Bereavement Overload

The term “bereavement overload” was coined by psychologist and gerontologist Robert Kastenbaum over 30 years ago to refer to circumstances in which a grieving individual confronts multiple losses simultaneously or in rapid succession, such that one loss cannot be accommodated before another occurs. Although bereavement overload can be triggered by a great range of circumstances (e.g., deaths of multiple friends or family members in a vehicular accident, war, fire, natural disaster, or even from unrelated causes over a short span of time), much of what is known about its impact has resulted from the study of the AIDS pandemic and the mounting losses of later life. Viewed in a developmental frame, however, overwhelming grief can arise at any point in the life cycle, posing challenges that are distinctive to each phase of life and type of loss.

Much of the focus on bereavement overload in the lives of children has been stimulated by a concern for the plight of AIDS orphans, particularly in developing countries, where entire communities can be decimated by mounting losses in the context of inadequate or nonexistent healthcare. In such cases, complications in grief per se (e.g., chronic depression, trauma, and separation  distress  resulting  from  ruptured  attachments to parents and other caregivers) can be compounded by pervasive insecurity about one’s very survival in a social system that is overwhelmed by the pandemic and related stresses engendered by poverty and unemployment. Even in developed countries, AIDS orphans confront unique problems of stigmatization and secrecy regarding the nature of their loss and do so without the benefit of the more developed psychological and social resources on which most adults can draw.

In the working years of adulthood, members of the gay community and healthcare workers are particularly likely to experience bereavement overload, which may be exacerbated by the inherent stress associated with these roles. Gay men grieving multiple losses to AIDS must also contend with stigmatization, societal invalidation, and the absence of traditionally available support systems. Men contending with a high number of such losses—averaging dozens of friends and partners over the 20 years of the pandemic—often report death anxiety, defensive avoidance, and intrusive experiences, which can be managed through seeking social support or counseling and reconstructing a meaningful self-identity in the wake of loss.

Healthcare workers experiencing multiple losses are put in the position of balancing their own grief for dying patients with their desire and need to be competent care providers. Striking this balance can be a tremendous strain, whose traumatic impact grows with accumulating experience in “high death” specializations. In general, it appears that processing emotion, seeking the support of peers, and active confrontation rather than avoidance of loss are therapeutic for this population.

Finally, later life can usher in a predictable sequence of losses, as one’s parents, older relatives, and eventually siblings, spouse, and peers age and die in increasingly quick succession. Feelings of helplessness, guilt about outliving other family members, and diminished self-esteem are common responses to this seemingly relentless progression, especially for older adults who are themselves in failing health or who suffer from social isolation. Suicide can be a particular  risk  at  this  stage  of  life  and  requires  close monitoring by health care professionals who might mistakenly interpret the silent depression of stoic elders as a normal response to changing life circumstances. Although antidepressant medication can make a useful contribution to treating mood disorders associated with bereavement overload in the final decades of life, mobilization of social, familial, and spiritual supports are especially important at this time.

In summary, the germinal literature on bereavement overload highlights a cluster of responses— depression, helplessness, death anxiety, isolation, survivor guilt, and traumatic stress—that are common to circumstances of multiple loss, as well as distinctive issues that arise in connection with different stages of the life cycle. Conversely, coping strategies that concentrate on helping others, joining groups, strengthening ties to family and community, grieving shared losses, and seeking to make meaning of catastrophic bereavement can help promote its integration into a changed life, but one that nonetheless is characterized by newfound purpose and reconnection.


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