Normal Grief Reactions

1. Normal Grief Reactions

2. Grief • “an emotion or set of emotions due to a loss” • Grief is a normal reaction to loss. • The absence of grief is abnormal in most cases. • Grief is based on the individual perceptions of the loss by the griever.

3. Mourning • “an adjustment process which involves grief or sorrow over a period of time and helps in the reorganization of the life of an individual following a loss or death or someone loved” • Mourning is the process of adjustment and adaptation to the loss. • Mourning is driven by the social and cultural influences to which the griever is exposed.

4. Characteristics of Grief • Lindemann: • Somatic (bodily distress) • Preoccupation with the image of the deceased. • Guilt • Hostile reactions. • Loss of patterns of conduct (inability to function as before the loss)

5. Determinants of Grief • How the bereaved perceives the loss. • The bereaved’s age. • The age of the person who died. • The degree to which the bereaved was prepared for the death. • The bereaved’s inner strength and outer resources. • The nature of the relationship with the person who died.

6. Worden’s Grief Characteristics • Feelings • Physical sensations • Cognitions • Behaviors

7. Worden’s Tasks of Mourning Accept the reality of the loss. Experience the pain of grief. Adjust to an environment in which the deceased is missing. Withdraw emotional energy and reinvest in another relationship.

8. Psychological Factors Influencing Grief • Raphael: • The preexisting relationship between the bereaved and the deceased. • The type of death. • Previous losses.

9. Rando’s Psychological Factors • Meaning of the loss. • Qualities of the relationship. • Roles of the deceased. • Age of the griever. • Griever’s sex-role conditioning. • Deceased’s unique characteristics • Griever’s mental state • Griever’s maturity and intelligence. • Previous experience with loss.

10. Rando’s Psychological Factors (cont’d) • Cultural elements affecting the griever. • Fulfillment of the deceased’s life. • Context of the death. • Preventability of the death. • Timeliness of the death. • Expectation of death. • Length of illness. • Involvement with dying person. • Secondary losses. • Additional stressors.

11. Rando’s Sociological Factors • Available support systems. • Cultural background and context. • Socioeconomic status. • Funerary rituals.

12. Physiological Factors • Drugs and sedatives. • Nutrition. • Rest and sleep. • Exercise • Overall physical condition.

13. Theories of Grief • Freud: psychoanalytic • Lindemann: physical • Bowlby: relational • Parkes: clinical

14. Freud • “grief is a process by which libido (energy) is withdrawn from a love object • The grief process absorbs the energies of the ego. • Grief is normal, appropriate and necessary. • Grief is painful.

15. Lindemann • “Grief Syndrome” • Physical expressions of grief: • Somatic or bodily distress. • Preoccupation with the image of the deceased. • Guilt. • Hostile reactions. • Inability to function as one had before the loss.

16. Bowlby • “Attachment Theory”: 4 aspects • Strength of attachment. • Security of attachment. • Reliance. • Involvement.

17. Parkes • Clinical viewpoint • Describes the experience of grief as a normal reaction to overwhelming loss. • Describes somatic distress as “pangs”. • Resistance to change and a reluctance to give up possessions, people, status and expectations are the basis of grief.

18. Complicated Grief (Unresolved, Chronic)

19. Canine’s Variable That Can Obstruct the Grief Process Past Losses (Worden: Historical Factors) Death Surround (Worden: circumstantial Factors and Relational Factors) Social Issues: (Worden: Social Factors And Personality Factors) (Lazare: 3 conditions) Abnormal Grief Responses (Worden: Abnormal Grief Reactions)

20. Worden’s Abnormal Grief Reactions Chronic Grief Reaction Exaggerated Grief Response Delayed Grief Response Masked Grief Response

21. Therapeutic Strategies • Reaching out to the bereaved. • Rituals of bereavement. (Funeral Rites) • Resolving complicated grief. • Expectations for closure. • 4 behaviors: acceptance of feelings detachment from the deceased reestablishment of relationships restoration of wholeness