The Chains of Grief

1. The Chains of Grief The Compassionate Friends Annual Grief and Loss Seminar 18 June 2011 Presenter: Associate Professor Judith Murray The University of Queensland

2. The Chains that Bind:Reminiscence I hear your whisper on the wind I hear your voice just as it has always been Your laughter fills the air around me And I turn with a smile to laugh with you But when I turn there is silence There are only echoes in my mind I know this, and yet, often they are so loud So clear, so real, that I just can’t believe you’re not here Karen Gerry in‘ Words of Sorrow Words of Love’

3. The Essence of Our Chains: The EXPERIENCE of Loss Experience is not an unstable irrational and emotive concept but rather it is the world, it is knowing. Lumby (1994) Understanding the experience…. An Emic rather than an Etic approach. It is also you have shared with all humanity...

4. No one ever told me that grief felt so like fear. C.S. Lewis1898-1963 Well has it been said that there is no grief like the grief which does not speak Henry Wadsworth Longfellow1819-1892 Our trials, our sorrows and our grieves develop us. Orison Swett Marden 1850-1924 What right have I to grieve, who have not ceased to wonder? Henry David Thoreau 1817-1862

5. OTHER DEFINITIONS • Change • Loss is produced by an event which is perceived to be negative by the individuals involved and results in long-term changes to one’s social situations, relationships, or cognitions. Miller and Omarzu (1998) • Bereavement is the loss through death of a significant other. • Grief is • “the emotional response to loss: the complex amalgam of painful affects including sadness, anger, helplessness, guilt and despair.” Raphael (1984) • (Grief) incorporates diverse psychological (cognitive, social-behavioural) and physical (physiological-somatic) manifestations. Stroebe, Hansson & Schut (2001)

6. GRIEF IS HARD !!!

7. Losses rarely exist alone…What did you lose? Edvard Munch: The Dead Mother 1899-1900

8. The Chains weigh us down in every aspect .........

9. Physical Reactions to Loss • Heart palpitations • Sighing, trouble breathing • Headaches • Appetite changes • Numbness, tingling of feeling of heaviness in the arms or legs • Stiff neck, jaw tenseness • Susceptibility to colds, allergies • Easily startled • Chills • Fatigue • Sweating • Backache • Rapid shallow breathing • Nausea, upset stomach, diarrhoea, constipation • Other gastrointestinal problems • Tremors of hands, lips etc. • Sleep disturbances • Muscle weakness or aches • Faintness, dizziness • Pains in chest (needs checking by doctor) • Sensation of ‘lump in throat’ • Lack of coordination

10. Psychological Reactions • Irritability, anger or general agitation • Restlessness, excitability • Sadness, depression, crying • Feeling lost, isolated, abandoned • Wanting to be alone • Recurrent dreams, insomnia, night waking • Frustrated • Anxiety • Fears, worry • Apathy • Feeling overwhelmed. • Thoughts of ‘can’t go on’, (even suicide) in some cases • Feeling powerless, hopeless • Moodiness, periods of ‘highs’ and ‘lows’ following closely one after the other • Guilt, blaming • Flashbacks of traumatic events • Numbness, shock, confusion, inability to feel • Loss of interest in sex

11. Behavioural Reactions to Loss • Difficulty in concentrating, slowness of thinking and decision making • Difficulty expressing oneself verbally • Withdrawing socially, reluctance to leave home • Frequent arguments, family difficulties • Forgetfulness • Disorientation • Hyperactivity/ Inability to carry out even the most minor tasks • Increase in use of alcohol, tobacco and other drugs • Difficulty in organizing daily tasks • Avoidance of any reminder of the event • Preoccupation with memorabilia of lost person • Eating more or less • Loss of work efficiency

12. Other Reactionsto Loss SOCIAL • Loss can shape and change families (e.g., family secrets), communities (indigenous loss), societies (Australia and Port Arthur, Effects of War, AIDS crisis and Uganda) and Global Trends (9/11 and the War on Terrorism). • Effects on larger groups can then have affects on individuals (eg., transgnerational transmission of loss, Oklahoma Bomber) SPIRITUAL • Loss makes people ask the big questions of life • Difference between spirituality and religion

13. DEFINITIONS Mourning is the “the psychological processes that occur in bereavement whereby the bereaved gradually undoes the psychological bonds that bound him/her to the deceased” (Beverley Raphael 1984) Grieving : the process of dealing with losses other than bereavement

14. Definitions Suffering: The width of the gap between reality ‘what is’ and what is desired Suffering is not a question that demands an answer; It is not a problem that demands a solution; It is a mystery that demands a presence. Unknown

15. The Journey Through Loss What do we know about Grief and Grieving???

16. Chains of grief are normal and hard-working.As hard as it is, grieving is a normal, natural process

17. Dual Process Model (Strobe & Schut 2006)

18. The experience of loss is integrated into the basis psychological functioning of a person even from the earliest age. Therefore there exist both the potential for personal growth and personal deterioration.

19. Prototypical patterns of disruption in normal functioning following loss or potential trauma Bonanno 2008 Chronic Delayed Severe Moderate Recovery Mild Resilience Event 1 year 2 year

20. Grief to Growth Model(Hogan & Schmidt, 2002)

21. Different chains bind different people……Many factors will affect the journey through grief. Grieving is a mostly private and even at times lonely experience. For a child in an adult’s world it can be even more lonely

22. Internal Influences • Individual personality factors • Life Orientation / Purpose in Life • Spirituality / Religious beliefs • Death Anxiety • Coping Styles • Age • Gender • Individual culture • Attributional style • Vulnerability/Resilience • Previous mental health • Previous physical health • Mental capacity/Complicating disabilities

23. Circumstances Surrounding the Loss • The type of loss • Anticipation versus suddenness • The opportunity to say goodbye • The legal requirements of sudden death • Location of the loss • Perceived preventability/responsibility • Chronic sorrow

24. External Factors that Affect Grieving • Social context of the loss/Sanctions/Taboos. Disenfranchised grief • Family context • Concurrent stresses • Social support

25. Being Chained in Isolation

26. : The Existential Aloneness We were setting out on different roads. This cold truth, this terrible traffic regulation (‘You, Madam, to the right – you, Sir, to the left) is just the beginning of the separation which is death itself. And this separation, I suppose, waits for all. I have been thinking of H. and myself as peculiarly unfortunate in being torn apart. ‘Even if we both died at exactly the same moment, as we lie here side by side, it would just be as much a separation as the one you’re so afraid of’. Of course she didn’t know, nay more than I do. But she was near death; near enough to make a good shot. She used to quote ‘Alone into the alone’. She said it felt like that. And how immensely improbable that it should be likewise. C.S. Lewis, 1961, ‘A Grief Observed’, p.14

27. Alone …..Lonely… Difference between being ‘alone’ and being ‘lonely’ • Alone but not Lonely • Alone and Lonely

28. The Chains in our Heads Messages given to a person during early losses, that may contribute to a sense of being overwhelmed by life and loss at a later time, may include: • My pain in not as important as that of some others • My family falls apart under pressure. They can’t care for me when the going gets tough • I am ‘bad’ • I am responsible for other’s pain and comfort • I’m hopeless. I’m useless • You mustn’t bother people with your problems • Bad things happen to me, no matter how hard I try • People can’t be trusted • The world is a very scary place

29. The Chains in our Heads Messages adopted by people as a result of previous losses, that may enhance growth, include: • In times of trouble, someone will always be there for you • My family can weather bad times • I am safe • My needs matter to others • I can cope with bad times • There are many things in life I have control over • The world is an exciting place just waiting for me to explore it • Other people need me • I’m OK even if I’m not perfect • It’s OK to tell people how you feel • I know there are things you can do to help yourself feel better

30. Chains that Damage

31. Definition of ‘Problem Grieving’ Unresolved (‘problem’) grief is grief… That is preoccupying, incapacitating and immobilizing for a prolonged period in a way that causes concern to the bereaved person and his/her family and friends. McKissock & McKissock (1991)

32. Complicated Grief Complicated grief occurs when integration of the death does not occur. People who suffer from complicated grief experience a sense of persistent and disturbing disbelief regarding the death and resistance to accepting the painful reality. Intense yearning and longing for the deceased continues, along with frequent pangs of intense, painful emotions. Thoughts of the loved one remain preoccupying often including distressing intrusive thoughts related to the death, and there is avoidance of a range of situations and activities that serve as a reminder of the painful loss. Interest and engagement in ongoing life is limited or absent (Complicated Grief Review, Edith Cowan Uni and Australian Government).

33. Prigerson’s Criteria for Complicated Grief Proposed for DSM-V Criterion A: Chronic and persistent and disruptive yearning/ longing/ heartache Criteria B: 4 of 8 at least several times a day to distressing degree • Trouble accepting the death • Inability to trust others • Excessive bitterness or anger related to death • Uneasy about moving on • Numbness/Detachment • Feeling life is empty or meaningless without deceased • Bleak future • Agitated Criteria C: Marked and persistent dysfunction in social, occupational or other important domains

34. What are we chained to? What chains us?

36. Neurobiology and Complicated Grief Neuroimaging (O’Connor, 2005) has found a number of areas of the brain specifically active when grieving people (compared to viewing neutral similar forms of stimuli) are presented with picture and word stimuli of lost loved one or bereavement. Most active ones were: Posterior Cingulate Cortex: Area activated during autobiographical memory so memories being recalled. Also deals with emotionally salient stimuli Anterior Cingulate Cortex and Insula: ACC role in attention and Insula in processing visceromotor information. Suggests strong somatic element in reaction eg., ‘broken heart’, ‘pangs of grief’

37. Neurobiology and Complicated Grief O’Connor et al.(2007)imaged the brains of 12 women diagnosed by Prigerson Complicated Grief Scale as suffering complicated with 12 women not showing complicated grief. Found difference in nucleus accumbens, that is the part that anticipates rewards ie., the part that knows you want something, so the longing becomes like a ppowerful craving. Much more research needed.

38. Grief and Depression

39. The Powerful Chain: FearLoss threatens a person’s sense of safety, mastery and control

40. Loss that never seems to end because IT DOESN’T…. It simple changes It can be so very scary having the world you know totally turned upside down…..

41. No one ever told me that grief felt so like fear C.S. Lewis ‘A Grief Observed’

42. WITH FEAR….. If fear is natural…… Living with fear of the world as it now is…… So loss of hope is natural….. Frustration, anger and sadness is natural…. Not pleasant, not what you want, bloody hard…. But NATURAL !!!!

43. Breaking the Chains that Bind

44. Finding The Weakest Links

45. The Weakest Links • Trusting in the healing power of grief and time • Saying goodbye in a meaningful way • Gaining and giving forgiveness • Calming the trauma • Rethinking our assumptions and our thoughts • Receiving and giving support • Finding a ‘livable’ spot for them • Cherishing • Finding solace

46. I have been to the edge of the abyssAnd I have looked into the depths.There I looked at deathAnd I have returned to the living.There I looked at madnessAnd have returned to the sane.There I looked at destructionAnd I have returned to create.For only creation and loveCan answer destruction and madness and death.Marjorie Pizer IS THIS OUR HOPE…. TO RETURN OR TO KEEP MOVING?

47. Leaving Beautiful Chains

48. Maybe through….. • ‘Knowing we will never be the same’ • Knowledge of what is happening within and around us • Companionship • Finding what our children/siblings/grandchildren have given us • Being assured of the parents we are now to our children who are no longer here for us to parent

49. The chains of love are never binding as when the links are made of gold. Royale Tyrell

50. The Gold....Our Children Some people come into our lives and quickly go. Some people move our souls to dance. They awaken us to new understanding with the passing whisper of their wisdom. Some people make the sky more beautiful to gaze upon. They stay in our lives for awhile, leave footprints on our hearts, and we are never ever the same. Flavia Weedn