Klicker 2

Question 1

1. Normal coping behavior
2. Number of previous losses and deaths
3. Grief overload
4. Concurrent stressors
5. Expectations of local, cultural, and religious groups
6. Available support network
7. Gender conditioning
8. Physical and mental health
9. Pre-death adjustment time
10. Unfinished business with the deceased
11. Secondary losses
12. Importance of the relationship
13. Age of deceased
14. Fulfillment of dreams

Answer 1

Determinants of grief (chapter 6)

Question 2

Past coping behaviors (anger, physically ill, cries, turns inward with silence and introspection) is usually how one will behave in the future.- Important to know because someone who does not may may seem cold when in reality it is normal coping behavior for that individual.

Answer 2

1. Normal coping behavior

Question 3

• Grief can be cumulative, a person does not always gain strength from each loss in a given period of time.
• Can gain knowledge about the effect of loss and the response each time a new loss is experienced
• Each loss does not make the adjustment to the new loss easier
• the negative effect may build up and be brought to the surface during subsequent losses.

Answer 3

2. Number of previous losses and deaths

Question 4

This means that a person can experiences too many losses in a given period of time.

• These losses do not need to be the same.
• grief overload
• can manifest itself in what others consider an exaggerated response to the most recent loss.

Answer 4

3. Grief overload

Question 5

Just as someone can experience grief overload, they can also experience a state of overload from different stressful events that occur at the same time.

• May not be able to react with their usual “together” response.

Answer 5

4. Concurrent stressors

Question 6

Part of our response, despite grief being an individual response, is determined by what is expected of us by members of important groups in our lives.

• part of our behavior can be dictated and nurtured by different affiliations in our life.
• Dictates can become so ingrained in our psyche that we are not even aware of their source.
• Revert to what seems instinctual
• What is right and appropriate for one group of people may not be the same for another group

Answer 6

5. Expectations of local, cultural, and religious groups

Question 7

Experience and research in Thanatology, the study of death, has show repeatedly that the more positive support a griever has, the more positive his adjustment to the death will be.

• family, friends, co-workers
• For children: school, support group or counselor

Answer 7

6. Available social support

Question 8

• Men (boys)- still expected to be stronger than women (girls).
• Men conditioned to express anger more than grief or fear.
• Women taught that sadness and crying are acceptable female behaviors used to express their grief even if they feel angry.

Answer 8

7. Gender conditioning

Question 9

The fact that grief can contribute to ill health, both physically and mentally, makes the state of health of an individual at the time of a death of an important factor in determining the outcome of the experience.

• good health does not = good experience- good health = one more positive defense mechanism to help in this task

Answer 9

8. Physical and mental health

Question 10

Having time to prepare for a death has both positive and negative outcomes for an individual.

• opportunity to tell the dying person things you want them to know can be a positive experience.
• meaningful to the dying person and the griever
• Having to watch a person slowly degenerate can be heartbreaking.
• Anticipatory grief - The pain experienced from anticipating the person’s death, what life will be without that person, how the actual death will occur, and how the dying person actually feels about dying.- Experiencing these feelings before the death can help relive some of the grief following the death.

Answer 10

9. Pre-death adjustment time

Question 11

“If I only had a little more time”

• most people go through life with some loose ends hanging in relationships
• We don’t always let people know how we feel about them
• Arguements or ill-feelings intended to amend later
• The more of this unfinished business that remains after a death, the more difficult the adjustment can be.

Answer 11

10. Unfinished business with the deceased

Question 12

Losses that come about because of a primary loss and often involves the loss of some type of status.

• Primary losses: Someone important dies, job loss, divorce- Secondary losses: No longer a wife or husband, no longer a brother or sister, losing a breadwinner, school transfer, moving- More abstract
• secondary losses: loss of the dreams and expectations a parent has for a child’s future.

Answer 12

11. Secondary losses

Question 13

Common misconception: the closest relationships we have are with family members. This is not the case. Special relationship among friends can be the most important and positive relationships in a person’s life.

• The psychological intensity of the pre-death relationships between the deceased and the mourner will influence the mourner’s response. The grief reaction will increase or decrease depending on the intensity of the relationship.
• The death of a friend may cause a more severe response than the death of a family member.

Answer 13

12. Importance of the relationship

Question 14

Almost everyone feels that the death of a child or adolescent is the most tragic type of death.

• Normal course of nature- the young survive and the old die.- Exception : death of newborn or stillborn. Mistakenly believe there was too short a time for much love and bonding to take place.

Answer 14

13. Age of the deceased

Question 15

One of the reasons that we feel that the death of a young person is so tragic is because they have not lived to fulfill their dreams, experience the wonders of life, and feel a sense of accomplishment.

• also felt about adults who have not accomplished their goals
• With a child- feel that they have been cheated out of the opportunity to fulfill dreams rather than the opportunity having passed them by.

Answer 15

14. Fulfillment of dreams

Question 16

• -Anticipated - opportunity for some degree of closure
• Sudden and violent - no time to prepare, sense of senselessness, fear, powerlessness, unreality
• survivors of a traumatic death are probably the ones that most need to view the body (they often choose closed casket), it makes the experience real. “seeing is believing.”

Answer 16

Mode of death

Question 17

• 4th leading cause of death in the US for people between the ages of 15 and 24.
• Most common is motor vehicle - very traumatic for families, usually a surprise.
• Immediate problem is the identification of the body.- may be a delay in burial or cremation due to the usual need for a post-mortem examination- Mourning process does not end with the final disposition
• May be followed by court case or inquiry, which prolongs the process of mourning and means the relatives have to relive the moment over again
• tend to have trauma in their own family.

Answer 17

Accidents

Question 18

The killing of one human being by another.-

• Possibly the most difficult unexpected death to cope with- Causes shock, rage, helplessness and vulnerability, devastating emotional trauma for close friends and family.
• Reactions to the grief process may be exacerbated due to the violent natures of this and the suddenness, injustice, and preventability of the death.
• Guilt is heightened - survivors may feel that they could have protected the person- Anger is intensified to the point of rage which may later be directed toward the criminal justice system which may be perceived as insensitive, inept, or favoring the murderer over the victim.
• preoccupation with the deceased and events surrounding death- especially painful and frightening as thoughts tend to be concentrated on the terror, suffering, and helplessness endured by the victim.
• Persuasive fear - world is perceived as an unsafe place filled with dangerous, perverted people.
• Nightmares, startle responses, social withdrawal, physical reactions- chest pains, palpitations, insomnia - commonly experienced
• Consider retribution and revenge.
• Media coverage complicates grief

Answer 18

Homicide

Question 19

1. The murderer must be caught. This can take months, years, or may never happen.
2. The murderer is apprehended and is let out on bail, survivors usually do not feel it is justified. They may also fear for their own safety.
3. The trial date can be months or years away. When it does start, the family can become hurt even more as the defense lawyers try to smear the reputation of the deceased, or partake in character assassination.
4. If the murderer is not found guilty, the survivors may never get the justice they are seeking.
5. If the murderer is found guilty, survivors seldom feel the sentence is severe enough. Their lives are changed forever, and the murderer can be eligible for parole in fight to eight years.
6. When the murderer is eligible for parole, some survivors make it their life’s mission to do everything possible to get the parole denied. If the murderer is paroled, survivors may again fear for their own safety.
7. Even when the murderer is sentenced to death and the execution is carried out, often there is not the closure that people are hoping for.

Answer 19

Recovery from a homicide doesn’t start until these events take place

Question 20

Suicide: The deliberate act of killing oneself. Survivors of suicide may feel:

• Shock
• Bewilderment
• Denial
• Guilt
• Powerlessness
• Obsessive review
• Blame
• Shame
• Anger
• Fear
• With death in this manner, the bereaved survivors go through the same grief process as others, but have some unique and additional problems due to stigma and taboo that other survivors do not have.

Answer 20

Grief responses after a suicide

Question 21

• Usually the first response after suicide- Particularly intense and long lasting
• The fact that most suicides are violent increases this, especially for the person who finds the body.

Answer 21

Shock

Question 22

• Do not know why the loved one took their own life.
• Believed objectively that there often was nothing particularly wrong in the person’s life.
• Often the suicide occurs at a time when it appears the deceased had everything going for them.
• It can take years to deal with this.

Answer 22

Bewilderment

Question 23

• A close partner to shock
• Because of the unexpectedness and violence of the death, survivors instinctively deny it.
• Often initially react by searching for proof of another explanation
• Family may has the coroner to call the suicide an accident to spare the family the stigma that accompanies suicide.

Answer 23

Denial

Question 24

• Often intense and long
• Feel that they should have known the person was suicidal
• May feel that they personally had been all or part of the reason
• May not have felt like good enough parents, siblings, friends, etc.

Answer 24

Guilt

Question 25

* Perhaps the hardest and lowest point for survivors * Occurs when they realize they were powerless to stop the suicide from happening. * A suicide forces us to acknowledge that we are not always in control- that we are powerless from preventing some events from happening.

Answer 25

Powerlessness

Question 26

There is in intense need to understand what happened and why with suicides. ## Footnote * Cause obsessive review of the events leading up to the suicide. * Conversations, activities, comments made, and actions are all looked under a microscope of need.

Answer 26

Obsessive Review

Question 27

Survivors often feel compelled to put the blame somewhere, anywhere, to explain a loss that is so difficult to imagine, let alone comprehend. ## Footnote * May target police, coroner, another family member, or a treating therapist. * Placing the blame on another person may appear immediately or emerge later.

Answer 27

Blame

Question 28

The assumption of blame directed at oneself by others ## Footnote * Suicide carries with it this feeling and a certain taboo. * The tendency to blame, whether oneself or someone else, is often intertwined with this. * Part of a larger response to suicide that is woven into the fabric of our society. * At every level- individual, family, community, and society- suicide represents the failure of our connections, and we feel shame in the face of that failure. * Society suggests that a traditional funeral may not be appropriate * Survivors need all the support they can get, support a funeral can provide.

Answer 28

Shame

Question 29

* May experience this with themselves, or direct it toward those they think have contributed to the reason for the suicide. * other family members, friends, school, work, society for its view on suicide * Later directed at the deceased for causing all the pain and may appear immediately or appear later.

Answer 29

Anger

Question 30

Strong emotional response marked by such reactions as alarm, dread, and disquiet. ## Footnote * Main that is experienced is the thought that if he can commit suicide, they may be someone else I love who could do it, or even I could do it.

Answer 30

Fear

Question 31

* Surviving mate may suddenly remember every fight, not matter how trivial, may come to believe that this was the cause of the suicide. * May externalize these feelings- feeling that others may believe that he/she caused the suicide- Suffer tremendous guilt * Must also help children get though the crisis

Answer 31

Suicide: Spouse of the deceased

Question 32

* Become overly protective of remaining children- heightened fear other children will kill themselves as well. - leads the parents to smothering the children with attention and affection, sometimes questioning and doubting their every move.

Answer 32

Suicide: Parents of the deceased

Question 33

* Experience a variety of emotions * Anger- the deceased did not confide in them, the deceased did this to hurt them. * Jealousy or resentment - witnessing their parent's grief * Parents may find it difficult to be there for their remaining children * May feel slighted and deserted or may blame themselves for being unable to comfort their parents.

Answer 33

Suicide: Children- Sibling's death

Question 34

* Very intense emotional reactions * Mixed with a sense of guilt is a feeling of blame. * Blames his/herself for not having been a better child.

Answer 34

Suicide: Children and a parent's death

Question 35

* Guilt- should have recognized a problem or that the deceased did not think enough of their friendship to confide in them about a problem.

Answer 35

Suicide: Friend of victim

Question 36

* Unique grieving factors and raises painful psychological issues for family members. * Many cases, the parents are young and this is their friends experience with grief. * Usually found by the parents, memory picture they must always live with.- "if onlys" they may never be able to solve * Often have to explain it to young children or adults who have no knowledge on the subject

Answer 36

SIDS deaths

Question 37

* Education on the dynamics of the death because SIDS is a diagnosis of exclusion. There is no one concrete cause the bereaved can focus on in trying to understand how the death occurred. * Reassurance that there was nothing they could have done to prevent the death because there are no specific predictors or preventable measures.- Validation for both their primary loss of the infant, and also for the secondary loss of dreams and expectations for the future life of the baby that most bereaved parents experience.

Answer 37

Grieving parents and family of SIDS' deaths need:

Question 38

An occurrence of a severity and magnitude that normally results in death, injuries, property damage, and cannot be managed through the routine procedures and resources of the government.

Answer 38

Disaster

Question 39

* Vary in size, scope, extent of damage, loss of life, injury, and degree of disruption to families and the community. * Characterized by long periods of threat- not age specific

Answer 39

Disasters

Question 40

Extend over a few moments of many months * Tornados, hurricanes, typhoons, earthquakes, floods, tsunamis, volcanic eruptions, dam breaks, explosions, nuclear accidents, fires, transportation crashes, structural collapses, murders, suicides, accidents. * homes can never be replaced, overwhelmed by the sights and smells and sounds, expected to produce significant levels of psychological impairment among survivors.

Answer 40

Disasters- Natural or Man-Made

Question 41

Disasters in which dead bodies are exposed. * Clearly linked to mental health problems * Exposure of victims to life-threatening situations (terror), in which they witness or directly experience overwhelming forces is like to generate psychological impairment * Earthquakes, volcanoes, flash floods, tornadoes, accidents, or terrorist attacks. * Terror and horror are more likely to be experienced in intense disasters that are unexpected or those which the victims have had no previous experience. * Allow for no time for preparation and do psychological damage by undermining the survivors' sense of control

Answer 41

Horror Factor

Question 42

Particularly threat of recurrence after an initial impact. * More likely to generate mental health problems than disasters unaccompanied by prolonged threatperiods * Post-impact threat is more stressful than pre-impact threat and often occurs after natural disasters

Answer 42

Disasters Characterized by Long Periods of Threat

Question 43

* Crying * Thumb-sucking * Loss of bowel, bladder control * Fear of being left alone, fear of strangers * Irritability * Confusion * Irritibility

Answer 43

Preschool Reactions to Disaster

Question 44

* Headaches, other physical complaints * Depression * Fears about weather, safety * Confusion * Suspicion * Inability to concentrate * Poor performance * Fighting * Withdrawal from peers

Answer 44

5 to 10 year old Latency Age Reactions

Question 45

* Headaches, other physical complaints * Depression * Suspicion * Irritability * Confusion * Poor performance * Aggressive behaviors * Withdrawal and isolation * Changes in peer group, friends

Answer 45

Preadolescent and Adolescent Reactions to Disaster

Question 46

* Psychosomatic problems, such as ulcers, heart trouble * Withdrawal * Anger * Loss of appetite * Sleep problems * Loss of interest in everyday activities

Answer 46

Adult Reactions to Disasters

Question 47

* Depression * Withdrawal * Apathy * Agitation, anger * Irritability * Disorientation * Confusion * Memory loss * Accelerated physical decline * Increase in number of somatic complaints

Answer 47

Senior Citizen Reactions to Disasters

Question 48

* Necessity of developing rapport * information or referrals that can help them deal with immediate problems * Encourage and approve of the expressing emotions or catharsis * Be patient and understanding of the uniqueness of their responses- this is due to their fragile state.

Answer 48

Disaster Victims

Question 49

An act or practice of allowing the death of a person suffering from al ife-limiting condition.

Answer 49

Euthanasia.

Question 50

* Voluntary active euthanasia * Involuntary active euthanasia * Passive euthanasia * Physician- assisted suicide

Answer 50

Types of euthanasia

Question 51

A deliberate intervention by someone other than the person whose life is at stake. Ends the life of a competent, terminally ill person who makes a fully voluntary and persistant request for aid in dying.

Answer 51

Voluntary Active Euthanasia (Mercy Killing)

Question 52

An intervention intended to kill a person who is incapable of making a request to die: an infant or young child, a mentally incompetent patient or someone, who because of impaired consciousness, is unable to give voice to his opinion.

Answer 52

Involuntary Active Euthanasia

Question 53

The forging or withdrawal of medical treatment that offers no hope or benefit to the total well-being of the patient with the intent of causing death.

Answer 53

Passive Euthanasia

Question 54

When a physician provides medication or other means for a patient to use on himself to end life. * The physician does not control the act, the patient does.

Answer 54

Physician-Assisted Suicide

Question 55

* Not a phenomenon of the 21st century- reports go back thousands of years * ancient Greeks and Romans- Aristotle and Pythagorus were opposed to it * Post-classical period, with the ascendancy of Christianity, acceptance of euthanasia varied. * 20th century- culminated in the near unanimity of medical opposition to it. * Sir Thomas Moore presented one of the earliest theoretical discussions of euthanasia in English literature in 1516 (ibid).

Answer 55

Euthanasia

Question 56

An abnormal grief response that is more intense than normal grief, yet different than clinical depression.

Answer 56

Complicated grief (Known as pathologic, chronic, delayed, masked, or exaggerated grief. (worden) chapter 7)

Question 57

A reaction that is prolonged, expressive in duration, and never comes to a satisfactory conclusion.

Answer 57

Chronic grief

Question 58

A reaction that does not occur in a normal timeframe but occurs at a later time.

Answer 58

Delayed grief

Question 59

Occurs when a person experiences symptoms and behavior which causes them difficulty but they do not recognize the fact that these are related to the loss.

Answer 59

Masked grief (also called inhibited, suppressed, or postponed grief).

Question 60

Occurs when the reactions to the loss are excessive and disabling.

Answer 60

Exaggerated grief

Question 61

Kenneth Dakota introduced this term to describe a loss that society believes does not deserve mourning. The loss is not openly acknowledged, socially sanctioned, or publicly shared.

Answer 61

Disenfranchised grief

Question 62

* Chronic grief * Delayed grief * Masked grief * Exaggerated grief * Disenfranchised grief

Answer 62

Types of complicated grief

Question 63

1. Relationship to the deceased is not socially recognized. -This would include relationships such as homosexual relationships, extramarital affairs, or heterosexual cohabitation. 2. Loss is not acknowledged by others being as a genuine loss. -Examples include abortion, miscarriage, pet loss, and death of a former spouse. 3. The grievers are unrecognized. -Examples include the death of a friend, co-worker, or someone mentally disabled. 4. Death is not socially sanctioned.- Examples include suicide, auto-erotic asphyxia, or legal execution.

Answer 63

Doka's 4 types of death that lead to disenfranchisement

Question 64

* Relationship factors -such as ambivalence * Circumstantial factors - Such as uncertainty and multiple losses or when the death is sudden, traumatic, or shocking. * Personality factors - Such as the inability to tolerate extreme emotional issues, negative self concept. * Social factors - Such as shame, embarrassment, or social stigma, when death is not approved by society, or not strong support group.- ie- suicide, execution or a crime * Historical factors - such as previous complicated grief reactions or the influence of early parental loss

Answer 64

Factors that may complicate grief

Question 65

* Relationship factors * Circumstantial factors * Personality factors * Social factors * Historical factors

Answer 65

Factors that may complicate grief

Question 66

If left untreated, this may lead to depression, suicide, drug or alcohol abuse, or even heart disease.- 15-20% of all mourners will have their grief turn into this.

Answer 66

Complicated grief

Question 67

* They have difficulty speaking of the deceased without experiencing renewed and intense grief. * They constantly bring up the themes of death and loss in even the most causal conversations * They have ongoing sleep problems sleeping too much or too little that persist for more than 6 weeks. * They make sudden and radical changes in lifestyle * They exhibit self-destructive behavior, i.e., excessive drinking substance abuse, promiscuity * Without any real medical problems, they develop some of the same symptoms of the deceased person experienced just before death- Continued disbelief in the death of the loved one.- Inability to accept the death- Presistent flashbacks, nightmares, intrusive memories- Magnified and prolong grief symptoms: anger, sadness, or depression- Maintenance of a fantasy relationship with the deceased with feelings that he is always present and watching. * Continuous yearning and searching of the deceased * Unusual symptoms that seem unrelated to the death (physical symptoms, strange or abnormal behavior) * Breaking off all ties to social contacts

Answer 67

Indications that someone may be suffering form complicated grief (these must usually be in excess of several months)

Question 68

* They avoid anyone or anything associated with the deceased including friends, family, and previously shared activities * Even relatively minor events trigger an intense grief reaction * They exhibit consistent symptoms of depression, especially extreme and persistent feelings of guilt, hopelessness, and lowered self-esteem. * Their ability to manage everyday responsibilities at work, school, or home is significantly imparied.

Answer 68

Other symptoms of complicated grief