Bereavement is the term used to identify the situation and the period of time following the death of significant others (e.g., spouse, parent, sibling, child, friend). Bereavement is usually considered a time of intense distress in which people are trying to cope with their grief. Grief is a normal reaction to loss and death and can be experienced through emotional, psychological, and physical manifestations. The symptoms of grief are diverse and varied depending upon individual differences, cultural norms, age of the survivor at which the loss occurs, circumstances and implications of the death (e.g., expected versus unexpected death, age of the person who died), as well as the timing of the experience (i.e., at what point in time is the grief occurring in reference to the loss). While the experience of grief varies, mourning, which is the public display of grief, is often dictated by cultural and religious norms and expectations.
Bereavement is an important context for health communication researchers because the manifestation of the grief experienced is often accompanied by both psychological and physiological outcomes. For example, there is an increased risk of mortality for the surviving spouse within the first six months postdeath; this heightened risk continues for the first three years postdeath of the loved one. The risk is higher for men than women and is often tied to the level and type of grief experienced by the survivor. Two kinds of grief are often highlighted: normal grief and complicated grief.
Normal grief occurs within expected norms given the circumstances surrounding the death and also takes into consideration the intensity and the timing of the symptoms. It has been widely accepted that most people follow a specific pattern of adjustment during the bereavement period. The grief pattern is often discussed as the five stages of grief (shock or disbelief, separation distress or yearning, angry protest, depressed mood or despair, and ultimately, acceptance of or recovery from the loss). In general, as time progresses from the death, the intensity of the grief experienced lessens as acceptance of the loss is reached. The bereavement period varies depending on numerous factors such as personality, coping mechanisms and support systems, cultural norms, and the amount of interdependence that an individual experienced with the deceased person prior to the death. On average, however, a majority of people are able to reach a level of acceptance, can engage in productive work, and can once again enjoy leisure activities at approximately six months post-loss. However, these individuals may continue to experience periodic occurrences of grief, sadness, anger, or loss.
Complicated grief is a clinical deviation from the normal expression of grief in either (1) the frame of time and/or intensity of the symptoms (i.e., chronic or long-term grief); or (2) the level of impairment as it pertains to a person’s functioning in his or her daily life. Prolonged grief disorder (PGD) is characterized by the presence of long-lasting symptoms of intense grief. Individuals suffering from PGD often suffer from depression and mental anguish and are incapable of making adaptations to their lives in the absence of the loved one. These individuals focus on their loss and sorrow, find it difficult to concentrate on anything except their loss, and feel disconnected from other individuals who are going on with their lives, thereby heightening their sense of loss and isolation.
Bereaved individuals must experience at least one of the three symptoms daily for a diagnosis of PGD: (1) interfering thoughts of the deceased; (2) severe experiences of separation anguish; and (3) disturbingly intense longing for the deceased and/or for their life together. In addition, these individuals must experience five of the following nine symptoms daily: (1) uncertainty as to what they are supposed to do with their lives; (2) inability to accept the loss; (3) avoidance of reminders of the loss; (4) inability to trust others; (5) bitterness or anger about the loss; (6) trouble moving on with life; (7) numbness; (8) feeling that life is meaningless or worthless; and (9) feeling stunned or shocked at the loss. These symptoms must last for at least six months postdeath or onset of the symptoms, and the intensity of these symptoms must combine to create a level of disruption that makes daily functioning (social, occupational, or other areas of responsibility) difficult or impossible. These individuals are at a heightened risk for suicide and other risky behaviors that may threaten their health and/or well-being.
Multiple factors are useful indicators as to how individuals will cope and deal with their grief during their bereavement. These factors include social support, skills and experience in dealing with adversity, co-occurring stressors (e.g., loss of financial support, loss of home, illnesses brought on by or escalated by stress and caregiving for their loved one), and social networks and communication within families as well as with health professionals.
While much of the research focuses on the detrimental consequences of bereavement on mental and physical health, there are a number of positive outcomes that come from effectively dealing with bereavement, including growth, positivity, and resilience. For instance, uses of metaphors by survivors are valuable for meaning-making and for revealing how individuals are coping with the loss over time. In addition, co-constructing stories about the death is a valuable tool to help family members make sense of their experience. Reflecting back on the metaphors and stories over time helps highlight turning points in grief experiences and provides valuable evidence of individuals' progress in the bereavement process. Individuals who successfully cope with their grief tend to be more resilient in dealing with death in the future. Finally, individuals who can make positive meaning of the death of their loved one fare better in bereavement.
Death and Dying
Family Communication and End of Life
Social Support, Types of
- Counseling Hispanics Through Loss, Grief, and Bereavement: A Guide for Mental Health Professionals. New York: Springer, 2012. .
- Handbook of Bereavement Research and Practice. Washington, DC: American Psychological Association, 2008. ; ; ; .
- Grief, Loss and Bereavement: Evidence and Practice for Health and Social Care Practitioners. London: Routledge, 2011. ; .
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