Module 3 Flashcards
Bereavement
- Objective fact of losing someone close to us
- Close is subjective
- Change in status (ex: child becomes an orphan)
Large scale bereavement
- Outcome of a large-scale social phenomena such as the survivors of a natural disaster, pandemic, or war
Grief
- Internal response to bereavement
- Impacts everything we do
- Can impact all spheres of life
- May lead to insomnia, attention issues, memory issues, anxiety, rage, etc.
Acute grief
- Tightness in throat
- Shortness of breath
- Lack of muscle or power
- Empty feeling in abdomen
Prolonged stressor
- Increased risk of cardiovascular, infections, and inflammatory disorders, and weakened immune system
Mourning
- Culturally patterned expression of the bereaved person’s thoughts and feelings
- Reflects local, regional, national, ethnic, and religious cultures at particular points in history
- Ex: During WW1 widows dressed in black with veils covering their heads
Difference between mourning and bereavement
- Bereavement is a universal experience while mourning is more personal
Normal grief
- Stays within bounds of a particular culture
Complicated grief
- Once called pathological or abnormal
- Most common feature is that the bereaved person does not move on from the shock and pain of loss toward a return to a fulfilling life
Integrated grief
- Type of grief most parents achieve after the death of a child
- Finding ways to remember and honour them while living
Traumatic grief
- Severe and disabling response to sudden and often violent death
Anticipatory grief
- Has become more common in recent years as people live longer with life threatening conditions
- Grief before the actual death
Resolved grief
- Movement toward recovery from the most debilitating effects of gried
Unresolved grief
- The debilitating effects of grief have continued longer than one would expect
- This is difficult to define because there is no time line
Hidden grief
- Hiding any signs of grief in order to appear as “normal” as possible
Disenfranchised grief
- Occurs when society does not recognize a person’s right to grieve
- Ex: health care professionals, a person who is working with dying people
The Grief-Work Theory
- Freud
- Grief is an adaptive response to loss
- The work of grief is difficult and time consuming
- Basic goal is to accept the reality of death and thereby liberate oneself from the strong attachment one had to the lost
- Grief work is carried out through a long series of confrontations with the reality of the loss
- The process is complicated by the survivor’s resistance to letting go of the attachment
- Failure results in continued misery and dysfunction
Bowlby’s attachment theory
- Basic goal is to maintain the security provided by the relationship
- Stress comes as we try to re-establish the relationshi-
- In grief work we must overcome our attachment
Parkes’ Three Basic Components of Grief Work
- Preoccupation with thoughts of the dead person
- Repeatedly going over the loss experience
- Attempts to explain the loss
- Grief tasks
Stage theory
- Also been applied to grieving
- Most theorists agree on the beginning and ending points, but the middle stages vary by theory
- There is little independent evidence to verify the application of universal stages to the grieving process
- Like the seven stages of grief
- Everyone grieves differently but it can help start a conversation
Meaning-making perspective
- The ability to find meaning in what happened is the best predictor of how people deal with grief
- Time and stages are considered less useful in this perspective
Dual process model of coping with bereavement
- The practical adaptations to loss are regarded as important to the bereaved person’s adjustment as the emotional
- Loss-oriented: doing grief work, etc.
- Restoration-oriented: attending to lifes changes, etc.
Continuing bonds theory
- Grief doesn’t mean detaching from the deceased
- People often maintain emotional ties (talking to or honouring the dead)
Two-track model of bereavement
- How grief affects daily life (biopsychosocial impact)
- How people redefine relationships with the dead
Evolutionary model of grief
- Grief like reaction also occurs in birds and mammals when they lose an SO
- Grief can be viewed as maladaptive, but it is adaptive in that it is cause by having social bonds, which are beneficial
Do dolphins feel grief
- Yes, lots of evidence
- They’re highly social, so they miss their friends when they die
- They may carry the dead body for days or weeks or they may circle around it and stay with them
- They also recognize death of other species
How well do we support the bereaved
- Absence of culturally endorsed mourning behaviours can create the illusion that the person is over the loss
- Our discomfort with grief and mourning is influenced by its orientation toward time and efficiency
- After the funeral, the bereaved are often left alone, deviating from historical traditions of support
- The web has provided a new avenue for the expression of mourning
Cross-Cultural perspectives on grief
- Grief and mourning are culturally shaped
- Different cultures express grief through rituals, behaviours, and beliefs about death
- Some cultures emphasize continuing bonds rather than detachment
Widow to widow program
- Predating professional grief counselors and peer support
- Grief do not have a final outcome; it is a life transition
- People an provide meaningful support to each other
- Founded by Phyllis Silverman
Formal supports for grief
- Grief counseling or therapy
- Support groups
- Bereavement programs and workshops
- Online communities
- Bereavement/Grief retreats
- Spiritual care
- Hospice or Palliative care services
Informal supports
- Express Care and Condolences
- Good listening skills
- Empathize
- Instrumental support
- Respect Individuals Grieving Process
- Avoid Platitude and Clichés
- Share information (if appropriate)
- Be Patient
- Create a Supportive Work Environment
Social media and grief
- Online memorial pages allow continued connection
- Public vs private mourning dilemmas
- Virtual grief communities
- Digital legacies and online tribute spaces
Language when talking to bereaved people
Most helpful:
- I’m here if you need to talk
- Put your faith in God
- They will be in our memories
- Etc.
Least helpful:
- Didn’t the funeral home do a good job?
- Were they in much pain?
- It’s okay to be angry at God
Grief in kids and teens
- Their understanding of death evolves with cog. development
- May express grief through play or behaviour, not words
Grief in older adults
- Experience cumulative losses (spouses, friends, health decline)
- May feel more isolated due to lack of social support
Grief in neurodivergent individuals
- Grief responses may differ
- May need alternative ways to express emotions
Ambiguous loss
- Loss without closure (dementia, missing persons, estrangement)
- Leaves the bereaved in a state of uncertainty
Non-death losses
- Divorce, job loss, infertility, chronic illness, migration
- Can trigger grief response similar to bereavement
Worden’s four tasks of mourning
- Views grief as a series of tasks that the bereaved must work through to adjust to their loss
- The tasks aren’t linear, and people may move between them
- Accept and the reality of loss
- Process the pain of the grief
- Adjust to a world without the dead person
- Find an enduring connection while moving forward
Difference between grief and depression
- Depression is more prolonged and persistent
- Depression is reflected inwards
- Grief is strong emotions related to loss
- Grief comes up with a trigger
- Depression is harder to pin point
- Grief becomes an issue when it is clinically significant
Prolonged grief disorder
- Symptoms include
- Identity disruption
- Marked sense of disbelief about the death
- Avoidance of reminders that the person is dead
- Intense emotional pain related to the death
- Difficulty with reintegration
- Emotional numbness
- Feeling that life is meaningless
- Intense loneliness
What are continuing bonds
- The ongoing inner relationship with a deceased loved on
- Can involve memories, rituals, or perceived interactions
- Opposes older grief models that emphasized detachment
- Allows for a more humanistic approach to grief
Forms of continuing bonds
- Reminiscing and storytelling
- Keeping possessions
- Perceiving the deceased’s presence
- Engaging in rituals or memorial activities
- Seeking guidance or communicating with the deceased
Are continuing bonds helpful or harmful
- Research is mixed
- Some studies suggest they provide comfort and aid adaptation
- Others associate them with prolonged grief and distress
- The impact depends on perception, relationship quality, and beliefs
Factors influencing continuing bonds
- Perceived positivity or negativity of the bond
- Quality of the pre-death relationship
- Cultural and religious beliefs, including views on the afterlife
Cultural and religious perspectives on continuing bonds
- Many embrace ongoing relationships with the deceased
- Belief in an afterlife can shape continuing bonds
- Some religious views see continued attachment as normal, while others encourage detachment
The role of social support in grief (Sarper et al)
Background:
- Grief affects mental and physical well being
- High anxiety is linked to stronger grief symptoms
- Self compassion helps reduce emotional distress
- Social support can help or worse grief depending on the individuals traits
Purpose:
- How trait anxiety, self-compassion, and perceived social support interact to influence grief
Method:
- Cross sectional with 539 people
- Completed surveys on trait anxiety, self-compassion, and perceived social support
- Grief symptoms
Findings
- Perceived social support did not buffer the association between trait anxiety and higher grief symptoms
- Higher trait anxiety was linked to stronger grief symptoms only when they perceived less social support
- Higher self compassion was related to fewer grief symptoms when they had social support
Physiological changes in grief
- Grief operates as a significant stressor.
- Individual differences influence physiological responses.
- Existing physical weaknesses can be exacerbated.
- The body initiates a stress response.
- Increased levels of cortisol, epinephrine, and norepinephrine.
- Chronic stress adaptation can cause further health issues.
Social and behavioural factors influenced by grief
- Social supports mitigates stress effects
- Self care (eating, sleeping) is crucial
- Alcohol and medication misuse can worsen physiological distress
Individual differences in grief
- Personal adaptation skills and coping behaviours/experiences vary
- Grief tends to have a greater physiological impact when caused by human error or malice
- Fear arousal complicates the stress
Cognitive and emotional consequences of grief
- Decreased or impaired attention and memory
- Increased risk of accidents and errors
- Emotional distress, including anxiety and depression
Mitima-Verloop et al study of funerals
Methods:
- People attended a funeral and they were sent a satisfaction survey six months later
- Sent a follow up three years later
Results:
- Perception of the funeral was stable
- Perception of mental health was stable
- Grief reaction was not related to rituals but not the number of collective rituals
- no significant association between evaluation of the funeral and usage of grief rituals and grief reactions was found
Limitations
- A lot
- People who actually responded may have just been doing better than the people who didn’t
Alice Walker’s “To Hell with Dying”
- Illustrates both universal and culturally specific experiences of grief through the story of Mr. Sweet, an elderly black man loved by Walker and her siblings
Yoruba compassion in grief
- Strong communal support for mourners
- Daily greetings from community members
- Expression of concern, encouragement, and recognition of grief
- Acknowledgment of pain and loss
- Encouragement to remain strong and resilient
- Reminder to take care of oneself for the sake of family obligations
- These communities emphasize long term communal greiving
HIV/AIDS impact on sub-saharan Africa
- Multiple deaths in short periods disrupt grief rituals
- Traditional grief models struggle to adapt
Zimbabwe’s experience:
- Traditional and christian mourning practices coexist
- Intensity of loss challenges ability to balance respect for the dead and continuation of life
- Grief is universal but shaped by culture and circumstances
When a spouse dies
- Common later in life (especially for women)
- Rising rates of divorce and declining marriage rates may affect future trends
Emotional and physical impact of loss (immediate impacts) for widows
- Emotional distress: numbness, despair, weeping, guilt
- Physical symptoms: sleep disturbances, loss of stamina, aches and pains
Difference in gendered responses for widows
- Widows (women) report abandonment and loneliness
- Widowers (men) experience loss as “dismemberment”
- Men suppress emotions
- women express grief more openly
Widower’s experiences
- Men
- Widowers tend to suppress
outward expressions of grief. - They push themselves back into
immediate realities sooner. - Social recovery is often faster,
but emotional recovery is
slower. - A year later, widowers report
higher loneliness and
depression than widows.
Dreams and Dream visitations
Common dream themes:
- reunion with the dead
- Romantic or intimate encounters
- The deceased’s death was a mistake
- Physical separation in the dream
- Dreams can become part of ongoing emotional life
Factors influencing recovery
- Early emotional distress predicts long term struggles
- Strong attachment bonds shape the grief process
- Quality of the marriage influences adjustment
- Clinging dependence = harder adjustment
- Troubled relationships = more intense yearning
Shadow grief: perinatal death
- Grief work may appear completed, but shadow grief persists
- Shadow grief manifests as emotional dullness and inhibited normal activity
- It occasionally surfaces as sadness, tears, or mild anxiety under certain circumstances
- Grief lingers years after child’s death
Societal recognition of perinatal death
- From the 20th week of preg to one month after birth
- Limited societal acknowledgment isolates grieving parents
- Newspapers often exclude newborn death notices
- Sympathy cards and support resources are scarce
Complications of perinatal grief
- Parents may be physically and emotionally prepared for the baby.
- Mother’s body continues postpartum processes (e.g., lactation).
- Unhelpful comments from others can add to distress.
- Support from friends and family often fades quickly.
- Grief can trigger a crisis of faith or belief.
- Parents may struggle to find meaning in the loss.
- Maintaining an “inner representation” of the child helps some parents.
- Symbolic interactions (e.g., sensing the child’s presence) are not pathological.
Romantic relationships after the death of a child
- Increased emotional strain within couples
- Decrease in sexual intimacy, but increased need for comfort
- Communication often breaks down, leading to isolation
- Most couples do not divorce but must work through grief together
Moving forward with integrated grief
- Allows parents to manage their sorrow while continuing life
- Grief remains but becomes more controlled
- Many bereaved parents develop a newfound purpose or compassion
- Support networks play a crucial role in long term adjustment
Cumulative loss
- The longer one lives, the more losses accumulate
- Grief from past losses may resurface, depleting emotional energy
- Holocaust survivors and disaster survivors often experience intensified grief
Bereavement overload
- Coping with one loss while still processing past grief
- Death of a sibling may trigger fear of personal mortality
Misinterpreted grief among older adults
- Can be mistaken for depression or cognitive decline
- Emotional withdrawal and changes in behaviour could be grief related
- Recognizing and addressing grief is crucial for mental well being
- They are very resilient
Causes of death among the bereaved
- Heart disease and cancer
- Suicide spikes after spousal loss, especially in men
- 66x higher for men and 9x higher for women in the first week
- Immune function weakens
