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1

1. It provides acting-out ceremonies that give expression to feelings too deep to be put into words.
2. It provides the framework for group support
3. It encourages the expression of feelings
4. The funeral provides values to live by

Todd Van Beck's - the funeral does 4 specific things that are available to everyone.

2

When a person is confronted with a stressful situation, whether it is positive or negative, the body responds with the "flight-or-fight" response.

Physiology of stress

3

Starts in the hypothalamus, then to the pituitary gland, then the chemicals are changed into hormones that enter the bloodstream and travel to the cortex of the adrenal glands, which produce chemicals that increase blood sugar level and metabolism.

Pituitary gland path

4

Starts in the hypothalamus, then travels down the brain stem and spinal cord to the core of the adrenal glands. There, adrenaline is produced to help fuel the muscles and brain, and norepinephrine is produced to increase heartbeat and blood pressure.

Path down the brain stem and the spinal cord

5

The body preparing itself to take physical action in response to the stressor. A positive defense mechanism when the situation calls for a physical response.

Flight-or-fight response

6

A condition where your mind and body are relentlessly strained when you develop physical, emotional, and mental fatigue. It produces feelings of hopelessness, powerlessness, cynicism, resentment, failure, depression and unhappiness.

- Occurs when the stressors are long-term and do not generate physical response, the tension activates a series of responses that wear away a body's health.

Burnout

7

An event capable of producing stress.

Stressor

8

1. Religious or other types of ceremonies are enacted
2. Visual contact with the deceased is encouraged, most often occurring with the body lying in a casket and the face and body exposed.
3. A procession, or family parade, occurs, allowing a public display of grief and accompaniment of the deceased to a final resting place.
4. Social support - gathering of relatives and friends
5. The financial expenditure
6. The body is prepared by a sanitary method for permanent place in the grave.

General types of funeral rituals

9

In wake of the trend towards this, science, medicine, religion, philosophy, and education developed new ideas and specialized approaches to working and living.

Industralization

10

Brought on by the modifications of death previously perpetuated by the church.

- Farrell: Religious thought in the 19th century migrated from the morbid, medieval notions of death to ideas developed from the logic and reason inherited from the Age of Enlightenment.

Secularization

11

1. Treatment of the body
2. The burial container
3. The funeral environment
4. Funeral procedures

Ferrel's 4 basic elements changed by American funeral practices

12

Removed the ugliness and fear of death while simultaneously reducing its sting though aesthetic enhancements and distancing its reality.

The advent of 20th century industrialization and expansion of innovation.

13

1. Visitation of the deceased
2. The rite of passage
3. A funeral procession
4. Disposal of the body
5. The commitment of death

5 elements of the contemporary American funeral

14

The primary purpose of a funeral is embedded in this for both the deceased and the bereaved.

- During the service - the deceased is symbolically transferred from his or her surviving social community to the afterlife.
- Then physically placed into the land of the dead through burial or cremation

- For the bereaved - The funeral is the initial step toward separation from the deceased- the beginning of the grief process and the reestablishment of a place in the social community without the loved one.

Rite of passage

15

1. Funerals impose the reality of death upon the bereaved.
2. Funeral rituals validate and legitimize the griever's feeling of loss.
3. Funerals offer the survivors an environment conductive to the expression of grief.
4. Funerals rekindle memories of the deceased, a necessary aspect of detachment
5. Funerals initiate thoughts about life without the deceased.
6. Funerals allow the opportunity for input from the community
7. Funeral rituals themselves contain many of the elements that constitute psychological therapy.

Psychological benefits of funerals

16

Detachment

Decathexis

17

Artifacts that are associated with the loved one and are included in the casket or in the grave. These personal items are of sociological interest.

Grave goods

18

When the expressed wish of the deceased becomes an important element of the funeral process.

- Performs much the same function as a funeral service where a burial is involved, except that it tends to be more positively focused on the life and values of the deceased, rather than focusing on the dead body.

Memorial service

19

One where the deceased has planned in advance by him or herself.
- Includes preselected readings, music, and even decisions regarding the people who will perform these activities.
- Also includes entertainment, recordings, readings, or refreshments prearranged by the person who has died, or someone chosen to act on his or her behalf.

Prearrangements

20

When the deceased has ties or history in more than one location.
- More than one gathering in more than one place.

Multiple services

21

- Shock
- Alarm
- Disbelief
- Yearning
- Searching
- Disorganization
- Resolution

The stages of grief for children

22

Grief responses that could be considered norms.

Stages

23

Return to the behavior of an earlier age. Temporarily giving up a skill that was mastered earlier in the developmental process.

Regression

24

Impact of events on the child.

Internal frame of reference

25

Takes a physical, mental, emotional, and spiritual toll on people.

Stress

26

A debilitating psychological condition brought about by unrelieved work stress, which results in depleted energy reserves, lowered resistance to illness, increased dissatisfaction and pessimism, increased absenteeism and inefficiency at work.

Burnout

27

A progressive loss of idealism, energy, and purpose experienced by people in the helping professions as a result of the conditions of their work.

Burnout

28

A state of physical, emotional, and mental exhaustion caused by long-term involvement in situations that are emotionally demanding.

Burnout

29

A term coined by Dr. Ronald Barrett, a situation that develops when there is such an accumulation of unresolved, compounded grief that an individual may simply grow numb.

Bereavement burnout

30

A resources are devoted to simply coping. Often happens when professionals become caught in a cycle of attachment and loss.

Emotional disinvestment

31

1. Characterized by the initial stimulation of a new job and the enthusiasm and desire to succeed and prove oneself.
2. Stress has started to build and fatigue and job disappointment have set in.
3. Chronic exhaustion - brings a higher intensity of emotion and possible physical symptoms.
4. The emergency, or crisis point - if no intervention takes place, the death care professional is at risk for illness and likely to demonstrate aversive behavior on the job.
5. The crossroads between help or hopelessness

The stages of burnout

32

1. Intellectualization
2. Emotional survival
3. Depression
4. Emotional arrival
5. Deep compassion

- These stages are likely to be encompassed in the maturing of the professional who copes with stress in caring for the dying.

Harper's 5 stages - Schematic growth and development scale in coping with professional anxieties in terminal illness

33

Identifies 5 major arenas of life that death care professionals must attend to in order to minimize their potential of likelihood for burnout.

- Intentionally circular "a wheel is meant to go somewhere" if one area of the wheel is flat, the wheel doesn't go anywhere.

Canine's model illustrating management of burnout

34

1. Spiritual
2. Mental
3. Emotional
4. Physical
5. Social

5 categories in Canine's model

35

Accepting the core of every human being as the same as yourself, and giving them the gift of not judging them.

Joan Borysenko's definition of forgiveness

36

1. Age or developmental level
2. Manner of the death
3. Relationship with the deceased

3 Factors that determine children's belief structures surrounding death and how they respond when death occurs.

37

Refers to person experience of the loss.

Grief

38

- Example is the bereaved keeping the body in the house for a number of days before notifying anyone of the death.
- People experiencing this are manifestly psychotic or eccentric and reclusive.
- Mummification (long-term is abnormal)

Denial by delusion

39

Retaining possessions of the deceased's in a mummified condition, ready for use when he or she returns. This is not unusual in the short term, but becomes denial if it goes on for years.

Mummification

40

An example is if the person sees the deceased embodied in one of his or her children. This distorted thinking may buffer the intensity of the loss but is seldom satisfactory and hinders the acceptance of the reality of death.

Distortion denial

41

Blocking out the reality of the deceased- even visual images - from his or her mind.

Selective forgetting

42

The hope for reunion with the dead person is a normal feeling, particularly in the early days and weeks following the loss, however the chronic hope for such a reunion is not normal.
- search for the dead in the spiritual realm

Religion spiritualism

43

Both knowing and not knowing at the same time. Found in terminally ill patients who both know and don't know that they are dying.

- In mourning, the bereaved may believe and disbelieve at the same time.

Middle knowledge

44

Broad definition is appropriate to use in speaking of pain because it includes the literal physical pain that many people experience and the emotional and behavioral pain associated with loss.

The German word Schmerz

45

Travel from place to place and try to find some relief from their emotions, as opposed to allowing themselves to process the pain- to feel it and know that one day it will pass.

Geographic cure

46

How the death affects one's everyday functioning in the world.

- Depends on relationship or various roles the deceased played.
- Must come to terms with living alone, facing an empty house, managing finances
- Usually not aware of all the roles played by the deceased until some time after the loss occurs
- Current theory by Neimeyer - meaning making.

External adjustments

47

An important process for the grieving deaths that tend to challenge beliefs about oneself, others, and the world. Important to discover and invent new meaning in the face of loss.

Meaning making

48

Adjusting to one's own sense of self.
- self definition
- self-esteem
- sense of self- efficacy

Internal Adjustments

49

The person's sense of self esteem is dependent on the person to whom he or she is attached.
- if that person dies, the bereaved person may suffer real damage to his or her self esteem.

Secure attachments

50

The degree to which people fee that they have some control over what happens to them.

- Can lead to intense regression where the bereaved perceive themselves as helpless, inadequate, incapable, child-like and personally bankrupt.

Self-efficacy

51

Attempts to fulfill the deceased's roles may fail, and this can lead to increasingly lowered _______.
- Personal efficacy is challenged
- People may attribute any change to chance or fate, not to their own strengths and abilities.

Self-esteem

52

Internal task for the mourner to address the questions "who am I now?" "How am I different from loving him/her?"

- Over time negative images will give way to more positive ones, and the survivors are able to carry on with their tasks and learn new ways of dealing with the world.

Sense-of-self

53

One's sense of the world. Neimeyer writes that death can shake the foundations of one's assumptive world. Loss through death can challenge one's fundamental life values and philosophical beliefs.
- May feel that they have lost some direction in life.

Spiritual adjustments

54

Beliefs that are influenced by our families, peers, education, and religion as well as life experiences.

Philosophical beliefs

55

- The world is a benevolent place
- The world makes sense
- That the person him-or herself is worthy

Three basic assumptions challenged by the death of a loved one.

56

Difficulties of using these:
- People do not pass through in seriatim.
- Tendency for a novice to take these too literally

Stages

57

The task for the bereaved parents to evolve some ongoing relationship with the thoughts and memories that they associate with their child, but to do this in a way that allows them to continue with their lives after such a loss.
- Find an effective place for the loss.

Relocation

58

Focus on the deceased person and involve grief work on such issues as separation distress, appraisal of the meaning of the loss, and relocation of the deceased in a world without the deceased's presence.

Loss-oriented stressors

59

Involve skill mastery, identity change, and other psychosocial transitions and changes.
- Rebuilding of shattered assumptions of the self and the world.
- Almost identical to task 3

Restoration-oriented stressors

60

An alternative approach to stages.
- As with stages, people do not approach these in the same order as they are listed
- Imply a certain passivity, someone that the mourner must pass through.

Phases

61

Phase 1: The period of numbness that occurs close to the time of the loss. This numbness (experienced by most survivors) helps them to disregard the fact of the loss for at least a brief period of time.

Phase 2: Yearning. He or she yearns for the lost one to return and tends to deny the permanence of the loss. - Anger plays an important part.

Phase 3: The phase of disorganization and despair - The bereaved person finds it difficult to function in the environment.

Phase 4: The phase of reorganized behavior, survivors being to pull his or her life back together.

Parke's 4 phases of mourning

62

1. Shock
2. Awareness of loss
3. Conservation withdraw
4. Healing
5. Renewal

Sander's 5 phases describing the mourning process

63

Proves an equally valid understanding of the mourning process and is much more useful for the clinician
- Constant with Freud's concept of grief work and implies that the mourner needs to take action and can do something.
- Implies that mourning can be influenced by intervention from the outside.
- Gives the mourners a sense of leverage and hope that there is something that he or she can actively do to adapt to the death of a loved one.

Tasks

64

Developmental tasks that occur as the child grows. If the child does not complete a particular task on a lower level, then that child's adaptation will be impaired when trying to complete similar tasks on higher levels.

-Physical
- Social
- Emotional

65

A cognitive process involving confrontation with and restructuring of thoughts about the deceased, the loss of experience, and the changed world within which the bereaved must now live. Some would call this grief work.

Grief

66

Task 1: Accept the reality of the loss
Task 2: To process the pain of grief
Task 3: The adjust to a world without the deceased
Task 4: To find an enduring connection with the deceased in the midst of embarking on a new life.

Tasks of mourning

67

Indicates the process that occurs after a loss.

Mourning

68

People frequently use this notion on themselves as the amount of pain that they will let themselves experience at any one time.

Dosing notion (they dose themselves)

69

People who have sustained a loss find themselves calling out for the lost person, and/or they sometimes tend to misidentify others in their environment.

The searching behavior

70

Most often involves either the facts of the loss, the meaning of the loss, or the irreversibility of the loss.

Denial

71

1. Be a good observer
2. Respond in an empathetic manner
3. Allow the child to express feelings and thoughts
4. Respond to the child in language that he/she can understand
7. Develop your skill in recognizing and responding to minimal cues of the child.
8. Express your own feelings that are natural to the situation
9. Accept the child's questions
10. Be patient and available
11. Provide reassurance though action as well as words
13. Maintain a continuing dialogue with children about death as the opportunity arises
14. Create a healthy relationship between you and the child.

General suggestions concerning children and grief.

72

- All stress is not negative and harmful
- Some stress in our daily lives is desirable and even necessary.
- The excitement and anticipation makes the event more enjoyable.

Good stress

73

1. The inclusion or placement of grave goods can be seen as a last act of love.
2. Burying objects with the dead can also help bring closure to the relationship for other grievers.
3. It might help them to feel close to their loved one in a manner that promotes healthy mourning.
4. It might simply provide a useful way to say good-bye.

Elliot's survey - the benefit of grave goods

74

1. Funerals allow community-wide support for the mourners.
2.Funerals provide social interaction thought meaningful, structured activities where the mourner is thrust into a newly defined social role.
3. Funeral rituals assist the bereaved individual in initiating the process of social reintegration
4. Funerals assist the community in grieving the loss of one of it's members.
5. Funerals validate the continuity of life when, following the death and final commitment, society lives on and continues to move forward.
6. Funerals are a reminder to society that every individual will die someday, and participation in funerary rituals repeatedly confirms one's future mortality.
7. Funerals serve as a channel through which the community communicates its belief system regarding life and death.

Social benefits of funerals

75

- Exhaustion and loss of energy
- Irritability and impatience
- Cynicism and detachment
- Physical complaints
- Disorientation, confusion
- Omnipotence and feeling indispensable
-Depression
- Minimalization and denial of feelings.

Characteristics of stress and burnout

76

1. The job of the funeral director is to make the funeral as meaningful and personal as possible to both the deceased and the bereaved.
2. Inquire and stay aware of the value, expectations, religious preferences, and style of the family.
3. Ask the grievers how they want the deceased to be remembered.
4. Explain their options. As customers, they are likely to be unaware of choices of services and the sequence of funeral activities available to them.
5. Try to broaden involvement to include other family members besides the immediate family.
6. Encourage the bereaved to include affected children in funeral rituals.
7. Funeral directors should understand the cultural values, expectations, philosophical and religious tenets, and customs and socioeconomic norms that operate in their clients' communities.
8.At all times, invite the bereaved to ask questions.
9. Listen carefully to specific needs of the grievers
10. Offer and allow grieving families more than one opportunity to spend private time with the deceased.
11. Invite mourners, particularly mothers whose children have died, to help you prepare or dress the body.
12. Respect any choice made by the bereaved.
13. Encourage grievers to express their feelings- but don't force it.
14. Recognize and be alert to the fact that various family members will react differently to the funeral.
15. Be sensitive to the fact that you might be one of the few people to observe and understand the needs and dynamics of the while family and its support system.
16. Recommend that the bereaved reach out for support and love.
17. Remember that some people might regret decisions that are made in a time of crisis.
18. Funeral directors need to integrate into the larger community.
19. Funeral directors must not become "surrogate suffers"
20. Do not be surprised or offended at hostility that mourners sometimes display.

20 suggestions for funeral directors

77

- Recognize that you are working in an area of care where the risks for burnout is high.
- Create periods of rest and renewal
- Be compassionate with yourself about not being perfect
- Set limits and alleviate stress you can do something about
- Learn time management skills
- Cultivate a personal support network
- Understand your motivation for working in funeral service
- Develop healthy eating, sleeping and exercise patterns
- Identify ways in which your body informs you that you are stressed.

The ABFSE recommendations for reducing stress

78

Might be created by psychosocial tasks demanded by death, but they are controlled by social factors, such as the extent and type of social organization, and the demographics within it.

Funeral rites

79

- Held in the presence of a body (open or closed casket)
- Involve a visitation period of 1-3 days

Types of funerals - common characteristics

80

The burning of the body.

Cremation

81

- Inurnment
- Urn can be maintained privately
- Ashes may be strewn or scattern

Cremation ritual opportunities

82

- Quick, clean and inexpensive
- Important element of naturalness

Cremation pros

83

- Allows grievers a quick avenue to escape grief and try to ignore their real need to mourn
- Might provide an angry mourner a way to act out at the deceased
- May be chose in direct opposition to the wishes of the deceased.

Cremation cons

84

- Funerals
- Cremations
- Funeral service followed by cremation

Types of funerals

85

- Tell the child as soon as possible about the death
- Be truthful
- Share only the details the child is ready to hear
- Encourage the child to express feelings
- Take the child to the funeral
- Take the child to the cemetery, even if the person is already buried.
- Let the child tell others about the death
- Encourage the child to talk about the loss
- Be available to answer the child's questions
- Never say "you shouldn't feel like that"

Things to tell a child about the death of a loved one.

86

- Be reality- oriented: accept the "givens" of a system
- Develop reinforcement alternatives: look for ways to validate yourself
- Use time management techniques
- Conduct routine attitude tests or assessments
- Seek information that may make the job easier
- Establish and maintain support systems
- Take time out
- Monitor diet and physical fitness
- Learn to delegate
- Nurture and cultivate spirituality

Prescriptions for death care professionals to practice

87

In a survey of funeral directors, the most cited cause is the:

Uncertainty of and lack of control of their time.