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Part IV has two chapters that take on the issue of what happens to those who are left behind when someone they love dies. Chapter 10 explores “normal” bereavement, grief, and mourning. In it, we will look at the “grief-work” model first developed by Sigmund Freud, Elisabeth Kübler-Ross’s famous stage-based model, Bowlby’s attachment theory, and some pioneering work by Colin Murray Parkes, who was the first contemporary bereavement expert to distinguish between ordinary and “complicated” forms of grief. After reviewing the established grief-work models, we will look into the “new science of bereavement research” that challenges the old assumptions. We will also examine new research about what happens when we experience loss. For example, we will find out that most people get through this painful experience quite well. Then we explore some cross-cultural examples, and what it means to enter into the story of the person who has died.

In Chapter 11 , we will look at what happens when grief goes awry—the topic of complicated grief in its various forms. We will also review what we know about grief that can erupt in response to traumatic death. Two types of mental conditions are associated with this: posttraumatic stress disorder and dissociative disorders. In this context, we also look at evidence supporting specific approaches to their treatment. In addition, we learn about a new diagnosis that was being proposed for the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, which was tentatively called “bereavement-related disorder,” as well as a discussion about what was ultimately included in the new DSM-5.

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CHAPTER

Life after Loss

Bereavement, Grief, and Mourning

■ Core Concepts

■ Grief Work

■ Freudian Theory

■ Kübler-Ross’s Stages of Grief

■ Bowlby’s Broken Bonds Theory

■ Work of Colin Murray Parkes

■ Worden’s Task-Based Approach

■ Grief After the Death of One’s Child

■ Paradigm Shift

■ Challenging Prevailing Theory and Clinical Lore

■ The Other Side of Sadness

■ Dual-Process Model

■ Mourning

■ Telling the Tale

When a loved one dies, those left behind may experience a roller coaster of sometimes confusing, often powerful, twisting, turning thoughts and feelings: shock, feelings of being ripped apart, profound sadness, confusion, guilt, loneliness, and sometimes even relief and hope. These, of course, are all just words. The experiences that go with the words, however, are profoundly personal. They vary from person to person and from situation to situation. What they have in common is that they are all linked to encounters with loss.

In this chapter, we will endeavor to make sense out of the often powerful, usually inimitable, experiences of the people left behind. The text begins with a discussion of three essential concepts: bereavement, grief, and mourning. We will then review several key classical theories that have been used to explain grief, including the concept of “grief work.” We will also look at some problems associated with the classical models. Also we will explore revelations from “the new science of bereavement research” and briefly look at mourning from a cross-cultural perspective. Finally, we will discuss “telling the tale”—what people seem to do naturally to keep the memories of their loved ones alive.

CORE CONCEPTS

Although the terms bereavement, grief, and mourning are sometimes used almost interchangeably, the terms actually signify quite different things. The word bereavement has old English roots connoting the idea of being despoiled or left destitute (Onions, Friedrichsen, & Burchfield, 1966). Today, the term is used to indicate the objective fact, or reality, of a loss sufficiently severe to cause significant disruption in the lives of the bereaved, usually involving the death of a family member or a close personal friend. Corr, Nabe, and Corr (2008) suggest that, for bereavement to occur, three elements must be present:

Bereavement is the experience of a severe loss, usually from death.

1. A relationship with a valued person or thing.

2. The loss of that relationship.

3. A survivor who is now bereft of it.

Bereavement is not only a personal experience but also a social one. The late Robert Kastenbaum, author and pioneering thanatologist, reminds us that, depending on the nature of the relationship, the social status of the bereaved also changes, since the survivor is left as an orphan, widow, or widower (2008, 2016). In death studies, it’s commonly understood that grief is a response to bereavement (Corr, Nabe, & Corr, 2008; DeSpelder & Strickland, 2014; Kastenbaum, 2016). Although there are many variations, and no one has exactly the same experience, grief is associated with physical sensations, strong emotions, changes in thinking, behavioral reactions, altered social relations, and spiritual or existential struggles. For a brief overview of these, please see Figure 10.1 .

Grief is also a cluster of distressing reactions that often occur in waves (Lindemann, 1944; Lindemann & Greer, 1972). Some of these mirror the signs and symptoms of clinical depression (American Psychiatric Association, 2000, 2013), but even acute, or intense, grief is usually not understood as “pathological” but as a normal reaction to a profoundly disturbing experience. In contrast to normal grief, we usually think of complicated grief—the form of grief that lasts longer than normal or that is destructive—as unhealthy and worthy of professional attention (see Chapter 11 ; Ginzburg, Geron, & Solomon, 2002; Parkes, 1998a). We will discuss this in more detail when we review the work of Colin Murray Parkes, below.

Although the terms mourning and grief are often used synonymously, mourning doesn’t refer to the reactions that come as a direct result of loss; rather, it refers to a largely culturally determined process that survivors use as they attempt to cope with it (Corr, Nabe, & Corr, 2008; DeSpelder & Strickland, 2014). This social dimension is imbued with religious, spiritual, and cultural significance and has practical implications. So, you may wish to think of mourning as a culturally patterned process through which bereaved people deal with their grief (Kastenbaum, 2016). How people mourn in Papua New Guinea (Brison, 1995) is different from how it’s done among the Hmong of Indochina (Adler, 1995), or in Japan (Yamamoto, Okonogi, Iwasaki, & Yoshimura, 1969).

FIGURE 10.1 Manifestations of Grief.

Source: This figure is based on Robinson & Fleming, 1989, 1992; Worden, 2008.

GRIEF WORK

If you are like many people, when you consider coping with a significant loss you may very well think in terms “working through” your grief. As a creature of your culture this is understandable. If observers and critics of modernism can claim we live in a medicalized society (see Chapter 2 ), they might also say we live in a highly “psychologized” one as well. There is probably no one who can claim more credit for this mind-set than Sigmund Freud, the father of psychoanalysis, which has profoundly influenced modern thinking. The very concept of grief work, which has been at the heart of how we have been approaching the professional care of grief-stricken people, traces its origins to Freudian ideas and the psychoanalytic model (Freud, 1917/1959a).

The death of a person one deeply loves naturally evokes feelings of profound grief.

FREUDIAN THEORY

In classical Freudian psychoanalysis, the patient is expected to uncover, confront, and work through emotionally threatening material in the unconscious (Freud, 1917/1959b). This is especially so in Freud’s view of successful grief work. At its core, this involves learning to confront and deal with one’s losses. In a classic paper on the subject, Freud suggests that there are actually six interlocking principles involved in this the grief-work process (Freud, 1917/1959b). For a summary, refer to Figure 10.2 .

According to Freud, grief work—emphasis on work—involves getting past one’s resistance, facing the realities of loss through a series of confrontations, freeing oneself from the strong emotional ties to the lost person, and opening oneself to new life and new experience (Freud, 1917/1959b).

KÜBLER-ROSS’S STAGES OF GRIEF

In Chapter 8 , we briefly reviewed the use of Kübler-Ross’s stage-based model in understanding what it’s like to face one’s impending death (Kübler-Ross, 1969). It was only years later that she applied her model to grief, long after others had co-opted the concept (Kübler-Ross, 2005; Kübler-Ross & Kessler, 2014). Indeed, she did not initially intend this theory as a way of understanding grief. Rather, it was developed as a way to understand the reactions of people who had been told by their physicians that they were going to die. According to this well-known model, people respond to the “bad news” in a sequence of stages, beginning with denial, followed by anger, bargaining, depression, and finally acceptance, sometimes abbreviated by the mnemonic DABDA (see Chapter 8 for a review of the model).

FIGURE 10.2 Freud’s Principles of Grief Work.

Source: Adapted from Freud (1917/1959b).

Kübler-Ross was a Swiss-born physician who completed her residency in psychiatry at the University of Colorado School of Medicine in 1963. She moved to Chicago in 1965 and became an instructor at the University of Chicago’s Pritzker School of Medicine, where she developed a series of seminars using interviews she and several theology interns conducted with terminally ill patients (Kübler-Ross, 1998). We may wish to take note that she undertook this work at a time when the appeal of the self-help movement and its promises of personal transformation were particularly alluring (Konigsberg, 2011). It was also a time when Freudian theory was still influential. Indeed, Freud’s concept of denial was on full display in Kübler-Ross’s bestselling book, On Death and Dying (1969). Ultimately, her stage-based theory became so popular that a whole new grief counseling industry grew up around it (Konigsberg, 2011). This may be well and good. However, this new enterprise was based on a theory that was unsupported by scientific evidence.

In 2011, Ruth David Konigsberg, a journalist, wrote a bestselling book exploring why Kübler-Ross’s theory became so entrenched in Western culture despite the lack of scientific research to back it up (Konigsberg, 2011). Konigsberg refers to Kübler-Ross’s five-stage theory as a myth, i.e., a belief that is widely held but false. Konigsberg observes that skepticism about Kübler-Ross’s stage-based model began to emerge within the scientific community by the early 1970s. Richard Schulz, then a graduate student in social psychology at Duke, and his adviser, David Aderman, conducted a literature review looking for evidence that supported Kübler-Ross’s stage-based theory (Schulz & Aderman, 1974). Quite to the contrary, they found a consensus among researchers working on the topic that suggested that, although terminal patients often experienced depression before they died, there was no evidence documenting the existence of any of the other so-called “stages.”

As we discuss later in this chapter, it was not until the work of George Bonanno and his colleagues, which emerged in the late 1990s and early 2000s, that we get a resounding refutation of Kübler-Ross’s stage-based model based on research (Bonanno and Kaltman, 1999. 2001; Bonanno et al., 2001; Bonanno et al., 2002; Bonanno, 2004, 2005, 2009, 2013; Bonanno et al., 2004; Bonanno et al., 2007). Bonanno and his colleagues tracked elderly people whose spouses died of natural causes. The single largest group, about 45 percent of participants, showed no signs of shock, anger, despair, depression, anxiety, or intrusive thoughts six months after their loss. Indeed, most had returned to living a normal life.

BOWLBY’S BROKEN BONDS THEORY

Freud and Kübler-Ross focused their attention on a hypothesized internal struggle. In contrast, John Bowlby, a British psychiatrist, put more emphasis on the interpersonal dimension of grief, what others have referred to as the broken bonds theory (Bowlby, 1969, 1973, 1980). While Bowlby was willing to use and build on Freud’s theoretical foundations, he was a creative thinker interested in lived experience of real people (Ainsworth, 1992), including grief. He believed, with some justification, that human beings naturally seek to form bonds with others. Indeed, he likened the experience of adult grief to what children experience when they are separated from their parents. Bowlby’s key concept in this regard is attachment. According to Bowlby, attachment—the natural capacity and inclination to form emotional bonds with others—is essential to social relationships and human survival. Indeed, his work on attachment has become a pillar in modern attempts to understand troubled children who—because of early separation, abuse, or neglect—have difficulty in forming meaningful relationships with other people (Kobak, 2002; Page, 1999; Steele, 2002).

According to Bowlby, the reason grief work is so painful for bereaved people is because the very purpose of attachment is to provide for the emotional security and interdependence that is experienced in significant interpersonal relationships (Bowlby, 1980). His work suggests that strong emotion, such as that which occurs upon the death of someone close, reflects on the importance of emotional attachment. Like the child who acts out when he or she feels abandoned, the bereaved person may turn to whatever primal behavior he or she knows—crying, begging, clinging, and even threats—in a futile effort to restore the lost relationship. According to Bowlby’s attachment theory, the pressure to withdraw one’s psychological investment of libido, or emotional energy, from the lost relationship comes into dynamic conflict with the human need for social bonds. According to Bowlby’s theory, as the conflict persists, and as the bereft person does his or her grief work, the established emotional investment is eventually detached from the loved one, thereby freeing the person to invest in new relationships.

WORK OF COLIN MURRAY PARKES

Colin Murry Parkes is another of those iconic figures in the history of thanatology. He is British psychiatrist who, at this writing, is quite elderly but still living. He drew extensively from Bowlby, yet worked quite apart from him. He was an early convert to Dame Cicely Saunders’s hospice movement. Indeed, Parkes worked with her at St. Christopher’s Hospice until her death and is still affiliated with her organization (Parkes, 2001; Parkes & Prigerson, 2013). Like Freud, Kübler-Ross, and Bowlby, Parkes maintains that dealing with grief is a process. He is best known for three major contributions to the study of bereavement, grief, and mourning: (1) his rich description of the grieving process, (2) the recognition that grief affects both one’s mental and physical health, and (3) the finding that there are at least two types of grief: normal and complicated grief.

Phases of grief. Parkes suggests there are three elements of grief present from the outset but that they ebb and flow as the process unfolds. He asserts that each is more or less prominent at different times after loss (Parkes, 1998a). Like Freud, Kübler-Ross, and Bowlby, Parkes believes the process of grief unfolds in a sequence of phases, but describes them differently (e.g., Bowlby, 1980; Parkes, 1998a, 2001), See Table 10.1 .

The numbness and blunting phase is a response to the initial shock after the loss, especially if death occurred suddenly and unexpectedly. It is an immediate reaction characterized by feelings of unreality that unfold in the hours and days after the loss (Parkes, 1998a, 2001). The pining and yearning phase emerges as the reality sets in. The loss is felt. This period is one in which there is a fluctuation between intense pining interspersed with periods of relative quiet, a time when emotional turmoil, anger, self-reproach, and bewilderment dominate the emotional landscape.

Physical signs and symptoms may be present to such an extent that the bereaved and others may have doubts about their psychological health—concerns that could themselves contribute to anxiety at such a level that it may lead to panic attacks. As the “pangs of grief” diminish, the disorganization and despair phase may arrive. During this phase, there are longer periods of apathy and despair. The bereaved may exist from day to day, remain disengaged, feel physically depleted, and lose interest in food. During the reorganization and recovery phase, the appetite returns, lost weight is gained back, and life returns, more or less, to normal. According to Parkes, it is a time when a new internal model of the world is built alongside the old.

TABLE 10.1

Elements and Phases of Grief

Elements of Grief	Phases of Grief
The urge to cry and search for the lost person	Numbness and blunting
The urge to avoid and repress the urge to cry and search	Pining and yearning (pangs of grief) Disorganization and despair
The urge to review and revise internal conceptualizations	Reorganization and recovery

Source: This table is based on Parkes (1998b)

To recap, one of Parkes’s major contributions is his rich description of the experience of grief, including the notion that bereaved people engage in pining, the intense desire to be with, or reexperience, their lost loved one (Parkes, 1998b). Another of Parkes’s major contributions to thanatology is that he was the first to suggest that bereavement can lead to the temporary impairment of the immune system, endocrine changes, and increases in the production of human growth hormone, all of which, he suggests, may exacerbate feelings of depression and distress (Parkes, 1998b). A third major contribution of Parkes’s is his identification of both “normal” and “complicated” types of grief (Parkes, 1998b).

Complicated grief. Another of Parkes’s contributions is his understanding that there are both normal and complicated types of grief. He describes the normal psychosocial transition as being similar to the kind of relearning that must take place when someone becomes disabled or loses a body part (Parkes, 1998b). According to Parkes, whenever bereaved people aren’t able to successfully negotiate the psychosocial transition back to normal life, they experience complicated grief.

Although Parkes is aware that the relationship between risk factors and the outcome is complex (Parkes, 1998a), he is, nevertheless, convinced there are factors that predispose some individuals to experience complicated grief following loss. He suggests that complicated grief, sometimes called pathological grief, poses a threat to both the physical and emotional health of the individual.

Parkes suggests that if professionals know more about the risks and risk factors, they may be able to predict, intervene, and prevent the adverse effects of complicated grief. He identifies three key risk factors: the existence of traumatic circumstances, personal vulnerability (dependence), and the nature of the relationshipwith the deceased. He ties these risk factors to three types of complicated grief:

1. Traumatic (associated with the traumatic circumstances of the death).

2. Conflicted (associated with having a conflicted relationship with the deceased).

3. Chronic (associated with the grief lasting longer than is healthy).

Traumatic grief is a subtype of complicated grief characterized by the way the death occurred; it involves trauma of some kind, perhaps due to sudden occurrence, its unexpected nature, mutilation of the body, or some other such circumstance (Parkes, 1998a). Parkes suggests that, as a result, the immediate reaction may be numbness and blunting, which may persist for a long period of time, perhaps leading to social withdrawal and interfering with the completion of grief work.

Conflicted grief, another subtype of grief, refers to the conflict-ridden nature of the relationship that interferes with accomplishing the grief work. According to Parkes, the conflicted or ambivalent nature of the attachment can result in an immediate sense of relief that often gives way to “unfinished business”—haunting memories, anger, and guilt.

Parkes suggests there is a danger of chronic grief when a very dependent, or mutually dependent, relationship had existed between the deceased and the bereaved. According to Parkes, this type of grief can be prolonged and unhappy, but sometimes he suggests there is also a manipulative dynamic, as when comforting gestures of others become reinforcing to a very dependent, or needy, bereaved person. Figure 10.3 presents an overview of risk factors Parkes (1998b) suggests are associated with the three forms of complicated grief in his model.

WORDEN’S TASK-BASED APPROACH

William Worden, who has written a bestselling book for bereavement counselors, suggests an alternative to stages and phases, which he calls a task-based approach (Worden, 2008). He frames the process as one involving accomplishing tasks, such that he puts the responsibility on mourners to take a more active role doing their grief work. He also suggests that this can provide the mourner with a sense of empowerment. According to Worden, bereaved persons know there are things he or she can actually accomplish. Worden also suggests that identifying specific tasks can give professional helpers more clarity about a course of action.

FIGURE 10.3 Factors Identified by Parkes as Increasing the Risk of Complicated Grief after Bereavement.

Source: Based on Parkes, 1998b.

FIGURE 10.4 Worden’s “Tasks” and “Mediators” of Grieving.

Source: This figure is based on Worden, 2008.

In Worden’s task-based approach, there are four basic tasks of mourning and seven factors that influence the process, which he calls mediators of mourning. In Worden’s model, the tasks are more or less universal, things that he believes that most everyone should accomplish. The mediators are variables that help explain individual differences. Please refer to Figure 10.4 for a quick overview of tasks and mediators. As you can see from even a casual perusal of this figure, Worden has developed a rather comprehensive model that is intuitive, easy to follow, and comprehensive in scope.

GRIEF AFTER THE DEATH OF ONE’S CHILD

According to Therese Rando (1986), a pioneering investigator on the topic, “Parental loss of a child is unlike any other loss. The grief of parents is particularly severe, complicated, and long lasting” (p. xi). Not only is this loss difficult for the parents to cope with, but it seems as though the kind of society in which we live has its own peculiar difficulties, which exacerbate the challenges faced by the parents. As a reflection of this, Rando suggests that even the kind of language we use may tell us something about the difficulty with which society has in dealing with the death of a child. She points out that, although we have a word to denote the status of a child who loses their parents, orphan, a spouse who loses their partner, widow or widower, we have no word for a parent who experiences the death of a child.

Cultural attitudes toward death are extremely important (Ariès, 1974, 1981; Becker, 1973; also see Chapter 4 ). In a previous time, before the technological advances of the modern world, death may have been more a part of day-to-day life (see Chapters 2 and 5 ). As we’ve already discussed, when someone died in an earlier time, it was often at home, and it became the task of the family to deal with its aftermath, including the process of preparing the body for burial and actually disposing of it. This experience was not limited to the deaths of adults. Perhaps because of more primitive conditions, and the general hardships of life, the death of one or more children was a more common experience. Frank McCourt’s (1996) book Angela’s Ashes is about growing up poor, Irish, and Catholic. In it, McCourt writes about his childhood in Ireland during hard times, and about the deaths of a sister and two brothers. Indeed, the untimely deaths of many children continue to be an experience of poor families and those who live in the developing world.

BOX 10.1

Cowboy in the Sky

Michelle is the director of a social service agency in a large metropolitan community. When I interviewed her, she told me she sought out a career in the helping fields because of her own experience with the death of her little boy, Justin. “I wanted to help other people who are going through the same thing I went through to get through the system,” she said.

When Michelle was just 28 years old and living in San Diego, she went to Justin’s preschool to pick him up and was confronted by one of the teachers. It was the afternoon of New Year’s Eve; 1993 was just around the corner. The very young preschool teacher commented on the lump Justin had on his head. Reflecting on it in my office several years later, Michelle said she felt accused of child abuse. Driving Justin home, she wondered if her boyfriend’s teenaged son might have “dumped” Justin when he took him to preschool. They got home and Michelle went to the boy and asked him. “He swore up and down he hadn’t,” Michelle said.

On New Year’s Day, Michelle took Justin to the emergency room. Over the previous few months Justin had been a little crabby at times. Michelle had thought he’d had ear infections, and the pediatrician had prescribed antibiotics on and off by phone. At the emergency room that New Year’s Day they thought Justin might have had a cold or flu, and indicated that he probably had a salivary gland infection. On the tenth day, when the infection didn’t resolve itself, Michelle took Justin to the pediatrician. The doctor looked at him and said, “Oh no, this isn’t an ear infection.” She looked alarmed. “This was a little bit scary for me,” Michelle explained, “You don’t anticipate a doctor being alarmed.”

The situation became even more serious when the ear, eye, and nose specialist, who their pediatrician referred them to, found significant hearing loss in one ear and the presence of a tumor showed up on the ultrasound. He gave Michelle a phone number and advised her to make an appointment within ten days. “They answered the phone ‘UCSD Cancer Center,’” Michelle related. Michelle said that, although all kinds of things had run through her mind about the possibilities, “I had no idea this is where I was calling. I was shocked. I hadn’t been warned.” The situation intensified. She had been told that getting Justin in for a CT scan and biopsy was urgent, but there was a mix-up at the hospital that led to a confrontation with the medical team, which resulted in the intervention of the hospital’s president. When the CT scan was done, the medical team reassured Michelle that she was being a good mom by kicking up a fuss. She got the news the next day. Justin had a soft tissue cancer called embryonal rhabdomyosarcoma.

The system that Michelle had run up against would become the world she and Justin would live in until a few short months later. After aggressive attempts at treatment with chemotherapy and radiation, Justin, a little boy who above all things wanted to be a cowboy, died as the result of a 28-day medically induced coma. As Michelle put it, he had lived “three years, nine months, twenty-eight days, eight hours, and fifteen minutes” when he passed away.

In our society today, the parents of critically ill children, and the children themselves, have contact with legions of professionals (doctors, nurses, and therapists) who perform various specialized tasks associated with the attempt to treat the child. The vignette above tells one such story.

Simply explaining to readers that the “parental loss of a child is unlike any other loss” cannot begin to touch the actual impact of having one’s child die. Michelle, whose little cowboy, Justin, died, would eventually join an organization called the Compassionate Friends, in order to begin healing from her agony. This is a self-help group of parents who have had a child die. As Michelle and several other members told me when I was conducting a piece of qualitative research on their experiences (Kemp, 2001), “It’s a club no one wants to join.”

Although categorizing is always tricky, the kind of loss that Michelle describes in the vignette is one of two types of loss commonly experienced by parents whose child has died—that of an expected loss. It is the kind of loss usually experienced after a lengthy illness. Parents who have a sudden loss generally experience it in a different way. (For an in-depth exploration of the distinctive experiences of parents who have suffered both types, refer to Bolton, 1986; Kupst, 1986; Nichols, 1986; Sanders, 1986; and Schmidt, 1986.) It is the experience of loss that is common to both groups.

With loss comes the necessity to somehow deal with the stark reality of death. Parents who have had a child die commonly report a sense of shock—the sense of living in a dream world (unreal and surreal were words that were used), and having difficulty accepting and integrating the experience (Kemp, 2001). Dennis Klass (1997), a well-known figure in the field who has extensive experience working with Compassionate Friends, uses the concept of disequilibrium to describe the kind of disruption that takes place in the lives of bereaved parents. As the parents told me, “Your whole life changes forever.”

Grief is the process of reacting to the loss, which is required in order to find a new equilibrium. Once the reality of the loss sets in, shock turns to grief (see DeSpelder & Strickland, 2014; Corr, Nabe, & Corr, 2008; Kastenbaum, 2016; Sormanti & August, 1997). For parents who experience loss after a child’s lengthy illness, some of this grieving—aptly enough called anticipatory grief—may actually start before the child’s death.

The reality of the lives of those parents whose child has died suddenly and unexpectedly changes radically from one moment to the next (Kemp, 2001). Parents whose loss occurs from illness have a much longer period of time to contemplate the ultimate possibility of death. They commonly face other challenges, however, such as living a roller coaster existence in which they are constantly subjected to the shifting tides of their child’s illness. As some parents told me, life is experienced from one crisis to the next. At one moment there is a time of great peril and crisis, sometimes followed by a rally, and even long periods of remission, when there seems to be a realistic hope that the illness might recede into a more or less permanent remission if not an actual cure.

What parents have to go through after the death of a child is suffered at a profound level. It is also complex, since parents deal with loss in so many ways (see Bolton, 1986; Dyregrov & Dyregrov, 1999; Klass, 1997; Kupst, 1986; Milo, 1997; Nichols, 1986; Oliver, 1999; Sanders, 1986; Schmidt, 1986; Schwab, 1996; Van Dongen-Melman, Van Zuuren, & Verhulst, 1998; Van Setten, 1999). Survivors commonly feel shock, isolation, anger, distrust, and an inability to communicate, and sometimes resort to the use of alcohol or drugs and “unhealthy” behaviors like workaholism, and you name it.

In contrast to such so-called stage theories, like the classic ones discussed above, for parents who have had a child die the “recovery” process never really ends (Klass, 1997; Kemp, 2001). Although Kübler-Ross’s model, for example, was originally developed to understand how terminally ill people come to terms with their own dying, it has been applied to the experience of grief. In the cases of parents who have had their child die, there is but one thing clear they have in common: an experience is so profound and poignant that there is rarely a complete resolution of the grief, even years later (Arbuckle & de Vries, 1995; Klass, 1997; Dyregrov & Dyregrov, 1999; Farrugia, 1996; Gillis et al., 1997; Kemp, 2001).

Dennis Klass (1997) suggests that there is a transformation that does eventually take place—from having a concrete, physical relationship with the child, which is truly ended forever, to a symbolic one, in which the child assumes a new place in their parents’ lives. Parent survivors suggest that, although they never would have wished for the experience, it has left them changed in profound ways (Klass, 1997; Kemp, 2001). For the first time, they say that they feel as if they truly understand the stark reality of death. Some suggest they have an enhanced appreciation of how temporary life really is, and how critical it is to spend every minute wisely. They often have a sense that they have gained an enhanced capacity to feel empathy and compassion. Their lives are different, they suggest—more people-oriented. One parent, who described himself as being modest, shy, and retiring, suggests he discovered boldness about sharing with others about his vision of what’s really important (Kemp, 2001).

PARADIGM SHIFT

The discussion so far may seem intuitive and familiar. This is precisely because the stages, phases, and tasks of grief have become so integral to the Western cultural world view. Thomas Kuhn, in his groundbreaking book The Structure of Scientific Revolutions, argues that science doesn’t evolve in a gradual, predictable path toward truth, but instead develops as a result of alternating periods of relative peace and intellectual revolution (Kuhn, 1962; Richards & Daston, 2016). Kuhn, who is credited with coining the term paradigm shift, suggests that, when scientific revolutions occur, one conceptual world view effectively replaces another.

One such shift may involve rethinking the classic grief-work paradigm, inaugurated by Freud and further developed by succeeding generations of theorists—Kübler-Ross, Bowlby, Parkes, Worden, and others—who took his basic ideas and refined them into new theories about attachment, and the stages, phases, and tasks of grief work. One review comments, “Over the years, the stage theory of grief resolution . . . described for dying patients . . . and for adjustment to bereavement . . . has had enormous appeal among bereavement experts and lay persons” (Zhang, El-Jawahri, & Prigerson, 2006, p. 1189).

CHALLENGING PREVAILING THEORY AND CLINICAL LORE

The opening volley of this paradigm shift was fired when at least three teams of investigators revisited the familiar models just discussed. They conducted independent research and began looking at the familiar grief-work paradigm with new eyes (Wortman & Silver, 1987, 1989; Stroebe & Stroebe, 1987 Stroebe, 1992; Bonanno & Kaltman, 1999, 2001; Beckett & Dykeman, 2017). Indeed, Margaret and Wolfgang Stroebe (1987) were among the first to suggest that, despite a considerable body of literature and public acceptance, the actual benefits of grief work aren’t scientifically well established (Lindstrom, 2002; Stroebe, 1992–1993; Walker & Pomeroy, 1996).

Camille Wortman and Roxane Silver observed that professionals and laypeople alike make assumptions about how people ought to cope based on the tenets of prevailing theory and clinical “lore” (Wortman & Silver, 1987, 1989). For this reason, they felt it was important to revisit five basic assumptions prevalent in both the professional literature and the culture:

1. Grief, which involves significant emotional distress, necessarily follows in the wake of loss.

2. Not having such a grief experience is indicative of either a weak relationship with the deceased or psychological pathology.

3. Grief routinely involves the unavoidable experience of psychic pain, often accompanied by physical distress.

4. In order to get through grief successfully, one must engage in grief work, fully exploring one’s feelings and expressing them, with the goal of releasing the attachment to the deceased.

5. Avoiding doing the grief work merely delays the inevitable and could contribute to more serious problems (i.e., complicated grief).

Wortman and Silver did a careful review of all the available empirical research in a quest to determine how valid these assumptions really were (Wortman & Silver, 1987, 1989). Although the research on major loss showed there are often feelings of sadness or what appeared to be a depressed mood following loss, there was no universal experience of significant distress. Indeed, only a minority of participants were distraught enough to warrant professional attention. For the majority—those that did not experience significant impairment—there was little support for the notion that those who don’t become distraught, sometimes called absent grief, either develop problems later on or else had a weak relationship to begin with. Likewise, they found very little evidence that trying to “work through” one’s grief was actually beneficial. Finally, the convergence of literature was fairly clear. Contrary to “clinical lore” and popular belief, people never seem to achieve a satisfactory “resolution” of their grief over a significant loss, even many years later.

Broken Bonds or Broken Hearts?

Margaret Stroebe and her colleagues (Stroebe, Gergen, Gergen, & Stroebe, 1992) described traditional grief-work theorists as creatures of their own culture and era. They contrasted the zeitgeist of modern society with that of the previous age, the so-called Romanticist era (Stroebe et al., 1992). As you may recall from Chapter 2 , according to historian Ariès, the Romanticist era is the time that roughly spanned the end of the eighteenth century to the beginning of the twentieth century, and which Ariès calls the era of death of the other (Ariès, 1981). It was a sentimental time, when there was a great deal of emphasis on the emotional aspects of grief. To grieve intensely, from this perspective, was thought to be an expression of great love for the deceased and a reflection of the depth of their relationship. In contrast, the modern perspective may be thought to have medicalized, psychologized, and perhaps even “pathologized” it (Stroebe et al., 1992).

Stroebe and colleagues (1992) use the metaphors broken bonds or broken hearts to respectively describe the modern and romantic views of grief. From the Romanticist perspective, the human spirit is at the center of love, creativity, and the human imagination. Marriage, in this view, is a communion of souls. Because love is seen as being a human experience of profound depth, having a broken heart upon the death of one’s beloved is an understandable, poignant, and human response—not grist for the therapist’s couch. Grief isn’t an illness, they suggest, and breaking a love-bond is not a task to be accomplished, but an unpleasant fact of life to be endured.

Quest for a New Paradigm

Bonanno and Kaltman, like Wortman and Silver, and the Stroebe team, challenged the claims of classical bereavement theory, which asserts that recovery from loss requires accomplishing grief work, which itself is aimed at the ultimate goal of severing one’s emotional attachment to a deceased loved one. Like the other two teams, Bonanno and Kaltman (1999) pointed to the surprising absence of empirical evidence to support this view and decided to explore several alternative perspectives. They sought to develop a conceptually sound and empirically testable framework in which to explore the many individual differences in the grieving process. Ultimately, they identified four integrated components of the grieving process: context, meaning, representations of the lost relationship over time, and coping or emotion regulation. See Figure 10.5 for a brief description of each.

FIGURE 10.5 Integrated Componments of the Grieving Process.

Source: This figure is based on Bonanno & Kaltman, 1999, 2001.

Contemporary Bereavement Research

After the more than 30 years that have passed since the first volleys in this paradigm war were fired, we have amassed a large body of impressive empirical research on the experiences of people who suffer loss (see, for example, Bonanno, Wortman, & Nesse, 2004; Stroebe, Abakoumkin, & Stroebe, 2010; Wortman & Boerner, 2007; Beckett & Dykeman, 2017). As a result, the smoke is clearing and a consensus seems to be forming among today’s new generation of bereavement experts. From the remains of the old stages, phases, and tasks, something new seems to be emerging.

Most bereavement researchers now seem to agree that with the help of family and friends, most bereaved people actually do pretty well after a significant loss (Jordan & Neimeyer, 2003; Wortman & Boerner, 2007). Bonanno and colleagues call this ability to bounce back resilience (Bonanno, 2004; Bonanno et al., 2002). Certainly there are many emotional ups and downs during the grieving process, but it seems that bereft people often have positive feelings and experience humor, which actually seems to help them get through it. Not everyone needs to do “grief work”—that is, actively confront their difficult feelings. Indeed, two independent reviews of the research now suggest that grief counseling, the way it has been done, tends to be ineffective (Kato & Mann, 1999; Neimeyer, 2000). Indeed, one study suggests that up to 38 percent of bereaved people who had this type of treatment would have been better off without it (Neimeyer, 2000). This new grief research also suggests that it is not only normal but also healthy to keep a deceased loved one alive in memory (i.e., attempt to maintain a bond, a relationship with them, after they have passed).

Although bereft people do very well, on the whole it also seems true that those who have significant losses never completely “get over it.” In one national prospective study of over 1,500 couples—the Changing Lives of Older Couples study—we learn that it is common for bereaved spouses to maintain memories and thoughts, and even to have complete conversations with their deceased mate, which leave them feeling poignantly sad (Carnelley, Wortman, Bolger, & Burke, 2006, cited in Wortman & Boerner, 2007).

Perhaps most important of all, this new generation of bereavement researchers now suspect, in contrast to popular thinking, that the experience of grief may in some ways be a good thing. For instance, it may very well help bring about “enduring positive changes, such as increased self-confidence, independence, altered life priorities, and enhanced compassion for others suffering from similar losses” (Wortman & Boerner, 2007, p. 312).

Researchers are concerned about whether or not the accumulated wisdom from over 30 years of research has actually filtered down to therapists, counselors, and other helpers—the “boots on the ground” who actually work with bereaved people (Wortman & Boerner, 2007). Although clinicians are well-meaning and the research seems clear, studies suggest that as many as 65 percent of those who practice grief therapy continue to subscribe to the old assumptions of the grief-work paradigm (e.g., Middleton, Moylan, Raphael, Burnett, & Martinek, 1993).

With inaccurate assumptions being rampant about how people ought to grieve, one can only imagine the potential impact of the expectations of physicians, nurses, therapists, and even family, friends, and clergy. The problem seems to be a one-size-fits-all mentality (Bonanno, 2004; Wortman & Boerner, 2007). We previously came to believe that, if therapy is good, we ought to offer it to everyone. As alluded to in this chapter, what we now know that this is not true for everyone. Resilient grievers do very well with just the support of friends and family. For them, formal grief therapy is generally ineffective and can be even harmful. Grief treatment for traumatized or chronically grief-stricken people, on the other hand, may be highly appropriate. However, we are coming to the position that their needs probably demand that treatment methods be precise and targeted. Those who have been traumatized may need intervention akin to that used for posttraumatic stress disorder, whereas those with chronic grief may need help with finding meaning in their loss (Neimeyer, 2000, 2001).

THE OTHER SIDE OF SADNESS

George Bonanno points out that sadness and depression are really two very different things. Sadness, such as what occurs when one experiences a loss, is a normal response to that loss (Bonanno, 2009). Depression is a pathological mental health condition that requires intervention.

Bonanno began his career in bereavement research right out of graduate school in response to a job offer. He describes himself as a relative outsider who never intended to make grief a career. Now a professor of psychology at Teacher’s College, Columbia University, he has been at the forefront of grief research and practice. His research publication record is impressive, but what may be even more impressive is that he has been able to take some fairly complex theoretical material and make it understandable to everyday people. In 2009, he published The Other Side of Sadness, an immensely popular book in which he shares the stories of bereft people and what the new science of bereavement can tell us about life after loss (Bonanno, 2009).

One of the problems is that concepts have gotten confused. Bonanno points out that grief, depression, and posttraumatic stress are three different things (Bonanno et al., 2007), and depression and sadness are different things (Bonanno, 2009). Depression is a clinical syndrome of related signs and symptoms, which is described in the Diagnostic and Statistical Manual of the American Psychiatric Association (American Psychiatric Association, 2000, 2013). “The emotion of sadness occurs when we know we’ve lost someone or something important and there is nothing we can do about it” (Bonanno, 2009, p. 31). About the only thing that sadness has to do with depression is the experience of feeling “blue.” Other basic emotions that might be encountered during grief are anger, fear, or even relief, depending on the person and the circumstances.

A function of sadness is to turn our attention inward so that we can take stock, reflect, and adjust to our changing circumstances (Bonanno, 2009). After a loss, sadness helps us accept what has happened and accommodate to it. In addition, it tends to evoke a supportive response from others. A person who is sad needs support and time to himself or herself so that he or she can sort things out. A person who is depressed, on the other hand, may need clinical intervention, usually some combination of medication and supportive psychotherapy.

Another problem relates to confusion between different patterns of grief reactions (Boerner, Wortman, & Bonanno, 2005; Bonanno et al., 2002, 2004). Bonanno’s basic premise is that grief, even though the experience itself is common, is experienced differently by each of us. No two people go through it exactly the same way. Nor does a single individual go through each experience of loss the same way. This having been said, there do seem to be some common patterns. In a prospective study of 276 persons who had a spouse die, Bonanno and colleagues looked at depressive symptoms three years prior to the loss, then at six and 18 months afterward. The results reveal five distinct grief trajectories (Bonanno et al., 2002). Figure 10.6 visually summarizes them.

As discussed above, the resilient grief pattern is actually the most common, with nearly half of all bereaved people falling into this category. The common grief pattern—the type of grief described in the classical grief literature—as it turns out, is really not so common, with only about 16 percent of bereaved people following that pattern. It can be described as the kind of grief where the surviving spouse has time-limited impairment in functioning—elevated depression, disorganization, and health problems (Bonanno & Kaltman, 2001). The chronic grief pattern is said to exist when symptoms persist for an extended period. In addition to these three categories of grief, Bonanno and colleagues take note of the existence of two distinct categories of depression. In the chronic depressed category (8 percent), the spouse has symptoms of clinical depression both before and after the death of their partner. In the depressed-improved category (10 percent), the spouse has significant depression before the spouse’s death coupled with marked improvement afterward. Why?

FIGURE 10.6 Grief Trajectories

Source: Based on Bonanno et al., 2002.

In a follow-up study, Bonanno and colleagues concluded that those in the resilient group tended to have long, satisfying, marriages (Bonanno, Wortman, & Nesse, 2004). They also tended to cherish the memories of their spouses. Even though they experienced grief-related symptoms—yearning, emotional pangs, and distressing thoughts and emotions related to their spouses—they were able to bounce back. They needed the continued love and support of their friends and family—not therapy. Those in the chronic grief group did seem to need professional help. Those in the chronic depressed group were depressed before and after the death of their spouses. They got worse when their spouses died and then returned to their previous level of depression. Their underlying depression was a separate matter. Those in the depressed-improved group were relatively unhappy in their marriages and were often long-term caregivers. The death of the seriously ill spouses came as a relief. Months afterward, they looked a lot like the resilient group, needing little or no outside intervention.

DUAL-PROCESS MODEL

Many people have observed that the strong feelings associated with grief after a major loss often come in waves. A Dutch team of bereavement researchers—Stroebe, Schut, and Stroebe—developed a dual-process model (DPM) of coping, which is quite consistent with these informal observations (Stroebe & Schut, 1999; Stroebe, Schut, & Stroebe, 2005). The model proposes that, following the death of a loved one, bereaved people alternate between two different kinds of coping: loss-oriented and restoration-oriented coping. Loss-oriented coping relates to such things as the loss of the person, yearning and rumination, and trying to find a new place in their consciousness for the deceased loved one. Restoration-oriented coping relates to factors that are secondary to the loss of the person, including such things as adjusting to one’s new role as “widow” or “widower”; mastering the skills that used to be provided by the other person, such as cooking, taking care of the finances, and so forth; and restoring one’s world view.

An interesting feature of DPM is the concept of oscillation, the idea that bereft people go back and forth between processing emotionally painful aspects of loss and distancing themselves from those feelings of loss, which are referred to as confrontation and avoidance (Stroebe, Schut, & Stroebe, 2005). In the researchers’ view, it is “a matter of slowly and painfully exploring what has been lost and what remains; what must be avoided or relinquished versus what can be retained, created, and built on” (p. 52). A group of clinicians helping survivors of sexual abuse to cope began from the premise that posttraumatic “symptoms” are actually necessary attempts to deal with traumatic experience (Patten, Gatz, Jones, & Thomas, 1989). They found it helpful to encourage their clients to alternate between “processing” emotionally charged material with taking recuperative rest periods, called “respite.”

While not calling them stages, phases, or tasks, Stroebe and colleagues seem to envision oscillation as being part of a process that has both short-term, moment-to-moment alternations and a longer-term shift, from the early period after the death, when there is an emphasis on loss to a later time period when it seems more important to deal with the stuff of everyday life (Stroebe, Schut, & Stroebe, 2005).

MOURNING

The shifting paradigm in the West about the experience of grief can be seen as a change between a world view based on Freudian psychoanalytic theory to a newer, but still emerging one based on the use of science and new theory. You might want to remember, however, that the debate has occurred, and continues to occur, within the Western cultural world view. As we make a shift between a discussion of grief to an exploration of mourning, perhaps we might consider that mourning, by definition, occurs within a cultural context. As discussed in the chapter introduction, it is a culturally patterned way of coping with loss.

Although death seems difficult for people in virtually all cultures—as expressed in tears, anger, confusion, depression, or difficulty functioning—there is ample evidence to show there is a great deal of diversity in terms of how human beings grieve across time, place, and the society. Paul Rosenblatt comments that, whatever anyone writes about bereavement, it is in essence a culture-bound viewpoint (Rosenblatt, 2001). As we discussed earlier, mourning is both a process people go though as they attempt to cope with loss and a culturally patterned way of dealing with it.

Friends mourn at a roadside memorial in Burbank, California, where five young people died and a sixth was injured in a tragic car crash. Roadside memorials, like this, in which people light candles, leave written notes, and offer-up sentimental objects, often spontaneously spring up as a way for people to publicly express their grief.

A feature of culture in the West today is that we put a premium on diversity and multiculturalism. Diversity is a thing to behold, but embracing it also means rejecting universals, including universals about how we deal with death. In our own circle of friends and family, my wife and I dealt with a lot of life-threatening illness and death lately. One of our friends made the comment, “Where are all the rituals that tell you what to do when the people you know get sick and die?” Indeed, many of us are uncertain about this.

Dennis Klass began his career in 1968 as one of the four chaplaincy students recruited by the late Dr. Elisabeth Kübler-Ross to help interview dying patients for her project on death and dying. In addition to his impressive work with parents who have had a child die (see earlier text), he has also gone on to do some interesting work in the study of cross-cultural bereavement (Goss & Klass, 1997; Klass, 1996; Klass & Goss, 2002a, 2002b).

In 1996, he wrote an article that explored ancestor worship in Japan, sosen suhai—a tradition he says that might help explain the role played by the dead in Eastern cultures (Klass, 1996). Klass notes that the veneration of ancestors in Japan is an important feature of its culture, which at its core is an expression of a shared sense of community that is not broken with death. He suggests that there is no autonomous, independent self in the Japanese tradition, as there is in the West. In Japan, one’s identity, one’s self is understood primarily as a function of membership within a family, which itself is deeply rooted in an ancestral system. This system is intertwined with Japanese religion—a blend of indigenous traditions and Buddhist religion, a religion that came to Japan through China. In Japanese Buddhism, the individual is not regarded as having a soul, or atman, as in Hinduism, but rather is understood as a paradoxical anatman, or identity, that comes into being as a result of the interaction between physical form, feelings, perceptions, and complexes (response patterns) and that takes place in the context of higher consciousness.

When Japanese people die, they are thought to become a part of the spirit world unless they achieve Buddhahood, or enlightenment, in the present lifetime (Klass, 1996). The spirits of the dead progress through the spirit world, starting out as shirei, or newly dead sprits, and ultimately achieving the status of kami, or deity. The spirits of the dead are thought to be available to the living, who may converse with and venerate them as members of the family ancestral system. Indeed, they are at its core, giving the family its very identity. Figure 10.7 gives a brief description of the spirit categories in this system.

In this system, the shirei are considered closest to the living (Klass, 1996). Indeed, of all the spirits they are thought to be closest, and remain available to the living for 35 to 50 years, effectively for the remainder of the lives of those who knew them. These shirei will eventually become ni-hotoke, new Buddhas, as they become more a part of the spirit world, then Buddhas, hotoke, and finally deities, or kami.

It is not until the annual O Bon festival, celebrated each summer, however, that shirei will loosen, but never completely sever, their bonds with the living (Klass, 1996). The O Bon seems to have much in common with how Los Dias de Muertos, the days of the dead, which as we discussed in Chapter 4 , is celebrated in Oaxaca and other parts of Mexico. O Bon is rooted in indigenous tradition and Buddhist religion, much as Los Dias de Muertos is rooted in a mix of indigenous traditions and Catholic faith. Also similar to what occurs during Los Dias de Muertos, at O Bon members of Japanese communities prepare for the return of their ancestral spirits by gathering wild flowers; clearing the paths to the graves; washing and decorating them; and lighting lanterns, fire, and incense to guide the spirits home. Like what occurs at the days of the dead, Japanese families prepare favorite foods and beverages for the spirits, offering them to the spirits on specially erected shrines or the family Budsudan, the Buddha shrine traditionally found in Japanese homes. Whereas in Mexico the name differs (the altars for the dead are called ofrendas)—the practice is familiar. As the O Bon celebration draws to a close, the shirei loosen their attachments to the physical world and the bereaved loosen their ties to the dead, but keep their spirits firmly rooted in their memories as revered beings in the ancestral system, where they will forevermore occupy a place of honor.

FIGURE 10.7 The Names for the Spirits of Japanese Deceased.

Source: Based on Smith, 1974, cited in Klass, 1996.

The Western Penan people are a small band of hunter-gatherers, living in remote parts of Borneo (Brosius, 1995). They have a complex system of using death-names—names that denote the status of the dead person and others. Using death-names instead of usual names is their way to protect the feelings of the bereft (using the name of the dead might arouse sad feelings). It is also their way to keep the spirit of the dead person at a distance. In their world view, the dead are as sad as the living about their demise. The Western Penan believe that using the name of the deceased can only disturb them further, perhaps inciting them to return and make trouble for the living.

In contrast are the practices of the Yoruba people, who live in southwestern Nigeria (Adamolekun, 1999). They believe in explicitly showing their support to the bereft by special greetings they extend to mourners—greetings that acknowledge the grief, ikedun, that ask blessings, iwure, and that make analogies to other similar or worse experiences a person might have, iferowero.

In some traditional Gaelic traditions, death was regarded as a natural extension of life, albeit an existence that would continue in the spirit world (Donnelly, 1999). The community showed its support to the bereft by active involvement in the wake (including the sharing of stories), walking in the procession to the cemetery, and keening (wailing), and through their music.

As in many religious traditions, in Japanese culture it is very important to purify oneself before participating in important religious ceremonies.

Raymond Lee, a social theorist at the University of Malaya, suggests there are important distinctions in how premodern peoples—for example, the Western Penan, Yoruba, and Celtic peoples of old—and modern people approach mourning (Lee, 2002). He suggests there are several key distinctions, including how the self is conceptualized, the disenchantment of death, and the significance of mourning.

The premodern self can be understood as a being that is subject to the changing tides of nature and demands of an all-encompassing community, in which the survival of the group depends on each of its members doing his or her part. In contrast, the modern self can be conceived as a highly autonomous and individualized entity endowed with inherent rights and privileges—the kind of self that can take charge and play an active role in writing his or her own biography or even changing the course of history. It is also this kind of self that finds it extremely difficult to face the reality of its final destination.

One of the features of life today is that we have stripped death of its spiritual and religious significance. In premodern culture, death is seen as the culmination of a journey—perhaps involving the release of the soul from the body or reunion with the divine. In our modern world view, Lee (2002) suggests, metaphysical meaning dissolves and death becomes instead an obstacle that gets in the way of what we want to accomplish. Lee (2002) also believes that how a people mourn says a great deal about their society. For premodern people, the purpose of mourning—the rituals and practices concerned with death—are deeply imbued with spiritual meaning and sacred significance. For them, ritual helps reaffirm their relationship with the universe, provides a sense of community, and helps maintain their relationship with the dead. In the modern context, our rituals are much abbreviated. The few that remain have often become secularized, their cosmological significance now reduced to providing for the psychological and emotional well-being of the living.

The late Greg Palmer, formerly a journalist and PBS personality, produced a TV mini-series and wrote a book titled Death: The Trip of a Lifetime (G. Palmer, 1993). In the process of working on the show he made an interesting observation. He said our death rituals and practices help us accomplish three things: get rid of the body, work out our feelings, and tell the tale about the life of the person who died. In Chapters 5 and 6 , we already discussed getting rid of the body. In this chapter so far, we have discussed how we work out our feelings. In the final section of the chapter, we conclude with a few words about telling the tale.

TELLING THE TALE

Tony Walter is a British thanatologist currently teaching at the University of Bath. In a 1996 article for the journal Mortality he movingly addressed the importance of “telling the tale” by sharing two stories of his own grief experience (Walter, 1996). At his father’s funeral, Kingston, a black Zimbabwean longtime friend of the family, had been asked to give the memorial address. Kingston was from the Shona tradition, a very different cultural heritage than that of the rest of the mourners. What he did was read a passage from Henry Scott Holland’s poem “What Is Death?” The chosen passage invites mourners to keep the name of the deceased alive in their hearts. As Walter describes it, what Kingston did was give permission to the rest of the mourners to do what they wanted to do naturally—remember. He recounts that it changed the entire tone of the ceremony from a stiff, formal event to be endured to one in which everyone had the rich opportunity to reminisce and share their own stories of the deceased.

In a second story, Walter (1996) recounts an experience he had after the death of his best friend, Corina, who had once been his lover. After her tragic death, it fell to him to contact her many friends and coordinate the arrangements. Actually, a great deal more unfolded. Using her address book, he contacted each person by phone. He noticed that, after he gave them the bad news, they would often begin to spontaneously share their stories and experiences of Corina. When they came together for the funeral, he noticed that they filled in the holes of her story for each other, providing rich new detail and in a sense rewrote her biography.

Walter’s comments that the two “experiences,” so briefly sketched, are quite natural examples of the healing that can take place when people gather after the death of a loved one (Walter, 1996). He laments, however, that in today’s modern, individualistic society, it is often hard to find others with whom to share stories like these. He identifies five factors that interfere with this (Walter, 1996):

1. Since in the West most individuals die in hospitals or nursing homes, those most capable of telling how the person died—the health care providers—are not personally connected with the family, and may be too busy caring for others to converse with them about what happened.

2. There are no common denominators in grieving. Members of the same family may grieve in different ways, or different times, making it difficult to engage in a recreative process together.

3. The religious and cultural ambiguity of our times creates uncertainty about how to behave. Whereas in the past people may have shared a common religious tradition and cultural heritage, in our more pluralistic society it is more uncertain as to how to behave.

4. The compartmentalization of home and work life often means that the various people involved in a person’s life are less likely to know each other, making communication on a personal level difficult.

5. Social mobility and increased life expectancy mean that people live longer and move. The bereaved are therefore often separated geographically and emotionally from each other.

Walter (1996) speculates about whether or not professional counseling and the proliferation of self-help groups is not somehow a natural consequence of not having other opportunities in which to tell the tale. In the classes I teach on death and dying, I sometimes like to have students do a short “seat writing” assignment that I refer to as “An Important Person Who Has Died.” It provides students with an opportunity to share a story. If you are reading this text in connection with a course, perhaps your instructor will include it as a class activity.

BOX 10.2

An Important Person Who Has Died

Consider the contrast between the broken bonds and broken hearts perspectives. Here is an opportunity to participate in an activity. It is a similar activity to one that was done with a large group of students as part of research on withdrawing ties to the dead (Marwit & Klass, 1995, cited in Klass & Walter, 2001; Walter, 1996). Take out pen and paper and write about an important person in your life who has died. Consider the role, if any, this person plays in your life today. After finishing, review what you wrote. How does your paper square with what you might have expected based on the “broken bonds” model? Perhaps you will want to share and compare your response with others.

When Marwit and Klass (1995) asked students to participate in a similar activity, they were initially uncertain about whether or not their students might see the request as odd, and perhaps even have difficulty with it. As it turned out, no one had any trouble writing about a deceased loved one. Many, in fact, wrote extensively. Marwit and Klass (1995) identified four possible roles played by the deceased in the lives of the living:

1. Role model: Defined as a global identification with the deceased.

2. Situation-specific guidance: Defined as the living calling on the deceased for guidance in specific situations.

3. Values clarification: Defined as adopting a moral position identified with the deceased.

4. Part of survivor’s biography: In this continuing role, the deceased becomes an important part of the survivor’s own story.

I would like to conclude by sharing a story from my own experience. During the writing of the first edition of this text, Ric LaPlant, a valued mentor, adviser, and the chair of my doctoral program, died suddenly of a stroke. As sometimes occurs when someone you love dies, I’ve periodically found myself reflecting on my memories of Ric. When I do, I can hear his words reverberate in my mind—“Trust the process”—or I just reminisce about his manner and tone. While working on the original version of this chapter, I sometimes found myself thinking about Ric, wondering what he might think or how he would suggest handling a particular topic or issue.

Chapter Summary

We began this chapter by outlining a few basic definitions of bereavement, grief, and mourning before embarking on a review of traditional ways of approaching the subject: the Freudian perspective, Bowlby’s contributions on attachment, the elaborations done by pioneer Colin Murray Parkes, as well as a model developed by William Worden. With this exploration came a lot of exposure to theories about the impact of bereavement. We briefly looked at one particularly difficult form of bereavement—the kind parents experience when a child dies. Then we discussed criticisms of classical theory and revelations from new theory, including the work of George Bonanno and his colleagues.

In the context of discussing mourning, we looked at the work of Dennis Klass on ancestor worship in Japan as contrasted to the Western world view on mourning. We also briefly sampled the practices of three other peoples from around the world: the Western Penan of Borneo, the Yoruba of southern Nigeria, and the traditional Gaelic people from Ireland and parts of Scotland. This also provided context for a discussion of the work of sociologist Raymond Lee of the University of Malaya, who helps contrast premodern and modern mourning. Finally, we turned to the topic of telling the tale, with some speculation about what people today can learn from those of yesteryear. For this, we briefly explored what British sociologist Tony Walter has to say about the value of telling the stories of those we’ve lost.

Key Terms

anticipatory grief

attachment

bereavement

broken bonds

chronic grief

Compassionate Friends

complicated grief

conflicted grief

disequilibrium

dual-process model (DPM)

expected loss

grief

grief trajectories

grief work

libido

mediators of mourning

mourning

oscillation

psychosocial transition

resilience

sudden loss

tasks of mourning

traumatic grief

Suggested Activities

1. Using pictures from old magazines, put together a “grief collage.” Cut out whatever pictures seem to represent aspects of any bereavement experiences you may have had. Paste these images onto a large piece of colored construction paper. This is an activity you can do by yourself or with others.

2. Think of a loved one of yours who has died. Reflect on the time you had together and write a biography about this person’s life, or about the time you shared with this other individual.

3. If you become aware of things you’d like to say to someone you care about who has died, consider writing a letter to that person. You may either save the letter or destroy it, depending on what seems most appropriate for you.

4. Journal about any losses you may have experienced. In what ways is your own experience similar or different from what is proposed in the various models? What approach to healing from the loss seems best suited to your needs?

5. Using the Internet or your library, search out poetry or stories with bereavement themes. What do you notice about what the poets try to communicate about their experience? Are you able to relate to their experiences?

6. Draw a time line of the life of a person whose death you are grieving. Include the significant events in that person’s life. Draw a parallel line with world events during the same time frame.

7. Write a story, fairy tale, fable, song, or poem about a deceased loved one.

8. Write a story from the point of view of a deceased person you know who has died.