Understanding Loss

A Guide for Caring for Those Facing Adversity

Judith Murray

• Publisher: Taylor & Francis
• Year: 2015
• eBook ISBN: 9781317571247
• Edition: 1
• Topic: Psychology
• Subtopic: Health Care Delivery
• Index: Psychology

Loss and consequent grief permeates nearly every life changing event, from death to health concerns to dislocation to relationship breakdown to betrayal to natural disaster to faith issues. Yet, while we know about particular events of loss independently, we know very little about a psychology of loss that draws many adversities together. This universal experience of loss as a concept in its own right sheds light on so much of the work we do in the care of others. This book develops a new overarching framework to understand loss and grief, taking into account both pathological and wellbeing approaches to the subject.

Drawing on international and cross-disciplinary research, Judith Murray highlights nine common themes of loss, helping us to understand how it is experienced. These themes are then used to develop a practice framework for structuring assessment and intervention systematically. Throughout the book, this generic approach is highlighted through discussing its use in different loss events such as bereavement, trauma, chronic illness and with children or older people. Having been used in areas as diverse as child protection, palliative care and refugee care, the framework can be tailored to a range of needs and levels of care.

Caring for people experiencing loss is an integral part of the work of helping professions, whether it is explicitly part of their work such as in counselling, or implicit as in social work, nursing, teaching, medicine and community work. This text is an important guide for anyone working in these areas.

Part 1 Introduction

Loss is not new

Loss is not new! For as long as humans have existed, for as long as they have formed attachments and relationships and been able to feel emotion, grief has existed. Much of the great literature of the world has spoken about the pain of the human condition, about loss – death, illness, and the loss of love, family, trust, home and country. All the great religions of the world give comfort to human suffering. Burial grounds and monuments of the world remind us that grief is not something that has been invented in the twentieth century.

The happiest life consists of ignorance, before you learn to grieve and to rejoice.

From Ajax, Sophocles, 496–406 BC

Each substance of a grief hath twenty sorrows.

From Richard II, William Shakespeare

Unending search in endless quest

So cold and still, how cold and still;

By grief and anguish, grief and anguish hard oppressed.

This season of sudden change from warm to chill

Weighs down the heart in search of peace …

Tell me, with this, with all this,

How can one word “sorrow” paint what sorrow is?

Li Ch’ing Chao, 1084–1151

We have always sought to understand this experience; yet it still eludes us in many ways. With the recognition of the awe-inspiring mystery of this deeply human experience, this book will seek to explore the science of loss. It will seek to collect the knowledge in a systematic way that will make the knowledge useful to the care of those facing the pain of loss.

This Part 1 offers a discussion of the various understandings of loss as it exists within adverse life events. Part 2 of the book explores in some depth the existing knowledge associated with many situations that involve loss. It seeks to organize this knowledge in a thematic manner that when considered in its entirety offers a means of giving some structure to the phenomenon of loss. Part 3 then seeks to show how this systematic understanding of loss can be utilized within practice to enhance the wellbeing of those affected by loss.

This book does not provide a definitive statement concerning a psychology of loss. It seeks to present a manner of organization of existing knowledge in the area of loss that it is hoped will support and enhance existing efforts toward integration already provided by other proponents of a psychology of loss. This book therefore seeks to stimulate further discussion and refinement of the ideas in this vital area of study of what it means to be human. It seeks to add to the call for an understanding of loss and grief to not only be a core part of the practice of psychological health, but in fact to be a core foundation of the care offered by all disciplines, sectors and the community at large to those facing adversity.

Please embark with me on this journey in the spirit of openness and curiosity. This is a truly fascinating world of knowledge we will explore.

1 Finding a place for a psychology of loss

Judith Murray

DOI: 10.4324/9781315737775-1

Loss and grief have been mentioned and studied for many years. However, such study has often only been consequent to the study of specific areas, most notably bereavement. Serious life/loss events have been linked to problems such as depression (Tennant, 2002). Less common has been the recognition of loss as the larger encompassing concept deserving of study in its own right. Early proponents who have called for developing a psychology of loss have argued that loss is deserving of its own consideration for a number of reasons. Harvey and Weber (1998) argue that a psychology of loss forms an implicit assumptive base for other concepts such as stress, death and dying, and trauma; that loss is universal; and that there exists in the community a culture, and hence a language, of loss. Others have come to the conclusion in their study of a specific area that a study of loss does indeed permeate that area and many other areas. In their comprehensive review of bereavement, Stroebe, Hansson, Stroebe and Schut (2001) also advocate a need to advance study in the area of loss:

The study of loss offers a framework with which to search for commonalities versus differences with respect to the nature of these life events and the ways of coming to terms with them. It also encourages comparison of theoretical analyses of different types of stressors… . A psychology of loss then, would incorporate comparative trauma-bereavement theorizing and the analysis of a broad range of stressful life events including burns; divorce/separation; spinal/brain injury or loss of limb; rape victimization; and so on.

(p. 743)

These writings provide some of the arguments being advanced for the recognition of the value of a study of a psychology of loss. However, this may simply be a case of academia catching up with the general population who live each day with loss, as well as the clinicians who work with loss. People facing adverse life events often speak much of the loss in their lives. While they may present with one particular problem, many speak of the many losses associated with the event, or speak of losses of the past that affect their ability to live with the loss that confronts them in this moment in time.

Yet, while there is an implicit understanding of loss among all peoples, for there to be an advancement of a psychology of loss there needs to be a systematic study of the concept as it is manifested in adverse life situations. It needs to be possible to communicate the knowledge and practice to others interested in such a branch of study. It must also provide frameworks for further exploration and determination of favorable and unfavorable conditions and outcomes, a set of understandings and an underlying basis for working with those affected by loss. The existing literature, while extremely valuable, provides limited systematic organization of the area. This book therefore seeks to advance the psychology of loss by presenting a framework for loss into which much of the existing knowledge can be integrated, yet still encourages the reader to explore many specific areas of loss in greater depth.

Advances in science and the strong adherence to the scientific method have not only brought about great advances in our way of life, but they have also led us to believe that every aspect of life can and should be reduced to explainable parts. Gaining a scientific understanding of emotional responses and mental processes has helped to remove the stigma and improve the care of many of those who in the past had been rejected by society. No longer is mental illness equated with being possessed by demons. Grief has become a subject of study and through such study our knowledge of grief has grown. However, some (e.g. Walter, 2000) would argue that the inclusion of grief in the same texts as those describing mental illness and potential cures for such conditions has also damaged many. Any suggestion of grief as a condition requiring treatment by a specially trained professional may have disenfranchised the general community from its rightful place in the care of those faced with loss and removed its discussion from the hands of the poet, the artisan and the philosopher to the sterile words of the scientist. Hence in considering the discussion of the science of loss in this book, it is imperative that we remember that science within psychology is simply the systematic manner in which we can study the human experience of loss. The stories that give us the science are the real stories of real people who grieve. Comprehensive scientific knowledge will never replace the respect that we as scientists need to bring to our encounters with those who face loss.

What is loss?

Life and change

Before we talk about loss, we need to talk about life – and in talking about life we need to talk about change. Humphrey and Zimpfer (1996) put it this way:

Loss is an integral part of life. It is not something that happens to us as we live; rather, it is life itself. Death is not the only loss a human might experience; yet it is often the only loss that is validated as a legitimate grief experience. In our view, any event that involves change is a loss that necessitates the process of grief and transition.

(p. 1)

Change is part of life. For two people, a similar change in their lives can be viewed as positive for one and negative for another. A man who dislikes his job and has a number of sought-after skills will most likely have numerous options for employment. For him, being made redundant might be seen as a positive event, in contrast to a man for whom redundancy may mean long-term unemployment and financial crisis for his family. For the former man, change is seen as a challenge, an opportunity; for the latter man, change is a source of distress, a loss. Hence it could be argued that it is the interpretation by a person of change as a threat, and the attempt to endure that change, that constitutes loss. Parkes (1988) discusses psychosocial transitions rather than change, with such transitions being defined as life events that require people to make major revisions in their world, are lasting in their implications and happen over a relatively short period of time. Even a simple word like change is not always understood universally.

The differing meanings of loss

This confusion about the term change highlights a very important issue in the area of loss and grief: a common language. This issue must be discussed before we can be sure that what will be communicated in this book will actually be interpreted by the reader as intended.

We use the words loss and grief commonly in our academic literature and our everyday speech and often assume that we share the same understanding of these concepts as do those to whom we address our communication. It is likely that this is an assumption that we can’t actually make.

Before we even consider a common language, we perhaps need to consider if there is even indeed a universal concept on which we could base such a common language. During the last few decades, there has been increasing interest in the issue of psychic unity and the universality of emotions versus cultural diversity (Eid & Diener, 2001) resulting in the consensus that there are both universal and culture-specific norms for experiencing emotions or presenting distress. This debate has included a discussion about the universality of grief (Klass, 1999). Studies of biology have also recognized commonality of reactions to stress and distress. Many argue that loss is such an integral part of our lives because humans are social animals and hence grief can be considered from an evolutionary perspective that suggests it is a result of natural selection (Archer, 2001a). It has even been suggested that the location of physical pain centers in the brain close to those that are activated during times of social rejection has been an evolutionary measure to ensure that humans as social animals, when removed from those necessary to his or her survival and wellbeing, are given a powerful physical warning system that all is not well (MacDonald & Leary, 2005). As such, the physical effects of grief often described in the literature and by people in words like a ‘broken heart’ indeed may have a biological basis. In common with other social animals, Parkes (2001) argues that loss, such as bereavement, creates in us alarm, separation reactions and changes to an assumed world. However, he goes on to suggest that four factors profoundly influence human reactions compared to those of other social animals. He argues that humans have the ability to imagine and rehearse complex models of the world; the ability to postpone or avoid disturbing thoughts; the ability to communicate models of the world; and the ability to communicate social expectations of behavior, thoughts and feelings.

Hence there appears to be growing evidence that humans in general are affected by loss and have been affected ever since humans began to live within social groups. However, the social institutions of different groups who evolved together have resulted in different interpretations of these universal concepts, and one of these differences is in the language and the discourses around concepts such as death. Toynbee (1980) argues that different cultures will talk differently about death depending on whether they are death-accepting, death-denying or even death-defying societies; whether death is seen as the end of existence or as a transition to another state of being or consciousness; whether an afterlife is perceived as a continuation of the individual or as one becoming part of a oneness. Even within apparently homogeneous cultures, the language of grief can differ as the result of other subcultural groupings such as social class or educational background. For example, in cultures of very strong contrasts of social class where child death among lower classes is common while a rarity in upper classes, the popular language around child death may not match that of the more official language mainly determined by upper ruling classes.

Barnhart (1988) suggests that the word loss emerged in the twelfth century and was equated with death and destruction. Since that time the word loss for many has continued to be equated with a particular event. However, it has also slowly been accepted into the language in terms of other adverse life events: the loss of a relationship, the loss of a job or t...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents
• List of tables
• List of figures
• Part 1 Introduction
• Part 2 Understanding
• Part 3 Enablement: taking our understanding into practice
• In conclusion
• Index