LOSS AND GRIEF

What is meant by loss?

Loss may be experienced in a variety of situations such as:

  • separation from a job
  • loss of a relationship through separation or death
  • changes in health status
  • injury,
  • the aging process,
  • a traumatic event 6
  • failure, removal or alteration of body parts, whether internal or external; 4
  • alteration in physical, psychological or social functioning, such as intellectual capacity, income, role, self-esteem, well-being, security, leisure or sporting activities4
  • youth mental illness can constitute a source of loss and grief for parents This type of loss is ambiguous and unending. Because the “lost” person has not disappeared; rather, they have changed3
  • Immigration may involve pain and loss (as people struggle with a severing of family ties, secure jobs, language, ethnic customs, food, status, friendship and even pets).2
  • When expectations of parents for having a mentally healthy child are not fulfilled3

Such experiences may be acute or gradual and progressive, temporary or permanent, actual or potential, sudden or anticipated, obvious to other or possible to conceal.4

What is meant by Grief?

Grief is a unique experience, a natural human response to major losses such as the loss of a parent or siblinghe grief response associated with the loss will also be experienced in a variety of ways 6. Generally, to grieve is understood to involve a process of adjusting to, or accommodating a changed reality3. There may come a time when an individual requires additional support to navigate this process in the most therapeutic manner possible.6

Unresolved and unaddressed grief may then lead to complicated grief later in life.7

Prolonged grief disorder (PGD) or complicated grief- by a sufferer

“It is my greatest regret today that I didn’t accept the support that was offered but let my grief grow for seven years until it wasn’t containable any longer.”8

PROLONGED GRIEF DISORDER (PGD) (in the past has also been referred to as complicated grief or traumatic grief)9 refers to a state of chronic grieving that persists for 6 months or longer and is characterized by intense separation distress, intrusive and emotionally troubling thoughts about the deceased, a sense of meaninglessness, trouble accepting the loss, and functional impairment (Prigerson and Jacobs 2001).

PGD at 6—12 months after a loss had a 2.6 fold increased risk of alcohol use, a 3.4 fold increased risk of smoking, and a 3.1 fold increased risk of sleep problems compared to bereaved individuals not meeting diagnostic criteria at 12—24 months after a loss.9

RISK FACTORS:

  • Parents’ gender did not influence grief scores in a study by Davis and Schultz (1998),
  • Parents who spent more time with their adult offspring experienced more frequent intrusive thoughts3

Solomon and Draine (1996) found that more grief was expressed by family members who were:

  • Caucasian,
  • had less education,
  • had an adult relative with a shorter illness duration,
  • possessed a smaller social network,
  • received greater emotional support,
  • experienced concurrent crises,
  • did not reside with the adult relative and reported greater subjective burden.

SYMPTOMS OF GRIEF:

The grief symptoms include:

  • intrusive thoughts and emotions (Godress et al. 2005)
  • avoidance (Davis and Schultz 1998; Godress et al. 2005)
  • preoccupation with their relative’s mental illness
  • difficulties accepting their circumstances (Atkinson 1994; Godress et al. 2005; Miller et al. 19903
  • anger and shame (incase of coping with mental illness of a family member)
  • hopelessness
  • sadness
  • shock
  • emotional numbness
  • Urge to weep
  • dysphoria
  • hallucinations8
  • insomnia

TREATMENT:

  • Family psychoeducation (PFE) combines information sharing—typical content includes mental illness symptoms, etiology, course and indicated treatments—with illness management techniques and skills training (e.g., problem solving, communication) (de Groot et al. 2003; Goldstein and Miklowitz 1995; Lefley 2009; Lucksted et al. 2012).3

 

  • Family education (FE) is another form of targeted support; it is generally briefer than FPE, facilitated by trained consumers (not mental health professionals, as is the case for FPE) and places more emphasis on caregivers’ wellbeing .(Stephens et al. 2011)

 

  • Family psychotherapy. (e.g., Dixon et al. 2001)

 

  • A grief therapy was also introduced by Miller (1996), who adapted Worden’s (1982, 2009) tasks of mourning (e.g., making the loss real, facilitating the expression of affect, assisting the individual to live without the deceased and facilitating emotional withdrawal from the deceased) for family members of adults with major psychopathology. group psychoeducation. 3

 

  • Art, play, music, dance/movement, drama, and animals can be therapeutic modalities in clinical work with individuals experiencing grief and loss issues.6

 

References:

  1. Bylund-Grenklo, T., Fürst, C.J., Nyberg, T. et al. Support Care Cancer (2016) 24: 3095. doi:10.1007/s00520-016- 3118-1
  2. Lee, TY. Pastoral Psychol (2010) 59: 159. doi:10.1007/s11089-009-0261-3
  3. Richardson, M., Cobham, V., McDermott, B. et al. J Child Fam Stud (2013) 22: 719. doi:10.1007/s10826-012-9625-x
  4. Bridget Adams, Barbara Bromley; loss and grief therapy; psychology for health care.
  5. Kathy Charmaz; grief and loss of self; The Unknown Country: Death in Australia, Britain and the USA
  6. Chaneb, B. J Child Fam Stud (2016) 25: 2353. doi:10.1007/s10826-016-0379-8
  7. Chaneb, B. J Child Fam Stud (2016) 25: 2353. doi:10.1007/s10826-016-0379-8
  8. Bylund-Grenklo, T., Fürst, C.J., Nyberg, T. et al. Support Care Cancer (2016) 24: 3095. doi:10.1007/s00520-016-3118-1
  9. Holland, J.M., Neimeyer, R.A., Boelen, P.A. et al. J Psychopathol Behav Assess (2009) 31: 190. doi:10.1007/s10862-008-9113-1