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Summary Article: BEREAVEMENT from A-Z of Death and Dying, The: Social, Medical, and Cultural Aspects

Bereavement is the term that denotes having irretrievably lost someone or something of value. While the word is commonly reserved to refer to the death of someone, what has been lost can also include material possessions or intangible realities, such as one's reputation, thereby generating a grief-like response. The term grief is used less exclusively to denote the emotional and behavioral reaction to loss, including (but not limited to) bereavement, whereas the term mourning typically describes the outward manifestation of grief in a variety of social and cultural practices and contexts. Bereavement, grief, and mourning are thus intricately interwoven, and discussions of bereavement lead naturally to discussions of grief and mourning (see also Grief; Mourning).

Two powerful explanations of bereavement and its outcomes have influenced scholars and clinicians, one by the founder of psychoanalysis, Sigmund Freud (see Freud, Sigmund), and the other by the British psychiatrist, John Bowlby. Freud described grief as the normal, yet deeply painful response to being bereaved. Freud explicitly asserted that grief's anguish would mislead some observers to label the reactions pathological, but that in reality the torment of grief involves not only the normal response to the loss of someone loved but also the process of recovering from the condition of being bereaved. Freud indicated that the process of recovering from bereavement is drawn out and filled with distress. He identified three tasks that the griever must endure: (1) they must allow themselves—consciously and fully—to experience the agony that their loss causes; (2) they must detach themselves emotionally from the person who has died; and (3) they must create a mental representation of the person who has died, a representation that permits remembering the person without experiencing the anguish that their death has elicited. Freud suggested that grievers needed time to carry out the painful tasks of grieving, and he warned that grievers do not—and indeed, should not—be referred for professional help (Freud, 1957/1917).

American psychiatrist Erich Lindemann (1900–1974) had a considerable influence in promoting Freud's understanding of bereavement. In the early 1940s, Lindemann and his team of clinicians were working with people traumatized and bereaved by the deaths of nearly 500 people in a Boston nightclub fire. Looking for a framework to help guide interventions with these people, Lindemann turned to Freud's account of bereavement and, in effect, institutionalized the process that Freud had described. Lindemann called it “grief work,” and this approach has remained the leading explanation for what recovery from bereavement entails. Among the tasks that a griever must accomplish in completing grief work, Lindemann noted such actions as accepting the distress that bereavement causes, expressing feelings of guilt, talking openly about one's feelings, and appraising one's relationship with the person who has died. Lindemann reshaped Freud's explanation in two key ways: (1) by asserting the need to talk about one's grief as a core requirement and (2) by suggesting that bereavement was a condition treatable by therapeutic intervention.

Attachment Theory

Bowlby derived his theory of bereavement from his work to understand the reactions of British children separated from their families during World War II. The British government had evacuated children from major cities into rural areas of England in order to prevent them from being killed or maimed in the German bombing of metropolitan areas. The children were cared for by strangers and Bowlby turned to attachment theory to explain children's responses to, at first, being separated from their parents and, eventually, at then being reunited with them. He recognized through his clinical observations that he had discovered a powerful mechanism for explaining the human response to bereavement. In short, Bowlby argued that bereavement caused by the death of a person occurs because attachment bonds had been irreparably sundered. Correspondingly, in the absence of attachment to someone, a person would not become bereaved when that person died.

Bowlby's use of attachment theory is complex and involves appeals to both ethology (the study of animal behavior in natural settings) and evolutionary theory; for instance, Bowlby maintained that attachment bonds were a result of human evolution that enabled infants to survive into adulthood because mutual attractions developed between infants and caregivers. Individuals construct their own expectations about human relationships due to the quality of attachments formed with caregivers, and these attachment expectations (which Bowlby termed “schemas”) influence a person's ongoing relationships over a life span. There is a similarity between Bowlby's emphasis on these early attachment experiences and Erik Erikson's notion of the first psychosocial crisis in identity formation; namely, whether or not, and the extent to which, personal experiences help foster a sense of trust between an infant and the external world.

Bowlby described the process of recovering from bereavement as occurring in four distinct phases: (1) numbing, during which the bereaved person seems unable to comprehend the loss; (2) yearning and searching, during which the person becomes preoccupied with thinking about the deceased individual and desiring their return; (3) disorganization and despair, during which the person gradually succumbs to a realization that the loss is permanent; and (4) reorganization, during which the person begins reclaiming relations with the world, with other people, and with oneself. What occurs during these phases is completely compatible with Freud's and Lindemann's understanding that recovery from bereavement requires considerable “grief work” and will not simply happen by itself.

Stage Theories of Bereavement

Building directly on Lindemann's legacy, Worden has developed a four-task framework for dealing with bereavement. Initially, these four tasks were (1) accept the reality of the loss; (2) work through the pain of one's grief; (3) adjust to an environment in which the deceased is missing; and (4) withdraw one's emotional energy from the deceased and (re)invest it in other relationships. Worden, however, has since rephrased task 2 to read “process the pain of grief.” He has rephrased task 4 a further two times. The first rephrasing was “to emotionally relocate the deceased and move on with life,” and has subsequently become “to find an enduring connection with the deceased in the midst of embarking on a new life.” In addition, Kenneth J. Doka has further suggested that people engage in a fifth task; namely, in rebuilding their spiritual worldviews and assumptions which are sometimes shattered by the sense of shock, pain, and incredulity caused by some types of bereavement.

Continuing Bonds

Worden changed the wording of task 4 due to his growing awareness that ongoing attachments with the deceased are far more common than had first been recognized. One publication in particular forcibly challenged the assertion that normal bereavement entails withdrawing all emotional and psychic attachments to the deceased. This book, Continuing Bonds: New Understandings of Grief, published in 1996 by Dennis Klass, Phyllis Silverman, and Steven Nickman, presented research data which asserted that, at the very least, a corrective was needed to the assumptions that normal responses to bereavement require relinquishing emotional bonds with the person who has died. The concept of “continuing bonds” was rapidly accepted within scholarly and clinical circles until, eventually, almost a wholesale reversal in clinical thinking had occurred, whereby ongoing attachments to the deceased, which were once considered unhealthy or “pathological,” were now considered healthy and normal. Research data have now tempered the sweeping prescription that maintaining bonds is expected of all grievers; rather, and as demonstrated by Stroebe et al. (2010), it is now understood that secure attachments forged during life lend themselves to remaining attached following death, but that insecure attachments require letting go of one's ongoing bonds.

Dual Process Model of Bereavement

The dual process model of coping with loss, as developed by Margaret Stroebe and colleagues in the Netherlands, has also recently entered mainstream thinking about bereavement. This model accepts the grief work theory up to a point; however, a modification has been introduced. Clinical observation of bereaved people reveals that they engage in, and oscillate between, two distinct behavioral processes: at times they engage in direct, purposeful confrontations with the distress that bereavement causes, but at others deliberately avoid such confrontations and instead engage in being alive in the world. The first process is called loss orientation, and it confirms assumptions underpinning grief work theory, while the second is referred to as restoration orientation. The dual process model insists that people recover from bereavement by engaging in both processes and that they do so naturally and intuitively. Insisting that recovery from bereavement requires solely confronting one's loss is, according to the dual process model, counterproductive and at odds with how people actually behave when bereaved.

Analysis of longitudinal data with many older adults whose spouses had died has further led George Bonanno (2009) to postulate recently that human responses to bereavement take the form of one of three distinct trajectories: a person's bereavement responses follow either: (1) a “resiliency trajectory,” (2) a “recovery trajectory,” or (3) an “enduring grief trajectory.” The resiliency trajectory describes people who very quickly return to normal functioning following the death of a loved one. Bonanno noted that a plurality of persons, perhaps even the majority, exhibit this response to bereavement. It is not that these people are unmoved by bereavement, but that what has happened has not challenged what they fundamentally understand and believe about the world, and thus they do not struggle to come to terms with the death.

The recovery trajectory describes people who struggle with the death of a loved one, who experience acute grief that subsides within six to eight weeks, but who grapple for up to two years following the death with distress over the loss. Around 40–45 percent of people demonstrate this response to bereavement, and it is plausible that such persons are the ones who come to the attention of professional counselors and therapists. These people engage in grief work, especially the loss orientation and restoration orientation identified in the dual process model of coping.

The enduring grief trajectory describes a small proportion of bereaved individuals, somewhere between 10 and 14 percent, for whom acute grief never lessens. We have come to think of these people as experiencing complicated bereavement (i.e., grief reactions which deviate from normal patterns of grieving through their intensity and duration, and which threaten to overwhelm and debilitate the griever, leading to maladaptive behaviors that inhabit the successful resolution of grief). People whose bereavement constitutes an enduring grief trajectory do not recover unless they are provided with professional help and support. Fortunately, evidence-based practices have been developed that effectively work with people mired in an enduring grief trajectory.

Two overall approaches to grieving have been identified. One involves the open, conscious, desired sharing with others of what a person is experiencing. Here, the focus is on talking about feelings, and the primary strategy, described as an “intuitive” approach to grieving, is to experience fully the distress that bereavement causes and is thus consistent with theories of grief work. The second approach, referred to as an “instrumental” approach to grieving, focuses cognitively on bereavement. The primary strategy here is to identify and solve problems and to master the situation in which one finds oneself; people employing the instrumental approach to grieving are generally reluctant to discuss their feelings. While these two approaches to grieving have been linked respectively to how females and males deal with bereavement (see Gender), evidence also shows that not all females are intuitive grievers and not all males are instrumental grievers (Doka and Martin, 2010).

Other contemporary approaches to explaining bereavement include the growing emphasis on psychological constructivism, which asserts that the central issue at stake in bereavement is meaning-making (Neimeyer, 2001). There has also been the application of existential phenomenology to explain that grieving requires people to “relearn” their relationships with others, with the world, and with oneself (Attig, 2010).

See also: Freud, Sigmund; Grief; Mourning.

Further Reading
  • Attig, T. How We Grieve: Relearning the World, 2nd edition. Oxford University Press New York, 2010.
  • Bonanno, G. A. The Other Side of Sadness: What the New Science of Bereavement Tells Us about Life after Loss. Basic Books New York, 2009.
  • Doka, K. J.; T. L. Martin. Grieving beyond Gender: Understanding the Ways Men and Women Mourn. Routledge New York, 2010.
  • Freud, S.Mourning and Melancholia.” In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 14, edited and translated by Strachey, James (pp. 243-58). Hogarth Press London, 1957/1917.
  • Klass, D.; P. R. Silverman; S. L. Nickman (eds.). Continuing Bonds: New Understandings of Grief. Taylor & Francis Philadelphia, 1996.
  • Neimeyer, R. A. (ed.). Meaning Reconstruction and the Experience of Loss. American Psychological Association Washington, DC, 2001.
  • Stroebe, M.; H. Schut. “The Dual Process Model of Coping with Bereavement: Rationale and Description.” Death Studies, 23(3) (1999): 197-224.
  • Stroebe, M.; H. Schut; K. Boerner. “Continuing Bonds in Adaptation to Bereavement: Toward Theoretical Integration.” Clinical Psychology Review, 30 (2010): 259-68.
  • Worden, J. W. Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner, 4th edition. Springer Publishing Company New York, 2009.
  • David E. Balk
    Copyright 2014 by Michael Brennan

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