Overview of grieving: general observations continued.

Before we get to describing the stages of grief there are few more topics worth mentioning about grieving in general.

Disenfranchised grief is grief that people experience without any social recognition or acknowledgement. A lover of a married spouse who dies without there ever being any public recogition of the nature of the relationship. Deaths of ex spouses after divorce.

Deaths experienced by professionals of patients or clients who were part of confidential relationships. This happens freguently to health care providers in all kinds of settings.

There are many other examples where loss is experienced alone without any social recognition, acknowledgement, or support. Miscarriages may fall into this category. People who die in institutions like prisons or nursing homes or by stigmatized circumstances like suicide, drug overdose, alcoholism.

Liberating losses - Sometimes death is experienced as a relief or as if a burden has been lifted. This often occurs after a long illness where the death is anticipated, but also can happen in a sudden death when the deceased is a part of a conflicted relationship.

Moral injuries - These are deaths witnessed or inflicted in war, capital punishment, or other acts of revenge or intentional or unintentional "accidents." Abortion is sometimes thought of as falling into this category.

Overview of the grieving process.

What are the stages of grief?

What is about to be described here is a frame of reference. Nobody goes through the stages exactly as described in a linear way. Most people oscillate back and forth through the stages but the person can probably identify where their emotions and thoughts are predominately at a given period of time when they are going through the stages.

What is presented here is boiled down from a clinical perspective. There are other descriptions but the one presented here is what seems most helpful when talking with people about their grieving process in my practice.

Here the stages:

1. Shock and disbelief
2. Bargaining
3. Acceptance
4. Hope
5. Meaning

This is the first in a series of articles on the grieving process.

Before a description of the stages, here are some general observations about grieving in our society.

The grieving process is not something to be fixed but a normal part of life.

Grief is not depression and should not be medicated except when extreme symptoms appear which are usually a sign of an underlying psychiatric problem and not the grief itself.

Our society is very intolerant of grief and does not have appropriate expectations about the grieving process.

The two biggest ways of managing grief are simply to sit with it and be mindful about its existence and workings, and two, having a shoulder to cry on, an understanding witness who can accept the expression of grief without getting upset oneself.

There are differences in the grieving process the major difference being an anticipated death and a sudden death.

Death is nothing to be afraid of but a normal part of the life cycle.

Social reactions to death are varied and often difficult to deal with for the person who is mourning.

Grief is best exprienced with one's natural support system. Professional grief counsling services initially following the death are not recommended even though they often are. 

While the deceased person's physical body is dead, their spirit lives on in the stories that are told about them.

To be continued

PHQ - 9 overestimates prevalence of depression

More and more primary care medical practices are using the PHQ-9 depression screening tool and sometimes the abbreviated version. I've had it administered to me on my primary care medical visits along with my weight, blood pressure, and pulse.

A new study finds that these depression screenings over estimate the prevalence of depression. A symptom check list screening is not the same as a structured clinical interview for depression (SCID).

The most common misdiagnosis I find in my clinical practice is the depression for grief. Often I find that people who screened positive for depression in their doctor's office are actually experienced what is sometimes called "disenfranchised grief." Disenfranchised grief is sorrow and mourning triggered by a signficant loss that is not socially recognized, acknowledged, and therefore not supported with consolation and solace. Often I find that these patients have been started on an antidepressant medication which not treatment of choice for grief.

There is no substitute for good mental health care by a trained clinician.

For more click here.

During school closure teens getting more sleep but it needs to be on a regular schedule

During the pandemic with school closure teens are getting more sleep which is a good thing because it makes them more communicative, family friendly, less moody while at home. It is important though to stick to regular sleep schedule. Staying up all night playing video games and messaging with friends is not conducive to a regular sleep schedule which is necessary to reduce inflamation and enhance physical and mental health.

I hear in my psychotherapy sessions about teen's symptoms of anxiety, depression, and irritability. I ask about their sleep. Almost always the answer is that it is disturbed and irregular in some way. This leads to an interesting observation. Is it the anxiety and the depression interfering with the sleep or the lack of sleep contributing to the symptoms? Which comes first the chicken or the egg? However you answer the question, improving the sleep cycle goes a long way in enhancing the feeling of well being.


For more click here.

Need stress relief? Commune with nature.

The ego's need to be right is more powerful than the fear of death

Question

I wonder if we reopen and things get worse will those protesters admit they were wrong. Conservatives are very reality denying, even in the face of evidence. But the reality of the pandemic is very harsh, but is it harsh enough to break through their denial mechanism?

Jim

Answer

They'd rather die first than admit they were wrong.

Remember the Vietnam Era when they said, "Better dead that red."

These folks have to die off which social Darwinism predicts will happen. Let them swarm and infect each other, but you and yours stay home and the hell away from them.

People are more than willing to die for a cause as long as they don't have to lose face and admit they're wrong. The ego is a deadly thing.

I don't say these things lightly. I have seen it clinically with people who kill themselves and kill others and then themselves. Freud is accused of calling it a death wish but that is an oversimplification. It is the tremendous need to be right which is more powerful than death.

What is the purpose of your life?

This idea that people benefit from a sense of purpose is not only especially true for children but for people over 60 until their death as well. What is your purpose in life?