Chapter 1. Bereavement

Synopsis

Human Development Video Activity

true

You must read each slide, and complete any questions on the slide, in sequence.

bereavement

The personal process of expressing grief that is unique to each individual.

cohort

A group of people with characteristic(s) or life experience(s) in common.

grief

The highly personal mental suffering or distress caused by a loss or death.

mourning

The public or outward expression of bereavement that often follows social

Bereavement

Authors

Field of identical cross headstones all aligned perfectly

Catherine Robertson, Grossmont College
Raechel Soicher, American River College

Synopsis

In this activity, you will learn about the different aspects of how we respond to someone’s death. In videos, individuals describe their experiences of loss following the death of someone close. Experts discuss bereavement and outline some strategies for coping with loss.

REFERENCES

Clements, P.T., Vigil, G.J., Manno, M.S., Henry, G.C., Wilks, J., Sarthak, D., Kellywood, R. & Foster, W. (2003). Cultural perspectives of death, grief, and bereavement. Journal of Psychosocial Nursing and Mental Health Services, 41, 18-26.

Cluver, L. & Gardner, F. (2007). Risk and protective factors for psychological well-being of children orphaned by AIDS in Cape Town: A qualitative study of children and caregivers’ perspectives. AIDS Care, 19, 318-325.

Cowles, K. (1996). Cultural perspectives of grief: An expanded concept analysis. Journal of Advanced Nursing, 23(2), 287-294.

Faschingbauer, T., Zisook, S., & DeVaul, R. (1987). The Texas revised inventory of grief. In S. Zisook (Ed.), Biopsychosocial aspects of bereavement (pp. 111-124). American Psychiatric Press, Inc.: Washington, D.C.

Faschingbauer, T. R., DeVaul, R. A., & Zisook, S. (1977). Development of the Texas inventory of grief. American Journal of Psychiatry, 134(6), 696-698.

Gallagher, D.E., Thompson, L.W. & Peterson, J.A. (1982). Psychosocial Factors Affecting Adaptation to Bereavement in the Elderly. The International Journal of Aging and Human Development, 14, 79-95.

Golden, T. (2000). Swallowed by a snake: The gift of the masculine side of healing. Gaithersburg, MD: Golden Healing Publishing.

Kastenbaum, R. (1998). Death, society, and human experience. Boston: Allyn and Bacon.

Kübler-Ross, E. (1997). On children and death. New York: Touchstone Books.

Kübler-Ross, E., & Gold, T. (1998). The wheel of life: A memoir of living and dying. New York: Simon and Schuster.

Lacy, B., & Sanderson, R. (1993). Grief: Getting over the death of someone close to you. Manhattan, KS: Kansas State University. Available at: http://www.k-state.edu/counseling/topics/life/grief.html

Maciejewski, P.K., Zhang, B., Block, S.D., & Prigerson, H. G. (2007). An Empirical Examination of the Stage Theory of Grief. The Journal of the American Medical Association, 297, 716-723.

National Cancer Institute (2002). Loss, grief, and bereavement. Available at: http://www.cancer.gov/cancertopics/pdq/supportivecare/bereavement/patient

Powell, T. (1997). Free yourself from harmful stress. New York: DK Publishing. Available online at: http://www.fema.gov/rebuild/recover/bereave.shtm

Texas Revised Inventory of Grief. CHITPS Assessment Instruments by topic. Available at: http://chipts.ucla.edu/assessment/Assessment_Instruments/Assessment_files_new/assess_trig.htm

Tousley, M. (2000). Understanding the grief process. Available at: http://dying.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.griefhealing.com%2Fcolumn1.htm

Webb, M. (1999). The good death: The new American search to reshape the end of life. New York: Bantam Books.

Grief and Bereavement

Mourners of all ages dressed in black at a military gravesite. The spouse of the deceased is comforting her daughter with one arm and holding the US flag folded up in the other arm.

When someone we love dies, we experience an emotional response called grief. Grief is characterized by mental and emotional suffering. Each of us expresses our grief in a process referred to as bereavement, which is experienced in a different way and to a different extent by each individual. The manifestation of bereavement is influenced by our age or stage of development, personal experience, and social and cultural norms.

While individuals grieve, a community or cohort might also experience grief. Many people may be thrown together by events or circumstances, such as the 2001 World Trade Center bombing or international conflicts that take the lives of civilians and those in the military services.

Bereavement may be expressed through physical responses, such as lightheadedness, rapid heartbeat, or increased rate of breathing, and/or cognitive responses, such as confusion, disorientation, or difficulty concentrating. While grieving, we may experience anger, guilt, sadness, or fear.

Grief Inventory

High school-aged mourners, some holding flowers, gathered around a new gravesite

Using a standardized grief inventory, research on grieving has revealed:

• Women are more likely to score high on questions regarding past grief as are people who had someone pass away on whom they had depended for help providing for the family.

• Groups with high scores for questions regarding present grief are more likely to suffer illness as a result of their increased grief. Possibly, they experience delayed or unresolved grief.

• People who were able to go through a grieving process that included a funeral are more likely to score lower on the scale of past grief. This finding suggests that attendance at a funeral or service appears to help people to integrate the loss in a meaningful way with other experiences that one goes through in life.

The Grieving Process

Three men dressed in dark suits staring at a coffin with a single yellow rose on top of it. One is holding a young girl with her teddy bear.

There are generally five stages to the grieving process. Grievers tend to progress through these stages in the following order:

1. disbelief – a period of denial that a loss has taken place;

2. yearning – an intense desire for the return of the deceased;

3. anger – outrage may be directed at self or the deceased;

4. depression – a period of intense sadness, numbness, and confusion;

5. acceptance – the final stage in which the person has accepted the loss of their loved one.

Factors Affecting Bereavement

An American flag draped over a casket, with a camouflage helmet and sunglasses on top of the flag.

^{Bereavement is affected by factors related to specific circumstances surrounding the death. Because of the amount of military activity for U.S. armed forces in the recent decades, this type of coffin for a fallen soldier is, unfortunately, a common sight.}

How each individual experiences grief and expresses bereavement depends on a range of factors from income level, religious commitment, and strength of social network to age and relationship to the deceased (Gallagher, Thompson, & Peterson, 1982; Cluver & Gardner, 2007).

How we grieve is also affected by whether we have had another recent loss or even a string of losses over a short period as might occur in late adulthood. The stress from a number of losses tends to add up and may increase the intensity of the grief and bereavement.

Bereavement and Grief: Children and Adolescents

Since bereavement is an individual’s unique expression of grief, bereavement is dependent on the person’s cognitive understanding of what death is, and this understanding is dependent on his/her developmental stage. Therefore, a person’s emotional expression of grief is directly related to his/her developmental stage.

Bereavement and Grief: Early and Middle Adulthood

Grief and bereavement continue to change through the adult years.

Early adulthood: The reality of death is well understood but is a far-away thought. Generally, this is a period of peak health and well-being. Young adults are busy establishing a life that may include work, relationships, marriage, and children. With the first child, the reality of death emerges more prominently because the adult is now responsible for another life and may be anxious about something happening to the child. The actual expression of grief follows a normal adult pattern.

Middle adulthood: Death becomes more real at this stage because this is a time when some peers may begin to die. Many people consider making changes in an effort to lengthen their lives, such as improving diet, stopping smoking, losing weight, and exercising more. The death of parents generally becomes a reality if it has not already. Grief and bereavement may be intense if this is the first time that an adult has experienced profound loss.

Question 1.1

FQwQrjwMo1xofQekMqFk99S1VgXfAvtSn5kEd/ASejIHvQWdA+o/zjjXAxGKy1LpyU2Cx7SD/GjrcdRqXOW8uHeuY0NO703qOtTf/14CwIFL5TgiDJm0108WzGKNVHNZdmLLuJRynOGfWh2DvD2hRrALWTX8mS0yMxwY6n1ME4+wzxB9MdGONjsBL1kkdlmQ8QvlM2G8JQ3Saa8yPshtoFa3CN45ZTIktvH8c4W1J9K8K5Avye18ee8hK80LhwJWsWeKLgzsP9igLV/+EjDY8AJitAexY43TBCt5Zk1FHALSwl0BmKDO7gDPHViSAoYeL3+X18mxg9k=

Both the daughter and mother experience the adult pattern of grief. The daughter is in the middle of establishing her adult life and preparing for her wedding, and that makes the reality of her uncle’s death a more remote thought even though his loss has clearly affected her. As is typical for middle adulthood, this mother grieves more intensely because she has experienced more than one loss in her family recently. Her mother died just a month before her brother was diagnosed with cancer. Death is more prominent to her as well because other relatives in her family and her husband’s family have passed. Because this couple has had multiple experiences with death, they can offer support to each other.

Bereavement and Grief: Late Adulthood

Coming to grips with one’s own mortality is a developmental task at this stage. Older adults realize that death is inevitable, and engaging in a life review is a typical reaction to this acceptance. Bereavement may be a common companion during this life stage as losses occur with more frequency. The most common and most difficult loss that may occur during this phase is death of a long-term spouse. Grief over this loss may be very intense and may even cause sufficient physical and emotional suffering to actually threaten the griever’s health and life expectancy.

Keeping in mind the developmental stage of each person and the five stages of the grieving process that you have learned in this activity, listen carefully to how each person expresses grief in this video.

Question 1.2

De2diKe7MxysAIMnJMvJ78RoKrY+QlaZMvAu5yQRt7JUEmAOSU+pMtYU+EiExmlp7flYs+F6H+jb7trf38jEDKyDjwJB6mX8EJi+9zGi9FHalPyvv9t19HzztCjarCq7AfgG/OY5+J7p0X8ydipvuV2TE6VcqjwZkzrxnOZTugBbn5NEjkWZtrfWilaFvJeLbvlqw9sKhRNIKNBV9zStKB+KmIYaJmms0gsJWTauLuj+6aETbSEJlBRsSj04Zx+TcdUNujtGL9eSuk1v3ti9v9+uRJDQ6u049dcSPtFVEkkZ7CPMcGM8RBPPsOY=

For the people in late adulthood, there is more of a sense of the inevitable in their losses. Many in late adulthood experience numerous losses, and those losses are likely to continue. Acceptance of death may be easier for those in this developmental stage as compared to those in other stages. However, this is not to say that loss is easy for those in late adulthood. In this video, several talk of the loss of their spouses and how painful that was and still is, but these individuals have gone on and continue to engage in life. In middle adulthood, a loss may act as more of a reality check that may prompt efforts to stave off death. At this stage, death may be something to avoid and may cause stage 3 and 4-type brash reactions of anger and depression.

Bereavement and Grief: Late Adulthood

Question 1.3

For the people in late adulthood, there is more of a sense of the inevitable in their losses. Many in late adulthood experience numerous losses, and those losses are likely to continue. Acceptance of death is relatively easy for those in this developmental stage as compared to those in other stages. However, this is not to say that loss is easy for those in late adulthood. In this video, several talk of the loss of their spouses and how painful that was and still is, but these individuals have gone on and continue to engage in life. In middle adulthood, a loss may act as more of a reality check that may prompt efforts to stave off death. At this stage, death may be something to avoid and may cause stage 3 and 4-type brash reactions of anger and depression.

The Social Viewpoint: Mourning

Street memorial to Vaclav Havel, surrounded by lit candles

^{Mourners came to light a candle at a memorial in Prague in honor of Vaclav Havel, who died on December 18, 2011. Hovel was a prominent playwright, poet, author, humanitarian, the last president of Czechoslovakia, and the first president of the Czech Republic.}

Bereavement has a social and cultural connection. In the United States and other Western nations, grief and bereavement following a death historically called for definite signs and symbols of mourning, which is the public expression of bereavement. In the past, the mourning process had social structure and social rules and was a public process that included a great deal of emotional display. This practice allowed for adequate recovery time, attention, and sympathy for the bereaved person(s).

Today, mourning and bereavement have become much more private, and the acceptable customs for a public level of emotional display have lessened. Consequently, a person who is feeling bereaved is often more socially isolated from the community and has limited opportunities for public expressions of grief. The lack of social support can make recovery from the loss much more difficult. The best way to help someone to recover is to provide sympathy and support and to acknowledge the pain of bereavement.

The Cultural Viewpoint

^{A Day of the Dead Celebration}

How individuals react to death seems to differ from one culture to another. How individuals bereave, mourn, and grieve is often closely related to the religions predominant in their culture. Cowles (1996) has found that despite cultural differences, the human experience of grief across cultures is more similar than different. The rituals and traditions surrounding the public display of mourning reveal the greatest perceptions of difference.

Coping with the Grieving Process

When we understand the grieving process and its function, we can assist grievers by offering sympathy and support and by acknowledging the pain of loss. Grief generally lessens over time. Dr. George Bonanno, a psychologist at Columbia University, has found that laughter can be a part of healing during the grief process.

Play the video to hear what Dr. George Bonanno advises for those who are experiencing grieving.

Question 1.4

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

This statement is not mentioned in the video. Dr. Bonanno advises grievers to take advantage of professional help or support from resources at area hospitals or from grief counselors.

This advice is presented in the video. The expert advises that one should listen to the griever but should be careful not to take on the grieving person’s pain, that grievers should allow themselves to laugh, and that talking about the deceased is beneficial and allows for pleasant memories and even sadness to be shared.

Summary

A close-up of a coffin being carried by a pallbearer

The death of a close relative or friend occurs sooner or later in everyone’s life. Social, cultural, and developmental factors affect how each of us expresses our grief through individual bereavement or in more public displays of mourning. These factors include the sense of loss, nature of the death, relationship and attachment to the deceased, personal history, developmental stage, personality, and whether we have had another recent loss.

Cultural differences may be most evident in the mourning process, but across cultures, people’s personal experience of grief is more similar than different.

There is a process of grieving that is common to adults, adolescents, and older children who are capable of understanding the reality of death. There are also coping mechanisms, such as laughter, that may help in healing those who grieve.

Assessment: Check Your Understanding

Question 1.5

zq+c1e5OXmjseICakRZrNrxZJ8D+GyXamnK56PzwqU6QGI+tUDxqzlfIeOpclOL6zlVXMEge0L7zxOnNKsNUJ0+HFsmLbaS48OIKnZn5WyEe7Kuh2QvjEX6Os5f5qJo0wxAqE862aUQ0rpxBvCcGgESMLSjlPMp0E18GiLQjPrQgItKQOoFsbcT7gC4VvUZ7n0cjU4XNzn4CmKPzLG4+cuLxkF898RQ8T+Z7K9NsRhk=

Correct! Bereavement is the personal process of expressing grief that is unique to an individual.

Sorry. Bereavement is the personal process of expressing grief that is unique to an individual.

Assessment: Check Your Understanding

Question 1.6

Ubi5uyJM4Yj9rXsD/HJK6iyJJghs0KQasg+/DoXcYSnN5xZ8vJWuPrTX/uy8zEVucEx1bLDi+6E9D/MGn7yxQEfi6IlTWVB7mLdz2qonwTy0YdQnmYVrqytd1yW5S0O6uuJYzy+6CodSRGjnk/y+ap7KmDOGv5YFgo48A44EPgKOGrm6l5cOZp7ozKwCrKYpYfFsq7L/dcgOin+nBzmXeUwesxFFNk0xxV2KVdOFBJvfmfXY38wEW1BKo6hhAZoU

Correct! At this early stage, a griever is not able to face the reality of the loss.

Sorry. Disbelief is an early stage of grief when a griever is not able to face the reality of the loss.

Assessment: Check Your Understanding

Question 1.7

iuswNOA3V3WgiWGQD3bBYa8syrJ1E4OGTNyF0/CYBIV80fD56txOC6ZdnganP896VDFqr7t8uyG75n0dfBQVxBUinzBlTgWpC2ST5X/8tIoDLmL3YcfgpQyqEQA=

Correct! The cultural or religious rituals and traditions surrounding the public display of mourning demonstrate the greatest amount of difference.

Sorry. The cultural or religious rituals and traditions surrounding the public display of mourning demonstrate the greatest amount of difference.

Assessment: Check Your Understanding

Question 1.8

zst0HlLieOYuYM3jAE0x75rYhRDmWEw3Oe/6muXJP+Acy1v2xxy9qFxZ4brjXxEsfUm6ub/bC+hefL62ocKYpCOxn5PHgn4/CtBO8C4hnBMRroAWjMVe8Q4a5/SiR1ypYubCdU2S/Kf9DdU+VFOQI3OUmb2mU0LqMsYAM0Ak4dllehBb56Xq0gMFzme7SBR7

Correct! A person’s emotional expression of grief is tied to his/her developmental stage.

Sorry. A person’s emotional expression of grief is tied to his/her developmental stage.

Congratulations! You have completed this activity.Total Score: x out of x points (x%) You have received a provisional score for your essay answers, which have been submitted to your instructor.