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Critique of a Model of Bereavement

1963 words (8 pages) Essay in Nursing

5/12/16 Nursing Reference this

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Grief is the reaction to loss, which might have been aroused through the loss of someone or something that one has established a bond with. Death of friend, family member, or companion can activate grief and this is common to human experience. Grief is an unavoidable human experience more common in women than men (Love, 2007). Studies have shown that specific emotions play a central role in coping with the grief process of late pregnancy loss, such as guilt and loss of self esteem (Forray et al. 2009).

This essay will explore the eight-state model called the Process of Grieving which was developed by Schneider (1984). The eight-state holistic model will be used to illustrate my personal experience of loss and grief when I had a six-month miscarriage. The essay will also discuss and critique the relevance of Schneider’s process of grieving to Social Care practitioners.

Professor John M. Schneider is a psychologist at the Psychiatry Department in the University of Michigan. Schneider is interested in how the process of grief can lead to creativity, growth, and forgiveness. Schneider’s grief process attempts to incorporate an individual’s physical, emotional, behavioural and spiritual manifestation into a circumstance of nurture and growth. Schneider stated that his eight-state holistic model of grief helps personal growth (Metzger, 2008). My own personal experience of grief is compared to Schneider’s model.

The eight stages of the Process of Grieving are as follows:

1. Initial Awareness of Loss

2. Attempts at Limiting Awareness by Holding on

3. Attempt at Limiting Awareness by Letting go

4. Awareness of the Extent of the Loss

5. Gaining Perspective on the Loss

6. Resolving the Loss

7. Reforming Loss in the Context of Growth

8. Transforming of Loss into New Levels of Achievement

The initial awareness of loss or the awareness of an imminent loss will activate various responses in the body system such as shock, confusion, disbelief, detachment and numbness (Metzger, 2008).

Relating this to my experience, when I observed that I had discharged amniotic fluid uncontrollably, the fear of imminent loss of another baby gripped me. This had already happened three times before. When I remembered my tribal belief about crying during miscarriage, I was numb, confused, shocked and disoriented about the next step of action to take. In my tribe it is believed that crying after miscarriage will lead to the reincarnation of the miscarried baby, hence, causing another miscarriage. It was difficult to believe that, despite the fact that I adhered to my doctor’s advice and instructions. My experience of miscarriages was becoming spiritual to me because of the frequency and the reactions of my in-laws. According to Love (2007) an individual may find it difficult accepting their loss and this can lead the person to feel numb and shocked. In some cases it may take hours or a few days before the person will believe what had happened because of the response of people around the individual (Love, 2007).

An attempt at limiting awareness by holding on is a strategy of making use of the individual’s inner strengths to help the situation (Metzger, 2008).

I was alone in a shop when I realised the imminent loss. At this stage, I deliberated on what next to do without raising any alarm to the people in the next shop. I gathered my inner strength without feeling helpless and called my husband. My husband came over and accompanied me to the hospital. He was reassuring me but I did not find this helpful.

The second stage is the attempt at limiting awareness by letting go. The detachment and habit to the individual’s loss is divided at this level. Acknowledgment of one’s personal limits with regards to the loss is turned loose, by letting go the unnecessary assumptions so as to create means for future adaptive behavior and attitudes. The loss reactions associated at this level are depression, rejection, anxiety, shame, self-destructiveness, disgust, ideation, cynicism, ideals and values (Metzger, 2008).

I had to give up on the six-month pregnancy when the physician regretfully confirmed there was nothing that could be done to save the situation. I was induced again the fourth time, at this stage I had accepted my fate of not being able to have that baby. I became very ashamed and helpless, thinking of a divorce since I couldn’t successfully perform the task of womanhood. It was my fourth miscarriage; I became very forgetful and I felt rejected within the family based on the reaction of my mother-in-law. Neugebauer and Lok (2007) did a qualitative study on psychological morbidity following miscarriage. They found out that 40% of women that had miscarriages displayed symptoms of grief after miscarriage (Neugebauer and Lok 2007).

The third stage is the awareness of the extent of the loss. The assimilation or acceptance that the loss had occurred is well-known at this level. Depending on the extent of loss, the individual reflects on the relation and association with what one has lost. It is the period of mourning, where the individual feels weak in accepting the certainty of the loss that has occurred. Reactions at this stage include; weakness, emptiness, existential loss and preoccupation. Others are pain, silence, loneliness, helplessness, sadness, and exhaustion.

After the birth of the fetus – a baby boy – I became exhausted, empty and very weak because the joy of having a live baby was just dashed away. On realising this, I was exhausted, pain occupied my physical system and I preferred to be alone. I thought of the progress of the pregnancy up to that day as being part of me. Bronquet (1999) looked into the psychological consideration of pregnancy loss. She stated that women see the fetus as part of them rather than as a separate being growing in their uterus. In case the pregnancy ended up in miscarriage, most women feel part of them has been lost. This can lead to the feeling of loneliness and worthlessness (Bronquet, 1999).

Gaining perspective on the loss is the stage at which acceptance of the loss is cognitive and accepted. The individual that is bereaved will be given time to make peace with the past and the reality of the situation. According to Schneider (1984:190), the reactions associated to this stage of loss are endurance, separation, approval, mercy, honesty, recollection, healing and peace (Metzger, 2008).

When I was discharged from the hospital, I was confused. People came around to sympathize with me. This time my mind split in two: one side blaming myself for the miscarriage and the other side blaming the lack of facilities available in Nigeria for such late miscarriages. I weighed my loss and my future chances of getting another pregnancy. I forgave my in-laws for their utterances during the healing process so as to allow peace to prevail. A study of 46 women conducted on grief of late pregnancy loss showed that emotions have an impact in coping with late miscarriage such as guilt and loss of confidence (Forray et al., 2009).

Resolving the loss is not the stage when the bereaved is seen to be doing things or activities that are not connected nor have any reference to the loss. The bereaved must have ‘let go’ at this stage, by accepting responsibilities for actions and saying goodbye to grief in order to forge ahead into the future. Some characteristics of this stage may include self care, relinquishing, forgiveness of self and others, determination, and peace.

I left home one afternoon and decided to run away. I left a note for my husband, who was away at the time, that he can carry on with his life without me. Unfortunately for me, he met me at the bus station, which was about 450km from home. When he realised my intentions, he counseled me and made me realise that I had to let go of the past, forgive him, myself and others and be determined to begin again. He rekindled my hope and aspiration and made me go back to my normal life. Mary (1992) cited in Payne et al. (2000) stated that grief is a psychological process of integration in order to escape from painful reminders of the loss.

Reforming loss in a context of growth is the seventh stage. This stage is resolving the grief over a period of time and it entails realization of potential rather than limitation; accepting problems as challenges; becoming inquisitive again; and looking for a balance among the different aspects of self. The characteristics of this stage include genuineness, endurance, truthfulness, the awareness of illusion, and curiosity (Schneider, 1984 cited in Metzger, 2008).

I realized that life must go on, and weighing the support accorded to me by my husband, I accepted the loss as a challenge to be a mother in my marital life, and I researched into causes and preventions of miscarriages. I was afraid of searching my innermost self in case the situation repeated itself for the fifth time. I heightened my curiosity for womanhood and was very alert to any changes within my physical system. Anxiety is a common response to bereavement because an individual will be afraid of how to cope with it in the future (rch.org).

The final stage is the transforming of loss into new levels of achievement. This stage is the combination of physical, emotional, cognitive, behavioral and spiritual aspects. Transformation after the loss occurred and can generate a new person capable of doing things she was not capable of before the loss. The characteristics of this stage include awareness of inspiration, fulfillment, understanding, unconditional love and commitment (Metzger, 2008).

I became a new being; I got pregnant and moved to Ireland. I decided to live separately from my husband whom I am highly fond of. The transformation of the loss changed me for the better; I now have children of my own; I am more independent than before; I returned to school to change my career; and the level of commitment and creativity of whatever I do is higher compared to before.

I agree with Schneider’s process of grief and loss because it relates to my own experiences of miscarriage. However, Schneider’s eight-state models of process of grieving has been criticized. Schneider fails to consider cultural effects on the process of grief. This is evidenced in my experience because it is not only the news of the loss that can make you numb but cultural beliefs may also contribute. In addition, some people may not grow due to their loss experience because it depends on individual perceptions to grief and loss.

It is important for Social Care workers to study the process of grieving because they work with vulnerable people in society. The client’s vulnerability may be because of the loss of a family member, loved one or friend. The study of grief and loss empowers practitioners to support people in making choices about placing a child for adoption, and pre-bereavement support. It also helps Social Care workers to support clients experiencing loss. For instance, it helps in supporting people with chronic disability, people that are mentally ill and palliative care support for the dying (Machin, 2009)

In conclusion, Schneider’s eight-stage model for the Process of Grieving can be of great reassurance. Considering the behaviour and characters displayed in this process will help in understanding ourselves and the people around us. The process of grief in my experience helps me to understand my husband’s family better, especially my mother-in-law. Grief also brings awareness, freedom, and a change of attitude to life.

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