Tuesday, December 10, 2013

Final Reflection

     For my final entry my professor asked for a reflection on the class and project. This course was very valuable to me as a student. We learned many different theories of grief, loss, and coping. But what I will really take away from this course is a new sense of empathy. I learned to broaden my definition of "loss" and more readily accept different kinds of grief. I've always believed that one's experiences are relative to their own life. Now I know one's experience of loss is the same and one can only cope with the mechanisms they have available to them, making their experience entirely unique. There is no "right" way to grieve or "right" time to feel loss or not, for that matter. It is our jobs as mental health professionals to help validate our clients grief so that they might begin to heal.

     This project was also extraordinarily eye-opening for me. Prior to this class and project, I believed "loss" meant: someone you loved died. What I learned through this project was that the meaning is so much more broad and deep than that. It is, perhaps, almost impossible to realistically define. I also came to value, strongly, the ability for one to find closure. Through my research I have come to discover that the most painful thing, after the initial loss, is the inability to get closure. I am very concerned for the populations I research who are experiencing ambiguous loss or whose grief is disenfranchised. The inability to find closure is, essentially, like reliving the loss over and over and over. Through this research I have come value the research being done with groups of people experiencing ambiguous loss and disenfranchised grief. It is integral that this research continue so that we can continue to understand and serve these populations.

     In conclusion, I am extremely grateful for this assignment. Not only has it equipped me to empathize with future clients, I feel it has made me a better person. I am far more well-informed on loss now than I was at the beginning of the semester or ever would be without the aid of this class. I even gained a little closure for myself in the process. I urge any one, student or no, reading this to broaden your understanding of loss and grief. Empathy is the first integral step and it will take us miles in the field of ambiguous loss and disenfranchised grief.

Sunday, December 8, 2013

Dr. Jeffrey Kreutzer on Ambiguous Loss

    These are a few great videos explaining ambiguous loss and a few different kinds of ambiguous loss. Dr. Kreutzer has worked closely with Dr. Pauline Boss (whom I wrote about in my previous post, Ambiguous Loss of a Loved One) who did much of the pioneer work on this topic. The focus of his work is the ambiguous loss faced by families with a member who has experienced a traumatic brain injury.

Disenfranchised Grief Experienced by the Familes of Death Row Inmates

     In my last post I talked about challenging my own ideas of grief and broadening my definition. The article on the disenfranchised grief of the descendants of Nazi perpetrators got me thinking. What other kinds of families are experiencing disenfranchised grief? Then it hit me: the families of death row inmates. I began searching through scholarly journals, hoping someone had done some work in this particular area of loss. I found this article; Disenfranchised Grief and Nonfinite Loss as Experienced by the Families of Death Row Inmates by Sandra Jones and Elizabeth of New Jersey and Georgia, respectively. The authors acknowledge that the issues facing these families are neglected by society and clinicians alike and that it is important to try to understand their unique pain and circumstances. The authors of the study interviewed twenty six family members of death row inmates who are incarcerated along the East Coast of the United States. Of the families interviewed one wife of a death row inmate said this about her pain, "I really can't put it into words...anguish, I guess..." The brother of another inmate stated that it felt as if, "...someone had died in the family...". These statements present a clear view of how ambiguous this kind of loss is for these family members.

     One particularly unique scenario that faces families with a member on death row is the appeals process. One might assume this would present on opportunity for hope, but that is not the case. Often families said that appeals only confirm the death sentence, effectively dashing any hope whatsoever. One interviewee states that the appeals process made them feel as if they were, "reliving the worst days since the arrest". Another loss commonly experienced by many of these families was the loss of support from their nuclear families and other social circles. These family member essentially had to face the entire process alone, with absolutely no support. Another unique and intriguing commonality of loss cited by many of those interviewed was a loss of a sense of self. One mother said she had always thought she was a "good mother" until the crime (committed by her son) had occurred. Last, but most certainly not least, there is the contempt the families experience from practically everyone they interact with including lawyers, judges, prison guards, strangers, and even close friends.

     I think there is still much to be learned about the grieving process of individuals in this particular situation. However, this study is an exceptional start. The article states, "Despite the intensity and uniqueness of their experience, there has been little written about this population in general and less about their grief. Yet, it is because of the intensity and uniqueness...[that it is] important for future research.". Studies have shown families of death row inmates largely suffer from dsythymic depression, PTSD, social isolation, and stigmatization. I believe it is the responsibility of the mental health community to continue to work to understand this population in order to serve their needs as best we can.

     Jones, S. J., & Beck, E. (2006). Disenfranchised grief and nonfinite loss as experienced by the families of death row inmates. Omega: Journal Of Death And Dying54(4), 281-299. doi:10.2190/A327-66K6-P362-6988



Saturday, December 7, 2013

Disenfranchised Grief of the Descendants of Nazi Perpetrators

     Part of the reason I took on this topic for this project was to broaden my definition of grief and challenge my own stigmatized view of it. When browsing for information and articles on ambiguous loss and disenfranchised grief I came upon an extremely interesting article about the disenfranchised grief that is experienced by the descendants of the Nazi regime. I chose this article to read and reflect on because, honestly, it is not a kind of grief I would have ever considered and I almost looked right over it. This paper, titled, Opportunists for Mourning When Grief is Disenfranchised: Descendants of Nazi Perpetrators in Dialogue with Holocaust Survivors, was written by Kathy Livingston of Quinnipac University in Connecticut was written to document and analyze a new and growing phenomenon. As the children of Nazi perpetrators grow into adults and start their own families they are coming up against awful stigmas of grief. It would seem that just about no one sympathizes with one who is grieving for a Nazi. I hate to say, I am not surprised. What does surprise me, however, is one of the only groups that adult children of Nazi perpetrators are receiving sympathy from is Holocaust survivors. According to the paper, dialogue groups consisting of multiple generations of perpetrator's families, survivors, and survivors and victims families are coming together to talk about their grief. Though the article is a scholarly one, and a valuable one, I couldn't help myself from focusing more on the amazing power of forgiveness and the resiliency of the human spirit. Children and grandchildren of Nazi perpetrators have been living a silent grief for years, unable to express their pain. They grieve over what there ancestors did during the time of the Third Reich and, a bit more confusingly, the loss of these people. Livingston states that as a group the second and third generations of the Nazi regime can be characterized by the, "secrecy, anger, and shame they experienced as they pursued knowledge of their parents’ involvement in the Holocaust". Not until I read this paper would I ever had considered the difficulty in both despising what a loved one stood for but mourning them at the same time. She goes on to describe the differences between grief, an almost entirely reactive process, and mourning. Mourning, she says, is "active rather than reactive, and involves intentional and deliberate attempts to cope with the loss...". She emphasizes the need for these generations to mourn, whatever they may mourn.

     In conclusion, this article really opened my eyes even further about the needs of those who are experiencing disenfranchised grief. Also the need of mental health professionals to continue to expand their knowledge of the topic and empathy for those who are experiencing disenfranchised grief or ambiguous loss. This article reminded me of how I must never assume to know what someone is going through or think that their experience of loss is invalid.

Until next time,
Be Well.

     Livingston, K. (2010). Opportunities for mourning when grief is disenfranchised: Descendants of Nazi perpetrators in dialogue with Holocaust survivors. Omega: Journal Of Death And Dying61(3), 205-222. doi:10.2190/OM.61.3.c

Perinatal Loss and Disenfranchised Grief

     While exploring the subject of disenfranchised grief and ambiguous loss I came upon a paper titled, Perinatal Loss and Parental Grief: The Challenge of Ambiguity and Disenfranchised Grief.  This published work outlined a study conducted by Dr. Ariella Lang and assistants. The purpose of this study was to identify sources of ambiguity unique to those experiencing perinatal loss and identify how they may contribute to disenfranchised grief. For those who are not already familiar with the term, perinatal loss is the death of an unborn or newly born baby. For the purpose of the study the authors considered ecotopic pregnancies (pregnancies that take place outside the uterus), miscarriages, stillbirths, and neonatal deaths. Thirteen couples were interviewed at two, six, and thirteen months after the death of their child. The sources of the most ambiguity for these couples were identified as ambiguity a) about the viability of the pregnancy, b) about the physical process of losing the pregnancy, c) arrangements for the remains, and d) sharing the news of the loss. Like any loss the bereaved often ask themselves, "How?" and "Why?", but the how's and why's are different for each particular situation and the loss of a neonate is no exception. The study also concluded that there are three main kinds of disenfranchised grief that the bereaved experience after the death of a baby. These are identified as disenfranchised grief a) within the relationship of the couple, b) when communicating with health professionals, and c) when interacting with extended family and community. The couples in this study found it increasingly difficult to express their grief to health care professionals, family and friends, and even each other. In the discussion the author said this of their study,  "The findings of this study help improve our understanding of how many textures of ambiguity ,ambiguous loss, and disenfranchised grief contribute to bereaved couples' suffering and influence their mourning experience surrounding perinatal death". (Lang et al)

       Studies like this are incredibly important to begin to understand and sympathize with those experiencing an ambiguous loss. Empathy is the first and most crucial step we can take when conducting studies of this nature. But there is also the clinical implications of these studies that are vital to providing care for the bereaved. This study particularly calls for sensitivity from health care providers and more well-developed and enforced protocols following the death of a baby. Also, the information gleaned from these interviews and subsequent analysis of them should allow mental health care providers to choose or create a more adequate therapy for those that seek it.

      Lang, A., Fleiszer, A. R., Duhamel, F., Sword, W., Gilbert, K. R., & Corsini-Munt, S. (2011). Perinatal loss and parental grief: The challenge of ambiguity and disenfranchised grief. Omega: Journal Of Death And Dying63(2), 183-196. doi:10.2190/OM.63.2.e

Saturday, November 30, 2013

Re-enfranchising Grief Due to Pet Loss

     A kind of disenfranchised loss that hits close to home for me is the loss of a pet. I mentioned in an earlier post about my cat but just before I adopted her I lost my dog, Nala. Nala was a Staffordshire terrier mix who my family rescued from the ASPCA when I was just a young girl and, I don't care how cliche it sounds, she was the best dog ever. We lost her during my senior year of high school and I distinctly remember how hard it was with no one in my immediate social circle to "get it". Of course my friends understood why I was upset but after a week or so I was expected to get over it and return to completely normal function. It has been five years since her passing. My younger brother can't talk about her without tearing and my mother still refuses to adopt another pet because the loss of Nala was so hard on her.

     Dr. Millie Cordaro is making an effort to understand and re-enfranchise this kind of loss. She has recently published a paper on creating a grief model for clients experiencing pet loss. She does this by conceptualizing the grief of pet loss using Elizabeth Kubler-Ross' model of stage-based theory and two contemporary theories, dual-process theory and adaptive grieving theory. She acknowledges the importance and strength of the bond a pet owner feels to his or her pet and the increasingly important roles pets are playing in our lives. Her findings were that bereaved pet owners were more likely to experience "silent" grief due to insufficient social support. This kind of grief is link with intensified grief reactions and long-term unresolved grief. Her suggestion is the grief counselors acknowledge and empathize with clients experiencing this kind of loss and should make an effort to recommend resources and refer clients to support groups. She says this in closing, "Considering pet loss as a normative grief process is not only an indication
to bereaved pet owners that their loss is valued, it is also an initial step toward reinstating within our society a stigmatized grief."

Cordaro, M. (2012). Pet loss and disenfranchised grief: Implications for mental health counseling practice. Journal Of Mental Health Counseling34(4), 283-294.

Thursday, November 28, 2013

The Disenfranchised Loss Experienced by Birth Mothers

      Another kind of disenfranchised loss worth mentioning is the loss experienced by mothers who are placing their children for adoption. This is not a kind of loss I had ever considered before this project. However, my eyes are opening and my definition of loss becoming more expansive and inclusive. During my research on the topic of loss experienced by birth moms I discovered an organization doing great work for birth moms. Birth Mom Missions is a non-profit organization created by and for birth mothers of adoption. Their mission is to offer services and support to women who have or are placing their child through adoption. According to the Journal of Obstetric, Gynecological, and Neonatal Nursing, "the relinquishing mother is at risk for long-term physical, psychological, and social repercussions. Although interventions have been proposed, little is known about their effectiveness in preventing or alleviating these repercussions."

    Brooke, the found of Birth Mom Missions, has created an affiliated YouTube page where she promotes her organization but also talks about a lot of the personal aspects of her experience with adoption. I think this is a wonderful way for her to not only reach out to birth moms but, also, to inform a potentially uninformed population on the aftermath, for lack of a better word, of putting your child up for adoption. Here is a video from her YouTube channel. I encourage you to watch it and to check out the organization. 

As always; thanks for reading and please remember to be sensitive, understanding, and always broaden you definition of "loss".

Until Next Time,
Be well.