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College aantekeningen loss and psychotrauma
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Loss and psycho trauma lecturesLecture 1: introductory lecture
Part 1: general information
The information is divided in phenomenology and assessment/care counseling
and therapy. We will talk about grief and post traumatic reactions.
Death can be a trigger for PTSS but is not necessarily
Structure of the course:
• 9 Lectures (divided by two) → optional
• 4 workshops (1,5 our) → mandatory + preparation
• 2 exams: essay (17 dec, 15:00) & open-ended questions (25 jan, 17-20)
Exam Essay
- Literature - max 1500 words (excl cover and reference list)
- Lectures - Based on proposition
- Workshop content - Scientific paper (investigative, weighing arguments,
→ geen stampwerk maar manier van denken! logical line of reasoning, critical, theory-based,
research-based etc).
- Written to be read
Argumentation: 25%
General content: 25%
Creativity: 20%
Structure: 20%
APA 7: 10%
Part 2: death and grief: a societal and scientific positioning.
There are deaths everyday everywhere, we avoid it. But we are also fascinated by it. It is showed in religion
(after death), art, cryonic suspension: lichamen opzetten, health care: trying to lengthen life, biohacking, virtual
reanimation: hologram of death person for example. There is a normalization going on: musea, child books,
stores, sites. Grief on the internet: outdated, non-empirical and not helpful. The most information is based on
the 5 stages of grief, but they are not for everyone. Patterns do not resemble everything.
Grief task model:
1. Accepting the reality of the loss
2. Allowing yourself to experience the emotions
3. Adjusting to life without the deceased
4. Relocating the deceased emotionally and move on
Grief: the primary emotional reaction to the death of a significant other (loved one). It is a complex emotional
syndrome accompanied by psychical changes and psychical symptoms. In addition, it involves a wide range of
possible cognitive and behavioral reactions.
Dimensions of grief:
- Emotional: sorrow, loneliness, numbness, anxiety, guilt, aggression, helplessness, pessimism, relief.
- Cognitive: loss of concentration, lowered self-esteem, confusion, intrusive images, preoccupation with the
deceased, hopelessness, etc.
,- Physical: sleep-related problems, decreased appetite, stress, headaches, tension, low energy, similar symptoms
to the deceased).
- Behavioral: agitated, withdrawn, seeking behavior, avoidance.
Widows and widowers: Mensen gaan sneller dood als ze hun partner verliezen. Voor mannen is dit hoger dan
voor vrouwen en hoger in jongere leeftijdsgroepen. Explanations for this gender differences:
- Differences in social support, women more social support. They keep more friendships.
- Women more focus on solutions, men more on problems.
- Different types of bereavement
Religion: life philosophy. Sometimes helpful, sometimes they lose religion because of loss, and that is double
worse. Religion in terms of a social community helps with grief.
Characteristics of death:
- Cause of death: natural, accident, suicide, homicide.
- Sudden, untimely, intentional, painful, violent death lead to higher risks. Debilitating and exhausting (terminal)
conditions are a risk factor too.
- Talking about and acting in perpetration of imminent death predicts less intense grief.
The deceased:
- kinship (parent (past), partner (present), child (future) → all soo different.
- Nature of the relationship (periferical, central)
- Quality of the relationship (more ambivalent relationships)
Unacknowledged losses (disenfranchised grief):
- Ex-partners
- In the past (miscarriage, perinatal death)
- In some circles: homosexual relationships (cannot say goodbye because not allowed in church for example)
- Extramarital affairs
After the loss:
- Coping
- Social support
- Secondary losses (leave house, leave family)
- Multiple bereavements
- Family dynamics
- Material resources (change)
Conclusions:
1. From a societal perspective, the concepts of death and dying, and surviving relatives, are surrounded by
a complicated context of denial and fascination.
2. Death in most western societies becomes more normalized, more like it is in many countries elsewhere.
3. The death of a loved one is virtually inescapable and, in most cultures, has significant consequences for
others physical, psychological and social functioning.
4. There is no such thing as THE grieving process. There are tremendous individual and cultural
differences. Every model is a simplification and should be recognized as such.
5. There are factors that lead to a higher risk of problems in the grieving process, but the predictive power
of these factors is usually not very high and hence sound explanations are generally not available.
6. A small minority cannot cope by themselves and need professional help.
7. A large majority of surviving relatives eventually succeed in overcoming the loss.
,Lecture 2: psychotrauma
1. Psychotrauma: historical, social and scientific positioning.
Traumatic events are:
• War violence and destruction.
• Combat (millitairy stress)
• Long-term imprisonments (eg concentration camps)
• Criminal violence (rape, robberu, hijacking)
• Disasters (natural, man-made and technological)
• Accidents (traffic accidents)
• Child abuse and family violence
• Sudden and traumatic loss of a loved one.
Science started after world war 2. Characteristics of overwhelming events: extreme powerlessness, profound
disruption and extreme discomfort.
Type 1 Trauma: single, intense, unanticipated events.
Type 2 trauma: prolonged, repeated, extreme conditions (series of extreme events over time).
During the last 100 year there were flows in more/less interest. Now it is really popular. The current focus on
trauma is due to:
• Huge popularity of the term “trauma” today in both science and society.
• Something really dramatic happens that could happen to anyone: the cause is clear and the
responsibility lies elsewhere.
• Traumatic experiences show us the limits of our capabilities and defy our efforts to control them.
• Risk of overstretching of the concept of trauma (trauma culture) especially in the media and daily life.
2. Clinical definition, classification and diagnostics of trauma related disorders
Changes in the diagnosis concepts:
1. DSM-I (1952): gross stress reaction.
2. DSM-II (1968): -
3. DSM-III (1980): Post Traumatic Stress disorder (PTSD)
4. DSM-III-R (1987): PTSD Revised
5. DSM-IV: acute stress disorder revised (>2 days), PTSD
6. ICD-10 (1992) acute reaction to a stressor, PTSD, personality change after catastrophic experience.
7. DSM-5 (2013): ass, PTSD
8. ICD-11 (2018): ASS, PTSD, C-PTSD
Two systems: DSM in the Netherlands, but ICD is biggest parts of Europe.
, PTSD in DSM-5: extra:
• The dissociative subtype is applicable to individuals who meet the criteria for PTSD and experience
additional depersonalization and derealization symptoms.
• If symptoms emerge more than six months after experiencing trauma, this is described as ‘delayed
PTSD’ or ‘delayed-onset PTSD’.
• Separate diagnostic criteria are included for children ages 6 years or younger (preschool subtype).
Clinical interviews are a more reliable measurement instrument than surveys.
Why does PTSD happen: fear conditioning, disruption of fundamental assumptions, fragmented encoding of
memories, excessive negative appraisal, enhanced psychophysiological mechanisms.
But: do not exaggerate PTSD, not everyone has it!! The reactions on a traumatic event are normal (nightmares
etc.) but PTSD is different from that.
Who does develop PTSD and who does not:
• Importance of risk factors and protective factors:
o Event characteristics
o Personal characteristics
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