Loss Grief and Bereavement

Almost every person in the world, at one time or another, experiences events that can be considered major losses (Harvey and Weber 1998). A loss occurs when an event is perceived to be negative by individuals involved, and it results in long-term changes in one's social situations, relationships, or way of viewing the world and oneself. Death is the event most often thought of as a loss, but there are many others. Tangible losses can be personal (i.e., loss of one's vision, hearing, sexual activity, or mental capacity; infertility; chronic pain or illness; rape, domestic violence and abuse; or political torture), interpersonal (i.e., divorce, ending a friendship, or death of a loved one), material (i.e., losing a job, leaving one's country, war-time trauma, changing residence, or becoming homeless), or symbolic (i.e., losses related to racism, role redefinition, or reentry adjustment to home culture). Intangible psychological losses include changes in self-worth due to harassment at work or job demotion; changes in sense of control and safety due to crime, terrorism, or victimization; changes in identity related to widowhood; or changes in worldview related to experiencing a natural disaster or chemical accident.

Dominant cultures in Western countries tend to define loss dichotomously: an object is either present or absent, a person is either dead or alive. However, coexisting cultural groups in the West and other parts of the world may categorize losses by many levels of gradations—thus, someone from whom we are recently separated (through death or physical separation) may be seen as still communicating and with an active presence, different from someone who has been physically absent for many years (Rosenblatt 1993). There may be a series of stages of transition into nothingness, or to another state. In addition, losses have different meaning between cultures and among individuals within a culture, depending on their life circumstances. For example, in impoverished cultures where infant and child deaths are viewed as inevitable, seriously ill children may be categorized as dead, and their later deaths may not be mourned for more than a few days. Such responses may seem puzzling to outsiders when they learn that those dead children still are considered a part of the nuclear family and are expected to be reunited with the mother in an afterlife (Scheper-Hughes 1985).

Each traumatic or stressful event may cause several losses; and each loss can have multiple consequences. Therefore, when individuals have a severe chronic illness, they and their partners experience multiple losses, including losses each of them experience related to physical or mental deterioration. There can be related losses involving careers, finances, sexual interaction and love life, inability to do normal chores together or participate in activities previously enjoyed. They may experience losses in self-esteem related to having the disease, or the stigma of being with a chronically ill person; and losses related to being ignored by medical personnel discussing one's own condition, or (in the case of unmarried partners) being ignored in medical decision-making because one is not an "official relative."

There are several imprecise terms used to discuss reactions to loss, and it is important to clarify their intent. The usual reaction to a loss of someone or something that was valued is termed grief. It consists of emotional, psychological, and physical dimensions (Stroebe et al. 2001) and there has been debate as to whether grief occurs only for individuals, or whether there is such a thing as family grief (Gilbert 1996; Moos 1995). In Western cultures grief is typically discussed as a psychological phenomenon—largely as a cognitive challenge, an emotional reaction to loss. In many other cultures, however, grief is viewed as a somatization, where "personal and interpersonal distress [is manifested as] physical complaints [and people have learned Grieving for the loss of their child, who was killed in an earthquake, this Armenian family crowds around the coffin. Expressions of grief and mourning are shaped by one's cultural group. DAVID TURNLEY/CORBIS to respond to their losses] through the medium of the body" (Kleinman 1986, p. 51).

The term mourning is often used to describe the varied and diverse social expressions of grief. Affects can range from pain and sadness to humor, pleasure, and joy. Actions, rituals, and emotions observed during mourning are shaped and controlled by the beliefs and values of a society or cultural group and are intended to be for the benefit of grievers and/or the community. In countries in which hundreds of cultures are represented (such as the United States and Canada) one might expect that cultural expectations for mourning would evolve in a manner that represents the many cocultures. However, Paul Rosenblatt and his colleagues (Rosenblatt, Walsh, and Jackson 1976) found that overt expressions of crying, fear, and anger were common, acceptable, and encouraged in most parts of the world, except for some Western cultural groups. This suggests that the United States and Canada have never truly been "melting pots" beyond some of the early European nationalities in terms of cultural, ethnic, and religious attitudes toward grief, loss, and mourning (Irish 1993).

Bereavement is used to describe the objective situation of someone who has experienced deprivation through the loss of a person or thing that was valued (Corr, Nabe, and Corr 2000). Although bereavement is a factual situation of loss, how individuals respond to loss can be highly varied. The extent to which one grieves, and overt expressions of mourning, will differ from culture to culture, from person to person, and from situation to situation for any one person. For example, the extent to which one grieves for the loss of her parent, colleague, stepchild, pet, partner, homeland, or unfulfilled dream may differ. Level of display of mourning may also differ depending on the societal messages received about one's position in the hierarchy of grievers—that is, how entitled one is to mourn a particular loss. In the United States a bereaved mother is considered more entitled to a high level of grief than are surviving siblings or classmates; and a current spouse is more entitled to grieve than a former spouse. However, the effect of culture on style of grieving may not be "visible" to those within the culture. It is important to remember that there is no one way that an individual "should" react to loss, and that our discomfort with the reactions of others often occurs when their reaction contradicts values and beliefs we have developed in response to our own culture and experiences.