The Emotional and Mental Repercussions Resultant of Losing an Immediate Family Member
by: Isaiah Hwang
This project is one of two pieces in collaboration with Summer Nguyen. Our projects focus upon the topics of anticipated death as well as the emotional and mental repercussions surrounding anticipatory grief. My project explores the empirical findings in regards to the internal reactions towards the passing of an immediate family member, as well as the legal perspectives of a case-study argument sourced from interviews with Summer’s parents. On the other hand, Summer’s project focuses on the stages before and immediately after the death of a family member – touching on the more abstract and metaphysical components of grief.
Summer’s Project Link:
https://2020mdhm201.blogs.rice.edu/2020/12/11/mourning-time-by-summer-nguyen/
Abstract
In this research paper and legal-case argument, the central theme of grief after the death of an immediate family member is explored through both primary and secondary scholarly sources, as well as through personal interviews with two individuals that underwent such an experience with a loved one. Inspired by my personal experience with witnessing and coping with the death of my beloved grandfather in 2018, I will be focusing upon understanding the effects of one’s passing away on the immediate family members’ emotional and mental states as well as various coping methods developed to help alleviate the mourning process to a deeper level. The sources will first include a variety of academic peer-reviewed articles that focus on grief symptoms among individuals who have lost loved ones and points from interviews with Summer’s parents who lost their grandmother in November of 2014. I will utilize the informational responses garnered from the interviews along with both from personal research to form a research paper that explores the theme of death, its effects on those who were closest to the one who passed away, and how to better understand those effects. Additionally, towards the end, a series of arguments made by different individuals involved in the event of Summer’s great-grandmother’s death will be projected in a legal-case setting exploring the topic of wrongful medical treatment and its potential impacts on the coping process. Through this work, I aspire to both humanize and increase understanding of the grieving process through an informational and personal basis as well as analyze how hospital treatment of patients in their final days can have a significant emotional impact through the legal argument.
The Issue
Amongst the plethora of differences that humans across Earth possess, one unifying factor is the presence of a family or community within each and every individual’s life. Whether it is biological family members, distant relatives, or even close friends, it is oftentimes the people that surround an individual that shapes his or her perspectives and experiences within life. Therefore, it is appropriate to state that one of the most painful and difficult experiences that most people have to undergo within their lifetimes is that of losing a loved one – particularly that of an immediate family member.
Oftentimes, when left without emotional or medical attention, extreme grief resulting from the death of a loved one can develop into much more severe mental and psychological diseases and even long-term trauma According to the U.S. Department of Health and Human Services[1] , “population-based studies in the US show that unexpected death of a loved one is the most frequently reported potentially traumatic experience making mental health consequences of unexpected death an important public health concern” (Keyes, 2014).
Loss of a close relationship through death, especially one that is unexpected, is a stressful life event for both children and adults that is associated with the development of psychiatric disorders. Given the central role of close relationships through the life course, loss of close relationships is unique among stressful experiences. Close relationships influence a wide range of physical, cognitive, and emotional processes in everyday life. They can contribute importantly to a sense of identity and are often intertwined in a person’s self-concept, and as such, the death of a close loved one has unique psychological sequelae. Therefore, it is necessary to explore the range of psychological and emotional repercussions that are associated with the loss of an immediate family member, as well as potential methods to alleviate the recovery process.
The following information that will be analyzed is sourced from various peer-reviewed sociological studies as well as quotes from the interview with Mr. Nguyen regarding the emotional repercussions and coping mechanisms due to the passing of his dear grandmother. The usage of a real-life case study is ideal in order to humanize the topic of death, as well as offer personal experience to complement claims from social science research.
The Study
When an individual goes through the trauma associated with that of losing a loved one, there are many coping mechanisms that can manifest depending on the persona and the specific situation. Coping mechanisms operate to psychologically protect individuals and are used to reduce the level of anxiety they feel at a given moment. Among the variety of coping mechanisms in which normal individuals experience when going through grief, there are three main expressions: disbelief or denial, disorganization and dependence, and finally intellectualization (Drakulich, 2020). According to Mr. Nguyen, “I remember several coping mechanisms, if you could say, that helped me move on past the emotional stronghold associated with my grandmother’s death.” Coping mechanisms, in essence, allow for the individual to better adjust to the loss of a loved one as well as begin the grieving and healing process. Below, the three main types of coping mechanisms are explained in greater detail.
First of all, the expression of disbelief or denial is a straightforward and oftentimes, difficult stage for people to go through when dealing with the loss of an immediate family member. This response reduces anxiety by allowing individuals to limit their awareness about the reality of what has happened until the pain can be let in more slowly (Caregivers, 2020). Everything inside shouts “No”! and the mind struggles to escape, and oftentimes is unable to tolerate the pain that would emerge if reality were faced, the individual experiences emotional anesthesia coupled with extreme numbness and confusion which are often predominant responses; sighing and crying can be readily observed while others cannot cry and may withdraw. This stage is relinquished more easily if people will listen to the bereaved person and help them express their whole range of feelings. Mr. Nguyen stated during his interview that he remembered “waves of sorrow and despair” made the reality that his grandmother was gone real, even though deep inside, he tried to ignore that she was never coming back. He says that “it was the late-night talks with his family” that truly allowed him to eventually accept her death peacefully. While it may seem that offering constructive advice is helpful to the one in a stage of disbelief, listening to feelings without giving advice is the best helping strategy (Roxanne, 2020).
Second of all, the expression of disorganization and dependence is a stage of great distress and can create feelings of helplessness and even loss of hope. The disorganization and dependence stage is characterized by a period of confusion in which the grieving person may feel out of touch with the ordinary proceedings of life; they may exhibit very dependent behavior and a time-orientation that focuses solely on the present (Bereavement, 2020). The person may become quite demanding, asking others to do things they normally can do themselves, and some of their talk and actions may seem foolish and out of character to others. Such a stage can also oftentimes be characterized by people wanting to make impulsive decisions such as selling one’s house, car, or even cutting off social contact with close friends and other family members. The push and pull of periods of disorganization, or confusion, as well as dependence in which the grieving person will want social interaction is oftentimes able to develop into mental illnesses such as schizophrenia, anxiety disorders, or even depression (APA, 2020). Fortunately, Mr. Nguyen noted that he did not experience many of the symptoms associated with the disorganization phase, although he did report that he felt the “absence of grandmother Nguyen’s presence” during their weekly family dinners pervasively.
Finally, the third and final coping mechanisms among those that have lost an immediate member of their family is intellectualization. Intellectualization is a coping mechanism in which the grieving person attempts to master the loss by gathering a great deal of knowledge and information and analyzing in detail the situations leading to the loss (Drakulich, 2014). They may find out the most intricate medical data of a fatal disease, for example, or, they may plan in detail what will happen after the loss occurs. Surviving individuals may rationalize the loss by saying “He’s better off in the long run,” or “She suffered so much” (Keyes, 2014). This allows the individual to remain emotionally detached and to become an “observer” of the situation. If it remains within reasonable bounds, intellectualization can give the individual and family members a greater sense of control, which can oftentimes, lead to the road of recovery emotionally, mentally, and even physically (Bereavement, 2020). However, in the case of Mr. Nguyen, the intellectualization stage served as a period of great questioning, uncertainty, and familial-strife as he argued whether the hospital had utilized correct strategies or resources in treating his grandmother towards her final days – even considering the possibility that if things had been done differently, she could have possibly thrived longer. (This provides the premise for the legal-argument case which is presented below in detail.)
In addition to coping mechanisms, emotional responses or guards coexist with the coping process and are means for the individual to express emotions and feelings associated with the loss. Anger and resentment are common emotions of bereaved individuals, and it is often expressed as a protest against what seems to be a cruel, unfair and incomprehensible fate (Roxanne, 2020). Mr. Nguyen displayed such feelings when he recalled numerous instances of anger when thinking of the possibility of his grandmother living for a potentially longer amount of time had the hospital done particular procedures differently. Such anger is a reaction to frustration—the source of which cannot be removed, so the person feels trapped and helpless, and when this happens, the individual may project this anger onto more accessible targets (e.g. spouse, family member, hospital, physician, the government) or others involved in the loss chain. Overt expressions of anger, such as verbal outbursts, sarcasm, and unreasonable or persistent demands, should be recognized as an understandable response to a traumatic situation and not necessarily as a personal attack (Drakulich, 2020). In addition, fear and anxiety is another emotional component of bereavement. The grieving person may exhibit feelings of helplessness, hopelessness, as well as hurt and anxiety since sudden loss oftentimes demands great adjustment (APA, 2020) – feelings Mr. and Mrs. Nguyen felt when having to adjust to the lack of his grandmother’s presence at family gatherings, reunions, and events.
The Legal Case
When interviewing Mr. Nguyen, he stated that one of the aspects of his grandmother’s death that affected him the most was his belief that the hospital and physician could have done several things differently that perhaps, would have extended her life. When grandmother Nguyen was in the hospital, her lungs began to fill with fluid due to pneumonia and a constant cough. One of the central decisions during her final days amongst the immediate family and medical staff was whether draining grandmother Nguyen’s lungs would help or hurt her condition. While several of the immediate family members strongly believed that draining her lungs would alleviate her inability to breathe properly, the physician claimed that doing so would be too invasive and could possibly cause further complications and damage to her other organs. In addition to such a dilemma, several other methods of assistance were discussed and considered including the possible delay of putting grandmother Nguyen on a respirator. Detailed below, each perspective involved in such a legal discussion of whether the hospital had done an adequate job of helping grandmother Nguyen during her final days.
The Perspectives
The Hospital
Mrs. Nguyen is currently in a very critical situation with fluid building up in her lungs causing her great difficulty in breathing. We strongly believe that unfortunately, at this point, we are unable to do much for her. Therefore, it is appropriate to consider moving her from the Intensive Care Unit (ICU) into hospice where she will be subject to a more tranquil environment where she can spend her final moments with immediate family members.
The Physician
Mrs. Nguyen is currently experiencing symptoms of pneumonia in which her lungs are filling up with fluid. When she coughs, she is having trouble coughing up the phlegm within her. This state causes a lack of oxygen within her system, which subsequently reduces the amount of blood that is getting to her body. While draining her lungs is an option to be considered, it is quite an invasive procedure. At the current state that Mrs. Nguyen is in, I believe that it would be extremely risky and could in fact, speed up the process of her deterioration. It could cause permanent damage to her other vital organs including her diaphragm, esophagus, as well as her lungs – all of which would not be preferable. I personally do not want to put Mrs. Nguyen into any unnecessary pain – especially if the end result would be relatively the same.
Mr. Nguyen (and his father)
Mr. Nguyen and his father state, “My grandmother (and mother) deserves better medical treatment.” Although we understand the risk that is attached to performing such an invasive procedure as draining her lungs given her age, deterioration of health, and other factors considered, we would like to at least try to see if this could extend her life. We strongly believe that draining her lungs earlier will allow for her to cough properly, and thus increase the oxygenation within her bloodstream. In addition, we would like to see the hospital put her on a respirator as soon as possible so she can breathe comfortably. It is worth a try, even if the end result would be the same.
Legal-Argument Reflection
In reality, while the physician did end up draining grandmother Nguyen’s lungs, the procedure was done too late and she ended up passing away due to suffocation and inability to cough up phlegm. Mr. Nguyen noted that this outcome caused “a good amount of anger” in the following months after her death. “Knowing that pneumonia was her only major health issue, it was painful to see her go down in a matter of weeks” Mr. Nguyen states. Would draining her lungs earlier have extended her life significantly? Perhaps. Regardless, the hospital’s inability to react accordingly and fulfill procedure-based wishes that the Nguyen family desired exacerbated the emotional repercussions experienced after grandmother Nguyen’s death. According to Harvard Health Magazine, “the notion that hospital staff could have been more involved in a case that involved the death of a patient is a significant factor in determining immediate family members’ emotional states – oftentimes worsening feelings of anger and disappointment” (Harvard, 2018). Therefore, it is imperative that within hospitals, medical staff strive to provide to the family members’ wishes for their loved one apart from medical doctrine in an effort to reduce the emotional distress associated with their loss.
Conclusion
While the possibility of losing a loved one, whether it is expected or unexpected, can oftentimes be quite stressful for an individual, it is of utmost importance for the person to take the grieving and recovery process step by step – oftentimes with trusted family members, friends, and even professional help. As shown through both the research as well as interview responses with Mr. and Mrs. Nguyen, the emotional repercussions of a family member’s death are extensive and diverse which require a deliberate approach to deal with. One of the potentially negative repercussions of the grief process – when not approached correctly – is the development of psychological or mental diseases and long-term pain. However, when one can fully understand the symptoms and extents of their pain, it is much easier to be able to reach out to those that they trust for help and emotional support. With clear anticipation of the three coping mechanisms as well as the wide range of emotional responses that one can undergo when in grief, professionals and loved ones are in a much more advantageous position to help alleviate the grieving process and mitigate the risk of negative repercussions being cultivated as a result. Furthermore, hospitals and medical staff can help aid the family members’ feelings of grief and sadness by not exacerbating the situation through offering patient-centered care and openness towards different opinions and viewpoints. Ultimately, through such methods, emotional grief can be faced and even embraced in a way that allows for family members to best transition into a new phase of living life.
References
APA, Grief: Coping with the loss of your loved one. (2020, January 1). Retrieved December 11, 2020, from https://www.apa.org/topics/grief
Bereavement and Grief. (n.d.). Retrieved October 17, 2020, from https://www.mhanational.org/bereavement-and-grief
Caregivers, N. (n.d.). Caregivers Resources. Retrieved October 17, 2020, from http://www.caregiverslibrary.org/Caregivers-Resources/GRP-End-of-Life-Issues/HSGRP-Grief-and-Loss/Psychological-Responses-To-Loss-Article
Drakulich, A. (2020, August 12). When a Loved One is Dying: The Unspoken Emotions & Impact. Retrieved October 17, 2020, from https://www.psycom.net/eleven-phases-grief
Keyes, K., Pratt, C., Galea, S., McLaughlin, K., Koenen, K., & Shear, M. (2014, August 5). The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. Retrieved October 17, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119479/
Harvard, H. (2018, April). How to overcome grief’s health-damaging effects. Retrieved December 11, 2020, from https://www.health.harvard.edu/mind-and-mood/how-to-overcome-griefs-health-damaging-effects
Roxanne Dryden-Edwards, M. (2020, January 21). Grief Symptoms: Get Facts on the Seven Stages of Grief. Retrieved October 17, 2020, from https://www.medicinenet.com/loss_grief_and_bereavement/article.htm
Edward Nguyen, Rosa Nguyen. 2020 December, 6. Interview regarding death of grandmother.