Working with Loss, Death and Bereavement

A Guide for Social Workers

Jeremy Weinstein

• Publisher: SAGE Publications Ltd
• Year: 2007
• Print ISBN: 9781412923910, 9781412923903
• eBook ISBN: 9781446240557
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

`This book makes a significant contribution to the literature. The author is to be commended for the huge amount of work he has put into this volume which deserves to be widely used? - Professor Bernard Moss, Staffordshire University

All social workers encounter complex and diverse forms of loss throughout their practice. Working with Loss, Death and Bereavement helps trainee and practitioners navigate these difficult situations by developing the skills and values necessary for effective and empowering practice.

Each chapter is grounded in social work theory and is illustrated by practice scenarios, exercises, suggestions for further study, and contemporary cultural examples from novels and films. The book explores:

• definitions and assessment of loss

• psychological aspects of loss and grief

• skills, methods and theories working with the individual

• families, support groups and communities

• avenues of support for social workers

• key themes of anti-discriminatory practice, evidence based practice and ethical awareness.

This invaluable skills-based book meets the training requirements for social workers and will be essential reading for students or practitioners wishing to reflect on and develop their own practice in working with loss, death and bereavement.

Jeremy Weinstein worked as a social worker prior to teaching at London South Bank University, where he is now a Visiting Fellow. Jeremy is an accredited trainer and gestalt psychotherapist with a small private practice offering therapy, supervision and consultation.

1	Introduction

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Chapter contents

• Basic definitions
• The importance of the social worker as the reflective practitioner
• Examples from contemporary dramas: novels, film and television, biographical accounts
• Scenarios that will be drawn upon throughout the text
• The major ways of assessing loss, including issues of difference and anti-discriminatory/anti-oppressive practice
• Core theme of ‘living psychologically beyond our means’
• The structure of this book

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This chapter introduces the reader to this text, setting out how it is organized and its contents. It starts out with some key definitions, an overview of basic concepts including understanding and assessing the experience of loss, incorporating the impact of gender and race/ethnicity and from this point exploring the meaning of anti-discriminatory and anti-oppressive practice. Underlying all this is the text’s core aim: how we can be helped to recognize, rescue and revive the social work role within our work with loss, death and bereavement.

In focusing on social workers this is not to deny that there are, of course, a host of other professionals and lay people with important parts to play. Health care workers, teachers, bereavement counsellors, those involved in pastoral responsibilities: all take on the caring/curing role, working alongside social workers in the wider community and multidisciplinary teams. Hopefully this text will be useful to all or any of these groups but there is already a body of writing intended for this audience. This is less so for social workers, those individuals whose precise roles may change across agencies, different service user groups and countries, whose titles might shift and slide between social care worker, mental health worker or care manager, but who share a body of theories, skills, values and roles which are broadly similar.

Concentrating on what may be called mainstream social work means paying attention to the needs of service users when someone important to them has died, or they face losses related to disability, life limiting conditions, the onslaught of mental ill-health, ageing and the disasters that befall family life and child care. The discussion will draw on, but not seek to compete with, the more specialist texts that are already available on palliative care (Berzoff and Silverman, 2004; Firth et al., 2005; Beresford et al., 2006,) or the experience of those who are dying (Armstrong-Coster, 2004).

Integrated into the text are various case scenarios linking the experience of both service users and workers with the theories, research studies, professional values and practical skills that we can draw upon. Examples will also be taken from films, novels and personal accounts while self-tests, points for practice and advice on further reading help readers to stay in touch with your own processes, check and advance your knowledge and indicate where else you might go to consolidate and broaden your understandings. Readers are always encouraged to return to the various texts and authors that are cited, to check your own understandings and develop your own criticisms rather than relying on what other people, including this writer, have said they said.

To start with, however, what follows are some general working definitions.

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Some Working Definitions

Loss is wider than a response to a death, important as that is. It is any separation from someone or something whose significance is such that it impacts on our physical or emotional well-being, role and status. The experience and manifestation of loss can be more or less difficult depending on other important variables. This is explored in fuller detail in Chapter 2.

Dying Bob Dylan expressed it well when he sang: ‘he not busy being born is busy dying’ (1965). Professional definitions tend to be more prosaic: Medical practitioners usually draw distinctions between chronic illness/disabilities which are life limiting and diagnosed terminal conditions such as cancer or motor neurone disease, needing palliative care. Sociologists discuss the various degrees of aware dying ranging from closed through to open awareness (Glaser and Strauss, 1965). Writing as a social worker, Currer sees dying as involving ‘1) a degree of physical deterioration, 2) an emotional or individual component concerning the self (possibly incorporating a spiritual dimension) and 3) a social dimension about interaction with others’ (2001: 38).

Death outside of strictly medical terminology can prove difficult. Broadly speaking there is:

Living death or a social death e.g. lying in a coma, suffering from dementia, imprisonment. Individuals are physically alive but their situation isolates them from their former familial or social links.

Psychosocial death (Doka and Aber, 2002) where someone’s psychological essence or prior sense of self is perceived as having died. This may be through drug dependency, mental illness, coming out as gay, joining a cult, undergoing a religious conversion or, the opposite, losing one’s belief, e.g. some orthodox Jewish parents will formally mourn, sit shiva, for a child who marries out of the religion and the community.

Bereavement is the response to a loss. It is a core human experience, common to, and also varying across, all cultures and historical periods. Grief is the intrapersonal or psychological expression of the bereavement. Mourning is the interpersonal or social expression, taking its cues from the attitudes and values of the surrounding context, religious, cultural etc. Both the intra and inter dimensions serve to sanction, or disallow and disenfranchise people’s reactions.

Within these general definitions there are those specific to the role of the social worker.

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There is discussion about the word we use for those who turn to social workers for support, whether the traditional term, client, or even patient in some specific work settings or more recent phrases like service user. The latter is the most popular currently so it is this I will use in the text, except, of course, where citing other sources.

Once engaged with service users Currer draws attention to the need to combine in our work ‘the Emotional and the Practical’ (2001: 78); Berzoff and Silverman refer to the need to draw on ‘the physical, psychological, social, spiritual and existential’ (2004: 8); Farber et al. comment on how social workers need to be ‘consultants, collaborators and guides’ to those private individuals newly caught up in the uncertainties of significant loss (2004: 115).

This text highlights the importance of the social worker as a critical and reflective practitioner. There are many definitions of this concept, certainly it incorporates the skills, theories, values and evidence base of our work and this text seeks to integrate, implicitly and explicitly, these aspects throughout. It also incorporates the all important elements of action and analysis and the need for practice to develop through a commitment to questionning of what we do and why rather than being defensive. Adams uses the phrases ‘engaging with ourselves’, ‘engaging with knowledge’, ‘engaging with practice’ and ‘engaging with paradoxes and dilemmas in developing our own critical practice’ to represent the various processes (2002). Fook suggests the phrase critical reflection to embed within practice:

the intuition and artistry involved in professional practice … the importance of context and interpretation in influencing action … each person engages in a process of theory-building by reflecting on their own practice. What is also vital to a critical approach – which is not necessarily articulated in a reflective stance – is the emancipatory project, the capacity to analyse social situations and to transform social relations on the basis of this analysis (emphasis in the original) (1999: 201–2).

Telling Tales: Dramatic Tales of Loss, Death and Bereavement

The above discussions illustrate how our understandings of loss, death and bereavement cannot be captured in a neat turn of phrase. Perhaps we can be brought nearer to its essence by stepping back from the strictly professional arena and looking to literature and other cultural forms. Dinnage (1992) draws on poets such as Coleridge, Browning and Owen, Silverman (2004) turns to the classic images of Antigone by Sophocles and Michelangelo’s Pietà while for many music is the compelling medium: funerals, cremations or memorials accompanied by hymns, selections from the great composers or more contemporary choices, such as ‘I Did It My Way’ and ‘Knocking on Heaven’s Door’. In Canada a university focuses entirely on novels and autobiographies by way of introducing palliative care to health students (Hall et al., 2006).

This medium has its limitations, of course. Freud notes the attraction of fiction and theatre as a way of fulfilling our need to ‘find people who still know how to die … . We satisfy our wish that life itself should be preserved as a serious stake in life.’ Further, fiction offers us all a ‘second chance … We die with the hero: yet we survive him, and possibly die again, just as safely, with a second hero on another occasion’ (Freud, 1915/1993). Modern commentators are also cautious. Gibson (2001) believes that cinematic death bed scenes can emotionally distance audiences while Davies comments that, for all our familiarity with death on the television and cinema screen, this ‘is largely devoid of serious impact’ (2005: 16) since it does not relate to intimate deaths of people close to us.

Nonetheless, such dramatic stories do serve an important role. Bettelheim, in his classic study of fairy stories, argues that they help the child ‘make some coherent sense out of the turmoil of his feelings. He needs ideas on how to bring his inner house into order’ (1991: 5). The following examples suggest that the stories, or narratives as they are increasingly termed, expressed in contemporary film, television and novels help bring order to the inner house of today’s adults.

Scenes From Contemporary Dramas

Interestingly many successful British films use death as a powerful counterpoint to humour. Four Weddings and A Funeral (Newell, 1994) sets the funeral scene against the celebrations and portrays the depth and range of passion and pain which is felt by the various mourners: parents, friends, gay lover. Love Actually (Curtis, 2003) starts with scenes set in an airport, people hugging their greetings, as a contrast to all those who never arrived because on 9/11 their planes crashed into the twin towers, the lesson of their deaths is to love more. In Calendar Girls (Cole, 2003) a group of middle aged women pose nude as a charity stunt. Since this is also a memorial to a husband it shows, amid the humour, something of the obsessions of mourning and the disruption it can cause within friendship groups.

Death is a metaphor in more seriously intended, iconic, films such as Field of Dreams (Robinson, 1989) where legendary, and long dead, baseball players gather for one last game and assert the survival of American values as well as providing the opportunity for personal and political healing. Death comes as a climax in One Flew Over the Cuckoo’s Nest (Forman, 1975) when Chief Bromden kills the rebel hero McMurphy, whom the mental hospital professionals have already mentally murdered by means of a lobotomy. Loss is represented not just in this death, it is there in the loss of liberty, either enforced since McMurphy is detained under an order, or surrendered, since most of the fellow patients are there in a voluntary capacity. Chief Bromden, a native American, is an elective mute, becoming voiceless when, despite the verbal protests of the elders, the tribe is forcibly moved to a reservation. Loss is played out on many levels in this story, as is the redemption in Bromden’s escape to freedom.

A more prosaic style is chosen for the film Last Orders (Schepsi, 2002), based on the award winning Swift novel (1996) which follows the misadventures of a group of South London working-class men struggling with their own clumsy feelings about grief while following their dead friend’s last request to have his ashes scattered into the sea. Mourning is portrayed in Truly, Madly, Deeply (Minghella, 1991), where the partner of a young woman, Nina, dies suddenly. This is, in some ways, a very realistic presentation of the pain of her loss, deeply felt in her counselling sessions and repressed in the face of the sheer ineptitude of family and friends who want to help but have no idea about how to reach her. The non-straightforward aspect lies in the way that Nina moves from the ‘normal’ sensing of the lover’s continued presence around the home to his becoming a very real manifestation. They play, bicker and make love, much as they had before his death, until Nina escapes the thrall of this all too fleshy ghost and is ready to move on with another relationship.

This theme is played out more fully in television series. As I write the weekly schedules include repeats of Six Feet Under (Ball, 2001–2005), about a family business of undertakers, and two programmes featuring reluctant mediums, Ghost Whisperers (Fox, 2006) and Afterlife (Volk, 2005–2006) whose strap line is: ‘You don’t contact them, they contact you’. Similarly in the best selling novel The Lovely Bones (Sebold, 2002) the dead are a...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• 1 Introduction
• 2 Psychological Theories
• 3 Social and Cultural Dimensions
• 4 Social Work Values
• 5 Social Work Skills, Methods and Theories in Work with Individuals
• 6 Social Work Skills, Methods and Theories in Work with Families, Groups and the Wider Community
• 7 The Evidence Base
• 8 Social Workers within our Agencies: The Need for ‘Relentless Self-care’
• References
• Index