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Grief, Burden, Violence, Stigma

Grief, Burden, Violence, Stigma . Week Five: Special Topics PSRT 4271: The Family Role in Rehabilitation. Grief. The Mystery of the Hereafter and The Peace of God that Passeth Understanding (1891) Adams Memorial, Rock Creek Cemetery Augustus Saint-Gaudens. Augustus Saint-Gaudens.

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Grief, Burden, Violence, Stigma

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  1. Grief, Burden,Violence, Stigma Week Five: Special Topics PSRT 4271: The Family Role in Rehabilitation

  2. Grief The Mystery of the Hereafter and The Peace of God that PassethUnderstanding (1891) Adams Memorial, Rock Creek Cemetery Augustus Saint-Gaudens

  3. Augustus Saint-Gaudens

  4. Grave of Henry Adams’s wife

  5. Grief The Mystery of the Hereafter and The Peace of God that PassethUnderstanding (1891) Adams Memorial, Rock Creek Cemetery Augustus Saint-Gaudens

  6. Phases of Grief (Mohr & Kubinski, 2001)

  7. Phases (Mohr & Kubinski, 2001) • Avoidance Not reality!

  8. Phases (Mohr & Kubinski, 2001) • Avoidance Not reality! • Confrontation Harsh reality

  9. Phases (Mohr & Kubinski, 2001) • Avoidance Not reality! • Confrontation Harsh reality • Accommodation New reality

  10. “Disparity” • Theory of chronic sorrow (Eakes et al., 1999) • A trigger for grief… • What is vs. what might have been

  11. Mohr & Kubinski Study • 4 focus groups • 8 per group • 90 minutes each • Children ages: 17 to 31

  12. Findings • Epiphany: “nightmares” • Action: from “shattering tension” • Deluge: “emotional shredding” • Fear: of everything… exhausting • Anguish, Guilt, Sequelae…

  13. Implications… • Caregivers must know grief dynamics • Not dysfunction • Rather: understanding • Refer families to programs that can help… • NAMI Family to Family, etc.

  14. Burden

  15. Interesting facts… (Doornbos, 2001) • Up to 60% live with, receive care from families

  16. Types of burden (Lefley, 1989) • Objective • Subjective

  17. Behavior management issues…(Lefley, 1989) • Abuse • Mood swings • Offensive public behavior • Conflicts • Squandering of money • Poor hygiene • Property damage • Disruptive sleep patterns • Rejection of medications

  18. Lit Review: Caregiving analyses… • 9 processes (Schumacher et al., 2000) • Monitoring • Interpreting • Deciding • Acting • Adjusting • Caring (hands-on) • Assessing (resources) • Collaborating • Negotiating • 5 categories (Bowers, 1987) • Anticipatory • Preventative • Supervisory • Instrumental • Protective

  19. Doornbos: 5 caring processes • Monitoring • Managing • Maintaining • Encouraging • Socializing

  20. Doornbos: Needed… • Information! • Medications • Symptoms • Resources • “Everything!” • Where? • Support groups • Education programs

  21. Wanted from professionals…(Doornbos, 2001) • Understanding of family impacts • Inclusion in treatment planning • Understanding of family time devoted • Understanding of family frustration

  22. Violence

  23. I am Adam’s Lanza’s Mother!... http://www.youtube.com/watch?v=Dgrr2jDcXAs

  24. http://www.youtube.com/watch?v=qMDssBTWgJ4

  25. Families speak out in CA (News10/KXTV, 2012) Laura’s Law http://www.youtube.com/watch?v=GOAoI5-0l9o

  26. Elbogen & Johnson (2009) “…if a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next 3 years as any person in the general population.” http://www.youtube.com/watch?v=wCeFEr5ioqo

  27. Is this the answer? • http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=192996785&m=192996772

  28. Stigma

  29. What is stigma? • A mark, brand, or label • An interactive social process • Both

  30. Stigma  Effects (Heflinger & Hinshaw, 2010) • Lack of recognition of prodomal symptoms • Shame  less assessment, treatment • Less funding, lower reimbursements • Low status, marginal priority

  31. Structural models of stigma (Larson & Corrigan, 2008) Besides public cues… • Cognitive (stereotypes) • Emotional (prejudice) • Behavioral (discrimination)

  32. 3 levels (Heflinger & Hinshaw, 2010) • Individual • Community • Societal

  33. Stress from providers…(Lefley,1989) 4 sources of “iatrogenic” damage: • Avoidant or recriminant responses • Double-bind messages • Interventions that alienate • Provocative family-provider interactions

  34. Providers as family members…(Lefley, 1989) Role conflicts: • 72%: had psychotherapy, but… • 26%: strong reluctance to discuss… • 90%: overheard colleague disparagements

  35. Stigmatizing provider attitudes • ID by diagnosis (“bi-polar kid”) • Focus only on deficits instead of strengths • Focus on condition instead of whole person • Planning without them or their families • Facilities: subpar, difficult to access

  36. “Courtesy stigma” • Stigma by association

  37. The last word on stigma… President Obama, June 3, 2013 http://www.youtube.com/watch?v=UqnF3UicuQs

  38. Today’s Guest Presentation…

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