COMMUNICATING WITH THE COMMUNITY ABOUT GRIEVING: A DESCRIPTION AND REVIEW OF THE FOUNDATIONS OF A BROKEN LEG ANALOGY OF GRIEVING

With loss permeating the lives of all people throughout the entire life span and its potential for serious long-term deleterious effects, providing effective care for those experiencing situations of loss would be an important element of any preventive community-based mental health promotion approach.The low use of mental health services by those confronted with loss, and the lack of such services in many areas, makes it imperative to enhance the competency of the broader community to provide appropriate care during times of loss. Contributory to such care is a sound knowledge of the literature concerning loss and grieving. The broken leg analogy of grief presented in this article integrates the traditional and emerging grief theories and empirical evidence into an analogy of grieving that can be easily communicated to the general community, is relevant to many losses, and yet upholds the differing positions concerning grieving held by various schools of psychiatric thought.     

THE ROLE OF CARDIAC REHABILITATION IN DEALING WITH PSYCHOLOGICAL LOSS AMONG SURVIVORS OF A CARDIAC EVENT

The aim of the current study was to examine the experiences of cardiac rehabilitation (CR) patients within the framework of psychological loss. All participants in this study reported experiencing losses of some nature, some of which were tangible and others less so. However, these do not appear to be strictly independent from each other in that tangible losses, such as loss of income, were underpinned by intangible losses, such as loss of self-esteem. For CR patients, it seems that the losses reported are experienced at more than one level.The first is an externally visible and objectively quantifiable level (for example, loss of occupation) , whereas the second is a more symbolic, phenomenologically based level (for example, loss of purpose as previously defined through one's occupational role). The CR program examined in this study helped patients to effectively deal with these losses and to experience additional developmental gain.     

TEACHING ABOUT LOSS

In this article, we develop a case for teaching about loss as part of social and behavioral science curricula. We discuss the first author's development of a class that focuses on loss and trauma. This class emphasizes the view of loss as a pervasive aspect of human life and that it is the core experience for other phenomena, including trauma and chronic illness. The course involves a component in which students write about some loss experience that may reflect their personal life. This component permits many students to express pain, sometimes for one of the first times in their lives, regarding the events in question and relate their experience to what they have learned in the course. Significant features of the course are a score of videos and guest presentations, documenting the diversity of loss and people's myriad ways of coping with loss. It is argued that the course and students' experiences in fulfilling course requirements speak to the gains that may be realized by honest, in-depth probing of losses within the context of psychological and other literatures.     

Social Comparison in Medically High-Risk Pregnant Women1

The present study examined social comparison processes in 147 pregnant women at high risk of incurring an adverse birth outcome such as fetal loss or preterm delivery. These women typically undergo physical and psychological changes which elevate uncertainty and distress. Theoretically derived hypotheses concerning the impact of threat, self-esteem, perceived control, age, and gravidity (previous pregnancy) on social comparison were tested. Women experiencing low pregnancy-related threat and those with higher self-esteem were more likely to compare themselves favorably to other pregnant women. Younger women who had not been pregnant before compared most frequently; comparisons of physical state were more common than comparisons of emotional well-being or interpersonal relationships. Results are contrasted with social comparison processes in other populations facing stressful life events.     

Adverse Life Events, Coping and Internalizing and Externalizing Behaviors in Urban African American Youth

African American youth residing in low income urban neighborhoods are at increased risk of experiencing negative life events in multiple domains, increasing their risk for internalizing and externalizing behaviors. However, little is known about youth’s differential responses to life event stress, or protective processes and coping strategies for urban African American youth exposed to adverse life events. Thus, the present study examined whether variability in predominantly low income, urban African American youth’s responses to life event stress are accounted for by the type of life event experienced or the type of coping strategies used. Participants were a community sample of 353 urban African American youth (52.8 % girls; age range 8–12 years) who participated in the Multiple Opportunities to Reach Excellence (MORE) Project. Youth reported about their experiences with adverse life events, coping strategies, and internalizing and externalizing symptoms. Results indicated that violent life events were uniquely associated with externalizing behavior, while discrimination and economic stress were uniquely associated with internalizing behavior. The utility of coping strategies varied by gender, such that avoiding problems was protective for girls who experienced violent life events, but not for boys. For boys, exposure to violence was significantly positively associated with externalizing symptoms regardless of the amount of avoiding problems coping used. Findings suggest that interventions to develop coping strategies may need to be gender-specific as well as tailored for the types of stressors common for low income urban youth.     

Traumatic loss and major disasters: strengthening family and community resilience

This article presents the core principles and value of a family and community resilience-oriented approach to recovery from traumatic loss when catastrophic events occur. In contrast to individually based, symptom-focused approaches to trauma recovery, this multisystemic practice approach contextualizes the distress in the traumatic experience and taps strengths and resources in relational networks to foster healing and posttraumatic growth. The intertwining of trauma and traumatic losses is discussed. Key family and social processes in risk and resilience in traumatic loss situations are outlined. Case illustrations, model programs, and intervention guidelines are described in situations of community violence and major disasters to suggest ways to foster family and community resilience.     

Relationship Between Specific Adverse Life Events and Psychiatric Disorders

This study examines whether certain psychiatric disorders are associated more closely with adverse life events than other disorders are, and whether some adverse life events are associated with a specific group of disorders (e.g., depressive disorders), but not with other disorders (e.g., anxiety disorders). A probability sample of youth aged 9–17 at 4 sites is used (N = 1,285). Univariate and multivariate logistic regressions identify specific relationships between 25 adverse life events and 9 common child and adolescent psychiatric disorders, measured by the Diagnostic Interview Schedule for Children. Conduct Disorder, Oppositional Defiant Disorder, Major Depressive Disorder, and Dysthymia are significantly associated with many of the adverse life events examined, whereas Attention Deficit/Hyperactivity Disorder, Agoraphobia, and Social Phobia are related to very few. This study suggests that certain psychiatric disorders may be more closely associated with adverse life events than other psychiatric disorders are, and that some adverse life events seem to be related to specific types of disorders.     

Loss aversion in the eye and in the heart: The autonomic nervous system's responses to losses

The common view in psychology and neuroscience is that losses loom larger than gains, leading to a negativity bias in behavioral responses and Autonomic Nervous System (ANS) activation. However, evidence has accumulated that in decisions under risk and uncertainty individuals often impart similar weights to negative and positive outcomes. We examine the role of the ANS in decisions under uncertainty, and its consistency with the behavioral responses. In three studies, we show that losses lead to heightened autonomic responses, compared to equivalent gains (as indicated by pupil dilation and increased heart rate) even in situations where the average decision maker exhibits no loss aversion. Moreover, in the studied tasks autonomic responses were not associated with risk taking propensities. These results are interpreted by the hypothesis that losses signal the subjective importance of global outcome patterns. Copyright © 2010 John Wiley & Sons, Ltd.     

Sacrilege: A Study of Sacred Loss and Desecration and Their Implications for Health and Well-Being in a Community Sample

In this study, we proposed that people understand major life events in terms of spiritual as well as psychological, social, and physical dimensions. Specifically, we examined the possibility that life events that are perceived to be sacred losses or violations of the sacred (i.e., desecrations) have significant implications for the health and well-being of the individual. A total of 117 adults, randomly selected from a community, identified the most negative life event they had experienced in the past two years. They then completed measures of the degree to which they appraised this event as a sacred loss and as a desecration, as well as measures of religious coping, the impact of the event, and four sets of criteria: traumatic impact, physical health, emotional distress, and growth. These hypotheses were largely supported. Sacred loss and desecration were unrelated to physical health. However, they were tied to higher levels, though somewhat differential patterns, of emotional distress. While sacred loss was predictive of intrusive thoughts and depression, desecration was tied to more intrusive thoughts and greater anger. Furthermore, sacred loss was linked to greater posttraumatic growth and positive spiritual change; in contrast, desecration was associated with less posttraumatic growth. The links between the spiritual appraisals and outcomes were partially mediated by positive and negative methods of religious coping. These findings underscore the importance and multidimensionality of the spiritual meanings people attribute to major life stressors.     

Proximal Predictors of Depressive Symptomatology: Perceived Losses in Self-Worth and Interpersonal Domains and Introjective and Anaclitic Mood States

Although much research has demonstrated a relationship between negative life events and depressive symptoms, relatively little research has examined the mechanisms that may mediate this relationship. The theories of Blatt (1974), Bowlby (1980), and Gilbert (1992) each propose proximal predictors of depression. In accordance with these theories, this study examined the relationships among perceived losses in self-worth and interpersonal relationships, anaclitic (dependent) and introjective (self-critical) mood states, and depressive symptoms following a significant negative life event. A sample of 172 undergraduate students completed measures of depressive symptoms and depressive vulnerability factors and retrospectively described the worst period of their lives. They also rated the extent to which the events surrounding this worst period affected their self-worth and their relationships with close others. Structural equation modeling demonstrated that the effect of a perceived loss of self-worth on depressive symptoms was fully mediated by both introjective and anaclitic mood states, whereas the effect of a perceived loss of interpersonal relationships on depressive symptoms was fully mediated by an anaclitic mood state. Additionally, perceived losses of self-worth showed a stronger effect on introjective mood in highly self-critical individuals. Findings highlight the importance of perceived losses in both self-worth and interpersonal domains in response to adverse life events and suggest pathways through which perceived losses may affect depressive symptoms.     

Proximal predictors of depressive symptomatology: perceived losses in self-worth and interpersonal domains and introjective and anaclitic mood states

Although much research has demonstrated a relationship between negative life events and depressive symptoms, relatively little research has examined the mechanisms that may mediate this relationship. The theories of Blatt (1974), Bowlby (1980), and Gilbert (1992) each propose proximal predictors of depression. In accordance with these theories, this study examined the relationships among perceived losses in self-worth and interpersonal relationships, anaclitic (dependent) and introjective (self-critical) mood states, and depressive symptoms following a significant negative life event. A sample of 172 undergraduate students completed measures of depressive symptoms and depressive vulnerability factors and retrospectively described the worst period of their lives. They also rated the extent to which the events surrounding this worst period affected their self-worth and their relationships with close others. Structural equation modeling demonstrated that the effect of a perceived loss of self-worth on depressive symptoms was fully mediated by both introjective and anaclitic mood states, whereas the effect of a perceived loss of interpersonal relationships on depressive symptoms was fully mediated by an anaclitic mood state. Additionally, perceived losses of self-worth showed a stronger effect on introjective mood in highly self-critical individuals. Findings highlight the importance of perceived losses in both self-worth and interpersonal domains in response to adverse life events and suggest pathways through which perceived losses may affect depressive symptoms.     

Self-Appropriation between Social Mourning and Individuation: a Qualitative Study on Psychosocial Transition among Jehovah’s Witnesses

Pastoral Psychology - Loss and its associated grief are important elements of many adverse life events. The focus of this study is centred on a particular form of mourning: the affliction derived...     

Maternal sensitivity during infancy and subsequent life events relate to attachment representation at early adulthood.

A prospective longitudinal research study of 86 prematurely born children from birth to age 18 years provided empirical evidence for continuity from infancy experience to representations of attachment at age 18 years. Young adults whose representation of attachment was dismissing had been objectively observed during infancy, 16-17 years earlier, to receive less sensitive maternal care than those infants who were later judged at early adulthood to have secure or preoccupied representations. Infancy experience alone did not differentiate young adults with secure representations from those with preoccupied representations. Rather, adverse life events through age 12, particularly parental divorce, reduced the likelihood of secure representations and increased the likelihood of preoccupied representations. The absence of adverse life events did not increase the likelihood of security for those who had not experienced early sensitive caregiving.     

Factors influencing placement recommendations for hospitalized individuals with chronic mental illness

This study was undertaken to identify factors that may preclude a patient's discharge from a community mental health center and result in the patient being labeled "unplaceable." Placement recommendations differed between the state hospital staff and a mental health professional employed by the center to evaluate 28 patients. A measure designed to assist in the assessment of patients' competencies suggested the professionals' recommendations were more related to patients' skills in areas associated with community living than were those of the state hospital staff. Follow-up indicated that 15 patients discharged according to the professionals' recommendations maintained community tenure. Use of a more psychometrically sound and comprehensive assessment concerning discharge and placement may improve likelihood of success.     

Lesbian Grief and Loss Issues in the Coming Out Process

This article explores the concept of loss during the lesbian coming out process. A five-stage model is proposed which examines the process of grieving various losses such as the loss of the heterosexual lifestyle, rituals of marriage and divorce, societal acceptance of the relationship, and possible loss of the esteem of family and community. Ethnicity and life stages are discussed. Clinical interventions are proposed.     

Aging: Downward,upward, or forward?

Life views are dominated by an iconic illusion that forces the span of life into a low-high-low sequence of stages. Aging is seen as loss, decline, a downhill course. But while there are losses in aging, there are also gains, and empirical observations show that many persons enjoy getting older. From a psychodynamic viewpoint the losses in aging, though painful, are made bearable by considerable gains that afford new pleasures. Aging's gains and losses are described, leading to the conclusion that the life course is neither upward nor downward, but a forward movement full of new discoveries.     

Life satisfaction in old age: linking social psychology and history

A life course perspective on aging assumes that adaptation is governed by factors beyond the immediate situation. Using longitudinal data on 79 women from the 1900 generation of the Berkeley Guidance Study, we examined how social and psychological factors interact over time in the course of successful aging, as expressed by life satisfaction. The consequences of adaptive resources in early adulthood vary in relation to social class. Intellectual skills in 1930 indirectly predict life satisfaction in old age for women from the working class, whereas emotional health is more influential in the life satisfaction of women with higher class origins. Social activity in old age makes a difference only in the lives of women from the working class. Finally, adaptation to old age is related to women's experiences with past stressful events. Middle-class women in 1930 showed gains attributable to Depression hardship (1930s), whereas the life satisfaction of women from the working class was diminished by such hardships. Several mechanisms are discussed that may link widely separated problem situations and life events across the life course. The analysis provides empirical support for the proposition that the influence of social change on life trajectories is contingent on what individuals bring to change situations.     

Pregnancy as a stressful life event

Pregnancy and childbirth typically are associated with positive emotions and with motherhood, but the reality is that this is not the case for all women or for all pregnancies. This review addresses a different aspect of these reproductive events, focusing on stressful circumstances surrounding pregnancy, as well as times when the pregnancy itself becomes a stressful life event. Pregnancy-related topics that tend to receive less attention will be emphasized. These include issues related to infertility; unplanned pregnancy; stress associated with testing and diagnosis of common medical complications; peripartum cardiomyopathy; fear of childbirth; and pregnancy loss as a risk factor for psychopathology. Epidemiologic information will be presented, as will relevant psychosocial factors related to each phenomenon. Healthcare providers should be sensitive to the distress and anxiety experienced by many women and their families as a consequence of these adverse events and the stressful challenge of any consequential decision-making, as well as stressors in their broader life context that can further exacerbate their distress, and make mental health referrals as appropriate.     

Maternal separation exaggerates the toxic effects of 6-hydroxydopamine in rats: implications for neurodegenerative disorders

Many studies have shown that early life stress may lead to impaired brain development, and may be a risk factor for developing psychiatric pathologies such as depression. However, few studies have investigated the impact that early life stress might have on the onset and development of neurodegenerative disorders, such as Parkinson's disease, which is characterized in part by the degeneration of dopaminergic neurons in the nigrostriatal pathway. The present study subjected rat pups to a maternal separation paradigm that has been shown to model adverse early life events, and investigated the effects that it has on motor deficits induced by a unilateral, intrastriatal injection of 6-hydroxydopamine (12 microg/4 microl). The female rats were assessed for behavioral changes at 28 days post-lesion with a battery of tests that are sensitive to the degree of dopamine loss. The results showed that rats that had been subjected to maternal separation display significantly impaired performance in the vibrissae and single-limb akinesia test when compared to normally reared animals. In addition, there was a significant increase in the loss of tyrosine hydroxylase staining in maternally separated rats. Our results therefore suggest that adverse experiences sustained during early life contribute to making dopamine neurons more susceptible to subsequent insults occurring during more mature stages of life and may therefore play a role in the etiopathogenesis of Parkinson's disease.