Olivia Retallack MA Mental Health Worker * Crisis Services * Addictions Counselor * Domestic Violence Counselor * S.M.A.

1. Olivia Retallack MA Mental Health Worker * Crisis Services * Addictions Counselor * Domestic Violence Counselor * S.M.A.R.T Volunteer Thanatologist

2. Why Learn About Grief? To enrich our personal lives. “The really important thing isn't to live, but to live well” (Plato) To inform and guide us with death interactions in our society. To prepare individuals for our public roles. - clarify social issues that our society faces. To enhance the ability of individuals to communicate effectively about death-related matters. To understand and appreciate how development of human life interacts with death related issues. - Children grieve differently than adults. • *To enrich our personal lives. • “The really important thing isn't to live, but to live well” (Plato) • * Inform and guide us with death interactions in our society. • * To prepare individuals for our public roles. - clarify social issues that our society faces. • * To enhance our ability to communicate effectively about death-related matters. • * To understand and appreciate how development of human life interacts with death related issues. - Children grieve differently than adults. • * Understand the role the grief plays in our own lives – personally/professionally

3. Types of Loss • Physical: Loss of something tangible - House burns down; car is stolen, person dies. • Psychosocial: Symbolic loss – divorce, retired, loss of a dream • Primary Loss: The ending of the basic attachment.(The person) • Secondary Loss: The loss that follows. (Accountant, Planner, Organizer, gardener etc.)

4. Grief – Physical * Hollowness in stomach * Lump in the throat * Tightness in the chest * Aching arms * Oversensitivity to noise * Shortness of breath * Lack of energy * Muscle Weakness * Dry Mouth * Loss of Coordination

5. Grief - Behavioral * Sleep/Appetite Changes * Absentmindedness * Social Withdrawal * Loss of Interest in activities * Crying * Avoiding reminders of the deceased * Searching/Calling Out * Restless Activity * Cherishing Objects of meaning

6. * Relief * Numbess * Depersonalization (Out of body experience) Grief Emotional * Sadness * Anger * Guilt * Anxiety * Lonlieness * Fatigue * Helplessness * Shock * Yearning

7. Types of Grief • Anticipatory Grief – expected, terminal illness • Complicated Grief – Suicide, Homicide, etc. • Exaggerated Grief- prolonged symptoms, not recognized as grief

8. Types – Con't • Delayed Grief – no signs of grief for weeks or months. • Disenfranchised Grief – when the loss is not socially acknowledged. • Bereavement Overload – becoming saturated with grief experiences.

9. Tasks of Mourning • * an active process • 1. Accept the Reality of the Loss • 2.To work through the pain of grief • 3.to adjust to an environment in which the deceased is missing. • 4.to emotionally relocate the deceased and move on with life.

10. Sanders Integrative Bereavement Theory • Shock • Awareness • Conservation and the need to withdraw • Healing • Renewal

11. Shock • Provides a temporary buffer – it's purpose is beneficial. • Symptoms: Confusion, restlessness (May feel motivated to do something but don't know what.), helplessness, preoccupied with thoughts of the deceased, turning inward, loss of interest in outside factors. • What caregivers can do: Pick a few people that they are willing to stay connected with. Encourage them to ask for help, to allow themselves to be nutured, encourage them to be patient with themselves. Do not make major decisions!! It's okay if they are still referring to the deceased in the present tense.

12. Awareness • * Strong seesawing of emotions (happy/sad, good/bad) • * Separation Anxiety – feel as though a piece of you is missing, a sense of danger or vulnerability. • * Intellectually know the person is deceased, emotionally not convinced: seeking, bargaining – searching for a sign of existence. • Physical symptoms: yearning, crying, anger, frustration, guilt/survivors guilt, shame, sleep disturbance, increased fear of death., oversensitivity to others.

13. What caregivers can do: Let them know there is going to be pain and they can't avoid it. Alert them that their support system will dwindle, encourage not to hid feelings, give them permission to cry, vent anger in a healthy way (exercise), allow them to talk about the loss over and over, help them to understand they may be more sensitive right now, encourage them to eat properly.

14. Conservation and the need to Withdraw • Symptoms: • Obsesional Review – obsess and ruminate about the death, wonder if we could have done something to prevent it. • Turning Point – near the end of this phases is where we will see an individual starting to have feelings of hopefulness. • Physical Characterisics: Fatigue, weakness, great need for sleep, weekend immune system, helplessness, feeling loss of contro • What do Caregivers do? Give permission to withdrawal – with decreased energy increase in sleep is good, encourage them to look at photos, to nurture themselves, maybe recognize the bad times are getting less, simplify life, start to make some changes at home – maybe move furniture – do not get rid of it yet. It is up to the individual what happens from here.

15. Healing • “As we die to our old life, a new one is being forged in its place.” (Sanders, 1992) • Begin to assume control – if making changes (reversible – paint house etc.) • Relinquish Roles • Form new identity – take vacation, get a job, go back to school • Increased energy • Forgiving – the deceased, themselves • Searching for meaning – spiritual connection is important here. • Renewed Hope • What caregivers can do? Help them to see the increased in energy, help them to find new roles to replace those that were lost, look for new relationships, take time for meditation and prayer, allow self time off from grief.

16. Renewal Renewed self awareness – we have changed and are aware of it. Accepting responsibility Learning to live without the deceased Re-energized Reaching Out Living for oneself What caretakers can do: Help them understand it is okay to still talk about the deceased, Maintain healthy lifestyle, look for unfinished business, plan a final goodbye, express the gains they have made on their journey, focus and explore new goals, help them understand grief may reemerge briefly at holidays etc, reach out during bad days

17. When Grief isn't Normal • 365 days of “new” without the deceased • * If the death is of a child is could be 2 years of “new” the first year can be that of total shock. • When to refer out: • * Months or years after the death still thinking about the loss and ignore personal responsibilities. • *Months or years later you feel sad, hopeless, and angry most of the time. • * Lost interest in daily activities or relationships. • *You feel guilty that you are still alive, or feel guilty for starting to feel better as though you are betraying the deceased. Experiencing suicidal thoughts.

18. CRITICAL INCIDENTS Understanding & Managing Responder/Caregiver Stress

19. LEARNING OBJECTIVES • Learn the definitions of critical incidents • Learn the effects of critical incidents on the body & the brain • Learn the factors that affect recovery • Learn the “Top 5” stress management techniques

20. CRITICAL INCIDENT • An event outside the range of a normal human experience • Involves perceived threat to your own or someone else’s physical integrity • Overwhelms coping mechanisms • World view changes – ie, planes in Clarence Center Event – what happened…the critical incident Trauma – response from the person after the event

21. Intense fear, horror, or helplessness

22. TRAUMATIZING EVENTS, INDIVIDUAL • Automobile accident • Sexual assault/abuse • Any life threatening experience • Severe injury/death of one’s own child • Homicide • Suicide Everly & Mitchell

23. TRAUMATIZING EVENTS, INDIVIDUAL, Con’t. • Perception of serious threat to self or significant other • Serious physical injury/abuse • Life altering diagnosis • Observing any of the individual or community traumas Everly & Mitchell

24. TRAUMATIZING EVENTS, COMMUNITY • Earthquake • Hurricane • Fires • Floods • Large scale environmental pollution • Multiple injury/fatality accidents Everly & Mitchell

25. TRAUMATIZING EVENTS, COMMUNITY, Con’t. • Homicides in the Community • Child related traumatic events • High publicity crimes of violence • Community wide disasters • Terrorism Everly & Mitchell

26. Post Traumatic Stress Disorder • Witnessed, experienced or was confronted with a critical incident that involved serious injury, threat of death, etc • Response involved intense fear, helplessness or horror • Dissociation in response – person describes numbing, detatchment or absence of emotional response • Reduction in awareness of surroundings, memory loss • Re-experiencing of the event – images, dreams, night terrors, flashbacks • Avoidance • Anxiety • Increased hyper arousal • Impairment of functioning • PTSD when above take place for 3+ months and also: • avoidance of stimuli associated with critical incident; increased arousal affecting sleep, concentration, attitude; psychological distress when reimagining event • CLERGY play a KEY role in assessment!! Long term relationships!! 50% of people more likely to consult clergy than MHP.

27. STATISTICS • PTSD prevalence ~ 10-15% law enforcement personnel • PTSD prevalence ~ 10-30% fire suppression/EMS • New Orleans – 9:1000; Post Katrina 28:1000 • Clergy?

28. DOMAINS • Behavioral • Cognitive • Emotional • Physical • Spiritual Everly & Mitchell Handouts

29. IMPRINTS OF HORROR Refers to the sights, sounds and smells recorded in one’s mind during a traumatic experience Locally: bike path, planes, trees down

30. HOW THE BRAIN WORKS • Amygdala detects threat – freeze, fight, flight – Boston! • Activates the SNS, Pituitary Gland • Release of chemicals in the system • Flow of blood redirected • Physical symptoms – cotton mouth, cold fingers, bathroom issues • Transfiguration? Not such an odd response after all!

31. THE HUMAN BRAIN Talk therapy and prayer > Presence >

32. FACTORS AFFECTING RECOVERY • Size and nature of the event • Assumed/assigned responsibility • Physical/emotional proximity • Dose exposure – • Children involved - • Previous experience in crisis/trauma - • Interpersonal reactions National Center for PTSD

33. Man is not disturbed by events but by the view he takes of them Epictetus

34. Good Friday or Easter? Half Empty Half Full

35. FACTORS AFFECTING RECOVER, Con’t. • Being a rescue worker, responder • Prolonged events • Major trauma/loss in past year • Injuries to self or loved ones/deaths • Watching a great deal of media coverage • Stress status at time of event • What are you still carrying around in your backpack? National Center for PTSD

36. PREDICTORS OF LONG-TERM PROBLEMS • Being close to the event • Being injured • Knowing someone who was killed or injured • Being a rescue worker, responder, care giver • Dose exposure National Center for PTSD

37. PROTECTIVE FACTORS • Strong support network • Mastery of past critical incidents • Provided with information – funeral plan • Pre-existing spiritual practice • Shown care, concern & understanding by disaster relief personnel/first responders National Center for PTSD

38. STRESS MANAGEMENT The term applied to the conscious effort to better control, mitigate or interact with the stress in one’s life Everly & Mitchell

39. STRESS MANAGEMENT, Con’t. • Diet • Water • Physical activity • Rest & relaxation • Support systems

40. Kind words may be long or short to speak, but their echoes are truly endless. Mother Teresa

41. VIDEO CLIP Suggestions on How to Live a Happy & Rewarding Life Questions?

42. FOR MORE INFORMATION Bonita S. Frazer, MS, CTS, FAAETS Mental Health Emergency Planning Coordinator Lake Shore Behavioral Health, Inc. 254 Franklin Street Buffalo, New York 14202 716-218-2398 bonitafrazer@yahoo.com