Loss and Grief

The Aging Survival Kit

 Grief: A Universal Experience
 “To spare oneself from grief at all cost
can be achieved only at the price of total
detachment, which excludes the ability to
experience happiness.”

Erich Fromm (1900-1980)

 Five Stages of Grief
(Kubler-Ross, 1969)
 Denial: The initial stage: “It can’t be happening.”
 Anger: “Why ME? It’s not fair?!” (either referring
to God, oneself, or anybody perceived, rightly or
wrongly as responsible)

 Bargaining: “Just let me live to see my son

graduate.”

 Depression: “I am so sad, why bother with

anything?”

 Acceptance: “It’s going to be OK.”

 Five Stages of Grief, Continued
These stages of grief do not come in order. They can be
applied to any form of catastrophic life losses:

 Loved One
 Employment
 Home
 Income
 Freedom
 According to Kubler-Ross a person simultaneously
experiences two of the stages at any given time.
 Understanding Loss
(Rando, 1984)
 Avoidance: Shock, denial, disbelief, confusion,
disorganization.

 Confrontation: “highly emotional state wherein

the grief is most intense and the psychological
reactions to loss are felt most acutely.”

 Reestablishment: “gradual decline of the grief

and marks the beginning of an emotional and
social reentry back into the everyday world” (pp.
28-29).
 Understanding Loss, Continued
According to Rando, the griever will:

 Acknowledge, accept, and understand the

reality of the loss.

 Experience the pain of the grief and react

to the separation from that which is lost.

 Adapt a new way of life.

 Reinvest in a new way of life.

 Anticipatory Mourning
(Rando, 2000)
“The phenomenon encompassing seven generic operations:

 Grief
 Mourning
 Coping
 Interaction
 Psychosocial reorganization
 Planning
 Balancing conflicting demands
 Facilitating an appropriate death” (p. 51)
Disenfranchised Grief
(Doka, 2002)
According to Doka: “this grief is experienced in
connection with a loss that is not socially
acknowledged, publicly shared, or supported through
usual rituals. The significance of the loss is either not
recognized or the relationship between the deceased
and the bereaved is not socially sanctioned, the
person suffering the loss is given little or no
opportunity to mourn publicly. It is experienced when
the relationship is not recognized (lovers, ex-spouses,
same-sex partners, close friends), when the loss itself
is not recognized (stillbirth, miscarriage, abortion,
adoption, pet loss), when the griever is not
recognized (very young, very old, developmentally
disabled). The manner of death itself can be
disenfranchising (murder, suicide, AIDS). When such
deaths are treated as less than significant losses, the
process of grieving becomes more difficult.”
 The Grief Process
(Worden, 1982)
The Tasks of Grief:

 To accept the loss

 Experience the pain

 Adjust to the new environment

 Reinvest in the new reality

 Complicated Grief
(Worden, 2001)
 Chronic Grief: One that is prolonged, is excessive in
duration, and never comes to a satisfactory conclusion.

 Delayed Grief: Emotion that has been “inhibited,

suppressed, or postponed.” A subsequent loss may
elicit an exaggerated reaction because the bereaved is
grieving for two losses.

 Exaggerated Grief: Occurs when feelings of fear,

hopelessness, depression, or other symptoms become
so excessive that they interfere with the daily existence
of the bereaved.

 Masked Grief: Symptoms and behaviors experienced

by a person who does not recognize the fact that these
are related to a loss.
 Case Study
Mr. and Mrs. B. have been married for 50 years.
They have been in good health and have been
enjoying retirement (traveling, seeing their
grandchildren and sleeping until noon!)

Both Mr. and Mrs. B. will be turning 70 this year

and the family are planning a BIG surprise party.

One morning Mrs. B. wakes up and she can not

move the left side of her body. Mr. B. calls an
ambulance and the family physician. Mrs. B. is
taken to the hospital.
Case Study, Continued
Upon Mrs. B.’s arrival at the hospital you have been assigned as
her social worker. You have just been to a workshop on loss
and grief and have been reviewing the powerpoint (Yes, this
one!). What do you consider to be the most pressing medical,
psychosocial, and spiritual concerns that they will both face?

What will grief look like to:

Mr. B

Mrs. B

Their family (all 30 people!)

How will you, as the social worker, provide a therapeutic

intervention that will meet their needs.

Is meeting everyone’s needs possible or realistic?

“Who Dies?”
(Levine, 1982)
“How much of what we call grief is the
experience of previous loss? And how do
we allow such grief not to be a motivator
for our life? How do we get in touch with
that deep pain, that place of loss that
creates a fear of life itself, our doubt in
ourselves about our ability to deeply
experience the world because we so fear
loss and change?”
 Bibliography
Gehlert, S., & Browne, T.A. (2006). Handbook of
Health Social Work. Hoboken, NJ: John Wiley &
Sons, Inc.

Levine, S. (1982). Who Dies? An Investigation of

Conscious Living and Conscious Dying. New York:
Anchor Books.

Kubler-Ross, E. (1973). On Death and Dying. New

York: Routledge.

Kubler-Ross, E., and Kessler, D. (2005). On Grief and

Grieving: Finding the Meaning of Grief Through the
Five Stages of Loss. New York: Scribner.