Loss Grief and Bereavement

There are many factors that appear related to differences in nature and intensity of the grief one experiences following a loss. Those who experience losses that are stigmatized by others (e.g., losses that are assumed to have been caused by an individual's disturbed or immoral behavior, or ones where there is a fear of contagion or fear for one's own safety) often feel isolated and pressured to show no grief in public. Grief of someone who recently has experienced an "unusually" high number of losses, as well as that related to the death of a loved one who was a drunk driver, a partner with AIDS, or a son in prison, are not well-acknowledged. Suicide, which is both violent and stigmatized, can provoke feelings of anger and guilt and result in secrecy and blame within the family.

Sometimes what one views as a loss is unrecognized by others, particularly if the loss has been stigmatized. Disenfranchised grief occurs when society does not recognize one's "need, right, role, or capacity to grieve" (Doka 1989, 3). Examples of these unacknowledged losses can include divorce after years of being abused; immigration to a "better" place; death of a former spouse, foster parent, stepchild, coworker, companion animal, professional caretaker; or death related to pregnancy. Individuals who may be seen as incapable of, or without a need for, grief include young children, older adults, mentally disabled persons, those who are deaf, masculine grievers, military, police and firefighters, or those in cultures who do not grieve or mourn according to societal norms.

Families may have additional difficulties with loss if they are experiencing other stressful situations at the same time. They may have difficulty if dealing with the stress of typical life-cycle events (e.g., a new marriage, birth of child, changes during adolescence, beginning employment) concurrent with major losses (e.g., illness, death, trauma, loss of employment or homeland). Dealing with life-cycle events and additional losses may tax resources (e.g., money, health, friendship, self-esteem, or sense of mastery).

Vulnerability also is related to centrality of the role and function of the lost item or person, such as items with significant meaning, those that can never be replaced, or losses that are critical to everyday functioning. Complications can also arise with the loss of individuals who played central roles in our lives, or when we lose someone for whom we feel ambivalence, estrangement, or intense continuous conflict. Differences in adjustment often attributed to gender may actually be related to other intertwined cultural factors (Wisocki and Skowron 2000).

To understand how a family perceives a loss, one needs to understand its view of the world. One common family paradigm is known as the Belief in a Just World (Lerner 1971). This perspective values control and mastery and assumes there is a fit between one's efforts and outcomes; therefore, one gets what one deserves. This view is only functional when something can be done to change a loss-situation. Otherwise, it results in blaming the griever for the loss. Chronically ill persons are blamed for their condition or lack of recovery, and it is assumed that adolescent deaths are caused by their own reckless behavior or drug use.

Another factor that can influence coping with grief is boundary ambiguity—confusion that arises when it is not clear who is in and who is out of the family (Boss 1999). Such a situation can exist in cases where someone is physically absent, but psychologically present in the family (e.g., a soldier missing in action, a missing child, an absent non-custodial parent, or yearning for one's family who remained in the homeland rather than immigrating). It can also exist when someone is psychologically absent but physically present (e.g., a family member with dementia or a brain injury, a parent who spends all her time with work or hobbies, or a depressed adult who has difficulty connecting to his partner). In the case of a sudden traumatic loss, denial and boundary ambiguity may initially be functional, giving the family time to regroup before dealing with the loss, but a high degree of ambiguity over time poses difficulties for coping. Reports that continuing bonds often occur following death (Klass, Silverman and Nickman 1996), with conversations with the dead replacing rituals as the normative way bonds are maintained (Klass and Walter 2001), may challenge the notion of boundary ambiguity, suggesting that conflicting images can coexist within the psychological domain—that one can cognitively recognize the loss and still maintain psychological, emotional, and spiritual connections.

Although the study of what facilitates coping with grief originally tried to classify factors that facilitated grief versus those that inhibited grieving, it appears that some elements may simultaneously complicate and facilitate grieving (Doka 1998). For example, it appears that no single length of time between the first hint of the inevitability of a loss and its actual occurrence is most problematic. Losses that are sudden or unanticipated do not allow one the opportunity to engage in anticipatory grieving; losses that are long and drawn-out result in depleted resources, including wearing out one's network of social support. In light of modern technological and medical advances, protracted losses (e.g., chronic illness) can involve a series of improvements and relapses that occur so often that family members begin to expect that with each relapse there will be another recovery. Thus, when death finally occurs, family members may experience it as a sudden unanticipated loss.

Other factors that can simultaneously complicate and facilitate the grieving process include the belief that a loss is "God's will" and the availability of a social support network (Doka 1998). A belief in God's plan can help one in finding meaning in the loss. It can also create anger toward God for being unfair and allowing such an act to happen, leading to guilt and isolation from one's spiritual connection or religious community. A social support network can lend assistance and be there to listen, but it may also place unrealistic expectations on the griever.