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Grief, Burden, Violence, Stigma

This comprehensive overview addresses the complex dynamics of grief, burden, and stigma through the lens of family roles in rehabilitation. Utilizing key concepts from foundational studies, it explores the phases of grief, types of burdens faced by caregivers, and the pervasive stigma surrounding mental illness. Special attention is given to the impacts of caregiving on families, the importance of understanding grief dynamics, and the necessity of educational resources and support programs. This presentation aims to enhance awareness and foster effective interventions for families affected by these challenges.

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Grief, Burden, Violence, Stigma

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  1. Grief, Burden,Violence, Stigma Week Five: Special Topics PSRT 4271: The Family Role in Rehabilitation

  2. Grief The Mystery of the Hereafter and The Peace of God that PassethUnderstanding (1891) Adams Memorial, Rock Creek Cemetery Augustus Saint-Gaudens

  3. Augustus Saint-Gaudens

  4. Grave of Henry Adams’s wife

  5. Grief The Mystery of the Hereafter and The Peace of God that PassethUnderstanding (1891) Adams Memorial, Rock Creek Cemetery Augustus Saint-Gaudens

  6. Phases of Grief (Mohr & Kubinski, 2001)

  7. Phases (Mohr & Kubinski, 2001) • Avoidance Not reality!

  8. Phases (Mohr & Kubinski, 2001) • Avoidance Not reality! • Confrontation Harsh reality

  9. Phases (Mohr & Kubinski, 2001) • Avoidance Not reality! • Confrontation Harsh reality • Accommodation New reality

  10. “Disparity” • Theory of chronic sorrow (Eakes et al., 1999) • A trigger for grief… • What is vs. what might have been

  11. Mohr & Kubinski Study • 4 focus groups • 8 per group • 90 minutes each • Children ages: 17 to 31

  12. Findings • Epiphany: “nightmares” • Action: from “shattering tension” • Deluge: “emotional shredding” • Fear: of everything… exhausting • Anguish, Guilt, Sequelae…

  13. Implications… • Caregivers must know grief dynamics • Not dysfunction • Rather: understanding • Refer families to programs that can help… • NAMI Family to Family, etc.

  14. Burden

  15. Interesting facts… (Doornbos, 2001) • Up to 60% live with, receive care from families

  16. Types of burden (Lefley, 1989) • Objective • Subjective

  17. Behavior management issues…(Lefley, 1989) • Abuse • Mood swings • Offensive public behavior • Conflicts • Squandering of money • Poor hygiene • Property damage • Disruptive sleep patterns • Rejection of medications

  18. Lit Review: Caregiving analyses… • 9 processes (Schumacher et al., 2000) • Monitoring • Interpreting • Deciding • Acting • Adjusting • Caring (hands-on) • Assessing (resources) • Collaborating • Negotiating • 5 categories (Bowers, 1987) • Anticipatory • Preventative • Supervisory • Instrumental • Protective

  19. Doornbos: 5 caring processes • Monitoring • Managing • Maintaining • Encouraging • Socializing

  20. Doornbos: Needed… • Information! • Medications • Symptoms • Resources • “Everything!” • Where? • Support groups • Education programs

  21. Wanted from professionals…(Doornbos, 2001) • Understanding of family impacts • Inclusion in treatment planning • Understanding of family time devoted • Understanding of family frustration

  22. Violence

  23. I am Adam’s Lanza’s Mother!... http://www.youtube.com/watch?v=Dgrr2jDcXAs

  24. http://www.youtube.com/watch?v=qMDssBTWgJ4

  25. Families speak out in CA (News10/KXTV, 2012) Laura’s Law http://www.youtube.com/watch?v=GOAoI5-0l9o

  26. Elbogen & Johnson (2009) “…if a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next 3 years as any person in the general population.” http://www.youtube.com/watch?v=wCeFEr5ioqo

  27. Is this the answer? • http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=192996785&m=192996772

  28. Stigma

  29. What is stigma? • A mark, brand, or label • An interactive social process • Both

  30. Stigma  Effects (Heflinger & Hinshaw, 2010) • Lack of recognition of prodomal symptoms • Shame  less assessment, treatment • Less funding, lower reimbursements • Low status, marginal priority

  31. Structural models of stigma (Larson & Corrigan, 2008) Besides public cues… • Cognitive (stereotypes) • Emotional (prejudice) • Behavioral (discrimination)

  32. 3 levels (Heflinger & Hinshaw, 2010) • Individual • Community • Societal

  33. Stress from providers…(Lefley,1989) 4 sources of “iatrogenic” damage: • Avoidant or recriminant responses • Double-bind messages • Interventions that alienate • Provocative family-provider interactions

  34. Providers as family members…(Lefley, 1989) Role conflicts: • 72%: had psychotherapy, but… • 26%: strong reluctance to discuss… • 90%: overheard colleague disparagements

  35. Stigmatizing provider attitudes • ID by diagnosis (“bi-polar kid”) • Focus only on deficits instead of strengths • Focus on condition instead of whole person • Planning without them or their families • Facilities: subpar, difficult to access

  36. “Courtesy stigma” • Stigma by association

  37. The last word on stigma… President Obama, June 3, 2013 http://www.youtube.com/watch?v=UqnF3UicuQs

  38. Today’s Guest Presentation…

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