1. Chapter 8 Loss, Grief, and Adjustment

2. © 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

3. © 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

4. © 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

5. © 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

6. © 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

7. © 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.

8. © 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.

9. © 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

10. © 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.

11. © 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.

12. © 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.

13. © 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.

14. © 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

15. © 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.

16. © Copyright 2009 Delmar, Cengage Learning. All Rights Reserved.16 Coping - Learning from Experience Defense Mechanisms: –Denial –Projection –Regression –Displacement –Emotional insulation –Compensation –Acting out

17. © 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.

18. © 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.

19. © 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

20. © 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.

21. © 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.

22. © 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