Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
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Pages 45-68
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From page 45... ...
Adults' Reactions to Bereavement
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From page 46... ...
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From page 47... ...
The bereavement experience may include not only sadness, an expected response, but also numerous other unanticipated emotions, experiences, and behaviors that can puzzle the bereft, their friends and relatives, and the health professionals called upon to assist them. Increased knowIedge about the various processes and outcomes associated with bereavement is likely to help avert some of the misunderstanding that can make the experience more difficult.
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From page 48... ...
They have systematically observed and measured changes in emotions, thought, and behaviors, and the emergence or intensification of physical complaints following bereavement. Despite the nonlinearity of the grieving process, most observers of it speak of clusters of reactions or "phases" of bereavement that change over time.
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From page 49... ...
When the lost person fails to retum, however, these behaviors decrease and despair sets in.i Symptoms such as depressed moods, difficulties in concentrating, anger, guilt, irritability, anxiety, restlessness, and extreme sadness then become common. Offers of comfort and support are often rejected because of the bereaved person's focus on the deceased.
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From page 50... ...
Although no two bereaved persons are exactly alike, depression and emotional swings are characteristic of most people for at least several months, and often for more than a year following bereavement. As old, internalized roles that included the deceased begin to be given up and as new ones are tried out, the bereaved person enters the final phase of "resolution"5 or "reorganization.4 23 Eventually, the survivor is able to recall memories of the deceased without being overwhelmed by sadness or other emotions and is ready to reinvest in the world.
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. Especially in the elderly, this grief-related depression may be misdiagnosed as organic dysfunction if health professionals are not aware of the nature of bereavement reactions and the history of the particular patient.
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"Completion" is helpful in denoting relative resolution, but it suggests that there is a fixed endpoint of the bereavement process after which there is no more grieving, a notion that is inaccurate. Each expression is important and useful, but no one term alone adequately describes the end of bereavement.
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From page 53... ...
Clinical observations of psychiatric patients show that anniversaries can trigger serious pathology in vulnerable persona, 35 but usually such responses are transitory; recurrent waves of grief are normal and usually limited both in intensity and duration. An examination of bereavement outcomes should consider not only the presence or absence of various signs and symptoms, but also the quality and personal meaning of different behaviors.
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From page 54... ...
One measure of the possible frequency of prolonged or chronic grief reactions derives from the epidemiologic findings of Clayton and Darvish9 discussed in Chapter 2. Although the vast majority of widows and widowers no longer had symptoms one year after bereavement, approximately 12-15 percent still reported symptoms that were sufficient to meet the criteria for clinical depression.
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From page 55... ...
Over the course of many years of clinical observation of the bereaved, Horowitz20 has found that denial is a form of coping that may be temporarily useful if reality receives more and more attention as time passes. He has observed that it is typical for most bereaved persons to go through a period of denial; denial that continues for weeks or months, however, may be cause for concem.
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From page 56... ...
EXPLANATORY MODELS OF THE BEREAVEMENT PROCESS A number of models in this report divided into classical psychoanalytic, psychodynamic, interpersonal, crisis, and cognitive and behavioral have been developed to explain the observable reactions to and reported experiences of bereavement. Each conceptual framework tries to account for the various normal and pathologic processes and outcomes related to bereavement.
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From page 57... ...
According to this perspective, grieving presents a dilemma because there is a need to relinquish the tie to the cherished love object if one is to complete the grieving process, but "letting go" of the deceased involves considerable emotional pain. Initially the bereaved person is likely to deny that the loss has occurred, increase his or her investment in the lost person, become preoccupied with thoughts of the deceased, and lose interest in the outside world.
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From page 58... ...
Those who are psychologically healthier prior to bereavement are expected to experience the pain of Toss, but are viewed as unlikely to become overwhelmed or unduly frightened by their feelings. Observers with psychological training agree that personality variables also probably relate to the quantity and quality of a bereaved person's social support network, which, in turn, has been found to influence outcome.
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From page 59... ...
Clinical experience with a number of bereaved psychotherapy patients has led Horowitz et al.22 to infer that people who are particularly vulnerable to difficulties following bereavement have latent images of themselves as bad, incompetent, or hurtful. They speculate that loss activates these once-dormant negative images and find that distorted thoughts about the self and others intensify the grieving process, frequently resulting in pathologic responses.
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. Researchers who assert that excessive dependency may lead to difficulty following bereavement cite as evidence the literature on the psychologic development of the young child.
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The grief responses of the widows and widowers in this previously dependent group were characterized bv r,~si~ions of helplessness, indecisiveness, and intense yearning. Although excessively dependent spouses may be vulnerable if left on their own, the tendency of many families to reconstitute following bereavement may offer some protection from frightening levels of increased anxiety.
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They found that bereaved persons sometimes chose new satisfactions that were appropriate in light of the role loss but would not have been appropriate before. Thus, one measure of a favorable outcome
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Its focus on the relationship between disturbed thinking and dysphoric feelings parallels the thinking of some current dynamic theorists {e.g., Horowitz et al.22J, thus reflecting some of the convergent thinking noted earlier among theorists with different orientations. Cognitive therapists have not explicitly delineated the psychologic processes specific to bereavement, although Beck's cognitive model of depression could be applied to pathologic grief reactions.
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From page 64... ...
Mental health professionals with a behavioral orientation also view severe or persistent grief as a function of inadequate or misplaced social reinforcement. For example, Ramsay38 has found that persons suffering
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According to this theory, because people feel powerless in the face of death, they conclude that all action is futile and stop responding in ways that would eventually alleviate their stress. Gauthier and Marshalli7 have found that grief reactions may be prolonged or exacerbated if family or friends provide excessive social reinforcement for grieving behavior.
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However, detailed clinical case reports should not be discouraged. Clinical observations continue to serve as a valuable source of insights into the bereavement process and to provide ideas for systematic research.
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From page 67... ...
. New York: American Psychoanalytic Association, 1968.
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From page 68... ...
and Freeman, S Correlates of enduring stress patterns following bereavement: social network, life situation, and personality.
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