Supporting Individuals Experiencing Loss and Grief

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Supporting Individuals Experiencing Loss and Grief.

Loss can be defined as "a condition of being bereaved or deprived of someone or something". Loss takes many forms, from the bereavement of a loved one to the loss of a door key. Loss can give rise to feelings ranging from deep mental anguish to feelings of annoyance. Grief or deep mental anguish rises from a great significant loss, a loss where an emotional attachment has been formed. Sorrow, deep sadness, regret, misery, unhappiness are words that are often used to describe grief. Deep mental anguish can lead to severe depression or simple annoyance can lead to frustration. These feelings need to be recognised, understood and if necessary treated.

A significant loss that causes grief may differ from person to person and so a situation that maybe painful to one person may not necessarily affect another in the same way. Those losses causing grief however, are more likely to have a major impact on the life of the person suffering anguish.

Death of a loved one is the most common cause of grief. Loss of a partner through divorce or breakdown, loss of a parent by the same means, loss of a relation through breakdown of the family or a family member moving a great distance may also cause grief. The person lost, may have been a major force in the life of the griever. Someone, who provided, love, friendship, influence, protection, assistance, fiscal security are now gone. Feelings of helplessness, insecurity, shock, and coping uncertainties may take hold without that person around, The loss of a pet may also cause grief. A pet that has become a member of a family and is loved as such, dies, one member of the family maybe extremely upset at this loss while another member knowing the pet was an animal and not a human being, they accept the situation. Death is not the only loss to cause grief, the loss of a limb will have a major impact on the person concerned. Feelings of fear, denial, vulnerability, anger, may affect the amputee. In the stages of life, when death is totally unexpected, grief can be more extreme. Extreme grief can also take hold if the loss is of something that is extremely important to that person, for example, redundancy, victim of crime, injury, compulsory relocation.

A persons mental state before or at the time of a painful loss may also contribute to their ability to cope with the sudden situation and how this new situation will affect them. So, grief maybe more pronounced in someone already depressed as opposed to someone who is mentally strong and able to deal with a situation thrust upon them. Emotional and traumatic responses are therefore relative and not absolute.

The loss of a close loved one, partner or parent may cause that person to display their feelings of great sadness by crying, but this crying may also be a display of other feelings that maybe affecting them at the same time. Behavioural, physical and emotional reactions are common place that can leave the bereaved confused, numb, lonely, helpless, and worried.  As well as crying, other physical reactions could be nausea, insomnia, anxiety. While the common reactions to loss are denial, depression, guilt, anger, bargaining, sadness and acceptance. These reactions have been used to describe models of grief that take place in a certain distinct manner.

The most well known model was described by Elizabeth Kubler-Ross (1926 - 2004) in her book `On Death and Dying` published in 1969. She wrote this book after interviewing the terminally ill over a four year period in Chicago. She advocated that as a period of adjustment, those experiencing loss went through five stages of grief. This became known as the "stages model". She believed that those terminally ill patients moved from one stage to the fifth stage in chronological order.

Denial, Anger, Bargaining, Depression, Acceptance, with hope being felt at all stages.

1. Denial and Isolation can be defined as the refusal to acknowledge that something exists or to face facts.

It can be a passing surprise reaction to bad news. Isolation occurs when friends and family avoid the terminally ill patient, they don't know what to do or say to the ill person.

2. Anger is a feeling of great resentment, rage, annoyance, or displeasure. "Why me?" maybe the thoughts of those who are ill. They may also resent others for being well. Anger can be felt towards those around them, e.g.  Doctors or nurses.

3. Bargaining is stated as a brief stage and for those who are terminally ill it tends to be between the patient and God. For those people who are going through a less traumatic situation, they may bargain with their friends and family or employer.

4. Depression can be described as a state of sadness, hopelessness, dejection, which can be either reactive or preparatory, reacting to a past loss or future known losses.

5. Acceptance can take time and differ from each individual situation and tends to be empty of emotions.

This Kubler-Ross model has been important to those working with the bereaved and has been applied in many situations. Other authors have felt that these stages are too strict and that perhaps not everyone goes through all the stages. This said Kubler-Ross brought the subject of dying and grief from behind closed doors and into the world to be discussed, and cared about.

The William Worden model however, took us from the "stages model" to a hypothesis that a definite list of "tasks" must be concluded in order to resolve the issue of grief. In his book of 1991 "Grief Counselling and Grief Therapy" he compares mourning to the "healing process" making the bereaved active in their grief.

1. Accept the reality of the loss.

Acceptance can take time, but the motion of arranging a funeral allows movement towards acceptance. The news of death may bring shock, disbelief and denial to the bereaved but is slowly replaced by the acknowledgement that the deceased has gone forever.

2. Work through the pain of grief.

Acknowledgement of the reactions or pain of grief is important. It is not wise to ignore these feelings as they will not go away, but to be stored away in the mind to appear later. It is essential to deal with the emotions for the well being of the bereaved.

3. Adjusting to an environment in which the deceased is missing.

This means that the bereaved must adjust to their total surroundings, be it spiritual, psychological or physical. The deceased person may have played a role that filled all these needs for the bereaved. Death confronts the bereaved to adjust to a new environment without the deceased, and to find new roles for themselves.

4. To emotionally relocate the deceased and move on in life.

This is the need to "move on" to find new outlets for your emotional wellbeing. This may involve perhaps finding new hobbies, job, relationships and to search for new experiences. There is a need to still have a connection with the deceased but now at a different level. It is important to realise that the deceased is not coming back and to use memories and associated thoughts to evolve this new form of the relationship. Task 4 may take a year or more for some people to complete.

There are many agencies available to those suffering grief, offering advice and support via a telephone line and online. The Child Bereavement Trust offers leaflets and advice for parents who lose children and for children who lose parents and for those children and parents who need support through terminal illness. Age Concern has a wide range of information for those who are dealing with death, giving sensible and to the point help on what to do when someone dies. They also provide assistance on how to put your affairs in order. Cruse - Bereavement Care Scotland supply bereavement support through internet advice, a national helpline and one to one counselling.

A change in routine such as friends relocating away from one another can cause emotional pain if not dealt with correctly. I had to deal with such a situation. Mr D and his friend had daily contact by meeting at the local cafe to have tea and a chat. I had to discuss with my client Mr. D why his friend had to move and that I explained that the move was necessary and for the benefit of his friend.

We had to examine the situation Mr D found himself in without his friend and try to improve it. We discussed the fact that his friend had moved away and that daily contact was not possible anymore but perhaps weekly or monthly contact was still possible. We discussed the possibility of arranging outings to meet one another and to find new social activities to meet new friends. With the agreement of his friend, we looked at technology to improve the circumstances. E-mail accounts to be set up with web cams to keep in touch with his friend. Telephone numbers to be exchanged to allow telephone contact and addresses to be exchanged to allow written correspondence and visits for lunch to be organised. After examining all these choices of contact Mr.D felt much happier knowing that contact with his friend could still take place.

In the event of a death there are certain legal and other procedures that should be followed. These measures differ slightly depending on whether the death takes place at home or in a hospital setting.

If death takes place at home the GP, nearest relative and if the death was unexpected, accidental or suspicious then the police must be called, nothing should be touched if the police are to be involved. If in hospital the body should be identified. Confirmation of next of kin, beneficiary should be identified before personal possessions are released. If an organ is to be donated then death at home tends to make this difficult, the doctor needs to  be called immediately and if death takes place during the night then getting a GP in a hurry may not be possible. If in hospital staff tends to discuss with the deceased relatives the possibility of organ donation.

A medical certificate will be issued by the GP or Hospital Registrar if the cause of death is known; this will be required by the Registrar of Births, Deaths and Marriages. A second doctors` signature will be required for a cremation certificate if the deceased is to be cremated. The Registrar will require the medical certificate and also a list of other personal information. If the death is suspicious then the procurator fiscal will become involved, usually via the GP, hospital doctor, Registrar or police. Although anyone may contact the Fiscal if suspicions are aroused. The procurator fiscal may request a post mortem if a doctor cannot issue a death certificate. The next of kin do not need to give consent, if religious, cultural or other objections are to be made, the Procurator fiscal should be informed immediately. A post mortem maybe unavoidable for legal reasons.

A minister of religion is to be contacted if a religious service is required. The undertaker is to be contacted and if a will is available then it should be found and acted upon as directed therein.

Over the years dealing with death has changed. Historically, 80 years ago before the use of professional funeral directors was common place, people lived at close quarters with one another in large families in close communities. Death tended to take place at home as hospital care was not always available and a public health service did not exist. The lack of these services, poor working condition and high incidence of disease meant that death was seen often within local communities, perhaps even a daily experience. The men ordered the coffin and arranged the funeral service but it was the women who attended to the body and had the body "laid out" most often in an open coffin, in the one room of the house usually dressing the body in their "Sunday best". Normal day to day to activities still took place around the body, with curtains drawn, there would be visits from friends and family, prayers said, they would pay their last respects and reminisce about the deceased.  Black, the colour of mourning would be worn. The tea and alcohol would be flowing as a way of consoling the family. As money was tight local communities would collect door to door to help pay for the funeral and the wake. As most people worked and lived in smaller communities, church and graveyard amenities tended to be nearby and so a walking funeral procession took place, usually within three days after the death, few women attended. At the burial those women who attended the service often went home to help prepare food and drink for those who attended the funeral while the men went to the graveside to bury the coffin.

Today, however, the experience of death is not so common. Deaths most commonly take place in hospital and so the use of a funeral director is now tradition, even if death takes place at home. The funeral director takes over the whole process of the funeral by arranging the body, arranging the funeral service and even attending to finding the burial plot or arranging cremation.  Contact with the deceased on a physical level e.g. viewing, and dressing the body by family has declined.

As death is a natural process in life, all cultures and religions have developed their own practices of dealing with death. It is important to try to understand the needs of families belonging to both religious and non religious groups and how they deal with the aftermath of the death of a loved one.

Depending on where people live some religious faiths have larger congregations than others. There are many faiths in the UK some with their own splinter faiths, e.g. There maybe as many as 220 different Christian denominations.

Christianity, Islam, Judaism, Hinduism, Mormons are some of the common religions.

Christians tend to have church service and in some cases the deceased has to be a regular attendant at the church. This usually takes place around three days after death. Dark clothes tend to be worn, at the service. Hymns are sung, readings from the bible are heard, eulogies from friends and family about the deceased are given and prayers over the coffin are given by the priest or minister. If a burial takes place, prayers are said at the graveside as the coffin is lowered into the grave and soil maybe thrown onto the coffin. If it is a cremation prayers are said or hymns sung while the coffin departs from the congregations` sight. Food and drink is laid on afterwards for those who attended the service.

Moslems however, tend to bury the deceased 24hrs after death. According to the sex of the deceased, family members ritually wash the body. The body is then laid out after being respectfully wrapped in white cloth. Collective prayers are given and

the body is then buried with the head turned right facing the Holy city of Mecca. It is forbidden to cremate the body. After burial a collective prayer is said with the throwing of soil onto the body in the grave. The style of the grave varies from place to place. An official mourning period of three days with a special meal takes place, this maybe longer for a spouse.

The Baha`i faith is one of the worlds youngest faiths taking its present form in Iran from the Shi`ite Moslem faith in 1844. There is no clergy in the Baha`i faith and so it is the responsibility of the family to arrange and conduct the service with the help of the Baha`i community. The funeral laws of Baha`i are that the body should not be embalmed unless required by law. Cremation is not allowed. The body should be washed respectfully and covered in a white cloth, a Baha`i burial ring is placed on the finger and the body put in a fine hardwood coffin and buried with the feet pointing to the Holy Land. The remains must be buried within one hour's travel of the place of death. Every service is unique but the only obligation of the family is that the specific "Prayer of the Dead" be recited either at the chapel or graveside.

For the non- religious person a burial tends to be a legal process with funeral procedures taking place by the family as a means of sharing grief and support for those closest to the deceased. This type of funeral tends to come under the heading of a Humanist service. These services tend to be personal and unique to the family of the deceased. The service may sometimes take the form of the family head holding proceedings perhaps in woodland which can also be common for those who follow the New Age movement, or the funeral directors chapel of rest, or a crematorium. Eulogies are read, music is played, memories are shared, and candles are lit, moments of silence followed and final farewells said. The New Age followers tend to pick and choose their beliefs and practices and have no formal holy texts or dogma. Their funeral service may follow that of a humanist funeral but with added prayers, poetry and music that the deceased had used throughout life. They may include eco friendly burials using "Green Burials" with cardboard or basket weave coffin which are bio- degradable with the planting of a tree marking the spot of the grave.

Death can affect many people who have known the deceased and it is important to acknowledge the emotional impact on those affected and to offer support, even sometimes to advise the use of professional agencies.

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