Week 10: Grief and Mourning

Question 1

What is grief?

Answer 1

The personal response to loss. This loss can be anything which is significant in their lives- a person through death, separation, divorce; health; job, trust; home; country; position

Question 2

What is bereavement?

Answer 2

The condition of loss due to the death of someone we love

Question 3

What is mourning?

Answer 3

The behaviour which expresses our internal experience of grief. It may involve wearing certain clothing, a sports team wearing black arm bands etc. Such rituals as the funeral and memorial services are important aspects of mourning

Question 4

What is ‘normal’ grief?

Answer 4

Does not follow linear pathway

Chaos Theory: out of control sensation

Question 5

What happens physiologically when we grieve?

Answer 5

• Stress stimulates sympathetic nervous system
• “Fight or flight” reaction
• Many biochemicals released including adrenaline and cortisol
• Physical symptoms include hyperactivity, palpitations, increased heart rate and respiratory rate, sweating, dry mouth, nausea, anxiety including sense of panic, insomnia.
• These physical symptoms can be so severe that people think they are dying and present to the Emergency Department.

Question 6

What usually happens in the first day of grief?

Answer 6

Survival Mode
• First we survive, then we grieve.
• Emotional Shock- can include disbelief, screaming, sobbing, collapse, anger, numbness- virtually any reaction is possible.
• These reactions make it hard to comprehend what is happening, and even hard to hear and understand.
• Important to use clear, unambiguous language.
• Avoid using euphemisms like “lost” and “passed away”.
• The numbness can change to an overwhelming expression of grief. Wailing, screaming, tearing at clothing and hair are common.

Question 7

What usually happens after a few days of grieving, after the initial survival period?

Answer 7

• Numbness decreases.
• Pain increases.
• Often pressure to have the funeral

Question 8

What usually happens after a week of grieving?

Answer 8

• Loneliness can become very evident.
• Auditory and visual hallucinations common.
• Need reassurance they are not crazy

Question 9

What is the experience of people grieving 4-6 weeks after the event?

Answer 9

Often people feel their grief is getting worse, not better

Question 10

What the usual experience of somebody grieving after a year?

Answer 10

• Pain of grief comes in waves.
• Various triggers, dates, events can all cause the intensity of grief to flare up. Often there is no warning and the person can feel the pain is similar to the very beginning.
• The first anniversary of the death can be particularly painful and the person can “relive” the events that occurred in the lead up to the death

Second year often reported as harder than the first

Question 11

What are common expressions of grief?

Answer 11

• Crying
• Anger
• Physical symptoms (especially common in kids)
• Guilt
• Nightmares
• Regression

Question 12

What is regression?

Answer 12

A universal reaction to grief is regression. This does not mean the person becomes childish, but that they feel much more vulnerable, like they did when they were much younger. It seems most people regress to feeling somewhere between an 8-15 year old. If they have had an earlier significant loss, they will regress to the age they were when they experienced that loss.
This means that tasks such as making important decisions are especially difficult

Question 13

How long does grief last?

Answer 13

• 2-3 years for acute grief.
• 5-6 years if the person has been very central in their life, or if they have numerous risk factors which may complicate grief
• We never really get over it; we learn to live with it

Question 14

How do toddlers generally grieve?

Answer 14

• Concrete thinkers.
• Don’t understand death as a concept.
• Often have intense periods of crying, and then calm.
• Regression can be obvious

Question 15

How do 4-7 year olds usually grieve?

Answer 15

• Often still think death is reversible.
• They ask lots of questions.
• They can have lots internal distress but can seem to appear as if nothing has happened

Question 16

How do 77-11 year olds usually grieve?

Answer 16

• Starting to have better understanding of death.
• Ask for very detailed information often to try and understand.
• Physical symptoms common.
• Common to act out and get into trouble

Question 17

How do 11-18 year olds usually grieve?

Answer 17

• Better at abstract thinking.

* Begin to have more adult understanding of death

Question 18

What are the different types of grieving?

Answer 18

• Overt (intuitive, feminine type) grievers
• Covert (instrumental, masculine type) grievers
Many men are covert grievers and many women are overt grievers. In reality, the vast majority of us are a mixture of both

Question 19

What is overt grieving?

Answer 19

• Tend to grieve more openly.
• More open to talking about their grief.
• Tend to withdraw when their grief feels raw.
• Tend to seek help and support.
• Tend to elicit care from others.
• Less likely to find comfort in sexual activity.
• More usual to be women than men.

Question 20

What is covert grieving?

Answer 20

• Grief may be expressed as anger.
• Often turn to problem solving and activity.
• Often read extensively about grief.
• Often grieve internally or privately.
• Often seek comfort in sexual activity.
• May find respite in work.
• May turn to alcohol/drugs for comfort.

Question 21

What should you avoid when providing care to someone who is grieving?

Answer 21

• Don’t offer clichés. We don’t need to say anything clever.
• Don’t avoid the subject or pretend everything is OK.
• Don’t avoid using the deceased’s name.
• Don’t patronise or touch. For those of us who see the clients face to face, we must avoid the urge to touch them to try and comfort them. It may be appropriate in the crisis moment to give the person a hug, or put your arm around them. You will be in a public setting, and sometimes they physically need some physical support. Much more important though is being able to “touch their heart”. This will far more effective and comforting to them than any hug or embrace.
• Don’t think you are useless because you feel helpless.
• Don’t expect your client to retain complex information.
• Don’t use long-winded or overly technical explanations.
• Don’t encourage your client to make major decisions too early, unless it is imperative or in your clients best interests to do so (e.g. organ donation). At least acknowledge how difficult it is to make these decisions.
• Don’t agree to what you can’t sustain-we have the rule of 100. If we can’t do it for 100 clients, we can’t do it.
• Don’t exploit your client’s vulnerability.

Question 22

What should you do when providing care to someone who is grieving?

Answer 22

• Do speak the truth about yourself- verbalise your discomfort.
• Do remember that your client will be feeling regressed.
• Do provide simple, truthful information- information you know about the person at the time of death such as “she died quickly”, “she wouldn’t have felt any pain”,” I was with her when she died”…. can all bring incredible comfort.
• Do allow a person to cry, without having to ‘fix’ things.
• Do pass the tissues when you need to proceed with practical discussions.
• Do write down or record important details for later use.
• Do give advice when appropriate, reassurance when necessary.
• Do be prepared to act as advocate.
• Do establish clear boundaries.
• Do remember that grief may exaggerate previous behaviour.