Goals for this Unit

Preliminaries

• What do you mean when you think about "family?" Is it a group of people, a "haven in a heartless world," a state of being? How about family as your history and future?
• What are your expectations of family? This is important, because it affects what you will identify with as you work on this unit and on the remainder of the course. This is your insider's perspective on the family, and it colors your view of family and what you feel comfortable in "allowing" others to have in their own families.

Readings

Anthology

Gilbert, K. R. (1996). 'We've had the same loss, why don't we have the same grief?' Loss and differential grief in families. Death Studies, 20, 269-283.

Lipton, S. T. (June 30, 1995). The mourning gradient. Ethnic News Watch, 60-.

Web Resources

For the most part, our understanding of grief concentrates on the grieving individual. In general, the family is seen as a supportive resources for bereaved family members. This has provided a limited sense of how family members deal with multiple roles and varied pressures in the grieving process.

Grief in families is a complicated thing, because each person must deal with his or her own grief while also coping with that of others in the family. When the loss affects all family members, the expectation may be that others in our family will be supportive and understanding. After all, they have experienced the same loss, haven't they? In the case of the loss directly affecting only one (or few) family member, do others grieve too, and what exactly is it that they are grieving over? How far does this "secondary" grief extend beyond the primary griever(s)?

Loss in families can be tremendously painful and can contribute to the breakdown of the family system. It can also serve as a catalyst for positive change. These positive effects can be facilitated in a number of ways and these will be addressed throughout the course.

The Effects of Loss on the Family System

Much work in this area focuses on the mutual loss of a family member, but families also are indirectly affected by the loss experience of individual or few family members. Impacts of the loss may spread through multiple generations in the family and may not be restricted to the generations that directly experience the loss. Grief has an effect across multiple generations and within the extended family culture. Although these familial effects are often thought of as negative, they need not be. For example, previous successful experience with a loss can provide families with shared coping resources as well as perceptions of family competence.

Before I go on to describe a variety of aspects of family systems, I'd like to define what a system is: A system is an ordered composition of elements in a unified whole and the whole is more than the sum of its parts (Simon, Stierlin & Wynne, 1985). A systems perspective, in looking at grief, considers the way relationships within the family and among family members as well as the relationship between the family and other elements of the social environment influence individual and family bereavement. 

Considering The Family as a System

• Wholeness (holism): A system is defined as a whole made up of interacting parts (Cook & Oltjenbruns, 1989). Members of a family system interact in reciprocal relationships, responding to one another in the context of roles. The central thesis of holism is that, in order to understand the family system, the whole system must be considered, rather than breaking the system down into its parts.
• Transgenerational Effects: According to Bowen (1991), unresolved loss disrupts normal family process and this can extend into future generations if it is not resolved. The experiences of Holocaust survivors and their descendants are well-documented examples of transgenerational effects
• Family Communication: All behavior is viewed as interpersonal messages that contain both factual and relationship information (Krauss & Jacobs, 1990). Thus, it is not possible to not communicate. The exchange of information among family members and the quality of their communication often are identified as an important, if not the most important, factor in reconciliation of grief in the family system. Most frequently, families are urged to be open in their communication. This is because a loss of access to others in the family, which is characteristic of closed communication, often results in a deep sense of isolation in family members. In her book Grief as a Family Process, Shapiro presents a more balanced view. She suggests that a balance between open expression, especially of emotions, and their containment is the best approach. Essentially, a system can only handle so much openness.
• Family Beliefs: These are beliefs that are shared (or believed to be shared) among family members.
  • Family Myths: beliefs that serve the same function as individual defense mechanisms (Cook & Oltjenbruns, 1989; Simon, Stierlin & Wynne, 1985). They are accepted and adhered to by family members that defend against disturbances or changes in existing family relationships (Cook & Oltjenbruns, 1989). These can be myths of harmony, myths of forgiveness and atonement or rescue myths (Stierlin, 1973).
  • Family Secrets: this refers to topics that carry negative emotional weight . They are not discussed, and treated as if they do not exist, even though the entire family, or members of the family know about them. Family secrets may be maintained in the service of family myths (Simon, Stierlin & Wynne, 1985). A suicide that is not discussed, or the refusal to allow anyone to discuss a death are examples.
• Roles: Social expectations and norms held regarding an individual’s position and behavior within a group (Simon, Stierlin & Wynne, 1985). Following the death of a family member, roles may need to be reassigned or roles shared, with role behavior apportioned to various family members (Walsh & McGoldrick, 1991).
• Rules are prescriptions for and proscriptions against certain behaviors of all or some family members and are related to appropriate role performance (Krauss & Jacobs, 1990). They may be implicit (i.e., hidden) or explicit (i.e., known). Implicit rules are believed to be more powerful in affecting family behavior; the fact that they are hidden makes them powerful. With the loss, many implicit rules become explicit, causing stress to the family. New rules must be created or existing rules must be modified to adapt to the altered family system (Satir, 1988). A death results in disequilibrium in family rule systems and rules may need to be changed to meet the needs of individual family members (Cook & Oltjenbruns, 1989).
• Family Rituals: Rituals are composed by metaphors, symbols and actions that are "packaged" in a highly condensed, time-bounded and space-bounced, dramatic form to establish and maintain family identity (Burr, Day & Bahr, 1993). Family rituals are built around common symbols and symbolic actions that are familiar to family members, providing an emotional anchor. They provide a sense of safety and acceptance to members. Rituals serve five functions within families: relating, changing, healing, believing and celebrating (Imber-Black & Roberts, 1992). Imber-Black and Roberts (pp. 28-56) indicate that the relating function addresses issues of expressing and maintaining relationships; changing addresses transitions for self and others; healing is concerned with recovery from relationship betrayal, trauma or loss; believing functions are focused on voicing beliefs and making meaning; and celebrating is concerned with affirming deep joy and honoring life with festivity. Rituals serve a powerful function when families deal with loss and can facilitate the necessary reorganization of families when a family member has been lost.
• Development: Family development addresses the process of change in the family system and takes place interactively with development and change of family members (Shapiro, 1994, 1996). Normative events can be anticipated and planned for (e.g., marriage, births, retirement) while non-normative events can not be anticipated are unusual and result in unexpected change, are more likely to be experienced as crises, and are more likely to result in the family life course being changed (e.g., divorce, death of a child) (McCubbin & Figley, 1983). 
  • The family life cycle is one view of normative change that is commonly used. The death of family member and the related grief reconciliation is a long-term process and normal development may act as complicate grief; indeed, what may appear as pathological grief behavior may be developmentally appropriate behavior (e.g., the perception of children’s approach and avoidance grief as evidence of a lack of emotional involvement) (Shapiro, 1994). Families at different points in their evolution will have different strengths and weaknesses, as will family members in terms of their individual development. Finally, transitions or other stressors encountered later in life may function as triggers and bring family members back to the pain and memories of earlier, unresolved losses.
• Family Structure: The family has a structure which includes hierarchies, boundaries and subsystems. Loss of a family member or the loss of some aspect of a family member results in structural change in the family.
  • Hierarchy has three meanings in family systems. It describe power aspects of relationship (i.e., who makes decisions in family or carries more weight in decision-making); roles of parents and children and boundaries between generations (i.e., structural character between generations); and logical types and order of family systems (i.e., systems and subsystems) (Simon, Stierlin & Wynne, 1985).
  • Subsystems are made up of members of the larger family system and may be made up of a single individual (Cook & Oltjenbruns, 1989). Alliances or coalitions are particularly close bonds between and among family members (Cook & Oltjenbruns). As a result of unique subsystem relationships, each family member will experience a different loss with the death of a family member.
  • Boundaries are "lines" of demarcation determined by members of the system that encloses the system and establishes those who are members of the system (Minuchin, 1974). The permeability of a boundary (i.e., the ability of others to enter the system and for members to leave it) determines the degree of openness in that system. 
    • Because a death within the family alters the system, boundary ambiguity (i.e., uncertainty as to who is in and who is out of the system) may result (Boss, 1999). We will address this concept in greater detail later in this course.
    • Openness: System openness and closedness refer to the extent to which a family is open or closed to new information and to change. Open systems are dynamic and open to events and feeling while closed systems are more rigid and insensitive (Cook & Oltjenbruns, 1989).
• Homeostasis (related to equilibrium) refers to the continuity of a system, a relatively steady internal state of a system that is maintained through regulation the use of family norms and a mutually reinforcing feedback loop (Krauss & Jacobs, 1990; Simon, Stierlin & Wynne, 1985). Homeostasis in families will be disrupted by the loss of a family member or a family member’s inability to maintain role performance. Systems that are more open will be able to deal with this better than more closed systems. The death of a family member creates a structural instability that requires readjustment (Bowlby-West, 1983). The first task of the family after the death of a member is to achieve a stable equilibrium needed for ongoing family development (Shapiro, 1994).
• Morphogenesis/Morphostasis: Morphogenesis is the ability of a system to change its form and morphostasis is the ability of a system to hold its shape. These maintain a constant dynamic tension in families (Simon, Stierlin & Wynne, 1985; Chubb, 1990). As a system, the family exists in paradox. It needs stability so that family members know their roles and can carry them out with the security that they are "doing it right." Stability provides continuity over time. At the same time, the system needs to be able to adapt to the changes in and among family members. The result is a balancing act (Shapiro, 1994). If there is too much change, the system breaks down; if too much stability the system atrophies and dies away. Most typically, the family adapts to the changes resulting from a loss to reclaim new structures and functions related to the new memberships and the perceived strengths of the members.
• Equifinity/ Equipotentiality. With equifinality, the same result occurs, even though individual family members begin at different starting points. With equipotentiality, different endings can result from the same starting point. The same event leads to different outcomes and a given outcome may result from different events (Simon, Stierlin & Wynne, 1985). Thus, family members may achieve the same resolution of a loss, even though they started at different points or they may reach very different grieving conclusions, even though they were quite similar, initially.
• Family Resilience: "The property of a family system that enables it to maintain its established patterns of functioning after being challenged and confronted by risk factors...The family’s ability to recover quickly from a misfortune, trauma, or transitional event causing or calling for change in the family’s patterns of functioning" (italics in original) (McCubbin, McCubbin, Thompson, Han & Allen, 1997) These two factors are identified by McCubbin and his colleagues as elasticity and buoyancy. General resilience factors include: family problem-solving communication, equality, spirituality, flexibility, truthfulness, hope, family hardiness, family time and routine, social support, and health.
• Resources: People are most likely to turn to their families for support when in crisis. If social support is available and accepted, it can reduce stress on the bereaved while simultaneously allowing the helper to feel useful and more capable (Gilbert, 1995, 1996). When family members turned to, and support given, family relationships were generally strengthened (DeFrain & Ernst, 1978). Providing such support is difficult, at best. Support frequently does not come easily, it may be positive or negative in its impact, or it may not come at all. This is because family members, in broad context, are coping with their own loss issues as well as the loss issues of others in the family (Rosenblatt et al, 1991).

Family systems theory has been useful as a tool for creating explanations for patterns of behavior seen in families. It has come under increasing criticism, primarily because of its neglect of the individual in the family. In addition to the possible loss of the individual in family systems, suggested by others, Rosenblatt (1994) has critiqued metaphors used in family systems theory while suggesting creative ways of reconceptualizing these metaphors. I strongly recommend his book.

Family as a Context for Creating and Maintaining Meaning

The family is an important resource in this social construction after loss. In fact, people are embedded in an ongoing process of definition within the context of the family. On a daily basis, family members validate each others' view of reality, often without awareness that this is going on. As they encounter new information, they compare and attempt to confirm beliefs, opinions, hunches, and theories. If family members confirm one another's subjective views of each other and the situation, these subjective views are then given objective reality. By that I mean that what they perceive comes to be seen as real because significant others also see it that way; if not, they question their own or the other's perceptions and formation of an objective reality is made more difficult.

As you will recall from Unit 1, the need to create a new, trustworthy view of the world is a driving force after a loss. Ambiguity is uncomfortable, even frightening, and the urge to find certainty and to have it confirmed by others we trust is quite strong. Where a loss has occurred, if the family is able to develop a shared view, ambiguity about who and/or what has been lost is reduced. Family members who can do this have a better sense of how they are to cope with that loss and how they are to move forward with their lives. Shared meaning also facilitates positive communication, provides structure and meaning to their interactions, and serves as the basis for family coping.

An important point to remember here, as we address "shared" views, is that families do not actually hold beliefs; families are a collection of individuals held together by, among other things, a sense among its members of commitment, history and the promise of a future. So when we talk about "shared views" in families, we are demonstrating the need for a socially confirmed reality. As members of a family, we assume that others see things as we do based on our observation of and interaction with other family members. We may, in fact, be inaccurate, but as long as our belief in a shared view is not confronted by contrary information, that belief continues to be held. I found in separate interviews with marital partners that they frequently made assumptions about shared beliefs that were not held by the other partner. You may have already noted this, but this is the central idea I present in the article "We've had the same loss, why don't we have the same grief?"

At the same time they feel a need for a shared view, family members may all find themselves overwhelmed by the loss. Each has unique issues to address as they grieve and this diminishes their ability to verify each others' view of the loss. Thus, paradoxically, family members actually may be more likely, at first, to recognize differences, rather than the similarity they desire. One possible explanation for this awareness of differences actually may be the drive to find a shared view. The difference between what they expect and what they encounter may exaggerate the differences.

As I have indicated above, one consistency in clinical and scholarly literature is that the drive for a shared family view is powerful and a lack of one is painful for family members. Logically, the push should be for consistency. Yet, trying to establish a single view may be counterproductive. Consistent with Shapiro's view on family communication, it may be best to recognize that there are aspects of the loss that are open to discussion and confirmation within the family and others that are not. Figley (1989), in proposing the "family healing theory" as a single, unifying healing theory, also recognizes that family members may agree to disagree about certain aspects of the loss.

Family Development and Grief

Some changes in families are considered normative events because can be anticipated and planned for (e.g., marriage, births, retirement). Others, non-normative events, can not be anticipated, are unusual and result in unexpected change. These are more likely to be experienced as crises and are more likely to result in the family life course being changed (e.g., divorce, death of a child). Some events that could be considered as normative at one age (e.g., the natural death of a parent when s/he is 85 years old and in ill health) might be experienced as untimely or out of sequence at another time (e.g., the accidental death of a parent when s/he is 30 years old and in good health).

A variety of models of normative change have been suggested, the most commonly mentioned of which is the "family life-cycle" which moves from dating, through the rearing of children, to the death of one spouse. Unfortunately, the number of families that meet this "normal" model is extremely small, reducing the utility of this model. The complexity of family life within the context of a wide variety of family forms suggests that it would be best to think of development as a process of change and adaptation rather than a set of "normal" elements.

Because grief reconciliation is a long-term (some say never-ending) process, normal development in the family may act as a complicating factor. This is due to the fact that, even as the family members must cope with the loss, they also are going through developmental changes as individuals and as a family. Various developmental tasks are tied to one's individual stage of development as well as the stage of family development. Individuals will have different developmental tasks to complete, as well (This will be addressed in greater detail when we discuss developmental issues in the next few units.).

Families at different points in their evolution will have different strengths and weaknesses. A newly married couple, for example, will have very different resources to draw on than a couple who have been married for over 25 years.

Development of the family may be affected by a loss far into the future. Later life transitions or other stressors may bring family members back to the pain and memories of earlier losses. Often I have spoken with family members who talked about "supposed to" times or "should have been's"-- These are characterized by statements like "When the next Christmas came, it killed me. We were supposed to be together at Christmas," or "I woke up in the morning, ready to go to Luci's graduation with such mixed feelings. John wasn't there and he'd never be there. He was such a good dad. He should have been there."

A loss can affect family development into future generations. Transgenerational effects of loss have been explored by Bowen (1991), who found through his practice of therapy that unresolved loss can have long-term implications for the family. His contention is that loss disrupts normal family process and this can extend into future generations if it is not resolved. The experiences of Holocaust survivors and their descendants are well-documented examples of transgenerational effects.

The Family as a Resource after Loss

Although the family often serves as the primary source of support during times of great stress, the reality is that providing such support is difficult, at best. More often than not, the ideal picture of the family is tempered by pressures on the family and its members. Support frequently does not come easily, it may be positive or negative in its impact, or it may not come at all. This is because family members, in broad context, are coping with their own loss issues as well as the loss issues of others in the family. Later in this course, when we cover roles and relationships, we will address the nature of support in families and why family members actually may be the least capable of providing support.

Family Tasks of Grieving

• Recognize the loss as real. Family members must acknowledge the loss as real while each family member shares her/his grief. In order to do this, family members must share emotions and thoughts with each other. Grief is an isolating experience; a sense of acceptance among members would be promoted by displays of tolerance of differences in grief response by family members.
• Reorganize and reinvest in the family system. The family system is destabilized by the loss; yet to continue to function, order and control must be reclaimed. Family members must reconstruct what family means to them and the roles and related tasks of the person who has died must be reassigned or given up. Family life may seem chaotic at this time and there may be battles over how the family will be reorganized. Differences in grieving may contribute to a feeling of being out-of-synch among family members. To get in-synch, families must reframe their differences as strengths rather than weaknesses. The family must reinvest itself in normal developmental evolution. Tasks that are carried out as a matter of course in families must again be carried out in the family. This reclaiming of a normal life may be seen to some as abandonment of the deceased loved one. Trying to avoid mention of the deceased may inhibit communication, contributing to a sense of secretiveness in the family. Family members should let each other hold onto the memory until releasing them feels voluntary.

General Conclusions

Development, both of individuals and family systems, is one of the more important and overlooked aspects of family grief. This may be related to the tendency among most family systems theories to concentrate on the "here and now," rather than to think in historical terms. Yet, grief extends far beyond the weeks, months, or even years, that it was traditionally seen to last and people do not enter a developmental vacuums as they work through their grief. Both interact to influence each other.

In looking at the tasks of grief described by Walsh and McGoldrick, one thing that strikes me is how important it is to have a stable, supportive family system in order to resolve the grief of the family members. Yet I know that pressures on the family system are tremendous after a loss. Family members must contend with outside as well as inside pressures and may feel that, somehow, there is a sense that they "deserve" their loss. They may even feel this way themselves, adding to their stress.

Finally, the readings for this unit listed a number of factors that contribute to the complexity of grief in families. We will be using the remainder of this course to address several of these contributing factors.

Questions for Discussion

In addition to posting questions, observations, and insights on the readings in the e-anthology and for the "lecture" provided by Dr. Gilbert on Oncourse. In addition, post your response to the following questions on the Class Discussion and your additional musings on your blog.

1. Walsh and McGoldrick recommend open communication for successful completion of the family tasks of grieving (listed above). The communication style in some cultures, though, is one of veiled communication and limited direct sharing of emotions (e.g., Asian cultures). Do you see this "task" focused model of grieving to be appropriate in families from these cultures? How so?
2. After reading and considering the readings and the lecture, respond to this statements: "Families don't feel. Families don't think. Families don't grieve. Only individuals do these things."
3. Starting in this unit, I'd like you to go back at the end of the week and identify at least one "take away" message you took from the readings, lecture and class discussion.

Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief. Cambridge, MA: Harvard University Press.

Bowen, M. (1991). Family reaction to death. In F. Walsh & M. McGoldrick, (Eds.), Living beyond loss: Death in the family (78-92). New York: W. W. Norton & Co.

Bowlby-West, L. (1983). The impact of death on the family system. Journal of Family Therapy, 5, 279-294.

Burr, W. R., Day, R. D., & Bahr, K. S. (1993). Family science. Pacific Groves: CA: Brooks/Cole.

Chubb, H. (1990). Looking at systems as process. Family Process, 29, 169_175.

Cook, A. S., & Oltjenbruns, K. A. (1989). Dying & grieving: Lifespan & family perspective. New York: Holt, Rinehart and Winston, Inc.

DeFrain, J. D., & Ernst, L. (1978). The psychological effects of Sudden Infant Death Syndrome on surviving family members. The Journal of Family Practice, 6, 985-989.

Figley, C. R. (1989). Post-traumatic family therapy. In F. Ocher (Ed.), Post-traumatic therapy (pp. 83_109). New York: Brunner/Mazel.

Fowlkes, M. R. (1991). The morality of loss: The social construction of mourning and melancholia. Contemporary Psychoanalysis, 27, 529_551.

Gilbert, K. R. (1996). 'We've had the same loss, why don't we have the same grief?' Loss and differential grief in families. Death Studies, 20, 269_283.

Imber-Black, E., & Roberts, J. (1992). Rituals for our times: Celebrating, healing, and changing our lives and our relationships. New York: Harper Collins.

Krauss, M. W., & Jacobs, F. (1990). Family assessment: Purposes and techniques. In Meisels, S. J. & Shonkoff, J. P., (Eds.). Handbook of early childhood intervention. (pp. 303_325). New York, NY: Cambridge University Press.

McCubbin, H. I., McCubbin, M. A., Thompson, A. I., Han, S. Y. & Allen, C. T. (1997). Families Under Stress: What Makes Them Resilient. [Available on-line: http://www.cyfernet.org/research/resilient.html].

McCubbin, H. I., & Figley, C. R. (1983). Bridging normative and catastrophic family stress. In H. I. McCubbin & C. R. Figley (Eds.), Stress and the family: Volume I: Coping with normative stress (pp. 221_228). New York: Brunner/Mazel.

McGoldrick, M., Almeida, R., Hines, P. M., Rosen, E., Garcia-Preto, N., & Lee, E. (1991). Mourning in different cultures. In F. Walsh & M. McGoldrick, (Eds.), Living beyond loss: Death in the family (pp. 176-206). New York: W. W. Norton & Co.

Minuchin, S. (1974).Families and family therapy. Cambridge, MA: Harvard University Press.

Peppers, L. G., & Knapp, R. J. (1980). Motherhood and mourning: Perinatal death. New York: Praeger.

Rosenblatt, P. C. (1994) Metaphors of family systems theory: Toward new constructions. New York: The Guilford Press.

Rosenblatt, P. C., Spoentgen, P., Karis, T. A., Dahl, C., Kaiser, T., & Elde, C. (1991). Difficulties in supporting the bereaved. Omega, 23, 119_128.

Satir, V. (1988). The new peoplemaking. Mountain View, CA: Science and Behavior Books, Inc.

Shapiro, E. R. (1994). Grief as a family process: A developmental approach to clinical practice. New York, NY: Guilford Press.

Shapiro, E. R. (1996). Family bereavement and cultural diversity: A social developmental perspective. Family Process, 35, 313_332.

Simon, F. G., Stierlin, H., & Wynne, L.C. (1985). The language of family therapy: A systemic vocabulary and sourcebook. New York: Family Process Press.

Stierlin, H. (1973). Group fantasies and group myths–Some theoretical and practical aspects. Family Process, 12, 111-125.

Walsh, F. & McGoldrick, M. (Eds.) (1991). Living beyond loss: Death in the family. New York: W. W. Norton & Co.

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