Loss Grief and Bereavement

Although loss is a normal event, there can be physical, psychological, and social consequences for survivors, as well as a reduction of individual and family resources, whether personal, material, or symbolic. Over the lifespan, one experiences a buildup of memories associated with losses—some of which may be painful and sad, and some of which may be positive in that we feel we have grown or reacted to situations in ways consistent with our values. These memories are triggered by cues we encounter in daily life, rituals on holidays or anniversaries, familiar places, hearing someone use a word in the same way, or wind blowing the way it did just before the storm that took our home.

Despite attempts by scholars like John Harvey (1998, 2000) to develop an inclusive field called the social psychology of loss, most literature on outcomes of loss still comes from research on survivors of the death of a family member, probably because death is viewed as the only type of loss that can never be recovered. Grief related to bereavement can result in negative consequences for physical health, including susceptibility to illness and disease, new symptoms (often similar to those the deceased had endured), aggravation of existing medical conditions, anorexia or loss of appetite, energy loss, sleep disturbances, a drop in the number and function of natural killer cells, and long-lasting changes in both the brain and gene expression (c.f. Murray 2000, 122).

Reported changes in mental health include affective changes (i.e., depression, guilt, anxiety, anger, and loneliness), cognitive manifestations (preoccupation with thoughts of the deceased, helplessness, hopelessness, lower self-esteem, and self-reproach), and behavioral changes (i.e., crying, fatigue, agitation, and social withdrawal) (Stroebe et al. 2001). However, it is not clear to what extent mental and physical health changes occur because of grief and how much change is related to other life changes (i.e., increased consumption of drugs, alcohol, and tobacco, and/or poor nutrition). Individuals with prior personality disorders are more likely to experience complications during grief (Rando 1993). However, neither researchers nor clinicians have done a good job of distinguishing grief from depression, nor of examining traumatic grief separately from "normal" grief.

Dealing with social ramifications of loss can also be problematic. Grieving individuals often report there is a lack of clarity as to their role, and a lack of social or family support. Loss may have resulted in changes in their social status, identity, or income; there may be family or community conflicts related to inheritance or lawsuits—all contributing to a sense of social isolation.

Despite the emphasis on problematic outcomes, literature is emerging that emphasizes growth as an outcome of many types of major losses. Post-traumatic growth is said to occur when, at some point following a loss, growth occurs "beyond" one's previous level of functioning (Tedischi, Park, and Calhoun 1998). This growth can include changes in perception of self (i.e., as survivor rather than victim, or as self-reliant while recognizing heightened vulnerability), interpersonal relationships (i.e., increased ability to be compassionate or express emotions), and philosophy of life (i.e., spiritual change or sense of wisdom, gaining a new meaning and purpose in life, or reorganized priorities). However, the experience of trauma alone does not "heal" problematic family relationships; there are other cognitive, motivational, and behavioral changes required as well.