Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
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3 Adults' Reactions to Bereavement
3 Adults' Reactions to Bereavement
Pages 47-70
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From page 47... ...
Unlike Chapter 2, the findings presented here are based mostly on clinical observation and inference. The focus is on the phenomenology of grief- changes in emotions, thought processes, behavior, interpersonal interactions, and physical symptoms that characteristically follow Toss ant!
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From page 48... ...
Noting recent misapplications of Kubler-Ross's25 stages in the acceptance of one's own impending death, the committee cautions against the use of the word "stages" to describe the bereavement process, as it may connote concrete boundaries between what are actually overIapping, fluid phases. The notion of stages might lead people to expect the bereaved to proceed from one clearly identifiable reaction to another in a more orderly fashion than usually occurs.
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From page 49... ...
In their experience, anticipatory grieving allows people to begin to let go of the relationship. The clinical observations of Parkes and Weiss33 and Vachon et al.,44 however, have led them to conclude that persons threatened with loss typically intensify, rather than give up, attachment behaviors.
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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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From page 51... ...
Physical Complaints Because of the defense mechanisms used by a particular person, as well as cultural norms that influence the way psychologic pain is expressed, grief may be expressed more in terms of physical symptoms than psychologic Complaints.2~29~4l An nip in {~h~'orc' ~ ~ Q ~= _ ~_ 1 _ 1 _ ~· ~ ~ "v _ .~ _.~c~ Cl..~. ~ ~.~L~ ,J,bun `;~c;a~ observers and social scientists have found that acute grief is associated with a variety of physical complaints, including pain, gastro~Il~na~ cl~sruroances, and tne very vegetative symptoms that, at another time, might signal the presence of a depressive disorder {e.g., sleep disturbance, appetite disturbance, loss of energy)
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From page 52... ...
Thus, using varied terminology provides a better perspective on the multiple issues pertaining to outcome. In fact, as described below, a healthy bereavement process can be expected to include recovery of lost functions (including investment in current life, hopefulness, and the capacity to experience gratifications, adaptation to new roles and statuses, and completion of acute grieving.
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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... ...
Clinical experience with bereaved psychiatric patients has led a number of practitioners to speculate on the psychologic meaning of absent grief. Deutsch, i2 basing conclusions on a limited number of patients undergoing psychoanalytic treatment, found that grief-related affects were sometimes omitted in persons who were emotionally too weak to undertake grieving.
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From page 56... ...
Those who formulate the problem as purely psychologic would be more likely to recommend psychotherapeutic intervention, whereas those who diagnose a major depressive disorder, unrelated to bereavement, might be more inclined to treat the symptoms with antidepressant med . catlon.
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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... ...
The Role of the Preexisting Personality. Although there are almost no systematic studies of the role played by preexisting personality variables in affecting the process or outcome of grieving,44 clinicians generally agree that such factors do influence every aspect of the grief experience, ranging from the way the loss is initially perceived to the way it is or is not resolved.
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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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From page 60... ...
. 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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From page 61... ...
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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From page 62... ...
Dowdy, studying young children who were placed in institutional settings away from their parents, observed that when a bond was threatened by separation, powerful attachment behaviors including cringing, crying, and angry protest were instigated. When the actual loss of an important relationship occurred, Bowing found that there was a brief period of protest followed by a longer period of searching behavior.
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From page 63... ...
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... ...
Ramsay's38 clinical experience has led him to conclude that persons likely to become "stuck" in pathologic grief reactions are those whose prebereavement response patterns were to avoid confrontation and to escape from difficult situations. He has found that, following the death of someone important, these people fail to enter situations that could trigger their grief.
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From page 65... ...
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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From page 66... ...
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... ...
Bereavement: a behavioral treatment of pathological grief. In: Trends in Behavior Therapy ;Sioden, P.O., Bates, S., and Dorkens, III, W.S., eds.~.
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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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From page 69... ...
Reactions to Particular Types of Bereavement
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From page 70... ...
i::::::::: a::::: ~ i:::: :~: ::::::::::: :~::: :~:; i: ::: TI~ ·- ~ ace: ~ t~ ~ Of the many musical expressions of bereavement, Gustav Mahler's Kin~ertoten~ie~er are among the mostpoignant and ten den Gready affected by the numerous illnesses of his twelve brothers and sisters, half of whom died, Mahler chose for this song cycle the poems of Fned~ich Bucket, who hadJost two of his own chidden.
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