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HUMAN BEHAVIOUR IN HEALTH AND ILLNESS. MR OGUNDELE. Death. Death is a crisis that all families encounter, and it is recognized as the most stressful life event families face, although most do not need counseling to cope. In the western world, the development
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HUMAN BEHAVIOUR IN HEALTH AND ILLNESS MR OGUNDELE
Death • Death is a crisis that all families encounter, and it is recognized as the most stressful life event families face, although most do not need counseling to cope. In the western world, the development • The development of life-extending medical technologies has had several effects on their experiences with death:
Death (a) It has moved most dying from people’s homes to institutions (b) It has resulted in care dominated by efforts to delay death by all means available, (c) It has led us to question our assumptions about what constitutes life and death (d) It has confronted families with decisions about whether to prolong the process of dying or terminate the lives of loved ones.
BEREAVEMENT, GRIEF AND MOURNING • Bereavement refers simply to having a loved one pass away; grief is the emotional reaction attached to this experience, and mourning is the expression of this bereavement and grief through cultural, religious, and family traditions .
BEREAVEMENT, GRIEF AND MOURNING • Grief is a person’s emotional response to the experience of loss. • Mourning is the outward expression of that grief, including cultural and religious customs surrounding death. It is also the process of adapting to life after a loss. • Bereavement is the period of grief and mourning after a loss.
BEREAVEMENT, GRIEF AND MOURNING • Everyone experiences grief and a sense of loss following the death of a loved one. But the way that people have and express these feelings differs acros. • Culture is the mix of beliefs, values, behaviors, traditions, and rituals that members of a cultural group share. Each culture has its own rituals that influence the expression of grief.
BEREAVEMENT, GRIEF AND MOURNING • Every culture has its own worldview. It has a core set of beliefs that describe how the world works and people’s roles in the world. In societies in which most people share the same religion, religious beliefs significantly shape the culture's worldview. • Each culture's worldview includes beliefs about the meaning and purpose of life and what happens after death. This informs how people in those cultures approach death.
BEREAVEMENT, GRIEF AND MOURNING • People adopt the beliefs and values of their culture to meet their unique needs and their current and past experiences. As a result, grief responses within a culture vary from person to person
ANTICIPATORY GRIEF • Anticipatory grief is the form of grief that occurs when there is an opportunity to anticipate the death of a loved one (or oneself). • It is different from unanticipated grief in the amount of time to "look forward" to death and in its form. • It may be affected by such things as the duration and pattern of the illness, by concurrent stresses (financial, social, physical, emotional, developmental, etc.), periods of uncertainty and (sometimes dreaded) certainty, interactions with sometimes incomprehensible medical personnel, varying support from others.
ANTICIPATORY GRIEF • Individuals/Families that are able to engage in anticipatory grief may have a less intense post-death grief experience than those who experience unanticipated grief. • In unanticipated grief, the capacity to cope is diminished by the suddenness of the loss. With anticipated loss, the expected death will make more sense because it can be experienced as a part of a predictable process. • NB: Anticipatory grief is not a device for completing the tasks of grief prior to the death of the individual (i.e., anticipatory grief does not substitute, or necessarily lessen, the post-death grief process).
Multidimensionality of Grief According to Fulton and Gottesman (1980), it is necessary to consider three levels of analysis when looking at grief, regardless of the form of grief. These dimensions are • The psychological level -- What are the coping abilities, beliefs, feelings, psychological characteristics of the bereaved? • The interpersonal level -- What is the type of relationship being grieved, the style of responding to the situation, the type of support they receive? • The sociocultural level -- What are the norms, roles, and rituals available to the bereaved?
FACTORS THAT CAN AFFECT ANTICIPATORY GRIEF Psychological: • Characteristics related to the nature and meaning of the person and relationship to be lost • The personal characteristics of the griever • Characteristics that pertain to the illness and type of death with which the griever must contend
Social Factors • Characteristics of the dying individual's knowledge and response to the illness and ultimate death • Characteristics of the family and its members' responses to the illness and impending death • General socioeconomic and environmental factors
Physiological factors -- • the griever's physical health. • the amount of the griever's energy depletion. • the amount of rest, sleep, and exercise available to and engaged in by the griever. • the griever's use of drugs, alcohol, cigarettes, food, and caffeine. the griever's nutrition.
The Key Terms in Sociocultural Context: Attitude: • A state of mind or a feeling; disposition: an attitude of open mindedness. Value: • A principle, standard, or quality considered worthwhile or desirable. Belief: • Something believed or accepted as true, especially a particular tenet or a body of tenets accepted by a group of persons. Societal: • Of or relating to the structure, organization, or functioning of society, relating to human society and its members; "social institutions," "societal evolution," "societal forces," "social legislation." Culture: • The totality of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought.
Cultural diversity • Culture plays a significant role in the way an individual understands and responds to grief and loss and can be an influential factor in an individual’s ability to cope with a loss and become resilient even in spite of th. • Every culture has a specific approach or response to grief and loss; the specific cultural beliefs, values, expressions, expectations, ceremonies, and rituals give meaning to the loss in different ways.
Cultural diversity • Appreciation of cultural diversity and norms regarding loss, rituals, and cultural constructions of grieving is important in order for professionals to understand the meaning of loss for different groups of people across the life span • There seem to be common themes that appear within multiple cultural groups regarding the approaches to how grief and loss is understood and dealt with.
1) Perceiving death as a transition • One such common cultural theme regarding death is the manner in which the death is perceived. For example, in many cultures death is not viewed as the end of life, but as one of many steps or transitions throughout life • A key component of this belief is that the next step after death is not nothingness, but some other plane of existence
2) Maintaining bonds after death • Maintaining contact or a bond with a loved one after their death is another common cultural perception • In many cultures, there is a belief that when a loved one dies they are able to maintain a literal communication connection.
Maintaining bonds after death • Some cultures make offerings to the deceased as a way of honoring them and reinforcing the bond. “These offerings are a mode of communication with the dead and remind the living of their continued presence in the family”
3) Experiencing grief and loss in stages • Another common cultural coping strategy is to break down the bereavement experience into concrete stages that help people conceptualize their loss.
Advantages of experiencing grief in stages. • This way of grieving reminds the grieving individual that the loss of a loved one is a process or a transition • It gives people permission to carry out their grieving for a significant period of time, and “allows for expression of grief at times when it is most keenly felt” . • It breaks the grief up into experiences that are more manageable
JEWISH TRADITION AS A CASE STUDY In the Jewish tradition, when someone dies, their family participates in six stages of mourning
JEWISH TRADITION • The first stage is the time period between the death of an individual and their burial; it is known as Aninut • The second stage consists of the three days following the funeral and burial, where the family spends much of their time by themselves in the home to grieve in private.
JEWISH TRADITION • The third stage is referred to as sitting Shiva ( people slowly move from a feeling of incapacitating grief towards a state where the individual can at least talk about the loss and accept help and support from others). • The fourth stage following Shiva is known as Sheloshim and takes place for thirty days following the funeral. This is an important time when the family starts to integrate back into their normal lives.
JEWISH TRADITION • The fifth stage is the ten months following Sheloshim. During this period of time the family is still slowly integrating back into normal life, and may go to services at their synagogue . At the end of the year of mourning, the deceased’s tombstone is unveiled and at that point the bereavement period is over.
JEWISH TRADITION • The sixth stage is fully returning to normal life, except for occasional rituals and services of remembrance
4) Death as a community event. • Another common way that death is experienced in many other cultures is to treat it as a social or public event. This integration of the entire community into the grief process provides support and mutual sharing for the immediate family of the deceased. • This is providing support but also taking some of the grief off of the family and given to the community, in essence sharing the grief load with them, rather than leaving them to deal with the grief in private.
5) Death as a celebration • In some cultures, they approach a death as a celebration rather than a loss. This small shift in the perception of the loss could potentially be helpful for those individuals most affected by the loss. of life. • Families and communities exchange memories and commune with the souls of their loved ones” . Music, jokes, storytelling, and laughter, all are part of the celebration of life.
Coping Strategies • These strategies fall into two major categories: 1. The “Problem-Focused” strategies, also known as " Fix-It” response and reaction where individual view the loss as a problem to address and solve. 2. The “Emotion-Focused” strategies, where individual reach out to get the support and use “cognitive reframing” to mentally adjust to ones loss.
1) HANDLE THE INITIAL SHOCK Almost always, our most significant losses come suddenly and the immediate feelings of shock and disbelief can be overwhelming. • Allow time to pass. Give individual time to adjust to the shock. It is important to allow mind and body to adjust to the shock and to begin the coping process.
HANDLE THE INITIAL SHOCK • Compartmentalize between loss and normal life. Sometimes, individual need to compartmentalize between the grief and the demands of your daily life – in other to keep functioning. Compartmentalizing doesn’t mean individual don’t feel the loss, it is just an important and sometimes very necessary way to not let loss create a crisis in your life. • Engage in Normal Activities: most individual, especially early in the grieving process do like to continue to engage in some pleasurable activities eg Distraction with exercise, indoor games etc. This not only is healthy but, allows time to pass until individual can more constructively deal with your grief.
2) GET SUPPORT The single most important factor in recovering from loss is to have the support of other people • Turn to family members and friends : Individuals draw loved ones close rather than avoiding them – and accept the assistance that is offered. Now is the time to lean on the people who care – a shoulder to cry on or help with funeral arrangements – • Seek comfort and emotional support from others. Individual share loss and grief with others beyond their inner circle. It is important not to grieve alone. Sharing loss makes the burden of grief lighter and easier to carry.
GET SUPPORT • Draw comfort from faith, Individual turn to their religion for solace and support. Embrace the comfort of its mourning rituals. Spiritual activities that are meaningful to individuals – such as praying, meditating, or attending church – can offer comfort and support.
3. FACE LOSS HEAD ON It’s only natural to possibly even subconsciously try to suppress grief for a while but It’s unrealistic to think one can – even if one want to – its unhealthy for individual to keep their feelings inside • Face ones Feelings In order to finally heal. Trying to avoid feelings of sadness and loss only prolongs the grieving process. • Individual should feel how they feel and not allowing someone to tell them how to feel – and try not to tell yourself how you think you should feel either.
4. TAKE CARE OF YOURSELF Individual needs to look after their physical and emotional needs to help get through these difficult times. • Look after your physical health: The mind and body are connected. When individual feel good physically, they also feel better emotionally. • Avoid negative coping responses: Be especially aware of counterproductive coping responses. For example: - Avoid overuse of stimulants like alcohol, caffeine, sugar, or nicotine. -
5. TAKE THE LONG VIEW Even when faced with the most severe of losses – and its accompanying level of intense grief encourage patients to take long view • Believe that “It’s my turn.” View your loss – even the most painful of losses – and the resulting pain as a “normal” part of life. Individual should view it as one of the experience in life that, eventually, almost everyone must experience – and now is just “your/my turn.”
TAKE THE LONG VIEW • Know and trust the long view. Know and trust that, with enough time (often months and even years), even the most severe losses will be able to be looked back on and reflected upon with some perspective.
6. SEEK PROFESSIONAL HELP It is “normal” to feel angry, sad, and numb following a loss. But, as time passes, these emotions should become less intense as one move through the grieving process and get closer to acceptance of the loss – and as one begin to move forward in your life.
DEFENSE MECHANISMS • Defense mechanisms refer to behaviors used to protect oneself from unpleasant thoughts and emotions like guilt, anger, shame, and jealousy. Some people find these emotions so unacceptable that they will unconsciously employ defense mechanisms to prevent themselves from ever having to acknowledge or experience them.
Denial: • Denial is used to avoid acknowledging an unpleasant truth or reality; usually, because this reality is painful or threatening. However, there is no end to the ways that a person can use denial to protect themselves in their grief. For example, by saying and believing things like – “I don’t need help.” “I’m fine.” “I don’t have a problem.” “Nothing needs to change” or “I’m over it.”
Regression: • Who hasn’t had a good grief temper tantrum? I know I have. When a person uses regression they revert to an earlier stage of development and display what might look like immature and insecure behavior. A person engaging in regression in their grief might do things like shut down or withdraw, become clingy with family and friends, or act childish.
Projection: • Projection is when a person attributes their own unacceptable thoughts and feelings to someone else. So for example, if I were mad at my husband but I didn’t want to acknowledge my feelings of anger so instead I projected my feelings onto my husband by saying,“I know you’re mad at me. Why are you mad at me?”
Displacement: • Displacement is when a person has thoughts and emotions towards someone or something, but instead of directing them towards the appropriate source, they take them out on another person or object. This defense mechanism is often used when a person is unable to express their emotions towards the actual source because it would be ineffectual or have negative consequences.
Intellectualization: • When a person is confronted with painful or frightening emotions they might try to intellectualize them, rather than actually experiencing them. In this way, they avoid making contact with their feelings by examining them from an arm’s length away.
