The Complexity of Grief
A Constructivist Approach to Grief and Mourning
Much has been written about psychosocial responses to death and bereavement, from which professional specialties and nonprofessional bereavement programs have developed. The conceptual models of loss and the clinical programs flowing out of them reflect outdated theories that have restricted the important questions that need to be asked, including the methods used to interpret findings (Neimeyer, 2001). Various authors have criticized the “standard model of grief,” and they point to a new direction—from the function of mourning being a conservative, restorative process to one that is transformative; mourning as a private, intrapsychic process, to one that is social and relational; mourning as having normal, standardized characteristics, to one being personal and unique; mourning’s central task as detachment to one of continuity; mourning leading to full resolution, to one being open and evolving (Hagman, 2001).
The criticisms raised on previous ways to grieve and mourn, and the transitions in mourning described above, reflect a contextualist, constructivist, and interpretive shift in psychology and allied disciplines—a new wave in grief theory. New models exhibit a skepticism about some of the fundamental tenets of standard grief theory: the universality of predictable emotional trajectories (i.e., stages, phases, etc.) and the presumption that grieving requires withdrawal of psychic energy from the deceased so staunchly supported by Freud and his followers. A constructivist approach supports greater awareness of the implications of loss on the individual’s sense of identity, and a broadened focus on individual experience and the patterns and processes by which loss is negotiated within the individual, within families, and within broader social contexts (Neimeyer, 2001). This approach acknowledges that grief is an emotion that is influenced by social factors, but its shape, its meaning, the length of time it is expressed, and how it is expressed vary not only from one individual to another but from one cultural and historical group to another (Lofland, 1985).
A central process in grieving that involves meaning reconstruction in response to loss has begun to replace former approaches to clinical practice (Neimeyer, 2001): that of “meaning making” (inferring that we are self-consciously active and deliberate in making new meaning out of our lives), and “meaning finding” (less self-conscious and more passive or receptive to meaning that arises spontaneously out of our grieving)—processes that reflect Attig’s (2001) “relearning the world.” Grief response is inherently active and unpredictable, shaped by a person’s personality, through exercising freedom and choice, by relationship to the deceased, and by familial and cultural backgrounds (Hagman, 2001). Loss results in a crisis in the meanings by which our lives are given structure and substance, and in bereavement we respond as multidimensional beings (Attig, 2011).
The Individuality of Grief Response—a Woman Whose Grief Works through Her
Jenn, a registered nurse and clinic administrator, is married to Mike. She is a mother and also a grandmother to little Jeremy, who is barely two years old. Jeremy’s father—Jenn’s son, Steven, a firefighter—died in a sudden and tragic accident almost a year before Jenn’s own car crash, which she describes below. Her story describes a journey through the confusion and complexity that loss and grief have visited upon her as she works her way through grief, and it works its way through her.
Mike was still in the shower and the children were busy getting ready for school. It was late. I was due at the clinic at 7:00 a.m. It usually took an hour to get there, and in my rush to the freeway, I failed to see the black ice on the road just as I came over the last hill out of the woods. The rear of the car slid to the left, and I maneuvered it out of the skid, but then it slid again. Again I maneuvered successfully, all the while my car was picking up speed. I started to spin out of control in the middle of the road, like I was caught in a whirlwind. In that flash, I knew that I would not be able to correct anymore, so I just hung onto the steering wheel and braced myself.
I don’t know how many times the car spun in circles. The more it spun, the farther from reality I felt. It seemed as if I was looking through a long black tunnel, and I felt as if I was going to pass out. Soon everything was moving in slow motion. Then I felt a crushing pain as the right side of my car slammed against the curb. The jolt somehow cleared my vision long enough to see that that I was heading into a roll down a steep embankment. That’s when I must have passed out.
I awoke to a tomb of silence. Everything was blurry. I wondered if this was death. But then I began to hear falling glass and I was relieved to feel the cold morning mist sifting in through the broken windows. I just sat there, afraid to move, my mind stalled. I remember not really knowing what to do next. Should I stay in the car or get out, stay still or move, scream or be quiet? I closed my eyes, hoping that when I opened them again, I’d find myself back home, slicing oranges for breakfast. But when I opened them, all I saw was twisted metal and broken glass.
Nothing made much sense to me. I was in a car. I thought it was my car, but when I reached to the right, I felt the bark of a tree. I was still in the driver’s seat, but my door was above my head. I reached for the door handle and tried to push it open, but felt a horrible pain in my chest. It was a twisting, grinding pain that seemed to echo throughout my whole body. Breathing became difficult. I wanted to be free of all this, but at the same time I didn’t want to move, so I sat there, closed my eyes, and pulled my coat close around me.
I could feel myself growing sleepy, and that’s when I started to panic. I tried to get out again. I couldn’t see my glasses or my purse, and I had on only one shoe. The keys weren’t in the ignition anymore either. I could hear cars behind me, but they were high up, and no one was even stopping.
The windshield was shattered, but it was still intact. My only way out was through the broken window of the passenger side door. I put all my effort into climbing out, cutting my arms and legs with each move. When I got outside the car, nothing looked familiar. I heard a car come close, and I tried to scream, but I couldn’t take in enough air to even yell. My car was hidden, and so was I. I knew that somehow I had to climb up the embankment or I would likely freeze to death. I started to crawl up the embankment.
Mike came to mind. He had asked me where his burgundy sweater was, throwing his parka on the bed, saying that it was only 19 degrees outside. I remembered that we didn’t say goodbye. Then Steven’s face came to me.
“Well, isn’t this another fine mess you’ve gotten yourself into?” He laughed. “I blew it this time, Steven,” I said. It was so strange. I felt his warmth all around me, but I knew he wasn’t there. I closed my eyes and smiled. I think I passed out again. “Get up! Get up!” I could hear him yelling at me, but I couldn’t see him—even with my eyes closed.
Steven had been a fighter. He’d loved life. He’d seen the tragic results of “dangerous” living every day at work. The night he died, he had been on call, and others working with him said it had been a very busy night. Steven was just tired and fell asleep. He wasn’t wearing a seatbelt. He was tired and he just forgot.
Steven’s voice kept getting louder and louder. “Get up!” “Oh God,” I thought, “I must be going crazy.” Steven had been dead for over a year, but he kept yelling.
It took several tries. I’d make it halfway up the hill, and then I’d slide back down. The pain was excruciating. I’d close my eyes, and again the long, dark tunnel would appear. But Steven was at the end of it now, laughing. It reminded me of when he would swim out to the waves and dare me to swim after him.
I don’t know how long I tried, but finally I could feel the concrete curb. There was still so much pain, and Steven was gone. That long cold aloneness of his never being there was back again. How I missed talking with him, hugging him hello and good-bye. I should have died that day—could have, but didn’t. I likely would have if it hadn’t been for Steven—or I guess the memory of him.
When I think about him, I wished that I had died. It would have been easier to avoid all the pain I felt with him gone. I felt angry, numb, helpless as I tried to deny that he was actually gone, and it had been a year. I would vomit every time I ate. If I didn’t vomit, I’d make myself. I felt better when I did. There were other things too.
I was in a world and didn’t feel a part of it. I walked through familiar places and saw no one. One night I awoke from a dream with hives all over my body. I couldn’t stand the itching, so I drove myself to the emergency room. It was three in the morning.
I didn’t know what I was going to tell the doctor. I sat in the parking lot, wondering what I would say—that my son had died and I was actually going crazy and now I had hives? I just wanted relief and some sleep. So, being a nurse (which I did not mention), I presented the doctor on call with my real symptoms (generalized hives) and a fake history of having unknowingly eaten fish in a salad that evening (I have an allergy to fish). My blood pressure was elevated and my pulse rapid, and I looked like a normal case of allergic reaction. Except that I didn’t feel normal.
No one asked me if there was another reason I was crying. No one questioned the fact that I said I was married but had driven myself to the hospital. No one wondered why I was 400 miles away from the home address I gave them on the admission form. No one really cared, or cared to know.
My allergy was not from fish, but from the pent-up feelings of grief I was experiencing—denial, anger, sadness, and guilt. Like being out of control on the icy road, those feelings were part of the whirlwind I was spinning in and couldn’t free myself from.
After my car accident, I resigned my nursing position. How could I help anyone when I couldn’t even help myself? Even simple decisions seemed confusing and difficult.
I talked about my turmoil with a friend, who immediately blamed the chaos in my life on my falling away from the church. Actually, I’d never felt closer to God than when I decided to get away from the chaos and drove to the Grand Canyon alone for a weekend. I stayed out all day wandering along the edge of the South Rim. I watched the sunrise and the birth of color against the sculptured canyon walls at dawn, the dancing colors as the day passed, and the somber peaceful colors of sunset.
I wanted to believe that change could be good in my life too. Climbing up the embankment from the wreckage was exhausting. Just as exhausting as searching for who I am now. Surviving the accident was a lonely journey encouraged by the beautiful memories of Steven. Surviving this grief is another lonely journey. Like memories of Steven, the help of friends has been inspiring—at least some of them. An old friend, 3,000 miles away, listened and talked me through a time of wanting to give up on life, and a new friend taught me to accept that nothing is forever, that it’s okay to cry, and especially to concentrate on living. I run down the path and still trip over pebbles, and bike down the road and fall off, but it is a lot easier to get up and keep going, and someday I know that I’ll swim out to the waves where Steven is.
What Jenn experienced as a time of chaos and confusion with even simple things did not really surprise her. She was a modern woman easily fulfilling her job as nursing administrator. She was also already familiar with the bereavement process. She understood, as Eliot had described long ago in the 1930s, that grief could cause a sense of abandonment, shock, denial, guilt, and anger, and most of all, an intense longing for the deceased. She had experienced depression too, but she had not realized the extent to which her depression had been prolonged and that perhaps she had allowed the busyness of her life to mask and maybe even stifle it. Jenn was aware of some of the physical reactions to grief (dyspnea, tight sensations in the throat, physical exhaustion, sleeping lethargy, feelings of emptiness, decreased appetite, gastrointestinal disturbances, crying, auditory and visual hallucinations, and insomnia), and some of these had been part of her grief too—but in mild form. It wasn’t until the nightmares and the hives that Jenn was shaken by what her body was telling her—that she had not yet dealt with the mental anguish of her son Steven’s death. And like the skidding tires and the seemingly endless spins of the car on the icy road and then careening down the embankment, her life was out of control. Strangeness in her own body, out of sync with her world, emotional flatness—these were the signals to Jenn that it was time to surrender to her loss.
Jenn turned to nature—to a weekend of solace alone in the Grand Canyon. To family and friends, it may have seemed dis-regarding. To work colleagues, it may have seemed neglectful. But to Jenn, it marked the first real step to begin reconstructing her life without her son in it.
Some time ago, Deutsch (1937) remarked that every unresolved grief is given expression in some form or other—that the process of mourning must be carried through to its own completion.
Should church have been the place for resolution of Jenn’s grief? Was Jenn’s car crash the impetus for her to know that connecting with Steven was real for her, but it just happens in a different way now? Will that memory sustain her? Clearly, Jenn’s path is her own. No one can really tell her what will work best for her. Friends and family can support her, but her journey is one of making meaning from and out of her life now.
Meaning Reconstruction
Perhaps as Bowlby (1961, 1998) suggested, both overt and hidden reactions to grief do occur in overlapping stages—sometimes as disbelief and numbness at the news of death and its denial; of disorganization of one’s own personality as the loss is accepted; and eventually, as reorganization of one’s own personality as it reestablishes connection with the deceased—in Jenn’s case, with Steven and the memory of him.
Through Jenn’s symbolic association between the reactions to the death of her son and then the experience of her own automobile crash, the intensity of the grief she felt and the precious value of her lost relationship became disclosed to her. As discussed earlier, although grief has been categorically described in stages or phases, behavioral responses of the survivor of loss are not so clearly defined or differentiated (Hagman, 2001). They are complex and often intertwined, more closely reflecting oscillation between loss- and restoration-oriented coping and life reconstruction (what Stroebe and Schut’s portray in their Dual Process Model, 1999). And certainly, it reflects what Neimeyer and Attig refer to as “re-learning one’s world.”
Backsliding is a normal experience. Just when the bereaved seem to be progressing well into the reorganization stage, a particular incident, day, or time of year that holds specific association with the deceased may plunge the survivor back—like Jenn sliding backward down the embankment. Typically these incidents occur with increasingly less frequency, and with less intensity. The most important thing to remember is that when these backslides do occur, this is not indicative of the individual’s failure to cope. Jenn, like other survivors of loss, should not be held to the pressure of “getting on with it” or “letting go.” These kinds of pressures cause an unhealthy suppression of grief. Falling back into depression is a normal occurrence and does not mean that Jenn or other survivors are “losing it” or that they should feel guilty about their feelings for not recovering quickly enough. The path through grief, or grief’s path through us, is complex, inherently active, and yet unpredictable (Attig, 2011). It is an individual process that is influenced by many factors—as the next chapter explores.