Grief and Bereavement

Grief and Bereavement

Theories of Grief

·        Freud: work of mourning: detachment from person who has died. Healthy resolution when this is completed 

·        Kubler-Ross: Stages of terminal illness: denial, anger, bargaining, depression, and acceptance. But it‟s not sequential, and this only talks of emotions, not physical or behavioural dimensions

·        Worden: Tasks of mourning:

o   Accept reality of loss (harder if no body etc)

o   Experience pain of grief 

o   Adjust to an environment in which the deceased is missing (often very practical – change in roles etc) 

o   Withdraw emotionally and invest in new relationships (later he revised this to emotionally relocate the deceased and move on) – put the deceased in another place

·        Silverman:

o   There is a continuing bond between deceased and survivor

o  Stages:

§  Impact: this is not real

§  Recoil: I‟m going crazy, why am I worse now (can be months later) 

§  Accommodation: what do I carry with me? Being a living memorial – don‟t have to cut off – can move on and still carry something with them 

·        Stroebe et al: Dual process moving between expression of grief and containment of grief (women prefer former, men latter)

Characteristics of Grief

·        Reassure bereaved person that these are normal.  If overwhelming, seek help 

·        Emotional: bewildering and intense range or emotions without warning - shock, numbness, relief, anxiety, anger, blame, guilt, loneliness, helplessness, hopelessness 

·        Physical: hollow stomach, tight chest, breathlessness, weakness, lack of energy, ¯sexual desire, sleep disturbances, symptoms similar to person who died (this can be pathological) 

·        Cognitive responses:  disbelief, confusion, ¯concentration, going crazy, preoccupation 

·        Behaviours: searching, crying, sighing, absent minded, restless, ¯socialising, visiting/avoiding places that are reminders

 Coping with Loss 

·        Losses are a common cause of illness – they often go unrecognised

·        Conflicting urges lead to a variety of expression of grief – but there is a pattern 

·        Understanding factors that predict problems in bereavement enables these to be anticipated and prevented

·        Grief can be avoided or it may be exaggerated and prolonged

·        Doctors can help to prepare people for the losses that are to come

·        People may need permission and encouragement to grieve and to stop grieving

Factors Complicating Grief – Risk Factors for Pathological Grief

·        Dependent family members (children, handicapped, elderly)

·        Loss of primary care giver/constant companion

·        Loss of financial provision

·        Loss of home (feared or actual)

·        Anxiety about decisions

·        Unable to share feelings

·        Family discord

·        Uncontrolled pain/emotional distress before death

·        Concurrent life crisis

·        Prolonged reaction/suicidal thoughts

·        Lack of community support

Children’s Grief

·        It is not possible not to communicate to children (ie not telling them is not an option)

·        Help should start at the time of diagnosis

·        Talk about what won‟t change as a result of the illness

·        Maintain things that are important in a child‟s life (e.g. routines)

·        Talk about practical concerns

·        Provide extra stability, order, routine and physical affection

·        They need to know who will take care of them if key people leave or die

·        Offer reassurance

·        Children often assume responsibility for what has happened and feel very guilty

·        Offer clear, simple, truthful information: repeat, repeat, repeat

·        Don‟t use euphemisms (e.g. asleep – explain death, body stops working)

Signals for attention from a grieving child

·        Marked change in behaviour: illegal behaviour, persistent aggression (> 6 months), tantrums, withdrawal, drug abuse

·        Inability to cope with problems and daily activities

·        Many complaints of physical aliments

·        Persistent depressions, panic attacks

·        Change in school performance

·        Fearfulness for self, or for loved ones

Helping Families

·        Listen effectively

·        Foster communication

·        Engage siblings

·        Check social supports

·        Address symptoms

·        Provide constant factual data

·        Help build positive memories

·        Don‟t take offence