chapter 8 loss, grief, and adjustment. © copyright 2009 delmar, cengage learning. all rights...

Chapter 8Chapter 8

Loss, Grief, and Adjustment

Loss, Grief, and Adjustment

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 2

Loss

• Loss: the removal of one or more of the resources which I depend on to meet my needs in life (See textbook Figure 8-1.)

• Losses may be divided into:

– Internal and External

– Primary and Secondary

• Internal loss: personal, such as a physical loss or mental / emotional loss

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 3

Loss

• External loss: the loss of a home, family, or social roles

• Primary loss: the initial loss; may be either internal or external, as with a heart attack or loss of a home

• Secondary loss: the result of the primary loss, such as a heart attack resulting in the loss of employment

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 4

Loss

• Types of primary loss: eight basic types of primary loss:– Sudden loss: such as an unexpected

accident which gives no time for preparation– Gradual loss: the gradual deterioration

involved in aging or chronic disease – Anticipated loss: some diseases and aging

have a predictable progression that we can prepare for over time

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 5

Loss

– Uncertain loss: diseases, such as multiple sclerosis, have a high degree of uncertainty

– Total loss is the death of a loved one, or learning you have a terminal disease

– Partial loss: an illness or disability that takes away a part of daily functioning

– Permanent loss: no hope of recovery – Temporary loss: good hope of recovery

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 6

Loss

• The effects of loss The serious impact of a loss depends on all of its elements.

• Impairment: the result of loss that prevents us from meeting our needs

• Functional limitation limits our ability to perform in some way

• Disability: the inability to carry out our role in society

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 7

Grief

• Grief: the psychological and physiological response to loss

• Grief may be divided into five types:– Anticipatory grief occurs when a loss is

eminent and involves preparation. – Acute grief begins at the time of loss. The

severity of the grief is proportional to the severity of the loss.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 8

Grief

– Chronic grief: continual or intermittent mourning; the person does not adjust to the loss and may always grieve

– Delayed grief: held in until a safer time and then released

– Suppressed grief is repressed, unfelt for many years, and then some future event may unexpectedly trigger its release.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 9

Grief

• Grieving behavior: the stages of grief as identified by Elisabeth Kubler-Ross– Denial– Anger– Bargaining– Depression– Acceptance

• Not a progression but a process

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 10

Grief - Grieving Behavior

– Denial On first learning of impending loss it is common for the person to try to make it not be true; they may seek a second opinion.

– Anger As the reality of the loss becomes evident. it triggers strong emotion.

– Bargaining After the initial acceptance of their loss, people often try to make deals.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 11

Grief - Grieving Behavior

– Depression: facing reality without the denial, anger, or bargains. The person feels the full impact of the loss which in turn produces a deep sadness or depression.

– Acceptance Accepting the loss and grieving it allows the person to adjust and focus on what they still have or can achieve.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 12

Grief

• Modern grief: today’s world moves quickly

• Prolonged grief is seen as a weakness requiring medical, psychiatric, or psychological intervention.

• It can take some time to return to being reasonably normal after a major loss.

• Take the time to listen.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 13

Coping

• Coping The ability to deal with general misfortune can either help or hinder the coping with a loss.

• The ability to cope is created by beliefs.

• If my beliefs leads to behaviors of non compliance, my coping is diminished. If my beliefs lead to acceptance, then I am able to adapt and cope.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 14

Coping

• Experience The ability to face a major loss is strongly influenced by the range and depth of experiences.– Range: the number and variety of

experiences in life– Depth: the extent of the experiences

• Maturity: the ability to remain in control emotionally and cope with difficulties

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 15

Coping

• Learning from experience: changes how I think and act

• Accommodation: accepting the experience for what it is, even if beliefs are altered

• Assimilation: twisting the information presented by an experience to make it fit into existing beliefs. This may require the avoidance of defense mechanisms.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 16

Coping - Learning from Experience

• Defense Mechanisms:– Denial– Projection– Regression– Displacement– Emotional insulation– Compensation– Acting out

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 17

Adjustment

• Health: a “state of complete physical, social, and mental well being, and not merely the absence of disease or infirmity”

• Quality of life is not determined by what we have or by what we are able to do, it is determined by how much we appreciate what we have.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 18

Healing

• Cure: to correct what is wrong; to remove the cause of disease or disability

• Pain syndrome: chronic and worsening pain in the absence of physical causes

• Gate-control theory of pain offers an explanation for pain syndrome. Neurons in the spinal cord act as gates to increase or decrease pain messages to the brain.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 19

Healing

• Therapeutic relationship: helps a person to heal; enhances the quality of life by encouraging acceptance and hope

• Healing: a person who has worked through to acceptance and found a way to be active in life, whether or not they have been cured

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 20

Summary

• Loss is a part of everyone's life. We may have physical or mental/emotional losses.

• Grief is a mind and body response to loss.

• Grief, in turn, powers adjustment.

• Grieving is a process not a progression.

• If we are well adjusted to life, we are usually able to adjust to loss and grief.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 21

Summary

• If we have to use defense mechanisms to cope with life, then we have little ability to adjust to loss and grief.

• Experience also plays a role in our ability to cope with loss.

• Quality of life is determined by how much we appreciate what we have and the belief and hope that keeps us striving toward the future.

© Copyright 2009 Delmar, Cengage Learning. All Rights Reserved. 22

Summary

• Pain and illness can often create functional limitations. This may or may not lead to disability.

• We need to try and focus on what we can accomplish day by day

• A person can experience healing, whether or not they have been cured