Personal Guidebook to Grief Recovery

Back To Life! A Personal Grief Guidebook

Back to Life is a comprehensive, quality bereavement handbook. It consists of 73 pages that explore many aspects of grief in detail. There are 19 chapters or lessons, each addressing a different aspect of grief, a coping skill or a strategy for emotional survival. Here you will learn: Good, solid information on how the grief process really works. Which symptoms of grief are normal, and which are dangerous warning signs. Valuable and practical coping skills to help you get through each day. Secrets to getting a good night's restorative sleep without prescription drugs. How to endure the holidays and thoughtless visitors. How to identify and defuse anger, guilt, and regret. Family changes to look for and how to keep your family intact through this. Just the right activities and comforting rituals to help ease you through your darkest days. Tried and true psychological exercises and strategies to help lessen the raw pain. Satisfying and therapeutic creative expressions of grief. Effective memorializing techniques to honor and remember your lost loved one. How to cling to hope and move surely towards brighter days. More here...

Back To Life A Personal Grief Guidebook Summary


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Grief and bereavement

The term grief can be defined as a type of stress reaction, a highly personal and subjective response that an individual makes to a real, perceived, or anticipated loss. Grief reactions may occur in any loss situation, whether the loss is physical or tangible, such as a death, significant injury, or loss of property or symbolic and intangible such as the loss of a dream. The intensity of grief will vary, depending on many variables such as the meaning of a loss to the individual experiencing it. It should be recognized that loss does not inevitably create grief. Some individuals may be so disassociated from the loss object that they experience little or no grief, or their response may be characterized by intense denial. This definition of acute grief distinguishes it from other terms such as bereavement or mourning. Bereavement refers to an objective state of loss. If one experiences a loss, one is bereaved. Bereavement refers to the fact of loss, whereas grief is the subjective...

Ethical Issues in Grief

Ethical issues in grief may emerge from three sources. First are general issues for counselors. Grieving persons can be highly vulnerable. Counselors have to have personal integrity and follow the ethical standards of their profession, including maintaining confidentiality, preventing harm to the client or others, assuring competence, and upholding standards of professional behavior. Counselors should familiarize themselves with their respective codes of ethics. They may wish to review as well the Code of Ethics of the Association for Death Education and Counseling. In addition to the normal standards of professional conduct, counselors should be aware of two other ethic-related issues that might arise in grief counseling. Ethical issues within the course of the medical treatment of the deceased person may affect responses to grief. For example, a person who decided to terminate treatment may struggle with that issue within the grief process. In similar ways, ethical decisions made...

Paradigms of Grief

Grief was first empirically described in 1944 by Eric Lindemann, a psychiatrist who studied survivors of the Coconut Grove Fire, a 1942 Boston fire that swept through a nightclub, killing many. Lindemann described grief as a syndrome that was remarkably uniform and included a common range of physical symptoms, such as tightness of throat, shortness of breath, and other pain, as well as emotional and other responses. It should be recognized that Lindemann's research was based on a sample of primarily young survivors of sudden and traumatic loss. This medical model of grief was continued most clearly in the work of George Engel (1961). Engel believed that grief could be described as a disease, one having a clear onset in a circumstance of loss a predictable course that includes an initial state of shock a developing awareness of loss characterized by physical, affective, cognitive, psychological, and behavioral symptoms and a prolonged period of gradual recovery, with the possibility...

The Course of Grief

There have been a number of approaches to understanding the process or course of acute grief. Earlier approaches tended to see grief as proceeding in stages or phases. Colin Murray Parkes (1972), for example, described four stages of grief shock, angry pining, depression and despair, and detachment. Recent approaches have emphasized that grief does not follow a predictable and linear course, stressing instead that it often proceeds in a roller-coaster-like pattern, full of ups and downs, times when the grief reactions are more or less intense. Some of these more intense periods are predictable holidays, anniversaries, or other significant days but other times may have no recognizable trigger. More recent approaches have emphasized that grief involves a series of tasks or processes. J. William Worden (1992) described four tasks to grief recognizing the reality of the loss, dealing with expressed and latent feelings, living in a world without the deceased, and relocating the deceased in...

Help and Grief

Persons experiencing acute grief can help themselves in a number of ways. Because grief is a form of stress, lifestyle management including adequate sleep and diet, as well as other techniques for stress reduction, can be helpful. Bibliotherapy or the use of self-help books can often validate or normalize grief reactions, suggest ways of adaptation, and offer hope. Self-help and support groups can offer similar assistance as well as social support from others who have experienced loss. Others may benefit from counselors, particularly if their health suffers or their grief becomes highly disabling, impairing functioning at work, school, or home, or if they harbor destructive thoughts toward self or others. Parkes (1980) particularly stressed the value of grief counseling when other support is not forthcoming. Pharmacological interventions also may be helpful particularly when the grief is disabling, that is, severely compromising the individual's health or ability to function. Such...

Complicated Grief

While models of complicated grief vary (Rando Worden), complicated grief reactions generally involve intensifications and exaggerations of the earlier described responses to grief that effectively impair the individual's ability to function. Complicated grief can also be evident in masked reactions that is, the grief is masked by another problem such as substance abuse. One factor that can complicate grief is disenfranchise-ment. The term disenfranchised grief refers to a grief that results when a loss is not socially sanctioned, publicly acknowledged, or openly mourned. Grief may be disenfranchised because a loss is not recognized (e.g., the loss of an animal companion), a relationship is not recognized (e.g., a friend or therapist), the griever is not acknowledged (e.g., a very young child or a person with developmental disabilities), the death evokes shame or censure (e.g., an execution), or the way the person expresses grief is considered inappropriate or unacceptable. In such...

Grief And Loss

Unfortunately, there remains an inconsistent use of terms and definitions in the grief literature, leading to sometimes confusing conclusions. For the sake of clarity, grief is defined here as representing the particular reactions one experiences while in a state of bereavement. These reactions to the perception of loss can be psychological, social, and physical. Bereavement has been conceptualized as the experiential state one endures after realizing a loss. It refers to the emotions, experiences, changes, and conditions that take place as a result of the loss. Using these definitions, patients who are diagnosed with a life-threatening illness are undoubtedly in a state of bereavement as they navigate the changing landscape the illness brings. It might be said that they are in a state of mourning. Mourning can be conceptualized as involving both intrapsy-chic processes and cultural responses to a loss. Intrapsychic processes, according to the cognitive-behavioral literature, might...

Grief Reaction

Individual responses to the death of a loved one vary greatly. The initial response has been described as a psychic pain spike. Although it lasts only a brief amount of time, usually 5 to 15 min, it occurs. During this period, the family can make no decisions. Once this period of acute grief has ended, the family members will progress through other reactions denial, anger, and or guilt.13 what should have been done may be often made. Although difficult to accept, the physician must see these as expressions of grief. This anger is often misplaced guilt at causing or failing to prevent the death. Unconscious frustration with the deceased for abandoning the bereaved can find its outlet in anger directed at others. A defensive posture on the part of the physician is counterproductive. Reflecting the family members' feelings back to them, and not accepting them personally, is the best response. Eventually the anger will dissipate, allowing the family to move on with the grieving process....

N Psychosocial Aspects of Aphasia

The psychological reactions to aphasia are believed to be influenced to some degree by premorbid personality, level of achievement, and values. As a result of its negative effect on interpersonal activity and quality of life, aphasia is frequently referred to as a social disability. By far the most commonly mentioned psychological reaction is depression. Difficulty in coping with being socially different, feelings of loss, grief, and lowered self-esteem are also pervasive. Family members also suffer from the effects of role changes, caregiving, the impact on the family's sources of gratification, and difficulties in communication.

Instrumental Activism

While death is inevitable, its social impact is meliorable. Parsons explored two respects in which this is true (Parsons and Lidz Parsons, Fox, and Lidz). First, medical and public health technologies have reduced premature death and now typically enable members of society to use God-given talents to advance their vocations in good health over long lives. The demographic changes of the late nineteenth and twentieth centuries, and related efficiencies in the use of human talents, thus flowed from an effort to master death. Second, when individuals die, the resulting experiences of social loss can be controlled. Measures ranging from life insurance to retirement planning in business to estate planning in personal affairs to psychotherapy for grief and loss reduce harms ensuing from death (Zelizer, 1983). Similarly, American mourning customs emphasize austerely supporting the bereaved in overcoming grief and guilt, so they are able to return to their routine social obligations without...

Personality Differences by Gender

The Yuquiare notable for their high degree of expressiveness among both men and women. They show all emotions openly and there is no stigma for either sex in showing joy, anger, or sadness. Because of this, to outsiders they appear to be reactive or excessive in their response to any situation they find exciting, joyful, distressing, or antagonistic. When unhappy or sad (e.g., on the death of a member of the group), both sexes will cry openly for days. During these periods of intense grief, the YuquMlow large strands of mucus to hang from the nose and then wipe it on their hair as a demonstration of the depth of their feelings. A man will cry out of anger or frustration, or speak in a rapid high falsetto, just as frequently as will a woman, when agitated. There are no social rules that encourage the control of one's emotions, which as a consequence are completely uninhibited. Anger often escalates into physical violence, as much among women as men.

Applying an Integrated Cultural Epidemiological Approach

Had this happened at her former home in Puerto Rico, her relatives would probably have known she was having a nervous attack, or ataque de nervios, prompted by extreme grief. Such ataques were an acceptable cultural response to strong emotions like grief and anger. There people would have known Rosa needed her family to rally around her, and they would perhaps have taken her to a local espiritista (spirit medium) for a spiritual cleansing that would help heal her grief. But in New York City the funeral home director thought she was having some kind of epileptic seizure and called an ambulance.

Native American Traditional Medicine

Home management dietary and medication complexities coupled with a fatalism regarding complications can elicit fear and grieving related to the diagnosis of diabetes. Goforth-Parker (1994) conducted a study in rural Oklahoma using unstructured interviews and clinical observations to elicit disease processes and insights into the lived experience of diabetes. The responses were constructed into thematic patterns that illuminated these concerns.

Confucianism and Daoism

The ancestor cult was based on rituals, or li. It assumed the continuity of life after death, communication between the living and the dead, the legitimacy of a social hierarchy, and a virtual deification of the ancestors. In his Analects, Confucius upheld the ancient practices, refusing to shorten the period of mourning (XVII.21). Nevertheless, he taught that the spirits should be kept at a distance, so as not to preoccupy the living (VII.20 XI.11). He also thought that mourning rituals should be moderate they should express grief rather than fear (III.3). Four centuries later, details of the mourning rituals were described in the ritual text Yi Li. Now elaborate, they were to last for three years. During the first year, the eldest son (as chief mourner) had to wear sackcloth, live in a hut outside the home, wail periodically, and eat very little food. Over the next two years, the restrictions were gradually lifted. Even after life returned to normal, though, he reported family...

Telling The Survivors

Once the initial statement is made, allow a brief period for the initial grief response (30 to 60 s). The physician may give physical comfort to the family if the physician is comfortable doing so. After the initial delay, asking the most stable survivor for their perception of the event allows the initial presentation of information to conclude. Families may receive some comfort from statements that the patient suffered no pain (if appropriate) and that everything possible was done. They are told that the coroner medical examiner and their private physician will be contacted. They are also told that the physician will return to answer any questions they may have.12

Theoretical Bases

Grief therapy, whether utilizing the tasks of mourning or focusing on the reconstruction of one's meanings, can be understood as an opportunity for heightened self-perception. Recent studies have indicated that at least 70 to 85 of bereaved persons typically engage in a search for meaning in their lives following a death. This means that for most people bereavement holds the potential to be a time when they are looking at such existential questions as What is the purpose of my life and the corollary Who am I, after all While completing the many therapeutic experiences described earlier, grieving persons observe their own responses to the urgent experience of death and loss. With the therapist's aid, they can examine their own answers to existential questions and learn who they are. If therapists explicitly foster such self-perception, grieving persons have unique opportunities to redefine themselves. Both a grief therapy centered on the tasks of mourning and one focused on a...

Biomedical Engineering Medical Technology and Issues in Bioethics

Medical technology has had a variety of profound effects on family-care as well as healthcare practice. For example, some people have criticized the intrusiveness of intensive-care technology in light of the relatively high frequency with which people die in intensive-care units. The unit isolates a critically ill patient from family members, making it impossible for them to care for and comfort the patient in his or her final hours and disrupting the grieving process.

Conclusion Bioethics Culture and Globalization

Analysis of the rituals and symbols evoked by death and dying also suggest the powerful role of social and economic conditions that necessarily define and constrain death experiences, including the treatment of bodies, burial practices, and reactions to grief. Viewed from a cultural perspective, death practices provide an important foundation for understanding the meaning of human suffering in response to loss.

Criticisms Of Cbt

Literature specifically focusing on persons with AIDS, COPD, cardiac conditions, cancer, and others may offer support to cognitive-behavioral interventions for terminally ill persons. However, caution is warranted in generalizing across populations due to the inherent differences in disease processes, length of time from diagnosis to death, societal reactions to such illnesses, and medical technology and knowledge addressing such conditions. Cognitive-behavioral therapies have traditionally been characterized as cold, methodological, and promoting a logical analysis rather than emotional expression. It has often been characterized as technique focused rather than process focused. Although various techniques have been cited in the previous sections, it is equally important to develop the therapeutic relationship in which the context of therapy takes place. Working with this population requires sensitivity, creativity, and attention to one's own beliefs about grief, loss, pain, and...

Coping And Adjustment

Affective components of treatment include identifying, labeling, and expressing affective states as well as regulating and modulating emotions. For example, a client may have difficulty recognizing and managing anger relating to one's life-threatening illness. Education about the normative affective components that comprise a grief reaction and the physiological correlates of anger may be necessary to help the client identify and accept this emotion in him- or herself. Furthermore, teaching and rehearsing necessary skills for modulating anger may be helpful. Behavioral aspects of treatment for those with a life-threatening illness are varied and can be used to facilitate the grieving process, promote coping, and or increase quality of life. Some interventions targeting behavior change or skill acquisition might include learning relaxation and other anxiety reducing techniques, scheduling activities to build structure into daily functioning and create opportunities for pleasant...

Coping With The Death Of A Child

Both family members and the resuscitation team members will mourn the death of a child. Little attention has been focused on this issue for either the family or the emergency department staff. Several tasks of mourning have been described that must occur for successful resolution of grieving (I bJ.e, 10 6)13 Whether a child dies in the emergency department or after several days of hospitalization does not seem to affect the grieving process. 14 Pathologic grief reactions are often the result of fear that the child will be forgotten. Excessive focus of time, energy, and effort is spent on remembering the child without resolving the grief. Sharing feelings and memories about the child is crucial persons who do not allow parents to express their feelings may mar the grieving process.14

Stephanie H Felgoise and Holly Kricher

Keywords terminal illness, grief, coping, loss, quality of life The psychological sequelae to a terminal illness diagnosis, also termed life-threatening illness, are complex and ideographic. Terminal illness or life-threatening illness is operationally defined as any condition that shortens normative life expectancy, a condition that is not due to normative causes. Some examples of these types of illnesses include AIDS, COPD, cardiac conditions, and some forms of cancer. Individuals often struggle with medical treatment, end-of-life planning, cognitive and behavioral changes, grief issues, and more. Although empirical data specific to psychological interventions for persons with life-threatening illnesses are sparse, cognitive-behavioral treatments seem appropriate and promising to facilitate coping and adjustment for such patients. As death becomes imminent, improving quality of life versus quantity of life becomes the focus and goal of treatment for medical and mental health...

Persevering Through Infertility Treatments Together

Finding out that you may have trouble conceiving can be devastating. Most people assume that having children is an inalienable right and they're shocked to find out it may not be that easy. Families dealing with infertility go through all the stages of grief denial, anger, bargaining, and rationalization before acceptance and dealing with the problem face on. (See Chapter 7 for a complete rundown on infertility issues that endometriosis can cause.)

TABLE 107 Giving Bad News Effectively

Many hospitals have policies requiring that family wait outside the area where resuscitation efforts are being conducted, but family presence during resuscitation efforts is increasing in popularity. Both positive and negative family responses can occur during resuscitation. 15 Family presence during an attempted resuscitation may enable family members to begin appropriate grieving earlier. No studies have shown that the long-term effects on family grieving are beneficial, however. Some family members may become distressed or exceedingly emotional while care is being given to a loved one. Worries by emergency department staff members about the family's critiques of the resuscitation, or the family's unwillingness to terminate efforts, also contribute to the desire not to have the family present during resuscitation. However, the desire to have family members present during a resuscitation is a holistic approach to patient care with both the family's and the patient's needs addressed...

Overview Of The Caregiving Literature

Across groups, it is accepted that most caregivers face multiple challenges and stressors, and therefore, many often experience feelings of depression, anxiety, powerlessness, role strain, guilt, and grief (Ruppert, 1996). Caregivers struggle with juggling multiple roles (family, work, household) with their caregiving responsibilities and often do so without adequate support. The psychological distress that results when caregiving responsibilities exceed caregivers' available resources has been defined throughout the literature as caregiver burden.

Education and Support

Knowledge a patient and family have about the disease, treatment, and expected problems, the more effectively they can deal with the care of the patient. Even simple coping strategies, such as taking intermittent naps, writing notes, and taking special care to plan and organize activities, may be sufficient to effectively cope with symptoms. Support groups and counseling can also be very helpful in assuring patients and families that their experiences are not unusual and in helping them deal with the grief, anger, frustration, and other problems that are frequently manifested over the course of the disease.

Cancer Patients Psychotherapy

Even the process of grieving can be reassuring at the same time that it is threatening. The experience of grieving others who have died of the same condition constitutes a deeply personal experience of the depth of loss that will be experienced by others after one's own death. The acceptance of the possibility of illness shortening life carries with it an opportunity for reevaluating life priorities. When cure is not possible, a realistic evaluation of the future can help those with life-threatening illness make the best use of remaining time. One of the costs of unrealistic optimism is the loss of time for accomplishing life projects, communicating openly with family and friends, and setting affairs in order. Facing the threat of death can aid in making the most of life. This can help patients take control of those aspects of their lives they can influence, while grieving and relinquishing those they cannot. Having a domain of control can be quite reassuring. Previous studies by...

Gender and Religion

The Earth Mother, Pachemama, rules the land and its fertility and live-giving qualities. She is not automatically generous and nurturing but must be paid for her bounty. Ceremonies and offerings at harvest and during events that mark life transitions, such as the child's first haircut or the construction of a new house, include burying of offerings (e.g., the blood of sheep slaughtered for the harvest festival, or the child's shorn locks) to pay the earth. Also, any drinking of alcohol is preceded by a libation to the Earth Mother. The Catholic Virgin Mary often serves as her syncretic symbol. For example, the grieving Mother of Christ who follows his coffin through the streets in Good Friday processions (which is during autumn in the Southern Hemisphere) is seen by the indigenous people as a symbol of the earth entering into its bereft winter period.

Ritual as Prophylaxis Funerals Mourning and the Work of Remembering

The way in which ritual may support emotional processes is especially evident in rituals of mourning. Several anthropologists have examined the ways in which ritual and cultural attitudes toward death support (or impede) the work of mourning (Bateson 1968 Levak, 1979 Reid, 1979). Beth Conklin discusses how the endocannibalistic funerary rites of the Wari Indians of Brazil work. She appropriately rejects the stereotyped Freudian explanations of some self-styled psychoanalytic folklorists of the old school such as Aggression. It's all about aggression. Every time you put something in your mouth, it's aggression (Conklin, 2001, pp. 93-108). Then, after developing Wari ethnopsychol-ogy and their ideas about grief, ghosts, and the dangers of dwelling on memories, she gives her own interpretation George Pollock (1972) drew on Melford Spiro's (1965) concept of a culturally constituted defense to demonstrate how orthodox Jewish mourning prescriptions segment mourning into periods that...

Responding to Suicidal Risk

Evaluating and responding to suicidal risk is a source of extraordinary stress for many therapists. This aspect of our work focuses virtually all of the troublesome issues that run through this book questions of the therapist's influence, competence, efficacy, fallibility, over- or underinvolvement, responsibility, and ability to make life-or-death decisions. Litman's study (1965) of over two hundred clinicians soon after their clients had committed suicide found the experience to have had an almost nightmarish quality. They tended to have intense feelings of grief, loss, and sometimes depression as anyone else professional or nonprofessional might at the death of someone they cared about. But they also had feelings associated with their profes

Critique and Innovation

While Hertz noted that death rituals tapped deep emotions, his study and those that followed emphasized the socially determined nature of emotional responses to death. Indeed, Block and Parry (1982, p. 41) describe emotion only in the service of sociality, stating that mortuary practices anchor the social group, not just by political power, but by some of the deepest emotions, beliefs and fears of people everywhere. An exception is the work of LeVine (1982) in psychological anthropology on grief, anger, and fear among the bereaved in Gusii funerals. In their comprehensive cross-cultural review of death studies up to 1984, Palgi and Abramovitch (1984, p. 385) comment When reading through the anthropological literature in one large sweep, one is left with the impression of coolness and remoteness. The focus is on the bereaved and on the corpse but never on the dying. Agreeing with and extending that assessment of observer detachment and an absence of an engagement with powerful emotion,...

Clinical Ethics Analysis of Case

When not in the abnormal moods, Crystal seemed to be a bright and happy child. She enjoyed playing the piano, singing, and dancing, and made friends easily. She was a straight-A 10th-grade student, described by her parents as artistic, outgoing, and active in her church youth group. During the prior 2 years she had twice secretly taken large doses of analgesic tablets from the family bathroom medicine cabinet and ingested them without telling anyone, and without apparent physical harm. These incidents occurred at a time when several relatives and a friend of the family were creating a climate of grief in her family by unexpectedly committing suicide, so that a posttraumatic stress phenomenon or grief and confusion might have been factors.

Future Directions

As previously stated, there remains a need for clear operational definitions of some of the concepts surrounding coping with a life-threatening illness. Concepts such as grief, bereavement, and mourning are often used interchangeably, contributing to confusion in understanding these processes. There is also a need for operational definitions of spiritual aspects of coping. For example, what does it mean to have a sense of connectedness or maintain continuing bonds There needs to be a more integrative approach to theories surrounding coping with grief and loss and coping with the problems that arise as a result of life changes due to a life-threatening illness. It may be somewhat artificial to view these as separate areas of coping. In order to promote a better understanding of the coping process and test specific theories, there must be improved assessment instruments and intervention methods consistent with theories. Furthermore, attention should be focused on unique characteristics...

TABLE 106 Tasks of Family Mourning a Lost Child

The physician should remain quietly in the room or return after a few minutes (or later, if other duties require) to answer questions. This is also the time to ask whether the family would like to see the child and to prepare them for what they will see. This is also the time to inquire about organ or tissue donation, if a regional transplant consortium does not provide this service already. Although parents do not regret organ donation, donation is not associated with a higher likelihood of successful grieving.14

Long Distance Notification

There are times when distance, environmental, or other factors make physical notification inadvisable. One study showed that many survivors preferred to be notified by telephone if the driving time exceeded one hour.19 Notification should not be rushed but should proceed in the same fashion as if done in person. The notification should not be forced if the family member seems unprepared, offer to speak with another family member in the home or another relative. After the notification is made, if the survivor is alone, offer to contact some supporting person. If pathological grief is present, ensure the safety of the survivor by contacting other supporters to attend them. If the survivor appears suicidal, local police may need to be contacted. If no adult is present, ask the oldest child how to contact an adult relative. Assure the child that an adult will be contacting them shortly. Depending on the circumstances (distance, time of day, weather), the survivor should be instructed to...

The Classic Studies Religion Ritual and the Social

The studies of Malinowski and Radcliffe-Brown, while influenced by Durkheim and Hertz, focused not on the corpse, but instead on the problem of death as a social crisis for society. (See Palgi & Abramovitch, 1984, for a review of the classic studies.) The impact of functionalist theory on anthropological studies of death, especially regarding the social implications of mortuary rituals, was felt well into the 1970s and 1980s. The period from the 1960s to the 1980s saw a profusion of ethnographic accounts of rituals surrounding death, in both their symbolic and structural aspects (e.g., Block & Parry, 1982 Danforth, 1982 Douglass, 1969 Goody, 1962 Gorer, 1965 Huntington & Metcalf, 1979 LeVine, 1982 Metcalf, 1982). Rosenblatt, Walsh, and Jackson (1976) surveyed grief and mourning practices in 78 cultural groups to identify universal or near-universal cultural responses to the death of someone close. They compared death customs from around the world behavior surrounding the bereaved,...

Psychological Treatments For Depression

Interpersonal therapy (IPT) attempts to reduce depressive symptoms by focusing on current interpersonal problems. Specifically, IPT examines grief, role conflicts in relationships, role transitions, and social deficits, all in the context of problematic relationships. Depressed individuals are asked to pay close attention to all of their social interactions and social disappointments. By carefully examining their own role, patients become better able to reconstruct (or construct new) relationships more productively.

Psychoanalytic and Psychodynamic Theories

Sigmund Freud and his followers developed the first psychological theories of depression. According to Freud, depression (or melancholia) was comparable to normal grief following the loss of a loved one. Depression, however, would occur in certain people who experienced a loss or disappointment at an early age. These individuals would actually feel rage at the lost loved object, but since part of their personality had become identified with this lost loved object, the individuals would then direct this rage at the self. Often, this redirected self-hatred was safer than rage at the lost loved object. Thus, according to the psychoanalytic model, depression is actually anger turned inwards toward the self. This anger turned inwards'' is the source of low self-esteem, feelings of guilt and worthlessness, and sense of deserving punishment, and it may ultimately lead to suicide.

Interventions With Patients With Dementia

Medications are now available for Alzheimer's disease and other dementias that sometimes slow the progression of symptoms, but do not reverse the overall course of the disorder (Mendez & Cummings, 2003). Psychological interventions have focused on the early stages of the illness when people still have an awareness of their problems, and can actively participate in treatment. Early stage support groups for patients and their families have been very popular and can now be found in many communities (e.g., Yale, 1989, 1999). Examples of counseling with the person with dementia or with the person and his her caregiver have also been reported (Zarit & Zarit, 1998). Many different treatment strategies have been described, including improving communication between the person with the illness and his her spouse or other family caregiver, learning strategies for managing memory loss, exploring how to talk about the disease with family and friends, finding ways for the person with dementia to...

Rehearsals For Love Crushes Infatuations Flirtations And Fantasies

For example, a young boy may hang out with the sports coach, mimicking his speech and adopting his diet. One woman remembers that as a young girl, about eleven, she idealized the young married woman next door and involved herself with the whole family by becoming the baby sitter. (How many mothers lament the fact that their au pairs wish to become daughters, rather than mother's helpers ) Less exalted than the subject of the usual family romance, the neighbor's family had the advantage of affording real interactions and intimacy. It was a wonderful relationship until the outbreak of a polio epidemic (pre-polio vaccination) when the neighbors saw the girl playing with her friends and consequently forbade her any contact with the baby, thereby cutting off her lifeline to the beloved young mother. The woman still remembers her profound grief at what she experienced as a betrayal, clear evidence that she was of no real emotional significance to her idealized friend, worse than second...

Control and Responsibility

Common parlance includes many expressions presuming that emotions are up to us in various ways. We exhort ourselves and others by such phrases as pull yourself together, snap out of it, put on a good face, lighten up, be cheerful, think positive, and keep a stiff upper lip. In many of these cases, what the person is being implored to do is to take on the semblance of an emotion with the hope that it might take hold and rub off on the person's inner state. Practice as if you believe and you will believe. Or, as de Sousa put it, earnest pretense is the royal road to sincere faith (de Sousa, 1988, p. 324 also see Ekman and Tomkins on posed expressions and facial feedback mechanisms). Similarly, we can sometimes fuel the flames of a sincerely felt emotion by allowing it bodily expression. To weep may intensify our grief or make us more conscious of its presence. The James-Lange theory, and its notion of proprioceptive feedback from the expression of emotion, may be in the background here....

Summary And Conclusion

Extremely challenging and can contribute to considerable psychological distress on the part of the caregiver. Given that there are over 52 million lay caregivers in the United States (Health and Human Services, 1998), and that depression, anxiety, powerlessness, role strain, guilt, and grief are common feelings experienced by caregivers, the need for intervention is clear. While supportive and educational group interventions have long been utilized with this population, caregivers are likely to have needs that are not sufficiently addressed by these types of interventions alone. Thus, the need for more active, directive, goal-driven interventions has been recognized. As discussed in this article, cognitive-behavioral interventions have been increasingly used with the caregiver population to improve coping and problem-solving skills, promote relaxation, enhance self-efficacy and quality of life, and decrease distorted thought processes regarding the caregiving experience. While the...

The Transition at Marriage Transformation

Whereas the wedding ceremonial in our own society typically provides the bride with a shining moment, and the prospect of happily ever after, such illusions do not pertain in the wedding celebrations of many nonindustrial societies. Girls attempt to run away to avoid not only the ceremony itself, but the diminished and difficult existence to which it leads. The mother of the bride also enters a new status. In many societies, the tears mothers shed at the weddings of their daughters are tears of true grief because their daughters will be separated from them and will embark on a life of toil, possible abuse, and the dangers of child-bearing under traditional conditions. The transition at marriage, which is so eagerly anticipated by girls in our own society, is viewed quite differently by young women in many parts of the world, where remaining unmarried during the child-bearing years is not an option.

Courtship and Marriage

Love magic is claimed to exist, causing a person to desire another. It can also be used by a third person against two other people whom he or she wants to get involved in an affair. It can result in love sickness. The term for this and the behavior are referred to as grieving. This emotional state is equivalent to that felt by someone who has lost a parent, spouse, or child. The behavior includes refusing to eat or drink and sometimes running away into the forest. It can lead to suicide attempts. Both men and women can experience this. This state can occur over an unmarried love object, or over a love object who is marrying someone else. There are no statements that the love object could be a spouse of someone else.

Experience and Consequences

The kinds of suffering that result, and the depth of that suffering, tell us something about how profound an experience love can be. Love reawakens wishes and fantasies from one's earliest life. If it does not culminate in their fulfillment, the resulting devastation to the lover's ego reveals how much of the lover's feeling of self-worth is at stake, how inextricably the lover's self-identity has become intertwined with that of the beloved. To witness the unravelling of love is to learn something about its genesis the role of the imagination in sparking love becomes clear when we see the equally forceful role it plays in trying to forestall (or deny) love's end or, paradoxically enough, in bringing it to an end and the power of the old submerged dreams is attested to by the grief the unsuccessful lover experiences in relinquishing them.

Contemporary Philosophy

The problem of death has not often been seen by contemporary philosophers as a choice between devising consolations for our finitude and demonstrations of our eternalness. For many, perhaps most philosophers early in the twenty-first century, the death of God is more than a century past, the grieving finished more than half a century ago. The problem of death, understood as the struggle to make life meaningful in an increasingly secular age plagued by the temptations of nihilism, continues. The little that philosophers in the present time have had to say about death outside of chiefly moral concerns centering on choosing death has tended to suppose death is final, not, in any form, to be survived.

Love That Enriches Love That Endures

Secondly, the literary depiction of love, from which we draw so many of our judgments about it, has had difficulty depicting happy love. Auden has said Of the many (far too many) love poems written in the first person which I have read, the most convincing were, either the fa-la-las of a good-natured sensuality which made no pretense at serious love, or howls of grief because the beloved had died and was no longer capable of love, or roars of disapproval because she loved another or nobody but herself the least convincing were those in which the poet claimed to be in earnest, yet had no complaint to make. Fiction has had as much trouble as poetry in depicting realized, sustained, passionate love, and thus we have few literary models for this experience. Perhaps this is because, as Tolstoy suggested and many others following his lead have concurred all happy families are alike.

Objectification Of Animals

In the scientific laboratory setting, additional practices support the devaluing of animals. Many scientists use the term ''anthropomorphism''* as a criticism of both scientific and popular accounts that use psychological terms to describe animals other than humans. For example, terms like ''intended,'' ''anticipated,'' and ''felt'' and attributions like ''play,'' ''grief,'' and ''deceit'' to animals other than humans are avoided because their use is necessarily committing the error of anthropomorphism. This prohibition against terms implying consciousness in animals other than humans is a continuation of the ideas of the philosopher Rene Descartes,* in whose view such animals were mechanical beings, without psychology, without minds. Consistent with this view, pain,* suffering,* and death* accompanying either the conditions of an experiment or the conditions under which animals in the laboratory are kept are typically not described as such. For example, an animal is said to be ''food...

Overview Of Intervention Applications

General behavioral target areas common to most caregiving populations include increasing coping skills, problem-solving skills, time management, prosocial and health behaviors, relaxation, assertiveness, and communication skills. Cognitive targets may focus on decreasing mal-adaptive thoughts and beliefs in connection with feelings of depression, anxiety, or guilt, and increasing positive coping and self-efficacy or self-affirming statements. Services may be structured as therapy, support, psychoeducation, respite, self-enhancement, or a combination of these approaches. Interventions may focus on interpersonal (social isolation, competing work, family, and recreational demands) or intrapersonal (finances, emotional and physical well-being, changes in identity or future goals and expectations) variables, preexisting stressors or problems further complicated by the caregiving role, symptom management, and grief and loss issues. Contrary to many theorists' and researchers'

Case Illustration

I suggested Kim experiment with looking at me and imagining allowing herself to let down and cry with me. She imagined me having a critical and rejecting response. As she worked with her reluctance over a period of weeks, and felt supported by me in doing only what she was comfortable with, her reluctance moved into the background and her organismic desire and need to experience and express her feelings became more figural. At that point she was able to let down into her feelings of loss and grief, thus beginning the process of getting the closure she needed around her mother's death. I asked Kim to reflect on where she was now and where she had been when she entered treatment. Kim reported that she felt more at peace with her parents, even though she still felt sad about her childhood. She said that it had been life changing to risk opening up to another person and allowing herself to need and depend on me. Kim saw the connection between her process of shutting down on her feelings...

Challenges With Dna Identification Of Victims

Unfortunately, there can be challenges in dealing with family members of disaster victims such as family disputes (e.g., feuding family members fighting over who is entitled to the recovered remains) or discovery of illegitimate relationships when biological non-paternity is demonstrated for someone who previously thought that they were the father or the child of a victim. Care must be taken by the laboratory director or other laboratory personnel that may interact directly with the families of victims to be sensitive to their grieving process.

Unexpected or sudden deterioration

Deaths from breathlessness (and the time leading up to them) can be very distressing and the palliative care service may need to keep in touch, through bereavement services or with primary care team, with the relatives to help them with their grief, through explanation or answering questions about the medical circumstances of the death.

Death Investigation and Forensic Nursing in the United States and Canada

Rutty41 discovered through hermeneutic inquiries that nursing brings to the work of the coroner the encompassing roles of holistic family caregiver, researcher, manager, investigator, educator, health promoter, pathology assistant, and forensic nurse clinician. The nurse also brings to the role knowledge, clinical skills,and holistic experience in clinical care intervention, anatomy, and physiology psychology, sociology, health studies, and people skills family dynamics growth and development and cultural language interaction. The range of responsibilities practiced by nurses includes attending death scenes, photography, anthropology, fingerprinting, computerized facial reconstruction, and management of multidisciplinary forensic teams. As advocates for the deceased and family, nurses handle the issues of death certification, victim support, family notification, survivor grief resolution, media management, criminal proceedings, and probate. Nurse coroners believe they are making a...

The study of empathy

The study of empathy has become the focus of recent investigation in social neuroscience and can be contrasted with research on a related topic, Theory of Mind (ToM). In contrast to ToM, which refers to the process of attributing propo-sitional attitudes to another person (e.g. desires, beliefs and intentions), the ability to empathize refers to the process which allows us to experience what it feels like for another person to experience a certain emotion or sensation (e.g. qualia). The capacity to understand another person's emotions by sharing their affective states, such as sharing the grief of a close friend, is fundamentally different in nature from the capacity to understand their thoughts and intentions, the latter lacking a bodily sensation.

Pcp Therapy

A PCP framework has been utilized to explore a variety of areas in psychology. Dorothy Rowe (1991) outlines the building blocks that go into constructing the prison of depression and describes the journey out of this prison. Bannister (1965) has elaborated a PCP approach to schizophrenia in which the person's constructions of the future are serially invalidated, leading to a progressive loosening of the construct system. Constructs cannot be tested when they are too vague, thereby protecting the schizophrenic from further invalidation. Robert Neimeyer (2001) has integrated constructivist and narrative themes in describing grieving as a process of meaning reconstruction in the wake of loss. Constructivist grief therapy prompts the articulation and elaboration of the client's narrative of loss to promote a new sense of coherence and continuity. Ravenette (1997) utilizes drawings to elicit children's personal constructs.

Body Image

The major consideration in terms of adaptation to the change in body image after stoma surgery would seem to the length of time that the grieving process takes. Parkes (1972) outlined the stages that appear to occur in all individuals with a change in body image Grief characterized by feelings of internal loss and mutilation.

Rostyslaw W Robak

Meaning Reconstruction with Grieving Persons III. Theoretical Bases Most people experience the loss of a loved one as a painful, confusing, and disruptive event. Several approaches to therapy with grieving persons have been widely applied. The two most well-known models of grief therapy are J. William Worden's tasks of mourning and Robert Neimeyer's meaning reconstruction. Both of these approaches offer valuable specific therapeutic interventions. When applied well, they allow for the expression of feelings and provide bereaved persons with important opportunities to make sense of their grief experiences. Perhaps most significant, such grief therapies provide grieving persons with an important opportunity for self-perception and self-definition. Although grief therapy may be done in either individual or group contexts, group settings usually offer the advantages of support from others, of engaging in altruistic behaviors toward others, and of the recognition of some degree of...

Viewing The Body

After the family has undergone the initial grief reaction, they should be offered an opportunity to view the body of the deceased, without pressuring them to do so. Failure to view the body may prolong the process by not permitting the survivors to believe the person is really dead. SI I6 While most find viewing the body to be a helpful experience, those who do not view the body express no regret about their decision.17


Government programs, 178 assistance from, 175, 177 using, 178-179 Grants and contracts, 61-62. See also HOME Program grant funds from Department of Labor, Employment and Training Administration, 61 for a national initiative, 7 state, 7 Grieving process, 138, 146 Grooves, 228-229 Group instruction, steps for, 365 Group living settings, 96 Group school support, 364-365 Group support, in families, 365 Growth, Down syndrome and, 194196

Major Symptoms

Only a brief overview of depression symptoms is provided in this section. Readers are directed, however, to the complete article on the subject that is included in this volume. Depression is different from sadness, grief and bereavement, feelings of loneliness and isolation, or disappointment. Each of these situations creates a normal, but nonetheless unpleasant mood reaction to a real or perceived event. More importantly, one is able to shift away from the reaction, receive relief, and often block the feelings by engaging in nonrelated activities. That is, normal


Buddhism does look upon cloning with skepticism and caution for other reasons. The universal value shared by all Buddhist traditions remains ego-transcending thought and behavior. Egocentric conduct and its motives are considered great moral wrongs. Buddhism is likely to analyze the morality of human cloning in terms of the motives, intentions, and desires of those engaged in genetic engineering and cloning. Should the motives behind cloning in general, or cloning in a specific instance, be found to be purely self-centered or self-gratifying, then the practice would be immoral and contrary to Buddhist values. This point is nicely illustrated by the classic Buddhist narrative, the Parable of the Mustard Seed. According to the parable, a mother who is grieving over the death of her child approaches the Buddha to ask that he bring her dead child back to life. The Buddha instructs the woman that she will be able to accomplish her goal if she prepares tea from mustard seeds that have come...


The Institute for the Study of Health and Illness is a nonprofit educational and research foundation focused on, among other things, the professional development of physicians who serve people who have life-threatening illnesses. Directed by Rachel Remen, MD, it offers books, tapes, and category I CME credit at small retreats that focus on topics such as loss, grief, personal limitation, impotence, isolation, and the examination of goals, values, and meanings. (Contact ISHI, PO Box 316, Bolinas, CA 94924.)

Pediatric Concerns

Regardless of the etiology of the child's death, survivors are at increased risk of pathological grief. 3 Divorce is common after the death of a child.29 Parents of deceased children display a wide range of emotional responses, but anger and guilt with associated despair predominate. 30 These emotions may be related to a sense of failure of the parent's protective role. 31 Both parents are equally devastated and unable to support each other adequately. 19 The need to care for surviving children may not allow time for proper grieving to occur. In particular, a perinatal death with either a surviving twin or subsequent pregnancy within five months places families at higher risk for pathological grief responses. 32 Surviving children are also deeply affected by the death of a sibling. Feelings of abandonment, fear of death, and guilt predominate. If the child wished their sibling dead at a time near the death, they may believe that their magical thinking was causative.19 Parents, unable...

Empirical Basis

The empirical support for cognitive-behavioral therapy with terminally ill individuals is limited but growing. In a review of the grief literature, Malkinson (2001) found that the few studies that exist and have been cited as effective have utilized desensitization to avoided stimuli, cognitive restructuring, visualization, stress inoculation training, thought-stopping, relaxation exercises, and skill acquisition to assist individuals in coping with grief reactions. While these studies focused on individuals who lost loved ones, it makes intuitive sense that these interventions could be used to help an individual with a terminal illness cope with the reactions to a number of losses that may occur during the illness (e.g., occupational roles, future opportunities, autonomy).

Anxiety Disorders

In contrast to the better representation of phobias in the professional literature, other anxiety disorders have rarely been investigated. For example, there are few reports of Posttraumatic Stress Disorder (PTSD) in persons with DD. In reality, individuals with DD are more likely to be abused physically, emotionally, and sexually and because of their cognitive deficits, may be more vulnerable to the emotional sequelae of traumatic experiences. Some reported biases specific to this disorder revealed that mental health professionals again claimed their belief that persons with MR do not experience trauma. Many persons with MR DD who have suffered abuse have never been asked about this experience in mental health or other evaluations. Screening measures developed for use with the dually diagnosed typically do not include PTSD as a diagnostic category. Recommended treatment in the literature for PTSD in persons with MR DD involves the judicious use of medication, habilitative...


Idea of continuity* between humans and other animals, researchers have attempted to rebuild the idea of animality. It has been necessary to establish that animals experience emotions beyond basic ones love, grief, resentment, hope, and the like. Darwin himself began this work in The Expression of the Emotions in Man and Animals. Jeffrey Masson and Susan McCarthy have gathered together much of the anecdotal evidence for animal emotion in When Elephants Weep.

Concluding Process

As in any other emergency encounter, follow-up arrangements conclude the visit. The survivors are educated about common grief symptoms. They are told to expect these as a normal part of grieving. At the minimum, the family should have the name and number of a staff member who can provide further information or answer questions that may arise.11 Most authors recommend a follow-up phone call or letter within one week and again in two months.3 One facility has established a program in which the staff sends a sympathy card, phone calls are made periodically during the year following the death, and the attending physician sends a letter explaining the autopsy findings.5


The transition into widowhood, which is unrelated to any biological event in the life-course of women, receives considerable cultural elaboration in certain societies, where the widow is demeaned, compelled to change her appearance, and to engage in public acts that denote grief, such as wailing and inflicting pain on herself. She may be blamed and punished for her husband's death and accused of poisoning or sorcerizing him, unless she can prove her innocence, as Strathern (1972) reports for the people of Mount Hagen, New Guinea. Perhaps most dramatic (and most controversial) is the Indian custom of sati (suttee), which dictates that, to avoid widowhood, the bereaved wife must throw herself on her husband's funeral pyre to be immolated with his corpse (Hawley, 1994). Embree (1994) explains, in India, as elsewhere, widows were


Some tales of metamorphosis are etiological that is, they explain the origins of specific animals or animal features. The tale of Philomela (Ovid, book 6) is an example. Philomela is raped and has her tongue cut out by her brother-in-law Tereus. She and her sister Procne get revenge by killing his and Procne's children and serving them to Tereus for dinner. Discovering what he has eaten, Tereus flies into a rage and pursues the sisters. All three are transformed into birds Philomela into a swallow, Procne into a nightingale whose mournful song and red feathers signify both her grief and her crime, and Tereus into a hoopoe who appears ever ready for battle and whose typically wide-open beak might symbolize the horror of his cannibalism.

Death and Dying

A grieving family forces a physician to face both system and personal conflicts. The need of the patient and family for compassion is a difficult process to rush. Their wishes and belief systems deserve exploration. There are questions from loved ones about the events leading up to a death that must be dealt with empathically to facilitate the grieving process. Offering understanding, comfort, compassion, and solace can be important source of satisfaction for physicians. Often, deaths resurrect powerful feelings in physicians, based on prior personal experiences.

Outcome Research

Since 1975, when the first controlled research of such therapy appeared, there have been at least 23 empirically based outcome studies of grief therapy. A significant caveat must be underscored before a The experience of loss, particularly through death, is usually a confusing experience that triggers a search for meaning in the majority of bereaved persons. Grief therapy, especially in a group context, can provide grievers with a scheme of mourning and recovery such as the one provided by working through the four tasks of mourning. These are accepting the reality of the loss, acknowledging the pain of the loss, adapting to an environment in which the deceased is missing, and emotionally relocating the deceased and moving on with life. Grief therapy can also aid the griever in reconstructing the meaning of one's life. This can be done with several techniques. One such technique is to review one's life with a special emphasis on placing the meaning of the loss into one's lifeline and...


The treatment starts with an explanation of the condition and its cause. It is important that the patient understands that this is a chronic inflammatory condition of the gut and not a simple food allergy, that it is permanent eventhough the intestine will heal, and that the central and indeed only treatment at present is a gluten-free diet for life. The clinician should expect shock and even a fully expressed grief reaction on the part of the patient. Disbelief that something as basic to the Western diet as wheat is responsible is common. Some patients are overwhelmed both by the realization of having a chronic illness and others by relief that an explanation for their suffering has been found. The tone that the physician sets is crucial to the patient's success. A positive and upbeat though serious demeanor on the part of the doctor is appropriate, as most patients will do very well so long as they stick to the diet. Probably the most important thing that the doctor can do beyond...

Search and Reunion

The secrets inherent in the closed-adoption system make reunion difficult for both birth mother and adoptee. To return to each other is to return to their earlier traumas. The adoptee experiences grief, anger, and divided loyalties the birth mother relives the unresolved sadness, guilt, and humiliation she felt at the time of pregnancy, birth, and relinquishment (Lifton, 1994).


Advantages of the autopsy include improvement in medical care nearly half the time, frequently by clarifying the diagnosis. 21 Diagnosis of new diseases is aided by the autopsy. Autopsies can assist in the grieving process by demonstrating to the family that they did not contribute to the death. Despite physicians' fear that the autopsy will lead to increased liability exposure, postmortem examinations are more often used as a defense. 22

Moderating Affect

As extreme mood swings are characteristic and problematic aspects of bipolar disorder, cognitive therapists help their patients to take measures to moderate their emotionality. For example, the patients schedule their live's activities so that they are taking care of their chief responsibilities (balanced with family time, and rest and relaxation), but not to the extent that they are working frenetically or excessively. Similarly, patients are taught to reduce excessive arousal via the techniques of relaxation and breathing control. Self-instructional statements can be used to remind individuals with bipolar disorder to refrain from acting on bursts of anger and ardor, and instead to monitor the intensity and longevity of these moods prior to taking any action. The therapist must be sensitive to the patients' difficulties in managing their moods, acknowledging that high affect (and its concomitant urges to express them publicly) is quite a challenge to contain. Further, some patients...

Suffering Of Animals

Suffering is a general term used in referring to animals who may be experiencing adverse physiological and mental states such as pain, * discomfort, fear,* distress,* frustration, boredom (see ANIMAL BOREDOM), torment, or grief. It is possible for an individual to suffer without pain for example, an individual who constantly fears something and to experience pain without suffering for example, when one pinches oneself. In humans, suffering is recognized as having the dimension of mental processing involving awareness of self in relation to that physical state and reflects the integration of

Stephen G Post

Artificial Nutrition and Hydration Autonomy Beneficence Care Christianity, Bioethics in Compassionate Love Competence Confidentiality Genetic Testing and Screening Grief and Bereavement Human Dignity Informed Consent Judaism, Bioethics in Life, Quality of Life, Sanctity of Long-Term Care Medicaid Medicare Moral Status Neuroethics Palliative Care and Suffering Research, Unethical Right to Die, Policy and Law


They may also misinterpret gestures of affection such as a hug with the comment that the squeeze was perceived as uncomfortable and not comforting. Their emotional reactions can also be delayed perhaps with an expression of anger some days or weeks after the event.

Treatment Issues

Systematic problem-solving, reinforcing positive behaviors and cognition, and understanding one's self and world. More specifically, psychotherapy can help individuals who have manic-depressive illness better understand their disorder, remain on prescribed medications, learn to predict and prevent or soften recurring episodes, learn to not be afraid when experiencing normal sadness, grief, or joy, how and when to let others take charge of their decision making, and how to better care for their significant others and friends. A combination of cognitive, behavioral, and supportive therapies can accomplish these goals with many individuals. An important part of psychotherapy is recording in a chart or journal how moods change over time, how they are affected by medication, and reactions in differing environments. Methods of this type are also used to identify internal thoughts or cognitive nonverbal self-talk. The messages we silently give ourselves can highlight strengths, fears, and...

Single Women

For most women, it's wise for you to first come to terms with your life circumstances. Many women must deal with the sadness that their first choice of finding Mr. Right and living happily ever after may not be a reality. This may involve a grieving process, given that most of us were conditioned from childhood that we should find love, marriage, and a baby carriage, in that order.

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