This document discusses loss, grief, dying, and death. It defines key terms and outlines the historical overview of losses, including obvious losses like death and less obvious losses like illness or aging. It describes the stages of loss and dying, including denial, anger, bargaining, depression, and acceptance. The stages of grief are also outlined. The document discusses unresolved and dysfunctional grief and provides signs and symptoms. It notes that the duration of grief is expected to last weeks to over a year. Mourning and bereavement are also defined. The phenomenology of grief includes social withdrawal and restitution. Dying can imbue humans with values and a desire to make the most of their time.

1. Loss, Grief, Dying,
and Death
PreparedandPresentedBy
GlenChristie,MS,EdS,ThD,LPC,CASAC
FaithBibleCollege
CrisisCounselingII

2. Loss, Grief, Dying, and Death
Loss
An aspect of self no longer available to a person
Death
Cessation of life
Grief
Pattern of physical and emotional responses to bereavement
Grief Work
Adaptation process of mourning a loss
Mortality
The condition of being subject to death

3. Historical Overview
Not all losses are obvious or immediate
Obvious Losses
 Death of a loved one
 Divorce
 Breakup of a relationship
 Loss of a job
Not-So-Obvious Losses
 Illness
 Aging
 Changing schools, jobs, or neighborhoods

4. Historical Overview
Losses may be actual or perceived
Actual loss is easily identified
 A woman who has a mastectomy
Perceived loss is less obvious
 Loss of confidence
 A women who hopes to give birth to a female child delivers a
male child instead
 Perceived losses are easily overlooked or misunderstood, yet
the process of grief involved is the same as an actual loss

5. Historical Overview
Maturational Loss
 Loss resulting from normal life transitions
 Loss of childhood dreams, the loss felt when adolescents when a
romance fails, loss felt when leaving family home for college or
marriage and establishing a home of one’s own
 As an individual ages, they experience menopause and loss of
hair, teeth, hearing, sight, and “youth”

6. Historical Overview
Situational Loss
 A loss occurring suddenly in response to a specific external event
 Sudden death of a loved one, or the unemployed person who
suffers low self-esteem
Personal Loss
 Any loss that requires adaptation through the grieving process
 Loss occurring when something or someone can no longer be
seen, felt, heard, known, or experienced; individuals respond to
loss differently

7. When helping someone deal with the loss of a loved one the social worker
should:
- assess the impact of loss the deceased has on the bereaved
- be informed about the available formal and informal resources to
help minimize grief and isolation from family, friends and supporters
- be aware of their own feelings about death, dying, and the grieving
process, so that they may become more comfortable being physically
and emotionally present with clients and their loved ones
- identify literature, cultural experiences, and other ongoing education
about the ways in which your client(s) deal with death. Remember,
the client may be your best teacher

8. DeathAbsolute cessation of vital function
Not all vital functions terminate at the same time

9. Good Death
Free from avoidable distress and suffering for patients,
families, and caregivers

10. Bad Death
Needless suffering
Dishonoring of patient or
family wishes or values
Offending norms of decency

11. Dying
Losing vital functions
Natural process of birth-to-death continuum

12. Stages of Loss,
Death and Dying

13.  Denial
-”I feel fine.” “This cannot be happening to me.”
 Anger
-”Why me? It’s not fair!”
 Bargaining
-”I’ll do anything, can you stretch it out just a few more
years.”
 Depression
-”I’m so sad, why bother with anything?”
 Acceptance
-”I can’t fight it, I may as well prepare for it.”

14. The most commonly reported behaviors include:
-sleep disturbance
-altered appetite (over/under eating)
-absent mindedness
-social withdrawal
-dreams of the deceased
-avoidance behavior
-restlessness
-searching or calling out for the deceased
-crying, which is believed to relieve emotional stress

15. Shock and Denial
Stage 1

16. initial shock ,
disbelief, and
denial “No, not me”

17. After the initial shock has worn off, the next stage is
usually one of classic denial, where they pretend that
the news has not been given. They effectively close
their eyes to any evidence and pretend that nothing
has happened.
Interventions:
a.) Do not interfere unless it becomes destructive
b.) Do not support denial; conversations should
include reality
c.) Continue to teach and encourage self-care and
activities
Denial

18. Anger
Stage 2
“Why me!”

19. This stage often occurs in an explosion of emotion,
where the bottled-up feelings of the previous stages are
expulsed in a huge outpouring of grief. Whoever is in
the way is likely to be blamed .
Interventions:
a.) Give them space, allowing them to rail and
bellow. The more the storm blows, the sooner
it will blow itself out.
b.) Try not to respond in “kind”
c.) When anger becomes destructive, it must be
address directly. Remind person of
appropriate and inappropriate behavior

20. BargainingStage 3
“Yes me, but”

21. In this stage, the patient attempts to
negotiate a postponement, usually
with God and is generally kept a secret
Interventions:
a.) Spend time with patient
b.) Discuss importance of valued
objects and people

22. Depression
Stage 4
The inevitability of the news eventually (and
not before time) sinks in and the person
reluctantly accepts that it is going to happen
Interventions:
a.) Be available and don’t attempt to
cheer patient
b.) Find out about any religious
support

23. Acceptance
Stage 5
Restful time, but not necessarily happy.
Often begin putting their life in order,
sorting out wills and helping others to
accept the inevitability.
Interventions:
a) Plan care to allow person with whom
patient is comfortable to care for him/her
b) Important that you don’t withdraw.

24. Grief
subjective feeling
precipitated by
the death of a
loved one

25. Stages of Grief
Shock and disbelief
Yearning and protest
Anguish, disorganization, and despair
Identification in bereavement
Reorganization and restitution

26. Unresolved, Dysfunctional Grief
Bereavement is a state of great risk
physically, as well as emotionally and
socially.
Unresolved Grief
There have been some disturbances of
the normal progress toward resolution.
Dysfunctional Grieving
There is a delayed or exaggerated
response to a perceived, actual, or
potential loss.

27. Unresolved, Dysfunctional Grief
* Dysfunctional grief occurs when an
individual
* Gets “stuck” in the grief process and
becomes depressed
* Is unable to express feelings
* Cannot find anyone in daily life who acts
as the listener he or she needs
* Suffers a loss that stirs up other, unresolved
losses
* Lacks the reassurance and support to trust
the grief process and fails to believe that he
or she can work through the loss

28. Signs, Symptoms, and Behaviors
of Dysfunctional Grieving
a) Acquisition of symptoms belonging to
the last illness of the deceased
b) Alteration in relationships with friends
and relatives
c) Lasting loss of patterns of social
interaction
d) Actions detrimental to one’s social and
economic well-being
e) Agitated depression with tension,
insomnia, feelings of worthlessness,
bitter self-accusation, obvious needs
for punishment, and even suicidal
tendencies

29. Signs, Symptoms, and Behaviors of
Dysfunctional Grieving (continued)
a) A feeling that the death occurred
yesterday, even though the loss took
place months or years ago
b) Unwillingness to move the possessions
of the deceased after a reasonable
amount to time
c) Inability to discuss the deceased
without crying, particularly more that 1
year after the loss
d) Radical changes in lifestyle
e) Exclusion of friends, family members,
or activities associated with the
deceased

30. Duration of Grief
the bereaved is expected to
return to work or school in a
few weeks
to establish equilibrium within
a few months
to be capable of pursuing new
relationships within 6 months
to 1 year

31. Mourning
process by
which grief is
resolved
There is “a time to weep, and a time to laugh; a time to mourn, and a time
to dance” (Eccl 3:4, ESV).
“I walked a mile with Pleasure,
She chattered all the way,
But left me none the wiser
For all she had to say.
I walked a mile with Sorrow,
And ne'er a word said she,
But, oh, the things I learned from her
When Sorrow walked with me!”

32. Bereavement
deprived of
someone
by death

33. Feelings of bereavement can also accompany other losses
the loss of your health
the health of someone you care about
the end of an important relationship,
through divorce

34. Phenomenology
of Grief

35. social
withdrawal
Intense feelings of loneliness and
isolation, following the death of a
loved one, can sometimes become
so overwhelming that the
bereaved may withdraw from
social contact, which may mean
isolating themselves from support

36. restitution

37. Dying, and the
individual's awareness
of it, imbues humans
with values, passions,
wishes, and the
impetus to make the
most of time