“Everyone seems to think I should be crying since my daughter Laura died. She had a heart attack working in her garden. But I never cried—not for Laura, or for my mom, or my dad when they died. The day after Laura’s funeral, I finished up her work in the garden. I still sometimes drive over and work there. Everyone said it isn’t important anymore. I think it is.” —Tom, 62 years old
The question that brought Tom into counseling was why he was not grieving. Yet, as Tom talked about the varied strategies he used after his daughter’s death—working in the garden, helping Laura’s husband raise their three children, sharing stories of their mom with her kids—it was clear that Tom, in fact, was grieving. And his ways of dealing with his daughter’s loss did seem to ameliorate his pain.
Tom’s question really focused on his definition of grief. He, like many, defined grief as an affective reaction to loss. In the absence of overt affect, Tom simply could not see that he was grieving in his own characteristic way. Tom’s limited definition of grief reflects a bias evident not only in the field, but in the counseling profession at large—a bias that places great value on affective expressiveness (Sue & Sue, 2008). Yet the literature on grief has always emphasized that grief reactions may be manifested in a wide range of strategies.
This chapter begins by exploring grief and grieving. It then further develops the thesis that there are a variety of ways in which people adapt to grief. Each of these strategies offers distinct strengths as well as limitations as individuals cope with loss.
Traditionally, loss and grief are associated with death. In fact, loss is a much broader concept. At its broadest, loss refers to being deprived of or ceasing to have something that one formerly possessed or to which one was attached.
There are different types of losses. In general, loss can be understood as either developmental or situational. Developmental losses are those incurred by most people and are related to maturation and continued development. These losses usually bring about gain as well as loss. For example, the original loss for every living human was birth. Each of us lost the perfect physical environment—our mother’s womb. In turn, we gain personhood. Another maturational loss involves the arrival of secondary sex characteristics. Lost is some of the innocence of childhood. What is gained is the ability (for most people) to conceive and have a child.
Other types of developmental losses include getting married (loss of independence, gain of intimacy), having a child (loss of freedom, gain of parenthood), and retirement (loss of some identity and perhaps income with a regaining of some freedom and independence). These losses are often anticipated with pleasure.
Situational losses are less often seen as beneficial and are usually anticipated (if at all) with anxiety. For example, physical loss refers to the loss of something tangible that is no longer present. Death involves a physical loss, as would a robbery or the destruction of an object. Relational loss refers to losing a relationship with someone to whom one has an attachment. Again, death causes the loss of a relationship, as does divorce, interpersonal breakups, or other losses such as the loss of a job or moving, where ties between individuals are consequently severed. Symbolic loss is intangible, involving the loss of a psychological or spiritual attachment such as the loss of one’s dreams, hopes, or faith. The death of someone can also create significant symbolic loss (see Rando, 1993).
Such distinctions also help in understanding the phenomenon of anticipatory grief (Rando, 1986; Corr & Corr, 2000) or, as Rando (2000) now prefers, anticipatory mourning. As Rando (2000) notes, anticipatory mourning refers to the mourning experienced by the patient, family, and others in a life-threatening illness, over all the losses— physical, relational, and symbolic—experienced throughout the course of illness.
This discussion is also a reminder of the importance of understanding secondary loss, or the losses that follow as a consequence of a primary loss. For example, the loss of a job may also entail a series of resultant losses—the loss of self-esteem, income, friends, or dreams. Similarly, the death of a person may engender a wide range of losses in its wake, such as the loss of other, dependent relationships (e.g., in-laws, friends), and losses of income, hopes, and even perhaps of faith. Rando (1993) notes the importance of such secondary losses, reminding counselors that each of these losses will need to be identified and mourned.
In addition, Rando (1993) states that loss is a constant throughout human life for every change involves at least an element of loss. For example, each transition through the life cycle, whether a pleasant milestone (e.g., a wedding, graduation), a loss of abilities (such as in the aging process), or relationship (including changes in relationships that occur in development, for example, the change in relationship that parents might experience as a child becomes an adolescent), brings with it the experience of losses. These losses will vary in intensity and scope as well as in the social support they engender. For example, one can expect severe reactions to the death of someone significant. However, although one may expect some reaction to another loss, perhaps not deemed significant, one expects that reaction to be brief and controlled. For example, it is normal to understand someone’s momentary upset when his or her favorite team loses, but we also assume that such a response will be limited in scope and intensity.
This raises a critical point: social support also varies for given losses. Whereas the loss of a family member such as a parent, child, or spouse is acknowledged by many to be significant, others may not perceive the loss of other persons such as friends or lover as a significant loss. Similarly, although most physical losses are acknowledged, relational or symbolic losses may have less recognition and support. In such cases, the loss and resultant grief may be disenfranchised. Disenfranchised grief refers to a situation where a loss is not openly acknowledged, socially sanctioned, or publicly shared (Doka, 1989a, 2002). In his work, Doka (1989, 2000) emphasized types of losses (e.g., divorce, prenatal deaths, pet loss, etc.), relationships (e.g., lovers, friends, ex-spouses, etc.), grievers (e.g., the very old, very young, persons with developmental disabilities, etc.), or circumstances of death (e.g., AIDS, suicide, etc.) that might disenfranchise grief. In summary, loss encompasses far more than death. It is interesting to remember that Freud (1917/1957), in his seminal essay “Mourning and Melancholia,” used as his illustrative example of loss a bride abandoned at the altar. Identifying loss and thereby grief solely with death-related loss then, can obscure the many losses we do experience and grieve. And it can limit the ability of grievers or counselors to draw insights from experiences of earlier adaptations to loss.
These earlier experiences can be powerful indicators of an individual’s pattern of grief. Ways of adapting to previous losses, such as a relational breakup, are evidence of an individual’s basic pattern.
From an early age, John, in a wide variety of losses, showed a more instrumental approach. As a teenager experiencing a romantic breakup, he reacted by intensifying his involvement in sports and other activities. This pattern persisted. When his mother died he found solace in planning the funeral and in thoughtfully clearing away her clothing and possessions. Even in his own premature death from cancer in his 30s, he rarely ventilated his inner feelings. Instead he concentrated on making arrangements for the care of his young son.
For that reason, case illustrations used are of individuals experiencing a range of losses. However, most of these illustrations are deathrelated losses. There are three reasons for this: First, it reflects the base of our experiences. Second, most death-related losses involve physical as well as relational and symbolic losses (secondary losses also tend to be most intense in a death-related loss). Finally, death is a universal experience, whereas other losses, such as divorce, are not.
Another term used to denote a state of loss is bereavement. As Rando (1993) states, bereavement shares a root with the word rob. Both refer to a state in which something has been violently taken away. Within the field of thanatology, bereavement tends to be used to refer to the basic fact or objective reality of loss, while grief refers to the person’s response and reactions to the loss (see Doka, 1989a). Remember, one can experience bereavement without an intense grief reaction. For example, a survivor may have little attachment or connection to the deceased, as in the following case.
Mark was a 15-year-old boy who had lived with his mother, Sue, and stepfather, Tom. Mark’s biological father had separated from his mother 2 weeks prior to his birth. For much of his life, and all that he could remember, he lived with his stepfather, with whom he enjoyed a close relationship. His biological father, Jack, played a very limited role in his life, intermittently sending cards and gifts and visiting on rare occasions. When Jack died after a sudden heart attack, Sue called her son in to tell him his father had died. Mark’s eyes welled with tears. “Tom’s dead?” he said. When his mother told him it was his “real” father, Mark was visually relieved. “Wow,” he stated, “for a minute, I thought you meant Tom.” His mother reported that he took little interest in details or in sending the flowers that bore his name. “It was much more important to me,” she said. But she continued to worry that “one day the loss would hit.” Almost 20 years later, she asked Mark as he openly wept at Tom’s funeral, if he thought much about his biological dad. He seemed surprised. “He never meant much to me.”
Not every such case might yield that reaction. In some cases, it is the very absence of the relationship, or the fact that any future relationship is precluded, that engenders grief. But this case does illustrate the conceptual distinction between grief and bereavement, and reinforces the fact that the meaning of loss both differs among people and is a central component in understanding the grief reaction.
Grief or grieving1 arises as a reaction to loss. Specifically, grief can be defined as the psychic energy that results from tension created by an individual’s strong desire to
For example, a person whose spouse dies wishes to hold onto that relationship, yet knows it is not possible and is unclear on what the future may be. It is that conflict between the world that was, what it cannot be, and how it may become that creates the tensions that engender grief. This grief energy is converted into the various domains of human experience, including the physical, affective, cognitive, and spiritual. These internal experiences are often expressed outwardly in varied grief-related behaviors.
Such a definition of grief, while building upon classical perspectives (Bowlby, 1980; Freud, 1917/1957), offers certain advantages. First, classic definitions focused on withdrawing the attachment from the deceased or lost object and reinvesting elsewhere. Current treatments of grief emphasize that many individuals maintain a connection with the lost object; however, the nature of this connection is now changed (e.g., Klass, Silverman, & Nickman, 1996; Worden, 2009). The clearest example may be found in divorce. Individuals will grieve a divorce, yet the divorce does not so much end a relationship as change it. Even in death, bereaved survivors may still find a sense of connection in such things as memories, legacies, and their spiritual beliefs.
Moreover, this definition of grief was the possibility of bridging some of the differences between psychological and sociological perspectives of grief. Psychological theories of grief (see Bowlby, 1980) have stressed that the biological/psychological roots of grief lie in attachment. In this regard, mourning and grief, it is noted, seem to be exhibited by primates and other social animals. For Bowlby, adaptation to loss is achieved by “extinction” of behaviors associated with attachment—the reinforcement that comes with physically attaching or reattaching to another. Death represents the ultimate form of extinction since whatever efforts are expended, there can be no physical reinforcement.
Sociological explanations tend to eschew language such as “drives” or “instincts,” while emphasizing the symbolic constructions or meanings that are disrupted by the loss (see Nadeau, 1998; Neimeyer, 1997a, 1997b). This definition acknowledges that there is a primal aspect to grief, but notes that the nature of that primal tension is very much affected by the meaning of the loss, the social expectations that frame appropriate manifestations of grief, and the support accorded to people experiencing loss.
Second, this definition of grief uses the term psychic energy to connote a dynamic force created by the emotional arousal and tension resulting from the loss. This energy needs to be expended; however, the manifestation of this energy varies in different individuals. And indeed, the theory and research on grief have stressed that grief can be exhibited physically, affectively, cognitively, and spiritually, as well as expressed in a wide range of behaviors (see Doka, 1989a, 1989b; Lindemann, 1944; Rando, 1984; Worden, 2009).
Third, such a definition of grief is congruent with current theories on cognitive appraisal, stress, emotion, and emotion regulation (these will be explored further in Chapter 5). In addition, emotion is a word with different meanings. On one hand, particularly in the field of thanatology, emotion generally has been identified with affect or feeling (Elias, 1991). However, that is a narrow definition. A wider use of the term emotion, evident in psychological literature, defines emotion as biologically based adaptive reactions that involve changes in physical, affective, cognitive, spiritual, and behavioral systems in response to perceived environmental events of significance to the individuals.
Grief, then, can be perceived in this broader sense as an emotion, an attempt to make internal and external adjustments to the undesired change in one’s world brought upon by the loss. Grief triggers changes in various adaptational systems—affective, physical, spiritual, and cognitive— that constitute the individual’s response tendency.
Response tendencies are predispositions that operate subconsciously, allowing quick and efficient reaction to environmental challenges, threats, and opportunities. These predispositions are shaped by powerful forces, namely, cultural influences and personality styles. Individual response tendencies veer toward either an affective or intuitive grief response or a cognitive, behavioral, or instrumental response. Whether one’s grief is intuitive or instrumental depends on whether the individual is more sensitive or tuned in to their thoughts (cognitions) or their feelings. As noted earlier, instrumental grief is largely a function of the individual’s emphasis on cognitions.
These response tendencies have been noted throughout the literature of grief that documents a wide range of physical, affective, cognitive, and spiritual reactions that manifest themselves in varied behaviors. This literature (see Lindemann, 1944; Rando, 1984; Raphael, 1983; Worden, 2009) has documented and described these reactions, and they are discussed in the following.
Physical Reactions
Physical reactions can include a wide range of somatic complaints and distress, including
Here the energy generated by the grief may be converted to physical symptomatology as in the following case.
Bob was overwhelmed when his wife died, leaving him to balance his job with the demands of raising four young children. While he claimed he responded to the loss reasonably well, he complained of incessant neck and back pain. His physician could not find any evidence of physical injury, but the doctor reminded Bob of the language he had been using in describing life after Jen’s death. “Everything now is on my back,” he often would state.
Many individuals will experience a host of grief reactions that will include physical ones, but some, like Bob, may experience grief primarily as a physical reaction.
Moreover, physical complaints may allow an individual to elicit care in ways that do not seem threatening to autonomy. Interventions that use physical behavior as a way to expend energy resulting from grief are also helpful (or commonly used) in assisting individuals to deal with other forms of stress. For example, exercise often is suggested to mediate stress levels. This can be seen in the following case.
Susan, a middle school counselor, was attempting to assist students after the death of a classmate, an adolescent girl with whom most of them had had an ambivalent relationship. She was seen as sexually and behaviorally precocious. In fact, she had died in a car crash with a college student who had been under the influence of alcohol. While many girls sought out Susan the day following the death, few boys did. Susan questioned a consultant who suggested that the boys have some extra gym time and play dodgeball. She later reported that it was an intensely competitive game with many references to the driver and the crash. At the end of the game, she noted, the boys seemed much less tense.
Affective Reactions
The energy of grief is commonly manifested in affect. Individuals can experience a wide range of affective responses, including (but not limited to) the following:
These emotional responses bear further comment, as bereaved individuals may be upset at the wide range of feelings they experience in response to a loss. In fact, virtually any feeling can manifest itself following a loss. And it is not unusual that bereaved persons experience a host of affective responses, even contradictory ones, simultaneously.
Some of these feelings may even be positive. For example, Elison and McGonigle (2003) affirm that feelings of relief are common responses to loss. Sometimes the relief is based on an altruistic idea that the deceased’s suffering is now over. Other times it may be more a relief to the bereaved that a difficult caregiving experience or a troubled relationship has now been terminated. Naturally, relief can include both senses of relief for the other and for the self—a dual focus.
Even beyond the ambivalent reaction of relief, other affective responses also may be positive. Margaret, for example, felt a deep sense of satisfaction that she had kept her promise to her husband, as he died of ALS (amyotrophic lateral sclerosis), that she would care for him at home. Others may experience a sense of appreciation or gratitude for the relationship, the presence of the other in their life.
In short, since grief is a reaction to a loss, a wide range of feelings may be evident. Although this wide range of affective responses may follow a loss, it is critical to reiterate a central point. Affective responses are but one way grief may be manifested.
Cognitive Reactions
Cognitive reactions can include
Given the effect of loss upon cognitive processes, it is not unusual that work at home, school, or in the office can be adversely affected. It is also critical to remember that cognitive responses are not necessarily attempts to deny or suppress affect. They are simply another way that grief is manifested.
Spiritual Reactions
Grief affects us spiritually as well. These reactions can include
Spirituality, broadly defined, is used here to connote the ways that people seek to understand the meaning and purpose of life. These transcendental systems of belief may center on religious tenets or other philosophical frameworks. Although some losses may fit easily into one’s underlying beliefs, other losses may proudly challenge those beliefs. Such was the following case:
When Rita’s mother died, she grieved the loss deeply. But her mother’s long and happy life, as well as peaceful death at 91 years of age, reaffirmed her beliefs about the way that life should be. She found great comfort in her religious beliefs and rituals. Yet, when her younger brother was brutally tortured and murdered, she had a faith crisis. She could not understand why God would take her brother so young, leaving a wife and children in dire straits. Nor could she find explanation in her faith for the terror and pain he must have experienced.
In such cases, the reconstruction of meaning in the face of loss may become one of the most critical aspects of the grieving experience (Doka & Morgan, 1993; Neimeyer, 1997a, 1997b). For here, grieving individuals must, in the face of loss, reconstruct such issues as their own identity and the identity of the deceased, as well as their assumptions about the world. Loss, then, can create an intense spiritual crisis that challenges all of an individual’s core beliefs, necessitating reevaluation, if not a reformation.
Behavioral Experiences
The different reactions that people experience in each of these four response tendencies (physical, affective, cognitive, and spiritual) may be outwardly expressed as behaviors. Among observable behaviors of grief are
Although behaviors are external expressions of internal reactions, care should be taken when inferring from the external to the internal. Behaviors such as crying or withdrawal could be outward expressions of a variety of internal states such as anger, sadness, or embarrassment. The connection between the external expression and internal reactions is a clinical question.
This also reinforces that many different behaviors, such as physical activities or activities that provide a connection to the deceased, may be manifestations of grief even if that connection does not seem obvious.
When her younger sister died, Maria, a high school student, continued to coach her sister’s soccer team. Her parents wondered how she could do that and were concerned that she was denying her grief. In fact, continuing to coach made her feel close to her sister and provided opportunities to reminisce with her sister’s teammates and their parents.
Over time, many of these behaviors may diminish among bereaved individuals. As with other responses, there can be negative and positive aspects of different behaviors. For example, withdrawal can both isolate one from sources of support or give people space to effectively grieve. Crying may elicit help and restore emotional homeostasis, perhaps even correcting stress-related chemical imbalances (Worden, 2009). But crying can also generate feelings of guilt and shame, and exacerbate withdrawal.
In summation, grief involves multifaceted responses to loss. The energy of grief, generated by the tension between wishes to retain the past and the reality of the present, is felt at many levels—physical, emotional, cognitive, and spiritual—and expressed in a wide range of observable behaviors. In many cases these responses will be varied or blended, even in individuals who tend to have different styles of grief. This is particularly true early in the loss when the amount of energy generated tends to be high. Thus, it is not that the instrumental griever has no affect or exhibits no affectively oriented behavior; rather, it is that his or her response tendencies likely emphasize cognition.
The Individual Experience of Grief
Not only does the way individuals express grief differ, the very experience of grief is different as well. Some individuals will show few intrusive manifestations of grief, quickly resuming their regular activities. Bonanno, Wortman, and Nesse (2004), for example, found that 45.9% of their sample of widows fit that pattern, a pattern they labeled resilient.
Many factors have been identified in the literature that frames these individual reactions. For example, Worden (2009), Rando (1984), and Sanders (1993) have noted such variables as
Recent research has been inconsistent in assessing the actual degree to which these factors do affect bereavement outcomes. Lund, Caserta, and Diamond (1993) found religion, gender, health status, and marital happiness relatively important predictors of adjustment in a sample of older widows and widowers. Social support was a moderate predictor. As Lund et al. note, social networks often have both positive and negative aspects (e.g., offering encouragement, placing unrealistic expectations, etc.). The most predictive factors were positive self-esteem and personal competencies in managing the tasks of daily living.
In a study of younger German widows and widowers, Stroebe and Stroebe (1993) indicated that in sudden loss, a sustained belief in one’s internal control seemed to buffer the stress of loss. They reasoned that people who experience an unexpected catastrophic loss need a strong belief that they can still retain control of their life to recover from depression. On the other hand, people with little belief in internal control may find that the loss reinforces a sense that they have little control over life, exacerbating feelings of depression and hopelessness. Other risk factors did not seem as important in Stroebe and Stroebe’s study, though it is critical to remember Sanders’s (1993) caution, in her review of research on factors affecting adjustment, that it is difficult to analyze the individual effects of interacting factors.
These factors emphasize that the “very meaning of loss” varies both in different circumstances and among individuals. All of these variables emphasize that a given loss means different things to different people. For example, the meaning of the loss of a child or a spouse will be very different depending on the role attributed to that person by the survivor. If one primarily lives life in the private sphere of home and family, the meaning or role of spouse or parent is likely to be more central than one who has significant roles in the public sphere of work and the larger community. This may be one reason why Schwab (1996) found that mothers and fathers not only varied in the intensity of grief but in their perception of the events. The critical point is that grief is a very individual experience. This will be further discussed in Chapter 5 in the exploration of the appraisal process.
Beyond the psychological and social variables, other factors too can frame the meaning of a loss. Certainly, for example, loss may be perceived differently in other cultures, historical periods, or social and economic circumstances. Take, for example, the interview of a 90-year-old woman a number of years ago. She had been born prior to the turn of the 20th century in Spain. Reflecting on the death of a 4-year-old son in a typhus epidemic, she remarked: “I was very lucky. I had six children, five survived to be adults.” Few modern Western parents would have such an interpretation of a similar death. Yet her meaning reflects a time when there was an expectation that not all of one’s children would survive to adulthood. Kastenbaum (1971) suggests that in cultures with high childhood and infant mortality, social norms and structures actually serve to limit such attachments.
Thus, to summarize, one both experiences and expresses grief differently. It is that simple statement that underlies much of this book.
While grief is defined as the psychic energy generated by the loss, grief work may be defined as a process, both short and long term, of adapting to the loss.2 It includes the shorter term process of acute grief where the griever deals with the immediate aftermath of the loss. Building on Rando (1993), immediate reactions in this period may include such things as
All of these grieving reactions represent initial, albeit fragmentary, attempts to adapt to the immediate aftermath of loss.
In short, this acute period is characterized by both shock and numbing, and after they recede, by a series of intense reactions and adaptations to the newly experienced loss. Because of the intensity of this period, it should be noted that reactions and adaptations observed may not be typical of those observed later. For here, in this early period, the energy released may overwhelm the person’s typical adaptive strategies leading to uncharacteristic responses. The following case illustrates this:
When Dan’s dog, a companion for a decade, had to be euthanized, Dan held him and stroked him as he died. When he went to his car, he uncharacteristically cried for about 10 minutes. After that, his reactions took on more typical forms. He buried the dog, etched a memorial, stored or disposed of the dog’s artifacts, and went through a variety of photographs of the animal. After that, he often thought of the dog, but he never again cried.
The role of initial responses and its relationship to patterns of grief is explored further in ensuing chapters.
But beyond this period of adaptation to acute grief, which itself can last for many months or longer, there is a longer term process that involves living the rest of one’s life in light of that loss. This process is often referred to as mourning. The term mourning has had mixed usage within thanatology. It has been used to refer to the social customs and outward behaviors that manifest grief. Doka (1989b), for example, in the Encyclopedia of Death defined mourning as “the culturally patterned expressions or rituals that accompany loss and allow others to recognize that one has become bereaved” (See page). For example, attending funerals or wearing black clothes or armbands may be seen as mourning behaviors. In some ways, that is a useful distinction since it reminds us that one may grieve and not mourn, or mourn without grief. Illustrations of the former include many cases of disenfranchised grief (e.g., divorce) that are devoid of rituals or other outward manifestations of loss. On the other side, many attend funerals in support of others but experience little direct grief over that particular loss. Nonetheless, by attending they are mourning.
However useful that definition of mourning has been, Rando’s (1993) work on mourning has been increasingly accepted within the field. Rando has built upon Freud’s (1917/1957) definition of mourning as a psychological process that occurs as individuals experiencing loss reorient their relationship to the deceased, their own sense of self, and their external world. As Rando’s work describes it, this involves three distinct operations. The first involves reorienting one’s relationship to the deceased and stimulates the period of acute grief as one acknowledges that current ties can no longer be maintained. A second operation involves redefining oneself and one’s own identity after the loss. A third operation involves any modifications that occur as survivors seek to redefine their world and adjust to the many changes necessitated by the loss. In this definition, mourning is a long-term process that involves living the rest of one’s life in the face of the loss. Persons who are unable to effectively mourn their loss may experience deterioration in physical or mental well-being or even death (Rando, 1993; Sanders, 1989).
Building on this work, Rando (1993) then offers a model of mourning that identifies three phases of grieving with six “R” mourning processes:
Avoidance Phase
1. Recognizing the loss (e.g., acknowledging and understanding the death)
Confrontation Phase
2. Reacting to the separation (which includes experiencing the pain, expressing the psychological reactions to the loss, and identifying and mourning secondary losses)
3. Recollecting and reexperiencing the deceased and the relationship (which includes cognitive and affective dimensions)
4. Relinquishing the old attachments to the deceased and the old assumptive world
Accommodation Phase
5. Readjusting to move adaptively into the new world without forgetting the old
6. Reinvesting in new relationships
Another model is the dual–process model offered by Stroebe and Schut (1995), who posit two sets of interrelated and dynamic processes that individuals utilize in adapting to loss. One set of processes is lossoriented, where individuals cope with things as the new reality of loss or separation. Restoration-oriented processes refer to the processes that individuals employ as they readjust to the new demands of life now in the face of this loss. This is a critical point. “Restoration” does not mean a return to the old reality, for that no longer exists. Rather it emphasizes that individuals are challenged to develop new patterns of behavior and assumptions as they respond to loss. To Stroebe and Schut, individuals vacillate between these two complementary demands of grieving, “oscillating” as they cope with each in turn.
Worden (2009) offers another popular model of the grief work process. Instead of processes, Worden refers to four tasks that one has to accomplish as one does grief work. These tasks are
Since these tasks represent cognitive, affective, and behavioral adjustments to the loss, Doka (1993) has suggested the addition of a spiritual task:
While acknowledging the different definitions of mourning, grief work, and even grieving that exist within the field, the preferred term in this text is grief or grieving.
In summary, the process of grieving can be compared to a roller coaster, where bereaved individuals find themselves on an up-and-down cycle, sometimes overwhelmed by the stress of the loss. The energy generated by that tension might wax and wane as people continue to redefine life in the presence of the loss. The low points are often punctuated by varied crises that accentuate the loss. In cases of death, these can include such events as anniversaries, birthdays, holidays, or varied “settlement reactions,” such as when the insurance check is received. This cycle tends to be more intense in the first 2 years; after that, generally the low points become less intense, are experienced less often, and do not last as long. Over time, most bereaved persons experience an amelioration of their grief. This means
The end result of the process does not involve a relinquishing of all ties with the loss. Instead, people continue to retain bonds with the lost person, albeit in a different way (see, for example, Klass et al., 1996). The following case illustrates this.
Rose and Joe were an older Italian American couple living in New York City. Rose’s great joy was her tomato garden grown with much effort in a small backyard plot. Joe would affectionately complain about the trouble and cost of the tomatoes. Rose would joke that if she died first, he could turn it into a carport. He would rejoin that the cement trucks would soon follow the hearse. Rose did die first and Joe lovingly tends “Rose’s Garden.”
Grief work is then a process of adaptation. Adaptation can be defined as how individuals adjust internally and externally to their loss. It involves the short-term process of adapting to the demands of grief as it is experienced and processed. However, it also includes the long-term process or ongoing work of redistributing the energy created by the loss. It requires people to reformulate their definitions of who they are and what they lost, and redefine and reformulate their assumptive world.
Throughout this grieving process, individuals may use a variety of adaptive strategies as they attempt to deal with the loss. These adaptive strategies may vary and can include
The term adaptive strategies comes from the work of Silverman (1986). Adaptive strategies are the learned responses people utilize to manage disequilibriating events. There are two significant aspects of this definition. The first is the affirmation that these strategies are “learned.” Throughout a crisis, individuals can learn and employ new strategies. In fact, to Silverman (1986), one of the most valued aspects of widow-to-widow programs or other similar support groups is that they provide opportunities for new learning. This also reinforces the fact that adaptive strategies are dynamic. Individuals may attempt a variety of adaptive strategies, including those both in their repertoire as well as those newly learned or applied. Individuals who have both a larger repertoire of strategies to draw upon, and a capacity and willingness to learn and employ new strategies are likely to be more successful in managing the crisis.
The second valued aspect of this definition is the understanding that these strategies are employed in “disequilibriating” or transitional events that challenge an individual’s ability to manage. These strategies then enable the person to manage a transition and adapt to a new reality created by the loss.
Silverman’s definition of adaptive strategies is similar to much of the present language that is used to describe coping (see Lazarus & Folkman, 1984; Moos & Schaefer, 1986). But it avoids some of the problems associated with the use of that term. First, for example, the term coping has been criticized for failing to make clear distinctions between reactions (such as anger or physical pain) and adaptive strategies utilized to manage that reaction (e.g., ventilating, anger, acting out, seeking information, etc.; see Ellis, 1997). As Weisman (1979), who does use the term coping, notes, a clear distinction has to be made between a show of distress and behavior that copes with distress. Guilt, for example, is a form of distress. But writing a letter to the deceased or punishing oneself to expunge guilt are reactions to that distress. This critical distinction is often lost in discussion as coping. Second, coping has been used to describe responses to both extraordinary and everyday problems (e.g., Lazarus & Folkman, 1984; Weisman, 1979, 1984). For example, although most who use the term (see Corr & Doka, 2001) refer to extraordinary events such as dying or experiencing a significant loss, everyday usage can be clouded; people can be said to cope with crises like death or annoyances like taxes. Furthermore, the term coping has other difficulties. It has a negative connotation often perceived as merely managing, while adaptation or adaptive strategies carries no such onus. Adaptation or adaptive strategies carries a different connotation. Adaptation is a process common to humans and, for that matter, other animals, as they continually have to adjust to changes within their environment. Finally, coping suggests a time-bound process, whereas adapting seems more ongoing. Coping has been used in confusing ways. It has been defined as strictly behavioral responses or as a range of varied responses. For those reasons, we prefer Silverman’s adaptive strategies. Clinicians, however, are wise to recognize that for each individual, words have different meanings and adaptations can suggest conforming or acceptance. Clinicians, then, should always listen and reflect the words their clients use whether grieving, mourning, coping, dealing, struggling, or whatever terms describe their experiences.
A further point should be made about varied adaptive strategies. Although these strategies represent attempts to manage the crisis, they may be more or less effective in any given situation. Any strategy may, in and of itself, complicate or facilitate one’s response to the crisis. For example, venting one’s feelings can both allow a release of tension and can simultaneously, depending on the situation or the perception of others, drive away or generate support. Some strategies of avoidance may allow one to function at work, but abusing alcohol to avoid grief can create other difficulties such as health or relational problems, thereby complicating grieving. Individuals who can utilize multiple adaptive strategies and skills may have distinct advantages both in responding to and surmounting crises. Often, exploring an individual’s adaptive strategies allows people to assess the strengths and limits of their styles as well as to learn and practice alternate adaptive strategies. Chapter 4 will revisit this issue as it deals with dissonant grieving.
One approach to understanding the grieving process has been framed by an often-implicit grief work hypothesis. This hypothesis emphasizes that only by experiencing strong affect such as distress or depression and “working through” such feelings can a bereaved person ever expect to reach a sense of resolution about the loss.
As stated in Chapter 1, the hypothesis has been challenged (see Bonanno, 1997; Wortman & Silver, 1989). In fact, there is little research to support such a hypothesis (Wortman & Silver, 1989), and there is evidence that disassociation from negative emotion and use of alternate approaches such as positive reframing can facilitate grief adjustment (Bonanno, 1997, 2004; Nolan-Hoeksema, 2001; Pennebaker, Zech, & Rimé, 2001).
Ultimately, the problem with the grief work hypothesis is that it identifies grief solely as an affective response to loss and posits one adaptive strategy as the only effective response. Such an approach ignores both the multifaceted manifestations of grief and the multiplicity of adaptive strategies bereaved individuals use as they grieve. It denies that individuals experience, express, and adapt to loss in highly individual ways.
The danger of such an approach is that in the final analysis, it disenfranchises grievers who use such cognitive and behavioral strategies. But as Corr (1998) points out, disenfranchised grief is a far more inclusive concept. Much can be disenfranchised in grief. Corr notes that when grief is identified purely as affect and one insists on a single set of responses as appropriate reaction, considerable risk is incurred:
What is central is the recognition that human beings may and indeed are likely to respond to important losses in their lives with their whole selves, not just with some narrowly defined aspect of their humanity. Failure to describe grief in a holistic way dismisses and devalues its richness and breadth. (see page)
The challenge to the grief work hypothesis is part of a larger rethinking of the paradigms of grief. This has included such tenets as a move away from stages (Corr, 1992), an extension of the concept of grief in nondeath circumstances (Doka, 1989a), a recognition of the role of continuing connections with the deceased (Klass et al., 1996), a greater appreciation of the elements of grieving beyond the affective (Attig, 1996; Doka & Martin, 1998; Neimeyer, 1997a, 1997b), the application of new models (Rando, 1993), and the recognition of growth even in the midst of loss (Prend, 1997). This work draws from and hopefully adds to that paradigmatic revision by positing two patterns or adaptive strategies by which individuals respond to loss—instrumental and intuitive.
1. Whereas the term grieving has had wide, varied, and inconsistent usage in the literature (see, for example, Corr, Nabe, & Corr, 2009, or Rando, 1993, for discussion), grieving, in particular, has been defined, at times, as the process of adapting to loss. In this book, grief and grieving are used synonymously, referring to internal experiences and external behavior that results as a response to loss. Thus, to say an individual experienced grief, was grieving, or grieved all express the similar idea that in some way that individual was reacting to or presumed to be reacting to the loss. Grief work is used to refer to the process of adapting to loss.
2. In short, adaptation involves the process of continually adjusting to circumstances that have changed or are changing. Adaptation is an ongoing process. People have to adapt daily to minor, sometimes major environmental challenges. Significant loss creates major changes (both long term and short term) to the environment, challenging one to employ all resources (both internal and external) as one tries to adapt to those changes in the world. Grief work is simply a specific instance of an ongoing and multifaceted process. What is, perhaps, most surprising is that individuals continue to form close bonds with others, thus risking future loss and efforts to adapt. In his chapter on grief, Richard Kalish (1985) writes, “Anything that you have you can lose; anything you are attached to, you can be separated from; anything you love can be taken away from you. Yet, if you really have nothing to lose, you have nothing” (See page).