Bereavement and Support

Healing in a Group Environment

Marylou Hughes

• Publisher: Taylor & Francis
• Year: 2013
• eBook ISBN: 9781317763543
• Topic: Psicología
• Subtopic: Salud mental en psicología

In the early 1970s bereavement support groups were almost unknown. However, the obvious benefits of the group process for recovery - the mutual support and understanding that helps mourners to a better outlook - has created a demand for people who can organise and facilitate these groups.

Addressing the basis and need for support groups for the bereaved, this book presents a theoretical overview, examines benefits and variety of support groups structured and unstructural, special populations and specifics for initiating, organising and running them, such as publicity. It differs from other treatments in that theory and practice are moulded into a how-to approach, with all procedures presented equally for the widest range of choices. Also included is a comprehensive book bibliography for adults, children, children's helpers and parents.

This text is intended to be of use as a resource for professionals in the field of thanatology, including psychologists, psychiatrists, gerontologists, therapists, group counsellors, hospice workers, educators, funeral home directors, home health employees, hospital staff and volunteer organisations that work with survivors.

Chapter 1

A Theoretical Overview

According to Ariés’s (1981) research, attitudes toward death prevail for thousands of years, shifting only slowly as historical events and emerging beliefs affect practices. Indifference in ancient times was followed by emotional reactions to death, which persisted until the seventeenth century, when the prevailing culture mandated that emotional displays be controlled. Early recorded history documents that a presentiment about one’s own death was expected, documented, and believed. In the thirteenth century unusual and untimely deaths were frightening and thus not talked about.

Ariés explains that rituals of mourning came out of the Middle Ages, with the ritual eventually being simplified by the practice of religious modesty.

Ariés reports that in the 1800s death was seen as peaceful and pleasant. Early American settlers were expected to be brave, stoic, and accepting in death.

Ariés observes that present death customs in the Western world emphasize denial. Mourning customs are no longer observed, and there is no perceptible pause to mark the death of a person. Life goes on as it has been.

Ariés notes that efforts to deny death are not working. Death as a loss to be acknowledged is in the forefront.

ATTITUDES ABOUT DEATH

Death is the unacceptable alternative. Loved ones are expected to fight death, be good patients, do what has to be done to survive, follow the physicians’ advice, and get well. In the American culture it is possible for people to deceive themselves about the inevitability of death because people are living longer, machines keep patients alive in segregated sections of hospitals, youthful life-styles have become the established norm, and loss of vigor and self-control is derided (Stoddard, 1978). Dying is evidence of failure (Thomas, 1980). Thomas intones that Americans have not lost their fear of dying, but their respect for it. In 1978 Ross and Duff found that passive euthanasia was favored by 98% of the pediatricians that they studied in the New Haven area. Active euthanasia was approved by 39% of the pediatricians polled, and 33% opposed it. Mixed feelings were expressed by 28% of this group of physicians.

In 1961 Oken learned that 9% of 219 staff members of the Michael Reese Hospital in Chicago never told patients of their impending deaths. Another 47% very rarely told, and 29% occasionally did. Only 3% often explained the prognosis to the patients. A 1979 study reflects the change in how physicians see their responsibilities to dying patients (Novack). The researchers found that 98% of the doctors they questioned favored telling cancer patients when they were terminally ill. Only 2% of the respondents said that they made frequent exceptions to the policy of telling.

These attitudes about death influence how friends and relatives of the deceased manage their mourning. Hope and miracles are pursued. Although there is more awareness of death, survivors continue to think they could have done something to forestall the death. Even though the dying are frequently urged to talk about their journey, they are expected to remain cheerful and involved with life. This dichotomy is carried over into the mourning process. There is no set ritual. Grieving family members are exhorted to mourn, but not for too long. Expressions of deep mourning such as wearing black, staying at home for an extended period, and refraining from frivolous activities are discouraged. Dying and funeral patterns are in disarray. I have heard many stories that show this progression: People remember family members sitting at the bedsides of their grandparents until they died. But their parents died alone in hospitals. Friends who died recently were cremated without any ceremony or means of paying respects. If there is a funeral, black mourning attire is seldom seen. At most, businesses grant members of the immediate family three days of excused leave. The message is that life goes on and work comes first. Yet mourners frequently cannot comply with society’s expectation of what grief should be.

GRIEF DEFINED

Worden (1991) defines grief as a normal reaction to loss and mourning as the process that the grieving person experiences. Bereavement is the adaptation to the loss. The Department of Health and Human Services (1981) refers to grief as a continuing, natural, and individual reaction to loss, whereas mourning is seen as the cultural response to grief. Bereavement is the state of having suffered a loss.

THE STUDY OF GRIEF

Grief as a normal reaction to loss was identified and written about as early as 1917. Sigmund Freud said that mourning was not pathological; it would be overcome after a time, and interfering with it was useless and probably harmful. In 1940 Melanie Klein wrote Mourning and Its Relation to Manic-Depressive States, in which she suggested that the mourner goes through a transitory manic-depressive state and overcomes it. In 1944 Lindemann claimed that “acute grief would not seem to be a medical or psychiatric disorder … but … a normal reaction to a distressing situation” (pp. 141–148). He went on to describe the symptoms of normal grief as “waves” of physical distress “lasting from twenty minutes to an hour,” “tightness in the throat, choking,” “shortness of breath,” “sighing,” “an empty feeling in the stomach,” weakness, “tension,” and poor appetite. Additionally there is a feeling of “unreality,” withdrawal from others, “preoccupation with the image of the deceased,” thoughts of negligence and “guilt,” anger, “restlessness,” pressure of speech, and an inability to “initiate and maintain organized patterns of activity.” Lindemann said that the length of the grief reaction depended on the person’s success in completing the grief “work.” He and other researchers have described the overall effects of grief on the lives of the bereaved, the consequences of loss for the physical, social, emotional, behavioral, and intellectual functioning of the bereaved.

Marris (1958) studied widows in London, England. He found many of the same symptoms that Lindemann did but also commented on the widows’ inability to acknowledge their loss. They brooded over their memories, clung to possessions, felt the presence of the deceased, and talked to them.

In 1965 Gorer reported that among the 80 bereaved he studied, 15 said that they never forget and never get over the loss.

Parkes (1972) calls grief the price paid for love. Grief and joy are both part of life. If people ignore that truth, then they will be unprepared for life’s losses. Parkes likens a loss to a physical injury. It is a blow; a wound occurs, and there is healing. When complications or other injuries occur, healing does not take place or is retarded. Tatelbaum (1989, p. xiii) also uses the metaphor of a wound and suggests “tools” for healing in her book You Don’t Have to Suffer.

In Lopata’s 1973 study of widows, 48% of the participants told her that they were over their husbands’ deaths in a year’s time. But 20% said that they were not over their husband’s death and did not expect ever to get over it.

A 1974 study (Glick, Weiss, and Parkes) revealed that men and women react differently to being bereaved. In that study, the men felt that they had lost part of themselves, but the women felt abandoned. Although the men accepted the death more rapidly, they were uncomfortable expressing grief and found it harder to work during their bereavement than did the women.

Loneliness, a common complaint of widows and widowers, appears to differ among widows in urban and rural locations. Kunkel (cited in Atchley, 1988) found that only a fourth of a sample of widows in small towns had problems with loneliness. Lopata (1973) and Blau (1961) found much greater loneliness among urban widows. Atchley’s (1975) study revealed no difference in loneliness reported by older widows and widowers.

Berardo (1968, 1970) believes widowers have more difficulty adjusting than widows because men are unaccustomed to taking care of a household and of themselves. However, Bell (1971) concluded that older widows have more problems than older widowers because women encounter more financial hardships, have fewer opportunities to remarry, and lose the role of being a wife, which is more important to them than being a husband is for men. They become more socially isolated. In Atchley’s (1975) comparison of widows and widowers, aged 70 to 79, he found more anxiety among widows, while the widowers suffered more from alienation, normlessness, and powerlessness. Widowers were more active socially, especially in the case of the working class. Atchley decided that working-class widows were less socially active than widowers because of inadequate income, which lowered their social participation and increased their loneliness.

Kunkel (cited in Atchley, 1988) compared widows and widowers over age 50 who lived in a small town. She found that although widowers had less interaction with their families and friends than did widows, they were satisfied. Widows had more interaction, but they were not satisfied and wanted more.

In 1981 Susser reviewed 14 studies spanning the years 1858 to 1981, which indicated that widowed men die more readily after the death of their spouse than do women. In the first 6 months after the deaths of their wives, men die at a rate exceeding that of married and remarried men. That mortality was still observable in a follow-up three years later. Susser questions whether these results should be attributed to the distress caused by the loss itself or to the stress of bereavement caused by the environmental situation.

When researchers separate the widows and widowers who gave longterm care to sick spouses from those whose spouses died suddenly, a different picture emerges. Smith (cited in Traub, 1990) studied 5,000 married couples from 1968 through 1989 and found that 13% of the men and 49% of the women who cared for their deceased spouses through a prolonged illness were more likely to die than the non-widowed.

Wolfelt (1990) sees men’s grief as naturally complicated because of difficulty in overcoming their social conditioning to repress their feelings; they need to appear self-sufficient, cannot let themselves appear nonproductive, and cannot ask for help.

In 1989 Zisook (cited in Ritter, 1989) reported on a study of 300 widowed people and determined that those aged 56 and older did better than those aged 55 and younger. Older widowed people suffered less depression and anxiety 7 months after the death of the spouse than did the younger widowed.

Bereavement is different for men and women, and also for parents of deceased children. Sanders (1979–1980) interviewed 109 individuals who had relatives who had died. She found that bereaved parents experienced more intense grief, a wider range of reactions, and greater emotional and physical distress than people whose parents or spouses had died. Rando (1985) reviewed that study and others and concluded that the “unique factors of parental bereavement” (pp. 19–23) contribute to their profound grief. These parents experience survival guilt, a threat to their immortality, loss of hopes and dreams for the child, loss of the child’s love, and loss of the parental role. They are often unable to support each other because of their individual grief and grieving styles and are reminded through a lifetime that the deceased child is not alive to achieve any of the normal milestones. Other parents may find their loss so upsetting that they do not know what to say or do and end up avoiding them.

In 1986 Knapp studied parents’ reaction to the death of a child. He talked with 150 families and found common themes. The agony over the death of a child endures, as do the memories, which the parents do not want to relinquish. They wish for their own death. They search for meaning and become more tolerant, focus more on the family, and often turn to religion as they look for a reason for survival.

In 1985 Obershaw spoke to the Widowed Persons Service conference on the myths about grieving. He debunked the myths, saying that grief is not something a person gets over. People get through it, and do so by working at it, not by waiting for time to heal them. That they suffer the pain of grief does not mean that the bereaved have lost their faith; it means that they have experienced a traumatic loss. He does not believe in anticipatory grief, nor does he think individuals go through demarcated stages of grief. There is no steady forward movement. There are setbacks, up and downs, and always new challenges. Obershaw thus sees loss and grief not as despair, but as an opportunity for new experiences and growth.

When Silverman wrote Helping Women Cope With Grief (1981), she indicated that people know who they are by the way others treat them. When there is the loss of an important relationship, disorganization occurs. The bereaved need to develop new identities based on changed responsibilities, interests, and directions in their lives.

Children are not immune to the suffering of bereavement. Because of their dependence on adults for care, communication, and understanding, they may have more problems with loss than do adults. Loss that is realized and integrated at one age rears up and needs to be worked through at another age. As children go through developmental stages, their mentality changes. What was settled at age 3 needs to be revisited at age 13.

In 1985 Sandra Fox spoke on children’s understanding of death, explaining that children through the age of 5 do not conceptualize death. They think the dead are still alive but living in a different dimension. They wonder how the deceased manage to go about their activities of daily living in their changed circumstances.

By the time children reach the age of 6, they understand that death is not reversible and struggle to understand it. They wonder who dies, why they die, and what happens to them.

Children aged 9 to 12 have an intellectual understanding that no one escapes death. They want to be involved in tangible death rituals, such as the funeral.

Adolescents are outraged by death. They are dramatic in their sorrow or embarrassed by the occurrence of a death. They are able to grieve openly with their friends over the death of a friend, but feel different and set apart from their friends when there is a death in their family.

Kastenbaum’s (1967) explanation of children’s reactions to death is similar to Fox’s. Nagy (1948) studied children aged 3 to 10 and agrees with these developmental delineations. She posits that children’s main questions are, “What is death?” “What makes people die?” and “What happens to people when they die; where do they go?” (p. 327).

Bowlby (1980), Furman (1964), and Freud and Burlingham (1942) wrote about their observations of grief in very young children. Furman points out children’s differences in ability to comprehend death. Some 2-year-olds can understand what some 5-year-olds cannot. Bowlby and Freud and Burlingham have documented grieving observed in infants.

In validating the effects of early loss at later stages of development, Brown (1982) wrote that the death of a child’s mother leads to clinical depression later in life. Silverman (1987) found that college-aged women continued to be tearful and have trouble talking about the death of a parent years after it occurred.

Researchers and practitioners agree that children should be told about death, allowed to participate in the rituals related to the death, be given time to mourn in their own way, and helped to feel secure in their living situation.

PHASES OF GRIEF

Many researchers who have studied the symptoms of grief believe that the bereaved go through identifiable phases on their struggle toward a life-style that incorporates memories of the deceased and adjustment to their absence. The number of phases ranges from Pollock’s (1961) two to Westberg’s (1973) ten. In 1961 Engel designated six phases, which he labeled shock and disbelief, developing awareness, restitution, resolving the loss, idealization, and the outcome. The idea of phases took hold when Kubler-Ross popularized the five phases of dying in 1969. The phases of denial (this can’t happen to me), bargaining (give me one more chance and I will never tell another lie), anger (life is unfair), depression (it is hopeless), and acceptance (peace and readiness to move on) have also been applied to grief. Parkes (1972) identified four phases, which he called numbness, searching and pining, depression, and recovery. O’Connor (1984) wrote of stages of grief that incorporate the tasks of the bereaved: breaking old habits, beginning to reconstruct life, seeking new love objects and friends, and readjustment completed.

Briese and Farra (1984) proposed that grief theory based on phases is misleading, that no one goes through the phases sequentially, and that the ideal stage of acceptance or recovery is unrealistic and unhelpful. They suggested an alternative way of viewing the grief process that they believed was more acceptable to men. Instead of a method based primarily on emotion, they proposed a model based on life components, namely, self, others, work, community, and transcendence. Depending on the stresses, responsibilities, and priorities of life, a person invests more or less ener...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• CHAPTER 1 A Theoretical Overview
• CHAPTER 2 The Why and Wherefore of Bereavement Support Groups
• CHAPTER 3 Getting Them to Come
• CHAPTER 4 Setting Up a Bereavement Support Group
• CHAPTER 5 Structured Bereavement Support Groups
• CHAPTER 6 Unstructured Bereavement Support Groups
• CHAPTER 7 Groups for Special Populations
• CHAPTER 8 Group Participation Troubleshooting
• CHAPTER 9 After All Is Said and Done
• Book Bibliographies for Support Group Participants
• References
• Index