Bereavement Support
These are notes and transcriptions of handouts from a three-hour seminar given in about 2001. Most people don’t know what to say to the person who has just lost someone close. “I’m sorry,” or “I’m sorry for your loss” is often enough. And a simple “Thank you” is enough as a reply.
When the person is ready, you may offer yourself as a listener, and facilitate the mourner’s telling stories about the person, about his/her relationship with that person, and about how his/her life has changed now that the person has gone. The mourner does well to tell these stories to willing listeners. Even repeating stories helps define things better in one’s mind.
The first handout I’m summarizing for you is my favorite, a one-page diagram titled “The Experience of Grief.” I may not put it on line, as the copyright belongs to Jack Locicero, 1991, but try to visualize it. Across the top five stages are listed. The first is Acknowledging the loss. Underneath that heading the darkest band stretches out below with “Shock” written across it and then a descending sequence of near-rectangles: shock/disbelief; confusion/anxiety; panic/bargaining; depression; anger/guilt; lowered self-esteem; pre-occupation; retell story; loneliness; sadness/despair.
The next stage is Experiencing the pain. The broadest and next darkest band stretches out with the words “Disorientation: Fear of losing control” written on it, as the rectangles continue at the bottom of the page: helplessness; frustration; limbo; resentment; bitterness. The last of these rectangles begins an ascent that continues through the rest of the series.
The next stage is Re-adjusting to the loss. Underneath is a medium grey band with “Adaptation: Struggling with new roles and responsibilities” written on it, and then come the rectangles ascending from the bottom of the diagram: envy; yearning; missing; struggling; hope.
The next stage is Reinvesting emotional energy. Underneath is a light grey band on which you read the words, “Sense of healing: Developing new environments, relationships, activities.” The rectangles contain the words, growth; healing, acceptance.
The last stage is Reconciling the loss. The band below is white, with the words, “New Directions: Remembering with less pain.” There are two rectangles, the first laid out horizontally, like all the previous ones, and the last one laid out at a 30-degree ascending angle, both containing the word “Opportunities.”
The presenter suggested regarding the stages as a cycle or spiral and said that the whole process takes 3-5 years.
The next handouts come from the Hospice of Visiting Nurse Service (see http://www.vnsa.com/Hospice/GriefSupport.aspx).
Grief=the emotional reaction to all types of loss; an emotional upheaval resulting from loss.
Mourning=the expression of grief or that emotional upheaval. It is the process we utilize to adapt and adjust our lives to loss, to take what is inside and put it outside. It includes three sets of operations, each with its own particular focus.
Bereavement=is the state of having suffered a loss. To be bereaved means to have the experience of loss. Bereave derives from the same root as the term “rob.” Both imply the unwilling deprivation by force, having something withheld unjustly or injuriously, a stealing away of something valuable—all of which leave the individual victimized.
1) Focus is on the deceased
Gradually undo the psychosocial ties that had bound the mourner to the loved one, and ultimately facilitate the development of new ones. Finding new ways to relate to the deceased.
2) Focus is on the self
Help the mourner to adapt to the loss. Deal with assumptive world and identity.
3) Focus is on the external world
Help the mourner learn how to live healthy in the new world without the deceased.
Mourning goes on forever: acute grief does not. Grief is to mourning what infancy is to childhood.
Types of Loss [notes: these types are related]
Secondary loss is that loss which goes with or is the result of the death: role, status, love, power. Loss always results in deprivation.
Material loss is the loss of a physical object or familiar surroundings to which one has an important attachment. Objects have either intrinsic or extrinsic value. Objects with extrinsic value attached to another human being that we love cause the deepest pain when lost. [Notes: A person may well need an object to facilitate the sense of connection.]
Intrapsychic loss is the experience of losing an emotionally important image of oneself, losing the possibilities of “what might have been,” abandonment of plans for a particular future, the dying of a dream. Although often related to external experiences, it is itself an entirely inward experience. Very often what we lose has been a secret, a hope or a dream seldom if ever shared with others. Because of that, the fact that a loss has occurred will also be a secret.
Functional loss is the losing of the muscular or neurological functions of the body. Most often associated with aging, it often carries with it a loss of autonomy. The sense that “I can manage” is gone. [Notes: the mind gets scattered, and hence one forgets how to do things or can’t sustain one’s focus.]
Role loss is the loss of a specific social role or of one’s accustomed place in a social network. This is directly related to the extent to which one’s identity is linked to the lost role (i.e., retirement, promotion).
Systemic loss occurs when a change takes place in the system as a whole. We all belong to some interactive system in which patterns of behavior develop over time. When those patterns change, loss occurs (i.e., leaving the family of origin).
Relationship loss is the ending of opportunities to relate to, talk with, share experiences with, settles issues with, fight with and otherwise be in the emotional and/or physical presence of a particular other human being. [Notes: most want one more chance for the perfect culminating conversation. Find creative ways of saying what you didn’t say. One may feel anger: he left her with the gutters and shrubs to deal with. She was at a loss.]
Assumptive World (another Hospice handout)
Pertains to expectation and beliefs and assumptions that we have about life and the people in life==our worldview of life such as God is good or the world is just.
When a person dies all the assumptions about that person are shattered. A person’s assumption of safety from vulnerability is shattered.
When assumptive world is destroyed the person’s basis is stunned and shattered. Assumptive world breaks will be harder to get over because their very existence is in our very nature.
Two classes of assumptive world beliefs.
1. Expectation, beliefs directly related to the person
2. General world view: i.e., God is God, or life is orderly and predictable.
Support is expected from certain people.
Examples of assumptive world issues
For a person whose parent dies: The parent is the initial creator of the world for the mourner. When the parent dies, the mourner needs to redefine the world without that person who first created life. The parent, even of an adult, is still a cornerstone person in the mourner’s world.
For a person whose spouse dies: This is the loss of a person the mourner chose to love. This choice defines the importance of the deceased to the mourner. Oftentimes the spouse promises to “Always be there.” When death comes, that promise is broken. In the mind this can be dealt with; but this promise goes further than the mind. It defines the basic assumptions of the relationship.
For the person whose child dies: We all expect that children will outlive parents. When they do not the world of future hopes, dreams, and assumptions is broken. Even if the child is an older adult, the assumptive world of the parent is broken.
STUG
STUG=Subsequent Temporary Upsurge of Grief
STUG is the experience of suddenly being overcome with emotion w hile remembering your loved one. This comes without warning and no apparent cause. When first experienced, since there may seem to be no cause for the reaction, STUG’s can cause people to question their own ability to cope, their own sense of reality and possibly their sanity. This is a normal grief reaction, and people need to be educated accordingly.
There are three types of STUG reactions.
CYCLIC PRECIPITANTS
Anniversary reactions
Holiday reactions
Seasonal reactions
Ritual prompted reactions (repetitive)
LINEAR PRECIPITANTS
Age-correspondence reaction
Experience-associated reaction
Transition-stimulated reactions
Developmentally determined reactions
Crisis evoked reactions
Ritual prompted reactions (single event)
STIMULUS CUES PRECIPITANTS
Memory-based reactions
Reminder-inspired reactions—smell
Loss and/or reunion theme-aroused reactions
Music-elicited reactions
Best wishes on a meaningful and progressive process of grieving and on helping others in the light of your knowledge and experience!
Jeffrey Wattles
Revised, November 26, 2012