THE GRIEVING PROCESS AT END OF LIFE AND IN BEREAVEMENT

DR HELEN GREALLY

CANCER CARE WEST

ONE PERSON

SOMETIMES WHEN ONE PERSON IS MISSING, THE WHOLE WORLD SEEMS DEPOPULATED

ALPHONSE DE LAMARTINE (1790-1869)

GRIEF

• EMOTIONAL AFFECTIVE REACTION

• INCORPORATES DIVERSE PSYCHOLOGICAL AND PHYSICAL MANIFESTATIONS

MOURNING

• SOCIAL EXPRESSIONS OR ACTS EXPRESSIVE OF GRIEF SHAPED BY CULTURE AND SOCIETAL NORMS

COMMON ASSUMPTIONS

• PREDICTABILITY

• CONTROLLABILITY

• PERMANENCE

UNDERSTANDING GRIEF

• DEATH AS AN EVENT CAN VALIDATE OR INVALIDATE OUR CONSTRUCTED WORLD.

• WE LIVE BY A SET OF EXPECTATIONS AND ASSUMPTIONS:

• ORDER ABOUT OUR PASTS, FAMILIARITY WITH OUR PRESENT AND PREDICTABILITY ABOUT THE FUTURE.

• EXPERIENCES OF LOSS THAT FIT WITH OUR CONSTRUCTIONS OF THE WORLD CAN PROVIDE POWERFUL VALIDATION FOR OUR ASSUMPTIVE WORLD WHEREAS FORMS OF DEATH THAT ARE AT VARIANCE WITH OUR CORE ASSUMPTIONS CAN CHALLENGE THE ADEQUACY OF OUR MOST STRONGLY HELD BELIEFS.

GRIEF IS A PERSONAL PROCESS ONE THAT IS INTIMATE AND INEXTRICABLE FROM OUR SENSE OF WHO WE ARE AND OUR PLACE IN THE WORLD.

OUR IDENTITIES ARE SHAPED AS WE GROW OLDER BY BUILDING PERSONAL THEORIES OR INTERPRETATIONS OF EXPERIENCES WHICH WE ARE CONFRONTED WITH.

• GRIEVING IS SOMETHING WE DO NOT SOMETHING THAT IS DONE TO US.

• ALTHOUGH BEREAVEMENT IS A CHOICELESS EVENT BECAUSE WE WOULD NEVER CHOOSE TO HAVE THOSE WE LOVE DIE, HOWEVER, THE EXPERIENCE OF GRIEVING IS NOT.

• THE MOST BASIS CHOICE IS TO ACKNOWLEDGE THE DISTRESS OR DENY IT.

• CONCEIVING GRIEF AS AN ACTIVE PROCESS CORRESPONDS CLOSELY TO WHAT THE BEREAVED SAY.

• THERE ARE HUNDREDS OF CHOICES IN BEREAVEMENT TO THE POINT WHERE THE BEREAVED MAY FEEL OVERWHELEMED BY THE CHALLENGES THESE CHOICE BRING.

THE GRIEF JOURNEY

• THE STATIONS OF GRIEF

• UNIQUENESS OF EACH JOURNEY

• THE TASKS OF GRIEF

• COGNITIVE REHEARSAL WHEN THERE IS FOREWARNING OF THE DEATH

• THE SEARCH FOR MEANING

THE RIPPLE EFFECT

• THE INDIVIDUAL

• THE FAMILY

• THE COMMUNITY

BEREAVEMENT

NORMAL

GRIEF

Information / Awareness

Interpretation / Assimilation

Integration / Adaptation

SHOCK

• PHYSICAL

• DISBELIEF

• CONFUSION

• REGRESSION

• ALARM

• SLEEPING DIFFICULTIES

• PSYCHOLOGICAL

• PREOCCUPATION WITH DECEASED AND FACTS ABOUT DEATH

• DISTANCING

• EGOCENTRIC

AWARENESS

• PHYSICAL

• YEARNING

• CONFLICTING EMOTIONS

• FRUSTATION

• ANXIETY

• ONGOING STRESS

• PSYCHOLOGICAL

• SEARCHING

• SENSING THE PRESENCE

• SENSITIVITY

• NEED TO DENY REALITY

REALITY

• PHYSICAL

• WITHDRAWAL

• LACK OF SOCIAL SUPPORT

• REALITY/DESPAIR

• FATIGUE

• SLEEPING DIFFICULTIES

• PSYCHOLOGICAL

• CHALLENGING ASSUMPTIONS

• FEAROF CHANGE

• REVIEWOF EVENTS

• FACING GRIEF

DECISIONS

• PHYSICAL/ACTION

• DECISION MAKING

• FACING A CHANGED IDENTITY

• INCREASED ENERGY

• GLIMPSES OF HOPE

• PSYCHOLOGICAL

• MAKING SENSE

• ABLE TO LIVE WITHOUT

• CONTINUING RELATIONSHIP

• LIVING IN THE PRESENT

RENEWAL

• PHYSICAL

• NEW SELF AWARENESS

• ACCEPTING RESPONSIBILTY FOR SELF

• CARING FOR PHYSICAL NEEDS

• PSYCHOLOGICAL

• LIVING IN THE PRESENT

• LETTING GO OF GUILT

• LONELINESS

• BAD DAYS

• TIME FOR PROCESS OF GRIEF

THE PASSAGE OF TIME

• FIRST YEAR ACTS AS A BUFFER

• SECOND AND THIRD YEAR MORE DIFFICULT

• EXPECTATION TO ‘RECOVER’AFTER FIRST ANNIVERSARY

• POSITIVE REAPPRAISAL

TASKS

• EXPERIENCING EMOTIONS

• EXPERIENCING THE REALITY OF LOSS

• CHALLENGING ASSUMPTIONS

• THE SEARCH FOR MEANING

EMOTIONS

• SADNESS

• ANXIETY/ALARM

• FRUSTRATION

• ANGER : DECEASED, SELF, OTHERS, GOD

• GUILT/DEEDS/SURVIVOR

• ABANDONMENT

GRIEF CHARACTERISTICS

• PROTEST

• PREOCCUPATION WITH LOSS

• WAVES OF PAIN, AGITATION, TENSION

• VIGILANCE TO POSSIBILITY OF REAPPEARANCE OF LOST PERSON

GRIEF CHARACTERISTICS

• DESPAIR

• WITHDRAWAL OF ATTENTION FROM EVERYDAY LIFE

• LOW MOOD AND PERVASIVE SADNESS

• YEARNING

PERSONAL RISK FACTORS

• PERSONALITY TRAITS

• SELF ESTEEM LEVEL

• ATTACHMENT STYLES

• RELIGIOSITY

• GENDER

• AGE

• COPING STYLE

INTERPERSONAL RISK FACTORS

• LACK OF SOCIAL SUPPORT

• RELATIONSHIP BETWEEN THE DECEASED AND THE BEREAVED

• ACKNOWLEDGEMENT OF THE LOSS

• PREVIOUS LOSSES

SOCIAL SUPPORT

• DEPENDABLE

• RELAXATION

• GOOD LISTENER

• CHALLENGING

• GOOD FUN

• GRIEVING IS THE ACT OF AFFIRMING OR RECONSTRUCTING A PERSONAL WORLD OF MEANING THAT HAS BEEN CHALLENGED BY THE LOSS.

• RECONSTRUCTING A WORLD THAT RESTORES A SEMBLANCE OF MEANING, DIRECTION AND PREDICTABILITY TO A LIFE TRANSFORMED.

• THE TASK OF THE SUPPORTER IS TO HELP THE GRIEVER BUILD A BRIDGE BETWEEN THE PAST AND A CHANGING AND UNCERTAIN FUTURE.

• IN THIS WAY CLIENTS TELL AND RETELL THEIR STORIES IN ORDER TO MAKE SENSE OF THEIR LOSS.

• IN SO DOING, THE BEREAVED IS SEEKING SOCIAL VALIDATION FOR THE CHANGED CONSTRUCTION OF THEIR WORLD.

• GRIEF HAS A SIGNIFICANT SOCIAL DIMENSION.

• THE SELF, THE FAMILY AND BROARDER SOCIETY.

• THE INDIVIDUAL DIPS IN AND OUT OF MANY SYSTEMS WHILE GRIEVING AND MAY ACT DIFFERENETLY ACCORDING TO THE SYSTEM THEY ARE IN.

• THE FAMILY DYNAMIC REGULATES THE EXPRESSIONS OF GRIEF.

• THE BROADER COMMUNITY INFLUENCES GRIEF ALSO.

• EXPECTATIONS IMPOSED ON THE BEREAVED AND THE NORMS THAT REGULATE THE MOURNING PROCESS ARE SIGNIFICANT ISSUES FOR THE BEREAVED.

• WHILE GRIEVING, THE BEREAVED HAVE TO MAINTAIN THEIR RELATIONSHIP WITH THE LIVING.

WHAT HELPS

FOLLOWING GUT INSTINCT

GOOD SOCIAL SUPPORT

ONE OR TWO KEY PEOPLE

NOT FEELING JUDGED

NO MAJOR DECISIONS FOR AT LEAST 12/18 MONTHS

DEVELOPING A CONTINUING RELATIONSHIP WITH THE DECEASED

LEARNING TO LIVE WITH DECEASED IN ABSENCE RATHER THAN IN PRESENCE

BEING ABLE TO MAKE SENSE OF THE LOSS

THE JOURNEY OF LOSS

We should not lose sight that the journey of grief is as individual as

the person who makes it

ONLY A LITTLE WHILE

WE WERE TOGETHER

ONLY A LITTLE WHILE

AND WE BELIEVED OUR LOVE

WOULD LAST A THOUSAND YEARS

YAKAMOCHI (c. 716-785)

REFLECTION

• HOW DO THE ASSUMPTIONS THAT YOU BRING TO BEREAVEMENT CARE INFLUENCE HOW YOU SUPPORT BEREAVED PEOPLE