Helen Kanyagia
Psychology Assignment
An outline of the grieving process that an individual may experience following the loss of a significant person and factors that Health Care Professional would consider when implementing these knowledge
In this essay, I will talk about grief and also present an outline of the grieving process that an individual may experience following the loss of a significant person in their life. I will look at some of the psychological theories and concepts that are related to the process. I will examine the challenges that have been identified by different psychologists and how people cope with them. I will give an evaluation, advantages and disadvantages on the theories and concepts. In the final part of the essay, I will explore on three possible factors that the health care professionals would consider in implementing this knowledge in practice.
Loss is an experience, which is likely to happen to all of us at some time in our lives.
It can be an experience, which may be sudden but can often be presumed before it actually happens. Experiencing loss is normal, as it is something that we have been exposed to in our lives. Some of the examples of loss and change are; end of a relationship- this could include divorce or separation from a marriage, loss of physical capacity whereby one has been involved in an accident and losses either his/her leg or hand and therefore left disabled. Loss of freedom which could be brought about by the birth of a baby, loss of sexual identity, and the major one is death of a loved one to name a few. It is through these small losses although important and painful to cope with that we can learn how to cope with more significant ones.
Bowlby (1980) defines loss of a loved person as one of the most intensely painful experiences any human being can suffer and not only is it painful to experience but it is also painful to witness. People deal with losses in different ways and this may be because of our individual preferences or influence by our family background or religious beliefs. For many of us, the loss of a close relation can be an experience of a very big loss and this kind of loss is known as bereavement. Bereavement can lead to intense regression where the bereaved perceive themselves as helpless, incapable or feeling worthless and leads to low self-esteem. However, these negative images may give way to positive ones whereby the bereaved makes sense of the world and starts carrying out the task in newer ways. Bowlby however, states that the more a bereaved person has relied on the deceased to provide goods and service including extended social relationships, the greater the effort he has to make to re-organize his life afresh.
Following bereavement comes in grief. ‘Grief is a normal reaction to overwhelming loss, although a reaction in which normal functioning no longer holds‘. Parker and Weiss (1983). Grief may be strong or weak, brief or prolonged, immediate or delayed. It does not last forever and the way in which we feel about the loss changes as time moves on. Sudden deaths can produce even more problems than others can, which leads to some very serious difficulties in the grieving process. The sadness of grief therefore can be a pain inside us, which at one time will end. When we are feeling grief, each of us has different ways of expressing what we are feeling. For some crying is a way of relieving emotional stress while others are very quiet and hide their feelings. Visiting places and carrying objects that remind us of the deceased is an indication that one has fears that she/he might lose memories of the deceased, expressing anger is also another way and can be the most confusing feeling therefore and the root to many problems in the grieving process. Unlike Bowlby, who saw expressing of anger as an important aspect if one is to recover.
Some psychologists like Parkes, Kubler-Ross, Worden have identified the characteristics phase of the grieving process and agree that grief must be worked through and some sort of natural progression and blending of feelings must be experienced if a healthy adjustment to the loss is to be achieved. Parkes (1989) for example identified four phases of grieving process, which are similar to those identified by the other two theorists. According to him, the impact of death is normally followed by a period of numbness, which lasts for hours or days. This he referred to as the first phase of grieving and where one refuses to accept the reality and so it takes time for the bad news to ‘sink in’. and think of it all being a dream. The second phase that people went through was a period, which Parkes called ‘Pinning’. Here, one will experience a strong sense of the other person’s absence and a tendency of looking for him/her in familiar places. He pointed out that grief comes and goes in ‘pangs’ or waves whereby it will reach its peak which is usually 5 to 15 days after bereavement although it might not ease for sometime because of being triggered. Worden (1991) agrees with Parkes that small things can trigger grieving, which sets people to feeling the pain of grief. For example anniversaries and special occasions are often sees as triggers. The bereaved will continue with their responsibilities but in an anxious way and one might loss weight or concentration and become depressed. This gives way to the third stage of grieving. At this point, the bereaved tends to be disorganised and despair and their grief might be felt most acutely. They feel that they have difficulties coping with those tasks the deceased did and the memory of the dead person is never far away. This results in the bereaved having hallucinations where they will believe they are communicating with the dead. The fourth stage is the recovery period where most individuals realise that their lives must go on and they must try to find a new meaning to their existence. Signs of recovery from the pain of grief can be sleeping well. Worden however, argues that although the task can be accomplished, it is the most difficult task to accomplish as individuals get stuck at this point in their grieving and later realize that their life in some way stopped at the point the loss occurred.
Worden (1991) saw excessive repression of grief as a major factor that can give rise to complicated grief. The four areas of these grief that he identified were; Chronic grief: where the griever may be unwilling or unable to continue on grieving which prolong the grieving process and results to mental illness. The second, which is Delayed grief: where the grieving reactions seem suppressed to the griever during the expected grieving process. Exaggerated grief: this is where the griever will go to an extend of alcohol abuse, taking of drugs and the reactions may worsen. The fourth one was identified as masked grief: where grieving reaction is unrelated or unrecognised by the griever.
Grief, even in the best of circumstances can affect us in numerous ways. It can affect us physically, psychologically, emotionally, spiritually and socially. In a health care profession, all professionals are in a unique position to help people through the turning points in their lives, which arise at times of a loss. In order to provide this help, we need to make the bereaved aware of the situation they face and where possible, add to their knowledge or correct any misperceptions of what they might not be aware of. We need to spend time with them helping them to talk through and to make sense of the implication of the information we have given. Research has enabled health care professionals to identify people at special risks after bereavement either because the circumstances of the bereavement are unusually traumatic or because they are themselves already vulnerable. As a nurse/social worker, I would consider the risk factors which can give rise to complicated form of grief that end in mental illness, clinical depression, post traumatic stress disorder and with the understanding of these factors, psychiatric disorders in bereaved patients will be prevented.
An important element in the way that an individual copes with grief is that of the support they receive and the perceived reaction of those that are within the family and social circle of the bereaved. Not only are health professionals a soothing presence, but they also act as a check to the bereaved ideas and more violent impulses. Hospital staff members develop social ways of coping with death, which often continues the isolation of the dying person.
Health care professionals will need to consider the needs of the patient and that of the relatives before death and after although it might be a potential problem trying to balance these needs. The implication would be to convey the need, to explain daily care, medication, tests, changes and such. Giving practical advice and information to put relatives with other members of the caring team also needs to be considered as
this will help to prevent anger that may be turned against them when a loss was experienced.
Considering the social variables of the bereaved since all of us belong to different cultures, ethnic and religious groups is very essential. To predict how one is going to grief, professionals will need to consider the social, ethnic and religious background of the bereaved. For example when caring for bereaved family members of ethnic minority groups, their customs and religion must be considered sensitively. There may be special ceremonies or adjustments to hospital procedures that the family will want to be carried out. For example relatives may want to express their grief in a customary way and some issues like post-mortems will need to be discussed. An interpreter will be essential if the family members do not understand English. Other cultural issues that could be considered are funerals which serve as a ceremony and provides an opportunity for self-expression at which relatives and friends get the chance to say goodbye to the dead and also a way of remembrance of the wishes expressed by the deceased. Religious needs are very important at the time of death and many patients and relatives turn to some kind of religious beliefs at such a time. Offering of some kind of blessing to be said by the vicar or priest before and after the death can be very comforting to the bereaved family. Health care professionals may therefore consider referring relatives to the hospital priest.
Professionals would consider therapies where children and adolescents who are bereaved are introduced to life games, which are a series of therapeutic board games. These games have been devised to facilitate the understanding and disclosure to the many painful and complex feelings experienced by children when they are confronted with traumatic life events. The goal for this therapy is to identify and resolve the conflicts of separation which preclude the completion of mourning tasks in persons whose grief is absent, delayed or prolonged. Counselling would be considered also as it helps the bereaved to facilitate uncomplicated or normal grief to a healthy completion of the tasks of grieving within a reasonable time frame.
In conclusion of the above, I would suggest that the different concepts on grieving used all seem to focus on grief as an illness that affects us and when it has gone, one reverts to one’s old state. It can also be noted that when phase are negotiated successful, results in an end point higher up the scale of mood and self worth. Learning the skills to care for the dying and the bereaved takes time and experience as one needs to identify the family dynamics and further identify those members of the family who need assessing for the way they are coping with their grief. Making sense of these is part of the process as is taking time to care as professionals.
REFERENCES
Bowlby J., (1980) Loss: Sadness and Depression Volume 3. Bucks. Hazell Watson and Viney Ltd.
Faulkner A., (1995) Working with Bereaved People. London: Churchill Livingstone.
Gross R., (1996) Psychology The Science Of Mind and Behaviour. 3rd Edition. London. Hodder and Stoughton Educational.
Niven N., (1994) Health Psychology: An introduction for Nurses and other Health Care. Professionals. 2nd Edition. Churchill Livingstone.
Worden J.W., (1991) Grief, Counselling and Grief Therapy. 2nd Edition. London. Routledge Publishers.
Wright B., (1991) Sudden Death, London. Churchill Livingstone Publishers.
Seave Y., Streng I., (1996) The Grief Game. London. Jessica Kingsley Publishers.
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