BEREAVEMENT

LOSS AND GRIEFLOSS AND GRIEF

DefinitionsDefinitions• BEREAVEMENT : this is the situation of anyone who has y

lost a person to whom they are attached.

• GRIEF: the psychological, social, spiritual, physical andGRIEF: the psychological, social, spiritual, physical and emotional reactions to loss.

• MOURNING: is the process of adaptation including• MOURNING: is the process of adaptation, including the cultural and social rituals prescribed as accompaniments.

• ATTACHMENT: a strong tendency to remain close to or, from time to time, to return to another individual.

• ANTICIPATORY GRIEF: psychological social, spiritual, physical and emotional reaction to anticipation of loss

DefinitionsDefinitions ...

• Pathological grief represents an abnormalPathological grief represents an abnormal outcome involving psychological, social or physical morbidityphysical morbidity.

• Disenfranchised grief represents the hidden sorrow of the marginalized wherehidden sorrow of the marginalized where there is less social permission to express many dimensions of lossmany dimensions of loss.

• Grief is universal. However shape and t t i lt ll d t i dcontent is culturally determined

DIFFERENT SORTS OF LOSS • Having children• Adoption• Children growing up

• Loss of hair/appearance• Ageing

Becoming parentsChildren growing up• Children leaving home• Children getting married

M i

• Becoming parents• Becoming grandparents• Still birth

• Marriage • Divorce• Separation

• Abortion• Miscarriage• Cot death

• Death of a pet• Loss of innocence• Loss of virginity

Cot death• Having a handicapped child• Rape

UnemploymentLoss of virginity • Unemployment

DIFFERENT SORTS OF LOSS……..

• Loss of face • RetirementLoss of face• Loss of security• Loss of faith

Retirement• Moving house,

school, workLoss of faith• Loss of bodily

function

,• Loss of income• Loss of creditfunction

• Incontinence• Loss of a limb

Loss of credit• Theft, burglary

• Loss of a limb• Loss of

hearing/eyesighthearing/eyesight

THE GRIEF WHEELTHE GRIEF WHEEL

(Goodall et al 1994)(Goodall et al 1994)

THE GRIEF WHEELTHE GRIEF WHEEL…..Shock

• Numbness• Denial and disbeliefDenial and disbelief• Emotions – unaffected, hysterical, euphoric• Thinking – unaffected, slowed, chaotic, efficient

A ti it ff t d l d ‘ d i ’• Activity – unaffected, slowed, ‘superdrive’• Suicidal thoughts

THE GRIEF WHEEL……

ProtestProtestSadnessA

• Dreams and nightmaresAnger

Guilt

g• Yearning• SearchingFear

Relief

Searching• Preoccupation• Physical distress• Physical distress

THE GRIEF WHEEL ……….THE GRIEF WHEEL ……….Disorganization

Confusion • LonelinessConfusionApathy and aimlessness

Loneliness• Concentration and

memory difficultiesaimlessnessLoss of interestRestlessness

y• Sadness• Loss of meaningRestlessness

Loss of confidenceLow self esteem

Loss of meaning• Loss of faith• HopelessnessLow self-esteem

AnguishDepreciation

• Hopelessness• Suicidal ideas• Decreased resistanceDepreciation

Anxiety• Decreased resistance

to illness

THE GRIEF WHEEL ……….

ReorganizationReorganization

DevelopmentDevelopmentPleasure in rememberingControl over rememberingControl over rememberingReturn to previous levels of functioningCh d lChanged valuesNew meaning in life

THE TASKS OF GRIEVINGTHE TASKS OF GRIEVING

• Task 1: Accepting the LossTask 1: Accepting the Loss

T k 2 F li th P i• Task 2: Feeling the Pain

• Task 3: Adjusting

• Task 4: Letting Go

TEN WAYS TO HELP THE BEREAVEDBEREAVED

1. By being there2. By listening in an accepting and non-judgmental way 3. By showing that you are listening and that you understand

something of what they are going throughg y g g g4. By encouraging them to talk about the deceased5. By tolerating silences6 By being familiar with your own feelings about loss and grief6. By being familiar with your own feelings about loss and grief7. By offering reassurance8. By not taking anger personally9. By recognizing that your feelings may reflect how they feel10. By accepting that you cannot make them feel better

FUNERALS/RITUALSFUNERALS/RITUALS

• SupportSupport• Ritual/ceremony

Vi l f t ti ith th d d b d• Visual confrontation with the dead body• Procession (public display)• Disposal of the body• Material expenditureMaterial expenditure

FUNCTIONS OF FUNERALS

• Confirm the reality of the death: viewing the body, saying f llfarewell

• Encourage the recognition and expression of emotions• Provide an opportunity to reflect on the deceased’s life• Provide an opportunity to reflect on the deceased s life• Provide the opportunity for action: maintaining order in

the face of chaos• Allow family and friends, the social network, to come

close and begin to reintegrate the bereaved person into the communitythe community

• Can provide a context of meaning• Serve as a vehicle for rehearsal of one’s own mortalityy• Confirm that community goes on in spite of death

POINTERS TO COMPLICATED GRIEF

1. It feels as if the loss happened yesterday, although when you askabout it you find out that it was a number of years agoabout it, you find out that it was a number of years ago

2. You feel that the emotion expressed by the person is out ofproportion to the loss they are describing

3 Th i l id t lki b t th l lth h th3. The person simply avoids talking about the loss, although they arehappy to talk about other things

4. The deceased is never mentioned, and there are no photographst di lor mementoes on display

5. The person has made radical changes in their life shortly after theywere bereaved

6. The person has phobias about illness and death, or is convincedthat they have a life limiting illness. They may have some of thesymptoms, though medical investigations prove negative

POINTERS TO COMPLICATED GRIEF

7. The deceased’s belongings remain untouched, they are talked

GRIEF…g g , y

about in the present tense, or the bereaved is very aware oftheir presence

8. The bereaved keeps their grief very close to them. They arep g y yconcerned that others will fail to understand how special thedeceased was and still is

9. There is an unaccountable sadness, repeated episodes ofp pdepression, or repeated suicide attempts

10. There are repeated relationship difficulties11. There is a long history of alcohol or drug abuse11. There is a long history of alcohol or drug abuse

MISCONCEPTIONSMISCONCEPTIONS• Unfortunately, misconceptions about grief keep us fromy, p g p

developing the courage we need to face grief. Many ofus fear that, if allowed in, grief will overwhelm usindefinitelyindefinitely

• The truth is grief experienced does dissolve. The onlygrief that does not end is grief that has not been fullyfaced. Grief unexpressed is like a powder barrel waitingto be ignited.

• We also misunderstand tears A slang expression for• We also misunderstand tears. A slang expression forcrying is to “break down”. We act as if weeping is wrongor akin to illness, while tears actually afford us anecessary release of our intense feelings

MISCONCEPTIONS……• If we truly loved someone, we will never finish with our

grief, as if continued sorrow is a testimonial to our love.But true love does not need grief to support the truth.We can honour the dead more by the quality of ourcontinued living than by constantly remembering thecontinued living than by constantly remembering thepainful past.

• Self-neglect is part of grief. Healthy grief, however,li lf S lf l t i t t ti i l t lrelies on self-care. Self-neglect is not testimonial to love.

Instead, our deceased dear one would want us to loveourselves and take good care of ourselvesg

• Grief cannot be finished. Our own physical, emotional and spiritual health can testify to our finishing, especially if we had been plagued with symptomsif we had been plagued with symptoms

RECOVERY• That we can grieve and recover often seems an amazing

feat, yet human resilience is amazing• Just as a forest can burn to the ground and eventually• Just as a forest can burn to the ground and eventually

grow anew, or a town can be devastated by a flood andrebuild, so each of us can be overcome by our grief,have the enormity of our loss overwhelm us and stillhave the enormity of our loss overwhelm us, and stilleventually recover and restore our lives. This is nature’swayGrief is a o nd that needs attention in order to heal To• Grief is a wound that needs attention in order to heal. Towork through and complete grief means to face ourfeelings openly and honestly, to express or release ourf li f ll d t t l t d t f li ffeelings fully, and to tolerate and accept our feelings forhowever long it takes for the wound to heal. For most ofus it is a tall order. Therefore, it takes courage to grieve

RECOVERYRECOVERY…..

It t k t f l i d t f th• It takes courage to feel our pain and to face theunfamiliar. It also takes courage to grieve in culturesthat mistakenly value restraint, where we risk the

j ti f th b b i diff trejection of others by being open or different.• Open mourners are willing to journey into pain, sorrow

and anger in order to heal and recoverg• We are finished when our grief feelings seem dissipated,

when we can think of the loss or the deceased withoutpain, and when we can incorporate the fact of death intopain, and when we can incorporate the fact of death intoour lives. Time is one of the most important ingredientsof healing

RECOVERYRECOVERY…..

• In many cases it is our lack of knowledge aboutIn many cases it is our lack of knowledge aboutgrief that increases our fear, despair,hopelessness, and helplessness when we facea major loss in our lives

• Hence, it is helpful to increase ourunderstanding and acceptance of grief as anormal, inevitable life experience. We can eachlearn to trust that although grief is painful it islearn to trust that although grief is painful, it ishealthy and surmountable and that grieving fullywill enable us not only to recover but also towill enable us not only to recover but also toexpand and grow

TYPICAL GRIEFTYPICAL GRIEF

Adapted from Keri (2003)Adapted from Keri (2003)

TYPICAL GRIEF…TYPICAL GRIEF…

Deeply involved but with many

th i t t

All wrapped in each otherother interests

and attachments

in each other

Understanding bonding, helps us understand griefg g g