Death, Dying and Grief in Families Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Compare experiences by video of those facing death with those who mourn  Evaluate stressors related to death, dying, and grief in families  Define posttraumatic growth and disenfranchised grief. Identify the situations in which these occur.  Describe family characteristics that can facilitate or complicate grief  Using ABC-X model, compare and contrast experiences of family after death of child, sibling, parent, and spouse/partner Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Public vs.. private mourning and grieving  Changes in history of what people die from  Child birth and acute illnesses vs.. long term diseases  “Invisible Death”  Common place through 17 th century.  Death much more sequestered, privatized, invisible now.  Most deaths in health care setting  Care used to delay death by all means  Families faced with decisions about prolonging dying of loved ones or not  Children often excluded from family experiences with death Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 No direct link, but bereavement is antecedent of disease  Risk factors for increased morbidity or mortality include:  Self- damaging behaviors  Self-Neglect behaviors  Additional stress  Elevated psychological arousal  Depression  Being male or Caucasian Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Difficult to measure  High rates of depression, insomnia, suicide, anorexia  Lack of differentiation between grief and depression Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Complicated Grief or Prolonged Grief Disorder - more severe than normal grief, pathological  Posttraumatic Growth - process and outcomes in which growth occurs beyond individual’s previous level of functioning.  Perceptions of self ( survivor, not victim)  Interpersonal relationships ( compassion, express emotions)  Philosophy of Life ( reorganized priorities)

 Individual to group theories  Individual theories  Assume that grief follows three phases  Shock, denial, disorganization  Critics question definition and defining how people “should” grieve.  Theories not necessarily supported by research – population specific, but not individual specific research  View grief as passive with few choices for grievers Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

RANDO’S R’S MODEL 9 INDIVIDUAL DUAL PROCESS MODEL OF COPING – STROEBE & SCHUT  Recognition of loss  Reacting to separation  Recollection and re- experiencing deceased and relationship  Relinquishing old attachments  Readjusting to new world without forgetting old  reinvesting  Active confrontation of loss not necessary for positive outcome  Denial, avoidance of reminders, repressive strategies may be necessary in some situations  Minimizing negative emotions and using laughter to disassociate from stress may improve functioning.  Movement between coping w/ loss and moving forward may differ for individuals, type of loss, culture, gender Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Integration of three approaches to explain grief  1. continuing bonds and mental representation of the relationship  2. the meaning of bereavement  3. loss of relationship supports from deceased and social networks Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Family reacts to loss as a system  Actions and reactions of family members influence the whole system  Death disrupts the system’s equilibrium  Death may produce changes in a wave of serious life events that can occur for years following the loss  No single outcome from death that characterizes all family systems  Theories that consider individual, family, and cultural dimensions are most useful. Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Characteristic of loss  “Timely” vs. “Untimely” or tragic death  Perception of whether loss could have been prevented  Whether loss was natural or human caused  Degree of intentionality  Amount of suffering, anxiety, physical pain experienced while person was dying  Number of people killed  Degree of expectedness  How survivor found out about the death Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Secondary losses and other stressors  Centrality of deceased role in family and degree of family’s emotional dependence on that individual  Attachment of deceased to family, or presence of conflict, ambivalence, estrangement  Resources  Tangible (money)  Intangible (friendship)  Social support networks an complicate and facilitate grieving Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Coping strategies used to perceive death or make meaning from death  Legacy of dealing with previous deaths in family system  Grief can be viewed as a way to construct meaning revolving around the life of the bereaved.  Ambiguity can complicate process  Missing person  Facts surrounding death unclear  Family denies the loss Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Grief that exists although society doesn’t recognized one’s right, need, or capacity to grieve.  Loss of unacknowledged personal relationships  Deaths related to pregnancy  Young children, mentally disabled who grieve  Often become “invisible mourners”  Often results from “stigmatized loss”  AIDS death, suicide Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Widowers experience greater depression and health consequences than widows.  Men’s response to grief  Socialization to not feel emotion  Remaining silent  Take physical or legal action to express anger or control  Secret mourning  Addictive behaviors Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Rituals attached to death (funeral, emotional displays of grief)  Need to see dying relative  Openness of emotion  Emphasis on verbal expressions of feelings  Anniversary events  Gender differences  Role of extended family  Coping strategies  Definition of when death actually occurs  Religious and political narratives  Appropriateness of recovery Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Death of child or unborn child viewed as most difficult  Spouses expected to comfort during times of stress, but may not be possible if both experiencing significant loss  Sibling or Parent death  Reactions not uniform or same as parents  Boys more affected by loss of parent, girls by loss of sister  Child reactions to death of parent depend on cognitive ability, interactions with surviving parent Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Death of Spouse  Most attention to later-life loss  Military loss  Community support increased  However, desensitization of community to time it takes to recover from such a loss  Impact of combat losses for other soldiers Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Dealing with death is a process, not an event  Loss is a normal experience, but is often treated as a “problem.”  Family adaptation to death and loss varies. Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications

 Using ABC-X model, compare and contrast experiences of family after death of child, sibling, parent, and spouse/partner. Address resources, coping mechanisms, etc. Prepared by Carrie LeFevre Sillito,Ph.D. © Sage Publications