The feelings experienced during grieving are intense, which not only makes it difficult to cope but can also make a person question her or his own reactions. The feelings involved usually include sad­ness, denial, anger, loneliness, and guilt. A summary of these feelings is presented in the following list (Vickio, Cavanaugh, & Attig, 1990). Take a minute to read through them to see whether they are what you would expect.

Disbelief

Denial

Shock

Sadness

Anger

Hatred

Guilt

Fear

Anxiety

Confusion

Helplessness

Emptiness

Loneliness

Acceptance

Relief

Happiness

Lack of enthusiasm

Absence of emotion

Many authors refer to the psychological side of coming to terms with bereavement as grief work. Whether the loss is ambiguous and lacking closure (e. g., waiting to learn the fate of a missing loved one) or certain (e. g., verification of death through a dead body), people need space and time in which to grieve (Boss, 2006). Even without personal experi­ence of the death of close family members, people recognize the need to give survivors time to deal with their many feelings. One study asked college students to describe the feelings they thought were typically experienced by a person who had lost par­ticular loved ones (such as a parent, child, sibling, or friend). The students were well aware of the need for grief work, recognized the need for at least a year to do it, and were very sensitive to the range of emo­tions and behaviors demonstrated by the bereaved (Vickio et al., 1990).

Muller and Thompson (2003) examined people’s experience of grief in a detailed interview study and found five themes. Coping relates to what people do to deal with their loss in terms of what helps them. Affect refers to people’s emotional reactions to the death of their loved one; for example, most people have certain topics that serve as emotional triggers for memories of their loved one. Change involves the ways in which survivors’ lives change as a result of the loss; personal growth (e. g., “I didn’t think I could deal with something that painful, but I did”) is a common experience. Narrative relates to the

Dying and Bereavement 515

stories survivors tell about their deceased loved one, which sometimes includes details about the pro­cess of the death. Finally, relationship reflects who the deceased person was and the nature of the ties between that person and the survivor. Collectively, these themes indicate that the experience of grief is complex and involves dealing with one’s feelings as a survivor as well as memories of the deceased person.

How people show their feelings of grief varies across ethnic groups. For example, Latino American men show more of their grief behaviorally than do European American men (Sera, 2001). Such differ­ences also are found across cultures. For example, families in KwaZulu-Natal, South Africa, have a strong desire for closure and need for dealing with the “loneliness of grief” (Brysiewicz, 2008). In many cultures the bereaved construct a relationship with the person who died, but how this happens differs widely, from “ghosts” to appearances in dreams to connection through prayer (Rosenblatt, 2001).

In addition to psychological grief reactions, there are physiological ones, too. Widows report sleep disturbances as well as neurological and circulatory problems (Kowalski & Bondmass, 2008). Physical health may decline, illness may result, and use of health care services may increase (Stroebe, Schut, & Stroebe, 2007). In some cases it is necessary to treat severe depression following bereavement; research indicates that using SSRIs (see Chapter 10) is one effective medical intervention (Simon et al., 2007).

In the time following the death of a loved one, dates that have personal significance may reintro­duce feelings of grief. For example, holidays such as Thanksgiving or birthdays that were spent with the deceased person may be difficult times. The actual anniversary of the death can be especially troublesome. The term anniversary reaction refers to changes in behavior related to feelings of sadness on this date. Personal experience and research show that recurring feelings of sadness or other exam­ples of the anniversary reaction are very common in normal grief (Attig, 1996; Rosenblatt, 1996). Such feelings also accompany remembrances of major catastrophes across cultures, such as Thais remember­ing the victims of a major flood (Assanangkornchai et al., 2007).

516 CHAPTER 13

Grief over Time. Most research on how people react to the death of a loved one is cross-sectional. This work shows that grief tends to peak within the first 6 months following the death of a loved one (Maciejewski et al., 2007). However, some work has been done to examine how people continue griev­ing many years after the loss. Some widows show no sign of lessening of grief after five years (Kowlaski & Bondmass, 2008). Rosenblatt (1996) reported that people still felt the effects of the deaths of family members 50 years after the event. The depth of the emotions over the loss of loved ones never totally went away, as people still cried and felt sad when discussing the loss despite the length of time that had passed.

Norris and Murrell (1987) conducted one of the best longitudinal studies of older adults’ grief work; three interviews were conducted before the death and one after. Among bereaved families, overall family stress increased before the death and then decreased. The level of stress experienced by these families was highest in the period right around the death. Moreover, bereavement was the only sig­nificant predictor of family stress, meaning that the anticipation and experience of bereavement caused stress.

Even more interesting were the findings con­cerning the relationship between health and stress. As shown in Figure 13.4, bereaved individuals who reported stress before the death were in poorer health before the death than were bereaved per­sons who were not experiencing stress. However, as shown in Figure 13.5, bereaved individuals report­ing prior stress showed a significant drop in physi­cal symptoms 6 months after the death; bereaved persons reporting no prior stress reported a slight increase. The net result was that both groups ended up with about the same level of physical symptoms 6 months after bereavement. These findings also have important implications for interventions. That is, interventions aimed at reducing stress or pro­moting health may be more effective if performed before the death. In addition, because health prob­lems increased only among those in the bereaved group who felt no stress before the death, it may be that the stress felt before the death is a product of anticipating it. Lundin (1984) also found it to be the

Bereaved group Nonbereaved group

S Mostly bad § Slightly bad

18 months12 months 6 months Death 6 months 12 months
before before before interval after after

Figure 13.4 Average level of family stress of bereaved and nonbereaved older adults.

Source: Norris, F. N., & Murrell, S. A. (1987). Older adult family stress and adaptation before and after bereavement. Journal of Gerontology, 42, 609. Reprinted by permission.

Postbereavement

case that health problems increased only for those bereaved individuals experiencing sudden death.

Religiosity is thought to provide a support mech­anism for people following the loss of a loved one. Research evidence for this belief is mixed. Some studies (e. g., Nelson, 2001) show that religi­osity has no effect on the duration of grief. Other research points to a different conclusion. For exam­ple, Latino men who practice their religion openly show lower levels of grief than do Latino men who are not openly religious or European American men (Sera, 2001). Varying religious practices among the Caribbean island cultures strongly influence dem­onstrations of grief (Marshall & Southerland, 2008). Bereavement counselors also report better outcomes when religious or spiritual issues are included in the therapeutic process (Golsworthy & Coyle, 2001). Clearly, more and more carefully designed research is needed in order to understand the role that survi­vors’ religious beliefs play in grief.