Dr. Sally Karioth, Grief Expert

 Dr  Sally Karioth is testifying to her education.

Detailed Biography of Sally Karioth

Sally Karioth is a very special public speaker who has a gift for evoking a wide range of emotions from her audience. It is a gift she has acquired from her varied experiences as a nurse, teacher, writer, talk show hostess and nationally renowned grief therapist. And if one sentence characterizes her speeches, it is her slogan "life is not a dress rehearsal." Karioth is a 1967 graduate of the Wisconsin-Green Bay Bellin School of Nursing and a 1969 graduate of the University of Wisconsin (Madison), of which she was named an outstanding Alumnus in 1992. She went on to earn two master's degrees and a Ph.D. Since 1970, Karioth has been a member of the faculty of Florida State University School of Nursing, where she teaches one of the university's most popular courses on death and dying. For more than 20 years, Karioth also has been a counselor, helping people cope with the death of loved ones. Her particular concern is parents who have lost a child to death. Karioth recently updated and expanded her 1985 book, If You Want To Know If You're Dying, Ask the Cleaning Lady (And Other Thoughts On Life and Happiness). The book offers a common sense, sometimes humorous, approach to illness and death, and emphasizes that bereavement is a natural part of life to which we are all entitled. Karioth carries that message on the lecture trail, over which she travels more than 500,000 miles a year, and repeats it in motivation tapes and videos sold at her speeches. Most in demand among business, education and health care groups, Karioth takes listeners on a rollicking ride of funny anecdotes, somber insights and helpful suggestions.

DOROTHY CLAY SIMS, DEFENSE

She teaches classes on grief. She is a certified traumatologist.  She debriefs first responders during disasters. She  does see patients with new poor prognosis and she sees family dealing with grief. She sees anybody who is grieving or who is having trouble coping. Her patients are referred  by primary care physicians.  She sees patients pro bono. She has treated 30,000-40,000 patients.  She trained with Dr Kubler-Ross!! (She is the foremost expert on Grief. ) The witness trains everyone in health care and dog trainers.   
She spends 5-6 hours a week reading knew research on grief. She had authored 2 books and she has been a contributer to the "Chicken Soup for the Soul" books. 
Ashton has objected several times saying Karioth is not answering question and giving narrative.Perry has had to tell her to answer questions only.

DR LISABETH KUBLER- ROSS

 DR KUBLER -ROSS 5 STAGES OF GRIEF. TAUGHT EVERYWHERE IN HEALTH CARE.

The stages, popularly known in its abbreviated form DABDA, include:^[2]

1. Denial — "I feel fine."; "This can't be happening, not to me."
   Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of possessions and individuals that will be left behind after death.
2. Anger — "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"
   Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy.
3. Bargaining — "Just let me live to see my children graduate."; "I'll do anything for a few more years."; "I will give my life savings if..."
   The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just have more time..."
4. Depression — "I'm so sad, why bother with anything?"; "I'm going to die... What's the point?"; "I miss my loved one, why go on?"
   During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed.
5. Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it."
   In this last stage, the individual begins to come to terms with her/his mortality or that of a loved one.

Kübler-Ross originally applied these stages to people suffering from terminal illness, later to any form of catastrophic personal loss (job, income, freedom). This may also include significant life events such as the death of a loved one, divorce, drug addiction, the onset of a disease or chronic illness, an infertility diagnosis, as well many tragedies and disasters.

Kübler-Ross claimed these steps do not necessarily come in the order noted above, nor are all steps experienced by all patients, though she stated a person will always experience at least two. Often, people will experience several stages in a "roller coaster" effect—switching between two or more stages, returning to one or more several times before working through it.^[2]

However, there are individuals who struggle with death until the end. Some psychologists believe that the harder a person fights death, the more likely they will be to stay in the denial stage. If this is the case, it is possible the ill person will have more difficulty dying in a dignified way. Other psychologists state that not confronting death until the end is adaptive for some people.^[2] Those who experience problems working through the stages should consider professional grief counseling or support groups. WILKEPEDIA

Karioth, FSU professor, teaches classes on grief, trauma, loss.  She has testified as an expert in grief and trauma.. Clay Sims wants her to entered as expert. Ashton objects.
Ashton> Karioth has authored peer review articles on grief. She names the journals she has been published. She name Parents Magazine and Ashton tells her that is not a peer review journal. 



She asks for her bio. She starts to read. Ashton stops her again and states he just wants  magazines names.   She reads off articles and Ashton then has to prompt her for peer review journal names. 
Sidebar. 
Ashton> She has testifed in  6 criminal and 6 civil cases and 1  maritime. She testified as to the trauma experienced.  One time she has testified in a case in which she had not interviewed  defendent. She identified in a case where a child had died in a boot camp. She identified family members of victim. 
She is entered in as expert with stipulations from AShton. She is not qualified in the events of this case per Ashton.
Clay Simms.> She asks witness about peer review journal.  SK testifies not everyone grieves the same way. There is a plethora of differences such as, I work with mother s who lost children  Sidebar. 
 Clay Sims> Sims is giving Sally Karioth a hypothetical, then wants a response.
Hypothetical> A 22 year old of a young child, who has a loving bond and adores child. She loses the child .(What would you see in behavior)?  What is typical past.
Objection  by Ashton, cites law. Sidebar.

 Side Note.Sally Karioth has never evaluated anyone involved in this case 

ASHTON, PROSECUTION

Clay Sims repeats the hypothetical. What are they reactons expected in relation to grief. SK> Everyone grieves differently. I have  seen mothers who lose children who comitt themselves to bed. I have see woman who clean out the room , give away clothes and toys. They get rid of memories. Som people go to the cematary everyday.  In , ounger adults, they are reluctant  to grieving. They often enter into risky behavior. Objection sustained.  They have survivor guilt.  SK testifies , no two grieve the same .  

Clay Sims Let's say a mother comes from a family that copes with grief with DENIAL. Objection and Sidebar.

Assume that the mother is small in stature. Assume the hidden pregnancy is explained by parents as a sedentary lifestly, the brother notices and asks., the mother is a nurse and never takes the daughter for  GYN appt until she is pregnant......Clay Sims goes on to state the particulars in the case including Casey s belief that Caylee was still alive. Sims continues to run down more assumptions- bro is angry w/ family:father tells cops he was concerned. How would someone grieve?
Sk> There are two groups of people  who grieve. Those with healthy individuals and those with a conspiracy of silence. In those situations, the response to an an event would leave people questioning  their behavior. 
Denial is a great helper.   It may be that the family says nothing. 
Clay Sims states Caseys behavior. She rented movies, went out, got a tattoo.  SK said it woudl be important to see how eeryone behaves in this situation. In young people, they are reluctant grievers, they may participate in risky behavior. They may drink and do drugs , participate in retail shoppes. They may go out and spend money they do not have. They may appear to be haiving a good time.  It is called Bereavement Overload. 
They may act out , of loss after loss.  SK testifies their is difference between grief and loss. People  can get stuck on behavior without treatment.  Sims asks how long this type of behavior may last? Karioth says it could last for years













Loss of Loved Ones -- Bereavement Overload

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A concept that's useful here is called "Bereavement Overload." Extreme grief behavior among some older people may come from having to deal with a succession of bereavements, sometimes in overlapping timeframes, which may interfere with the completion of the mourning process.

The successive demise of friends and loved ones at older ages are often accompanied by various personal, physical, mental, social, and economic losses as well. Hence, some find they are unable to absorb more losses than they can accommodate. 
No more questions. 


Ashton> SK testifies being very happy and very sad is it consistant with grief.  SK testifies that sex can be used as a a tool to feel better when one does not have words to feel better. SK testifies promiscuity takes it too far.   Promiscuity to fridgity can be consistant with grief. Ashton asks what  behavior is inconsistant with grief.   Ashton: can you tell me anything that is inconsistent with grief? Karioth: Well there are healthy and abhorrent, anything could happen.  SK states she has a tool at work which lists responses and catagorizes them.  She does not know the facts of the case so she cannot use tool.
SK testifies she was notified in May/June 2011  to possible be an expert witness in this case. She was not given an facts of the case.  She emailed Baez and told him that there were experts in Tallahasse . She was in London. She did not research anything in the case. Ashton asks her to testify  on what she knows on the facts of the case. She said a young girl who lost a child. She testifed in the Susan Smith case. (Ashton asked if she had testified in a mother who murdered their child. ) Clay Sims calls for sidebar. 
Ashton asks about Denial. Denial does not mean lyng. SK> It can not mean lying to self.  One could deny a death  One who uses denial as a tool may use denial as a coping mechanism until they can deal with death.  Ashton gives hypothesis. 22 year old mother has child who dies and she does not tell anyone.  She lives with parents. She then goes to boyfriend , rents a movie and has sex.  She  goes back into the house. Over the next 30 days, she tells people different stories to others where the baby is. After a couple of days of her mommy demanding  to see the baby she tells the mother the baby is in Tampa.  Later, she is tells the mother there is a car accident and she has to stay in Tampa in fact, she has been in Orlando all the time.She then tells the mother she is with an imaginary 
wealth y boyfriend..... Ashton I could  go on on ... SK Karioth says that sounds like a woman in crisis. Says it may be woman trying to fix something.>    I would agree that is a mother in crisis. I would call it grief.  However, with those scenarios , I would think the mother needs help. I would call that magical thinking. 
Ashton> Lets add the element that the mother killed the child. Sidebar.
EVERyone is standing. We must be in recess.  Ashton leaves th courtroom. The witness is on the stand.  The attorneys  are all standing around talking. Judge says "Take them out" jury leaves courtroom Judge leaves too.
The jury is returned.
Ashton> Denial is a common coping mechanism. It is a common mechanism for guilt. SK> It can be. Objection. SK  testifies denial can be coping for guilt and shame.  SK testifies that  they can put the event 'in a box." They can not have done anything and feel guilty. Ashton>  one could commit an unspeakable act and put it in a box  and go on as nothing has happen. SK testifies that that would be psychological . It falls under a different umbrella not in her field. Ashton> guilt can be from a small  or large act.SK> Yes. SK testifies in an attempt to stay afloat they may create an enviromet that works for them Because to look back is hurtful. SK> People have an amazing ability to compartamentalize.  Karioth says people can come up with an almost merry way of telling stories.
Many folks believe exactly what they believe. Magical Thinking works for them.  SK states these are  not delusions.   SK> The bond between mother and child ever breaks. 
 Sims elects not to have any redirect. The witness is excused. Adjourned for day.