1. DEATH & GRIEF D.Mohamed Elwasify Assistant Professor of psychiatry
Mansoura University,Psychiatry Dept.
DSM category (v62.82 Bereavement

2. 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.”
The Nemours Foundation.
The Nemours Foundation.

3. “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.”
The Nemours Foundation.
ｩ The Nemours Foundation.

4. *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.
The Nemours Foundation.
ｩ 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.”

5. 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.
The Nemours Foundation.
ｩ The Nemours Foundation.

6. “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.”
The Nemours Foundation.
ｩ The Nemours Foundation.

7. *Grief can make us feel guilty.
*Some people might blame themselves or think they could have done something to stop the death.
The Nemours Foundation.
ｩ The Nemours Foundation.

8. 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.”
The Nemours Foundation.
ｩ The Nemours Foundation.

9. 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.
The Nemours Foundation.
ｩ The Nemours Foundation.

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

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

12. The 5 Stages of Grief
Denial
Anger
Bargaining
Depression
Acceptance

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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

20. (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

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

22. 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

23. 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.