Grief and Mourning in Schizophrenia
Grand Canyon University: PCN-605
March 27, 2017
Grief and Mourning in Schizophrenia
Schizophrenia is a disorder, like many, which affects the individual and their daily routine. With schizophrenia, the individual may experience grief, mourning, depression, and suicidality. In the beginning when the individual is diagnosed they may not be understanding of their diagnosis and can therefore experience grief and mourning. Therefore, as a counselor, it is important to implement a safety plan for clients diagnosed with schizophrenia. In the safety plan, the therapist must include the relationship between grief and mourning, as well as the necessity to treat it, an implementation of the client’s religious/spiritual beliefs, and treatment options for addressing potential depression/risks of suicide
Grief and mourning are two concepts which can be present in an individual’s life as a result of schizophrenia. Grief and mourning are presented due to the fact that a diagnosis such as schizophrenia can be considered a crisis for the individual. The reason for this is by cause of the client having to change certain aspects of their life and live through their diagnosis. An example of this would be someone who has auditory hallucinations and has to still go to their job regardless of hearing voices. The grieving process in the client’s life is essential in order to come to terms of their diagnosis, which therefore allows the client to mourn the life and identity of the changes which are currently taking place (Wittmann & Keshavan, 2007). Elizabeth Kubler-Ross (1969) expressed that there are five stages of grief which take place in an individual’s life, which include: denial, anger, bargaining, depression, and acceptance. Although these stages are mostly associated with grief in regards to losing someone, these stages are also applicable to an individual with schizophrenia since the individual is grieving who they used to be and who they are now after their diagnosis. Additionally, understanding the grief and mourning period can help the client to apprehend and help adapt to their future life after their loss of self. Addressing grief and loss during the treatment process is a vital part in order for the client to accept their diagnosis. The client may experience feelings of loss due to the loss of their identity, job, social settings, etc. Therefore, by addressing the grief and loss, the client will be able to understand, accept, and work through their diagnosis in order to begin the treatment process.
Religious and spiritual beliefs exert a substantial role in the process of grief and mourning after being diagnosed with schizophrenia. The usual treatment of schizophrenia involves the use of antipsychotic medications and therapeutic interventions for the client and family (Kirov, Kemp, Kirov, et al., 1998). However, one of the vital roles that religious and spiritual beliefs play in the process of grief and mourning is to offer a coping resource to the individual. These types of resources include, but are not limited to: support from pastors and other congregants, rituals to assist with the mourning process such as prayer, and the ability to find peace and acceptance in order to return to their normal and daily lives (Halifax, 2008). Research has also shown that associating religion with schizophrenia has helped individuals with grief and loss by providing increased social integration, reduced risks of suicide attempts and substance use, reduced rate of smoking, and overall better quality of life (Grover, Davuluri., & Chakrabarti, 2014). Overall, religion and spirituality helps the client to accept their diagnosis and work through it while still maintaining an active life, knowing that there is something bigger than themselves which has the control of their mental health and life.
Suicide is one of the leading causes of death among people with a diagnosis of schizophrenia (Montross, Zisook, & Kasckow, 2005). As a result of this, it is important that clinicians address potential depression and risks of suicide for all clients. There are two types of approaches when addressing depression and risks of suicide in a schizophrenic client; psychosocial and pharmacological approach. Within the psychosocial approach, the client will acknowledge their quantity of despair, loss, and troubles with daily life, which can help in accomplishing realistic goals (Kasckow, Felmet, & Zisook, 2011). With doing so, the therapist will be able to help the client understand and identify specific triggers in their life which are contributing to their depression and risk of suicide. Another important factor to consider is the client’s social support. Within treatment, it is important to know that the client has a healthy support to help them when they are feeling hopeless and lost due to their diagnosis. One way in which a clinician can help the client with developing a healthy social support is by encouraging the client to engage in social support groups for individuals with schizophrenia in order to help the client see how others manage their schizophrenia and also have people they can turn to when they feel misunderstood. With the pharmacological approach, the clinician will need to refer the client to a psychiatrist. However, the clinician will need to explain to the psychiatrist the importance of the client being on an anti-psychotic and anti-depressive prescription (if truly needed) in order to help them accomplish their treatment goals. Although a pharmacological approach is not always the best treatment option, if the client truly needs it then it is advised that they seek the advice of a psychiatrist.
When working with clients with a diagnosis of schizophrenia, it is exceptionally important that a safety plan is implemented, specifically since suicidal intent and depressive symptoms can occur with newly diagnosed clients. The first part of the safety plan would be to have the client list the symptoms they have experienced and could potentially feel in the future. Two examples of this would be: 1) I feel like the voices in my head don’t stop and I want to just end it all, and 2) I feel sad and don’t want to do anything anymore because people feel weird about me. These are two examples of thoughts that clients can face after being diagnosed with schizophrenia since it is something different that they were not used to. After understanding the symptoms and thought process the client can have, it is vital that an action plan is established. An action plan can include, but not limited to: the number to the suicide hotline, primary therapist number, psychiatrist number, and family members and/or friends who can support them. This is also why being involved in a support group is important, as previously mentioned, because it is during this time that the client can reach out to others who may have experienced similar symptoms. Finally, it is important that the clinician and client discuss items in the client’s home which could be considered dangerous due to self-harm. This can include objects such as knives, alcohol, and a weapon. By identifying these objects, the client will be able to understand what is considered harmful and can take specific measures to hide these objects in order for the client to not self-harm. A safety plan is important at all times in order for the client to know what to do in case they ever experience suicidal or depressive thoughts.
In conclusion, a diagnosis of schizophrenia changes the perspective of someone’s life. Due to this change, clients may experience feelings of grief and loss, and therefore is important for them to understand the grieving process of it all. The clinician can help establish a safety plan with the client in order to make sure that the client does not harm themselves when experiencing suicidal or depressive thoughts. The client will not only learn how to use the safety plan, but can also know that there is hope despite of their diagnosis.
Grover, S., Davuluri, T., & Chakrabarti, S. (2014). Religion, Spirituality, and Schizophrenia: A Review. Indian Journal of Psychological Medicine, 36(2), 119–124. http://doi.org/10.4103/0253-7176.130962
Halifax, J. (2008). Being with dying: Cultivating compassion and fearless in the presence of death. Boston: Shambhala.
Kasckow, J., Felmet, K., & Zisook, S. (2011). Managing Suicide Risk in Patients with Schizophrenia. CNS Drugs, 25(2), 129–143. http://doi.org/10.2165/11586450- 000000000-00000
Kubler-Ross, E. (1969). On death and dying. New York: Scribner.
Kirov, G., Kemp, R., Kirov, K., & David, A. S. (1998). Religious faith after psychotic illness. Psychopathology, 31(5), 234-245.
Montross, L. P., Zisook, S., & Kasckow, J. (2005). Suicide among patients with schizophrenia: a consideration of risk and protective factors. Annals of Clinical Psychiatry, 17(3), 173- 182.
Wittmann, D. & Keshavan, M. (2007). Grief and mourning in schizophrenia. Psychiatry, 70(2), 154-166.