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Question 1

The reactions of the body to an event often experienced emotionally as sudden, violent and upsetting disturbance.

Answer 1

Feelings

Question 2

• Shock/disbelief/denial- Sadness- Loneliness - Guilt- Anger- Anxiety- Crying- Preoccupation with thoughts of the deceased- Dreams/nightmares- Confusing awake events

Answer 2

Emotional responses

Question 3

Usually occurs with sudden deaths, but may also be seen with a prolonged illness. This is a defense mechanism to allow the person tie to adjust to the situation. It is usually short term.

Answer 3

Shock/disbelief/denial

Question 4

Can be felt for the deceased for the suffering he may have had or because he will no longer be able to experience life. This is also felt for oneself and one’s own loss.

Answer 4

Sadness

Question 5

Even if the mourner has many other friends and is involved in different social or family activities, he may still experience feelings of this.

Answer 5

Loneliness

Question 6

Blame directed at oneself and may be based on real or unreal conditions.- May be real or perceived. Often these feelings are exaggerated because the death does not allow the person to resolve the issue that caused this with the deceased.

Answer 6

Guilt

Question 7

Can be directed at the person for dying and leaving, at God for not preventing the death, toward other people, or even toward oneself.

Answer 7

Anger

Question 8

A state of tension typically characterized by rapid heartbeat and shortness of breath. An emotion characterized by a vague fear or premonition that something undesirable is going to happen.- Can range from mild insecurity to intense panic. Fear of one’s own death or fear of how life will be without the deceased person may cause this.

Answer 8

Anxiety

Question 9

Whether considered a physical or emotional response, has a therapeutic value. It diminishes the negative effects of pent-up emotions and relieves stress.

Answer 9

Crying

Question 10

This may cause absent-mindedness or the inability to concentrate. These thoughts may not only be of the past life of the deceased, but also fantasies about the deceased still being alive.

Answer 10

Preoccupation with thoughts of the deceased.

Question 11

May be very distressful to a mourner and increase his feelings of guilt, fear, and anxiety. Pleasant dreams of the deceased may give the person a feeing of reassurance and calm.

Answer 11

Dreams/nightmares

Question 12

Although these are considered by many people to be paranormal or spiritual happenings, all have a firm foundation in reality and psychology. They include seeing or hearing the deceased or feeling as though the deceased is present or directing events.

Answer 12

Confusing awake events

Question 13

• Strengthening of a person’s spiritual beliefs- Weakening of a person’s spiritual beliefs - Causing questions as to the meaning of life and death, beliefs, and values.

Answer 13

Spiritual responses

Question 14

• Preoccupation with death- Inability to concentrate- Disorganized thoughts- “I wish I could have a few more minutes with”- “I wish it would have been me”- “It all seems like a bad dream”- Sense of presence, seeing, hearing loved one- Suicidal thoughts- Inability to remember- Easily distracted- “Why”- “I think I am going crazy”- “If only…”

Answer 14

Cognitive responses (Thinking)

Question 15

• Doing or saying things contrary to beliefs or accustomed behavior- Staying inside all the time or needing to stay away from home- Frequent visits to the gravesite, church or places associated with the deceased- Loss of interest in social activities and the world in general- Sleep disturbances, i.e., trouble getting to sleep, staying asleep, troubled dreams.- Changes in eating habits and appetite, social withdraw- Increase in chemical use- Frequent crying or angry outbursts

Answer 15

Behavioral responses (actions)

Question 16

• Sighing- Headaches- Startle response- Crying- Menstrual difficulties - Dizziness- Fatigue- Trembling- Muscular tension- Insomnia - Emptiness in gut- Appetite loss- Stomach problems- Something stuck in throat- Lowered immunity to illness- Sexual desire changes- Shortness of breath- Increased/decreased activity

Answer 16

Physical responses

Question 17

• Negative thoughts- Confusion - difficulty concentrating- Lower productivity - Sleeplessness- Forgetting details- Mind going blank

Answer 17

Mental responses

Question 18

• Emotional responses- Spiritual responses- Cognitive responses- Behavioral responses- Physical responses- Mental responses

Answer 18

Normal Grief Reactions (chapter 5)

Question 19

1. Normal coping behavior2. Number of previous losses and deaths3. Grief overload4. Concurrent stressors5. Expectations of local, cultural, and religious groups6. Available support network7. Gender conditioning8. Physical and mental health9. Pre-death adjustment time10. Unfinished business with the deceased11. Secondary losses12. Importance of the relationship13. Age of deceased14. Fulfillment of dreams

Answer 19

Determinants of grief (chapter 6)

Question 20

Past coping behaviors (anger, physically ill, cries, turns inward with silence and introspection) is usually how one will behave in the future.- Important to know because someone who does not may may seem cold when in reality it is normal coping behavior for that individual.

Answer 20

1. Normal coping behavior

Question 21

• Grief can be cumulative, a person does not always gain strength from each loss in a given period of time.- Can gain knowledge about the effect of loss and the response each time a new loss is experienced- Each loss does not make the adjustment to the new loss easier - the negative effect may build up and be brought to the surface during subsequent losses.

Answer 21

2. Number of previous losses and deaths

Question 22

This means that a person can experiences too many losses in a given period of time.- These losses do not need to be the same.- grief overload- can manifest itself in what others consider an exaggerated response to the most recent loss.

Answer 22

3. Grief overload

Question 23

Just as someone can experience grief overload, they can also experience a state of overload from different stressful events that occur at the same time.- May not be able to react with their usual “together” response.

Answer 23

4. Concurrent stressors

Question 24

Part of our response, despite grief being an individual response, is determined by what is expected of us by members of important groups in our lives.-part of our behavior can be dictated and nurtured by different affiliations in our life.- Dictates can become so ingrained in our psyche that we are not even aware of their source.- Revert to what seems instinctual - What is right and appropriate for one group of people may not be the same for another group

Answer 24

5. Expectations of local, cultural, and religious groups

Question 25

Experience and research in Thanatology, the study of death, has show repeatedly that the more positive support a griever has, the more positive his adjustment to the death will be.- family, friends, co-workers- For children: school, support group or counselor

Answer 25

6. Available social support

Question 26

-Men (boys)- still expected to be stronger than women (girls).- Men conditioned to express anger more than grief or fear.- Women taught that sadness and crying are acceptable female behaviors used to express their grief even if they feel angry.

Answer 26

7. Gender conditioning

Question 27

The fact that grief can contribute to ill health, both physically and mentally, makes the state of health of an individual at the time of a death of an important factor in determining the outcome of the experience.- good health does not = good experience- good health = one more positive defense mechanism to help in this task

Answer 27

8. Physical and mental health

Question 28

Having time to prepare for a death has both positive and negative outcomes for an individual.- opportunity to tell the dying person things you want them to know can be a positive experience. - meaningful to the dying person and the griever- Having to watch a person slowly degenerate can be heartbreaking.- Anticipatory grief - The pain experienced from anticipating the person’s death, what life will be without that person, how the actual death will occur, and how the dying person actually feels about dying.- Experiencing these feelings before the death can help relive some of the grief following the death.

Answer 28

9. Pre-death adjustment time

Question 29

“If I only had a little more time”- most people go through life with some loose ends hanging in relationships- We don’t always let people know how we feel about them- Arguements or ill-feelings intended to amend later- The more of this unfinished business that remains after a death, the more difficult the adjustment can be.

Answer 29

10. Unfinished business with the deceased

Question 30

Losses that come about because of a primary loss and often involves the loss of some type of status.-Primary losses: Someone important dies, job loss, divorce- Secondary losses: No longer a wife or husband, no longer a brother or sister, losing a breadwinner, school transfer, moving- More abstract secondary losses: loss of the dreams and expectations a parent has for a child’s future.

Answer 30

11. Secondary losses

Question 31

Common misconception: the closest relationships we have are with family members. This is not the case. Special relationship among friends can be the most important and positive relationships in a person’s life.- The psychological intensity of the pre-death relationships between the deceased and the mourner will influence the mourner’s response. The grief reaction will increase or decrease depending on the intensity of the relationship.- The death of a friend may cause a more severe response than the death of a family member.

Answer 31

12. Importance of the relationship

Question 32

Almost everyone feels that the death of a child or adolescent is the most tragic type of death.- Normal course of nature- the young survive and the old die.- Exception : death of newborn or stillborn. Mistakenly believe there was too short a time for much love and bonding to take place.

Answer 32

13. Age of the deceased

Question 33

One of the reasons that we feel that the death of a young person is so tragic is because they have not lived to fulfill their dreams, experience the wonders of life, and feel a sense of accomplishment.- also felt about adults who have not accomplished their goals- With a child- feel that they have been cheated out of the opportunity to fulfill dreams rather than the opportunity having passed them by.

Answer 33

14. Fulfillment of dreams

Question 34

• Anticipated - opportunity for some degree of closure- Sudden and violent - no time to prepare, sense of senselessness, fear, powerlessness, unreality- survivors of a traumatic death are probably the ones that most need to view the body (they often choose closed casket), it makes the experience real. “seeing is believing.”

Answer 34

Mode of death

Question 35

• 4th leading cause of death in the US for people between the ages of 15 and 24.- Most common is motor vehicle - very traumatic for families, usually a surprise. Immediate problem is the identification of the body.- may be a delay in burial or cremation due to the usual need for a post-mortem examination- Mourning process does not end with the final disposition- May be followed by court cause or inquiry, which prolongs the process of mourning and means the relatives have to relive the moment over again- tend to have trauma in their own family.

Answer 35

Accidents

Question 36

The killing of one human being by another.- Possibly the most difficult unexpected death to cope with- Causes shock, rage, helplessness and vulnerability, devastating emotional trauma for close friends and family.- Reactions to the grief process may be exacerbated due to the violent natures of this and the suddenness, injustice, and preventability of the death.- Guilt is heightened - survivors may feel that they could have protected the person- Anger is intensified to the point of rage which may later be directed toward the criminal justice system which may be perceived as insensitive, inept, or favoring the murderer over the victim.- preoccupation with the deceased and events surrounding death- especially painful and frightening as thoughts tend to be concentrated on the terror, suffering, and helplessness endured by the victim.- Persuasive fear - world is perceived as an unsafe place filled with dangerous, perverted people.- Nightmares, startle responses, social withdrawal, physical reactions- chest pains, palpitations, insomnia - commonly experienced - Consider retribution and revenge.- Media coverage complicates grief

Answer 36

Homicide

Question 37

1. The murderer must be caught. This can take months, years, or may never happen.2. The murderer is apprehended and is let out on bail, survivors usually do not feel it is justified. They may also fear for their own safety.3. The trial date can be months or years away. When it does start, the family can become hurt even more as the defense lawyers try to smear the reputation of the deceased, or partake in character assassination.4. If the murderer is not found guilty, the survivors may never get the justice they are seeking.5. If the murderer is found guilty, survivors seldom feel the sentence is severe enough. Their lives are changed forever, and the murderer can be eligible for parole in fight to eight years.6. When the murderer is eligible for parole, some survivors make it their life’s mission to do everything possible to get the parole denied. If the murderer is paroled, survivors may again fear for their own safety.7. Even when the murderer is sentenced to death and the execution is carried out, often there is not the closure that people are hoping for.

Answer 37

Recovery from a homicide doesn’t start until these events take place

Question 38

Suicide: The deliberate act of killing oneself.Survivors of suicide may feel:- Shock- Bewilderment- Denial- Guilt- Powerlessness- Obsessive review- Blame- Shame- Anger- Fear- With death in this manner, the bereaved survivors go through the same grief process as others, but have some unique and additional problems due to stigma and taboo that other survivors do not have.

Answer 38

Grief responses after a suicide

Question 39

• Usually the first response after suicide- Particularly intense and long lasting- The fact that most suicides are violent increases this, especially for the person who finds the body.

Answer 39

Shock

Question 40

• Do not know why the loved one took their own life.- Believed objectively that there often was nothing particularly wrong in the person’s life.- Often the suicide occurs at a time when it appears the deceased had everything going for them.- It can take years to deal with this.

Answer 40

Bewilderment

Question 41

• A close partner to shock- Because of the unexpectedness and violence of the death, survivors instinctively deny it.- Often initially react by searching for proof of another explanation- Family may has the coroner to call the suicide an accident to spare the family the stigma that accompanies suicide.

Answer 41

Denial

Question 42

• Often intense and long- Feel that they should have known the person was suicidal - May feel that they personally had been all or part of the reason- May not have felt like good enough parents, siblings, friends, etc.

Answer 42

Guilt

Question 43

• Perhaps the hardest and lowest point for survivors - Occurs when they realize they were powerless to stop the suicide from happening.- A suicide forces us to acknowledge that we are not always in control- that we are powerless from preventing some events from happening.

Answer 43

Powerlessness

Question 44

There is in intense need to understand what happened and why with suicides.- Cause obsessive review of the events leading up to the suicide.- Conversations, activities, comments made, and actions are all looked under a microscope of need.

Answer 44

Obsessive Review

Question 45

Survivors often feel compelled to put the blame somewhere, anywhere, to explain a loss that is so difficult to imagine, let alone comprehend.- May target police, coroner, another family member, or a treating therapist.- Placing the blame on another person may appear immediately or emerge later.

Answer 45

Blame

Question 46

The assumption of blame directed at oneself by others.- Suicide carries with it this feeling and a certain taboo.- The tendency to blame, whether oneself or someone else, is often intertwined with this.- Part of a larger response to suicide that is woven into the fabric of our society.- At every level- individual, family, community, and society- suicide represents the failure of our connections, and we feel shame in the face of that failure.- Society suggests that a traditional funeral may not be appropriate - Survivors need all the support they can get, support a funeral can provide.

Answer 46

Shame

Question 47

• May experience this with themselves, or direct it toward those they think have contributed to the reason for the suicide. - other family members, friends, school, work, society for its view on suicide- Later directed at the deceased for causing all the pain and may appear immediately or appear later.

Answer 47

Anger

Question 48

Strong emotional response marked by such reactions as alarm, dread, and disquiet.- Main that is experienced is the thought that if he can commit suicide, they may be someone else I love who could do it, or even I could do it.

Answer 48

Fear

Question 49

• Surviving mate may suddenly remember every fight, not matter how trivial, may come to believe that this was the cause of the suicide. - May externalize these feelings- feeling that others may believe that he/she caused the suicide- Suffer tremendous guilt- Must also help children get though the crisis

Answer 49

Suicide: Spouse of the deceased

Question 50

• Become overly protective of remaining children- heightened fear other children will kill themselves as well. - leads the parents to smothering the children with attention and affection, sometimes questioning and doubting their every move.

Answer 50

Suicide: Parents of the deceased

Question 51

• Experience a variety of emotions- Anger- the deceased did not confide in them, the deceased did this to hurt them.- Jealousy or resentment - witnessing their parent’s grief- Parents may find it difficult to be there for their remaining children- May feel slighted and deserted or may blame themselves for being unable to comfort their parents.

Answer 51

Suicide: Children- Sibling’s death

Question 52

• Very intense emotional reactions- Mixed with a sense of guilt is a feeling of blame.- Blames his/herself for not having been a better child.

Answer 52

Suicide: Children and a parent’s death

Question 53

• Guilt- should have recognized a problem or that the deceased did not think enough of their friendship to confide in them about a problem.

Answer 53

Suicide: Friend of victim

Question 54

• Unique grieving factors and raises painful psychological issues for family members.- Many cases, the parents are young and this is their friends experience with grief.- Usually found by the parents, memory picture they must always live with.- “if onlys” they may never be able to solve- Often have to explain it to young children or adults who have no knowledge on the subject

Answer 54

SIDS deaths

Question 55

• Education on the dynamics of the death because SIDS is a diagnosis of exclusion. There is no one concrete cause the bereaved can focus on in trying to understand how the death occurred.- Reassurance that there was nothing they could have done to prevent the death because there are no specific predictors or preventable measures.- Validation for both their primary loss of the infant, and also for the secondary loss of dreams and expectations for the future life of the baby that most bereaved parents experience.

Answer 55

Grieving parents and family of SIDS’ deaths need:

Question 56

• Vary in size, scope, extent of damage, loss of life, injury, and degree of disruption to families and the community.- Natural or man-made- Extend over a few moments of many months- Tornados, hurricanes, typhoons, earthquakes, floods, tsunamis, volcanic eruptions, dam breaks, explosions, nuclear accidents, fires, transportation crashes, structural collapses, murders, suicides, accidents.- homes can never be replaced, overwhelmed by the sights and smells and sounds, expected to produce significant levels of psychological impairment among survivors.- Horror factor can lead to mental health problems- terror- allow no time for preparation - Characterized by long periods of threat- not age specific

Answer 56

Disasters

Question 57

• Voluntary active euthanasia - Involuntary active euthanasia- Passive euthanasia- Physician- assisted suicide

Answer 57

Types of euthanasia

Question 58

• Not a phenomenon of the 21st century - reports go back thousands of years- ancient Greeks and Romans- Aristotle and Pythagorus were opposed to it- Post-classical period, with the ascendancy of Christianity, acceptance of euthanasia varied.- 20th century- culminated in the near unanimity of medical opposition to it.- Sir Thomas Moore presented one of the earliest theoretical discussions of euthanasia in English literature in 1516 (ibid).

Answer 58

Euthanasia

Question 59

Known as pathologic, chronic, delayed, masked, or exaggerated grief. (worden)

Answer 59

Complicated grief (chapter 7)

Question 60

A reaction that is prolonged, expressive in duration, and never comes to a satisfactory conclusion.

Answer 60

Chronic grief

Question 61

A reaction that does not occur in a normal timeframe but occurs at a later time.

Answer 61

Delayed grief

Question 62

Occurs when a person experiences symptoms and behavior which causes them difficulty but they do not recognize the fact that these are related to the loss.

Answer 62

Masked grief (also called inhibited, suppressed, or postponed grief).

Question 63

Occurs when the reactions to the loss are excessive and disabling.

Answer 63

Exaggerated grief

Question 64

Kenneth Dakota introduced this term to describe a loss that society believes does not deserve mourning. The loss is not openly acknowledged, socially sanctioned, or publicly shared.

Answer 64

Disenfranchised grief

Question 65

• Chronic grief- Delayed grief- Masked grief- Exaggerated grief- Disenfranchised grief

Answer 65

Types of complicated grief

Question 66

1. Relationship to the deceased is not socially recognized. -This would include relationships such as homosexual relationships, extramarital affairs, or heterosexual cohabitation.2. Loss is not acknowledged by others being as a genuine loss. -Examples include abortion, miscarriage, pet loss, and death of a former spouse.3. The grievers are unrecognized. -Examples include the death of a friend, co-worker, or someone mentally disabled.4. Death is not socially sanctioned.- Examples include suicide, auto-erotic asphyxia, or legal execution.

Answer 66

Doka’s 4 types of death that lead to disenfranchisement

Question 67

*Relationship factors -such as ambivalence* Circumstantial factors - Such as uncertainty and multiple losses or when the death is sudden, traumatic, or shocking.* Personality factors - Such as the inability to tolerate extreme emotional issues, negative self concept.* Social factors - Such as shame, embarrassment, or social stigma, when death is not approved by society, or not strong support group.- ie- suicide, execution or a crime* Historical factors - such as previous complicated grief reactions or the influence of early parental loss

Answer 67

Factors that may complicate grief

Question 68

• Relationship factors- Circumstantial factors- Personality factors- Social factors- Historical factors

Answer 68

Factors that may complicate grief

Question 69

If left untreated, this may lead to depression, suicide, drug or alcohol abuse, or even heart disease.- 15-20% of all mourners will have their grief turn into this.

Answer 69

Complicated grief

Question 70

• They have difficulty speaking of the deceased without experiencing renewed and intense grief.- They constantly bring up the themes of death and loss in even the most causal conversations- They have ongoing sleep problems sleeping too much or too little that persist for more than 6 weeks.- They make sudden and radical changes in lifestyle- They exhibit self-destructive behavior, i.e., excessive drinking substance abuse, promiscuity- Without any real medical problems, they develop some of the same symptoms of the deceased person experienced just before death- Continued disbelief in the death of the loved one.- Inability to accept the death- Presistent flashbacks, nightmares, intrusive memories- Magnified and prolong grief symptoms: anger, sadness, or depression- Maintenance of a fantasy relationship with the deceased with feelings that he is always present and watching.- Continuous yearning and searching of the deceased- Unusual symptoms that seem unrelated to the death (physical symptoms, strange or abnormal behavior)- Breaking off all ties to social contacts

Answer 70

Indications that someone may be suffering form complicated grief (these must usually be in excess of several months)

Question 71

• They avoid anyone or anything associated with the deceased including friends, family, and previously shared activities- Even relatively minor events trigger an intense grief reaction- They exhibit consistent symptoms of depression, especially extreme and persistent feelings of guilt, hopelessness, and lowered self-esteem.- Their ability to manage everyday responsibilities at work, school, or home is significantly imparied.

Answer 71

Other symptoms of complicated grief