What happens when grievers consistently choose adaptive strategies that do not fit or complement their style of grief? Is this tantamount to complicated mourning? In this chapter maladaptive responses to loss are identified as dissonant. In some cases, these reactions may become semipermanent ways of responding to loss and may sometimes serve as cornerstones for complicated mourning. This chapter begins by looking at the initial responses that may cloud the distinction between intuitive and instrumental grievers. Again, remember that patterns exist on a continuum, and those nearer the center are a blending of both styles.
It is important to remember that, with a few rare exceptions, the redirection of psychic energy from the griever’s initial pattern of behavior to his or her enduring pattern of adaptation to loss occurs gradually and over time. The speed with which energy is channeled into the pattern that is customary may vary as an individual develops and matures. It may also vary from situation to situation. Thus, it may be difficult to categorize an individual griever’s global response immediately after a loss as either intuitive or instrumental.
While models may vary somewhat, most of the literature identifying reactions to death-related loss presupposes an initial period of disorganization (see, for instance, Bowlby, 1980; Rando, 1993; Worden, 2009), where responses may include shock, numbness, hysteria, and confusion. These initial features are especially evident following sudden and traumatic losses. Taken together, these responses may represent an atypical expression of grief for a particular griever. In other words, initial responses may not be indicative of the individual’s customary pattern of grieving. During this period, it may be virtually impossible to distinguish instrumental grievers from intuitive grievers or blended grievers.
Intuitive grievers may initially focus on suppressing intense, painful feelings and controlling their grief-related behavior. The following case illustrates how an individual’s initial responses may reflect adaptive strategies typical of the other pattern of grieving, yet differ from his or her enduring pattern of intuitive grieving.
When Glen’s 24-year-old daughter was killed in a boating accident he was overwhelmed by pain. His previous experience with bereavement included the losses of both of his parents, a younger brother, and a stillborn infant son. Through these encounters, Glen had learned that for him, grief was a profoundly painful, overwhelming feeling experience. Glen’s eventual adjustment to his losses required that he focus and refocus on his feelings and that he share these feelings with others. Glen described himself as highly emotional and very sensitive.
Despite experiencing crushing agony, Glen took charge, as events unfolded over the next several days. He made the initial identification of his daughter’s body, arranged her funeral, and provided transportation for the scores of relatives and friends who traveled from a distance. He comforted his wife and two children and cooperated with the police investigation into his daughter’s accidental death. He later identified his strategy for coping with his daughter’s death as “absolutely shutting down my feelings.”
It was not until the funeral was over and the relatives and friends were ferried back to local airports that Glen, as he described it, “imploded.” He became dejected and cried incessantly. He withdrew from others and contemplated suicide. Finally, he joined the local chapter of The Compassionate Friends, a support group for bereaved parents, and began his long, torturous journey to recovery. Today, he is a local chapter president of The Compassionate Friends.
It may take hours or even days for the person’s true pattern of grieving to dominate his or her behaviors. In Glen’s case, he might easily have been identified as an instrumental griever when, in fact, he had always followed the intuitive pattern for grieving.
Glen illustrates how intuitive grievers may initially choose adaptive strategies that typify an instrumental response to allow them to manage both their experiences and expressions of grief. These grievers may choose to manage their feelings by avoiding certain thoughts. Many grievers choosing this form of adapting manage by effectively dosing feelings by managing pain-eliciting thoughts (Shuchter & Zisook, 1993). They accomplish this by selectively displacing some conscious thoughts into their subconscious. This pain inventory remains in subconscious storage until they choose to reintroduce some or all of its contents into consciousness, reexperiencing the affective component of their grief. This usually occurs at times and places that do not interfere with the griever’s self-defined goals and tasks.
Other ways that grievers may attempt to distract themselves include forcing painful thoughts from consciousness and substituting pleasant memories. In fact, it is the effective management of memories and thoughts that enables most grievers, regardless of their pattern, to eventually adapt to their altered worlds.
Generally, intuitive grievers revert to their customary pattern of grieving and choice of primary adaptive strategies—in this case, going with their intense feelings and openly expressing those feelings.
Instrumental grievers use these same strategies (dosing, distraction), but are generally less conscious of choosing them and invest less energy in maintaining them. Instrumental grievers naturally perceive and interact with the world through their cognitive systems. Readers should recall that however similar their behaviors are, intuitive grievers differ from their instrumental counterparts in the relative intensity of their feelings and in their motivation for dealing with their feelings.
Whereas intuitive grievers may express stoicism in the face of loss, instrumental grievers may show evidence of feelings such as crying. They may also show signs of cognitive impairment, becoming confused, disoriented, and disorganized. Eventually, instrumental grievers’ cognitive control, their desire for mastery, and the muted intensity of their feelings lead to their adapting strategies usually identified with the instrumental style. Such was the case of Jim in the following illustration.
Jim was holding Alice’s hand when she died after a long fight with lymphoma. He was surprised at his intense feelings of grief since he had been anticipating this moment for months. When the hospice nurse arrived just a few minutes later, she found Jim sobbing. He looked up at her and said, “I don’t know what I should do.” She replied that she would take care of everything and then began making the necessary calls. Fifteen minutes later, she was surprised when Jim walked into the kitchen and said, “Can I fix you a cup of coffee?” He made the coffee and then sat down and asked the nurse whom she had called and what arrangements had been made. As she described it later at the hospice interdisciplinary team meeting, “It was like he threw a switch that said ‘Okay, I’m over that and back to my old self.’”
By the time the funeral staff arrived to remove Alice’s body, Jim was fully back in charge. He insisted on carrying Alice down the three flights of stairs to the waiting vehicle. He then threw himself into whatever needed to be done. He contacted relatives, cleaned the house, and ordered food for the anticipated onslaught of relatives and friends. He arranged for the medical supplies company to pick up Alice’s hospital bed. He did not cry again. He returned to work the day after the funeral. He politely refused offers of help from the hospice bereavement coordinator, although he did have lunch with the nurse, where they laughed and shared funny stories about Alice.
One year later, Jim became a hospice volunteer and arranged several fundraising events. He chose, however, not to be involved in direct patient care.
In this case, if the hospice nurse had left before witnessing Jim’s transformation, she would have assumed that Jim would be having a very rough time of it and, even if he refused it, would probably need whatever help could be given to him. Jim’s initial choice of discharging his feelings as an adaptive strategy would have identified him as an intuitive griever, when in fact, he was most comfortable with resolving losses by mastering his feelings and remaining active.
Some grievers may be unable to alter their initial strategies; it may be maladaptive for these grievers to persist in managing or giving into their feelings and behaviors beyond the initial period of loss. These grievers are not only expressing grief differently than it is experienced, they are truly at war with themselves.
For example, male intuitive grievers are often at odds with societal norms for gender-stereotyped behaviors. For the male intuitive griever whose identity is determined solely by societal stereotypes, intense feelings of grief are more than a mere inconvenience; they represent a threat to the self. For these grievers, their need to express their feelings and share them with others is overshadowed by a rigid definition of manliness. In disenfranchising their own grief, these unfortunates may contribute to the stereotype of the poker-faced male griever. Being at odds with one’s feelings has its consequences, and those who choose this method of coping might best heed the warning implicit in an ancient Chinese proverb: Expression of feelings leads to momentary pain and long-term relief; suppression leads to momentary relief and long-term pain.
The term dissonant is used to describe a persistent way of expressing grief that is at odds with the griever’s primary internal experience. The choice of this term is consistent with the theorizing of Festinger (1957), who defined one’s awareness of a contradiction among two or more elements of the mind and the resulting discomfort as cognitive dissonance. In most cases, individuals are motivated to behave and think in ways that reduce dissonance. This is why most grievers experience disharmony at one time or another in their grieving, yet eventually achieve resolution through expressing their experiences of grief. Unfortunately, for some, this lack of harmony between an inner state and an outer expression persists, resulting in dissonance.
Earlier it was discussed how grievers manage their expressions of grief through the dosing feelings. This usually involves manipulation of thoughts and memories, that is, cognitive management. For instrumental grievers, the management of their thoughts and memories becomes a cornerstone of their adaptive strategy. Since most of the psychic energy is channeled into the cognitive rather than the affective realm, instrumental grievers do not need to rechannel as much energy from other realms of inner experience to manage their cognitions as do intuitive grievers. This allows instrumental grievers to harness more energy for activities— both planned and unplanned. Instrumental grievers commonly employ dosing and other cognitive strategies, such as repression, as they adapt to their losses.
On the other hand, intuitive grievers are usually not as adept at managing their cognitions; thus, they expend more energy reining in their feelings. As seen previously by Glen’s experience after his daughter’s death, this can be an effective strategy if employed temporarily. Unfortunately, some grievers confuse dosing with suppression and attempt to permanently contain their strong feelings. (Here the distinction between suppression and repression is made. Repression is seen as an autonomous way of adapting to loss; suppression is seen as the ongoing conscious and deliberate act of avoiding painful feelings by pushing painful thoughts aside.)
This is risky business, particularly if the grief is intuitive—that is, of primarily a feeling nature. The more intuitive the griever, the greater is the danger. Thus, perpetual suppression of feelings, where the griever’s expression of grief is incongruent with his or her inner experiences, becomes a way to avoid the reality of the loss as well as a way to avoid feelings. As the following case illustrates, self-deception extracts a price from the griever’s mental and emotional health.
After 12 years of loving companionship, Tim decided it was time to say goodbye to his canine best friend, Zeus. Over time, Zeus had grown increasingly feeble. For the previous several months, Tim had been forced to lift the dog’s hindquarters off the ground so that Zeus could stagger into the yard to relieve himself. Zeus became disinterested in food. Then the dreaded day arrived, when Zeus had his first accident in the house. After three consecutive days of cleaning up messes and carefully bathing Zeus, Tim and his wife reluctantly decided that the dog’s quality of life did not warrant the additional time with Zeus that Tim and his wife desired.
Tim carefully and deliberately arranged to take Zeus to his veterinarian the following morning. Both Tim and his wife remained at Zeus’s side, stroking him, and talking to him as the vet administered the drug. As Zeus drew his last breath, Tim began sobbing. He cried uncontrollably, unwilling to leave his companion behind. It was not until he was seated behind the steering wheel that he forcibly regained his composure. The rest of that day and into the evening, Tim distracted himself from thinking about Zeus. He removed the food and water bowls and stored the collars and leads.
During the next several weeks, Tim ejected memories of the events at the vet’s office, replacing those images with images of Zeus as a young dog, frolicking on the beach. He also increased his daily consumption of alcohol from his customary two beers to a six-pack and began avoiding his friends. Unfortunately, Tim never allowed himself to review Zeus’s last months and moments. He denied himself the opportunity of realizing that he had given his old friend the greatest gift he could—release from his suffering.
Two months later at his insistence, Tim and his wife began visiting kennels, and after several months of careful researching, searching, and planning, they introduced a new puppy into their home. However, Tim could not bring himself to accept the new puppy. He would not help choose a name, avoided spending time alone with the dog, and declined to participate in any of the normal grooming and care activities that had cemented his bond to Zeus.
Eventually, Tim’s wife confronted him with his lack of interest in the puppy, and the resulting conflict stressed the marriage. When the puppy died from an accidental poisoning, Tim was initially relieved, but then experienced intense feelings of guilt and began withdrawing from others. He drank himself to sleep every night. At his wife’s prodding, Tim sought counseling for his depression. In reviewing his previous losses (father, high school best friend), Tim recognized that he had always allowed himself the luxury of his feelings and had sought the support of friends and family during times of emotional crisis. Eventually, Tim began to understand how concerned he was that his friends and coworkers would find his intense grief over a dog “silly.” He also gained insight into his habitual ways of maintaining the approval of others at the expense of his own feelings. Confronting his unresolved grief over Zeus and expressing his deep feelings over the loss finally bore fruit and led to Tim’s consequent recovery.
In Tim’s case, one can trace the redirection of his affective energy to a cognitive strategy (avoiding all reminders of the loss, suppressing feelings) as he began removing all of Zeus’s possessions. Although choosing suppression as an adaptive strategy may have been wise initially (enabling Tim to drive home), it soon disenfranchised him from his true experience of grief, which remained primarily affective. As Tim suppressed more and more affective energy, he estranged himself from his grief and established the enduring pattern of avoidance and suppression for adapting to his loss—in this case, Tim’s grief became dissonant.
Intuitive grievers adapt to their losses by actively experiencing and expressing their feelings. Complicated grief responses may result if the intuitive griever’s initial adaptive strategies, which temporarily enabled them to control their feelings and behaviors, persist.
Instrumental grievers, too, must find ways to express the grief energy experienced as feelings. They are often at a disadvantage since their strengths usually do not include being comfortable with an uninhibited expression of feelings. Whatever the limits of an individual’s capacity to experience vivid feelings, that person will become increasingly uncomfortable as the ceiling of that boundary is approached. This fact reinforces the notion that the experiences and expressions of grief exist on a continuum.
This may severely limit the choices of secondary adaptive strategies. For instance, if the only way an instrumental griever has learned to express feelings is through anger, he or she will most likely find himself or herself in difficulty with his or her environment. Stated differently, what is initially a time-limited pattern of grieving may become an ongoing dissonant response to a specific loss.
What could motivate a griever to ignore his or her disharmonious behavior? Are certain people predisposed to use suppression as a response to bereavement? The answer may lie in exploring the concept of impression management (Goffman, 1959).
Comparing Tim’s responses to Glen’s reveals that the key difference between the brief and benign nature of Glen’s efforts to suppress his feelings and Tim’s ongoing, deleterious attempts to accomplish the same is that of motive. Whereas Glen temporarily suspended his feelings to handle the immediate aftermath of his wife’s death, Tim was concerned with how others would view his grief over a dog. Tim was responding in his habitual way of needing to control the impression that he presented to the world. Thus, rather than temporarily suspend their customary pattern of grieving to accomplish necessary tasks, some grievers may be motivated by a desire to preserve their self-image, especially the image they display to the public. These image managers carefully screen their behavior for content that corresponds with the image the person believes is needed at the time. Despite primarily experiencing grief as painful feelings, these grievers cope by suppressing and disguising their feelings.
The concept of image management is consonant with the research on impression management, which is defined as “attempts to control images that are projected in real or imagined social situations” (Schlenker, 1980, p. 6). Whereas most people are motivated by the twin needs of getting along with others and thinking well of themselves, some people carry this to extremes. Individuals who consistently try to control others’ reactions to them are identified as high self-monitors (Snyder, 1974). Whereas low self-monitors maintain consistency in their behavior from one audience to another, high self-monitors modify their behavior to please their current audience. As one might expect, high self-monitors care more about social norms and conformity. Thus, image managers are grievers who are high self-monitors and whose outward reactions to their losses are motivated by their desire to control how others think of and respond to them.
This may be particularly true of the male intuitive griever, who may tailor his behaviors to match gender role stereotypes that he believes will match the expectations of his immediate audience. For example, the male image manager might hide his sorrow and grief from those he believes would judge the open expression of these feelings as weak or effeminate. He might also suppress his feelings in order to maintain his own selfdefined image to himself. This is an example of extreme self-deception.
Women, too, can be image managers. In fact, if the motive is to portray oneself in control of a situation, gender matters less than the need to be seen a certain way. Recall that image managers carefully screen and guard against any behaviors that they believe may give another a “bad” impression of them. Bereavement presents a formidable challenge to high self-monitors.
Suppressing powerful feelings requires constant vigilance and conscious control of all publicly observed actions—a taxing task at best. Some grievers expend huge amounts of energy in an effort to preserve their highly prized public image. Public expressions of grief are carefully tailored to the situation and are often counter to how the griever actually feels. If stoicism and self-control are deemed appropriate at the time, the griever becomes a true member of the “stiff upper lip” crowd.
This is not to suggest that image managers are the only grievers influenced by their immediate environment. Even the most extreme intuitive or instrumental grievers sometimes base their actions on the people around them at the time. The difference is in whether one is primarily motivated by a consistent desire for approval from others or driven by a need to respond effectively to specific environmental responsibilities. Although some grievers may initially respond in ways not consistent with their patterns, most eventually reestablish harmony between their behaviors and their internal representations of themselves. Image managers are social chameleons; their public personas are transitory and their grief behaviors are responsive to whatever role they are playing for others.
Although image managers may use some of the same strategies for managing affective expression (dosing, distraction) as other grievers, they differ in two ways. First, image managers are motivated to protect their self-images, while the others manage feelings in order to accomplish specific tasks (childcare, work environment). Second, image managers tend to continue to suppress their feelings even when others are not present, attempting to stem the tide of affective energy that needs expression. In other words, the image manager eventually seeks to hide his or her true feelings from his or her potentially most dangerous critic—himself or herself.
Since image managers depend on others to define appropriate behaviors for them, they are not grounded by a secure sense of identity. Consequently, they often experience anxiety that they carefully hide from others. When death takes a loved one, it often robs them of a primary source of self-definition. This often exacerbates their anxiety and generates intense feelings of pain and loneliness.
Unfortunately, image managers have learned only to channel energy into maintaining their public persona. With most of their efforts focused on their projected selves, they are often ineffective problem solvers. They have little reserve energy with which to assimilate and adapt to their changed worlds.
When an image manager finds that specific situations, people, and places threaten his or her control over feelings, he or she will avoid them. This is not the same as temporarily shielding oneself from painful feelings. Many grievers—both intuitive and instrumental—employ avoidance as a temporary solution and are usually motivated by a need to accomplish a specific task. However, the image manager evades certain things to avoid damaging the image he or she is trying to project to others. In some cases, these may be people who previously played a central role in the griever’s life. Unfortunately, some image managers not only lose the support and comfort that others may provide, but also terminate lifelong and important relationships.
Similarly, some image managers avoid feeling-eliciting situations by remaining alone. They do not choose solitude as a way of harnessing energy to problem solve or engage in mourning-related activities; rather, they shun situations that threaten their control over their feelings of anxiety, anguish, and anger. Again, they are not consciously choosing to redirect their feelings into adjusting to their changed circumstances; they are hiding those impulses, which might overwhelm them and tarnish the image they want to project.
One strategy image managers select to control their public expression of grief is to outwardly deny the importance of the loss. Unfortunately, this public denial may extend to a private denial of the significance of the loss—a true act of self-deception. Although using self-deception occasionally may have a role in maintaining one’s self-image, it is a risky mechanism to employ, especially for the individual motivated by a desire for social approval. For example, pretending that the death of one’s parent is not significant because “they were old and sick” can result in a denigration of the relationship one had with the parent. Because the image manager already has a weakened sense of self, redefining a relationship to enable him or her to control public expressions of grief may deepen the estrangement from his or her true feelings about the deceased.
Another way of suppressing feelings is to anesthetize them. For most people this means using mood-altering substances. Again, there is a difference between image management and the initial numbness that is characteristic of an uncomplicated grief response. Although there are a variety of both prescription and nonprescription drugs that can generate the quiescence associated with a more desirable feeling state, the most popular choice—alcohol—is also the easiest to obtain (see Sidebar 5.1).
Gender role conflict (GRC) or strain (O’Neil, 1990) is believed to result from gender role socialization and creates distress and conflict, resulting in a wide range of negative consequences for men as well as those who populate their environment. There is a body of literature suggesting that the negative effects of GRC result from the conflict men experience when they attempt to live up to masculine expectations. These negative consequences include
There is some criticism of GRC that suggests psychological distress among men is not related to gender role strain but to a man’s ability to solve problems (Good, Heppner, DeBord, & Fischer, 2004). Thus instrumental grievers’ innate ability to solve problems presented by their loss might provide immunity to the distress associated with GRC. Also, since most studies of the consistency between real and ideal GRC use college-age men, rigid conformation to gender role ideals may reflect the importance of solidifying one’s identity during this period of life rather than exploring different ways of being a man. This concurs with both Jung’s (1964) concept of anima and animus as well as Gutmann’s (1987) research on cross-cultural similarities and gender role development. Both Jung and Gutmann point to the fact that men and women are most different in late adolescence and early adulthood and become increasingly similar in middle age and late life.
Perhaps the concept most important to a discussion of dissonant grief responses is restrictive emotionality. Restrictive emotionality has been defined as “having difficulty and fears about expressing one’s feelings and difficulty finding words to express basic emotions” (O’Neil, Good, & Holmes, 1995, p. 176). The Gender Role Conflict Scale included a 10-item subscale, the Restrictive Emotionality scale, in an attempt to demonstrate the consequences of restrictive emotionality. Restrictive emotionality competes with several other constructs of emotional inexpressiveness including suppression (Gross & Levenson, 1993), repression (Weinberger, Schwartz, & Davidson, 1979), inhibition (Pennebaker, 1997), and alexithymia (Krystal, 1982). One way to clarify the differences between these various concepts, as well as which might differentiate the behavior of an instrumental and a dissonant griever, is applying the cognitive-evaluative model of emotional expression and nonexpression (Kennedy-Moore & Watson, 1999). This model describes the steps leading to overt emotional expression from covert emotional experience.
In Step 1, there is preconscious processing of emotional information and automatic physiological arousal resulting from emotion-provoking stimulus. At this juncture, nonexpression can occur simply because a person has little or no primary affective reaction to the stimulus. This represents one of the cornerstones of instrumental grief.
Step 2 involves the individual attempting to consciously perceive his or her emotional state. Disruption can occur when the person is motivated to block the experience of negative emotions. This is repressive coping. Not only have attempts to find a relationship between emotional expression or nonexpression and disease failed, Bonnano (2001) provided empirical validation for the potential benefits of emotional inexpressiveness for people who have been bereaved or experience another kind of significant trauma.
Step 3 of the model entails labeling and interpreting one’s affective response. Here, nonexpression may occur because the person lacks the skill to label or interpret his emotional processing. This is also known as alexithymia (Krystal, 1982), a deficit in one’s ability to put emotions into words. Since most instrumental grievers value intellectual abilities (problem finding, problem solving), it follows that they would have less experience with a vocabulary emphasizing emotions.
Step 4 involves evaluating the individual’s affective responses in terms of his or her beliefs and goals. Here, it may be a negative evaluation concerning the expression of emotions. This would represent a dissonant behavior.
Finally, in Step 5, one tries to determine whether the immediate social context permits the expression of emotions. This, too, is a form of response representing a dissonant griever.
Wong, Pituch, and Rochlen (2006) created a study tool to examine the concept of restrictive emotionality based on the previous cognitive evaluative model of emotional expression and nonexpression. Their findings:
Thus, the concept of emotional restrictiveness lies at the core of the first of the two forms of dissonant grief: image managers.
Why are most image managers—especially male grievers—found toward the intuitive end of the continuum? Why are there not more instrumental image managers?
In summary, most image managers experience their losses in the affective domain, but because of their habitual need to seek approval of others, they are burdened immensely by their grief as they struggle to hide their true feelings. This differs from another dissonant response in which grievers may not actively attempt to alter their expression of grief, but may experience intense guilt because they believe that their inner experience and outer expression should be different from what they are.
Whereas image managers are usually intuitive grievers who hide their feelings from others by censoring their expressions of grief, penitents are often instrumental grievers who condemn themselves for not having feelings to hide. The two responses are outwardly similar except that in the former, grievers experience anxiety at the potential failure to cover up their feelings, while in the latter grievers experience intense guilt because they cannot pretend to have feelings that they believe they should have. They also differ in that image managers are simply continuing a habitual way of handling general stress, whereas bereavement may precipitate the inner crisis of the penitent.
SIDEBAR 5.1: Alcohol—Balm or Bane
Although intense debate has often centered on using psychoactive medications to treat normal bereavement (see Rando, 1993), there is generally a consensus that alcohol is the most frequently chosen agent for self-medication, especially among men (Hughes & Fleming, 1991; Parkes & Weiss, 1983; Stroebe & Stroebe, 1993). What remains clouded is the question of when, outside of the disease of alcoholism, is imbibing either help or hindrance to the griever?
For the past 5,000 years humankind has been participating in a largely uncontrolled natural experiment of the relationship between alcohol and health, with few conclusions reached. Partly, this is due to ambiguous counsel from normally unimpeachable sources. For instance, as Noah stepped from the Ark, God bid him to plant vineyards, and Proverbs (31:6–7) reads: “Give strong drink unto him that is ready to perish, and wine unto those that be of heavy hearts. Let him drink, and forget his poverty, and remember his misery no more.” Of course there is admonition to the contrary: “For he shall be great in the sight of the Lord, and shall drink neither wine nor strong drink, and he shall be filled with the Holy Ghost, even from his mother’s womb” (Luke 1:15).
Likewise, advice about using alcoholic products from the American Medical Association (AMA) is equally ambivalent. For instance, the AMA warns that drinking can cause a whole series of health problems including heart disease, certain types of cancers, liver disease, and of course, alcoholism. At the same time, a recent issue of JAMA (The Journal of the American Medical Association; January 6, 1999) included a finding that moderate consumption of alcohol actually reduces the risk of stroke and heart disease. (This effect is not limited to red wine as previously thought.) However, there is little debate that habitually consuming too much alcohol is not a good thing.
In our own work we have found that people who already drink alcohol tend to increase their intake following the death of a loved one. This behavior does not seem to be related to any particular pattern. Different grievers may use alcohol in different ways. For example, intuitive grievers may use alcohol to anesthetize grieving, while to instrumental grievers drinking might be an activity. To dissonant grievers, alcohol may permit the release of pent-up emotion. For the vast majority of grievers, however, alcohol consumption returns to preloss levels within a year of the death. Although we would not recommend beginning or increasing drinking, we are not clear about whether alcohol interferes with grieving or simply makes it more bearable. Stay tuned.
Unfortunately, some penitents attempt to conjure up such feelings by using various substances, such as alcohol. Here, alcohol is employed in an attempt to elicit feelings versus being used to numb or suppress feelings. Other penitents share concerns that are common to image managers and may avoid or withdraw from people. The difference, of course, is that penitents fear that others will discover that they have no feelings to express. This may be especially true of the female instrumental griever, as seen in the following case.
Anyone who knew Shirley described her as “low key.” She was also very bright, finishing at the top of her graduating class from Georgia Tech. She began her career as a chemical engineer for a Japanese firm. Within 6 years she had been promoted several times and became a senior vice president of her company. She then met Marshall.
She and Marshall were opposites: he was moody, passionate, and excitable; she was stable, cerebral, and controlled. In fact, when she calmly accepted his proposal for marriage, he became upset that she wasn’t more “excited.”
After 3 years of marriage, Shirley finally gave into Marshall’s pleas for a baby. Although she was happy being pregnant, Shirley could not begin to match Marshall’s euphoria. His recently widowed mother was equally excited, believing that her first grandchild would give her a reason to go on living.
Tragedy struck when the baby’s umbilical cord wrapped around its throat. It was born dead.
As one could expect, Marshall and his mother were devastated, weeping constantly. Shirley was hurt and disappointed by her loss, but reasoned that she and Marshall could have another child. Marshall and his mother were aghast at her lack of reaction. Even many of her coworkers, especially the women, suggested to Shirley that she seek help for her repressed grief. Her mother-inlaw refused to speak to her. When Marshall threatened to leave her, she began to wonder and feel guilt at her own lack of feeling. She found that being with others exacerbated her guilt so she began avoiding people. She also discovered that after two large glasses of wine, she would become depressed and begin to cry. Soon, two glasses of wine became three, and then four. Although he at first encouraged her drinking since it enabled her to “feel,” Marshall became alarmed as Shirley’s drinking increased. She was also confronted at her office with her frequent lapses in judgment. Eventually, Marshall, along with her employer, convinced her to enter an alcohol rehabilitation center. Fortunately, one of her therapists recognized her as an instrumental griever and was able to validate Martha’s tempered feelings as normal for her. Two years later, she and Marshall had another baby and the family is still intact. Sadly, the mother-in-law withdrew from her son and her new grandson as she had from Shirley.
Although Shirley had never experienced intense feelings, it was not until her baby’s death and the responses from her family and friends that she became penitent.
Male instrumental grievers are also vulnerable to excessive selfcriticism as highlighted by the following:
As his wife, Helen, lay dying, Peter grew increasingly alarmed at his own lack of feelings about her impending death. He began experiencing a profound sense of guilt. Peter’s guilt deepened when Helen herself accused him of not loving her. She, too, could not understand how he could calmly sit by her bed as she wrestled with her anxieties about dying and her grief at having to say goodbye. As he searched his soul, Peter realized that he had never felt that deeply about either of his parents’ deaths. Consequently, he began to drink more heavily, as he later described it “to feel something.” The alcohol relaxed him but did not generate any feelings other than additional guilt about his drinking. Peter asked for and received a referral to a counselor from the hospice providing services to Helen and him.
Peter shared his sense of guilt with the counselor. Rather than focus on how Peter felt, the counselor asked Peter to describe what he was doing for Helen. As it turned out, he was doing practically everything. Peter cooked Helen’s meals, changed and washed her linens, managed her medications, and cleaned her room. He provided personal care as well, including washing Helen’s hair, ferrying her to the bathroom, and when there were accidents (and there were many), wiping and washing her bottom.
Peter’s sigh of relief was clearly audible when, with the counselor’s assistance, he finally realized that he was expressing his love and concern by “solving problems” rather than by expressing feelings.
What is so remarkable about Peter’s case is how blind he was to the significance of his caring actions toward Helen. Peter did not have or share deep feelings, yet he tenderly performed tasks that most others would find repugnant.
When does a response become dissonant? Without knowing the individual’s history and patterns of behavior it is difficult to identify dissonance. Often, grievers themselves will recognize the clash between their feelings and their behaviors.
In general, the twin compasses of movement and direction may serve as beacons of adaptation. For example, some grievers become “stuck” in their grief. Examples include image managers who do not find appropriate ways of discharging affective energy and penitents who become mired in guilt. And while the path from acknowledging a loss to a final reconciliation is rarely direct, there is an overall progression. Often, others may notice improvement before the grievers themselves. In short, a recovery that becomes stalled for an extended period, or a pronounced regression that cannot be attributed to the usual causes (anniversary dates, specific events, additional losses, and the like), may signal a dissonant response. In particular, any behaviors that interfere with the overall health and functioning of the individual should be suspect and viewed as possible indicators of a dissonant response (see Sidebar 5.2).
To summarize, image managers act in ways to suppress or avoid their true feelings, whereas penitents experience guilt because they do not have feelings they believe that they should. Both of these responses represent immature or maladaptive strategies and, if persistent, are dissonant ways of responding to losses. It is important to explore a griever’s motivation for responding in a dissonant fashion. Whereas image managers and penitents are motivated by the fear of damaging their public and private self-images, other dissonant responses may represent attempts to avoid accepting the reality that a loss has occurred. This presents an interesting question: When does a dissonant response become complicated mourning?
Therese Rando’s remarkable text, Treatment of Complicated Mourning (1993), remains the standard for the field. Rando defined complicated mourning as “some compromise, distortion, or failure of one or more of the six ‘R’ processes of mourning” (See page). (Rando’s “R” processes are listed in Chapter 2.) Rando further explicates complicated mourning as hinging on the mourner’s “attempts to do two things: (a) deny, repress, or avoid aspects of the loss, its pain, and the full realization of its implications for the mourner, and (b) hold on to and avoid relinquishing the lost loved one” (See page). Although every dissonant response does not lead to complicated mourning syndrome, many do. In this respect, dissonant responses may be precursors to complicated mourning.
SIDEBAR 5.2: Grief and Health Promotion
Stroebe and Stroebe’s (1993) longitudinal research has found that men may be more at risk for health difficulties during the course of bereavement. That research looked at gender rather than grieving patterns. It is difficult to determine, therefore, what patterns may truly incur more of a health risk. Nevertheless, Carverhill’s (1995) suggestion that therapists promote health with male grievers is sound advice, regardless of the individual’s grief pattern. Both Worden (2009) and Rando (1993) have theorized that conversion reactions, where grief manifests itself in another way such as illness, often occur when other responses are deemed unsuitable and blocked. Dissonant patterns, particularly since affect is suppressed, may be especially vulnerable to health problems.
But the very experience of grief threatens health. Grief and the inherent change accompanying loss generate enormous stress. Eating and nutritional patterns as well as exercise regimens and adherence to medical treatments may suffer. Counselors are wise to assess changes in health, alterations in daily routines, and to suggest to clients the prudence of a health examination with a physician who knows the patient’s medical history as well as their current status, and who is aware of the health risks inherent in bereavement.
A dissonant response represents the griever’s failure to effectively discharge grief energy over time. Since it requires energy to restrain energy, dissonant responses may delay or inhibit the griever from resolving his or her losses. This is especially true of the image manager who consciously suppresses and avoids deep loss-related feelings.
Dissonant responses meet Rando’s (1993) requirement of avoiding aspects of the loss, particularly the pain. These responses may also represent a failure on the griever’s part to complete Worden’s (2009) second task of experiencing the pain. Recall, however, that complicated mourning must involve the griever’s refusal to let go of the lost love. Not all dissonant grievers are motivated by their desire to cling to the deceased. As seen previously, some image managers are motivated to protect only their public personas. While this may rob them of the opportunity for comfort and support, it is not necessarily a way of clinging to the deceased or avoiding the reality of the death. Penitents, too, may experience selfdoubt and self-condemnation at their perceived lack of feeling but not deny the reality of their loss.
Other dissonant grievers may suppress their thoughts and feelings to avoid acknowledging the reality and finality of the loss. For instance, image managers may continue their deceptions even absent of an audience. And some grievers use penitence as a way to generate discomfort, viewing their pain as the only link they may have to the deceased. These grievers fit the definition of complicated mourning.
Since it is natural for an organism to return to a state of homeostasis, grieving becomes an adaptive response that attempts to adjust to the external and internal changes wrought by a loss. Unfortunately, these adaptive strategies do not guarantee success (see Sidebar 5.3). By choosing a strategy that permits an unfettered expression of grief congruent with the inner experiences of loss, the griever can promote healing and recovery. Likewise, persistent incongruity between the individual’s inner experiences and his outward expressions of grief often inhibits recovery and increases the griever’s vulnerability to complicated forms of mourning. However, choosing an adaptive strategy congruent with inner experience does not necessarily guarantee success; even effective strategies fail if the individual does not possess the necessary skills to implement them.
SIDEBAR 5.3: Grieving and Violence
In some cultures or even subcultures, the grieving rules may allow or even encourage violence as an adaptive strategy. For example, in certain cultures or subcultures, there may be norms that allow “blood feuds” or encourage revenge slayings. Here, the death of someone by violence necessitates taking another’s life. That person might be the suspected perpetrator of the initial act, a member of their family or group, or perhaps any bystander. Barrett (1997), too, notes the relationship of homicide violence as an expression of grief in subcultures of urban adolescent males. He emphasizes that in such subcultures, violence becomes a rite of mourning when the violent death of a friend or family member occurs. In this culture, the retaliatory violence has the same role as other mourning rituals, that is, it reasserts control, expresses respect for the deceased, reaffirms the loyalty of the group, and allows the ventilation of feelings such as anger.
Parkes (1996a), in his research on violence in Rwanda, speculates that such violence may arise when affect is repressed, as is the case in Rwandan society. However, anecdotal evidence as well as Barrett’s (1997) research suggests the answer may be more culturally complex. In an essay, the rapper Ice-T (1995) describes the violence evident in his community of South Central Los Angeles: “When you see these drive-bys and kids are hitting five or six people on the street, they are retaliating for the murder of one of their boys. I’ve seen crying men enter cars and when the doors shut, they go out and murder” (See page).
Perhaps in cultures where violence is an accepted form of expression, it can serve instrumental or intuitive grievers equally well. For those with an intuitive pattern, it allows ventilation of affect. For instrumental grievers, it offers action as a way to reassert a sense of control. Even dissonant grievers can find a culturally acceptable way, consistent with the male role, to ventilate at least one acceptable feeling—anger. In fact, one can speculate that violence, for that reason, is a likely response of grievers with dissonant patterns. Their affect can be channeled to anger and discharged through violence. The answer to violence as an expression of grief may lie less in changing the individual’s way of adapting to loss, and more in constraining and ultimately changing cultural norms that allow or encourage violence.