DEATH & GRIEF D.Mohamed Elwasify Assistant Professor of psychiatry Mansoura University,Psychiatry Dept. DSM category (v62.82 Bereavement http://ajp.psychiatryonline.org/cgi/content/abstract/154/7/904

What Is Grief? “Grief is the emotion people feel when they experience a loss. There are many different types of loss, and not all of them are related to death. For example, a person can also grieve over the breakup of an intimate relationship or after a parent moves away from home.” 1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html 1995-2007 The Nemours Foundation.

“Grief is a natural reaction to the loss of someone important to you “Grief is a natural reaction to the loss of someone important to you. Grief is also the name for the healing process that a person goes through after someone close has died. The grieving process takes time, and the healing usually happens gradually.” 1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html ｩ1995-2007 The Nemours Foundation.

*Depends on relationship with person. *“Although everyone experiences grief when they lose someone, grieving affects people in different ways.” *Depends on relationship with person. *Circumstances under which they died. 1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html ｩ1995-2007 The Nemours Foundation. “How it affects you, partly depends on your situation and relationship with the person who died. The circumstances under which a person dies can influence grief feelings. For example, if someone has been sick for a long time or is very old, you may have expected that person's death.”

Cont. *Knowing someone is going to die can give us time to prepare. *If they were suffering, it can mean a sense of relief. *If the person that died was young, we may feel it was unfair. 1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html ｩ1995-2007 The Nemours Foundation.

“Losing someone suddenly can be extremely traumatic, though, no matter how old that person is. Maybe someone you know died unexpectedly - as a result of violence or a car accident, for example. It can take a long time to overcome a sudden loss because you may feel caught off guard by the event and the intense feelings that are associated with it.” 1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html ｩ1995-2007 The Nemours Foundation.

*Grief can make us feel guilty. *Some people might blame themselves or think they could have done something to stop the death. 1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html ｩ1995-2007 The Nemours Foundation.

Coping With Grief “The grieving process is very personal and individual - each person goes through his or her grief differently. Some people reach out for support from others and find comfort in good memories.” 1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html ｩ1995-2007 The Nemours Foundation.

Coping cont. *Throw selves into activities to take mind off loss. *Become depressed and withdraw from activities, peers, family. *Everyone handles grief in different ways. 1995-2007 The Nemours Foundation. http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html http://www.kidshealth.org/teen/your_mind/emotions/someone_died.html ｩ1995-2007 The Nemours Foundation.

What are the Five Stages of Grief and Do They Always Occur in the Same Order?

Elisabeth Kübler-Ross The five stages: Denial Anger Bargaining Depression Acceptance Elisabeth Kübler-Ross Elisabeth Kübler-Ross

The 5 Stages of Grief Denial Anger Bargaining Depression Acceptance

Stage 1: Denial Refusing to believe a probable death will occur. You can help others face it by being available for them to talk instead of forcing them to talk about it.

Stage 2: Anger Once the diagnosis is accepted as true, anger and hostile feelings like the following can occur: Anger at God for not allowing them to see their kids grow up Anger at the doctors Anger at the family Try not to take it personally. They have a right to be angry so allow them to express themselves so they can move on in the grieving process.

Stage 3: Bargaining They dying person may start to negotiate with God i.e. “I’ll live a healthier life,” “I’ll be a nicer person,” “I was angry so let me ask nicely to please let me live.” They may negotiate with the doctor by saying, “How can I get more time so I can live in my dream home, and so on. There is a deep sense of yearning at this stage to be well again.

Stage 4: Depression When reality sets in about their near death, bargaining turns into depression. Fear of the unknown Guilt for demanding so much attention and depleting the family income occurs. Be available to listen instead of cheering them up, or rambling, repetitive talk. Distraction like talk about sports, etc., is good but don’t ignore the situation.

Stage 5: Acceptance When the dying have enough time and support, they can often move into acceptance. There is an inner peace about the upcoming death. The dying person will want someone caring, and accepting by their side.

Grief or Depression? Grief Depression Experienced in waves Diminishes in intensity over time Healthy self-image Hopelessness Response to support Overt expression of anger Preoccupation with deceased Depression Moods and feelings are static Consistent sense of depletion Sense of worthlessness and disturbed self-image Pervasive hopelessness Unresponsive to support Anger not as pronounced Preoccupation with self * Excerpts from Therese A. Rando (1993). Treatment of Complicated Mourning. Research Press, Champaign, IL.

There are many ways people who are grieving can help themselves: Attending support groups Therapy with a psychologist or other licensed mental health professional Journaling Eating Well Exercising Getting enough rest Antidepressants such as Zoloft, Paxil, Wellbutrin, Lexapro, Celexa, Prozac and can be very effective to those who become clinically depressed

(continued) Reading and learning about death-related grief responses Seeking comforting rituals Avoiding major changes in residence, jobs, or marital status Allowing emotions Seeking solace in the faith community

Factors that may hinder the healing process Avoiding or minimizing emotions Using alcohol or drugs to self-medicate Using work to avoid feelings

Gender Differences Women Men express their feelings early after loss reach out for social support are seen to express more sorrow, depression, and guilt more willing to talk about the loss of a child Men more likely to take on a managerial role intellectualize their emotions indicate that they feel more anger, fear, and loss of control use denial more more private about grief

Summary The stages don’t always occur in order. Whether you are the patient or the loved one, nobody escapes grief. People grieve at different rates of time. Delayed grief can occur when people suppress the emotions of the death and years later, get depressed. Cultural differences, age, gender, race, and personality change the way people grieve. Bereaved persons have higher rates of depression, and are at greater risk for illness than non-bereaved.