The paradoxical nature of the grief experience

This paper develops the thesis that the grief experience attendant to loss by death is a natural phenomenon and that language has been used to obscure its nature as a process. The paradoxical nature of the grief experience refers to an expanded appreciation of its nature which can include a consideration of the survivor's own joy at being alive. A feeling of joy can occur consequent to allowing the more intense grief pain to be exposed and shared. Frequent references from playwrights and other well-known authors herein support the universal recognition of the above. The author has found these thoughtful individuals to constitute an important intellectual network for himself through the years.This paper was originally presented at the International Conference on the Occasion of the Tenth Anniversary of the Department of Basic Psychoanalytic Research and Family Therapy, University of Heidelberg, West Germany, May 17, 1985.Appreciation is expressed to Betty Byfield Paul, L.I.C.S.W., Counseling Associates, Lexington, Massachusetts, for consultation and editorial review.     

Unresolved grief

This paper has reviewed the literature on bereavement and, with particular emphasis on the authors' own work, describes three syndromes which seem to be related to the nonresolution of distinct phases of the grief process. The possibility of unresolved grief should receive a high index of suspicion for the patient with otherwise unexplainable depression, chronic illness behavior, or symptoms similar to those of a deceased relative or friend. When any of these syndromes are identified, it is useful to ask the patient who he has lost, how he has lost them, how he felt about the loss, whether he felt that he grieved, whether he still cries or feels the need to cry, and whether he has adjusted. The answer to these questions--both verbal and nonverbal--will help identify unresolved grief, when present, and may be a guide to specific interventions. On the other hand, our studies have suggested that unresolved grief is a somewhat overly simplistic concept. Most, if not all, people never totally resolve their grief; significant aspects of the bereavement process go on for years after the loss, even in otherwise normal patients. For some, identification syndromes continue. Others may continue to feel the presence of the deceased or have daily visions of him or her. Still others may feel pain, anger, and guilt for years after the death. It is still unclear at what point and to what degree these behaviors and symptoms become medical or psychiatric concerns and become pathological or predispose to serious medical, psychological, or social complications. Investigations into these unreported areas have been initiated and, we trust, will lead to clinically useful answers.     

Impact of current grief on memory for past grief in spousal bereavement

This study examined the impact of changes in level of current grief over time on changes in memory for past grief. Following from previous work on the impact of current affective state on memory for past affectively salient events, bereaved individuals who underwent a greater reduction in grief over time were expected to show a similar pattern of changes in memory for past grief. A sample of conjugally bereaved participants completed measures of current grief and memory for past grief at the time of the loss of their spouse at each of the 2, 6, 13, and 30 month post-loss time periods. As predicted, those who reported greater reduction in grief over the course of the study were more likely to remember their past grief as progressively less severe relative to those who underwent less reduction in grief over time. A nonrecursive causal model analysis verified that changes in memory for past grief were explained by changes in current grief. These results were discussed in terms of contemporary reconstructive memory accounts of the effect of affective state on memory.     

Impact of current grief on memory for past grief in spousal bereavement

This study examined the impact of changes in level of current grief over time on changes in memory for past grief. Following from previous work on the impact of current affective state on memory for past affectively salient events, bereaved individuals who underwent a greater reduction in grief over time were expected to show a similar pattern of changes in memory for past grief. A sample of conjugally bereaved participants completed measures of current grief and memory for past grief at the time of the loss of their spouse at each of the 2, 6, 13, and 30 month post-loss time periods. As predicted, those who reported greater reduction in grief over the course of the study were more likely to remember their past grief as progressively less severe relative to those who underwent less reduction in grief over time. A nonrecursive causal model analysis verified that changes in memory for past grief were explained by changes in current grief. These results were discussed in terms of contemporary reconstructive memory accounts of the effect of affective state on memory.     

Self-defining memories in complicated grief

There is increasing attention to the mechanisms underpinning maladaptive responses to bereavement. This study indexed self-defining memories in bereaved individuals with and without complicated grief (CG). Participants with and without complicated grief (N = 40) were asked to describe three self-defining memories. Results showed that CG participants provided more self-defining memories involving the deceased. Both groups were equally likely to report their loved one's death as a self-defining moment, however, the no-CG group showed more evidence of benefit finding in their memory narratives and experienced less negative emotion on recall. The findings suggest that CG is associated with distinctive patterns of autobiographical memory that are linked to self-identity. The pattern is consistent with self-memory system models of autobiographical remembering, and suggests that grieving individuals who experience ongoing yearning for their loved one view their self-identity as more closely linked to the deceased are more distressed by memories involving the loss.     

Measuring grief: A short version of the perinatal grief scale

Despite a considerable number of studies, there are two major drawbacks in the literature on grief and bereavement. One is a lack of adequate and generally agreed upon measures for assessing grief. The second is a lack of ability to predict from existing measures the likelihood of what has been termed chronic or pathological grief reactions. This paper reports the results of the development of a bereavement measure for the study of perinatal loss which attempts to address these gaps. The measure is specific to a pregnancy-related loss, although it has the potential for adaptation to use for other types of loss. Analysis of responses from 138 women has resulted in the reduction of the original measure from 104 to a more manageable and almost equally comprehensive and reliable 33 items. In addition, a factor analysis has produced three factors, two of which indicate the possibility for longer-term and more severe grief reactions. Because of its sound psychometric qualities and interesting factor structure, the measure shows promise of being useful for both research and clinical purposes.This research was funded by National Institute of Child Health and Human Development Grant R01 H18431-04, with additional assistance from the Center for Social Research at Lehigh University. Dr. Potvin is supported by the Quebec Health Research Fund.     

Some stages of grief

Does grief progress through stages? Do all people go through the same experiences? What health considerations are present in each grief experience? Does religion help? Although all people do not go through the same stages nor do they progress at the same rate, many people do go through such stages as the following: shock, lamentations, withdrawal, frustration, panic, depression, detachment, adaptation, reinvestment, and growth. There is often an interaction in these stages between stress and physical symptoms, and many grievers report that religion gives a good philosophical arean in which to work through their grief.     

Impaired autobiographical memory in complicated grief

This study investigated the relationship between autobiographical memory and goals in complicated grief (CG). Twenty-four individuals with CG and 21 bereaved individuals without CG completed an autobiographical memory task and a personal goals task. CG participants were more likely to recall memories related to their loss, particularly in response to negative cues. There was a positive relationship between the proportion of loss-related memories recalled and the proportion of grief-related goals held by individuals after controlling for symptom level. Individuals with CG also showed impaired retrieval of specific autobiographical memories in response to both positive and negative cues. These results suggest that CG is characterised by impaired and biased retrieval of specific autobiographical memories. These patterns are consistent with propositions stemming from the self-memory models of autobiographical memory.     

Factors affecting grief adjustment

Earlier research has suggested that therapy and time are factors of change in grief level for those who are grieving. This follow-up study of widows and widowers suggests that there are also other relevant factors such as church activities, death of other relatives, other activities, time of grief counseling group, health, age, consideration of remarriage, religion, number of months widowed, and financial situation. A regression analysis of 138 widows and widowers found each of these factors significantly related to the. 05 critical level of significance to various measures of grief level.     

Predictors of complicated grief

Abstract

This study examined whether process variables predict an outcome of complicated grief. A turbulent and prolonged grief was predicted to occur after the death of a spouse in subjects who had self-blame, used the deceased for an extension of self, had ambivalence toward the deceased, or overcontrolled emotional responses. Ninety subjects were examined at 6, 14, and 25 months after the loss via a self-report battery of process variables and a structured clinical interview designed to assess symptoms. Subjects with complicated grief were compared with those with normative grief. Predictions were supported only in tertiary data analyses; they were not supported well in the primary and secondary statistical analyses. The authors concluded that either self-reports of process variables are inadequate measures or the theory that led to these measures and predictions is in need of revision.     

Cognitive behavioral grief therapy

From a REBT perspective, loss through death is viewed as an intense negative and traumatic Activating event which effects the Belief system and related emotional and behavioral Consequences. Grief, then, is seen as a normal reaction and the process that follows is a necessary one characterized by the bereaved attempting to reorganize a shattered belief system. In the present paper a distinction between functional and dysfunctional grief is made. Based on Ellis' differentiation between iB's and RB's, typical irrational grief-related beliefs are identified (with specific focus on pain related ones). Various REBT interventions aimed at facilitating a more functional, healthier course of grief are suggested.     

Enacting memory and grief in poetic landscapes

Much geographical work has focused on sites of memory, where memories and grief are inherently tied to particular places, monuments and landscapes. Memories and grief can also, however, be spatially and temporally dispersed and fragmentary, creating landscapes in which things are simultaneously present and absent. In this paper I trace the creation of a memorial poem - a marwnad - for my great aunt, who lived her entire life on the margins of Cors Goch, a lowland bog in rural south-west Wales, as part of a long tradition in Welsh-language poetry. Like many Welsh marwnadau, the poem highlights spatial and temporal complexities of memory, emotion and grief. They are both inherently tied to shifting, ephemeral, fluid landscapes and politicised in changing regional and national cultural landscapes, speaking to challenges faced by rural communities and the changing geographies of the Welsh language. As well as reflecting the temporality and seasonality of site-specific memory and grief, the poem contributes to that temporality as memories resurface and intensify during composition and in subsequent personal readings. I discuss the place of such performative poetry in mapping grief and the implications of poetic grieving and memory-making for absence and presence and relationships with the landscape.     

The syndrome of traumatic grief

Traumatic grief is a common and debilitating syndrome whose clinical presentation is well recognized but whose diagnostic criteria have only recently been delineated. Though it shares features with major depressive disorder, adjustment disorder, and posttraumatic stress disorder, none of these subsume the criteria set for traumatic grief, and the diagnostic overlap is limited in community samples. Furthermore, diagnosis of traumatic grief appears to have prognostic value for clinical course and treatment response among bereaved individuals. In the absence of empirically supported treatments of pathological grief, a new, manualized treatment for traumatic grief symptoms has been developed and is currently undergoing testing in a randomized controlled trial. The conceptual basis for Traumatic Grief Treatment (TGT) is presented, the structure of the treatment is outlined, and the primary clinical strategies employed are described.