Loss and Grief
The Aging Survival Kit
Grief: A Universal Experience
 “To spare oneself from grief at all cost
can be achieved only at the price of total
detachment, which excludes the ability to
experience happiness.”
Erich Fromm (1900-1980)
Five Stages of Grief
(Kubler-Ross, 1969)
 Denial: The initial stage: “It can’t be happening.”
 Anger: “Why ME? It’s not fair?!” (either referring
to God, oneself, or anybody perceived, rightly or
wrongly as responsible)
 Bargaining: “Just let me live to see my son
graduate.”
 Depression: “I am so sad, why bother with
anything?”
 Acceptance: “It’s going to be OK.”
Five Stages of Grief, Continued
These stages of grief do not come in order. They
can be applied to any form of catastrophic life
losses:
 Loved One
 Employment
 Home
 Income
 Freedom
 According to Kubler-Ross a person
simultaneously experiences two of the stages at
any given time.
Understanding Loss
(Rando, 1984)
 Avoidance: Shock, denial, disbelief, confusion,
disorganization.
 Confrontation: “highly emotional state wherein
the grief is most intense and the psychological
reactions to loss are felt most acutely.”
 Reestablishment: “gradual decline of the grief
and marks the beginning of an emotional and
social reentry back into the everyday world” (pp.
28-29).
Understanding Loss, Continued
According to Rando, the griever will:
 Acknowledge, accept, and understand the
reality of the loss.
 Experience the pain of the grief and react
to the separation from that which is lost.
 Adapt a new way of life.
 Reinvest in a new way of life.
Anticipatory Mourning
(Rando, 2000)
“The phenomenon encompassing seven generic
operations:
 Grief
 Mourning
 Coping
 Interaction
 Psychosocial reorganization
 Planning
 Balancing conflicting demands
 Facilitating an appropriate death” (p. 51)
Disenfranchised Grief
(Doka, 2002)
According to Doka: “this grief is experienced in
connection with a loss that is not socially
acknowledged, publicly shared, or supported
through usual rituals. The significance of the loss
is either not recognized or the relationship
between the deceased and the bereaved is not
socially sanctioned, the person suffering the loss
is given little or no opportunity to mourn publicly.
It is experienced when the relationship is not
recognized (lovers, ex-spouses, same-sex
partners, close friends), when the loss itself is
not recognized (stillbirth, miscarriage, abortion,
adoption, pet loss), when the griever is not
recognized (very young, very old,
developmentally disabled). The manner of death
itself can be disenfranchising (murder, suicide,
AIDS). When such deaths are treated as less
than significant losses, the process of grieving
becomes more difficult.”
The Grief Process
(Worden, 1982)
The Tasks of Grief:
 To accept the loss
 Experience the pain
 Adjust to the new environment
 Reinvest in the new reality
Complicated Grief
(Worden, 2001)
 Chronic Grief: One that is prolonged, is excessive in
duration, and never comes to a satisfactory
conclusion.
 Delayed Grief: Emotion that has been “inhibited,
suppressed, or postponed.” A subsequent loss may
elicit an exaggerated reaction because the bereaved is
grieving for two losses.
 Exaggerated Grief: Occurs when feelings of fear,
hopelessness, depression, or other symptoms become
so excessive that they interfere with the daily
existence of the bereaved.
 Masked Grief: Symptoms and behaviors experienced
by a person who does not recognize the fact that
these are related to a loss.
Case Study
Mr. and Mrs. B. have been married for 50 years.
They have been in good health and have been
enjoying retirement (traveling, seeing their
grandchildren and sleeping until noon!)
Both Mr. and Mrs. B. will be turning 70 this year
and the family are planning a BIG surprise party.
One morning Mrs. B. wakes up and she can not
move the left side of her body. Mr. B. calls an
ambulance and the family physician. Mrs. B. is
taken to the hospital.
Case Study, Continued
Upon Mrs. B.’s arrival at the hospital you have been
assigned as her social worker. You have just been to a
workshop on loss and grief and have been reviewing
the powerpoint (Yes, this one!). What do you consider
to be the most pressing medical, psychosocial, and
spiritual concerns that they will both face?
What will grief look like to:
Mr. B
Mrs. B
Their family (all 30 people!)
How will you, as the social worker, provide a therapeutic
intervention that will meet their needs.
Is meeting everyone’s needs possible or realistic?
“Who Dies?”
(Levine, 1982)
“How much of what we call grief is the
experience of previous loss? And how do
we allow such grief not to be a motivator
for our life? How do we get in touch with
that deep pain, that place of loss that
creates a fear of life itself, our doubt in
ourselves about our ability to deeply
experience the world because we so fear
loss and change?”
Bibliography
Gehlert, S., & Browne, T.A. (2006). Handbook of
Health Social Work. Hoboken, NJ: John Wiley &
Sons, Inc.
Levine, S. (1982). Who Dies? An Investigation of
Conscious Living and Conscious Dying. New York:
Anchor Books.
Kubler-Ross, E. (1973). On Death and Dying. New
York: Routledge.
Kubler-Ross, E., and Kessler, D. (2005). On Grief and
Grieving: Finding the Meaning of Grief Through the
Five Stages of Loss. New York: Scribner.