1. Loss and Grief
The Aging Survival Kit

2. Grief: A Universal Experience
“To spare oneself from grief at all cost can be achieved only at the price of total detachment, which excludes the ability to experience happiness.”
Erich Fromm ( )

3. Five Stages of Grief (Kubler-Ross, 1969)
Denial: The initial stage: “It can’t be happening.”
Anger: “Why ME? It’s not fair?!” (either referring to God, oneself, or anybody perceived, rightly or wrongly as responsible)
Bargaining: “Just let me live to see my son graduate.”
Depression: “I am so sad, why bother with anything?”
Acceptance: “It’s going to be OK.”

4. Five Stages of Grief, Continued
These stages of grief do not come in order. They can be applied to any form of catastrophic life losses:
Loved One
Employment
Home
Income
Freedom
According to Kubler-Ross a person simultaneously experiences two of the stages at any given time.

5. Understanding Loss (Rando, 1984)
Avoidance: Shock, denial, disbelief, confusion, disorganization.
Confrontation: “highly emotional state wherein the grief is most intense and the psychological reactions to loss are felt most acutely.”
Reestablishment: “gradual decline of the grief and marks the beginning of an emotional and social reentry back into the everyday world” (pp ).

6. Understanding Loss, Continued
According to Rando, the griever will:
Acknowledge, accept, and understand the reality of the loss.
Experience the pain of the grief and react to the separation from that which is lost.
Adapt a new way of life.
Reinvest in a new way of life.

7. Anticipatory Mourning (Rando, 2000)
“The phenomenon encompassing seven generic operations:
Grief
Mourning
Coping
Interaction
Psychosocial reorganization
Planning
Balancing conflicting demands
Facilitating an appropriate death” (p. 51)

8. Disenfranchised Grief (Doka, 2002)
According to Doka: “this grief is experienced in connection with a loss that is not socially acknowledged, publicly shared, or supported through usual rituals. The significance of the loss is either not recognized or the relationship between the deceased and the bereaved is not socially sanctioned, the person suffering the loss is given little or no opportunity to mourn publicly. It is experienced when the relationship is not recognized (lovers, ex-spouses, same-sex partners, close friends), when the loss itself is not recognized (stillbirth, miscarriage, abortion, adoption, pet loss), when the griever is not recognized (very young, very old, developmentally disabled). The manner of death itself can be disenfranchising (murder, suicide, AIDS). When such deaths are treated as less than significant losses, the process of grieving becomes more difficult.”

9. The Grief Process (Worden, 1982)
The Tasks of Grief:
To accept the loss
Experience the pain
Adjust to the new environment
Reinvest in the new reality

10. Complicated Grief (Worden, 2001)
Chronic Grief: One that is prolonged, is excessive in duration, and never comes to a satisfactory conclusion.
Delayed Grief: Emotion that has been “inhibited, suppressed, or postponed.” A subsequent loss may elicit an exaggerated reaction because the bereaved is grieving for two losses.
Exaggerated Grief: Occurs when feelings of fear, hopelessness, depression, or other symptoms become so excessive that they interfere with the daily existence of the bereaved.
Masked Grief: Symptoms and behaviors experienced by a person who does not recognize the fact that these are related to a loss.

11. Case Study
Mr. and Mrs. B. have been married for 50 years. They have been in good health and have been enjoying retirement (traveling, seeing their grandchildren and sleeping until noon!)
Both Mr. and Mrs. B. will be turning 70 this year and the family are planning a BIG surprise party.
One morning Mrs. B. wakes up and she can not move the left side of her body. Mr. B. calls an ambulance and the family physician. Mrs. B. is taken to the hospital.

12. Case Study, Continued
Upon Mrs. B.’s arrival at the hospital you have been assigned as her social worker. You have just been to a workshop on loss and grief and have been reviewing the powerpoint (Yes, this one!). What do you consider to be the most pressing medical, psychosocial, and spiritual concerns that they will both face?
What will grief look like to:
Mr. B
Mrs. B
Their family (all 30 people!)
How will you, as the social worker, provide a therapeutic intervention that will meet their needs.
Is meeting everyone’s needs possible or realistic?

13. “Who Dies?” (Levine, 1982)
“How much of what we call grief is the experience of previous loss? And how do we allow such grief not to be a motivator for our life? How do we get in touch with that deep pain, that place of loss that creates a fear of life itself, our doubt in ourselves about our ability to deeply experience the world because we so fear loss and change?”

14. Bibliography
Gehlert, S., & Browne, T.A. (2006). Handbook of Health Social Work. Hoboken, NJ: John Wiley & Sons, Inc.
Levine, S. (1982). Who Dies? An Investigation of Conscious Living and Conscious Dying. New York: Anchor Books.
Kubler-Ross, E. (1973). On Death and Dying. New York: Routledge.
Kubler-Ross, E., and Kessler, D. (2005). On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss. New York: Scribner.