In at least 500 of your own words, outline the stages of grieving as described by Kubler-Ross. Provide a scenario, as if you were explaining it to someone who was abou

Psychological Aspects of Living with HIV/AIDS

I. Coping With HIV A. It goes without saying that learning that one is HIV positive is a traumatic event. B. The level of trauma a person experiences will depend on numerous factors such as:

1. Method of infection a. Depending on how the person became infected, he/she will

react with either anger, shock, disbelief, etc. 2. Personality characteristics

a. Those who are most affected by trauma are usually those who already feel disempowered or disconnected from others.

b. Also, those who are impatient, so called “Type A” personalities, seem to deplete their immune systems quicker.

3. Degree of support a. If a person has perceived and/or real supports in the form of partners,

family, and friends, coping with the diagnosis may be easier. b. Support provides a buffer against the stress of knowing they are HIV

positive. c. The old rule that “the lonely die sooner” is particularly applicable to

this patient population. d. Support mitigates and limits isolation. e. Many fear, and sometimes experience, abandonment at disclosure.

4. Accessibility to HIV related drugs a. Being able to get medications and stave off further declines in health

can enhance coping. 5. Knowledge and experience of AIDS-related issues

a. Familiarity with the illness, especially knowing someone with it, influences ones coping skills.

b. Those who view the illness in a less negative way may cope more positively.

II. Death and Dying A. Our experience with HIV has shown that patients deal with news of their illness in a

way similar to people who are experiencing a loss, that is, death and dying. B. One of the most widely known frameworks for understanding the stages of the dying

process has been advanced by Elizabeth Kubler-Ross. C. According to Kubler-Ross, dying persons experience five stages of reaction of their

death. D. Denial (shock)

1. Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned.

2. It is a common defense mechanism. 3. However, some people can become locked in this stage when dealing with a

traumatic change that can be ignored. 4. Death, of course, is not particularly easy to avoid or evade indefinitely.

Psychological Aspects of Living with HIV/AIDS

E. Anger 1. Anger can manifest in different ways. 2. People dealing with emotional upset can be angry with themselves, and/or

with others, especially those close to them. 3. They may also become angry at perceived unfairness of their situation (ex.

“Why me?”). F. Bargaining

1. Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in.

2. People facing less serious trauma can bargain or seek to negotiate a compromise.

3. For example "Can we still be friends?" when facing a break-up. 4. Bargaining rarely provides a sustainable solution, especially if it's a matter of

life or death. G. Depression

1. This phase has been equated to a “practice run” for what is to come. 2. In many ways it is an acceptance of the situation with emotional attachment. 3. It's natural to feel sadness and regret, fear, uncertainty, etc. 4. It shows that the person has at least begun to accept the reality.

H. Acceptance 1. Like depression, this stage varies according to the person's situation. 2. Broadly it is an indication that there is some emotional detachment and

objectivity. 3. People dying can enter this stage a long time before the people they leave

behind, who must necessarily pass through their own individual stages of dealing with the grief.

III. Meaning of Stages A. Each of these stages represents a form of coping with the process of death. B. Once the person comes to terms with the diagnosis of HIV, individuals are able to

engage with the realistic losses that follow, and can achieve a sense of purpose about their lives.

IV. Losses Due to HIV Illness A. People with HIV often experience a variety of losses.

1. Loss of the ability to have experiences. a. Because during the initial stages of HIV infection, no visible signs

of illness are present, it is easy to see how patients can deny their illness

b. Some experience a sense of relief once the outward symptoms start appearing, because it seems to confirm the diagnosis

Psychological Aspects of Living with HIV/AIDS

c. The ongoing uncertainty that surrounds HIV also makes dealing with the implications particularly difficult. We call this process of denial “splitting”—where the person “splits” off the diagnosis of HIV from their conscious existence and the rest of their life.

d. The person might not want to talk about it. e. Might not refer to the illness by name. f. Sex becomes associated with “badness” and death. g. Some start to desire asexual relationships. h. HIV infection can be seen as a punishment for their enjoyment of

sex. i. Secretiveness:

1. Some HIV+ patients deal with the issue of keeping secrets about their illness from family, friends, co-workers, etc.

2. This can lead to isolation, guilt and feeling that they can no longer interact with others like they used to.

2. Loss of control and the ability to predict subsequent events. a. Illnesses such as HIV/AIDS take away control from its patients. b. Things like work, finances, having to deal with the health care

system all come under question. c. It’s impossible to predict how long one will survive, or be healthy

enough to carry out day to day activities. d. Patients worry about being able to take care of themselves.

3. Loss of control over their bodies. a. The very real fear of death. b. The fear of losing one’s health. c. The fear of losing the ability to use one’s body or rely on it like

before. 4. Loss suffered by friends and family (causing grief to others).

a. AIDS patients know that their family and close friends will suffer once they receive news of the illness.

b. Fear and guilt may set in. c. AIDS patients become more and more isolated as their illness

progress, thereby impacting relationships with loved ones. 5. Loss of opportunity to continue and plan projects.

a. The knowledge that the illness has no cure and will eventually end in death puts a hold on long-term planning about every day things like the future.

b. Relinquishing of hopes and dreams 6. Loss of being in a relatively painless state.

a. Some patients fear that with illness will come pain.

IV. Psychological Challenges Facing HIV Patients A. There is a need to strike a balance between acknowledging the harsh realities of the

disease while maintaining a sense of meaning, hope and purpose about one’s life.

Psychological Aspects of Living with HIV/AIDS

B. Part of this means having to find a way of living with uncertainty, while acknowledging real difficulties and loss.

C. Bearing feelings of anger as well as thoughts of illness and death without rejecting love and support from others can be particularly challenging.

Psychological Aspects of Living with HIV/AIDS

Coping With HIV • It goes without saying that learning that

one is HIV positive is a traumatic event. • The level of trauma a person

experiences will depend on numerous factors such as: – Method of infection

• Depending on how the person became infected, he/she will react with either anger, shock, disbelief, etc.

Coping with HIV (cont’d)

– Personality characteristics • Those who are most affected by trauma are

usually those who already feel disempowered or disconnected from others.

• Also, those who are impatient, so called “Type A” personalities, seem to deplete their immune systems quicker.

Coping With HIV (cont’d) – Degree of support

• If a person has perceived and/or real supports in the form of partners, family, and friends, coping with the diagnosis may be easier.

• Support provides a buffer against the stress of knowing they are HIV positive.

• The old rule that “the lonely die sooner” is particularly applicable to this patient population.

• Support mitigates and limits isolation. • Many fear, and sometimes experience,

abandonment at disclosure.

Coping With HIV (cont’d) – Accessibility to HIV related drugs

• Being able to get medications and stave off further declines in health can enhance coping.

– Knowledge and experience of AIDS- related issues • Familiarity with the illness, especially

knowing someone with it, influences ones coping skills.

• Those who view the illness in a less negative way may cope more positively.

Death and Dying

• Our experience with HIV has shown that patients deal with news of their illness in a way similar to people who are experiencing a loss, that is, death and dying.

• One of the most widely known frameworks for understanding the stages of the dying process has been advanced by Elizabeth Kubler-Ross.

Death and Dying (cont’d)

• According to Kubler-Ross, dying persons experience five stages of reaction of their death: – Denial (shock) – Anger – Bargaining – Depression – Acceptance

Denial (Shock)

• Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned.

• It is a common defense mechanism. • However, some people can become

locked in this stage when dealing with a traumatic change that can be ignored.

• Death, of course, is not particularly easy to avoid or evade indefinitely.

Anger

• Anger can manifest in different ways. • People dealing with emotional upset

can be angry with themselves, and/or with others, especially those close to them.

• They may also become angry at perceived unfairness of their situation (ex. “Why me?”).

Bargaining

• Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in.

• People facing less serious trauma can bargain or seek to negotiate a compromise. – For example "Can we still be friends?"

when facing a break-up. • Bargaining rarely provides a sustainable

solution, especially if it's a matter of life or death.

Depression

• This phase has been equated to a “practice run” for what is to come.

• In many ways it is an acceptance of the situation with emotional attachment.

• It's natural to feel sadness and regret, fear, uncertainty, etc.

• It shows that the person has at least begun to accept the reality.

Acceptance

• Like depression, this stage varies according to the person's situation.

• Broadly it is an indication that there is some emotional detachment and objectivity.

• People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief.

Meaning of Stages

• Each of these stages represents a form of coping with the process of death.

• Once the person comes to terms with the diagnosis of HIV, individuals are able to engage with the realistic losses that follow, and can achieve a sense of purpose about their lives.

Losses Due to HIV Illness

1. Loss of the ability to have experiences. 2. Loss of control and the ability to predict subsequent events. 3. Loss of control over their bodies. 4. Loss suffered by friends and family (causing

grief to others). 5. Loss of opportunity to continue and plan projects. 6. Loss of being in a relatively painless state.

Losses and HIV

1. Loss of ability to have experiences:  Because during the initial stages of HIV

infection, no visible signs of illness are present, it is easy to see how patients can deny their illness

 Some experience a sense of relief once the outward symptoms start appearing, because it seems to confirm the diagnosis

 The ongoing uncertainty that surrounds HIV also makes dealing with the implications particularly difficult.

Losses and HIV (cont’d)

 We call this process of denial “splitting”—where the person “splits” off the diagnosis of HIV from their conscious existence and the rest of their life.

 The person might not want to talk about it.

 Might not refer to the illness by name.

Losses (cont’d)  Sex becomes associated with “badness” and death.  Some start to desire asexual relationships.  HIV infection can be seen as a punishment for their

enjoyment of sex.  Secretiveness:

 Some HIV+ patients deal with the issue of keeping secrets about their illness from family, friends, co- workers, etc.

 This can lead to isolation, guilt and feeling that they can no longer interact with others like they used to.

Losses (cont’d) 2. Loss of control and ability or predict subsequent

events:  Illnesses such as HIV/AIDS take away control from

its patients.  Things like work, finances, having to deal with the

health care system all come under question.  It’s impossible to predict how long one will survive,

or be healthy enough to carry out day to day activities.

 Patients worry about being able to take care of themselves.

Losses (cont’d)

3. Loss of body:  The very real fear of death.  The fear of losing one’s health.  The fear of losing the ability to use

one’s body or rely on it like before.

Losses (cont’d) 4. Loss suffered by friends and family:

 AIDS patients know that their family and close friends will suffer once they receive news of the illness.

 Fear and guilt may set in.  AIDS patients become more and more

isolated as their illness progress, thereby impacting relationships with loved ones.

Losses (cont’d)

5. Loss of opportunity to plan and continue projects

 The knowledge that the illness has no cure and will eventually end in death puts a hold on long-term planning about every day things like the future.

 Relinquishing of hopes and dreams

Losses (cont’d)

6. Loss of being in a relatively painless state

 Some patients fear that with illness will come pain.

Psychological Challenges Facing HIV Patients

• There is a need to strike a balance between acknowledging the harsh realities of the disease while maintaining a sense of meaning, hope and purpose about one’s life.

• Part of this means having to find a way of living with uncertainty, while acknowledging real difficulties and loss.

• Bearing feelings of anger as well as thoughts of illness and death without rejecting love and support from others can be particularly challenging.