Grief, Burden, Violence, Stigma
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Grief, Burden, Violence, Stigma Week Five: Special Topics PSRT 4271: The Family Role in Rehabilitation 1
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Grief, Burden, Violence, Stigma . Week Five: Special Topics PSRT 4271: The Family Role in Rehabilitation. Grief. The Mystery of the Hereafter and The Peace of God that Passeth Understanding (1891) Adams Memorial, Rock Creek Cemetery Augustus Saint-Gaudens. Augustus Saint-Gaudens. - PowerPoint PPT Presentation
Transcript of Grief, Burden, Violence, Stigma
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Grief, Burden,Violence, Stigma
Week Five: Special TopicsPSRT 4271: The Family Role in Rehabilitation
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Grief
The Mystery of the Hereafter and The Peace of God that Passeth Understanding (1891)Adams Memorial, Rock Creek Cemetery
Augustus Saint-Gaudens
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Augustus Saint-Gaudens
4Grave of Henry Adams’s wife
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Grief
The Mystery of the Hereafter and The Peace of God that Passeth Understanding (1891)Adams Memorial, Rock Creek Cemetery
Augustus Saint-Gaudens
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Phases of Grief (Mohr & Kubinski, 2001)
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Avoidance Not reality!
Phases (Mohr & Kubinski, 2001)
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Avoidance Not reality!
Confrontation Harsh reality
Phases (Mohr & Kubinski, 2001)
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Avoidance Not reality!
Confrontation Harsh reality
Accommodation New reality
Phases (Mohr & Kubinski, 2001)
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Theory of chronic sorrow (Eakes et al., 1999)
A trigger for grief…
What is vs. what might have been
“Disparity”
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4 focus groups
8 per group
90 minutes each
Children ages: 17 to 31
Mohr & Kubinski Study
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Epiphany: “nightmares”
Action: from “shattering tension”
Deluge: “emotional shredding”
Fear: of everything… exhausting
Anguish, Guilt, Sequelae…
Findings
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Caregivers must know grief dynamics◦ Not dysfunction ◦ Rather: understanding
Refer families to programs that can help…◦ NAMI Family to Family, etc.
Implications…
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Burden
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Up to 60% live with, receive care from families
Interesting facts… (Doornbos, 2001)
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Objective
Subjective
Types of burden (Lefley, 1989)
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Abuse Mood swings Offensive public behavior Conflicts Squandering of money Poor hygiene Property damage Disruptive sleep patterns Rejection of medications
Behavior management issues…(Lefley, 1989)
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5 categories (Bowers, 1987)
1. Anticipatory2. Preventative3. Supervisory4. Instrumental5. Protective
9 processes (Schumacher et al., 2000)
1. Monitoring2. Interpreting3. Deciding4. Acting5. Adjusting6. Caring (hands-on)7. Assessing (resources)8. Collaborating9. Negotiating
Lit Review: Caregiving analyses…
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Monitoring Managing Maintaining Encouraging Socializing
Doornbos: 5 caring processes
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Information!◦ Medications◦ Symptoms◦ Resources◦ “Everything!”
Where?◦ Support groups◦ Education programs
Doornbos: Needed…
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Understanding of family impacts
Inclusion in treatment planning
Understanding of family time devoted
Understanding of family frustration
Wanted from professionals…(Doornbos, 2001)
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Violence
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I am Adam’s Lanza’s Mother!...
http://www.youtube.com/watch?v=Dgrr2jDcXAs
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Families speak out in CA (News10/KXTV, 2012)
Laura’s Lawhttp://www.youtube.com/watch?v=GOAoI5-0l9o
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Elbogen & Johnson (2009)
http://www.youtube.com/watch?v=wCeFEr5ioqo
“…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.”
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Is this the answer? http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=192996785&m=192996772
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Stigma
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A mark, brand, or label
An interactive social process
Both
What is stigma?
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Lack of recognition of prodomal symptoms
Shame less assessment, treatment
Less funding, lower reimbursements
Low status, marginal priority
Stigma Effects (Heflinger & Hinshaw, 2010)
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Besides public cues…
Cognitive (stereotypes)
Emotional (prejudice)
Behavioral (discrimination)
Structural models of stigma (Larson & Corrigan, 2008)
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Individual
Community
Societal
3 levels (Heflinger & Hinshaw, 2010)
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4 sources of “iatrogenic” damage:
1. Avoidant or recriminant responses
2. Double-bind messages
3. Interventions that alienate
4. Provocative family-provider interactions
Stress from providers…(Lefley,1989)
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Role conflicts:
72%: had psychotherapy, but…
26%: strong reluctance to discuss… 90%: overheard colleague disparagements
Providers as family members…(Lefley, 1989)
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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
Stigmatizing provider attitudes
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Stigma by association
“Courtesy stigma”
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The last word on stigma…
http://www.youtube.com/watch?v=UqnF3UicuQs
President Obama, June 3, 2013
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Today’s Guest Presentation…
