New Models of Bereavement Theory and Treatment

New Mourning

George Hagman

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781317610519
• Topic: Psicología
• Subtopic: Salud mental en psicología

Honoring the centennial of Sigmund Freud's seminal paper Mourning and Melancholia, New Models of Bereavement Theory and Treatment: New Mourning is a major contribution to our culture's changing view of bereavement and mourning, identifying flaws in old models and offering a new, valid and effective approach.

George Hagman and his fellow contributors bring together key psychoanalytic texts from the past 20 years, exploring contemporary research, clinical practice and model building relating to the problems of bereavement, mourning and grief. They propose changes to the asocial, intra-psychic nature of the standard analytic model of mourning, changes compatible with contemporary psychoanalytic theory and practice. Arguing that the most important goal of mourning is often to preserve, rather than give up the relationship to the deceased, this book provides a more positive, hopeful model. Crucially, it emphasizes the importance of mourning together, rather than alone.

New Models of Bereavement Theory and Treatment: New Mourning will be the go-to resource for researchers, clinicians and interested lay people seeking a clear, accessible overview of contemporary mourning theory, useful in their daily lives and in clinical practice. It will appeal to psychoanalysts, psychotherapists, grief counsellors, as well teachers, undergraduates and advanced students studying in the field.

Chapter 1
Mourning

A review and reconsideration (1995)

George Hagman

Editor’s note: I begin this selection of papers with a survey and reformulation of bereavement and mourning theory. In this paper I review the development of the standard psychoanalytic model of mourning and offer a critique from several perspectives. The psychoanalytic model of mourning, while useful in its depiction of a certain type of process, may not be valid as a general model. First, the psychoanalytic literature and data from clinical practice fails to confirm basic components of mourning theory. Second, some non-analytic research is at odds with several of the model’s key assumptions, and historical studies have shown how individuals in Western culture have mourned differently over time. Finally, from a cross-cultural perspective, it is also clear that there is infinite variety in people’s responses to death, in how they mourn, and in the nature of their internalization of the lost object. In closing, I propose a perspective on bereavement that, rather than being process-oriented, understands mourning to be an adaptive response to specific task demands arising from loss, which must be dealt with regardless of individual, culture or historical era.

This paper was published in 1995 by George Hagman as ‘Mourning: A Review and Reconsideration’ in the International Journal of Psychoanalysis, Volume 76.

Among the clinical constructs of psychoanalysis, few have been as influential as the ‘work of mourning’. The model of mourning as a painful process of identification, decathexis and re-cathexis in reaction to the loss of a loved one is the cornerstone of the contemporary Western understanding of bereavement and has been used by psychoanalysts since 1917 (Abraham, 1927; Fenichel, 1945, p. 394; Nunberg, 1955; Pollock, 1961; Rochlin, 1965, pp. 154–5; Kohut, 1972; Greenson, 1978, p. 267; Loewald, 1980, pp. 257–76; Meissner, 1981, pp. 173–4; Volkan, 1981, pp. 67–8; Frosch, 1990, p. 369; McWilliams, 1994, pp. 109–10). This model has had a significant effect on how we view ‘normal’ or ‘healthy’ mourning, and it has defined for us when and how mourning becomes pathological. In fact in a survey of bereavement experts, 65.7 per cent claimed psychoanalytic theory to be one of the three most useful models (Middleton et al., 1991, p. 506). In recent years, a number of writers have studied mourning from historical, ethological, cultural and clinical perspectives; however, there has not been a thorough critical review of the psychoanalytic model of mourning since Siggins’s contribution in 1966.

The concept of mourning has been extended to various forms of loss (Furman, 1974; Pollock, 1989). I will concentrate here on one form – bereavement, the death of a loved one. More specifically, I intend to limit our focus to the psychoanalytic model of the normal mourning process, notwithstanding that the distinction between normal and pathological mourning is often hard to make, and may be only of heuristic value. I will argue that the standard model of mourning is not a reliable or accurate model of normal mourning, and I will offer what I believe may be a more accurate way of viewing grief. Unfortunately, we will be unable to consider the extensive literature on pathological mourning, as this would divert us from our primary focus (for an excellent comprehensive review of the literature on pathological mourning see Rando, 1993).

I will embark on this critical review in full recognition of the importance of Freud’s model of the intrapsychic dynamics of mourning for psychoanalytic theory – from our understanding of the development and nature of the ego to the internal world of object relations. As metapsychology Mourning and Melancholia is a monumental and seminal work. What I intend to question is the adoption by subsequent analysts, mental health professionals, social theorists and others of Freud’s description of mourning as a general model of the normal process. In fact it is not clear whether Freud ever intended to promulgate a ‘standard’ model of mourning. As Furman (1974) points out, Mourning and Melancholia can be misleading if considered by itself:

It was written during a period when Freud’s investigative efforts focused on the understanding of narcissism and the ‘critical faculty’, and when he tried to clarify processes in melancholia. For this purpose he sets up a model situation for mourning (Siggins, 1966, p. 16) but does not attempt to portray actual mourning processes in their full clinical complexity and theoretical implications.

(pp. 241–2)

I will begin by reviewing Freud’s writings on mourning, followed by a survey of the contributions of other analysts. I will then discuss some of the relevant clinical, historical and cultural research data. In conclusion, I will reconsider our understanding of mourning in the light of this new knowledge.

Review of the psychoanalytic literature

The psychoanalytic literature on ‘normal mourning’ is not extensive. Nonetheless, there have been significant contributions from a variety of schools of thought. This paper will focus on those parts of the literature that have contributed to the model of mourning first delineated by Freud in his paper Mourning and Melancholia (1917).

Before 1917 Freud discussed mourning in several papers (Freud & Breuer, 1895; Freud, 1909, 1915). However, in these three instances he approached mourning from the perspective of psychopathology (for example, in his study of the Ratman, Freud [1909] showed the role of competitive rivalry in pathological mourning) or in primitive mental life. It was not until Mourning and Melancholia that Freud offered his major contribution to the study of normal mourning in a brief section that served as the introduction to his discussion of melancholia. He began with the question:

Now in what consists the work which mourning performs?… The testing of reality, having shown that the loved object no longer exists, requires forthwith that the libido shall be withdrawn from its attachment to this object. Against this demand a struggle of course arises – it may be universally observed that man never willingly abandons a libido-position, not even when a substitute is already beckoning to him.… The normal outcome is that deference for reality gains the day. Nevertheless its behest cannot be at once obeyed. The task is carried through bit by bit, under great expense of time and cathectic energy, while all the time the existence of the lost object is continued in the mind. Each single one of the memories and hopes which bound the libido to the object is brought up and hyper-cathected, and the detachment of the libido from it is accomplished.… When the work of mourning is completed the ego becomes free and uninhibited again.

(Freud, 1917, pp. 244–5)

Freud observed the symptoms of mourning to be similar to melancholia: (a) a profoundly painful dejection; (b) abrogation of interest in the outside world; (c) loss of the capacity to love; and (d) inhibition of all activity. Present in cases of melancholia, but absent in normal mourning, is ‘lowering of the self-regarding feelings to the degree that finds utterance in self-reproaches and self-reviling’ (Freud, 1917, p. 244), the difference being due to ambivalence towards the lost object on the part of the melancholic.

As to why the mourning process should be so painful, at first Freud was not sure. Later, in Inhibitions, Symptoms and Anxiety, he asserted that separation should be painful in view of ‘the high and unsatisfiable cathexis of longing which is concentrated on the object by the bereaved person during the reproduction of the situations in which he must undo the ties that bind him to it’ (Freud, 1926, p. 172).

As to the abrogation of interest, loss of capacity to love and general lessening of vitality, Freud saw this as an ‘inhibition and circumscription of the ego’ in its exclusive devotion to mourning ‘which leaves nothing over for other purposes or other interests’ (Freud, 1917, p. 244). This pervasive inhibition of the ego and restriction of the libido lessens as the work of mourning (the successful decathexis of the object) is accomplished and ‘the ego becomes free and uninhibited again’ (Freud, 1917, p. 245).

Later analysts would add identification with the lost object to Freud’s model (Abraham, 1927; Fenichel, 1945). In another context, Freud himself seemed to be saying this when he stated in The Ego and the Id, ‘It may be that this identification is the sole condition under which the Id can give up its objects’ (Freud, 1923). For example, Abraham notes that the bereaved person effects ‘a temporary introjection of the loved person. Its main purpose is to preserve the person’s relation to the lost object’ (Abraham, 1927, p. 435). Fenichel supported Abraham’s point in 1945. In any case, though Freud did not specifically include identification in his original model of the mourning process, his other references to object loss and the contributions of his close supporters have led to identification being included in the standard psychoanalytic model.

In 1937 Deutsch offered an observation which has also been integrated into psychoanalytic thinking: that is, the absence of grieving is indicative and/or predictive of psychopathology. She writes:

every unresolved grief is given expression in some form or other.… The process of mourning as a reaction to the real loss of a loved person must be carried to completion. As long as the early libidinal or aggressive attachment persists, the painful affect continues to flourish, and vice versa, the attachments are unresolved as long as the affective process of mourning has not been accomplished.

(Deutsch, 1937, pp. 234–5)

Another feature of the psychoanalytic model of mourning is ambivalence. Freud himself introduced the notion that the essential dynamic distinction between normal mourning and melancholia is the predominance of libidinal cathexis in the former and aggression in the later. Abraham, Fenichel and Jacobson would provide support for this viewpoint. It has therefore become accepted that successful mourning can only occur when there is a predominance of feelings of love towards the lost object.

Finally, in recent years the notion of mourning as a phylogenetically based, adaptive response to loss has been put forth by Pollock (1961). Combining etho-logical research with observations of human bereavement, Pollock claimed that the mourning process, as we have come to know it, is biologically grounded, having developed over evolutional time to insure optimal survival in the face of separation and loss. In many publications Pollock argued for the acceptance of the standard theory of mourning as a universal, adaptive process. Unfortunately, space will not permit a full appreciation of Pollock’s rich contribution to the literature of mourning. Suffice it to say that Pollock, single-handed among analysts, wrested Freud’s mourning theory from fifty years of neglect and argued for its inclusion in contemporary theory and practice.

The aforementioned psychoanalysts constructed the standard model of mourning from common sense, personal experience and through extrapolation from theories regarding the dynamics of depression. Even in Mourning and Melancholia Freud offered no clinical data to support his statements regarding mourning, nor did he claim to have carried out any formal investigation of the matter. In fact Freud’s only recorded clinical example was his observation (outside the consulting room) of a woman who, having suffered numerous losses, engaged in an obsessive method of disengaging from her deceased loved ones (Freud & Breuer, 1895). Freud used the example for the purpose of illustrating the occurrence of neurotic symptomatology in a case of bereavement; he did not see this woman as ‘normal’. Abraham (1927) later noted the intuitive nature of Freud’s findings regarding melancholia and mourning, and asserted the need for verification. Almost half a century later, Pollock would point out that ‘until the early 1960s surprisingly few investigations had been made of the mourning process per se by psychoanalysts and others involved in psychological research’ (Pollock, 1961). Even in Pollock’s case, his thinking on mourning was developed, he states, from his own mourning and his observation of family members (Pollock, 1989, p. 13). Finally, as recently as 1993 Selby Jacobs continued to lament our limited understanding of normal mourning. Therefore, essentially by default, Freud’s model of mourning has remained the standard one. In fact, as recently as the 1990 edition of Psychoanalytic Terms and Concepts, edited by Moore and Fine, the definition of the term mourning is a restatement of Freud’s original formulation. There, mourning is defined as:

The mental process by which one’s psychic equilibrium is restored following the loss of a meaningful love object… it is a normal response to any significant loss. The predominant mood of mourning is painful and is usually accompanied by loss of interest in the outside world, preoccupation with memories of the lost object, and diminished capacity to make new emotional investments. Uncomplicated mourning is not pathological and does not require treatment. With time the individual adapts to the loss and renews his or her capacity for pleasure in relationships. Although reality testing is preserved and confirms that the loved object no longer exists, in the internal process of mourning the aggrieved person initially is unable to withdraw attachment from the lost object. Instead the mourner turns away from reality, through denial, and clings to the mental representation of the lost object. Thus the object loss is turned into an ego loss. Through the stages of the mourning process, this ego loss is gradually healed and psychic equilibrium restored. The work of mourning includes three successive, interrelated phases; the success of ...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Contributors
• Preface: New mourning
• Acknowledgements
• Introduction
• 1 Mourning: A review and reconsideration (1995)
• 2 Object loss and selfobject loss: A contribution to understanding mourning and the failure to mourn (1990)
• 3 The psychoanalytic understanding and treatment of double parent loss (1993)
• 4 Flight from the subjectivity of the other: Pathological adaptation to childhood parent loss (1996)
• 5 Mourning theory reconsidered (1994)
• 6 The role of the other in mourning (1996)
• 7 Mourning and the holding function of shiva (1993)
• 8 Self experience in mourning (1995)
• 9 Detachment and continuity: The two tasks of mourning (1997)
• 10 Some observations of the mourning process (2010)
• 11 Out of the analytic shadow: On the dynamics of commemorative ritual (2011)
• 12 New mourning: A new psychoanalytic understanding and treatment of mourning
• Index