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Living with Grief Living with Grief –– After After Sudden LossSudden LossKenneth J. Doka, PhD
Professor of Gerontology, The College of New Rochelle
Senior Consultant, The Hospice Foundation of America
An InterAn Inter--Cultural DialogCultural Dialog
“The United States and Great Britain are two countries separated by a common language.” (attributed to G. B. Shaw)
My context is American – so you need to constantly ask – Do the same conditions and factors apply in the UK?
GoalsGoals
To briefly review factors common to sudden loss and delineate some factors unique to particular types of sudden loss
To offer some comments on ways to assist survivors of sudden loss
When Grief Is SuddenWhen Grief Is Sudden
The dual challenge
The challenge of grief
The challenge to our assumptive world – benevolence, meaning and fairness, identity, and predictability
Sudden LossSudden Loss Common FactorsCommon Factors
Loss of the assumptive world
The issue of grief + trauma
Suddenness, unfinished business ( and the role of ritual)
Issues of preventability
Powerlessness
Missing or disfigured body
Intense reactions (possibly including anger, rage, anxiety, and survivor guilt)
RynearsonRynearson’’ss The 3 VThe 3 V’’s of Violent s of Violent DyingDying
1. Violence – injurious action
2. Violation – transgressive
3. Volition – someone is responsible (commission or omission)
Sudden LossSudden Loss Unique Factors to Natural Sudden DeathsUnique Factors to Natural Sudden Deaths
Can include heart, attacks, strokes, aneurisms etc.
Issues of personal culpability
Death situation – did person witness, did person die alone, un- helped, failure to help etc.
Sudden LossSudden Loss Unique Factors to AccidentsUnique Factors to Accidents
Issues of culpability
Legal after-effects and adversarial legal system
Sudden LossSudden Loss Unique Factors to Homicide Unique Factors to Homicide
Stigma and disenfranchisement
Often relationship with both victim and perpetrator
Even if the survivor was not a witness, they may still have fantasized intrusive imagery – strong imaged of the imagined event (Blakley, 2009)
The media
Criminal justice system
Secondary Victimization Secondary Victimization HomicideHomicide
Refers to individual victims of homicide feeling an additional sense of being victimized after the homicide such as by the media which may denigrate the reputation of the deceased victim or the criminal justice system which might not capture the perpetrators, fail in prosecution, or besmirch the victim’s reputation in court proceedings.
Sudden LossSudden Loss Unique Factors to SuicideUnique Factors to Suicide
Conflict and ambivalence
Stigma and disenfranchisement
Family stigma and feelings of guilt and preventability
Spiritual issues and suicide
Strained support
Multiple loss
Concurrent crises
A process that likely includes significant disenchantment
Sudden LossSudden Loss Unique Factors to Public Tragedy or DisasterUnique Factors to Public Tragedy or Disaster
RynearsonRynearson’’ss Restorative Restorative RetellingRetelling
Persons may often review and re-enact event
May see themes of remorse (“I should have prevented this.”)
Retaliation (“I will get someone for this.”)
Over-protection (“This will not happen again.”)
Finally restorative retelling allows one to find some sense of meaning in the loss.
What Can Help?What Can Help?
Choices in grief
Catherine Sanders Phases– Shock– Awareness of loss– Conservation and
Withdrawal– The Turning Point– Renewal
Worden’s Tasks
Accepting RealityAccepting Reality
The role of funeral and other rituals
Talking about the loss freely
Experiencing EmotionsExperiencing Emotions
No need to bottle feelings
Understanding ambivalence and finishing business
Planning for difficult times
Adjusting to Life without the Adjusting to Life without the PersonPerson
Assessing change
Coping (and assessing) with loneliness
Drawing from strengths – and avoiding past weaknesses
Secondary losses
Getting Support (D, L, R)
Continuing the BondContinuing the Bond
Building in moments to remember or reaffirmSanders’ Questions
1. What do I wish to take from my old life into my new life?
2. What do I wish to leave behind?
3. What do I need to add?
Reviewing Faith and Meaning Reviewing Faith and Meaning
The challenge to our spirituality and assumptions
How does your faith or philosophy speak to you?
What resources does it offer (beliefs, practices, rituals, community)?
Resources for Your StruggleResources for Your Struggle
Books
Counseling
Self-Help Groups
Support GroupsSupport Groups
Validation
Ventilation
Respite and Support
Learn Coping Techniques
Lund – Helping others helps self
Support Groups Support Groups –– Possible Possible DangerDanger
The Danger of Shared Anguish in a poorly led group
The Need for an IntakeProcess
Creating RitualsCreating Rituals
The Value of Rituals
Types of Ritual– Continuity– Transition– Reconciliation– Affirmation
Caregiver StressCaregiver Stress The Role of The Role of Secondary Secondary
TraumatizationTraumatization
Secondary traumatization refers to the trauma that results from helping traumatized individuals as their stories challenge the caregiver’s assumptive world
This can add to caregiver stress