Chapter 11 – Grief and Bereavement
SOME RESPONSES TO LOSS
People who have been through the same thing are the most helpful.
If a spouse was unhappy with their marriage, they’ll still grieve, but not as
long as people who were happy.
Sometimes people avoid the grieving individual… perhaps they’re unsure
what to say to them, or simply don’t want to deal with their drama.
“Attack of the nerves” may occur loss of consciousness from shock
Some people think death is friendly and believe they can communicate with
Los Madres de la Plaza after these mothers had their children kidnapped,
they marched around the plaza… rebelling not only against the constricted
role of women in their society, but also against the militaristic regime to
which force and violence were systematically employed against the public at
o Discovered new self – one of courage, dignity, and worth.
Bereavement (an objective fact) – We are bereaved when someone dies. We often
have had a relationship with that person. It’s sad to lose something we once had. It is
also defined as a change in status (become widow, widower, orphan, etc). More
widows than ever, social isolation and loneliness have become recognized as a
major source of stress and vulnerability.
Grief (a painful response) – Response to bereavement. Effects how the person
feels, thinks, eats, sleeps, and makes it through the day. This is not the only response
to bereavement (some people are angry or indifferent), but most common.
Dissociative flight can occur, leaving the person in extreme, even psychotic denial.
Some people delay their emotions. Other people have insomnia, failures of memory,
problems concentrating, tendency to repeat things over and over, shortness of
breath, tight throat, lack of muscular power, etc.
Neuroendocrine Changes in Grief
Grief is a stressor
People become inactive and withdrawn and increase their vulnerability to
infection because of lowered muscle tone.
Homeostatic mechanisms of the body try to moderate the stress as the first
shock of the loss, followed by a period of active grieving.
Difficult to “get over” because our central nervous system has dedicated itself
so effectively to moderating the effect of the stress.
Internal wear and tear leads to cardiovascular, infectious, and inflammatory
disorders. Higher levels of cortisol, epinephrine, and nonrephrine are signs that people
are undergoing a destabilization of their physiological systems that place
their health and survival at higher risk.
“Killer cells” in our immune system people come fewer and less active in
In a study, monkeys who were most agitated, slouching and withdrawn were
those whose immune systems were most affected by the stress of separation.
Stress in the monkeys was less when they were left in a familiar
Other health concerns: not eating well, neglecting self, alcohol, medications,
Often feel like things are getting worse, and feel like they’re going crazy.
Pangs of distress can come up again throughout life.
Half-masting – hanging flag half way to indicate a loss. First occurred in
1612 with Heart’s Ease (a ship that had an altercation with Eskimos).
In WWII, there was more support for the losses than the Vietnam War.
Why It Was Important to Have Memorial Services for 9/11
1. Individuals were recognized at every opportunity (reading names, showing
2. NYC itself was treated as a victim (losing their towers, etc).
Hmoung Grieving Traditions
Believe there is a spiritual world that the deceased needs to be guided to
Guide will read Qhuah Ke verses from memory with mention of every place in
which the deceased lived. Placcenta was buried in their birthplace, so it’s
important to know where that is.
Reed pipe player and drummer play music
Counselor to the family (an elder)
Personal director and assistant
Shoemaker special shoes for the deceased to cross over to the spiritual
Stretcher maker bamboo, 2 long wooden poles… deceased stay there until
Food server who can communicate with the dead
Warrior – shoots arrows or fires his gun in the air to protect deceased
Coffin maker – specific tree cut down and used – not metal or anything other
than this wood
Sacrificial ox slayers
Problems with this in the USA
Sometimes autopsies will throw off plans
No opportunity for Hmoungs to wash, dress, lay out stuff or put the deceased
on the stretcher (horse) Pipers and guns may not be permitted
Some of these people become Christians
APPRECIATING UNIVERSALITY AND DIVERSITY IN THE RESPONSE TO
1. Racism and Grief: Dying was his Specialty
Children’s book called To Hell with Dying, tells a story of Mr. Sweet who was
an African American alcoholic guitar player that lived down the road from a
cotton farm. Dying was one of “specialties” – he was close to death in several
situations and was always saved by the Walker children.
This book told a story of African American grief, love, and bereavement.
2. Yoruba Compassion
An example of the instructive way that Africans cope with grief in the
homelands is displayed by the Yoruba from Nigeria.
Strong support – mourning person greeted daily with concerns and support.
Acknowledge the pain of the loss, and let them know how courageous they
are… The bereaved person is reminded to take care of themselves.
3, AIDS, Multiple Deaths, and Grief
AIDS continues to be responsible for such stressful situations, although less
pervasive in the news.
In Zimbabwe, the mourning rituals are partially Christian-based, and
partially the traditional/folk way.
A grieving person in one society probably has much in common with grieving
people in other societies. However, tradition and ongoing circumstance can
exercise powerful influence over the nature and effectiveness of the morning
WHAT KIND OF GRIEF?
Since grief isn’t the same for everyone, researchers and clinicians make
useful distinctions among types of grief.
7 types of grief: normal, pathological, complicated, traumatic, resolved,
unresolved, and anticipatory.
Normal and Complicated Grief
Human nature… not a weak or pathological response to loss – different than
what we previously thought
Normal – when grief stays in within the bounds of a particular culture
Abnormal and pathological – Neglect the interpersonal side of the situation
and unnecessarily stigmatize the distraught person. Complicated grief – can be complicated in several ways… commonly the
person doesn’t move from shock and pain of loss toward a substantial return
to an active life.
Traumatic grief – severe and disabling response to sudden, unexpected, and
often violent death. Example: families of terrorist attacks.
Grieving before death occurs
Common in recent years as people live longer with life-threatening
More time to worry, more time to plan, more time to experience stress.
Also more time to make decisions, clarify values, and strengthen
People who prepare themselves for the loss feel less grief.
Doesn’t seem to be the case with situations like Alzheimer’s when death is
expected, but not imminent (pending/looming).
Resolved and Unresolved Grief
Some experts think it should be resolved within a reasonable period of time,
whereas others believe that think people will never heal completely from the
Author doesn’t think people should be pushed to resolve grief in a certain
amount of time.
Hidden or Disenfranchised Grief
Grief may be intensified and it’s resolution delayed when the bereaved are
denied the opportunity to express their feelings.
In some cases (like a teacher going into a class), grief may be hidden because
they don’t feel “entitled” to those feelings.
Caregivers in hospitals or nursing homes often get attached to their patients
and grieve their loss, however this isn’t seen as acceptable in society… thus
they hide their grief – not suppose to be “too involved” with patients.
Emotionally close healthcare workers who repress their grief are more likely
to be involved in single car accidents, and experience illness (requiring more
sick days) after the death of a patient – these effects are greatly reduced
when staff were allowed support groups that they can love and mourn their
Lover-companions of people with AIDS may not have feel they have the right
o Lovers are often excluded from supportive interactions because
they’re not considered “family”.
o However, as times are changing, it’s become more acceptable for
lovers to mourn.
Parents of stillborn babies often have forced to keep their grief inside.
Disabled children are sheltered longer, thus take grief harder. THEORIES OF GRIEF
Freud’s Grief-Work Theory
1. Grief is an adaptive response to loss. Not just an expression of emotional
2. The work of grief is difficult and time-consuming.
3. The purpose of grief work is to accept the reality of the death and thereby
become liberate from the strong attachment one had to the “lost object”.
4. Grief work is carried out through a long series of confrontations with the
reality of the loss.
5. The process is complicated by our resistance to letting go of the attachment.
6. The failure of grief work results in continued misery and dysfunction.
From Grief-Work to Attachment
More recent theories have studied how a loss affects our relationships.
Attachment behaviour – current interest in which connects the biological
need for survival with grief and mourning.
People show need for attachment when there is danger… All humans at all
ages have separation anxiety.
Under what conditions does grief work fail?
3 Basic Components of Grief Work:
Preoccupation with thoughts of the deceased person.
Repeatedly going over the loss experience in one’s mind.
Attempts to explain the loss.
How Useful is Grief-Work Theory?
Some people get back to functioning normally without grief work – widows
often distract themselves.
But there are individual differences – some people prefer counseling, others
Although Freud was fascinated by cultural differences, he did not take them
into account in his grief-work theory.
Bereaved persons in Bali are expected to distract themselves and participate
in cheerful interactions, whereas those in Egypt are encouraged to share
their pain and sorrow with others.
From Attachment to Continuing Bonds
In many cultures, grief kept the lost loved one somehow alive to the survivor
over the years.
Grievers must sever the bonds with the lost loved ones, and make new
It doesn’t make a person pathological if they keep the bond.
Doesn’t deny all grief-work theory, but is considered an alternative A continuing bond doesn’t necessarily mean that a person is living in the
past… This is human nature… People don’t just get over a loss or find closure.
Continuing bonds are often an adaptive part of adjustment to loss, but can
also contribute to difficulties in adjustment in certain circumstances.
Researchers are not likely to have positive or negative effects on the grieving
Other Theoretical Approaches
The first response is shock, numbness, and disbelief.
The final phase is the reestablishment of physical and mental balance.
The middle points vary from person to person and researcher to researcher.
The Dual-Process Model
May different responses – “normal” responses can take many different forms