The Nature of Grief

The Evolution and Psychology of Reactions to Loss

John Archer

• Publisher: Routledge
• Year: 2003
• ISBN:
  9781134683512
• Edition: 1
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

The Nature of Grief is a provocative new study on the evolution of grief. Most literature on the topic regards grief either as a psychiatric disorder or illness to be cured. In contrast to this, John Archer shows that grief is a natural reaction to losses of many sorts, even to the death of a pet, and he proves this by bringing together material from evolutionary psychology, ethology and experimental psychology.
This innovative new work will be required reading for developmental and clinical psychologists and all those in the caring professions.

1
Introduction
What is grief?

Every perturbation is a misery, but grief is a cruel torment, a domineering passion: as in old Rome, when the Dictator was created, all inferior magistracies ceased, when grief appears, all other passions vanish. It dries up the bones, saith Solomon, makes them hollow-ey’d, pale and lean, furrow-faced, to have dead looks, wrinkled brows, shriveled cheeks, dry bodies, and quite perverts their temperature that are mis-affected with it.

(Robert Burton, 1651, The Anatomy of Melancholy: 225–6, 1938 edn)

Approaches to the understanding of grief

The aim of this book is to provide an understanding of the process of grief, the reaction to loss. We normally think of grief as occurring in the context of bereavement, the loss of a loved one through death, but a broadly similar reaction can occur when a close relationship is ended through separation, or when a person is forced to give up some aspect of life that was important. I shall concentrate on examining the general features of grief in the context of losing a close relationship.

I begin by considering three different ways in which grief has been understood by those who have studied it in the past. It has variously been described as a natural human reaction, as a psychiatric disorder and as a disease process. Robert Burton’s description at the beginning of this chapter reveals all three aspects: it is a natural reaction or ‘passion’, yet it produces mental suffering and afflicts physical health. All three statements contain some element of truth, but the first one is perhaps the most useful for understanding the meaning and origins of grief.

Grief can be described as a natural human reaction, since it is a universal feature of human existence irrespective of culture, although the form and intensity its expression takes varies considerably. It also occurs widely in other social mammals and in birds, for example after loss of a parent, offspring or mate. Animals and young children show similar responses to temporary separations and permanent losses. Two types of reaction are shown under these circumstances, active distress and passive depression. These can also be identified in extended and modified form in the grief of adult humans, indicating that this has probably originated and developed from these simpler reactions.

Seeking medical help to alleviate the state of mind which follows bereavement has a long history, depression (melancholy) being acknowledged as a common and serious consequence of grief. Robert Burton described grief as a ‘cruel torment’. The nineteenth-century physician Benjamin Rush recommended bleeding, purges and opium for grief (Rush, 1812). More recently, it has been said that the study of grief has been hijacked by psychiatry. Certainly, the best-known pioneering studies were carried out in a psychiatric framework (Lindemann, 1944). The first scientific descriptions were obtained from people who had suffered bereavement under traumatic circumstances, or who had sought psychiatric help to overcome problems associated with grief. Two broad types of reaction were described: one, associated with a sudden and traumatic death or a dependent relationship, involved intense and prolonged grieving; the other, associated with the suppression of painful thoughts or with an ambivalent relationship, involved delayed grief.

While the study of grief from a psychiatric vantage point was undoubtedly necessary in view of the mental suffering such cases involved, it did distort the descriptions of grief that resulted. Both community-based and cross-cultural studies were necessary to redress the balance and to emphasise the range of reactions shown and their social context.

The present-day relation of grief to psychiatry is ambivalent. Whilst a large proportion of studies are still carried out by psychiatrists, grief itself has not —and never has been—classified as a psychiatric disorder.¹ Yet grief experienced under traumatic circumstances would be classified as a post-traumatic stress disorder; and intense and exaggerated forms of grief reactions, such as severe depression or pronounced panic or anxiety, can lead to a psychiatric diagnosis (Kim and Jacobs, 1993; Prigerson et al., 1994). Although a number of terms have been applied to the different forms of abnormal grief, there is some confusion in their use amongst experts (Middleton et al., 1993).

A recent trend has been toward including forms of grief referred to as ‘complicated’ (Marwit, 1996; Prigerson et al., 1994; Rando, 1992–3), ‘traumatic’ (Prigerson et al., 1997a) or ‘pathological’ (Horowitz et al., 1993) as diagnostic categories, which are seen as distinct from a major depressive episode or anxiety state resulting from bereavement (Prigerson et al., 1997c). These forms of grief do not resolve with time and therefore require psychiatric intervention. Yet their descriptions (Horowitz et al., 1993; Prigerson et al., 1995) appear not to be qualitatively different from the typical grief reaction. There is the added problem, realised in some earlier writings on grief (Eliot, 1932; Volkart and Michael, 1957) that attempts to define normality in the grieving process are beset by the problem of cultural relativity.

Broadly speaking, the psychiatric framework emphasises the human suffering grief involves, and therefore provides a useful balance to viewing it simply as a natural reaction.

Robert Burton also emphasised the adverse consequences of bereavement for health, and referred to examples of historical figures who died of grief, such as the Roman Emperor Severus. In recent times, more systematic comparisons have indicated high morbidity and mortality amongst bereaved people. This, and the general recognition of the importance of psychological suffering in generating physical disorders, has led to grief being described as a disease process. Examples can be found among those who study grief and among lay persons. Engel (1961) advocated this view in a paper entitled ‘Is grief a disease?’. Bartrop et al. (1992) referred to bereavement as a ‘toxic life event for the vulnerable’. In a BBC Radio 4 programme on personal experiences of grief (10th November 1992), the British Conservative politician Lord Hailsham said: ‘One thing you’ve got to realise is that grief is an illness’.

We should treat this statement with some caution. Deaths and deterioration in health shown during bereavement are not necessarily the direct result of the grief process. On the one hand, there is clear evidence that separation reactions in animals give rise to a physiological stress reaction which is associated with suppression of the immune system (Chapter 4). On the other, among bereaved people such direct stress-induced effects on health are dif ficult to separate from indirect effects caused by a change in life-style, such as altered nutrition and drug-intake, and increased attention paid to physical ailments which were in existence before the bereavement. There may be other influences which lead to married couples having similar illness patterns and dying close to one another in time, such as selective pairing of similarly healthy or unhealthy people, or sharing common health hazards (M.S.Stroebe et al., 1981–2; M.S.Stroebe and W.Stroebe, 1993).

Having said this, there are now several prospective studies showing increased mortality for bereaved spouses compared with matched non-bereaved controls (Young, Benjamin and Wallis, 1963; Parkes, Benjamin and Fitzgerald, 1969; Helsing and Szklo, 1981). This is particularly (or perhaps only) the case of widowers (M.S.Stroebe and W.Stroebe, 1993; M.S.Stroebe, 1994a). However, a prospective study which divided the sample by age and sex (Smith and Zick, 1996) found that the elevated risk was confined to younger widowers experiencing an unexpected death. There is also evidence to suggest that mortality is increased in the case of bereaved kin (M.S.Stroebe, 1994a).

These findings, together with the existence of a plausible physiological mechanism (Irwin and Pike, 1993), generally support the case for a link between bereavement and mortality (Middleton and Raphael, 1987; Rogers and Reich, 1988; M.S.Stroebe and W.Stroebe, 1993; W.Stroebe and M.S. Stroebe, 1992), and to some extent justify Engel’s (1961) portrayal of grief as a disease process.

Overall, it is fair to say that although grief is a natural human reaction, the mental suffering involved has linked it with the psychological problems that come under the domain of psychiatry, and these can lead to a deterioration of physical health, highlighted by considering grief as a disease. It is therefore understandable that grief has been studied largely within a psychiatric and medical framework. I shall argue that this focus has held back our overall understanding of the processes involved, since it is narrow in scope and has been dominated by one way of looking at grief, originating from psychoanalysis.

Instead, a synthesis of three perspectives is used to consider grief as a natural human reaction. First, evolutionary psychology provides an understanding of how grief arose through the process of natural selection, and also enables us to understand variations associated with kinship, age and sex. The evolutionary approach is limited to one type of explanation, that concerned with the origins of a phenomenon through natural selection. The older biological approach to the study of animal behaviour, ethology, was broader in that evolutionary function was one of four types of explanation applied to the study of behaviour (Tinbergen, 1963). This perspective enables us also to examine the mechanisms underlying the grief process, in terms of their origins in nonhuman animals, using interspecies comparisons, in particular involving the process of attachment. I shall also adopt another feature of the ethological approach, which is to provide a detailed description of a phenomenon before theorising about it. This is applied to an examination of the features of human grief. It is apparent from the description that a full appreciation of human grief must involve mental processes. This leads us beyond a view of grief based in ethology to a consideration of relevant areas of human psychology. From these, we can construct an overall understanding of human grief in terms of its immediate causes, its changes over time and its eventual resolution. We can also use psychological research to understand more fully some of the mental processes characteristic of grief.

Grief as a product of natural selection

The evolutionary approach to human behaviour, which is becoming an important part of modern psychology, provides a fundamentally different way of looking at the process of grief from that found in psychiatry, medicine or conventional psychology. First, it poses the question of how grief originated through the process of natural selection, in other words its contribution to reproductive success, or ‘fitness’. Second, such reasoning can be extended to ask how, from the viewpoint of natural selection, we should expect grief to vary according to relationships which differ in terms of the fundamental biological variables of kinship, sex and age.

The answer to the first question is not straightforward. In general terms, we should expect natural selection to result in psychological dispositions which enhance an individual’s chances of surviving and reproducing in its natural environment. We have already seen that grief involves a number of features— ill-health, depression, distress—which are likely to detract from this. Therefore, how can we reconcile the existence of grief with the workings of natural selection? The key to answering this question is to appreciate that any solution to an evolutionary problem has to fit in with the way the organism works already, and must not impose too great a cost on other adaptive responses. Organisms are generally well adapted for their environments, but any particular set of reactions which contributes to this adaptation may prove maladaptive under a particular set of circumstances.

The evolution of grief can be viewed from this perspective, in terms of trade-offs with other adaptive features. Bowlby (1980a) proposed that a psychologically distressing reaction to separation from a loved one is generally useful because it motivates the individual to seek reunion. Those occasions when it is useful in this way greatly outnumber those when it is not because the loved one has died: thus, grief (which is itself not adaptive) arises as a by-product of the broadly similar reaction to separation (which is adaptive).

Parkes (1972) proposed a related view, that grief is a consequence of the way we form personal relationships. These involve representations of the loved one which affect every aspect of our lives, and which are resistant to attempts to change them. This motivating aspect of close relationships shows itself in terms of wanting to maintain contact and as jealousy, mechanisms which go back a long way in evolutionary history. But they have one drawback. The emotional and motivating responses which are essential for maintaining the relationship when the other is alive (felt as love) also operate when the loved one is no longer there (felt as grief): that is, when, in functional terms, they are futile. Grief, then, is the cost we pay for being able to love in the way we do. This view implies that grief will vary according to strength of the lost relationship.

This evolutionary analysis helps us to understand what sort of process grief is. A further application of evolutionary principles to grief concerns the way in which it varies under different circumstances. We are here considering the relative benefits of certain types of relationships. Evolutionary theorists have concentrated on the impact of kinship, sex and age on the value of particular classes of relationships. This type of reasoning can be applied to grief reactions in an indirect way via Parkes’ view that the intensity of grief will vary according to the strength of the relationship. Evolutionary theory provides reasons why certain classes of relationships—between parents and offspring, for example—should in general be stronger, and hence more resistant to change, than others. It also provides a clear basis for understanding the impact of age, both in relation to the bereaved and the deceased, and enables us to examine sex differences in grieving in a new light.

Grief from the viewpoint of ethology

As indicated above, the evolutionary approach provides only one type of explanation. Ethology is a way of studying the behaviour of animals which is rooted in the evolutionary approach and in an appreciation of the way animals behave in the natural world (Tinbergen, 1951, 1963; Hinde, 1970, 1982). The same general approach has also been applied to studying aspects of human behaviour (Archer, 1992a; Hinde, 1982). It is relevant to the study of grief in a number of ways. First it involves an appreciation of not just why certain types of behaviour have originated through natural selection (as evolutionary psychology does) but also of their evolutionary history. This is studied through a comparative approach, whereby universal features of human behaviour are compared with similar features in non-human animals (and in some cases very specific aspects such as smiling and laughing, traced back to possible antecedents). The roots of grief in the animal world were recognised in Charles Darwin’s writings on comparative psychology (Darwin, 1872), which formed one of the bases for the emergence of ethology in the 1930s and 1940s. Although not systematically studied from a comparative perspective by ethologists, the scattered material on grief in animals was later discussed in several reviews of grief (Bowlby, 1961; Pollock, 1961; Averill, 1968), and there are further descriptions of animal grief in more recent studies.

Ethology involves several different types of explanation of behaviour, including the evolutionary But it is recognised that there is no direct line from the genes to behaviour, and therefore it is also important to study the mechanisms through which evolutionarily important forms of behaviour are controlled. The mechanisms underlying the reactions to the loss of a loved one are those controlling the way relationships originate and are maintained. Bowlby (1969) described these in terms of the concept of attachment, which refers to biologically important relationships in non-human and human animals. Bowlby’s theoretical writings on attachment drew upon the ethological concept of a behavioural system, which refers to the organised system that controls a pattern of instinctive behaviour. In making this link, Bowlby viewed attachment as involving a form of instinctive behaviour which is essentially similar in different animals (including humans). Within this framework, grief was the by-product of a set of mechanisms which would set off the urge to search for and seek proximity with a loved one who is missing. In this sense grief is a reaction to a deficit, representing the disruption of a goal-directed organised system.

One other aspect of the ethological approach is relevant to the approach to grief taken in this book. Referring to the way that human psychology had developed up to that time, the pioneering ethologist Niko Tinbergen (1963) criticised the omission of a preliminary natural history phase, which was present in ethological studies of animal behaviour. He viewed psychologists as having been too ready to generate and test theories without much prior description of the phenomena they were considering. Only by prior description, Tinbergen argued, could one fully appreciate the impo...