Understanding Bereavement and Sudden Death

Question: Describe about the Report for Understanding Bereavement and Sudden Death. Answer: Introduction One experience that is surely confirmed and will surely happen to every living organism is death. It is a naturally occurring phenomenon that death is confirmed and can be encountered at any stage of life. Being such a known and acceptable phenomenon, death is still a complicated one because its consequences can create complication like grief, bereavement, shock etc. in the life of the other individuals related to the descendant. Death can impact anything either stage or phase of life and it is generally unpredictable for people (Worden, 2013). In psychological studies, death is a complicated phenomenon that can bring grief in different multiple factors related to life, like personality, relationships, experiences, spirituality, beliefs, profession and much more (Simpson, 2012). Bereavement is a grief phase occurring after the death of any living organism. It is a natural process that is a form of reaction to the loss (death) in life. The bereavement can be a physical, psychological, social or emotional reaction that expresses the grief of death. Bereavement persists no symptoms, duration and frequency; this can be mild to disastrous either from short to the long time duration. It can occur in form of slow to quick reaction for sudden death. Bereavement establishes depending on the strength of the relation between the people who dies to the person who is in grief (Stroebe et al. 2013). This research paper focuses on understanding the bereavement and sudden death by analysing three critical case studies that are my personal and professional experiences of death and bereavement. A proper literature study is performed to understand the details of bereavement and death followed by explaining all the three case studies. These case studies are then compared to theories of death and bereavement to assure that provided concepts are correct or not. This critical analysis helps me to analyse their knowledge gained from studies about sudden death and bereavement. Aim and objectives This research paper aims to understand the concept and impact of bereavement and sudden death on the life of people by undertaking a critical analysis of three case studies that are either my personal or professional experiences in life. These case studies are analysed on the basis of literature related to bereavement and sudden death. To understand the impact of bereavement and sudden death on life of people To understand the basic theories of bereavement and death To understand the cultural context of how people deal with sudden death To understand different stages of bereavement and death To understand and compare the provided case studies with literature studies about bereavement and sudden death Literature study Concepts and definitions of bereavement and death According to Breen and O'Connor (2011), death is more than a biological phenomenon that involves sociological, political, psychological, spiritual and legal elements influencing bereavement. Bereavement is the mourning or grief that occurs specifically after the death of any person to the individual or group attached to that person. Bereavement is determined in the form of death reaction. Further, Foster et al. (2012) studied that bereavement assumptions and interpretation varies from culture to culture and individual to individual. According to Zisook (2012), bereavement is diagnosed as a Major Depressive Disorder with common symptoms like insomnia, appetite loss, loss of interest, sadness, silence etc. The four common zones of disruption after bereavement are dysphoria, social disruptions, cognitive disorganisation and health deficits. Brubaker et al. (2012) indicated that death is a simple termination of all biological functions occurring in a living machine just like switch on-off mechanism of a non-living machine. Further, Bremer et al. (2012) indicated that basic concept of death is that it is an irreversible cessation of functions in the living body leading to irreversible loss of personhood. Death persists a no subjective importance yet holds academic importance in psychological studies due to bereavement occurring as a consequence of death. Some psychologist considers death as the end of individual future whereas some say is a life cycle defect and it is also considered to be the end of existence. However, Breen and O'Connor (2011) indicated that death conceptualization is a critical process because to form a concept one should exist as an object or subject. But, death is neither an object nor a subject. According to Shear et al. (2013) death is a reality that can be sudden or expected, in both cases it is c hallenging. However, sudden death leads to no adjustments, assumptions, and no opportunities for creating emotional stability. Moos (2013) studied that sudden death is generally the outcomes of trauma, suicide, murder, disasters, accident and evidence-based outcome. This category of sudden death leads to deepest bereavement and complications. Therefore, sudden death is more linked to grief than expected death yet development of grief is possible in both situations of death. Theories of death and bereavement According to Nakajima et al. (2012) studies, there are two theories provided by Freud that clearly describe a proper understanding to death. As per Freud, there are two explanations for death in form of two theories, one is unconscious immortality and second is death instinct theory. As per first theory death of any individual does not persist a representation. As per clinical studies, attitudes towards death and studies of denial, death is considered immortal. However, this theory was criticised by various psychologist making Freud revise his theory. Further, Freud came up with a theory of instinct death, which is developed on the basis of dual instinct theory where death is considered purely true shock reaction that is biological not a clinical phenomenon. As per this theory, death is seen as a biological program rather than clinical or physical malfunction. Breen and O'Connor (2011) studied the theory of eternal life that describes the circle of life from the time of conception to the time of death. The circle starting from gestation to childhood to maturity involves different stages and phases of life development having only one termination point that is death. As per this theory, death, conception and judgement are three similar things in the circle of life. Further, Brubaker et al. (2012) mentioned about Buddhist theory of life, death and rebirth. As per this theory, there are three different views about death, some believe death is permanent and termination of everything, some believe that invisible world continues after death and last believe is that death is the transformation from one life to another. From past few decades, there has been intense research on the concept of bereavement that is now presented in form of certain theories and models that are popularly accepted by experts (Lindemann 1944, Kubler-Ross 1969, Parkes 1975, Bowlby 1980 and Worden 1991, Shut and Strobe 1999). These theories and models provide an acceptable approach for interpreting and managing explanation to bereavement. Previous grief theories were based on the behavioural and psychological reaction to grief but later these theories emphasised on the pathological and natural grief reactions (Parkes, 2013). According to Herberman et al. (2013), Scientist Freud (1961) studied about the pathological features of bereavement where people facing grief are clinically depressed and stress. Further, Lindemann (1944) with his theory identified the difference between pathological and normal grief based on parameters like grief duration, intensity and social functionality. Lindemann gave five phases of bereavement that described grief as somatic disturbance (clinical features like throat tightness, breath shortness, depression), deceased imagination and preoccupation, guilt, hostility feeling or anger and last phase is difficulty in daily routines. These phases indicate that bereavement is not only a clinical disturbance with no explanation for psychological, spiritual and mental disturbance occurring in bereavement. Kaplow and Layne (2014) studied about the Kubler-Ross five-stage model for understanding and coping with bereavement. As per this model, grief is a five-stage process that is Denial, Anger, Bargaining, Depression and Acceptance (DABDA) model. This model is also named as stage or phase model of bereavement because it describes all the stages of bereavement. The Denial stage involves the rejection of reality (death) by the vulnerable followed by the Anger phase where person-suffering grief becomes frustrated and angry because of rejection to their denial. In other words, anger is a reaction to overcome the acceptance of reality. Further, the Bargaining phase involves negotiations to avoid the cause of grief. However, bargaining is a feature indicating that vulnerable is recovering the grief because bargaining is a characteristic of a healthy mind. Further, Depression phase is to understand the reason for grief where vulnerable tries to recognise the reason for grief and starts to overc ome their denial. Lastly, Acceptance phase is the coping phase where individual finally accept the reality, situation and death. However, this model was criticised by another psychologist by indicating that stage of grief do not follow the similar phases in chronological order rather they overlap as per situation and loss. Secondly, phase model focussed more on the clinical impressions, not the empirical data to explain grief. Further, this model was considered too linear, passive and simple to underestimate the complexity of bereavement. Further, Shear (2012) opines that after the criticism of phase model, Bowlbys attachment theory gave a very acceptable interpretation to explain grief. As per Bowlbys theory of attachment and bonding, grief is the flexible and overlapping situation of shock, protest, despair and recovery. As per Bowlbys theory, bereavement is the outcome of past experience, attachment, mutual relationship and interactions. The main cause of bereavement is the detachment with the dead person that causes the birth of negativity in form of despair and protest. Similar to this theory, Parkes also proposed a four-stage model of grief, which involved shock, pining, despair and recovery. However, Parkes mentioned that grief is not a staged process rather it is a process that starts and end irrespective of time. According to Simon (2013) studies, Worden in 1991 developed the recovery theory of bereavement. As per this theory, there are four tasks to recover from grief, where task one is to accept the loss, task two is to work on the pain, task three is to adjust without the deceased person and lastly, task four is to move on or overcome the loss completely. This model completely focuses on the recovery process or stages of grief. Further, Dual process model of Shut and Strobe 1999 involves two-process model for grief recovery. These two processes are Loss-oriented processes and restoration-oriented processes. The loss-oriented process is a negative viewpoint process where vulnerable works through his grief and suffering to develop recovery. However, restoration-oriented process is completely positive where new strategies and living styles are adopted to overcome grief. Effects of death Death affects almost everything in the life of an individual moving from materialism to emotions because it directly affects the psychology of human mind. The effects of death are categorised as cognitive, physical, and behavioural based on the bereavement caused to the vulnerable. The cognitive effect involves preoccupation with the deceased, disbelief formation, symptoms of hallucination, confusion, memory loss, detachment from people, dreams of deceased and depersonalisation (Brubaker et al. 2012). Bell and Taylor (2011) studied some of the most noticeable physical effects of sudden death on people facing grief after the death. For this purpose a population of 50 vulnerable was targeted where each person was observed, analysed and questioned on the basis of grief symptoms. The most common physical effects of bereavement are numbness, feeling cold or hot, breath shortness, hollowness in the stomach, weak muscles, oversensitivity, dry mouth, lack of energy and appetite loss. Further, Gamino and Ritter (2012) studies about the behavioural effects of death that include sleep disorder, social isolation, morning awakening, searching deceased, restlessness, over activity, anger outburst, crying, lethargy, holding on the memories and objects of deceased. These are some of the most common effects of death that work as symptoms of bereavement. Cultural context and practices about death Lichtenthal et al. (2013) studied that different cultures share a different viewpoint about death as per their practices, beliefs and values. The Christianity, Judaism and Islam believe that soul remains after death making life as an immortal factor leading to the formation of grief. Further, Hinduism and Paganism supports reincarnation and Atheism consider death as the end of everything related to life. However, Buddhism shares a completely different viewpoint where the cycle of birth and death is explained indicating that reincarnation is achieved after one gets rid of birth to death cycle. Nakajima et al. (2012) indicated that this difference is cultural context also affects the bereavement process and reaction of people after a sudden death of closed once. The reactions and acceptance are highly dependent on this cultural context where people react as per their practices and beliefs, which they were taught since childhood (Brown, 2012). From this study, it is completely clear that bereavement and death is a complex phenomenon that involves various fluctuations, differences, modifications, exceptions and assumptions. As per my viewpoint, all the concepts and theories about bereavement are true and hold some sort of importance depending on the situation they are meant for. The research framework includes three personal and professional case study descriptions that are further evaluated on the basis of literature study performed in initial part of research. I have researched that how perfectly my life experiences about sudden death and bereavement are justified by these theories and studies about death and bereavement. Case studies Case study -1 This case study is my personal experience around 9 years ago when my husbands father, my father-in-law died due to his ill health suffering kidney failure, cancer and heart issues. He was always in the critical situation of life due to these chronic diseases and was preparing his children for unavoidable situations. However, still irrespective of this situation, after his death, my husband and other family members faced a shock and trauma. My husband faced a sudden grief in form of depression where he locked himself in a room and was silent, not ready to communicate or express his views. His reaction after attending the fathers funeral completely expressed his grief. Further, he was not able to cope up with his fathers death and was not able to accept his death. My husband came home picked our new-born baby (9months old) and sat on the floor for hours just holding his baby. However, this movement from his side was a sign of positivity or recovery where he was trying to assure his bab y that he will always be there for him. As per my viewpoint, the feeling of responsibility and maturity developed after the death of father helped my husband to recover. Further, the religious belief helped my husband to recover because his family is a believer of God. His religion and religious books, which he used to read, taught him a lot about death and bereavement. My husband started reading spiritual books that explained the concept of death and soul. These reading assured him about the liveliness, responsibilities and presence of his father irrespective of his physical disappearance helping him to recover grief. From my husbands grief, I learned that grief recovery is an automatic process that follows certain stages as described in theories of bereavement. Further, my sister-in-law being younger expressed her grief in a completely different manner that is anger, disapproval and despair for the present situation. She was angry with doctors, God and other family members. She was not able to accept the denial and was not able to deal with her anger due to small age. My sister-in-law was only 13 years by age and not having that sense of maturity to recover like her brother. Therefore, I helped her in recovery by counselling her as a mature person. I explained to her that her father is still supporting her, looking after her and no longer in pain. I told her that fathers soul with God is helping her, she can talk to him and he will surely listen because his soul is still alive. From this experience, I learned that some people express bereavement as anger especially people who are not able to understand the difference between reality and assumptions. The grief form of anger leads to hatred where people even start hating God and blame him for their suffering. However, blaming God for any situation either negative or positive is a natural phenomenon but in death bereavement it requires a control otherwise person develop negativity and depression towards life. Further, my mother-in-law suffered the most because her grief was the longest and deepest one. Suddenly, she became the man and woman of the family as well as father and mother of her children. She was managing everything along without a word of sorrow on her face. She lost her husband, yet a mature reaction shows her spirit and power to deal with grief. I tried my best to support and let there be happiness in her life and family. I worked hard to let all people understand the importance of uniting in the family for moving forward with this situation. However, such a loss cannot be recovered but it is still possible to live with this loss. With this amendment process, all the family members recovered their grief with time. All learned to live with the physical absence but spiritual presence of my father-in-law. As an outcome of the situation, my husband and his sister were more mature, responsible, family-oriented and independent people. My mother-in-law became a dynamic lady with po werful attitude. Therefore, lastly, I can say that loss of sudden death and bereavement brought exceptional quality after recovery in my family members. Case study- 2 Another lifetime experience, I attained that increased my knowledge and understanding about sudden death and grief is my colleague losing his child at a very young age. My colleague Tom and his wife Jenny lost their only child Jack who suffered a sudden accident while returning home from school. Jack was their only child; he was too young only 10 years by age. Tom was my batch mate as well as my colleague at my first job. Tom and jenny got married in their early twenties and had a child in very small age. These are factors that decreased their capability to cope up with such sudden death and they developed an extreme level of grief after the death of Jack. Jenny left her job and was send to the hospital almost 10 times after the death of her son, further following Tom he lost his complete grading and reputation for not concentrating on his work. I observed this situation in their life for almost 2 years. Both of them were in continuous depreciating situation physically, mentally as well as spiritually. With concern to their present situation, I suggested Tom about getting professional counselling for the welfare of his family. Tom agreed to my suggestion and went for professional counselling with Jenny. In almost 5 sessions, Tom started coping up with his past grief and sorrow of losing his child. He told me that he was feeling much better after professional sessions. However, Jennys recovery was not so positive, She was not able to cope and was having continuous thoughts like Why him, He was so young, My child, he is still alive, She once mentioned to counsellor that She saw Jack in the house twice or thrice after 6 months of his deat h. According to Jenny, Jack returned home and was physically present at home complete whole day until Tom arrived from office. This situation explained her deep grief and mental depression developed as an outcome of this grief. As the death of Jack was accidental such response from his mother was an expected one. As per counselling observations, Tom told me that he and Jenny developed guilt for the death of their child both confessed that they are not able to understand, where they went wrong in their parenthood. Jenny is a talkative personality; she kept on blaming Tom and herself for the death of Jack. To overcome this guilt, counsellor tried to establish recovery by determining goals for Tom and Jenny about why they want this counselling, what they wanted to achieve from this counselling and how they will know that they do not need this counselling further. Tom further told me that counsellor provided them knowledge about loss and grief to help in recovery and look forward to better future. Counsellor mentioned about five stages of grief and asked them to determine their stage of grief. This helped both in understanding their present situation. Tom acknowledged that both of them are in different stages of grief however their suffering was similar. To explain this counsellor told them that every person moves and expresses grief stages differently as per their perception, character, strength and conscious. Jenny was in the depression stage whereas Tom identified himself in the first stage of grief that is denial and anger. However, Tom already faced the stage of depression before denial in the first 6 months of bereavement. Therefore, their recovery was occurring in a different manner as per their mental stability. Soon after almost 1 year of counselling, Tom and Jenny started recovering their grief behaviour. Tom was getting back to normal in his professional and personal situation whereas Jenny was now at the stage of acceptance and out of her depression. As per counsellor and doctor advice, Tom and Jenny were planning another child as a conclusion to their recovery because the existence of another child will surely refill the emptiness of their family and life. Almost 4 years after the death of Jack, Tom and Jenny had another child and appearance of the new member in the family was an end to their grief. Case study- 3 As I was working as a deputy manager at one of the most reputed firms in my city there was a sudden incidence that completely shocked the whole organisation. It was a sudden death of my 50 years old CEO in the office premises due to heart failure. This created a shocking situation within the organisation. My CEO Sir, Michael was having a small family with a wife and a young son who just completed his post graduation. His name was Albert, he was our next CEO after Michael owning the huge responsibility in such a small age. Due to certain circumstances and professional decision, the board of directors considered Albert as a perfect replacement of Michael. However, Albert loved his father very much and he was not ready to overtake his position. Albert joined the organisation as per her mothers decision but his grief and sorrow due to death of his loving father were visible in his professional functionality, attitude and behaviour. It is always been said that after the sudden death of loved once, people need time to recover the bereavement occurring due to this loss. People undergo various modifications at their different stages of grief that can be confusing have feelings like anger, loneliness, sadness, silence etc. the stages of grief move from accepting the loss to experiencing, trying and developing recovery. I was able to observe these stages completely in case of Albert. Albert was going through his grief recovery process within his professional circumstances. After joining the office, Albert was behaving in a complete loss; he was confused, nervous, unpredictable and careless towards his responsibilities. He was not able to understand his work even after explaining it more than 5 times by me. I was always there as a helping hand both professionally and personally. But, still, I was not able to manage this situation of Albert because he needed professional help. On a very fine day, I explained Albert about his grief that is visible to complete organisation, which he needs to manage and cope up for the welfare of his fathers dream organisation. I explained Albert about how important this organisation was for his father where he was ready to sacrifice anything for this organisation. Albert listened to me and developed a feeling of guilt for not giving his complete attention towards his work. Albert was ready to quit his position and he remained silent was many days there after this incidence. I was also becoming hopeless and was not able to help Albert in any condition. However, as an account of stability, Albert worked upon his drawbacks. After few months, he was willingly participating in office activities and was observed to be better. Slowly and steadily after 6 months of Michaels death, Albert recovered from his grief and was ready to take his responsibility as a mature person. Albert was now a better person having a positive attitude towards life with no anger, confusion and denial regarding his professional responsibility. The good thing was that he recovered his grief by himself without any professional advice and co unselling, this explains his tremendous strength and willpower just like his father. In this case, I was practically able to observe all the stage of grief and bereavement as a personal experience. Evaluation of case studies by comparison between the examples relating them to theories All the above-described case studies are the personal and professional experience of sudden death and its consequences in form of bereavement occurring with people attached to the descendant. With reference to the case study one that was my personal experience of death and grief in my own family I observed that people have a different capability to cope up with their sorrow. This experience completely proves the fact mentioned in Lindemann (1944) theory that bereavement is a psychological phenomenon, which is indicated in form of phases. Not only case study one but all the case study proves that Lindemann phases of bereavement are completely correct. All the vulnerable or grief sufferers in all the case studies faced one or the other symptom of grief as mentioned by Lindemann. These symptoms are clinical, psychological, mental or spiritual but are related to their grief. In case study one, my husband developed depression, in case study two Tom developed stress, guilt and Jenny were i maging the deceased person and in case study three of Albert developed spiritual loneliness and mental depression. Further, case study one completely disproves the Kubler-Ross five-stage model where it is mentioned that bereavement is a five stage linear process. In the case study one, I observed bereavement recovery of three persons that are my husband, sister-in-law and mother-in-law. All the three completely their recovery irrespective of the five-stages model where her husband developed depression prior to bargaining and sister-in-law entered bargaining stage after the depression. My sister-in-law was in depression but positive counselling approach adopted by me helped her to bargain and accept the situation. Hence, Kubler-Ross five-stage model is a complete failure in this case. Further, all the case studies completely accept the Bowlbys attachment theory where it is observed that grief is an outcome of attachment, mutual relationship and interactions. In the case study one, I didnt go through any grief because I shared a low level of interaction with her father-in-law whereas other family members developed grief due to their attachment relationship with the deceased person. Further, in the case study two, Tom and Jenny had a strong relationship with their child; therefore they faced tremendous grief after his death and proved that Bowlbys theory of attachment is completely true explaining death and bereavement. The Parkers four-stage theory of shock, pining, despair and recovery was completely applicable to the case study of Tom and Jenny where they both followed this stage process model in recovery irrespective of start and end time of recovery. Further, Shut and Strobe 1999 theory describing two stage recovery processes that are the loss-oriented process and restoration oriented process are applied in case study two by the counsellor. The counsellor adopted a recovery-oriented process to let Tom and Jenny overcome their grief that ends up with having another child replacing the grief of their child loss as a restoration. Further, the professional counsellor in case study two also used Worden 1991 four-task recover from grief. The professional initiated recovery of Tom and Jenny by helping them to accept the loss, work with their own pain; start adjustment without Jack by getting the new child and move on in life with the new birth. However, case study three that was about Albert suffering grief of his fathers death proves the Kubler-Ross five-stage recovery process that is completely disproven in other two case studies. In the case of Albert, I personally experienced that his recovery was a self-recovery process that was a five-stage process involving denial, anger, bargaining, depression and acceptance (DABDA) as a self-motivated phenomenon in the life of Albert. His recovery was a complete example of Kuble-Ross five stage recovery model. Hence, from the above evaluation, it is clear that all the theories somehow or the other fits into the grief explanation of different case studies depending upon the situation, suffering, vulnerability and perception of the bereavement person. Bereavement is a complex phenomenon that cannot be explained with the help of one theory or understanding because it is applicable to different human perceptions, attitudes, intuitions, behaviour, conscious, understanding and knowledge. Therefore, as all humans are not same their grief suffering and recovery is also not similar. The recovery fluctuates as per different factors leading to acceptance and rejection of different bereavement theories and explanations. Conclusion From the research study, it is clear that bereavement arising because of loss (death) is a complex phenomenon that is been explained by different scientific viewpoints and perceptions. Each scientific theory that is widely accepted to explain bereavement and death shows different understandings about death and explain bereavement in the best possible manner. In this research, three personal and professional experiences of mine about death and bereavement are evaluated as per these academic theories to understand death and bereavement. As per literature underpinning, the Lindemann 1944, Kubler-Ross five-stage model 1969, Bowlbys attachment theory, Worden 1991 recovery task theory, Parkers four-phase grief model and Strobe 1999 two-process model of recovery are best possible and acceptable theories that explain grief and death. However, each and every theory shares a different viewpoint and perception about the death, bereavement and recovery process. To test the acceptance and rejection of these theoretical perceptions, research is based on evaluating three case studies as per these theories. All the case studies support the Bowlbys attachment principle and Lindermann theory about grief. The case study one being my personal experience of grief completely rejects the Kubler-Ross five-stage recovery process whereas case study three about Albert proves that Kubler-Ross five-stage recovery is a perfect recovery process from grief. Further, case study one and two are perfect examples of Shut and Strobe 1999 two types recovery process where in case one loss recovery process and in case two restoration recovery process is used to recover. Further, case study two is a perfect acceptance of Worden 1991 task based recovery process and Parkers four-stage theory. Hence, this research based on case study evaluation about death and bereavement clearly indicate that all theoretical explanations are workable depending on the grief situation, vulnerable perception and attachment with the deceased person. From research study, it can be concluded that understanding about death and bereavement as per psychological concepts is a complex phenomenon that varies as per circumstances and understanding of human mind. Therefore, a more focused and specific approach based theory that is applicable to all situations is required to explain death and bereavement. However, still, the provided theories and models are satisfactory enough to understand bereavement in different situations. Bibliography Bell, E. and Taylor, S., 2011. Beyond letting go and moving on: New perspectives on organizational death, loss and grief.Scandinavian Journal of Management,27(1), pp.1-10. Breen, L.J. and O'Connor, M., 2011. Family and social networks after bereavement: experiences of support, change and isolation.Journal of Family Therapy,33(1), pp.98-120. Bremer, A., Dahlberg, K. and Sandman, L., 2012. 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