Goals for this Unit

Preliminaries

Another way in which this unit will be different is that questions will be embedded throughout the unit rather than being saved for the end. They will be in red and in a different font to make it easier for us to locate them. For these questions, read at least two interviews by your fellow class mates (in the Folder dedicated to interviews) or go to the archived cross-cultural interviews and incorporate them in your discussion. Also, unlike the units you have already done, you are required to answer ALL of the questions. 

As you read through this unit, we want you to view grief as complicated in two different ways: first, within the context of individual family members, that is, as the atypical grief of individual family members; second, within the context of the family as an environment that can be a potentially complicating factor for the grief of family members. Before reading the rest of this unit, think about how you view complicated grief within the family.

This unit will seem unusually short when you first see it. This is intentional. You're being asked to return to earlier units, to look at the information in them through a new "lens," that of complicated grief. Throughout this unit, you'll be drawing on your readings, material from previous units, and on your analytical skills, to look at ways in which grief may and may not be complicated within families.

Readings

Anthology

(Re-read) Gilbert, K. R. 'We've had the same loss, why don't we have the same grief?' Loss and differential grief in families.

Rando, T. A. (1992). The increasing prevalence of complicated mourning: The onslaught is just beginning, Omega, 26, 43-59.

Web Resources

For this unit, we will return to the web pages of earlier web units and use the following:

What is Complicated Grief -- children and grief

You'll remember that, in Unit 1, you were asked to define what you saw as unhealthy grief. In many cases, you described complicated grief. You may find, by now, that your view has changed or expanded.

Question 1: I'd like you to go back to your definition of unhealthy grief and see what your thoughts are now. Have they changed? Do you think that complicated grief, the topic of this unit, is necessarily unhealthy? What are the implications for your view as an "outsider" reading the two interviews you read? Tell us why you feel this way.

As you read in Rando's article, a great deal of controversy exists over the definition of what we are calling "complicated grieving." It also has been called many other name, including abnormal, atypical, unresolved, dysfunctional, unhealthy, and, most commonly, pathological grief. We have had tremendous difficulty in operationalizing this form of grief (that is, we have had problems in setting a clear, measurable set of criteria for defining "complicated grief"). As we saw in the first unit, grief is defined in a wide variety of ways. Given that uncomplicated grief does not have a single definition, it should not be surprising that complicated grief does not have a single definition. We did, I want to point out, discuss the four forms of complicated grief, as seen by Worden, in that unit. I encourage you to visit that unit and look at the section covering grief as an illness

Family forms and ongoing family processes influence the grief response of individual family members (Unit 2), as do relationships, both with others and the ongoing, but altered, relationship with the deceased (Unit 6). The relationship with the deceased at the time of death is an important factor. Interestingly, it is not necessarily the death of someone with whom we have a close and warm relationship that leads to complicated grief. It may, in fact, be the death of someone with whom we have a conflictual relationship, especially if we feel that relationship should have been warm and close, that is more likely to lead to complicated grief.

Other factors that add complexity to the picture are age and development, which we discussed in the units on early and later development, gender, and culture. Each of these can contribute to a situation in which someone's grief is viewed by others as unhealthy, pathological, or disabling, yet can also be seen as appropriate by another.

Worden (1991, pp. 75-77) proposed a list of indicators of unresolved grief that he put forward as diagnostic criteria to be used by clinicians. The indicators include:

1. The person cannot speak of the deceased without experiencing intense and fresh grief.
2. Some relatively minor event triggers an intense grief reaction.
3. Themes of loss come up in conversation.
4. The person who has sustained the loss is unwilling to move material possessions belonging to the deceased.
5. The person who has sustained the loss develops the symptoms like those the deceased experienced before death.
6. Those who make radical changes in their lifestyle following a death or who exclude from their life friends, family members, and/or activities associated with the deceased.
7. A person who has had a long history of subclinical depression, often earmarked by persistent guilt and lowered self-esteem. The opposite (a false euphoria after a death) may also indicate that grief is complicated.
8. The person has a compulsion to imitate the dead person, particularly if he or she had no conscious desire nor competence for the same behavior.
9. Self-destructive impulses may be stimulated by unresolved grief.
10. Unaccountable sadness occurring at a certain time each year can be a clue to unresolved grief.
11. A phobia about illness or death is often related to the specific illness that led to or caused the death.
12. The circumstances around the death can contribute to complicated grief (We will, by the way, be going into this in much greater detail in Units 10 through 13). 

In the article by Rando, you read about another way to thinking about complicated grief (please note that Rando speaks of complicated mourning--this is not the way we use the term in this class--in clinical psychology and psychiatry, mourning and grief often are used interchangeably). In this, grief is complicated if, after accounting for the timeframe, there is compromise, distortion, or failure of one or more of the six "R" processes of grief:

1. Recognize the loss
2. React to the separation
3. Recollect and reexperience the deceased and the relationship
4. Relinquish the old attachment to the deceased and the old assumptive world
5. Readjust to move adaptively into the new world without forgetting the old
6. Reinvest

Question 2: Look at these factors and think of them in the context of age, development, gender and culture. How do you see each of these factors potentially leading to a complicated grief reaction?

In looking at the family as an environment of grief, it was suggested that families can contribute to the complicating of the grief process of family members, which is addressed in the Gilbert article you were assigned to re-read. In previous semesters, during this unit, we also discussed how families can act as a buffer, reducing the complications of grief (which we also alluded to in Unit 6.) Cendra suggested elements of the circumplex model (Olson, 1995) as useful for understanding family process and grief.

The Circumplex Model is comprised of two dimensions, Cohesion and Adaptability. The cohesion dimension ranges from low, Disengaged, through Separated and Connected, to high, Enmeshed. Adaptability ranges from low, Rigid, through Structured and Flexible, to high, Chaotic. If you picture a 4 X 4 table that results in 16 cells, you have a sense of what the circumplex model looks like. A very rough picture of this is presented below (incidentally, if you're using a text only browser, let me know. I'll fax a copy of this image to you):

Each of the 16 cell in the table represents one family type. For example, if a family was high in adaptability and low in cohesion, that family would be classified as chaotically disengaged.

According to Olson, these dimensions are curvilinear, that is, the four central categories of the table are considered balanced families, and are seen as the most functional. These are flexible-separated, flexible-connected, structured-separated, and strucured-connected. Mid-range families are extreme on one dimension, yet are balanced on the other dimension, and there are eight cells in this category. Families at the extremes of both dimensions are considered the least functional.

Families are in an ongoing struggle to maintain a balance between the extremes of cohesion and adaptability, between connectedness and separateness and between organization and disorder. Olson suggests that balanced families have more balanced communication skills.

Cendra also suggested that we look at such classification systems and look at them in terms of functional and dysfunctional family activity. She defined these in the following ways:

• Functional means the family members share common goals and beliefs and that their interactions are generally productive and in accord with these goals and beliefs.
• Dysfunctional means that the family members may not share common goals or beliefs and that their interactions are generally nonproductive and directed toward different and potentially often conflicting goals and beliefs. This can lead to conflict and disaffection among family members.

Question 3: With this model in mind, consider how it might be used to understand and explain the potential for complicated grief within families. How might family form affect the grief of its family members? Do you agree that families classified as balanced are the most function, especially at the time of a loss? How might the ethnicity of a family complicate the classification of a family? Could there be, for example, families that might be extreme by the standards of this model but would be functional in the context of their culture? Going back to our discussion of "no family can think, feel, grieve," can a family be defined as functional or dysfunction? Can a family be functional for one member's grief and not for another?

Finally, the article you re-read on differential grieving proposed that families can contribute to more complicated grief. We discussed this earlier in the semester and you're asked to re-visit this question:

Question 4: We have had the proposition put before us that families cause grief to be complicated. You might argue the opposite. Could both positions be true, simultaneously? Are these necessarily oppositional--that they can only cause grief to be complicated or only facilitate uncomplicated grief?

General Conclusions

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Page created: 2/96. Last updated: 8/26/07.
URL: http://www.indiana.edu/~famlygrf/units/complicated.html
Copyright 1996-2007, Kathleen R. Gilbert, Ph.D.

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