Video: The Ongoing Face of Grief and Loss and the Theory Behind It

This video identifies matters related to grief and loss. Losses associated with disabilities and the need to address them are explored.

About this video

Production Date: October 5, 2009
Length: 2 hours, 2 minutes
Presenters: Dan Dubovsky, MSW
Download slide notes for this video (PDF, 13 pages)

Dan Dubovsky has worked for over 35 years in the field of mental health as a clinician and teacher. He has worked in residential treatment and in inpatient, outpatient, and community settings. Dan has presented regionally, nationally and internationally on Fetal Alcohol Spectrum Disorders, focusing especially on interventions for children, adolescents and adults. For this work, his son Bill has been his mentor and best teacher. At the time of the video, Dan was the FASD Specialist for the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) FASD Center for Excellence.


This video will help you understand:

  • cultural views of death and mourning
  • physical and behavioural manifestations of grief
  • losses associated with disabilities and the need to address them


  1. Theory of loss and grieving (14:30)
  2. Losses experienced by families (40:30)
  3. Issues in grief (1:43:22)

Theory of loss and grieving


  • different ways of handling life and death
  • expression of suffering and grief can be very different
  • important not to impose own beliefs
  • acceptance of outside help can be seen as a failure if belief is “we take care of our own”
  • what does it mean to accept outside help?
  • whose responsibility is it to take care of dying individual?

Gender roles can play a part in the way someone grieves. Elizabeth Kubler Ross (author of ‘On Death and Dying’) worked with individuals who were dying.

She found that the 5 stages of grief were:

  1. Denial and isolation
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
  • this psychological theory is not a rule
  • not everyone goes through the stages in the same order
  • stages may be experienced with other losses as well
  • Ross: “If people do not someway mourn their losses, they end up living in the past, regretting the present and fearing the future”
  • Dubovsky has seen this many times in individuals with disabilities, families and care providers
  • losses need to be grieved

Katz and Floria (1986-87)

Common responses associated with loss:

  • denial
  • guilt
  • grief
  • psychosomatic manifestations
  • reconsideration of life’s meanings

Some physical manifestations of grief:

  • sense of hollowness in stomach
  • tightness in chest and throat
  • shortness of breath – might think they are having a heart attack
  • oversensitivity to noise
  • hallucinations and mask-like schizophrenic appearance

Behavioural manifestations of grief:

  • sleep and appetite disturbance
  • distressing dreams
  • appetite disturbances
  • restlessness, crying, sighing
  • absent minded behaviour
  • anger, outbursts, mood swings
  • social withdrawal, isolation
  • severe grief reactions are not pathological but if not dealt with, could become pathological

Losses experienced by families

Losses associated with disabilities and frequently experienced by families and caregivers include:

  • hopes and dreams
    • everyone experiences loss when the hopes and dreams for families are not met
    • caregivers may avoid the subject of the loss to avoid hurting the client
    • or because of fear that there is nothing to offer for support when this grief is expressed
  • enjoyment of birth and infancy
    • sorrow over birth disabilities often rob family members of the joy of the birth
  • self-esteem and confidence
    • parents often experience loss of pride in their parenting
    • being more vulnerable than one thought is a loss
  • family balance and family support systems
    • behavioural or mental health issues are often stigmatized or misunderstood
    • an important intervention can be to increase peer support for the family through support groups
  • companionship (family)
    • marital disruption
  • faith
    • faith in system
    • loss of spiritual faith
  • financial security
    • paying for services and supports
    • ability to plan for future
  • privacy
    • a problem for people in small communities
  • freedom
    • obligations
    • not able to go away for a weekend or even an evening
  • control
    • can result in angry behaviour such as blaming

Losses experienced by persons with disabilities

  • repeated loss, not like a death
  • hopes and dreams
    • talk about them and recognize them
  • self-esteem and confidence
    • feel like failures
    • set themselves up for failure
  • close relationships
    • relationships formed in programs are often transient
    • abusive relationship may be better than no relationship
  • consistent caregivers
  • vocational/educational opportunities
  • role in society
    • how and where do they fit?
  • freedom
  • fitting in
  • security
  • control
    • when you feel out of control, tend to over control in some way, such as behaviour

Losses experienced by service providers

  • hopes and dreams for clients
    • don’t talk about them
    • appear over-involved
  • self-esteem and competence
    • can’t fix it all
    • know what someone needs, but can’t provide it
  • relationships
    • form relationships with clients that cannot be sustained
  • faith
    • in health system
  • security in future
    • health care system, being able to provide services
  • sense of control

Issues in grief

Risk factors for prolonged grief:

  • history of multiple losses
  • incomplete management of grief
  • inadequate supports
  • unrecognized loss
  • social isolation response
  • duration
  • must be dealt with or may become pathological

For families:

  • shared knowledge and acceptance of the reality of loss shared experience
  • pain of grief reorganization of family system redirection of relationships and goals

Helping individuals address loss and grieving:

  • observe and listen to behaviour patterns
  • could there be trauma and abuse in person’s history, is this causing patterns of behaviour if client is difficult to engage?
  • consider whether issues of bonding or abandonment may be factors; listen to their story
  • be honest with what you can or can’t do
  • acknowledge and validate losses as they are shared
  • confront losses in a supportive positive way
  • become familiar with and sensitive to difficult dates
  • care genuinely
  • be there for support
  • acknowledge your own losses, so you may address others
  • recognize when further treatment is needed and refer
  • dealing with loss and grieving can be very powerful growth experience
Modified: 2015-09-09
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