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Course Sample:
INTRODUCTION
(Hors d?Oeuvre)
It is reported that one in three losses (from death) involve sudden or unexpected loss (Raphael, 1983). Though anticipated or expected loss can be just as painful, there are some distinct differences from sudden loss. What are those differences and how do they effect people?s reactions and ability to cope?
The aftermath of sudden loss, also known as complicated mourning, hits millions of individuals and can have both short and long term effects upon the individual, family and society. Sudden loss can increase existing physical, emotional and mental distress or be the catalyst for newfound anxiety, stress, depression, intrusive images, addiction and abuse.
There are as many ways to adjust to sudden loss as there are individuals who experience it. Some people shut off their feelings and "numb out" with obsessive behavior and others become so overwhelmed with shock, emotion and change, that it is difficult for them to function or cope.
This course provides personal and professional information, reflection and time-tested tools for healthy ways to cope and adjust to life after sudden and/or violent loss. You will learn how to differentiate between grief from sudden and anticipated death and the corresponding reactions; the many factors that effect our reactions to sudden loss; how to normalize and validate those feelings and reactions; and tools? you can provide for healthy grieving and ongoing connection with the deceased.
MAIN COURSE
(Entree)
Differences Between Sudden and Anticipated Loss
Expected or anticipated loss is when someone has a life-threatening illness or disease and it is known before they die that their death is or was imminent. This period of time can be weeks to years, depending on how fast the illness or disease progresses and what the individual does or does not do in response to the situation.
Because an anticipated death is known of before hand, it is easier, though does not always take place, for that person?s family and friends to have opportunities to communicate whatever they wish to communicate with the person dying and vice-a-versa. This is often referred to as "anticipatory grieving", though it is actually taking place in the present moment and is more accurately referred to as "active grieving". Because of this opportunity, there is the chance for the person dying and those who will live on; to say and do what they feel is necessary, thus alleviating or at least diminishing, further feelings of being "unfinished" or having guilt and remorse.
- A woman came to see me, whose husband had died after being ill for three years with Alzheimer?s. It had been two months since his death. She said, "I didn?t feel anything but relief for the first month or two and after having little sleep for years, slept 12 to 14 hours a day. I loved my husband, but in many ways he died long before his body did. It felt like a part of him died day by day. The person I married and knew for thirty-four years was gone. Even though, towards the end, he didn?t understand what I was saying, I was able to tell him how much I loved him and what a pleasure our lives had been together. Sometimes he heard me loud and clear and responded in kind; at others, especially in the last half year, I don?t think he comprehended what I was saying. Even though it was long, exhausting, sad and frustrating, I much preferred having the opportunity to share what was on our minds than if he had died suddenly, without warning. This way we had no unfinished business."
Knowing of someone?s expected death also provides time to make arrangements ? financial, funeral, health-care decisions, children, living arrangements and work. It doesn?t always give time to have everything in place or taken care of, but there is more opportunity to do so. These issues are often referred to as "secondary losses", though they can, at times, be just as primary as the loss of the individual who is about to or did die. "A secondary loss is a physical or psychosocial loss that coincides with or develops as a consequence of the initial loss. Each of these secondary losses initiates its own grief and mourning reactions, which ultimately may be greater or lesser in intensity and scope than those following the precipitating loss." (Rando, 1993).
Having the change to know what someone?s health care wishes are before they are in a situation where they cannot let you know, can make a world of difference in the survivor?s peace of mind. Letting a loved one die or "live while they die" in the fashion you know they wanted, lessons guilt, anger, frustration and questioning after they have gone.
- A man who came to me for counseling said his mother laid out everything before she died "in black and white". He said, "It would have been a mess, if my mother hadn?t been so prepared and let us know what she wanted. She completed a Do Not Resuscitate form as soon as she learned she had pancreatic cancer and gave copies to my sister and me. She made me her Durable Power of Attorney for Health Care and told us all, including her doctor, that she didn?t want any heroics when her time came. She was at home and we were caring for her," he continued, "when she went into a coma and eventually stopped breathing. I freaked out and was about to call 911. I couldn?t stand to see her that way, but my sister reminded me what Mom wanted and that this was the natural progression of things and I was able to let her be."
There are a number of common reactions, though not inclusive, to expected or anticipated death. They can include physical, cognitive, emotional and behavioral manifestations.
Physical symptoms can involve: shakiness, dizziness, nausea, disorientation, sweating, shortness of breath, chest pain, headaches, backaches, muscle tightness, fatigue, thirst, tightness in the throat, weakness and chills.
Cognitive symptoms can include: blaming, confusion, poor attention and concentration, memory problems, poor problem solving and abstract thinking, loss of time and place.
Emotional reactions may include: anxiety, guilt, grief, denial, uncertainty, loss of emotional control, depression, apprehension, feeling overwhelmed, anger and irritability.
Behavioral responses often encompass: changes in activity, withdrawal, emotional outbursts, loss or increase in appetite, increased alcohol or chemical abuse, inability to rest or excessive sleeping, pacing and lowered level of functioning.
"I seem to be falling apart.
My attention span can be measured in seconds;
my patience in minutes.
I cry at the drop of a hat.
I forget things constantly.
The morning toast burns daily.
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