impact on development of plaques in
    arteries?
  • How can development of cancer be influenced by
    psychological factors (make reference to the
    immune system)? What are the characteristics of
    cancer-prone individuals (discuss at least two of
    them)?
  • What are the stages of the disaster syndrome?
    Give an example for each of the stages.
  • What is post-traumatic stress disorder (at least
    three characteristics) and what is exposure
    therapy as a treatment of PTSD?
  • We discussed two basic models of stages of dying
    (Kubler-Ross and Pattison). Pick one of the
    models and discuss each of the stages. Critically
    discuss why you would prefer this model over the
    other.
  • What are the four basic categories of needs of a
    dying person that Corr discussed? Provide a brief
    example for each of the categories.

26
  • Discuss at least three out of the four dimensions
    of the near-death experience. Provide an example
    for each dimension.
  • What is the difference between grief and
    mourning? Describe at lease two characteristics
    of each using and example.
  • What are the four basic phases of mourning we
    discussed in class? Briefly discuss
    distinguishing features of each using an example.
  • Briefly discuss the three coping strategies.
    Provide an example for each.
  • Pick two kinds of complicated mourning. Discuss
    them briefly using an example.
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