College aantekeningen
Loss and Psychotrauma Lectures
- Instelling
- Universiteit Utrecht (UU)
Very extensive summary of the Loss and Psychotrauma lecture series, 2022.
[Meer zien]Voorbeeld 3 van de 28 pagina's
Voorbeeld 3 van de 28 pagina's
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Door: jeaninevandermeer1 • 2 jaar geleden
Very elaborate! Basically a transcript of all the lectures. Pics and graphs included when necessary.
Voorbeeld van de inhoud
LECTURE 1 - DEATH AND GRIEF: A SOCIETAL AND SCIENTIFIC POSITIONINGTalking about the Netherlands, approximately 4200 people under the age of 30 die every year. There is fascination about
death, and fascination to conquer it. Religion usually has a version of what happens after death and a place for death, and it
is seen in art (van Gogh). But also in science: think of cryonic suspension (freezing and storage of bodies), biohacking
(extracting data from bodies and store it), and virtual reanimation (holograms of death people). There is also a tendency to
normalize death: normalization. There are funeral shops, funeral museum. Just like where you buy your bread, you can buy a
coffin too or discuss funeral preparations. Death is discussed with small children too (Nijntje).
How do we deal with death? The Price of Love book: phrasing of what grief is. The only way to avoid grief is to stay out of
contact and not to attach with people. We try to inform ourselves on the internet. There is a lot information available, but it’s
outdated, non-empirical, and really not helpful. A lot of information resources is still about the five stages of grief theory, but
that is not scientific information. For example: the internet states that anger is a necessary stage of the healing process. In
turn, people might be worried if they do not go through the phase of anger. But grief can be in all different kind of directions.
There is a lot to be done on the internet to give bereaved people right information.
Grief Task Model
There are different kinds of looking at grief. Most models tried to focus on 5 stages of grief. But other models are relevant as
well. Grief Task Model: instead of waiting for 5 phases to occur, grief needs some work. You need to do certain tasks if you
want to continue with your life:
- Accepting the reality of the loss.
- Allowing yourself to experience the emotions (any emotions; anger, grief, relief). Emphasize on experience, not just
expressing it or avoid it.
- Adjusting to life without the deceased.
- Relocating the deceased emotionally and move on. Not just detaching from the person, but moving on to another
chapter of your life.
What is grief?
A (working) definition of grief: the primary emotional reaction to the death of a significant other (a loved one!). It is a
complex emotional syndrome accompanied by physical changes and physical symptoms. In addition, it involves a wide range
of possible cognitive and behavioral reactions.
There are basically 4 dimensions/levels of grief. Grief can manifest itself on different levels:
- Emotional: sorrow, loneliness, numbness, anxiety, guilt, aggression, helplessness, pessimism, relief.
- Cognitive: loss of concentration, lowered self-esteem, confusion, intrusive images, preoccupation with the
deceased, hopelessness.
- Physical: sleep problems, appetite, stress headaches, tension, low energy, similar symptoms to the deceased.
- Behavioral: agitated, withdrawn, seeking behavior, avoidance.
Major determinants of grief (also in the literature)
- Background of the bereaved person: gender, age, personality, attachment, health, history.
- Characteristics of the death: sudden, unexpected, premature death, traumatic circumstances.
- Characteristics of the deceased: kinship relationship, quality of the relationship with the deceased.
- Situation after loss: lack of support, secondary loss, ways of coping.
Example: gender differences. There was research on the risk of dying after people become widow and if this is different from
people who did not lose their partner. Men have a higher chance of dying after the loss of a partner than women. In the UK,
the risk of dying for males is 8 times higher compared with a married man who still has his partner. It is much higher for men
than for women. We don’t really know why. Possible explanations for gender differences are:
- Differences in social support. Women have a larger social network, so when their partner dies, they have a larger
network of social support.
- Differences in coping strategies. Men deal with death in a more problem focused way for instance.
- Differences in types of bereavement. Perhaps marriage is a different thing for men than it is for women. Men maybe
gain more from marriage, and lose more when the partner dies.
Example: religion. Life philosophy (systems of meaning) helps in certain ways, but there are also conflicting results. That
system of meaning is helpful for people, but what we also find that people lose their religion after loss of a child for example.
Then, there is a double loss. However, a religious social community may help, since there is a relation between worship
session attendance and social support, and between social support and health (‘social capital’).
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,Characteristics of death
Cause of death: there is a NASH classification of four main categories: Natural, Accident, Suicide, and Homicide. There are
also underlying dimensions: sudden, untimely, intentional, painful and violent death usually lead to greater risks of
complications of grief losses. Also, debilitating and exhausting (terminal) conditions are a risk factor too. If you have to take
care of your dying partner for years, that is exhausting and isolating. You need more time to deal with the fact you’re your
partner has died. Lastly, talking about and acting in preparation of imminent death predicts less intense grief. Saying
goodbye, talking about who raises the children, or trying to round of the relationship, is helpful.
The deceased
You cannot compare losses, but some losses are more important than others. Who is the deceased? This depends on:
- The kinship (is it a parent, partner, child, etc.).
- Nature of the relationship (daily or weekly contact for instance).
- Quality of the relationship. The more ambivalent relationships are the most difficult to deal with (because there are
positive and negative feelings to deal with).
Unacknowledged losses or ‘Disenfranchised grief’
For example ex-partners, or in the past: miscarriage, perinatal deaths, etc. People can treat it like a non-death because a
person did not exist as a person yet. In some circles also homosexual relationships (when homosexuality is disapproved,
there is nothing to grief about, because there was no relationship). Or extramarital affairs.
After the loss
There are aspects after the loss that are important too:
- Coping.
- Social support.
- Secondary losses (move houses for example).
- Multiple bereavements (for instance with a second death, the first death may come up again).
- Family dynamics (maybe you don’t see other family anymore after a death).
- Material resources (change): for instance you lose income after the loss of your partner.
Conclusions
- From a societal perspective, the concepts of death and dying, and surviving relatives, are surrounded by
acomplicated context of denial and fascination.
- Death in most western societies becomes more normalized, more like it is in many countries elsewhere.
- The death of loved ones is virtually inescapable and in most cultures has significant consequences for others’
physical, psychological and social functioning.
- There is no such thing as the grieving process. There are tremendous individual and cultural differences. Every
model is a simplification and should be recognized as such.
- There are factors that lead to a higher risk of problems in the grieving process, but the predictive power of these
factors is usually not very high, and hence sound explanations are generally not available.
- A small minority cannot cope by themselves and need professional help. A large majority of surviving relatives
eventually succeed in overcoming the loss.
2 – GENERAL INTRODUCTION PSYCHOTRAUMA
Traumatic events (which are studied in the field of psychotrauma)
- War and violence destruction
- Combat (military stress)
- Long-term imprisonment (e.g., concentration camps)
- Criminal violence (e.g., rape, robbery, hijacking)
- Disasters (natural, man-made, and technological)
- Accidents (e.g., traffic accidents)
- Child abuse and family violence
- Sudden and traumatic loss of a loved one
Characteristics of overwhelming events
1. Extreme powerlessness. You are not in control anymore.
2. Profound disruption. Suddenly, your life is totally different.
3. Extreme discomfort.
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, Typology of traumatic experiences
In the field, we usually make a distinction between type I and type II trauma. Don’t take it too strict.
- Type I trauma: single, intense, unanticipated events.
- Type II trauma: prolonged, repeated, extreme conditions (series of extreme events over time).
The problems after these types of traumas do overlap, but are different.
History of psychotrauma field
The introduction of the concept of trauma and PTSD (DSM-III) was around 1980. The roots are in the Vietnam war. In the
seventies, it was discovered that many veterans suffered from depression, sleeping problems, etc. In the beginning, they did
not pay much attention to it. That changed in the seventies, which resulted in the introduction of the concept of trauma in
1980. Slowly, the concept of PTSD was accepted in the eighties.
Psychotrauma was already described in the 19th century. Interesting is that the attention for trauma disappeared in the early
20th century. Freud became popular and focused on fantasy and imagination and not so much on real events. Also Pierre
Janet focused on a split mind and dissociation (trauma works for its own account, it is cut off from the rest of the conscious
mind, which manifests in disturbances). During world war 1, soldiers who had a trauma were considered as cowards and
were killed. But later in the war, people realized that trauma deserved real attention. Again we saw that attention
disappeared, and returned during world war 2. A book was written about the consequences of fighting and combat stress,
and hypnosis and drugs were used to treat symptoms. After world war 2 attention disappeared again: the first two editions
of DSM did not pay attention to trauma. It was later incorporated in 1980.
Current focus on trauma
- Nowadays, there is a huge popularity of the term ‘trauma’ today in both science and society.
- Something really dramatic happens that could happen to anyone: the cause is clear, and the responsibility lies
elsewhere.
- Traumatic experiences show us the limits of our capabilities and defy our efforts to control them. We realize that we
cannot control everything.
- There is a risk of overstretching of the concept of trauma (‘trauma culture’), especially in the media and daily life. Be
careful that you don’t use the concept too much and only for the right purposes.
Trauma is one of the most thriving areas in mental health research and clinical practice. It is a quite multidisciplinary field:
psychology, psychiatry, medicine, sociology. Also, it is a field dominated by USA scientists and clinicians, and it is a field
shaped by the input of victims and ‘experts by experience’.
Diagnostic concepts
There were a lot of changes in diagnosis concepts. There are 2 systems of classification: DSM and ICD. PTSD is one of the few
disorders in the DSM that has the cause, the event, as part of the definition. You have to be confronted with death, serious
injury, or violence (also just witnessing it). There are 4 criteria of symptoms (B, C, D, and E).
A. The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened
sexual violence, as follows (one required): direct exposure, witnessing, indirectly by learning that a close relative was
exposed to trauma, or repeated or extreme indirect exposure to aversive details of the event(s). This last one does
not include non-professional exposure through electronic media, tv, pictures, etc.
B. The traumatic event is persistently re-experienced in at least one of the following ways: intrusive memories,
traumatic nightmares, dissociative reactions (flashbacks), distress after exposure to traumatic reminders, and
marked physiologic reactivity after exposure to trauma-related stimuli.
C. Persistent effortful avoidance of distressing trauma-related stimuli, as indicated by at least one of the following:
efforts to avoid thoughts, feelings or conversations associated with the trauma, and efforts to avoid activities, places
or people that arouse recollections of the trauma.
D. Negative alterations in cognitions and mood (two required): inability to recall key features, persistent negative
beliefs and expectations about oneself or the world, persistent distorted blame of self or others for causing the
event or the resulting consequences, markedly diminished interest in activities, feeling alienated from others, and
constricted affect.
E. Trauma-related alterations in arousal and reactivity (two required): difficulty falling or staying asleep, irritability or
aggressive behavior, self-destructive or reckless behavior, problems in concentration, hypervigilance, and
exaggerated startle response.
F. The duration of the disturbance (symptoms in criteria B, C, D and E) for more than one month.
G. The disturbance causes clinically-significant distress or impairment in social, occupational or other important areas
of functioning.
H. Disturbance is not due to medication, substance use, or other illness.
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