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M05.03.10 Death and Bereavement
This section explores how children and adults experience death and bereavement, with a focus on attachment theory and the grieving process.
Attachment and Loss in Children
John Bowlby’s attachment theory posits that children are biologically predisposed to form strong emotional bonds with caregivers, typically parents, during the first two years of life. This secure attachment provides a sense of safety and security, allowing the child to explore the world confidently.
Impact of Separation:
Separation from a primary caregiver can have a significant impact on a child’s emotional well-being. Bowlby described three stages of protest a child might go through during separation:
- Protest: (Usually within 2 weeks of separation) This stage is characterized by:
- Crying, screaming, and clinging to the caregiver when they leave.
- Anger towards the caregiver upon their return.
- Despair: (If separation continues) The child may appear calmer but exhibit:
- Despondency and sadness.
- Withdrawal and disinterest in their surroundings.
- Detachment: (Long-term separation) The child may:
- Begin to engage with others but reject the caregiver.
- Show indifference upon the caregiver’s return.
Remember:
- Secure attachment in early life is crucial for a child’s emotional development and coping with loss.
- Prolonged separation from caregivers can lead to emotional distress in children.
Mourning and Loss in Adults
Adults experiencing the loss of a loved one (bereavement) go through a period of emotional adjustment. The Kübler-Ross model suggests individuals may progress through various stages of grief, though not everyone experiences them all or in a linear fashion.
Stages of Grief (Kübler-Ross Model):
- Denial: Refusal to accept the reality of the loss.
- Anger: Feeling rage and resentment towards the deceased or oneself.
- Bargaining: Attempting to negotiate with a higher power to alter the situation.
- Depression: Experiencing sadness, despair, and a loss of interest in activities.
- Acceptance: Coming to terms with the loss and beginning to move on.
Important Considerations:
- Not everyone experiences all stages of grief.
- The time spent in each stage can vary significantly.
- Some individuals may reach a point of adequate adjustment, while others may require additional support.
Table 1. Normal Grief vs. Depression
| Feature | Normal Grief | Depression |
|---|---|---|
| Duration | Up to 1 year | More than 1 year |
| Symptoms | Crying, decreased libido, weight loss, insomnia | More severe symptoms of the above |
| Yearning for deceased | May see or hear deceased (illusions) | Overidentification with deceased, personality changes |
| Focus on loss | Focus on loss of self | |
| Suicidal thoughts | Rare | Common |
| Self-limited | Symptoms usually improve within 6 months | Symptoms persist for years |
| Treatment | Antidepressants may not be helpful | Antidepressants may be helpful |
Remember:
- The grieving process is unique for each individual.
- Seeking professional support can be beneficial for those struggling with prolonged or complicated grief.
Bibliography:
- Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. Basic Books.
- Kübler-Ross, E. (2016). On death and dying. Routledge.
- Worden, J. W. (2018). Grief counseling and therapy: A handbook for the mourning heart (5th ed.). Routledge.