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.     

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.     

Youth Mental Illness and the Family: Parents’ Loss and Grief

Parents and family members whose adult child or relative has a mental illness endure significant losses, to which they respond with grief. Such grief may negatively affect family members’ physical and psychological health and also the relationship with their relative. Yet, research in this field is sparse. Very few studies have examined parents’ loss and grief in the context of the patient being a child or teen. It is not clear the extent to which parents’ loss and grief in response to their child or adolescent’s mental illness is similar or different to the accounts of older parents and family members caring for an adult relative with major psychopathology (e.g., Schizophrenia, Bipolar disorder). Parental loss and grief is not often addressed in child and adolescent mental health services’ provision of care; alarmingly, little is known about how best to support parents who access these services. The present study aimed to bridge this knowledge gap and identify the therapeutic needs of this younger parent population. Comprehensive interviews were conducted with 14 parents and one custodial grandparent of a youth aged 18 years or younger who was currently attending a child and adolescent mental health service. An inductive thematic analysis identified six themes; parents’ narrative of finding out, profound and pervasive loss, complex grief, waning support, the challenges of caregiving and a call for assistance. It can be inferred from these results that youth mental illness can constitute a source of loss and grief for parents. Participants’ loss and grief was largely consistent with the experience of families caring for an adult relative with major psychopathology. Opportunities for mental health practitioners to support families’ loss and grief were identified. Further studies are needed to enhance understanding of this complex and, to a large extent, ignored familial experience. Results do underscore the importance of clinicians acknowledging parents’ loss and grief and working directly with this experience over the course of youths’ treatment, perhaps in conjunction with family psychoeducation approaches.     

Conceptualizing an HIV Diagnosis Through a Model of Grief and Bereavement

For people living with HIV/AIDS, grief and bereavement typically refer to the loss of life felt in the HIV community. However, changes in HIV treatments allow care providers to view HIV grief in a way that considers physical, social, and emotional loss, as well as a loss of the life they had previously pictured for themselves. Kübler‐Ross's ( 1969 ) model of bereavement is presented as a way to conceptualize clients living with HIV who are dealing with grief and bereavement. In addition, popular bereavement counseling approaches relevant to clients with HIV are discussed, and a case illustration is provided.     

Predicting Grief Symptomatology among the Suddenly Bereaved

Social scientists have long been interested in the study of grief and bereavement, but only recently has research focused on the aftereffects of sudden loss. Theory and research alike suggest that grief is multidimensional and that specific grief reactions have a unique set of predictors. The purpose of this study is to examine the relative contribution of risk factors in explaining variations in specific grief reactions following a sudden death. Data for this study come from medical examiners' reports and mail-back surveys of survivors of sudden loss from suicide or accident. The results indicate that several characteristics of the survivor, mode of death, and social support are important determinants of grief symptomatology. This research concludes by directing future theoretical and empirical endeavors to examine more fully the role of relational factors in influencing grief experiences following bereavement.     

Psychopathology Symptoms,Rumination and Autobiographical Memory Specificity: Do Associations Hold After Bereavement?

Symptoms of psychopathology are associated with overgeneral memory retrieval. Overgeneral memory is hypothesized to be the result of an emotion regulatory process, dampening emotional reactions associated with retrieval of distressing specific memories. However, higher post‐loss symptom severity has been related to higher specificity of loss‐related memories recalled on the Autobiographical Memory Test. This may imply that such memories are ‘immune’ to the reduced specificity effect. We aimed to test this idea by investigating, for the first time, associations of depressive and complicated grief symptoms and depressive and grief rumination with autobiographical memory specificity on a sentence‐completion task (SCEPT) in a bereaved sample. One hundred ninety‐one adult mourners (89% women) filled out questionnaires and the SCEPT. A main finding was that higher depressive and complicated grief symptom and grief rumination levels were associated with reduced specificity of non‐loss‐related memories but not with specificity of loss‐related memories. Implications of these results are discussed. Copyright © 2015 John Wiley & Sons, Ltd.     

Religious Beliefs Affect Grieving After Pregnancy Loss

Religious beliefs and practices may aid in coping with bereavement and grief after pregnancy loss. Data from 103 women enrolled in the original Lehigh Valley Perinatal Loss Project, and who were followed-up for at least 1 year, were evaluated for the impact of initial religious practices and beliefs on the course and severity of grief. Religious practices corresponding to standard scales of religiosity and agreement with specific beliefs were rated by the women on a Likert scale of 1–5. Neither agreement with statements corresponding to extrinsic and intrinsic religiosity or to positive religious coping, nor frequency of religious service attendance was predictive of follow-up scores on the Perinatal Grief Scale. Religious struggle, agreement with statements classified as negative religious coping, and continued attachment to the baby were all associated with more severe grief.     

Zhuangzi on Friendship and Death

Zhuangzi suggests that death is a transformation that we commonly and mistakenly think means the end of someone but really just marks a new phase of existence. This metaphysical thesis is presented at several points in the text as an explanation of distinctively Daoist responses to death and loss. Some (such as Wong 2006) take a Daoist response to death, as presented by Zhuangzi, to indicate dual perspectives on friendship and death. But I argue that the metaphysical view sketched above is consistent with a unified perspective, allowing the Daoist to enjoy deep friendships without risking some potential for grief typically associated with strong attachment. However, it leaves the Daoist best suited to friendships with those who endorse the same metaphysics. Furthermore, while the grief associated with the death of a friend is somewhat mitigated, the Daoist has reason to mourn even given this thesis.     

Disenfranchised grief: the loss of an adolescent romantic relationship

This paper identifies the conclusion of a romantic relationship as a significant loss for adolescents. The grief response initiated by this loss is frequently disenfranchised by adults and peers. Adolescent grief symptomatology as well as strategies for surviving a loss are outlined.     

Can parental responses to adult children with schizophrenia be conceptualized in terms of loss and grief? A case study analysis

It has been suggested that parental responses to adult children with schizophrenia may involve feelings of loss and grief, centred around loss of the pre-morbid version of their child. In this exploratory study, an in-depth case study analysis of four parental accounts of their responses was undertaken in order to obtain insights into whether these responses can be conceptualized in terms of loss and grief, with the aim of informing therapeutic practice with parents in this position. Information was also obtained on how parents coped with the reactions that their child's condition elicited in them. Data were analysed using Interpretative Phenomenological Analysis. In relation to the central research question, it was found that the perception of loss was not uniform amongst participants. Three acknowledged a sense of loss, at least to some extent, but one parent resisted such an interpretation because she perceived a continuity over time in her son's behaviour and she also challenged her son's diagnosis. One parent acknowledged a loss of his daughter's pre-morbid self but qualified this by pointing to her continued physical presence. The usefulness of existing models of grief is examined in light of the findings. The implications for the practice of counselling psychology are discussed.     

The role of cognitive variables in psychological functioning after the death of a first degree relative

The present study sought to explore the relationship between negative cognitions and emotional problems after bereavement, with a group of 329 adults who had suffered the loss of a first degree relative. The following cognitions were assessed: global negative beliefs, cognitions about self-blame, negative cognitions about other people's responses after the loss, and negative cognitions about one's own grief reactions. Results showed that each of these cognitive variables was significantly related to the severity of symptoms of traumatic grief, depression and anxiety, even when background and loss-related variables that were initially found to influence symptom severity, were statistically controlled. When the shared variance between the cognitive variables was controlled, it was found that global negative beliefs about life, the world, and the future, and threatening interpretations of grief reactions each explained a unique proportion of variance in traumatic grief symptom severity. Global negative beliefs about life, the self and the future, and threatening interpretations of grief explained most variance in depression, while negative beliefs about the self and threatening interpretations of grief explained most variance in anxiety. Overall, the findings are in support of cognitive theories of grief, and suggest that effective treatment of problematic grief will need to address negative cognitions.     

Pastors,parishioners, and pets

Case examples of how three parishioners in one congregation dealt with pet loss are examined. Each person discusses reasons for owning a pet, relates personal reactions to the loss, explains who was and who would have been supportive during the grief process, and illustrates why such support was needed. Suggestions for how a local minister might provide outreach to parishioners dealing with grief over a pet's death are presented.     

Circumstances of Death and Complicated Grief: Indirect Associations Through Meaning Made of Loss

Losses by violent means and the loss of primary attachment figures may increase the likelihood of developing a chronic and severe grief response (referred to as complicated grief, or CG). Path analysis was used to examine the relationships between these risk factors and CG symptoms. College student participants filled out online questionnaires relating to their bereavement. Analyses provided support for statistical models whereby meaning made of the loss fully mediated the association between cause of death and CG symptoms and partially mediated the association between relationship to the deceased and CG symptoms. Although based on cross-sectional data, these findings provide additional support for meaning-oriented understandings of adaptation to loss.     

Intolerance of uncertainty and emotional distress following the death of a loved one

Abstract

Research has shown that intolerance of uncertainty (IU) – the tendency to react negatively to situations that are uncertain – is involved in worry and generalized anxiety disorder, as well as in other anxiety symptoms and disorders. To our knowledge, no studies have yet examined the association between IU and emotional distress connected with the death of a loved one. Yet, it seems plausible that those who have more difficulties to tolerate the uncertainties that oftentimes occur following such a loss experience more intense distress. The current study examined this assumption, using self-reported data from 134 bereaved individuals. Findings showed that IU was positively and significantly correlated with symptom levels of complicated grief and posttraumatic stress disorder (PTSD), even when controlling for time since loss (the single demographic/loss-related variable associated with symptom levels), and for neuroticism and worry, which are both correlates of IU. Furthermore, IU was specifically related with worry and symptom levels of PTSD, but not complicated grief, when controlling the shared variance between worry, complicated grief severity, and PTSD-severity. The present findings complement prior research that has shown that IU is a cognitive vulnerability factor for worry, and indicate that it may also be involved in emotional distress following loss.     

Comparison Of Narratives Of Loss Experiences Of World War Ii and Vietnam Combat Veterans

Abstract

While their continuing grief now is receiving periodic media attention, for years and even decades, American soldiers who fought in World War II (WWII) and who fought in Vietnam have suffered their life-altering experiences of loss in silence. Many of the WWII generation now have died and cannot share their grief with us. We as scholars of loss and trauma have a special obligation to reach out to the living survivors of WWII for information about their experiences. As has been often noted (e.g., Kuenning, 1990), for years after the conclusion of the Vietnam War, the stories of loss and grief of Vietnam veterans were not welcomed. The purpose of this chapter is to report some comparative narrative evidence from veterans of these two wars. Our major question was whether strong differences between groups in perceived long-term impact of combat experience would be reported.     

Promoting Meaning-Making to Help our Patients Grieve: An Exemplar for Genetic Counselors and Other Health Care Professionals

Genetic counselors and other health professionals frequently meet with patients who are grieving a loss. It is thus helpful for medical professionals to be familiar with approaches to bereavement counseling. Grief theory has evolved over the last few decades, from primarily stage theories of grief such as Kübler-Ross’s “five stages of grief” to frameworks that promote more complex and long-term ways to cope with a loss. Herein I present one recent grief theory – meaning-making - and describe how it can be applied to help parents of children with disabilities grieve the loss of the child that they expected. In particular, I describe a scenario that many genetic counselors face - meeting with the parents of a child with Down syndrome. I outline the research done on the reactions, grief and coping experienced by parents in this circumstance, and I present suggestions for encouraging healthy coping and adjustment for parents, based on the meaning-making perspective. The meaning-making theory can also be applied to many of the other losses faced by genetic counseling patients.     

Tools for Many Trades: Reaffirming the Use of Grief Counselling by Health, Welfare and Pastoral Workers

The use of counselling is increasingly questioned as an appropriate and viable activity for professionals in statutory and general settings whose work roles and tasks are varied. This paper looks specifically at grief counselling and examines some of the reasons why applications of grief theories and grief counselling by such workers have been narrow and limited. It then suggests a framework for teaching the subject, offering relevant applications. Finally, it points to developing areas of grief counselling in multi-disciplinary contexts and argues that working with grief and loss must be recognised and fostered as core, generic skills for the non-specialist.     

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.     

PSYCHOLOGICAL IMPACT OF MIGRATION ON LATINAS

This paper examines the psychological implications of the migratory process on Latin American women in the United States, addressing is-sues of gender roles, acculturation, language, loss, and grief that are frequently presented by immigrant Latinas in psychotherapy. The paper interprets these issues as reflective of the stresses created by the migratory process rather than as issues of individual psychopathology, and suggests ways to respond to them through psychotherapy.     

Parental Mourning and Children's Behavior

This article alerts professionals to sibling death as a possible reason for behaviors exhibited by young clients. Aside from their own grief, children are affected by parental mourning over a child's death and accompanying changes in the family environment. Children show their distress in a variety of behaviors, some of which appear to be unrelated to the loss. Four areas of concern are presented with case illustrations: cognitive distortions, reactions to parents' distress and preoccupation with the loss, being a replacement child, and effects of parents' failure to work through their grief. Suggestions for helping children and parents include using a genogram for identifying loss, helping the family talk about the death, and providing a support group for children.