Grief is the pain that results from any significant loss, especially the death of a loved one. Grief and mourning (the act of grieving) are normal, not something to avoid (though, heaven knows, we wish we could), nor illnesses to cure. Grief then, is the inevitable cost paid for living and loving.

When a loved one dies, grief is nearly always influenced by factors in addition to the loss of the person who died. Previous losses and related grief may reemerge and add to the pain. There are usually changes in the survivor's role in life, financial status, and living arrangements. So grief is related to the death and to the consequences of the death.

Characteristics and Process of Grief

Grief is experienced globally; with emotional/psychological, spiritual, and physical pain. One would expect sadness and grief after a loved one dies, but often the depth and encompassing nature of the pain of grief is shocking: Grief impacts all areas of life and living. We usually view grief as the response to the death or loss of a person loved in the conventional sense of warm, loving, and reciprocated feelings. However, grief or related feelings are experienced when the relationship was characterized primarily by anger, rejection, or other negative emotion. Grief after death is felt not just for a person and love; but for love unexpressed, anger unresolved, or a relationship unfulfilled. This paragraph may be worth reading again.

The emotional/psychological manifestations of grief include sadness, guilt, and anger. The sadness is profound and often includes aspects of depression. There is intense yearning for the deceased and the life that was shared with him or her. Again and again there is the shock-like realization that the loss is permanent and all the tomorrows will be without the deceased. Sadness comes in waves of despair and crying. There are times when the bereaved person cries and groans uncontrollably.

The sadness is expected, but guilt may come as a surprise. Suddenly, when it is too late to do anything about them, all the lost opportunities of the relationship come into sharp focus. Some survivors blame themselves for what happened, "Its all my fault. If only I had . . ." Even more surprising and distressing to some is the anger at the person who died. For many people, it feels "wrong" to be angry at someone who died. Nevertheless, anger is an almost universal (though often denied) response to a loved one dying. "How could he do this to me! Its not fair!" Regardless of how much guilt and/or anger is experienced, however, sadness is usually the most powerful and enduring feeling. There are countless other emotional/psychological responses to grief. Among them are:

Numbness or denial is common and pervasive. "This didn't happen. Its not happening. Maybe I can do something that can change it." In the many attempts by theoreticians to conceptualize grief, the first "stage" is usually numbness or denial. And, in fact, the first response to a terrible event is often denial. However, some form of denial (of what happened or what is felt about what happened) often continues intermittently well past the beginning of grief.

Ambivalence is not only common, but normal. Some people feel obligated to feel only love and sadness, but the fact is, it is common to feel love and anger at the same time toward the same person. We may even feel love and hate at the same time. Of course, many people have the idea that one shouldn't hate - but sometimes and in some ways, it is normal to have feelings that can only be accurately described as hate.

Severe anxiety or nervousness is also common and normal. Anxiety may be experienced as pervasive feelings of dread, nervousness, apprehension, or tension. Some people feel like they are losing control; and if control is ever lost, they feel they will never regain it. Tears come with little or no provocation. There may be increased desire for prescription or other mind-altering substances.

Changes in behavior and relationships may range from an inability to perform even the most basic activities of daily living; to dragging through daily life; to restless, disorganized behavior, including a kind of hopeless searching for what was lost. Relationships are dissatisfying and seem like more trouble than they are worth. Sometimes family conflict occurs or worsens. Developing new relationships seems out of the question. Who could ever understand this much sadness? Life loses its meaning and satisfaction without the lost person, and there does not seem to be any hope of a new life to which the bereaved individual can turn. This inability to relate to others, coupled with loss of meaning is a major factor in the development of despair or hopelessness. There are people who prey (usually sex or money) on people who are bereaved. Be wary of any relationship that involves sex or money.

Disturbing thoughts/experiences may include hallucinations or a strong sense of the presence of the deceased. These may cause great discomfort and the feeling that the bereaved person is losing his or her mind. In the vast majority of cases, these perceptions of presence decrease over time and, unless threatening or abusive, are not generally considered abnormal. Angry feeling about or toward the person who died are common - and distressing.

Grief often affects all aspects of the spiritual life of the bereaved. Without the deceased, life may lose much of its meaning. There may be little perceived meaning in the suffering of the person who died and the pain of survivors. Hope may have been destroyed in the course of the illness; and the future may seem without hope. Relatedness to God may seem impossible. The question arises, "What kind of God would cause this kind, gentle person . . . this child . . . anyone . . . to suffer like this?" Prayers seem empty. Church feels awkward. God seems far far away. Transcendence seems impossible.

Physical manifestations of grief commonly include fatigue, insomnia, anorexia, feelings of choking, shortness of breath, tightness in the chest, menstrual irregularities, and gastrointestinal disturbances. Bereaved persons tend to frequently seek medical attention for vague symptoms such as chest discomfort or abdominal pain. While some physical complaints may seem to have no physiologic basis, there is a clear link between grief and increased vulnerability to physical and mental illness, especially heart disease and depression.

There are certain times when the mourner is most vulnerable to despair. These commonly include (but are not limited to):

Complicated GriefAs with any other human behavior or experience, grief and mourning are sometimes carried to extremes in behavior or length - "complicated grief." What constitutes extremes in grief is subject to debate and influenced by culture, who died, the circumstances of the death and other factors. Some experts view mourning that lasts beyond a year as extreme, while others view mourning as normally lasting at least a year. In a sudden traumatic death such as by murder or suicide; or when a child dies, grief may last longer and be more incapacitating. What is normal, then, is not well-defined and varies according to many factors. Types of complicated grief includes grief which:

There are no absolute predictors of who will experience complicated grief. There are, however, factors that, when several are operational, indicate increased risk of complicated grief. These include:

If several of the above are present, the bereaved person and his or her support system should be alert to the possibility of complicated grief, and should consider seeking help as described in the section on what to do about grief. One possible rule of thumb is that help should be sought when grief results in depression or has a significant negative impact on life a year past the death, especially when there are persistent or serious thoughts of suicide.

What to Do About Grief

Dealing with grief begins before the death in two important ways: (1) contributing to the care of the person who is terminally ill and (2) making significant effort to resolve any conflicts or "unfinished business" with the person who is dying. Contributing to the care gives people the sure and lasting knowledge that they helped in the final days. This knowledge does not make grief go away, but it is like a rock to which people can cling. They may question the relationship, themselves, others, God, and whatever and whoever else they usually turn to in troubled times; but doing the work is something solid that endures. Grief is complicated by conflict or regrets about not saying words of love or forgiveness. Thus the resolution or attempts at resolution of conflicts is very helpful in bringing the relationship to a close. It may be hard to accept, but some conflicts may not be resolved and some "business" (of love or forgiveness) may not be finished. But grief is harder with the realization that there was not an effort made at resolution.

Hopefully, family, place of worship, friends, and one's own internal resources provide most of the support needed to move through grief. When this is not the case, bereavement groups are helpful to many people. Such groups are usually offered through churches, synagogues, and other places of worship. Hospice programs, the American Cancer Society, hospitals, and other health providers may also offer or be able to help find bereavement groups (contact social services or chaplain committee or department).

The Bible is a time-tested source of help. Jews and Christians alike can turn to Psalms, Ecclesiates, and other books for understanding and solace. Most bookstores have a number of books on grief in the self-help section. Libraries tend to have less current books, but most have at least several books on grief. Many people find the brief or meditation-style books helpful.

The Tasks of Bereavement

In working with mourners, therapists, nurses, ministers, and others have identified some "tasks of bereavement." These tasks can be used as a kind of checklist to identify blocks in the mourning process. The tasks are not, however, a checklist that one can mark off one by one and then be done with grief! Grief is more than that. Some of the tasks are ongoing and all are usually addressed more than once. When one works on or addresses a particular task, one's understanding of self, the deceased, and the relationship usually deepens. The tasks of bereavement include telling the "death story;" expressing and accepting the sadness; expressing and accepting guilt, anger, and other negatively perceived feelings; reviewing the relationship with the deceased; exploring possibilities in life after the death, including, for some, finding new relationships; understanding common processes and problems in grief; and being understood or accepted by others. These are discussed one by one below. Telling the "Death Story"

Those who gave care and/or were there when the death occurred have a need to tell and retell in as much detail as possible what happened and how they reacted to what happened. In most cases, these stories are an attempt to make it real and understand what happened. Often there is a sense of disbelief that what happened actually happened. In addition to telling the story, some find that they reach a deeper understanding of what happened by writing (and usually rewriting) the story. Expressing and Accepting the Sadness

It might seem obvious that expressing and accepting the sadness of grief is part of mourning. Not so. Many people, men in particular, feel that they should not express sad feelings beyond, perhaps, acknowledging that some sadness exists. Some people are reluctant to express their feelings because they fear if they ever start, they will be unable to stop. Some families have rules about not expressing feelings, such as "We don't wallow in misery." In other cases, a mourner may be consistently in the role of being strong and helping others to the extent of not helping self, "I have to be strong for her/him/them." Another very common way that feelings are inhibited is through the "comfort" that insists that everything is or will be fine. This alleged comfort comes from friends, family members, and even in funerals that "celebrate" religious beliefs or life rather than acknowledge the pain of life and death. To mourn, it is normal and necessary to express, and gradually, over time, to accept the deep sadness of grief. Note that the focus here is more on enduring than resolving or working through the sadness. TV newscasters send the consistent message that "the healing has begun." So now its time to move on. Not likely!Expressing and Accepting Guilt or Anger or Other Feelings Perceived as Negative

People and their relationships are not perfect. That seems obvious, but often people and relationships are idealized after death. Moreover, many bereaved persons see themselves as at fault in some aspect of the relationship or the care. "If only I had . . . " then he or she wouldn't have died or would have lived better, etc. etc. Of course regrets are common in relationships. But in grief there often is excessive guilt. Acknowledging and expressing this guilt is sometimes complicated by the bereaved person feeling great shame over his or her perceived shortcomings that, to the guilt-ridden person, seem completely unique.

Of course whatever the perceived shortcomings might be, they are not unique. Talking about the guilt with others is probably the most helpful action one can take to relieve it. Just saying out loud what one feels guilty about can begin the process of putting the feelings in perspective and eventually letting go. Some people find that service to others is helpful in dealing with guilty feelings.

Guilt and anger are sometimes connected. The bereaved person is angry at (the idealized) deceased and feels guilty about the anger. Anger may also be denied or suppressed; or turned inwards to self and ultimately experienced as depression; or be chronically expressed toward others. In any case, anger felt toward the person who died is often directed to any other target. But the fact is, it is normal and usual to feel angry about a loved one dying. It is not wrong to have such feelings; it is just human.

To resolve anger it is first necessary to acknowledge and express it. A major block to expressing the anger is the unrealistic idealization of the deceased and the relationship. It may thus be necessary to take a realistic look at the person and the relationship. He or she was not perfect and neither was the relationship. Looking realistically at the relationship allows one to look realistically at the anger; and then at what lies beneath the anger. Beneath the anger we often find feelings of abandonment, of devastation, of helplessness and hopelessness. There is no magic thing one can do to deal with these. Recognize them, accept them, and gradually, in working through the grief, the "negative" feelings slip slowly away. Reviewing the Relationship With the Deceased

Too often mourning focuses on the last or more difficult days of the relationship. But there was more than that. In looking at all the days of the relationship with the deceased, one realizes the fullness of the relationship, not just the painful last. This is a task that is both sad and enriching; and necessary to grieving.

Look as far back as the early days of the relationship. For spouses or life partners, for example, one might recall meeting, the courtship, early hopes, disappointments, successes, friends, children, and all else that makes up a shared life. For children (adult or child) of a parent who died, looking back to early as well as later remembrances is important. For anyone, it is important to explore what would have been or what was hoped for had the death not occurred. Exploring Possibilities in Life After the Death

Looking to the future is a task that usually emerges later in the grief process. Early in the process of grief it may seem like the future holds only the sadness and pain of grief. But as the sadness is endured and worked through, there is a growing awareness that there may be hope for a life in the future. How long this takes varies; it is a gradual process and most people do not at first notice that it is happening. Sometimes the awareness that there may be life (and perhaps even happiness) seems like a betrayal of the deceased. That, too, is part of the process and gradually passes. Rushing into new possibilities is a relatively common mistake. Emotional, sexual, and/or financial commitments or decisions must be approached with extreme caution.

Exploring future possibilities is complicated by the loss of the past. Among adult couples, a death often changes friendships. Not only is the survivor impacted by the loss, and thus less socially able, but the dynamics of couples relationships are also radically changed. Simply put, some relationships no longer work. Bereavement groups are especially helpful in showing that life and relationships are possible. Understanding Common Processes and Problems in Grief

In times past, grief was often a community experience and people knew how devastating it can be. Now, except for the few days surrounding the death and funeral, grief is often a private experience, and as families and communities, we know less about it than before. The power and duration of grief and its overwhelming emotions are a terrible surprise for many. Knowing what is common or expected in grief helps people understand that they are not abnormal or different. Knowing what is common or expected does not change or make grief easier. It only tells the mourner that he or she is grieving, not losing his or her mind.Being Understood or Accepted by Others

The emotion and process of grief, along with the way we live, often results in isolation. Isolation, to some extent is a natural part of mourning. But the isolation should be that of the mourner, not of the misunderstood. Family and other sources of support are better able to help when they, too, understand what happens in grief. It is not that they can necessarily change what happens; only that they understand.

Finally

Grief is a terrible and universal experience that affects all aspects of life. It cannot be understood except by direct personal experience. There is no "answer" to grief that can remove the pain like an antibiotic removes an infection. The best we can do is live in it and work to understand it and our relationship with who was lost. Ultimately we look to where humans have always looked for help: family, community, self, and God. We do not always find what we were looking for at these sources. But we keep on because that too is what we, as humans, have always done. And we get better.

A voice says, "Cry!" and I asked, "What shall I cry?" "All flesh is grass, and all its beauty is like the flower of the field. The grass withers, the flower fades; but the word of our God will stand forever." Isaiah 40: 6,8

Test Chapter One

Fill in Missing words, send missing words only, answer true or false, send to churchoflivingwater2001@yahoo.com

3. The sadness is expected, but _____ may come as a ______.

4. Anger is an almost universal (though often denied) response to a loved one dying. T/F

5. Some ______ feel like they are ______ control; and if _______ is ever lost, they feel they will _____ regain it.

6. There are people who prey on people who are bereaved. T/F

7. Without the ________, life may ____ much of its _______.

8. ________ persons tend to __________ seek medical _________ for vague ________ such as chest discomfort or abdominal pain.

9. As with any other human behavior or experience, grief and mourning are sometimes carried to extremes in behavior or

length - "___________ _____."

10. In a sudden _________ death such as by ______or _______; or when a______dies, grief may last longer and be more incapacitating.

11. There are absolute predictors of who will experience complicated grief. T/F

12. When there is complicated grief when should help be sought out?

13. Dealing with grief begins before the death in two important ways, what are they?

14. But grief is harder with the ___________ that there was not an ______ made at _________.

15. Grief is harder with the realization that there was not an effort made at resolution. T/F

16. The Bible is a time-tested source of help. Jews and Christians alike. T/F

17. In working with mourners, therapists, nurses, ministers, and others have identified some As what?

18. It might seem obvious that __________ and _________ the sadness of _____ is part of ________.

19. Talking about the guilt with others is probably not the most helpful action one can take to relieve it. T/F

20. It is normal and usual to feel angry about a loved one dying. T/F

21. For children (adult or child) of a parent who died, looking back to early as well as later remembrances is important. T/F

22. Looking to the future is a task that usually emerges earlier in the grief process. T/F

23. Among adult couples, a death often changes friendships. T/F

24. The power and duration of grief and its overwhelming emotions are not a terrible surprise for many. T/F

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Grief is a normal yet complex phenomenon, which has been broadly explained through the Descriptive and Process theories. The former depict the phenomenology of the grief process in a basic and descriptive way, but lack an explanation as to why or how grief responses occur. The latter, provides a model for the psychological mechanisms underlying grief and investigates the purposes behind these mechanisms (Barbato & Irwin, 1992). This paper refers mostly to Bowlby’s Attachment Theory a specific Process theory, which considers the reasoning behind grief in response to death and major losses and the various factors that impact on the intensity of the response that is experienced.

The meaning of attachment furthers our ability to comprehend grief. Throughout human development, continual attachments to others are formed. According to Bowlby’s Attachment Theory, attachments develop from needs for security and safety which are acquired through life, and are usually directed towards a few specific individuals (Worden, 1991). The goal of attachment behaviour is to form and maintain affectionate bonds, throughout childhood and adulthood.

Bowlby proposed that grief responses are biologically general responses to separation and loss. Throughout the course of evolution instinct develops around the premise that attachment losses are retrievable. Similarly, behavioural responses making up the grieving process are pro-survival mechanisms geared towards restoring the lost bonds (Worden, 1991).

The process of grief is multifaceted, with bereaved individuals experiencing major physical, emotional, and cognitive changes. Barbato and Irwin (1992) suggested that grief is a state in which the bereaved person has lost someone or something of personal value. When faced with this loss, the most powerful forms of attachment behaviour are activated in an attempt to reinstate the relationship. Worden (1991) described the vast repertoire of behaviours under four general categories; emotional response, physical sensations, altered cognitions, and behaviours.

Grief is fundamentally an emotional response to loss, the expression of which can include sadness, sorrow, fatigue, depression, relief, shock, anger, guilt, and anxiety (Barbato & Irwin, 1992).

Grief behaviours frequently have a similar profile to those found in people suffering from depression. Although grief and depression do share a number of similar aspects including sleep and appetite disturbances, and intense sadness, these behaviours are only evident for a short time in a grief reaction. In addition, those experiencing a grief reaction do not always experience the loss of self esteem that is commonly found in most people who are clinically depressed (Worden, 1991). However, intense feelings of loneliness and isolation, following the death of a loved one, may become so overwhelming that the bereaved may withdraw from social contact, thereby isolating themselves from support. Such reactive depression following a significant loss is not abnormal and usually dissipates over the first year of bereavement.

Anger is a frequently experienced emotion following a loss and is often confusing for the bereaved. The anger may be directed at the deceased for leaving the bereaved or may result from a sense of frustration that the bereaved couldn't prevent the death (Worden, 1991). If the anger is not addressed complications in the grieving process may arise. There is a risk that the anger will be directed towards others through attributing blame, or turned inwards.

Grief not only elicits emotional disturbances, but also physical symptoms such as: tight feelings in the throat and chest, oversensitivity to noise, breathlessness, muscular weakness and lack of energy (Barbato & Irwin, 1992). These sensations are considered to be a normal component of grief (Worden, 1991). Usually these are transitory, but on occasions may become of concern to the bereaved and warrant clinical intervention. Occasionally physical health may be seriously impaired, and growing evidence indicates that recently bereaved people are relatively vulnerable to illness (Barbato and Irwin, 1992).

Often new thought patterns occur in the early stages of mourning but usually disappear after a short period. However, persistent maladaptive thoughts may trigger feelings that can lead to depression or anxiety (Worden, 1991). Disbelief is often the initial cognitive reaction to the news of a death, especially if the death was sudden. Although this response is usually transitory, it can persist and become denial, where the bereaved does not accept the death. Other cognitive responses include feelings of confusion, difficulty organising thoughts and preoccupation with the deceased, which may evoke intrusive thoughts of how the deceased died. The bereaved person may report a sense of presence of the deceased and may think that the deceased is still around. A further cognitive phenomenon is that of auditory and/or visual hallucinations. Many find these experiences comforting, and assign spiritual or metaphysical explanation to the phenomena, which can help the bereaved to cope with the loss (Worden, 1991).

Although there are a number of behaviours associated with grief which may be of concern to the bereaved, they generally subside over time. Complications in the grieving process or a depressive disorder may be indicated if the behaviours impede a person’s ability to function. The most commonly reported behaviours include disturbances in sleep, altered appetite (either over-eating or under-eating), absent mindedness, social withdrawal, dreams of the deceased, and avoidance behaviour in which the bereaved may go to great lengths to avoid any situations or objects that remind them of the deceased (Worden, 1991). Additionally, the bereaved may feel restless, breathless or find themselves searching or calling out for the deceased. Another behaviour often associated with grief is crying, a response which is believed to relieve emotional stress, although the exact mechanism by which this occurs is not known (Worden, 1991).

The intensity and emotional response to loss vary according to many factors, including the importance attributed to the loss, the circumstances of the death and the availability and utilisation of support networks. The length and intensity of grief experienced by the bereaved varies depending on the nature of the relationship and the degree of attachment. The strength and existence of ambivalence of the relationship has an impact on the intensity of grief felt. Relationships that include a high degree of ambivalence may lead to extensive feelings of guilt often accompanied by anger.

The mode of death impacts on the degree of grief experienced. Worden (1991) categorises death into four groups: natural, accidental, suicidal, and homicidal. Sudden and accidental deaths are likely to have the greatest impact on grief.

Impact of Grief on Morbidity and Mortality.Grief exacerbates not only physical morbidity but psychiatric morbidity as well, particularly in cases associated with the loss of a spouse. Studies have found that bereaved individuals suffer from more depressive symptoms during the first year after the loss than non-bereaved controls. The young are more susceptible to physical distress and drug taking for symptom relief. Further, following the death of a spouse there is an increase in symptoms such as headaches, trembling, dizziness, heart palpitations and gastrointestinal symptoms .

Nineteenth-century physicians working with cancer patients frequently reported that severe emotional losses and grief occurred in some cases before cancer. Research in psychoneuroimmunology has reactivated interest in the connection, and provides a convincing background. Studies strongly suggest that stress, through neuroimmune modulatory mechanisms, can significantly affect the appearance and progression of mammary cancer. Although the difficulty of measuring stress makes it difficult to demonstrate a tangible relationship between stress and breast cancer, studies reveal that stress is related to breast cancer in various ways.

For example, a study by Biondi and his colleagues investigated the case of a 45-year-old woman who had a moderate genetic-familial risk of mammary cancer, but was clear at time of initial examination. The woman’s affection for her only child compensated for inadequacies in her marriage, which had become increasingly unstable. The child died in a traumatic accident at home while she was near him but unable to help. The patient developed long-lasting intense grief, despair and hopelessness, and developed symptoms of breast cancer 3 years after the loss of her child. Although aware that stress does not necessarily create cancer, Biondi suggested that in this case the stress of unresolved grief could have contributed to the cancer by activation of a latent neoplasia and/or by impairing immunocompetence during a critical life phase.

Further support was provided by Kemeny and colleagues who conducted a study to investigate whether immune changes relevant to HIV progression occurred in 39 HIV-seropositive men after the death of their intimate partner. They compared the Immunological parameters, from blood samples drawn before and within 1 year after the death of the partner (bereaved group) or over an equivalent time period (non-bereaved group). They found evidence to suggest that the death of an intimate partner in HIV-positive men is associated with immune changes that are relevant to HIV progression. This study confirms that the death of an intimate partner can adversely affect immune function and promote the progress of illness.

If unresolved grief can exacerbate health problems, the question that begs to be asked is whether grief counselling can reduce the incidence of health problems following intense grief. A general model of psychosomatics assumes that inhibiting or holding back one's thoughts, feelings, and behaviours is associated with long-term stress and disease. It seems that actively confronting upsetting experiences, through writing or talking, can increase measures of cellular immune-system function and reduce health centre visits. Hence, externalising traumatic experiences is physically beneficial, and may serve as a preventative treatment for health problems. The implications are that grief counselling which encourages disclosure of pain may prevent future health problems.

Mourning is a process, not a state of mind, and as in any process, work is done so that the process can proceed to successful finalisation. According to Worden (1991), there are four tasks to mourning, which may take place in any order.

This task involves coming face to face with the reality that the person is dead and will not return. Often the bereaved refuse to face the reality of the loss, and may go through a process of not believing, and pretending that the person is not really dead. This denial can take several forms:

· Denying the facts of the loss. The bereaved may manifest symptoms that range from slight reality distortions to full blown delusions. There may be attempts to keep the body in the house, retaining possessions ready for use when the deceased returns or keeping the room of the deceased untouched for years.

· Denying the meaning of the loss. In an attempt to make the loss less significant than actuality, the meaning of the relationship can be denied. The bereaved may express thoughts such as "We weren't close", "he wasn't a good person", or may remove all reminders of the deceased so as not to be reminded of his or her existence.

· Denying that death is irreversible. In an attempt to maintain the attachment contact, the bereaved may seek recourse to spiritualists. There may be incidents of selective forgetting, or blocking out memories of the deceased. Traditional rituals such as burials and cremations may help the bereaved accept the loss as the rituals force them to face the reality of death.

The process of allowing oneself to feel the pain rather than suppressing the experience is thought to be beneficial in the normal resolution of mourning. In some social contexts the expression of grief may be encouraged, while in others a subtle message may be given that the mourner should stop grieving and get on with life. Hence, the expression of grief may be considered unhealthy and demoralising, with the proper action of a friend being to distract the mourner from grief. People can hinder the mourning process by avoiding painful thoughts, using thought stopping strategies, or by entertaining only pleasant thoughts of the deceased, idealising the dead, avoiding reminders of the dead, and using alcohol or drugs to desensitise.

Following the death, the bereaved must take on new roles and adjust to the changed dynamics in his or her environment. Frequently the full extent of what this involves, and what has been lost, is not realised for some time after the loss occurs. Many resent having to develop new skills and cope with the changed situation. In addition, survivors have to cope with their own sense of self, particularly if they have denied their own identity so as to care for others following the death. If attempts to fulfil the roles previously carried out by the deceased fail, a reduction in self-esteem can result. Alternatively, the bereaved may promote their own helplessness by not using or developing the skills they need to cope. In response, the bereaved person may withdraw from the world and not face the requirements of the situation.

Emotional relocation requires that the bereaved form an ongoing relationship with the memories associated with the deceased, in such a way that they are able to continue with their own lives after the loss. Holding on to the past attachment rather than allowing the evolution of a new relationship with the memories of the deceased can hinder this task.

Likewise, Speckhard and Rue (1993) argued that the psychological effects of abortion on women ranged from Post Abortion Distress, a type of adjustment disorder, to Post Abortion Syndrome a variant of post-traumatic stress syndrome that has been reported to occur in some women who perceive their abortions as traumatic, to Post Abortion Psychosis which may include major thought and affective disorders. However, the American Psychiatric Association does not support the existence of Post Abortion Syndrome. Speckhard and Rue presented the convincing argument that the effects on a woman of an abortion, that is perceived to be traumatic, closely match the diagnostic criteria of the DSM for post traumatic stress disorder, and that this creates grounds for inclusion of such a diagnostic category in future updates.

The circumstances surrounding the death have a marked impact on how people grieve. Survivors of suicide, for example, have been found to experience a severe form of bereavement that differs both quantitatively and qualitatively from other forms of bereavement (Silverman, Range, & Overholser, 1994-95). Likewise the sudden death of a child leads to unique grief responses by the parents (Lang & Gottlieb, 1993). Therapeutic interventions that have proven helpful in these groups include the provision of information regarding the death, opportunity to view the body, or photographs of the body, support groups, and advice regarding the likelihood of further such deaths in the family (Clark & Goldney, 1995).

Adolescent bereavement frequently differs from that experienced by adults. It is common that when an adolescent is confronted with these issues that they have no previous experience to draw on to help them cope with the feelings of rage, loneliness, disbelief, and guilt that accompany personal loss. Consequently the adolescent may not consider that things will get better (Kandt, 1994). Frequently adolescents express their feelings through behaviours rather than emotions. Kandt suggested that appropriate interventions for this group include careful questioning to encourage the individual to express emotions, providing support for the legitimacy of feelings expressed and encouraging involvement in a support group for bereaved adolescents.

The Resolution of Grief
Mourning is considered to be complete when the person is able to experience pleasures, take on new roles, look forward to new events, and when memories of the deceased no longer evoke physical responses of sorrow and pain, although occasional feelings of sadness may remain (Worden, 1991).

Conclusion
Bereavement is a complex issue with emotional and behavioural impacts. Individuals experience grief through a wide range of reactions, and research has indicated that grief can have an impact on morbidity and mortality. The model of the grief process presented by Worden (1991) provides a comprehensive framework around which counselling and therapy can be structured to help individuals to satisfactorily resolve their grief.

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Fill in Missing words, send missing words only, answer true or false, send to

churchoflivingwater2001@yahoo.com

2. Who suggested that grief is a state in which the bereaved person has lost someone or something of personal value.

3. Grief behaviours frequently have a similar profile to those found in people suffering from depression. T/F

4. There is a ____ that the _____ will be directed towards ______ through __________ blame, or turned inwards.

5. Who said, "However, persistent maladaptive thoughts may trigger feelings that can lead to depression or anxiety?

6. One of the most commonly reported behaviours associated with grief is disturbances in sleep. T/F

7. The ______ and _________ of grief experienced by the ________ varies depending on the ______ of the ____________ and the degree of attachment.

8. Older persons are more susceptible to physical distress and drug taking for symptom relief.T/F

9. Studies ________ suggest that ______, through ___________ modulatory mechanisms, can _____________ affect the appearance and progression of mammary cancer.

11. Often the bereaved refuse to face the reality of the loss, and may go through a process of not believing, and pretending that the person is not really dead. This denial can take several forms: How many forms does this writer give?

12. In some social ________ the expression of _____ may be __________, while in others a subtle message may be given that the mourner should stop ________ and get on with life.

13. Task three states; _________ the death, the ________ must take on new _____ and adjust to the changed ________ in his or her environment.

14. Frequently adolescents express their feelings through behaviours rather than emotions. T/F

15. Explain How you believe this course will help you in helping others who are grieving the loss of a loved one.

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Myth #1. "It has been a year since your spouse died. Don't you think you should be dating by now?" Reality. It is impossible to simply "replace" a loved one. Susan Arlen, a New Jersey physician, offers this insight: "Human beings are not goldfish. We do not flush them down the toilet and go out and look for replacements. Each relationship is unique, and it takes a very long time to build a relationship of love. It also takes a very long time to say goodbye, and until goodbye has really been said, it is impossible to move on to a new relationship that will be complete and satisfying." Myth #2. "You look so well!" Reality. The bereaved do look like the non-bereaved on the outside but inside, they experience a wide range of chaotic emotions - shock, numbness, anger, disbelief, betrayal, rage, regret, remorse, guilt, etc. These feeling are intense and confusing.

One example comes from British author C.S. Lewis who wrote these words shortly after his wife died: "In grief, nothing stays put. One keeps emerging from a phase, but it always recurs. Round and round. Everything repeats. Am I going in circles, or dare I hope I'm on a spiral? But if a spiral, am I going up or down it?"

Thus, grievers feel misunderstood and further isolated when people comment in astonishment, "You look so well!" Helpful responses should simply and quietly acknowledge their pain and suffering through statements such as "This must be very difficult for you," "I am so sorry," "How can I help?" or "What can I do?" Myth #3. "The best thing we can do (for the griever) is to avoid discussing the loss." Reality. The bereaved need and want to talk about their loss, including the minutest details connected to it. Grief shared is grief diminished. Each time a griever talks about the loss, a layer of pain is shed.

When Lois Duncan's 18-year-old daughter, Kaitlyn, died because of what police called a "random shooting," she and her husband were devastated. Yet, the people most helpful to the Duncans were those who allowed them to talk about Kaitlyn. "The people we found most comforting made no attempt to distract us from our grief," she recalls. "Instead, they encouraged Don and me to describe each excruciating detail of our nightmare experience over and over. That repetition diffused the intensity of our agony and made it possible for us to start healing." Myth #4. "It has been six (or nine or 12) months now. Don't you think you should be over it?" Reality. There is no quick fix for the pain of bereavement. Of course, grievers wish they could be over it in six months. Grief is a deep wound and takes a long time to heal, and that time frame differs from person to person according to their unique circumstances.

Glen Davidson, Ph.D., professor of psychiatry and thanatology at Southern Illinois University School of Medicine, tracked 1,200 mourners. His research shows an average recovery time from 18 to 24 months. Myth #5. "You need to be more active and get out more!" Reality. Encouraging the bereaved to maintain their social, civic and religious ties is healthy. Grievers should not withdraw completely and isolate themselves from others. However, it is not helpful to pressure the bereaved into excessive activity. Erroneously, some caregivers try to help the grieving "escape" from their grief through trips or excessive activity.

This was the pressure felt by Phyllis seven months after her husband died. "Several of my sympathetic friends who have not yet experienced grief firsthand suggested that I interrupt my period of mourning by getting out more," she recalls. "They say, solemnly,'What you must do is get out among people, go on a cruise or take a bus trip. Then you won't feel so lonely.' I have a stock answer for their advice: 'I am not lonely for the presence of people, I am lonely for the presence of my husband.' But how can I expect these innocents to understand that I feel as though my body has been torn asunder and that my soul has been mutilated? How could they understand that for the time being, life is simply a matter of survival?" Myth #6. "Funerals are too expensive and the services are too depressing!" Reality. Funeral costs vary and can be managed by the family according to their preferences. More importantly, the funeral visitation, service and ritual create a powerful therapeutic experience for the bereaved.

In her book, What To Do When A Loved One Dies, author Eva Shaw writes: "A service, funeral or memorial provides mourners with a place to express the feelings and emotions of grief. The service is a time to express those feelings, talk about the loved one and begin the acceptance of death. The funeral brings together a community of mourners who can support each other through this difficult time. Many grief experts and those who counsel the grieving believe that a funeral is a necessary part of the healing process and those who do not have this opportunity may not face the death." Myth #7. "It was the will of God." Reality. The Bible makes this important distinction: life provides minimal support but God provides maximum love and comfort. Calling a tragic loss the "will of God" can have a devastating impact on the faith of others.

Consider Dorothy's experience: "I was nine years old when my mother died and I was very, very sad. I did not join in the saying of prayers at my parochial school. Noticing that I was not participating in the exercise, the teacher called me aside and asked what was wrong. I told her my mother died and I missed her, to which she replied,'It was the will of God. God needs your mother in heaven.' But I felt I needed my mother far more than God needed her. I was angry at God for years because I felt he took her from me."

When statements of faith are to be made, they should focus upon God's love and support through grief. Rather than telling people, "It was the will of God," a better response is to gently suggest, "God is with you in your pain," "God will help you day to day," or "God will guide you through this difficult time." Rather than talking about God "taking" a loved one, it is more theologically accurate to place the focus upon God "receiving and welcoming" a loved one. Myth #8. "You are young, and you can get married again," or "Your loved one is no longer in pain now. Be thankful for that." Reality. The myth is in believing such statements help the bereaved. The truth is that cliches are seldom useful for the grieving and usually create more frustration for them. Avoid making any statements that minimize the loss such as, "He's in a better place now," "You can have other children," or "You'll find someone else to share your life with." It is more therapeutic to simply listen compassionately, say little and do whatever you can to help ease burdens. Myth #9. "She cries a lot. I'm concerned she is going to have a nervous breakdown." Reality. Tears are nature's safety valves. Crying washes away toxins from the body that are produced during trauma. That may be the reason so many people feel better after a good cry.

"Crying discharges tension, the accumulation of feeling associated with whatever problem is causing the crying," says Frederic Flach, M.D., associate clinical professor of psychiatry at Cornell University Medical College in New York City. "Stress causes imbalance and crying restores balance. It relieves the central nervous system of tension. If we don't cry, that tension doesn't go away." Caregivers should get comfortable at seeing tears from the bereaved and supporting their crying. Myth #10. "Grief support groups are too depressing and not helpful." Reality. Groups formed specifically to provide support for grievers are extremely helpful for the bereaved. Most who attend describe the meetings as anything but depressing. There, grievers receive encouragement, sympathy, practical advice and emotional support from people who have "been there." Also, those early in the grieving process see and hear from others who are further along and adjusting in healthy ways to the loss. Such individuals become strong role models for the recently bereaved.

Required to read but no test

Grief Counseling Resouce Guide

http://www.omh.state.ny.us/omhweb/grief/GriefCounselingResourceGuide.pdf