Chap 2 - Mental Health and Mental Illness: Theoretical Concepts - P3

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• Grief is a subjective feeling of sorrow and sadness accompanied by emotional, physical, and social responses to the loss of a loved person or thing.

• The loss or anticipated loss of anything of value to an individual can trigger the grief response. This period of characteristic emotions and behaviors is called mourning.

• The normal mourning process is adaptive and is characterized by feelings of sadness, guilt, anger, helplessness, hopelessness and despair.

• Absence of mourning after a loss may be considered maladaptive.
Stages of Grief: stage 1

• A stage of shock and disbelief.

• The response may be one of "No, it can't be true!" The reality of the loss is not acknowledged.

• Denial is a protective mechanism that allows the individual to cope in an immediate time frame while organizing more effective defence strategies.
Stages of Grief: stage 2

• "Why Me" and "it is not fair!" are comments often expressed during the anger stage. Envy and resentment toward individuals not affected by the loss are common.

• Anger may be directed at the self or displaced on loved ones, caregivers, and even God.

• There may be a preoccupation with an idealized image of the loss entity
Stages of Grief: Stage 3

• During this stage, which is usually not visible or evident to others, a "bargain" is made with God in an attempt to reverse or postpone the loss: "If God will help me through this, I promise I will go to church every Sunday and volunteer my time to help others."

• Sometimes the promise is associated with feelings of guilt for not having performed satisfactorily, appropriately, or sufficiently
Stages of Grief: Stage 4

• During this stage, the full impact of the loss is experienced. The sense of loss is intense, and feelings of sadness and depression prevail.

• This is a time of quiet desperation and disengagement from all association with the lost entity.

• It differs from pathological depression, which occurs when an individual becomes fixed in an earlier stage of the grief process. Rather, stage 4 of the grief response represents advancement toward resolution.
Disenfanchised grief• experince of a loss that is not publicly known • Miscarriage, death of an extra-marital loverMaladaptive Grief Response• Maladaptive responses to loss occur when an individual is not able to satisfactorily progress through the stages of grieving to achieve resolution. • These responses Usually occur when an individual becomes fixed in the denial or anger stage of the grief processProlonged Response• It is characterised by an intense preoccupation with memories of the lost entity for many years after the loss has occurred. • Behaviours associated with the stages of denial or anger are manifested, and disorganization of functioning and intense emotional pain related to the lost entity are evidencedDelayed or inhibited Response• The individual becomes fixed in the denial stage of the grieving process. • The emotional pain associated with the loss is not experienced, but anxiety disorders (e.g., phobias, somatic symptom disorders) or sleeping and eating disorders (e.g., insomnia, anorexia) may be evident. • The individual may remain in denial for many years until the grief response is triggered by a reminder of the loss or even by an unrelated loss.Distorted Response• In the distorted response, all the normal behaviors associated with grievings, such as helplessness, hopelessness, sadness, anger, and guilt, are exaggerated out of proportion to the situation. • The individual turns the anger inward on the self, is consumed with overwhelming despair, and is unable to function in normal activities of daily living. • May lead to pathological depression