LOSS AND GRIEF

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Loss and Grief
The Aging Survival Kit
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Grief A Universal Experience

• To spare oneself from grief at all cost can be
  achieved only at the price of total detachment,
  which excludes the ability to experience
  happiness.
• Erich Fromm (1900-1980)

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Five Stages of Grief(Kubler-Ross, 1969)

• Denial The initial stage It cant be
  happening.
• Anger Why ME? Its not fair?! (either
  referring to God, oneself, or anybody perceived,
  rightly or wrongly as responsible)
• Bargaining Just let me live to see my son
  graduate.
• Depression I am so sad, why bother with
  anything?
• Acceptance Its going to be OK.

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Five Stages of Grief, Continued

• These stages of grief do not come in order. They
  can be applied to any form of catastrophic life
  losses
• Loved One
• Employment
• Home
• Income
• Freedom
• According to Kubler-Ross a person simultaneously
  experiences two of the stages at any given time.

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Understanding Loss(Rando, 1984)

• Avoidance Shock, denial, disbelief, confusion,
  disorganization.
• Confrontation highly emotional state wherein
  the grief is most intense and the psychological
  reactions to loss are felt most acutely.
• Reestablishment gradual decline of the grief
  and marks the beginning of an emotional and
  social reentry back into the everyday world (pp.
  28-29).

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Understanding Loss, Continued

• According to Rando, the griever will
• Acknowledge, accept, and understand the reality
  of the loss.
• Experience the pain of the grief and react to the
  separation from that which is lost.
• Adapt a new way of life.
• Reinvest in a new way of life.

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Anticipatory Mourning(Rando, 2000)

• The phenomenon encompassing seven generic
  operations
• Grief
• Mourning
• Coping
• Interaction
• Psychosocial reorganization
• Planning
• Balancing conflicting demands
• Facilitating an appropriate death (p. 51)

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Disenfranchised Grief(Doka, 2002)

• According to Doka this grief is experienced in
  connection with a loss that is not socially
  acknowledged, publicly shared, or supported
  through usual rituals. The significance of the
  loss is either not recognized or the relationship
  between the deceased and the bereaved is not
  socially sanctioned, the person suffering the
  loss is given little or no opportunity to mourn
  publicly. It is experienced when the relationship
  is not recognized (lovers, ex-spouses, same-sex
  partners, close friends), when the loss itself is
  not recognized (stillbirth, miscarriage,
  abortion, adoption, pet loss), when the griever
  is not recognized (very young, very old,
  developmentally disabled). The manner of death
  itself can be disenfranchising (murder, suicide,
  AIDS). When such deaths are treated as less than
  significant losses, the process of grieving
  becomes more difficult.

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The Grief Process(Worden, 1982)

• The Tasks of Grief
• To accept the loss
• Experience the pain
• Adjust to the new environment
• Reinvest in the new reality

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Complicated Grief(Worden, 2001)

• Chronic Grief One that is prolonged, is
  excessive in duration, and never comes to a
  satisfactory conclusion.
• Delayed Grief Emotion that has been inhibited,
  suppressed, or postponed. A subsequent loss may
  elicit an exaggerated reaction because the
  bereaved is grieving for two losses.
• Exaggerated Grief Occurs when feelings of fear,
  hopelessness, depression, or other symptoms
  become so excessive that they interfere with the
  daily existence of the bereaved.
• Masked Grief Symptoms and behaviors experienced
  by a person who does not recognize the fact that
  these are related to a loss.

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Case Study

• Mr. and Mrs. B. have been married for 50 years.
  They have been in good health and have been
  enjoying retirement (traveling, seeing their
  grandchildren and sleeping until noon!)
• Both Mr. and Mrs. B. will be turning 70 this year
  and the family are planning a BIG surprise party.
• One morning Mrs. B. wakes up and she can not move
  the left side of her body. Mr. B. calls an
  ambulance and the family physician. Mrs. B. is
  taken to the hospital.

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Case Study, Continued

• Upon Mrs. B.s arrival at the hospital you have
  been assigned as her social worker. You have just
  been to a workshop on loss and grief and have
  been reviewing the powerpoint (Yes, this one!).
  What do you consider to be the most pressing
  medical, psychosocial, and spiritual concerns
  that they will both face?
• What will grief look like to
• Mr. B
• Mrs. B
• Their family (all 30 people!)
• How will you, as the social worker, provide a
  therapeutic intervention that will meet their
  needs.
• Is meeting everyones needs possible or
  realistic?

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Who Dies?(Levine, 1982)

• How much of what we call grief is the experience
  of previous loss? And how do we allow such grief
  not to be a motivator for our life? How do we get
  in touch with that deep pain, that place of loss
  that creates a fear of life itself, our doubt in
  ourselves about our ability to deeply experience
  the world because we so fear loss and change?

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Bibliography

• Gehlert, S., Browne, T.A. (2006). Handbook of
  Health Social Work. Hoboken, NJ John Wiley
  Sons, Inc.
• Levine, S. (1982). Who Dies? An Investigation of
  Conscious Living and Conscious Dying. New York
  Anchor Books.
• Kubler-Ross, E. (1973). On Death and Dying. New
  York Routledge.
• Kubler-Ross, E., and Kessler, D. (2005). On Grief
  and Grieving Finding the Meaning of Grief
  Through the Five Stages of Loss. New York
  Scribner.