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close this bookMental Health Services in Disasters: Manual for Humanitarian Workers (PAHO; 2000; 92 pages) [ES]
View the documentPreface
View the documentObjectives
View the documentIntroduction
open this folder and view contentsChapter 1: Historical Overview and Mental Health Role
close this folderChapter 2: Basic Mental Health Content
View the documentStress/Stressor Response
View the documentCoping and Adaptation
View the documentLoss and Mourning
View the documentSocial Support Systems
View the documentCrisis Response and Resolution
View the documentThe Bio-psycho-socio-cultural system*
open this folder and view contentsChapter 3: Developmental Stages of Survivor Behavior
open this folder and view contentsChapter 4: Post-disaster Intervention Programs
open this folder and view contentsChapter 5: Populations with Special Needs
View the documentMental Health Services in Disasters: Manual for Humanitarian Workers
 

Loss and Mourning

Loss, mourning, and grief reactions are concepts of particular use in disaster work. Although a discussion of loss usually focuses on death, losses resulting from a disaster may also include:

 

• property destruction,
• sudden unemployment, and
• impaired physical, social, or psychological processes.

THE POST-DISASTER MOURNING PROCESS

Grief is a natural, reflexive, psychological response that begins in childhood following a loss of any kind. Grief is part of the process of healing that depends on the depth and character of the loss, as well as the condition of the person.

Mourning and grieving The reaction produced by loss, especially the death of an important individual or symbolic objects in a person's emotional life.

Barriers that impede the process of grieving and mourning include:

 

• Unmet basic needs during childhood;

• Multiple previous losses;

• Nature of the relationship with the person who is gone, such as ambivalence, over-dependency, or unresolved conflicts;

• Circumstances of the sudden loss, such as whether it was brutal or whether the body is unrecoverable;

• Cultural values, such as "stiff upper lip and no crying."

Many professionals have pointed out that disaster survivors go through a five-step process of mourning:

 

1. Denial
2. Rage/anger
3. Bargaining
4. Depression
5. Acceptance/resignation

These five stages do not always occur, nor do they always appear in a specific order. The stages and their order are strongly influenced by an individual's total personality and philosophy of life. Therapeutic intervention helps the mourner move through the process if he/she is "stuck" at one stage or has difficulty achieving resignation.

The processes of mourning, grieving, and bereavement involve cognitive elements that are frequently expressed as physical or psychological symptoms. The process begins with recognition and awareness of the loss. The individual needs to come to grips with reality in emotional as well as intellectual terms. When only an intellectual acceptance of loss occurs, the chance of emotional maladaptation increases.

The process of grieving takes a person from shock through acute distress to resignation. Along the way, the individual may suffer physical discomfort, susceptibility to illness, withdrawal into apathy, or increased hostility toward others, and he/she may become totally isolated.

A predominant reaction is a strong defense of denial; that is, survivors appear to be preoccupied with activities or conversations that do not include mentioning the loss. This delayed reaction appears to facilitate coping with uncontrollable emotions.

To understand the role of bereavement, it is important to look at the quality of the personal relationships that have been severed. A high percentage of survivors cannot move beyond the hopeless, "giving-up" stage. This, in turn, is associated with different levels of depression, including interference with all the decision-making functions necessary for survivors to reorganize their lives. Because of this inability to deal with all the human and bureaucratic interactions necessary to obtain relief resources from agencies, the crisis feelings intensify. The continuation and intensification of survivors' apprehension about the crisis stimulates a circular down-spiral, leading to a lack of energy, depression, passivity, loss of self-esteem, and helpless behavior.

Ultimately, the way a survivor deals with problems during a period of emotional stress influences whether he/she emerges from the crisis with increased susceptibility to mental distress or an increased likelihood of improved coping capacity after the disaster.

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