Loss, bereavement and grief Flashcards
What is loss?
- deprived of something/someone
- separation from loved thing/one
When can loss happen?
- losses = can be multiple e.g. lose partner, then lose financial income
- loss out of sequence= greater impact e.g. child dying
What is bereavement?
- Loss of a loved one through death
What is grief?
- Emotional reaction to loss
1. psychological (cognitive, social, behavioural)
2. physical (physiological, somatic). - emotions are associated with bereavement
sadness, anger, guilt, shame and anxiety
What is mourning?
- process of adapting to loss
- includes cultural and social rituals
- includes expectations
- Psychological processes triggered by loss and process of recovery. The act of expressing grief.
What is the acute grief response?
- Disbelief/ shock/ numbness/yearning
- Agitation/anger/hostility/irritability
- Crying, tearful, sadness
- Disrupted sleep
- Aimless activity / inactivity
- Illusions or hallucinations
- Preoccupation with images of the lost person
How long does acute grief response last?
- hard to say
- no set time
- people differ
- about 6 weeks
What are long term grief responses?
- Social withdrawal
- Sleep disturbance
- Restlessness or anxiety
- Decreased concentration
- Decreased or increased food intake
- Reduced libido
- Depressed mood
How long do long term grief responses last?
- 3 -12 months plus
- individuals vary.
- BUT minimal/absent grief response not unusual
How do children respond to grief?
- they need support
- allow to make their own meaning
- some children are resilient
- support from family, friends, school
What are the 5 stages of grief model?
D - Denial A - Anger B – Bargaining, Reason with the situation D – Despair and Depression A – Acceptance
What is the dual process model of grief? (CAME UP IN SEM 2 EXAM)
- Dynamic
- Oscillation between Loss Oriented and Restoration Oriented coping
What are loss oriented aspects of grief?
- denial
- thinking about relation
- avoiding restoring changes
- grief
What is the restoration orientated coping of grief?
- attending to life changes
- doing new things
- distracting from grief
- new roles
- keeping occupied
What are modern changes to grief models?
Newer grief theories = maintain bond with dead people
Facilitating grief = hold relationship in new perspective
Cognition and meaning in addition to emotion (post traumatic growth)
Challenges concept of endpoint in grieving – no ‘back to normal’ rather a ‘different normal’.
What is pathological grief?
- absent grief
- prolonged grief
What is absent grief?
- Failure to display symptoms of grief
- can result in ‘delayed’ grief or anxiety problems e.g. during anniversary
What is prolonged grief?
- initially seems normal grieving
- intense grief persists
- distressing and disabling
- persist more than 6 months with FUNCTIONAL IMPAIRMENT
- searching for the person who has died
- persistent intrusive images/ideas/nightmares/dreams
- actively avoiding communication and actions associated with loss
How does bereavement compromise people and how does it cause increased mortality?
- more mental illness
- more physical illness likely
- higher medications used
- neglect early signs of disease
- can’t manage current diseases like diabetes
- have alcohol
- self harm
- suicide
How is the immune system affected with grief and bereavement?
- bereavement causes
- high ACTH and cortisol
- reduced NK cells
- vulnerable immune system
- increase morbitiy and hospitalisation
What are the risk factors for complicated grief?
- Circumstances surrounding loss:
• Sudden / unexpected bereavement / Violent /Multiple bereavements /Not told – delay in finding out/ Excluded - Individual circumstances:
• Previous problems coping/ Previous history of mental health problems/ Separation/ anxiety / Unable to understand loss/ Dependent children/ People with intellectual disability - Social support unavailable:
• Loss disrupts routines & relationships/ Others make choices and decisions
• Limited opportunities for new roles/status
• Positive family/social support = important protective factor. - Quality of lost relationship:
• Very close, dependent relationship
• Difficult, ambivalent, abusive or violent relationships - Disenfranchised grief - loss that cannot be openly acknowledged, publicly mourned or socially supported
How do you deal with loss and grief in a clinical setting?
- commone experience
- deal with patients and relatives
- recognise signs and symptoms of complicated grief
- address and listen
- dont ignore
What support services are given to those grieving?
- social network
- family, friends, colleagues
- faith based network
- Docs/GP
- wandworth bereavement centre
- in hospital counselling services
- self- help groups
