Gerontology 130
Working with the Frail Elderly

UNIT 12

Understanding Grief

Overview
Stages of Grief
Required Reading
Online Activities

Overview

Everyone who is born experiences some type of loss. Whether it is a loss with regard to a limb, loved one, a friend, a job, or self-esteem, loss is a universal phenomenon. Grief is the universal emotion of sorrow or pain and is often the primary response to loss or separation. The process in which people deal with loss is called the grieving process.

Adaptation to loss depends upon (1) the nature of the loss, (2) the person experiencing the loss, (3) the social environment in which the loss occurs, and (4) the frequency of other losses. Several individuals have identified stages of the grieving process; most notably the late Elisabeth Kubler-Ross and Granger Westburg, who were professors at the University of Chicago and the University of Illinois in Medicine in the 1960's. Dr. Westburg's book, Good Grief (1962), Fortress Press, Philadelphia, PA., has been the foundation for many grief support groups and is still applicable today.

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Stages of Grief

Dr. Kubler-Ross identified five stages of dying with terminal patients. These stages include: denial and isolation, anger, bargaining, depression, and acceptance. Although stages provide a helpful framework to understand the cycle of grief, it must be kept in mind, that stages of grief is not necessarily a step by step or orderly process. Furthermore, a person may experience more than one stage of grief at the same time, and not everyone goes through all the stages.

Prior to Dr. Ross, Dr. Granger Westburg had delineated several stages of grief. He believed that in order for people to cope with grief successfully, they needed to "work" through the various stages of the grief cycle. Dr. Westburg identified these stages as follows:

Shock and/or Disbelief—This is a temporary retreat from what has happened and may last from a few hours or days. There is a numbing effect during this stage.
Emotional Release—This stage includes crying, sobbing, and sometimes uncontrollable hysteria.
Depression/Loneliness—This stage can last a long time, and is characterized by a sense of loneliness and alienation from others and God.
Physical Distress—A feeling of weakness, or that strength has been drained way. Physical distress can include digestive upsets, loss of appetite, high blood pressure, rapid heart beat, or change of body temperature.
Panic—This is experiencing disbelief or not knowing what to do.
Feelings of Guilt—This includes wishful thinking or regret about what happened into he past. There is often heightened feelings due to loss. Guilty feelings may be expressed as anger towards others.
Hostility and Resentment—This can be directed outwards; perhaps to doctors, hospital staff and others involved. It may include relatives or friends who have not been directly effected, or may be directed towards self.
Inability to Return to Normal Routine—Everything seems to hard or impossible. The person tends to question the worthwhile of everyone and everything.
Reconciliation—This can be take a long time. One is beginning to make adjustments and adaptation or take on positive attitudes.
Struggle to Adjust to Reality—This is when individuals acknowledge that the loss has occurred and that a life must go on. This takes on coping with new arrangements and reality.

The loss for caregivers is even more pronounced. The person they are caring for may no longer respond like they have in the past. The person being cared for may be difficult or aggressive. The caregiver cannot let go of their perception of who that person was. Additionally, the mental and physical losses that occur magnify and intensify the grief. A scientist of years ago, may no longer recognize his family member leading to feelings of depression and sadness.

The physical task of caring for someone may be so overwhelming that the caregiver may wish that the person would die quickly and soon. This of course leads to feelings of grief, depression and guilt. The person is learning to let go of the person who "was" and is anticipating his/her death. Once death does come, many caregivers are consumed with guilt wondering why they weren't patient enough, and feeling guilty for wishing that death would come. At this point, they are coping with feelings of guilt and wishful thinking.

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Required Reading

Read the information on "Understanding The Grieving Process" listed on this website or other materials you may have access to: http://www.aarp.org/griefandloss/

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Online Activities

Opportunity for Reflection: Reflect upon the following: Everyone experiences loss some time in their life.
What type of loses have you personally experienced?
What strategies helped you overcome your loss?
Post at least two responses on the WebBoard Unit 12 under Grief.

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