chapter 8 loss, grief, and adjustment. © copyright 2009 delmar, cengage learning. all rights...
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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
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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
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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
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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
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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
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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.
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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.
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Grief
• Grieving behavior: the stages of grief as identified by Elisabeth Kubler-Ross– Denial– Anger– Bargaining– Depression– Acceptance
• Not a progression but a process
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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.
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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.
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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.
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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.
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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
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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.
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Coping - Learning from Experience
• Defense Mechanisms:– Denial– Projection– Regression– Displacement– Emotional insulation– Compensation– Acting out
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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.
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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.
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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
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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.
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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.
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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