Personal Guidebook to Grief Recovery
But Jove-born Helen otherwise, meantime, Employ'd, into the wine of which they drank A drug infused, antidote to the pains Of grief and anger, a most potent charm For ills of ev'ry name. Whoe'er his wine So medicated drinks, he shall not pour All day the tears down his wan cheek, although His father and his mother both were dead, Nor even though his brother or his son Had fall'n in battle, and before his eyes.
It is equally important to recognize that Ann's behavior, while clearly antisocial, was not as a result of underlying psychopathology. She acted out to give vent to her anger and grief. Perhaps the fact that Ann returned to normal functioning so soon after Mrs. Gardner was able to resume her responsibilities confirms that much of Ann's behavior was a direct response to her mother's illness. It was a testimony to the central role Mrs. Gardner played in holding this family together. It is noteworthy that Mrs. Gardner was in psychotherapy during this entire period. Mr. and Mrs. Gardner also had an intensive period of couple therapy.
Countertransference is defined as therapist emotional and behavioral reactions to clients. As an example, imagine an interviewer who lost his mother to cancer when he was a child. His father's grief was very severe. As a consequence, little emotional support was available when the interviewer was a child. The situation eventually improved, his father recovered, and the interviewer's conscious memory consists of a general sense that losing his mother was very difficult. Now, years later, he's a graduate student, conducting his first interviews. Things are fine until a very depressed middle-aged man comes in because he recently lost his wife. What reactions might you expect from the interviewer What reactions might catch him by surprise
PATIENT C The women who was grieving her window-cleaning needed to be listened to by a professional person who understands how to look and listen under and beyond the surface. Again, no psychotherapy sessions are needed for this, just an awareness that often listening with patience and refraining from advice is the best therapy for troubled emotions.
Cultural norms are very important to consider when evaluating mental status. For each category addressed in the traditional mental status examination, try to think of cultures that would behave very differently but still be within normal parameters for their cultural or racial group. Examples include differences in cultural manifestations of grief, stress, humiliation, or trauma. In addition, persons from minority cultures who have recently been displaced may display confusion, fear, or resistance that is entirely appropriate to the situation. Further, in traumatic or stressful situations, persons with disabilities may be misunderstood.
When seen at a pain clinic for a psychosocial assessment, she was angry with the medical profession as she blamed her doctors for her medical problems and her ongoing struggle with the worker's compensation board. She was convinced that at the heart of her problem was a surgical procedure that had gone seriously wrong. She was in an acute state of grief.
In the unfortunate event that one of your clients completes a suicide, be aware of several personal and legal issues. First, seek professional and personal support. Sometimes, therapists need psychotherapy or counseling to deal with their feelings of grief and guilt. In other cases, postsuicide discussion with supportive colleagues is sufficient. Some professionals conduct psychological autopsies in an effort to identify factors that contributed to the suicide (Conwell et al., 1996). Psychological autopsies are especially helpful for professionals who regularly work with suicidal clients autopsies may help prevent suicides in future situations (Kaye & Soreff, 1991).
To consult with your attorney regarding what you can discuss with them. Your attitude toward the family may be more important than what you disclose about your client's case. Avoid saying, My attorney recommended that I not answer that question. Make efforts to be open about your own sadness regarding the client's death, but avoid talking about your guilt (e.g., don't say, Oh, I only wish I had decided to hospitalize him after our last session. ). At the therapeutic level, talking with the family can be important for both them and you. In most cases, they will regard you as someone who was trying to help their loved one get better. They will appreciate all that you tried to do and will expect that, to some degree, you share their grief and loss. Each case is different, but do not allow legal fears to overcome your professional concern and your humanity.
The barnacle years were eventful ones for Darwin and his family. Some incidents of the period were joyous Darwin's new friendship with Thomas H. Huxley, for example, and the medal awarded him by the Royal Society in 1853 for his contributions to natural history. Some, such as the deaths of Darwin's father in 1848 and his daughter Annie's death a few years later, were tragic. Distress over Dr. Robert's illness and death may have contributed to a breakdown in Darwin's health that kept him bedridden for months during 1848 and 1849. Barely had Darwin recovered from his grief over his father's death when Annie, his beloved daughter, fell ill with a stomach complaint that caused prolonged vomiting. Darwin took her to a health resort to consult the best doctor he could find, but nothing helped. Annie grew weaker and weaker. From her bedside Darwin wrote tearfully to Emma, who was at home caring for the younger children, I wish you could see her now, the perfection of gentleness, patience &...
The phase structure of rehabilitation in CHD is illustrated in Figure 45-2. Rehabilitation phase I includes treatment in a hospital or a cardiologic center for children. Here, the main focus is placed on somatic treatment including medical care and nursing. If surgery is performed on older children, adolescents, and adults, physiotherapeutic care is prioritized in order to achieve early mobilization. The most important goals are pain relief, thrombosis prophylaxis, stabilization of the circulatory system, as well as the management of existing neurological deficits.28 In neonates, infants, and children, it is crucial for the attending doctor to provide information, counseling, and assistance to the family. Extensive information and advice offered to the parents constitutes the fundament of an adequate management of the child's heart defect. Hereby, parents also receive help in dealing with their unexpectedly difficult situation. Grief about the child being chronically ill, concerns...
I can see that losing your son has been terribly painful. You probably already know that your feelings are totally normal. Most people consider losing a child to be the most emotionally painful experience possible. Also, I want you to know how smart it is for you to come and talk with me so openly about your son's death and your feelings. It won't make your sad and horrible feelings magically go away, but in almost every case, talking about your grief is the right thing to do. It will help you move through the grieving process.
All good fairytales end happily ever after, don't they Well, no, not always. Angela Carter reminded us that fairytales, even the ones with happy endings, always betray a hidden darker version of reality (45). Subtexts are nearly always also found that speak of secrets, shame, and lies of villains and weaklings dispatched without justice of hegemonic patriarchal morality banishing precocious attempts at usurpery and perhaps most pertinent to the current arguments, of grief and loss. Models of delivery of chronic pain management will come and go. In the absence of a strong public health argument for coordinated widespread treatment programs for adolescents with chronic pain, treatments will develop in isolated pockets, driven often by individuals, in temporarily supportive environments. What is missing, however, is any widespread change in the overall system to embrace these treatments as a standard or as a requirement. We are too often debating in response to the question should we...
The information in Table 13.2 reveals many things about the broad field of mental health diagnostic systems. First, symptoms may be similar across cultures, but causes may be viewed very differently. (Psychotic thinking, anxiety, or depressive symptoms may be consistently described across cultures but attributed to satanic influence, bad behavior, brain disease, trauma, family patterns, learning, etc.) Second, causes of human distress (brain disease, trauma, exposure, grief, attachment loss or disturbance)
There are several problems often associated with bipolar disorders that may worsen the quality of life of patients and therefore deserve special attention. Patients may run into problems during their adjustment to a diagnosis common reactions to receiving a diagnosis of a severe, chronic illness are denial, anger, ambivalence, and anxiety (Goodwin and Jamison 1990). It is essential for the clinician to respond appropriately in order to to improve illness awareness, treatment compliance, and avoid self-esteem problems (Colom and Vieta 2002a, 2002b). Another problem that should be carefully addressed by therapists is a patient's feeling of loss and grief after the loss of real or abstract objects, such as a job (which is mentioned by 70 of patients and their partners as the most relevant difficulty in the long term Targum et al. 1981 ), job status (which affects more than 30 of patients Harrow et al. 1990 ), economic status, and loss of love relationships and family support. All of...
Like weight loss, fatigue is a relatively non-Lecific symptom with many causes. It refers to a sense of weariness or loss of energy that patients describe in various ways. I don't feel like getting up in the morning I don't have any energy I just feel blah . . . . I'm all done in I can hardly get through the day . . . By the time I get to the office I feel as if I've done a day's work. Because fatigue is a normal response to hard work, sustained stress, or grief, try to elicit the life cir-
The role of social support in fending off morbidity, enabling sick partners to cope more effectively with their illness and disability, and generally contributing to the well-being of the partners, is impressive (Day et al. 2000 Fernandez et al., 1998 Hagedoorn et al., 2000 Holicky and Charlifue, 1999 Manne, 1994). This aspect of couples dynamics has rarely been incorporated in assessing the impact of spousal illness on the well partner. Moreover, when the well partner also succumbs to physical or emotional disorder, the vulnerability of the sick partner is enhanced. The consequence of illness in the well partner in turn has the potential to eliminate or significantly reduce a major source of support for the sick partner. This is a double-edged phenomenon. An added complication, again generally ignored in the spousal illness literature, is the grief that many well partners go through in the face of spousal chronic or progressive illness. This grief can be a potential source of...
Besides pining for Lenina, John is grief-stricken to learn his mother is dying, a strange emotion in a world where an individual is insignificant among the masses. At the hospital the soma-drugged Linda cannot communicate, which makes John feel guilty and alone, fearful he is losing his one human connection. The death-conditioned Bokanov-sky Group comes into the room, surprised at such an extreme reaction and horrified at seeing Linda's flaccid and distorted senility. Their modern medicine is able to give even a moribund sexagenarian a girlish appearance. When his mother dies, John's grief is palpable, upsetting the visiting group that associates death with pleasure. In his presence, identically cloned Delta workers obediently receive their daily soma, and John realizes in a flash he must make this slave world free again. He throws their soma out the window, calling it poison to soul as well as body. A fight ensues. Bernard and Helmholtz arrive. Bernard declares John mad while...
Q' i professional education and the literature on the need to address the issues f death and dying. Topics such as end-of-life decision-making, grief and )ereavement, and advance directives are beyond the scope of this chapter. asic concepts are appropriate even for beginning students, however, since you will care for patients near the end of their lives. Many clinicians avoid the subject of death because of their own discomforts and anxieties. You will need to work through your own feelings with the help of reading and discussion. Kubler-Ross has described five stages in a person's response to loss or the anticipatory grief of impending death
Be seen together at the pain clinic for a family assessment. From all accounts, she was in the throes of what can only be described as acute grief. Her assumptive world had collapsed around her in the space of 6 months. Mrs. Davies's response to the multitude of losses was predictable and understandable, and had virtually nothing to do with the burden factor, which is predicated on the stress of caring for a sick and disabled partner. Mr. Davies not only lost his major source of support, he developed inordinate guilt over his wife's condition. He remained a patient at the pain clinic for 2 years, and during the entire period Mrs. Davies showed little sign of improvement. An unanswered question was whether Mrs. Davies had slipped into a dysthymic disorder. Prolonged grief is often associated with anxiety or mood disorders (Roy, 2004). Subsequently all contact was lost with this family, so there are several unanswered questions in this case. Without the benefit of direct contact with...
A 69-year-old woman presents to your office with the complaint of pain. She was diagnosed with breast cancer that has metastasized to the bone 6 months ago. At the time, she did not want radiation therapy even for relief of the pain. You then discussed with her that her prognosis is poor and that her time to live is limited. She was not interested in hearing about it. You observe that she has lost more weight and that she is even more anorexic than at her previous visit 1 month ago. Today, she is frustrated because she hurts when she gets up and tries to walk around. She has planned a trip to the Bahamas to take place in 4 more months. What stage of grief is this patient currently in
Upon admission to the pain clinic, she was depressed and demoralized. She could no longer work or function with any degree of authority as a parent or partner. She was grief stricken over the multitude of losses she had to endure since the fateful accident. She had great concern about the health of her marriage, and stated that her relationship with her husband had become unstable.
Investigation of her family and social situation revealed some startling facts. Three persons she had been close to had died within the past few months. She denied any feelings of grief and generally minimized these losses. She and her husband had not talked about these deaths. She did not wish to waste his time with her problems. He was in a critical stage with his research, and she felt he should be left alone. This led the therapist to a conversation about her pain and how she was coping. She said she was trying to carry on as normally as possible, but at times it was very hard to do so. She did not get much help from her husband, but her mother helped out every now and again. Was her husband aware of her health problems He knew that she had horrible headaches that could last for days, but quite often she did not tell him when she was in bad pain.
For people with CFS, emotional changes can be just as unsettling as the physical symptoms produced by the illness. Many people do not understand that the emotional roller coaster is as organic as the fever, swollen glands, low blood pressure or any other symptoms of the illness. That is, the illness can produce 'negative emotions' -overwhelming grief, irritability, anxiety, depression and guilt, and these symptoms come and go like all the other symptoms the illness throws at you.
Perhaps the most basic level at which iterative processes appear in the world is that of time. It is very difficult to say what time is because, although it is self-evidently there, it is in some way intangible. Attempts to give a definition of time almost always come to grief in problems of self-reference. If asked what time is, people will usually say something like time is the succession of events but what is a succession something involving time so we are no further forward.6
Attempts to classify the emotions have been made and one successful one is that of Fischer et al. (1990). They identified two main types, positive and negative. There were sub-categories of these. In the positive group there are love, joy, pride, contentment. In the negative group there are anger, annoyance, hostility and aggression sadness, grief, depression and guilt and finally fear and horror. Watson and Clark (1992) identified similar groups in a cross-cultural setting. In this section we shall be considering some of the more common ones associated with pain.
Inkster's case is both tragic and poignant. It is a story of a woman with a lifelong history of migraine-type headaches, and her dependency on a caring but somewhat aloof husband and their two children. She attended a pain clinic for treatment of her unremitting headaches for the past 6 or 8 months. Her family physician noted that she had responded very poorly to a range of analgesics including narcotic medication. On close examination a number of startling facts emerged, the most telling of which was the sudden death of her husband 2 years prior to her arrival at the pain clinic. Mrs. Inkster had been married for 20 years at the time of her husband's death. The marriage was not without conflict, which mostly centered on child-rearing issues. Her husband was very permissive and allowed the children to get away with anything. She believed in strong discipline. Yet she was very dependent on her husband because he was always there for her and never complained about anything. Her...
E. de Flacourt, the Governor of Madagascar when it was under French rule during the mid-17th century, was the first to write about these tropical pitcher plants, of which there are more than 70 species. In 1689 J. P. Breyne described the plants and was the first to use the name Nepenthes. Digestion in Nepenthes was reported by J. D. Hooker to the British Association for the Advancement of Science in 1874. In 1875 L. Tate discovered the presence of a digestive enzyme in Nepenthes secretions. Thereafter the tide of opinion swept back and forth between digestion caused by enzymes and digestion by bacterial decay. Today it is recognized that both processes contribute to digestion. Nepenthes is derived from the Greek word nepenthes meaning the removal of sorrow and grief. It is also the name of a plant that is used with wine to make a potion or drug to relieve sorrow and grief and produce exhilaration.
Other diseases that are important to consider in the perimenopausal woman include hypothyroidism, diabetes mellitus, hypertension, and breast cancer. Women in this stage of life may also experience depression, whether spontaneous in onset or situational due to grief or midlife adjustments. The practitioner should advocate aerobic exercise at least three times per week, with weight-bearing exercise advantageous for preventing osteoporosis. Bone mineral density (BMD) testing, such as dual-energy x-ray absoiptiomelry (DEXA), is useful in the early identification of osteoporosis and osteopenia.
However, there are now good data on the assessment of the needs of children, adolescents, and their families in maximizing the quality of remaining life and managing death, grief, and loss. In particular, data from families at Canuck Place in British Columbia, Canada, found substantial need for a dedicated facility for patients and after provision found that families reported significant support for such a dedicated facility (16,17).
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