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Lets Make It Very Clear.ppt


                                    Annual Grief and
                                       Loss Seminar
                                        18 June 2011
Associate Professor Judith Murray
The University of Queensland
The Chains that Bind:
 I hear your whisper on the wind
 I hear your voice just as it has always been
 Your laughter fills the air around me
 And I turn with a smile to laugh with you
 But when I turn there is silence
 There are only echoes in my mind
 I know this, and yet, often they are so loud
 So clear, so real, that I just can’t believe you’re not
                 Karen Gerry in‘ Words of Sorrow Words of Love’
The Essence of Our Chains:
 Experience is not an unstable irrational and emotive
   concept but rather it is the world, it is knowing.
                                             Lumby (1994)

 Understanding the experience….
 An Emic rather than an Etic approach.

 It is also you have shared with all humanity...
No one ever told me that grief felt so like fear.
                                             C.S. Lewis 1898-1963

Well has it been said that there is no grief like the grief
which does not speak
                            Henry Wadsworth Longfellow 1819-1892

Our trials, our sorrows and our grieves develop us.
                                   Orison Swett Marden 1850-1924
What right have I to grieve, who have not ceased to
                                   Henry David Thoreau 1817-1862
 Change
 Loss is produced by an event which is perceived to be negative by the
  individuals involved and results in long-term changes to one’s social
  situations, relationships, or cognitions.   Miller and Omarzu (1998)

 Bereavement is the loss through death of a significant other.
 Grief is
    • “the emotional response to loss: the complex amalgam of painful
      affects including sadness, anger, helplessness, guilt and despair.”
                                                           Raphael (1984)
    • (Grief) incorporates diverse psychological (cognitive, social-
      behavioural) and physical (physiological-somatic) manifestations.
                                      Stroebe, Hansson & Schut (2001)
                        rarely exist

                        What did
 Edvard Munch: The
                        you lose?
Dead Mother 1899-1900
The Chains weigh
us down in every
aspect .........
    Physical Reactions to Loss
   Heart palpitations                    Backache
   Sighing, trouble breathing            Rapid shallow breathing
   Headaches                             Nausea, upset stomach, diarrhoea,
   Appetite changes                       constipation
   Numbness, tingling of feeling         Other gastrointestinal problems
    of heaviness in the arms or legs      Tremors of hands, lips etc.
   Stiff neck, jaw tenseness             Sleep disturbances
   Susceptibility to colds, allergies    Muscle weakness or aches
   Easily startled                       Faintness, dizziness
   Chills                                Pains in chest (needs checking by
   Fatigue                                doctor)
   Sweating                              Sensation of ‘lump in throat’
                                          Lack of coordination
  Psychological Reactions
 Irritability, anger or general    Feeling overwhelmed.
  agitation                         Thoughts of ‘can’t go on’, (even
 Restlessness, excitability         suicide) in some cases
 Sadness, depression, crying       Feeling powerless, hopeless
 Feeling lost, isolated,           Moodiness, periods of ‘highs’ and
  abandoned                          ‘lows’ following closely one after
 Wanting to be alone                the other
 Recurrent dreams, insomnia,       Guilt, blaming
  night waking                      Flashbacks of traumatic events
 Frustrated                        Numbness, shock, confusion,
 Anxiety                            inability to feel
 Fears, worry                      Loss of interest in sex
 Apathy
  Behavioural Reactions to Loss
 Difficulty in concentrating,     Hyperactivity/ Inability to carry
  slowness of thinking and          out even the most minor tasks
  decision making                  Increase in use of alcohol,
                                    tobacco and other drugs
 Difficulty expressing oneself
                                   Difficulty in organizing daily
  verbally                          tasks
 Withdrawing socially,            Avoidance of any reminder of the
  reluctance to leave home          event
 Frequent arguments, family       Preoccupation with memorabilia
  difficulties                      of lost person
 Forgetfulness                    Eating more or less
                                   Loss of work efficiency
 Disorientation
Other Reactions to Loss
                                     Loss can shape and change
SPIRITUAL                             families (e.g., family secrets),
                                      communities (indigenous loss),
 Loss makes people ask the big       societies (Australia and Port
  questions of life                   Arthur, Effects of War, AIDS
 Difference between spirituality     crisis and Uganda) and Global
  and religion                        Trends (9/11 and the War on
                                     Effects on larger groups can
                                      then have affects on individuals
                                      (eg., transgnerational
                                      transmission of loss, Oklahoma

Mourning is the “the psychological processes that
 occur in bereavement whereby the bereaved gradually
 undoes the psychological bonds that bound him/her
 to the deceased” (Beverley Raphael 1984)

Grieving : the process of dealing with losses other than

Suffering: The width of the gap between reality ‘what
 is’ and what is desired

   Suffering is not a question that demands
   an answer; It is not a problem that
   demands a solution; It is a mystery that
   demands a presence.

The Journey Through Loss

   What do we know about
    Grief and Grieving???
    Chains of
     grief are
  normal and

As hard as it is,
   grieving is a
normal, natural
Dual Process Model (Strobe & Schut 2006)
  The experience of loss is
  integrated into the basis
psychological functioning of
   a person even from the
         earliest age.
 Therefore there exist both
 the potential for personal
   growth and personal
         Prototypical patterns of disruption in normal functioning
         following loss or potential trauma
          Bonanno 2008




           Event                   1 year                     2 year
Grief to Growth Model
(Hogan & Schmidt, 2002)
  Different chains bind
  different people……
 Many factors will affect the
  journey through grief.
 Grieving is a mostly private
  and even at times lonely
For a child in an adult’s world
 it can be even more lonely
Internal Influences
•   Individual personality factors
•   Life Orientation / Purpose in Life
•   Spirituality / Religious beliefs
•   Death Anxiety
•   Coping Styles
•   Age
•   Gender
   Individual culture
   Attributional style
   Vulnerability/Resilience
   Previous mental health
   Previous physical health
   Mental capacity/Complicating disabilities
Circumstances Surrounding the Loss
   The type of loss
   Anticipation versus suddenness
   The opportunity to say goodbye
   The legal requirements of sudden death
   Location of the loss
   Perceived preventability/responsibility
   Chronic sorrow
External Factors that Affect Grieving

 Social context of the loss/Sanctions/Taboos.
  Disenfranchised grief
 Family context
 Concurrent stresses
 Social support
Being Chained
in Isolation
 The Existential Aloneness
We were setting out on different roads. This cold truth, this terrible
traffic regulation (‘You, Madam, to the right – you, Sir, to the left) is
just the beginning of the separation which is death itself. And this
separation, I suppose, waits for all. I have been thinking of H. and
myself as peculiarly unfortunate in being torn apart. ‘Even if we both
died at exactly the same moment, as we lie here side by side, it would
just be as much a separation as the one you’re so afraid of’. Of course
she didn’t know, nay more than I do. But she was near death; near
enough to make a good shot. She used to quote ‘Alone into the alone’.
She said it felt like that. And how immensely improbable that it
should be likewise.
                                          C.S. Lewis, 1961, ‘A Grief Observed’, p.14
Alone …..Lonely…
Difference between being ‘alone’ and
being ‘lonely’

      • Alone but not Lonely
      • Alone and Lonely
The Chains in our Heads
Messages given to a person during early losses, that may
  contribute to a sense of being overwhelmed by life and loss
  at a later time, may include:
 My pain in not as important as that of some others
 My family falls apart under pressure. They can’t care for me
  when the going gets tough
 I am ‘bad’
 I am responsible for other’s pain and comfort
 I’m hopeless. I’m useless
 You mustn’t bother people with your problems
 Bad things happen to me, no matter how hard I try
 People can’t be trusted
 The world is a very scary place
The Chains in our Heads
Messages adopted by people as a result of previous losses, that may
  enhance growth, include:
 In times of trouble, someone will always be there for you
 My family can weather bad times
 I am safe
 My needs matter to others
 I can cope with bad times
 There are many things in life I have control over
 The world is an exciting place just waiting for me to explore it
 Other people need me
 I’m OK even if I’m not perfect
 It’s OK to tell people how you feel
 I know there are things you can do to help yourself feel better
Chains that
Definition of ‘Problem Grieving’

Unresolved (‘problem’) grief is grief…
That is preoccupying, incapacitating and immobilizing
 for a prolonged period in a way that causes concern to
 the bereaved person and his/her family and friends.

                          McKissock & McKissock (1991)
Complicated Grief
Complicated grief occurs when integration of the death does
  not occur.
People who suffer from complicated grief experience a sense
  of persistent and disturbing disbelief regarding the death
  and resistance to accepting the painful reality. Intense
  yearning and longing for the deceased continues, along
  with frequent pangs of intense, painful emotions.
  Thoughts of the loved one remain preoccupying often
  including distressing intrusive thoughts related to the
  death, and there is avoidance of a range of situations and
  activities that serve as a reminder of the painful loss.
  Interest and engagement in ongoing life is limited or

     (Complicated Grief Review, Edith Cowan Uni and Australian Government).
Prigerson’s Criteria for Complicated
Grief Proposed for DSM-V
Criterion A:
Chronic and persistent and disruptive yearning/ longing/ heartache
Criteria B:
4 of 8 at least several times a day to distressing degree
 Trouble accepting the death
 Inability to trust others
 Excessive bitterness or anger related to death
 Uneasy about moving on
 Numbness/Detachment
 Feeling life is empty or meaningless without deceased
 Bleak future
 Agitated
Criteria C:
Marked and persistent dysfunction in social, occupational or other
   important domains
What are we
chained to?
What chains us?
 Neurobiology and Complicated Grief
  Neuroimaging (O’Connor, 2005) has found a number of areas
   of the brain specifically active when grieving people
   (compared to viewing neutral similar forms of stimuli) are
   presented with picture and word stimuli of lost loved one
   or bereavement. Most active ones were:

Posterior Cingulate Cortex: Area
activated during autobiographical memory
so memories being recalled. Also deals with
emotionally salient stimuli
Anterior Cingulate Cortex and
Insula: ACC role in attention and Insula in
processing visceromotor information.
Suggests strong somatic element in reaction
eg., ‘broken heart’, ‘pangs of grief’
 Neurobiology and Complicated Grief
O’Connor et al.(2007)imaged the brains of 12 women diagnosed
  by Prigerson Complicated Grief Scale as suffering
  complicated with 12 women not showing complicated grief.

Found difference in
nucleus accumbens,
that is the part that
anticipates rewards ie.,
the part that knows you
want something, so the
longing becomes like a
ppowerful craving. Much
more research needed.
                  Grief and Depression
        Normal Grief                    Clinical Depression
Responds to comfort and support      Does not respond to support
Often openly angry                   Irritable and may complain but does
                                     not directly express anger
Related depressed feelings to loss   Does not relate experiences to a
experienced                          particular life event
Can still experience moments of      Exhibits an all pervading sense of
enjoyment in life                    doom
Exhibits feelings of sadness and     Projects a sense of hopelessness
emptiness                            and chronic emptiness
May have transient physical          Has chronic physical complaints
Expresses guilt over some specific   Has generalized feelings of guilt
aspect of the loss
Has temporary impact upon self-      Loss of self-esteem is of greater
esteem                               duration
 The Powerful Chain: Fear

  Loss threatens a person’s
sense of safety, mastery and
Loss that never seems to end because
IT DOESN’T…. It simple changes

    It can be so very scary having
     the world you know totally
        turned upside down…..
No one ever told me that grief
       felt so like fear
               C.S. Lewis ‘A Grief Observed’
If fear is natural……
Living with fear of the world as it now is……
So loss of hope is natural…..
Frustration, anger and sadness is natural….
Not pleasant, not what you want, bloody
                But NATURAL !!!!
that Bind
Finding The
Weakest Links
The Weakest Links
 Trusting in the healing power of grief and time
 Saying goodbye in a meaningful way
 Gaining and giving forgiveness
 Calming the trauma
 Rethinking our assumptions and our thoughts
 Receiving and giving support
 Finding a ‘livable’ spot for them
 Cherishing
 Finding solace
I have been to the edge of the abyss
And I have looked into the depths.
         IS THIS OUR
There I looked at death
And I have returned to the living.
There I looked at madness
And have returned to the sane.
There I looked at destruction
And I have returned to create.
For only creation and love
Can answer destruction and madness and
                             Marjorie Pizer
Maybe through…..

 ‘Knowing we will never be the same’
 Knowledge of what is happening within and around
 Companionship
 Finding what our children/siblings/grandchildren
  have given us
 Being assured of the parents we are now to our
 children who are no longer here for us to parent
The chains of love are never binding as
when the links are made of gold.
                                Royale Tyrell
The Gold....Our Children
Some people come into our lives and quickly go.
 Some people move our souls to dance. They
 awaken us to new understanding with the passing
 whisper of their wisdom. Some people make the
 sky more beautiful to gaze upon. They stay in our
 lives for awhile, leave footprints on our hearts, and
 we are never ever the same.
                                         Flavia Weedn

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