De Leo / DeLeo / Cimitan Bereavement After Traumatic Death
1., 2014
ISBN: 978-1-61676-455-5
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
Helping the Survivors
E-Book, Englisch, 224 Seiten
ISBN: 978-1-61676-455-5
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
Authoritative guidance, written in a wonderfully simple and straightforward way, on helping the bereaved cope after the traumatic death of a loved one
Unless forced by circumstances, people in modern societies go to great lengths to deny death, to the extent that even death of a loved one from natural causes tends to catch us unprepared and unable to cope with its consequences. Death as the result of a sudden, catastrophic event (traffic accident, suicide, a natural disaster, etc.) can have even more extreme effects, sometimes striking survivors so violently and painfully that it leaves an indelible mark.
This book speaks about the consequences of such traumatic deaths in a wonderfully simple and straightforward way. The authors describe, step by step, what happens to people after the sudden death of a family member or close friend, the difficulties they face in coping, and how professionals and volunteers can help. With their wide experience, both personally and as internationally renowned authorities, they have written a book for professionals and volunteers who deal with bereavement in language that is accessible to all, so it will also help those who have suffered a traumatic loss themselves to understand what to expect and how to get help.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
1;About the Editors and Authors, Foreword by John L. McIntosh, Foreword by Ian Webster and Table of Contents;3
2;Introduction;16
3;1 The Loss of a Loved One: Theories of Adaption;20
4;2 Reactions to Traumatic Death;34
5;3 Surviving Suicide;52
6;4 Grief in the Family;64
7;5 Social Networks as a Source of Support;80
8;6 Support in the Work and School Environment;96
9;7 Dreams and Symbols in the Process of Mourning;110
10;8 Suicide After a Loss or Around Anniversary Times;114
11;9 Traumatic Bereavement for the Therapist: The Aftermath of a Patient Suicide;120
12;10 Postvention: How to Organize It;130
13;11 Helping With Complicated Bereavement;140
14;12 Peer Support and Self-Help Groups;152
15;13 Support Groups for the Bereaved;158
16;14 Spreading Awareness for Bereavement Support: Working With the Media;166
17;15 Spreading Awareness: The Charter of Rights of Suicide Survivors;170
18;16 Is Suicide Grief Different? Data From Empirical Studies;174
19;17 Suicide Postvention for Different Groups In Different Cultures: All Different, All The Same?;188
20;18 Future Perspectives on Assisting the Bereaved;196
21;References;206
1 The Loss of a Loved One: Theories of Adaption Alberta Cimitan and Diego De Leo The death of a beloved person is a universal experience, a painful event, and leaves an indelible memory, which inevitably disrupts the lives of the survivors. The experience of loss nearly always has an impact on the overall situation of the entire family group and nearest friends. It would be simplistic to consider the impact of a loss without paying attention to the multiple consequences and implications of such an event (De Leo, 2010a). Psychological reflections on loss and on issues related to the affective state of mourning characterize many perspectives, both interpretive and theoretical. We owe to Sigmund Freud the conceptualization of grief as a constant experience of our lives that occurs whenever we suffer a loss. This consideration of mourning was used by Freud to explain the depressive phenomena linked both to the loss of a beloved person and to that of a significant internal object, meaning by this the internalized image of another human being. With Mourning and Melancholia (Freud, 1915/1976), psychoanalytic theory began to put in close relation melancholia (depression) and mourning, considering the latter as a psychic condition. The bereaved person is forced to suffer the detachment from an object on which he/she has made “libidinal” investments: Libidinal energy is withdrawn from the lost object and reinvested in the ego until the mourning is resolved, making this energy available for new investment. This process can bring to an end the “work of mourning.” For Freud, the libidinal disinvestment could take a long time; it is difficult to say which aspects are to be disinvested first and whether the entire process follows a specific sequence. An important aspect of Freud’s elaborations on the bereavement process regards the repression of aggressive feelings toward the deceased. In fact, the presence of these implies that a certain part of the work of mourning is accomplished at an unconscious level, with the failed (or incomplete) recognition/acceptance of the suffered loss. Even if libidinal energies are being withdrawn from the lost object, the ego ends up identifying with it. Thus anger and resentment are directed toward the self with the “advantage” that this self-punishing mechanism avoids the expression of open hostility toward the person who died. According to Freud, then, when there are ambivalent feelings of both love and hostility, the process of mourning can be much more difficult and “abnormal” (Freud, 1915/1976). Melanie Klein (1940) assumed that the condition of mourning involves the temporary regression to early stages of development, with the consequent danger of collapse and disintegration of the inner world of those who have suffered the loss. The emotional development of every child goes through the integration of libidinal and aggressive drives connected to the pleasant and frustrating features of the objects, which – by virtue of this merger – become total. This process is accompanied by the anguish of loss of partial objects (previous libidinal investments), thereby leading to the emergence of feelings of sadness and guilt. Every process of mourning in adulthood would be the reissue of feelings experienced during the psychic life of childhood in relation to separations from significant figures. In Klein’s view, the elaboration of mourning thus coincides with a reconstruction of the inner world, only possible if the subject in early infancy has been able to consolidate the relationship with their good objects. Again from the psychoanalytical perspective, Erich Lindemann (1944) was perhaps the first to provide important insights into unexpected and traumatic grief, basing them primarily on observations performed on family members of soldiers who died in the Second World War, and on the victims of a fire that erupted in a night club in Boston, Massachusetts–the Cocoanut Grove. His work anticipates many of the concepts that are now part of posttraumatic stress disorder. In fact, he identifies five main elements in reaction to a violent and unexpected bereavement: somatic disorders, concerns with the image of the deceased person, feelings of guilt, hostility, and disorganized behavior. There are two types of reactions to traumatic grief: a “delayed” form, potentially lasting for several years, and a “distorted” one, characterized by social withdrawal, psychosomatic disorders, hypochondriac elaborations, and manic hyperactivity. For Lindemann, mourning involves the verbalization of experienced guilt and the management of feelings of fear and hostility, and passes through the emancipation of the relationship with the lost object, the readjustment to the environment, and the formation of new relationships. In the psychological analysis of mourning, a vital contribution was made by Bowlby (1969, 1973, 1980) and his assumption of an ambivalent relationship between attachment and loss. According to the author of the attachment theory, childhood experiences of relationships influence the style of personality and relationship in adulthood. The way people deal with separation and loss of a loved one is then related to patterns of internalized relationships with each other. In the third volume of Attachment and Loss, entitled Loss, Sadness and Depression (Bowlby, 1980), Bowlby focuses on the psychopathological consequences of mourning, taking into consideration the many forms of developmental blocks and regressions that the individual may experience after a significant loss. The author stresses that, to overcome the consequences that the loss brings with it, subjects face lengthy and complex dynamics and intricate intrapsychic and interpersonal processes. For Bowlby, grief is essentially similar to separation anxiety. He considers mourning as the forced separation from an attachment figure, which is followed by a period of protest and then a longer period of research of the missing figure (analogous to animal behavior). After some time, these reactions cease, since they are not effective in allowing the reunion with the attachment figure. The individual then enters a phase of despair and depression, followed by the reorganization phase, characterized by the restoring/restructuring of one’s own life condition. The “internal” presence of the deceased can be comforting and facilitate this reorganization (Cleiren, 1991). The family systemic and relational symbolic approach considers mourning as an event that can only be analyzed in the interpersonal context in which it takes place. To understand the reaction to the situation of the bereaving individuals, we must consider the resources, history, relations, and dynamics of the family to which they belong (Andolfi & D’Elia, 2007). Within the systemic approach, the concept of the family constellations of Bert Hellinger should be mentioned (Hellinger, 2003). According to this recent (and somewhat controversial) perspective, our lives are conditioned by fates and feelings that are not only ours but are also part (and a consequence) of the lives of our ancestors. So it seems that we continue to act within an archaic structure, blind and unconscious, under the charge of cohesion and belonging to the family system. Therefore, if a family member has taken their own life, a member of succeeding generations – someone who knows nothing about this predecessor – will bring upon himself/herself this fate and will eventually follow that tragic destiny. So, according to Hellinger, serious illness, death wishes, and problems at work may result from systemic family tangles that can be brought to light through the reconstruction of the “constellations.” In the cognitive behavior approach, the central role is played by thoughts and beliefs of the person: The same event can trigger different emotional and behavioral responses, depending upon the significance individuals assign to it. For example, the emotional response to the death of a loved one might be, at any given time, sadness, if the predominant thought is to have suffered an irreparable loss, or anger, if we believe that we have suffered a gross injustice. The cognitivist Guidano (1987) states that loss and grief can represent an interruption of the sense of self as perceived by the subject; therefore, mourning can end only when the subject has become able to reorganize their sense of self. In this perspective, importance is given to the analysis of changes in the vision of the self, others, and the future, as a result of the loss. Several other authors have made important contributions to our understanding of bereavement, based on cognitive principles (e.g., Marris, 1974; Parkes, 1970, 1987) or on more purely behavioral or sociobiological ones – for example, Littlefield and Rushton’s study (1986) on the biological “value” of the deceased is of considerable interest. In general, however, from the 1980s onwards the contributions to the scientific model of stress have focused on clinical-theoretical constructs mainly related to the stress of separation. According to these studies, the loss of a loved one may be followed by dysfunctional thoughts and beliefs (e.g., conviction of one’s own guilt), with these ideas also leading to emotional...
