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Greiving Case Study
Grief is a powerful, and somewhat self-regulating condition which we face having experiences a traumatic event. The wonders of our human body respond with pre-programmed efficiency in order to help us adjust to the reality of the new situation. In the face of a traumatic occurrence, when our emotional or mental reaction may be to shut down, or run and hide, the grieving response gives a person the needed boundaries in which they can continue to function. However, some time after the events have past into the distance, the need exists for the person to process through the grief. Only by processing the grief can the person reenter a healthy relationship with the daily responsibilities of life, and healthy relationships with others in their life.
Charley's current situation in life is a function of poor decisions in his adult life. However, these decisions are also a response to unresolved emotional turmoil in his own life. His current decisions can be understood as attempts to return to, and correct some of the events in his earlier years. Because he hasn't processed the emotional unrest, the feelings act like rough waves under the hull of a small boat. No matter how skilled the boat captain, the waves affect the progress, and the course he can set.
The 5 standard stages of grief are:
1. DENIAL: In the denial stage we refuse to believe what has happened, and try in our mind to tell ourselves that life is as it was before our loss.
2. ANGER: We are angry at ourselves, and at others, and at the world in general. We can blame others for our loss, and we can become easily agitated having emotional outbursts. Often during this stage the person turns their anger inward, toward self-destructive behaviors.
3. BARGAINING: Bargaining can be with ourselves, (if I'd only done . . .) or if the person is religious, with your god. It is natural to want thing as they were before.
4. DEPRESSION: Depression is a very likely outcome for all people that grieve for a loss, and depression is even more likely response to long-term anger. This stage is the most difficult stage of the five to deal with. There can be a feeling listlessness and tiredness, overwhelming sorry, or a general loss of interest in anything outside of what brings the person direct pleasure. Thoughts of suicide can also plague the person
5. ACCEPTANCE: The final stage of grief. When the person realizes that life has to go on in the new setting and that the person can function with the new realities that life has dealt them. Acceptance is marked by accepting your loss, and the persons own feelings about the situation.
Charley faced a traumatic situation in his childhood in the loss of his father. Not knowing about his father's gambling problem, he was caught completely unawares when his father left. The emotional trauma for a child looking his role model, in accompaniment with the associated negative changes in his family, such as loss of income, and loss of stability, created for young charley the trigger events which initiated the grief response.
In addition, the coping mechanisms which his father taught him, such as not fighting, not defending himself, yet tendency to respond to challenged with emotional violence, etc., only hurt young Charley's ability to build positive interactions with his peers. Charley, as a young boy, was out on his own, and without any tools to build bridges of social connectiveness with others.
According to the DSM-IV, Charley would be diagnosed as suffering from 296.3x, recurrent major depressive episode. The Criteria for Major Depressive Episode are the presence of 5 (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning, and at least one of the symptoms is either a depressed mood or loss of interest or pleasure. The other criteria for identifying this mood disorder include:
1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. Insomnia or Hypersomnia
5. psychomotor agitation or retardation nearly every day (observable by others)
6. significant fatigue or loss of energy
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by personal observation, or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
For Charley, numbers 1, 5, 7, and 8 are evidence of a significant emotional trauma. His grieving has forced adjustments to his thought process in order to function while carrying the emotional trauma. These adjustments are both the cause, and the response to painful emotional experiences. If Freud is right about the grief process, a failure to recognize and process pain in the body will impede the fluidity with which positive ideas can be entertained. In other words, the presence of unresolved grief, or a state of mourning impedes and restricts the person from being able to accept new ideas. According to Alcorn, (2001) this bad ideology is like a "bad" mother who could not be easily abandoned. Another cultural studies professor suggested that making progress in through the grieving cycle is like reliving the plot of the movie Groundhog Day. As you may recall, the plot of Groundhog Day circles around a central character's reliving one particular day over and over again until he is able to find a way to give up his narcissism and establish a relationship to a woman he loves.
Researchers on the grieving process have found that grief often initiates bodily changes that pose real medical risks. Lindemann lists a group of psychosomatic conditions -- predominantly ulcerative colitis, rheumatoid arthritis, and asthma -- often triggered by loss. One study showed "thirty-three out of forty-one patients with ulcerative colitis developed their disease in close time relationships to the loss of an important person" Lindemann further observes that the "picture shown by persons in acute grief is remarkably uniform" (Lindemann, 1994)
Further support for this diagnosis is found from Yvonne Butler Clark, author of It's Okay to Cry - Guide Through Grief. Her work stresses that children and adolescents, when experiencing a significant grief experience, will need all the support they can get and they will require a long time to recover. If the child does not receive this gently directive help he or she is likely to carry the pain into adulthood, 'stalled' in the process of working through the grieving process.
The range of reactions that children display in response to the death of significant others, on in Charley's case, the death of his family through the loss of his dad, may include:
Emotional shock and at times an apparent lack of feelings, which serve to help the child detach himself or herself from the pain of the moment;
Regressive (immature) behavior, such as needing to be rocked or held, difficulty separating from parents or significant others, needing to sleep in a parent's bed or an apparent difficulty completing tasks well within the child's ability;
Explosive emotions and acting out behavior that reflect the child's internal feelings of anger, terror, frustration and helplessness. Acting out may reflect insecurity and a way to seek control over a situation for which they have little or no control. This anger may be revealed in boisterous play, nightmares, irritability, or a variety of other behaviors. (Manveet, 2002)
These elements of Clark's research have followed Charley into adulthood, evidence of the unresolved grief. In order to help him, a treatment plane will need to revolve around helping him revisit these events, and process through the emotions of the situations.
In order for Charley to find resolution for his grieving, he will need to be engaged in ongoing counseling by a mental health professional. While the combative, competitive nature of Charley will likely resist help from a 'shrink' as needless and lacking beneficial personal returns, the process should be presented to him in terms of helping him attain his own personal goals. He obviously has talent, his time in the military services being one example. And his time in the service can be used as clues to the direction which will be beneficial to the counselor.
The military services are highly regulated, and highly structured in order to facilitate a specific goal, creating a unified fighting force. The goal for Charley is not the same as the military, however his need for personal structure in…[continue]
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