Bereavement




The process of human development inevitably ends in death. Bereavement, grief, and mourning are terms used to describe distinct aspects of people’s reactions following the death of a loved one or other significant loss. Bereavement is the state that results from having experienced the death of a loved one; so to be bereaved is to have suffered a loss. And when someone is bereaved, they grieve. Grief is the personal  reaction to both death and nondeath-related losses, which includes feelings, physical sensations, and thoughts. Mourning is the internal struggle to reorient to life and the outward behavioral expression of grief that is shaped, in large part, by social and cultural norms, rituals, traditions, and practices.

The terms bereavement, grief, and mourning are distinct concepts, but both the general public and professionals frequently use the terms interchangeably, although often with different intentions and different definitions. To maintain consistency with general and professional use, in this entry the terms grief and mourning will be used interchangeably to describe how people respond to and cope with the state of bereavement.

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General Characteristics Of Grief And Mourning

It is important to understand some basic characteristics of grief and mourning. First, they are natural processes that facilitate healing; in that respect, they are helpful, albeit painful, experiences. Second, they are not linear, orderly, predictable, or generalizable processes. Third, although there are some similarities across people, each individual experiences grief and bereavement differently. Additionally, each person mourns all deaths differently since each death and relationship is unique. Accordingly, the phrase so commonly uttered to the bereaved, “I know just how you feel,” can never be true. Additionally, the processes of grief and mourning do not result in the bereaved person “getting over” the loved one who has died. Rather, grief and mourning are more likely to result in a gradual adjustment to the loss that is often never fully resolved or “gotten over.” Finally, grief is pervasive, affecting potentially every aspect of the bereaved person’s life.

Elements Of Grief And Mourning

The bereaved experience grief in all areas of life: physical, psychological, social, and spiritual. Common physical/somatic grief-related reactions include sleep difficulties, appetite changes, nervousness, restlessness, heart palpitations, chest or throat tightness, shortness of breath, nausea, muscle weakness, exhaustion, trembling, dry mouth, sighing/yawning, and crying.

Psychological reactions to grief include emotional, cognitive/intellectual, and sensory components.

Common emotional reactions include sadness, fear, anxiety, anger, guilt, depression, hopelessness, helplessness, frustration, shame, irritability, tension, and a sense of being overwhelmed. Common cognitive responses include yearning (longing for the deceased), disbelief, preoccupation with thoughts of the deceased, lack of concentration, and impaired memory. Altered or heightened sensory responses are also reported by the bereaved. For example, some may experience dreams, apparitions, or hallucinations related to the deceased.

Social grief-related reactions may include isolation, alienation, or withdrawal. Conversely, some bereaved people cannot tolerate being alone and experience anxiety or even panic when not in the presence of others.

Spiritual grief-related reactions may include spiritual emptiness, loss of meaning in life, or disillusionment or anger with God or a higher power. However, bereaved individuals may also find more spiritual comfort than at any other time in their lives and seek to nurture an initial or stronger relationship with God in an effort to find meaning and comfort.

Theories/Models Of Grief And Mourning

In order to better understand how bereaved people grieve and mourn and how others might best support them, researchers and clinicians have developed different models or theories that attempt to account for how people react to and recover from the death of a loved one. Early conceptualizations of grief and mourning presented by researchers such as Elizabeth Kübler-Ross and Collin Murray Parkes focused on predictable stages or phases of reactions that bereaved individuals  went  through.  These  approaches  have been criticized for assuming that all bereaved persons grieve in similar, prescribed ways. Most current conceptualizations of grief and mourning incorporate individual differences into the models and are task-rather than stage-oriented.

William  Worden’s Task-Based Model of Mourning

William Worden has proposed one popular model of mourning that includes four tasks that the bereaved undertake following a loss. Task 1: Accepting the reality of the loss means accepting the reality of the death intellectually as well as emotionally. Task 2: Working through to the pain of grief is surrendering to and experiencing the physical, emotional, social, and spiritual pain that results from the death of a loved one. This task can be complicated by societal expectations to quickly “get over it” and “move on.” Task 3: Adjusting to an environment in which the deceased is missing means adjusting to the end of one’s physical, emotional, spiritual, and social life that existed in relationship with the deceased. Task 4: Emotionally relocating the deceased and moving on with life involves realizing that although the deceased will always be in one’s thoughts and memories, life continues and it is important to go on to live and love fully.

Therese Rando’s Task-Based Model of Mourning

Therese Rando offers an alternate task-based model of mourning, which includes the six R’s (Rando, 1991). To recognize the loss is to acknowledge and understand the implications of the death. To react to the separation of the loss involves experiencing the pain by feeling, identifying, accepting, and expressing one’s reactions. To recollect means to realistically remember and reexperience feelings associated with the deceased. To relinquish attachments to the deceased and to one’s assumptive world involves the process of letting go. To readjust is to move adaptively into the new world by developing a new relationship with the deceased and forming a new identity. Finally, the bereaved must reinvest in their new world.

Both Rando and Worden present task-based models of mourning that support the long-standing conceptualization of grief as “work.” However, researchers Margaret and Wolfgang Stroebe and Henk Schut have highlighted shortcomings with the traditional “grief work” conceptualization including lack of definitional clarity and operationalization, absence of strong empirical evidence to support the model, and lack of generalization across cultures. Accordingly, Stroebe, Stroebe and Schut have argued that grief “work” is not always essential or necessary for adjustment during bereavement. Regardless of which model of grief and mourning one considers, all share the challenge of adequately capturing the complete essence of the experience across all bereaved persons because there are so many factors that combine to individualize bereavement.

Factors That Influence Grief, Mourning, And Bereavement

Bereavement is shaped by numerous factors, such as the bereaved’s psychological stability, intellectual level, maturity, and loss history. The deceased person’s role in the family also influences one’s experience of bereavement. For example, if the deceased person was the center of the family or had daily, close contact with the bereaved, the impact of the death will often be greater than that of a more distant, less central loved one. The nature of the relationship with the deceased also influences bereavement. For example, ambivalent relationships characterized by both love and pain are generally  difficult  to  mourn.  The  circumstances  of the death also influence grief and mourning. Sudden and unexpected deaths are often difficult to adjust to because of the lack of preparation for the death and because they often result from traumatic circumstances (e.g., accident, homicide, and suicide). Additionally, the perceived timeliness of the death influences grief and mourning. Generally, the death of a child is considered to be untimely, whereas the death of someone who has lived a longer life is viewed as more timely. Finally, one’s ethnic, cultural, and religious background also shapes the bereavement experience.

Culture And Bereavement

The specific role that culture, religion, and ethnic background play in bereavement varies. Additionally, most researchers have focused on cross-cultural mourning practices rather than on intrapersonal, emotional experiences of grief. In general, those researchers who have studied grief across cultures (e.g., Chinese, Taiwanese, British, African, Mexican, Puerto Rican, Anglo-American, Native American, and African American) have not found significant differences in the grief experience.

Conversely, mourning rituals and practices have been found to vary widely across cultures. For example, funeral rituals, the length of the period of mourning, and other acceptable and expected customs and practices (e.g., what color clothes to wear and for how long, what social events are permissible to attend, how publicly or privately one mourns, whether to speak the name of the deceased during the mourning period) reflect unique and distinct cultural and ethnic values.

Often the mourning rituals and practices of a cultural or ethnic group are intimately connected to its religious beliefs. For example, among African Americans, funeral rituals are tied to one’s religion. Traditional or more conservative Catholic and Episcopalian services involve formal rituals performed by priests in robes. Conversely, less formal Baptist services often include singing of hymns, readings by family and friends, and a eulogy delivered by the family pastor.

Summary

Experiencing loss and death is a normal part of life, and all people grieve and mourn during the period of bereavement that follows the death of a loved one. Exactly how a bereaved person mourns and experiences grief, however, is shaped by many unique biopsychosocial and cultural factors.

References:

  1. Children’s grief and loss issues and how we can help (n.d.) Available from http://www.childrensgrief.net
  2. DeSpelder, L. , & Strickland, A. L. (2002). The last dance: Encountering death and dying (6th ed.). Boston: McGraw-Hill.
  3. GriefNet, http://griefnet.org
  4. Rando, T. (1991). How to go on living when someone you love dies. New York: Bantam
  5. Worden, W. (1982) Grief counselling and grief therapy, New York: Springer.