Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
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Pages 69-96
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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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From page 71... ...
Thus, it is assumed that the death of a spouse, for example, is experienced differently from the death of a child.75 This chapter summarizes and discusses current knowledge about the various psychosocial responses to particular types of bereavement. The focus is on loss of immediate kin-spouse, child, parent, and sibling.
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From page 72... ...
72 / Bereavement: Reactions, Consequences, and Care ated with this type of bereavement is thought to be due to the emotional valence of marital bonds linking husbands and wives to each other. Spouses are co-managers of home and family, companions, sexual partners, and fellow members of larger social units.
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From page 73... ...
Problems of social isolation may be particularly pronounced among elderly widows who frequently cannot afford social outings and who may live some distance from grown children. Failing health among the elderly may also make it difficult to engage in social activities following bereavement.
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74 / Bereavement: Reactions, Consequences, and Care
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Clinical observations of grieving couples52 7i reveal (as discussed in Chapter 3J that feelings of attachment may actuaiTy intensify {as is typically the case in response to threat) and the marital tie may be further reaffirmed by demonstrations of loyalty and commitment.
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From page 76... ...
Although this forewarning could provide parents with an opportunity for anticipatory grieving, the tendency to rely heavily on denial when told of an intrauterine death commonly precludes this. Kirkley-Best and Keliner,35 in their clinical observations, have found that the emotional reaction to both types of stillbirth is similar-both are experienced as "the simultaneous birth and death of the child." By the time of a stillbirth, the subtle but powerful bonding of parents, especially of mothers, to a baby has usually progressed to a stage of "primary maternal preoccupations and a narcissistic investment has been made in the child.
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From page 77... ...
Until recent years, the intensity of the parental attachment was underestimated, resulting in stillborn babies being whisked away before being seen by the parents. Research conducted since 1970, however, indicates that visual and physical contact with the dead infant may facilitate the bereavement process.70 An increasing number of hospitals are now encouraging parents to name and spend time with the infant, and to collect memorabilia such as pictures, locks of hair, and the nursery bracelet.
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From page 78... ...
In fact, in some ways, such a loss may be even more difficult because usually less support is available. Others assume that parents are grateful that one baby survived and focus attention on the living child, although, as these researchers discovered, no matter how many children someone has, the loss of any one of them causes painful grief reactions.
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From page 79... ...
The Death of an Older Child Deaths are less common among older children than among infants, with accidents the most frequent cause of death, especially in adolescence. lI1 an epidemiologic study including bereaved parents, Owen et al.5~ found that the median age of the dead child was 16.6 years.
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From page 80... ...
Looking at mortality rates in bereaved parents, he found no significant increases in the first year following bereavement, but very great differences between grieving parents and controls over a five-year period. It has been found that cause and locale of death can significantly influence the outcome of bereavement, especially in terms of the parents' need to feel a sense of control.
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From page 81... ...
Based on her own research and the work of others, Raphael57 concludes that, although the child will probably have left home, "the older parent who experiences the death of an adult child is likely to be deeply disturbed by it." From his clinical observations, Gorer27 has come to believe that "the most distressing and Tong-lasting of all griefs, it would seem, is that for the loss of a grown child." Gorer,27 Raphael,s7 and Levav38 all infer that untimeliness is what makes this form of bereavement so difficult. Older parents typically fee} that it is "unnatural" for a young or middle-aged adult to die while an older parent lives on, which may be a particular form of "survivor guilt.
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From page 82... ...
In relationships lacking a pattern of stable communication, help from friends, relatives, or mental health professionals may be needed to facilitate mutual understanding. Another potential complication involves the discrepancy between a parent's real feelings for his or her child and the feelings he or she believes should exist.
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From page 83... ...
haunted by this realization. When children who have significant roles in existing parental conflict die, the bereavement process may take a pathologic course.
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In a study of 35 persons seeking treatment following the death of a parent, compared with 37 field subjects who had also lost a parent but who had not sought treatment, Horowitz et al.30 found that "the death of a parent is a serious life event that can lead to a measurable degree of symptomatic distress." Furthermore, the data suggested that the death of a mother was harder to sustain than the death of a father, possibly because of her earlier status as the nurturing caretaker.3i Another theory suggests that because in three out of four marriages the husband dies first,39 most adults lose their fathers by death before their mothers. When the second parent dies, some adults may mourn the loss of having "parents." The death of the second parent may "leave the child bereaved for the loss of the specific relationship, stripped of all living parents, and also with a reactivated mourning process for the earlier parental death."3i In contrast to these findings, several studies reported that the loss of a parent in adulthood was the least disruptive and caused the least intense grief reactions.
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From page 85... ...
Nevertheless, it is rare to find adult siblings who have completely severed ties with one another.60 Observation suggests that many sisters and brothers continue to visit each other, share memories, reunions, and responsibility for aging parents, and psychologically influence each other explicitly and implicitly, such as in the selection of marital partners.49 Despite an earlier view that sibling relationships were simply a function of and subordinate to a child's relationship to parents, researchers are now commenting on the special characteristics unique to the sibling bond.49 The empathy siblings form for one another when they are young may continue into adult life, making this tie a potentially profound one. tant.
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From page 86... ...
In an exploratory study of adult sibling relationships, Ross and Milgram60 found that shared childhood experiences and critical life events {including parental deaths) influence the level of sibling closeness in adult life.
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From page 87... ...
There also is good evidence that children whose parent committed suicide are at risk for enduring adverse consequences and for suicide itself {Chapter 5~.63 Clinical observations of suicide survivorsi2 65 reveal that they experience some reactions that are unique to this type of bereavement, as well as displaying typical bereavement reactions in exaggerated form. While the death of a close relative by any cause may leave the survivor with feelings of abandonment and rejection that may be irrational, the feeling of rejection following suicide is almost universal.
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From page 88... ...
Bereaved individuals also often blame themselves for the death, resulting in what is often called "survivor guilt. " In fact, blaming others may be one way of avoiding self-blame.
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From page 89... ...
A common fear among survivors concerns the "heritage of insanity," leading people to wonder whether others in the family are now "doomed" to kill themselves someday. Indeed, there are data that show a far higher than chance incidence of prior suicide in families of individuals who commit suicide.6 2i This may be due, in part, to a shared vulnerability to mental illness, specifically depression, or to specific feelings of inevitability and gUiit.73 Warren73 has observed that a "survivor may feel or fear the inevitability of his own death by suicide at a time
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From page 90... ...
Roman Catholics, regarding suicide as a mortal sin, used to forbid memorial mass and last sacraments for a Catholic who died in this way and insurance companies continue to deny benefits to families of people who commit suicide within two years of buying life insurance. These social stigmata compound the problems of suicide survivors.
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From page 91... ...
They are generally so isolated by the experience, however, that they may need more formal opportunities to ventilate their feelings and more reassurance than other bereaved persons. In recent years, mutual support groups, such as "Survivors of Suicide" and "Seasons," have been developed to bring together survivors of suicides to clarify their understandings of the loss and to find ways of dealing with the often confusing and traumatic aftermath.
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From page 92... ...
Further research is also needed on the meanings and responses to different types of suicides, for example drug overdoses in adolescents or suicide among the terminally ill and elderly. More information on the coping styles of suicide survivors could help others deal with the loss through suicide of someone close.
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From page 93... ...
Psychiatric breakdown foIlo~ing recent parent death.
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From page 94... ...
Initial psychological response to parental death. Archives of General Psychiatry 38:316-323, 1981.
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From page 95... ...
The importance of the sibling experience. In: The Psychoanalytic Study of the Child.
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From page 96... ...
Some psychological sequelae of parental suicide in surviving children. In: Survivors of Suicide {Cain, A., ed.J.
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