Unit 1 -- What is Grief?

Grief in a Family Context -- HPER F460/F560

Goals for this Unit

The intent is that upon competing this unit, students will understand the multi-faceted nature of the grief process and will be able to demonstrate that understanding through their contributions on the discussion list. Readings from non-North American cultures, primarily African and Asian, are included to expand our view of grief.

Preliminaries

Answer these questions before you go on to the next section. Send your response to me (Dr. G). at gilbertk@indiana.edu and remember to save a copy for yourself. You will need these later in the course.

  1. What do you think of when you hear the term "grief"? Is it possible to experience a significant loss and still not go through grief? Why is that so?
  2. How would you determine that someone's grief is resolved. . . or if it is necessary that it be resolved?

Readings

Anthology

Attig, T. (2001). Relearning the world: Making and finding meaning. In R. A. Neimeyer, Meaning reconstruction & the experience of loss (pp. 33-54), Washington, DC: American Psychological Association.

Gilbert, K. R. & Smart, L. S. (1992). Grief on the individual level: The grieving process. In K. R. Gilbert, & L. S. Smart, Coping with infant or fetal loss: The couple's healing process (pp. 27-49), New York: Brunner/Mazel Pub. Co.

Murray, C. I. (2001). Loss and attachment, trauma and grief: Issues for the international study of stressor events. Paper presented at the annual meeting of the National Council on Family Relations, Rochester, NY.

Web Resources

 (NOTE: Because of the unpredictability of our ability to access web resources (here today, gone or moved somewhere else tomorrow), these are included as supplemental reading unless otherwise noted.)

http://opentohopefoundation.com/  -- this site is an excellent resource on loss and grief.

 

"Lecture"

For lack of a better term, I'm calling this a lecture, even though I won't be talking to you. As with many lectures, the information presented here builds on your readings and suggests ways in which you might analyze the topic under consideration. Incidentally, if you can suggest a better term than "lecture," please let me know.

This lecture and the readings present a number of different ways in which grief has been viewed. As you read, consider how these views relate to your own. How do you see grief as defined here relating to losses you have known (either your own or those of others you have observed)?

As you consider what grief is, both while working on this unit and as you continue through the course, I want you to keep the following in mind: Grief is not restricted to loss to death. It is true that many--in fact, most--of the work on grief looks at it in the context of a loss to death. It is also true that most of the examples we will be using in this class will involve death. However, loss to death of a person who is significant to us is the most recognized source of grief but it is not the only source. Grief can result from any loss: divorce, either one's own or that of a significant other; the end of a friendship; infertility; giving a child up for adoption; a family member with a disability or a chronic condition. All of these involve loss and another person, yet none involve death. In addition, one may experience grief as the result of the loss of (for lack of a better term) something as well as someone: Family relocation, job loss, the loss of a pet. In each case, a loss resulting in grief takes place, even though the focus of one's grieving is not necessarily on another human being.

Finally, as you work on this unit and all the units that follow, read and think critically. By that I mean, consider alternative views to those presented here. Is there anything about any of the perspectives presented that you question? Let us know.


Grief is. . .

. . .many things. Here are some of the most common interpretations.

. . . an emotional response

One of the more common ways of viewing grief is as an emotional reaction to loss. Grief can include deep sorrow that is breathtakingly painful. It can be a dull, constant ache that seems never to leave. Grief is sudden and sharp or slow and agonizing. It can come in waves and may be of such intensity that sufferers may question their sanity. It may also leave them with thoughts of emptiness, questioning whether life is worth living.

Yet, grief is more than just emotion. Worden (1991) has suggested that it consists of four dimensions. He has provided the following list of the most common manifestations of each:

An even broader picture of grief might also include the following dimensions:


. . . a series of stages or phases

Grief as a progression through stages has maintained great popularity. This may be because the structure of such models allows for a sense of direction and order. Even those (myself included) who struggle with stage or phase models, find themselves drawn to their tidiness. There is something intuitively appealing in a structure that predicts a beginning, middle and end of something that feels interminable.

The vast majority of stage or phase models of grief follow a similar pattern: first, a period of disorganization, emotional numbness, and denial of the reality of the loss; followed by a period of extremes, in which the bereaved search for the one who is now lost to them and also struggles to accommodate to a revised reality; ending in resolution of the loss, in which the changed reality is accepted and the bereaved moves on with their lives. A prominent model, developed by Bowlby (1961, 1980) and Parkes (1972), involves four stages: 1) shock and numbness, 2) searching and yearning, 3) disorientation, and 4) reorganization and resolution.

Possibly the most popular stage model is one that was developed by Kübler-Ross (1969) in her work with dying patients. She intended this model to be used in relation to one's grief at one's own death, but it has been adopted by many as the standard by which all grief should be assessed. In this model, the griever moves through five stages of loss, characterized by denial, anger, bargaining, depression, and finally acceptance. The griever might move through these stages in a varied way, but the ultimate goal is acceptance of the loss.

Stage models have come under increasing scrutiny and the current thinking has shifted toward seeing the stages as benchmarks, but they often are seen as causing more problems than they resolve. Although not intended by the vast majority of writers, they often are seen as prescriptive rather than descriptive; individuals who "haven't gone through the stages" may come to feel that they are not grieving "right." Researchers looking at different types of loss are unable to find evidence that people move through a consistent set of stages toward recovery. Indeed, common patterns found, especially among parents who had lost a child, included: recurrent grief, also referred to as shadow grief (Peppers & Knapp, 1980). In this, bereaved individuals experience episodes of renewed grief after a period of assumed recovery; and worsening of grief over time, sometimes after they had experienced their grief as less intense. There is some questions about whether or not people "recover" (Silver & Wortman, 1992) and what that term actually means. Much evidence shows that later losses may trigger earlier grief thought to have been resolved.

Ultimately, stage models only have utility to identify overall patterns that must, of necessity, remain very broad. When we try to apply them to the grief of individuals, we often find the patterns wanting. Alternatives to stage model have been suggested. One I particularly like was developed by Davidson (1979). He used the metaphor of an onion, suggesting that going through grief is like peeling an onion. Each new layer will be a different aspect of the grief process and these aspects may be reexperienced over and over as each new layer is peeled back.


. . . an illness

Here, grief is seen through the lens of the medical model. Indeed, there is some evidence that, during the time following a significant loss, one's immunity is reduced and susceptibility to disease and even death is increased. An excellent source for exploring this further than is possible in this lecture is The Handbook of Bereavement: Theory, Research, and Intervention by Stroebe, Stroebe and Hansson (1993). Several chapters specifically address physiological changes during bereavement.

This model would suggest that we exist in a normally healthy state and, after the trauma of loss, we enter an illness state. Engel (1961) proposed this view and argued that healing is necessary for the bereaved to return to a healthy state. Certainly, acute grief feels like an abnormal state, physically, emotionally, intellectually. In my own work, I have found that many people refer to their state using medical terminology (e.g., It's like when you break your leg. You have to heal. I just healed."). The phrase "Time heals all wounds" also reflects this conceptualization.

It is from this image of grief as a medical state, with symptoms and an anticipated "normal" course of recovery, that has the idea of normal versus pathological grief arose. In this, grief that falls within a certain range is diagnosed as normal, while other grief expression is seen as pathological or abnormal. Much discussion of this has taken place, particularly in relation to the basis for defining something as pathological. Because pathology is culturally based, the questions "In relation to what?" becomes important here. How is pathology defined? Because pathology is a culturally determined concept that will be modified as times and attitudes change, caution should be taken in its use.

Many scholars and clinicians have abandoned the concept of pathology in assessing grief, and have substituted the term, "complicated grief." In this, the focus can then be shifted to complicating factors -- factors that contribute to this grief being more difficult to resolve. Still, the initial awareness of complicated grief results from observations of non-normative grief. Worden (1991) has described four classes of complicated grief:

As Worden and others have described it, complicated grief seem to be related to one of two extremes -- grief that is avoided or suppressed and grief that the individual can or will not "let go of." This form of grief is on the increase and it will be important to understand some of the factors that lead to it. We will spend more time, later in this course, on this particular manifestation of grief and will look especially at family factors.


. . . a series of tasks

In his ground breaking study, in 1944, Lindemann wrote about grief work, which is physically, intellectually and emotionally draining. He described this work of grief as the completing of tasks necessary for the resolution of grief and formation of new relationships. Worden (1991) has proposed that grief work following a loss to death involves four tasks: 1) to accept the reality of the loss, 2) to work through the pain of grief, 3) to adjust to the environment in which the deceased is missing, and 4) to emotionally relocate the deceased and move on with life.

Once these four tasks have been completed, grief is assumed to have been resolved. As with all models of grief, criticism has been made of the idea that grief tasks can be resolved and grief can be left behind. The fourth task, emotionally relocating the deceased and moving on with life, has been subject to particular discussion. One interpretation of this task is not that the bereaved abandon the memory of the deceased; rather it is that they recognize a different perspective on the deceased and begin to find joy in their life and in relationships with others. As one father I interviewed told me, "My daughter's not in my life anymore. She's in my heart." In a sense, what he experienced was not the end of a relationship with his daughter -- it was the transformation of the relationship.

An adaptation of Worden's model has been proposed by Tagliaferre and Harbaugh (2002), who expanded this model of grief by proposing five tasks: 1) acknowledge the loss, 2) feel the impact, 3) acquire temporary substitutes, 4) detach from the relationship, and 5) reconstruct a new life.  They have gone on to describe a 20-step model of grief that overlaid the five tasks with four elements of personal wholeness: physical, intellectual, emotional, and spiritual. They then proposed that individual survivors will use the model in a hierarchical form according to their personality type as displayed by the Myers-Briggs Type Indicator, while focusing on their most preferred coping resources. They showed an elementary correlation between coping resources and personality types that was compiled by Allan Hammer (To explore this model in greater detail, see their book Recovery From Loss).


. . .an active process of coping directed at remaking reality

Grief is seen in this constructivist view as an active, cognitive process of reconstructing "normal," of reconciling the reality that existed before the loss with the reality that exists after. Grief consists of efforts to reclaim lost stability and to search for understanding of why the loss had occurred and for meaning in the loss. Attig (1992) proposes, rather than view this as a part of grief, we should view this active process as "grieving" rather than "grief."

The work of grief, in this case, is nothing less than a reclamation of a stable and dependable world. Assumptions about how the world "should be" have been assaulted and the conflict must be resolved. These assumptions have been referred to by Parkes (1972) as the assumptive world. Seen as coping, grief is goal-directed behavior, intended to bridge between the assumptive world that was in existence before the loss and the assumptive world that follows the loss. This process is an expansive one. It grows to include the consideration of assumptions not directly related to the loss, but related to the assumptions under consideration. Ultimately, the bereaved may believe they have been changed to the very core of their being.

This process is difficult: The bereaved may feel that their lives have become meaningless. Things that made sense before the loss no longer make sense. At the same time, they need to make sense. The bereaved feel a strong need to regain the feeling that their life, somehow, is normal. Unfortunately, the "normal" they now experience is no longer normal as they knew it before. They are caught in a paradox of needing a normalcy that is predictable and understandable while seeing a world that is neither.

One example of the coping that results from this quandary can be seen in the reading by Gilbert and Smart (1992), in which we used a traumatic stress model to explore parental grief. We identified two general approaches to coping: The first is an effort to reclaim normal by actively seeking out and processing information about the loss. It focuses on regaining a sense of structure in the parents' lives, attributing meaning to the loss and events surrounding the loss, and the gathering of information that would provide a context for understanding. The other general approach involves both active and passive efforts to protect themselves from pain, either by preventing information about the loss from being considered, or by choosing not to think about the information after it had been considered. The ultimate goal is a to develop a "healing theory" that allows the bereaved to understand the loss and its effect on their lives and to regain a new sense of normalcy.

If avoidant coping is used in the quest for normalcy, the bereaved may appear to have resolved their loss because the outward signs of grief are missing. "Acting normally" does not result in true reorganization of the assumptive world and does not resolve the underlying issues. According to Horowitz (1986), the completion tendency, or the drive toward consistency between anticipated reality and experienced reality will trigger recurrent grief. Anniversary reactions, the return of grief on significant dates, is an example of this recurrent grief. Thus, grief may leave only to return later, unanticipated and uninvited, or it may be there continually, acting as our connection to the person who was lost.

This is a view of grief that sees it as highly active. In this view, the statement "time heals all wounds" would be translated into "Time in itself does not heal. It's what you do with the time that makes it meaningful." Yet, the question must be asked--what if the loss is so senseless or so immense that no meaning can be made? Is the only possible result a sense of meaninglessness and futility in life?


. . . grief as a spiritual journey

In this view of the grief process, grief is seen as a transformational experience, a journey toward a new awareness. Included in this view is the idea that suffering is necessary for transformation, that it transcends the individual experience of grief and extends to a broader cultural, moral, and religious view of what suffering is. More than the typical psychological, physiological, and social view of grief that most conceptualizations take, grief is seen here simultaneously to include elements of morality, philosophy and theology. An excellent example of this view can be seen in A Grief Observed, the diary that C. S. Lewis kept after the death of his wife. In it he painfully recounts how he struggled to reconcile his wife's death with his strong religious faith. Ultimately, his faith was strengthened, and he was an altered person, transformed by his grief. But, it is important that this does not need to occur in the context of an organized religion or that there is a single religious tradition that best serves this. The journey has unique elements to each individual, which brings up the next point...


. . . a uniquely personal experience

Often, their grief feels to bereaved individuals like something that is radically different from anything they have experienced before and from the grief of others. In this case, grief responses are not seen as universal. Each person has experienced a particular loss and, as a result, will experience a unique grief.

Here, we would see grief as one's personal response to a loss, the result of allowing yourself to be emotionally vulnerable and open to an attachment/bonding with another. Because each relationship is unique, and we grieve the loss of this relationship, each grief will be unique. For example, one may grieve for a wished for child, a wished for parent, the moment of reconciliation in a troubled relationship, strengthening of a sibling bond, or the chance to correct problems in a relationship with spouse or partner.

An important aspect of this view is the loss of dreams and hopes for the future, both of which often are related to an altered view of one's past. An example of this is a man who has resented what he has perceived as his wife's meddling in his affairs. After her death, he discovers that he misses her and feels deeply the loss of their wished-for, relaxed, post-retirement years and now sees her as having been caring and attentive in their time together. Another example would be a mother struggling with the reality of her adolescent child engaging in dangerous and illegal behavior (e.g., using illegal drugs and alcohol, "hanging out" with a dangerous crowd, stealing). She may grieve over the lost hopes she has for her child and for the future relationship she had hoped for (with her child as well as with other family members), for her own hopes for herself in the role of mother. She might also, in looking backward, grieve over the loss of what she now sees as a fantasy of happy family life.

As you can see, this perspective that takes into account individual uniqueness is an important view, especially as one works as a grief counselor or attempting to support a friend or family member. A generic model of grief will not be a perfect match with the grief of the individual.

General Conclusions

The sentence, "Grief is . . ." can be completed many ways. In part, this is because loss is something all of us experience and the specific characteristics of each loss contributes to a unique sense of loss and grief. If we took all of the responses from class members to the questions at the beginning of this unit, we would find something different about each definition. At the same time, we would find patterns of similarities among definitions. The same is true, as you can see, of scholars who study and write about this phenomenon.

As you see here and throughout the course, grief is much more than a person's emotional response to a loss. It is the totality of the response. Grief includes emotions and thoughts and is contradictory and confusing: Bereaved feel a need to be a part of something and to be apart from everything; the need to feel deeply and to avoid feelings; the need to talk and to be silent. Grief is the state of being that results from the recognition that the world that "should be" is different from the world that is--a world that is forever changed by the loss.

I see people as makers of meaning--in any situation, we need to make sense of the world we encounter. I also see grief as the natural response to a meaningless situation, that is, grief is an effort to make sense of the senseless and to regain a feeling of control and predictability in one's life. I agree with the participant in my research who called grief a "redefinition of normal." I think the process underlying what we see as grieving is a painful struggle to reconcile ourselves to the reality of the loss. To paraphrase psychologist Peter Marris, to lose someone you love is not like losing your car keys. It's like the laws of gravity have been repealed. We need to reclaim the law of gravity to survive. . . and that is the work of grief.

Questions for Discussion

At some point early in the week, post your response to at least one of the following questions (remember, this is the bare minimum for the class. You'll want to post to more than a single question for the full value of the class and, if your concern is your grade, for a high grade in the course). Remember to respond to other students' postings in order to complete the assignment.

This unit, What is Grief?, serves as an orientation to our understanding of what grief is and the various ways in which it is understood. Remember that we are approaching this information on three ways:

I've organized this below into this order: the first question below is the broad, open-ended instruction on responding to the reading; questions 2 through 4 are more philosophical or projective..

  1. Questions, thoughts, observations, insights, etc. on assigned readings and lecture: This is where you will be posting your reactions to the readings. For example: What did you learn? What surprised you? What confused you? Did you have an 'aha' moment? What was it? Basically, what is the 'take away message' from the reading(s)?
  2. All of these models of grief have been critiqued and their appropriateness for ALL grievers and ALL forms of loss has been questioned. In fact, some models have been seen as prescriptive (the "best" way to grieve) rather than descriptive (the form that grief takes or one of a number of forms that grief takes). All have been seen as culturally specific. Select one or more of the ways of viewing grief and share your thoughts on these criticisms.
  3. These different models of grieving frequently use metaphoric images of grief. In my research, some of the metaphors have included seeing it as a great weight, a disease, a devouring monster, a pit. What are some of the metaphoric images you use when thinking of grief? Why do you think we use these?
  4. After you've had an opportunity to read, think, and discuss grief, go back to the questions at the top of this unit. Have your views on grief changed? If yes, in what ways? If not, why do you think this is? Post your thoughts on this, but do it only several days after you've responded to questions 1, 2, and 3.

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