Aspects of Human Living
Written by listed counsellor/psychotherapist: Sharn Waldron M. Arts; FIP; CAP; BJAA; BPF; UKCP; BPC, IAAP.
7th February, 2008
What is Grief?
The grief associated with bereavement is not a feeling that is easy to describe. There may be a good deal of ambivalence at the time, for example, sorrow and disappointment may be mixed with anger, guilt and anxiety. Bereavement is a stress that can precipitate psychiatric disorder and psychosomatic illness. Many widows, for example, experience feelings of guilt about their role in the events leading up to the death of their husbands. The reorganisation called for following the death of a spouse introduces an added source of stress with regard to emotional deprivation and living arrangements.
Bereavement is the loss of someone very precious; grief is the resultant emotional experience of being bereaved. Most people think of grief as a natural response to someone being bereaved, and would be suspicious if someone denied or hid his or her feelings of bereavement. Many people see grief as therapeutic, a healing and necessary process before people can move on with their lives. We are often told “Get it off your chest and have a good cry!” However, grief is more complicated than that. It is a dynamic and we live through it. We go through several steps along the way each of which is hard work. It is not just a passive force of letting out pent up feelings. It is an active process of adjustment. It is a positive ‘letting go’ of something or someone that has been very precious to you for a long time.
Grief is important in that it is a half way stage between the experience of losing someone and coming to terms with the loss. When we are grief stricken we have strong feelings which we have to deal with so that the wound can heal.
There is no right way to grieve. Grieving varies from person to person and from culture to culture. The point about grief is not how it is done but that it should be done somehow. Things may go wrong. Grief may be denied totally, or it can begin and then be inhibited. It may be turned towards the body instead of outwards to relationships with other people. We quite often see a person who appears not to be affected by grief but know that such good spirits are superficial and brittle. If grief is delayed or inhibited, superficial relief is only gained for a short time. When grieving does start it is often more severe because it has been delayed.
If grief is denied altogether, the person may slip from grief, which is normal and healing, into a depressive illness which is distressing and debilitating. When grief is turned inwards into the body, the person may complain of physical illness. Research has shown that during the first six months after bereavement, widowers often complain of heart trouble and widows tend to consult their doctors with gastric upsets and rheumatic conditions.
It is very often easy to confuse grief with depression. The bereaved person feels sad and lost. Appetite goes and sleep is interrupted. There may be reproach for not having cared more for the lost one. Kind friends may tell the person not to cry, not to be upset and try to forget it all. That is exactly what the person should not do if they are to go through the natural process of grieving. They must be allowed and encouraged to grieve.
It is not easy to grieve in our society. We can however, grow and mature as human beings if we are allowed to grieve successfully. Grief is a process, not a state. It takes time to work through. Grief is normal, natural, painful and takes time to resolve.
• We are in a state of shock.
• We experience emotion
• We feel depressed and very lonely
• We may experience physical symptoms of distress
• We may become panicky
• We feel a sense of guilt about the loss
• We may be filled with resentment and hostility
• We are unable to return to our usual activities
• Gradually hope comes through
• We struggle to adjust to reality
Death is the universal experience of all human kind, but each individual death is unique not only to the person who has died, but also the surviving relatives and friends. When death occurs in a family, the anguish and grief we feel can be personally shattering and socially disruptive. Sorrow and helplessness, denial and anger, guilt and relief, hopelessness and confusion, are all common reactions to the loss of someone we loved.
The personal dimension of grief must be resolved by each of us in our own way. But the burden of grief, although personal, should not be borne alone. It is important during this period that supportive and loving friends and family allow this grieving to take place.
It is possibly the last taboo subject in our society. As a result, death and its consequences are not well understood. This, in turn makes it more difficulty for us to cope with when death does occur. Even the professionals, the doctors, nurse, social workers, psychologists and clergy share our reticence, our mental discomfort. There is a reluctance to invest to much of ourselves in an others death. Through fear of our own death, we fear to confront it in others. Whilst we can’t prevent the profound emotional turmoil and grief that accompanies death, greater understanding can help alleviate our fears and hesitancies. Knowing what to expect can help us to cope with our feelings, and hopefully bring some comfort and tranquillity to both the dying and the bereaved. This is increasingly important in today’s world, where changes in society have tended to remove death from our everyday experience and discussion. SGW
What is mental illness?
For many years mental illness has been considered as shameful, dangerous, unpleasant, embarrassing, weak, incurable and above all, something that had to be hidden away. This sort of attitude has caused misery to many people, almost as much misery to the people concerned as the illness itself.
Many of us will have had a friend, work colleague, neighbour or family member who has suffered a nervous breakdown or mental illness. We may feel uncomfortable or even frightened of these people – what should we say to them and is it safe to ask them how they are feeling? Is this discomfort or fear that we feel, caused by our ignorance or by the mental illness?
Mental illness is a disorder of the functioning of the mind. It is a general term that refers to a group of illnesses, just as heart disease refers to a group of illnesses that affect the functioning of the heart.
Professionals who work with the mentally ill classify the illnesses and some of the commonly used classifications are: neurosis, anxiety, phobia, obsession, neurotic depression, psychosis, psychotic depression and schizophrenia.
Neurosis or neurotic disorders seem to be an exaggeration or distortion of feelings, thoughts and behaviours that we all have. For instance, we have all at some time experienced deep or uncontrollable feelings of depression, sadness, tension or fear when parts of our life have become too difficult to handle. With some people these feelings become so disturbing for them that they are unable to cope with day-to-day activities like going to work, dealing with household duties, relating to others or even enjoying their leisure time.
In psychotic disorders, the person usually becomes in some way out of touch with the real world. The person may develop delusions - false ideas of persecution, guilt or grandeur. Or they may have hallucinations and this can appear strange and disturbing to others.
Intellectual disability or developmental disability is not the same as mental illness. People with intellectual or developmental disability have learning difficulties and develop at a slower rate. The condition is usually identified during early childhood. It can also result from damage to the brain and can occur at any age. Mental illness on the other hand can affect anyone of any level of intelligence. A person with an intellectual or developmental disability can also develop mental illness.
Mental illness has many causes and many factors interact and influence one another to cause mental illness. Some of these factors are our genetic inheritance, our family environment and cultural background, life stresses and events and even physical illness. However, it is important to remember what is stressful to one person may not be to another.
Certain types of mental illness such as schizophrenia and manic-depressive illnesses tend to be more common in some families than in others and are probably influenced by the genes (heredity). But it should be stressed that even then, the majority of relatives will not develop the illnesses. What is inherited, is a predisposition to develop the illness, and other factors are still necessary for the illness to appear.
Is Mental Illness catching?
Mental illness is not an infectious germ that can be caught like measles and mumps.
Are Mentally Ill people violent?
Unfortunately, there is still an image that all mentally ill people are violent, raving, dangerous lunatics and need to be locked up. The truth is that mentally ill people are no more dangerous or violent than the rest of the community. Most of the mentally ill are very vulnerable and afraid.
Are Mentally Ill people sexually disturbed?
Most sexual offenders are not mentally ill. The vast majority of mentally ill people never commit sexual offences; in many instances the illness reduces their interest in sex.
Why don’t Mentally Ill people just pull themselves together?
Most people suffering from a mental illness would love to do just this. Unfortunately will power alone cannot cure mental illness, just in the same way it cannot cure a broken leg.
Shouldn’t we lock up the Mentally Ill for their own good?
Most people suffering with a mental illness never need to be admitted into hospital and can be successfully treated in their own homes. It is only when a person becomes so disabled by their symptoms and cannot cope that they may need the sheltered environment of a hospital and most wards of psychiatric hospitals are not locked. Only a small percentage of mentally ill people need to be locked in a hospital for their own or society’s protection.
Is Schizophrenia the same as ‘split personality’?
No! Schizophrenia is a psychosis, where a person’s feelings, thoughts and behaviours become very disorganised and do not fit together. Some sufferers have delusions, ideas and hear voices and various combinations of symptoms may appear in any one person.
What is Manic-Depressive Illness?
This is a psychosis that is mainly characterised by disturbances of the mood of the sufferer. During the manic phase of the illness the person may be more happy than their circumstances would warrant, overactive, over talkative and over-confident. They may even feel that they have super abilities and may overspend dramatically. These feelings are often associated with irritability.
During the depressive phase, the person may become sad, pessimistic about the future, withdrawn and under-active, sometimes with strong feelings of guilt. In either phase the person may experience hallucinations and/or delusions.
Episodes of this illness may be mild or severe and last for short or lengthy periods. In between episodes the person may be symptom free.
Can Mental Illness be cured?
Many people have one episode of mental illness and then never break down again, but there are a small percentage of people who have recurrent episodes. There is an even smaller percentage of people who have mental illness all their lives. Even people who have had a mental illness for years have recovered. It should be remembered that you can have relapses in physical illnesses and mental illness is no different.
What treatments are used for Mental Illness?
Psychotherapy: There are many forms of ‘talking treatment’, but basically they all try to help sufferers by talking with them and relating to them in a special way so that they can understand themselves better.
Behaviour Therapy: The therapist is concerned in helping people alter their behaviour or thinking in order to reduce their symptoms.
Medication: Some medications, like ‘major tranquillisers and anti-depressants’ reduce or remove the symptoms of psychosis. Other medications can help relieve tension and depression and therefore make it easier for the person to deal with their symptoms. Medication should always be taken under the direction of a doctor. It is usually given at night since drowsiness may occur as a side effect in the early stages, and this can be put to good use by being slept off as difficulty in sleeping is often part of the illness.
Electro-convulsive therapy? This is used only occasionally, mostly for very severe depressions, where doctors believe it can make a dramatic improvement in a person whose symptoms are intolerable. A general anaesthetic is always given before this form of treatment is given.
Alternative therapies: Some people find alternative therapies helpful in the treatment of mental illness. These alternative therapies can be anything from nutritional, orthomolecular medicine, movement therapies, relaxation and meditation. Though these treatments have not all been thoroughly validated some people find them of considerable benefit.
There are also a wide range of social and physical activities that can be used to teach and to encourage people suffering from a mental illness to express and enjoy life, and to learn coping skills. It is here that community and church groups can play an important part in restoring the self-esteem of someone who has been mentally ill. They can also offer support for relatives and friends of the mentally ill person.
What is Schizophrenia?
Schizophrenia is a severe mental illness occurring mainly in young adults. Schizophrenia happens to people from all walks of life but most commonly its onset occurs between the ages of 18 and 25 years. However, having said this schizophrenia can occur in older people as well. The symptoms of schizophrenia can include
When acutely ill, people with schizophrenia make unusual, illogical associations in their thinking. They lose the capacity for abstract thought. Words can become jumbled, strange and incoherent. The flow of thoughts is often blocked and conversation no longer makes sense.
These are immovable, rigid beliefs held by the person about being controlled or harmed in some way. They feel that thoughts are being unwantedly inserted into or withdrawn from their minds, that others can ‘hear’ their thoughts or that the T.V. or radio is sending them special messages.
These are illusory sensations, where people with schizophrenia hear voices that no-one else hears. Thoughts are spoken aloud by other voices, conversing with the individual about themselves, telling them what is happening, describing their situation in bizarre and warped contexts. The voices can be so persuasive that people often act in wildly inappropriate ways as the voices incite them, sometimes with serious consequences.
Inappropriate Emotional Expression-
Emotions may be dull, flat, or out of control and over excited. They may be inappropriate, like laughing at something sad, or crying at something amusing.
People with schizophrenia retreat into their own world, avoiding company and spending hours alone, often in their bedroom.
Severe loss of motivation-
People with schizophrenia lose initiative and energy to a marked degree. They can become unconcerned about personal hygiene or appearance.
People with schizophrenia may not accept that they are ill. They may refuse to seek professional help, refuse prescribed medication or remain completely untreated, causing serious problems for their relatives and other carers.
Most people with schizophrenia do not have all of these symptoms, and some are more severely affected by them than others. At their worst, the symptoms may make it very difficult for the person to lead a normal life. They can make the world a confusing and often frightening place.
Causes of Schizophrenia:
The cause of schizophrenia is not known. It is considered, however, to be not one, but a group of diseases of the brain, characterised by disordered perception, thinking and feeling. Research is concerned with possible contributing factors, such as genetic or biochemical defects, slow acting viral infections, as well as environmental influences. There have been a number of studies linking the onset of schizophrenia with substance abuse. Marijuana usage has been particularly noted as a relevant factor, It is not proven whether Marijuana is a cause of schizophrenia, a contributing factor in an individual who has a predisposition to the illness, or whether drug usage is sometimes used by sufferers to escape the trauma of undiagnosed schizophrenic experiences.
Management of Schizophrenia:
Medication is the most effective method of controlling hallucinations, delusions and thought disorders. Some people recover, but more often they continue to have trouble with the symptoms throughout their life. It may be necessary to stay on medication for extended periods, perhaps forever. Some of the drugs have very difficult side effects and can cause dry mouth, weight gain, impotence and nausea. For this reason, as well as for the reason that once people start to feel well they may believe they no longer need medication, relapses due to failure to take medication are a common occurrence. Some people simply refuse to take medication.
Learning to live with the Illness:
As a result of schizophrenia adjustments have to be made. Ways of coping can be developed by:
* Gaining information about schizophrenia
* Getting help with interpersonal difficulties
* Encouraging the development of self help training, advice about nutrition, hygiene, budgeting and homemaking
* Developing recreational pursuits
* Assessing educational levels and training for a vocation
Today, the emphasis is primarily on treating people with mental illnesses whilst they remain living within the community, with brief periods in hospital prescribed only if necessary.
Often families of people with schizophrenia are the major sources of patient care. For this reason, the families of people with schizophrenia also need support. Being the parent or close family of a person living with schizophrenia is a heart breaking and difficult task requiring extraordinary patience. Not only does the illness mean that family are never sure what the next moment will bring but often, there is the added difficulty of coping with social ostracism and lack of understanding.
What is ‘Obsessive Compulsive Disorder’ (OCD)?
OCD is an anxiety disorder affecting about two percent of the population. Sufferers are disabled by obsessions that are persistent, unwanted, involuntary and intrusive thoughts. The sufferer may or may not recognise these thoughts as irrational or excessive. They are not able to control these thoughts nor effectively limit their intrusiveness, nor the anxiety they cause. Sufferers may be further disabled by compulsions which are persistent needs to act and repeats acts are also to try and control the obsession.
Sufferers are often acutely embarrassed about their symptoms and may keep them a secret for years, at times even from their close friends.
Those affected can live in their own private hell for years, while outwardly seeming to cope well and to lead a relatively normal life. The latter is an illusion which is only maintained at great cost in time, energy, stress and personal effort.
What are the symptoms of Obsessive Compulsive Disorder?
Some common obsessions are thoughts that sufferers are dirty or contaminated that they unwittingly have harmed others in some manner, and that they are to blame for something or another. These obsessions can vary from time to time both in nature and severity.
The most common compulsions involve cleaning and checking. For examples, a sufferer can have the obsession that their hands are dirty after being to the toilet, and no matter how many times they wash and re-wash their hands, they still feel they are dirty. Their anxiety may not only be that they are dirty themselves, but that they may infect others, contaminate foodstuffs and so forth. They may know that further washing is unnecessary, but cannot stop the feeling of needing to wash and re-wash. Similarly, compulsions to check may involve repeatedly checking light and power switches to ensure that they are off, or checking the locks to ensure that they are secure despite knowing that they had only just been checked confirmed that the switches were off and the locks were shut.
Carrying out a compulsion may momentarily reduce the obsessional thought and associated anxiety, but these may almost immediately return so that the cycle has to be repeated. These persistent thoughts and repeated acts may occupy hours of a sufferer’s time, can be exhausting, and can stop them doing other work or leisure activities.
The symptoms can seem inexplicable, irritating and frustrating to the families, friends and workmates of sufferers.
What are the causes of ‘Obsessive Compulsive Disorder’?
There are many theories about possible causes but the exact causes are unknown. Theories include the possibility of a slight genetic predisposition, effects of behaviours, after-effects of some infections of the brain, and changes in one or more brain chemical systems especially changes linked to the brain chemical called serotonin (5HT). No one theory explains all cases and the causes still remain a mystery.
It is important to realise that for a proportion of sufferers, the symptoms of obsessions and compulsions result from other illnesses. These disorders include, infections of the brain, the after effects of some brain trauma, dementia, and other psychiatric disorders like depression and schizophrenia.
How is ‘Obsessive Compulsive Disorder’ treated?
This depends on the symptoms and severity of the disorder. It is common for therapists to use several treatment techniques at the same time.
This includes ways of helping the sufferer to acknowledge their thoughts and behaviours and ways to control them.
Some antidepressants, especially those which can affect serotonin, can help the disorder. These medicines can only be prescribed by a medical practitioner. You will not become physically dependent on the tablets but they do have side effects and need to be monitored.
Talking to a trained therapist can help in understanding symptoms, feelings, and difficulties with the disorder so that they individual can be freed from the anxiety associated with the disorder.
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