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Loss and Grief

The Aging Survival Kit



Grief: A Universal Experience

“To spare oneself from grief at all costcan be achieved only at the price of totaldetachment, which excludes the ability toexperience happiness.”

Erich Fromm (1900-1980)



Five Stages of Grief (Kubler-Ross, 1969)

Denial: The initial stage: “It can’t behappening.”

Anger: “Why ME? It’s not fair?!” (either referringto God, oneself, or anybody perceived, rightly or

wrongly as responsible)

Bargaining: “Just let me live to see my songraduate.”

Depression: “I am so sad, why bother with

anything?”

Acceptance: “It’s going to be OK.”



Five Stages of Grief, Continued

These stages of grief do not come in order. Theycan be applied to any form of catastrophic lifelosses:

Loved One

Employment

Home

Income

Freedom

According to Kubler-Ross a person

simultaneously experiences two of the stages atany given time.



Understanding Loss(Rando, 1984)

Avoidance: Shock, denial, disbelief, confusion,disorganization.

Confrontation: “highly emotional state whereinthe grief is most intense and the psychological

reactions to loss are felt most acutely.”

Reestablishment: “gradual decline of the grief and marks the beginning of an emotional andsocial reentry back into the everyday world” (pp.

28-29).



Understanding Loss, Continued

According to Rando, the griever will:

Acknowledge, accept, and understand thereality of the loss.

Experience the pain of the grief and reactto the separation from that which is lost.

Adapt a new way of life.

Reinvest in a new way of life.



Anticipatory Mourning(Rando, 2000)

“The phenomenon encompassing seven genericoperations:

Grief

Mourning

Coping

Interaction

Psychosocial reorganization

Planning

Balancing conflicting demands

Facilitating an appropriate death” (p. 51)



Disenfranchised Grief (Doka, 2002)

According to Doka: “this grief is experienced inconnection with a loss that is not sociallyacknowledged, publicly shared, or supportedthrough usual rituals. The significance of the lossis either not recognized or the relationshipbetween the deceased and the bereaved is notsocially sanctioned, the person suffering the lossis given little or no opportunity to mourn publicly.It is experienced when the relationship is notrecognized (lovers, ex-spouses, same-sexpartners, close friends), when the loss itself isnot recognized (stillbirth, miscarriage, abortion,adoption, pet loss), when the griever is notrecognized (very young, very old,developmentally disabled). The manner of deathitself can be disenfranchising (murder, suicide,AIDS). When such deaths are treated as lessthan significant losses, the process of grievingbecomes more difficult.”



The Grief Process(Worden, 1982)

The Tasks of Grief:

To accept the loss

Experience the pain

Adjust to the new environment

R einvest in the new reality



Complicated Grief (Worden, 2001)

Chronic Grief : One that is prolonged, is excessive induration, and never comes to a satisfactoryconclusion.

Delayed Grief : Emotion that has been “inhibited,suppressed, or postponed.” A subsequent loss may

elicit an exaggerated reaction because the bereaved isgrieving for two losses.

Exaggerated Grief : Occurs when feelings of fear,hopelessness, depression, or other symptoms becomeso excessive that they interfere with the daily

existence of the bereaved.

Masked Grief : Symptoms and behaviors experiencedby a person who does not recognize the fact thatthese are related to a loss.



Case Study

Mr. and Mrs. B. have been married for 50 years.They have been in good health and have beenenjoying retirement (traveling, seeing theirgrandchildren and sleeping until noon!)

Both Mr. and Mrs. B. will be turning 70 this yearand the family are planning a BIG surprise party.

One morning Mrs. B. wakes up and she can notmove the left side of her body. Mr. B. calls anambulance and the family physician. Mrs. B. is

taken to the hospital.



Case Study, Continued

Upon Mrs. B.’s arrival at the hospital you have beenassigned as her social worker. You have just been to aworkshop on loss and grief and have been reviewingthe powerpoint (Yes, this one!). What do you considerto be the most pressing medical, psychosocial, andspiritual concerns that they will both face?

What will grief look like to:

Mr. B

Mrs. B

Their family (all 30 people!)

How will you, as the social worker, provide a therapeuticintervention that will meet their needs.

Is meeting everyone’s needs possible or realistic?



“Who Dies?” (Levine, 1982)

“How much of what we call grief is theexperience of previous loss? And how dowe allow such grief not to be a motivatorfor our life? How do we get in touch with

that deep pain, that place of loss thatcreates a fear of life itself, our doubt inourselves about our ability to deeplyexperience the world because we so fearloss and change?”



Bibliography

Gehlert, S., & Browne, T.A. (2006). Handbook of Health Social Work . Hoboken, NJ: John Wiley & Sons, Inc.

Levine, S. (1982). Who Dies? An Investigation of

Conscious Living and Conscious Dying. New York:Anchor Books.

Kubler-Ross, E. (1973). On Death and Dying. NewYork: Routledge.

Kubler-Ross, E., and Kessler, D. (2005). On Grief and Grieving: Finding the Meaning of Grief Through theFive Stages of Loss. New York: Scribner.

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