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Grief

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Grief

  1. 1. Grief The reaction to loss 21 Feb 2014 Kornkanok Jaruch, MD
  2. 2. Outline 0 Definition 0 Basic task of grief 0 Descriptions of the grief process 0 Psychological manifestations of grief 0 Social manifestations of grief 0 Physiological manifestations of grief 0 Abnormal grief reaction 0 Anticipatory grief
  3. 3. Grief 0 The process of psychological, social, and somatic reaction to the perception of loss. 0 Based upon the unique, individualistic perception of loss by the griever
  4. 4. Bereavement 0 The state of having suffered a loss 0 Resolved grief
  5. 5. Mourning 0 A wide array of intrapsychic processes, conscious and unconscious, that are prompted by loss. (from psychoanalytic theory) 0 The cultural response to grief
  6. 6. Loss 0 2 kinds 0 Physical (Tangible) loss 0 Losing a desired possession 0 Having a friend die 0 Symbolic (Psychosocial) loss 0 Getting a divorce 0 Losing status because of a job demotion 0 An argument with a colleague
  7. 7. The basic tasks of grief Emancipation from bondage of the deceased Readjustment to the environment in which the deceased is missing Formation of new relationships
  8. 8. Emancipation from bondage of the deceased 0 “cathexis” when an individual cares about someone, he emotionally invests part of himself in that person 0 To withdraw the emotional energy that was invested in the person who is longer alive. 0 Movement along the continuum from a relationship of presence to a relationship of memory.
  9. 9. Readjustment to the environment in which the deceased is missing 0 To accommodate to the world without the presence of the deceased 0 To adopt new roles and skills to compensate for those functions that once were performed by the loved one.
  10. 10. Formation of new relationships 0 Based on the altered status of the loved one
  11. 11. Stage of grief  Lindermann  Shock and disbelief  Inability to accept the loss and occasionally the absolute denial that the loss has occurred.  Acute mourning  Acceptance of the loss, disinterest in daily affairs, weeping, feelings of loneliness, insomnia, and loss of appetite.  Resolutions of the grief process  A gradual reentry into the activities of daily life and a reduction in preoccupation with the image of the deceased.
  12. 12. Stage of grief  Bowlby, 1980  Phase of numbness  Phase of yearning and searching  Phase of disorganization and despair  Phase of reorganization
  13. 13. Stage of grief  Kubler-Ross (1969) Anger Bargaining Acceptance Depression
  14. 14. Psychological manifestations of grief 0 The avoidance phase 0 Shock, confused, dazed, unable to comprehend what has happened 0 Denial immediately crops up (therapeutic) 0 Emotional anesthesia 0 Disbelief and a need to know why the death occurred may appear at this time 0 The loss is recognized -> intellectualized acceptance of the death, followed by activities ex. Comforting of others, making funeral arrangement
  15. 15. Psychological manifestations of grief 0 Caution !! 0 When the mourner is denying the death 0 Denying the emotions stimulated by the death
  16. 16. Psychological manifestations of grief 0 The confrontation phase 0 Grief is experience most intensely in this phase 0 Angry sadness 0 Panic or generalized anxiety disorder 0 It is critical to assure the mourner that his feelings are normal and legitimate. 0 Anger to God, the doctors, the person who died, other who have not sustained the loss, and the bereaved person himself
  17. 17. Psychological manifestations of grief 0 The reestablishment phase 0 A gradual decline of grief and marks the beginning of the emotional and social reentry back into the everyday world. 0 The loss is not forgotten but be the memory.
  18. 18. Social manifestations of grief 0 Loss of normal patterns of conduct 0 Restlessness and inability to sit still 0 A painful lack of ability to initiate and maintain organized patterns of activities 0 Social withdrawal behavior that is antithetical to the establishment of new relations and the alleviation of stress
  19. 19. Physiological manifestations of grief 0 Anorexia and other gastrointestinal disturbances 0 Loss of weight 0 Inability to sleep 0 Crying 0 Tendency to sigh 0 Lack of strength 0 Physical exhaustion 0 Shortness of breath
  20. 20. Physiological manifestations of grief 0 Feelings of emptiness and heaviness 0 Feelings of “something stuck in the throat” 0 Palpitation 0 Nervousness and tension 0 Loss of sexual desire or hyper sexuality 0 Lack of energy and psychomotor retardation
  21. 21. Abnormal grief 0 4 type 0 Chronic grief reaction 0 Delayed grief reaction 0 Inhibited, suppressed 0 Postponed grief reaction 0 Exaggerated grief reaction 0 Masked grief reaction
  22. 22. Abnormal Grief Reaction  Factors that relate to abnormal grief reaction  High ambivalence relationship to the decease  more anger and guilt  highly narcissistic relationship : the decease as the extension of oneself  highly dependent relationship: helpless  Circumstance:  the death was not confirmed Ex. Soldier dead in the war  The death of many people in family
  23. 23. Abnormal Grief Reaction  Past history  early parental loss  insecure childhood attachments  ambivalent toward mother – first love objects  Personality  Can’t resist to emotional stress  Obstinate person  Social  loss of social support  Suicide, criminal abortion  uprooting
  24. 24. Prolonged grief disorder 0 DSM-V Criteria 0 experience 5 of 9 of these symptoms for 6 months or longer after loss 0 yearning, disbelief, bitterness over the loss 0 confusion about one's identity 0 a sense of numbness 0 distrust of others 0 a feeling that life is meaningless since the loss 0 difficulty accepting the loss 0 feeling stunned by the loss
  25. 25. 0 0 0 0 0 0 psychomotor retardation) (marked
  26. 26. To recovery from grief 0 3 tasks 0 Intellectual recognition and explanation of the loss 0 Develop an explanation of how the loss happened 0 Identified the inevitable cause of the death 0 Emotional acceptance of the loss 0 Finally reach a point where they no longer find the reminders of the loss too painful to face
  27. 27. To recovery from grief 0 Assumption of a new identity 0 The process begins as mourners become uncomfortably aware of the discrepancy between the world that is now and the world that was 0 Inevitably painful and time consuming
  28. 28. Anticipatory grief In dying patients and the families of the terminally ill Depression Heightened concern for the terminally ill person Rehearsal of the death Attempts to adjust to the consequences of the death
  29. 29. Anticipatory grief Absorbing the reality of the loss gradually overtime Finishing unfinished business with the dying person  Ex. Expressing feelings, resolving past conflicts Beginning to change assumptions about life and identity Making plans for the future so that they will not be felt as betrayals of the deceased after death
  30. 30. Anticipatory grief The Lazarus syndrome Occur when a patient is expected to die, the family members’ potential losses are as resolved as possible prior to death, and the patient goes into remission. The family members may be frustration, anger ,and resentment
  31. 31. Basic tasks of grief  Emancipation from bondage of the deceased  Readjustment to the environment in which the deceased is missing  Formation of new relationships Stage of grief -denial -anger -bargaining -depression -acceptance Prolong grief disorder experience 5 of 9 of these symptoms for >6 months  yearning, disbelief, bitterness over the loss  confusion about one's identity  a sense of numbness  distrust of others  a feeling that life is meaningless since the loss  difficulty accepting the loss  feeling stunned by the loss To recovery from grief • Intellectual recognition and explanation of the loss • Emotional acceptance of the loss • Assumption of a new identity JkPang
  32. 32. Pathological grief

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