Bereavement and Grief

Learning Outcomes

  • Explain bereavement and types of grief

Grief is the psychological, physical, and emotional experience and reaction to loss. People may experience grief in various ways, but several theories, such as Kübler-Ross’ stages of loss theory, attempt to explain and understand the way people deal with grief. Kübler-Ross’ famous theory, which we’ll examine in more detail soon, describes five stages of grief: denial, anger, bargaining, depression, and acceptance.

Man holds flowers at a grave.

Figure 1. Bereavement is the term to describe those who have lost a loved one—everyone deals with this is different ways, although there are some common threads shared by many who experience this loss.

Grief reactions vary depending on whether a loss was anticipated or unexpected, (parents do not expect to lose their children, for example), and whether or not it occurred suddenly or after a long illness, and whether or not the survivor feels responsible for the death. Struggling with the question of responsibility is particularly felt by those who lose a loved one to suicide. [1] These survivors may torment themselves with endless “what ifs” in order to make sense of the loss and reduce feelings of guilt. And family members may also hold one another responsible for the loss. The same may be true for any sudden or unexpected death, making conflict an added dimension to grief. Much of this laying of responsibility is an effort to think that we have some control over these losses; the assumption being that if we do not repeat the same mistakes, we can control what happens in our life. While grief describes the response to loss, bereavement describes the state of being following the death of someone.

As we’ve already learned in terms of attitudes toward death, individuals’ own lifespan developmental stage and cognitive level can influence their emotional and behavioral reactions to the death of someone they know. But what about the impact of the type of death or age of the deceased or relationship to the deceased upon bereavement?

Death of a child

Death of a child can take the form of a loss in infancy such as miscarriage or stillbirth or neonatal death, SIDS, or the death of an older child. In most cases, parents find the grief almost unbearably devastating, and it tends to hold greater risk factors than any other loss. This loss also bears a lifelong process: one does not get ‘over’ the death but instead must assimilate and live with it. Intervention and comforting support can make all the difference to the survival of a parent in this type of grief but the risk factors are great and may include family breakup or suicide. Feelings of guilt, whether legitimate or not, are pervasive, and the dependent nature of the relationship disposes parents to a variety of problems as they seek to cope with this great loss. Parents who suffer miscarriage or a regretful or coerced abortion may experience resentment towards others who experience successful pregnancies.

Suicide

Suicide rates are growing worldwide and over the last thirty years there has been international research trying to curb this phenomenon and gather knowledge about who is “at-risk”. When a parent loses their child through suicide it is traumatic, sudden, and affects all loved ones impacted by this child. Suicide leaves many unanswered questions and leaves most parents feeling hurt, angry and deeply saddened by such a loss. Parents may feel they can’t openly discuss their grief and feel their emotions because of how their child died and how the people around them may perceive the situation. Parents, family members and service providers have all confirmed the unique nature of suicide-related bereavement following the loss of a child. They report a wall of silence that goes up around them and how people interact towards them. One of the best ways to grieve and move on from this type of loss is to find ways to keep that child as an active part of their lives. It might be privately at first but as parents move away from the silence they can move into a more proactive healing time.

Death of a spouse

The death of a spouse is usually a particularly powerful loss. A spouse often becomes part of the other in a unique way: many widows and widowers describe losing ‘half’ of themselves. The days, months and years after the loss of a spouse will never be the same and learning to live without them may be harder than one would expect. The grief experience is unique to each person. Sharing and building a life with another human being, then learning to live singularly, can be an adjustment that is more complex than a person could ever expect. Depression and loneliness are very common. Feeling bitter and resentful are normal feelings for the spouse who is “left behind”. Oftentimes, the widow/widower may feel it necessary to seek professional help in dealing with their new life.

After a long marriage, it may be a very difficult assimilation to begin anew. A marriage relationship was often a profound one for the survivor.

Furthermore, most couples have a division of ‘tasks’ or ‘labor’, e.g., one spouse mows the yard, while the other pays the bills, etc. which, in addition to dealing with great grief and life changes, means added responsibilities for the bereaved. Immediately after the death of a spouse, there are tasks that must be completed. Planning and financing a funeral can be very difficult if pre-planning was not completed. Changes in insurance, bank accounts, claiming of life insurance, securing childcare are just some of the issues that can be intimidating to someone who is grieving. Social isolation may also become imminent, as many groups composed of couples find it difficult to adjust to the new identity of the bereaved, and the bereaved themselves have great challenges in reconnecting with others. Widows of many cultures, for instance, wear black for the rest of their lives to signify the loss of their spouse and their grief. Only in more recent decades has this tradition been reduced to shorter periods of time.

Death of a parent

For a child, the death of a parent, without support to manage the effects of the grief, may result in long-term psychological harm. This is more likely if the adult carers are struggling with their own grief and are psychologically unavailable to the child. There is a critical role of the surviving parent or caregiver in helping the children adapt to a parent’s death. Studies have shown that losing a parent at a young age did not just lead to negative outcomes; there are some positive effects. Some children had an increased maturity, better coping skills and improved communication. Adolescents valued other people more than those who have not experienced such a close loss.[2]

When an adult child loses a parent in later adulthood, it is considered to be “timely” and to be a normative life course event. This allows the adult children to feel a permitted level of grief. However, research shows that the death of a parent in an adult’s midlife is not a normative event by any measure, but is a major life transition causing an evaluation of one’s own life or mortality. Others may shut out friends and family in processing the loss of someone with whom they have had the longest relationship.[3]

Death of a sibling

The loss of a sibling can be a devastating life event. Despite this, sibling grief is often the most disenfranchised or overlooked of the four main forms of grief, especially with regard to adult siblings. Grieving siblings are often referred to as the ‘forgotten mourners’ who are made to feel as if their grief is not as severe as their parents grief (N.a., 2015). However, the sibling relationship tends to be the longest significant relationship of the lifespan and siblings who have been part of each other’s lives since birth, such as twins, help form and sustain each other’s identities; with the death of one sibling comes the loss of that part of the survivor’s identity because “your identity is based on having them there.”

The sibling relationship is a unique one, as they share a special bond and a common history from birth, have a certain role and place in the family, often complement each other, and share genetic traits. Siblings who enjoy a close relationship participate in each other’s daily lives and special events, confide in each other, share joys, spend leisure time together (whether they are children or adults), and have a relationship that not only exists in the present but often looks toward a future together (even into retirement). Surviving siblings lose this “companionship and a future” with their deceased siblings.[4]

Loss during childhood

When a parent or caregiver dies or leaves, children may have symptoms of psychopathology, but they are less severe than in children with major depression. The loss of a parent, grandparent or sibling can be very troubling in childhood, but even in childhood there are age differences in relation to the loss. A very young child, under one or two, may be found to have no reaction if a carer dies, but other children may be affected by the loss.

At a time when trust and dependency are formed, a break even of no more than separation can cause problems in well-being; this is especially true if the loss is around critical periods such as 8–12 months, when attachment and separation are at their height information, and even a brief separation from a parent or other person who cares for the child can cause distress.

Even as a child grows older, death is still difficult to fathom and this affects how a child responds. For example, younger children see death more as a separation, and may believe death is curable or temporary. Reactions can manifest themselves in “acting out” behaviors: a return to earlier behaviors such as sucking thumbs, clinging to a toy or angry behavior; though they do not have the maturity to mourn as an adult, they feel the same intensity. As children enter pre-teen and teen years, there is a more mature understanding.

Children can experience grief as a result of losses due to causes other than death. For example, children who have been physically, psychologically or sexually abused often grieve over the damage to or the loss of their ability to trust. Since such children usually have no support or acknowledgement from any source outside the family unit, this is likely to be experienced as disenfranchised grief.

Relocations can also cause children significant grief particularly if they are combined with other difficult circumstances such as neglectful or abusive parental behaviors, other significant losses, etc.

Loss of a friend or classmate

Children may experience the death of a friend or a classmate through illness, accidents, suicide, or violence. Initial support involves reassuring children that their emotional and physical feelings are normal. Schools are advised to plan for these possibilities in advance.

Survivor guilt (or survivor’s guilt; also called survivor syndrome or survivor’s syndrome) is a mental condition that occurs when a person perceives themselves to have done wrong by surviving a traumatic event when others did not. It may be found among survivors of combat, natural disasters, epidemics, among the friends and family of those who have died by suicide, and in non-mortal situations such as among those whose colleagues are laid off.

Try It

Anticipatory grief occurs when a death is expected and survivors have time to prepare to some extent before the loss. Anticipatory grief can include the same denial, anger, bargaining, depression, and acceptance experienced in loss one might experience after a death; this can make adjustment after a loss somewhat easier, although a person may then go through the stages of loss again after the death. A death after a long-term, painful illness may bring family members a sense of relief that the suffering is over or the exhausting process of caring for someone who is ill is over.

Complicated grief involves a distinct set of maladaptive or self-defeating thoughts, emotions, and behaviors that occur as a negative response to a loss. [5] From a cognitive and emotional perspective, these individuals tend to experience extreme bitterness over the loss, intense preoccupation with the deceased, and a need to feel connected to the deceased. These feelings often lead the grieving individual to engage in problematic behaviors that further prevent positive coping and delay the return to normalcy. They may spend excessive amounts of time visiting the deceased person’s grave, talking to the deceased person, or trying to connect with the deceased person on a spiritual level, often forgoing other responsibilities or tasks to do so. The extreme nature of these thoughts, emotions, and behaviors separate this type of grief from the normal grieving process.

Disenfranchised grief may be experienced by those who have to hide the circumstances of their loss or whose grief goes unrecognized by others. Loss of an ex-spouse, lover, or pet may be examples of disenfranchised grief.

It has been said that intense grief lasts about two years or less, but grief is felt throughout life. One loss triggers the feelings that surround another. People grieve with varied intensity throughout the remainder of their lives. It does not end. But it eventually becomes something that a person has learned to live with. As long as we experience loss, we experience grief.

Prolonged Grief Disorder

In March 2022, prolonged grief disorder (PGD) was added as a mental disorder in the DSM-5-TR. It is characterized by a distinct set of symptoms following the death of a family member or close friend (ie. bereavement). People with PGD are preoccupied with grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance, and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.[6]

Along with bereavement of the individual occurring at least one year ago (or six months in children and adolescents), there must be evidence of one of two “grief responses” occurring at least daily for the past month:

  • Intense yearning/longing for the deceased person.
  • Preoccupation with thoughts or memories of the deceased person (in children and adolescents, preoccupation may focus on the circumstances of the death).

Additionally, the individual must have at least three of the following symptoms occurring at least daily for the past month:

  • Identity disruption (e.g., feeling as though part of oneself has died) since the death
  • A marked sense of disbelief about the death
  • Avoidance of reminders that the person is dead (in children and adolescents, may be characterized by efforts to avoid reminders)
  • Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death
  • Difficulty reintegrating into one’s relationships and activities after the death (e.g., problems engaging with friends, pursuing interests, or planning for the future)
  • Emotional numbness (absence or marked reduction of emotional experience) as a result of the death
  • Feeling that life is meaningless as a result of the death
  • Intense loneliness as a result of the death

The duration and severity of the distress and impairment in PGD must be clinically significant, and not better explainable by social, cultural, or religious norms, or another mental disorder. PGD can be distinguished from depressive disorders with distress appearing specifically about the bereaved as opposed to a generally low mood. According to Holly Prigerson, an editor on the trauma and stressor-related disorder section of the DSM-5-TR, “intense, persistent yearning for the deceased person is specifically a characteristic symptom of PG [prolonged grief], but is not a symptom of MDD (or any other DSM disorder).”[7]

There are layers of grief. Initial denial, marked by shock and disbelief in the weeks following a loss may become an expectation that the loved one will walk in the door. And anger directed toward those who could not save our loved one’s life, may become anger that life did not turn out as we expected. There is no right way to grieve. A bereavement counselor expressed it well by saying that grief touches us on the shoulder from time to time throughout life.

Grief and mixed emotions go hand in hand. A sense of relief is accompanied by regrets and periods of reminiscing about our loved ones are interspersed with feeling haunted by them in death. Our outward expressions of loss are also sometimes contradictory. We want to move on but at the same time are saddened by going through a loved one’s possessions and giving them away. We may no longer feel sexual arousal or we may want sex to feel connected and alive. We need others to befriend us but may get angry at their attempts to console us. These contradictions are normal and we need to allow ourselves and others to grieve in their own time and in their own ways.

The “death-denying, grief-dismissing world” is often the approach to grief in our modern world. We are asked to grieve privately, quickly, and to medicate our suffering. Employers grant us 3 to 5 days for bereavement, if our loss is that of an immediate family member. And such leaves are sometimes limited to no more than one per year. Yet grief takes much longer and the bereaved are seldom ready to perform well on the job. It becomes a clash between life having to continue, and the individual being ready for it to do so. One coping mechanism that can help smooth out this conflict is called the fading affect bias. Based on a collection of similar findings, the fading affect bias suggests that negative events, such as the death of a loved one, tend to lose their emotional intensity at a faster rate than pleasant events. [8] This is believed to help enhance pleasant experiences and avoid the negative emotions associated with unpleasant ones, thus helping the individual return to their normal daily routines following a loss.

Link to Learning

Sociologist Nancy Berns explains that in the United States and other western societies, people are encouraged to deal with grief or loss through closure. She contradicts this advice and explains that people do not necessarily need closure in order to “move on.” Watch Nancy Berns’ TED talk “Beyond Closure” to learn more.

Try It

 

Glossary

bereavement:
the period of mourning following the death of someone
complicated grief:
when feelings of grief are persistent and incapacitating
disenfranchised grief:
grief that is not acknowledged by others
fading affect bias:
idea that negative events, such as the death of a loved one, tend to lose their emotional intensity at a faster rate than pleasant events
grief:
the psychological, physical, and emotional experience and reaction to loss
survivor guilt:
mental condition that occurs when a person perceives themselves to have done wrong by surviving a traumatic event when others did not
  1. Gibbons, J. A., Lee, S. A., Fehr, A. M., Wilson, K. J., & Marshall, T. R. (2018). Grief and avoidant death attitudes combine to predict the fading affect bias. International Journal of Environmental Research and Public Health, 15(1736), 1-19. ↵
  2. Ellis, J; Lloyd-Williams, M (July 2008). "Perspectives on the impact of early parent loss in adulthood in the UK: narratives provide the way forward". European Journal of Cancer Care. 17 (4): 317–318. doi:10.1111/j.1365-2354.2008.00963.x. PMID 18638179. ↵
  3. Marshall, H (2004). "Midlife loss of parents: The Transition from Adult Child to Orphan". Ageing International. 29 (4): 351–367. doi:10.1007/s12126-004-1004-5. ↵
  4. P. Gill White, Sibling Grief: Healing After the Death of a Sister or Brother (iUniverse, 2006), 47. ↵
  5. Boelen, P. A., & Prigerson, H. G. The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults. Eur. Arch. Psychiatry Clin. Neurosci. 2007, 257, 444–452 ↵
  6. Lundorff, Marie; Holmgren, Helle; Zachariae, Robert; Farver-Vestergaard, Ingeborg; O’Connor, Maja (April 2017). "Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis". Journal of Affective Disorders. 212: 138–149. doi:10.1016/j.jad.2017.01.030. ↵
  7. Frances, A. (2012, February 28). When Good Grief Goes Bad. The Huffington Post. Retrieved from http://www.huffingtonpost.com/allen-frances/grief-depression_b_1301050.html ↵
  8. Walker, W. R.; Skowronski, J. J.; Gibbons, J. A.; Vogl, R. J.; Thompson, C. P. On the emotions that accompany autobiographical memories: dysphoria disrupts the fading affect bias. Cogn. Emot. 2003, 17, 703–723. ↵