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Grief Across the Life Cycle

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Hostility- 'Why should it happen to me' ... Try to rescue or solve their problems. Say 'I know how you feel' or use other cliches ... – PowerPoint PPT presentation

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Title: Grief Across the Life Cycle


1
Grief Across the Life Cycle
Some Tips for the Caring Professional
  • by Dr. Stan Wilson

2
Two Considerations
  • Anticipatory Grief of Death Dying
  • Participatory Grief of Bereavement

3
Terminal illness
A Definition
  • Any irreversible illness that does not respond to
    curative treatment modalities and will result in
    death in a relatively short period of time.

4
Key points to this definition
  • Irreversible
  • Does not respond to treatment
  • Stopping curative treatment is not the same as
    stopping care!
  • Relatively short
  • How long is a relatively short period of time?

5
we are all terminal . . .
6
Issues of the terminally ill
Confronting problems
  • fears
  • of helplessness
  • of being alone
  • of being dead
  • of pain and suffering
  • of being a burden
  • of humiliation

7
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8
Fears, continued
  • of unfinished business
  • of separation of loved ones
  • of care of those left behind
  • of punishment
  • of impairment or limitations
  • of the unknown
  • of financial ruin
  • of loss of emotional control

9
Fears, continued
  • of unfinished business
  • of separation of loved ones
  • of care of those left behind
  • of punishment
  • of impairment or limitations
  • of the unknown
  • of financial ruin
  • of loss of emotional control

10
Understanding age sensitive concerns
  • 20's
  • leaving family that they love
  • how love ones will cope
  • financial burdens
  • lack of significant accomplishment

11
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12
Understanding age sensitive concerns
  • 30's
  • fear of pain
  • abandonment of children
  • guilt
  • not living to see children growing up
  • end of productivity
  • loss of control

13
Understanding age sensitive concerns
  • 40's
  • welfare of children, spouse
  • financial security of survivors
  • dread of separation

14
Understanding age sensitive concerns
  • 50's
  • welfare of families
  • anxiety concerning drawn out death, suffering
  • fear of being kept alive beyond hope of recovery

15
Anger
  • Anger may be fueled by fear, anguish, loss
  • Crisis anger v. grief anger
  • Targets of anger
  • The person who died
  • People and agencies who try to help
  • God
  • Those still living
  • Perpetrator
  • Anger at ones self (survivors)

16
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17
Anger and Coping
  • Can be used to express pain of grieving.
  • May motivate survivors to become more physically
    active.
  • May precipitate involvement in purposeful
    activities.
  • Can be form of righteous indignation.
  • Can help survivors continue to live long enough
    to find other reasons to keep on living.
  • Anger maintains connections or relationships with
    the deceased.

18
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19
Anger can hinder grieving
  • May get stuck in anger and not be able to mourn
    or grieve.
  • Can inhibit and interfere with relationships.
  • May be used to avoid grieving
  • Revenge fantasies (restoring power)
  • Compensation fantasies (payment for loss)
  • Forgiveness fantasies (transcending, may be used
    to bypass anger)

20
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21
Guilt
  • Guilt about preparations for death
  • Guilt about lifestyle changes
  • Guilt about negative thoughts or feelings about
    the person who died
  • Guilt about surviving
  • Guilt confuses survivors

22
Shame
  • Shame about how someone died
  • Shame about reactions to the death or the death
    notification
  • Shame over relief
  • Shame over ones own circumstances after someone
    dies
  • Shame imposed by society

23
Kinds of losses
  • Loss of life
  • Invasion of body
  • Loss of limb, physical capability
  • Loss of beauty, self-image
  • Loss of memory
  • Loss of sensorial perception

24
Guilt
  • Guilt about preparations for death
  • Guilt about lifestyle changes
  • Guilt about negative thoughts or feelings about
    the person who died
  • Guilt about surviving
  • Guilt confuses survivors

25
More Kinds of losses
  • Material losses
  • money, expenses incurred, sentimental property,
    pets, home, car
  • Intangible losses
  • trust, faith, identity, history and connection to
    the future, time, values, will to live, feeling,
    innocence, hope

26
Traumatic Grief
  • Crisis reactions complicate grieving.
  • No time to say good-bye.
  • Pre-existing problems complicate sorrow.
  • Relationships complicate sorrow.
  • Attributes of particular types of deaths.
  • Grief may be minimized or denied.
  • Everyone grieves differently.
  • Spasms of grief may last a lifetime.

27
The Six Rs of mourning
  • Recognize the loss
  • React to the missing
  • Recollect the missing
  • Relinquish attachments
  • Readjust to a new world
  • Reinvest in the world around you
  • Theresa Rando, 1993

28
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29
Bereavement
Grief An anxiety over loss/separation(or
apprehension of such) of relationships ordinarily
meaningful, crucial, or significant.
  • Loved one
  • Aspect of self
  • Externals
  • Developmental
  • Existential

30
Your Particular Grief is unique
Shapers of your Particular Grief
  • the nature and depth of your unique relationship
  • the manner of death and loss
  • previous experience with grief
  • Multiple loss--it can make you stronger or
    weaker!!!

31
Your Particular Grief is Unique
  • timeliness or untimeliness of the loss
  • spiritual resources of the mourner
  • the extent of the network of supportive
    relationships
  • emotional resources
  • your own cultural conditioning

32
Everyones Grief is Unique
33
Your Particular Grief is unique
Shapers of your Particular Grief
  • the nature and depth of your unique relationship
  • the manner of death and loss
  • previous experience with grief
  • Multiple loss--it can make you stronger or
    weaker!!!

34
Everyone reacts differently
35
Kinds of Grief
Anticipatory Grief (threatened loss)
  • additional coping devices
  • shock,
  • numbness,
  • hyperactivity,
  • humor,
  • existential search,
  • discipline of prayer.

36
Anticipatory grief
37
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38
Traumatic or Sudden Grief
  • dynamics
  • shock,
  • alarm,
  • disbelief,
  • panic,
  • numbness,
  • recovery

39
Kinds of Grief
No-End Grief
  • illustrations
  • divorce,
  • physical handicaps,
  • birth defects, etc.,.

40
Kinds of Grief
Near Miss Grief
  • illustrations
  • combat,
  • near miss accidents,
  • Cancer diagnoses.

41
Near-miss grief
42
Categories of Loss
Actual, Threatened, Perceived
  • Concrete Loss
  • Abstract loss

43
ABNORMAL GRIEF
(Eric Lindeman, Symptomatology and Management of
Acute Grief, AJP, 1944)
  • A. Delayed Reactions- may involve years
  • B. Distorted Reactions
  • Over activity without a sense of loss
  • the acquisition of symptoms belonging to the last
    illness of the deceased.
  • certain psychosomatic diseases

44
Distorted Reactions
  • alteration in relationship to significant others.
  • furious hostility against specific persons.
  • hidden personality
  • lasting loss of patterns of, social interaction
  • social patterns detrimental to own socia1 or
    economic existence
  • agitated depression

45
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46
Assessing Complicated Bereavement
47
Factors that make assessment difficult
  • Uniqueness of Grief experience
  • Cultural factors in grief
  • Lack of knowledge of previous patterns
  • Unknown emotional problems
  • Confusion--what is abnormal?

48
Factors, continued
  • Acute grief impossible to measure distortion
  • The nature of delayed responses
  • Previous psycho social instability

49
  • Complicated Bereavement

50
Questions to ask in assessment instruments
  • Avoiding pain?
  • Attempts to retrieve lost person
  • Reasserted psychological problems
  • Relationship was ambivalent or hostile

51
  • Sudden or traumatic loss
  • Emotional release stunted
  • Overwhelming reality-based demands
  • Adequate social support
  • History of multiple losses

52
  • Unusual circumstances
  • Overly stoic personality
  • History of Clinical depression
  • Internalized anger
  • Absence of intense emotion

53
  • Inappropriate behavioral changes
  • Overly idealize the deceased
  • Continue to withdraw
  • Increased illness
  • Noticeable personality changes

54
  • Severe undiminished
  • Guilt
  • Anger
  • Phobias
  • Loss of interest in life
  • Increase drug alcohol use
  • Extreme self-reproach

55
Common Grief Reactions
Physical/Behavioral
  • Fatigue
  • Social withdrawal
  • Hollowness in stomach
  • Dreams of deceased
  • Tightness in chest or throat

56
Physical/Behavioral
  • Searching behavior
  • Over sensitivity to noise
  • Sighing
  • Sense that nothing is real
  • Restless/over activity
  • Breathlessness

57
Physical/Behavioral
  • Crying
  • Weakness
  • Visiting places as reminders
  • Dry mouth

58
Remember, everyones reaction is unique
59
Physical/Behavioral
  • Treasuring objects
  • Lack of energy
  • Appetite disturbance
  • Sleep disturbance

60
Emotional/Mental
  • Sadness
  • Over sensitivity to behavior of others
  • Anger
  • Inability to focus/concentrate
  • GuiltNumbness

61
Emotional/Mental
  • Anxiety
  • Disbelief
  • Loneliness
  • Confusion
  • Helplessness
  • Preoccupation
  • Shock

62
Emotional/Mental
  • Sense of presence of deceased
  • Emancipation
  • Hallucinations
  • Jealousy
  • Inability to make decisions
  • Absent-minded
  • Relief

63
Grief Dynamics
  • Not steps
  • Ways of Viewing the Grief Process

64
Dr. Elisabeth Kübler-Ross
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

65
Carl Nighswonger
  • The Drama of Shock
  • The Drama of Emotion
  • The Drama of Negotiation
  • The Drama of Cognition
  • The Drama of Commitment
  • The Drama of Completion

66
Wayne Oates
  • Shock
  • Numbness
  • The Struggle Between Fantasy and Reality
  • The Flood of Emotion
  • Selective Memory
  • Commitment

67
The Rituals of Grieving
  • Denial- It cant be
  • Release- (tears and emotion)
  • Depression/Isolation/Self-pity- No one
    understands
  • Physical Symptoms- I just cant go on

68
The Rituals of Grieving
  • Panic/Anxiety- I cant make it
  • Guilt- Why didnt I... If I had only...
  • Hostility- Why should it happen to me
  • Inability to do normal activities- I dont want
    to go out

69
The Rituals of Grieving
  • Social Sharing- Now with my situation...
  • Rituals and Appeasements- Ill do this right
  • Hope- Someday Maybe this will work
  • Acceptance/Readjustment/Integration/Redefining
    our lives - Ill get on with it

70
Supporting the One Grieving
DO
  • Be yourself
  • Be a non-judgmental, non-advice giving listener
  • Don't be afraid to touch if appropriate
  • Cry
  • Call before visiting
  • Show up when you say you will
  • Offer specific, practical help

71
Not everything is helpful
72
DON'T
  • Try to rescue or solve their problems
  • Say "I know how you feel" or use other cliches
  • Force joviality
  • Avoid intimacy
  • Avoid eye contact
  • Commit to more than you can realistically do
  • Do all the talking

73
YOU ARE RESPONSIBLE FOR
  • Being self-aware and in control
  • Encourage them to grieve in their own way
  • Being consistent and stable
  • Knowing when and how to let go
  • Taking care of yourself

74
YOU ARE NOT RESPONSIBLE FOR
  • Making the pain go away
  • Making everyone happy
  • Having all the answers
  • Being their all the time
  • Always being sharp or in a good mood
  • Making people have the same values or priorities
    that you have

75
Not everything is helpful
76
Remember . . .
  • Grief is work
  • It takes along time!
  • Grief is a spasm
  • Grief is the ultimate self-absorbed phenomena
  • Everyones grief is unique
  • Without God, we grieve as those without hope
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