Worden.Kosminsky.Carverhill.FoundationalTheories.7.8.20 (1)
docx
keyboard_arrow_up
School
University of Eldoret *
*We aren’t endorsed by this school
Course
310
Subject
Arts Humanities
Date
Nov 24, 2024
Type
docx
Pages
25
Uploaded by GeneralNeutron38
FOUNDATIONAL THEORIES
1
Foundational Grief Theories
J. William Worden, Phyllis Kosminsky, and Philip Carverhill
“Clearly no single theory is going to cover all of the consequences of bereavement, let
alone the other losses that we suffer” (Parkes, 2006, p. 30).
The theories we review in this chapter represent the foundation of our understanding of
the nature of grief, the impact of significant loss, and the factors that contribute to variations in
peoples’ grief responses. The evolution of this understanding continues to the present, and later
theoretical developments are addressed in the chapter on contemporary theories of grief (
Chapter
XX) in this volume. In addition to describing the key features of each theory, we offer
information regarding the background and person of each theorist.
Sigmund Freud and Psychoanalytic Theory
Sigmund Freud, the father of psychiatry, was among the first to provide an analysis and
description of grief in a clinical population. Whereas Freud studied medicine at the University of
Vienna, he was never interested in practicing as a conventional physician, but was more
interested in “philosophical- scientific investigations that might solve some of the great riddles
that fascinated him” (p. x, Gay, 1952). When Freud (1917/1957) published his influential
Mourning and Melancholia
, during the First World War, it was at a time of both significant
disillusionment in his professional life as well as a period of great personal anxiety in that all
three of his sons were serving in the army.
In terms of personal experiences of loss, Freud (1917/1957) ultimately described his
father’s death in 1896 as “the most important event . . . the most poignant loss of a man’s life” (p.
FOUNDATIONAL THEORIES
2
xiii, Gay, 1952). Although his sons ultimately all survived the war, Freud’s 27 year-old daughter
Sophie died in the inter-war Spanish flu epidemic leaving behind two young children and a
spouse. Then only three years later, her 5-year-old son Heinz died from tuberculosis. Having
experienced the death of his daughter and grandson, Freud wrote of his “irreparable narcissistic
wound” in a letter to Sandor Ferenczi. In 1929, in an effort to console Ludwig Binswanger, who
was suffering from a similar loss, Freud wrote; “We know that the acute sorrow we feel after
such a loss will run its course, but also that we will remain inconsolable, and will never find a
substitute. No matter what may come to take its place, even should it fill that place completely, it
remains something else. And that is how it should be. It is the only way of perpetuating a love
that we do not want to abandon.” It would appear that Freud’s theoretical notion of decathexis
(i.e., letting go) as applied to grief did not hold fast in his own experience.
Freud’s (1917/1957) theories grew out of his work with adult patients who displayed
what he identified as neuroses and neurotic symptoms (i.e., excessive and irrational anxiety). He
maintained that these symptoms stemmed primarily from repressed memories, many of them
traumatic in nature.
Freud (1917/1957) employed a variety of means to help patients recover
these repressed memories, ultimately focusing on the method of first putting pressure on the
patient’s head, then by using hypnosis.
Later he used free association, which involved observing
hesitations and parapraxis (i.e., inadvertent slips of the tongue) in order to try and uncover
repressed memories that would lead to insight and the freeing of neurotic conflicts.
Along with their neuroses, many of Freud’s (1917/1957) patients also exhibited grief
reactions that resembled symptoms of depression. To him these two manifestations were similar
but not identical. In his classic essay
Mourning and Melancholia
, Freud (1917/1957) introduced
his distinction between mourning, which was related to grief, and melancholia, which referred to
FOUNDATIONAL THEORIES
3
depression. In this book he makes his classic distinction: in grief the world looks empty to the
person, and in depression, the person experiences the self as empty.
Interestingly, Freud (1917/1957) viewed grief as not only an unavoidable consequence of
loss but also as a necessary process after losing a loved one to death. Through this process,
bereaved individuals engage in the difficult work of reality testing and accommodating to the
actuality of the loss. A second, fundamental aspect of mourning in Freud’s (1917/1957) view
involved bereaved individuals’ withdrawal of their emotional attachment to the deceased, a
process he labeled decathexis. This process of mourning enabled people to test the reality of the
loss, not always an easy task.
Freud (1917/1957) believed that grief was resolved when
decathexis from the lost loved one was complete and grieving persons’ emotional energy could
be reinvested in new relationships and activities.
Scholars have attributed the concept of “grief
work” to Freud (1917/1957) in connection with these mourning activities.
Freud’s (1917/1957) theory of grief remained in vogue for the next several decades
especially among proponents of psychoanalytic theory. He had his detractors who created their
own theories of mental health (e.g., Adler, Rank, Jung) but few, if any, focused on grief in the
way he did.
It is interesting to note that during Freud’s (1917/1957) time, a British psychologist
named Shand (1914) had also developed a series of hypotheses about grief he called “the laws of
sorrow” (p. 331), which unlike Freud’s (1917/1957) concepts, were constructed in such a way as
to be more empirically testable (Stroebe & Archer, 2013). Archer (2008) noted that whereas
Shand’s (1914) laws of sorrow “did not constitute a coherent theory of grief” they “covered a
broader range of features of grief than Freud’s” (p. 46). Shand’s (1914) ideas, however, have
essentially been lost to the pages of history.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
4
Erich Lindemann and Acute and Morbid Grief
The next theorist to make an impact on thinking about the process of mourning was Erich
Lindemann (1944), a German-American psychiatrist on the staff of Massachusetts General
Hospital who later became the Chief of Psychiatry. Lindemann’s (1944) interest in bereavement
can be traced to a horrific event: the Cocoanut Grove Fire, which occurred in the fall of 1942.
Lindemann was born in Witten, Germany into a prosperous business family (Satin,
1982). He earned doctoral degrees in both medicine and psychology, which makes him unique
among grief theorists, both then and now. His combination of personality characteristics and
acute powers of observation hearken back to some of Freud’s traits. He was a seminal figure in
social psychiatry and community mental health (Satin, 1982) and the publication of his research
with the survivors of the Cocoanut Grove fire served as a catalyst for others to carry out
empirical research on grief.
There were two teams playing football that day from Boston’s two Catholic colleges:
Boston College and Holy Cross College. In the fall of 1942, these two fierce rivals met for their
traditional game, and Holy Cross unexpectedly won. Afterwards a number of students and fans
went to celebrate at the Cocoanut Grove nightclub in the Park Square area of Boston. The club
was packed, and during the evening one of the decorative light bulbs burned out.
A busboy came
to change the bulb.
In order to see, he lit a match and accidentally lit a decorative palm tree on
fire. The fire spread rapidly, and in a short time 500 people were trampled, burned, and killed.
Lindemann (1944) decided to study the survivors from that disaster to further
understanding of grief and mourning.
In addition to the families served by the Massachusetts
General Hospital, he located and interviewed individuals served by other hospitals in Boston. He
FOUNDATIONAL THEORIES
5
ended up with a sample of 101 grieving patients.
Some of the people had been in the fire and
survived, whereas others were family members of those killed at the Cocoanut Grove.
Lindemann (1944) published his findings in a seminal paper entitled
Symptomatology
and Management of Acute
Grief.
In this article he made distinctions between normal grief and
morbid grief. In normal grief, which he referred to as “acute grief” (p. 141), mourners confront
the loss and experience the various emotional reactions stemming from it. Lindemann (1944)
found the emotional reactions to be quite varied and much broader in scope than those described
by Freud (1917/1957).
“Morbid grief” (p. 144) is the term that he used to describe the grief of
those who repressed their grief and avoided outward expressions of grief. Lindemann (1944)
came up with a fairly simplistic treatment recommendation which was that to return to normal,
individuals must express their grief.
Although Lindemann (1944) advanced thinking about grief and loss after a major
disaster, there are at least two major limitations of his study. First, he did not focus on individual
differences that contributed to mourners having different expressions of grief and/or different
outcomes.
Second, he overlooked the issue of chronic grief. Some of these mourners moved
rather quickly through their grieving experiences, whereas there was a sub-group of mourners for
whom grief continued for a long period.
It would have been helpful if he had studied this latter
group. Nevertheless, Lindemann (1944) must be credited for offering the field this seminal study
as it moved toward mid-century.
John Bowlby, Colin Murray Parkes, and
Attachment Theory
In the 1960’s John Bowlby began publishing groundbreaking work on Attachment
Theory (Van Dijken, 1998). His work continued for the next 25 years, and he was joined in
collaboration by Colin Murray Parkes. Attachment theory has provided a key foundation for
FOUNDATIONAL THEORIES
6
much of what is understood
about bereavement, grief and mourning, and its influence continues
to the present day (e.g. Mikulincer & Shaver, 2013; Delespaux et al., 2013; Kosminsky &
Jordan, 2016; Maccallum & Bryant, 2018), as seen in the development of contemporary models
of grief addressed more fully in
Chapter
XX
.
Bowlby was born into a professional upper-middle-class Edwardian family in London,
England in 1907 and died in 1990. He is quoted as saying that the effect of his particular
childhood was that he was “sufficiently hurt but not sufficiently damaged” (van Dijken, 1998, p.
11). As was the case for many children in his social class, Bowlby’s upbringing was handed over
from his mother to a nanny and nursemaids. When Bowlby was about four years old, his
nursemaid Minnie, who was his primary attachment figure, left the household employ. Van
Dijken (1989) quoted Bowlby as writing later in his career that “ . . . for a child to be looked after
entirely by a loving nanny and then for her to leave when he is two or three, or even four or five,
can be almost as tragic as the loss of a mother.” (p. 26).
It would seem apparent that he was
writing about his own early childhood experience. Van Dijken (1989) further noted that for some
years Bowlby repressed this memory and “his widow Ursula suggested that he buried his grief”
(p. 26).
Parkes is a British psychiatrist born in 1928 who continues to be active in the
international thanatology field.
Parkes’ (1972) interest in bereavement preceded his work with
Bowlby and continued through a lifetime of contributions to the field. Parkes (1972) began his
investigation of grief in the 1950’s when his studies focused on the impact of bereavement on
both physical and mental health.
His research posed the question of whether bereavement could
cause psychiatric morbidity and/or mortality (Parkes, 1964).
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
7
Parkes conducted his research in three key venues. His first investigations took place
while he was on the staff of the Tavistock Clinic in London.
A second location was St.
Christopher’s Hospice in London where Parkes established, along with Cicely Saunders, the first
hospice bereavement service and studies of dying and bereavement. A third research venue was
the Harvard Medical School, where he was the principal researcher in the Harvard Bereavement
Study (Parkes & Weiss, 1983). This study was based in the Laboratory of Community Psychiatry
at the Massachusetts Mental Health Center (MMHC), where Caplan (1964) did his pioneering
work on crisis intervention. MMHC has played a pivotal role in the development of preventative
psychiatry and community mental health in the United States. In the Harvard Bereavement
Study, researchers examined the impact of bereavement on young widows and widowers under
45 years of age in Boston and followed them for 4 years following their death losses.
Parkes and his colleagues (Parkes, 1972; Parkes & Weiss, 1983) were able to identify
bereavement risk factors that predicted later adjustment. Early identification of persons who
were not likely to do well ensured that these “at-risk” people were selected for early intervention
in order to do preventative mental health work.
Like Freud (1917/1957), Parkes described grief
work as necessary. To him, the work involved helping mourners to cope with preoccupied
thoughts of the loved one, helping them deal with painful repetitions of the loss experience, and
helping them to modify their assumptive world so as to make sense of the world without the
deceased. Over the years, Parkes (1972) research has strongly influenced the thinking of many
other bereavement theorists (e.g., Raphael, Silverman, Rubin).
A notable aspect of the contributions of Bowlby (1960, 1980, 1982) and Parkes (1998,
2006, 2010) to the body of knowledge in thanatology is their identification of patterns of
adaptation to loss and their observations concerning the relationship between attachment security
FOUNDATIONAL THEORIES
8
and grief response. Bowlby (1960, 1980, 1982) focused on elaborating the distinctions among
different patterns and made the distinction between secure and insecure attachments, whereas
Parkes (1998, 2006, 2010) focused much of his work on the role of how insecure attachment
plays a role in reactions to bereavement and in complications to the grieving process.
Bowlby’s (1944) interest in attachment began with his observations of young children
separated from their parents, work that led him to propose that the need to sustain connection
with caregivers is innately felt and that loss of connection activates
protest
behaviors designed to
restore contact. In three volumes on attachment, separation and loss that are the centerpiece of
his life’s work, Bowlby (1969, 1973, 1980), emphasized the importance of dependable and
responsive connection with a primary caregiver. These responses are part of the
attachment
system
, the healthy functioning of which is essential to the infant’s emotional well-being and
development.
In collaboration with Parkes (Bowlby & Parkes, 1970), Bowlby (1969) defined the
phases of mourning that represented the trajectory of grief after the death of a loved one. They
offered four phases of mourning. The first phase is Shock and Numbness. This phase helps
defend mourners against the pain experienced after the death of a loved one. The second phase
is Yearning and Searching. Searching for the lost loved one is very common after a death as
mourners look for the loved one to make sure that they are gone. Pining for the loved one is the
affect most frequently associated with searching behavior. The third phase is called
Disorganization and Despair. Here mourners struggle with questions of identity. For example, a
woman who loses her only child may struggle with the questions of whether she is still a mother.
Uncertainty about the ability to survive without the lost loved one is another feeling that arises
during this phase, which involves some of the most painful aspects of significant loss.
The
FOUNDATIONAL THEORIES
9
fourth and final phase is called Reorganization. The goal of this phase is to mend the fabric of
mourners’ lives and to find a way to move forward as new people in a new reality (Bowlby &
Parkes, 1970).
Attachment Security as a Factor in Response to Separation and Loss
Bowlby (1960, 1969) proposed that variations in infants’ separation response could be
understood as a reflection of their attachment security or insecurity. He, and later Ainsworth
(Ainsworth et al., 1978) and Main (Main & Solomon, 1986), observed hundreds of children and
their caregivers. They found that whereas some children persisted in their efforts to attract the
caregiver’s attention, others became still and withdrawn, and in extreme cases appeared to sink
into a state of despair. Ainsworth (1978) classified these responses as primary and secondary
behavioral strategies. The primary strategy of
securely
attached children is to signal for their
caregiver’s attention when they are uncomfortable or afraid. Once they have calmed down, they
return to play and interaction. Their behavior is fluid and reflects their internal state and felt
needs. This kind of flexibility in attention and behavior is regarded as an important indicator of
attachment security.
Behavioral flexibility is less evident in infants who do not have the benefit of consistent
and responsive nurturing. Based on what they come to understand of their reading of caregivers’
preferences, these young children appear to settle on one of two secondary strategies: either they
are
anxiously
attached, and cling to their caregiver or they are
avoidantly
attached and suppress
outward expressions of distress.
Disorganized
attachment, which is associated with early
relational abuse or neglect, is reflected in erratic attachment related behavior, mirroring the
erratic and frightening behavior of the caregiver (Main & Solomon, 1986).
Origins of Disordered Grief
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
10
Bowlby (1982) proposed that the patterns of secure and insecure attachment observed in
young children persisted into adulthood and had a continuing influence on individuals’ response
to attachment loss. In Volume III of
Attachment and Loss
, Bowlby (1982) wrote:
This leads to a central theme of the volume, namely, the influence on responses to loss of
the experiences which a bereaved person has had with attachment figures during the
whole course of his life, and especially during his infancy, childhood and adolescence.
These experiences are held to account for a large proportion of the variance observed in
the course taken by mourning in adults. (p. 76).
Anxiously attached individuals, whose emotional dependence would have been evident
when their loved one was alive, would be expected to have an extended and highly disruptive
response to the person’s death. Avoidantly attached individuals, who were resistant to forming
close attachments and generally downplayed the importance of emotions and their own need for
emotional support, would tend to suppress their grief. These patterns of disordered grief
contrasted with the normal grief, in which bereaved individuals neither suppressed, nor were
overwhelmed by, their feelings of loss. Their behavior would reflect their internal state, which
could be expected to feature periods of expressive, immersive sadness and interludes of respite
(Bowlby, 1982).
Bowlby’s
(1980) un
derstanding of the importance of flexible attention in adaptation to
loss along with his hypotheses concerning the role of anxious and avoidant attachment in
divergent patterns of disordered grief have been incorporated and extended in contemporary
models of bereavement (
see Chapter
XX). A notable example is the Dual Process Model
(Stroebe & Schut, 1999). The Dual Process to which the model refers involves an oscillation
between what the authors refer to as the loss orientation and the restoration orientation. Healthy
FOUNDATIONAL THEORIES
11
grief, according to the model, involves attention to the reality of the loss, with its attendant
feelings and need for accommodation to a world without the deceased, interwoven with attention
to ongoing roles and relationships: that is, to reintegration into life. A lack of emotional and
behavioral flexibility is associated with problematic grief, with anxiously attached individuals
more likely to become submerged in their grief, and avoidantly attached persons actively
avoiding grief related emotions and reminders of the deceased.
The research of Mikulincer and Shaver (2008, 2013) has given support to the role of
attachment in adaptation to grief, and together with the Dual Process Model (Stroebe & Schut,
1999), has provided a foundation for clinical applications that address attachment related
obstacles to adaptive grief (Kosminsky & Jordan, 2016). Clinical reports substantiate the value
of recognizing attachment insecurity as an obstacle to healthy grief and tailoring grief
interventions to clients’ attachment related needs. An understanding of problems in adapting to
loss that have been associated with different patterns of insecure attachment can guide clinicians
in the formulation of treatment, while also contributing to their ability to build strong therapeutic
bonds with their clients (Delespaux et al., 2013; Kosminsky & Jordan, 2016; Maccallum &
Bryant, 2018).
Kübler-Ross and Stage-Based Theory of Grief
Elisabeth Kübler-Ross was born in 1926 in Zurich, Switzerland where she completed
medical school, met her husband, and then moved to Long Island, New York
(Weisberg 2018).
The University of Chicago recruited Kübler-Ross in 1965, and during the next five years while in
the Psychiatric Consultation and Liaison Service, she helped hospital chaplain Rev. Carl
Nighswonger expand and strengthen the Death and Dying Program (Siegler 2019).
During that
time Kübler-Ross interviewed 400 terminally ill patients, typically in the presence of 40-50
FOUNDATIONAL THEORIES
12
theological and medical students, psychiatry residents, nurses, social workers and attending
psychiatrists (Siegler 2019).
It was these interviews that formed the basis for Kübler-Ross’s
(1969) famously influential publication
On Death and Dying: What the dying have to teach
doctors, nurses, clergy and their own families
. In it she outlined her five stages of dying: Denial,
Anger, Bargaining, Depression, and Acceptance (
see
Chapter XX for full description). There was
hardly a health care provider trained in that time period (or since) who had not heard of her five
stages of dying. Along the way, some who were seeking a quick and easy way to understand
bereavement began applying these stages to the bereavement process, although this was never
Kübler-Ross’ original intent (E. Kübler-Ross, personal communication with first author, July 15,
1971).
Her stage approach continued to influence grief theory for 40 years, and despite a lack of
research evidence, Kübler-Ross’ stages remain prominent in the popular media.
A plethora of articles and books provide detailed critiques of the many limitations and
assumptions of Kübler-Ross’s (1969) stage-based theory (see Stroebe, Schut, & Boerner, 2017
for comprehensive account). One of the main criticisms of this theory is that, although it was
based upon the experiences of people living with a terminal illness, it was inappropriately
generalized to apply to the bereaved and their grieving/mourning processes.
J. William Worden and Tasks of Mourning
J. William Worden is a clinical psychologist who began his thinking and research on grief
and loss in 1968 when he joined Harvard psychiatrist Avery Weisman at the Massachusetts
General Hospital. Their 18 year collaboration, funded by grants from the National Institutes of
Health, examined various aspects of life-threatening illness and life-threatening behavior. A
main focus of this research was people’s participation in their own death whether overtly by
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
13
suicide or more subtly by giving up and losing the will to live.
Out of this clinical and research
focus on existential issues, an interest in grief and bereavement naturally followed.
Worden put together a training course for health and mental health professionals, to
educate them about grief and how to work with grieving individuals and families. To come up
with a useful model, Worden borrowed the notion of tasks from developmental psychology (e.g.,
Allport, Erickson, Havinghurst), the focus of his earlier graduate education at Harvard. Most
specifically, he envisioned that there were certain tasks that mourners must address as they adjust
to the death of a loved one.
The idea of tasks seemed more fluid to Worden (1982) than that of stages. Tasks could
be re-visited and re-worked over time. Not every task presented the same obstacles to certain
mourners. The challenge depended on the attachment to the deceased, the circumstances of the
death, prior loss experiences, changes and disruptions in daily life, and social support. Worden’s
(1982) model gave mourners a perspective on what they may experience and gave mental health
professionals a way to understand their patients/clients’ experiences, especially when they
present for therapy feeling stuck in their grief. The task model was used in these original
training courses at Harvard and at the University of Chicago beginning in the early 1970’s and
culminated in Worden’s (1982) book,
Grief counseling & grief therapy : A handbook
for the
mental health professional
practitioner
. Since 1982 five editions of this book have been
published, the most recent in 2018.
According to Worden (2018), four tasks of mourning can be applied to the experience of
all mourners. Task I
is to
accept the reality of the loss
. If mourners do not believe the loss is real,
then they cannot deal with the affect associated with the death. This task involves not only
intellectual acceptance, but emotional acceptance as well, the latter often taking some time to
FOUNDATIONAL THEORIES
14
accomplish
.
Task II is
to process the pain of the
loss/grief.
Not every death is equally painful but
pain must be acknowledged and processed. To suppress or repress the pain before it is
adequately processed can lead to delayed grief reactions or to some type of somatic
manifestation of the grief. Task III is
to
adjust to a world without the deceased
. Under this task,
three types of adjustments challenge the mourner. External adjustments
are the changes that the
death brought that affect the functioning of daily life.
Internal adjustments are ways in which the
death has affected mourners’ self-definition, including how the death has challenged mourners’
sense of self-esteem and self-efficacy. Spiritual adjustments are ways in which the death has
changed or shattered mourners’ basic assumptions about God and the world. This includes how
the death has affected their core beliefs and values. Task IV is
to find a
way to
remember the
deceased while embarking on the rest of life’s journey
. Unlike Freud’s (1917/1957) notion of
decathexis, mourners find healthy ways to remember the dead person, ways that can help them to
move forward with life.
Although the tasks apply to all mourners, how they are worked through varies based on
individual differences. Worden (2018) outlined a series of six mediators that influence how
people handle the various tasks of mourning. These mediators include relationship and
attachment issues, death factors, personality and social factors, as well as concurrent
stressors. Worden’s (2018) task model has been widely used around the world as a standard
reference on grief counseling and grief therapy and has been translated into 14 languages.
Therese Rando Six Processes in Adapting to Loss
Therese Rando is a Rhode Island clinical psychologist whose clinical practice and
research have long focused on bereavement, anticipatory grief, and traumatic loss. Rando is the
Clinical Director and Founder of The Institute for the Study and Treatment of Loss in Warwick,
FOUNDATIONAL THEORIES
15
RI.
After Worden’s (1982) book appeared, Rando (1984; 1993) developed the
Six “R” Model
.
She used alliteration to help clinicians and mourners remember what needs to be done in the
mourning process. Although she did not use the term “tasks” she suggested six activities or
processes that are important in adapting to a loss.
Recognizing the loss
involves acknowledging
the death and beginning to make meaning of the event.
Reacting to the separation
involves
mourners experiencing the pain and finding ways to express their feelings, including finding
ways to mourn secondary losses.
Remembering and re-experiencing the deceased
encompasses
reviewing the personhood of those who died and re-experiencing the feelings associated with
those memories
.
Relinquishing attachments and assumptions
involves reworking attachments to
the deceased and the old assumptive world.
Readjusting to a new world
without forgetting the
old one includes developing a new identity and revising the assumptive world.
Reinvesting in
new activities and new
relationships
involves reconnecting to the world in novel ways.
Many of
these processes overlap with Worden’s (2018) tasks of mourning, although with different
wording and ordering.
Language of Grief Theories
Over the course of time, the language and words that have been used by various theorists
to describe grief, bereavement and mourning have changed with the broader social,
environmental, paradigmatic and political contexts in which they are situated.
As qualitative
research methods/methodologies such as discourse analysis and narrative analysis have
developed, there is a greater appreciation for the implication of language and linguistic devices
in both grief theory and practice.
Any thorough survey of the burgeoning literature in
thanatology will reveal significant variability as to how various writers approach the words grief,
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
16
grieving and mourning.
Rosenblatt (2008) described the sense of blurring between the terms
grief
and
mourning
and offered that to him, the distinction no longer quite makes sense.
Another example of this blurring lies in the use of the words “accept” or “acceptance” by
some grief theorists.
Across various iterations of his model Worden (2018) continues to define
Task 1 as accepting the reality of the loss and offers that “the opposite of accepting the reality of
the loss is not believing through some type of denial” (p. 41). An alternate word to accept is
to
acknowledge,
and for some bereaved individuals such a linguistic shift can ironically make the
difference from being
stuck
to being able to move forward in their realizing the death of a loved
one.
As this chapter has surveyed the various foundational theories of grief, the limitations of
words chosen to describe the grieving or mourning process have also been revealed (e.g., stages,
phases, tasks, grief work). Words and language are also representative of culture, and thus the
accessibility of any particular grief theory can be significantly affected by the words that are used
to describe the lived experiences of loss. In attempting to describe the processing of pain in his
second task, Worden (2018) borrows
schmerz
from the German language to more fully
encompass the somatic experience of mourning.
There are many other examples of words that are heavily laden with social expectations
that seem unrealistic and may serve to further burden the bereaved (e.g., closure, resolution,
recovery). In considering the issue of discourse in thanatology, the question also arises whether,
for example, some contemporary descriptors (e.g., instrumental grieving) are essentially a re-
wording of older concepts (e.g., grief work), thus different ways of saying the same thing, or
whether they are actually different ideas. Grief work is the Freudian (1917/1957) concept
(Archer, 2008; Worden, 2018), ultimately coined by Lindemann (1944), which has lost some
FOUNDATIONAL THEORIES
17
popularity, empirical support, and acceptance in the field (Bonanno & Kaltman, 1999; Stroebe et
al., 1992; Wortman & Silver, 1989).
Indeed, in summarizing the four basic tasks that mourning
creates that need to be addressed, Worden (2018) concluded that: “some would call this grief
work” (p. 41). Worden (2018) explains that his choice of the word
tasks
is harmonious with
Freud's concept of grief work in that both are action-oriented/instrumental, in contrast to the
word
phases
(Bowlby, 1980; Parkes, 1998) which he states implies "a certain passivity" (p. 40).
Accessibility and Relevance of Foundational Theories of Grief
The foundational theories of grief would not in this day and age be seen as having been
created with cultural sensitivity. Whereas the theorists themselves may have been culturally
curious or possibly attuned in certain ways (e.g., Freud’s interest in archeology and prehistory,
Worden’s discussion of subcultures in Boston), the reality is that they were all ultimately
Eurocentric in their orientations by virtue of their own inescapable heritage.
A significant presumption that is both explicitly and implicitly held in the field of
thanatology, and also as represented through foundational grief theories, is what Klass (1999)
termed a multicultural perspective.
More specifically, this is the presumption of universality,
whereby human grief across the planet has a core of similarity; grief is universal.
Rosenblatt
(2008) argued that the lack of openness to challenging this notion of the universality of grief,
along with a lack of evidence and documentation, results in a significant unfounded claim.
It is
similarly inaccurate to assume that all people who belong to a particular culture will benefit from
the mourning practices and expectations of that culture.
Rosenblatt (2008) outlined a host of important factors in becoming culturally attuned,
sensitive and responsive.
These factors include (a) challenges in translating bereavement feeling
terms from one culture or language to another, (b) methodological sensitivity, (c) understanding
FOUNDATIONAL THEORIES
18
how grief is expressed across cultures; (d) appreciating the meaning of death, and (e) discerning
what inhabits the emotional space in various cultures that is expressed in the English language by
the word
grief
.
Foundational theories of grief vary in their relevance in part due to the cultural
divide between their assumptions and the realities of those to which they purport to apply. Walter
(1999) offers another excellent discussion on culture, including an exploration of the influence of
mainline white culture on how people grieve in modern western societies.
The question of applicability of any one theory of grief or mourning is an important one.
In terms of gender and type of loss, the overall bias in foundational theories appears to have been
towards women bereaved of their male spouses.
Women comprised a majority of the patients
that were seen in clinical practice by those who developed these grief theories, and, as is still the
case, bereaved women are more likely to participate in research studies on grief (Doka & Martin,
2010).
Even though Freud, for example, had tried to convince his psychoanalytic colleagues that
men also suffered with hysteria, he was rebuked (Strachey 1917/1952).
Most of Lindemann’s
(1944) subjects after the Cocoanut Grove fire were women. Worden’s (2018) task-based
conceptualization of mourning, which remains one of the most influential in the field, relied
mainly on his investigations and experience with bereaved spouses, although this is not stated in
his book (J. W. Worden, personal communication, May 17, 1996).
To expand upon his
understanding of age, gender, and cultural differences in grief, Worden (1996) and Silverman
(2000) studied a community-based sample of bereaved families from the greater Boston area
with school age children who had experienced the death of one parent.
Another dominant idea found present in Freud (1917/1957), Bowlby (1980), Parkes
(1970), and Worden (1982) is that bonds between the living and the dead must eventually be
broken (Walter, 1999).
However,
in the second edition of his book, after beginning his initial
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
19
work with the Harvard Child Bereavement Study (Worden & Silverman, 1996), Worden (1991)
shifted his language to reflect the recognition and integration of the concept of continuing bonds
that emerged from his research with grieving children.
Finally, the foundational theories of grief
and mourning are all ultimately psychological, and as such are limited in their perspective, with
an emphasis on individual experience. Thompson et al. (2016) are among those who have called
for a more holistic view of the field and argue that a sociological perspective could advance
attempts to understand and respond to the challenges of dying, death, and bereavement.
Likewise, Kellehear (2005) challenged the field to integrate a health promotion perspective.
Conclusion
All foundational grief theories, as well as their contemporary successors, are inevitably
challenged by the limitations of trying to describe the phenomena of grieving and mourning
across the range of human conditions, time periods, cultures and individual circumstances.
Current and future thinking on thanatology can only be enhanced by a thorough and critical
examination of where the field has been, what has been learned, and what questions still need to
be asked.
Further Resources
We recommend the following additional resources for readers who are interested in learning
more about foundational theories of grief:
Kosminsky, P. S.
& Jordan, J. R. (2016). Attachment Informed Grief Therapy: The Clinicians
Guide to Foundations and Applications. Routledge.
Stroebe, M.S., Hansson, R.O., Schut, H., & Stroebe, W. (2008). Handbook of bereavement
research and practice: Advances in theory and intervention. American Psychological
Association.
FOUNDATIONAL THEORIES
20
Walter, T. (1999). On bereavement: The culture of grief. Open University Press.
Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health
practitioner (5th Ed.). Springer.
FOUNDATIONAL THEORIES
21
References
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978).
Patterns of attachment: A
psychological study of the strange situation
. Hillsdale, NJ: Erlbaum Associates.
Archer, J. (2008). Theories of grief: Past, present and future perspectives. In M.S. Stroebe, R.O.
Hansson, H. Schut, & W. Stroebe (Eds.),
Handbook of bereavement research and
practice: Advances in theory and intervention
(pp. 45-65). Washington, DC: American
Psychological Association.
Bonanno, G.A. & Kaltman, S. (1999). Toward an integrative perspective on bereavement.
Psychological Bulletin
, 125, 760-776.
Bowlby, J. (1944). Forty-four juvenile thieves: Their characters and home life.
International
Journal of Psychoanalysis, 25
(19-52), 107=127.
Bowlby, J. (1960). Grief and mourning in infancy and early childhood.
Psychoanalytic
Study of
the Child,15(1),
9-52.
Bowlby, J. (1969).
Attachment.
Attachment and Loss (Vol. 1). London: Hogarth Press.
Bowlby, J. (1973).
Separation: Anxiety & Anger
. Attachment and Loss, Vol. 2. London: Hogarth
Press.
Bowlby, J. (1980).
Attachment and loss: Loss, sadness and depression
. Attachment and Loss,
Vol. 3. London: Hogarth Press. .
Bowlby, J. (1982).
Attachment and loss: Attachment
(Vol. 1). New York, NY: Basic Books.
Caplan, G. (1964).
Principles of preventive psychiatry.
New York: Basic Books.
Delespaux, E., Ryckebosch-Dayez, A. S., Heeran, A., & Zech, E. (2013). Attachment and
severity of grief: The mediating role of negative appraisal and inflexible coping.
Omega:
Journal of Death and Dying, 67
(3), 269-289.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
22
Doka, K. J. (2008).
Disenfranchised grief in historical and cultural perspective. In M.S. Stroebe,
R.O. Hansson, H. Schut, & W. Stroebe (Eds.),
Handbook of bereavement research and
practice: Advances in theory and intervention
(pp. 223-240). Washington, DC: American
Psychological Association.
Doka, K. J. & Martin, T. (2010).
Grieving beyond gender: Understanding the ways men and
women mourn
(Revised Edition). New York, NY: Routledge.
Fichtner, G. (Ed) (2003).
The Freud-Binswanger correspondence: 1908-1938. London
: Open
Gate Press.
Freud, S. (1917/1957). Mourning and melancholia. In J. Strachey (Ed. & Trans.),
The standard
edition of the complete psychological works of Sigmund Freud
(Vol. 14, pp. 239-260).
London: Hogarth Press & Institute of Psychoanalysis. (original work published 1917)
Freud, S. (1929). Letter from Freud to Ludwig Binswanger, April 11, 1929. The Sigmund Freud-
Ludwig Binswanger Correspondence 1908-1938, 196.
Gay, P. (1952). Sigmund Freud: A brief life. In J. Strachey (Trans. & Ed.),
Sigmund Freud: An
autobiographical study
. New York, NY: Norton.
Kellehear, A. (2005).
Compassionate cities: Public health and end-of-life care
.
London, UK:
Routledge.
Klass, D. (1999).
Developing a cross-cultural model of grief: The state of the field
.
Omega: The Journal of Death and Dying, 39
, 153-176.
Kosminsky, P. & Jordan, J. (2016).
Attachment Informed Grief Therapy: The Clinician’s Guide
to Foundations and Applications.
New York, NY: Routledge, Traylor & Francis..
Kübler-Ross, E. (1969).
On death and dying
. New York, NY: Macmillan.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
23
Kübler-Ross, E. (2014).
On death and dying – 50
th
Anniversary Edition
. New York,
NY:
Scribner - A Division of Simon & Schuster, Inc.
Lindemann, E. (1944). Symptomatology and management of acute grief.
American Journal of
Psychiatry, 101(2),
141-148.
Main, M. & Solomon, J. (1986). Discovery of a new, insecure disorganized/disoriented
attachment pattern. In T.B. Brazelton & M. Yogman (Eds.).
Affective development in
infancy
, pp. 95-124. Norwood, NJ: Ablex.
Maccallum, F., & Bryant, R.
(2018). Prolonged grief and attachment security: A latent class
analysis.
Psychiatry Res 268,
297-302.
Parkes, C. M. (1970). The first year of bereavement: A longitudinal study of the reaction of
London widows to the death of their husbands.
Psychiatry, 33
(4), 444-467.
Parkes, C. M. (1998).
Bereavement: Studies of grief in adult life
(3
rd
ed.) Madison, CT:
International Universities Press.
Parkes, C. M. (2006).
Love and loss: The roots of grief and its complications
. Hove,
UK:
Routledge.
Parkes, C. M. (2010).
Bereavement: Studies of grief in adult life
(4
th
ed.)
New York, NY:
Routledge/Taylor & Francis Group.
Parkes, C. M. (2013).
Elisabeth Kübler-Ross, on death and dying: A reappraisal
. Mortality,
18(1), 94–97.
Parkes, C. M., & Weiss, R. S.
(1983).
Recovery from bereavement
. New York Basic Books.
Rosenblatt, P. C. (2008).
Grief across cultures: A review and research agenda. In M.S. Stroebe,
R.O. Hansson, H. Schut, & W. Stroebe (Eds.),
Handbook of bereavement research and
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
24
practice: Advances in theory and intervention
(pp. 207-222). Washington, DC: American
Psychological Association.
Satin, D. G. (1982). Erich Lindemann: The humanist and the era of community mental health.
Proceedings of the American Philosophical Society
, 128(4), 327-346.
Shand, A. F. (1914).
The foundations of character
(1st ed.). London, UK: Macmillan.
Siegler, M. (2019). Recollections of Dr. Elisabeth Kübler-Ross at the University of Chicago
(1965-70_. Posted on November 21, 2019 Facebook Twitter Share
https://www.bioethics.net/2019/11/recollections-of-dr-elisabeth-kubler-ross-at-the-
university-of-chicago-1965-70/
Silverman, P. (2000).
Never too young to know: Death in children’s lives
. New York, NY:
Oxford.
Strachey, J. (1917/1952). (Trans. & Ed.)
Sigmund Freud: An autobiographical study
. New York,
NY: W. W. Norton & Company.
Stroebe, M., Gergen, M., Gergen, K., & Stroebe, W. (1992). Broken hearts or broken bonds?
American Psychologist
, 47, 1205-1212.
Stroebe, M. S. & Schut, H. (1999). The dual process model of coping with bereavement:
Rationale and description.
Death Studies, 23
(3), 197-224.
Stroebe, M. S. & Archer, J. (2013).
Origins of modern ideas on love and loss:
Contrasting
forerunners of attachment theory
. Review of General Psychology, 17(1), 28-39.
Stroebe, M., Schut, H., & Boerner, K. (2017).
Cautioning health-care professionals: Bereaved
persons are misguided through the stages of grief
. Omega – Journal of Death and Dying,
74(4), 455-473.
Thompson, N., Allan, J., Carverhill, P. A., Cox, G. R., Davies, B., Doka, K., Granek, L., Harris,
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
FOUNDATIONAL THEORIES
25
D., Ho, A., Klass, D., Small, N., & Wittkowski, J. (2016).
The case for a sociology of
dying, death, and bereavement
. Death Studies, 40(3), 172-181.
Van Dijken, S. (1998).
John Bowlby: His early life – A biographical journey into the roots of
attachment theory
. London, UK: Free Association Books Ltd.
Walter, T. (1999).
On bereavement: The culture of grief
. Buckingham, UK: Open University
Press.
Weisberg, J. (2018). Death’s best friend. The New York Review of Books – NPR Daily Posted on
April 2, 2018 https://www.nybooks.com>2018/04/02>deaths-best-friend
Worden, J. W. (1982).
Grief counseling and grief therapy: A handbook for the mental health
practitioner
(1
st
Ed.). New York, NY; Springer.
Worden, J. W. (1996).
Children and grief: When a parent dies
. Guilford Press.
Worden, J. W. (1991).
Grief counseling and grief therapy: A handbook for the mental health
practitioner
(2nd Ed.). New York, NY: Springer Publishing Company.
Worden, J. W. (2018).
Grief counseling and grief therapy: A handbook for the mental health
practitioner
(5
th
Ed.). New York, NY: Springer.
Worden, J. W., & Silverman, P. (1996). Parental death and the adjustment of school-age children.
Omega, 33
(2)
,
91-102.
Wortman, C. B., & Silver, R. C. (1989). The myths of coping with loss.
Journal of Consulting
and Clinical Psychology
, 57, 349-357.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help