Psych: Loss, Death, And Dying

Front 1

Name and give examples of the four types of loss.

Back 1

1. Real loss- death of a family member, loss of health (can be timely, intentional, unintentional, or subintentional)

2. Threatened loss- threat to survival (ie: life-threatening illness, armed forces)

3. Symbolic loss- real loss with societal impact (ie: political assassination, terrorist attack)

4. Fantasized loss- imagining negative consequences (ie: failing exams)

Front 2

Differentiate between grief, mourning, and bereavement.

Back 2

Grief consists of subjective feelings and behaviors in response to an irreversible loss (not necessarily death). Mourning is a social/cultural expression of grief, like going to a funeral. Bereavement is a reaction to loss by death.

Front 3

Describe Bowlby's four stages of bereavement in adults.

Back 3

1. Numbness/protest: thinking and acting as if loss never occurred, loneliness, isolation, fear, anger

2. Yearning/searching: preoccupation with lost person, interprets feelings with reference to deceased, restlessness, weeping, anger

3. Disorganization/despair: restlessness, aimlessness, ineffective efforts and initiating and perpetuating productive behavior, gradual recognition of loss

4. Reorganization: establishment of new patterns, goals, and relationships

Front 4

Describe Bowlby's three stages of bereavement in children.

Back 4

1. Protest: disbelief of loss, searching for missing person

2. Despair: realization that person is gone, sadness, withdrawal, apathy, unable to maintain normal behavior

3. Detachment: reawakening of interests, searching for substitute figure, reattachment

Front 5

Compare and contrast bereavement and clinical depression.

Back 5

Bereavement is intense over a course of 1-2 months, while depression lasts longer.

Thoughts of death and suicide are usually not present with bereavement, but may be with depression.

Individuals in bereavement may experience transient visions or sounds of the deceased, while a depressed individual may have prolonged delusions.

Pangs of grief interspersed in normal feelings are normal in bereavement, while with depression, continued depressive feelings are characteristic.

Self-blame and guilt focused on a deceased individual comes with bereavement, while a focus on self indicates depression.

Bereavement is usually eased by support and time, while depression is not.

Front 6

List and describe Kubler-Ross's five stages of dying.

Back 6

1. Shock and denial: dazed, emotional denial, doctor shopping (want another opinion)
2. Anger: venting frustration at family, friends, physician
3. Bargaining: patient makes promises in exchange for respite from illness, new diagnosis
4. Depression: reality of loss of job, finances, anticipated loss of life
5. Acceptance: deal with inevitability of impending death, talk about it with support groups

Front 7

Discuss the physician's role in grief management and caring for the dying patient.

Back 7

The physician needs to demonstrate concern, be supportive, and be tactfully honest. It is important to continue to visit dying patients, make eye contact, and listen. Develop an alliance with the family and be willing to discuss hospice and palliative care.