Kamalamani - Therapist and mentor in Bishopston, Bristol
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This article reviews different theories of grief and will be of interest to those of you who wish to learn more about these theories or perhaps want to make sense of your own grieving process. If you wish to jump to a particular section the article includes the following bookmarks:
- the Buddhist story of Kisa Gotami
- definitions of grief
- characteristics of grief
- Elisabeth Kubler Ross model
- Colin Parkes stages of grief
- J. William Worden's 'tasks of grief
- Catherine Sander's integrative theory of bereavement
- Alida Gersie and story making and grief
- Tony Walters and continuing bonds
- the bibliography
‘Caught between the world of the living and the dead’: an introduction to grief theories
Kamalamani, May 2008
Kisa Gotami lived in Savatthi in India at the time of the Buddha. After the death of her only child Kisa Gotami became desperately inconsolable and asked if anyone could help her. Her sorrow was so great and her despair so deep that many thought she had lost her mind. Someone suggested that she go and meet the Buddha. The Buddha told her that he could help her on one condition; if she could get mustard seeds from a household where no-one had ever died. She desperately went from house to house, from door to door, but to her disappointment, every household had had someone who had died. She finally realised that there is no home which is completely free of loss and death. She returned to the Buddha and became one of his disciples, as she realised the truth of impermanence.
As the famous Buddhist story of Kisa Gotami reminds us, loss is around us all the time, affecting us personally or our friends and colleagues. I thought it might be useful to include some theories of grieving on this website. Some people who are grieving (or supporting grieving friends or relatives) may find it helpful to make sense of the process they are moving through, perhaps by noticing which of the concepts and ideas resonate with their experience. Hopefully some of you reading this will realise that the array and intensity of emotions you may be experiencing in grief is a natural part of your healing process. There is no ‘right’ way to grief and no theory that will completely encapsulate your own grieving process.
For many people, it seems important for grief to be expressed and talked through with a trusted person for healing to occur. Some see grief as comparable to a physical illness (see Parkes and Worden). For example, Parkes (1972, pg 6) speaks of the ‘blow’ of a loss and how the blow, in most cases, gradually heals, as does a physical blow. He also explores why it may be that different people heal at different rates. So it’s important that those who are grieving and seek counselling can be supported through their very particular grieving process, whether that’s grieving for a loved one, the loss of a relationship, job or whatever has been lost that was significant.
Some feel that the support of close family and friends should be sufficient support in coming to terms with a death. This may be the case, although the difficulty in many circumstances is that when family members are all coming to terms with the death of a person, the resources to support each other (as well as dealing with ongoing daily life), can be lacking, so in these situations, coming to counselling can be useful and supportive. It can also be useful to talk to someone who’s ‘neutral’, especially when you find yourself facing challenging family relationships and dynamics. If those who are mourning are able to express their feelings of grief, there is less chance of more ‘complicated grief’ arising; when grief becomes unresolved, and where the healing process is interrupted.
Definitions
So to begin with, a few agreed definitions.
·Bereavement is the state of having lost someone.
·Grief refers to the range of emotions experienced by individuals following bereavement.
·Mourning refers to the process which occurs after a loss. Mourning is often strongly influenced by culture and cultural norms, expectations and practices.
What is lost after a loss?
When we lose a loved one, it is often not simply our loved ones that we lose. Parkes (1972, pg 8) points out that a whole host of other things are lost. To illustrate this point, I bring to mind my own experience of working with clients who work in family businesses. For these clients, losing a close relative can have far reaching consequences, because they not only lose a family member, but also a work colleague, often a mentor, as well as having to deal with the practical difficulties in finding someone to fulfil their business role and function. So oftentimes, a loss creates ripples through the different dimensions of our lives. A loss can sometimes ‘echo’ of all the previous losses of our lives, which we re-visit and make sense of in the light of our most recent loss.
What characterises grief?
‘All I remember is the endless cups of tea, a sea of faces and an excruciating, crushing tiredness in every fibre of my body’
(Abrams, 1992 pg 3).
This quote really leapt out of the page when I first read it, as it so strongly resonated with my own feelings during times of grief and those feelings I have witnessed in close friends, family members and clients. Worden provides a very comprehensive review of ‘normal grief reactions’ (pg 21 to 36), which I will summarise below.
In terms of feelings, he notes: sadness, anger, guilt and self-reproach, anxiety, loneliness, fatigue, helplessness, shock, yearning, emancipation, relief, and numbness. In terms of physical sensations, he cites: hollowness in the stomach, tightness in the chest, tightness in the throat, over sensitivity to noise, a sense of depersonalisation (‘I walk down the street and nothing seems real, including myself’), breathlessness, muscle weakness, lack of energy and a dry mouth.
In terms of cognition and thought processes during grief, Worden cites the following responses:
·Disbelief. ‘It didn’t happen’.
·Confusion. An inability to order very ordinary thoughts.
·Preoccupation. Obsessive thoughts about the deceased.
·Sense of presence. This is especially true immediately after death, when mourners still believe that the person who has died is still in the same time and space.
·Hallucination. These can be of both the visual and auditory type which tend to happen in the first few weeks after a loss, and mourners can find them either disconcerting or helpful.
With regards to the last point, Worden points out how these ‘hallucinations’ may actually be ‘metaphysical phenomenon’. Walter contests the use of the term ‘hallucination’ preferring ‘continuing relationship with the dead’ (Walter, 1999, pg 57). Obviously how each individual interprets this phenomenon depends upon their own spiritual, religious and world views.
In terms of other specific behaviours, Worden explores: sleep disturbance, appetite disturbance, absent-minded behaviour, social withdrawal, dreams of the deceased, avoiding reminders of the deceased, searching and calling out, sighing, restless over-activity, crying, visiting places or carrying objects that remind the survivor of the dead, and treasuring objects that belonged to the dead. Worden also looks at determinants or factors affecting grief, which I have included in Annex 1.
What are the documented phases, stages or tasks in the grieving process?
In this section I will introduce briefly some of the well known ideas about the grieving process. Please bear in mind that these stages/phases should not be seen literally or chronologically, as grief is not a ‘tidy’, sequentially experienced set of emotions.
Elisabeth Kubler-Ross
The stages of grief as outlined by Elisabeth Kubler Ross are probably the best known and documented set of ideas. Kubler Ross (1970) says that those who have been bereaved, or who have experienced other forms of loss, pass through the following stages:
·Shock stage: “It can’t be true”. Initial paralysis at hearing the news.
·Denial stage: Trying to avoid facing up the reality of what’s happened.
·Anger stage: Frustrated outpouring of bottled-up emotion.
·Bargaining stage: Desperately seeking a way out of facing the truth of what’s happened
·Depression stage: Final realising the truth and size of the loss.
·Testing stage: Seeking realistic solutions as they adjust to their new reality.
·Acceptance stage: Finally finding the way forward and looking to the future.
Kubler Ross’s model certainly broke new ground when it was first published, as there had been very limited research from those actually working with the dying and grieving until her ideas became popular.
Colin Parkes (ideas developed with John Bowlby)
Parkes cites the stages of:
1.numbness
2.pining
3.disorgnisation and despair
4.recovery
J. William Worden
Worden’s emphases the ‘tasks (my emphasis) of mourning’ (1983, pg 10). He suggests that rather than think of mourning as a set of phases, it’s most important to identify what he sees as tasks that help facilitate a healthy grieving process:
·Task 1: to accept the reality of the loss
·Task 2: to work through to the pain of grief
·Task 3: to adjust to an environment in which the deceased is missing
·Task 4: to emotionally relocate the deceased and to move on with life
Catherine Sanders
Moving on from the ideas of ‘tasks’, Sanders (1989) introduces her ‘integrative theory of bereavement’ and is keen to emphasise that individuals have choice during the grieving process. She argues that it is very important to include the notion of motivation in looking at bereavement, and the decision the mourner makes (or not as the case may be) in deciding to carry on engaging with life. Sander’s five stages are:
1.Shock: intial confusion, disbelief, restlessness, a state of high alert
2.Awareness of shock: stress, feelings of conflict, separation anxiety
3.Conservation-withdrawal: despair, withdrawal, helplessness
4.Healing: the sense of a turning point, rebuilding identity and relinquishing roles
5.Renewal: new sense of freedom, awareness, learning to live without the person
Sanders (1989, pg 39) argues that the first three stages are based primarily on biological needs. For example, shock, the first phase, protects the griever from initially being overcome by the pain of the separation. Gradually, awareness of the individual’s shock occurs, with strong emotional outbursts countered by the individual pulling back and conserving energy (the conservation-withdrawal phase) in order to survive and move into the healing process. It is at the end of the third stage that Sanders says that the griever makes a decision, conscious or unconscious, to survive and begin a new life (moving into the phases of healing and renewal), or to remain a state of perpetual bereavement.
Towards the end of her own life, Sanders was in the process of developing a sixth phase in her schema, relating to “fulfilment”. Sanders sadly died before she was able to complete her work on fulfilment, so her colleague, Kenneth Doka, published her work on her behalf following her death.
The fulfilment phase as envisioned by Sanders, is when the grieving person looks back at his or her own life with a perspective which integrates that death into the fabric of their life. Sanders believed that in this phase “one’s life journey only made sense given the experience of loss. While the loss was neither welcomed nor anticipated, one could no longer imagine what life would be like without that loss” (Doka, 2006, pg 148).
Sanders apparently saw this phase of fulfillment as deeply spiritual, in that it required an underlying spirituality or philosophical perspective that allowed the griever to retain an ongoing sense of connection with the deceased as well as a framework which enabled him/her to integrate the loss within their life. In emphasising this, Sander’s work moved into the territory of “continuing bonds” in the grief literature, which we will move onto later in this article.
Alida Gersie and ‘Storymaking’
The very creative author, Gersie, introduces us to a very different set of ideas about grief and bereavement. Gersie is a therapeutic storymaker who uses myths and related stories to make sense of the process of grief, using global folk tales.
Gersie argues that there are four phases that must be experienced in the process of each of us ‘letting go’ of the dying (1991, pg 29):
1. Acknowledgement that an important bond exists with this person and that this bond will be irrevocably changed by their death
2. Addressing outstanding issues with the dying person, so that we can prepare for the final separation
3. Knowing that someone is dying, Gersie argues that we see the person in some respects for the ‘first time’ in this role, making it harder to let go. The offering and accepting of each others’ love and blessings is therefore important at this stage
4. The actual separation. Granting the other and ourselves true permission to embark upon our different journeys in life and death
Gersie goes on to say that depending upon how fully we have had the opportunity to live through each of the above stages, in terms of letting go of those we love in the final stage of their live, will influence the amount of grief ‘work’ we have to do following the death of that loved one. She sees the subsequent ‘tasks of grief’ as four fold:
1. Mourning in the life which we actually lived
2. Mourning the life we did not live, but we may have lived if circumstances had been different
3. Mourning the future which we imagined to be an extension of our actual life, the future which we could have reasonably expected
4. Mourning the ‘possible’ future, the life which might have been ours, if only our imagined past had become a reality
Gersie goes onto to say that we cannot come to grips with the loss endured in bereavement unless we are prepared to explore our own relationship with death as an experience and as a concept. She acknowledges that seeing our lives with such clarity is a very challenging experience and points out that the more we are aware of the complexity of our ways of being, the greater our willingness to accept and engage with both life and death.
‘Letting go and keeping hold’ or ‘Continuing Bonds’
Tony Walter is another author whose work provides a contrast to the more traditional ‘stage’ models of grieving. ‘On Bereavement: the Culture of Grief’. Walter is among a minority of authors who challenges the idea that all mourners need and want to ‘let go’ and ‘move on’, those themes which are prominent in the bereavement literature. Walter argues that:
‘many others maintain a bond with their dead indefinitely, even while forging new social ties. They do not let go and move on; they transform the relationship, keep hold and move on’, (Walter, 1999, p xiii).
Walter goes on to look at how our cultural conditioning has a huge impact upon the way we grieve. His ideas are similar to those of Klass et al, who challenge the idea that the purpose of grief is to sever bonds with the deceased in order to move on. They propose that the resolution of grief involves continuing bonds that survivors maintain with the deceased, and that those bonds can be a healthy, ongoing part of life.
Being ‘caught between the world of the living and the dead’. Walter beautifully explores the situation of the bereaved as being ‘caught between the world of the living and the dead’ and ‘somehow they must traverse this boundary’ (pg 19). This very aptly describes the strange ‘no man’s land’ that the grieving can find themselves in.
Different cultural approaches to death
It can also very useful and illuminating to read about death customs in other countries and cultures. This can help to throw light and how our own personal cultural conditioning impacts upon the way we feel we are able to grief, within the boundaries of norms, expectations, and rituals. It is beyond the scope of this particular work to look at the vast range of death customs around the globe, but fascinating further reading.
Conclusion
This brief introduction to grieving highlights its complexity and the fact that the mourning process cannot be captured by one simple model or outlined process. Grieving is a process which will be different for every person, depending upon all sorts of factors: their relationship to the person who has died, their own circumstances, their own emotional and physical wellbeing, their religious views, their stage in life, and other stressors that affect them.
Strong, turbulent feelings of grief lessen over time, if clients are given the space, time and dimensions to grief fully. Perhaps the real lesson to learn from all of this is that our lives are never the same from moment to moment. We are often able to avoid this truth until something as deeply disruptive and upsetting as a death occurs. Our living relationships with the people we know change us and their death changes us. And some believe we continue to in a different of form of relationship with the deceased after their death.
Go back to home page. Go back to Kamalamani's writing page. Go to bereavement counselling page. Go to bereavement links page.
Bibliography
NB The quote in the title is from Walter's work, see reference below.
Abrams R (1992) When Parents Die, Routledge. ISBN 0 415 20066 0
Bowlby J (1980) Attachment and Loss: Loss, Sadness and Depression Vol III, New York Basic Books.
Dickenson D & Johnson M (1993) Death, Dying and Bereavement, Open University. 0 8039 8796 8
Doka K (2006) ‘Fulfillment As Sanders’ Sixth Phase Of Bereavement: The Unfinished Work
Of Catherine Sanders’, Journal of Death and Dying, Omega, Vol. 52, No 2, Pg 143-151.
Gersie A (1991) Storymaking in Bereavement: Dragons Fight in the Meadow, JKP Books. ISBN 1 85302 176 8
Hennezel de M (1995) Intimate Death: How the Dying Teach Us To Live, Warner Books.
Hinton J (1967) Dying, Penguin. ISBN 0 14 02 0866 6
Klass et al (1996) Continuing Bonds: New Understandings of Grief, Taylor & Francis. ISBN 1-56032-339-6
Kubler Ross E (1970) On Death and Dying, Tavistock/Routledge. ISBN 0 415 04015 9
Kubler Ross E (1975) Death: the Final Stages of Growth, Touchstone Books. 0 684 83941 5
Parkes CM (1972) Bereavement: Studies of Grief in Adult Life, Penguin. ISBN 0 14 025754 3
Sanders CM (1989) Grief: the Mourning After, Wiley Series. 0 471 62728 3
Stroebe M & Schut H (1999) ‘The Dual Process Model Of Coping With
Bereavement: Rationale And Description’, Death Studies, No 23, pg197-224, Taylor & Francis
Walter T (1999) On Bereavement: the Culture of Grief, Open University Press. ISDN 0 335 20080 X
Worden JW (1983) Grief Counselling and Grief Therapy, Routledge. ISBN 0 415 07179 8
Annex 1
Determinants of Grief
(taken from Worden, 1991, pg 31). Also see Parkes (1972, pg 119) for a similar set of factors affecting grief responses.
1.Who the person was (how the person died and their relationship to the mourner, in terms of the significance of the relationship)
2.The nature of the attachment:
·The strength of the attachment (the strength of grief being linked to the strength of love)
·The security of the attachment (how necessary was the deceased for the sense of well-being of the survivor?)
·The ambivalence in the relationship (a more difficult grief response can occur where there was a greater degree of ambivalence)
·Conflicts with the deceased (this can complicate grief responses, particularly around earlier physical/sexual abuse)
3.Mode of death (how the person dies will say something about how the survivor grieves. Deaths are traditionally categorised into: natural, accidental, suicidal and homicidal. Other dimensions may be linked to where the death happened, whether near or far, and whether or not it was expected. Circumstances can also have a strong influence, for example, if one person survives an accident in which another was killed)
4.Historical antecedents (in order to understand how someone will grieve, it’s useful to know of previous losses and how the person responded to these. He also points out someone’s overall mental health history would be relevant here)
5.Personality variables (for example, the age and gender of the person, and how well they cope with anxiety and stress. People who have difficulty forming relationships may have more difficulty coping with loss, and those with personality disorders)
6.Social variables (the influence of the social, ethnic, and religious subculture of the mourner, the degree of perceived emotional and social support and the ‘secondary gain’ some may find in mourning. A survivor may get a lot of mileage in his social network as a result of grieving)
7.Concurrent stresses (other stresses that happen concurrently with the bereavement, for example, economic problems following a death)
- the Buddhist story of Kisa Gotami
- definitions of grief
- characteristics of grief
- Elisabeth Kubler Ross model
- Colin Parkes stages of grief
- J. William Worden's 'tasks of grief
- Catherine Sander's integrative theory of bereavement
- Alida Gersie and story making and grief
- Tony Walters and continuing bonds
- the bibliography
‘Caught between the world of the living and the dead’: an introduction to grief theories
Kamalamani, May 2008
Kisa Gotami lived in Savatthi in India at the time of the Buddha. After the death of her only child Kisa Gotami became desperately inconsolable and asked if anyone could help her. Her sorrow was so great and her despair so deep that many thought she had lost her mind. Someone suggested that she go and meet the Buddha. The Buddha told her that he could help her on one condition; if she could get mustard seeds from a household where no-one had ever died. She desperately went from house to house, from door to door, but to her disappointment, every household had had someone who had died. She finally realised that there is no home which is completely free of loss and death. She returned to the Buddha and became one of his disciples, as she realised the truth of impermanence.
As the famous Buddhist story of Kisa Gotami reminds us, loss is around us all the time, affecting us personally or our friends and colleagues. I thought it might be useful to include some theories of grieving on this website. Some people who are grieving (or supporting grieving friends or relatives) may find it helpful to make sense of the process they are moving through, perhaps by noticing which of the concepts and ideas resonate with their experience. Hopefully some of you reading this will realise that the array and intensity of emotions you may be experiencing in grief is a natural part of your healing process. There is no ‘right’ way to grief and no theory that will completely encapsulate your own grieving process.
For many people, it seems important for grief to be expressed and talked through with a trusted person for healing to occur. Some see grief as comparable to a physical illness (see Parkes and Worden). For example, Parkes (1972, pg 6) speaks of the ‘blow’ of a loss and how the blow, in most cases, gradually heals, as does a physical blow. He also explores why it may be that different people heal at different rates. So it’s important that those who are grieving and seek counselling can be supported through their very particular grieving process, whether that’s grieving for a loved one, the loss of a relationship, job or whatever has been lost that was significant.
Some feel that the support of close family and friends should be sufficient support in coming to terms with a death. This may be the case, although the difficulty in many circumstances is that when family members are all coming to terms with the death of a person, the resources to support each other (as well as dealing with ongoing daily life), can be lacking, so in these situations, coming to counselling can be useful and supportive. It can also be useful to talk to someone who’s ‘neutral’, especially when you find yourself facing challenging family relationships and dynamics. If those who are mourning are able to express their feelings of grief, there is less chance of more ‘complicated grief’ arising; when grief becomes unresolved, and where the healing process is interrupted.
Definitions
So to begin with, a few agreed definitions.
·Bereavement is the state of having lost someone.
·Grief refers to the range of emotions experienced by individuals following bereavement.
·Mourning refers to the process which occurs after a loss. Mourning is often strongly influenced by culture and cultural norms, expectations and practices.
What is lost after a loss?
When we lose a loved one, it is often not simply our loved ones that we lose. Parkes (1972, pg 8) points out that a whole host of other things are lost. To illustrate this point, I bring to mind my own experience of working with clients who work in family businesses. For these clients, losing a close relative can have far reaching consequences, because they not only lose a family member, but also a work colleague, often a mentor, as well as having to deal with the practical difficulties in finding someone to fulfil their business role and function. So oftentimes, a loss creates ripples through the different dimensions of our lives. A loss can sometimes ‘echo’ of all the previous losses of our lives, which we re-visit and make sense of in the light of our most recent loss.
What characterises grief?
‘All I remember is the endless cups of tea, a sea of faces and an excruciating, crushing tiredness in every fibre of my body’
(Abrams, 1992 pg 3).
This quote really leapt out of the page when I first read it, as it so strongly resonated with my own feelings during times of grief and those feelings I have witnessed in close friends, family members and clients. Worden provides a very comprehensive review of ‘normal grief reactions’ (pg 21 to 36), which I will summarise below.
In terms of feelings, he notes: sadness, anger, guilt and self-reproach, anxiety, loneliness, fatigue, helplessness, shock, yearning, emancipation, relief, and numbness. In terms of physical sensations, he cites: hollowness in the stomach, tightness in the chest, tightness in the throat, over sensitivity to noise, a sense of depersonalisation (‘I walk down the street and nothing seems real, including myself’), breathlessness, muscle weakness, lack of energy and a dry mouth.
In terms of cognition and thought processes during grief, Worden cites the following responses:
·Disbelief. ‘It didn’t happen’.
·Confusion. An inability to order very ordinary thoughts.
·Preoccupation. Obsessive thoughts about the deceased.
·Sense of presence. This is especially true immediately after death, when mourners still believe that the person who has died is still in the same time and space.
·Hallucination. These can be of both the visual and auditory type which tend to happen in the first few weeks after a loss, and mourners can find them either disconcerting or helpful.
With regards to the last point, Worden points out how these ‘hallucinations’ may actually be ‘metaphysical phenomenon’. Walter contests the use of the term ‘hallucination’ preferring ‘continuing relationship with the dead’ (Walter, 1999, pg 57). Obviously how each individual interprets this phenomenon depends upon their own spiritual, religious and world views.
In terms of other specific behaviours, Worden explores: sleep disturbance, appetite disturbance, absent-minded behaviour, social withdrawal, dreams of the deceased, avoiding reminders of the deceased, searching and calling out, sighing, restless over-activity, crying, visiting places or carrying objects that remind the survivor of the dead, and treasuring objects that belonged to the dead. Worden also looks at determinants or factors affecting grief, which I have included in Annex 1.
What are the documented phases, stages or tasks in the grieving process?
In this section I will introduce briefly some of the well known ideas about the grieving process. Please bear in mind that these stages/phases should not be seen literally or chronologically, as grief is not a ‘tidy’, sequentially experienced set of emotions.
Elisabeth Kubler-Ross
The stages of grief as outlined by Elisabeth Kubler Ross are probably the best known and documented set of ideas. Kubler Ross (1970) says that those who have been bereaved, or who have experienced other forms of loss, pass through the following stages:
·Shock stage: “It can’t be true”. Initial paralysis at hearing the news.
·Denial stage: Trying to avoid facing up the reality of what’s happened.
·Anger stage: Frustrated outpouring of bottled-up emotion.
·Bargaining stage: Desperately seeking a way out of facing the truth of what’s happened
·Depression stage: Final realising the truth and size of the loss.
·Testing stage: Seeking realistic solutions as they adjust to their new reality.
·Acceptance stage: Finally finding the way forward and looking to the future.
Kubler Ross’s model certainly broke new ground when it was first published, as there had been very limited research from those actually working with the dying and grieving until her ideas became popular.
Colin Parkes (ideas developed with John Bowlby)
Parkes cites the stages of:
1.numbness
2.pining
3.disorgnisation and despair
4.recovery
J. William Worden
Worden’s emphases the ‘tasks (my emphasis) of mourning’ (1983, pg 10). He suggests that rather than think of mourning as a set of phases, it’s most important to identify what he sees as tasks that help facilitate a healthy grieving process:
·Task 1: to accept the reality of the loss
·Task 2: to work through to the pain of grief
·Task 3: to adjust to an environment in which the deceased is missing
·Task 4: to emotionally relocate the deceased and to move on with life
Catherine Sanders
Moving on from the ideas of ‘tasks’, Sanders (1989) introduces her ‘integrative theory of bereavement’ and is keen to emphasise that individuals have choice during the grieving process. She argues that it is very important to include the notion of motivation in looking at bereavement, and the decision the mourner makes (or not as the case may be) in deciding to carry on engaging with life. Sander’s five stages are:
1.Shock: intial confusion, disbelief, restlessness, a state of high alert
2.Awareness of shock: stress, feelings of conflict, separation anxiety
3.Conservation-withdrawal: despair, withdrawal, helplessness
4.Healing: the sense of a turning point, rebuilding identity and relinquishing roles
5.Renewal: new sense of freedom, awareness, learning to live without the person
Sanders (1989, pg 39) argues that the first three stages are based primarily on biological needs. For example, shock, the first phase, protects the griever from initially being overcome by the pain of the separation. Gradually, awareness of the individual’s shock occurs, with strong emotional outbursts countered by the individual pulling back and conserving energy (the conservation-withdrawal phase) in order to survive and move into the healing process. It is at the end of the third stage that Sanders says that the griever makes a decision, conscious or unconscious, to survive and begin a new life (moving into the phases of healing and renewal), or to remain a state of perpetual bereavement.
Towards the end of her own life, Sanders was in the process of developing a sixth phase in her schema, relating to “fulfilment”. Sanders sadly died before she was able to complete her work on fulfilment, so her colleague, Kenneth Doka, published her work on her behalf following her death.
The fulfilment phase as envisioned by Sanders, is when the grieving person looks back at his or her own life with a perspective which integrates that death into the fabric of their life. Sanders believed that in this phase “one’s life journey only made sense given the experience of loss. While the loss was neither welcomed nor anticipated, one could no longer imagine what life would be like without that loss” (Doka, 2006, pg 148).
Sanders apparently saw this phase of fulfillment as deeply spiritual, in that it required an underlying spirituality or philosophical perspective that allowed the griever to retain an ongoing sense of connection with the deceased as well as a framework which enabled him/her to integrate the loss within their life. In emphasising this, Sander’s work moved into the territory of “continuing bonds” in the grief literature, which we will move onto later in this article.
Alida Gersie and ‘Storymaking’
The very creative author, Gersie, introduces us to a very different set of ideas about grief and bereavement. Gersie is a therapeutic storymaker who uses myths and related stories to make sense of the process of grief, using global folk tales.
Gersie argues that there are four phases that must be experienced in the process of each of us ‘letting go’ of the dying (1991, pg 29):
1. Acknowledgement that an important bond exists with this person and that this bond will be irrevocably changed by their death
2. Addressing outstanding issues with the dying person, so that we can prepare for the final separation
3. Knowing that someone is dying, Gersie argues that we see the person in some respects for the ‘first time’ in this role, making it harder to let go. The offering and accepting of each others’ love and blessings is therefore important at this stage
4. The actual separation. Granting the other and ourselves true permission to embark upon our different journeys in life and death
Gersie goes on to say that depending upon how fully we have had the opportunity to live through each of the above stages, in terms of letting go of those we love in the final stage of their live, will influence the amount of grief ‘work’ we have to do following the death of that loved one. She sees the subsequent ‘tasks of grief’ as four fold:
1. Mourning in the life which we actually lived
2. Mourning the life we did not live, but we may have lived if circumstances had been different
3. Mourning the future which we imagined to be an extension of our actual life, the future which we could have reasonably expected
4. Mourning the ‘possible’ future, the life which might have been ours, if only our imagined past had become a reality
Gersie goes onto to say that we cannot come to grips with the loss endured in bereavement unless we are prepared to explore our own relationship with death as an experience and as a concept. She acknowledges that seeing our lives with such clarity is a very challenging experience and points out that the more we are aware of the complexity of our ways of being, the greater our willingness to accept and engage with both life and death.
‘Letting go and keeping hold’ or ‘Continuing Bonds’
Tony Walter is another author whose work provides a contrast to the more traditional ‘stage’ models of grieving. ‘On Bereavement: the Culture of Grief’. Walter is among a minority of authors who challenges the idea that all mourners need and want to ‘let go’ and ‘move on’, those themes which are prominent in the bereavement literature. Walter argues that:
‘many others maintain a bond with their dead indefinitely, even while forging new social ties. They do not let go and move on; they transform the relationship, keep hold and move on’, (Walter, 1999, p xiii).
Walter goes on to look at how our cultural conditioning has a huge impact upon the way we grieve. His ideas are similar to those of Klass et al, who challenge the idea that the purpose of grief is to sever bonds with the deceased in order to move on. They propose that the resolution of grief involves continuing bonds that survivors maintain with the deceased, and that those bonds can be a healthy, ongoing part of life.
Being ‘caught between the world of the living and the dead’. Walter beautifully explores the situation of the bereaved as being ‘caught between the world of the living and the dead’ and ‘somehow they must traverse this boundary’ (pg 19). This very aptly describes the strange ‘no man’s land’ that the grieving can find themselves in.
Different cultural approaches to death
It can also very useful and illuminating to read about death customs in other countries and cultures. This can help to throw light and how our own personal cultural conditioning impacts upon the way we feel we are able to grief, within the boundaries of norms, expectations, and rituals. It is beyond the scope of this particular work to look at the vast range of death customs around the globe, but fascinating further reading.
Conclusion
This brief introduction to grieving highlights its complexity and the fact that the mourning process cannot be captured by one simple model or outlined process. Grieving is a process which will be different for every person, depending upon all sorts of factors: their relationship to the person who has died, their own circumstances, their own emotional and physical wellbeing, their religious views, their stage in life, and other stressors that affect them.
Strong, turbulent feelings of grief lessen over time, if clients are given the space, time and dimensions to grief fully. Perhaps the real lesson to learn from all of this is that our lives are never the same from moment to moment. We are often able to avoid this truth until something as deeply disruptive and upsetting as a death occurs. Our living relationships with the people we know change us and their death changes us. And some believe we continue to in a different of form of relationship with the deceased after their death.
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Bibliography
NB The quote in the title is from Walter's work, see reference below.
Abrams R (1992) When Parents Die, Routledge. ISBN 0 415 20066 0
Bowlby J (1980) Attachment and Loss: Loss, Sadness and Depression Vol III, New York Basic Books.
Dickenson D & Johnson M (1993) Death, Dying and Bereavement, Open University. 0 8039 8796 8
Doka K (2006) ‘Fulfillment As Sanders’ Sixth Phase Of Bereavement: The Unfinished Work
Of Catherine Sanders’, Journal of Death and Dying, Omega, Vol. 52, No 2, Pg 143-151.
Gersie A (1991) Storymaking in Bereavement: Dragons Fight in the Meadow, JKP Books. ISBN 1 85302 176 8
Hennezel de M (1995) Intimate Death: How the Dying Teach Us To Live, Warner Books.
Hinton J (1967) Dying, Penguin. ISBN 0 14 02 0866 6
Klass et al (1996) Continuing Bonds: New Understandings of Grief, Taylor & Francis. ISBN 1-56032-339-6
Kubler Ross E (1970) On Death and Dying, Tavistock/Routledge. ISBN 0 415 04015 9
Kubler Ross E (1975) Death: the Final Stages of Growth, Touchstone Books. 0 684 83941 5
Parkes CM (1972) Bereavement: Studies of Grief in Adult Life, Penguin. ISBN 0 14 025754 3
Sanders CM (1989) Grief: the Mourning After, Wiley Series. 0 471 62728 3
Stroebe M & Schut H (1999) ‘The Dual Process Model Of Coping With
Bereavement: Rationale And Description’, Death Studies, No 23, pg197-224, Taylor & Francis
Walter T (1999) On Bereavement: the Culture of Grief, Open University Press. ISDN 0 335 20080 X
Worden JW (1983) Grief Counselling and Grief Therapy, Routledge. ISBN 0 415 07179 8
Annex 1
Determinants of Grief
(taken from Worden, 1991, pg 31). Also see Parkes (1972, pg 119) for a similar set of factors affecting grief responses.
1.Who the person was (how the person died and their relationship to the mourner, in terms of the significance of the relationship)
2.The nature of the attachment:
·The strength of the attachment (the strength of grief being linked to the strength of love)
·The security of the attachment (how necessary was the deceased for the sense of well-being of the survivor?)
·The ambivalence in the relationship (a more difficult grief response can occur where there was a greater degree of ambivalence)
·Conflicts with the deceased (this can complicate grief responses, particularly around earlier physical/sexual abuse)
3.Mode of death (how the person dies will say something about how the survivor grieves. Deaths are traditionally categorised into: natural, accidental, suicidal and homicidal. Other dimensions may be linked to where the death happened, whether near or far, and whether or not it was expected. Circumstances can also have a strong influence, for example, if one person survives an accident in which another was killed)
4.Historical antecedents (in order to understand how someone will grieve, it’s useful to know of previous losses and how the person responded to these. He also points out someone’s overall mental health history would be relevant here)
5.Personality variables (for example, the age and gender of the person, and how well they cope with anxiety and stress. People who have difficulty forming relationships may have more difficulty coping with loss, and those with personality disorders)
6.Social variables (the influence of the social, ethnic, and religious subculture of the mourner, the degree of perceived emotional and social support and the ‘secondary gain’ some may find in mourning. A survivor may get a lot of mileage in his social network as a result of grieving)
7.Concurrent stresses (other stresses that happen concurrently with the bereavement, for example, economic problems following a death)