The Work of Mourning

1. The Work of Mourning Chapter 4 Dusana Rybarova 2007 Psyc 456

2. The Biological Roots of Grieving and Mourning • Grieving in graylag goose (Lorenz, 1952) • Grieving in dogs, hamsters, orangutans, chimpanzees, elephants • Grief marked by searching behavior, followed by depression, lack of appetite, apathy • Signs of ritualistic mourning in elephants, chimpanzees, baboons • Burying deceased animals with mud, earth, leaves, stones • Mourning sounds

3. Grief and Mourning • Grief • Immediate reaction to loss • Lasts a number of months or longer • Marked by sadness, anger, guilt, body sensations of hollowness in the stomach, lack of energy, shortness of breath, • Marked by following phases (Harvey, 1996): • shock, outcry, denial • tendency to review the loss obsessively, emotional and cognitive restructuring

4. Grief and Mourning • Mourning • Broader psychological process of adjusting to the changes following loss including our relationship with the deceased, our self, our world-views • Marked by reorganizing and reintegration of our lives in light of the loss, we are pulling our lives back together • Resolution and recovery, increased willingness to feel the pain of loss and the integration of a new self-concept • Includes behavioral, physical, cognitive, emotional, and spiritual dimensions • Influenced by predictability of the loss, nature and duration of our relationship to the deceased, self-confidence and coping skills

5. A Model of Mourning • Individual, social and cultural differences in mourning • Personality variables, anxiety about death, social support, death trajectory, ethnic and cultural background, spiritual/religious views etc. • The following four phases are not restrictive – the mourning person can move back and forth among them, and can be modified by individual, cultural and social differences • Four phases of mourning we will focus on: • Cognitive Restructuring • Emotional Expression • Psychological Reintegration • Psychospiritual transformation

6. The cognitive Restructuring Phase • We react to the news of a death of a loved one by denial, shock, outcry, panic, despair, helplessness, disbelief • Our cognitive schemas are challenged – knowledge and expectations about how the world works • Accommodation of our cognitive schemas to fit the change following the loss is important for our coping with the event

7. Cognitive Restructuring PhaseWeeping and Outcry • Weeping, sobbing and uncontrolled crying reflects the cognitive restructuring process assimilation of the new information into our pre-existing schemas • This helps us to move from the cognitive denial and high arousal to lower arousal and accommodation of the change into our life • Account making • Coming to understanding of why, when, where and how the death occurred • Making sense of the death • Recalling, reflecting and analyzing information related to the deceased and his death • Communication about the account with family and friends starts the healing process

8. Cognitive Restructuring Strategies • Cognitive restructuring based on the past • Focus on the habits, behaviors, lifestyle, health-related practices of the deceased (e.g. ‘he smoked too much, he drove too fast, he did not exercise enough…’ or medical staff • Reinforces our belief that the death did not happen arbitrarily and was a consequence of some previous action • Cognitive restructuring based on the future • ‘it could have been worse’ • Using the death as motivation for future accomplishments as a tribute to the deceased

9. Cognitive Restructuring Strategies • Cognitive restructuring based on the world • Restructuring on our beliefs about how the world works • Science-based accounts – e.g. disease ran in the family • Religious beliefs – God’s will, higher power etc. • Cognitive restructuring based on self • Self – set of assumptions about who we are, what we value, how we fit in the social context, where we fit with respect to the world • Encompasses the other three aspects of cognitive restructuring • Need for integrity and continuity of the self

10. The Emotional Expression Phase • Grief reactions are often very intense • Protest reactions, intense anger, frustration, feelings of profound emptiness • tendency to blame ourselves for having treated the deceased badly or for not having done enough to prevent the death, for not telling them how we felt about them • Physical disturbances • Weakness, sleep disturbances, loss of appetite, headaches, back pain, indigestion, shortness of breath, heart palpitations, dizziness and nausea

11. The Emotional Expression Phase • Secondary Losses • Secondary losses coincide with the initial loss • Physical, emotional, intellectual, financial, social, and spiritual aspects of our life influenced by the loss • Psychic Scars • The loss often leaves scars just like physical injury • The scars are more painful under some circumstances (anniversary) and can result in feeling of loss of control, predictability, safety, and security and post-traumatic stress • Can lead to damaging ways of coping such as alcohol abuse or drugs

12. The Time to Heal ‘It’s been 10 months since my teenage son was killed in an accident… It is a sad time, but it is also a very sacred and healing time. It takes time. It is a uniquely individual process, and only a few people seem to understand and respect that it’s important that we be allowed to grieve, for that is the only way to heal. The tears have to be shed. The anger and frustration need to be experienced. Please don’t be scared off by these stages. They are a normal and healthy process. There is incredible pressure from society, family and friends to ‘get over this.’ You don’t get ‘over’ death and grieving, you go through it. Step by step, teardrop by teardrop. We don’t’ want to be rescued from this healing work. You can’t ‘get our minds off it,’ or ‘know what is best for us.’ Just be there with us… It will be friends who are supportive, accepting and non-judgmental. Friends will allow for this journey to be healing.’ Denise Anderson (1995). I hear you. Please listen. Thanatos, 20(1), 11.

13. The Psychological Reintegration Phase • Involves integration of new coping responses, behaviors, cognitive strategies, and assumptions to deal with the world without the deceased

14. The Psychological Reintegration Phase • Coping strategies • Problem-Focused Coping • Direct confrontation with the loss • Includes planning, active problem solving, engaging in activities directed at mastering the loss experience • Emotion-Focused Coping • Managing our appraisal and stress associated with the loss • Meditation and relaxation techniques combined with positive reinterpretation and reframing of the loss • Seeking Social Support • Turning to support people for guidance, assistance and emotional support

15. The Psychological Reintegration Phase • Reintegration and Self-Efficacy • Self-efficacy is related to self-confidence, motivation, and degree of control over circumstances • High self-efficacy associated with being activity in social, community, altruistic affairs • Low self-efficacy can be associated with reactions of withdrawal and giving up • Inner Representations of the Deceased • Keeping the lost person psychologically alive by talking or writing to him/her • Serves as a coping strategy to lessen the impact of the loss on our self and world-integrity

16. The Psychological Reintegration Phase • Marks of achieved psychological reintegration • More control in life • Fading of feelings of abandonment • A personal sense of recovery and higher energy levels • A new sense of respect for self and confidence in the ability to cope • Less fear of being alone • Times of peace • Growing interest in activities and beign with others

17. The Psycho-Spiritual Transformation Phase • A close death may trigger a profound, growth-oriented transformation that fundamentally changes beliefs and attitudes about life, death, love, compassion and the sacred • Human beings have natural drive towards transcendence, spirituality and religion • With honesty and time to address the complex cognitions and emotions involved, the experience of watching a loved one die can potentially be transformative

18. Spirituality and Meaning • Marks of a spiritual experience • Transcendence of the ego boundaries, feelings of unity with others, the world or with the divine • A person becomes aware of a higher power, a higher intelligence, purpose or order in the universe outside of hers/his control • The belief in afterlife might be the most common spiritual transformation observed in mourning people • Members of church groups viewed death significantly more frequently as a transformation of life’s meanings than did non-church participants viewing death more often as a barrier to life’s meanings • The ability to find meaning in suffering, to find a spiritual or transcendent purpose, is vital for optimal human functioning in the face of adversity (Victor Frankl, 1984)

19. Psychospiritual transformationCaregiving, Faith and Joy • Caregiving • For some people the spiritual transformation phase of dealing with death may take on a form of philanthropic, political, or caregiving work • Faith • Acceptance of greater order, purpose, structure • Does not mean we give up our free will or desire to be in control – exercising faith is a choice • Joy • After challenges of psychological reintegration and psychospiritual transformation many mourners are able to see the positive, joyful, and triumphant aspects of their mourning experience • Liberating aspects of the mourning process can lead to more strength, confidence, viewing things in a new perspective, more patience and compassion in everyday life

20. Complicated Mourning • Death of a loved one – often the biggest stress situation we experience in life • Especially in cases of pre-existing psychological problems, death of a loved person can lead to marked and persistent cognitive disorganization and emotional turbulence • Three basic types of complicated mourning: • Chronic grief reactions • Masked grief reactions • Exaggerated grief reactions • Chronic depression

21. Chronic grief reactions • Long duration (5-40 years) without reintegration and resolution • Marked by extreme cognitive confusion, repression of emotions leading to depression, apathy, illogical fears, panic attacks, hallucinations • Often results in neurotic or psychotic disorders • Psychological mummification – cognitive denial and emotional repression leading to everyday activities as if the deceased did not die • Masked grief reactions • Complete absence of grief reactions • Repressed emotions resulting in psychosomatic problems – headaches, insomnia, body pain or even heart attack and cancer

22. Exaggerated Grief Reactions • associated with repressed grief reactions from previous losses that erupt in response to a current loss • Manifest as phobias, panic reactions, psychosomatic symptoms, or psychiatric disorders • Clinical Depression • Mood disorder of deeper intensity and longer duration than the profound sadness and acute depression • Marked by sleep problems, loss of appetite and energy, feelings of hopelessness, guilt and even thoughts of suicide • Young children – hyperactivity and aggressiveness • Adolescents and young adults – negativism, antisocial behavior, and feelings of being misunderstood • Middle-age and older adults – distractibility, confusion, memory loss

23. Individual differences in mourning • Adaptive denial • Can allow the individual time gradually handle and integrate a significant assault to their fundamental belief systems • Extended mourning • For some people there may not be an end to mourning and expecting all people to get over the loss in a certain time-frame does is not realistic • Absence of depression • Some people do not experience the distress of grieving and mourning, and are not in cognitive denial and emotional repression

24. EXAM 1 - SAMPLE QUESTIONS: • ‘Invisible Death’ • What does the term ‘invisible death’ refer to? • Briefly discuss at least 3 factors that lead to the attitude of ‘invisible death’. • What are the three attitudes of ‘invisible death’ through which the phenomenon manifests itself in our lives? Briefly outline an example for each of the three attitudes. • In class we discussed ethnic difference in attitudes towards death. Compare attitudes across two different ethnic groups of your choice. • How is the research in the field of thanatology and the death-education movement useful, if at all? • What are the three main causes of death in the USA?

25. What psychological attitudes can contribute to development of heart disease? How can emotion have impact on development of plaques in arteries? • How can development of cancer be influenced by psychological factors (make reference to the immune system)? What are the characteristics of cancer-prone individuals (discuss at least two of them)? • What are the stages of the disaster syndrome? Give an example for each of the stages. • What is post-traumatic stress disorder (at least three characteristics) and what is exposure therapy as a treatment of PTSD? • We discussed two basic models of stages of dying (Kubler-Ross and Pattison). Pick one of the models and discuss each of the stages. Critically discuss why you would prefer this model over the other. • What are the four basic categories of needs of a dying person that Corr discussed? Provide a brief example for each of the categories.

26. Discuss at least three out of the four dimensions of the near-death experience. Provide an example for each dimension. • What is the difference between grief and mourning? Describe at lease two characteristics of each using and example. • What are the four basic phases of mourning we discussed in class? Briefly discuss distinguishing features of each using an example. • Briefly discuss the three coping strategies. Provide an example for each. • Pick two kinds of complicated mourning. Discuss them briefly using an example.