Bereavement

Bereavement refers to the experience of loss of a person through death. Grief is the most typical response of survivors to bereavement, while mourning is the expression by the bereaved of thoughts and feelings in culturally patterned ways. In our society, typical responses include confusion, despair, forgetfulness, sleep disturbances, extended periods of crying, and a variety of physical symptoms.

The Contexts of Bereavement, Grief, and Mourning

The range and intensity of grief reactions vary as a function of the family position and life stages of the people involved, the nature of their relationships, and the manner in which the death occurred.

Loss of a Child

When a child dies, parents generally are stunned by the violation of their presumption that children don’t die, that they should bury their parents. Lost as well are parental hopes and dreams for the dead child along with belief systems about what was assumed to be a more orderly and just universe. Parents tend to have a strong need to tell their story and often search for reassurance that the child who died is all right.

The impact of miscarriage or early neonatal death often is unrecognized, and the parents’ grief is minimized or overlooked. Parents who have lost a child under such circumstances also may fear becoming pregnant again or feel guilty about being happy if and when they do.

Parents’ ability to care for surviving children is likely to be compromised. They may become either overprotective or withdraw in the face of their own confusion as they seek to make sense out of what has occurred. Additionally, the relationship between grieving parents may experience challenges. Parental conflict may occur given different mourning styles, an inability to meet each other’s needs, miscommunication, differences in readiness to return to sexual intimacy or social activities, and disagreement about religious beliefs. Parents also may differ regarding the handling of the dead child’s clothing, room, and possessions.

Loss of a Sibling

Loss of both an important relationship and of appropriate parental support may occur with sibling loss. Children’s sense of security may be threatened as parents behave differently, are inconsistent, appear vulnerable, refuse to reminisce about the dead sibling, and are unable to support their grieving processes. Insensitive behavior on the part of others may include failure to understand sibling grief and inquiries about their parents without first or ever asking how they are doing.

Sibling loss may increase children’s perceptions of vulnerability to death and may be a confusing and lonely experience. Younger children may feel the burden of being a “replacement” for the dead child, and older children may experience survivor guilt. Adolescents must face death in addition to such developmental tasks as contemplating the meaning of life. Reactions include excessive guilt, distorted concepts of death, death phobia, religious confusion, and disruptions in behavior and cognitive functioning.

Sibling loss in adulthood may heighten awareness of one’s own mortality. Loneliness and emptiness accompany the loss of an expected lifelong companion, or source of current and future support. Reactions due to a residue of pain from other losses likely to occur late in life are likely to resurface for older adults.

Loss of a Parent

The impact of parental death on children tends to have the greatest variation. It is an unthinkable and life-changing loss for young children; for older adults it is highly predictable and often assumed to be less disturbing. The level of cognitive and emotional maturation affects survivors’ ability to understand the meaning of a parent’s death.

Very young children may grieve, may continually request that the lost parent return, and may reject anyone who attempts to act as a substitute. Children between the ages of 2 and 5 may be helped to understand the meaning of death, can be dealt with in an honest, direct manner, and may regress in their behavior (e.g., bedwetting). Between ages 5 and 8, children may experience guilt about their parent’s death or may deny that it is permanent. Between ages 8 and 12, children’s reactions tend to mimic those of adults, including increased fears about both their own mortality and that of their surviving parent. For many adults, the loss of a parent may be followed by an extended, often unanticipated, period of anguish and bereavement.

Daughters may feel more depressed than sons as they tend to remain more closely tied to their parents, even as adults. For adult daughters, mother loss may mean the loss of a friend and companion. For adult sons, grief at the death of a mother may be intense because, of the two parents, she was the one with whom they were able to be more open and expressive. Father loss is significant for both men and women, who tend to measure their sense of personal success against the standard set by their fathers, turn to them for advice and guidance regarding finances and careers, and seek their sanction for life choices.

Loss of a Spouse

Spousal loss may shatter the survivor’s sense of security. For both widows and widowers, the most severe reactions tend to occur when the death was unanticipated. Women often report that they feel abandoned, while husbands tend to describe a sense of dismemberment. Women generally cry more freely than men, who are more likely to behave according to societal constraints against emotional expression. Both men and women may feel angry, with women tending to describe a sense of injustice and men tending to experience guilt.

The death of a spouse for both young and middle-age couples is an occurrence out of time. Surviving spouses suddenly may find themselves single parents of school age or teenage children. Having launched children, they may have anticipated greater freedom and more opportunities to spend time together. While more expected, spousal loss late in life ends a relationship of great length and may be painful for different reasons. The challenges of loneliness and of making it alone are very real as remarriage becomes less likely the older the surviving spouse is; this is even more typical for women than for men.

Partnerships created in committed relationships often are comparable to marriages in terms of depth of emotion and shared hopes, expectations, and dreams. However, there generally are few legal and societal supports for surviving partners. Lack of permission to express grief appropriately or participate in funeral and burial arrangements and ceremonies is likely. In the case of an AIDS- related death, stigma may further complicate grief reactions.

Loss of an Extended Family Member or a Friend

The role played by the person who died and the degree of emotional dependence between that person and the survivors affect the impact of losing a friend or extended family member. If similar the two are in age, the death may represent a reminder of one’s own mortality. Grief may be unrecognized or unsupported, because others tend to judge significance based on the degree of kin-relationship. Absence from work to attend funerals may not be permissible, the deceased’s close family members may not acknowledge or even be aware of the person’s depth of grief, and external expressions of grief may be curtailed for fear of intruding on the immediate family. Loss of a coworker may be confusing, with colleagues unsure of how to behave with each other, unable to attend funerals or other rituals, wary of speaking about the dead person, and unsupported relative to their grief. The parents of children who lose a classmate may not understand the impact of this loss or take appropriate steps to deal with its ramifications. When a pet dies, others are unlikely to understand the depth of grief that may be felt.

Understanding Bereavement, Grief, and Mourning

The responses of professionals to bereaved clients generally have been guided by two different models, with the degree of intensity and length of time in which reactions are considered appropriate much debated.

Classical Models of Grieving

Based on the psychoanalytic perspectives of Sigmund Freud and Erich Lindemann and the attachment theory of John Bowlby, classical approaches describe grieving as a time-limited process characterized by 2 weeks of shock and intense grief, 2 months of strong grieving, and 2 years during which the grief decreases and bereaved individuals recover and return to full, normal functioning. The ultimate goal is detaching from emotional ties to the deceased and regaining the ability to form new relationships with the living. Grief is considered maladaptive when not resolved within the designated appropriate amount of time. The basic assumptions underlying this approach are that bereaved people go through predictable stages of grief, depression following loss is inevitable, people who do not experience severe distress over the loss eventually will show some sign of psychopathology, and working through the loss is essential to recovery.

Revised Model of Grieving

Research conducted in the 1980s led to recognition of the importance of understanding grief in context and considering the bereaved person’s belief systems and coping skills. Newer conclusions include that the grieving process may have no fixed endpoint and may last a lifetime; complete detachment from the deceased is neither desirable nor possible; bereaved persons may remain involved and connected to the deceased, often constructing inner representations of them; bereavement may take many forms; and the degree to which grief is adaptive or maladaptive must be determined on an individual basis. Coming to terms with the loss may be particularly difficult when the circumstances of the death represent a threat to one’s worldview or when little social support is forthcoming. Those whose coping styles involve either avoidance or excessive rumination may have more difficulty dealing with bereavement. People who tend to be dependent or pessimistic, who lack self-control, or who are emotionally less stable also are likely to experience greater difficulty making the adjustments required.

Counseling the Bereaved

Professionals are advised to just be “with” the bereaved, to allow them to cry, to rage, to despair, to express all of their feelings. Understanding anger as an essential component of grief is essential, as is sensitivity to irrationality in thoughts, feelings, and behaviors, with both acceptance and a focus on transforming guilt becoming important. Survivors may benefit from engaging in a process of forgiveness. Working to achieve justice for an act of wrongdoing may provide a useful outlet for frustration and impotence felt following a violent death. Helping survivors replace painful images with those more consistent with how the person looked when alive may be helpful. Giving time and attention to perceived loose ends may facilitate a sense of completion.

Funerals acknowledge survivors’ loss and pain, allow for open expressions of grief, and offer opportunities for public recognition of the death and affirmation of the life of the person who died. They also provide a setting in which to consider and speak about the meaning of both death and life while serving the public purpose of disposing appropriately of the body. In some religious traditions, funerals support the transition for the deceased while providing comfort for the bereaved. They also create a context that facilitates connection with a community of support.

Survivors may need help deciding what type of arrangements they desire and how they would like things to be handled. They also may need support as they meet with funeral directors and clergy persons. Helpers may provide information about options for caring for the body and preparing for burial or cremation. They may listen sensitively, explore possibilities, encourage survivors to trust their intuition about what seems right, and make suggestions and offer ideas based on experiences with others.

Ceremonies may be small or large, public or private, and may be planned to achieve many goals. They may fill a void, providing closure if no service was held at the time of the death, or they may supplement, satisfying a perceived need for something additional. Professionals may assist survivors in considering their goals and maintaining an emphasis on the strengths of everyone involved. They may suggest the inclusion or exclusion of others as appropriate. They also may emphasize the importance of affirmation for the survivors as well as for the deceased, remembering that their primary role is that of consultant rather than creator.

Daily life involves a series of rituals, including the ways we get up in the morning, fix and eat meals, prepare for bed, etc. All rituals and regular routines are likely to be disturbed by the death of a loved one, thereby increasing the sense of dislocation experienced by the bereaved. Recognition of their importance and a focus on adaptation of rituals may be important. Meaningful healing rituals also may be encouraged, including maintaining or transforming rooms; journaling; meditating or praying; designating time to grieve; wearing an article of clothing or jewelry that belonged to the person who died; dealing with holidays, birthdays, and anniversaries; lighting candles; creating scrapbooks, albums, or videotapes; writing letters; and volunteering or supporting a cause.

Making sense of loss is the last and most difficult step in the search for resolution. Assisting the bereaved in this regard may include assessing the role of religion or spirituality as resource or disappointment, listening carefully and offering questions or reflections that test the logic of various lines of reasoning, recommending books, validating nontraditional explorations, suggesting explorations of death in other cultures, and confirming the possibility of reclaiming joy. Rather than getting over the loss, resolving grief may be understood as a process of acknowledgment, of learning to accept and to live with grief while at the same time being successful in reclaiming joy as an equally valid part of life.

References:

  1. Becvar, D. S. (2001). In the presence of grief: Helping family members successfully resolve death, dying, bereavement and related end of life issues. New York: Guilford Press.
  2. Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief. Cambridge, MA: Harvard University Press.
  3. Kastenbaum, R. J. (1986). Death, society, and human experience (3rd ed.). Columbus, OH: Charles E. Merrill.
  4. Kennedy, A. (1991). Losing a parent: Passage to a new way of living. New York: HarperCollins.
  5. Klass, D. (1988). Parental grief: Solace and resolution. New York: Springer.
  6. Nolen-Hoeksema, S., & Larson, J. (1999). Coping with loss. Mahwah, NJ: Lawrence Erlbaum.
  7. Rando, T. (1991). How to go on living when someone you love dies. New York: Bantam Books.
  8. Rosen, H. (1986). Unspoken grief: Coping with childhood sibling loss. Lexington, MA: Lexington Books.
  9. Smith, H. I. (1996). Grieving the death of a friend. Minneapolis, MN: Augsburg Fortress.
  10. Zonnebelt-Smeenge, S. J., & De Vries, R. C. (1998). Getting to the other side of grief: Overcoming the loss of a spouse. Grand Rapids, MI: Baker Books.

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