Personal Guidebook to Grief Recovery

Back To Life! A Personal Grief Guidebook

Back to Life is a comprehensive, quality bereavement handbook. It consists of 73 pages that explore many aspects of grief in detail. There are 19 chapters or lessons, each addressing a different aspect of grief, a coping skill or a strategy for emotional survival. Here you will learn: Good, solid information on how the grief process really works. Which symptoms of grief are normal, and which are dangerous warning signs. Valuable and practical coping skills to help you get through each day. Secrets to getting a good night's restorative sleep without prescription drugs. How to endure the holidays and thoughtless visitors. How to identify and defuse anger, guilt, and regret. Family changes to look for and how to keep your family intact through this. Just the right activities and comforting rituals to help ease you through your darkest days. Tried and true psychological exercises and strategies to help lessen the raw pain. Satisfying and therapeutic creative expressions of grief. Effective memorializing techniques to honor and remember your lost loved one. How to cling to hope and move surely towards brighter days. More here...

Back To Life A Personal Grief Guidebook Summary

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Contents: 73 Pages Ebook
Author: Jennie Wright
Official Website: www.recover-from-grief.com
Price: $17.95

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My Back To Life A Personal Grief Guidebook Review

Highly Recommended

The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this ebook are precise.

This ebook does what it says, and you can read all the claims at his official website. I highly recommend getting this book.

Phase 4the Grieving Process

Death is an inevitable part of the human experience yet we all have some level of emotional discomfort with death. It is only natural that we experience fears and concerns when we come in contact with the dead or dying and their loved ones. Even though we cannot do anything medically for those already dead, we can do a great deal to influence the way a family will begin coping with its loss. However, we must understand the grieving process so we can be optimally effective in our interactions.12 No two families or individuals are alike and there are no templates to grief. Understanding a family means needing to gather as much information as possible to know them as a unit and as individuals. This can take time but is invaluable in establishing trust and rapport. Often the smallest acts of kindness can win the trust and confidence of a family.12 When family members are notified of the death, they need a quiet and private place to express their grief and collect their thoughts....

Clinical features of bereavement and normal grief

Although the terms bereavement, grief, and mourning are often used interchangeably, the Committee on Health Consequences of the Stress of Bereavement suggests the following definitions. Grief is the involuntary emotional and related behavioural reaction to that loss. Grief is an individual process in which many symptoms occur.(22) No symptom is pathognomonic of normal or abnormal grief. The reactions to bereavement were described in detail by Lindemann(23 who suggested that the characteristics of normal grief were as follows Other components of the normal grief reaction have since been recognized. Bowlby(24) and others have placed these symptoms into three (or four) distinct phases (Table 1). Recent authors emphasize that this approach should not be taken to imply that a bereaved person must go through fixed steps in the grieving process. Table 1 Proposed phases of normal grief

Approaching The Family

We first learn of this inevitability during childhood and observe it again and again throughout our lifetimes. And although we may be exposed to death many times, the loss of our own loved one brings a uniquely emotional pain and grief. It is with this empathy, and often sympathy, that the organ procurement representative (OPR) approaches families about organ and tissue donation, helping death become life. Approaching a family about organ donation is a matter requiring expertise, sensitivity and the cooperation of a variety of individuals. Its success is contingent on hospital staff working in conjunction with the OPR. For optimal results, the process can be separated into six phases 1) identification and referral of the potential donor, 2) predonation family evaluation, 3) understanding brain death, 4) grieving process for the family, 5) presenting the option of donation, and 6) aftercare of the family.

Of The Potential Donor

The potential donor's physician is encouraged not to bring up organ donation at the same time he she is explaining that the patient is brain dead. Families need to experience their initial grief before making decisions about what to do next. We recommend that the physician inform the family of the patient's brain dead status and close the conversation by letting them know that there are important options to consider and that someone will be speaking with them about these options shortly.

Phase 2predonation Family Evaluation

Among the factors that bear consideration during the pre-donation family evaluation are specific relationships to the patient, religious and cultural beliefs, the family's stage of grief, and any emotional responses and language barriers. The United States is a very culturally diverse country, and as a result, many potential organ and tissue donors are of varying nationalities and cultural backgrounds. The basic tenets of life, death, and grieving vary widely among cultures. There is no normal or right way to grieve. It is possible to approach one family that is celebrating the death of a loved one, while approaching another family could mean trying to speak with a next of kin that is thrashing about in grief. Families must not be judged by the way they grieve, but instead be given the opportunity to do so in the way most comforting to them.

Phase 5presenting The Option

Many healthcare professionals continue to be hesitant about approaching families or mentioning the subject of donation for a variety of reasons. Often cited reasons include an unwillingness to intrude on a family's grief, lack of knowledge of specific procedures, lack of time, concerns regarding legal issues, and questions regarding donor suitability. It also can be very difficult for physicians and Some OPOs have compiled data that support the use of same race requesters. Theoretically the practice of using a requestor who is the same race as the next of kin helps build rapport with the family. However, emerging data indicate the most important factor affecting a family's donation decision is how well their needs have been met throughout their hospital experience. Consequently, hospital and OPO personnel must assist families in grief, help them get the answers to their questions regarding brain death, assure them that everything possible was done for their loved one, help them to...

Theory of mind and empathy mental simulation

In the case of chess-playing, especially when the game develops beyond a certain stage, into positions so far unencountered, the ability to perceive strategies apparently depends increasingly on the ability to play the game oneself. The recognition of intentionality in the other's moves draws on one's own inclinations to adopt this or that strategy at a given stage in the game. It can be seen here, in this simple case, that something like 'empathy' is involved in the attribution of intentional states. Consider now the more complicated, psychological case. A particular kind of cognitive-affective state has characteristic causes and characteristic expressions in behaviour. An observer who knows the emotion in his or her own case may recognize it in another, and thereby form expectations concerning the other's behaviour. In contrast, the observer who is unfamiliar with the emotion in herself will at best be able to record the other's behaviour, and not the emotion as cause (or reason)...

Medication and physical treatments

The most important indications for use of medication are probably severity and persistence. Two studies (56) have shown a threshold a little below major depression at which tricyclic antidepressants start to show superiority over placebo in acute episodes of depression. There is not yet equivalent evidence for SSRIs. Tricyclics are also superior to placebo in dysthymia,(85) but most studies do not separate those dysthymics without added major depression. For mild acute depressive episodes highly reactive to major stress, and for acute grief, prognosis for spontaneous resolution is often good, and medication may be delayed, provided that improvement is occurring. Impairment of function and suicidal feelings in the context of the depressive syndrome are other indications to treat. Recent guidelines (7 ,86) recommend use in major depression, equivalent to ICD-10 depressive episode. For depressions reaching these criteria, antidepressants should be used irrespective of life stress or...

Brainstemdead patients

It is essential that all staff understand the brainstem tests and accept their validity, as confusion may compromise their support in helping the family to come to terms with the death. If staff are able to cope personally with death and grief, it is easier for them to communicate and establish a rapport with grieving relatives without becoming detached or overwhelmed (Morgan 19.9 5.)

Chapter References

Stress response syndromes. PTSD, grief, and adjustment disorders. Jason Aronson, Northvale, NJ. 22. Prigerson, H.G., Shear, M.K., Jacobs, S.C., et al. (1999). Consensus criteria for traumatic grief. A preliminary empirical test. British Journal of Psychiatry, 174, 67-73.

Geriatric depressed patients

Grief and role transition specific to life changes were the prime interpersonal treatment foci. These researchers suggested modifying IPT to include more flexible duration of sessions, more use of practical advice and support (for example, arranging transportation, calling physicians), and the recognition that major role changes (for example, divorce at age 75) may be impractical and detrimental. The 6-week trial compared standard IPT to nortriptyline in 30 geriatric, depressed patients. The results showed some advantages for IPT, largely due to higher attrition from side effects in the medication group (Sloane et al., 1985).

Everyday Solutions to the Problem of Other Minds

Intuiting what the people around us think, want, and feel is essential to much of social life. To bargain, we make assumptions about what a partner prefers or wants to avoid. To persuade, we try to intuit an audience's beliefs. To console, we infer the depth of a friend's grief. Whether we are sizing someone up or seducing him or her, assigning blame or extending our trust, we are very nearly always performing the ordinary magic of mindreading. In some sense, of course, we cannot read minds. Some scholars have gone so far as to declare the problem of other minds whether a person can know if anyone else has thoughts and, if so, what they are intractable. And yet countless times a day, we solve such problems with ease, if not perfectly then at least to our own satisfaction. What strategies underlie these everyday solutions And how are these tools employed

Course and prognosis

The grief process usually resolves by 4 months. ICD-10 stipulates a maximum duration of up to 6 months for uncomplicated cases. This is a simplification as individual symptoms have their own time course. For example, emotional and behavioural attachment features often persist for years after the loss, and many changes of philosophy or attitude are permanent.

Treatment and prevention

The treatment of bereavement is contentious. Some clinicians do not want to interfere with what they perceive to be a normal process, arguing that any treatment may interfere with the grieving process in a harmful way. However, the distress and morbidity associated with complicated grief may well be amenable to treatment, and merits intervention on those grounds. Conventional psychological treatment for the bereaved involves 'grief work' in which emotional expression is encouraged, along with a review of the lost relationship 30 This can be achieved using a number of techniques psychoanalytical, cognitive-behavioural, cognitive-analytical, group, and supportive. Such grief work is usually conducted as a brief, focused therapy. Brief psychotherapy and group self-help may be equally effective. (31) On average over 80 per cent of spouses who have major depression after a bereavement receive no antidepressant medication,(32) and yet antidepressant treatment of bereavement-related...

Depressed HIVpositive patients IPTHIV

Recognizing that medical illness is the kind of serious life event that might lend itself to IPT treatment, Markowitz et al. (1992) modified IPT for depressed HIV patients (IPT-HIV), emphasizing common issues among this population, including concerns about illness and death, grief, and role transitions. A pilot open trial found that 21 of the 24 depressed patients responded. In a 16-week controlled study, 101 subjects were randomized to IPT-HIV, CBT, supportive psychotherapy (SP), or IMI plus SP (Markowitz et al., 1998). All treatments were associated with symptom reduction, but IPT and IMI-SP produced symptomatic and functional improvement significantly greater than CBT or SP. These results recall those of more severely depressed subjects in the NIMH TDCRP study (Elkin et al., 1989). Many HIV-positive patients responding to treatment reported improvement of neurovegetative physical symptoms that they had mistakenly attributed to HIV infection.

Virus replication in mosquito cells

During the early stages of infection, progressively more epithelial cells in the midgut become infected. This spread from the primary target cells may either occur directly via the basolateral membranes of neighbouring cells, or may occur indirectly by release into the lumen and infection of distally located cells. Replication of representative arboviruses has been studied in a variety of cell types, including cell culture lines derived from mosquitoes. Based on EM studies, replication and virion production in infected mosquitoes (Murphy et al., 1975 Sriurairatna & Bhamarapravati, 1977) would seem to be the same as observed in vitro (Deubel et al., 1981 Gliedman et al., 1975 Grief et al., 1997 Hase et al., 1987 Ng, 1987). Since the general details seem to be similar regardless of the tissues in which observations have been made, the following is a general description based on EM observations.

Application of counselling to specific conditions

When should counselling be offered, rather than specific psychotherapies, psychological treatments, medication, or psychiatric management Unfortunately, such a question is very difficult to answer.(4) Whilst there is high-quality outcome research linking specific therapies (e.g. cognitive therapy) to specific conditions such as depression, anxiety, and obsessive-compulsive disorder, the research for counselling models is much less clear. Depending on the settings in which they work, counsellors need to be equipped to work with clients with a range of psychological difficulties. For example, the primary care counsellor's caseload is likely to include client difficulties ranging from mild to moderate anxiety or depression to bereavement and relationship problems. However, there are some psychological difficulties for which counselling may be a more effective intervention stress-induced disorders, including adjustment disorder, grief, and trauma, postnatal depression, and relationship...

Stressinduced disorders

Psychodynamic principles have a place in counselling for adjustment disorders, particularly when past adversities or interpersonal conflicts have rendered the patient vulnerable to the present life challenge. Indeed, it may be necessary to examine unresolved past experiences in order to tackle the present problems successfully. For example, a patient may not begin to come to terms with redundancy until he recognizes and addresses his unresolved feelings about being abandoned by a parent in childhood. Or again, as will be developed below, a patient with a pathological grief reaction may not recover until they acknowledge the ambivalence felt towards the deceased. Grief counselling Grief is not a pathological state in itself, and most people grieve effectively with the support of family, friends, and perhaps community figures in the form of a priest or family doctor. Counselling has a role in facilitating grief for the minority of bereaved persons who are at risk. These may include...

Support and storage areas

A reception area at the entrance of the ICU controls access. If the receptionist is also the ICU secretary, files, and indeed the whole reception area, must be securable. The waiting lounge for relatives and visitors should be adjacent to the reception desk. The lounge should be sufficiently large to accommodate the anticipated numbers of visitors. One to two seats for every ICU bed is acceptable. Seats should be comfortable and single-seating arrangements are usually preferable. A television can be placed in one corner. An adjacent interview room is recommended for larger ICUs and for others if the floor plan allows. This will also provide some privacy for grieving relatives. Visitors should have access to a pay-phone, toilets, and refreshments either on-site or nearby. An arrangement whereby a hospital overnight suite can be made available for relatives of dying patients is ideal. Gowning facilities for visitors are not necessary.

A memory system in which new patterns are stored on top of previous ones

'Palimpsest' has been used as a metaphor for brain and mind by Romantic writers. 'What else than a natural and mighty palimpsest is the human brain Everlasting layers of ideas, images, feelings, have fallen upon your brain softly as light. Each succession has seemed to bury all that went before. And yet not one has been extinguished Yes, reader, countless are the mysterious hand-writing of grief or joy which have inscribed themselves successively upon the palimpsest of your brain' (De Quincey 1866). Postulated palimpsestic properties of biological memory systems were also contemplated by Freud (1925). Similarly, Gestalt psychologists have proposed that new memory records are inscribed on top of old ones (Koffka 1935).1 'Palimpsest' resurfaced in modern neurosciences with the introduction of models of artificial neural networks (Nadal et al. 1986 Amit 1989 Amit and Fusi 1994). In subclasses of such model networks, which keep a permanent capacity for learning, new patterns are stored on...

Counselling in primary care

In primary care, the entire spectrum of mental health problems is seen, and at the mildest end this includes worry, grief, emotional reactions to physical illness or threat of it, or events such as the loss of a job. GPs have reported a noticeable increase in patient demand for counselling and psychological treatment that cannot be met by secondary services 62) Many GPs have responded to the difficulties of obtaining psychological services for these patients by employing counsellors, counselling psychologists, clinical psychologists, psychotherapists, and community psychiatric nurses within their practices, and in the early 1990s around a third of practices declared someone who provided counselling in the practice. i3 The number of personnel who provide counselling in primary care has grown rapidly through the 1990s mainly because such patients would not be a priority in the psychiatric services, yet they have needs which cannot be met within a 10-minute GP consultation either through...

Integrating the components

When the patient is historically at risk of manic episodes, instead shifting them to the autumn and winter months when the patient is more likely to tolerate less structured social rhythms. Alternately, by using IPT strategies, such as grieving for the lost healthy self or managing the role transition from variable mood states to euthymia, the therapist can help the patient understand and mourn the lost highs while learning to value greater stability in mood and, ultimately, functioning.

A time for everything

Most parents are quick to become aware that there is something different about their child and by the time their child has been assessed and a diagnosis has been given, they are often merely expecting the professional to tell them what they already knew and even feel a sense of relief that they have some answers. However to have it confirmed and to see it in writing is very different from knowing in your heart that there is something different about your child. Some parents have battled for years to gain a diagnosis in order for their child to access the support he or she needs, yet still feel a sense ofloss, griefand confusion when the diagnosis is finally given. If you are reading this and are at this stage, indeed if you are at the unfortunate stage of realizing that your child is on the autistic spectrum but have not yet been listened to by professionals.be kind to yourself. One day that knot in the pit of your stomach will start to loosen and you will feel able to eat again, one...

Care of the dying child

Dying and grieving lead to a whole range of distressing feelings. This is part of a normal process, and mental health professionals can help their colleagues and families to acknowledge that this upset is acceptable. Bereaved children frequently model their grief experience on what they perceive as being acceptable in the family, and an overt denial of upset by parents may lead to psychological difficulties in the child. The issue of whether to involve siblings after the death of the child in funerals or graveside visits often arises. In general, if children are prepared for what to expect, involvement can be helpful in enabling them to acknowledge that a change has taken place and that other people are feeling as sad as they are 34

Donor Family Followup

Follow-up with the donor family includes a letter sharing some information regarding each of the recipients. This letter excludes confidential information such as name and geographic location of the recipient. OPOs may also choose to include a booklet regarding organ donation and or grieving after the death of a loved one. Some OPOs may have donor family support groups and conduct meetings for new donor families. Similar letters are also sent to all hospital staff involved in the donation, physicians, transportation teams and funeral home directors.

Introduction mapping the terrain

This chapter will concentrate on the impact of adoption and foster care on the lives and mental health of the children placed. However, its role in problem solution and problem generation for adults cannot be totally ignored. Adoption is more often than not a satisfactory way of meeting the need to become parents for those childless couples who succeed in having a child placed with them (a tiny minority of the involuntary childless). It is very rarely a solution to the problems of a parent who gives up a child for adoption whether voluntarily or involuntarily. Studies of adults who relinquished children (1) indicate that the reaction to the loss of their child may be associated with moderate distress or may lead to a long-term grief reaction, which in turn will potentially harm children subsequently born to that parent. One must also note that some parents who lose a child to adoption or foster care are themselves children, sometimes not yet in their teens, whose needs are often...

Preventive intervention

Therapeutic elements associated with good outcome include the promotion of communication within the family about the dead parent and the promotion of mourning. For young children this includes help in clarifying what has happened to the dead parent and in helping them to understand and cope with dysphoric affects both in themselves and in the surviving family members. It is doubtful if children under the age of 3 can understand the components of the concept of death, but by the age of 5 about 80 per cent of children can understand most of them. (3 Supporting a widowed parent in his or her grief, and enabling the process of mourning to occur by providing practical help (child care, financial advice, etc.), is probably as important as counselling in helping the children. Given the indications that problems may develop much later, a useful intervention strategy should include follow-up appointments after any time-limited intervention

Counselling and psychotherapy

Psychotherapy is directed more at psychopathology than normal reactions to stress. It is therefore essential to know about the normal range of children's responses to life events. For example, a 5-year-old child whose mother has just died will grieve differently from a 10-year-old child, because at 5 years of age most children have not yet developed a clear concept of death. Grief in a 5-year-old is most strongly influenced by the way the adults around the child react to the death, whereas a grieving 10-year-old child, although responsive to guidance from the adults around, will also have his or her own unique way of coping with grief. As a general rule, the younger the child the more important it is to consider the attitude and mental state of the parents.

Evidence of the Relationship Between Stressful Life Events and MS Exacerbation

Charcot, who first characterized MS in the 19th century, wrote that grief, vexation, and adverse changes in social circumstance were related to the onset of MS (Charcot, 1877). Since then, numerous clinical studies have been conducted examining the relationship between stressful life events and MS exacerbation.

Contributing factors and context

A comprehensive cognitive assessment provides essential information required to interpret behaviour and make a diagnosis. The intellectual and language ability of the young person will influence both their perceptions and ability to communicate their thoughts and emotions. Subjective experiences such as grief, anxiety,

Environmental influences

Apart from the range of potential adverse psychosocial experiences that children in the general community might experience, children with mental retardation are more likely to experience further potentially adverse experiences such as respite and institutional care, social rejection, teasing and school adjustment problems, abuse, and neglect. Limited cognitive ability to understand and discuss socially stressful experiences may compromise adaptation and contribute to behavioural disturbance. Parental grief, guilt, hostility, ambivalence, and rejection, increased financial burden of care, and family stresses are further factors likely to impair attachment, relationships, and the quality of the care environment. (52 Behavioural problems, impaired responsiveness and capacity for reciprocal social interactions, communication difficulties, and low resilience, particularly in some vulnerable groups of children with mental retardation such as those with autism, further impairs attachment and...

Parentcarer involvement

Parents and carers should be involved as partners in the management plan to avoid alienation of the family and to facilitate compliance with treatment. (73) Parent education and counselling regarding the nature of the mental retardation and associated emotional and behavioural problems may encourage the parents to cope with their grief, co-operate with management, and develop their own adaptive responses. Involvement of teachers and other carers also facilitates management. More specific family therapy exploring communication and patterns of interaction, conflict resolution, and beliefs may be helpful however, outcome research is required. (74 Parent involvement in the delivery of speech and physiotherapy and behaviour-modification programmes is indispensable. (75)

Psychodynamic therapies

Both the family and the individual have to adjust to disability this process is akin to a series of grief reactions in which people come to terms with the loss of normality 7) The process of adjustment occurs as a series of crises triggered by events such as the point of initial diagnosis, the failure of initial treatments, educational assessment and specialized placements, puberty, and leaving home. Each stage brings home afresh the degree and significance of the child's disability.

The early impact on a family of a retarded child

Diagnosis of an abnormality now frequently happens in pregnancy from screening tests or from ultrasound scans, all of which are routinely offered. Termination of pregnancy is offered. However, negative tests by no means guarantee normality but are often interpreted by the parents as meaning that major disability is ruled out. Hence the disappointment when a child is born with a defect is even more intense and follows a prolonged highly anxious period with a baby in special care. Initial hope is followed by temporary relief and hen by the reality of gross developmental delay. Others believe they have a normal child until they become aware of the slowness of development or the onset of seizures occurs in the second half of the first year. Parental reaction to these tragedies is often anger mixed with grief.

The mixed feelings at the time of the initial impact

The feelings that parents experience have been likened to those of grief occurring with a sudden loss. It is a useful comparison as there is a loss. Every expectant parent day-dreams about the child and the arrival of a sick or damaged baby destroys many of those dreams. Commonly the first stage is shock or a numb disbelief. The next phase is often denial, 'This cannot be happening to me', followed by anger, which may be directed against the other parent, the doctor, or God. The last two phases are constructive active adaptation, which might involve learning about the condition or joining a parents association, leading on to resolution. Unfortunately, not everyone goes through all these stages and certainly not at the same rate. The mother might still be feeling as if she is shell shocked while the father is making contact with a particular society or support group on the Internet.

The effect of a mentally retarded child on the parents

The parents feel the effects of grief from early on. Despite having moved, often very courageously, through the stages of reconciliation with the news, the sadness and disappointment can continue for many years(4) despite a very positive outlook towards the affected children and the other members of the family.

Other members of the family

The family has changed markedly in the last 30 years. There are many more divorces so that the 'parents' involved in the care of a child or young person are frequently one natural parent and one step-parent. There are also many divorced mothers living alone with the young adult after all the siblings have gone. Although some have adapted very positively, others feel very lonely, particularly if there are no members of the wider family to share the care and, often more pressing, to share the worries. Grandparents are as important in families with a member with mental retardation as they are in ordinary families, although initially grandparents can become severely affected by the grief, take sides in attributing blame, or offer unsought advice. One mother described her mother as an enormous help because 'she was always behind me in every decision I took'. When no helpful grandparent is available, an older neighbour, another member of a parents group, or a teacher at the school or day...

Personal injury cases

The courts have tended to adopt a cautious approach to psychiatric injury claims. The general conditions that have to be met for liability for damages in these cases include causation and forseeability. The claimant must be shown to have developed a psychiatric illness from the events, and it must have been reasonably forseeable that the claimant might suffer such illness as a result of the negligence of the defendant. (13 The psychiatric harm must amount to a recognized psychiatric illness grief and distress are not sufficient to merit a successful claim. Post-traumatic stress disorder is particularly likely to be a diagnosis that features in these cases, although some commentators have criticized its increasing use in litigation. (14 Sometimes claims are made by secondary victims individuals who have developed psychiatric illness as a result of harm caused to someone else. Claims in these cases are only likely to succeed if there was proximity between the claimant, the event, and...

The Self Defeating Masochistic Personality

Life is tough enough without making things even more difficult. Some people, however, deliberately put obstacles in their own way, seem to court suffering, and need to fail. Such individuals are called masochistic personalities, though they were termed self-defeating personalities in the DSM-III-R. Cursed with an uncanny sense for defeating themselves, they routinely set sail for stormy weather and call down setback, loss, frustration, and grief on themselves. When they do experience good fortune, they react with confusion or displeasure and secretly frown at the joy that others might feel for them. Real accomplishments they attribute to luck, specifically to avoid a sense of pride. Paradoxically, they may willingly contribute to the achievements of others, while subtly undermining progress toward their own goals. In love, they often discard genuinely caring persons as tiresome or boring, turn otherwise ordinary mates into persecutors, and seem subtly attracted to those who are...

Diagnosis and differential diagnosis

Rumke Differential Table Updated

The main diagnostic challenges are to identify pathological grief, and to identify other mental disorders provoked by bereavement ( Table ). Pathological grief has different meanings. It can be defined as follows (25) chronic grief the failure to resolve all adverse bereavement-related symptoms within 6 months inhibited grief the absence of expected grief symptoms delayed grief the avoidance of painful symptoms within the first 2 weeks of a loss. An unusually intense bereavement reaction is sometimes described as hypertrophic grief. There is some evidence to suggest that this form of grief may predispose to psychiatric comorbidity. An alternative way of defining pathological grief is to consider whether it is associated with significant functional disturbance, and secondly to consider whether it is unduly persistent. These two interact. Thus, severely distressing or disabling symptoms at 2 months, moderate symptoms at 6 months, or mild symptoms at 12 months could all reasonably...

The psychiatry of pregnancy Pregnancy adjustment

Many pregnancies are unplanned and not initially welcomed. Many women react to conception with grief and anger. A random sample of English mothers showed that 44 per cent of pregnancies were unintentional, including 17 per cent which ended by legal abortion. In married women aged 25 to 29 years with one child, 80 to 84 per cent of pregnancies were planned, compared with 26 per cent in the unmarried.(20)

Phase 3understanding Brain Death

In the Hispanic community, potential language barriers and the extended family are important considerations. In this community, the whole family is involved in the decision to donate.11 Collective hysteria , a grieving process marked by shouting, crying, fainting and sometimes convulsions has been noted by researchers studying the Hispanic population. Hospital-based professionals from all disciplines may hesitate or feel uncomfortable speaking to potential donor families because of reluctance to add to the next of kin's grief or because they feel they are not prepared for the many questions that donor families may have.14 For these reasons, it is strongly advised that hospital personnel team up with OPO personnel to approach families regarding donation.

The Case ofThelma Histrionic Personality Disorder

As a young child, Thelma lost her mother suddenly in an automobile accident. One night she went to bed and awoke the next morning without a mother. Her father was overcome by grief following the loss of his wife and soothed himself by further throwing himself into his work and consuming considerable alcohol at home after work. Thelma was mostly cared for by her maternal grandmother. A nice and well-intentioned woman, she was dealing with her own grief at the loss of her daughter. While she loved her granddaughter, she was also resentful at being called on to be responsible for a child at this stage of her life. Other brief affairs followed. None were serious, but collectively they served to reestablish Thelma's confidence in her ability to attract the attention of men and to heal her wounded self-esteem. When her husband suffered a second heart attack, which he did not survive, Thelma found herself a grieving wife and an available widow. She sold the family home in the suburbs and...

Differential diagnosis and ascertainment difficulties Depression

The three key features of lowered self-esteem, increased self-criticism, and acknowledgment of a depressed mood distinguish depression phenomenologically from states such as grief or bereavement where there is a distinct sense of 'loss', but no primary 'loss' of self-esteem. They also assist phenomenological differentiation from anxiety, where the individual is more likely to report a sense of insecurity, fear, apprehension, worry, panic, or of 'going mad'. In practice, such features, together with less specific concomitants such as crying, non-reactive mood, and anhedonia, assist in making a diagnosis of depression in the majority of instances.

Responses following specific criminal acts Murder

Murder is often regarded as the ultimate transgression, resulting in the sudden unexpected and violent loss of life. Those affected include not just the individual victim who is killed but the friends, family, and acquaintances who are left behind to deal with their loss. The act of murder is shocking in its finality and irrevocability, and the responses of survivors are both qualitatively and quantitatively different from the normal grieving process. (26) Feelings of stigmatization, isolation, shame, and betrayal by individuals bereaved by murder set them apart and they often feel unable to communicate their distress or to connect emotionally with fellow beings. Compared with 'natural' death, the survivors have not been prepared for their loss beforehand, there can be no anticipatory mourning, no reconciliation, and no proper leave taking 27 The pain experienced is impossible to put into words or to communicate in an effective way, and therefore often leads to social withdrawal and...

The Case of Lenore Borderline Personality Disorder

Lenore was stable until her twin's suicide at age 35. Maureen had been in and out of psychiatric institutions for much of her adult life, leaving Lenore feeling painful survivor's guilt, which overwhelmed her when her twin died. Her profound grief was experienced as blinding rage evolving into a psychosis, which was transient and resolved quickly. She was hospitalized and received shock treatments, which were a major psychiatric treatment at that time. A lengthy stay in the hospital, and perhaps the treatments, appeared to quiet her demons and to contain her. When she returned home, she appeared thinner, weary, and noticeably less animated.

What Adaptations And Under What Circumstances

When it is argued that adaptations are unnecessary, the assertion is that structural elements of cognitive therapy such as agenda setting, collaborative empiricism, cognitive conceptualisation, cognitive restructuring and homework setting are all essential elements. Cognitive therapy is a relevant and accessible therapy precisely because it deals with older people's current concerns, whether grief, physical limitations following a stroke or general emotional distress.

Physician as Coach

Most physicians probably do not think much about their various roles in treating patients. Physicians unconsciously do whatever needs to be done, like being a counselor for the grieving patient or a strong leader during times of crisis. Effective treatment of obesity depends on neither of these two roles it requires that the physician first be a catalyst who brings together the right patient with the right program at the right time to ensure the best outcome. Once accomplished, the physician now acts like a coach. The coaching perspective takes the focus for both success and failure for weight loss away from the pill, the program, or the physician.

Troubleshooting

When a patient reports good side effects, such as paresthesia from internal capsule stimulation, or obtains the usual side effects from periventricular stimulation when the voltage is turned up, this would indicate that the patient's electrode system is functioning properly, but that they have had something has changed in their own internal milieu that would prevent good analgesia. The main reasons for these patients not obtaining good pain relief from stimulation are as follows First, the use of drugs that inhibit stimulation pain relief, such as a narcotic, would especially prevent good stimulation relief with periven-tricular stimulation and would require an increase in stimulation intensity for internal capsule and sensory nuclei stimulation. Second, depression may be a marker for depletion of serotonin and norepi-nephrine, which are necessary for the cascade effect of perivcentricular stimulation for pain relief. Thus, we usually continue our patients over the long term on a...

Fishers Exact Test

So the number of ways three imbibers could have been taken out by fate is 200 X 199 X 198. But there's another wrinkle. Once they're gone, neither we nor the grieving relatives really care about the order in which they met their demise, so we have to see how many ways we could have ordered three bodies on the barroom floor. Three could have ended up on the bottom of the pile. Once this is decided, two could have been in the middle, and now there is only one choice for the top of the pile. So as to the number of ways to drop 3 boozers from 200, the answer is

The referral process

The referral process can take some hours and, again, the family need to be aware of the time-scale. If they wish to stay until the patient is transferred to the operating room, then of course they must be allowed to do so. However, experience has shown that most families say their last goodbyes before then. They should also be given the opportunity to view the body afterwards, as for some families this is a necessary part of the transition through the grieving process.

Death In The Family

Most people would have been devastated by such an announcement. After her first shock and grief wore off, however, Nancy Wexler vowed to fight the disease that threatened her and her family. She went from being dismal to . . . wanting to be a knight in shining armor going out to fight the devils, Milton Wexler, a psychoanalyst, told Lauren Picker in an interview published in the March 1994 issue of American Health.

Phases of treatment

The therapist assesses the need for medication, based on symptom severity, past illness history, treatment response, and patient preference, and then provides psychoeducation by discussing the constellation of symptoms that define major depression, their psychosocial concomitants, and what the patient may expect from treatment. The therapist next links the depressive syndrome to the patient's interpersonal situation in a formulation (Markowitz & Swartz, 1997) centered on one of four interpersonal problem areas (1) grief (2) interpersonal role disputes (3) role transitions or (4) interpersonal deficits. With the patient's explicit acceptance of this formulation as a focus for further treatment, therapy enters the middle phase. In the middle phase, the IPT therapist follows strategies specific to the chosen interpersonal problem area. For grief complicated bereavement following the death of a loved one the therapist encourages the catharsis of mourning and, as that affect is released,...

Brief therapy

Short-term groups may be homogeneous or heterogeneous. Homogenous groups have proved effective in helping patients deal with loss and grief, the consequences of trauma and abuse, and common problems involved in coping with physical illness and disability. Heteregenous groups require more psychodynamic commonalities such as shared problems in interpersonal relationships, the ability to recognize and work on psychological issues, and the ability to cope with the speed and intensity of the process. Those who lack psychological sophistication or are not motivated for self-exploration are not suited to this therapy.

Psychosocial Support

Just as important as a careful risk factor analysis and interpretation of risk to family members is attention to the psychosocial issues raised by the enhanced risk and the emotional needs of those involved.27 This consideration is especially critical in the setting of counseling for cancer risk, which deals with the complexity of probabilities, which involves the entire family, and which may provide risk information that can become a source of discrimination. Cancer is one of the most feared diseases of modern times. Cultural beliefs about cancer, painful memories of relatives' experiences with cancer, high levels of mental stress associated with cancer-related anxiety, unresolved grief, feelings of denial, guilt, and other family dynamics can all interfere with the receipt and understanding of risk information and with the formulation of strategies for risk reduction and can have a negative impact on quality of life. Both the information received during the process of genetic...

Consent

While the consent process may include a variety of hospital staff members, it should always involve the RSC. Some healthcare professionals believe that bringing up the topic of donation with a grieving family is an imposition, and may try to protect the family from being approached. Yet recent Gallup polls indicate that nearly nine in ten Americans support donation, and more than two-thirds are willing to donate their organs upon death. Hence, healthcare professionals should always be sure to provide the potential donor's family with the opportunity to donate.4 The consent process is discussed thoroughly in a previous chapter.

Other losses

The effects of other losses on children have been less well studied than that of parent death. The death of a grandparent, particularly if he or she lived with the child or carried out caretaking functions, can be devastating to child and parents, but there has been no study of the effects. Sibling death carries a high morbidity for the survivors, but this can be mitigated by preparation for the death when possible and by participation in community rituals. (26) Adolescents losing a sibling often deny the finality and universality of death, even when these concepts are well established prior to the death. (27) The losses of friends, of pets, or of homes, whilst eliciting sadness, are less likely to provoke pathological grief reactions provided that the child is supported by parents and other adults who are not themselves withdrawn in grief. However, adolescents are affected by the suicide of a friend. In a controlled study, Brent et al.(28) found that there was a higher incidence of...

Description of IPT

IPT focuses on four main problem areas in its treatment approach to depression (1) grief (2) interpersonal disputes (conflict with significant others) (3) role transitions (changes in a significant life situation) (4) interpersonal deficits (problems with an individual's initiating, maintaining or sustaining relationships). A number of authors have argued that the approach IPT takes and its focus upon the four problem areas identified above make this form of psychotherapy particularly well suited for use with older adults (Hinrichsen, 1999 Karel & Hinrichsen, 2000 Miller et al., 1998 Miller & Silberman, 1996). As Hinrichsen (1999) states, late life is a time of change and adjustment many older people will be dealing with the loss of a spouse, many will be negotiating changes in the nature of their relationships with friends, spouses and adult children, and many will be dealing with role transitions due to retirement or adjustments to functional health status. Miller and Silberman...

Different cultures

The very many worldwide studies that exist show a remarkable consistency in their findings. For all families of whatever ethnic origin, economic status, or religious persuasion, there is grief at the birth of a child who is in any way defective, and anxiety and sadness about a child who later is seen to fail. In some cultures, an affected boy is harder to bear than an affected girl, as boys have special roles, for instance taking part in the funeral of the parents. Obviously, a high infant mortality will mean an even higher rate in children with any sort of disability. There are a few studies that have come from countries in an early state of development. The authors of these papers are anxious not to repeat what they understandably see as the mistakes of Europe and America. There are for example excellent community services in Asian countries based on the strengths and the beliefs of the local people, A0.) whereas others model their services on those in the West, and thus have...

Depressive disorders

Sadness and grieving for loss of health and well being are normal responses in cancer patients. (3) A continuum is seen, beginning with these normal responses, and increasing intensity reaching the level of subsyndromal symptoms, adjustment disorder with depressed mood, and major depression and mood disorder related to medical condition. These are the most common depressive disorders encountered in patients seen at our counselling centre. A special diagnostic problem exists in cancer. Vegetative symptoms of depression are the same as many physical symptoms seen in patients with cancer, especially fatigue, slowed psychomotor activity, insomnia, absent libido, anorexia, and weight loss. The clinician must focus on the psychological symptoms of depression to make a diagnosis persistent depressed, dysphoric mood, feeling of worthlessness, guilt, anhedonia, and preoccupation with hopelessness and death ( Tab.l. , 2).

Diagnostic aspects

On the positive side, hyperthymic individuals are enterprising, ambitious, and driven, often achieving considerable social and vocational prominence. (105) Abuse of stimulants is not so much an attempt to ward off depression and fatigue as an effort to enhance their already high-level drive and, sometimes, to further curtail their already reduced need for sleep. Hyperthymic individuals typically marry three or more times. Others, without entering into legally sanctioned matrimony, form three or more families in different cities these men are capable of maintaining such relationships for long periods, testifying to their financial and personal resourcefulness, as well as their generosity towards their lovers and the offspring from such unions. Unlike the antisocial psychopath who is predatory on others and neglects or abuses his women and children, these men care for their loved ones. But obviously the 'arrangement' involving women of different generations is complex, and a fertile...

Clinical vignette

The centerpiece of IPT is the interpersonal case formulation (Markowitz & Swartz, 1997), a summary statement that reiterates the patient's diagnosis and links it to one (or at most two) interpersonal problem areas. In the formulation, the therapist explicitly links the onset and maintenance of the mood episode to a specific interpersonal problem area. A salient problem area is chosen, based on information collected during the psychiatric interview and interpersonal inventory. In IPT, there are four possible interpersonal problem areas grief, role transition, interpersonal role dispute, and interpersonal deficits. These four problem areas are discussed below, with a specific focus on their relevance in the treatment of bipolar disorder. Grief The patient and therapist will choose grief or complicated bereavement as the focal problem area when the current affective episode is linked to the death of an important person in the patient's life. Treatment focuses on facilitation of the...

Windigo

John Morris Anthropologist

Originally, a Native American name for a Cannibal Giant in northern North America. Now more commonly known as a supposed psychological compulsion to eat human flesh, said to occur among the Algonquian peoples of Canada and called Windigo psychosis. The craving is said to be brought on by desperate cannibalism during a famine. The reality of this syndrome has been challenged, though the condition may in fact have been used in the past as an excuse to expel or execute an outcast. In recent decades, turning Windigo most likely refers to an emotional display of grief or worry that betrays a fear of being lost or otherwise ill equipped to deal with a harsh, subarctic environment. Some stories may also involve BlGFOOT wandering outside its normal range.

Relating Styles

In the model I am suggesting, social contexts and relating styles (mediated by self-other schema) that make it difficult to elicit or maintain a flow of positive affiliative relationships, or achieve evolutionarily meaningful biosocial goals (McGuire & Troisi, 1998b), as well as disruptions of relationships that recruit perceptions of inferiority and low rank, are likely to be vulnerability factors for depression (Sloman et al., 2003). Brown et al. (1995) found that social losses associated with humiliation (perceptions of reduced social rank) were more depressogenic than loss events alone. In a study of grief-triggered depression, Horowitz et al. (1980) found that some people had negative latent self-schema (associated with feelings of worthlessness and inferiority), which their spouse had helped to keep latent. When the spouse died, these negative self-schema become reactivated (self as inferior and helpless), complicating grief and increasing the risk of depression. Some limited...

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