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© 2007 Baylor College of Medicine
Introduction to Grief
and Bereavement
Teen Club Community Partners Training Programme
© 2007 Baylor College of Medicine
Definitions
� Bereavement: to have suffered the
death of a loved one
� Grief: emotional distress caused by
or as if by bereavement
� Mourning: an outward sign of grief
for a person’s death
© 2007 Baylor College of Medicine
Simplified…
Grief / Bereavement
The internal process
experienced after a loss
Mourning
The external process or outward
expression of grief/
bereavement
© 2007 Baylor College of Medicine
Four Tasks of Grieving / Grief Resolution (J.W. Worden)
1. Accepting the reality of the
death
2. Experiencing the pain of grief
3. Adjusting to life without the
deceased
4. Withdrawing emotional energy
from the deceased, and
reinvesting in others
© 2007 Baylor College of Medicine
Determinants that Effect the Grief Process
� Age of the survivor, and age of the
deceased
� Children express grief through behavior
�Talking evokes energy
� Teens need confidentiality and respect
�Focus is on current issues
�Often prefer discussion, infused with light conversation and humor
© 2007 Baylor College of Medicine
Determinants that Effect the Grief Process
� Nature of the relationship
� All relationships are unique and not equal
� Can be different even within the same family
� Unique relationship = unique grief process
� Survivor support system
� Resiliency dependent upon quality
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© 2007 Baylor College of Medicine
Determinants that Effect the Grief Process
� Resources of the survivor
� Mental, physical, support…
� Nature of the death
� Anticipated or unanticipated
�If anticipated may begin grief tasks sooner
� Cause and circumstances
© 2007 Baylor College of Medicine
Nature of the Death
� Illness
� Evokes issues around body and health
� Suicide
� Issues around abandonment, shame, social stigma
� Need to know they are not alone
� May want to share beliefs around why
person suicided
© 2007 Baylor College of Medicine
Nature of the Death
� Murder
� Issues around safety, loss of control, rage, powerlessness
� May include media coverage, legal investigation
� Feelings of desire for revenge
� Trauma symptoms
� Accident
� Issues around safety, loss of control
� Desire to share what they’ve been told and what they think happened
© 2007 Baylor College of Medicine
Violent Death
� Question their own belief system
� Guilt for not protecting deceased
� Stigma
� Postpone grief for legal proceedings to end
� Revictimized by the media
� Possibility of no body, or mutilated
remains
� Loss of support system
© 2007 Baylor College of Medicine
Complicated Grief (R.C. Simmons)
� Extended persistence of denial or
delayed/absent grieving
� Depression accompanied by
impaired self esteem and suicidal thoughts
� Develop medical illness/symptoms (vs. only somatic complaints)
© 2007 Baylor College of Medicine
Complicated Grief (R.C. Simmons)
� Progressive social isolation
� Persistent anger and hostility,
leading to often paranoid
reactions
� Preoccupation with memories of
deceased, to the point of searching for reunion
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© 2007 Baylor College of Medicine
Disenfranchised Grief
� Grief that is not openly acknowledged, socially validated, or publicly observed (K. Doka)
� Can pertain to:� Relationships
� Losses
� Grievers
� Deaths © 2007 Baylor College of Medicine
Disenfranchised Relationships
� Related to the “type” of
relationship
� If outside immediate family, not
afforded the “right” to grieve
� Unrecognized relationships
� “You hardly knew them.”
© 2007 Baylor College of Medicine
Disenfranchised Losses
� Unwilling to recognize a loss has
occurred for an individual
� “It wasn’t your child.”
� Alzheimer’s and Dementia
� Loss of body parts
� Selective abortion
© 2007 Baylor College of Medicine
Disenfranchised Grievers
� The griever is excluded from the
greater grief process
� Young children
� Mentally handicapped
� Elderly
� Unrecognized relationships
© 2007 Baylor College of Medicine
Disenfranchised Deaths
� Involves circumstances
surrounding the death itself
� Stigma
� AIDS, suicide, execution
© 2007 Baylor College of Medicine
Effects of Disenfranchised Grief
� Exacerbates bereavement
� Precludes social support
� Reinforces denial and avoidance
Death is not the ultimate tragedy –
the ultimate tragedy is dying
alone and grieving alone.
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© 2007 Baylor College of Medicine
THANK YOU
� Thank you to all our Partners