GRIEF: AN OVERVIEW The Objectives of This Chapter: 1. To understand the many meanings of loss 2. To understand the stage models of grief 3. To understand cultures and their respective ways of dealing with grief 4. To understand the complications of grief

The Terminology of This Chapter: Grief: emotional suffering caused by or as if by bereavement; distress, bereavement, sorrow Loss: the harm resulting from losing; deprivation; bereavement; irretrievable Hansen (1990) describes four crushing losses: 1. Loss of a loved one through death or divorce 2. Loss of a job 3. Loss of a role; an example would be parenting adult children and how the relationship changes; loss of a job 4. Loss of health, one’s own or a loved one Researchers (Holmes and Rahe, 1967) have studied grief and assigned stress levels to items. Loss of a spouse and loss of a child are the highest stress levels. Others that we may not often think about are losses that occur with moving, changing schools, financial issues, and health problems. These are all associated with losses or a state of grief for an individual. We cannot generalize about the loss or expect everyone to respond in the same way. For example, loss of a spouse is rated the highest for causing stress, but consider it from different perspectives. A spouse who dies suddenly may cause more of a loss than the spouse who has been ill for some

time. On the other hand, the sudden death may be a relief to a spouse who has been victimized by a spouse while the spouse of the long-term ill person may have had a wonderful marriage. There is no road map for grief, and each loss must be examined aside from any others. Grief and loss is very specific to the person who is experiencing it. Couples may experience the same loss, but they may grieve very differently. When one spouse does not understand the grieving process of the other, marital problems can surface. This is often seen when a couple loses a child and can often lead to divorce if the couple does not seek help.

Stage Models of Grief Theorists (Kubler-Ross, 1969) have written about the stages of grief and what one might expect to experience while in one of those stages. Kubler-Ross’ model was specifically written for those who are terminally ill and explains what they are experiencing. Her stages are Denial, Anger, Bargaining, Depression, and Acceptance. Bowlby (1980) instead looks at grief as going through Phases such as: 1. Phase of numbing which usually lasts for a few hours to a week and may be interrupted by outbursts of extremely intense distress and/or anger 2. Phase of yearning and searching for the lost figure lasting some months and sometimes for years 3. Phase of disorganization and despair 4. Phase of greater or less degree of reorganization These models are very helpful as long as someone does not try and force their personal grief into one of the stages or think there is something wrong when their grief does not match up with what the stage says should be happening. These stage models are a guide and should not be strictly

used to plot one’s grief. As often happens with stage models, people may find that they move back and forth between the stages or phases.

Repressed Grief This type of grief occurs when an individual is unable or unwilling to grieve at the time of loss. There can be multiple reasons for this inability to grieve such as the fear of complete collapse if one starts the grief process. In such a case, the individual may get immersed in work, start an intense project or find anything to detour the grief process. Unfortunately, the grief does not go away and can surface in unexpected ways in the future. Marital issues can occur, especially if one spouse has been able to grieve, and the other spouse has not. The grieving spouse may wonder what is wrong with the spouse, why the spouse is not experiencing the loss as he/she is. People rarely grieve in the same manner, but when a person refuses to experience grief, either consciously or unconsciously, problems can be seen in relationships, on the job and just in overall functioning. The grief will come out, and the more it is suppressed or repressed, the more severe it may be evident at a later time. The following example consists of an example of what happens when grief is suppressed. This family consisted of a single-parent, Martha, and her teen daughter, Sarah. They experienced some typical mother-daughter conflict, and Sarah expressed a desire to live with her father and his family, consisting of a stepmother and a toddler. To coin a phrase, “the grass looked greener” to her in his house than in her own. After a few months with her father, Sarah stated that she wanted to return home. Before that happened, Martha and Sarah decided to pursue counseling to settle some issues. Martha wanted to make sure that Sarah was making this decision for the right reasons. She did not want Sarah to be a

ping-pong child and go back and forth when she was unhappy in one of the homes. After several counseling sessions, Sarah moved home, but they continued to come in for counseling. There was pressure from Sarah’s father for her to return to his house, and she was struggling with divided loyalty. One day Sarah and a friend were walking by her house, and a man swerved off the road, striking Sarah with the car. Her friend was pushed free. Sarah died at the site, and it was determined that the man driving the car was drunk, had several other citations for drunk driving, and his license was suspended. Martha was so devastated and did process some grief, but most of her energy went into punishing the man who killed her daughter. She joined Mothers Against Drunk Driving (MADD) and became very active in the organization. She also put energy into helping convict the driver. She and several friends would drive by his house and see if they could catch him driving. On one occasion, he was caught driving, the police were notified, and he was sent to jail without bail. Martha’s next round of energy went into the man’s trial and seeing that he received punishment for all of his offenses. This entire process of involvement kept Martha from focusing on her grief and loss. Once the trial was over, Martha “crashed” and finally started to grieve the loss of her daughter. She came into counseling sessions and spent most of the session sobbing. It took many sessions before she could begin to talk about the intensity of her loss. A problem with repressed grief is that once the individual does begin to experience the feeling of the loss, the resources may not be available to help them that may have been there immediately after the loss. Friends and family may have experienced grief at the

time of the loss and may not want to go through it again now that the person is ready to start the process. It may be too painful for others to be around this and the person can be isolated.

Complicated Grief Complicated grief occurs when circumstances around the loss are confusing or unknown such as a suicide or a murder. A person wants to grieve, but encounters mysterious circumstances, a lack of information, etc. An example of complicated grief follows. A woman in her mid-twenties enters counseling due to the death of her husband. She and her husband were separated but trying to work on the marriage. Her husband was found dead in the ceiling of a big box store after he had bled to death from gunshot wounds. The police theorized that her husband was part of an armed group that entered the store after hours to rob it. They thought that her husband had been wounded in the process and managed to climb into a ceiling panel to hide. He apparently bled out while he was hiding and was never discovered until later the next day after the store had reopened. The portrayal of her husband as a thief did not match with the person she was married to for five years. Aside from her loss of him, she was questioning if she really knew her husband, if he was involved in the robbery or if he had been an innocent bystander. The woman is left with a lot of unknowns in this situation, and she may have to realize that she may never get the answers she wants. She does not know “who” to grieve, the husband she thought she knew or the husband who was involved in criminal activity. A second example of complicated grief involves another young woman in her twenties whose brother was recently murdered. The family is of Hispanic origin and lived

in fear of the gangs in her neighbor. The brother who was killed was her younger brother, and she believed he was not involved in gangs. She is trying to mourn her brother, but she has questions about her judgment and his involvement in gangs. She asks herself if he was involved, how could he have hidden it from the family. She is also very angry at those who killed him as they dumped his body in a ditch. She has no way of knowing some of this information about her brother, and she realizes that she may never be able reconcile her perception of her brother and the person he really was.

Using Rituals for Healing Rituals are such an important part of our lives, but we often take them for granted and do not realize that we even have rituals or how they impact our lives. This is also true of rituals surrounding death. Every culture approaches death differently, and every family within those cultures may have its own way of experiencing death. We can make statements and generalize to cultures and groups and how they deal with death, but we know many divert from the expectations of the group when experiencing a loss. When a family loses a loved one, they may attempt to ignore those rituals that have held the family together. These are the commercial holidays or birthdays and anniversaries. Families just cannot face conducting the same rituals when a loved one is not there. This creates a gap in living for the family and can cause additional harm. I have had children express concerns about Christmas after a parent has died. They want to know what is going to happen since no one is talking about it. He was not asking for the same holiday celebrations, but he did want to know what they were going to do. The “gap” was of great concern to him.

On a personal note, I remember the first holiday dinner at my mother’s house after my father had died. He had always sat at the end of the table. We all got ready to sit down, realized the chair was going to be empty, and my brother in law slid over to my father’s chair, and we knew it would be ok. We had gotten over a major hurdle. The NAMES Project began as a way to affirm the life of every man, woman, and child who had died of AIDS. It was a healing ritual where people added squares to a quilt, each square representing a person who had died. On a smaller scale, a family can create a quilt for a loved one and ask family members and friends to contribute to the quilt. As far as cultural reactions to grief, there are a few examples in this paragraph. Again, these are generalizations, and people within these cultures may respond differently. In certain Mediterranean countries such as Greece and Italy, women will wear black for the rest of their lives after a husband’s death. In India women are expected to throw themselves upon the funeral pyre, a sacrifice for the husband’s life after death. The Americans and British tend to be pragmatic in how funerals are carried out. Cultural groups also differ in how they care for the dying. In the United States, most die in hospitals rather than inconvenience the family. Many other cultures consider it an honor to care for the dying person at home. Women and men differ in their roles during grief. Women will usually handle the emotional issues and men will handle the administrative tasks such as paying for the funeral, acquiring death certificates, etc. In the African American community, the funeral is characterized by someone “going out in style” and no expense is spared even if the funeral is a financial burden to

the family. Members publicly express their grief and the funeral service is designed to heighten the emotionality of those attending. Family networks are designed so that members take over the responsibilities of the deceased. It is important that those members do not overfunction and assume too many responsibilities. In Jewish families, the funeral serves more as a review of the person’s successes with intellectual abilities highly praised. It is not a time for celebration or a party as compared to the Irish wake and the consumption of large amounts of alcohol. After the Jewish funeral, members of the family participate in a shiva where they do not leave home for seven days as they are cared for by others. Mourning in the Jewish culture can take place for a year. In order to understand families and their grief process, Walsh and McGoldrick (2004) have composed questions that will elicit information about a culture and the response to grief. 1. What are the prescribed rituals for handling dying, the dead body, the disposal of the body, and rituals to commemorate the loss? 2. What are the group’s beliefs about what happens after death? 3. What do they believe about appropriate emotional expression and integration of a loss experience? 4. What are the gender roles for handling the death? 5. Are certain deaths particularly stigmatized, such as suicide or traumatic for the group, such as a death of a child? There are several suggestions that have been successful in helping individuals and Hopefully, readers can use these in some form and adapt them to fit their own needs.

1. Making visits to a grave or a special place where the deceased loved to be. 2. Letters can be written to or about the deceased. Often in therapy, we have clients write letters knowing that that is for the client’s expressions and not a letter that will be mailed.

3. Reading old diaries or letters. 4. Sorting through memorabilia, deciding what to keep or pass on. 5. Keeping a journal of dreams, memories and reflections. 6. Having discussions with others about the loss. 7. Watching movies about loss and grief. 8. Listening to music that the deceased liked. 9. Above all else, we encourage the use of grief support groups. Some people are ready immediately to enter a group, and for others, it may be several months before someone is ready. Whatever the time line, most people will experience a sense of support and understanding that others around them may not be able to provide.

Resources Bowlby, J. (1980). Attahment and loss: Loss, sadness and depression. Basic Books: N.Y. Hansen, V. (1984). Death and grief in the family. Aspen Systems Orientation. Rockville:MD. Holmes and Rahe (1967). The social readjustment rating scale. Journal of Psychosomatic Research 11(2).

Kubler Ross, E. (1969). On death and dying. Macmillan: N.Y. Walsh, F. and McGoldrick, M. (2004). Living beyond loss: Death in the family. W.W. Norton & Company: N.Y.

Online Resources Grief Store through www.amazon.com Griefnet.org Compassionatefriends.org