LEARNING OBJECTIVES

• How do people experience the grief process?

• What feelings do grieving people have?

• What is the difference between normal and prolonged grief?

• How do adults of different ages deal with loss?

A

fter 67 years of marriage, Bertha recently lost her husband. At 90, Bertha knew that neither she nor her husband was likely to live much longer, but the death was a shock just the same. Bertha thinks about him much of the time and often finds herself making decisions on the basis of “what John would have done” in the same situation.

Each of us suffers many losses over a lifetime. Whenever we lose someone close to us through death or other separation, like Bertha we experience bereavement, grief, and mourning. Bereavement is the state or condition caused by loss through death. Grief is the sorrow, hurt, anger, guilt, confusion, and other feelings that arise after suffering a loss. Mourning concerns the ways in which we express our grief. For example, you can tell that people in some cultures are bereaved and in mourning because of the clothing they wear. Mourning is highly influenced by culture. For some, mourning may involve wearing black, attending funerals, and observing an official period of grief; for others, it means drinking, wearing white, and marrying the deceased spouse’s sibling. Grief corresponds to the emotional reactions following loss, whereas mourning is the culturally approved behavioral manifestations of those feelings. Even though mourning rituals may be fairly standard within a culture, how people grieve varies, as we see next. We will also see how Bertha’s reactions are fairly typical of most people.

The Grief Process

How do people grieve? What do they experience? Perhaps you already have a good idea about the answers to these questions from your own experi­ence. If so, you already know that the process of

Customs regarding what bereaved persons should do vary around the world and include wearing certain types and colors of clothing.

grieving is a complicated and personal one. Just as there is no right way to die, there is no right way to grieve. Recognizing that there are plenty of indi­vidual differences, we consider some patterns in this section.

The grieving process is often described as reflect­ing many themes and issues that people confront (Kubler-Ross & Kessler, 2005). Like the process of dying, grieving does not have clearly demarcated stages through which we pass in a neat sequence, although there are certain issues people must face that are similar to those faced by dying people. When someone close to us dies, we must reorga­nize our lives, establish new patterns of behavior, and redefine relationships with family and friends. Indeed, Attig (1996) considers grief to be the pro­cess by which we relearn the world.

Unlike bereavement, over which we have no control, grief is a process that involves choices in coping, from confronting the reality and emotions to using religion to ease one’s pain (Ivancovich & Wong, 2008). From this perspective, grief is an active

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process in which a person must do several things (Worden, 1991):

• Acknowledge the reality of the loss. We must overcome the temptation to deny the reality of our loss, fully and openly acknowledge it, and realize that it affects every aspect of our life.

• Work through the emotional turmoil. We must find effective ways to confront and express the complete range of emotions we feel after the loss and must not avoid or repress them.

• Adjust to the environment where the deceased is absent. We must define new patterns of living that adjust appropriately and meaningfully to the fact that the deceased is not present.

• Loosen ties to the deceased. We must free ourselves from the bonds of the deceased in order to reengage with our social network. This means finding effective ways to say good-bye.

The notion that grief is an active coping process emphasizes that survivors must come to terms with the physical world of things, places, and events, as well as our spiritual place in the world; the interper­sonal world of interactions with family and friends, the dead, and, in some cases, God; and aspects of our inner selves and our personal experiences (Ivancovich & Wong, 2008). Bertha, the woman in the vignette, is in the middle of this process. Even the matter of deciding what to do with the deceased’s personal effects can be part of this active coping process (Attig, 1996).

In considering the grief process, we must avoid making several mistakes. First, grieving is a highly individual experience (Mallon, 2008). The process that works well for one person may not be the best for someone else. Second, we must not underesti­mate the amount of time people need to deal with the various issues. To a casual observer, it may appear that a survivor is “back to normal” after a few weeks. Actually, it takes much longer to resolve the complex emotional issues that are faced during bereavement (Mallon, 2008). Researchers and ther­apists alike agree that a person needs at least 1 year following the loss to begin recovery, and 2 years is not uncommon. Finally, “recovery” may be a mis­leading term. It is probably more accurate to say that we learn to live with our loss rather than that

514 CHAPTER 13 we recover from it (Attig, 1996). The impact of the loss of a loved one lasts a very long time, perhaps for the rest of one’s life. Recognizing these aspects of grief makes it easier to know what to say and do for bereaved people. Among the most useful things are to simply let the person know that you are sorry for his or her loss, that you are there for support, and mean what you say.

Risk Factors in Grief. Bereavement is a life experience that most people have many times, and most people eventually handle it. However, there are some risk factors that may make bereavement much more difficult. Several of the more important are the mode of death, personal factors (e. g., personality, religiosity, age, gender), and interpersonal context (social support, kinship relationship; W. Stroebe & Schut, 2001).

Most people believe that the circumstances or mode of death affects the grief process. A person whose family member was killed in an automobile accident has a different situation to deal with than a person whose family member died after a long period with Alzheimer’s disease. It is believed that when death is anticipated, people go through a period of anticipatory grief before the death, which supposedly serves to buffer the impact of the loss when it does come as well as to facilitate recovery (Lane, 2007). However, the research evidence for this is mixed. What does appear to be the case is that people who experience anticipatory grief tend to disengage from the dying person (Lane, 2007).

The strength of attachment to the deceased per­son makes a difference in dealing with a sudden as opposed to an unexpected death. When the deceased person was one with whom the survivor had a strong and close attachment, and the loss was sudden, greater grief is experienced (Wayment & Vierthaler,

2002) . However, such secure attachment styles tend to result in less depression after the loss due to less guilt over unresolved issues (because there are fewer of them), things not provided (because more were likely provided), and so on.

Few studies of personal risk factors have been done, and few firm conclusions can be drawn. To date there are no consistent findings regarding personality traits that either help buffer people from the effects of bereavement or exacerbate them (Lane, 2007; W. Stroebe & Schut, 2001). There is some evidence to suggest that church atten­dance or spirituality in general helps people deal with bereavement (Ivancovich & Wong, 2008; Nolen-Hoeksema & Larson, 1999), but this effect may be due more to the social support such people receive than to religion per se (W. Stroebe & Schut,

2001) . There are, however, consistent findings regarding gender. Men have higher mortality rates following bereavement than women, who have higher rates of depression than men, but the rea­sons for these differences are unclear (W. Stroebe & Schut, 2001). Research also consistently shows that older adults suffer the least health consequences following bereavement, with the impact perhaps being strongest for middle-aged adults (Nolen – Hoeksema & Larson, 1999; W. Stroebe & Schut, 2001).

Two interpersonal risk factors have been exam­ined: lack of social support and kinship. Studies indicate that social support and mastery help buffer the effects of bereavement more for older adults than for middle-aged adults (Onrust et al., 2007; W. Stroebe & Schut, 2001). The type of kinship rela­tionship involved in the loss matters a great deal. Research consistently shows that the loss of a child is the most difficult, followed by loss of a spouse or partner and parent (Leahy, 1993; Nolen-Hoeksema & Larson, 1999).