Continuing Bonds in Bereavement

New Directions for Research and Practice

Dennis Klass, Edith Maria Steffen, Dennis Klass, Edith Maria Steffen

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351784924
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The introduction of the continuing bonds model of grief near the end of the 20th century revolutionized the way researchers and practitioners understand bereavement. Continuing Bonds in Bereavement is the most comprehensive, state-of-the-art collection of developments in this field since the inception of the model. As a multi-perspectival, nuanced, and forward-looking anthology, it combines innovations in clinical practice with theoretical and empirical advancements. The text traces grief in different cultural settings, asking questions about the truth in our interactions with the dead and showing how new cultural developments like social media change the ways we relate to those who have died. Together, the book's four sections encourage practitioners and scholars in both bereavement studies and in other fields to broaden their understanding of the concept of continuing bonds.

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INTRODUCTION

Continuing Bonds—20 Years On

Dennis Klass and Edith Maria Steffen

Since the continuing bonds model of grief was introduced into bereavement studies in Continuing Bonds: New Understandings of Grief (1996), it has been extended from its origins in psychology into other disciplines and adopted in a surprising range of cross-cultural studies. In turn, developments in other cultures and disciplines have fed back into the psychological study and treatment of grief. We think the far-flung developments provide a solid basis for new directions in research and practice. The purposes of this anthology are, first, to show the range of ways the continuing bonds model has been used; second, to trace how the model has been expanded and enriched through this process of cross-fertilization and proliferation; and third, to encourage further cross-fertilization by having so many of the developments together in the same book.

While there appears to be a consensus that continuing bonds are a central aspect of grief, some active discussions and ongoing controversies remain. For example, there are disagreements about the nature of the bonds, how they fit into cultural narratives, and how “adaptive” they are when viewed in the context of Western mental health. We find stark differences in the scholarly discourses, as well as in lay opinion about the reality status of the deceased people with whom the living remain bonded and sharp differences about the empirical reality of the experiences through which continuing bonds are often experienced.

Most sides of the disagreements are represented by authors in this book. We do not think it is helpful, however, to cast the differences in either/or statements or in oppositional language. We are bringing together many developments and perspectives because we hope that by having so diverse a collection in one place, readers will find connections across disciplines, across populations, and across cultures. Furthermore, we hope that by presenting the broad range of settings in which continuing bonds are present and the variety of ways scholars and clinicians think about them, we can begin to develop a broader synthesis in which the views that now seem opposed to each other can all have a place.

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In this Introduction we first give a short overview of the continuing bonds model of grief. We have written it especially for readers from outside bereavement studies. Second, we set the developments in the continuing bonds model in the context of other developments in bereavement studies. Third, we describe four overarching themes that struck us as significant threads running through many of the book’s chapters. Finally, we outline how the chapters are organized. At the beginning of each of the book’s sections we have a brief introduction of the topic and chapters in that section.

The Origins of the Continuing Bonds Model of Grief

The book’s Prologue is a personal account of the origins of the term continuing bonds. The next few pages briefly sketch an overview of the scholarly background for readers who are unfamiliar with the history of the continuing bonds model of grief.

Even though scholarship and clinical work on continuing bonds are now grounded in many cultures, the model grew out of the discovery that the then-dominant Western model of grief did not account for important aspects of the experiences of bereaved people. This model replaced the theory of grief work that was rooted in an exaggerated, if not, some might say, obsessive adoption of some passages in Freud’s (1961) essay Mourning and Melancholia, published in 1917. He said that in the work of grief:

Reality-testing has shown that the loved object no longer exists, and it proceeds to demand that all libido shall be withdrawn from its attachments to that object. This demand arouses understandable opposition . . . people never willingly abandon a libidinal position, not even, indeed, when a substitute is already beckoning to them. This opposition can be so intense that a turning away from reality takes place and a clinging to the object through the medium of a hallucinatory wishful psychosis.

(p. 223)

In Mourning and Melancholia, Freud did not present any case material on the resolution of grief. When his daughter Sophie died, and later when her son died, Freud did not use the idea of grief work to understand his sorrow (see Klass, 2014). Right after Sophie died Freud connected how he responded to his lack of any religious sense.

Since I am profoundly irreligious there is no one I can accuse, and I know there is nowhere to which any complaint could be addressed. . . . Quite deep down I can trace the feelings of a deep narcissistic hurt that is not to be healed. My wife and Annerl are terribly shaken in a more human way.

(Jones, 1957, p. 20)

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Nine years after Sophie died, on what would have been her thirty-sixth birthday, he wrote to Ludwig Binswanger whose child had just died. He said he remained unconsoled (ungetröstet).

One knows that the acute grief after such a loss will lapse, but one will remain unconsoled, never find a substitute. (Man weiβ, daβ die akute Trauer nach einem solchen Verlust ablaufen wird, aber man wird ungetröstet bleiben, nie einen Ersatz finden.)

(Freud, 1960, p. 383)

Yet, for the next seven decades the overwhelming consensus among psychologists and psychiatrists was that for successful mourning to take place the mourner must disengage from the deceased, let go of the past, and move on.

The psychoanalytic idea of grief work was a radical change from the sentimental attachment to the dead in the middle and upper classes before the First World War. In “Footsteps of Angels,” a poem that was republished several times over the nineteenth century, Henry Wadsworth Longfellow described a visit from his wife, Mary, who died during a miscarriage in 1835:

With a slow and noiseless footstep

Comes that messenger divine,

Takes the vacant chair beside me,

Lays her gentle hand in mine.

. . .

Uttered not, yet comprehended,

Is the spirit’s voiceless prayer,

Soft rebukes, in blessings ended,

Breathing from her lips of air.

In the Freudian model, the poem would be evidence of Longfellow’s incomplete grieving.

Freud’s concept of grief work remained largely within the psychoanalytic circle until 1944, when Erich Lindemann (1979) began the contemporary discourse about grief. He defined acute grief as a psychiatric syndrome. Lindemann, who was a leader in the mental health movement in psychiatry, accepted the grief work model uncritically. That is, he thought that the task of grief was to sever the bonds with the dead, thus freeing the survivors to form new relationships that served individuals in their changed social environment. The concept passed quickly into popular usage. Lindemann thus codified the underdeveloped ideas about grieving of Freud’s essay, thereby giving the culture the concepts to make grief an individual matter for which psychiatric and psychological concepts and diagnoses provided the best explanations and paths to resolution.

Within the psychological/psychiatric hegemony, continuing an attachment with the dead was regarded as pathological grief. Widows beginning to date or marrying again was counted as evidence that they were over their grief. It was as if a woman could develop a new relationship with a man only if her deceased husband was fully out of her life.

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That theory proved inadequate to the data. In the 1980s, several researchers reported that seemingly well-adjusted survivors did not sever their bonds with the dead. People who continued their bonds said their ongoing relationship with a significant dead person helped them cope with the death, and supported their better self. Tony Walter put it succinctly:

The purpose of grief is . . . the construction of a durable biography that enables the living to integrate the memory of the dead into their ongoing lives; the process by which this is achieved is principally conversation with others who knew the deceased.

(1996, p. 7)

A bond with the deceased continues, but also changes the multi-dimensional bond with the living person. All the history in bonds between people when they were living continues into the bond after they die, although as we see in several of this book’s chapters, survivors may have opportunities to reshape the bond that they did not have when the person was living.

Phenomena that indicate active continuing bonds are a sense of presence, experiences of the deceased person in any of the senses, belief in the person’s continuing active influence on thoughts or events, or a conscious incorporation of the characteristics or virtues of the dead into the self. In individuals a continuing bond includes the part of the self actualized in the bond with the person, characterizations and thematic memories of the deceased person, and the emotional states connected with the characterizations and memories. Living people play roles, often complex, within the family and psychic system. After they die, roles change, but the dead can still be significant members of families and communities. Continuing bonds are, then, not simply mental constructs – that is, they are not just an idea, or a feeling.

The editors of Continuing Bonds: New Understandings of Grief never said they had developed a new model. They said their book articulated the consensus that had emerged among many bereavement scholars. Most psychological models of grief now accept that continuing bonds are a normal aspect of grief. George Hagman’s edited book (2016) shows that even some psychoanalysts accept that continuing bonds are normal.

Continuing Bonds in Bereavement Studies and Interventions

Although Continuing Bonds: New Understandings of Grief did not contain any chapters specifically addressing how continuing bonds may present themselves or be worked with in the consulting room, the book’s very inception was first and foremost a response to clinical perspectives, to the psychoanalytic theories that had informed them, and to the clinical practices that had arisen as a result of how these theories had been received, interpreted, and passed on. The grief work model became increasingly simplistic, one-sided, and removed from either scientific or human truths.

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The 1996 book became, then, a call to the clinical community to stop, look around, and take note of the clinical evidence that did not fit into the dominant model. Within a few years continuing bonds were an accepted aspect of grief in the psychological descriptions of grief and in clinical practice.

Not surprisingly, the early questions for clinicians and psychological researchers were whether continuing bonds contributed to “healthy” resolutions of grief, and then to what kinds of bonds were better for the bereaved than others. An early empirical strand of research investigated the “adaptiveness” of not breaking bonds to the dead. The research used measures of grief intensity and the attachment styles identified in Ainsworth’s stranger anxiety studies that were noted in the Prologue, but retained Bowlby’s understanding of attachment as a psychiatric construct measurable in individuals (e.g. Field et al., 2003; Stroebe & Schut, 2005). By searching for what may be “maladaptive” or “unhealthy” about continuing bonds (without, however, making transparent who decides what is healthy or unhealthy), that strand of research preserved a prescriptive medical model. The chapter by Samuel Ho and Ide Chan in this book shows the limitations of this research strand in a Chinese cultural setting.

It was tempting to move from the idea of continuing bonds being pathological, to continuing bonds as normal, and then to continuing bonds as good. Ten years on, in a response to the contributions in a special issue of Death Studies on continuing bonds, one of us (Klass, 2006) reminded readers that it was never the intention to replace old simplistic and prescriptive formulas with new ones. As many chapters in this book show, we have now moved to a more nuanced understanding of how the bonds function in individual and family life in different cultural settings, as well as how they function in the therapy process itself.

At the same time that the continuing bonds model was being enlarged, a group of researchers, largely quantitative, was pressing to define grief that merited treatment by mental health professionals. Rather than call it pathological, it was labeled prolonged grief disorder or complicated grief. Defining grief as a psychiatric diagnosis is part of what Heidi Rimke and Deborah Brock call “the shrinking spectrum of normalcy”:

The idea that some people are psychologically sick or disordered reflects the growth of the pathological approach, a distinctly Western and recent historical phenomenon, in which it is assumed that personal problems are individual and caused by biological and/or psychological factors.

(2012, p. 182)

As we decided whom to invite as contributors to Continuing Bonds: New Directions for Research and Practice, we did not want to isolate the experience of those seeking help from clinicians from those who do not, nor did we want to paint a picture of “healthy grieving” versus “pathological grieving” or of “adaptive” versus “maladaptive” continuing bonds. Instead, we wanted to open windows on the complex interweavings within diverse manifestations of continuing and discontinuing bonds in a nuanced way. We did not want to separate the psychological from the social and cultural but to see these as interlinked in complex ways. The scholarship, well represented in this book, that has grown around the construct of continuing bonds from disciplines other than psychology is as important for clinical practice as the latest empirical research in clinical and counseling psychology.

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The authors in this book are, then, for the most part reluctant to see pathology in grief as anything more than a cultural matter. That is, all cultures have guidelines for grieving and expectations of bereaved people. Among the book’s authors, the underlying viewpoint is that we should avoid drawing simplistic causal relationships and should be particularly careful when it comes to telling people how they should live – and grieve. By and large, then, scholars and clinicians who are extending and clarifying the continuing bonds model avoid getting involved in the questions of clinical diagnosis. The issues involved in labeling pathology show up in a few chapters in this book, but most of the chapters leave the matter aside.

Four Themes in the Book

A lot has happened in the way we understand continuing bonds and the issues to which the continuing bonds model has been applied since it was introduced. Few of the developments have happened in a straight line. Rather, as the chapters in this book show, the idea has been incorporated into a widely diverse set of clinical, cultural, and scholarly discourses.

We invited chapters from people we think have interesting, important, and novel contributions to the model. When we sent out invitations we had a provisional table of contents, but it was quite different from what we now have. As authors sent proposals and as we received drafts, we tried to let the structure of the book develop from the ground up rather than by fitting chapters into a preconceiv...

Table of contents

• Cover Page
• Continuing Bonds in Bereavement
• The Series in Death, Dying, and Bereavement
• Title
• Copyright
• Dedication
• Contents
• Series Foreword
• Prologue: A Personal History
• Contributors
• 1 Introduction: Continuing Bonds—20 Years On
• Section I Overview of the Continuing Bonds Model
• Section II Continuing Bonds and Clinical Contexts
• Section III The Truth Status and Reality Status of Continuing Bonds
• Section IV Continuing Bonds in Cultural Contexts
• Reflections and Conclusions: Going Forward with Continuing Bonds
• Index