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The paradox of loss: Toward a theory of grief

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The paradox of loss: Toward a theory of grief

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THE PARADOX OF LOSS:
TOWARD A THEORY OF GRIEF
by
Marilyn Michelle McCabe
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Counseling Psychology)
May 1997
Copyright 1997 Marilyn Michelle McCabe
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UMI Number: 9733101
Copyright 1997 by
McCabe, Marilyn Michelle
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES, CALIFORNIA 90007
This dissertation, written by
Marilyn Michelle McCabe
e r
under the direction of h. Dissertation
Committee, and approved by all its members,
has been presented to and accepted by The
Graduate School, in partial fulfillment of re
quirements for the degree of
DOCTOR OF PHILOSOPHY
Dean of Grqtjygjr Studies
Date
DISSERTATION COMMITTEE
Chairperson
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To my dearest and best friend and beloved mother, Ruthy "Pushkin,"
you are always present.
Every phrase and every sentence is an end and a beginning,
Every poem an epitaph . . .
(From "Little Gidding" by T.S. Eliot, 1943/1971, p. 58)
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Acknowledgments
There are many people whose love, support, influence, and belief have helped
to generate this work. There are those who shared their experience of death and loss
with me, and whose stories influenced my understanding and appreciation of the
complexity of grief and the needs and desires of grievers, and those who provided me
with support and understanding at the most difficult time in my life. Luisa Bottari’s
deep and compassionate heart provided comfort in my most difficult times, as did
Carol Siegel, whose depth of empathy and ability to feel another’s pain allowed her to
share most deeply with me her own experience and my experience of loss. When I
began this study, Carol was also an aid in my phenomenological research. Dr. Hilda
Mullin’s kindness, wisdom, and empathy are greatly appreciated.
Pat Dunn helped me in my processing of the dissertation process— an intrinsic
part of the writing of this dissertation— without which it would not have evolved as it
did. Dr. Michael Carbuto with his excellent osteopathic care and compassion, helped
me in my back injury so that I could withstand the physical rigors of dissertation
work (i.e., sitting), and, as he put it, am still able to walk after it is done. Jackie
Dylla’s genius at physical therapy is also appreciated. In my first year of writing,
Bemie Soon graciously loaned me complete use of her computer and printer. Ken
Reiff provided support in his friendliness, kindness, interest and encouragement. I
am indebted to "The Phenomenology Group," especially Judith Saunders, Sharon
Valente, and Marlene Cohen, who convinced me I could not do a grounded study
and phenomenological research project, and whose hermeneutic pursuits were awe-
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inspiring and cozy. Early on, he who will be identified as "the glad object"
participated with me in developing an understanding of a tacit, felt, and co
constructed self, a cornerstone of this work which has continued to develop and
provide a rich source of insight and pleasure.
The staff at the University Counseling Center at SUNY, Stony Brook, were a
palpable presence in my writing, and I often felt them and their keen psychological
insights in dialogue within me in my attempts to explain and understand the nature of
self/other, presence and loss. Drs. Anne Byrnes and Mark Lederway, and Don
Bybee were particularly important positive influences who made the writing of this
work pleasurable and a true scholarly and theoretical "conversation." Gerald
Shepherd is also remembered for our long conversations about death, grief and loss.
I thank Dr. Douglas Vakoch who has always showed remarkable courage and
ability to talk about the most difficult existential problems-death, mortality, and
finitude— in a realistic rather than an intellectual fashion, who was a springboard for
various philosophical ideas, who encouraged me in the practical aspects of dissertation
research and writing, and was also willing, if necessary, to "roll up his sleeves" and
do the "dirty work" of revising should it finally become too much for me (which
luckily it didn’t).
Dr. Donald Polkinghome was also a presence in my writing. His advice was
always sound, and even if I didn’t always want to follow it, improved the quality of
my work. His patience was extraordinary, as was his ability to allow me to develop
my own ideas without interference. He allowed me the rare pedagogical opportunity
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of seeing for myself what I wanted to say, and being happy with my own work before
he was happy with it.
Dr. Janet Hoskins lent her considerable intelligence and sensitive
understanding to my work, was a supportive and encouraging force on my committee,
and generously provided not only her time but her expertise in a crosscultural
appreciation of attitudes toward death, bereavement, and grief.
The knowledge and understanding my mother gave me about writing, and, at
some points, the memory/reconstruction of my father and other imagoes— particularly
Hemingway--were helpful in pushing difficult aspects of this work to fruition. At
arduous junctures, they encouraged me in their imagined messages to "bite the bullet"
and to face the toughest aspects of this work and to put my experience into words that
were simple and did not hide behind convoluted phrases.
When the going got tough, my friend and colleague Dr. Angela Albright
provided in even larger doses not only her sound practical ideas and encouragement,
but her ongoing faith, understanding, and commitment to the ideas important in my
life and this work. Without her truly amazing understanding and belief in what I was
trying to accomplish, I don’t know if I could have done it. Angie’s faith and her
diligent and constructive reading and hearing of many drafts of different chapters,
substantially helped me to complete this project. I cannot thank her enough.
I also cannot thank enough my kind and wise friend and sister-in-law, Kate
Chandler, who believed in the "eggs" I was struggling to develop and give birth to
and provided both psychic nurturance and mechanical support (i.e., along with my
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sister, Susan, a printer, and partial funding of a computer) for the "hatching" of my
ideas.
My wonderful and talented sister, Dr. Susan McCabe, was a constant support,
sounding board, and "coach" in my writing and the completion of this work. Using
her well-honed teaching abilities as well as her loving kindness and empathic
understanding, she provided large amounts of moral support and practical advice.
With consideration and sensitivity, she urged me on in completing what she knew to
be a monumental, difficult, and painful undertaking, and she understood when I
couldn’t meet the deadlines I set for myself. With her love, courage, and acute
intelligence, Susan helped make this work possible.
The effort for this work could not have existed without the influence of my
mother, Ruth Langer, who has inspired me with her talent and dedication, her
commitment to writing and understanding, and her spectacular empathic and creative
gifts to tell and receive stories. Ruthy supported and loved me, valued me and my
talents, and believed in my abilities to undertake complex and sometimes
overwhelming projects. The specialness of her being and the profundity of her loss
caused me to search beyond my known capacities for greater understanding.
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Table of Contents
Chapter 1: Introduction ...................................................................................................1
Chapter 2: Review of L iterature...................................................................................23
What Is G rief?.............................................................................................. 23
What is Wrong With Prevailing Grief M odels?....................................... 66
Chapter 3: M ethod................................................................................................... 145
Use of Subjective Material; Journals .................................................. 147
Other Bodies of Knowledge.................................................................. 160
Process of Developing the Proposed T heory....................................... 164
Validation .............................................................................................. 167
Chapter 4: A Personal Account of Loss ............................................................... 168
Chapter 5: Developing a New Theory of G r ie f .................................................... 250
The Paradox of L o s s ............................................................................. 251
The Self and O th e r................................................................................ 256
Symbolizing L o s s ................................................................................... 291
Time, Death, Knowing, and M em ory.................................................. 314
Culture Versus Biology ........................................................................ 362
Chapter 6: Issues of Definition, Variability, Diagnosis, and Verification 377
An Alternate View of Grief: A Sum m ary.......................................... 378
Grief as an Emotional Term and a Descriptive T erm ......................... 389
Factors Influencing Grief and C oping.................................................. 395
Health and Pathology............................................................................. 416
Verifying the Proposed Model ............................................................ 443
Chapter 7: Implications .......................................................................................... 457
Practice and Support Im plications....................................................... 463
Needs for Future Research .................................................................. 465
References ................................................................................................................. 468
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1
Chapter 1
Introduction
Do not for ever with thy vailed lids
Seek for thy noble father in the dust.
Thou know’st ’tis common--all that lives must die . . .
(Shakespeare, 1604/1963, I.ii.70-72, p. 9)
With the above lines Hamlet’s mother rebukes him for his continued expression of
grief two months following his father’s death. And step-father Claudius argues that it
is stubborn, unmanly and even blasphemous to continue grieving as Hamlet appears
to.
Not dissimilarly, the American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders (DSM-IU-R, 1987; DSM-IV, 1994) suggests
that "normal" or "uncomplicated" bereavement becomes pathological if symptoms
persist two to three months after the loss. Prevailing grief models (e.g., Bowlby,
1980; Kubler-Ross, 19691 '; Lindemann, 1944; Parkes, 1987; Rando, 1984; Worden,
1982) generally view grief as: (a) a process, or rather a task, to be completed; (b)
the result of a relationship which must be relinquished; (c) a negative experience to be
overcome; and (d) possibly pathological. The DSM criteria reflects some of the same
1/ Although not a theory of grief but one of death and dying (particularly the
dying of the terminally ill), Kubler-Ross’ (1969) work is often interpreted by
layperson and scientist-practitioner alike as applying to the bereaved and is referred to
in light of this usage.
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2
tendencies toward linearity, finitude and normalization found in most prominent grief
theories, the cardinal principle being that, normally, grief ends.
According to theory, grief ends along the lines of the "step" metaphor or what
Stroebe, Gergen, Gergen, and Stroebe (1992) call the "breaking bonds" approach. It
ends because, "normally," (1) there is a linear progression of stages or phases the
griever passes through that lead him or her to complete, excise, or encapsulate his or
her grief; and (2) the griever relinquishes or "lets go" of the deceased in order to live
a normal life. While grief models are ambiguous about the actual time needed to pass
through the various stages, they are usually adamant that the stages must be passed
through so that the griever can find "resolution" or "cure." According to the
standards set by the DSM, Hamlet is only a few days, or weeks, short of being a
pathological griever. In the common grief theory lingo, he has grief "work" to do.
What is most problematic about the above formulations is that they fail to
represent bereaved persons’ actual experiences of grief over time. Not only Hamlet,
but the experience of real-life grievers as reflected in autobiographical,
phenomenological, and clinical writings (see, e.g., Brice, 1991a; Carter, 1989;
Ericsson, 1993; Lawrence, 1992; Lewis, 1961; Philipe, 1964; Talbot, 1980;
Tittensor, 1984) and my own experience suggest that the templates of prevailing grief
formulations are incomplete, inaccurate, and biased. A central problem is that
current models are unable to account for variability of grief experience except by
labeling variants as pathological. Yet, as mentioned, diagnostic formulations such as
the DSM’s appear vague and arbitrary. Illogically, current theories suggest a time
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3
frame and hence end for grief, yet acknowledge that "total resolution of grief may
never occur" (Rando, 1984, p. 117).
The experience of time for those who grieve is more complexly organized than
stage and phase theories suggest. Step models do not reflect that although grief may
change as it is more removed in time from the death, reoccurrences of acute grief or
grief-like phenomena may occur long after the event of loss, that nonpathological
grief may not be "resolved," and further, that the relationship with the deceased often
continues and may even develop rather than be relinquished completely. Time may
offer a far more textured, multileveled, and relational experience. Different aspects
of grief may be experienced as interconnected parts of a whole experience rather than
a passage from one stage to another, aberrations, or solitary events experienced after
grief work has been completed. Further, the relationship with the dead loved one
may far from disappear.
Part of the problem with current grief formulations is that they are informed
by assumptions which have not been critically examined. Although no theory is value
free or transparent (Gergen, 1973; Howard, 1985; Prilleltensky, 1989; Sampson,
1977, 1978, 1981), the particular values that have helped to shape and construct grief
theory have been taken as implicitly true and as practically universal. These
assumptions include the positing of an objective, uniform reality; a pathologizing or
"deficit" model of personality which views the individual, rather than the
circumstances, as the locus of the "problem"; a consumer-oriented system which
values efficiency, (re)investment, "quick fixes," rationality, autonomy and material
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reality (what Stroebe et al., 1992, describe as "modernist" values), over values of
taking time, commitment, emotion or passion, relationship, and spiritual or internal
reality. Prominent grief models are largely based on a Western and materialist
conception of time (and conception of memory of times past) as linear and made up of
discrete units, an objectifying stance stemming from a positivist research framework
and medical disease model, and a bias toward autonomy and separateness in
relationship.
Partly because of these suppositions, and the time it has taken to develop
theory and research in other areas, current formulations have failed to incorporate
advances in the areas of self and relationship, time, memory, and emotion which
would better explain the multileveled texture of grief. Although relationship is the
foundation of most important grief theories (Bowlby, 1980; Freud, 1917/1959;
Parkes, 1987), there is a bias towards the "breaking bonds" perspective, and towards
the values of autonomy, individualism and "getting over" the loss. The concept of
internalization, although also a fundamental element, serves in stage/phase models to
construct the deceased not as a dynamic, changing aspect of the griever, but as a
static entity from which the griever is best "emancipated" (Lindemann, 1944).
Because of this bias, stage theories tend to ignore or downplay the significance of
relationship in constructing a sense of self and reality and do not give adequate
credence to an internal world of the bereaved where the deceased may continue to
"live." By assuming a linear, material and finite progression, stage and phase models
cannot allow (except parenthetically) that the ending of a relationship through death
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does not terminate the impact of the deceased on the bereaved person’s reality and
world view.
The griever’s experience of time and memory are central concerns when
considering this relationship. The step metaphor pictures the griever moving through
a series of sequential stages, progressing onward toward health and grief "recovery."
In this picture, the progression of stages runs parallel to the actual, physical time that
elapses after the death. The more time elapses, the theory goes, the closer the griever
should be to completing his or her grief work.
Such a model conflates two types of time, denying psychological, or inner,
time (Loewald, 1980) as opposed to objective, quantifiable time, and thus contributes
to confusion for the bereaved and the bereaved’s potential support system. Other
perceptions of time are then neglected, such as multiple levels of experience
organized temporally differently (see Heidegger, 1927/1971; Polkinghorne, 1988),
and the relation between traumatic memory and lived and relived experience (put
differently, the relation between events in "real" time and events in memory,
Horowitz & Reidbord, 1992; Tobias, Kihlstrom, & Schacter, 1992; Williams, 1992),
the latter especially important in bereavement as a source of trauma (Bowlby, 1980).
Both the processes of forgetting and remembering are significant aspects of
grief experience which serve to relocate the griever (perhaps again and again) in her
or his experience of time, and in the experience of her or his self and relationship
with the deceased other. Memory, like time, is not a purely objective phenomenon,
but could instead be viewed as partial (re)constructions or "reasonable facsimiles"
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(Loftus & Loftus, 1980). As LeDoux (1992) emphasizes, the memory for emotional
significance of events is different from the memory of the event itself. How a person
construes and then remembers an event such as death, and remembers and
reconstructs the deceased, are not the same as how she or he remembers a
mathematical sum or a date in history.
However, the links between emotion and memory, consciousness, and implicit
and explicit states have not been well articulated in the grief literature. Also,
contemporary Western views of emotion often stress a particular, limited time frame
for emotional experiencing (e.g., Bower, 1992). The event sequence of an emotion,
even while it may contain a feedback loop (e.g., Plutchik’s model, 1991), is
schematically insulated from other emotional events by a pre- and post-homeostatic
wall. This view is complementary with stage theories and adaptation models of grief
and neglects the ongoing feedback loop which may continue to transform the
experience. In Zajonc’s (1984) words, "The individual is never without being in
some emotional state" (p. 121). It is this continuous nature of emotional experience
(see, e.g., Izard, 1979; Zajonc, 1984) which needs to be addressed in relation to
grief.
Finally, the lack of clarity provided by linear, stage models contributes to
confusion in diagnosis and treatment of grief-related states and does not provide an
adequate basis for aligning theoretical knowledge to diagnostic and treatment
formulations. Because of the two month time limitation indicated by the DSM in
regard to "uncomplicated bereavement," after this time clinicians may feel inclined to
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consider grief "complicated" or pathological and to give a client or patient a
"stronger" (Axis I and/or II) diagnosis.- Though faulty and incomplete, the
prevailing formulations continue to contribute to diagnosis, treatment and outreach
efforts and may, as family therapist Michael White (1989) and some grievers (e.g.,
Ericsson, 1993; Hillman, 1992; Lewis, 1961; Talbot, 1980) indicate, influence the
bereaved’s personal construction of her or his grief experience. As White (1989)
asserts, the "‘saying goodbye’ metaphor" is so prominent in our clinical, scientific
and pop culture that it is not uncommon for grievers to "‘know’" what the proper
grief map looks like, and to blame themselves for discrepancies in their own
experience. Clinicians follow similar "maps" which affect the care they provide to
clients. Not being aware of but following the assumptions and values embedded in
much grief literature may lead psychologists not only to misrepresent grief but to
mistreat and misdiagnose it.
To address these deficits, I began a theoretical study in which my first goal
was to critically examine and deconstruct the philosophical and sociocultural
assumptions underlying present theory. In Chapter 2, I explore the influences,
problems, biases, and blind spots I discovered, including the problem of viewing grief
as a state or a series of states rather than a process, the influences of psychoanalysis,
2/ Depression appears to be one of the frequently considered alternatives to
pure, "uncomplicated" bereavement (e.g., Briscoe & Smith, 1975; Kim & Jacobs,
1991; Jacobs, Hansen, Berkman, Kasl, & Ostfeld, 1989; Zisook & Shuchter, 1991),
and other psychiatric disorders (e.g., anxiety, phobias, dissociation) have also been
considered (Jacobs, Hansen, & Kasl, 1990; Raphael, 1983).
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evolutionary and attachment theories, the privileging of a positivist world view, the
bias toward autonomy and "instant recipes," different attitudes towards relationship
and death, and the context of the researcher.
My second and primary aim was to develop a model more reflective of actual
grief experience and compatible with related bodies of knowledge. I focused, first,
on a refraining of the epistemological and philosophical approach to grief by shifting
from a positivist to a more constructivist, postmodern knowledge paradigm, as
reflected in various domains (see, e.g., Beebe, Jaffe, & Lacbmann, 1992; Cushman,
1990, 1991; Gergen & Gergen, 1988; Hoffman, 1991; Mitchell, 1988; Stolorow &
Atwood, 1992), as well as shifting from a medical-disease model to a more holistic
approach in the understanding, diagnosis, and treatment of grief-related concerns. As
my own experience and that of others I have mentioned have been at odds with
prevailing theory, I used personal material (primarily my own through written
journals), as well as autobiographical, literary, and anthropological works, to analyze
and explore the temporal, relational, and existential dimensions of grief. In addition,
I looked to bodies of knowledge which although significant to a theoretical
understanding of grief have not been fully utilized in the past, most particularly
theoretical work on the nature of the self and relationship with other, and empirical
and theoretical study in the areas of memory, emotion, and cognition.
Although a great deal of exploration will be needed beyond this study to better
explain responses to both cross-cultural and idiosyncratic conditions of grief, in the
present work I shadow forth a model that differs significantly from sequential step and
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9
"breaking bonds" approaches described in Chapter 2 and address some of their major
limitations. As Chapter 3 describes, my methodology for undertaking such an
investigation is based on a postmodern and existential epistemology, relational
theories of self and other, and recent views on the meaning of memory and emotion,
as well as on subjective experience, most importantly my own. A culling of my own
experience with grief is presented in Chapter 4. Drawing from this and the other
perspectives described above, in Chapter 5, I develop the position that a co
constituted relationship between self and other is fundamental to grief experience and
argue that an alternate pattern can be founded on the griever’s real and imaginal
relationship with the deceased, on the griever’s response to the existential givens of
reality, and on the regeneration of emotional and memorial experience caused by a
dynamic, ongoing dialogue between self and environment.
I identify grief as an ongoing as well as recursive experience. Although with
increased coping, maturity and experience, grief changes both in frequency and
severity of themes, it does not seem to progress linearly or necessarily to end.
Because of their complexity and recurrence, grief experiences are better described in
terms of oscillations between multileveled states than as a progression from one stage
to another. Oscillations comprise, for instance, the move between themes such as
belief and disbelief, denial and acceptance, yearning and despair, disintegration and
reintegration of self and world, a sense of absence and a sense of presence. These
themes could be said to occur at different "levels" or have different forms in that
although similar themes and experiences of grief recur, they are not identical. A
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10
variety of kinds of "disbelief" or "acceptance," for instance occur, and co-occur. A
multiplicity of themes, such as despair, sadness, shock, horror, missing, and both
longing for and recognizing the impossibility of recovering the lost one, often occur
together.
The pattern of oscillation occurs along with a process of increased coping so
that while the traumatic, shocking impact of death lessens, multileveled experiences of
different themes (e.g., belief, disbelief, acceptance, horror, yearning, missing, pain,
anxiety, depression, despair, feelings of presence, absence, transformation,
spirituality, enlightenment, and loss) may continue to reemerge. In addition, apparent
opposites (such as belief and disbelief, yearning and despair, hope and hopelessness)
do not seem to obviate each other but rather to provide a dialectic which is related to
loss and missing, and to the existential reality of death. Thus, a sense of hope may
occur without necessarily believing or hoping the lost one will be restored; instead
there may be a renewed sense of presence, which is dialectically related to missing,
and which because of the physicality of loss, is counteracted by the existential reality
of death, which then evokes a sense of loss and despair, and vice versa.
Complicating or affecting the entire picture of grief so that it does not follow a
straightforward or linear course are (1) different types of trauma related to the trauma
of death, (2) the impact of the environment-more precisely, the person-environment,
which Lazarus (1991) configures as essential to the emotion generating process; and
(3), related to the above, the passage of time, modifying perceptions and responses in
terms of a continued accrual of experience, or maturity, which affect both a view of
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11
death and of loss. In relation to (1), the trauma of death and the circumstances
surrounding or leading up to death are necessarily entangled. Yet the response to the
surrounding trauma may be more apparent in early or acute grief, making later grief
at loss of death more differentiated from the grief of the related trauma.
Shifts reveal changes in strength or intensity which are affected both by
internal and external changes. Additional life experiences, some of them stressful or
painful, and others nurturing, supportive, or positive, interact with previous
experiences and recall of experiences so that, for instance, additional losses (of
various kinds, e.g., bereavement, loss of relationship, financial difficulties / loss,
etc.) join the "pool" of previous losses, both with some positive effect (in terms of
our ongoing learning of how to cope with losses) and with negative effect (such as
feeling overwhelmed by losses or remembering and having the traumatic nature of
loss highlighted). In this way, emotions may continually be in the process of being
regenerated, although they are not precisely the same emotions. Also, the "story" of
one’s loss and how it fits into all of one’s life are therefore continually being
regenerated and rewritten, or rather re-understood in light of new experiences and
understandings.
Some painful triggers can be expected (as with anniversaries, holidays, or
environmental resemblances to the experience) or not expected (as when suddenly one
is reminded of the lost other and this evokes either feelings of trauma or loss).
Although with time and experience one learns how to deal with such events, ongoing
aspects of environment continue to interact with this experience to produce new
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12
emotional experiencing, as in new losses, stresses, etc. Experiences and memories
may also occur at varying levels of cognitive or intellectual awareness, at what might
be described as visceral or emotional levels (see, e.g., LeDoux, 1992; van der Kolk,
1994), with knowledge or construction of how or why these experiences and
memories are occurring not immediately obvious, or even perhaps irrelevant to the
fact that the emotion continues to be experienced. Therefore, "triggers" can
sometimes be known and even "controlled," but not always.
Coping with death also involves different levels of awareness, ranging from
the intense scrutiny described above to a kind of blunting or buffering of memories
and experiences, occurring however, not only at these extremes but involving both.
The "scrutiny" involves constructing the story, of death, of the lost other, of trauma,
and of meaning and seems to occur most copiously and distinctly the first several
years of bereavement. This includes reconstructing the relationship, knowing that the
relationship has necessarily changed, but asking, what remains permanent? what parts
are incorporated? what of the self and other remain? This kind of development and
storytelling continues, though gradually on a more tacit level. Whether it be triggered
by internal or external events, however, the development of the self-other relationship
may also be brought into relief.
Experience points to the possibility of an ongoing significant relationship with
the beloved who has died. There is a complexity in this relationship and in
realization of the other since it occurs in various forms at both explicit and tacit
levels, including reminiscences, imaginary dialogues, sense or evocation of presence,
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13
and a reconstruction of both separate and shared experiences of reality. Further,
remembering and reconstructing the other is, paradoxically, part of missing. It is
paradoxical because it is due to the other’s absence that her or his presence is
recreated. Remembering others as we knew them in life, we feel their loss and
absence; at the same time, we continue to "dialogue" with them in various ways or to
reconstruct them.
Finally, while grief— or the intolerable painfulness of grief--may abate, the
world is overall construed differently after death of a significant other, and loss is a
part of this construal. It is therefore possible that grief, or grief-like feelings, and a
connection with the lost one remain, whether in the background or in relief. The
trauma of death and the trauma of what led to death diminish, but the effect of death,
the sense of loss and its multiple effects on the griever, do not disappear.
Using the resources and bodies of knowledge described above, I argue that this
alternate, oscillating or recurring pattern of grief is founded on the griever’s real and
imaginal relationship with the deceased and on her or his response to the existential
givens of reality, as well as on the regeneration of emotional and memorial experience
caused by a dynamic, ongoing dialogue between self and environment. The
existential givens, involving death, time, self and other, are paradoxical; dealing with
these paradoxes results in a response to loss which is also paradoxical, alinear and
composed of qualities which are both unique and recurrent, enduring and
discontinuous.
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Recognizing and coping with these paradoxes seem to begin very early on,
along with the development of a relational, embodied self, and a cognition (perhaps
meager, at first) of metaphor, or of one thing (a memory or mental representation)
standing for something, or someone, else. Both the dialogical nature of self
(Hermans et al., 1992; Modell, 1993) and the notion of object constancy and related
ideas explains how it is that we can recognize a dead person is gone and in some
sense "relinquish" her or him, yet also maintain both the person and the relationship.
Further, the notion of a dialogical, embodied self explains how self and other are co
constructed and how the self continues to reconstruct an other even if the other is
absent. Paradoxically, it is when the other is absent that an "enduring presence"
(Modell, 1993) is most likely to be constructed. The capacity to be alone stems from
knowing that "someone else is there" (Winnicott, 1958).
The oscillation in movement between the real and the symbolic in some way
compare with the oscillations of knowing the dead beloved is gone, and recreating
him or her within ourselves, experiencing their presence, and then again, experiencing
their loss. There is, overall, a paradoxical sense that they are both "here" and "not
here." In many ways, they continue to shape and influence our lives; in others, we
acutely feel their absence and lack. The notion of a dialogical, embodied self is
essential to understanding grief as its development is founded on our earliest
negotiations with presence and loss. This self/other relationship can be best
understood in terms of object relations, relational, and intersubjectivity theory.
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Further, the ongoing experience of grief is explained by how memory
functions with the above paradoxes, and how emotions and memory function with the
process of "going on" in life and integrating and reintegrating all that has gone
before. "All that has gone before" includes of course highly significant events such
as death and loss, and constitutes a "past." However, this "past" is also "present" as
it is reconstructed in the present and affected by ongoing circumstances. Moreover,
from the point of view of adaptation to ongoing circumstances, a reintegration of
material would seem essential. Such an integration could be explained by viewing
emotion as a continuous (Izard, 1979; Zajonc, 1984) and regenerating (Lazarus, 1991)
experience, as well as operating on multiple levels of meaning from the most tacit to
the most explicit. Grief is complex not only because of the individual’s complex
interwebbing of self and other with loss, but because it emblemizes a complex,
nonlinear experience, awareness, and use of time, memory, and emotion which
interacts with the person-environment (Lazarus, 1991) as well as knowledge of
existential givens, and because this "regeneration" may occur at various and changing
levels of awareness.
In Chapter 6, I summarize this alternate view of grief, examine the concept of
grief as a descriptive and an emotional term, and address types of variability in the
situation, experience and expression of grief, including different types or categories of
relationship (e.g., parent, child, lover, friend), circumstances, and cultural
background, and how these types of variations might be incorporated into the
proposed approach. Although the linear, finite and relinquishing sequencing of
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stage/phase models has been relatively unaffected, present understandings of how the
relationship between grief and a griever’s particular relationship with the dead person
(e.g., as parent, spouse, child) and with the differing circumstances of the death (e.g.,
accident, "natural," suicide, sudden, expected, etc.) have contributed positively to
grief research in illuminating the variability of grief response and the importance of
the context of both the relationship and the death.
In addition, in Chapter 6 I examine how the proposed model considers issues
of pathology and non-pathology. In terms of understanding, assessing, diagnosing,
and treating clients who have suffered one or more bereavements, the suggested
approach focuses on a holistic view of the person in which (a) loss and grief represent
stresses and burdens which, potentially, may seriously interfere with a person’s
overall resilience and ability to cope, and (b) how a person responds to loss and
experiences and copes with grief are an aspect of how that person responds overall to
his or her life. In essence, I take the position that loss and grief represent difficulties
and "problems in living" (Szasz, 1974), but are not in and of themselves pathological,
although they may be complicated by additional circumstances.
In prevailing theory, the bereaved’s psychological health and coping ability are
measured not only by his or her going through the appropriate sequences of stages,
but are fundamentally tied to the relinquishment of the dead person. Without a final
acceptance of loss, and a final despair, the bereaved cannot be said to have "worked
through" or resolved his or her grief. The proposed theory, in contrast, suggests that
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the relationship does not necessarily end, especially if it played an important role in
the bereaved’s psychic world.
The necessity for "cure" or "resolution" of grief is not recognized in the model
I propose; indeed, the concept of "cure" is antithetical to the suggested approach.
However, what might be considered "growth" or "development" occurs in that both
grief and the relationship with the lost other continue to be transformed and that
coping processes evolve. What might be construed as "healing" first has to do with
the bereaved’s ability to cope with the trauma of loss. A major "difficulty" (which
can be both immediate and ongoing) is for the bereaved to be able to experience and
express his or her sense of loss, whatever that may be, with as little negative
interference and as much positive support as possible. A major issue is making sense
of and in some way integrating loss through death, and also achieving a partial mode
of buffering from the horror of traumatic reality. Further "development" might be
conceived as concerning the dynamic and relational internalization of the lost other,
which provides not only a "firming up" of what has already been internalized but a
dynamic interconnection with the griever’s continued reconstitution of the world; that
is, as her or his life changes, the perspective of relationship (and loss) also changes.
The depth or amount of this internalization and reconstruction, however, depends on
the nature of the individual relationship the griever has with the deceased.
"Development" may also involve recognizing one’s human limitations regarding death
and loss, and being able to negotiate and renegotiate both the acceptance and
difficulty of accepting a paradoxical reality involving loss, death, absence and
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presence. Such a process, however, should not be considered linear and is not
achieved in a step-wise fashion; rather, it oscillates as described above, and must
continue to be renegotiated and dealt with. Although all of the above aspects of grief
may recur or continue, integrating, buffering, and coping emphasizes the traumatic
aspect of loss, whereas internalization, humility, and ability to deal with ambiguity
characterize both the response to trauma and the longer-term response to loss and
death.
Finally, in Chapter 6 the proposed theory is tested by examining it in regard to
several case studies drawn from the grief literature and my own clinical experience. I
present vignettes of bereaved individuals, analyzing their situations in terms of the
proposed theory to verify whether this approach does in fact aid in understanding their
grief experiences. This comparative theoretical explication will provide the reader
with a sense of the aptness and applicability of the suggested approach and will
necessarily consider issues of individual and circumstantial variability as well as
issues of health and pathology.
As suggested in Chapter 7, the implications and potential benefits of the above
model for counseling psychology are many. Bereavement is associated with risk of
physical illness, altered immune system efficiency and neuroendocrine changes
(Clayton, 1979; Glick, Weiss, & Parkes, 1974; Irwin, Daniels, & Weiner, 1987;
Maddison & Viola, 1968; Maddison & Walker, 1967; Parkes, 1964; Parkes, 1970;
Parkes, 1987; Parkes & Brown, 1972; Schleifer, Keller, & Stein, 1987; Stem, 1988),
psychological difficulties (Briscoe & Smith, 1975; Khanna & Rajendra, 1988; Kim &
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Jacobs, 1991; Jacobs et al., 1989, 1990; Raphael, 1983; Schut et al., 1991; Zisook &
Shuchter, 1991), as well as increased mortality (Helsing, Comstock, & Szklo, 1982;
Mellstrom, Nilsson, Oden, Rundgren, & Svanborg, 1982; Osterweis, Solomon, &
Green, 1984; Parkes, Benjamin & Fitzgerald, 1969; Rees & Lutkins 1967; Stroebe &
Stroebe, 1983; Young, Benjamin, & Wallis, 1963).
Lack of support has been attributed to a variety of bereaved people’s
psychological, adjustment and health problems (Maddison, 1968; Maddison &
Walker, 1967; Parkes, 1987; Sheldon et al., 1981; Vachon et al., 1982) as well to
their subjective distress (Gorer, 1965), and a growing body of literature emphasizes
that social support is helpful if not crucial in affecting a person’s responses to
bereavement (Bruce, Leonard, & Bruhn, 1990; Fowlkes, 1991; Maddison & Walker,
1967; Parkes, 1987; Rando, 1984; Raphael, 1973, 1981). Proponents of crisis theory
agree that the outcome of a crisis may be tied to the type of social support a person
has available (Caplan, 1964; Raphael, 1973, 1981, 1983). However, my own
experience and the experience of colleagues and clients, suggest that social support
and understanding of grief are often inadequate and at times detrimental (see, e.g.,
Feifel, 1990; Fowlkes, 1991; Ericsson, 1993; Gorer, 1965; Rando, 1984).
The first area of relevance, therefore, is clinical and social support for the
bereaved. As I have already indicated, because of the prevalence of the linear
stage/phase approach to grief, individuals in pain often look to this "recipe" for help,
and often are not only disappointed but disempowered, viewing themselves as flawed
or "crazy" for not following the proper maps of grief experience. As Fowlkes (1991)
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asserts, we can construct melancholy, or depressive loss of self-regard, in the
mourner, through inadequate social regard. Socially and culturally biased
constructions of grief have multiple consequences and may:
1. Limit the care and support bereaved people receive;
2. Invalidate or negatively construe grievers’ views of themselves;
3. Desensitize us to problems related to death and dying (e.g., AIDS,
inadequate health care, war, poverty);
4. Forestall existential recognition of death and derealize the meanings of life
and death;
5. Hinder us in understanding psychotherapy clients’ needs and the relevance
of grief and loss to different areas of their lives; and
6. Cause us to "pathologize," "normalize," or depersonalize individual,
familial and cultural differences.
While present theory tends to rigidify grief and limit or pathologize the
griever, the major aim of the proposed model is to empower him or her by presenting
a consideration of grief and the expression of loss as healthy, and a rejection of a
static picture of grief or of discrete stages that must be followed in an orderly fashion.
Instead, an acceptance of flexibility and individual variability are emphasized with an
attention to the context of grief.
Clinically, one of the most important implications of this study is the
suggestion that it would be more helpful to the bereaved to view grief not as
something wrong to be fixed or cured, (although the pain of grief will, hopefully,
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become easier to deal with in time) but a natural response to the loss of a beloved.
Making our definitions and diagnoses of pathology more precise and accurate can
stem, first, from an appreciation of the healthiness (or nonpathology) of variable and
complex grief responses, as well as from an appreciation of the possible length and
depth of grief experience. Lack of resolution should not be the decisive criteria in
considering a person’s responses pathological, but instead we need to examine a
person’s grief experience in the context of his or her entire life circumstances.
While not in itself a disease, however, grief may perhaps indeed become
"complicated" as the DSM implies, by other life circumstances, including the
griever’s personality, past experience, immediate and ongoing stressors, his or her
resilience or vulnerability. Although we may consider that death is to some extent
always traumatizing, the more traumatic the circumstances of death, the more
complicated the situation becomes, as the strand of trauma relating to death in itself
and the strand relating to the particular circumstances of death, are entangled in the
griever’s experience. Other experiences (such as pre-bereavement traumatic
experiences), preexisting disorders of various kinds, including personality disorders,
may contribute to what is considered a "pathological" response. My position,
however, is that grief should not be viewed as the linchpin to the bereaved’s possible
pathology, but rather is affected and affects his or her overall experience.
In terms of research, more needs to be done to illuminate the variability of
grief response over the long-term in the context of individual case histories and
different cultures. Further, despite the growth of the death movement which has
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promoted awareness of death and dying (Feifel, 1963, 1969, 1977; Kastenbaum &
Aisenberg, 1972; Kubler-Ross, 1969; Parkes, 1987; Weisman, 1972), more research
and education needs to be conducted concerning awareness of death and of grief,
particularly individual and cultural differences.
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Chapter 2
Review of Literature
I will begin with a general review of how theorists have approached the
concept and context of grief. This exploration will highlight some of the most sharply
delineated themes of grief, how loss can be viewed in a general way or as particular
to death, and the tendencies of theorists to assign either a biological or cultural
explanation to grief. I will then describe the most prominent grief theories, paying
special attention to keystone thinkers with far-reaching influence (e.g., Freud,
Bowlby, Parkes, Lindemann), and the concepts of process, state and sequencing in
grief.
Following this, I will explore possible sociocultural, philosophical, and
scientific bases and assumptions that have guided and informed the above research
and why these foundations provide for an incomplete and inaccurate view of grief. In
addition, I will look to material in the areas of self theory, memory, emotion and
cognition, as well as self-reflection, autobiography and literature to determine what is
missing from prevailing theory and why this theory is inadequate.
What Is Grief?
By definition, grief is concerned with injury, suffering, trouble or disaster
(Webster’s, 1976); the injury or suffering is a result of the trouble or disaster. Freud
(1917/1957) defines the "injury" of grief as the loss of a loved person, or something
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else that has taken the place of a loved person. Although loss involves various
deprivations, needs, wants and burdens, including role loss/alteration (Averill, 1968),
changes in self-construct, and symbolic as well as concrete losses (Rando, 1984), the
"etiology" of grief, Engel (1961) argues, as do Parkes (1987) and Bowlby (1980), is
object loss. That is, whether the object be real or imagined (as in Freud’s suggestion
that an abstraction or ideal take the place of a beloved), grief always involves loss of
someone or something significant. Grief occurs, according to Rando (1984), as a
process of psychological, social and somatic response to this loss.
Like loss, pain is a hallmark of grief (Bowlby, 1980; Freud, 1917/1957;
Parkes, 1987; Raphael, 1983; Sanders, 1989). Although not all aspects of
bereavement are necessarily negative or painful (the griever’s sense of relief, for
instance, when great and prolonged suffering is ended), the experience of the death of
a loved one (and even a "hated one") generally consists of a majority of disturbing
features and experiences which can be bitterly distressing, agonizing to the bereaved,
including fear, panic, sadness, anger, helplessness, guilt and despair, a host of
somatic and behavioral complaints, difficulties thinking, making decisions and relating
with others, problems sleeping, eating and working, and generally feeling "crazy"
(Clayton, Halikes, & Maurice 1971; Lindemann, 1944; Marris, 1968; Parkes, 1987;
Parkes & Weiss, 1983; Rando, 1984; Raphael, 1983; Tatelbaum, 1980).
The physiological changes and disease processes (Clayton, 1979; Glick et al.,
1974; Irwin et al., 1987; Maddison & Viola, 1968; Parkes, 1970; Parkes, 1987;
Parkes & Brown, 1972; Schleifer et al., 1987; Stem, 1988), psychological problems
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(Briscoe & Smith, 1975; Kim & Jacobs, 1991; Jacobs et al., 1989; Jacobs et al.,
1990; Khanna & Rajendra, 1988; Raphael, 1983; Schut et al., 1991; Zisook &
Shuchter, 1991) and increased mortality (Helsing et al., 1982; Mellstrom et al., 1982;
Osterweis et al., 1984; Parkes et al., 1969; Rees & Lutkins 1967; Stroebe & Stroebe,
1983; Young et al., 1963) that have been associated with bereavement also lend
credence to the image of the griever who perishes from, or suffers the strain of a
"broken heart" (Parkes, 1987).
Freud (1917/1957) analogizes mourning to melancholia (or depression), in that
both partake of a "profoundly painful dejection," a loss of interest in the outside
world, a loss of the ability to love, and an inhibition of all activity. This description
coincides with Schwartz-Borden’s (1992) metaphor of bereavement as a profound
internal wound, leaving the griever also lost, "at sea," with a sense of unending,
immutable pain.
When we try to analyze what aspects of loss create the intense pain of grief,
many difficult consequences of bereavement may be considered, including
deprivations on a variety of levels such as loss of an important, personally meaningful
relationship, loss of companionship, social loss in the form of alienation and
stigmatization, economic loss, role loss, and symbolic and secondary losses (Parkes,
1987; Rando, 1984; Raphael, 1983). According to attachment theory (Bowlby,
1980), the deprivation caused by death is a loss of affectional bonds which are
evolutionarily adaptive. Separation of important social bonds, such as the bond
between mother and infant, are "prototypical occasions" for grief and distress
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(Averill, 1968). Bereavement is often experienced as a profound deprivation,
something that Rando (1984) links to all losses. And while viewing the pain of
deprivation and the pain of loss as separate and distinct, Parkes (1987) considers
deprivation a major determinant of overall grief.
Loss: The Basic Context
Rando (1984) comprehends the concept of loss as including not only that
which is traumatic, tragic or unexpected, but that which is everyday. Loss is natural
to existence, consisting of both physical and symbolic kinds of loss, and losses which
are aspects of normal development. Concrete or physical losses may include loss of a
person through death or other separation, or loss of an item, such as a stolen ring.
Symbolic or psychosocial losses may include such events as losing a particular role
due to a change in job, losing a dream or expectation due to a change in
circumstance. Some circumstances, such as losing one’s childhood or getting old,
incorporate both physical and symbolic aspects of loss.
As Rando (1984) notes, losses include those which we may not think of as
unpleasant at all, such as graduating or getting a new job. Change can be viewed as
loss, and even if the change is positive it must, according to Rando, be grieved in
some way. From this perspective, the process of loss is viewed as the same, even if
the nature of the loss is qualitatively different.
Some response will always occur, even if it is merely an "Oh, I wish that
hadn’t happened!" after a teenager breaks her longest fingernail. The very
same process also initiates the full-blown acute grief response to the death of a
loved one. (Rando, 1984, p. 17)
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The comparison between a broken fingernail and the death of a loved one is certainly
extreme. However, similarly, Bowlby (1980) contends that responses to loss caused
by death can help us to understand other kinds of loss responses:
There can be little doubt that, whatever the cause of a loss may be, certain
basic patterns of response are present. . . . [V]ariations . . . are best regarded
as variations on a single theme, (p. 76)
Despite the conceptual and heuristic value of identifying loss as a referent for grief,
comparisons such as Rando’s call to mind, unfortunately, a tendency in some of the
literature to equate different griefs, as all being subject to "some" loss. Yet while
grief is related to loss, obviously not all losses evoke the same type of grief.- As
Parkes (1987) writes, losses are common in our lives, and therefore grief as a
reaction to loss must be common, but that is not "grief with a capital G. . . . the term
grief is not normally used for the reaction to the loss of an old umbrella. It is more
usually reserved for the loss of a person, and a loved person at that" (p. 27). And
while death is obviously as common as it is inevitable, it is not, as Parkes remarks,
an everyday event or a common stress of our lives. Death therefore has the status of
being at once universal and inevitable, and at the same time strange and unusual, and
grief as it is related to death is similarly unique.
\l Analogizing the loss of bereavement with other types of loss may lead to
significant blind spots if, while commonalities are illuminated, distinctions between
experiences are blurred. This is problematic when one phenomenon of loss is equated
to another, as for instance, in the wholesale application of Kubler-Ross’ (1969)
model, which concerns the dying (particularly the terminally ill), to those who are
bereaved.
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As Freud conveys in his renowned Mourning and Melancholia (1917/1957),
and Parkes (1987) echoes, it is the loss of the loved person, or his or her substitute,
that is generative in grief rather than what Parkes considers secondary types of
deprivation such as loss of economic support or loss or role. It is the loss of the dead
person and the bereaved’s lost or altered relationship with her or him that seems to
make up the unique and harrowing pain of grief. This sense of deprivation and loss,
as Dickens illustrates in Dombev and Son (1846-1848/1963), may create an
immeasurable personal void and feeling of alienation from the world at large:
And can it be in a world so fully and busy, the loss of one weak creature
makes a void in any heart, so wide and deep that nothing but the width and
depth of vast eternity can fill it up! (p. 274)
Loss of a person is therefore often considered primary ("primary" or "object loss,"
Averill, 1968; Engel, 1961), while symbolic and functional losses associated with
bereavement (e.g., change in status, financial condition, role) are considered
secondary. Parkes (1987) identifies loss and deprivation as separate but intertwined,
loss referring to the loss of the person her or himself, and deprivation referring to
secondary losses. Deprivation is "the absence of a necessary person or thing as
opposed to loss of that person or thing" (Parkes, 1987, p. 29). Therefore, Parkes
writes, loneliness refers to deprivation, while grief is a response to loss, and of these
two features, the loss of the person is more powerful in grief than the loss of role, or
than secondary losses such as deprivation and stigmatization.
Loss as occasioned by death can also be considered as primary in that death is
a prototype or emblem of loss, representing for many the ultimate separation and
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withdrawal. Although the bereaved may imagine and may believe that he or she will
join the deceased in heaven or some other sort of afterlife, death marks a physical
change which is temporally irreversible, differentiating it from losses or transitions
that exist in a realm of material possibilities.
In contrast to Parkes (1987), Averill (1968) maintains that social disruption
caused by loss of roles is primary in engendering grief. The loss of the significant
object or person him or herself, he says, occasions grief only on a "superficial level"
(p. 724). In support of his position, Averill cites from the work of Volkart and
Michael (1957) in the Trobriand Islands. According to Volkart and Michael, the
maternal kin represent the most important family relationships; therefore, Averill
writes, the grief of a woman for her dead husband may be "more transitory and
ceremonial" (p. 724) than the grief of his maternal relatives.
Averill assumes that the cultural delimitation of emotional expression in
Trobriand Islands widows indicates a widow’s grief is less intense and genuine than
her dead spouse’s maternal relatives’, due, he speculates, to the lesser impact of the
death on the widow’s role.- He suggests that in cultures that either minimize the
dependency of individuals upon each other or that provide for replacement of lost
member functions (e.g., Ubena tribes that provide a widow with a new mate soon
2/ As Janet Hoskins (personal communication, March 14, 1997) pointed out to
me, however, it is strange to refer to this kind of grief as "short-lived" as a Trobriand
woman may literally walk around wearing her dead husband’s skull on a necklace for
years.
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after her husband’s death), grief, "although apparently genuine" (p. 725) may be
short-lived.
That a specific "role" is involved in loss does not mean that the role does not
foster a specific relationship. Therefore, mourning of a role does not necessarily
imply an absence of mourning of the primary object loss. Writing of Indonesian
mourning rituals, Metcalf and Huntington (1991) point out that the loss as severed
relationship leaves the "living person that much reduced: a social and [italics added]
psychological amputee" (p. 82), requiring that the mourner (and the community)
readjust his or her identity. Parkes (1987), speaking of the past Jewish custom for a
widow to automatically remarry her husband’s eldest brother, states that such a
custom may have reduced essential needs (e.g., loneliness, poverty, sexual
frustration), but not mourning.
Loss and Attachment
Although the everyday meaning of "lose" is linked with its Indo-European
base, leu-, meaning to cut off or separate, the Middle English version of the word,
losen or lesen, also connotes "merging" (Webster’s, 1984, p. 836). Loss is
separation and deprivation; but the separation issues from a state of merger, a state of
connectedness. Without attachment, loss would not be possible (Bowlby, 1980;
Parkes, 1987). Freud (1917/1957) states that mourning (in the German, Trauer,
meaning both the effect of grief and its outward manifestation), is the reaction to the
loss of a loved person, or the "loss of some abstraction which has taken the place of
one such as one’s country, liberty, an ideal, and so on" (p. 243). In other words
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some sort of attachment, caring, investment or, in Freudian terms, libidinal cathexis,
is necessary.
The prototypical attachment is often considered to be the early child-mother
[parent] attachment which, being prototypical, may significantly affect how later
attachments and losses are experienced and handled (Averill, 1968; Bowlby, 1980;
Freud, 1940/1964; Parkes, 1987; Winnicott, 1965). Object relations theorists (e.g.,
Guntrip, 1961, 1966; Fairbaim, 1954; Mahler, 1971; Mahler, Pine, & Bergman,
1975; Spitz, 1965) contend that this primal attachment is centrally concerned with
loss. It was Freud’s view in 1926 (1926/1959) that anxiety is aroused when the
caretaking person disappears from perception, and pain when that person is lost.
In addition to his well-known conceptualization of castration anxiety, Freud
describes the basic danger situations as first, fear of losing the loved object or person,
and second, fear of losing the important object’s love. These latter two danger
situations are not incongruent with evolution-focused theories concerning attachment
and loss. Both Bowlby (1980) and Parkes (1987) emphasize attachment behavior as
an evolutionary stratagem, a way of adapting and surviving.
Averill (1968) considers that certain situations, because of evolutionary
pressures, are more "biologically basic" (p. 725) to grief than others and, like Bowlby
(1980) in his discussion of attachment behavior, emphasizes the evolutionary
importance of the social bond. Separation of the infant-mother dyad is seen by both
Averill (1968) and Bowlby (1980) as a prototypical occasion for grief. Averill looks
for an evolutionarily viable explanation for grief and concludes that because the
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human species requires a social bond for survival, separation from the group or from
members of the group provokes a grief response.
As support for evolutionary and attachment views about the survival value of
separation as the impetus for grief, there is ample evidence that separations between
mothers and infants have potential for great distress (Bowlby, 1960, 1980; Mahler,
Pine, & Bergman, 1975; Winnicott, 1956, 1960), and in Averill’s words, "important
biological consequences" (p. 726)— namely survival of the infant. Subhuman primates
also evidence grief-like reactions (Hinde, Spencer-Booth, & Bruce, 1966; Kaufman &
Rosenblum, 1967; Seay & Harlow, 1965).
According to Averill’s logic, the biological "reason" for grief is its adaptive
value in keeping individuals bonded to the group in defense against the overwhelming
and horrible psychic pain consequent upon separation. Freud (1915/1957) similarly
indicates that our "emotional ties, the unbearable intensity of our grief, make us
disinclined to court danger for ourselves and for those who belong to us" (pp. 290-
291). And Yalom (1980) points out how abandonment and death are intrinsically
linked together: "The abandoned primate always perishes; the fate of the outcast is
invariably social death followed quickly by physical death" (p. 64).
Averill contends that while the behavior of grief may appear paradoxical and
nonadaptive (i.e., the individual withdraws from and is hostile to activities associated
with the group, including reproduction), a neo-Darwinian theory of natural selection
explains it. Survival is dependent on maintaining social relationships, and since
positives alone (e.g., playing, communicating, having sex) would not be enough to
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insure cohesion, there has to be a punishment for isolation. Separation from the
group is extremely stressful psychologically and physically, aiding in the insurance of
group cohesiveness.
The griever’s urge to call for, search for and recover the lost person has also
been attributed evolutionary significance. Bowlby (1980) points out, as Shand (1920)
before him, that this desire is so powerful that it often persists long after recovery is
obviously impossible. In searching behavior, Bowlby says, the griever will use
gestures, cries and forlorn appearance to appeal to others around him or her for help.
Both Shand and Bowlby attribute survival value to the appeal of the mourner’s "cry
for help," as when the young and vulnerable cry for help in distress, the attention of
the older and stronger members of his or her group is elicited. A griever, or loser’s,
cry for help also increases the possibility that the lost or missing person may return or
be found, if such retrieval is possible.
According to Averill (1968) although personal and circumstantial factors
account for individual variability, the typifying features and limits of "bereavement
behavior" are set by biology and culture. Biological givens shaped by evolutionary
requirements actuate a "highly reliable syndrome" (p. 723) of grief, and social norms
determine mourning patterns. Further, Averill claims, grief and mourning may be
completely independent of each other with, for instance, a grief reaction (the
biologically induced, stereotypical responses Averill defines as grief) occurring in a
situation with no prescribed mourning practice, or mourning practices occurring
without affect.
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The notion that grief is a time-limited emotion driven by biology is reflected in
stage theory and may be used to differentiate the bereaved’s earlier "acute" grief
response from her or his later response to the death (e.g., Lindemann, 1944; Parkes,
1987). According to prevailing models, the acute, early phase of grief is more highly
charged with emotional and physical demands than later stages. The stimulus of loss
through death is stressful, disrupting the bereaved’s equilibrium or homeostasis
(Pollack, 1961). Focusing on the homeostatic function of emotions, it is posited that
individuals naturally want to resolve or remove stressful disruption and are therefore
motivated to return to equilibrium.
However, an important aspect of the pain of grief is the fact that some of its
deprivations, particularly the loss of the loved person, cannot be reversed. Unlike
Averill (1968), Bowlby (1980) stresses that on some level nothing but the return of
the lost person can bring the griever true comfort, and that return is impossible.
According to Freud (1917/1957), the bereaved gradually detaches from the lost person
in a "piecemeal fashion," counter-balancing reality with fantasy. On the one hand,
reality-testing affirms that the loved person is gone; on the other, memories and
expectations of the lost one psychically prolong her or his existence in the mind of the
griever. While in 1917 Freud finds the extraordinary painfulness of the piecemeal
process difficult to explain, Bowlby indicates that it is just this forced compromise
between accepting the reality of the loss while still feeling and acknowledging the
emotional ties to the deceased that is so painful. The continued yearning for the lost
figure, Bowlby points out, makes pain inevitable.
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Grief Theory and Grief "Work"
Since people never willingly give up what they love, Freud (1917/1957)
indicates, meeting the demands of reality ensues with a struggle. The "work of
severance" is slow and gradual. The "lost object is psychically prolonged" while
"each single one of the memories and expectations . . . is brought up and
hypercathected" (Freud, 1917/1957, p. 245). Though this "piecemeal" and recursive
process, the end result of normal mourning, Freud states, is the ego’s "freeing its
libido from the lost object" (p. 252).
In the meantime, the griever is very much like any severely depressed person.
Freud compares melancholia, or depression, with mourning, in that in both instances,
the individual is dejected, uninterested in the outside world, inhibited and unable to
love. The world has become a "poor and empty place" (p. 127). Further, in
Thoughts for the Times on War and Death (1915/1957), Freud indicates there is a
"complete collapse when death has struck down someone whom we love";
Our hopes, our desires and our pleasures lie in the grave with him, we will
not be consoled, we will not fill the lost one’s place, (p. 290)
For Freud, melancholia is distinguished from mourning by the melancholic’s
extremely low self-esteem and self-blame which leads him or her to a "delusional
expectation of punishment" (p. 244). But pathological mourning occurs, Freud
indicates, when the griever takes on these melancholic features, namely obsessive
reproaches and self-blame which Freud ascribes to ambivalence toward the deceased.
Ordinarily, however, Freud maintains,
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Although grief involves grave departures from the normal attitude to life, it
never occurs to us to regard it as a morbid condition .... We rest assured
that after a lapse of time it will be overcome, and we look upon any
interference with it as inadvisable or even harmful, (p. 153)
Though clearly non-pathologizing, and somewhat arbitrary about the amount of time
needed by the griever to grieve, Freud remains "assured that after a lapse of time it
will be overcome," also, "without leaving traces of any gross changes" in the
mourner (p. 252).
Like many of the theorists following him (e.g., Bowlby, 1980; Lindemann,
1944; Parkes & Weiss, 1983; Rando, 1984; Worden, 1982), Freud suggests that in
order for grief to end, the grief work must be done, specifically the detailed reality
testing described above and the bereaved’s decathexis (or detachment) from the
deceased, after which her or his libidinal energy is "freed" to invest in new
relationships. Incentive for this is provided not only by the continuous "verdict of
reality that the object no longer exists" (p. 255), but also because the ego is faced
with the "question of whether it shall share this fate" (p. 255), the fate of the dead
person. Rather than psychically die and give up on life, Freud says, the ego is
"persuaded by the sum of the narcissistic satisfactions it derived from being alive to
sever its attachment to the object that has been abolished" (p. 255).
The premises of Freud (1917/1957) and Lindemann (1944) form the basis for
much of modem grief theory. In contrast to Freud, however, Lindemann (1944)
implies that grief and its "grave departures from the normal attitude to life" (Freud,
1917/1957, p. 153) does indeed represent a morbid, or "pathognomonic" (Lindemann,
1944) condition. Further, Lindemann’s description portrays grief as characterized not
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primarily by depression but by restlessness and disorganization and a heightened state
of alarm and panic.
One of the first to try to systematically categorize bereaved peoples’ reactions
to death, Lindemann notes five characteristics which he deduces as "pathognomonic
for" (i.e., typical or characteristic of) grief: somatic distress, preoccupation with the
image of the deceased, guilt, hostility and "loss of patterns of conduct" (p. 142), the
latter described by Lindemann as generally restless, aimless and disorganized activity.
In addition, Lindemann notes a sixth feature which he states may border on the
pathological, this being the bereaved taking on the appearance or behavior of the
deceased (particularly if this includes symptoms of the dead person’s last illness or
behavior shown at the time of death).
Lindemann describes somatic distress emerging in "waves" lasting from twenty
minutes to an hour. These "waves" of distress include throat tightness, choking and
shortness of breath, sighing, an empty feeling in the abdomen, and a lack of muscular
strength. Lindemann finds the most "striking feature" in the bereaved a "respiratory
disturbance" when discussing their grief, as well as a sense of exhaustion, lack of
strength, and digestive symptoms (e.g., lack of taste and disturbed appetite). He
notes some sense of unreality and an emotional distance from others. To the
bereaved, he says, other people may appear shadowy or small. The bereaved are
preoccupied with images of the deceased, visualizing the dead and possibly having
imaginary conversations with them.
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Lindemann also indicates that the bereaved are preoccupied with guilt and
search "the time before the death for evidence of failure to do right by the lost one"
(p. 142). The bereaved’s behavior, he says, has a hyperactive, rushed and restless
quality rather than one that is depressed and slow:
There is no retardation of action and speech; quite to the contrary, there is a
push of speech, especially when talking about the deceased. There is
restlessness, inability to sit still, moving about in an aimless fashion,
continually searching for something to do. There is, however, at the same
time, a painful lack of capacity to initiate and maintain organized patterns of
activity, (p. 142)
Clearly, as Lindemann’s descriptions point out, the response to bereavement often
includes a state of panic and alarm which may manifest in somatic symptoms--
difficulty breathing, eating, sleeping, muscular tension and agitation. While the above
characteristics may appear at different times in the mourning process, Lindemann’s
descriptions seem most apt in connection with the initial shock of death, perhaps
because his observations appear in relation to victims of trauma such as subjects who
had recently lost relatives in the Coconut Grove Fire.
Lindemann (1944) differentiates between what he terms acute and normal grief
syndromes, indicating that in the course of a normal grief reaction, the bereaved
person does the "grief work” (p. 143). The "successful" completion of this work, he
states, consists basically of letting go of the dead person, getting used to being
without him or her, and forming new relationships with other people. He outlines
three stages of grief: (1) shock and disbelief, in which the griever cannot accept the
loss and may even deny its reality; (2) acute mourning, characterized by the somatic
symptoms discussed above and including loneliness, weeping and preoccupation with
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39
the image of the deceased; and (3) resolution of grief wherein the bereaved resumes
the activities of daily life and is less and less preoccupied with the image of the
deceased. Lindemann indicates that all of these processes, if not completed normally
by the griever on his or her own, can be accomplished in eight to ten psychotherapy
sessions.
The stages suggested by Lindemann (1944) are depicted in chart form in
Figure 1 along with the "order" of grief according to several other prominent
theories. (See Figure 1, page 40.) This chart reflects that although theorists may
differ in their naming, stages and phases do tend to overlap or follow a parallel
course.
Like Lindemann (1944), most theorists posit a stage of "shock," "disbelief,"
"numbness" or "denial" (Averill, 1968; Bowlby, 1980; Engel, 1961, 1964, 1972;
Kubler-Ross, 1969; Parkes, 1974, 1987; Pollock, 1961) following the discovery of
death and loss, which is attributed to a kind of cognitive incapacity or disrecognition
related to an emotional need to defend against an overwhelming, traumatic reality
(Bowlby, 1980; Engel, 1964; Kubler-Ross, 1969; Tatelbaum, 1980), an attempt to
block out or buffer oneself from the recognition of loss and pain. Both Lindemann
(1944) and Kubler-Ross (1969) refer to a disbelief in death that may extend to radical
denial even that loss may (have) occur(red).
Using an information processing perspective, Bowlby (1980) explains that the
bereaved buffers her or himself from loss by excluding information. He describes a
process of "sensory inflow" from the environment to the person, in which the person
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Theorist Stage or Phase
Lindemann
(1944)
Shock &
Disbelief
Acute Mourning Resolution
Engel (1961,
1964 1972)
Shock &
Disbelief
Developing
Awareness
Restitution Resolving the
Loss
Idealization The Outcome
Pollock (1961)
(Acute Stage) (Chronic State)
Shock Grief Separation Reparation
Averill (1968) Shock Despair Recovery
Kubler-Ross
(1969)*'
Denial &
Isolation
Anger Bargaining Depression Acceptance
Parkes (1971) Numbness Searching & Pining Depression Recovery
Parkes (1974,
1987)
Numbness Yearning & Searching Disorganization
& Despair
Reorganization
Bowlby (1980) Numbness Yearning & Searching Disorganization
& Despair
Reorganization
Rando (1984) Avoidance Confrontation Reestablishment
Sanders (1989) Shock Awareness of Loss Conservation-
Withdrawal
Healing Renewal
Figure 1. Representative schema of prominent grief stage/phase theories.
1/ Although not a theory of grief but one of death and dying, Kubler-Ross’ (1969) model is included here because of
stage theory adherents’ frequent interpretation of it as a model of grief. g
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selects, interprets, and appraises information, often matching information already
stored in long-term memory. For the most part, he says, this process occurs outside
of awareness, yet the selection, interpretation and appraisal often influence mood and
behavior. In contrast to but similar to the more traditional, psychoanalytic terms,
denial and repression, Bowlby uses the phrase "defensive exclusion" to allude to the
process by which a person’s interpersonal "system" is threatened in trying to process
difficult information; when the system is threatened, it tends to exclude the
threatening information.
As Bowlby (1980) indicates, the cognitive inability to formulate or accept the
death may occur largely outside of awareness. Confusion, as illustrated by
Lindemann’s (1944) description of aimless, restless behavior, and a sense unreality
may prevail. In describing different ways of knowing and not knowing or forgetting
trauma, Laub and Auerhahn (1993) similarly note in relation to trauma that it "defies
the individual’s ability to formulate experience" (p. 290). Therefore, the person
somehow separates his or her internal world or self from the world and from
knowledge, and a protecting, fragmented self is created by means of denial, splitting,
amnesia, derealization and depersonalization. Pollack (1961) describes the initial state
of shock as an overturn of ego equilibrium which may include panic, wailing, and
perhaps fainting.
Death is a trauma, and shock as a reaction to this trauma (Sanders, 1989)
might be considered characteristic of the "acute" condition described by Lindemann
(1944). In what Rando (1984) calls the "avoidance phase," the bereaved does not
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want to acknowledge the death and goes into a protective state of shock. When he or
she recognizes the loss, "denial immediately crops up" (p. 29), along with confusion,
withdrawal or depersonalization, and disorganization.
In addition to disbelief and confusion, panic and alarm, restlessness, feelings
of unreality, as well as a sense of helplessness are part of what researchers (Bowlby,
1980; Lindemann, 1944; Parkes, 1987; Rando, 1984; Sanders, 1989) consider in this
initial phase/stage. And as Lindemann (1944) describes, these features are often
accompanied by somatic disturbances and crying. Lindemann’s (1944) and Sanders’
(1989) observation of self-absorption, egocentricity, distancing from others, and a
preoccupation with thoughts of the deceased may be similar to what Freud
(1917/1957) refers to as a cessation of interest in the outside world and loss of the
capacity to love. According to Freud, this is due to the immense and painful amount
of work involved in the "piecemeal" process of re-membering and dismembering the
memories, expectations, and desires related to her or his loss.
Bowlby (1980) posits that numbing lasts from a few hours to a week and may
be interspersed with bouts of extreme distress and/or anger— emotions that are
commonly associated with a later "phase" or "stage" in grief but apparently have
earlier origins. The state of shock or paralysis may be punctuated, as Bowlby notes,
with intense emotions and liveliness. Thus, along with feelings of numbness, feeling
as if "T was in a dream’" or as if it "‘didn’t seem real,’" (Bowlby, 1980, p. 86) are
tension and apprehension and, at times, intense emotion which may range from panic,
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to anger, to elation.- In what Bowlby considers the phase of "yearning and
searching," following that of "numbness," in addition to longing, anger becomes more
prominent. Similarly, in Kubler-Ross’ (1969) model of death and dying, the first
stage of denial and isolation is followed by a period of anger.
For Engel (1964, 1972) a phase of shock and disbelief is followed by a
developing awareness of the reality of death, which brings on acute and rising
anguish, and may be accompanied by guilt, anger, acting out or self-destructive
behavior. In this anguished state, the bereaved may typically cry and regress to a
feeling of helplessness which, like Bowlby (1980), Engel indicates is important in
order to get social support.
Parkes (1987) adds a particularly insightful explanation of the state of alarm in
early bereavement, underlining Lindemann’s (1944) observation of anxious and
somatic reactions associated with loss and describing these in evolutionary,
physiological and emotional terms. Parkes defines alarm as a state of stress when the
central nervous system is not at rest, emitting desynchronous electrical discharges,
and when there is heightened sympathetic activity and an inhibition of parasympathetic
activity. Such changes in nervous system activity were related by Cannon (1929) to
states of extreme arousal which would allow an animal the physiological wherewithal
and motivation to either fight or flee.
3/ Elation, for instance, at experiencing reunion with a dead husband (Bowlby,
1980).
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While any new situation may elicit some degree of alarm, Parkes (1987) says,
certain situations are particularly stressful and likely to lead to a high state of alarm
because they threaten individual security and include loss. These situations involve
either (a) the lack of an escape route, (b) the absence of a safe, secure place, (c)
particular "danger signals" (such as cries or sudden movements) which, he says, the
individual is pre-set to recognize, or (d) the loss of a child-figure. Obviously, in
bereavement the individual encounters an alarming situation in which the status quo of
her or his world has been overturned (Parkes, 1987; Pollack, 1961). In the loss of
the loved one, the personal safety and integrity of the bereaved seem to be threatened.
(And, very concretely, as Parkes (1987) points out, a widow’s security may clearly be
threatened if in the past she had always relied on her husband for financial as well as
social and emotional support.)
That a person could feel numb and at the same time experience alarm and
panic could be explained, as Parkes (1987) indicates, by the fact that although
arousal, autonomic disturbance and emotional reaction are all likely to be present in
extreme situations, it is often only after the danger situation has passed that a person
may become aware of any feelings at all: "During the period of intense activity they
are so preoccupied with the task in hand that emotion is redundant" (p. 52), or seems
so. Thus, different degrees of alarm, and awareness of alarm, seem to be present,
along with differing degrees of shock or numbness. There is often the need for the
bereaved to be "systematic and efficient," as Tittensor (1984, p. 11) writes, even
while in agony, as reality demands not only that we accept the loss of the other
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(Freud, 1917/1957), but that we get up out of bed, go to work, eat, sleep, and pay
the rent. Parkes (1987) notes there may be later attacks of panic and worry following
this early phase.
While Lindemann (1944) focuses primarily on the anxious and somatic
reactions of grief, and Freud (1917/1957) on its depression (a distinction I will
consider later), another prototypal characteristic of grief is what Bowlby (1980) refers
to as yearning, and Parkes (1987) as pining, for the lost loved one, a unique mixture
of anxiety, depression, longing and despair that sets grief apart other emotional states,
such as anxiety or depression, and which these theorists construe as the second phase
of grief.
Parkes (1987) asserts that episodes of severe anxiety and pain in which the
bereaved yearns and pines for the deceased loved one begin a few hours or days after
bereavement, reaching their peak within five to fourteen days. He characterizes these
episodes as "pangs of grief" (p. 60), a phrase which calls to mind the sharpness and
suddenness of certain physical pains, such as the pangs of hunger or childbirth, and
thus conveys a felt sense of piercing harshness and seemingly interminable agony. In
a "pang of grief" the bereaved pines for the deceased and may sob and cry aloud for
him or her, to pine meaning both to waste away and to have an intense longing and
desire for (Webster’s, p. 1081). The bereaved is thus wasting away with hunger for
the deceased which only fuels his or her desire and pain. Rando (1984) similarly
describes "grief attacks," in which there is a severe and sudden surge of grief, which
may occur in waves and may be painful both emotionally and physically. She adds
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that in this kind of state, the griever may also be confused, behave as though in a
fugue state, and feel as if she or he is going crazy.
According to Parkes, "attacks" of intense anxiety, longing and pain gradually
occur less frequently, yet may reoccur when triggered by a re-experience of the loss.
Situations which are likely to painfully and viscerally remind the griever of the earlier
collision with the reality of loss are days earmarked for occasion when the deceased is
palpably absent (e.g., anniversary of death, birthday, Christmas, Thanksgiving and
major holidays).
Raphael (1983) describes "separation pain" as a sense of such "palpable"
absence (p. 40) with yearning, pining and longing, a feeling of emptiness, a feeling of
being tom apart--as if the dead person had been yanked from his or her very body-
preoccupation with his or her image, alert arousal and scanning of the environment,
looking for cues of the dead one’s return, somatic distress, as Lindemann says,
emerging in "waves," sighing respiration, palpations, "a deep inner pain" (p. 40), and
often a choking sensation.
Part of the uniqueness of the grieving experience is that it involves the struggle
with the paradox of loss, associated specifically with the loss of the loved person,
whom the griever knows can never be restored. It is the very resistance to the change
brought about by death, that Parkes (1987) believes is the basis for grief. The tension
between desire and absence, between yearning for the loved figure and realizing she
or he is gone forever. Pain is inevitable, both Freud (1917/1957) and Bowlby (1980)
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indicate, because the bereaved continues to yearn for the beloved and cannot
immediately bring her or himself to give up the deceased for lost.
"Searching for the lost figure," Bowlby (1980) suggests, is a prominent and
natural theme during this period of pining and yearning, particularly in the early
weeks and months following bereavement. The griever demonstrates what Bowlby
refers to as the "cry for help," an act which is just that, aimed at getting help. The
motivation, as mentioned earlier, is to recover the lost person and is expressed in
gestures of helplessness and weakness, such as weeping and appealing to others, and
may persist, he says, even after it appears purposeless.
In Kubler-Ross’ (1969) model, there is a somewhat comparable desire to
"undo" the threat of death through "bargaining." In this third stage, the dying
individual tries to "bargain" his or her way out of the situation, pleading with God,
doctors or whoever may be perceived as in power, to reverse the situation and spare
him or her. Similarly, Bowlby (1980) and Parkes (1987) emphasize the repeated
attempts of the griever to "find" the dead person, to reclaim or recover him or her.
The cry for help has bearing on the relationship between features such as
anxiety, agitation and distress, on the hand, and depression, despair and giving up, on
the other. Anxiety and agitation may transmute into depression or despair, as Bowlby
(1980) illustrates so poignantly in his descriptions of young children (between one and
three years) when they are removed from the caretaking attachment figure. The
initial response is "protest and urgent effort to recover his lost mother" (p. 11). After
repeated expectations and disappointments, gradually despair "sets in." While the
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longing may continue, Bowlby adds, the hope that this longing will be answered
fades; and the right name for this particular misery, he says, is grief.
It is in the context of registering the reality of the loss, through pangs of
pining, distress, and sobbing, perhaps lying on the floor and pounding on it, as well
as restlessness, insomnia, and preoccupation with thoughts of the deceased, that the
griever searches for the lost person (Bowlby, 1980). It is through the back and forth
process of hoping and searching, frustration and disappointment, that she or he begins
to accept the reality and finality of loss, a proceeding similar to the "piecemeal"
process described by Freud (1917/1957).
Parkes (1987) echoes Lindemann’s (1944) observation that the bereaved is
often preoccupied with thoughts and images of the dead loved one, and may
hallucinate or have perceptual illusions. The bereaved may feel as if she or he is in
the presence of the deceased, smelling their perfume, hearing the sound of their voice
or footsteps returning (Lindemann, 1944; Parkes, 1987; Raphael, 1983). In the
newly bereaved widow, Parkes (1987) reports, the perceptual element is so strong that
some of his subjects report seeing a deceased loved one participating in everyday
situations, such as digging in the garden, coming through the garden gate, or standing
by the griever’s bedside. Hypnogogic or full-blown hallucinations may occur
(Parkes, 1987; Raphael, 1983). Freud (1917/1957) states, the "opposition [to the
demands of reality] can be so intense that a turning away from reality takes place and
a clinging to the object through . . . hallucinatory wishful psychosis" (p. 244).
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The bereaved may have a strong sense that the deceased should, logically,
return, and will focus on memories of his or her gestures, appearance, etc., and
replay past incidents, often including the circumstances of the death (Rando, 1984;
Raphael, 1983). Parkes (1970, 1987) illustrates that such searching behavior involves
use of an internal perceptual "set" which is used to look for and identify the missing
object/person. He suggests that bereaved people follow a particular sequence in
searching consisting of: (a) restless moving about and scanning the environment; (b)
thinking intensely about the lost person; (c) developing a perceptual set for that
person (i.e., a position of attention toward receiving information/stimuli indicating the
presence of the person, and inattention to other, irrelevant stimuli); (d) directing
attention to aspects of the environment where the lost person would be likely to be
found; and (e) calling for the lost person. Some grievers, he adds, are aware of an
urge to search.
Raphael (1983) similarly describes an orientation to the dead person such that
activities and rituals which existed in the relationship of the bereaved and the lost
loved one may continue as if the dead person were still there. This is reflected in
speaking of the dead person, holding onto the dead person’s possessions, as if
awaiting his or her return, dreaming of the dead person as if alive (with perhaps rude
and harsh awakenings to the reality of loss). In this situation, the bereaved may well
know, cognitively, that the beloved is gone, but her or his assumptive world is still
oriented towards the lost person and has not formed a new set of configurations
(Parkes, 1987; Raphael, 1983).
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Parkes (1987) adds relevance to the old adage, "seek and ye shall find" in
describing how a widow’s perceptual set for receiving certain information and
excluding others enables her to "find" what is missing. Thus, the act of construing or
imagining sounds or sights indicative of their dead husbands, seems to be related to
widows’ hearing their husband coughing at night or moving about the house, or
alternatively, sighting him on the street in error. Crying and sobbing, Parkes
suggests, is also related to the attempt to recover the lost person.
In writing of his two children who died in a fire, Tittensor (1984) illustrates
this urge to search (and to find) in his journal entry:
I stand and look across the gully to where we worked that day, and call their
names out through the bush as I did when they were alive and I went out
looking for them. Only silence comes back; yet it is a kind of answer--an
answer to which I feel I have not yet found the key. (p. 37)
As Parkes (1972) indicates, there is often something to indicate that something is
amiss in dreams of the dead beloved (e.g., that even in the dream, the dreamer knows
the deceased is dead or about to die). And Freud (1916) remarks on the "special
sort" of dreams of one who have "lost someone near and dear to him," dreams in
which "knowledge of the death arrives at the strangest compromises with the need to
bring the dead person to life again. In some of these dreams the person who has died
is dead and at the same time still alive. . . . In others he is half dead and half alive"
(p. 187).
As mentioned, Bowlby (1980) asserts that anger is common in the phase of
yearning and searching, and in Kubler-Ross’ (1969) model, it is facing the truth or
allowing the truth to come into awareness, that leads to anger. Both Bowlby and
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Kubler-Ross reason that this is because of the inevitably frustrating and disappointing
aspect of irrevocable loss. Anger and yearning and searching (or anger and
bargaining for Kubler-Ross) are related to the individual’s strong disinclination to
believe what appears to be true, and the desire to have reality switched back to the
way it was before the discovery of death or realization of impending death.
Anger is therefore not necessarily the result, Bowlby (1980) asserts, of
ambivalent feelings toward the deceased as Freud (1917/1957) suggests, but the result
of (a) wishing to see the separation from the deceased as temporary; (b) the futility of
the search; and (c) perceiving others’ responses regarding reuniting the bereaved with
the deceased as uncooperative if not brutal in endorsing the loss, as it were. From an
evolutionary standpoint anger and aggression might prevent such separations from
happening again, and might also shorten the separation time. Further, when anger
continues, Bowlby says, loss can be viewed as temporary.
Therefore, outbursts of rage are common in the first several weeks of
bereavement, Bowlby states, and are no cause for concern unless they continue.
Further, bereaved people may be hostile to comforters who "favour acceptance of
loss" before the bereaved is willing or ready to do so, resenting him or her "as if he
had been the agent of it" (p. 92), a sentiment that is echoed by Lindemann.
Bowlby combines the features "restless searching, intermittent hope, repeated
disappointment, weeping, anger, accusation, and ingratitude" together in what he sees
as the second phase of mourning, all related to the urge to recover the dead person.
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In this context, he describes an oscillation between, for instance, searching for and
wanting to escape memories of the dead person.
While loneliness may persist when the griever has lost a close attachment
figure (Bowlby, 1980; Weiss, 1975), the bereaved’s relationship with the deceased
may also continue or develop (Bowlby, 1980; Glick et al., 1974; Rees, 1971), as well
as a redefinition of self. In Engel’s (1964, 1972) phase of "restitution," following
shock and disbelief and developing awareness of the death and loss, a kind of
identification process between the bereaved and the deceased is initiated which
involves rituals that promote social support and allow for the expression of feelings.
In this phase are the "seeds" of Engel’s later phase, "idealization," which sets the
stage for what Engel considers a successful and healthy outcome, and an end, to
grief.
The dead person’s presence, Bowlby says, as either a companion or in some
specific location (though not in another person, he warns) is a feature of healthy
mourning. Nevertheless, he also asserts that while the urge to search and recover the
lost person is normal, it gradually diminishes and runs its course. Further, if the urge
to search persists (usually in disguised or distorted forms), Bowlby (1963, 1980)
indicates, mourning is likely to be pathological.
Engel (1964, 1972) believes the loss is "resolved" when the griever begins
actually dealing with the absence of the dead person and the emptiness and
fragmentation of self felt as a result. This occurs after his "restitution" phase, and as
in Freud’s (1917/1957) Mourning and Melancholia, the bereaved is seen as
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preoccupied with thoughts and memories of the deceased, the death, and a review of
the relationship. The upshot of this review process in Engel’s model is that an image
of the dead person lacking negative or unpleasant features crystallizes. Raphael
(1983) similarly states that in the "review and undoing processes," the loving aspects
of the relationship usually predominate, with minimal guilt and few negative affects
except for sadness. The "resolving the loss" phase is followed, in Engel’s model, by
"idealization," which differentiate’s his ideas most substantially from his
contemporaries and forbears, who tend to view this in the realm of the pathological.
In acute grief, the reality of the loss along with memories and desires of the
dead one are not only constantly being "brought up" by the griever for consideration;
they are being experienced. Hence, the sobbing, searching, pounding on the floor,
and raging. As Bowlby (1980) indicates, when longing and hope are finally waylaid
in their bitter collision with reality and loss, despair ensues. Therefore, in Bowlby’s
(1980) and Parkes’ (1971, 1974, 1987) models, the review process, and the yearning
and pining, searching and not finding the dead person, eventually lead to depression
or despair. Kubler-Ross (1969) similarly indicates that when "bargaining" fails,
depression sets in. In what she calls the "confrontation phase," Rando says that grief
is experienced most intensely, and extremes of emotion are felt, including panic,
anxiety, anger and guilt. She includes despair and depression as part of this phase
and describes them as common.
The only "true comfort" (Bowlby, 1980) for the griever, the return of the
deceased loved one, is impossible. Therefore, as Bowlby indicates, it makes sense
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that when the griever realizes the futility of her of his desire, she or he feels despair.
The bereaved has no control, no "mastery" over this ultimate loss, and no control
over death. Again, not only do depression or despair appear to be prototypical of
grief (cf., Freud, 1917/1957; Lange, cited by James, 1890/1950), but, as I will
discuss in my critique of stage/phase models, they also appear to occur early on in the
experience of grief and to reoccur in most if not all of the so-called stages and
phases.
Despair, Bowlby (1980) explains, has to do with completely giving up hope on
recovering the lost person and "despair that anything can be salvaged" of the "old
patterns of thinking, feeling and acting" (p. 94)--hence the name for both his and
Parkes’ (1974, 1987) third phase in the grief process, "disorganization and despair."
"If all goes well," Bowlby states, a redefinition of both self and situation
eventually takes place, which
[I]s as painful as it is crucial, if only because it means relinquishing finally all
hope that the lost person can be recovered and the old situation re-established.
Yet until redefinition is achieved no plans for the future can be made. (p. 94)
This redefinition of self and situation, he points out, is not just a discharge of strong
emotion, but "a cognitive act on which all else turns" (p. 94). Parkes (1972, 1987)
and Parkes and Weiss (1983) similarly point to changes in the assumptive world of
the bereaved.
The change of self and relationship described by Engel (1964, 1972) is what
he calls a phase of "idealization" which follows the painful review process he
describes as "resolving the loss." In the phase of idealization, Engel claims, negative
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or angry feelings are repressed, although guilt and remorse may occur for such past
negative feelings or behaviors, even to the extent of the bereaved feeling responsible
for the death. In being preoccupied with the deceased, the bereaved identifies with
her or him, both on a conscious and unconscious level, and may take on some of the
dead person’s characteristics or traits. Through this process, Engel implies, the
bereaved becomes gradually less preoccupied with the dead person, and over time,
feels less sad, less guilty, and misses the deceased less. As Engel (1964, 1972) views
it, through identification the bereaved feels less dependent on the past and more
interested in new relationships. In the last phase of grief, which he labels "the
outcome," the bereaved is realistic about the lost relationship and, moreover,
comfortable.
According to Parkes and Weiss (1983), the bereaved must not only be able to
acknowledge the loss, but to explain it. If unable to do this, they argue, the bereaved
will continue to feel anxiety and the need to guard against further loss. Second, these
authors say, the griever must emotionally accept the loss such that they do not
experience pain every time they are reminded of it. All aspects of the loss must be
confronted and reviewed, a process which again is complementary with the tasks
suggested by Freud (1917/1957), Bowlby (1980), Engel (1964, 1972), Rando (1984)
and others. Finally, Parkes and Weiss say, a new identity must be developed and
along with it a new world view. Once again, the image of the handicapped or injured
is called forth:
The amputee has to learn not to step on a foot that is not there, the nearly
blind must learn that it is useless to look toward the source of a noise . . . the
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bereaved must stop including the dead person in their plans, thoughts, and
conversations. . . .
Each time a mistake of this kind is made (and they are very common at
first), the person is brought up short. A pang of grief is experienced, a stab
of frustration, a sense of alarm— for it we cannot rely on our assumptions about
the world, what can we rely on. . . . time is out of jo in t. . . nothing makes
sense anymore, (pp. 70-71)
Theorists (e.g., Bowlby, 1980; Engel, 1964, 1972; Kubler-Ross, 1969; Rando, 1984)
generally indicate that it is only if the griever is able to "pass through the fire," as it
were, and endure all of the multiple types of pain and longing described above-the
yearning, the searching, the anger, as well as the despair— that she or he will have a
"favorable outcome."
For Parkes (1972, 1987) and Parkes and Weiss (1983), the griever must
develop new internal models and assumptions that are matched with the new situation.
For Lindemann (1944) it involves cutting the "ties that bind" and entering a new
relationship. For Freud (1917/1957; 1918/1946), it is to detach the survivor’s
memories and hopes from the dead one. Although Bowlby (1980) claims that the
actual prevalence of mourners’ continuing relationships (or having a sense of the
presence of the dead person) does not support Freud’s assertion, he nonetheless finds
the key element of "reorganization" or positive outcome in "relinquishing hope [italics
added] that the lost person can be recovered and the situation re-established" (p. 94).
In other words, the griever must accept the finality of the loss, and do this to
in some way start a "new life," whether that life is concretely mapped out in terms of
resuming daily activities, beginning a new relationship, or even more generally as
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realizing that the interior, and exterior, design of one’s world has drastically altered,
and that new arrangements must be made.
In Kubler-Ross’ (1969) model, depression must be dealt with in order for the
dying person to reach the last stage, "acceptance." In Lindemann’s (1944), the grief
"work" must be done to "extricate" the bereaved from the deceased. Therefore, the
bereaved must accept his or her pain, review the relationship with the lost one,
become aware of feelings and the nuances of his or her emotional reaction (including
hostility and fears of insanity), express her or his sorrow and guilt, develop a new
relationship with the dead person, and find other resources to organize his or her life
anew. All of this, Lindemann says, can be done in eight to ten psychotherapy
sessions.
In Rando’s last phase, "reestablishment," grief gradually recedes and the
bereaved returns to "the everyday world." This, she says, is "not an all-or-nothing
phase" but "waxes and wanes during the latter part of the Confrontation phase and
continues slowly thereafter" (p. 35). Further, it may coexist, she says, with previous
reactions. Rando points out that when the mourner begins the "reestablishment
phase," she or he may feel guilty as if "betraying the deceased" if enjoying life
without that person.
According to Engel (1964, 1972), the whole process of grieving takes
approximately a year or more. Bowlby (1980) emphasizes the process is much more
likely to be lengthy and indicates its open-endedness even while suggesting a final
"phase of greater or less degree of reorganization" (p. 85).
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Pathological or Unresolved Grief and Individual Factors
As mentioned, Freud (1917/1957) specifically indicates that grief is not a
"morbid condition" and therefore does not mandate medical treatment. "We rest
assured that after a lapse of time it will be overcome, and we look upon any
interference with it as inadvisable or even harmful" (p. 153). Many theorists’ lack of
a specific time frame seems to reflect a realization that the course of grief is variable.
Both Sanders (1989) and Rando (1984) warn, individuals are unique and therefore the
course of grief may vary. Despite these stipulations, however, there is a noticeable
bias toward a linear progression and resolution of grief as equivalent to health and
recovery.-
Further, grief of any kind may be regarded as a disease or disability (Engel,
1961; Lindemann, 1944; Parkes, 1987). Although Parkes (1987) states it would be
unfair to stigmatize bereaved people as "nut cases," he refers to grief as a "functional
psychiatric disorder" (p. 26) and compares it to a physical injury, a "‘blow,’" which
like the bruise or broken arm is "within the realm of pathology" (p. 25), thereby
implying not only that grief is a disorder, but that it possesses developmental
properties, a "course."
Researchers such as Averill (1968), Lindemann (1944), Bowlby (1980), Parkes
(1965), Parkes and Weiss (1983), Rando (1984), and Raphael (1983) identify the
following specific "pathological," "morbid," (Lindemann, 1944) or "unresolved"
4/ Sanders (1989) states: "The griever unquestionably moves forward and
backward, as circumstance or need requires, occasionally becoming stuck [italics
added] in one phase or another for some time" (p. 41).
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(Rando, 1984) grief responses: absent grief, delayed grief, distorted grief, chronic
grief, exaggerated grief, abbreviated grief, inhibited grief, and anticipatory grief.
Most of these disorders seem to involve either expressing too much, for too long, or
expressing too little, either too soon or too late.
When feelings generally related to grief and mourning appear absent, and "it is
as if the death never occurred at all" (Rando, 1984, p. 59), or as in "inhibited grief"
(Rando, 1984), when the griever inhibits many normal aspects of grief, and other
symptoms (such as somatic complaints) take their place, the griever is construed as
either being in complete "denial" or never having gotten past her or his state of
shock. He or she is able to see and relinquish only certain aspects of the deceased
(such as the positive aspects). Further, both Lindemann (1944) and Rando (1984)
suggest, grief can be "delayed" only to be triggered later by other losses.
In what is termed "exaggerated" or "chronic grief," grief is viewed as
"abnormally prolonged," often with intensification of normal grief characteristics and
neurotic symptoms (e.g., guilt and identification) (Lindemann, 1944, p. 723). Rando
(1984) states:
The mourner continuously exhibits intense grief reactions that would be
appropriate in the early stages of loss. Mourning fails to draw to its natural
conclusion and it almost seems that the bereaved keeps the deceased alive with
grief, (p. 61)
Rando continues that chronic grief is often accompanied by intense yearning, a
dependent relationship with the deceased, a relationship which is perhaps
"irreplaceable," which may be due to a pathological emotional investment in the
deceased.
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There is an exaggeration or distortion of some aspects of normal grief, and a
suppression of other aspects, according to Rando (1984) in grief that is "conflicted."
Similar to Freud (1917/1957) who alludes to pathological grief taking the form of
obsessive reproaches and self-blame due to the griever’s ambivalence towards the
deceased, Rando identifies conflicted grief as revealing patterns of extreme anger
and/or guilt, with an ambivalent or previously dependent relationship with the
deceased. Both Bowlby (1980) and Sanders (1989), however, indicate that feelings
such as guilt, ambivalence and anger may now more often be considered an aspect of
"normal grief."
Further, although Freud indicates that the pathological mourner reproaches her
or himself for the loss of the loved object, as if she or he "has willed it" (1917/1957,
p. 251), in Thoughts for the Times (1915/1957), he also indicates that ambivalence
"governs [italics added] our emotional reactions with those whom we love most" (p.
293). "With the exception of only a few situations" (p. 298), Freud adds, our most
intimate love relations contain some hostility which, without deprecating the feelings
of love, might lead to an unconscious death wish.
Although, Freud (1917/1957) indicates that typically we take the view that
death is a natural end to life (the same view spoken by Queen Gertrude to Hamlet
cited at the beginning of Chapter 1), this attitude, he says, is not the one we actually
adopt towards our own death. Tolstoy (1886/1960) similarly remarks in The Death of
Ivan Ilvch:
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[Tjhe mere fact of the death of a near acquaintance aroused, as usual, in all
who heard of it, the complacent feeling that, "it is he who is dead and not I"
(p. 96).
Therefore, Freud suggests, it is not out of the ordinary that experiencing the death of
someone close to us (forcing us to acknowledge our own ultimate death) is mixed
with ambivalence. A "conflict must ensue," Freud (1918/1946) asserts, between
"tenderness and hostility" (p. 83).
Interestingly, Averill (1968) admits that alternately no symptoms or any
symptoms could be interpreted as a manifestation of grief following the death of a
significant other. (This, it should be noted, despite his assertion that grief is
biologically determined.) Therefore, the social construction or reading of grief is
open to the particular slant the observer decides to place upon the bereaved’s
behavior: He or she continues on with "normal activity ‘in spite o f the loss" (p.
722) (the observer apparently seeing this behavior as stoic, rising above
circumstances, going on despite great difficulty); alternately, the bereaved’s response
is viewed as pathological (he or she needs counseling).
In what is known as "anticipatory grief” (Rando, 1984), grief occurs prior to
any loss due to the expectation of the loss. Anticipatory grief is sometimes viewed as
helpful in the grief process as the griever is "preparing" him or herself for the loss of
the significant other.
Glick et al. (1974), Parkes and Weiss (1983), and Rando (1984) also call
attention to "unanticipated grief," that is, grief which occurs in response to a sudden,
unexpected loss, and is therefore more disruptive and complicated than grief in
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response to a loss that is somehow expected. In such a situation, these authors
suggest, grief may be prolonged; and while the reality of death is recognized
cognitively, it remains inexplicable.
"Abbreviated grief," both Averill (1968) and Rando (1984) imply, is a normal,
though short reaction to loss. In Averill’s words it is "genuine," but short due either
to immediate replacement of the lost object or too little sense of attachment to that
object in the first place.
"Distorted" reactions, for Lindemann (1944), represent "alterations" which are
"the surface manifestations of an unresolved grief reaction" (p. 144). Such
"distorted" reactions, he states, may be reflected in (a) overactivity with no apparent
sense of loss, but instead a zestfulness; (b) the bereaved taking on the appearance or
behavior of the deceased, particularly the symptoms shown during the dead person’s
last illness or at the time of the tragedy; (c) a medical or psychosomatic condition
(e.g., ulcerative colitis, rheumatoid arthritis, asthma); (d) altered relations with
friends and relatives, particularly irritability, isolation and hostility; (e) hostility
against specific persons (such as doctors or surgeons); (f) a schizophrenic kind of
wooden attitude or absence of emotional expression, which Lindemann links to the
bereaved’s attempt to hide his or her intense hostility; (g) disorganization, indecision
and lack of initiative concerning activities; (h) destructiveness of one’s own best social
and economic interests (e.g., giving away belongings; ruining social, professional,
economic status) which Lindemann interprets as self-punitive and motivated by
unconscious guilt; (i) a "straight agitated depression with tension, agitation, insomnia,
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feelings of worthlessness, bitter self-accusation, and obvious need for punishment" (p.
146), including possible suicidality.
Many of the above qualities, for instance, the "mask-like appearance,"
"formal, stilted, robot-like” movements (p. 145), and dissociative type of behavior
Lindemann (1944) describes may be more aptly construed today as symptoms of
posttraumatic stress disorder or perhaps a "psychotic" or "reactive" depression, as
well as the agitated depression Lindemann notes. Although his allusions to guilt and
worthlessness call to mind Freud’s (1917/1957) suggestion of pathological mourning,
as Bowlby (1980) suggests, many manifestations of grief alternately considered
normal or abnormal in the past, have reversed positions and are now considered
abnormal or normal, respectively. Whether considered normal or pathological, guilt
is a highly prominent theme in various explanations of grief (Engel, 1964; Klein,
1940; Lindemann, 1944; Rando, 1984) and may be related to the griever’s anxiety.
That Lindemann characterizes normal grief as having " pathognomic" traits highlights
the confusion between what is normal and abnormal, as for instance in his inclusion
of disorganization (a feature recognized by most grief theorists as normal and
expected, e.g., Bowlby, 1980; Rando, 1984; Raphael, 1983) as a symptom of
distorted grief.
Both Lazare (1979) and Worden (1982) suggest criteria for unresolved grief
which is similar to Lindemann’s (1944), including most prominently, depression
(including guilt and lowered self-esteem), guilt, self-blame, panic attacks, and somatic
complaints, identification with the deceased, changes in lifestyle and possibly self
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destructive habits, restlessness and disorganization, and a re-"triggering" of the
original grief reaction. Also included as signs of unresolved grief are continued
searching, depression and searching specifically on anniversaries or special dates
(e.g., holidays, birthday of the deceased), a feeling that the death occurred
"yesterday," an inability to discuss the deceased without crying, and themes of loss
(Lazare, 1979). The more of these symptoms and behaviors an individual exhibits,
Lazare suggests, the more possible it is that he or she is suffering from unresolved
grief.
In trying to link what factors might predispose a griever to take a different
than expected course, researchers identify individual variables such as the suddenness
of the death, its traumatic nature, the personality disposition of the bereaved, his or
her relationship with the deceased, as well as other influences such as coping
behaviors, personality and mental health, maturity and intelligence, past experiences
with loss, social, cultural, ethnic and religious or philosophical background, sex-role
conditioning, and age (Rando, 1984). Bowlby (1980) particularly emphasizes the
influence of past losses-specifically losses of attachment figures during infancy,
childhood and adolescence. He asserts that the circumstances and responses to these
earlier losses account for a large proportion of the variance of individual mourning
patterns.
Further, as indicated, social support may be crucial in affecting a person’s
responses to bereavement (Bruce, Leonard, & Bruhn, 1990; Fowlkes, 1991;
Maddison & Walker, 1967; Parkes, 1987; Rando, 1984; Raphael, 1973, 1981).
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Support buffers the effects of stressful life events (Schwarzer, 1992), and lack of
support has been attributed to a variety of bereaved people’s psychological,
adjustment and health problems (Maddison, 1968; Maddison & Walker, 1967; Parkes,
1987; Sheldon et al., 1981; Vachon et al., 1982) as well to their subjective distress,
often composed of loneliness and despair (Gorer, 1965).
Recognizing that grief responses are unique, connected as they are with
individual factors such as the nature of the loss, the relationship to the lost one, the
deceased’s role in the griever’s life, and the bereaved’s coping behavior, Rando
(1984) nonetheless describes the process of grief as typical. The "variants" are
"unresolved because there has been some disturbance of the normal progress towards
resolution" (Rando, 1984, p. 59). In contrast, Middleton and Raphael (1987) point
up the lack of clear definition between "normal" and "unresolved" or "pathologic"
grief, noting that people often do not receive any formal treatment for grief, turning
instead to personal and social support systems.
The DSM. As mentioned, both the DSM-IH-R (1987) and the DSM-IV (1994)
imply a normal as well as a pathological kind of grief in their inclusion of
bereavement as a "V" code, but do not provide an explicit category for complicated
or "abnormal reactions." The DSM-IV does, however, make more specific mention
of how grief may be differentiated from a Major Depressive Episode (see pp. 684-
685) and changes some of the wording and sense of a normal versus an abnormal time
frame used in the DSM-EH-R. Describing "uncomplicated" bereavement, the DSM
DI-R states:
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The reaction to the loss may not be immediate, but rarely occurs after the first
two or three months. The duration of "normal" bereavement varies
considerably among different cultural groups. (DSM- ni-R, 1987, p. 362)
The DSM-IV, on the other hand, asserts:
The duration and expression of "normal" bereavement vary considerably
among different cultural groups. The diagnosis of Major Depressive Disorder
is generally not given unless the symptoms are still present 2 months after the
loss. (DSM-IV, 1994, p. 684)
Following this criteria, after a given time period (which could begin as early as two
months following the death), clinicians may feel inclined to consider grief
"complicated" or pathological, and, as remarked earlier, depression appears to be one
of the frequently considered alternatives. Anxiety, phobias, dissociation,
posttraumatic stress disorder have also been considered in association with grief.
What is Wrong With Prevailing Grief Models?
As I have described, Western theories about grief commonly revolve around
stages or phases, the central premise being that a person may move progressively
forward in her or his grief and ultimately achieve a sense of resolution. In a contrary
case, he or she may remain "stuck" and perhaps never fully mourn. If "unresolved,"
the bereaved’s grief is considered a "variant" (Bowlby, 1980) and labeled
pathological. In its barest form, resolution of the Western kind entails cutting the
"ties that bind" the bereaved to the deceased, and the bereaved’s forming other
relationships with living human beings to take the lost one’s place.
Although there is much to be valued in current theory, much that "rings true"
to grievers’ experiences, what is most blatantly wrong is the assumption that grief
necessarily ends and that all healthy people go through a series of similar stages
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ending in "emancipation" (in Lindemann’s, 1944, words) from the deceased. Even
the assumption that "resolution" is necessarily desirable is debatable. While models
such as Bowlby’s (1980), Parkes’ (1987) and Freud’s (1917/1957) provide
considerable leeway for the actual time needed to grieve (and indeed are none too
specific as to the overall temporal requirements), by emphasizing the discreteness of
the phase, or the fact that sooner or later the object "must" be relinquished to insure
health, they promote the view that grief is linear and circumscribed.
For the actual griever, many of the "stages" of stage theories overlap or occur
in a nonlinear fashion. Some "stages" never seem to reach their completion, and
some recur. Therefore, the stage/phase metaphor does not provide a model which is
holistic or synthetic enough to tie together and explain areas that are experientially
unified and develop over time. Because of the simplicity of the step approach, many
aspects of grief experience are lost or left out.
The prominence of the step metaphor and "breaking bonds" (Stroebe, et al.,
1992) approach further reflects not so much theoretical accuracy in describing the
stages and duration of grief, as the philosophical, scientific and sociocultural
assumptions that inform and help to construct grief theory, notions which have not
been critically examined but have been taken as implicitly true.
I will begin this section by analyzing the notion of grief as a state and as a
process, examining the inconsistencies of the step approach along with its incongruity
with actual experience. I will then turn to an exploration of the biases which have
helped to shape current views.
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Grief as a State and as a Process: Problems with Stage/Phase Sequencing
It has been agreed that grief has not one but many faces (Bowlby, 1980;
James, 1890/1950; Parkes, 1987; Rando, 1984), and because grief appears to alter
over time, it is not surprising that theorists would conceive of it as progressing
through various, seemingly predictable stages. Parkes (1987) wisely defines grief not
as a discrete state but a process: The symptoms don’t just "start after a loss and then
gradually fade away" (p. 27), but rather resemble a "succession of clinical pictures"
which overlap and replace one another.
The above state/process representation views grief as having the fluid
properties of a process in addition to the discrete properties which identify it as a
state. Nonetheless, notions about grief often refer to the entire process as made up of
a series of sequential states— i.e., stages, thus as a process retaining a linear,
hierarchialized order, each stage or phase being separated and compartmentalized
from the next and the whole process moving forward toward the goal of completion.
Common sequences of current theory are represented in Figure 1 above.
Including aspects of my own and others’ experience, I will now examine some
striking examples of the overlap, discontinuity, and recurrence of what are called
stages and phases, beginning with one particular "frame" (or rather double exposure?)
of distinct yet overlapping clinical pictures: the manifestations of anxiety and alarm
emphasized by Lindemann (1944) (as well as Parkes, 1987) as characteristic of early
bereavement, and the depression viewed by Freud (1917/1957) and often the
layperson as prototypical of grief.
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Grief as depression versus grief as anxiety and alarm. Lindemann (1944)
points out that the motions and behavior of grief may not be the slow, depressive
gestures we expect, but instead a restless, aimless push of activity and speech.
However, to say that this restless agitation is the substance of grieving behavior
would be misleading and would neglect the profound dejection identified by Freud
(1917/1957) and others as one of the prototypical features of grief. Approaching his
observation and description of grief in a fashion equally rigorous to Lindemann,
Lange (cited by James (1890/1950), a physiologist, takes a contrary stand:-
The chief feature in the physiognomy of grief is perhaps its paralyzing effect
on the voluntary movements. This effect is by no means as extreme as that
which fright produces, being seldom more than that degree of weakening
which makes it cost an effort to perform actions usually done with ease. It is,
in other words, a feeling of weariness; and (as in all weariness) movements
are made slowly, heavily, without strength, unwillingly, and with exertion,
and are limited to the fewest possible. By this the grieving person gets his
outward stamp: he walks slowly, unsteadily, dragging his feet and hanging his
arms. . . . He prefers to sit still, sunk in himself and silent. The tonicity or
’latent innervation’ of the muscles is strikingly diminished. The neck its bent,
the head hangs (’bowed down’ with grief). . . .
Lange continues:
With this condition of weakness of the voluntary nerve- and muscle-apparatus
of the whole body, there coexists, as aforesaid, just as in all states of similar
motor weakness, a subjective feeling of weariness and heaviness, of something
which weighs upon one; one feels ’downcast,’ ’oppressed,’ ’laden,’ one speaks
of his ’weight of sorrow,’ one must ’bear up’ under it, just as one must ’keep
down’ his anger. Many there are who ’succumb’ to sorrow to such a degree
that they literally cannot stand upright, but sink or lean against surrounding
objects. . . . (Lange, cited in James, 1890/1950, pp. 443-444)
5/ Because of the richness of Lange’s description of physical effects, I cite his
observations here at length, although not completely.
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As James (1890/1950) remarks, Lange’s rendition of grief is also not the whole story.
Criticizing Lange for making grief appear too simple and universal, James asserts that
there are "changeable expressions of grief" (p. 444). Weeping, James says, is quite
variable--it may not be immediate, and for some (men), it may not be at all. For
those who "can weep," the tearful and dry phases alternate, "sobbing storms being
followed by periods of calm" (p. 444). Also, he notes, the shrunken, cold condition
described by Lange is more characteristic of "severe settled sorrow than of an acute
mental pain." Thus, James states, these grief responses represent two distinct
emotions both prompted by the same object.
Both James’ and Lange’s views of emotions are radically different from
current theories’. Nevertheless, descriptions such as Lange’s and Lindemann’s,
beyond being highly detailed and methodical, raise the issue of a differentiation of
feelings or responses which may have roots even in the early reaction to bereavement
and which may partially explain the shifting clinical pictures described by Parkes
(1987) as well as explain how transitions evolve between what are categorized as
stages or phases of grief. At this juncture, the particular dialectic I am noting is the
appearance of both a depressive response, which includes the slowness, weariness and
downcast mood described by Lange (cited in James, 1890/1950), and an agitated
response, incorporating the restlessness and aimlessness noted by Lindemann (1944)
as well as the panic and alarm well described by Parkes (1987).
Freud’s (1917/1957) description of grief and mourning complements
Lindemann’s (1944) by providing some sort of intrapsychic and interpersonal
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explanation for the physical, "objective" features Lindemann delineates. As
mentioned earlier, for Freud, many of the features of melancholia, or depression, are
the same ones that stand out in grief or mourning: a profoundly painful dejection, a
loss of interest in the outside world, a loss of the capacity to love, and an inhibition
of activity caused by withdrawing from any activity not connected with thoughts of
the dead person. On the face of it, several of these features seem at odds with
Lindemann’s description (e.g., the dejection and the inhibition of activity).
However, it is not inconceivable that alarm and agitation (Lindemann, 1944;
Parkes, 1987) and "paralysis" (Lange, cited in James, 1890/1950) related to shock,
fright and panic, and depression, related to a sense of emptiness and loss, may co
occur and that both may be initiated when someone close to us dies. Restless activity
may then alternate or replace lack of activity, and anxiety and panic may switch hands
with depression.
The aimless activity and preoccupation with thoughts of the deceased described
by Lindemann corresponds in some sense to the withdrawal noted by Freud. That the
bereaved is preoccupied with thoughts of the deceased is evident from Freud’s
description of the internal work that needs to be done in recognizing the emotional
and physical fact of the loss and accepting it. Focused on this work, the bereaved
loses interest in the outside world, and may act confused and restless, engaging in
seemingly aimless behavior.
The state of shock or paralysis may be mixed with intense and lively emotions
Bowlby (1980) says. Anxiety related to the loss is also combined with longing and
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searching, both physically and symbolically, for the lost one, and a variety of
behaviors and emotions emerge or endure in this upset state, including anxiety and
restlessness, hope, crying, and somatic disturbances. Both Freud (1926/1959) and
Bowlby (1980) suggest that here, anxiety can be differentiated from the depression
involved in the pain of loss and mourning, contending that when the loved person is
believed temporarily absent, the response is anxiety, but when that person seems to be
permanently gone, the response is mourning. It is when hope is gone, Bowlby states,
that we give up anxiety.
"Mourning" is in this way tied to a "later" "stage" of grief which is
characterized by depression, whereas, such reasoning implies, anxiety is somehow
"pre"-mouming--or pre-acceptance of the loss. Yet while the anxiety of early, or
acute grief (pre-mourning?) is phenomenologically different from the despair that sets
in after the griever has had to deal over and over again with the loss and the
impossibility of return of the loved one, can we really say that this anxiety reaches its
terminus when the griever experiences despair?
As Bowlby (1980) also points out, hope may be present in different degrees.
Therefore a griever may fluctuate between being nearer to anxiety or to despair. And
yearning (Bowlby, 1980) and pining (Parkes, 1987) reveal a mixture of anxiety,
depression, longing and despair. If anything, this points to an oscillation between
states or "clinical pictures" rather than to discrete endings or beginnings.
If oscillation is said to occur, the current approach limits this process by stage
or phase. Bowlby (1980) thus refers to oscillation as occurring within a phase, for
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Instance in the oscillation between belief and disbelief in "numbing," and in the hope
and despair that occurs in "yearning and searching," but not to an oscillation that may
take place over a large experiential frame such as longing that occurs after a person
has in some sense reorganized her or his life, or shock and disbelief that occur after
acceptance of the loss. That such experiences may occur in different forms at
different times I will address in the next two sections.
Acute versus ongoing grief, and trauma and shock. The theories suggest that
the initial stage/phase of shock or numbness is a relatively short-lived, easily defined,
and uniform aspect of grief. The problem with such a conceptualization, as is a
problem with the other stages and phases delineated as well, is that it simplifies the
process of grief, overlooking what could be called the "overlap" between responses
but what could also be construed as ongoing or indiscrete process, and overlooking its
relation to multiple aspects of the griever’s experience of bereavement.
Further, there may be some confusion about how grief relates to trauma, and
the difference between acute grief— which could be construed as the immediate
response to trauma-and later grief. This lack of precision is indicated both in
Lindemann’s (1944) work and the DSM (1987, 1994). Lindemann’s 1944 study is
often, unfortunately, taken at face value as a study of grief in its entirety, rather than
an example of specific kinds of grief reaction, notably grief involving highly
traumatic loss. As indicated, Lindemann’s descriptions clearly resemble many trauma
patients’ experience in terms of the symptoms of anxiety and panic, somatic distress,
sense of aimlessness, guilt, restlessness and agitation mentioned, and one wonders if
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what Lindemann describes as a general reaction to grief could be better characterized
as a response to any life-threatening trauma or catastrophe. It is unclear from
Lindemann’s description whether the majority of subjects described are from the
Coconut Grove fire or otherwise.
Lazarus (1991) warns that if we look to only the immediate adaptational
encounter, or the short-term effect of the situation at hand, "we fail to consider the
figure-ground relationship and are in danger of misunderstanding the quality and
intensity of the emotions generated" (p. 33) In the case of grief, if we consider only
the acute, or early response to bereavement as constellating all of grief, as Lindemann
(1944) seems to do, we neglect the individual’s long-term response to the encounter.
Further, any one aspect of grief may have multiple meaning levels over time which
transcend any one meaning or reason for the experience, such as the experience of
shock or disbelief.
The concept of "shock," "disbelief," or "numbness" is applied generally to
early grief directly following discovery of loss and comprehends the physical,
emotional, and cognitive traumatic impact of the event. This experience is assumed
to be short-lived, but if we analyze the multiple subjective meanings of shock and
disbelief, this aspect of grief may be viewed over a longer time period as it recurs
and takes different forms.
Averill (1968) states that individuals remain bonded to the group in defense
against the overwhelming and horrible psychic pain consequent upon separation, and
the horrible psychic pain of separation and loss is, indeed, one of the hallmarks of
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grief. The word "horror," or "horrible," incorporates the anxiety, depression, panic
and shock that often accompany severe loss, as well as the uncanniness of death
reflected in ghost stories, myths and certain funeral rituals and reflects what many
grief theorists consider the first stage or phase of grief.
At one level of meaning, shock entails what Sanders (1989) refers to as
"impact" and "trauma," what she considers the emotional and biological levels of
shock, respectively. At this level, the effect of impact cannot be fully explained in
terms of what is thought or known, as the news of death often affects the bereaved on
an involuntary level. Somatic symptoms, preoccupation, confusion, restlessness, and
a feeling of being stunned all illustrate this level of shock. Such traumatization is
naturally related to a second meaning of shock and horror: the cognitive inability to
"take in" or process what has happened, perhaps best articulated in terms of Bowlby’s
(1980) suggestion that information is excluded from awareness.
At another level of meaning, the terms shock and horror are connected with
fear, panic and alarm, described by Lindemann (1944) and explained by Parkes
(1987). Bereavement encompasses a state of stress where the bereaved encounters an
alarming situation in which the status quo of her or his world has been overturned if
not destroyed (Parkes, 1987; Pollack, 1961). In the loss of the loved one, personal
safety and integrity seem threatened.
At still another but related level of meaning, the existential and interpersonal
horror of death and loss encompasses the dread of nothingness and aloneness. At this
very fundamental level, an existential sense of horror at death and annihilation, both
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as it applies to the world and the self may occur. Hertz (1960) describes the fear of
the dead body and the horror of death as the realization of death reconfiguring the
personal person— the person known and beloved to the bereaved— into something
uncanny, and unknown:
Death . . . by striking the individual, has given him a new character: his
body, which . . . was in the realm of the ordinary, suddenly leaves it; it can
no longer be touched without danger, it is an object of horror and dread, (p.
37)
It seems that embedded in this fourth horror are the seeds of the sadness and despair,
loss and loneliness of grief that are attributed to later "stages" or "phases." In this
horror is the recognition of annihilation and dissolution of self and world, both for the
deceased, and for the bereaved.
Following discovery of the death there is a complex interrelationship between
depression and anxiety/alarm, as well as between overwhelming pain and horror on
the one hand, and trying to block some of that horror out and continue with "practical
life" on the other. This complexity of different states and processes, between levels
of "letting reality in" and protecting oneself from it, explicitly or implicitly, are
revealed in a journal entry I wrote about five weeks after my mother’s death. Here,
like Tittensor (1984), I talk about the practical need for things to be done, but overall
there’s an awareness of a sense of horror and emptiness, and an oscillation between
overwhelming feeling and trying to "get things done":
I have been rather depressed all week, except the past couple of days. . . .
On Thursday, I was nervous and able to cry. . . . Yet I feel there’s a lot of
pain that I’m not even opening myself to — it would be too scary, or too
dangerous ....
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I was "busy" today-making love, going on bicycle rides, getting my car fixed,
eating and drinking coffee and reading and talking and lying on the beach,
and...and? And I got depressed, finally later-or the depression finally got the
better of me and rose up in the S.M. cafe, and that’s when i knew it was hell
to sit there— like a nightmare. Like this all is, still, a nightmare. . . .
But it is like I’m hiding somewhat, for if I don’t hide, or whatever it
is, how can i go on about any business? ("Keep busy, Mrs. Delaney."-)
Hiding, why do I say that?
Because I realize you’re always in the "wings" of my mind— somewhere
on the edge, waiting for you to come home/return. Even if I say you won’t -
how can I actually admit it/accept it?
I’m sobbing now.
These last 2 days (it seems)— have been like remembering the day it happened,
the evening it happened— the awesome, awful, uncanny feeling G-one?
It’s unacceptable; or I go about "My business"; my mind closes down on the
doomful (but I’m still depressed). . . .
the empty spaces-
the reality, and horror of it, comes back, goneness, nonexistence. . . . the
empty spaces, the un, I STILL CAN’T BELIEVE IT ALL.
In addition to the horror of emptiness, the mourner may feel as if a significant part of
him or herself has been lost, such that it is conceived of, and even fe lt in some sense
as, a physical scar, wound, or amputated limb (Schwartz-Borden, 1992).
An aspect again, of the shocking nature of this loss is the sudden deprivation,
the sudden emptiness an individual may then feel in terms not only of his or her outer
world, but the inner world. The emptiness of the inner world is reflected in what
Freud (1917/1957) conceives as the bereaved’s loss of interest in the world and
inability to experience love: "The world becomes poor and empty" (p. 127). This
emptiness can perhaps best be construed in Kohut’s (1984) term of the "selfobject"
61 A line from Inge’s Come Back. Little Sheba (1950), a play my mother was
fond of. The significance of the line in the play is to the main character’s
overarching sense of loss, aimlessness, groundlessness, and depression, to which her
constantly busy neighbor insinuates the remedy, "Get busy, Mrs. Delaney."
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world— a world of the self and the other, and the pathway between them. This
selfobject world is empty to the griever, and the emptiness is shocking. Tittensor
writes:
You open your eyes and there it is; and there is, in a sense, nothing else. The
world is gone with them, and only loss remains; there is an actual sensation
that all of existence has evaporated, except for an immense heaviness. . . . In
time you get up, shower, dress-eat even— but none of it is real, none of it
matters, none of it is possible, (p. 17)
He goes on to describe walking about, picking up objects at random and crying,
trembling, feeling claustrophobic, restless, purposeless— in fact, reflecting the aimless,
disorganized, agitated behavior meticulously outlined by Lindemann. Yet Tittensor’s
description adds an important point-the focus of this restless, random, agitated and
depressed behavior. The bereaved’s responses are reflectively aimed at a cardinal,
existentially felt aspect of reality-that final loss exists, and that one’s own reality is
invalidated.
In June of last year I write about being in a state of existential crisis, going
down into the "pits," the "grave," feelings connected with my actively reviewing and
living in the material for the present study. Reviewing and reliving the death, I note
here acute grief and a sense of both existential anxiety and despair which is connected
to concerns about my own mortality and the meaning of my life:
I woke up thinking,
we’re always dying.
and
What a horrendous- that is despairing/ existentially absurd feeling- . . . (the
terrible fact of shrinkage too. . . . I feel like i’ve gotten "to" another point,
realizing that I too will die and shrivel .... I was at the table, eating lunch,
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feeling like crying, still: I am in a state of extreme distress, despair . . .
existential aloneness.
Later this existential anxiety and despair are buffered as I remember,
[H]ow one can be allowed to break away from existential overwhelmment.
suddenly, we are blessed with the ability to live in the ordinary- the ordinary-
suddenly the cobwebs are brushed away- by a loving hand- things are normal
once again--
As both Parkes (1987) and Tittensor (1984) reveal, an individual may be able to both
separate (at least partially) him or herself from traumatic knowledge in order to
perform other tasks and to psychically survive, and at the same time, maintain a sense
of that knowledge. However, episodes of derealization or disbelief may also occur
long after the death. Almost four years after my mother, Ruthy’s death, following a
dream, I write:
I’ve been deeply feeling the loss of what I have written— and about Ruthy and
the dream. . . . It just doesn’t make sense, in a way .... The fact is I miss
you, Ruthy. The separation is really-maybe not — not- acceptable? ....
Oh, dearest Ruthy, are you Gone? It seems these years of grief have served-
have been not to dispense with denial, but to build it up . . . . The only way
to accept "Reality" in this way is to deny it— .... Dearest Ruthy, You are
gone & there are so many ways to be gone.
During the process of reviewing and scrutinizing memories and expectations described
by Freud (1917/1957), Engel (1964, 1972), Rando (1984) and other theorists, the
bereaved may obviously still experience periods of confusion, slowness and
disorganization, as well as a sense of disbelief. The fact that this review process may
continue just as the bereaved continues to interact with memories, desires, familiar
and new situations, is not acknowledged.
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"Shock," "disbelief," and "horror" may therefore be conceived as having
several meanings which may exist at different times in the grief experience. Like
other themes of grief, shock, numbing, and disbelief may best be conceived not as
discrete bits of experience, but as threads running through fabric of grief, coming into
sharper or dimmer relief depending on the surrounding pattern.
Yearning, searching, and the relationship with the dead beloved. Bowlby
(1963, 1980) indicates that if searching for the lost person continues, be it actual or
disguised, mourning is likely to be pathological. Yet, he also asserts that a sense of
the dead person’s presence, either as an imaginary companion or in some specific
location, is a feature of healthy mourning. Presumably, from this standpoint, a sense
o f the dead person’ s presence is interpreted as the griever’s somehow having "found"
the person and therefore no longer needing to "search” for him or her. Yet,
depending on how broadly or narrowly, concretely or symbolically we define
searching, some evidence suggests that searching (and perhaps yearning) may be
involved with actively constructing, or co-constracting, the dead person’s presence.
Further, this experience of active construction suggests that searching and yearning do
not end once and for all when an individual moves, for instance, on to
"disorganization and despair," and may even begin before "numbness" or "shock"
ends.
It seems that early on after a death the griever may look for evidence that the
lost person is not dead. Additionally, searching and/or yearning may reoccur even
after a griever has thoroughly "accepted" her or his loss. Throughout his chronicled
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first year of grief, Tittensor (1984) describes searching for, and symbolically finding,
his dead children:
And as I wander in the bush sometimes, half-demented with grief and calling
their names out through the places we shared, the world restores them to me~
not in any actual or hallucinatory sense, but by assuring me that because they
were once here, because I can place them here, they are always here . . . the
place they have in my heart is also a place outside me. (p. 88)
Parkes (1987), Bowlby (1980) and also Glick et al. (1974) relate the possibility of the
bereaved having an imaginal relationship with the deceased. Bowlby states that the
original relationship with the deceased continues to fill an important place in the
bereaved’s emotional life and relates that for many, maintaining an ongoing imaginal
relationship of some sort "is the preferred solution to their dilemma" (p. 98). Like
Freud, Bowlby believes that this relationship continues to change, albeit slowly. It is
this changing yet continuing relationship, he says, that explains the bereaved’s
yearning, searching and anger, as well as her or his despair and eventual acceptance
of the loss as irreversible.
It is therefore conceivable that an ongoing development in losing and searching
occurs such that the more graphic, concrete operations of searching change into other
(perhaps more symbolic) attempts to continue and extend the relationship with the
deceased into the world (for instance, memory and internalization serving as a motive
and influence for action and constructive shaping of reality). In late May of 1993,
two and a half years after my mother’s death, I write of actively remembering her:
Talking with you. Being with you. Ruthy, how precious you are and always
will be. How much I miss you.
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This ruminating process seems to be involved with a kind of "searching" in which I
conjure up memories of our times together, further in this passage a vacation we had
taken to Big Sur. The memories here, as I will discuss in terms of the broad concept
of memory later, are emotional and visceral memories, rather than categorical or
"objective" ones. Therefore, they partake of a kind of imaginative returning to actual
experience.
Dearest Ruthy, thinking about you again last night, yesterday - your essence
and physical presence. Big Sur. The smell and feel of the sheets and
pillowcases when we went to stay there- you let me have the "special" room
that time- the best in our cabin- waking up to see lights coming in through
points in the window curtains-1 thought they were stars. We woke up in the
woods. . . . Oh Ruthy, I miss you so much. I love you so.
How wonderful those times were-- Big Sur. Your face. [I could also
imagine you in the car with me.]- Your essence-
I’d brought all my paperwork baggage...Running on the path around the
campground and lodge. . . . All the fun we had.
Sitting in front of the fire place, playing cards. Oh how I wish I could
play cards with you now.
The memories are not complete, but reconstructed. Having moved from California to
Long Island I write:
Certain memories seem to have been blunted, out of focus for a time. -When
I drive up some of these streets with their now lush foliage--greenery--trees
everywhere I think of you and what would you think-
Not only are the memories of the other searched for here. There is also a suggested
co-construction in my trying to imagine what my mother "would think" of all these
things.
While the searching in some bereavement behaviors, gestures, thoughts and
imaginings seems tied to the experience of disbelief, ongoing and longer-term
attempts to preserve (not just restore) the lost person seem to be foundational in the
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internalized self-other relationship of the griever. And Bowlby’s examples (as well as
my own experience) of the ongoing beneficent influence of imaginary conversations
indicate that searching is not so discretely bounded as he indicates in speaking of
"yearning and searching."
Yet stage and phase theorists do not seem to coordinate the possibility of an
ongoing, imaginal relationship with the bereaved still somehow "searching" for the
deceased, nor with the possibility that through searching, the bereaved may in some
sense recover or firm up what she or he has already internalized of the deceased in
the form of imaginal other. "Searching" is also a way of researching, of making
sense not only of the loss, but of the lost person, the relationship and the loss as they
are all experienced together.
The griever’s yearning for-and thus searching for, "finding," adding to,
developing, and perhaps partially creating~the lost relationship is artificially
circumscribed in prevailing models in a way that is untrue to experience. Once again,
their focus is on a definitive ending and a definitive place the deceased can be for the
bereaved, and this emphasis ignores any kind of dynamic, ongoing, imaginative and
emotional process, except to label it as pathological.
Yearning oscillates within itself, as it were, to the paradoxes of absence and
presence, remembering and forgetting, pain and relief, desire and despair, as
illustrated in a dream I had about five months after my mother’s death:
I had a most precious dream. I dreamed I held my mother in my arms as she
was dying.
Ruthy was very sick-feverish, fluish or something (I think I also was
sick). We went out and I felt an urgency to get her home and to bed.
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What an experience it was to hold her in my arms as she lay in bed-
and I believe she talked to me and I kissed her. The feeling of the experience
was so immediate, full. It’s hard to remember specific parts— except the
closeness, the holding, the loving. Then I must have stepped away and
stepped away from that section of the dream because in another part, I thought
something like, oh my God, she was dying— I held her in my arms, as she
died— why did I ever leave— And so I went back, and she was still alive, but I
think I knew she would die. But I held her in my arms again as she smiled
weakly and talked.
In this dream, I wanted not only to recover my mother, to save her, but to spend time
with her before she died. In the dream there is a fluctuation between being dead and
being alive.
Yearning oscillates in time, and may reoccur with relevant triggers, as Parkes
(1987) points out. In Rosenblatt’s (1983) opinion, while the frequency of different
triggers decreases, the intensity of feelings associated with death changes little.
Unfortunately, the concept of "triggers" is thus used to explain outliers from the
regular process of grief, whereas instead triggers could be considered as always being
potentially present and part of the person-environment gestalt that makes up the
emotion generating process (Lazarus, 1991). There is always the possibility that
some event, memory or person will trigger feelings of grief; on the other hand, such
events, memories or people do not necessarily cause a grief response.
Further, it appears that at times (but not all the time) in the ongoing course of
bereavement, the griever is able to choose whether or not to yearn, whether or not to
trigger yearning in him or herself, whether to open a particular door leading to
particular chain of thoughts, feelings and desires, whether to remember or to
temporarily forget. This is not to say that the griever is in charge of all triggers or
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provocations of grief, but rather, the griever begins to learn some of the byroads of
her or his mental and physical travels. (Some bereaved, in fact, are accused of
learning these byroads too quickly and attempting to cut off or avoid their pain
prematurely.)
When does despair begin?: Continuous versus discontinuous states and
processes. Although Parkes emphasizes the fluidity of grief, he maintains it is still a
matter of stages, each of which eventually gives way to the next. For Parkes grief
may appear variable because at any given time a person may be in any one of these
stages and because, he acknowledges, there is considerable individual variation as to
the duration and form each stage assumes. However, he adds that "there is a
common pattern whose features can be observed without difficulty in nearly every
case" (p. 27). Similarly, in his delineation of four phases Bowlby (1980) contends
although phases may not be clear-cut and an individual may oscillate between any two
of them (any two contiguous phases), a general sequence is followed.
Because of our bias toward linearity, it is very difficult to construe grief
("normal" grief, that is) as anything other than progressing forward in an orderly
fashion. Therefore, while Sanders (1989) acknowledges that preexisting
circumstances and the personality of the bereaved as well as the circumstances of the
death affect the length of time someone might grieve, laying heavy stress on the
"moderator variables" which affect the individual’s unique course of bereavement, she
nonetheless posits a sequence of phases that lead eventually to healing and renewal.
If there is overlap, the theories suggest, it is between stages that are contiguous. But
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on the other hand, if a stage/phase is prolonged or experienced later in the grief
process, the individual is "stuck."
Yet grievers experience various responses at different times or "phases." To
say that someone is "still in" a phase of denial or shock and thus at a more regressive
phase of grief than if they truly accepted the loss, is misleading. It appears that
people may not only vacillate from feeling shock and disbelief to feeling acceptance
of the "fact" of death; they may indeed feel a paradoxical mix of disbelief and belief
which seems to be one of the dissonances in the experience of grief. As Brice
(1991a) suggests, grief may represent more a sequence of paradoxes rather than a
sequence of stages.
Toby Talbot (1980), the summer following her mother’s death in February,
writes:
Mourning has a path of its own. A route which does not move in one straight
line. Some days I can look at her photograph and the image revives her,
reinforces her for me. On other days I gaze at her and am blinded with tears.
Newly bereft, (p. 109)
And regarding writing a journal and the process of grief, C.S. Lewis (1961) says:
In so far as this record was a defense against total collapse, a safety-valve, it
has done some good. The other end I had in view turns out to have been
based on a misunderstanding. I thought I could describe a state; make a map
out of sorrow. Sorrow, however, turns out to be not a state but a process. It
needs not a map but a history, and if I don’t stop writing that history at some
quite arbitrary point, there’s no reason why I should ever stop.
What Lewis (1961) realizes about the ongoing process of grief is that its endpoint is
arbitrary-decided upon but not necessarily experienced. This arbitrariness is also
reflected in the very elastic frame Bowlby (1980) constructs for his last phase of
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"greater or less degree of reorganization." What Bowlby’s naming suggests is that a
reorganization takes place, but it may by no means be the final reorganization of a
griever’s response to loss, leaving much that is still disorganized, unintegrated, or in
other words unresolved.
As indicated, oscillation of response, a back-and-forth movement, seems to fit
both data from self-reflection and observations from prevailing models better than a
linear, step metaphor. We find this oscillation in the process of letting in, negating,
and trying to rework or re-understand, the loss that has occurred, in the piecemeal
process described by Freud (1917/1957) and the oscillation of hope and despair
explained by Bowlby (1980). The process differs from what is posited by prevailing
models in that it seems to begin early and that it may continue indefinitely. In
February of 1993, I write:
Yes I am -- Depressed.
And no one can block out my SORROW.
Later that month:
I eat in despair. Despair. Ruthy. No one can ever take away the pain and
the loss of you - You. There is only one You!
And now through the tanglewood of all I’ve heard, I still can know, hearing
from within, that despite the pain of the world, and the inevitable despair,~
despite this, This pain and despair is separate and unique. It is the pain of
loss of you through Death. It is the pain of having lost you, my Darling, my
dearest friend.
A year after his children’s death, Tittensor (1984) writes:
I know that my pain and sense of loss, although less than they were, are with
me in some form for life. Nor is anything really resolved, (p. 101)
He finds too many contradictions to be sorted out.
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Nothing is fixed or definite. . . . As time goes by, it does become easier, but
‘easy’ in this context is strictly a relative term; and I’m still not absolutely
sure that you ever actually recover by even the tiniest amount— it could simply
be that your methods of control, internal and external, are polished by full
time practice, (p. 42)
Similarly, I find, about four years after my mother’s death,
That is probably the truth of grief if there is one. If you must say there’s a
psychic progression- you could say the defenses become more sophisticated-
perhaps.
Freud himself, after experiencing several significant losses, conceived that grief could
not exactly be reconciled with life and love— that an ultimate severance of ties cannot
take place if we are to maintain our love. Although not formally revising his theory
concerning loss and detachment, six years after losing his grandson and on the
anniversary of his daughter’s death, he wrote to Binswanger:
Although we know that after such a loss the acute stage of mourning will
subside, we also know we shall remain inconsolable and will never fin d [italics
added] a substitute. No matter what may fill the gap, if it be filled
completely, it nevertheless remains something else [italics added]. And
actually, this is how it should be; it is the only way of perpetuating that love
which we do not want to relinquish. (Freud, 1929/1961, p. 386)
That stage theory seeks to view grief as a series of states, rather than as a relationship
between states, provides the basis for internal contradiction and inconsistency. As
indicated earlier, the "seeds" of sadness and despair, presented (e.g., by Averill,
1968; Bowlby, 1980, Kubler-Ross, 1969; Parkes, 1974, 1987) as occurring later in
the grief response (after a phase of shock or numbness) may be construed as already
apparent in the distress of the bereaved, in her or his separation pain (Raphael, 1983),
bouts of crying and even, as Tittensor (1984) describes, bawling, breaking down,
howling, lying on the floor, and wringing one’s hands. And further, such despair and
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inconsolability may not end after one has reconfigured one’s world. The "gap"
remains.
What is apparent is that grief is not a single state but a combination of states
and processes and these states and processes may not just suddenly make an
appearance and after the required time, cease. Classifying or fixing certain features
to a particular stage or phase of grief, is problematic, yet taking specific responses as
representative of the whole substance of grief is also misleading. Attempts to view
grief as either discrete parts (i.e., stages) of a whole process, or to view individual
aspects of grief as equivalent to a whole, raise questions such as the following: Does
grief consist of only the early, acute experience of loss? Or does it consist of
experiences which may unfold long after the loss has occurred, and which augment
the nature and understanding of the loss? These are questions that cannot be
adequately answered by a linear or hierarchical stage models.
Lazarus (1991) compares treating emotions as discrete categories versus
viewing them as overlapping dimensions and argues that in the latter instance, their
"distinctive qualities are lost or blurred" (p. 60). While asserting that it is preferable
to regard emotions in categories which can be dimensionalized according to their
intensity, however, he indicates that grief though an emotional reaction is not simply
an emotion. Because it involves more than one emotion and also implies a coping
process, grief is a complex state. And like other emotional reactions in Lazarus’
schema, grief involves an emotion generating process (p. 17) which includes the
environment, the person, the relation between them, the person’s appraisal of this
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relationship, as well as action tendencies, the coping process, and person’s behavior.
All of these factors may continue to generate emotion which is relevant to how a
person appraises a situation.
Unfortunately, although some theorists acknowledge a flexibility and
oscillation in response, using the step/stage metaphor maintains an overall
hierarchialized structure which forces us to view discrepancies of experience as either
(a) overlap between two adjacent stages; (b) a "reoccurrence" of an earlier stage; or
(c) part of the pathology of the griever.
In some models, overlap is addressed by constructing the last phase or stage as
so broad as to potentially include many aspects of grief experience, with the last
phase/stage being "reorganization" for Bowlby (1980) and Parkes (1987) and
"reestablishment" for Rando (1984). We might question, in this regard, if a
particular phase or stage is so vast as to contain almost everything (with the exception
of, say, shock and disbelief) what is the value of structuring grief in terms of a
stage/phase model? In such an instance, the intent would seem merely to differentiate
acute grief (or grief that is an immediate or relatively early response to loss,
consisting of a matter of weeks or months), from later grief which is less agitated and
less painful for the bereaved.
In such a maneuver, the hierarchialization is maintained, and also the
fundamental tenet that resolution or "recovery" is achieved and that the lost one is
relinquished. That grief does seem to change with time indicates that there may be
different phases to grief, but not that these phases precisely end or are completely
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discrete from each other. Further, change does not preclude the possibility that
certain experiences will reoccur and that they may not occur linearly. Finally, as
Bowlby (1980) also indicates, the relationship with the dead person very often
continues, although in a different form. Because of the discrepancies between step
models and people’s experiences of the sequence or process of grief, a less linear
metaphor would be more appropriate.
Assumptions and Biases of Prevailing Grief Theory
With its emphasis on linear progression, completion, and detachment from the
deceased loved one, prevailing theory has at its foundation a number of philosophical,
scientific and cultural influences including: (a) psychoanalysis; (b) the evolutionary
framework discussed above in connection with attachment theory; (c) the privileging
of a goal-oriented, cause-and-effect, material reality supported by a positivist world
view; (d) the value placed in Western culture on the individual’s autonomy and self-
reliance (ala Benjamin Franklin and Ralph Waldo Emerson); and (e) a fear of death
and what death is associated with. The preeminence of the material over abstract,
intangible reality (valuing the seen over the unseen) and rationality over emotion, may
also be related to Western values associated with industrialism and capitalism as well
as gender issues. The last theme, fear of death, its meaning, and the emotions and
behavior it might evoke, is often articulated in folk tales, myths and the rituals of
different cultures as well as in Western habits and attitudes which relate it to the
theme of relinquishment.
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Since the end of grief is mainly assumed to be accomplished with the griever’s
"relinquishing" the object and "severing" the "ties that bind" (e.g., Lindemann, 1944;
Rando, 1984), of particular interest is the "holding on"/"letting go" construct that
dominates grief theory, which I will discuss first in "Fetishizing Detachment," below.
Scientifically and culturally connected with this construct is the bias toward linearity
and completion associated with the self-other relationship and Western industrial work
ethic. Next, I will turn to an examination of different attitudes towards relationship
and death and some possible underlying motives for these attitudes. Finally, I will
discuss the context of the researcher in grief theory, including the researcher’s
existential concerns and the potential blind spots posed by a positivist and medical
model perspective.
Fetishizing Detachment: The Bias Toward Autonomy and Instant Recipes
Logically, to experience loss one must experience not only attachment, but
detachment— disconnection, disruption, change or end. Physical disconnection from
the beloved is a condition imposed upon the griever by death. However, in grief
theory and philosophy, the concept of disconnection is inverted so that the "task" of
the griever becomes psychological separation and relinquishment of the deceased,
converting the passive condition of bereavement and loss into an active process of
"letting go." Although attachment and detachment might be construed or rephrased in
alternative ways, for instance, as recognizing or experiencing absence and presence,
continuing and ending, remembering and forgetting, current approaches tend to
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subsume all of these categories into the construct of attachment/detachment,
constructing grief as a problem of "holding on" versus "letting go."
From a psychodynamic perspective, the premise involved in the tasks of
detachment and reattachment, letting go and reinvesting, is what underlies Freud’s
(1914/1959) libido theory and his notion of investing energy in (cathecting) external
objects (i.e., persons) and withdrawing that energy (decathecting). Freud (1923/1961)
can be said to have established the foundations of object relations theory by
suggesting that cathexis with the outside world is important to ego development and
by suggesting that cathexis of an internal representation of that outer object world is
also of great significance. That is, both intrapsychically and interpersonally, relations
with objects (people) that are internalized representations are just as important as
relations with real persons. In 1923, he (Freud, 1923/1961) describes how objects
are internalized and how as sources for identification, help to form ego and superego.
These objects clearly bear the imprint of significant persons in the individual’s world.
A social transaction takes place that allows these others to be refashioned as "part" of
the individual.-
Freud was of the opinion that humans do not willingly give up that which is
satisfying. Along the same lines, Kohut (1966) states:
7/ One thinks readily of Freud’s (1933/1965) description of the
"metamorphosis of the parent relationship into the super-ego" (p. 56). "Parental
influence governs the child by offering proofs of love and by threatening punishments
which are signs to the child of loss of love and are bound to be feared of their own
account," a role which is later taken on by the super-ego (p. 55).
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It [the psyche] will not resign itself to the loss [of the idealized parent imago
and idealized qualities of the parent], but will change the object imago into an
introject, i.e., into a structure of the psychic apparatus that takes over
functions previously performed by the object. Internalization . . . is therefore
enhanced by object loss. (p. 432)
According to Fenichel (1945), establishing an introject, or internal representation of
an outside object/person, allows one to detach from that external object. And states
Freud (1923/1961), "It may be that this identification [with the lost object/person] is
the sole condition under which the id can give up its objects" (p. 29). From a
psychoanalytic perspective, then, at least two conditions are necessary so that an
individual may mourn: She or he must be able to experience loss (requiring that she
or he see her/himself as separate from the person or thing lost), and be able to
internalize or reintegrate what has been lost. What was before outside the person,
becomes part of him or her self or internal world.
From a psychoanalytic framework, detachment of any kind in later life must
rest on or be related to the attachment and individuation process of the individual in
his or her prototypical, and earliest relationship (i.e., with her or his mother or
caretaker). The capacity for internalization is somewhat dependent on successful
accomplishment of early separation-individuation tasks: When the child develops
object constancy, she or he is able to separate from the primary caretaker for longer
periods of times because, presumably, he or she has an internal representation of that
person (Bowlby, 1980; Mahler et al., 1975). In addition, the "dual unity" (Mahler et
al., 1975) or symbiosis, of the mother and child bond gives way to individuation
which gradually allows the child to experience him or herself as a separate entity.
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Transitional objects (Winnicott, 1951), such as a cherished teddy bear or mother’s
perfumed scarf, serve as mediators between reliance on an external and an internal
object.
From this perspective, internalization makes it possible to withstand and
experience separateness, and to experience loss. This ability to experience loss and
the sadness that goes with it are referred to by Klein (1940) as the "depressive
position," a developmental milestone which marks the end of a symbiotic "dual unity"
with the world and the founding of the ability to tolerate loss. The separation-
individuation process of the infant described by Mahler et al. (1975) may be repeated
throughout the life cycle, most saliently during adolescence when the young adult
separates from home and parents, at times of intense and intimate joining with another
person (Birtchnell, 1987; Blanck & Blanck, 1979; Bowen, 1971; Person, 1988) and in
separation as a result of loss or death. The predominant model of grief which views
recovery as a relinquishment of the object or person is founded on these notions of
separation and individuation.
Bowlby’s (1980) views on loss and mourning incorporate certain
psychodynamic perspectives, but are also based on attachment theory and so consider
grief from an evolutionary perspective. According to attachment theory, people
instinctively develop attachments during development, as children with their parents
or caretakers, and later as adults to adults. Attachment behavior represents the means
by which a homeostatic, goal-directed system is maintained; the fostering of proximity
and attachment to caretakers and to others contributes to survival. Implicit in this
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model are object relational views of loss which stress the importance of internalizing
the lost object, as Bowlby’s phases of "searching," "disorganization," and
"reorganization" imply. According to Parkes (1974), grief responses may also serve
an adaptive pattern of attachment, as the unrewarded searching described by Bowlby
causes the griever to recognize the permanence of the loss.
Still another way in which values of attachment and individuation are
articulated in our culture are through a modernist ethos which, as described by
Stroebe et al. (1992) in relation to grief, follows a machine-type model exhibiting
characteristics of functionality and goal-directedness. Grief is work (Lindemann,
1944), not only because of the psychological and material burden imposed upon the
griever by the loss, but because it is the griever’s responsibility to complete basic
"tasks" in order to "successfully" grieve. As grief is "work," grieving is a
"debilitating emotional response" that interferes with "daily routines" and needs to be
"‘worked through’" (Stroebe et al.,1992, p. 1206).
The "machine model" and concepts of time, memory and em otion. The values
embracing the work ethic do not, however, require this work to last for years. Quite
the opposite, the machine model values instead the "quick fix," or recipe book
(Stroebe et al., 1992) approach. The "quick fix," goal-oriented approach of Western
industrialism finds some of its support in a positivist world view which emphasizes an
objective, uniform reality and a linear, cause-effect relationship. Thus, while the
literature (e.g., DSM HI-R, 1987; DSM-IV, 1994; Freud, 1917/1957; Lindemann,
1944; Rando, 1984) is contradictory, vague, arbitrary, and ambiguous about the time
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needed to complete grief, stage/phase models maintain that grief follows a
predictable, linear sequence and eventually ends. Such a way of thinking reflects a
Western notion of time as linear with causal properties, a "road or a ribbon stretching
into the future," focused on materiality and change, and segmented into limited
compartments (Hall, 1981, pp. 6-7).
The above view ignores other aspects of time as described earlier (e.g.,
psychological as opposed to objective, quantifiable time; multiple levels of
experience; the relation between events in "real" time and events in memory; and
time as central to our existence, "never to be defined as static points," May, 1983, p.
136) which might better describe and explain time for the griever, which involves not
only "getting through" time which is painful, but remembering and reconstructing the
deceased and all sorts of connected events, as well as the event of death.
Time is essentially related to the concept of memory: If there were no concept
of time, we would have no reason to remember. Likewise, the connection between
memory and mourning is indicated in the Old English derivative of memory, mumam,
meaning to mourn (Webster’s, 1984, p. 886). Memory is a way of reconstituting
imaginally what no longer materially exists.
In current grief theory, however, the relationship of mourning to memory is
portrayed more in terms of forgetting or letting go of the beloved, lost person, than as
a way of continuing or reconstituting. Preservation is conveyed in a somewhat static
sense, and any active or dynamic relationship with or reconstruction of the deceased
in the lived life of the griever is viewed in a negative light, as possibly an intrusion
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(as in the intrusive memories of trauma victims), a primitive "identification" (as when
the griever seems to do or express things the way the deceased did), or otherwise
pathological, as in continued searching. In what is considered healthy grief, the
deceased has her or his proper place on a stone tablet, or a fixed imaginary place
such as heaven, not in the day-to-day life of the bereaved.
Alternately, memory is implicated in grief variants which depict some problem
concerning the bereaved’s memory: She or he either remembers too much ("as if it
were yesterday"; e.g., "chronic sorrow/grief"), or fails to remember, fails to
acknowledge or, as Bowlby (1980) outlines in his discussion of defensive exclusion
and dissociation, fails to make the connection between the event of loss and her or his
psychic state (as in "denial," dissociation, "distorted grief," "abbreviated grief,"
"delayed grief").
The above concepts tend to view memory in a static way, suggesting that
memory is of objective, verifiable events, again adhering to a modernist perspective,
rather than as events that may continue to be constructed and reconstructed by the
experiencer. A particular focus in recent years has been the veracity, truth or
factuality of supposedly repressed and subsequently recovered childhood abuse
memories, with prominent researchers such as Elizabeth Loftus (cited in Denton,
1993) pointing out that in thousands of experiments subjects remember incorrectly and
also "remember" things supposedly that never happened to them.
As Rabin (1995) points out, Freud’s archeological metaphor, shaped partially
by the positivist metatheory of Freud’s time, not only depicts the analyst as the
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ultimate authority on objective reality, but portrays past reality in terms of "relics"
just waiting to be dug up. Although unconscious conflicts may shadow and distort the
memory of such "relics," in some sense they themselves are preserved so that
ultimately, "the truth" may be discovered.
Such a static view of time, the griever, and the deceased is also reflected in
the popular "multistore model" of memory (see, e.g., Atkinson & Shiffrin, 1968;
Tulving, 1985), where information is received or placed in memory (encoded),
stored, and retrieved. A variety of memory systems have been suggested (e.g.,
declarative and procedural, Cohen & Squire, 1980; procedural, episodic, and
semantic, Tulving, 1972, 1985, 1986; explicit and implicit, Schacter, 1987).
However, for the most part, these systems seem to imply a linear, objective, fact-
driven sequence, paralleling the Western view of time described above. Exceptions to
this are found in studies concerning the relation between trauma and memory (e.g.,
Christianson & Loftus, 1987; Christianson, Goodman and Loftus, 1992; Christianson
& Nilsson, 1984), and emotion and memory where emotion has been considered an
enhancer or occasion for memory (e.g., Blaney, 1986; Brown & Kulik, 1977;
Thompson, 1982), as a suppressor or repressor (e.g., Breuer & Freud, 1895/1955;
Christianson & Nilsson, 1984; Freud, 1915/1957; Erdelyi & Goldberg, 1979; Loftus
& Bums, 1982), or as a memory process itself, neurally stored (LeDoux, 1992). All
of the latter suggest that memory may have more of a fluid role in the experience of
grief and the bereaved’s relationship with the dead person than the view of memory as
a compartmentalized storage and retrieval place. LeDoux’s (1992) work concerning
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"emotional memory" is of particular interest. However, with the exception of
Bowlby’s (1980) views on defensive exclusion, the dynamic and emotional aspect of
memory does not play a substantial role in grief theory.
Notions about grief have also been informed by a focus on linearity, hierarchy,
and primacy which have influenced emotion theories (see, e.g., Bower, 1992;
Johnson-Laird & Oatley, 1989; Oatley & Johnson-Laird, 1987; Plutchik, 1991;
Shaver, Schwartz, Kirson, & O’Connor, 1987) until more recently, when a less rigid,
compartmentalized view of emotion, and a greater appreciation of tacit and
unconscious process, has begun to flower (see, e.g., Buck, 1991; Lazarus, 1984;
LeDoux, 1992; Zajonc, 1984).
Emotions are also usually seen as directed to some goal-directed enterprise
(i.e., achievement, failure or loss, threat, frustration or gustatory violation) (Bower,
1992; Johnson-Laird & Oatley, 1989; Oatley & Johnson-Laird, 1987). It is clear that
the concept of goal attainment has informed grief theories as it is reflected in an
emphasis of evolutionary goals and purposes (Averill, 1968), in terms of the
attainment of a personal goal as in Bowlby’s (1980) search for the lost object, and in
the positing of an overarching schema suggesting that grief resolution or "completion"
is the ultimate goal of grief work (Averill, 1968; Bowlby, 1980; Kubler-Ross, 1969;
Lindemann, 1944; Rando, 1984; Stroebe et al., 1992).
As Ellsworth (1991) indicates, theories about emotion can be readily classified
by the type of sequence following the "stimulus" for the emotion described, a
classification with particular meaning in terms of the delineation of stages and phases
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in grief. The concern with sequencing is with what causes what (e.g., does a thought
lead to a feeling, or does a bodily sensation lead to a thought; how is an emotional
experience generated, etc.), and often describe the process in terms of a linear or
episodic sequence, and sometimes in terms of a feedback loop. Even in the latter,
however, the direction is forward rather than back and forth.
Although most theorists (e.g., Buck, 1991; Ellsworth, 1991; Tomkins, 1980;
Lazarus, 1984; LeDoux, 1992; Zajonc, 1984) acknowledge a complex
interrelationship of bodily, neurophysiological, cognitive, affective and behavioral
aspects of emotion and do not support a strictly compartmentalized response sequence,
the models represent a stimulus-response type of metaphor, which is generally aligned
with the notion of a "goal" on the one hand (the stimulus) and either a frustration or a
fulfillment of that goal (the response) (Bower, 1992; Johnson-Laird & Oatley, 1989;
Oatley & Johnson-Laird, 1987).
Also fundamental, as discussed above, is the concept of homeostasis, or the
idea that an emotion disrupts (or reflects disruption of) a certain equilibrium which
the emotion(s) is/are involved in re-establishing. The emotion is therefore time-
limited. According to Bower (1992), the emotional event tied to a stimulus, generally
a change of some sort, are in his words, the "spasmodic reactions to changes in our
fortunes" (Bower, 1992, p. 10), and the responses of the autonomic nervous system
generally decrease and disappear soon after the event, followed by or occurring with
an evaluation or appraisal which is part of emotional adjustment and adaptation. Such
a view describes emotion as a time-limited internal event (triggered by external
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circumstances) which is primarily tied to somatic and autonomic variation, a view
which seems to reflect well Lindemann’s (1944) description of acute grief.
As Bower (1992) indicates, the responses of the autonomic nervous system
generally decrease and disappear from within a few minutes to a few hours. As this
adaptation takes place, Bower says, we are adjusting to the new conditions that
brought about the emotional response, redefining our expectations and reevaluating
events relative to the new experience. Thus, according to him, following or
occurring with the physiological response, is an evaluation or appraisal which is part
of emotional adjustment.
In this view, the notion of homeostasis appears to be pretty simply
physiological, an anabolic or catabolic event that can be measured in terms of heart
beats or sweaty palms. This kind of adaptation is important in our understanding of
the experience, process and transmutations of emotions, however, is not the whole
story. A view of emotional adaptation which takes as its primary consideration a
return to a baseline autonomic and endocrinal functions, neglects other aspects of
emotion which are not as physiologically dramatic as increased heart rate and blood
pressure.
That some sort of stimulus comes first is generally agreed upon. However, in
considering that this stimulus provokes a failed or fulfilled expectation (Bower, 1992;
Johnson-Laird & Oatley, 1989; Oatley & Johnson-Laird, 1987) and thus demonstrates
the relationship between emotional response and goal frustration or attainment, one
could also question where and how the "goal" arises in the first place. That is, does
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it arise solely from an environmental stimulus? An innate need or desire? Or a
combination such that a precoded representation of responses to certain environmental
stimuli is "released" upon exposure to these stimuli (Plutchik, 1991, pp. 47-48)?
As Lazarus (1991) makes clear, a generating process is involved in emotions
such that as the situation and an individual’s appraisal of the situation changes,
engaging also in a process of changing or coping with the situation, emotion is
generated. This suggests a much less clear-cut boundary line for when an emotional
experience begins and ends. Homeostasis in this light must be regarded as something
that might be attained temporarily and only in response to the immediate gestalt of
factors offered by the person-environment, not as a "resolution" in any clear-cut sense
of the word. Loss of a loved one presents the griever with the kinds of shifts in
experiencing, appraising and coping that Lazarus suggests and is therefore more likely
to have long-term boundaries than a response to stimulus with the likelihood of
generating fewer responses (like a tack in the foot, or a broken fingernail). The more
traumatic or shocking the change to a person’s environment, the more complex will
be the adjustment of the entire person, as it has repercussions on a person’s self
picture and world picture.
Izard (1979) and Zajonc (1984) further call attention to the continuous nature
of emotional experience. Zajonc (1984) states, "the individual is never without being
in some emotional state" (p. 121). Rather than occurring "in a vacuum" (p. 121),
emotional reactions represent changes from one emotional state to another. Zajonc
makes an important reference here, I believe, to the internal environment, in contrast
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to the external environment or stimulus, and acknowledges that a cognition (such as
remembering something sad) may be the stimulus for such emotional change.
Looking at the sequencing of emotional events or episodes in ever-broadening
circles, whose loops may do more than insure homeostasis (they may for instance
transmute the experience), allows us to view emotion in a more complex and
multifaceted way than, for instance, the stages or phases of grief theory suggest.
What this leads to is the idea that consciousness may operate on multiple levels and
that sequencing may be nonlinear and multicausal. While this would seem to be
especially important in a complex emotional state such as grief, the theories I have
discussed do not adequately address this complexity.
The bias toward autonomy and separateness. In the modernist ethos,
independence and autonomy as well as work and goal-directedness are valued.
Spence (1985) notes that in America where success is considered paramount, attitudes
toward achievement can be traced to the Protestant heritage and its emphasis on
individualism and the work ethic. As Jeremy Bentham is quoted as saying, "The word
independence is united to the ideas of dignity and virtue; the word dependence, to the
ideas of inferiority and corruption" (cited in Bradley, Daniels, & Jones, 1969, p.
389). The founders of grief theory illustrate their political and economic connection
with these values in some of their most striking and characteristic language. The
ending of the relationship with the deceased is often portrayed in socio-political terms
as a "severance" or "emancipation from the bondage of the deceased" (Lindemann,
1944; Rando, 1984; Volkan, 1975) which complement Freud’s language of economy
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where attachment and loss are about investment and dis-investment. "Emancipation"
and "severance" (Lindemann, 1944) suggest that any kind of continuing attachment of
the bereaved to the deceased is like a state of indenture with no economic, political or
personal freedom.
The self and other in grief theory. Theorization concerning personality or
"self" reflects similar biases. As Modell (1993) indicates, the current climate of self
theorization is biased toward the social self. However, the tendency of grief literature
has been to focus on severing ties to the deceased and relinquishing the other (e.g.,
Freud, 1917/1957; Bowlby, 1980; Lindemann, 1944; Rando, 1984), reflecting a self
that is more autonomous than "social," able to take care of itself rather than rely on
others for definition and cohesion.
The tradition of the "autonomous" self is related to the self as introspective
and the self as knower (James, 1892/1923), the "private" self possessing the capacity
to "bootstrap" itself from within (Modell, 1993). The view of self as autonomous,
discrete, and separate also seems to arise from a distinctly Western framework
(Kennedy, Scheier, & Rogers, 1984; Sampson, 1988, 1989; Shweder & Bourne,
1984). Sampson (1988) points to two aspects of individualism which he indicates are
inherent in American culture. One represents the "self-contained" variety which we
usually associate with individualism, exulting in firm boundaries, separateness and
personal control. The other he characterizes as "ensembled" individualism, supported
by a wider array of cross-cultural values.
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In contrast, what Modell (1993) refers to as the "social self" represents a
construct which relates to the influence of others on either (a) our perception or
evaluation of ourselves (e.g., Cooley, 1902; Erikson, 1968; Freud, 1923/1961;
James, 1892/1923; Rogers, 1951; Sullivan, 1953), and/or (b) the very construction
and existence of our selves (e.g., Kohut, 1984; Mead, 1982). While Freud did not
specifically allude to a "self" in describing his tripartite model of id, ego and
superego (Freud, 1933/1965), these structures, as well as his ideas concerning the
ego-ideal portion of the superego, clearly portray self-like qualities of being
fundamental to the individual’s experience, consciousness and identity. While the
Freudian "self" has a "private" (Modell, 1993) aspect, striving for autonomy in the
relinquishment of its "archaic" objects, infantile and instinctual trends and
transferences, clearly these strivings indicate a self that is not purely autonomous, but
social in the sense that it both takes in and ejects the world around it.
Kohut’s (1984) model of self is clearly implicated in the second category of
"social self," (b), mentioned above, in that for Kohut, the self cannot be a human self
--cannot be experienced as a human self, but disintegrates--in the absence of human,
empathic, responding "self" objects. From the self psychology perspective,
relationships with responsive others come to shore up ourselves, affecting not only
how we view ourselves, but our being in the world, our at-homeness, constituting to a
great extent our self-cohesiveness (Kohut, 1971, 1977, 1984; Solomon, 1989). When
this self-cohesion-maintaining function is threatened, one could say that the whole
fabric of one’s perception of self and reality are also threatened. Though this sense
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of self would seem to have particular significance in terms of loss, it is ignored in
looking at the bereaved’s loss as either purely a loss of role (Averill, 1968) or object.
While Averill does not appear to consider degree of emotional closeness and
attachment in the bereaved’s relationship with the deceased, Parkes’ (1968)
characterization of losing a beloved— "so powerful a reaction, that for a time, it
overshadows all other sources of difficulty" (p. 30)-is the opposite of the
"superficial" level of grief Averill describes. From an interpersonal and existential
perspective (Buber, 1965; May, 1983; Yalom, 1980), the loss of the person as a
meaningful and significant other, and the loss of the bereaved’s relationship with that
person, outweighs the more utilitarian functions the deceased person’s life provided
the bereaved in the form of a role. Further, James (1890/1950) suggests a
fundamental inseparability between role (and everything else that can "belong" to a
person) and the person her or himself. The "self" includes one’s body, mind,
clothes, house, spouse, children, ancestors, land, and even bank account, and when
these things are affected positively or negatively, the self is affected. Therefore,
"When they [immediate family] die, a part of our very selves is gone" (p. 292).
Such a view is also reflected in a self psychology perspective, where it is the
responsive "Other," both within and without, which supports a relationship between
oneself and the world. The empathic selfobject, Kohut (1984) writes, is the
"psychological oxygen" without which we could not psychologically survive.
Illustrating this psychic interdependency between self and world, Kohut (1984)
describes a patient, Mr. U, whose dream characterizes the nightmarish quality of a
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world without human relatedness, a world that does not acknowledge our humanness.
After leaving an ice tunnel shaped like a human heart, Kohut’s patient finds himself in
a cityscape which is "unreal" and whose inhabitants are unapproachable, a "’stainless
steel world’" where "communication . . . was unthinkable" (1984, p. 18). According
to Kohut, this experience is so horrible because without a selfobject, the self cannot
exist. The "self" can no longer be a human self because it disintegrates without an
object. "It makes no difference," he says, "whether we experience this fear as the
permanent loss of the responses of all present and potential selfobjects . . . or whether
we experience it as the [single] irrecoverable loss [of an archaic selfobject]" (p. 18).
Not loss of love nor even hatred can achieve the destruction that complete
indifference can--the indifference of a nonhuman, nonempathically responding world.
"It is not physical extinction that is feared," Kohut writes, "but the ascendancy of a
nonhuman environment. . . in which our humanness would permanently come to an
end" (p. 18). Kohut’s perspective explains why loss of an important relationship
through death would be of vital significance. Loss reflects our ultimate existential
aloneness. As poignant as the threat of physical extinction (Averill, 1968; Bowlby,
1980; Parkes, 1987) is the possibility that whatever we might call our human and
interpersonal "self" may also be extinguished. William James (1890/1950) similarly
writes:
No more fiendish punishment could be devised, were such a thing physically
possible, than that one should be turned loose in society and remain absolutely
unnoticed by all the members thereof, (p. 293)
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While Kohut (1984) and James (1890/1950) are both speaking of extreme instances of
the takeover of "nonhuman" environments, their remarks are relevant to the situation
of bereaved people who have lost significant others. These lost significant others
have largely constituted the grievers’ intersubjective worlds. Referring to what he
feels constitutes deprivation, Parkes (1987) refers to the "absence of those essential
‘supplies’ previously provided by the lost person"— "the psychological equivalents of
food and drink" (p. 29). And when Averill’s concept of role is expanded to include
roles that are not merely functional in a utilitarian or symbolic sense (e.g., "he [the
deceased] was the one who used to fix my dinner"; or "she was my nearest blood
relative"), but functional as aspects of relationship which "shore up the self" (Kohut,
1984), then loss of the object, in the form of the person and the relationship, and loss
of role seem to blur.
The dichotomy of the social versus autonomous self is just one cf the many
polarities that abound in self theorization. Other themes include continuity versus
change, and structure or identity versus consciousness. From a Western positivist
tradition, continuity and identity are core facets of what a self is supposed to be.
Also implicit are materialisms about the self s location, its place in time and space
and its structure which seem to reach back to Descartes’ position that the "I" exists
because it has thoughts. Entities, even those as amorphous as "selves," have an in
and an out, and it is important to us that we can "recover" our identity, whatever else
happens (Modell, 1993). From this standpoint, the "I" inside persists despite changes
of job, relationship, and address, as well as after more momentous changes such as
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social disaster, war and bereavement. Indeed, from a romanticist ethos, the self, or
soul, never dies but remains eternally the same.
The paradox is that the self is always changing, and it is evident that all of the
situations just mentioned (bereavement, job change, etc.) have an impact on the
experience of self (even if the "I" remains). William James (1890/1950) revolved his
idea of self on the experience of consciousness, which is constantly moving, rather
than on the structure which has become synonymous with identity or continuity;
numerous selves (like thoughts), he writes, may emerge like cattle each going their
own way, but are bound together and given coherence by the current "owner" of the
herd, which gives the person a sense of continuity and unity.
More recently, constructionist thinkers contest the notion of an enduring,
stable, and unitary self, suggesting instead that the self is made rather than
discovered, that it is multiplicitous, contextual and embodied (Hermans, Kempen, &
van Loon, 1992), can be construed as a narrative (see Gergen & Gergen, 1988;
Hermans et al., 1992; Kelly, 1955; McAdams, 1988; Polkinghome, 1988; Sarbin,
1986; Schafer, 1981) consisting of a self-created story, or dialogue (Hermans et al.,
1992) rather than a material entity or single idea. According to Cushman (1990,
1991), the self is determined by its particular social, cultural and political context.
The individual self (what he describes as the "bounded, masterful, self"), he says, is a
modem artifact which parallels the rise of industrialism (Cushman, 1990).
These different notions of self paint a potentially different picture of the
experience of grief than the views held which privilege an autonomous, "bounded,
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masterful, self." Current grief theory limits its perspective to the latter, and this
"self" resolves its grief not only in a very orderly step-by-step, concrete fashion, but
leaves a place for the Other (in this case the deceased other) in memory which is also
somewhat orderly, material, fixed and unchanging. Thus, the deceased is viewed
concretely on one side of the boundary, the bereaved on the other. The possibility of
an intersubjective, multiplicitous, or co-constructed self is not explored, and self and
other remain polarized.
Prevailing grief theory does not consider notions about self from a variety of
schools and disciplines (e.g., Caughey, 1984; Hermans et al., 1992; Kohut, 1984;
Modell, 1993; Watkins, 1986; Winnicott, 1958) which suggest the possibility of a
multiplicitous or "dialogical" self (see Bakhtin (1929/1973); Hermans et al., 1992).
This self, which may be more congruent with grievers’ experience of self and other,
may be viewed as consisting of "enduring presences" (Modell, 1993) or multiple "I
positions" (Hermans et al., 1992). The self as a dialogical narrator is both embodied
and social, Hermans et al. argue, and "other people occupy positions in the
multivoiced self" (p. 29). The imagined other(s) may or may not represent real
people, and their imaginal perspectives may or may not be congruent what they would
"really" say were they to say it in (external) reality. As examples, Hermans et al.
specifically mention the imaginal contact with a deceased parent or friend, as well as
the imaginal "ideal lover, or a wise advisor" (p. 28). Such different views of self and
other are given short shrift in current theory for, as mentioned, although Bowlby
(1980) acknowledges the possibility of an enduring relationship with the deceased
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other, he does not explore the development of this relationship and its effects on
grief, is ambiguous about its health/pathology, and maintains the linear and finite
sense of a phase model.
Proponents of the constructed or dialogical self criticize the autonomous,
unitary and disembodied self as fastened to, or created by, the culture and thinking of
the West (e.g., Cushman, 1990; Hermans et al., 1992). The "bounded, masterful
self (Cushman, 1990, p. 599) is not the transhistorical entity we take it to be.
"There is no universal, transhistorical self, only local selves; no universal theory
about the self, only local theories" (p. 599). The "self is dependent for its definition
on its social, political and economic surround.
The unitary, masterful self was created, Cushman (1990) argues, after
feudalism collapsed. Cushman connects the current political and economic power
structure and the growing absence of tradition and shared meaning in our culture with
the empty self which "embodies" these social "absences as a chronic, undifferentiated
emotional hunger" (p. 600), which is soothed, but never completely satiated, by
consuming commercial products, and by the social psychology, mirroring and
charisma of advertising strategies and psychotherapists.
Similarly, grief theories may have the effect of making certain kinds of
grieving more acceptable and possible than others. As Cushman (1990) indicates,
actual others and the social policies they promulgate lend a tangible hand to shaping
our personal or "private" selves. In regard to bereavement, Fowlkes (1991) asserts,
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we can construct melancholy, or depressive loss of self-regard, in the mourner,
through inadequate social regard.
When the self is viewed mainly as a discrete interior separate from the
individual’s sociocultural surround, the importance of external events and actual
human beings are also discounted. This is particularly important in the study of grief,
in that an interplay between the internalized, lost other(s), and the other’s real
physical absence actually serves to create a kind of dialogical self. Further, if we
focus primarily on attainment (as in a more or less static concept of identification or
internalization of the deceased other), we neglect the very real absence which is part
of, and contributes to, the internalized presence.
The privileging of the internal and the autonomous is reflected in Western
glorification of traits or mottos such as autonomy, achievement, "do-it-yourself" (or
in this case, construct yourself), perhaps at the exclusion of other values, such as
relying on others to provide support or nurturance. In a complementary fashion, the
experience of bereavement is frequently attended by similar adages from friends,
family or community (e.g., "you have to keep a hold of yourself," "you have to be
strong," the sense for instance, internalized from somewhere, that it is "weak" to cry;
weakness demonstrates emotional neediness and a lack of autonomy).
Feminist writers such as Irigary (1977/1980) and Cixous (1975/1980,
1976/1980) have critiqued what they consider Western patriarchal thinking because of
its division of schema such as cause and effect, subject and object, male and female,
and binarisms which inevitably privilege one term over another. Cixous (1975/1980,
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1976/1980) and Irigaray (1974/1985; 1977/1980) point out that the shadow of the
binary term— the term associated with the negative, with weakness, nature, chaos and
non-action-is commonly associated with the marginalized, specifically with women.
It is possible that if indeed women and other groups who historically have not had as
great a voice or power as White, European-American men, are thus undervalued,
terms which are associated with them become part of that aspect of the "equation"
and thus represent things to be avoided, repressed, or under-valued as well. Terms
such as dependence, emotion, and ambiguity or neverendingness, which are
counterpoised with the terms, autonomy, reason, and resolution, temporality,
completion or goal-accomplishment exemplify this.
Studies about women (e.g., Chodorow, 1978; Gilligan, 1982) and Eastern
cultures (e.g., De Vos, 1985; Hsu, 1988; Miller, 1988), suggest, in contrast, the
other side of the equation, at least in terms of valuing an interdependent, or other-
oriented, focus. Markus and Kitayama (1991) specifically explore variation in how
the self is construed in terms of what Americans and Westerners on the one hand, and
Asians and Easterners on the other, believe about the relationship between self and
other, suggesting two broadly-defined construals of self, the independent and the
interdependent view of self.
Prevailing grief models, because of their emphasis on finishing grief
(particularly its emotionally upsetting, disturbing aspects), detaching from the
relationship with the lost one, and viewing grief as "work," are reminiscent not only
of a puritanic, capitalist tradition and work ethic, but of a way of living which is
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traditionally associated with being male. The privileging of such values in grief as
strength (versus weakness), autonomy (versus relationship), reason (versus emotion),
call to mind epistemological and experiential differences (see, e.g., Chodorow, 1978;
Cixous, 1975/1980, 1976/1980; Gilligan, 1982; Irigaray, 1974/1985, 1977/1980).
The polarization Cixous (1975/1980) describes takes political as well as social
and emotional form in Holst-Warhafit’s (1992) illustration of the gradual excision of
women’s lament as part of mourning from the sixth century B.C. onwards. In her
study of women’s laments and Greek literature, Holst-Warhaft points out that in
traditional cultures (such as Greek, Chinese and Finnish cultures), women are often
chosen, or choose themselves to be, ritual lamenters- of the dead-weeping, wailing,
and singing songs and messages of mourning which often represent a highly
developed art form. She indicates that over the centuries women’s lamentation in
funeral rites has dwindled with remnants of songs for the dead to be found only in a
few isolated areas. She interprets this degradation of the form of lament to the threat
it causes patriarchal and political order. Laments focus on mourning and loss rather
than on praise of the dead, thus making it difficult for governments to justify or
recruit for wars. Lamentation also places certain power, both metaphysical and
8/ In various cultures, lament expresses mourning, but as Holst-Warhaft
(1992) points out, not necessarily mourning for the dead (e.g., a bride and her family
may mourn the separation caused by her marriage).
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practical, in the hands of women, in that women thus have a privileged "dialogue"
with the dead and over the rites of death, and that they may incite violence by means
of the violence of their laments.-
Holst-Warhaft cites that in classical Greece (sixth century B.C. onwards),
Athenian legislation aimed at restricting such "extravagant mourning" (1992, p. 3);
the dismissal of women’s role in the funeral ceremonies of Athens was combined with
a new genre of funeral oration in which the dead were not lamented, but praised.
This change is accompanied by an ethos which divides men’s and women’s forms of
mourning, justified by supposed differences in women’s and men’s natures. In this
ethos, as we are so familiar with in twentieth century Western culture, men are
viewed as rational, morally upright, and able to contain themselves and their feelings,
while women are emotional, somewhat untrustworthy, and cannot and will not contain
themselves, differences that are highlighted in Gilligan’s (1982) proposal of two moral
systems, one of justice (associated with men), and one of care (associated with
women). There are dangers associated with not being able to detach from the dead.
We can also see from the above example, that there are perceived dangers in
lamenting--in feeling and expressing powerful emotions concerning the dead.
Gilligan (1987) notes that developmental theorists have had a "penchant" for
"projecting a masculine image, and one that appears frightening to women" (p. 59).
9/ This point is especially interesting in light of Rosenblatt et al.’s (1976)
contention that grief must be controlled for social reasons. Grief and rage, Holst-
Warhaft (1992) states, are both important aspects of lament. Rage inspires revenge
for the death of the lost one. In Mani, she says, there is no clear distinction for
songs inspiring grief versus those inspire rage.
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When considering the literature dealing with the "natural" (or "pathological")
development of grief, it is important to keep in mind this "penchant," as it seems to
have influenced the way we view grief. Gilligan points out that Freud’s (1905/1961)
psychosexual theory of development focuses on the experiences of the male child.
When it comes to females, unable to fit them into this model because of women’s
strong and enduring preoedipal attachments to their mothers, he concludes that the
difference in women’s development represents a developmental failure (Freud,
1925/1961; Gilligan, 1987). Similarly, those who are unwilling to give up their
attachments to the dead, in a sense, fail in the development of the grief process
(Bowlby, 1980; Freud, 1917/1957; Kubler-Ross, 1969; Lindemann, 1944; Parkes,
1987; Rando, 1984; Worden, 1982).
The stigma of grief. In addition to the connotations of lose cited by Webster’s
(1984, p. 836) such as are commonly associated with death, separation, and being
"unable to find," many of the word lose's meanings imply some sort of failure on the
part of one who has lost (e.g., "to bring to ruin or destruction"; "to fail to keep or
maintain"; "to fail to win or gain"; "to cause the loss of"), or a sense of
involuntariness, slowness, and general inability. And it is not uncommon to see guilt
or self-blame as a concomitant of grief (Bowlby, 1980; Klein, 1940; Lindemann,
1944; Parkes, 1987).
Ostensibly, society does not blame people for their bereavement. Yet there
persists in many circles a sense of taboo~a sense of the wrongness of death, and the
"pornography" of mourning (Gorer, 1965). Individuals may feel socially stigmatized
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by being bereaved (Parkes, 1987), even when the cause of death is not socially
stigmatized by a particular culture (as may be the case, for example, when a gay
partner has died, in circumstances involving AIDS, murder, or suicide). In both
bereavements involving "natural" deaths and unexpected or out-of-the-ordinary ones,
a sense of social isolation and ostracism appear again and again in various
autobiographical writings. Gorer (1965) introduces his study of grief and mourning in
England with a personal account of his grief following the death of his brother:
I wore a black tie for about three months. I had great pleasure in seeing real
friends, but was unwilling to meet strangers. A couple of times I refused
invitations to cocktail parties, explaining that I was mourning; the people who
invited me responded to this statement with shocked embarrassment, as if I
had voiced some appalling obscenity. . . . as it was, the people whose
invitations I had refiised, educated and sophisticated though they were,
mumbled and hurried away. They clearly no longer had any guidance from
ritual as to the way to treat a self-confessed mourner; and, I suspect, they
were frightened lest I give way to my grief, and involved them in a distasteful
upsurge of emotion, (p. xxxii)
Rebuking himself for his "maudlin tears" (p. 8) and attempting stoicism, C.S. Lewis
(1961) writes in his journal:
An odd by-product of my loss is that I’m aware of being an embarrassment to
everyone I meet. At work, at the club, in the street, I see people, as they
approach me, trying to make up their minds whether they’ll "say something
about it" or not. I hate it if they do, and if they don’t, (p. 12)
Lewis thus appears almost as ashamed of his grief as the society he describes.
Why should being bereaved be taboo-something to be ashamed of? Why
should loss imply failure? Perhaps a partial answer may have to do with the
privileging of the autonomous self as well as the self who materially succeeds, even in
the face of death. Loss is both a deprivation and an assault, a blemish on one’s
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119
ability to maintain one’s resources and possessions. In The Importance of Being
Earnest Oscar Wilde (1987) comically points to society’s valuation that the bereaved
has somehow failed or fallen short of responsibilities when a character quips to the
orphaned (actually abandoned) Ernest, "To lose one parent . . . may be regarded as a
misfortune; to lose both looks like carelessness."
In a society which values team-playing, togetherness, and undervalues the
pursuit of solitary activities which betoken nonconformity or "eccentricity," part of
the stigmatization and blame of loss may be related to the taboo of being "alone," as
if the fault lay somehow in the one who has been "left," "alone," i.e. bereaved one
him or herself. From this line of thinking, one can scarcely help but think of the
evolutionary proscriptions described by Averill: Individuals remain bonded to the
group in defense against the overwhelming and horrible psychic pain consequent upon
separation. Someone who is not bonded to the group is in some way not playing the
game. They have, as Averill implies, lost their social roles.
The above explication suggests that the "norms" of prevailing grief theory
have been informed by a very particular subculture, based on an idea of "self" (and
"other") and values such as linearity, materiality, and goal completion which are not
universal. By extension the experience of grief is also not the same for everyone, but
possibilities such as a continuing relationship with the deceased or not "resolving"
one’s grief are hardly touched upon.
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Different Attitudes Towards Relationship and Death and Some Existential and
Cultural Explanations
Cushman’s (1990) concerns regarding the historical, context-specific nature of
self are echoed by Stroebe et al.’s (1992) reasoning that the influence of industrialism
may contribute to seeing grief as a task which requires a recipe book (preferably an
instant mix). Stroebe et al. point out that beliefs about the value of continuing a
relationship of some sort with the deceased vary with culture. Maintenance of ties are
accepted, for instance, in certain Japanese religious rituals; the Shinto and Buddhist
religions endorse the idea that contact should be maintained with the dead and believe
that the ancestor actually remains open or receptive to some form of communication
from the living. Stroebe et al. assert that within the context of romanticist philosophy
of the nineteenth century, to grieve was "to signal the significance of the relationship,
and the depth of one’s own spirit" (p. 1208). Eternal remembrance is exemplified in
Emily Dickinson’s poetry, for instance in her poem numbered "1560" (1883/1960):
To be forgot by thee
Surpasseth Memory
Of other minds
The Heart cannot forget
Unless it contemplate
What it declines (pp. 648-649)
While twentieth century influences have focused more on the severing of the
relationship and establishment or maintenance of autonomy of the living from the
dead, as Stroebe et al. indicate, such a tendency may be more an effect of social
mores than an innate striving to separate from old relationships and "move on." As
they point out, in the romanticist ethos,
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Dissolving bonds . . . would not only define the relationship as superficial, but
would deny as well one’s own sense of profundity and self-worth ....
[making] a sham of spiritual commitment and . . . living a meaningful life.
(p. 1208)
In Fu-Sheng and Yimou’s film, To Live (1994), which portrays the trials and
happinesses of a Chinese family from just before the rise of the Mao regime in the
1940s to the late 1960s, loss, grief, and mourning are depicted in many kinds of
circumstance: Fugui’s loss of all his family’s estate through gambling, the loss of an
old regime, the loss of Fugui’s and Ziazhen’s daughter through marriage and her loss
of her parents, loss of their children through death, and loss due to the casualties of
war, public execution, accidents and calamity. Most striking are the deaths of
Fugui’s and Jiazhen’s two children: first, their young son in grade school, and
second, their daughter due to uncontrolled hemorrhaging in childbirth. In reacting to
these losses the parents tear, wail and scream and are forcibly restrained by the
community, for instance when Jiazhen tries to see her dead son. People tell the
couple--as they in turn later tell others (for instance the suicidal friend who has lost
his wife)-that they must "buck up," hold on, that is, be "strong." Yet, in very
personal mourning rituals, when they visit their children’s graves, Fugui and Ziazhen
obviously continue some sort of an ongoing and discriminate relationship with each of
their dead children. As their young grandson smilingly notes, for her son the mother
brings dumplings, and for her daughter she brings pictures. Both the circumstances
of each child’s death, and the parents’ relationship with the lost child, differ.
Before his death, Fugui and Ziazhen’s son, a small child, although tired and
hungry is forced to go to school and take part in the smelting of iron. His mother
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packs him a goodly amount of mouth-watering dumplings to take with him. Greatly
fatigued from the pressure the Mao regime places on all its followers, he falls asleep
and is crushed by the accidental displacement of a wall when an inspector backs his
truck into it. He never has a chance to eat his lunch. Therefore, when she visits his
grave, his mother prepares him a double portion and partakes of it herself at his grave
site.
Fugui and Ziazhen’s daughter dies after giving birth to a child because of
horrendous medical treatment which fails to alleviate her hemorrhaging. She
therefore does not live to see her son grow up. Her mother arranges pictures of the
young boy at different ages over her grave.
Obviously, these "offerings" are not identical in kind. They are similar to but
different from the cigars, candy and money some cultures (e.g., Berawan
communities of northern Borneo; see Metcalf & Huntington, 1991, pp. 90-92) ritually
offer up to the dead for sustenance in the next world. They are particularized to the
relationship of the bereaved to the dead— the bereaveds’ perception of the lost ones’
needs, desires, lacks, missed opportunities— and likewise, those things that the
bereaved can no longer share with those they have lost-meals, the opportunity of
nurturing and being nurtured, parenting and grandparenting, and the passage of tim e-
except of course symbolically. Here, some sort of relationship with the deceased is
maintained, though the physical loss though death is acknowledged.
The kind of ongoing relationship described above exists in a variety of cultural
milieus. Nonetheless, many Western habits and attitudes towards death, as well as
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myths and rituals of other cultures, suggest that the separation theme may have
influences other than the values of political, economic, social or personal
individualism. Hopi Indians of Arizona believe that death brings pollution; after a
death, say Stroebe et al. (1992), the effort is to try to forget the deceased.
In his influential "A Contribution to the Study of the Collective Representation
of Death" (1907/1960), Hertz discusses the role of the corpse, the soul and the
mourners in Indonesia, particularly the island of Borneo, and asks why it is the corpse
is feared, and what is the nature of the horror it inspires. Both Hertz and later
Metcalf and Huntington (1991) reject the idea that it is hygiene or the smell and sight
of decomposing flesh that repulses mourners. Although Hertz argues that the
emotion, panic, revulsion, etc. of mourners have a direct relation to the social status
of the deceased (slaves’, children’s, and strangers’ deaths going virtually unnoticed in
comparison to the death of a chief of high rank), he also suggests a strong spiritual or
philosophical component to the role of pollution and purification of the corpse:
These tribes thus explicitly connect the dissolution of the corpse and their
belief in a temporary stay of the soul on earth, together with the obligations
and fears that derive from this belief. . . . This representation is linked to a
well-known belief: to make an object or a living being pass from this world
into the next, to free or to create the soul, it must be destroyed. . . . As the
visible object vanishes it is reconstructed in the beyond, transformed to a
greater or lesser degree. The same belief applies to the body of the deceased.
(Hertz, 1960, p. 46)
Metcalf and Huntington (1991) point out that the body is feared because until its
complete spiritual recreation, some of the spiritual essence remains on earth and thus
threatens the living with death. The danger of contagion, they say, is supernatural
rather than physical, and thus affects kin close to the deceased in a manner in which
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nonkin are not affected, so that nonkin may sit near the corpse without danger of
infection. "Close kin, wherever they happen to be, are immediately struck by the
‘petrifying thunderbolt’ when a death occurs" (Metcalf & Huntington, 1991, p. 82).
In a similar vein, Freud (1915/1957) writes that "primeval man," though
unwilling to acknowledge personal death, was forced to recognize death of a loved
one, and "It was beside the dead body of someone he loved that he invented spirits"
(p. 294) and a division of body and soul. Because of a sense of guilt due to her or
his ambivalent feelings (i.e., satisfaction mingled with sorrow), Freud says, these
new-born spirits were converted "into evil demons that had to be dreaded" (p. 294).
At least part of the satisfaction Freud proposes is due to the bereaved’s relief at
remaining on the life side of the boundary him or herself.
Beliefs about the liminal state of the dead and the horror that this provokes,
offer another convincing reason for some societies’ insistence on separation from and
relinquishment of the deceased. The treatment of the corpse, as Hertz (1960) notes,
may parallel how the soul is conceptualized. Separation of body and soul also seem
to bear upon how the living separate from those who enter the realm of the dead.
Rituals of burial, purification and in effect, separation, from the body, may thus have
to do with separation from the person, both body and soul. Secondary burial in many
cultures (e.g., see Metcalf & Huntington, 1991, regarding Berawan rites;
Mandelbaum, 1959, about funeral rites of the Kotas) point to the gradual attempt to
effect the separation between the deceased person, in the form of his or her body,
from his or her spirit, and between the mourners and the deceased.
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Many fairy tales, myths and stories also underscore the separation between the
world of the living and the world of the dead. In the myth of Demeter and Kore,
Kore is separated from her mother and the earth, excluded from the living to the
realm of the underworld, requiring the intervention of the gods and the enactment of
special rites for her to reenter the world of the living, and this for only half the year.
For mortal figures, attempting to cross over the boundary between living and dead is
often viewed as a transgression and abomination, as in Mary Shelley’s Frankenstein
(1818/1963). Doctor Frankenstein commits the iniquity of "playing at God" by
creating new life out of old, and in the recent film version directed by Kenneth
Branagh (Coppola, Hart, Veitch, Fuchs, & Branagh, 1994) adds to his atrocity by
resurrecting his dead love.
As a ghost/spirit in Beale’s Victorian ghost story "The Ghost of Guir House"
warns, "Let the experience of one who has suffered . . . warn you against the
unreasonable yearning for the return of those who have passed on to their spiritual
state!" (p. 413). Here, it is suggested that a bereaved’s "unreasonable yearning" can
have an adverse effect, preventing the spirit’s passage into spiritual life; instead of
making this transition, the deceased is kept in a state of spiritual limbo wherein he or
she hasn’t the full corporeal qualities of a human being, yet is compelled to haunt the
earth. All the more reason that firm boundaries between the living and dead be
maintained.
We may also note here that often the "ghosts" of ghost stories are not
essentially horrifying because they are evil or do bad deeds, but rather because they
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represent the other side of the boundary between life and death and have somehow
infiltrated or remained on the wrong side of that boundary. This limen, or threshold,
of death is indicated by Turner (1967) in his discussion of the corpse and its
inevitable decay as symbolic of social transition; symbolism of the corpse is
associated with the liminal, thus symbols of decay also prevail at other rites of
passage, such as initiations. (Van Gennep, 1960, also notes that funeral ceremonies
may be more concerned with rites of transition than of separation.)
It appears, however, that it is not only the act of crossing the boundary that is
"unnatural" and ghastly; there is also a fear that the dead will drag us, the living,
unwillingly over to the other side. Such "ghosts" are feared because like vampires
they may deprive survivors of their just deserts to go on living, instead depleting
them, physically, psychically, and spiritually. Vampires, interestingly, because they
remain in the limbo of the "undead," must draw on the life blood of their survivors,
an image with interesting parallels to Lindemann’s (1944) position that the griever
requires "emancipation" from the ties that "bind" him or her to the deceased. From
such a standpoint, to maintain an attachment would be almost tantamount to crossing
the boundary between life and death, therefore bringing up the fear of dying,
psychically if not physically, as indicated by Freud’s (1917/1957) hypothesis about the
mourner’s ultimate decathexis from the dead person: He or she would rather "sever
its attachment to the object that has been abolished" (p. 255) than share its fate.
Needless to say, being vampirized or dying oneself are extremely frightening
images which would seem to offer strong motivation to cut one’s ties. However,
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even with this motivation, as internalized presences (as well as absences or lacks), the
dead are entwined with the living in a number of ways.
Despite the felt "wrongness" of crossing the boundary, separation myths, as
well as some frequently noted characteristics of the bereaved (e.g., the oscillation
between belief and disbelief, despair and acceptance), display an essential conflict:
the conflict between wanting someone to remain among the living and being horrified
by this possibility. Commenting on the movie version of Frankenstein, a thirteen-
year-old recently summed up the conflict this way: On the one hand, Dr.
Frankenstein’s behavior in bringing back his wife from the dead via surgery, electric
shock and body-switching, was "horrible," and "no wonder she killed herself," the
adolescent said; on the other, "If I was Dr. Frankenstein and someone I loved had
died, I would probably try to do the same thing."
The above brings to mind other typical things that heroes and heroines are
likely to do regarding the death of a loved one, such as wreaking violence on
themselves or taking vengeance on the perceived wrongdoer. (Traditionally, critics
have viewed Hamlet’s dilemma as his inability to do either of these things.) Horror
and fear of both death and the corpse (and rituals to keep the living separate from the
dead and vice versa) seem to be bound up in different ways with notions of violence,
vengeance, blame, and general loss of control. Thus, Rosenblatt et al. (1976) argue,
the social function of ritual in bereavement is to control emotion, particularly anger
and aggression.
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Rosenblatt et al.’s (1976) ideas concerning society’s control of emotions are
somewhat substantiated by Holst-Warhaft’s (1992) explanation of the diminution of
traditional women’s laments for the dead from sixth century BC in Athens and
onwards. As Holst-Warhaft remarks, laments supply an outlet for passionate feelings,
and using the laments of Mani as an example, she illustrates how laments may move
quickly from songs of grief to songs of anger-anger that calls for revenge. And in
Mani, where she states vendettas were still common in the 1950s, laments of grief
and rage are not distinctive and are often intertwined in the same lament. As
Rosenblatt et al. imply, revenge and blood-wars do not make for an orderly, peaceful
state. Obviously from these perspectives grief can be quite dangerous.
As other stories tell, however, life and death may be separate but are
invariably intertwined, particularly because the world of the living is co-created in
some respect by the dead. The living remember the dead and also think about how
the dead might remember or view them. In a very basic (and physicalized) form,
they remain as commemorations, old possessions, descendants. As indicated, they
also remain in some sort of relationship. In James Joyce’s Dubliners (1967), for
instance, the dead alternately seem to act as a release or a fetter to the living,
engendering or limiting self-exploration, and closing or opening channels of
communication. In "The Dead" (Joyce, 1967), Michael Furey, the long-dead love of
Gretta’s past, is more potent in memory than is her living husband, Gabriel.
Similarly, in T.S. Eliot’s The Waste Land (1979), the past and future, death and life
are wedded in the horrors of the aftermath of World War I. Eliot depicts a death
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inherent in life (spiritually and morally as well as physically) in terms of the "Unreal
City" (London) and the oblivious live human crowds flowing over London Bridge: "I
had not thought death had undone so many" (line 63).
Yet despite, or because of, the interconnectedness of living and dead, the
"separation theme" is fairly constant in a variety of literature and art forms. In
contrast to Toni Morrison’s (1987) merging, almost incestuous ghost in her novel
Beloved, which definitely has her "fingers" in the "pie" of the living (sight of her
hand-prints in a freshly-baked cake finally pushes Howard, one of Sethe’s sons, to
leave home for good), and Joyce’s semi-intrusive departed, the dead in Thornton
Wilder’s Our Town (1938/1965), despite their yearning, are hopelessly cut off from
the texture and being of those living whom they love. When Emily discovers that
"one can go back there again— into living!," those who have been dead longer warn
her not to: "It’s not what you think it’d be" (HI, p. 75). For, even if Emily Webb is
permitted to return to "life," or the past, for one day, no one in that past is able to
see or respond to her as she is in the present tense (or rather the present past tense),
as they are only able to see and respond to her as they actually saw her that day in the
past. (The dead in Wilder’s play eventually come to talk wryly and with
philosophical detachment of the living, whom they see as hopelessly ignorant and
troubled.)
In Herk Harvey’s (1962) Carnival of Souls, the main character, Candace
Hilligoss, is similarly cut off from the world of the living, but resembles more the
souls in limbo discussed above than one who has inexorably crossed the boundary to
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the other side and is unable to return at all. Interestingly, after her apparent
drowning, we see her taking part in various human activities (like getting a job), but
there is something odd. Finally, there are scenes which sum up her disquieting cut-
offness from the world of living. She appears as if physically present, feels and
touches trees, etc., but she cannot hear the world (and, during these episodes, all
sound is blocked off for the movie-watcher as well). No one responds to her. She is
in-between two worlds, and in the end, goes off with a ghoulish entourage.
The world’s unresponsiveness to Emily in Our Town and to Candace in
Carnival of Souls (so reminiscent of Mr. U’s ice tunnel! described by Kohut, 1984)
represents, seemingly, the loss of the dead. They are cut off, no longer able to
communicate with the living, again implying that it is they who have lost us.
However, the sense of disconnection strongly bespeaks the tremendous loss of the
living at being separated from the dead. George Gibbs, Emily’s boyfriend, then
husband, in Our Town, displays his grief without restraint. Returning at night to the
cemetery the day of Emily’s funeral, he kneels before Emily’s grave and falls face
forward on the ground. In a really good performance his behavior is moving and the
audience is likely to feel the futile horror of the situation, as George lies on the stage
floor (which constitutes Emily’s grave), pounding it and crying, although nothing will
bring her back (meanwhile the dead, philosophic once again, say "Goodness! That
ain’t no way to behave"; "he ought to be home" [HI, p. 85]).
When we view Emily’s futile attempts to return to the living, however, the
passive condition of bereavement and loss--the being left-are converted to an active
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form in which the world, and life, cuts off the dead, instead of vice versa. The stage
manager persona of Our Town makes a good case for the relinquishing process that
the dead go through, again, like the "letting go" construct, reversing the position that
survivors find themselves in and suggesting to us the possibility that the dead need to
let go o f us. For the dead as well as the living, the stage manager reminds us,
memory and identity fade.
Like most "opposites," the themes of attachment and detachment are webbed
together. As Freud (1917/1957) and Bowlby (1980) note, after a death gradual
reality-testing ensues, but with it a struggle. This struggle is not without its
existential justification, as fear of death and its implications may create or foster a
sense of separation or dissociation in yet another sense (Becker, 1973; Yalom, 1980).
Denial, both of the ultimate end and of how the backdrop of death shades the meaning
of life, is the term Becker (1973) uses to allude to how people deal with death in the
Western world. The concept of death is so horrifying that we may come up with
numerous modes of denying or try to avoid dealing with it altogether. In his analysis,
Becker (1973) attributes the power of transference— to God, the "beyond" or anything
or anyone viewed as more powerful than ourselves-as a way of "slip[ping] into some
metaphysic of power and justification from beyond" (p. 275). This "vital lie," he
says, is needed when we are stripped down to our creatureliness, our physical
weaknesses, our mortality, and our aloneness. The vital lie involves not only
empowerment but negation of the forces of death.
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Denial of death and Becker’s (1973) "vital lie" illustrate what Gorer (1965)
refers to as "the pornography of death"— and the twentieth century counterpart to the
Victorian’s prudery concerning sex. Gorer writes:
The natural processes of corruption and decay have become disgusting, as
disgusting as the natural processes of birth and copulation were a century ago;
preoccupation about such processes is (or was) morbid and unhealthy, to be
discouraged in all and punished in the young. . . . The ugly facts are
relentlessly hidden; the art of the embalmers is an art of complete denial, (p.
196)
Like Gorer’s Britainers, many Americans, Rando (1984) says, try to avoid
confronting the reality of death, hence the prevalence of dying in hospitals and
convalescent homes. Privatization of grief (Feifel, 1990) and denial and
deritualization of death in America (Lifton, 1968; Mandelbaum, 1959) precludes an
understanding of grief and relationship with the lost one as anything but that which
must be relinquished, "gotten over," and hopefully forgotten. When we view death as
taboo and pornographic on the one hand, and natural and expected on the other, we
arrive at a rather split, perhaps schizoid, conception of death. Following this, our
attitude toward grief is equally ambivalent. Hence, we accept that grief is natural and
normal (cf. Rando, 1984; and Freud, 1917/1957: "It never occurs to us to regard it
as a morbid condition and hand the mourner over to medical treatment," [p. 153]).
Yet, in an ambiguous and non-specific fashion, it is also included in a diagnostic
manual of mental disorders.
Even if an afterlife is assumed, death marks a very real end to this life. In
contrast to seeking an "ultimate rescuer" transference figure (Yalom, 1980) to save us
from this chasm of eternal non-being, we may instead, as Yalom suggests, make
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ourselves the hero of sorts, invulnerable to death and creatureliness in a myth of self
emergence and personal inviolability. From this perspective, psychological separation
from people who die may very likely be a way of keeping death anxiety at bay,
similar in some sense to the pollution-exhuming rituals of the Berawan or to the
forceful forgetting of the Hopi Indians.
The Context of the Researcher
The above reasons for why detachment from the dead may be valued and even
seem essential, could also reflect why certain kinds of grief theory have been
developed and why they predominate. Common grief models may have at least some
of their roots in the kind of relationship researchers and potential comforters alike
adopt toward the bereaved, and toward their relationship with death and loss in
general. In addition, an underlying positivist world view and medical model approach
helps to inform assumptions about linearity, health or pathology, and completion or
end.
Caretaking impotence, and mortality. Bowlby (1980) indicates that a bias in
the literature might stem from the feeling of impotence at being able to comfort the
bereaved in the only way that would bring true comfort-bringing the lost person
back. Because of our sense of impotence as researchers and comforters in witnessing
and responding to "one of the most intensely painful experiences any human being can
suffer" (p. 7), he states,
[T]here is a tendency to underestimate how intensely distressing and disabling
loss usually is and for how long the distress, and often the disablement,
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commonly lasts. Conversely, there is a tendency to suppose that a normal
healthy person can and should get over a bereavement not only fairly rapidly
but also completely, (p. 8)1 2 '
Besides being unable to truly comfort the bereaved person by undoing death, one of
the aspects which makes grief such a difficult experience to explore is that it is
necessarily connected with death. It is also connected with dying, the personal
annihilation of a sense of self in time. From this perspective it makes sense that in
constructing grief theories we would be interested in metaphors of time and
development, especially those that imply a mastery of time (as in the sense of "getting
over" a particularly painful "stage" and progressing to a better one, which will
presumably relieve the griever of her or his pain). As indicated, existentially-oriented
psychodynamic theorists such as Becker (1973) and Yalom (1980) emphasize the
purpose of organizing and creating a developmental scheme to protect us from the
anxiety-evoking, upsetting realization of the end, our finitude and eventual
annihilation.
The impotence of the researcher/comforter may also promote the desire to
strive for greater objectivity, perhaps in order to prevent having any of the painful
experience her or himself, and also with the aim of examining the phenomena without
bias. The ironic aspect of this attempt is that through trying to avoid a personal bias
10/ The above statement from Bowlby (1980) is definitely at odds with the
notion of progressive stages or phases leading to completion or resolution of grief,
and as Bowlby adds, his work does emphasize the long duration of grief, the
difficulty of recovering, and its adverse consequences. However, his work is still
within the linear, medical model tradition because of its suggestion that the course of
grief should be outlined in terms of phases, that the goal is to "recover," that
recovery or resolution is positively valued, and that variants are "pathological."
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with the phenomena of death and grief, the researcher runs the risk of other blind
spots.
Positivist thinking. As Hoshmand and Polkmghome (1992) describe, the
positivist approach rests on the foundation that one can accurately know the essential
and true reality that exists outside of one’s own thought. The positing of this
knowledge of essential reality, as well as the assumption of an objective, neutral,
scientist-observer, are the bases for the objective, hypothetico-deductive approach to
knowledge. Many studies of grief represent the traditions of a positivist approach to
science through objectification of the subject, assumption of researcher distance and
neutrality, neglect of context, and use of a medical disease model. A major problem
with these tendencies in studying grief is that the subjectivity of the subject is ignored
or lost, and the subjectivity of the researcher is hidden. Further, use of the medical
model, usually implicit, to examine grief, its course, "prognosis," "cure," its
normality or abnormality, leads researcher and scientific community a priori to look
at grief as a disease entity rather than a naturally occurring process. The presumption
of methodological neutrality obscures the researcher’s interactive human response
concerning the confrontation of issues such as illness, loss and death.
Blind spots. Lindemann’s (1944) early work, because of its far-reaching
influence in the field, raises issues about the way that our biases, as well as our
method, style and theoretical bent affect our observations and interpretations of grief.
His report of bereaved subjects’ symptoms appears physically accurate yet
depersonalized and decontextualized, exemplifying a research stance which strives for
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clinical objectivity. The distancing of the researcher (and interviewer), however,
subtracts something from the wholeness of the account. The etiological significance
and personal meaning of the somatic symptoms are lost as Lindemann (1944)
separates them from the subject’s experience. Throat tightness, choking, shortness of
breath and muscular weakness as physical symptoms by themselves are conceived of
as "medical" (e.g., cardiovascular) problems, although if joined with the context of
loss, trauma and emotional strain, they are also indicative of other things, such as the
suppression of crying.
Similarly, Lindemann (1944) medicalizes the features of respiratory and
digestive disturbance and fails to connect the objective with the subjective sense.
Therefore, the fact that perhaps nothing tastes the same to the griever-that the world
may look markedly different after the death of a loved one— is, from Lindemann’s
description, understood more as an infirmity of the digestive tract and muscular
system than as an embodied emotional sense or construal of experience which affects
perception and sensation.
Further, because of the lack of subjective understanding created by a
subject/object dichotomization, the researcher may interpret phenomena in a way
which is markedly different than if she or he had the experience him or herself.
Although there are many possible blind spots, I will discuss two in particular here.
Existential or death anxiety and distress. As Parkes (1987) emphasizes,
bereavement represents a danger situation in which security is threatened, and the
individual is naturally likely to react with panic and alarm. On a very basic
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physiological level, central nervous system changes reflect a heightened sense of
arousal, and somatic symptoms such as difficulty breathing, eating, sleeping,
muscular tension and agitation (Lindemann, 1944) may occur. After losing his two
children in a fire, Tittensor (1984) remembers bouts of trembling, intense anxiety,
tension, crying, claustrophobia, agoraphobia and altered mood states. He describes a
sense of being out of control, as if he were "disintegrating," that he was on the point
of hallucinating, and as Tatelbaum (1980) points up in relation to the bereaved, feared
he might "go crazy."
Loss through death is threatening for the "selfobject" (Kohut, 1984) and
cohesion-maintaining functions described earlier, and because of the obvious
existential and evolutionary implications of death~i.e., annihilation, "the impossibility
of further possibility" (Heidegger, 1962), the realization of our fragility, and the
finality and finitude of all things. The existential meaning of loss through death
makes clear a connection between the bereaved’s high anxiety, distress, confusion,
sense of unreality, and perhaps rage, all of which can be felt as a condition which
cannot be neatly separated into "stages."
Death of a loved one detonates an existential crisis involving threat to one’s
very being and meaning in the world. When someone we feel closely about dies, we
can feel more acutely what it means for life to come to an end. Interpersonally, our
world is shattered and will never be the same again. All this happens in a manner
that is out of our control.
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Yalom (1980) points out that much anxiety, if fully explored, has to do with
the primary anxiety of death, but as May (1977) also discusses, "anxiety seeks to
become fear" (p. 207). According to Yalom we develop protective mechanisms (such
as denial) at an early age to insulate us from death anxiety and so therefore rarely
find it in its original form. As Freud (1915/1957) too points out, we show "an
unmistakable tendency to put death on one side, to eliminate it from life" (p. 289), to
think of it as impossible until we are confronted with it directly, as in threat to our
own lives or the lives of those dear to us, when it can no longer be denied.
Current theories of grief seem to neglect or downplay this basic reality.
Additionally, the models at hand try to isolate the factors (such as object loss, role
loss, biological or genetic predisposition) deemed constitutive of grief while ignoring
their relationship.
If we try to isolate whether it is the loss of the person, the loss of the role, the
evolutionarily-primed fear of danger due to aloneness or possible separation from the
group, or the fear of ultimate annihilation, that makes the experience of grief so
painful, anxiety-producing and horrible, it seems that we find all these things related.
Loss of one’s role is inextricably connected with one’s relationship with the deceased
and the meaning of the beloved lost person him or herself. Evolutionary danger is
ultimately connected with a fear of death or extinction. And, according to Yalom
(1980), other self-concerns, such as issues about self-esteem, interpersonal rejection
and humiliation, also represent "secularized" instances or offshoots of death anxiety
(p. 45).
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The existential outrage or assault of death also seems to be partially related to
grievers’ experience of a sense of unreality, interwoven though the sense of unreality
is with the shock of the unbelievable. Tittensor (1984) reports a feeling of being
crushed, and a feeling that the world itself is "an insane, chaotic place" (p. 9). "The
kids were dead. I felt dead myself. Darkness all around me, emptiness, the world
exposed as a shadow, an illusion" (p. 10).
With death, the givens of our external reality appear incongruent with our
emotional and existential experience. Reality not only fails to "gratify" our wishes
(from a Freudian perspective), is "narcissistically wounding" to our egos (from a
Kohutian)--it traumatically invalidates our very sense of being and groundedness.
Anger and hostility. Lindemann’s (1944) analysis of how bereaved individuals
are insensitive and hostile to their potential comforters, as well as the general
assumption (e.g., Bowlby, 1980; Parkes, 1987) that the only comfort the bereaved
wants, or rather demands, is return of the lost loved one, likewise ignore the
bereaved’s sense of existential crisis which Tittensor (1984) relates to a state of being
"enraged":
In my crazed and somehow enraged state I was screaming inwardly for the
one thing I could never be granted: to have the world as I had known it
restored to me. And at the same time I wanted to destroy the world that had
hurt me in this way: my mind kept filling with images of myself tearing at
walls, at buildings, and people, destroying, hurting, killing even. Mad,
unquestionably; but what alternative was there? (p. 16)
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Terrible loss in and of itself would seem sufficient to enrage one. It makes some
sense that in confronting the existential crisis of death one would, in Dylan Thomas’s
words, "rage, rage against the dying of the light." Yet, the literature seems to imply
that this anger is irrational and also unfair.
The above-mentioned account from Tittensor (1984), in fact, follows his
description of the behavior of a nonchalant funeral parlor employee. It describes that
one is enraged that the world goes on in a seemingly blase fashion when one’s own
world has come to an end~when the structure of life itself, by destructuring our loved
one’s life and our life, is revealed as cruel and absurd. And when the other or world
reflects indifference, denial, and/or trivialization of the death-acting as if nothing out
of the ordinary has happened— the bereaved may be goaded into "hostility." As
Tittensor (1984) indicates, the unequitable emotional response is matched by the
bereaved against the immensity of loss:
For the bereaved person looks at the world and sees it going its way as if
nothing had happened; as if the loved one had never died, never lived. And
no matter how hard he strives to be reasonable, he is filled with an anger that
must find its outlet (p. 61).
However, it is not only that an indifferent or nonchalant response underplays the
meaning or importance of a personally-felt death; it is that this neutrality likewise
ignores that for the griever meaning itself has become unhinged— there is a lack of
meaning, an inexplicability to the death, which, immense in its emotional
ramifications, is understated. This understatement may mirror the bereaved’s sense
that the world is an uncaring, empty, purposeless place and thus contribute to his or
her sense of existential crisis.
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The interconnection between researcher and subject is here significant, as
models of grief which strive toward neutrality and clinical objectivity, through their
apparent indifference, may interact with the griever’s responses. Also by appearing
to ignore their own response to death and loss, researchers may separate the meaning
of events from their factual description. Lindemann’s (1944) analysis of the
bereaved’s natural hostility is unsatisfying because this view neglects the greater
context in which the bereaved finds him or herself, including the context of any
relationship she or he is in, such as the relationship between researcher and subject.
Since the bereaved is the "object" of study, the role of the other (e.g.,
researcher, potential comforter, etc.) is not attended to in Lindemann’s (1944)
description. Potential comforters may show a lack of empathy by negating the
griever’s loss, and thereby also fail to show proper respect to the deceased. As
indicated earlier, there are many ways in which non-bereaved people can be
insensitive to the magnitude of the griever’s loss and her or his sense of existential
crisis. The bereaved’s hostility can be contrasted with her or his feeling of isolation
and ostracism:
Try as we might to see through the eyes of the world-the eyes the world
would have us see through~we cannot speak of it to anyone. What is there to
say? That we contemplate suicide. . . . then, a small wedge of light appears
under the door of our prison, and it is clear that it isn’t the actual loss that
makes us feel so insane, but the way others treat us. (Ericsson, 1993, p. 14)
The normal/abnormal dimension. Lindemann’s (1944) language and approach
set the stage for many of the apparently deeply-felt assumptions that echo throughout
the literature informing our ideas about health and pathology. As mentioned, one of
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the dimensions of chief interest to grief theorists is the normal/abnormal dimension,
and in general even "normal" grief has a tincture of abnormality or illness associated
with it (cf. Engel, 1961; Lindemann, 1944; Parkes, 1987), requiring some sort of
"cure." However, assumptions regarding issues of pathology, normalcy, disease,
progression, are so implicit in the literature that the reasoning behind them is blurred.
This is partially due to a history of using medical disease model language to describe
grief. The language used to address grief in Lindemann’s (1944) essay is, without
reservation, from a medical disease model perspective and therefore describes grief as
a disease. Lindemann’s choice of words (e.g., "pathognomonic," p. 142;
"convalescence," p. 143) clearly suggests that he regards grief itself as an abnormality
or disease. This thinking is echoed in the work of Engel (1961) and Averill (1968)
and even for one of the seemingly most compassionate of researchers (e.g., Parkes,
1987), grief represents a kind of disability needing to be fixed.
Meaning-making is a circulatory process, and embedded within terminology
are the assumptions that guide our theories and understandings. In Lindemann’s
(1944) study, words like "etiology," "prognosis," "course," "recovery," and even
"disease" inform our understanding of the experience of grief on many levels,
teaching us to think of grief as something concrete and medically treatable versus
something mental or spiritual, requiring or benefiting from another type of
intervention; teaching us to apply one model of time (with an emphasis on "course"
and "cure" or endpoint) to our perception of grief rather than another (with a here-
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and-now emphasis, for example, or a perception of the experience as simultaneous or
ongoing).
The categorization of "normal" is intrinsically related to stage models of grief
which stress a developmental model consisting of movement to hierarchialized stages
or states which are deemed as progressively more effective, sophisticated, and
desirable. It is clear, for instance, that in Kubler-Ross’ (1969) model that
"acceptance" or "resolution" are good, representing the highest level someone may
reach. "Denial" or non-acceptance of death is negatively valued, incomplete,
unresolved, even pathological, despite the fact that death is frequently denied in
Western society (cf. Gorer, 1965; Rando, 1984). Further, "normal," says Averill
(1968), is represented by stereotyped psychological and physiological reactions.
"Stereotype" means, as Webster’s (1984) informs us, "an unvarying form or pattern"
(pp. 1396-1397). Averill’s use of this descriptor emphasizes that (in the healthy
individual) grief is pretty much as invariable as biological functions such as breathing
or having one’s heart beat. The problem, as indicated earlier, is that there are only
general guidelines with regard to the timing of stages, and in practice, guidelines such
as those offered by the DSM-IH-R or DSM-IV, are unsatisfactory because reality is
too variable.
The construct of normal/abnormal also often centers around the individual
rather than around problems of the environment. Fowlkes (1991) addresses the
dichotomization of circumstance and individual in the diagnostic separation of
posttraumatic stress disorder from depression (and other sequelae) associated with
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bereavement. Posttraumatic stress disorder represents a disorder which is perceived
as due to circumstance and thus provides more socially acceptable reasons for
suffering than individual grief, in which the individual is viewed as suffering because
of internal flaws. This representation, Fowlkes argues, may contribute to less social
support for bereaved individuals than for individuals who have suffered a
posttraumatic stress disorder-inducing circumstance. Such a construction of
experience conforms to what Albee (1981) refers to as a defect model wherein most
problematic experiences in a person’s life are attributed to problems within himself or
herself. Efforts are thus directed at changing the person, and not the situation.
Therefore, in conclusion, it is clear that the tacitly accepted assumptions of
prevailing grief theory detract from forming a more accurate and less rigid conception
of actual grief experience. While the theories help organize a holding place with
which to view grief, it is necessary to see that the construction of universal-type
stages or phases and continuums of normality/abnormality is based on certain
presumptions, and does not represent truth itself. Because the linear, take-it-or-leave-
it (all or none) models- do not provide adequate explanation for the temporal or
relational aspect of grief, they need to be revised.
11/ I.e., the griever either "lets go" of the deceased and is considered
"healthy," or he or she "holds on" and is considered pathological.
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Chapter 3
Method
To remedy the deficiencies and counter the biases of current grief theory, I
have relied on a constructivist and postmodern, rather than positivist, knowledge
paradigm, as reflected in various domains (see, e.g., Beebe, Jaffe, & Lachmann,
1992; Cushman, 1990, 1991; Gergen & Gergen, 1988; Hoffman, 1991; Mitchell,
1988; Stolorow & Atwood, 1992) as a way of providing a different way of
understanding truth and knowledge. The postmodern or constructivist view, as
Mitchell (1993) notes, characterizes knowledge as
[PJerspectival, not incremental; constructed, not discovered; inevitably rooted
in a particular historical and cultural setting, not singular and additive,
thoroughly contextual, not universal and absolute, (p. 20).
This alternate metatheory provides some possible explanations for the inconsistencies
and lack of "fit" between present grief models and experience, and further helps to
underscore the complexity of relationship and time in grief. I have called upon a
postmodern or (de)constructionist perspective (Cixous, 1975/1980, 1976/1980;
Derrida, 1973, 1976, 1981, 1982; Grosz, 1989; Irigaray, 1974/1985, 1977/1980) in
order to destablilize or deconstruct certain positions on self-other, memory, and
emotion which fix our suppositions in rigid places, in order to facilitate the possibility
of developing alternate ideas. Part of enlisting this perspective has entailed not taking
for granted the suppositions I critiqued in Chapter 2 as basic to an understanding of
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grief (e.g., the supposition of, and valuing of, an autonomous self; the supposition of
the experience of time and memory as linear and somewhat concrete). In addition, I
have adopted an existential outlook in the sense that a focus on the ultimate givens,
specifically death and mortality, are fundamental in considering loss due to death. To
counter the medical model approach and tendency toward objectification of the
subject/patient which underlies much grief theory, alternate models of health/illness
were enlisted.
The present study departs from traditional research by giving a great deal of
consideration to subjective experience, and further departs by emphasizing primarily
my own experience. As noted, as my own experience and that of others I have
mentioned have been at odds with prevailing theory, I have used personal material
(primarily via written journals) to analyze and explore the temporal, relational, and
existential dimensions of grief with a view to uncovering an alternate pattern to that
proposed by "step" and "breaking bonds" approaches.
Finally, I have looked to bodies of knowledge which appear highly significant
to a theoretical understanding of grief but which have not been fully utilized in the
past, most particularly theoretical work on the nature of the self and relationship with
other, and empirical and theoretical study in the areas of memory, emotion, and
cognition. I have integrated relevant knowledge from these domains with an
interpretation of my own experience to explicate what I consider to be the paradoxical
nature of loss and grief, illuminating why grief may not always be experienced in
distinct, linear stages, but instead may feel to some like "waves," a spiral staircase,
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or like neverending oscillations. Below I will describe in detail how each of these
avenues of research was carried through, and how the proposed theoretical
formulation was tested.
Use of Subjective Material: Journals
I have drawn upon my own experience and to a lesser degree accounts from
others to provide a subjective, personal source for theorizing and to serve as a
complement, impetus, springboard, and touchstone to ideas and theories in areas such
as self, other, emotion and memory which have a bearing on grief. This subjective
component primarily concerns written journals I have maintained over the past five
years since my mother’s death, as well as on ongoing reflection in the form of memos
to myself. Additional material was provided through the use of others’ published
accounts in the form of autobiography, literature, anthropology, and clinical material.
As well as eliminating the gulf between researcher and subject, such material adds to
an understanding of the uniqueness and complexity of grief and in addition provides
for the development of vicarious experiences in the reader (Stake, 1995). Use of
personal material is only one aspect of this study, however. Research and theory in
other domains as well as present grief theory are also called upon in the development
of a new theory.
Rationale
A focus on individual, subjective experience has not been the keynote of a
positivist empirical epistemology which values objectivity and the ideal of the neutral
scientist-observer. Further, the use of diaries in research has been considered to have
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certain disadvantages. Speaking mostly to the quantitative uses of diary data-
gathering, Breakwell and Wood (1995) state, "Getting the respondent to tell you the
truth may be difficult. . . more importantly, you may never be able to ascertain
whether they did or not" (p. 296). Further, the fact of producing a diary may alter
behavior, thoughts, feelings, etc.
In contrast to an objectivist or positivist epistemology, the constructivist or
postmodern view takes as its premise that knowledge is not discovered but constructed
(Guba & Lincoln, 1982; Stake, 1995), suggesting that objectivity and neutrality are
not only impossible, but beside the point. This point of view would seem particularly
applicable to knowledge about humans as being human means existing in a realm of
meaning as well as in realms of organic and material reality (Polkinghome, 1988).
Josselson (1995) and Flax (1990) suggest that to study whole persons an
intersubjective and process-oriented epistemology is needed, and some feminist
researchers (e.g., Eisenstein, 1984; Griffiths, 1988; Keller, 1985) further assert that
exclusion of subjective experience is itself a distortion affected by masculine ways of
knowing privileging objectivity and technical control, and that "truth and knowledge
become distorted when feelings are not acknowledged" (Griffiths, 1988, p. 135).
In the above vein, the journal writing process calls to attention phenomenon of
veracity and meaning-making which are more to be appreciated than avoided.
Postmodern and constructivist thought is easier with the notion that complete
"veracity" or rather facticity might not be possible, and that in the process of living
we are always in the process of constructing and reconstructing reality. While stating
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that keeping a diary may be beneficial (and thus influential) in the developmental and
integrative capacities of the writer, Wiener and Rosenwald (1993) seem to
comprehend a more constructivist appreciation when they state, "Living one’s life and
recounting it are not distinct as reality and representation, but as two kinds of action-
re-reading as recollection; new construction as re-writing-both acts of the
imagination" (pp. 52-53). The past is contained within the present but shaped actively
by memory. And past, present, and even future (cf. Wiener & Rosenwald, 1993, p.
54, "anticipative memory") are all part of representation.
In the present case, I can definitely state that the act of writing is not just a
detailing of factual events or even of thoughts and emotions as they occurred, but
often includes a reflection on these— in short, what might be considered part of the
analytic process of the study. The journals are more than just the content of events,
but a process. Therefore, the criticism that journal-writing changes the experience is
somewhat circular when we consider that an individual is always in the act of
transforming or shaping her or his experience, although a journal contributes to this
process. In a sense the journal process may be reflective overall of a process which
uses memories and interpretations, past experience as well as fantasies of future ones,
to construct the present. Therefore, the fact that writing a journal may influence the
experience of what one is writing about should not be a reason for excluding this
writing from the understanding of the experience.
The benefits of using subjective experience is that this experience helps to
depict the "whole person" both intersubjectively and in terms of process (Flax, 1990;
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Josselson, 1995). The qualitative case study is, as Stake (1995) indicates, concerned
not with "nullifyfing] context" (p. 39) or treating uniqueness as "error," but rather
with elaborating on the uniqueness, complexity, and contextuality of phenomena.
And in a number of disciplines (see, e.g., Bruner, 1986, 1990; Geertz, 1973, 1983;
Rosaldo, 1989; Sarbin, 1986; Schafer, 1992), particularly anthropology, narrative or
storytelling is used to make sense out of being human. From these perspectives, the
inclusion of subjective experience would seem particularly valuable. Subjective
narrative provides a depth and richness to experience that "objective" or factual
description cannot. Further, as the anthropologist Rosaldo (1993) indicates in his
"Grief and a Headhunter’s Revenge," autobiographic material provides the researcher
with emotional information which is not available before he or she encounters
particular experiences firsthand. This is particularly true in situations of "force"
(Rosaldo, 1993) such as in the emotional force of a death. Before his wife’s
accidental fall off of a precipice during a field research expedition, Rosaldo writes,
"my life experience had not as yet provided the means to imagine the rage that can
come with devastating loss" (p. 4).
As Rosaldo (1993) also writes, of particular relevance to the "emotional force
of death" is "the subject’s position within a field of social relations" (p. 2)— i.e., his
or her relationship with the lost one. As I will also explore, one’s understanding of
grief is affected by one’s knowledge, experience, and maturity: Rosaldo notes "the
relative youth of field-workers who, for the most part, have not suffered serious
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losses and could have, for example, no personal knowledge of how devastating the
loss of a long-term partner can be for the survivor" (p. 9).
Journals as an avenue to subjective experience have the advantage of being
able to provide "thick" narrative descriptions (Geertz, 1973) about material that is not
only intimate, spontaneous, and rich, but temporally ordered (Breakwell & Wood,
1995). As Stake (1995) points out, the case study provides for the development of
vicarious experiences for the reader, and for Stake as well as others, subjectivity is
essential to understanding. Drawing on my own experience helped me to identify the
limitations of present theory, added to a complex understanding of the relational,
temporal and process dimensions of grief, and enabled me to focus on areas that have
been neglected, such as the experience of paradox, existential concerns regarding
mortality and loss, and spiritual issues.
Written journals call attention to important instances over time and, as case
study material, as Stake (1995) indicates, optimizes experiential understanding for the
reader, also allowing for the use of interpretation of that experience. While journal
writing is reflective, it also often occurs in the "heat" of an experience, and is then
able to provide a sense of the actual experience or a particular line of thinking about
that experience as it occurs. Journal sources are not only valuable because they
provide a chronological account of experience, but because they describe themes and
details which were important at the time of their experience but which may no longer
have the same importance to the experiencer in the here-and-now. Themes and
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details may change over time, but a diary record gives a sense of how they were
experienced or perceived at their inception, and how they change.
While using my own experience as a case study does not form the basis for
generalization, it provides a basis, as Stake (1995) indicates, to modify generalizations
and add to previous knowledge and understanding. Further, it provides a basis for
understanding the uniqueness of a single case. Although use of journals here applies
specifically to my own experience, what they reveal shows what is possible in grief.
Husserl (1913/1967) states in his General Introduction to Pure Phenomenology:
Whatever holds good for me personally, also holds good, as I know, for all
other men whom I find present in my world-about-me .... I understand and
take them as Ego-subjects, units like myself, and related to their natural
surroundings .... I apprehend the world-about-them and the world-about-me
objectively as one and the same world, which differs in each case only through
affecting consciousness differently .... For each, again, the fields of
perception and memory actually present are different, quite apart from the fact
that even that which is here intersubjectively known in common is known in
different ways, is differently apprehended .... Despite all this, we come to
understandings with our neighbors, and set up in common an objective spatio-
temporal fact-world as the world about us that is there fo r us all, and to which
we ourselves none the less belong, (pp. 94-95)
What Husserl is saying is that through how we ourselves feel and see things, we are
able to assume another is similar to us. Whatever our idiosyncratic perceptions and
ways of knowing, there is a kind of knowledge that is shared which allows us to
agree on certain "facts." There is further validity in the use of personal experiences
described above in that they correspond or fit in with important features and patterns
noted both by other theorists as well as with alternate notions of relational
development.
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Says Stake (1995), "The function of research is not necessarily to map and
conquer the world but to sophisticate the beholding of it" (p. 43). I argue for the
relevance and usefulness of my case material on the grounds that it will enhance
experiential understanding of the subject matter, that it eliminates the bifurcation
between researcher and subject which often interferes with an appreciation of context,
uniqueness, and complexity, and that it provides a window through which to tie
empirical and theoretical knowledge with practical and subjective understanding.
Method of Journal Analysis
The construction of the journals. I began journal writing about five and a half
years ago after my mother’s death, first because I needed and wanted to talk to her,
and then also to express my feelings and thoughts in general. Initially I had no idea I
would use the journals for a study, but I felt they were very important. I wrote the
journals without trying to impose any definite form, requirement of subject content,
specific time or place to be written, but as a means of expressing how I felt as freely
as possible in whatever way felt best. The journals therefore provide a sense of how
experiences were felt and thought of at the time of their occurrence, as well as how
they were reflected upon later. Although the mode of expression could vary (e.g.,
include prose, poetry, drawings, etc.), it was primarily verbal.
Entries vary in terms of length, content and time between writings. For a
period of approximately five years I wrote 23 journals of about 70 handwritten pages
each and computerized journal entries of about 359 single-spaced pages. Journals
were numbered according to date, so that when narrative illustrating categories or
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concepts were extracted from a journal, their context and location in the total
narrative could be identified by date and the number of the journal they appeared in.
Issue questions. In qualitative case study, Stake (1995) suggests beginning
with issues or issue questions as conceptual structure. Issue questions are used to
facilitate research and organize the study of a case, and in addition, are problematic.
In my early analysis of the literature, I engaged in what might resemble Douglass and
Moustakas’ (1985) conception of a heuristic inquiry, a form of phenomenology that
focuses on meaning and knowing through personal experience and intense self
exploration. The result of this exploration was that in Chapter 2, I was able to
demarcate several important and problematic issues in grief theory. First, that grief
may not follow a linear, finite pattern. Second, that the relationship with the lost
other may continue to play an important and dynamic relation in the bereaved’s life.
And third, that the dynamics of self, memory and emotion may explain why the
patterns put forth in the literature do not hold. In re-exploring and analyzing my
journal data, these are the primary issues I kept in mind by considering the following
topic questions:
1. What are the types of experiences, issues, themes involving or relevant to
grief?
2. How do these occur over time (only once? regularly? recur? with triggers
["anniversaries," etc.]?); what kinds of patterns emerge, if any?
3. What is the relationship with the dead loved person like; how, or does, this
change over time?
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4. What other areas, internal or external (e.g., memory, social support) affect
either grief or the relationship?
Further, in interpreting a span of approximately five years of journal material, I was
constantly asking: What is characteristic or unique to the experience being described;
what is the same or similar; what is different; how are these experiences the same or
different; and what is the impact of the environment and my own processing and
coping with the experience. The questions are broad in order to facilitate an open-
ended approach and thus not foreclose on a variety of possible patterns or instances.
Recursive process. As qualitative researchers (e.g., Stake, 1995; Strauss
Corbin, 1990; Tesch, 1990) note, data gathering and analysis are often done
concurrently, or recursively. Similarly, in the present project, tasks that might seem
like "data gathering" (e..g,. identifying the concepts, themes, and categories to be
analyzed) could also be seen as part of the entire analytical process. In a larger
sense, too, self-reflection and use of journal material oscillated with inquiry into other
bodies of knowledge in addition to grief theory and research to provide understanding
of the patterns or differences in patterns and relationship I was observing. Therefore,
analysis of personal experience occurred recursively with exploration of other data
bases (e.g., theories) to help explain the nature of grief and the bereaved’s
relationship with the deceased.
Identifying and Interpreting Categories. Concepts. Themes. In accordance
with Stake’s (1995) case study approach, the first step in analyzing the journals was to
begin picking out themes and categories from the material, keeping the issue questions
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in mind. Stake describes both direct interpretation of the individual instance and
categorical aggregation as a way of analyzing meaning. By looking at individual
instances of themes of grief and relationship and by seeing how these themes
developed, recurred, or changed over time, I used both these procedures in
interpreting my personal journals. Such a process could be compared with finding
"meaning units" in phenomenological research which Giorgi (1989) describes as being
"determined whenever the researcher experiences a significant shift in meaning in the
description being analyzed" (p. 101). In this process of interpretation, there is a
search for meaning and patterns of correspondence (Stake, 1995). Because this study
relies mainly on my personal experience, the themes and patterns I identify are not
necessarily stereotypical or generalizable in a broad sense, but they speak to the
possible uniqueness and complexity of individual experience.
Because one of the goals of the study was to explicate how grief is experienced
over time and what patterns might emerge, I decided it was important to consider the
journals in chronological sequence, identifying themes as they emerged over time. I
began by reading the journals over from the time I began keeping a journal after my
mother’s death in December 1990, through 1995, identifying and labeling themes and
concepts relating to grief and to my mother, noting either an example of the text or
the relevant journal and page number to find the supporting text. In addition, I noted
shifts, similarities, differences, and recurrences in the experience of grief and the
relationship as the journals continued. Further, I recorded the general and more
specific contexts surrounding the "action" of the journal, such as moving, money
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difficulties, job pressure, new relationships, etc., which pertain to overall experience
and as such might bear on my individual experience of grief.
Instead of grouping occurrences to form categories divorced from their
temporal context, I was more concerned to explicate the basic "story" or themes of a
particular time frame before a major shift occurred (for instance, a shift from grief
and grief-related depression to growing hopefulness in the second half of the second
year of bereavement). These shifts were often not as clear-cut as they would be if
they involved a dramatic change from one discrete state to another, but rather
represented changes or different pattemings of some aspects of grief with others
continuing roughly the same. My intent was therefore to get a general sense of the
"story" or "picture" which seemed to emerge clustered around a certain span of
journal entries and to look for variations, similarities, and differences.
Further, I noted and interpreted aspects of the journals and the journal-keeping
process (as well as the analytical process) which I considered to be
metacommunicative. An example of this is that the journals change form after a
certain point (about five months after her death), when instead of being primarily
addressed to my dead mother, they are addressed more and more to myself; they then
fluctuate between being mixed (addressed sometimes to my mother and sometimes to
myself), and being addressed to myself. General movements in overall processing
such as the recollection of different types of memories (e.g., "big" memories, such as
those relating to trauma) versus, for instance, "small" memories (relating to everyday
events) were noted. Another example of meta-events considered is my response to
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the process of examining and thematizing the journals. Particularly in reading and
interpreting the earlier journals and in prolonged sessions of analyzing a range of
journals, despite my feeling that the journals represented valuable and evocative
material, I often felt a strong reluctance, difficulty, and at times grief-related
responses of a very particular kind, responses which clearly resemble a traumatic
response. Such process notes add to an understanding of both grief and the
predicament of researching grief. The process of synthesizing and selecting elements
form the journals involved, at times, reliving in a kind of hologram form, certain
very emblematic or prototypal aspects of the experience (e.g., a sense of shock and
sadness/depression), shedding light on how memory may re-trigger experience. In
terms of research implications, this is especially salient if the researcher him or
herself has experienced death, but even when the subject is not the researcher, the
above process sheds light on the experience of the subject and how being a subject
affects or is affected by grief.
Finally, to illustrate the development of the theory and enhance the reader’s
"vicarious experience" (Stake, 1995), I culled patterns and single instances which I
found most pertinent to an understanding of the experience of grief over time and in
relationship. A portion of these observations were selected for Chapter 4.
The process of selection involved summarizing and resummarizing elements
and themes of experience. For practical reasons, the narrative presented can only
represent "broad strokes" or trends and cannot delve into all the intricacies of my
experience. However, in selecting examples I have chosen those which might shade
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in the meanings of the most pertinent themes and elucidate their depth and
complexity. For instance, disbelief when coupled with acceptance of the death is a
very different version of disbelief than what we think of as part of an original shock
on the immediate confrontation with death. A recurring sense of yearning and
searching in multiple symbolic forms after the other is definitively and despairingly
accepted as irrevocably gone, also seems to be different from a "one-shot" phase or
stage in which the bereaved "gets over" his or her yearning and ceases to search.
Context. Because knowledge and experience are contextual, it is necessary to
articulate my own perspective and the circumstances at the time of my mother,
Ruthy’s death. I consider our relationship was close and positive. Further, it was a
relationship that evolved over a long period of time. As both mother-daughter and
mature friends, we had had a chance to share our personalities and experiences very
fully and to know each other in a variety of ways.
The circumstances leading to her death were traumatic and necessarily play a
role in my response to her loss. Ruthy’s medical condition evolved suddenly and
unexpectedly in September 1990. After a near-death experience following a
recommended but elective procedure and two more hospitalizations that had quasi-
hopeful outcomes, she died at the end of December.
My grief therefore includes traumatization at (1) the initial, unexpected chain
of events beginning in September; the fact that after discussing Ruthy’s release and
future plans with her only shortly before her operation, I was confronted with her
being almost dead and in a terminal condition for two and a half months; (2) my
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experience and assessment that Ruthy’s terminal condition was painfully expedited due
to medical mistreatment and misjudgment; and (3) the painfully ambiguous position of
this last month, both expecting and not expecting death.
The immediate context of death is that we were celebrating my sister Susan’s
birthday with another friend at our kitchen table when after exclaiming how delicious
the cake was, Ruthy collapsed, apparently with a stroke. After only a second or two
she seemed to be entering death and unconsciousness, although the paramedics
attempted resuscitation.
Other Bodies of Knowledge
A diversity of knowledge bases was utilized including: prevailing grief theory;
psychoanalytic, relational, cognitive and constructivist models of self and other;
anthropological and crosscultural accounts involving death, self, other, memory, time,
emotion; autobiographical and other subjective accounts, as mentioned above;
research concerning memory, emotion, and cognition; and some grief research as it
concerns categories and circumstances of grief. The goal was to integrate the
contributions of these various bodies of knowledge with the data from personal
experience to arrive at a more holistic and context-sensitive formulation of the
possibilities of grief experience. Aside from prevailing approaches, which obviously
represent a multitude of useful observations which can be integrated into new theory,
each knowledge base was selected for its very likely contribution to the development
of theory for the reasons I will detail below. Autobiographical, clinical, and
anthropological accounts are interwoven with the epistemological framework of the
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study so that all areas are considered in light of a constructivist and existential
interpretation.
Grief Research
The prominent grief models described in Chapter 2 are present throughout this
development as providing material and viewpoints with which to consider the
experience of grief. Present understandings of how a griever’s particular relationship
with the dead person (e.g., as parent, spouse, child) and how differing circumstances
of the death (e.g., accident, "natural," suicide, sudden, expected, etc.) might affect
the bereaved, have contributed most positively to grief theory in illuminating the
variability of grief response and how the context of both the relationship and the death
are crucial to understanding grief. Some of these were considered to be particularly
relevant to a model revising the self-other relationship and temporal dimensions of
grief.
Theories and Research Involving Self and Other
As evident, an understanding of relationship is essential to a study of grief in
that without attachment loss would not be possible (Bowlby, 1980; Parkes, 1987).
Indeed, it would not be an issue since, as Freud (1917/1957) indicates, if the
relationship were not of great significance, "reinforced by a thousand links" (p. 256),
then its loss would not cause either mourning or melancholia. Relationship does not
seem to be a static or objective entity which disappears as soon as one of its
participants leaves or even dies, and there is reason to believe that the individual
constitutes the relationship as part of the self. The interplay between a person’s
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interpersonal world and her or his internal world, or "self," is addressed both by
cognitive models which view the individual as having a hand in creating his or her
assumptive world or personal constructs (Kelly, 1955; Parkes, 1971, 1987), as well as
by psychodynamic models concerned with a relational construction of reality
(Fairbaim, 1952; Kohut, 1984; Mitchell, 1988; Sullivan, 1953).
The autonomous, self-sufficient individual suggested by "breaking bonds"
(Stroebe et al., 1992) theories is only one possible model of self. Other constructions
(such as the self as multiplicitous and dialogical— see, e.g., Bakhtin, 1929/1973;
Hermans et al., 1992; Modell, 1993) lend themselves to a different understanding of
the griever and her or his relationship with the deceased. In addition, social
constructivist understandings (Cushman, 1990, 1991; Gergen & Gergen, 1988), by
underscoring the social, cultural, economic and political situatedness or context of
theories, point to the possibility of greater context-specific variability for any
individual griever.
As the above is essential in formulating a more complete and accurate theory
of grief, I have drawn primarily upon the contributions of researchers and theorists
concerned with the self-other relationship, including the keystone theorists already
discussed (e.g., Bowlby, 1980; Freud, 1917/1959) and those utilizing relational,
object relations, self psychology, and social constructivist approaches (e.g., Beebe,
Jaffe, & Lachmann, 1992; Bollas, 1987; Cushman, 1990, 1991; Fairbaim, 1952;
Gergen & Gergen, 1988; Hermans et al., 1992; Hoffman, 1991; Kohut, 1984;
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Mitchell, 1988; Modell, 1993; Stolorow & Atwood, 1992; Winnicott, 1951, 1952,
1956, 1960, 1965, 1971).
Exploration of Paradox
Synthesizing my experience with the relational and constructivist views of self
and other mentioned above, I discuss and explicate the paradoxical nature of loss and
of grief--the fact that grief is not always experienced in distinct, linear stages, and in
fact may feel to some like "waves," a spiral staircase, neverending, oscillations or
paradoxes. I examine the nature of paradox in the self-other relationship in time,
including such paradoxes as belief and disbelief, acceptance and non-acceptance, and-
less talked about in the grief literature--the paradox of death, the paradox of self (self
as continuous as well as coterminous with consciousness), the paradox of other (other
as both absent and present), and the paradox of time (as both eternal and finite).
Memory
As I indicated earlier, memory is an important aspect in either preserving or
negating the relationship with the deceased, and also an important way in which the
griever locates him or herself in time. Further, the experience of trauma may be
related to how someone remembers, or does not remember (Christianson, 1984;
Christianson & Loftus, 1987, 1991; Christianson & Nilsson, 1984, LeDoux, 1992).
Recent developments in the memory, particularly different views of what memory is
(e.g., emotional memory; reconstructed memory), are used to augment understanding
of long-term grief processes and may help to explain some of griefs variations.
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Cognition/Emotion: Consciousness
As discussed in Chapter 1, theories which emphasize grief as a finite,
transitory experience are often based on a model which sees only biology and culture
(not the individual) shaping grief experience, and emotion itself is seen as a
transitory, bounded experience. In the service of explaining the multilayered, longer
term experiences of grief, I looked to other research which suggests more
permeability or interrelatedness between the areas of emotion, memory, cognition,
and even sensation and perception, and which stress tacit or unconscious ways of
knowing as well as more conscious ones (see, e.g., Buck, 1991; Lazarus, 1982,
1984; LeDoux, 1992; Zajonc, 1980, 1984). I found Lazarus’ (1991) conception of
the boundaries of emotional/ adaptational encounters also particularly relevant.
Incorporating some of the understandings of this literature into my proposed model
has, I believe, shed light on the complex and ongoing temporal aspect of grief which
current theories do not address.
Process of Developing the Proposed Theory
Although interpretations germinating from this study are presented in Chapter
5 in a roughly linear sequence for the convenience of the reader, the process of
arriving at these ideas was by no means linear. Instead, the method of arriving at an
alternate model of grief represented a back and forth movement between personal,
biographical, empirical, and theoretical sources which continued throughout
development of the proposed theory.
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A large part of this process has involved exploring in depth how the
constitution of the self-other relationship might explain how the other could and might
persist after death, and how the relationship with the other is constituted. When I
noticed the temporal sequence of grief-ful feelings was not only not linear but not
cyclical, corresponding more to an uneven, nonredundant oscillation of response than
a straightforward linear sequence, I tried to understand what about the nature of the
relationship and of its loss would account for this oscillation. As there is a seemingly
paradoxical oscillation in certain processes and themes of grief (e.g., belief and
disbelief, yearning and despair), I noted there is also a paradox to human
experiencing in the situation of death and loss itself. In addition, there seems to be an
oscillating kind of intersubjective movement beginning even with infant relationships
(see, e.g., Beebe & Lachman, 1988, 1994; Beebe & Stolorow, 1995).
To account for the paradoxical experience of loss, I examined both the
paradoxes related to development (e.g., development of the dialogical self, the
apprehension of absence and presence, symbolization) and those related to existential
givens (e.g., time, mortality), as well as their interaction (e.g., in the form of
memory). In regards to development, I particularly explored the concepts of object
conservation, permanence, and constancy through the works of Piaget (1937/1954,
1951), Bowlby (1980), as well as other influential theorists (e.g., Furman, 1974;
Hartmann, 1952/1964; Mahler et al., 1975; McDevitt, 1975; Pine, 1974) to gain a
developmental basis for understanding how the disappearance and loss of persons,
physically and psychically, affect the loser. In this I reiterated the importance of
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symbolization to loss and reconstruction of the lost other in order to emphasize the
presence of the lost other and the fact of this presence as a dynamic rather than a
static entity. I especially invoked object relations and constructivist theorists to
grapple with the experience of the presence of the lost other as a dynamic presence
rather than a static entity.
Considering the oscillating patterns noted above led to an insight that a
dialogical or multiplicitous self would better account for the relationship with the dead
other than the more traditional, unitary self and would also account for the
paradoxical sense of both presence and absence, acceptance and despair which may
itself oscillate, disappearing and recurring. The issues of an ongoing, dialogical,
remembered and reconstructed, dynamic relationship between self and other over
time, and the confrontation with death, fragmenting and annihilating self and other,
are two of the essential issues the griever has to deal with. Together, these issues
create a paradox of absence and presence, a paradox of loss, and this paradox is
reflected in an oscillating or partial recurrence of grief experience over time.
Further, empirical and theoretical material in the domains of emotion, cognition and
memory support that while no experience is ever repeated exactly, the sense of
present time and self are infused with a sense of the other both as remembered and as
constructed. This "infusion" and reconstruction of time and of the other creates a
more malleable set of temporal boundaries for emotional experiencing of loss.
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Validation
In order to "test" or validate the proposed approach, I examined it in regard to
several case studies drawn from the grief literature and my own clinical experience.
In Chapter 6, I present vignettes of bereaved individuals, analyzing their situations in
terms of the proposed theory to verify whether this approach does in fact aid in
understanding their grief experiences. This comparative theoretical explication will
provide the reader with a sense of the aptness and applicability of the suggested
approach and will necessarily consider issues of individual and circumstantial
variability as well as issues of health and pathology. The bases to be used here for
corroboration of the theory are the evaluation of "fit" and explainability.
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Chapter 4
A Personal Account of Loss
The aim of this and the following chapter is to begin to develop a theory that
can explain why grief in general may be "fluid and messy"- rather than unvarying
and orderly, why it may often remain "unfinished" or "unresolved," and how it is that
the bereaved’s relationship with the deceased may continue after death. To begin, in
this chapter I will present a selection of personal experience, chiefly my own, to
uncover how themes of loss and grief may emerge or transmute over time, and will
focus on patterns and themes that appear most meaningful, prominent, frequent, or
enduring.
As indicated, I have relied largely on personal journals written over a time
span of about five years. Building on the discussion presented in Chapter 2, I here
specifically call attention to:
1. The difference between acute or early experience and later experience;
2. The imbrication of surrounding trauma and the trauma relating to death as
a fact of loss;
3. The recurrence (or discontinuation) of similar types of response, and the
connection between earlier and later responses. Of particular interest are the themes
\J To borrow a phrase from Thelen and Smith (1994, p. 314), who apply it to
physiological and embryological development.
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of shock, disbelief, and hope; belief, acceptance, and despair; as well as missing,
yearning, searching, and "finding." Also implicated are self-other concerns such as
love and apprehension and various forms of dialogical interaction related to:
4. The nature of the relationship with the dead loved one, how this
relationship persists and changes, and its connection with the self of the griever.
Examples from the journals will be referred to in the present tense.
Some Themes and Patterns in a Personal Account of Loss
Contrary to his expectations, C.S. Lewis (1961) found that his grief didn’t
seem to have a real ending point, unless he imposed one, and that it occurred as more
of a process than a state. The poet Hillman (1992) likewise describes being
"baffled," as she looked for her dead friend and mentor,
. . . between the rows of books, between
griefs "stages"—
they lied, of course; grief has no stages— (p. 39)
Besides its painfulness, what stands out most about grief is that it does not seem to
follow a predictable pattern, except that generally the griever learns to cope with the
loss better as time progresses. When I reflected upon my own grief and examined my
journals written over a period of five and half years for distinctive qualities and
themes, shifts or patterns that emerged over time, the stage/phase, or "step,"
metaphor seemed neither fitting nor accurate. Since many of the shifts in experience
took a long time to occur and since qualities which had changed could reemerge in
somewhat different form later, it seemed problematic to say that a certain theme or
experience was in fact "over." Instead of discrete phases or stages which appeared
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and disappeared, the experiences often seemed to "run into" one another or recur.
Also, different levels or types of themes deemed typical of grief (e.g., shock, despair)
and combinations of these, continued to emerge. Instead of a final "resolution," there
seemed a set of contradictions or paradoxes.
On the other hand, the journals revealed some sort of process of change which
gave a unique "flavor" or atmosphere to certain periods of my experience,
differentiating them from others, and a development which has helped to temper the
frequency and intensity of the painfulness of grief. Along with these changes, the
journals indicate a continued transformation in my relationship with my mother, as
well as my experience and relationship with myself.
Perhaps the most inclusive concept to describe griefs distinctiveness is pain, a
pain of ultimate and irrevocable loss which resembles a psychic hole which "nothing
but the width and depth of vast eternity" (Dickens, 1846-1848/1963, p. 274) can fill
up, a pain which includes the hopeless yearning and despair described so well by
Bowlby (1980), the anxiety, agitation, somatic and behavioral distress depicted by
Lindemann (1944), and the utter dejection characterized by Freud (1917/1957). As
mentioned, the bereaved may also feel fear, panic, sadness, anger, helplessness, guilt
and despair, a host of ailments, difficulties thinking, making decisions and relating
with others, problems sleeping, eating and working, and generally feeling "crazy"
(Clayton, Halikes, & Maurice 1971; Lindemann, 1944; Marris, 1968; Parkes, 1987;
Parkes & Weiss, 1983; Rando, 1984; Raphael, 1983; Tatelbaum, 1980). However,
these indications in themselves would not define grief if they did not include the sense
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of irrevocable loss, hopeless yearning, and irreconcilability to the loss which, as
Tittensor (1984) conveys, makes the bereaved feel mad and the world seem inhuman.
Life seemed smashed, splintered, People phoned, relatives called in. I spoke
to them all, but what did I say? There was nothing to be said. I drank and
drank to no effect, one moment in tears, the next cursing in volent anger,
hurling my glass at the wall. Real grief is madness: the everyday world is
not an adequate context for the uncontrollable, inhuman intensity of feeling.
(p. 15)
Most of the above features are in some sense accounted for by current stage/phase
formulations. Important exceptions include the griever’s existential sense of loss,
anxiety, rage, and confrontation with death-that which makes the bereaved feel mad
and the world seem inhuman. Also left out is the griever’s concern for the lost other,
which is different from a sheer "preoccupation with the image of the deceased": The
bereaved is generally not only concerned with her or his own safety, roles, yearning
and loss, or fear of annihilation, but with the fate of the lost other.
As for a patterning of this pain and a determination of when, how, or if it
ends, in a broad sense, the aspects of my experience which most agree with the
itinerary of prevailing theory concern the immediate and early response to loss, what
we might also refer to as an acute or traumatic condition. It is early experience that
stage/phase models underscore, attesting that this experience is all there is to grief,
after which it ends. Although, therefore, themes as are assigned to certain "stages"
or "phases," such as shock, yearning, searching, anger, despair, acceptance,
reorganization, did occur in my own case, and occurred within the first six months of
loss, these themes did not occur linearly or discretely and reemerged again after they
were "done." They were perhaps, on the other hand, most marked or recognizable to
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an outsider as they occurred close together in the early months of bereavement and so
stand out as distinctive.
While "immediate" response has to do with initial discovery of the death and
the bereaved’s reaction, setting a time frame for the "early" and acute condition of the
bereaved is very difficult, first, because individual circumstances and responses vary,
and second, because acutely fe lt responses to the loss may recur long after the loss.
As I will describe, later traumatic responses have some qualitative differences in that
the experiencer has a memory of earlier such responses as well as the situations that
elicited them and memories of how she or he experienced and coped with these
responses, all of which make later experiences different from earlier ones when the
loss is still new, highly unintegrated, and traumatic. At the same time, later
responses seem to incorporate many earlier ones so that the similarity, or connection,
between responses stands out.
Any attempt to define "early" is necessarily provisional as what individuals
(and cultures) consider a short or long span of temporal experience differs.
Therefore, one may hear, "It has only been a year since her husband died," or
alternately, "It’s been more than a year." In trying to describe my own experience, I
will define "early" here as the period of time after my mother’s death when the fact
of death and of life going on seemed abnormal and strange almost every day, when
her loss was felt acutely either almost all the time, or so acutely and painfully that my
grief was "fresh" and it seemed like I would never not feel such terrible pain.
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As indicated earlier, one of the chief problems with current grief theory comes
from not differentiating the acute or traumatic aspects of grief, which are very
apparent in the immediate and early responses, from later and longer-term responses.
The trauma of death and the trauma preceding it are necessarily entangled in my
grief, as the threat of death in the hospital and the "road" to death are traumatizing
particularly because they are related to death. On the one hand, we could say that all
death is traumatic at a basic existential level, representing the annihilation of another
human being, and is especially traumatic if we care deeply about the person who has
died. Grief, particularly early grief, is partially a response to trauma. However,
grief is often imbricated with responses to the additionally traumatizing circumstances
of death.
Although the trauma of Ruthy’s surgery and almost dying in the hospital are a
profoundly painful and pervasive backdrop, it seems that in the beginning, my
conscious experience is focused primarily on the issue of death itself, the trauma of
loss and Ruthy’s disappearance from the world. The trauma of death itself takes
immediate precedence, possibly because the trauma of the hospital and what led up to
her death are too horrifying to consider in detail when joined with the trauma of
death, but also because death marks the end of hope and the struggle to erase or undo
the trauma. Contrary to Bowlby’s (1980) rather blanketing assertion regarding the
persistence of hope until reality quenches it completely, in a very basic sense, at the
moment of death, hope also seems to die. Yet, as I will illustrate, this is not clear-
cut as various kinds or levels of hope and despair, belief and disbelief, acceptance and
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refusal to accept, continue to manifest themselves from the beginning of bereavement
to a long time (at least five years in my experience) afterward. And although one of
my immediate experiences is of disbelief, even early on this disbelief and other
experiences are more multileveled and intertwined with other experiences than
stage/phase theories suggest. Therefore, in my first journal entry, which begins
several days after her death as a letter to Ruthy, I write of being struck with
emptiness and desolation, "lost grieved shocked," "bereft," "despairing-sad-missing
you." The death seems incomprehensible, and there is a sense of a terrible
separation--"a door has closed." It is the trauma of the immediate context of death-
the unexpected finale and the day leading up to it— that stands out in primary relief.
Although I have no journal data for the first several days after Ruthy’s death, I
remember the extreme sense of emptiness and loss, the horror, desolation, sadness
and shock I experienced almost immediately after. There is an immediate change in
so-called "patterns of conduct" (Lindemann, 1944), which existentially no longer
make any sense and seem emotionally insupportable. Therefore, after going to the
emergency room where we are assured she is dead, sitting with her body as long as
the nurse will allow us, my sister and I along with two friends walk the streets most
of the night, as if we are searching for something we know we will not find, as if the
> *
world were empty and there is no point in going anywhere. Although perhaps more
controlled than some of Lindemann’s (1944) subjects, we are agitated and despairing
and proceed apparently "aimlessly," yet, as I mentioned in Chapter 2 in relation to
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Tittensor’s (1984) observations, this aimless, disorganized, agitated behavior has an
"aim" or focus in the cardinal existential realization that final loss exists.
However, even as we are horrified, shocked, and hopelessly despairing after
Ruthy’s death, it is clear that my sister and I must have "believed" in the death at this
early point, or we would not have left Ruthy’s body in the emergency room to be
taken to the morgue. We must have believed it cognitively even after Ruthy collapsed
at our dining room table, because Susan began screaming hysterically and when after
about fifteen minutes the paramedics had not arrived, she screamed into the phone
that Ruthy was dying. I must have "known" in a certain way as the paramedics tried
to revive her that there was a strong possibility of death, fearing the effects of a
stroke, I prayed the "best" outcome would befall her, even if that meant death.
We were horror-stricken that "the inevitable" had happened and happened so
suddenly. The world seemed terribly unreal and empty. And in terms of "belief" in
death, life seemed so horrible and empty and unreal precisely because Ruthy was
certainly gone. From my own experience, it would seem that either disbelief follows
belief, or that they occur in tandem and in different forms, for while we seemed to
believe in the death, at the same time we could not believe it. As Tatelbaum (1980)
puts it,
The death of a loved one is always unbelievable. We do not want the death to
be true. It is much the same as living out a nightmare, for the fact of death
feels unreal and impossible, (p. 25)
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Therefore, a few days after the death I write that the death seems "incomprehensible, ”
"I can’t believe it," "Why now?" "I can’t make sense of it," although certainly I
"know" the physical or medical reason and fact of death.
Not only are disbelief and belief in the death muddled, but despair, sadness,
shock, horror, missing, and both longing for and recognizing the impossibility of
recovering the lost one, all are here present in the first few days of loss, and they
continue to emerge.
My "patterns" the following day and week continued to show deviation in my
inability to sit and eat at my own dining room table, feeling the newness and horror
of the loss, going down the street to McDonald’s every morning rather than make
coffee in the kitchen, which would remind me of Ruthy. Yet, even with these
deviations there was still an attempt to go on with life, and to find, accrue, and assign
meaning and explanation. My first tactic was to "go on" and "do the right thing,"
and as Parkes (1987) and Tittensor’s (1984) experience indicates, to survive initially I
had a sense of going somewhat on "automatic" in order to take care of funeral
arrangements and the daily demands of life. "Going on automatic" can be construed
as a kind of shock reaction or dealing with trauma by buffering reality. As explored
earlier, shock may be conceived as having several meanings, including disbelief,
horror, cognitive and emotional numbness, which may exist at different levels and at
different times in the grief experience. Inability to formulate or integrate traumatic
experience, and protecting oneself by such means as denial, splitting, amnesia,
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derealization and depersonalization is one aspect of the bereaved’s protecting him or
herself from the horror of trauma.
On the other hand, being only too aware of the existential horror of death
contributes, in "going automatic," to what I consider a kind of "double" state. The
reality of loss is at odds with the reality that remains. This creates a sense of
doubling wherein one is able to participate, non-fully, in various aspects of reality in
which one is called upon to act, and at the same time maintain other realities which
are not necessarily acted upon. Instead of being unconscious of this "double" reality,
the griever is aware and finds the "facts" of "reality" unreal. Reality requires a
certain behavior that seems emotionally impossible. Thus, the griever may go to
work, prepare funeral arrangements, etc., but as Tittensor (1984) indicates, but there
is always the underlying question, how could you be doing these things? These are
"impossible things, but you do them" (Tittensor, 1984, p. 19). That "life goes on,"
as Tittensor points out-ants crawl, birds sing and children laugh— seems to belie the
reality of loss.
In the face of the shock, horror, and sorrow of Ruthy’s death, in the early
weeks it seemed constantly necessary to curtail the greater existential picture and to
focus on the small, minute by minute details of going on. The world seemed
"splintered," as Tittensor says, and I felt inconsolable, unbelievable loss, hopeless,
despairing, wondering what the point was in going on. Yet somehow I believed (or
rather decided to assert while deferring a scrutiny into the "truth" of this assertion)
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that the point was just to go on. In order to continue, I felt it was necessary to stick
to this point almost mechanically.
"Finding the right thing" to do was a key initial concern, both as a strategy for
going on with life, as well as an example of my concern from the beginning for
Ruthy’s well-being, both in a spiritual and physical sense, and a concern that my
love, respect, and appreciation, as well as grief and loss, should be adequately shown
and expressed. Part of the "right thing," for instance, involved making the funeral
arrangements, deciding on cremation, calling my mother’s old friend, Y., finding a
special urn and trying to create a ritual which would give voice to our family’s
lament. Although theorists generally mention a "preoccupation with thoughts of the
deceased" as occurring in early bereavement, the thoughts described usually have to
do with loss and missing and do not consider the bereaved’s concern with the welfare
of the other who has just died. If the relationship is close, and as in my case there
was some medical/health problem that engaged the bereaved’s concern and care prior
to the death, then it does not seem likely that such care and concern would simply
disappear with the other’s last breath. In the beginning of bereavement, I was not
only concerned with loss but with Ruthy’s well-being. My thoughts and feelings are
still "with" her. In the first diary entry (and interspersing the journals), addressed
directly to Ruthy, there is a significant amount of affirming of the relationship and
love, wishing for Ruthy’s well-being, asking (as well as imagining) and accepting her
forgiveness, as well as expressions of appreciation. In the early period, I felt regret
about the circumstances immediately preceding her death (i.e., I wish I could have
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been more attentive and more aware that particular day), and attempted to console
myself with prayers not only for connecting and reuniting, but for Ruthy’s well-being,
and knowing that she would forgive me for any shortcomings.
On the one hand, I noticed debilitating sorrow, shock, horror and sadness at
the loss, including a sense of emptiness and unreality, but also the sense of belief that
the loss had occurred. There were also attempts at functioning. While anger arose, I
seem to remember that the anger at the doctors who I believed had precipitated
Ruthy’s death still did not emerge as largely immediately. What did emerge was
anger specifically at those who seemed to deny or diminish my loss or my grief, or
whom I perceived as showing disrespect to the memory of my mother (only two such
incidents occurring in the first month). Like Tittensor (1984), my brother and sister
were appalled with anger at the nonchalance— even joviality!— of the funeral parlor
employee, and sat apart, bridling as I carried out the "transaction." The world
seemed like a meaningless, stupid, abrasive, and uncaring place.
With the first "letter" and quite often afterwards, the journal reads somewhat
like a traditional lament. There is in this, overall, a desire to communicate. While
feeling the loss acutely and not knowing "how to go on living," my primary concern
is still for Ruthy’s welfare and well-being on her "journey" or in the "next world," as
well as for an ongoing sense of spiritual connection:
I pray that our souls and spirits intermingle. . . . I pray th a t. . . only good
and beautiful things happen to you. I pray that we will be reunited. I pray for
your good journey . . .
There is regret for the past:
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I wish I could have comforted you or helped you more. I wish you didn’t
suffer. I wish I had made life easier and better.
Although these communications might seem to indicate a non-acceptance in the death,
I acknowledge,
This all sounds ridiculous— I just wish you were here so I could talk to vou
and listen to y o u and show vou how much I love vou.
As the first journal entry goes on, deeper levels of "despairing-sad-missing you-"
surface, as well as disbelief and regrets.
I can’t believe it. Somehow I can’t believe it. Although I know we talked
about it, Ruthy— I still can’t believe it’s happened. I still see you, imagine
you, miss you . . .
There is a poignant sense of desolation and strangeness of loss:
I’m not sure how to go on living without vou. The shopping list is still on the
table-and a hundred other things .... medicine, glasses, coffee, lamp- pencil
holder, knick knacks - remind me of you you - and how much I miss vou and
long for you, and grieve what has happened.
From this account, "shock and disbelief" (or being "stunned") cannot, by themselves,
comprise the first "stage" of grief because they are bound up with other important
themes: the horror of emptiness and sadness or depression of loss. And further,
different types or aspects of belief and disbelief are entangled from the beginning and
continue to reemerge. Once again, in the same entry as there is "disbelief," there is
obviously some belief, hence prayers for welfare in the other world, and a sense of
tremendous separation along with tremendous longing and a sense of uncanniness
about this separation. Her things are still there; but she is gone.
A door has closed . . . and no one will let us inside.
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Although it was "comprehensible" to me cognitively, and although on some level it
must have been "acceptable," since during those last moments I prayed to God for
whatever outcome would be best, on another level I cannot believe it or accept it.
It’s still a mystery to me— I can’t understand- Why now? why aren’t you
sitting here now and me fixing you dinner? Or reading, or talking, or having
tea? Why aren’t you in your room resting— smiling at me when I come
in . . . . WHY? Why aren’t you setting up your hair? Why is your forehead
cold? Are you smiling? Do your eyes see anything. . . . And why can’t
Susan and I do more for you? and Why can’t we spend more time together?
That the "ordinary facts" of life— such as reading, talking or drinking tea-go on, and
someone beloved is dead, does not make emotional sense. We may "know" death,
and yet what is inexplicable is how someone who means so much to one, who is felt
as a part of oneself, can be "taken away," can disappear. This is a pivotal existential-
relational issue which returns again and again. In addition, as I indicated in Chapter
2, there is an existential sense of horror and unreality to loss because losing an
important beloved other "unhinges" both our sense of self and world. As mentioned
in Chapter 2, this sense of unreality has to do with an existential shock and horror.
The very idea of "normality," as Tittensor (1984) conveys, is challenged by the death
of a loved one, as nothing seems like it will ever be normal again. Bouts of feeling a
sense of unreality extend to things that may seem they should be most "normal" or
familiar, for instance,
[G]et into the car and just sit there; I’ve forgotten what to do. Finally get it
moving, but it seems foreign .... And out walking I find myself looking at a
familiar section of the roadside: it is exactly as it always was and yet quite
different, in a worrying, unsettling way-as if somehow alienated from me.
(Tittensor, 1984, pp. 92-93)
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The first two weeks (and more) of my journals continue with longing and
missing keenly, expressing love and care, questioning how I can accept the reality of
the loss, reflecting on past good times, and expressing desolation and wonder at my
ability to go on. It is about two and a half weeks after the death that the trauma
preceding the death emerges more powerfully in the journal, interwoven with the
experience of death. The journal describes anger, anguish, and my realization that I
could not really imagine death beforehand, as well as a memory of Ruthy’s anguish
and anger regarding her medical mistreatment and almost dying in the hospital. In
this I continue to wonder why I am going on, but seem to trust that "if I go on, I’ll
find out why, something will become clear," adding, "Or perhaps it won’t."
The horror of death and the meaning of ultimate loss seems to pervade in
several dreams, for instance:
I was a spectator, watching outside a carriage . . . we were passing the
cemetery. I thought I’d better get out. After hesitating . . . I did go out-1
saw R. face to face as I predicted in the instant - she became somewhat
frightened of me and ran away. I thought I could catch her— I wasn’t sure
how serious her fear was- and so I followed. But ahead of us I saw her reach
her grave and lie down, and even ahead of- or a little beyond that image, was
another her--1 think, covered up (?) When I woke up, I was glad I had at
least seen her but puzzled and guilty about her fear of me— & sad- so sad that
she’s not here.
When the journal entry of this dream begins, I label it "inauthentic" and "unreal,"
"stilted" because I could not understand at the time why the dream-Ruthy would have
such a horrible fear of me. In following entries, however, I construe it more as my
reaction to the separation and moreover as a somehow protective function of Ruthy’s
towards me. This is only a small example of how the events, both real and in dream,
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continue to be reconstructed. While at first I find it "inauthentic," thereby disowning
it, I come to find it highly meaningful and personally significant. This and other
dreams convey, moreover, themes of fear, death, a horror or fear of the boundary
between life and death, and the liminal, as for instance in this dream preceding the
above:
A horrible nightmare of being in a dark, ultimately spooky mansion with
Susan- signing some agreements (with death- the caretaker?) It was terrible
and horrible and I felt I wanted to escape but now I couldn’t.
The themes of missing, pain, and difficulty living continue, and there is a strong
sense of both missing and deprivation where I feel deprived of the comfort of a
specific relation, Ruthy as my mother and my dearest friend. Although part of the
immediate context includes a fairly strong support network of friends and colleagues
and in the journals I describe all the friends "who are supportive. L., H., now V.,
now even M, P," the journals also reveal a seeking to comfort myself, a desire for
Ruthy’s spiritual well-being, my affirmation of the past, and feeling or invoking a
sense of Ruthy as a guide, "urging me on, in a productive spirit." As well as
appreciation of Ruthy, however, there is a sense of dismalness and frequent crying,
and it is little more than three weeks after Ruthy’s death when I seem to start
recalling in detail incidents of the day of Ruthy’s death, which was also my sister
Susan’s birthday.
It seems that using the journal as a dialogical medium, I look for support in
the relationship with Ruthy. I strive to remember Ruthy’s sayings, conversations we
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had, remember and appreciate her talents and abilities. Further, I look to her past
experience and wisdom, including her own dealings with death:
I’m trying to understand and imagine what you must have gone through when
you lost your mother- and when you lost A.- how alone, lonely, and miserable
you were. How did you make it?
Somehow it seems that in combining my present with Ruthy’s past, I am not only
looking for strength and support but some continuity of meaning and purpose.
Still, at the end of the first month after the loss, I find it "unbelievable" and
unacceptable" and "being here . . . like putting on an act." Added to a sense of
desolation and sadness, the surrounding context of trying to attend school and
worrying about money and looking for a job contribute to my feeling overwhelmed.
At the same time as striving to be "functional," I find the process unreal. In the
journals, I continue to comfort myself and outline reasons for going on, but there is a
sense of fragmentation, lostness, and a sense of shock, as reflected for instance in the
following poem from the first month:
I feel like a lobster, or crab,
who’s lost
one -- or more-
of its legs-
my arms-
My arm.
I can only flounder
about,
pretending to move
Into the ocean.
I can only move backwards.
And only in dreams.
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which also depicts the feeling that I cannot move forward into the future and the
realization that I can also not really move backwards, even though the latter is where
my thoughts and feelings are focused.
There is a poignant sense of vacancy and loss, including a sense of the loss of
Ruthy’s intentions and activities, her life as it had been and as it might have been
lived, which I am reminded of by her possessions. I try to express this in a poem,
also at the end of the first month:
Dearest Ruthy, dearest one,
you won’t need
your little room
anymore.
or the vacant mirror, the vibrant lip
stick’s plume.
(I can feel
your breath
inside it,
as its color awaits your mouth
to explode,
[in vain].)
Your typewriter, neatly covered,
The pillow still
with your shape impressed-
Your medicines, unfinished . . .
. . . your work
in piles and bundles sits-
waiting to be completed,
willing to remit
their contents and their whole- . . .
Meanwhile, the remembering and reconstruction of the events leading up the death
and the death continue in an effort to make sense of it, and as if to understand,
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believe, and make sense of the fa ct of death. On 2/3/91, I write, "It’s still hard to
accept that you’re not here" and write of missing her and "all the little things and
places and times we would spend together," and it "seems so odd." I feel it as a
"wound" inside me," your not being here— concern over you— your life." And it
seems "utterly weird" that Ruthy should be gone.
While I had certain wishes for a spiritual reality, what emerges early on is
what I call my "materialism": "I am so worldly, it is difficult to conceive of another
reality or way of being." At the end of January: "Spiritually, we don’t know much
about anything, as I’ve begun to fmd out." Yet through this contact with death and
my love of Ruthy, the themes of spirituality, other realities, separation and connection
with these realities, and also of just not knowing, and a sense of humility and respect
towards the unknown, begins to gain importance.
It is only after I have lost Ruthy through death that I begin to realize,
experientially, what a "vital, life-supporting process" "internalization" is and to
consciously appreciate what before had been rather tacitly accepted. After losing
Ruthy, I realize more consciously how much a part of me she is in the most minute
and tacit ways. As both mother-daughter and mature friends, we had a chance to
share our personalities very fully, and in the journals I note that not only has she
"infused" me with her love, warmth, well-being and benignance, but given me
innumerable stories of herself and her ways of being. Our long years of relationship
contained varied modes of relating over time which allowed many different "me’s" to
be known by her, just as I got the opportunity to know many different aspects of her.
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In my reconstruction of Ruthy and the death, there seems to be a need both for
pleasant everyday memories of Ruthy which shored up our relationship, and also ones
of events that were painful because they lead up to the death. Of the former I think ,
for instance, of "the time we drove to Marina del Rey~ after you got out of the
[hospital] and had our coffee by the canals." Very moving is the memory of two
nights before Ruthy’s death:
I can still see you sitting there, almost. . . . the night I made spaghetti with
zucchini-and you enjoyed it so. . . . you spent a long time . . . sitting in front
of and watching the Christmas tree with the lights on, in your little chair . . .
I feel regret on thinking "I had decided to go to that ‘stupid’ party," and how foolish
I later knew it was, when I evaluated Ruthy’s fragile condition.
How strange that was! That I should trust you alone to such an extent. When
it would take me so long to get back if anything happened.
Part of these reminiscences and reconstructions are accounting not only for what
happened but how it happened. I speculate that some knowledge or feeling of Ruthy’s
impending death, or my response to this tragedy, was "so deep-that I could not even
clearly see or recognize its origin. Our days were numbered, then." Despite the pain
of the writing I remark, "It’s very important for me to account for those days. I must
do it."
Later that night, I reconstruct Ruthy’s apparent stroke at the kitchen table, the
paramedics’ arrival, and her lying in the hospital emergency room after death:
How can you be gone--? after a few bites of cake-- how can you be gone? —
after your operation .... Even seeing you lying so stilly— how could I buy
it?
Your hair was just as fresh as ever— And your lips— parted wide— your
teeth had come out when I was with you- And they had placed a tube down
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your throat with oxygen— leaving some bruises and cuts in your mouth— I was
concerned you had been hurt—
Your mouth was open- A little shrunken your cheeks without your
teeth— But as if you were saying "oh." (wasn’t it?)
And your eyes, beginning to glaze? -only just beginning— they looked
like they saw- something - if they could just turn their attention to me — you
were just asleep—
But lying flat— you could never stand lying flat without a pillow— now
— I can’t even believe/remember that— it must have not been flat— you weren’t
complaining— your arms placed down by your sides— so still and patient you
were— as if waiting— your forehead cold— out of your suffering— I kissed it
but you did not wake- I held and stroked your hands and kissed them— they
were getting cold, too- Oh, Ruthy.
I touched your feet, beneath the sheets- they felt a bit swollen- I
wonder if they were- I wonder if this could have been avoided (not
indefinitely)-1
Going over these details seems to represent the struggle with accepting or believing a
reality which seems emotionally incomprehensible and contradictory. Despite these
terrible physical details, I further state that I "refuse to accept it."
While this process may seem identical to that proposed by Freud (1917/1957)
where the "lost object is psychically prolonged" while "each single one of the
memories and expectations . . . is brought up and hypercathected" in order that the
ego finally "free its libido from the lost object" (pp. 245-252), although something is
being "worked out," I do not end by abolishing these memories or my attachment to
them. This is particularly true of the less traumatic memories of Ruthy and the past
and my relationship to her. What seems to be "prolonged," not to "abolish" but
rather to understand and incorporate in a way that makes it possible to endure the
pain or put it more at bay, are the memories and stories related to trauma, i.e.: How
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did the death happen? Why? What were the circumstances? Whose fault was it?
Could it have been prevented?, including, I believe, an important underlying question:
Is this particular pain over? Is this trauma finished?
The issues relating to death need to be interrogated again and again; however,
unlike the overall relationship and memories comprising this whole (including
traumatic memories), this line or rather mode of questioning or storytelling does seem
to reach a certain saturation (though not for a long time), after which the "answers"
seem to have been given, troubling as they are. In this sense, there is greater
"acceptance" of the facts of these answers, since the questions are not put as
frequently. However, as I will continue to illustrate, acceptance may exist on some
levels and still be absent on others. Therefore, there is a "story" of Ruthy and a
"story" of the death. It is the story of the death that needs to be "mastered" to some
degree in order to continue living, finding and appreciating meaning, and "accepting"
the terms of reality in general.
The incongruity of death with life and love and its "double state" underlines
the pain of loss, which also makes functioning stressful. Nevertheless, the "patterns
of conduct" alluded to by Lindemann (1944) continue to resume in concrete form.
Therefore, while continuing to miss Ruthy severely and feel the strangeness of death,
I am still a month later, trying to make plans, attending school, and looking for part-
time jobs-in short, "functioning." As I continue to reconstruct the loss, I continue to
return to what might be called "disbelief": "How could it be?" In a month’s time, I
am still "shocked" and dissatisfied with how the train of events could make any sense.
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I continue to reconstruct the loss, and there is a great deal of anguish and pain at the
loss, missing Ruthy severely and regretting the traumatic pain she went through.
Also, the desire to "talk" to Ruthy continues.
Slowly over the weeks I piece together the story of her death and the trauma
that led up to it. Both death and the surrounding circumstances are part of the
"story," but the immediate context of death itself needs to be told first. On 2/8/91,
about five weeks after her death, I write:
It seems so strange still, as I sit here at the kitchen table. It was sudden, and
unexpected. How could I/we expect that you would suddenly die at the table.
I had imagined your shortness of breath spells; sudden alarms where you
couldn’t breathe, escalating into death (strange phrase, "escalating"). But I
didn’t expect this, this sudden collapse. Suddenly, at the table. You did enjoy
the cake; you said so. And then suddenly, you collapsed, you collapsed
utterly, unexpectedly. Like a bridge, or a tree, suddenly crumbling or falling.
Why? "Arrhythmia"; cardiac arrest, the paper said. But why then, why
suddenly?
And I go on to think about how and/or why neither Ruthy nor I had imagined such a
thing, and whether perhaps Ruthy did have some idea of the impending death. I
continue to narrate for myself what happened, how I felt, and how Ruthy, and the
others present might have felt as death approached and occurred:
Susan and I felt "unconscious" at that time .... But even if you had expected
something, it seemed that you, too, were surprised - your sudden collapse, in
my direction, on the table, after you’d just said about the cake, "This is so
good, I shouldn’t eat it, but--" . ... you seemed to lose control you collapsed
on the table. . . . Suddenly, you fell . . . and you looked surprised-to-me-
.... I immediately hurried to phone 911 . . . .
Dearest Ruthy, I love you so much, isn’t it strange? . . . .
At last they came-it seemed like forever--it was- .... I knelt in the
kitchen with the paramedic men and prayed, and though, as I watched you,
and I thought, and I didn’t pray, as L. asked, for any "bargain" like: "let her
live" no, I prayed that the best thing would happen for you. I didn’t know
what was going on, if you had had a stroke ....
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Again, this is different from "psychically prolonging" the object in order to free the
libido. It is more like an accounting to make sense of or rather to explain to myself
what doesn’t make sense. Neither sheer catharsis nor logic-making, it is an attempt at
emotional comprehension in which the details involving the love of the lost one and
pain of the loss, the hurt of the trauma are laid out and accounted for. This does not
happen all at once, and in different ways, details and versions of the story are
"played" and reconstructed again and again over the years. However, the journals
also indicate that the fullest, most detailed emotional accounting seems to take place
over a period of about three years with various points at which this reconstruction
gathered.
This retelling the story and trying to explain it, to find meaning or cause in it,
as well as to experience its pain, does not wait for a period of "shock" or "numbness"
to end or for formal "yearning and searching" to begin or end: Instead, all are
implicated in a kind of process of "reorganization," which Bowlby (1980) for
instance, leaves for the last "phase," when he considers it, in fact, done. As my
experience indicates, this reorganizational process continues to occur along with grief.
Therefore, I did not go through a state of shock, disorganization, despair and arrive at
reorganization a finished product; instead I have found myself on an intermittent but
ongoing basis in a state of reorganization. Even the states of shock and
defamiliarization represent times when I have been comparing what is with what was,
and which therefore also represent a state of organizing.
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Nonetheless, the telling of the story of death, trauma, and loss when the facts
of these are recent is very different from the telling of the story later. First, there is
the sense that the whole story has not already been told or grasped, and the emotional
fact of death is grossly incongruous with the facts of reality. Part of the telling is
searching to make sense of the loss, and part of it is searching for who and what has
been lost and perhaps trying to reverse or undo this process. Searching, yearning,
and missing, therefore, are connected with disbelief and making sense out of death.
Additionally, the relational aspect of storytelling is important and continues to be. It
seems that in the journal I am often most concerned with telling the story to Ruthy, or
to "the Ruthy inside me," as well as to myself.
The journal entries lead further into the past with a processing of my feeling of
regret and self-reproach for the past, wondering if I could have done anything
different to change the course of events, alternating between thinking I "knew better"
and "could have done something," to wondering if I really did or could have. The
telling of the story is also therefore a search for the cause of death--and an
interrogation into my own responsibility. This also occurred most intensely during
this early period, but reoccurred frequently in about the first two years.
Part of the horrible feelings I have about the death then are of reliving Ruthy’s
trauma in the hospital and the terrible feeling of regret that I didn’t or couldn’t protect
her from it. My sense of rage and hopelessness emerge as I write the things that I
never had a chance to discuss with Ruthy after this fatal operation:
And then you know, they did lie a lot. . . . and they said, (K.) said, if
something wasn’t working/wasn’t necessary they come right back out (instead
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they spent. . . 4 1/2 hours with you on the table!! or was it more .... IT
WAS INHUMANE.) i feel so sad and outraged thinking of it all~as you, too,
felt sad and outraged. . . . You were being so brave .... damn bravery.
While this search for meaning goes on, so does a sense of lostness, emptiness and
missing. Depression and a sense of existential pointlessness are incongruously
counterpoised with attempts or semblance of functionality. Both mundane and
pleasurable acts seem incongruous with the traumatic reality. I am tom between
trying to be functional and allowing myself to feel and be dysfunctional:
After I’ve "nurtured" myself or tried to-sometimes I feel . . . as if I’m trying
to go on despite everything . . . then it seems so weird too . . . . Admitting,
Everything is Not all Right. I’m trying to go on— but everything is not all
right.
In some excerpts of the journals, it seems like I feel a need to explain as much
to Ruthy, the absent other, as to myself, what the loss is about, what I am doing and
thinking. There is a sense of trying to incorporate the past, in its everyday rituals
which were meaningful because they were part of the fabric of the relationship, into
the present. There are strong periods of pining, feeling depressed and anxious, and
feeling like the whole thing is a nightmare. It seems uncanny and unacceptable. As I
indicated earlier, I feel Ruthy’s death as "existential nightmare" and "I can’t bear the
thought of it."
Remembering is of course intimately bound up with longing and missing.
Constructing Ruthy’s presence in my memory is comforting on the one hand, and
painful in emphasizing her physical absence. Mixed with the memory in this early
period are fantasies which I know are impossible but still indulge:
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I was thinking, about Santa Barbara . . . not completely unpleasant, places
I’ve gone or might go~and the pain of going to them now— And then I had
this thought-1 wondered if deep down I didn’t have some feeling that you
would return— I mean, I’ve thought of it materially, and faced a stone wall;
but somehow I wondered whether my image of Santa Barbara was waiting for
some far-off, impossible day in the future when you would return and go with
me . . .
And reflecting on the dilemma of accepting versus disbelieving the death, or affirming
a spiritual world in which Ruthy might exist:
I can’t accept you’re not here .... Besides, how do I know you’re not here?
In some form .... it’s not just my cathections/fictions. The spirit world
exists; but I probably cannot even catch a glimmer of it, or maybe only a
glimmer. And more than a glimmer would be frightening.
Still and all, I see myself holding on; and it is appropriate that I hold
on now .... It would be too much to let go.
Smelling the perfume on her clothes, I imagine picking her up from the hospital
instead of her being dead. I try to recreate conversations we have had in the past and
conversations I would like to have. Despite my knowledge of the death, "It’s so
difficult, so hard to believe, you’re not here, physically," and of course, "I don’t
want to."
Such thoughts are supposed to be, it seems, brushed away almost immediately
without indulgence-one is supposed to accept the "truth"— that you— the other-
is not here now— and can’t be— and playing with such images and fantasies in
one’s mind is only torturing oneself and furthermore engaging in denial ....
I’d be in more complete denial if I didn’t’ realize how much I miss vou. Ruthv
.... I’d be denying . . . how important you are to me-and what a shocking
and terrible reality this is~unbelievable, yet believable-yet unbelievable.
Though it seems I am "on a constant pilgrimage to building something back to
life" in terms of my own functioning, it is "not within the scope of an idea of
finality." My perception and experience of time has changed in that my mind seems
to be "like a movie-going forward and back, back to the far past, forward to the very
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recent past, back again, forward." I begin to consider time in terms of the death, for
instance counting the nights since her death. "I feel like the calendar has stopped and
have some trouble remembering— wanting to know?— the date."
At times the reality of the loss expands and I feel her "spirit is farther away,"
as when,
I looked in your room today, instead of that look of "the person looks like
they’re just coming back" or "just left for a moment"~accessories all in their
daily living routine place— waiting for their owner’s return— instead I got the
feeling the owner had really left and didn’t need or decided not to want those
things anymore. I felt that you were gone. It was saddening .... Is this
now that . . . I’ve got to get used to this absence, Ruthy?
This and the following seems to correspond with Bowlby’s (1980) ideas about
yearning (along with anger) being followed by despair, except that here they are more
dynamically intertwined than separate:
After that visit to your room, the face of "unreality" seemed to be setting in—
it frightened me— another layer of loss— I went to my old room— which I don’t
use anymore . . . and wept on the floor and hit it—
That kind of discharge seemed to alleviate some of my tensions before.
But it doesn’t take away my loss.
And I kept remembering scenes from our recent . . . trip to SB before
this fatal tw ist. . . and I can’t believe/accept that you can’t come to SB
anymore.
Even so, the next day I write that:
It’s harder to continue with the idea of continuing— with . . . "unreality"-or
" reality"-settingjn.
Like Bowlby’s (1980) exemplars,
I guess that while it has been extremely painful at times— much of the time—
there’s been some slight hope - what for? I can’t say, rationally, that it was
for you to return . . . What was the hope for then? That I would come to
some understanding?- I know that will take many years, perhaps forever—
What was my hope for then? There must have been some, for me to feel this-
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-this— this sense of growing disappointment (???), this dull feeling—
anticipation?- that I will have to face reality, a reality I don’t like. That I will
not feel better, at least for any length of time, and that you’re gone— to another
place (?)
My grief is still fresh enough that I wailed out my eyes and nose
yesterday— still with that "unreality"/reality feeling growing upon me. That
dull painful reality feeling.
This process parallels what Freud (1917/1957) says about meeting the demands of
reality, and also Bowlby’s (1980) contention that it is just this compromise between
reality and yearning that is so painful. There is a sense of realizing the loss more and
more: "No tears of mine will ever bring you back, at least to this world." Yet at the
same time I continue to feel that this reality is "unreal," although more subdued:
"The dull unreality, the dull pain." And further, while missing her,
Something about You [Ruthy], some image I have of You— seems protective,
gentle, comforting. Encouraging me, it tells me to go on?
Again I remember some of the events leading up to the death and feel distressed.
Then I linger with a sense of Ruthy’s presence, invoking it in the sunlight and feeling
it comfort me.
Alongside this somewhat firmer acceptance of death itself (e.g., "‘reality’
setting in"), the trauma leading up to the death is further told and interrogated,
interwoven with sadness and loss. Because the trauma of Ruthy’s death follows the
period in the hospital in which she was on the edge of death, the trauma of the series
of events is multiplied. I wasn’t able to reflect or recover from the horror of the
traumatic situation in the hospital before Ruthy died. Because of her acute condition
after being released from the hospital, I did not have a chance to talk with Ruthy and
discuss this experience with her before she died. Further, because of our previous
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rich and close relationship and the nature of the difficult, traumatic circumstances, I
feel the need to explain and process, to Ruthy as well as to myself, what the course of
events were, what I did, and what happened:
I feel so sad and horrible about what happened to you in the hospital. It was
like a nightmare. But because we awoke from it temporarily, we thought it
went away.
Also I am trying to understand what happened in the period between the hospital
experience and her death:
And then when we got home, did I temporarily forget? -I did pray every
night- but once again, I didn’t know what could be hoped for-seeing you had
your breathing/congestion attacks, and complained so of struggling ....
And we talked about death— what was it?— that time .... How did you
put it? That it wouldn’t be long? That it’s only a matter of time??? How did
we talk, exactly? I wish I could remember. And when, was it after
Christmas?. . . .
I don’t know how long I have? you said? . . . I don’t know how long
I can keep this up. (Oh, dear.) I just don’t know how/when I’ll die. I can’t
imagine how I’ll die. How would you like to die? (I ask, wondering why I’m
sounding like this???) In my sleep, I guess. Are you scared? (Didn’t I ask
that? I wish I could remember— and I wish I had asked) ....
The telling of the story and reconstruction of events proceeds in some sense backward
in time, from the mystery and unbelievability yet factuality of death, in Ruthy’s
collapse at the table, back to her return home from the hospital, and finally back to
the hospital experience itself. And here the trauma of the hospital comes up in
remembering the suffering I saw Ruthy experience and my anguish at it. In this
period and for a long while to come, I have traumatic dreams involving the hospital.
I dreamed, horribly, you were dying in the hospital- they hadn’t given you
enough fluids .... I woke up feeling appalled again— Kurt’s words [from
Conrad’s Heart of Darkness! were more than appropriate, "The horror, the
horror!" The horror of it, I kept thinking (of the hospital experience as well
as of the fact of death)
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The feeling of horror and "unreality" at the death itself reaches stark, intense
proportions in what I think matches how Parkes (1987) describes "pangs" of grief, or
"grief attacks," as I write in large letters "WHERE ARE YOU. MY RUTHY?
Where are you? Not here, the way you used to be. I can’t describe this to you. It is
like a nightmare."
During this early period, about three months after Ruthy’s death, I continue
often to feel depressed, anxious, nervous, and missing Ruthy.
As I go on, day by day, minute by minute, I stumble, I get confused, I don’t
remember or know what my "goals" are, how to accomplish . . . I do one
thing, then another— then a wave of feeling— then a this and that- then my
feelings- my loss, my love, my pain, my questioning, you, then I wake up,
then I mourn, then I go to bed, then I drink coffee, eat, wonder what to do,
what are my "goals"? . . . a wave- of feeling . . . trying to do something,
practical, going out, about, on the freeway, suddenly home, suddenly a blank,
my heart aches— my heart cries "I love you! I miss you! where are you!" . . .
What do I do now? Go on. Go on how? (This sounds like a Pinter play or is
it Beckett?) I go on, but I don’t know how.
Feeling like my body is "sucked of energy, drained," and "twelve years older than it
is," there are also many attempts at self-nurturing and trying to "make myself cozy."
But in spite of sometimes feeling "somewhat cozy . . . the awfulness of the
situation . . . the- how-could-you-be-gone feeling" reemerges, and everything else
(such as school and work) seems insignificant.
Issuing from the same source as this horror and continuing alongside are the
dialogical and reconstructive efforts:
I must keep trying to imagine what you would say. I would imagine that you
are still mourning with me -- (?) - Although there are some hints- you want
me to go on- love mvself—
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This notion about Ruthy’s "hints” about "loving myselF conies from an early
"conversation" (2/9/91) when in "addressing the air (you, Ruthy)," self-nurturing
seems to come either from within, without, or somewhere in-between. Feeling regret
about the past and writing, "I wish I had been better," "I could have been better," "IF
I had a chance, I would be better," unexpectedly "a thought or a voice inside me"
says, "learn to love yourself a little bit better." Though I brush this aside at first and
continue to address "my idea of you [Ruthy] intellectually," how "I wish I could have
been better," etc., I then "hear" again very strongly and distinctly, inside: "You’ ve
got to learn to love yourself better.”
I am struck not only by the felt strength of this "message," but because,
though the message makes a great deal of sense, it seems to come from some other
source than my conscious thinking. I do not really hear Ruthy’s voice in my mind
saying this, or any other particular voice, nor is it not normally something she would
put in such distinct or seemingly "trendy" language, nor something I would say.
Therefore, I experience this, first, in a spiritual sense, as if "something bigger than
myself," larger than my ego, is involved. Second, I experience it as a healing
function of myself, which appears to be neither completely conscious or rational, but
dialogical-providing "messages" which are not only comforting and restorative but
insightful, as if from an outside source.
In addition to making sure I eat, rest, allow myself to cry, and enlist the
support and help of others, self-nurturing involves a kind of reconstruction of life as
well as of myself and Ruthy, a process that seems to parallel Bowlby’s (1980) and
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Parkes’ (1974, 1987) phases of "reorganization," but which again, occurs in my
experience alongside despair and all the other "stages." This self-nurturing includes
reminiscing and re-evoking Ruthy’s words and shoring up the relationship, as well as
realizing I have to create my own reality and help myself. It is an imaginal co
construction in that I actively call upon my memories of Ruthy for her advice,
wisdom, and past experience, all of which are not handily packaged or "done," but
rather which need to be reconstituted and imagined both with the physical and
immaterial reminders, created in the form of a self-dialogue. "All I have to do is
read the beautiful message you wrote to me on my birthday to feel your love and
sense you didn’t expect more from me than what I am."
In scrutinizing what I regret about Ruthy’s death, and thinking that she would
have "forgiven" me for my imperfections, I move towards a way of "forgiving"
myself. In addition to reflecting the ego and superego processes Freud (1933/1965)
elucidated, again what is highlighted is an active, dialogical transaction— something
which may change the story of the participants. With the story of death not finished
to my satisfaction, because of Ruthy’s suffering, and in addition, because I wished I
could have prevented it, protected her, comforted her, etc., I carry on this dialogue in
which I cannot change the past events, but in which some sort of "acceptance," in the
form of forgiveness and of love and compassion, as well as humility, can be
imagined. In wishing (and trying retrospectively) to comfort Ruthy, I myself am
comforted. "You [Ruthy] would remember that I’m human."
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Intense painfulness continues for a long time, with the pairing of the
reminiscences, still so close in time and in their sensory and emotional vividness,
making the absence at times feel unbearable. There is a combined sensation of
presence and absence, with absence predominating, which makes for a sense of
"weirdness" or "unreality." As indicated in Chapter 2, yearning seems to oscillate
along with the paradoxes of absence and presence, remembering and forgetting, pain
and relief, desire and despair. Anne Philipe, widow of the French film actor Gerard
Philipe, writes in her journal after his death:
I still find it difficult to live in the present. . . . (for your absence never lasts
longer than an instant) .... I want and don’t want to suffer from your
absence. When the anguish seems most inhuman and appears to have no
possible end, I want to be relieved, but each time you leave me a little repose
I refuse to lose contact, to let our last days and last sight of each other grow
blurred . . . (Philipe, 1964, p. 134)
Yet there are periods when Ruthy’s presence seems to follow me about and
dwell within myself. In the midst of painful missing, I begin to feel a sense of
comfort again from within, or beyond:
I feel as if I have felt your presence all day. It was a very nice, sweet,
wonderful feeling. A closeness.
and,
I was in a noticeable good mood at work in the morning . . . my co-worker
remarked on it asking me why, and I noticed it . . . and I realized that I felt
special.
I realized that I had been joking around with the co-worker in a way that was
reminiscent of my being with Ruthy, a "self" that she knew. In this process, I feel
both Ruthy and the self that she knew re-evoked.
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There is a growing sense of upliftment and sense of responsibility for my own
life, which is combined with the sense of loss and missing. However, although I
continue to have a sense of Ruthy as well as internalizations such as "your
encouragement that you’ve given me all my life," and "just the expression of words
helps on some level," there are times when I feel "there’s still a part that can’t be
filled with words . . . Loss the feeling of loss the loss itself," and "the pain and
hollowness of missing you."
Through acknowledging the loss, there is a sense of "searching" in, for
instance, the reflection that "it certainly seems like you could be here--all your
things .... It’s almost like you could be here . .. . I miss you so!!!! The world is
not the same." This emphasizes that from the beginning there are many ways of
acknowledging loss, and also--if we use the prevailing models as a lexicon~of
"denying" it. On the one hand, we could say, the loss is "denied" or rather not
accepted at some level, if searching continues. On the other, we could say that
different kinds of "presence" continue to coexist with absence.
"Reality testing" nevertheless continues:
The "reality" is so hard to face. Again and again .... I’m at a loss . .. .
Over and over and over again. There’s nothing (not much) I can know about
the other side. Therefore (?) I have to let go? I want to hold on-to some
things .... Maybe there is a spirit. Yet something tells me, I think, that
even if there is— I must let go?
There is a continued oscillation between accepting the physical and real loss and
struggling with it existentially: "No matter how much I think about it, feel about
it... . It is so weird not to have you here as you were before."
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Despite continued missing, yearning, sadness, depression, and the sense of
weirdness and difficulty in facing the reality of loss over and again, there is also an
ongoing search to go on which gains momentum in its life-affirming and joyous
qualities five to six months after the loss, as I try to make plans for the future,
including moving. These life-affirming themes occur in both remembered and
constructed narratives and dialogues I carry on with Ruthy— not only in the known
sense that she had always encouraged and loved me in the past, but in a kind of
active, dialogical co-creation which emerges very vividly in dreams. This creative
construction of Ruthy is intertwined with memories and reconstructions of trauma and
loss, which are again re-lived, both first in their painfulness, then with a sense of
coping.
Both the death, and the trauma preceding the death, take a significant amount
of time just to "let in," letting them "in" to process their meanings, entails continuing
to tell the story, bit by bit. At intervals, I continue to process and re-live my trauma
of the first appearance of death, of her being in the hospital and almost dying then,
and its connection to her death, reconstructing the "story" and summarizing all the
things that agonize me most about Ruthy’s death. Some major portions of narrating
the trauma emerge in the journal addressed not directly to Ruthy, but seems directed
to myself, and/or some general reader. There is trying to make all kinds of sense out
of the story, and a trying to soothe and comfort myself. Also I discuss acceptance of
her death, differentiating the difficulties between her death on the one hand, and the
trauma that led up to it on the other. One such significant entry reads, for example,
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I remembered how horrible it was in the hospital sitting by her bed realizing
she might die and never talk to me again- that was, of course, much weirder
even than this- to have Ruthy’s book she’d brought with her to read, to have
supposed she could read- her optimistic plans for getting out of the hospital -
and to sit there with her book in the dismal small blue room in ICU with a
picture on the wall I grew to hate,- reading a story she may never read with
her totally out . . . perhaps never to wake up and recognize me - hear me,
feel me, again - - that was the Horror of Horrors and to see her so ill and so
deprived of health— so ill as she had never been — and so weak, unprotected,
and suffering — at the mercy of drs, nurses and machines . . .
Again, the story is gone over in detail. The unique situation here is that even if death
is "hanging over" the bereaved, while there is still hope, one cannot accept death.
Because of this ambiguous and acutely stressful, traumatic situation, I do not have the
opportunity to "let up" or grieve even the "brush" with death and am exhausted at the
time of Ruthy’s death.
While the imprint of trauma continues to emerge vividly in dreams and in
waking thoughts, along with feelings of stress, physical ailments, and wondering if I
am "literally . . . falling apart, disintegrating, dying," yet coping with trauma and
loss and integrating these into a sense of future and self also begin to take significant
forms. Themes of yearning and missing, and trying to make sense of the trauma
preceding the death and the death itself, trying to undo and redo these events and to
experience the loss as well as the return of Ruthy’s presence, continue to develop, as
for instance in dreams of reuniting, such as the dream described in Chapter 2 of
Ruthy being sick, and my being able to hold her in my arms as she dies.
I continue also to wonder how she collapsed so suddenly, having a sense of
disbelief or wanting it to be a dream. I struggle with the paradoxical impossibility of
both believing or disbelieving the fact of death. Feeling as if I had already been
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through an almost-death with the hospital experience, I reason, "You arose from the
dead once. How could I expect you to arise again???" Thus indicating both my
yearning and desire for Ruthy, and my logical acceptance of the death.
Because of this combined belief and disbelief, acceptance and non-acceptance,
there is still searching and "finding" six months after her death, as in an ecstatic
dream when, leaning over Ruthy’s bed with her coats piled on top, suddenly I feel a
warm, lively hand grasp. At first I think it’s my own hand, then I know it’s not since
my other arm is down near my side. When I believe it is Ruthy’s I feel "ecstatic,"
"wistfully, longingly blissful/grateful." Then Ruthy’s face emerges, and we end up
going to a coffee shop. . . This searching and finding comprises yearning for and
attaining that which is most hoped for, and which cannot be hoped for— hence the
sense of wistfulness and bliss.
Further, although I desire more time with Ruthy, I find my dreams "seem to
say I’d be doing the same thing again and again," that is, going about normal day-to-
day living--that which I consider mundane in the face of death. I find myself
realizing, therefore, that I would never really be adequately prepared to accept death,
and would never feel as if I’d had "enough" time. In the face of these dream
reoccurrences of forgetting the fact of death and dying in my regrets also, I begin to
accept that it would always be difficult to accept Ruthy’s goneness, that I would
always make some mistakes over and over, and would never be able to perfectly
appreciate time or make use of its transitoriness.
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At six months, the conjoining of absence and presence are indicated in the
aura of contradiction and elusiveness which imbues both the sense of loss and the
sense of Ruthy. Therefore, in one dream I receive a telephone message from Ruthy,
"‘This call is for you.’" Unfortunately, I feel on wakening, and again elusively, "I
don’t remember what the voice told me!!!" In dreams I often "have" Ruthy back, but
don’t remember properly in the dream that she is "gone" so as to appreciate her being
"back." Or, she is dying, whereas at the same time there is some knowledge in the
dream that she is already dead. Things seem constantly in transit, elusive and
ungraspable, paralleled by my noticing "I keep dropping things these days . . . a jar
of coffee . . . mayonnaise, jam, spaghetti . . . a computer diskette into the toilet,
cake, ketchup~I seem to lose the grasp-glasses of water, coffee cups topple."
While, however, in the process of moving, and calling inwardly upon Ruthy
for support, the trauma of death and loss are interestingly bound up with various
modes of comfort and interconnectedness, as for instance in a dream in which a
friend, Luisa, and I are having lunch and then go to pick up some clothes where we’d
left them:
I wondered if we couldn’t leave them awhile longer (while we took a walk?)
But we were afraid they’d get stolen- then Luisa got mad because there was
something wrong with her silk shirt- L. had mined it- stepped on it or
wrinkled it . . .
The seemingly mundane matter of the clothes, connect with both my upcoming move,
and to death, loss, and trauma, as well as attempts to reorganize and make things run
smoothly. As the dream continues, I see the trunk of my old car,
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Where some of the clothes were being laid . . . Luisa was being nice and
careful . . . of my bone-colored suit skirt— holding it up to herself for a
minute . . . it had just been dry-cleaned .... Then Susan was there too. The
police/paramedics were trying to get the clothes moved out of the trunk. In
the front part of the vehicle— like a paramedic van, I saw an old man
dying .... Then, Ruthy like a flat (??) gliding form- beautiful . . . with her
hair done and make-up on, was there trying to help with the clothes situation-
reaching out to move a hanger? but she couldn’t quite reach and said
something to the paramedics like "shouldn’t you ..." "How about. . . "
and the paramedic brushed her away . . . and they were trying to move her
out of the trunk space— pulling her out and down . . . she seemed flat and [to]
be able to glide.
The dream of moving, clothes, and the trauma of death becomes a vision of Ruthy,
elusive but helping me (as in moving the hangers) and a search for the sacred:
She seemed flat, able to glide out of the trunk (they seemed to lose hold of
her). She went out then on her own accord. And I thought, I’d better follow
her- But instead of right away, I was kneeling and praying (?) (Although I
felt the urgency of wanting to go, I seemed to linger, feeling it necessary to
pray)- Then I followed- But I don’t remember her being there— precisely- I
was in, I believe, a room like the bedroom I had when I lived with M.— and
there was a beautiful medium-sized cactus there (on a small round table)—
bathed in the sunlight. I was praying to it.
There was a sweetness in the air, that yet was . . . yearning? I awoke
praying.
In many ways the reconfiguration of the trauma of death seems to be connected with
coping, as in this symbolic replay of the death, moving the clothes and the appearance
of Ruthy’s "soul." Although it recalls traumatic events (such as the paramedics
moving Ruthy), there is something positive in this dream which connects physical
moving, such as changing residence, with a spiritual journey or transformation.
Throughout these types of dreams and reminiscences involving searching, dialoguing,
sense or evocation of presence, integrative, self-protective, and coping functions
involved in grieving seem to arise not only because I, the griever, accept the finality
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of loss (Bowlby, 1980) and the "verdict of reality that the object no longer exists"
(Freud, 1915/1957, p. 255) and therefore despair, or because the ego is "persuaded
by the sum of the narcissistic satisfactions it derived from being alive to sever its
attachment to the object that has been abolished" (Freud, 1915/1957, p. 255), but
because these functions represent some other aspect of the relationship with Ruthy
which is not relinquished but continues to be reconstituted. Here the dream reaffirms
both that which is lost and its recovery or construction in some form. In addition,
dreaming and waking at times it seems as if Ruthy "should be" somewhere,
"somewhere" and "everywhere."
Other means of coping with the trauma preceding death include my knowledge
that the trauma itself is overwhelming and that I must protect myself from it in a
dream. Therefore,
Dreamed L. took me to some sort of operating room in a hospital. I thought I
would see blood, skin opening up, etc., and felt sick- and said to myself Oh,
no, this is not for me. I left the room . . . but before, I saw a series of
patients who didn’t look too sick, bandaged arms, etc. The feeling was that L.
would expect me to be able to face the operating room/hospital as if a matter
of course .. . . But it was definitely too much, I thought.
As in the "moving dream" above, recognizing death and Ruthy seems to include both
elements of trauma (e.g., ambulance and paramedic men) and coping, or comfort (the
vision of Ruthy being able to glide and her "helping" me; the sensation of prayer).
Although I wistfully look at photographs, wishing I could "steal back in time and feel
the living imprint of your presence," I notice more good moods alternating with grief
and even go dancing and take a small, pleasant vacation. The feeling that there is a
responsibility in life to "take joy in it," to "take charge of my potential" continues to
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emerge, but nevertheless, the pain of missing and loss, and the painfulness of
remembering the traumatic circumstances of the loss, still persist. I struggle with the
paradox of loss and missing, as well as the paradox of life and death. Pain is mixed
with desire and appreciation. And hope or disbelief also is complex and mixed, as
knowing Ruthy will not return, yet I cannot stop myself from yearning for her.
While "what is the point of going on?" and the issue of how to do the
simplest, everyday things are questions which I confront almost from the beginning of
bereavement, with increasing despair and depression, "how will I go on?" becomes
the prominent question and is involved with coping. A long, epic-like dream depicts
the agony of dealing with trauma, coping and protective functions, and the decision
that I will be able to survive. In this dream, I arrive at a large building, where I am
supposed to work, and am greeted by a friendly lady who is apparently giving an
orientation. She sends me on an amusement park ride which is reminiscent of the
story of the scenes that "pass before the eyes" of a drowning person:
It was very fast at first . . . and I saw scenes around me— like in a
commercial or movie "preview"— some family medical problem/crisis,
someone collapsed- a man— a bathrobe on the floor (heart attack, probably I
thought)- I thought as the scenes came up— Oh, no- Susan would have a
fit. . . if she had to see this— But I’m going fast-1 can try to hold on ’till I
get past it— and sort of ignore it, I thought — even close my eyes - And it did
go past to other scenes— I hardly remember them — they were not as
gruesomely significant. . . the vehicle I was in went slower.
The tunnel is dark and filled with water, with sprays attached from the "ceiling,"
emitting bubbles, water, and oxygen, I think. I become scared when I find myself
stranded in the tunnel with the "vehicle" stopped, thinking that I might die there:
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However, I didn’t panic. . . . I didn’t have those sensations of panic. . . . I
thought I’ll just swim out. I can swim. Float and swim out of the tunnel. I
can swim even in darkness.
Though still concerned that the tunnel might fill up completely with water, and having
no idea of the distance out of the tunnel I reflect that "I might die," in the dream I
make up my mind to "going through with it."
This dream is both reminiscent of my mother’s horrible situation, when she
was unable to breathe because of congestion (fluids) in the heart, and my living
through the trauma of her death and wondering if I can make it through the "tunnel"
of my pain and grief. Through all at the difficult thoughts confronting me in the
dream, I manage to cope: With the traumatic "scenes" played before me as in a
"movie," I decide I can close my eyes and avert attention to make it less painful. In
dealing with the existential difficulty of not knowing how my future will turn out, I
decide to rely on my natural ability to "swim." While in the earlier "moving dream,"
I seem to derive some support from the spirit world, in this one, I rely on my own
innate strength and abilities while recognizing my limitations and even my mortality.
In my immediate and earlier responses to Ruthy’s death, then, there are a
multitude of themes that arise, including the pain of loss and of missing, of sadness,
depression, horror, shock, anxiety, and anger; appreciation of Ruthy and the past,
expressions of love and hopes for her well-being, and affirmations of myself and the
relationship; regret and remorse; traumatization (including traumatically reliving the
death and what led up to it), and rage at the trauma; longing and yearning; the
difficulty of coping with the loss on a day to day basis, including slowness and
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feelings of inability or lack of concentration, somatic symptoms and changes of habit;
and an existential questing for the meaning of living and dying, as well as a sense of
existential strangeness, anxiety and horror.
The sense and play with relationship seems to be a distinctive feature of grief
from the beginning as I am concerned not only with my agonizing sense of loss and
emptiness, but with Ruthy’s well-being, with my appreciation and love for her, and
with both good and painful memories of our past. As well as a growing appreciation
of what I have already internalized of Ruthy, there is a recurring desire to "speak"
with her, and a constructive effort to engage in some sort of dialogue, to build and
rebuild the past, and also the present.
There is a continued grappling with reality and its incongruity with what is
real to me. Despair as well as yearning recur along with different types of acceptance
of the loss, and alternating conceptions of absence, presence, "distance" and
"closeness" to Ruthy. While at times I feel she is "farther away," at others I
surprisedly smell her perfume and feel a sense of her that I cannot put into words. I
feel her influence both when I least expect it, and at other times when I purposely try
to conjure up what I have "saved" of her. Yet at other times the physical reality of
her loss is overpowering and I am filled with a sense of loss, and sadness or despair.
As I indicated in Chapter 2, there are different types of shock and disbelief
that seem to run through the experience of grief, including for instance, cognitive or
intellectual belief accompanied by emotional disbelief, that is, a feeling of disbelief or
shock, as well as what I have called a sense of existential shock or horror. In my
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own situation, these experiences are also connected with my experience of the trauma
that preceded Ruthy’s death, making it unacceptable and unbelievable on still another
level. As I additionally implied, it also appears that yearning and searching, the sense
of the other and the sense of absence, may actually be a foundation for some sort of
"firming up" of what a griever has already internalized of the deceased in the form of
imaginal other, and more than that, an ongoing developmental process.
Many, in fact, all, of the above feelings continue or at times recur after what I
am here referring to as the "early" or "first" "period." Yet, in my own experience, a
kind of shift seems to occur after the eighth month of loss. The pain or
unacceptability of loss are not gone; nor do I stop reliving the trauma of Ruthy’s
death. However, while the starkness of the loss continues to be a primary force of
my experience, additions to the overall context of experience contribute to the
appearance of a shift.
There is a shift not only in my experience by itself, but rather in my
experience along with the impact of the world, the context of what Lazarus (1991)
calls the person-environment. By this time, I am working again, I have changed my
residence, and have begun a new love relationship. The social support that I
cultivated earlier is still in effect. Pressures of school and worry about money and
the future continue to present stress, perhaps more palpably than in the early months
when nothing seemed to have any meaning. Although I am increasingly productive,
my goals and tasks often jar incongruously with the reality of death, accompanied by
pain and depression or despair.
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As the year ends, there seems to be a movement in the journals such that they
do not express being so constantly weighted down with sorrow and loss. There is
also more capacity for joy, and a sense of ability to function better. Yet, at the same
time, there are bouts of intense grief and missing and longing for Ruthy, anxiety and
angst and depression, as well as experiences of traumatization. The depression of
grief with its "weight of sorrow" described by Lange (cited in James, 1890/1950) and
dejection, loss of interest in the outside world, loss of the capacity to love, and
general withdrawal from activities not associated with the dead person delineated by
Freud (1917/1957) seem to be at least temporarily displaced by a more agitated
sorrow, which includes yearning and despair. These feelings of grief-ful despair and
anxiety, yearning and sorrow, and trauma seem to be quite as intense as those that
preceded them; perhaps the difference in these is the awareness that time has elapsed
and that still the feelings and loss continue. The reality of loss continues to assert
itself, and continued grief and attempts to function "normally" create significant
stress. Nevertheless, with intermittent emotional turmoil and questioning about the
purpose of things, I am "getting things accomplished."
In addition to continued questioning about an overall sense of meaning and
spirituality, there is a sense of some sort of union with Ruthy, which comes often in
the form of dreams, and a sense of transformation. There seems to be a need to
continue to tell the story of loss over and again, and my new relationship provides
another opportunity for this retelling. The sense is not that Ruthy is replaced or
renounced by this relationship, but rather that I am able to share in a new relationship
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loving feelings, as well as tell the story of her death to an empathic other. With all
its grieving painfulness, this period, seems to be characterized by a special feeling
both of love and a sense of spiritual transcendence which lifts me up and makes it
possible for me to survive and to have hopes for myself.
This sense of spiritual transcendence begins before any new relationship comes
into view, and is illustrated well, I think, in a dream I had upon my move to the new
apartment. On signing the lease, I first feel a sense of desolation and loss: "Moving
is like having an operation or dying." The dream marks a positive change, however,
giving a special sense of destiny to the unknown, as well as a feeling of connection
and affirming the relationship with Ruthy.
The spiritual movement and my spiritual guide in the dream seem to parallel
or emulate my "practical" movements of the days preceding, when I had fumigated
my old house in an effort to clear insects from our huge library. All of the
associations with moving and the connection with losing Ruthy or moving away from
her things are transmuted in the "sweet dream I was having" which is nevertheless
elusive and "I felt I couldn’t quite grasp." In this dream I am in an unfamiliar house
or apartment at night. A dark, swarthy man whom I take to be from India had,
apparently set up some defoggers like the ones I bought, and was going to fumigate
the house while I was in it. The fumigation devices appeared like censors, as in a
mystical rite of burning incense or ashes.
Only he told me . . . to close the door to one section as the other was
fumigated. I did. One section was fumigated, then the next .... The place
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had a feeling of bigness, not artificially lighted but with dusky glimmering as
from fire ....
Ruthy was suddenly there,
inexplicably standing on a chair to reach my height, looking quite pleasant, beautiful
and rested and expressing to me that although she had had some concerns about this
separation (of death), she now no longer worried because after experiencing it she
knew we would always be close. The dream ends with a sense of almost physical,
lingering closeness:
As if she was right in front of me— As if she was so close I could feel the
trace of her breath on my face . . .
As mentioned, dreams in which the dead person actively figures are often
considered very meaningful by the bereaved. The griever may feel infused with the
lost one’s presence, a sensation that may linger hours or days after waking. It seems
in such dreams as if the bereaved is (a) trying to engage in, or experiencing, a
dialogue with the deceased; (b) experiencing loss or threat of loss; (c) finding or
trying to find and recover— to restore-the lost one; and sometimes in the same dream,
(d) trying to understand, make sense of, and accept the loss. Tittensor (1984)
recounts:
The dream. Emmy [his dead daughter] again. Jonathan [his dead son] had
recently died of a disease which would soon kill her too. She seemed sm all-
smaller than when she died-and we were playing with the bright yellow torch
I carry in the car. What stood out most clearly was the colour of the torch—
there seemed a childlike brightness, clarity, happiness about it— and the way it
drew our attention as we played. The whole dream pervaded by that bright
color.
Woke up feeling strangely consoled and the feeling of having enjoyed
her company stayed with me quite distinctly for a couple of hours. In a way
it’s still there— as if it were something that had really happened and been
incorporated into my store of memories about her. (p. 37)
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In my dream of the "fumigator" or mystical censor, above, there is a feeling of
connectedness or union, as well as a recognition of change and the sense of something
unknown. In addition, as well as Tittensor (1984) indicates, there is the sense of
something added to what is known and remembered.
However, along with the sense of a special connection, there is still often an
ongoing sense of loss. Thus, missing Ruthy and grief-ful feelings reemerge when I
feel desolate and again pound the floor and cry. I cry and hold Ruthy’s coat, "feeling
its lightweight-nothingness .... -missing Ruthy." At these times I feel "I must
force myself' to go on. There are memories of past experiences of sharing and I feel
haunted by them and their absence. In addition, there are re-remembrances of the
trauma of loss, as I realize it is the "anniversary" of Ruthy’s being in critical
condition. Yet, although there are resurgences of acute traumatic feelings, there is
also a "new relation"— a "new" period of grief. There is a seemingly contradictory
mixture of grief, love, loss, recovery, youth, age, coziness and starkness, as
illustrated in dreams which are painful but also transformative, as for instance, a
dream where Ruthy was presumably seeing a doctor in a clinic:
It’s confused— what Ruthy’s condition was in the dream- was it a mere
"check-up"- or near death?
Then I remember that this "is the month Ruthy was in critical care constantly in the
Hospital!! How it tears me!" I continue,
I wanted Ruthy to be seen in the dream -- by the doctor (why is it I usually
want this?) I felt she would be cured— or helped- to life . . .
There is a confusion of images:
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Ruthy’s hands— they are shaped more like claws?2 '- long fingernails- blood—
Blackish red on them— I know she is very sick- I feel for the pain of the
hands, their animal appearance despite their humanness-— their having been
made that way .... they are helpless and hurt— I think it has to do with
blood- transfusions— rather extractions— numerous tests . . . . I knew the
strange appearance of her hands was due to her sick condition—
There is then a transformation in the dream, that parallels the transformation of when
Ruthy "rose from the dead" when she got out of the hospital, yet also goes a step
further.
I got her up (?)- somehow? she was in the doorway with me; I touched her
arm— I was aware of both our bodies (aware of how H. strokes my arm - and
now how I feel when I stroke it myself)— Suddenly I became aware in the
dream of how voung Ruthy’s body felt and looked . . . A little surprised-
B ut- more of an appreciation and awe, I said something like "How young you
look— " or "Why, you feel/look as young as me."
I stroked her arm, I believe, she was wearing a sundress . . . the
feeling of youth is smooth skin, supple limbs . . . Her body was like
mine . . . like mine in my early twenties. I was delighted . . . at her
youthfulness.
This type of transformation seems to be magical; life and death, youth and age
become somehow unified. It embodies the supreme spiritual metaphor of
resurrection.
Then suddenly I realized Ruthy must be tired. I felt her body lighten . . . I
saw her ill face— her illness— I felt the tiredness of sickness— . . . I wanted to
hasten to take her back to the bed— yet I felt weak— as if I couldn’t quite
accomplish it in time (?)- like the encouragement I’d wanted to give before.
2/ There are multiple meanings to the "claws": Ruthy and I had shared a love
for sea animals including lobsters; after her death I had felt like a "frozen lobster"
until I met H. and felt that somehow his influence was thawing me out. In the
dream, Ruthy likewise is "thawed out" and becomes young and invigorated. Like the
dream in whole, then, the claws for me are images of transformation as well as pain.
3/ Becker’s (1973) rendition of our existential "creatureliness" comes to mind
here.
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This again, seems to emulate what actually happened when Ruthy was released from
the hospital out of critical condition. She "seemed" better, and yet she was actually
near death. In the dream,
She was light, like her coat— A feeling of not weighing very much at all . . . .
I thought she was getting well, recovering-1 said something like "You must
rest every day. You must rest an hour every day from 10:30 to 11:30." It
seemed like a silly statement and snap, as if that silly superficial statement
broke the spell, I woke up. Ruthy was gone. The young Ruthy and the old
Ruthy.
I woke up and cried.
Though this dream is a sad replica of what happened to Ruthy and my experience of
her death, it is also transformative. In the search for meaning and to bridge the gap
between incongruities such as life and death, absence and presence, transformations
occur. There is a contradiction in the dream described above, between the sense of
connection and the sense of loss, between the real absence, and the remembered or
imagined presence. Theorists such as Bowlby (1980) and Freud (1917/1957) indicate
that in grief, this conflict is regularly resolved in favor of the "verdict" of reality.
With acceptance of the reality of death, the other is relinquished. In the present
work, on the other hand, I question whether the paradoxes illustrated above describe
something which specifically have to do with our experience of death and of grief and
the paradoxes inherent in death and loss. In my own experience, this contradictory or
paradoxical sense of reality is an issue that comes up in various guises again and
again. It is also often when I feel the most acute despair, that I have the most
regenerative and spiritually enriching dreams. Such dreams seem to amalgamate
yearning and despair with what could be called "coping" or "transformation."
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As in the contradictory images of youth and age, death and reemergence to
life, my grief is also contradictory or changeable. I reflect, for instance, in my new
apartment:
For the first time that night, before I’d gone to bed, I lay in my room and read
and . . . felt more at home.
and express in the same month feeling a sense of "calmness and serenity." Yet on the
other hand, "I miss Ruthy’s physical presence-her reality— in stark sense." Thinking
"I wish I could smell your perfume again . . . I start crying when I say that, realizing
its absence." And "Ruthy’s being gone— seems as sudden as last October when things
looked so bad, were so bad."
Practical worries about money as well as trying to complete my academic
requirements contribute to the stress of loss, leading me to feel overwhelmed by
"obstacles," and wondering whether I have tried to do "too much" in these matters of
importance to me (internship, career, etc.), yet still desiring to do so. There seems
additionally a shift which includes more and more writing to myself, rather than
including Ruthy, indicating, perhaps, some of that "emancipation" Lindemann (1944)
seems to regard so highly, or more likely, the sense of separation, without excluding
the pain of loss and of missing.
Generally, "anniversaries" (such as the anniversary of the death, the lost one’s
birthday, Christmas, Thanksgiving and major holidays) are considered to be occasions
that trigger intense anxiety, longing and pain because the deceased is so palpably
absent. Although "anniversaries" are important every year, the first year of loss
represents the "first" time many of the "reoccurrences" or triggers of pain are met
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with, highlighting the freshness of the pain of loss. In my experience, in the first
year or so there seem to be anniversaries for everything, that is, a first time for every
experience in which Ruthy is no longer present. Most significantly is the first
"anniversary" or recurrence of the whole traumatic period which led up to Ruthy’s
death, from mid-September when she entered the hospital and almost died there, to
the end of the year when she did die. Thanksgiving and Christmas are naturally
anniversaries of loss and possible periods of sadness, difficulty, and missing, as are
my birthday in December, and my sister’s on the 31st, the day that Ruthy died.
Although the specific anniversaries can be planned for to some extent, so that some
sort of ritual of mourning takes place, other aspects of these time periods make them
viscerally and almost half-consciously felt, particularly the period of Ruthy’s
traumatic hospitalization. On occasions such as Thanksgiving and Christmas, part of
the mourning ritual my sister and I engage in, seems to be specifically the planning
for how we are going to "handle" these. In such planning, there is acknowledgment
of the pain and loss and also coping. It is during the period of severe "anniversary
reactions" (e.g., remembering the trauma of the hospital), the journals reflect an
increased sense of fragmentation as well as a struggle to construct some sense of unity
and meaning.
The sense of despair and loss at these times seems to connect me with the
spiritual in that "every moment we can feel such pain, it’s only when we feel this,
that we can cross over the bridge to something else— perhaps because we have given
up everything." While, as Bowlby (1980) points out, it is when we reach despair that
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we give up hope, hope that the lost one will ever return, paradoxically we may "give
up" hope again and again. Reaching the "depths" of despair, we find again that we
can reach that depth, or another, at a later date. Such a process of rediscovering
one’s attachment, and hence rediscovering loss and the yearning and despair that
accompany it, is comically portrayed in O. Henry’s Cabbages and Kings (1904/1993)
when the character Geddie throws the bottle bearing the message of his old beloved
back into the sea unopened. He has fully and methodically convinced both himself
and the reader that he has given up on his last love . . . until he swims out to retrieve
the bottle, almost drowning in the process.
As I will continue to reiterate, "endings" are purely arbitrary and constructed,
and lived endings may not be endings at all but beginnings. From this standpoint,
"letting go" and accepting despair and final loss may also paradoxically allow letting
in and acknowledging the meaning and continued meaning-making and
acknowledgement of what and who is lost. In this sense, to acknowledge loss is the
very opposite of either undoing or being done with. Therefore, in the journals I find
myself confronting despair more as I believe Kierkegaard (1843, 1849/1941)
understood it than Bowlby: It is because of my despair that I find everything open-
ended, unknown, and unexplored, and exploring the gap presented by death, I seem to
find some connection in myself. With the loss of hope for what I know and expect, I
experience a sense of humility toward the unknown. Not only is there this possibility
then for oscillation between despair and hopefulness, but in my extreme struggle and
pain, I seem to find some meaning.
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Again, despair, longing and searching, desire, hope, hopelessness, belief and
disbelief often join hands. Therefore, on the first anniversary of Ruthy’s death, I am
sad, down, depressed. Despair reemerges and is followed by longing and searching
as I write to Ruthy again about loving and missing and wishing to see her. Although
it is a year since Ruthy’s death, yet the effect of the "anniversary" is to bring back
the trauma of death and loss as if it had just happened, along with the desire to search
and recover, the knowledge that recovery is impossible, and the sense of unreality
that this brings:
I dreamed I went to Farmer’s Market [where Ruthy and I had gone the day
before she died]. When I got near the stand where we used to have coffee the
feeling was almost unbearable . . . unendurable. I was with someone else . . .
who suggested we go to the stand on the other side. It seemed modernized. I
sat inside to drink coffee with Ruthy. The feeling of loss was so strong-so
sad--so unreal. How I miss you . .. . so very, terribly much .... the
world seems unreal when I realize you’re not in it.
Although by many standards I continue to function better and better into the
second year of bereavement, accomplishing academic and work goals and
participating in social and other relationships, I continue to reexperience the trauma of
Ruthy’s death:
It seems so intolerable sometimes— this grief feeling I identify as grief. It is
different from depression. Different even from despair? It’s like an
intolerable burden; a wound, a scar that’s unhealable-only so straining to
endure. Like an intolerable, unbearable weight.
I go around like a zombie .... but the zombie-like depression is . . . just
trying to go on. Saying I will go on.
Now knowing once again that H. and love cannot overshadow my pain.
I’ve asked myself too, where is the poetry? .... there are now only
glimmers, the smell of trees and last light on the grass .... it’s like there’s
no poetry to be trusted anymore-no poetry that won’t evaporate in a second,
very quickly.
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This period of despair and intense grief is, however, followed by feeling later
in that month "more integrated," and I notice a "pattern of . . . ups and downs."
Again, a month or so later, transformative type of dreams follow, with a questioning
of my spiritual values and the limits of my knowledge, and the belief in something
sacred and unknown that is beyond my reason.
As I have indicated, this period is both a time of intense pain and also a
feeling of meaningful transformation and spirituality. The dreams seem to comprise a
kind of magical or supernatural meaning and could include: a sense of closeness with
Ruthy; loss and trauma; some kind of supernatural knowledge involving the unknown;
conflict regarding life and death and the boundaries between the physical and the
spiritual, the past and the present, recovery and loss; and something special and
enlightening, making me feel strengthened and encouraged. Thus, they may be either
or both painful and uplifting.
Other dreams reveal a counteractive effect to any fantasy of simple reunion,
revealing again the struggle between accepting the reality of loss and maintaining the
other within, and between demarcating the boundary between life and death. Both
Freud (1916) and Parkes (1972) remark on these "special sort" (Freud, 1916) of
dreams of the bereaved in which "the person who has died is dead and at the same
time still alive"; "knowledge of the death arrives at the strangest compromises with
the need to bring the dead person to life again" (Freud, 1916, p. 187). In just such a
dream, more than a year after Ruthy’s death, I am at the foot of my old bed and
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Somehow, suddenly Ruthy was there, in the flesh . . . .1 had mixed feelings
and concerns. There was happiness at her being there— and yet— I believe it
was a bit disturbing because I knew she was dead—
While these types of dreams offer "compromises," they are also assertions of a double
or compromised reality— an inner reality in which the beloved does not die as well as
a physical reality which insures death. The fact that I am disturbed in and by the
dream arises from knowledge of both realities. I continue throughout the dream to try
to "unriddle-how Ruthy could be there, with her body. How could it be possible?"
There are strong mixed feelings of gladness at the recovery of her, of longing, of
sadness that "it couldn’t be real or right," "disturbance at its weirdness," and
"disturbance at death."
This appears to be what I consider a "boundary" or liminal dream, in which
the boundary between death and life is acknowledged in a similar fashion to the tales
and myths mentioned in Chapter 2. The treatment of the corpse may parallel how the
soul is conceptualized, states Hertz (1960), and as noted, many societies seem to
demarcate this separation of body and soul and the bereaved from the deceased in
rituals such as secondary burial (see, e.g., Mandelbaum, 1959; Metcalf &
Huntington, 1991). The dream, however, further parallels the scenes of Ruthy
"coming back to life" in and upon leaving the hospital, as she expressed a similar
bewilderment upon finally gaining consciousness there, asking me if she was dead.
There is a reliving here of this trauma, and similarly, of the questions of in the
hospital of how much I should ask her to "hang on" to this life.
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In addition, the picture seems to be bigger than can be portrayed simply by
seeing such dreams as a "compromise"-although they are that— that enables the
bereaved to acknowledge reality and deny it at the same time. There seem to be
questions here about what is the place or purpose of the bereaved vis-a-vis the
deceased in the scheme of things; what is his or her relationship with death and "the
beyond." This was highlighted for me in a dream which I analyzed later as depicting
a kind of hubris on my part, in contrast to humility. In this dream, I was in a dark
house and had "some sort of spiritual or supernatural feeling":
I addressed something? someone? the air? . . . T il make the introductions." I
said. I guess I thought I had some sort of communications pipeline ....
referring to making the "introductions" for/to Susan. Right after I said
this . . . I seemed to realize the magnitude, or immensity of what I was
saying, what I was taking on. As if I had a special pipeline to God . . . or
spiritual world . . . I was scared. And I realized at the moment I had no or
not enough humility .... in the end my fear "won out" . . . . I was
sorry . . . innerly, silently realizing . . . I couldn't bear to see [it].
More than Ruthy, I felt the dream image emblemized "the unknown." The unknown
of death and time as processes too big and mysterious for me to be able to
"compromise." Despite the closeness I feel toward the Ruthy, there is something
more to this "Ruthy" beyond death; there is a boundary I cannot cross over and a
sense of separateness that along with my feeling of closeness creates another paradox.
While the relationship continues to develop imaginally, therefore, there is also
a sense of a boundary between life and death which pronounces the separation. By
crossing over the boundary of death, the deceased becomes part of a great unknown,
and in this sense as part of a continuing image or presence, the dead person is
recognized like the notion of life after death, with all its possibilities (e.g., as in such
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notions as "heaven," "the afterworld," the possibility of impossibility even), and is
unknown, as a "blank screen" onto which the griever can only project, intuit, and
imagine. In this way the loved person becomes part of the impersonal world, even
though the griever feels a personal connection. Says Jung (1963), although "we
cannot visualize another world ruled by quite other laws" and therefore are left to
"mythologize," it is nevertheless necessary to "create some image" of life after death
to make our lives rich and whole (pp. 300-302).
While both Bowiby (1980) and Freud (1917/1957) indicate that this back and
forth process of hoping and searching, frustration and disappointment, is instrumental
in accepting the reality and finality of loss, they do not indicate how almost
simultaneous such processes can be or on how many levels such searching and
frustration might occur. The above dreams are disturbing, first because they contrive
to "turn the clock back" to some extent upsetting the order of the natural world, but
also because the process that initiated the path leading to death and its consequences
cannot be reversed. There is still sickness and ultimately, death. There is a
perception in the dreams that the participants-both me, the bereaved, and Ruthy, the
dying ont — cannot undo their experience. The visceral, emotional going-through of
the experience cannot be undone even if imaginatively the results are reversed.
Instead, there is a sense of wrongness and increased disturbance due to the sense of
unreality an actual reversal would insinuate. Therefore, themes of "resurrection"
(which also seem related to Ruthy’s actual "resurrection" in coming home from the
hospital initially) are enacted in dreams with a sense of specialness, connection, and
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upliftment, on the one hand. On the other, the spiritual element includes a concern
for boundaries, and I find myself facing some sort of a taboo emerging, becoming
aware of the boundaries between life and death.
The search for meaning and grappling with the contradictions and paradoxes of
loss, as well as with the pain of loss, continue strongly in the second and third years.
In contrast to the dumbfounded disbelief as to how such a reality (ultimate loss) could
make sense, there is the implication of a Kierkegaardian "leap of faith," believing
there is some meaning and purpose, and at the same time feeling it is beyond my
conscious grasp. This search for meaning does not cease, only ebbs and flows, is
accentuated or eclipsed. There is no final "making sense," but an ongoing
readjustment of making meaning. Contradictorily, there is both depression regarding
the loss in the second and third years as well as a significant amount of hopefulness
concerning life. The fact that the positive feelings occur along with the painful ones,
or in relief of them as it were, seems to be distinctive. So much pain and suffering
highlights and gives added meaning to positive feelings, and the reconciliation
between the two types of feelings adds a sense of specialness and poignancy to the
positive.
Acute grief and mourning also continues to recur with "anniversaries" and
lessened social support. Appropriate social support helps to ameliorate, process and
experience some of the grief-ful feelings, although it does not take away the grief.
Patterns of lament seem to occur similar to Bowlby’s (1980) yearning and searching
accompanied by reality-testing. The laments focus on paradoxes such as: "That I
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could love you, you could have existed and no longer physically exist"; "that I could
remember you and still love you and feel your influence, and you do not physically
exist"; "that the rest of the world and life seems to go on immutably although it has
drastically changed." Although there is some sort of resolution in these "episodes," it
is more of a re-acceptance of these paradoxes of love and loss than an acceptance of
death as pure negation.
The trauma of the hospital experience is re-lived again at intervals, interwoven
with improved coping and a continuing reemergence of hopefulness and energy, as
well as with a sense of Ruthy’s strength and her "continuing presence," and a
growing sense of integration. There are seeming reverses, as in a fresh realization of
Ruthy’s death, "bawling and crying," periods of intense missing. Sometimes there is
a sense of presence followed by a feeling of absence (or vice versa), with the
realization that the spiritual does not negate the despair of loss or sense of a void.
Often stress concerning academic and financial pressures and difficulty striving and
competing in the midst of grief add to difficulties and depression. This, too, is mixed
with the fact that I am also encouraged by my accomplishments and excited about my
work.
In late 1992 and 1993, there are again reflections on social support and
additional stresses as during this period I move to New York to begin an internship.
During this time, there is an even greater sense of functioning (for instance, in terms
of work) as normal, and pleasant excitement about changes and tasks to be performed.
At the same time, there are also what Parkes terms "pangs of grief." There are
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oscillations. Therefore, a sense of more acceptance of the loss, as Bowlby (1980)
indicates (although he cordons this to a specific phase), inevitably leads to despair.
The acceptance of goneness, the immutability of loss and existential givens are part of
this despair. And yet despite this despair and acceptance, memories of Ruthy
infiltrate my life and often again fill me with a positive sense of her presence. These
include memories of everyday events and conversations, sometimes interwoven with
her death, that is, of her identity/life as a whole. As I try to type something, I
reflect:
I don’t now how you, Ruthy, typed 6-8 hours almost every day . . . . I still
remember you sitting . . . at your typewriter that last day! . . . you turned
toward me . . . you smiled ....
But as long as you could, you’d be busy working .... You were always (at
least in later years) afraid you would die and not have got enough done,
written enough . . . got enough accomplished!!!
In missing and longing and trying to deal with my grief, I continue to invoke Ruthy’s
presence and how she faced things in my own difficulties, remembering her little
habits as well as construing her life overall, reflecting not only on the more recent
Ruthy and more recent me, but on the past relationships, trying to reconstruct both of
our lives. Thinking upon my childhood and young adulthood,
But it feels like there is so much more. When I put myself in Ruthy’s
place . . . how hard it must have been [during economically difficult times]
and how much courage and strength she had.
and
Ruthy would love to sit and read . . . in the afternoon .... I ask myself what
Ruthy would do. What Ruthy did. To seek guidance .... How many deaths
she faced. And yet she went on, and enjoyed life . . .
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On other occasions, without trying to invoke it, I have some sense of Ruthy’s
presence which I am gratefully surprised by, as when sitting with a close friend,
Yet again, the strangeness, as I feel a trumpet broadcast, a symphony of
perfume [a particular perfume reminiscent of Ruthy], cascade upon me with its
blessing, when I was sitting and talking . . . in the outdoors of the restaurant.
Parkes (1970, 1987) makes a valid argument for why bereaved people may
experience what are considered hallucinations or perceptual illusions by attributing
these to searching behavior which involves an internal perceptual "set" which is used
to look for and identify the missing person. The perceptual set for the lost person
and aspects of the environment where the lost person would likely be found contribute
to illusions of the physical presence of the person. In my own experience, however,
such occurrences have a quality of feeling like gifts. My experiences, similar to those
Parkes describes, diverge from his description in that they often occur when I am not
actively "scanning" the environment and so am surprised. When I have been in an
environment likely to stimulate this perceptual set~for instance, Ruthy’s old bedroom
--I am still extremely surprised: The scent of the perfume seemed to arise "out of the
blue," congruent with my mood, but not with my conscious expectation.
Of particular interest in my own "perceptual" experiences is their relational
context. In the example described above, sitting in the restaurant with my friend, it
seems as if in the relief I receive from talking to him I also have a sense of relief at
somehow "sensing" Ruthy. This particular close friend is a strong support at the
time, and
I felt such relief -- from my loss-- temporarily - such relief from what I now
realize is an enormous amount of tension / ache / hurt. . . .
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This kind of transfer of relief and sense of a type of "presence" implicit in a third-
party relationship seems related to what Bollas (1987) describes as a transformational
relationship. In describing the infant’s experience of the caretaking figure, Bollas
uses the term transformational object to illustrate that the experience of the mother is
a "process of alteration" (p. 286). The language between them, spoken and
unspoken, is the process which is internalized. The object is "known" existentially
rather than representationally. It seems that here that what is transformational in my
relationship with Ruthy may be carried over into other relations, at different times,
like the relation with my friend--a particularly close and confidential friend. Thus,
though we are not discussing Ruthy, death or anything of the kind at the time, but
merely having a snack after a movie, my friend’s attitude o f care in the midst of my
overall feeling of the tensions of grief are relieving as would be the presence of
Ruthy. In the selfobject world, the real and the imaginary coalesce.
This confidential friend highlights again the importance not only of all sorts of
social support, but the kind of listening that allows for the story of loss to be retold
and shared. For "although others are empathic," when he "has listened to me, I feel
he has heard in a deep, deep part of him what I feel." Similarly, in the early months
of bereavement, I had often confided to another close friend, one who because of her
own experience of death, could empathize deeply. I was aware then only vaguely of
the mechanics of care, or transformative qualities that made, for instance, her
listening at her cozy fireplace and her cooking of eggs so soothing an aspect of her
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empathy. Besides invoking the presence of the lost one, telling the story of the loss
was crucial, telling it to myself, and to others who cared.
Like the dreams of transformation and boundary-crossing, these special types
of experience (i.e., a strong sense of Ruthy’s presence and perhaps even the fragrance
of her perfume), seem to have occurred more particularly at the end of the first year
of bereavement, and in the second and third years, than later. They seemed to occur
during periods of an overall sense of acute pain and missing and quest for meaning,
although at the time they occurred I was often not in any acute pain, and often least
expected it. Instead, frequently I was receiving active comfort, love, and support
either from myself or someone else.
My dreams reveal a shifting relationship with Ruthy, as well as multiple
personas both for her and for myself. While certain of these personas come direct
from life (e.g., remembrances of the types of relationships we did have, such as a
caring relationship indicated by Ruthy’s concern about some problem I wanted to tell
her), the effect of death necessarily obtrudes upon the relationship and changes it.
Thus, mentioned, in certain dreams I am sharply aware of the "boundary" between
us. In others, Ruthy is felt as almost a living, breathing presence. In still others, she
is a comforting, but silent being: Her silence bespeaks a special kind of detachment,
and while close, is, paradoxically, at the same time, somewhat impersonal-the voice
or image of someone who is "beyond" this life and does not or cannot interfere with
it. In contrast, at times the connection is felt as so powerful that the separation or
boundary between living and dead can only enrich its special significance. Notions of
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death thus inform the relationship (or one of the relationships, accepting here the
possibility of multiple types of relationship) and change it so that it can never be the
same mortal relationship again.
Awareness of death, and thus according to some definitions acceptance of it,
therefore, does not preclude an ongoing sense of relationship and even interaction.
As I have implied, however, the possibility of relationships is multiple, for along with
the more detached, impersonal recognition of Ruthy as a voice which is beyond the
living, there is the reconjuration of her from the past including the construction of
new experiences with this "Ruthy"--this Ruthy for instance, who would reply to my
own horror of her death with philosophical matter-of-factness.
Death recurs as an important "figure" in dreams, and additional anxious
searching for Ruthy is illustrated after almost two years of bereavement when in a
particularly catalytic dream, my sister Susan and I arrive at a house looking for
Ruthy:
It was dark .... We went down this street to a house th at. . . had a glass
door— there was light inside, but we had to wait outside for some reason, for a
time. The feeling was . . . of not having seen Ruthy for awhile-which was
also incomprehensible--the feeling, the thought that she existed, lived here . . .
in isolation, away from us, was very sad .... I missed her . . . .
Time, presence and absence may be mixed up in my dreams, and here I lose track of
time and what was lost.
As much as we both wanted to see her, Susan and I felt both anxious-we
couldn’t just go right in . . . . There was a separation. Susan waited
outside .... and I decided to go and get my car .... I went down the
street. Down past many clumps of cars . . . Was there a little cottage, or the
idea of a house to the side, . . . Ruthy- an image of an woman, Ruthy,
growing older-white hair- older than Ruthy was when she died- flowing white
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hair— I felt so sad . . . I felt I had to find her. Where was she? Anxiety,
desperate. I would take care of her. I would, I thought. I would, it didn’t
matter how old she grew ....(?? I don’t know what all I thought)— and then
I thought, but she’s dead. She’s already dead. Alive and dead, I felt. It was
queer. It was too late. It was impossible.
Later I come to see the dream as representing as much a journey for Ruthy as for me.
Again, though I want to "save" her, it is implicitly impossible. And yearning,
missing, and anxiety oscillate with both despair and acceptance.
During approximately the second and third year after Ruthy’s death, I am also
more aware of a sense of fragmentation associated with loss. Part of this seems to be
affected by the context of a new work and living environment; yet besides the stress
of ongoing environmental changes, I recognize a fragmentation which is specifically
related to a sense of the loss of my mother. This again is related to the despair and
acceptance that she will never be whole again, she will never be as she was, and the
effect of her absence on the wholeness of my life. A self fragmentation is felt as a
part of loss. Though a reconstitution may occur, this also is impermanent, changing,
and therefore fragmentary. It seems, in fact, that due to the "reorganization" after
loss, that the awareness of fragmentation (or what we might call disorganization)
becomes possible. Initially, there was an attempt simply to "go on" functioning;
later, when living became easier, I became aware of what had changed or dissolved in
the process.
Despair, as Bowlby (1980) asserts, is followed by a reorganization, but it is
through a kind of fragmentation that reorganization occurs, and recurs (and
paradoxically it is this reorganization that allows for additional despair and missing at
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loss). Withal the sense of loss and goneness, there remain loving feelings towards
Ruthy, a sense of presence or connection, as well as seeing through her eyes or
imagining how she would view something. There is a sense in the journals of the
process of self-dialogical support becoming firmer. Therefore there is a process of
both connection and fragmentation, disorganization and reorganization as the
relationship with Ruthy continues to be reconstituted. As I continue to change in
time, Ruthy seems, for instance "farther away" or "closer." New impressions and
experiences combine again with my internalization and my remembered and imagined
co-construction of Ruthy’s view of the world and of myself to include her somehow
in this psychic reality even as she is not there. Such tacit inclusion is illustrated, I
think, for instance, in a feeling of the past blending with the present such that,
although I know in reality Ruthy could never have met such people as I am now
meeting, I have a sense sometimes that she has met them.
Remembering and reconstructing the other is part of reorganizing reality and,
paradoxically, also part of missing. It is paradoxical because it is because the other is
absent that her or his presence is recreated. Holidays, and anniversary of Ruthy’s
death continue to evoke grief, a sense of emotional and existential fragmentation and
despair. It is during this time, that again there seems to be an attempt to find or
recover, as well as an acceptance of the finality of loss, as I dream of Ruthy dying in
my arms (the dream mentioned in Chapter 2). Other practical stressors combine to
make me feel as if I am "pushing a cart and a horse uphill," and I feel again the
difficulty of grief, the difficulty of functioning with grief. "Why is this so hard?
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Because it is. so hard." Although I am helped by various forms of social support,
there are times when I feel "no one can ever take away the pain and the loss of you."
Alternately, at times I also express that "money would solve a great deal" of my
tension. Both expressions indicate that although they cannot resolve it, environmental
stress and social support can contribute to or alleviate some of the difficulty of grief.
Two and a half years after my mother’s death, I write of feeling better,
"coming to myself," and feeling more constructive. Yet feeling loss is realizing the
finality of death and loss. Thus, the realization of Ruthy’s death and her loss
remains. Tittensor (1984) writes that after a year, thinking about his children~as he
does each day--brings the sense of a "knife lodged deep and hard in my chest; one
that must remain there until the very last second of my own life" (p. 25). Again, he
continues that, although less, the pain and sense of loss "are with me in some form
for life" (p. 101).
Environment, including social, financial and physical resources, continue to
play important roles in how my grief is experienced. With my internship, for
example, there are continued feelings of integration and "renewed hope and strength."
Yet, returning to California after the internship ends (which represents various other
losses) as well as other stressors, reverberate with my loss of Ruthy:
Severing some connections . . . maintaining relationships . . . but leaving and
losing nonetheless, to return to a place . . . where I have no mother-
physically-
Then I recognize that "loss is not static— not fixed-but alive," "interwoven . . .
affected by and affecting many other things." "Time does not only ‘heal’- it goes
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on . . . . The wound cannot he isolated." I experience this interaction of losses,
potential and actual, again, upon my brother having an accident, and my sister’s
projected move to another state.
There are ongoing but intermittent episodes of a kind of reconsolidation or re
understanding of the loss, when I summarize what it means that Ruthy is gone.
About three years after the loss, I recapitulate,
I guess I think that you are gone, Ruthy, gone on your journey— gone ....
you’re beyond this world— What does it mean?
Sometimes I feel very sad, and sometimes I cry with just a slight
memory— or when I say something honestly to myself and acknowledge you—
loss-again .... [But] it seems as if you’re gone farther, in some way—
Although I have these memories .... If only memories . . . could be
resuscitated to life through writing, but I do not feel-I can.
Once again, the "stage" of acceptance must be confronted and questioned. There is a
"reconsolidation" with the environment and with the regeneration of emotional
experience. And yet even with fresh sadness, despair, and acceptance, periods of
intense yearning also recur (as in 1/22/94, a full three years after Ruthy’s death),
when I long to see Ruthy again, and ask again, "How can you be dead?" Although
obviously not the same as my initial "disbelief" or shock, the questions are similar or
the same.
Although their time of occurrence is not to be charted or predicted, there
seems to be a pattern to these recurrences of missing, yearning, despair, sadness, an
acceptance, like an intermittent lament, which may last hours or days. This lament
seems to consist of the following type of sequence of themes: (a) remembering and
appreciating Ruthy; (b) missing her and longing for her to return; (c) asking "How
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could you be gone? Everything else goes on"; (d) not wanting to accept the finality
of the loss; (e) then driving home the reality, "You’ll never return to these
clothes . . . (f) again, either appreciating or invoking Ruthy, "What would you
say?" and soliciting an imagined dialogue; and finally, (g) affirming the paradox of a
strong inner sense of her, her presence, even with absence and the finality of loss.
The resolution of this is only temporary, as though I appreciate what presence there is
and what I can reconstruct, there is always the reality of death and goneness, the
physical reality of the absence, and of the fact that the world is fundamentally
changed.
Over the years, the above laments have seemed to occur less frequently and
often over a shorter time period, although in some manner they persist. Thus, there
is less questioning, less overt replaying of "how could this be" and disbelief-type of
statements. On the other hand, various aspects of the "lament" often seem fused so
that I am aware of my missing and sadness and loss almost at the same time as I
remember the process of trying to make sense of and deal with it. Sometimes what
occurs is just the final recognition of the sadness and pain of loss, along with the hope
that the "universe" and Ruthy and myself are "all right," with the acceptance of the
fact of death, and the paradox of love and the pain of loss.
The relationship continues to change even as patterns of missing and longing
recur. About three and a half years after her death, for instance, I dream that Ruthy
is moving.
Although I couldn’t understand why she was moving, I offered to help. . . .
Ruthy, bustlingly, far from ill or old it seemed, quickly, efficiently . . . began
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to unpack an oblong narrow box of books and put them in a more suitable
box.
Therefore, I interpret she was displeased with the packing and had a "mind and a will
of her own." I interpret this disagreement as a kind of differentiating which pertains
to me and my feelings towards her; yet in this process, it is interesting to note that
the internalized other also changes.
There continues to be a search for a balance between loss and love, as well as
an acknowledgement of the separation between life and death. This process is
illustrated in a dream I have more than four and a half years after Ruthy’s death.
Both disturbing and uplifting, the dream is inherently paradoxical. In it there is the
sense of both the disconnection caused by death and my feeling of closeness to Ruthy.
At one point maybe I tried to hug Ruthy . . . but she protested that I not
lift . . . or hold— her under her arms, as it was painful . . . which was
saddening . . . but asked that instead I hold her hands. I did.
I think at some point I had some crazy idea . . . [i.e., the presumption
or hope of returning to life "as usual"]
When in the dream I suggest something to her about being together in the future, I
am doubtful of her response.
I don’t know what she said if she said anything. Perhaps it was "N o -"- or "I
doubt it"—
She held out her hands, her palms, as if . . . in the hand holding in her
hands was the key to bring her back to where she had come from— the spiritual
world . . .
I felt a sense of contradiction since I interpreted holding her hands as a connection or
invitation. Overall I feel a sense of the sanctity and profundity of the message and
the presence of the dream, but at the same time a paradox:
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[T)f there is no life hereafter— if there is no connection (now or forthcoming)-
then how is it or why would it be that— I experience you, Ruthy, and telling
me this— or what I am now trying to formulate into words . . . ?
Continuing to feel and process loss means continuing to reconstruct loss and its
meaning. First, there is a re-giving up, a re-loss in the dream; but again there is a
sense of connection amidst this ultimate loss and separation. I decided on multiple
meanings to this dream, just as I felt there were multiple Ruthy’s. The dream
[Bjrought home to me again the Ruthy of my pictures and of my past and
memories is not the Ruthy of now. And yet that Ruthy is not gone-lost-
either. That is . . . The Ruthy who I know loved me so . . . .
Yet again, there is a confrontation of death and what death means. The dream
describing Ruthy in a supernatural sense with her palms outstretched is a dream about
ultimate separation, yet it is also about the mystery of death and its unknown. My
confrontation with grief and death involve neither a complete buttressing of belief in
the afterworld or disbelief, but a continued process of negotiation in which all of the
possibilities are acknowledged.
Withal the separation, in it I feel the profundity of a presence. Shortly after
this dream, I write, "Ruthy feels so alive to my memory today and my senses today,"
and, "People don’t die until they move from sensory to declarative memory."
Meaning that as long as an embodied, vivid, emotional sense remains, as opposed to
the declarative memory of "facts," the "real" other remains.
About four and a half years after Ruthy’s death, I write, "I am still haunted by
your loss," and yet I feel that overall there is some "blunting over" of the pain.
Again, I recognize an oscillation between psychological and philosophical equanimity
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and facing the pain, despair and horror that occurs if I actually imagine and live the
loss. This is not to say that I am as grief-filled precisely as on first learning of the
death. Grief changes— but also repeats itself. As an example, visits to the cemetery
are never the same experience, though these visits might be prompted by similar or
related motives, which I could summarize as: wanting something from Ruthy;
wanting to give something to Ruthy; wanting to experience, explore, and in some way
express my feelings; missing Ruthy and wanting to experience a sense of closeness;
wanting to express love and remembrance; wanting to continue a tradition of a
relationship that is valued; wanting to experience my feelings of sorrow and loss;
wanting to feel comfort for my experiences of sorrow and loss; wanting to open a
"dialogue" which might reveal what it is I am missing; wanting guidance of some sort
as to what Ruthy might express about a certain situation.
Each visit brings a different type of experience. Therefore, on one occasion,
saying "good-bye" as I prepare to leave for New York, there is overall a sense of
philosophical comfort I derive from the visit, meant to symbolize a seeking for
guidance and for blessing on an important change in my life. On another occasion,
several years later, there is an intense sense of loss and crying as I reexperience
Ruthy’s goneness and my missing of her. On another, occasion, I remember Ruthy’s
various reactions and experiences of loss, comparing them with my own, and
experience valuing and appreciating her. There is a sense of gladness that I was able
to share times and experiences with her, and these past enjoyments are present.
Another time, there is a sense of loss and sadness, as well as anger and irritation at
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tractors being driven over some of the graves at the cemetery. As a final example,
there is the most recent time, on occasion of Ruthy’s birthday in May of this year
when my sister and I visited the cemetery. On this day we talked about Ruthy, ideas
for stories she’d written, making plans for trying to collect and publish/republish
some of Ruthy’s works, as well as our own writing goals/plans. Interspersed is our
pervasive knowledge and awareness of Ruthy, our loss, and our memories.
On occasions that can be marked (birthday, death, major holidays), my sister
and I, either separately or together, perform an adaptable kind of ritual. In the
above-mentioned birthday, after visiting the cemetery, we read and discuss some
examples of Ruth’s work on a picnic in the mountains. The picnic is like a
reenactment or re-ritual of things we used to enjoy with our mother, including the
important thermos of coffee. Integrated in our talk of the past and of Ruthy, is a lot
of talk of the future and each of our plans. Although on the date of her death we talk
about her and read her work as well, a sense of sadness or depression pervades, while
on her birthday there is a more optimistic feeling, and as indicated by discussion of
our own projects, a looking toward the future. In contrast to these occasions,
anniversaries of the traumatic precursors of death are not something we plan or
prepare rituals for, but only something we acknowledge as painful. Even as our last
"ritual" was a pleasant occasion, filled both with poignant remembrance and plans for
the future, I realize again as I write, "Nothing will ever be the same again-though we
do some of the same things, and many new things. Nothing will be the same when
the part of reality with you isn’t here, is gone."
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My sense of self and reality are irrevocably changed although much of it
remains paradoxically the same. "The truth is you can’t eliminate your pain— " To
be able to remember the lost one and the loss involves pain as well as an integration
of absence and presence. Therefore, as Hillman (1992) continues "Sideways
Tractate," describing her futile search for her dead friend and mentor "between the
rows of books," she then sees her friend’s face:
her face came from the general background
not being looked for
but being found, (p. 39)
The irrevocability of loss and the existential givens continue to be negotiated at
intervals. In terms of the traumatic experience leading to death, although I
progressively cope better with this trauma, I still question at intervals, "Is the
Horrible forgotten?" There is a sense of greater control over painful experience,
because I have a sense of my prior experience and prior coping, but painful feelings
associated with trauma and grief do recur, although not as often. "Control" involves,
at times, a sense of either opening or not opening a particular "door" that may lead to
certain feelings. In this type of control, there is a knowledge of what triggers pain,
as well as how this pain can be pursued and felt in depth. Yet at the same time, it is
not simply a matter of learning how to avoid the painful, as the painful is connected
also with that which I want to preserve (my memory of Ruthy and the meaning of the
pain). Often, therefore, there is a choice not to avoid or control; on the other hand,
at times, painful feelings cannot be avoided no matter what I "decide."
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While the pain of loss and the missing of the significant other may never
completely cease, what is healing is in the midst of absence and the pain of loss and
the reality of our existential limitations, as well as the horror of how death may have
occurred, is the possibility of self-forgiveness, or rather of self, which allows life to
go on while the other has died. This means that even with the pain of loss and the
reality of absence, that there is the possibility for pleasure, connection with others,
and striving for meaning. This bears similarity to Freud’s assertion that the ego,
rather than share "the fate" of the dead person— and in essence, die psychically-it is
"persuaded by the sum of the narcissistic satisfactions it derived from being alive to
sever its attachment to the object that has been abolished" (p. 255). Yet what I
suggest is not that the ego needs to sever its attachments to the dead, but rather severs
its connections to the material fate of the dead person. The ego, or self, does not
sever attachments with the deceased because although the beloved is no more
physically, he or she persists in the psyche and the co-constructed world of the
bereaved. At the same time, while the griever continues to share, or reconstruct,
realities and memories of the deceased, there is a recognition that she or he is
necessarily on the other side of the "boundary" of life and death-the life side-with
realities and circumstances that the dead person does not participate in. On
commemorating Ruthy’s birthday some four and a half years after her death, I
theorize in my journal,
Some sort of healing must take place. It is not that you forget or cease to feel
the pain of loss-or when looked at full in the face-you can "accept" it— no—
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But it is acknowledging some positive presence-acknowledging a positive
influence in your life that tells you it is good you should try to live and also to
try to make your life beautiful.
That says the wounds shall not always hurt you-that you shall find some peace
and love.
Whether this "healing" should be construed as healing of the loss through
death, or healing of the trauma that led to death, cannot be differentiated as both are
implicated in the overall picture of grief. What seems clear is not that grief ends, or
that some elements of grief do not persist, but rather that the sense of unrelenting and
continuous painfulness of grief abates, and that meaning in life, including a particular
meaning imbued by the lost one, is instated, and that the ongoing relationship with the
lost one, as well as with others, is an important aspect of how grief is incorporated
into the self. There is a complexity in this relationship since it occurs at many
different levels involving tacit and less tacit ways of knowing, internalized values,
qualities, and ways of being, different "I" positions (Hermans et al., 1992), a
dialogue and a reconstruction of shared experiences of reality. Further, with
increased experience and maturity, one understands the context of the other’ s life
differently and therefore continues to reconstruct it, both as something apart and in
relationship.
My experience points not only to an overlap between what theory presently
considers separate stages or phases, but to a recurrence and regeneration of
experience. It is the unique painfulness of loss of someone close to us, the unique
situation of confronting death in our being in the world, and our alinear means of
responding and coping with this loss that distinguish grief. The pattern reflected in
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my journals and in my experience is one of oscillation between varying degrees of
intense to less intense grief, as well as reaffirmations of self and other and the
relationship. Although generally not as painful as in the first two to three years of
loss, acute, painful reactions do recur over time, with a combination of internal and
external triggers. Grief, or feeling the loss of the other, does not simply end but
continues in different degrees.
Yet, while similar themes and experiences of grief recur, they are not
identical. As C.S. Lewis (1961) writes, grief is like "a winding valley where any
bend may reveal a totally new landscape." He adds, "you wonder whether the valley
isn’t a circular trench. But it isn’t. There are partial recurrences, but the sequence
doesn’t repeat" (p. 47). As part of this "winding," despair occurs early in my
experience of grief and also at later intervals; yet the despair is different because of
surrounding circumstances, my perception of it, my previous experience with it, and
my continued coping.
Although certain aspects of grief become less severe and frequent (still,
however, recurring with various, sometimes unexpected, triggers), there seems to be
an overall pattern of oscillation which, though it does not proceed in a linear, step-by-
step fashion, may be compared to a spiral staircase in which different levels of a
similar type of experience recur and can be compared to earlier experiences. The
pattern of oscillation occurs along with a process of increased coping so that while the
traumatic, shocking impact of death lessens, multileveled experiences of different
themes (e.g., belief, disbelief, acceptance, horror, yearning, missing, pain, anxiety,
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depression, despair, feelings of presence, absence, transformation, spirituality,
enlightenment, and loss) may continue to reemerge. In addition, the apparent
opposites of prominent themes (such as belief and disbelief, yearning and despair,
hope and hopelessness) do not necessarily obviate each other but rather provide a
dialectic related to loss and missing, and to the existential reality of death. Thus, a
sense of hope may occur without necessarily believing or hoping the lost one will be
restored; instead there may be a renewed sense of presence, which because of the
physicality of loss is counteracted by existential realization of death, which may then
evoke a sense of loss and despair.
Coping with death involves different levels of awareness, ranging from the
intense scrutiny of details and telling and reconstructing the stories of death and the
deceased, rituals designed for "anniversaries," painful reminders, and/or affirmation
and acknowledgement of the deceased and the relationship, to a kind of blunting or
buffering of memories and experiences, with various levels of experience in between.
Some painful triggers can be somewhat expected (as with anniversaries, holidays, or
environmental resemblances to the experience), but ongoing aspects of environment
continue to interact with grief experience to produce new emotional experiencing, as
in new losses, stresses, etc. Therefore, some triggers can sometimes be "controlled,"
but not always. Further, as grief involves preservation and reconstitution of the lost
other, it is not always desirable to "control" the experience.
The scrutiny or reconstruction that seems most methodical, necessary, and
intense immediately or early after bereavement, is the scrutiny of the immediate past
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and trauma leading up to the death. As I have indicated, after much questioning,
telling and retelling, and reconstructing the traumatic story of death, the story, or
need to tell the story, seems to reach a certain saturation: The "answers" seem to
have been given, troubling as they are, and I recognize I cannot change them. In this
sense, there is a greater "acceptance" of the facts of these answers, since the
questions are not put as frequently. However, as I have pointed out, learning the fact
of death and constructing reasons for its occurrence, as well as a "place" and meaning
for the lost other, represents a reconfiguration of reality which is itself not static but
which may reemerge to undergo further modification.
Development and reconstruction of the relationship and of the death continues,
though gradually on a more tacit level. Whether it be triggered by internal or
external events, the development of the self-other relationship may also be brought
into relief. Remembering the other as we knew them in life, we feel their loss and
absence; at the same time, we continue to "dialogue" with them in various ways and
to reconstruct them. In varying degrees, these experiences continue to oscillate rather
than simply begin or end. The process of coping with loss and grief provides a
perspective for continued coping, so that one learns that although one may feel
miserable loss and yearning for the beloved during one particular time frame, at other
times, the loss is more in the background and that it is possible to go on with life and
enjoy one’s interests and aims, and at times even feel some sense of the other in one’s
everyday activities.
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Learning to cope with death and loss, therefore, is also a process that
continues to develop. Although people physically die, they do not die in our
memories or in our emotions. Any important person or event in our lives continues
to affect us and be woven into ongoing experience. Second, a new, ongoing, or
recurring experience, in mm, changes the way we construct the past. A relationship
with a significant other is particularly important to the process of reconstruction if we
view others as "shoring up" the self and responsible in a co-constructive way for the
way we look at and live in reality. Although the trauma of death and the trauma of
what led to death eventually diminish, the effect of death~the feeling of loss and its
effect on the griever-does not disappear.
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Chapter 5
Developing a New Theory of Grief
It appears that although there may be a development of grief-ful responses and
of the relationship with the deceased, rather than proceeding in an orderly stage
fashion, this development is fluid and "messy" and may not have a precise endpoint,
if it ends at all. In this chapter, I begin to construct a theory to explain this alinear
process, arguing that it is founded on our earliest negotiations with presence and loss,
our responses to the existential, and paradoxical, givens of reality, as well as on the
regeneration of emotional and memorial experience caused by a dynamic, ongoing
dialogue between self and environment.
The oscillating movements of grief can best be understood in terms of a
dialogical (Hermans et al., 1992), intersubjective (see Beebe, 1995; Beebe &
Lachman, 1988, 1994; Stolorow, 1995), and multileveled (Modell, 1993) notion of
self emerging out of our early negotiations with and the paradoxical interplay between
absence and presence, self and other, material and symbolic reality. The existential
givens which forcefully confront the griever, of death, time, being and non-being,
are, in addition, paradoxical. Added to and transforming this paradoxical reality are
the creative remembrance or reconstruction of time and regenerative nature of
emotional experience (Lazarus, 1991). As neither time nor experience stops, the
bereaved must renegotiate loss of the beloved other in terms of new changes, both
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internal and external. Further, loss is (re)experienced and (re)negotiated both on
conscious and more tacit levels. In the following I develop these areas of focus,
demonstrating that they are critical to the development of a reaction which itself is not
straightforward but paradoxical. Finally, I address the contradictions inherent in
considering grief as "cultural" and/or "biological."
The Paradox of Loss
— You asked for the difference between life and death.
Safe in your non-death,
you exposed yourself to an answer....
you were handed,
like a black rose, the paradox-
(From "Black Rose" by Brenda Hillman, 1992, p. 47)
Perhaps one of the most obvious reasons that the world seems "inhuman" and the
griever feels "mad," as Tittensor (1984) implies, and that in addition to shock and
horror at death we feel "disbelief"— even while knowing and believing that the death
has occurred-is the paradoxical fact of death itself which starkly emphasizes being
and not being, as well as the absence and presence, symbolism and reality we
constantly negotiate and live with. Existentially, death is a paradox because it is a
contradiction of life and yet part of it, something we can be aware of, yet which
ultimately means the end of awareness. At the same time death raises the issues of
materiality and nonmateriality. "Although the physicality of death destroys man, the
idea of death saves him," Yalom (1980) states; we are metaphysically and
existentially "saved" by the idea of death as it enhances our mindfulness of being and
awareness of life.
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In grief, the existential awareness of death reverberates along with a similar
awareness that the other is both irrevocably absent and present. In loss, the physical
relationship with the other must be relinquished, but the meaning of that relationship
is preserved and even continues to develop. There is a paradoxical sense that both
what we think of as "the self (or perhaps "soul" would be an apter term), and hence
the other, are both continuous and coterminous with consciousness. Along with this,
there is the contradictory possibility that time is both eternal and finite. While we
recreate the dead within ourselves, at the same time we experience their loss. As
they continue to shape and influence our lives, in many ways, we acutely feel their
lack.
Grief experience also often includes a paradoxical set of responses: Belief and
disbelief, denial and acceptance, yearning and despair, disintegration and reintegration
of self and world. Further, there is often a tension, oscillation, or recursive kind of
movement between various degrees of belief and disbelief, desire and absence,
yearning and despair, pain and relief, aspects of grief which are seemingly
contradictory but which paradoxically make each other possible. In traditional grief
models, some sort of resolution of these paradoxes is valued and perhaps for this
reason expected. In the model proposed here, such resolution is not expected and,
further, does not seem realistic in light of a possibly ongoing and dynamic interplay
between a "multi-leveled” (Modell, 1993) or dialogical self (Hermans et al., 1992)
and a paradoxical reality, and as I will illustrate it is this notion of self which is most
congruent with an understanding of grief and the paradoxes of loss and death.
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Modell (1993) represents the self as a paradox reflecting a paradoxical world
and a multileveled self. To a great extent this view of paradox rests on Winnicott’s
(1958) idea that to be alone requires internalization of a nurturing presence. Freud’s
(see 1914/1959, 1917/1957, 1923/1961) position with regard to loss and mourning has
similarities: In order to mourn, the lost person must be internalized. Of equal
relevance is the complementary position that in order to establish a presence, an
absence or loss must occur. As Kohut (1966) states, internalization is "enhanced by
object loss" (p. 432). Loss is involved with the ability to function metaphorically, to
live symbolically as metaphors are by definition used to "stand for," or "stand in
for," something else. In the process of creating metaphors, our appreciation and our
apperception of the original object of the metaphor, and what this object "stood for"
changes. We therefore live in a kind of paradoxical "double state" (Grotstein, 1995)
in which original and extended or constructed meanings blend.
Further, while one aspect of the paradox seems to originate in a dialogical or
"multi-leveled" (Modell, 1993) self where the double state of converging internal and
external reality, absence and presence, real and imaginary, coexist from infancy,
another aspect of these paradoxes has to do with the reality of death and our
mortality, the enduringness of our loss and our awareness of it even as we continue to
live. Death, both of ourselves and of others dear to us, is the apparently final in a
series of temporal indications which alert us to ongoing change, loss as well as gain,
which include how we remember the past and what has been lost, and our experience
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of the discrepancy between what is and what was. The paradoxes which we begin life
with thus become particularly pronounced when we face death and loss.
How we straddle and cope with these paradoxes seems to begin very early on,
along with the development of a relational, embodied self, and a cognition (perhaps
meager, at first) of metaphor, or of one thing (a memory or mental representation)
standing for something, or someone, else. Both the dialogical nature of self
(Hermans et al., 1992; Modell, 1993) and the notion of object constancy and related
ideas explain how it is that we can recognize a dead person is gone and in some sense
"relinquish" her or him, yet also maintain both the person and the relationship. The
relationship between self and other seems to exist internally, externally in the "real
world," and between those two worlds in some sort of co-constructive or negotiated
process. Further, as the experience of loss is involved in awareness of our ultimate
existential aloneness and extinction, it is also intertwined with the presumption of
intersubjectivity— the dialogue with the other, and the absence of that dialogue.
Relationship is experienced both as a presence and an absence in self such that, as
Webster’s (1984, p. 836) indicates, "to lose" represents not only the actual object or
person lost, but a state of being lost.
Anne Sexton (1977) writes in a letter to W.D. Snodgrass, "The trouble with
everyone just up and dying like that is that there are no faces left to throw your
emotions at: love or hate. What do you do with the emotion? It’s still there, though
they are gone" (p. 81). The paradox of death and loss is that something is "still
there, though they are gone." And that something seems to be this co-constituted,
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reconstructed, imaginal and real relationship which is part of the self. As Derrida
(1986) writes in his Memoires for Paul de Man.
If death comes to the other, and comes to us through other, then the friend no
longer exists except in us, between us. . . . But we are never identical to
ourselves, and between us, identical to us, a "self is never in itself or
identical to itself, (p. 29)
In line with Winnicott’s (1958) premise that the capacity to be alone arises because
someone else is symbolically present, Derrida continues that the "specular reflection"
of ourselves and the other "does not appear before this possibility of mourning" (p.
29). Not only are self and other co-constructed, but mortality is implicit in this co
construction, and vice versa. It is because of loss that the other exists; "there is no
friendship without this knowledge of finitude" (Derrida, 1986, p. 29).
None of the views outlined in Chapter 2 concerning what is generative in grief
are sufficient to explain grief and how the lost other affects the self, including the
existential implications of death, the paradoxical nature of death and grief, and the
interplay between loss and reconstruction. As grief is necessarily concerned with the
lost other and how this loss affects the self, any theory of grief must deal with the
nature of the self-other relationship. How the relationship between self and other is
constructed helps to explain the paradoxical nature of grief and its temporal
variations, as well as how "secondary" losses may coalesce with primary loss, thereby
affecting a griever’s ongoing experience and ability to cope. In this section I will
argue that a dialogical or intersubjective self, loss, and the capacity to live
metaphorically, are inextricably interwoven. I will connect this to the experience of
grief as itself relational, dialogical and inherently paradoxical. To begin, I will
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examine how a dialogical, embodied, and contextually-constructed self can be
apprehended, and how this view of self helps to explain grief experience.
The Self and Other
As indicated in Chapter 2, there is some argument as to whether "secondary
losses," such as changes in role and status, and other deprivations (e.g., loss of
income, loss of sex partner, loss of companion, loneliness, etc.) are more significant
to grief than the loss of the person him or herself. As Parkes (1987) indicates, it may
be difficult to identify and disentangle all the various types of deprivations and losses
resulting from a death. It is the primary loss of the beloved, Parkes argues, that
overshadows all others, but adds that this reaction eventually fades, giving way to
deprivation. Averill (1968), in contrast, argues that it is the social disruption caused
by loss of roles that is primary, and that the loss of the person engenders grief only
on a "superficial level" (p. 724).
I suggested earlier that Averill’s concept of role could be expanded to include
roles that are based not merely on functionality or blood/kin ties, but as aspects of
relationship which "shore up the self" (Kohut, 1984), and that instead of looking at
any one aspect of the loss as a discrete contributor, loss of the object, in the form of
the person and the relationship, and loss of role coalesce. Averill seems to
acknowledge the contiguity of loss of the person and loss of the role in his admission
that the griever’s loss of self-esteem is a significant factor alongside role loss.
Further, Kohut’s (1971; 1977; 1984) concept of "selfobject" illustrates how
relationships with responsive others come to shore up ourselves, affecting how we
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view ourselves and our being in the world, explaining why when a significant loved
other dies, our entire selfobject matrix might change.
A continuity between the construction of self and the construction of other in
relationship is implied in a variety of perspectives (e.g., Buber, 1965; Cushman,
1990; Gergen & Gergen, 1988; James, 1890/1950; Hermans et al., 1992; Kohut,
1984; May, 1983; Modell, 1993; Yalom, 1980). This suggests not only a contiguity
between the role of the griever vis-a-vis the deceased and the griever’s relationship
with the deceased, but between all that can be called the griever’s selfobject or self-
other world. What Parkes (1987) refers to as deprivation (the "absence of those
essential ‘supplies’ previously provided by the lost person"; "the psychological
equivalents of food and drink," p. 29) is not so very different from the "psychological
oxygen" Kohut (1984) refers to, without which, Kohut contends, we could not
psychologically survive. Further, the existential recognition of death of the loved one
assaults the griever with a specific kind of shock or horror, which as Tittensor (1984)
describes, appears "inhuman," paralleling the ultimate existential catastrophe
described above and James’ (1890/1950) and Kohut’s (1984) illustration of
"nonhuman" environments.
Therefore, how we view our losses, and what they represent to us, may
indicate just what in the self or other that is effaced or obliterated. Neither a focus
exclusively on the "roles" or deprivations of the griever, the lost person, or the view
of self as autonomous seemingly favored by prevailing grief theory do justice to the
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continuity and co-construction of self and other in the relationship between griever
and deceased, nor to the other’s existential significance.
Polarities and dichotomies abound in self theorization, including not only an
autonomous or social self, but a physical or mental self, the contingencies of biology
versus sociocultural factors, continuity versus change, structure versus consciousness,
unity versus fragmentation, knower versus known, form versus formlessness.
Nevertheless, when the work of various representatives of self theories is examined,
an expansion appears which illustrates an envelopment of attributes such as the unity
and flux, individuality and multiplicity, structure and consciousness, providing the
possibility of a "bridge" in the form of a multiplicitous or dialogical self, a
perspective which better explains the possibility of a griever’s ongoing relationship
with the deceased and recursive experience of grief. This "self" is arrived at both as
a product of construction and deconstruction, as well as inferences made about early
development and our existential sense of relation and embodiment.
Is There a "Self": Structure. Construction, and Deconstruction
In contrast to the self posited by Kohut (1984), which requires the
"psychological oxygen" of the empathic other to survive, not all clinicians or
researchers see the "self" as so "needy" that it cannot exist without specific personal
or sociocultural others to value it, "shore it up," or even construct it. And some
question whether a self can exist that is objective, context-free, universal and
transhistorical (Cushman, 1990; Gergen & Gergen, 1988; Hermans et al., 1992;
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Sampson, 1988). Such theorization raises not only the question, is the self
"autonomous" or "social," but is there a "self" at all.
While he originally found the term vague and ambiguous, Carl Rogers (1959)
later came to identify the self as central to his personality theory because "when given
the opportunity to express their problems and their attitudes in their own terms,"
clients "tended to talk in terms of the self. . . . It seemed clear . . . that the self was
an important element in the experience of the client" (pp. 200-201). Fedem (1952)
notes that despite breaks in consciousness (such as occur during sleep) the experience
of self is still continuous; there is a sense that both body and soul (or psyche)
permanently belong to our selves (or our egos). Modell (1993) further points out that
for the person who feels as if her or his self is disintegrating, whether or not there is
a "self" is a mute point, as the experience of "the self . . . becoming fragmented,
transformed or annihilated evokes the most terrible anxiety" that anyone is likely to
have (p. 12). Loss of a sense of continuity and identity is a "psychic catastrophe"
(Modell, 1993; Winnicott, 1962), illustrated by the fear of certain schizophrenic
individuals that their identity can be instantly annihilated. Therefore, Modell
contends that the idea of a self continuous over time cannot be an illusion. Our
experience of feeling ourselves continuous and stable and/or fragmented and
changing, verifies that something, which we call the self, exists.
Continuity and identify versus change, and structure versus consciousness are
important continuums in valuing the self, at least the Western self. Selves are seen as
having an "in" and an "out," a "me" and a "not-me." Says the voice-over in Wim
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Wenders’ (1987) film Wings of Desire, in the beginning the child asks, "Why am I
me and not someone else?" And thus former Senator Bob Dole asserts, "I am the
same man I was," when he was senator, when he rose from his hospital bed, and so
on.
"Structure" is often equated with the sense of continuity and identity of self,
while "consciousness" is associated with experience, temporality and change. For
James (1890/1950) numerous selves "like cattle" are bound together by the "owner"
of the herd so that consciousness rather than structure defines "self." It has also been
suggested that affect (Tomkins, 1965; Wilcox, 1995) or alternately, valuations which
alter our affect (Horowitz, 1995) may mediate our sense of self or "self state."
Structural theories of personality or self range from those that speak of psychic
structure (e.g., Fairbaim, 1952; Freud, 1923/1961; Kemberg, 1984; Kohut, 1984)--
which can be assessed via behavior as well as explicit and symbolic communication—
to neurophysiological structure (e.g., Stuss, 1991).
According to some, there is a concurrence between structure and
consciousness, in that a "taking in" or processing of the experience (whether it be
actualization, individuation, etc.) creates the structure. For Freud (1917/1957), the
psychic structures are the result of identifications or internalizations, and these in turn
constitute one’s sense of identity. Fairbaim’s (1952) self is a world of endopsychic
structures which represent internal relationships between exciting, frustrating and
persecuting objects. Blanck and Blanck (1979) look to the separation-individuation
process described by Mahler (1971) as intrinsic to the development of structure.
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Intersubjective or dyadic systems theorists (Beebe, 1995; Stolorow, 1995) suggest
both a structuring of "self" and a relational, co-constructive process of this
structuring. According to a systems model, the mind (including the
neurophysiological apparatus of the brain) is inherently relational, and by means of its
interrelationship with the environment is constantly creating and updating its "maps"
(Smith & Thelen, 1993; Thelen & Smith, 1994; Edelman, 1987, 1989). This view is
not incongruous with narrative and constructivist views of development and growth
which suggest that people are always constructing, always integrating the present with
the past in order to make satisfactory sense of both, and that this integration is
somehow relational. Constructionist thinkers (e.g., Gergen & Gergen, 1988;
Hermans et al., 1992; Kelly, 1955; McAdams, 1988; Polkinghome, 1988; Sarbin,
1986; Schafer, 1981) contest the notion of an enduring, unitary self, suggesting
instead a multiplicitous, contextual and embodied self, or one that can be construed as
a narrative rather than a structure or an idea. Such perspectives, however, contrary
to Hume’s standpoint, do not necessarily deny that the "self" exists, but rather view
its making as part of a (co)constructive process.
The beginning of a bridge between dichotomous aspects of self is most readily
apparent in the work of psychologists inclined to the "social" aspect of self who
obviously consider the "self" as a separate entity relating to others, a being or
consciousness that knows, as well as a being or entity that is known by others and
knows that it is "known" (illustrated by James’ "I" and "me" positions, 1892/1923).
In many models described above (e.g., Cooley, 1902; Erikson, 1968; Freud,
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1923/1961; James, 1892/1923; Kohut, 1984; Mead, 1982; Rogers, 1951; Sullivan,
1953), there is necessarily a "private" (Modell, 1993) or separate sort of self
responding to the personifications or perceptions of others and constructing these
personifications interpersonally in addition to its "social" aspect. And contrary, I
believe, to Mitchell’s (1988) depiction, Freud’s (1933/1965) tripartite model of the
ego, id, and superego perhaps represents most clearly not only a striving for
autonomy and a relinquishment of infantile instinctual impulses, but an object
relations premise. As mentioned, Freud (1923/1961) describes how objects are
internalized helping to form ego and superego, and how these objects clearly bear the
imprint of significant persons in the individual’s world. Therefore, "if one has lost an
object or has been obliged to give it up, one often compensates oneself by identifying
oneself with it and by setting it up once more in one’s ego" (Freud, 1933/1965, pp.
56-57).
Kohut’s (1984) model of self, too, is not so much a polarization as a merger
of "social" and "autonomous" in the recognition of an interdependence between self
and other such that the term he uses to relate the experience of self to other is itself a
merger. Thus, the term, "selfobject," refers to "that dimension of our experience of
another person that relates to this person’s functions in shoring up our self" (Kohut,
1984, p. 49). Kohut (1984) suggests that through a process of "transmuting
internalizations," or internalizing his or her interactions with the surround of
selfobjects, an individual establishes an inner world and sense of self, constancy and
cohesion.
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Because, according to object relationists and precursors of object relationists,
the relationship between parent and child can be recreated in self, the object relations
standpoint is that the self can be conceived of as being made up of internalized
relationships between a subject and an object (Modell, 1993). Winnicott (1958)
suggests that such relationships are founded as early as infancy with the support
provided by the maternal environment. In fact, according to Winnicott, the capacity
for solitude signifies that someone else is present. This "someone else" is a
subjectively experienced, internal, presence which sustains us as adults but which first
appears in the ego-support provided the infant by the maternal environment. As
Bollas (1987) suggests, not only transitional objects (Winnicott, 1951), but
"transformational" objects— that is, objects which are relational processes-such as the
way a mother talks to or holds her baby (her nonverbal, relational behavior) are also
internalized.
Polarisms in thinking about self and the above considerations of the
transactional and transformational nature of self-other relations point to a possibility
which is illuminated following a deconstructionist treatment as exemplified by Derrida
(1973, 1976, 1981, 1982), and feminist thinkers like Cixous (1975/1980, 1976/1980),
Grosz, 1989, and Irigaray (1974/1985; 1977/1980). Derrida (1976) explicates that in
the binary oppositions which structure Western metaphysics, the opposed terms are
not equally valued. One term occupies a dominant position and is used to define its
opposite. "The first term is given the privilege of defining itself and of relegating to
the other all that is not it" (Grosz, 1989, p. 27). Further, Grosz points out, asserting
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the primacy of one term over the other is arbitrary; its primacy is the result of power
relations and the requirement of such relations that one term occupy the superior
position.
Derrida’s work (e.g., 1973, 1976, 1981, 1982) concerns how the inevitable
and continuous dichotomization of logic can be deconstructed or overturned. Within a
particular cultured frame of discourse, merely asserting the opposite of something
does not reverse the political and social realities that hold these definitions in place.
Because of this, Grosz explains, Derrida’s strategies for deconstruction involve not
only reversal but displacement. In this displacement, the repressed or shadow term is
re-placed in "the core of the dominant term, as its logical condition" (p. 30). The
third or hinge term is created out of this displacement. Examples associated with
Derrida’s work are "trace," from presence and absence, and "differance" (a Derridean
neologism), from identity (or sameness) and difference. In these examples, both
terms rely on each other for their difference or identity, and the hinge terms
represents this condition.
This type of postmodern and deconstructionist approach allows us to find a
kind of "hinge term" in the idea of a dialogical, embodied self, which is not "not
one"— the phrase Irigaray (1977/1980) applies to her displacement of women and their
sexuality in Freudian thought-but also, as she indicates not "two.Likewise,
1/ In "This Sex Which Is Not One" (1977/1980), Irigaray plays with the
Freudian standard which emphasizes female sexuality within masculine parameters
(hence the binarism between "’viriT clitoral activity/’feminine’ vaginal passivity" p.
99), emphasizing the multiplicity and plurality not only of women’s sex organs, but of
women.
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Kohut’s (1984) thought provides what we might call a "hinge term." In contrast to
traditional models, Kohut (1984) starts from the position that (interdependence is not
a bad thing. Kohut rejects the notion that the self could or should be completely
autonomous, and in addition rejects the notion of Freud and many of his followers
that selfobjects should be replaced by love objects. ("Love objects" as opposed to
"selfobjects" are objects which are appreciated as completely autonomous from the
self.) Rather, he maintains that selfobject relationships do not end in infancy but
continue throughout life. Development occurs in the context of changing selfobject
relationships, not in the relinquishment of those objects or relationships. Rather than
following a "normal" developmental advance from dependence to autonomy, it is
more natural, Kohut suggests, that the need for others, and ties to these others which
are maintained within, persist.
In the above regard, Kohut’s formulation analogs with certain cross-cultural
models of self, cognition and emotion. As alluded to earlier, the ideal of autonomy
may be distinctly Western (Hsu, 1983; Johnson, 1985; Markus & Kitayama, 1991;
Sampson, 1988, 1989), whereas in Eastern cultures for instance, an interdependent,
or other-oriented, focus (De Vos, 1985; Hsu, 1988; Miller, 1988) may be more
prominent. The work of Markus and Kitayama (1991) provides another hinge term in
suggesting that self-other construals of Easterners are neither strictly autonomous or
dependent but rather are interdependent. Significant self-representations have a
referent to the other; they refer to self-in-relation. Thus, these representations are
schematized as lying on a kind of permeable boundary such that self and other flow
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into and affect each other. In cultures that emphasize interdependence instead of
dependence, these authors assert, "constructing a self means connecting one’ s self to
others, not separating out one’ s self [italics added]" (p. 22). This connection means
"people must find a way to fit in, to belong, to fulfill and create obligation . . . to
become part of various social units" (p. 22).
Although Markus and Kitayama (1991) point out that others are important in
terms of social and self-validation, they argue that the interdependent self-other
relationship is something quite different from the type of "social self I describe
earlier. What is focal in the interdependent self is not the individual, but the
relationships between the individual and others. The self does not exist in any core
centralized place, merely influenced or aided in its construction by outside sources;
instead the self is conceived as existing in the between space between an individual
and others, a notion that resonates with the ultimate, non-centralized, polyphonous,
dialogical self described by Hermans et al. (1992). Markus and Kitayama (1991)
further note that there is significant variation in self-other views of personhood not
only between cultures but within cultures, and significant variation within a culture
may depend on gender, ethnicity, religious, demographic, historical, and generational
parameters.
Balancing two entities on opposite sides of an equation inevitably marginalizes
one of these. But by destabilizing the equation, paradoxically, it is the very
contradictory nature of each position that allows the opposing position to exist and be
true. Therefore, while the notion of a constructed and dialogical self may seem to be
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in direct opposition to the "autonomous self," it is also through the paradox inherent
in public and private, social and autonomous, etc. (Modell, 1993), that it becomes
possible to think a dialogical or multiplicitous self. Taken together with Bowlby’s
(1980) attachment theory and Averill’s (1968) views of evolutionary imperatives, it is
this paradoxical, multiplicitous or "dialogical" self (see Bakhtin, 1929/1973; Hermans
et al., 1992) which may be most congruent with grievers’ experience of self and
other.
The Dialogical. Embodied. Constructed Self
Historically, Bakhtin (1929/1973) is responsible for calling attention to the
concept of polyphony (or plurality of voices and perspectives) in Dostoevski’s work,
and the notion of dialogical relations within a character’s psyche. Further, the idea of
pluralistic and/or interacting selves, roles, or personas has certainly been intimated in
different psychologies (e.g., object relations and relational theories; Gestalt therapy;
treatment of patients with Multiple Personality Disorder) as well as other domains for
a long time. Hermans et al. (1992) are specifically elaborate on the notion of a
dialogical self. Here I will use the expressions "dialogical," "multivoiced," and
"multileveled" (Modell, 1993) as well as "intersubjective" to describe the workings of
intersubjectivity and multiple selves in the form of imaginal or internalized other(s),
or as Modell (1993) refers to it (them), "internalized presences." I rely on a
synthesis of these terms as I am concerned with representing a multiplicity of internal
self/other positions and relationship possibilities without necessarily depicting the
ultimate dialogical self which, according to Hermans et al., is decentralized and
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polyphonic.^ I further include in my use of the above terms an appreciation of the
self as embodied and situated, as emphasized not only by constructivists (e.g.,
Cushman, 1990; Hermans et al., 1992) and phenomenologists (e.g., Merleau-Ponty,
1945/1962), but theorists concerned with development (e.g., Beebe & Lachman,
1988, 1994; Beebe & Stolorow, 1995; Winnicott, 1952). I take the position that the
themes of dialogicism or multiplicity, embodiment, situatedness, and co-construction
are not only related but are reciprocally necessary. Further, it is through a
consideration of these important aspects of self that the unruly, recurrent, and
paradoxical processes of grief and the griever’s connection with the lost loved one
become understandable.
Enduring presences. In The Private Self. Modell (1993) highlights the
paradoxical nature of the self that James (1890/1950) struggled with in considering
that while the self endures through time in the form of a sense of stable self-identity,
consciousness is always changing and self seems to be coterminous with
consciousness. In addition, Modell points out, while it is social in the sense of
relying on others for appraisals, assurance and support, the self seems to derive
coherence and continuity from within. As he indicates, many individuals who have
2/ The ideal of a bounded, centralized self necessarily limits possibilities for
multiplicity as it sets the boundaries for what is socially acceptable (Hermans et al.,
1992; Sampson, 1985). Thus, Hermans et al. contend that if a . "a certain divergence
of characters is admitted" (p. 30), then the ideal of a centralized self will still
organize these characters around a principle I position. Cixous (1975/1980) seems to
speak to this ultimate dialogicism in referring to herself as "the concert of
personalizations called I," arguing "there is no invention possible, whether it be
philosophical or poetic, without the presence in the inventing subject of an abundance
of the other, of the diverse" (p. 97).
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been beset with extremely traumatic histories, seem to have been able to "‘create’"
(p. 4) and maintain a coherent sense of self. The "private self" described by Modell,
however— the self that has the capacity to support, and even to some extent to
construct, itself~is not identical with the autonomous self or to the self suggested by
the precepts of much of the grief literature. Modell’s "private" self may be able to
"‘bootstrap’ itself from within" (p. 4), but in some fundamental way an "other" is
still present, and thus it is a dialogical self that is doing the bootstrapping. Again, as
Winnicott (1958) writes, the capacity for solitude signifies that someone else is
present.
Modell (1993) considers the muse as representing such an "other" or
"enduring presence" and relates the concept of muse to Kohut’s selfobject as well as
to the wished-for maternal presence described by Winnicott. The enduring presence
of the self-created muse reflects, Modell says, the "desire to see the other as a silent
presence who intuitively grasps the private self, who knows specifically who you are"
(p. 132). Although the relationship with the muse is dialectic, the presence exists
solely to affirm the self. Modell describes religious presences as well as various
animisms of nature as muselike. The idea of God or a creator, as an all-knowing, all-
embracing presence, functions very much like a selfobject, representing the kind of
presence Jung (1953) finds absolutely necessary from a psychological standpoint
regardless of whether or not a God exists. Modell further points out that other (real)
people may come to represent some aspect of the muse, as in Richard Graves’
relationship with the poet Laura Riding, who, became "in effect Graves’s White
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Goddess" (Modell, 1993, pp. 133-135), the "true" muse. Modell provides another
such example in T.S. Eliot’s relationship with Emily Hale: "Eliot’s psychic survival
depended upon the loving presence of . . . Emily Hale, who seems to have been his
principal muse" (p. 140). Clearly, this last example (i.e., the use of other people as
muses) runs parallel to Kohut’s notion of selfobjects. We could add to Modell’s list
the objects Cushman (1990) claims are recruited to fill up the "empty self," namely
advertising agents, celebrities and therapists, all of which could be said to fulfill the
mirroring or idealizable functions Kohut suggests as necessary to the developing self.
Caughey’s (1984) anthropological fieldwork in North America, Micronesia and
Pakistan also considers the prevalence of imaginary social worlds. In both Western
and non-Westem cultures, he concludes, people have interactions with imaginary and
semi-imaginary people such as media figures, purely imaginary dream or fantasy
figures, and representations of friends, lovers, or parents who are treated
imaginatively as if they were present. One could further speculate about the
possibility of many "objects," including nonhuman ones (e.g., cars, dolls, antiques),
experiences (as in Bollas’, 1987, "transformational object" as a process of
interaction), and even institutions or organizations serving as internalized presences.
Virginia W oolfs (1929) fantastic and serious essay, A Room of One’s Own,
based on lectures to women embarking on careers of higher learning, addresses the
problem of "what would have happened had Shakespeare had a wonderfully gifted
sister" (p. 46). Woolf calls upon the notion of an abiding cultural presence in the
form of the tradition of women struggling to live and to create. The fantasied sister
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of Shakespeare that Woolf calls forth "died young" and "never wrote a word." She
was "buried at the crossroads." Yet she still lives, for, Woolf writes,
Great poets do not die; they are continuing presences; they need only the
opportunity to walk among us in the flesh . . . . if we escape a little from the
common sitting-room . . . then the opportunity will come and the dead poet
who was Shakespeare’s sister will put on the body which she has so often laid
down. Drawing her life from the lives of the unknown who were her
forerunners, as her brother did before her, she will be bom. (pp. 113-114)
"Shakespeare’s sister" cannot exactly be called a being of once-living flesh, but is
rather a feminist ideal embedded in human flesh, a possibility that Woolf sees as
having been literally denied access and therefore has died, yet exists as a living
metaphor and a possibility. In some way, this sense of and aspiration toward an
enduring presence is similar to other symbolic attempts at immortality--such as living
on through one’s offspring, living on in a higher, spiritual plane of existence, and
living on though one’s work (Lifton, 1974). Internal, enduring presences may also
seem similar to Jung’s (1953) ghostly revenants or ancestors.
Naturally, the simple soul believes that his parents are as he sees them. The
image is unconsciously projected, and when the parents die, the projected
image goes on working as though it were a spirit existing on its own. The
primitive then speaks of parental spirits who return by night (revenants), while
the modem man calls it a father or mother complex. (Jung, 1953, p. 188)
This is how Jung explains how a dead, absent, or otherwise unknown person
somehow goes on living somewhere within the self (and also between the self and that
other person).
In many cultures, indeed, the ancestors, and the objects purported to have
belonged to or been connected with the ancestors, play a prominent role in the
construction of the present. As Hoskins (1993) points out in her study of Kodi
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culture in Eastern Indonesia, for instance, ancestors are ritually consulted for answers
to questions and advice on troubling issues; further, objects (including, importantly,
houses) are related not only to enduring relations with past others who lived in or
preserved them, but to the transmission of time itself and mortality. The "value" of
objects in this sense relates, as Hoskins indicates of the Kodi valuing of objects,
places, animals, and events, to "the perception of human mortality and efforts to
construct a ritual order in which~although people still die— something of what they
stood for is allowed to live on after them" (pp. x-xi). And, like the cultural ideal
suggested by Woolf, but representing "actual" people and their actions~at least as
they are remembered and reconstructed— the ancestors and their traditions described
by Hoskins provide "precedents to guide future innovation" (p. x). Yalom (1980)
notes that the process of history-taking is itself a symbolic quest for immortality in
which we as individuals are perpetuated in the continuation of the group.
Memorials to the dead seem to be an attempt to make concrete the experience,
or hope, of an enduring presence. However, the type of presence described by
Modell (1993), represents something that unlike the stone monument, may never
reach materiality, being both internal yet intersubjective, both an intrapsychic process
and a dialogue between oneself and something else. Like the absence it seeks to
confound, and like metaphor, the "enduring presence" straddles both worlds, the inner
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and the outer, the here and not-here. So too the Kodi use of rituals and objects which
not only emblemize but transform the past.-
Whether completely internalized or partially external, such presences come to
represent important and generative aspects of the self. Like Kohut’s selfobjects,
enduring presences serve to "shore up" up the self, reflecting the representations of
how others view and respond to our self(ves), including how we imagine they
perceive and respond to us. They further serve to inspire and encourage the
individual, as the muse-like qualities noted by Modell suggest. Finally, such
presences apparently make it possible to hold conversations from different "I-
positions" as suggested by Hermans et al., 1992), supporting a dialectic or
multiplicity which makes it possible for the self to change and expand.
Constructionism and the dialogical or narrative self. As indicated, a
constructionist perspective also supports the idea of a dialogical, or narrative, self
(Gergen & Gergen, 1988; Hermans et al., 1992; McAdams, 1988; Sarbin, 1986).
Hermans et al. base their assertion of a dialogical self on their belief that people have
always told each other stories, regardless of culture, and by this means come to some
understanding of their world and self. The self as a dialogical narrator, they argue, is
both embodied and social, although not social in the sense of the individual entering
into interpersonal interactions with people outside the self; instead, "other people
3/ In Kodi culture, Hoskins (1993) explains, this transformation occurs
differently in the use of historical objects on the one hand, which represent a past of a
collective heritage, and personal or biographical objects on the other, which are
individual and idiosyncratic symbols.
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occupy positions in the multivoiced self” (p. 29). The dialogical self described by
Hermans et al. (1992) is based on more than one "/ position," in that imagination
allows different people, multiple voices, to occupy the self. The imagined other(s)
may or may not represent real people, and their imaginal perspectives may or may not
be congruent what they would "really" say were they to say it in (external) reality.
Watkins (1986) likewise describes the almost constant presence of "invisible
guests" and the multitude of imaginal dialogues in our lives existing side by side with
the "real" ones. Interestingly, imaginal others, Hermans et al. (1992) point out, are
usually conceived as having a spatially separate position (a notion of interest in
considering how bereaved people imagine the deceased). As examples, Hermans et
al. specifically mention the imaginal contact with a deceased parent or friend, as well
as the imaginal "ideal lover, or a wise advisor" (p. 28).
The notion of a dialogical self implies not only that the self talks to itself, but
that it is multiplicitous and embodied. Distinguishing between the self as knower (the
"I") and the self as known (the "me"), in 1892 James suggested a variety of mes,
including a material me, a spiritual me, and a social me, the latter consisting of a
multiplicity of selves. His "material self actually consists of everything that belongs
to a person, including his or her body, mind, clothes, house, spouse, children,
ancestors, land, and even bank account. James indicates there is a bodily and
emotional connection such that when these things are affected positively or negatively,
in varying degrees, the self is affected. Our immediate family are "bone of our bone
and flesh of our flesh" such that "when they die, a part of our very selves is gone. If
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they do anything wrong, it is our shame. If they are insulted, our anger flashes
forth" (p. 292).
Of James’ different selves, his "social self' appears most related to Kohut’s
version of self, relying on surrounding others for recognition, sustenance and
creation. It is also most in line, I believe, with a social constructivist notion of self
and to how grief or mourning is constructed (Fowlkes, 1991). The social selves for
each individual, James indicates, are as multiple and varied as the people we know.
Every relationship could, potentially, generate another social self. Such is the
reverse, or corollary, of the notion that the object, or other, resides within the self;
rather, the self resides in the other. "The most peculiar social self which one is apt to
have," James says, "is in the mind of the person one is in love with" (p. 294),
because, as he describes, this self (or in other words, the self we see in the other
person’s eyes-how we see ourselves as seen by that beloved other) is highly bound
up with one’s sense of self-worth. In this way, James points to a social knowing
which defines both relationship and self. It is as much how we are known and by
whom, as who we know and how, that determines our selves.
The suggestion that the self has many unexplored potentials (or other "selves")
which a person could develop if she or he were so-minded also implies a narrative
structuring of self. A "narrative self" is concerned with a process of meaning-making
and (re)construction, not, as Polkinghome (1988) points out, by creating "a story of
one’s own choosing" (p. 152), but rather as an "emplotment" in which external
events, social and biological givens, and the unanticipated, converge with one’s own
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imaginative efforts. Hermans et al.’s (1992) dialogical self is based on the premise
that people have always told each other stories. They also tell themselves stories;
narratives inscribe meaning onto events and the experience of time in our life histories
(Polkinghome, 1988; Sarbin 1986).
As narrative is controlled by the temporal dimension (Polkinghome, 1988),
like the dialogical or multileveled self which "shores itself' up with imaginal others,
the narrative self also deals with loss in the attempt to grapple with the effects of
being in time (e.g., movement into an unknown future, disappearance of the past,
aging, mortality and other types of loss and change). The attempt to form some sort
of coherent whole is reflected in the comforting temporal sequence of traditional
plots. (Stage and phase theories of grief naturally draw from this comforting aspect
of sequencing time because it allows us to see ourselves moving in an organized
progression from one discrete stage to another, and this under circumstances that are
severely upsetting.) However, it should be noted that while traditional sequential
plots make sense, they do not always reflect experience. A variety of ways of
handling time have emerged throughout literature which differ from a straightforward,
linear plot, such as the early Greek technique of beginning an account in media res (in
the middle of things), harkening forward, and then again backward to the story’s
beginning and ending. The experience of time may actually be represented also as
nonlinear, cyclical, wandering and not always orderly, as reflected, for instance in the
fictional narratives of Virginia W oolfs To The Lighthouse (1992) and James Joyce’s
Ulvsses (1942). These works reflect a different experience of time than that
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suggested by strict sequencing models~and they also encourage the reader to play
with her or his experience of time.
While narrative aligns meaning temporally, through the concept of schema,
cognitively-oriented theorists (e.g., Beck, 1976; Beck & Clark, 1988; Beck & Emery,
1985; Horowitz, 1988, 1991; Horowitz & Reidbord, 1992) illustrate that meaning is
also aligned spatially or thematically. From Beck’s (1976) perspective, schemas
represent a way that knowledge of self and world are collected and organized,
affecting how we attend to something, understand it, and remember it later. In a
sense, schemas can be understood as the stories we tell ourselves. The stories not
only have various "plot lines," but also consist of themes and ways of looking at
things that cluster the themes together and drive the momentum of the "plot." Thus,
Beck (1976) suggests that depressed individuals utilize schemas based on
worthlessness, guilt, rejection, deficiency and deprivation. In their view of anxiety,
Beck and Clark (1988) and Beck and Emery (1985) propose that schemas involving
danger and personal vulnerability may be activated by certain stressful environmental
events. Like the narrative outlooks described above, Beck’s conceptualization
indicates an organization that is built on interaction between the individual and her or
his environment.
Certain schemas may be more comprehensive in their influence, such as the
self-regulatory schemas of the self-system proposed by Markus and Wurf (1987). As
Markus and Kitayama (1991) suggest, for instance, whether we construe the self and
other as independent or interdependent has far-reaching consequences for how we
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plan, think, feel and are motivated. Horowitz (1988, 1991) and Horowitz and
Reidbord (1992) specifically suggest that individuals utilize person schemas to
organize information about self and other, and further that among person schemas,
those which involve a role-relationship have special significance. According to these
authors, we have a repertoire of enduring person and role-relationship schemas, but
when events occur which do not fit the repertoire (such as traumatic events involving
injury or loss) self and other schemas may be destabilized. Bowlby (1969, 1973,
1980) likewise indicates that trauma does not fit habitual schemas.
In Kelly’s (1955) personal construct model, the person is a scientist who
develops ways of describing and interpreting events--constructs~to make sense of and
anticipate events. Anxiety is experienced when constructs do not seem to fit our
experience or observation. Similarly, Harber and Pennebaker (1992) define schemas
as theories people use to understand and manage their environment, helping people
make sense of novel events; as Kelly indicates, emotions are likely to come up when
schemas are upset or do not fit current reality (Harber & Pennebaker, 1992; Higgins,
1987).
The narrative self as understood in the nature of stories, "schemas," and
construction of potential selves is fundamentally dialogical, as we tell stories to
others, to ourselves, and to the other inside of us. This narrative ability implies the
possibility of not only two but multiple roles or personas, multiple I-positions. Such
a view allows inherently for multiplicity in that the self has the capacity to change the
narrative and thus change his or her life. According to Hermans et al. (1992), the
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can move to different positions, endowing each with a different voice. "The voices
function like interacting characters in a story" (p. 28) so that once started, each
character "takes on a life of its own" (p. 29). This independent existence, as it were,
Hermans et al. imply, is necessary because of the function and rules of narrative.
Further, the characters may exchange information about their "Mes" (or empirically
known selves), and hence create the complexity of narrative self structure.
This "self story" necessarily includes the historical, cultural, and existential
context. Cushman (1990) and Hermans et al. (1992) argue that the self cannot be
dissociated from its historical and cultural context.
Culture is not indigenous clothing that covers the universal human; it infuses
individuals, fundamentally shaping and forming them and how they conceive
of themselves and the world, how they see others, how they engage in
structures of mutual obligation, and how they make choices in the everyday
world. (Cushman, 1990, p. 601)
As discussed in Chapter 2, it is due to living in particular social and historical
contexts that certain stories are created, including the "valorization" of the internal
world "at the expense of the external, material world," causing the social world and
its connection to political and material reality to be "devalued or ignored" (Cushman,
1990, p. 605). Such a shortchanging might happen if in prioritizing the
internalization of the other in a dialogical self-other relationship, we discount the
importance and effects of real others in the world, and the effects of real absence,
thus, in a round-about way, reaffirming the autonomous self and the polarisms that go
with it. However, as I will continue to explore, the dialogical self and internalized
other are a product of paradox, resulting from both loss and attainment. Therefore, if
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we focus primarily on attainment (the attainment of the internalized other), we neglect
the very real absence which is part of, and contributes to, the internalized presence.
Embodiment and intersubiectivitv. Many theorists who view the self as
dialogical or intersubjective also see the self as embodied. In fact, as Jay (1993)
remarks in his discussion of Merleau-Ponty, our bodily experience is "an ontological
prerequisite for that internalization of otherness underlying human intersubjectivity"
(p. 311). We both see and are seen;, we can even be seen by ourselves. We feelingly
touch ourselves and others, and at the same time feel ourselves touched. As Anzieu
(1989) indicates, our "skin ego" is both a boundary between self and other and a
possibility to experience ourselves as an other. This intersubjective and intercorporeal
world represents a kind of tacit knowledge which could perhaps be described as a
kind of fe lt sense (see Gendlin, 1981), in which knowing or processing environmental
information is neither exclusively sensory, emotional, or cognitive.
Modell (1993), like Hermans et al. (1992), argues for an embodied self,
mainly citing Edelman (1987, 1989) in support of this position. For Edelman the
body is the biological and evolutionarily adaptive source for making meaning and
(re)constructing memory, recategorizing experience and freeing the individual from
the "tyranny of real time" (Edelman, 1989, p. 92). However, while Edelman’s self
has its roots literally in the body, it is difficult for the reader to feel, existentially, as
if this self belongs in the body. A more convincing argument of the experience of
embodiment is Johnson’s (1987) contention in The Body in the Mind that our spatial
and temporal orientation and our movement and interaction with the world affects
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what meanings we bestow. Johnson highlights the connection between bodily
experience and the use of metaphor explaining how the latter, based on bodily
schemas, allows us to translate physical experience into abstract understanding, for
instance, in the "in-out" or "up-down" schemas. The first represents how we use the
vertical position of our bodies to structure the world, and thus many concepts
organized spatially correspond to this schema (such as happy-up/sad-down; good-up;
bad-down). While the physical self is the converse of the mental or spiritual self
(e.g., Descartes), the embodied self conceived by Johnson connects the cognitive
world with the physical world of our bodies. Merleau-Ponty (1945/1962) likewise
indicates in The Phenomenology of Perception that the individual self is embodied
because the individual is situated in time and space. The phenomenal field unites the
lived body with the environment such that if a blind person were suddenly to regain
his or her vision, the body would have an intentionality toward the things seen before
the mind could make the distinction. "The senses translate each other without any
need of an interpreter, and are mutually comprehensible without the intervention of
any idea" (pp. 209ff).
The physical body that we feel, see, and are perceived by, is, as common
sense tells us, significantly connected with our sense of identity (Greenacre, 1958).
Others and I myself physically recognize myself through my body. It is between the
ages of six and eighteen months, Lacan (1977) contends, that the infant achieves a
compensatory sense of selfhood, and an imagined coherence, through identification
with its mirror image. The sight of the mirror image "situates the ego, before its
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social determination" (Lacan, 1977, p. 2). Whether through touching ourselves as
infants (and feeling ourselves touch ourselves), and seeing our own bodies, both
subject and observer, a fundamental rootedness in our bodies is established (Anzieu,
1989; Merleau-Ponty, 1945/1962). As James’ (1890/1950) schema of self/selves
implies, all that we "own" can be said to constitute our selves. Interestingly, in
speaking of a "spiritual self" as representing one’s inner, subjective being, James
speculates that this Self o f selves,’” "when carefully examined. . . . is really a
feeling o f bodily activities whose exact nature is . . . overlooked" (pp. 301-302). For
James, this "self of selves" is "felt" (p. 298).
Our bodies, which are material, tangible, and available for external scrutiny,
seem profoundly related to something "within" us. It is our bodies we see as such
and such, and we wonder if "we" would be the same if our bodies were changed.
The body as self perhaps becomes most apparent when we suffer an injury that
changes what our bodies can do and/or how they appear (see e.g., Zuckerman &
Volkan, 1989). And even when the self is experienced as dis-embodied or the body
is experienced as "not-me," the "not-me" (or body, in this case body absence) forms
part of a gestalt by which we experience our self.
The bodily self may be seen as dialogical and intersubjective from the
beginning because having a body allows for a dialogue, as well as our early intimate
relations with others, particularly the person(s) who takes care of us. As Bollas
(1987) points out, the self relates to itself as an object in recreating the process of his
or her early maternal care environment. That we think dialogically is very simply
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illustrated, he indicates, as we talk to ourselves all the time, engaging the self
intrasubjectively as an object. The self is objectified when we address ourselves as
"you," or "she," or "he," etc. According to Bollas, however, the intrasubjective
relation to the self is "not just a cognitive division enabling us to widen the
parameters of thought and action" (p. 42), but rather an object relation.
In addition, the intersubjectivity of the body opens up the possibility of the self
as both knower and known, as in Sartre’s (1966) distinction between the seeing
subject and the "object of the gaze." For Sartre, the two modes of experiencing the
self and relating to an other are seeing and being seen, as expressed in his concepts of
for-itself and in-itself. When one is seen, one becomes the object of the other, and
loses one’s subjectness. Sartre’s (1966) focus reflects what Jay (1993) describes as
the "occularcentrism" of Western culture.- Therefore, in comparing Sartre’s
philosophy with Merleau-Ponty’s, Jay describes Sartre as "a Cartesian despite
himself" (p. 311); his distantiating and objectifying gaze is not something that is
situated in the bodily shared experience of the people involved.
Implications for Grief
The notion of a dialogical, embodied, and co-constructed self explains not only
how a relationship with the deceased could be "preserved," but continue to develop—
as an important selfobject, enduring presence, and even "I position"-and
paradoxically, be internalized as an absence. Such a view of self also partially
4/ Jay (1993) points out that the dominance of sight as the premier sense is
related to the favoring of what can be materially and empirically proven— that is, what
"you can see with your own eyes," measure, and replicate, in order to believe.
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explains recurrences of aspects of grief such as searching, missing, yearning,
"finding," and the paradoxical blend or oscillation between presence and absence and
hope and despair. The dialogical process allows for the influence of both enduring
internal presences and supportive others in coping, and also illuminates the process of
constructing or narrating a meaning to loss.
If we accept the position that the self and other are co-constructed, in grief it
is the disrupted relationship and intersubjective knowing as well as the interpersonal
"role" (or being known) of the subject which disrupts the self. This disruption takes
into account the fact of the external, missing other because in bereavement, disruption
of one’s existence occurs because of the destruction of the loved other. However, in
addition, by considering the intersubjective views of Kohut (1971; 1977; 1984) and
James (1890/1950), we can see that, rather than loss of role or loss of object
constituting the sole reason for grief, there is a significant and interconnected
alteration in both the self and other when one of them changes. Further, because of
the dynamic, reconstructive aspect of the dialogical relationship, and the ongoing train
of both inner and outer circumstance and development, both self and other continue to
change.
As I indicated in Chapter 4, part of "going on" for the griever involves
continuing to incorporate or instate the other and the meaning of the loss. These
relations are better understood in terms of Kohut’s (1984) merger of the terms self
and object in the from of selfobject relations, in that it is a dialogical, rather than a
monological, relationship which underlies loss and grief. In terms of internalization,
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it is not that a significant other is only internalized after his or her death or loss, but
rather, as Kohut (1966) states, that internalization is "enhanced by object loss" (p.
432). In grief, various modes of yearning and searching, as well as finding (ranging
from the very concrete to the highly symbolized), and the sense of the other and the
sense of absence, may actually be a foundation for some sort of "firming up" of what
a griever has already internalized of the deceased in the form of imaginal other, and
more than that, an ongoing developmental process. Again, loss and the dialogue with
the other are inherently connected. This "dialogue" includes reminiscing and
speculating about the lost other and the dynamics of the relationship, evoking and
being "shored up" by such constructions, as well as experiencing a sense of presence,
and in possibly both a conscious and tacit way, seeing the world "through" his or her
eyes.
As mentioned earlier, integrative, self-protective, and coping functions
involved in grieving seem to arise not only because the griever accepts the finality of
loss (Bowlby, 1980) and the "verdict of reality that the object no longer exists"
(Freud, 1915/1957, p. 255), nor because the ego decides to be happy that it is alive
and so decides to sever its attachment to the lost one (Freud, 1915/1957), but because
these functions represent some other aspect of the relationship with the lost one which
is not relinquished but instead, continues to be reconstituted. We can see this
reconstitution in the number of forms "self" and "other" take in the psychic play of
the bereaved, including a vivid sense of remembrance and reconstruction of the real
relationship; a sense of an "infusion" of the other in terms of the past co-constructed
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relationship, the other’s way of perceiving reality, etc.; a sense that the other has
changed (e.g., is farther away, closer, somewhat impersonal, etc.) as our own
perspective, experiences, and maturity change; an invocation or imaginary perspective
of the other, based both on fact and fantasy (as in constructions of possible
conversations).
The internalized other and relationship include: mirror-like qualities of the
significant other (i.e., "facts" which can be verified by photographs and other
people’s memories); a biased reconstruction and reworking of selected aspects of the
significant other; reconstructed, and co-constituted, aspects of the relationship; a
reconstructed replay of events or responses; as well as reconstructed, imagined, or
"evoked" dynamisms of the other and the relationship. These processes and
constructions range from the more conscious and "factual" to the tacit and imagined
and a combination of these, possibly including what Bollas (1987) refers to as the
"unthought known," representing internalizations of those processes of relationship
and interpretive response that are implicit or preverbal. Further, the internalized
relationship is experienced as both a presence and a loss.
The concept of dialogical self suggests not only multiple "selves," but multiple
"others." Depending on a person’s sociocultural heritage, the other may be conceived
in varying degrees as part of or as separate from the self (Markus & Kitayama,
1991). The clinical and theoretical work I have alluded to (e.g., Bollas, 1987;
Cushman, 1990; Hermans et al., 1992; Kohut, 1984; Modell, 1993) suggests that the
other exists in and can be preserved or created by the self in various ways. In the
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experience of the bereaved, the internalized other may be a selfobject in Kohut’s
(1984) sense of the term, a muse-like figure (Modell, 1993) reflecting, cohering, and
shoring up the self, an internalized absence or loss felt as a gap in self-experience as
Bollas’ (1987) work suggests, and lastly may exist as a real object (Blanck & Blanck,
1979), who is actively remembered and, as it were, lived (e.g., the other is
viscerally, emotionally and cognitively remembered and appreciated as having a
separate and unique identity from one’s own). These various aspects of other are not
discrete but blended, just as in everyday experience our perceptions, expectations and
desires about an other are mixed in with whom that person is as a separate, real
person. As Hermans et al. (1992) and Watkins (1986) point out, we carry on our
conversations with real and imaginary others in tandem.
However, the "real," versus the imagined or internalized object, presents us
with another paradox concerning presence and absence. The demands of death
include that the dead person becomes more and more recognizable as an internalized
or imaginal other-a person who exists in and is preserved inside us, in memory and
imagination— while at the same time, her or his reality as a real person who once
existed apart from us, remains. Without that core of reality-of once having really
existed-nothing of the deceased person could be saved. The internalized person is
someone we may remember, reconstruct, converse with and dream about, without
receiving any definite input from reality as to the correctness of our perceptions. Yet
rather than existing only as a static photograph or accumulation of declaratory facts,
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the departed may form part of the dynamic, lived and constructed experience of the
griever.
The dialogue also includes the corporeal absence of this other and the
internalization of this loss. Undoing reality, or life, death makes reality itself seem
strangely "unreal." In losing the other, the griever may feel him or herself also lost.
Thus, he or she may feel "dead," as well as confused and unreal. In her discussion
of how individuals may mourn a lost childhood, Kulish (1989) remarks that the idea
of "lost souls" in literature (exemplified by Kulish’s description of Peter Pan) may
symbolize the emotional destitution experienced after surviving a loss. Anna Freud
(1967) indicates the relationship between losing and being lost saying that those who
frequently lose objects or find themselves lost, identify with lost objects and feel
deserted, alone or rejected. Loss of other, then, may be felt as a loss of self, which
may then be experienced as a loss of reality or even loss of memory. The corporeal
experience of self is, moreover, necessarily bound up with the material loss of the
other and is therefore implicated in the emotional experiencing of grief-the knowing
of grief which neither purely intellectual nor unthought.
Having imaginary "conversations" with the deceased, evoking their image,
wondering what he or she would think or feel about this or that event or
circumstance, ranging from everyday concerns to more profound questions of
meaning, dreams engaging the lost one in a kind of dialogue, as well as occasional
sense or visceral memory of the other’s presence, hallucinations, illusions and other
such phenomena, suggest not only that the lost person is being actively internalized by
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the griever, but that the relationship with the bereaved is also internalized, and that
this relationship is called upon, evoked, and received. Further, the internalized
presence is evoked precisely because of its physical absence and alongside the
experience of an internalized absence.
The telling of the stories relating to death and loss, and the lost one’s life
seems to be important in order to integrate and "make sense" out of the trauma of
loss (even if logical sense cannot be made), and is also a way in which the dead
person is reconstituted. Rando (1984) emphasizes the importance of the presence of
supportive others to provide help in a number of ways, one of which is simply
listening to the story being retold and being there, with the bereaved. In classic grief
theory, the final point of this review and integration is recovery from the trauma of
death and severance of emotional ties to the deceased. Here I suggest two main
interrelated themes: (1) integration of trauma relating to death and irrevocable loss,
and, instead of severance or relinquishment, (2) reconstitution of the dead person and
the world shared and co-constructed between the griever and the deceased.
In terms of the first aspect, the issues relating to death need to be interrogated
again and again (e.g., How did the death happen? Why? What were the
circumstances? Whose fault was it? Could it have been prevented? Is the trauma of
death finished?). Unlike the overall relationship with the other and memories
comprising this whole, this line of questioning or storytelling seems to reach a certain
saturation in which there may be a greater "acceptance" of the facts of these answers,
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since the questions are not put as frequently. Nevertheless, as I have indicated, some
of the same questions and stories recur over the years.
In terms of the second aspect of the "stories" relating to death, and actually
entangled with this first aspect, because of the dialogical and co-constructed nature of
self and other, there is a "story" (or stories) of the lost other as well as the
relationship with the griever. In this regard, the story told to others is important, but
also is the story told to oneself, and on some level, to the intimate loved one who has
died. The intimate relation with the beloved, and its co-constructed world, is also
recreated in the telling of the story. Therefore, it is not only telling the story of
"what happened," but a search to evoke or recreate the lost other in the telling. This
may happen on a very basic empathic level, when the listener is able, in some degree,
to join with the bereaved in the experience of loss.
In Hermans et al.’s (1992) words, one may assume different "I positions."
The process of storytelling, with its potential for multiple narrative voices, enlists in
the "reader" or listener the assumption of these different positions. In what I call
storytelling here, what are recreated and possibly integrated are not only the trauma
of loss and the trauma surrounding loss, but the lost one’s co-constructed "reality."
Further, in this co-constructed reality, the lost other may be "known" or felt
existentially in a "process of alteration" (Bollas, 1987, p. 286) of self in which
another person-or rather his or her relationship with the griever— serves as a
transformational object, co-constructing in this relationship a nonverbal narrative
which reconstructs the lost one, as for instance in a comforter’s attitude of care. The
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other is also recreated dialogically in the self without another person necessarily being
present. In this way, stories about the other many years after his or her physical
departure continue to evoke and make that person live, creating and recreating her or
his presence within us and within our self-narrative. The dialogical and narrative
nature of self forms a backdrop for the emotional and memorial experience of grief
and for negotiations with the paradox of loss.
Symbolizing Loss
The reconstitution of the lost beloved, both in the self and possibly in, or
between others, illustrates a conflation of metaphorical and real in which inner and
outer realities are always being negotiated, the essence of Modell’s (1993)
paradoxical, multileveled self in a paradoxical world. "There is no such thing as a
baby"--without its mother, says Winnicott (1952):
If you show me a baby you certainly show me also someone caring for the
baby, or at least a pram with someone’s eyes and ears glued to it. . . . the
unit is not the individual, the unit is an environment-individual set-up. (pp.
99-100)
We could say that although the "kernel" (Winnicott, 1952), or baby, becomes an
individual, in this paradoxical world, internal and external reality, the real and the
imaginary, and the worlds of self and other, cannot be fully separated. Instead,
multiple levels of self afford the "potential space" which Winnicott (1971) describes
as the "resting place for the . . . perpetual human task of keeping inner and outer
reality separate yet interrelated" (p. 2). In potential space, a reality is
created/constructed between the self and another person; it is therefore neither
completely self or other, but something in-between.
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Echoing Winnicott, Grotstein (1995) suggests that at birth the infant is
protected from the horror of the "Real" (Lacan, 1977) by paradox~by a "blessed"
ambiguity. As Grotstein expresses it, we are bom to paradox, live in paradox, and it
is the toleration of this "paradoxical double state which we never get over." This
double state implies that there "is no such thing as an infant" without its mother
(Winnicott, 1952), and yet the infant is separate. Absence and presence coexist. And
from a variety of frameworks, ranging from Winnicott’s (1971) view of potential
space and Lacan’s (1977) developmental scheme involving movement from the Real
to the Symbolic, to Johnson’s (1987) "body in the mind," a similar theme emerges:
Bound as we are by the physical and the real, our imagination, ability to symbolize,
to use metaphors, internalize, etc., seems to "free" us not only from "the tyranny of
time" (Edelman, 1989), but from existential limitations. In all of these frameworks,
the ability to live only in the concrete, factual world is recognized as wanting.
However, paradoxically, or ironically, it is only possible to "transcend" the raw form
of the physical by living in both worlds--the capacity for symbolization is tied to the
embodied self.
It is the experience of this paradoxical "double state" that allows for, and
enlists, a dialogue between self and other, an oscillation between inner and outer, and
a co-construction of reality. As Jay remarks, our intercorporeality is the
"prerequisite" for intersubjectivity (see Merleau-Ponty, 1945/1962; Jay, 1993).
Further, our embodied selves are necessarily connected not only with intersubjectivity
and the early appreciation of difference, discontinuity, attachment and loss, but with
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death and grief. In a sense, nothing could be more "factual" or "concrete" than the
physicality of death-the termination of material being. Yet our existential experience
of death as paradoxical and perhaps "absurd" interacts with our continual negotiation
of the double state of absence and presence and defines the experience of death and
grief as fundamentally oscillating and dialogical. Hence, not something which ends
with physical decay and separation.
Both the dialogical self and how we deal with loss and grief are founded on
our earliest negotiations with presence and loss. The "double state which we never
get over" (Grotstein, 1995) and our attempts to straddle the paradoxes of absence and
presence, self and other, loss and recovery, begin early, with what developmental
theorists term the formation of object permanence, object conservation, and object
constancy, and the relational and co-constructed formulation of self-experience,
including the use of both nonverbal and formal language communication. These
notions explain how an individual negotiates the difficulties of change and
discontinuity of consciousness and the conjoint or alternating experience of absence
and presence, and how eventually she or he copes with the paradoxical fact of death.
The patterns suggested compare with and imply a rudimentary form of the oscillating
patterns of grief and the dynamic, co-constructed, fluid relationship with the lost
other, and moreover, explain enduringness despite loss, and so I will explore them at
length here.
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Enduringness Despite Loss
Approximately halfway through the first year of life, and during the early part
of the second year, the average child knows, according to Piaget (1937/1954, 1951),
that an object still exists though it may disappear from view. Somewhat earlier
(during, approximately, the fourth to seventh month), the infant also recognizes that
persons (particularly the maternal or caretaking figure) exist although they may
disappear from sight. At this stage the infant is considered to be attaining the concept
of object permanence (Piaget, 1937/1954, 1951), and able to recognize objects as
existing independently of him or herself. The concept of person develops similarly,
but somewhat earlier than the knowledge of objects, with a recognition of a maternal
figure occurring between the fourth and seventh month (Bowlby, 1980).
There is a difference, Bowlby (1980) asserts, between the infant’s being able
to recognize the maternal, caretaking figure when she (he) is present, and being able
to remember her (him) when that figure is absent. Recall, in the absence of the
caretaking individual, does not fully develop, he continues, until the final months of
the first year. Prior to reaching the stage of object/person permanence, infants seems
to make no attempt to search for objects they have seen disappear. "Out of sight
seems . . . to be truly out of mind" (Bowlby, 1980, p. 426).
Piaget’s developmental scheme concerns the child’s growing ability to adapt
his or her organizational schemes to the world. This involves combining information
from perception with information from memory to make predictions and act upon
plans (Bowlby, 1980). Overarching this process is a coming to terms with absence
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and presence, a grasping of a material world which it becomes more and more
possible for the child to symbolize and thus consider internally. In what Piaget
describes as the stage of concrete operations (seven to eleven years), the child is able
to perform "interiorized" mental operations, such as performing arithmetic in her or
his head. This ninteriorizationn necessarily includes the understanding of one thing
standing for another-as in the understanding that "‘one’ stands for ‘one object’"
(Singer & Revenson, 1978, p. 20). In the stage of concrete operations children learn
that objects and quantities stay the same despite changes in physical appearance.
Bowlby maintains that while there is variability in the development of
cognitive abilities related to object and person permanence, by eighteen months,
children are generally able to generate some sort of picture of the world in their
minds, and to play with their representations imaginatively. The abilities to conserve,
to think abstractly and symbolically, to believe that an object still exists when it
disappears from view, and to know that even if it changes form, the object stays
fundamentally the same--are part of the cognitive foundation that make death, the
ultimate absence and conversion of forms, such a paradox for human understanding.
Metaphors and symbols themselves connote loss because they describe the tension
between the physical and the non-physical, between absence and presence. They
"stand fo r” something, rather than being the thing itself. The internalized other,
which is always "with" one in some way, is, like the living metaphor, created out of
loss. Thus, "the shadow of the object" falls upon the ego, and the ego becomes the
"forsaken object" (Freud, 1917/1957, p. 249).
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Although the development of object/person permanence (Piaget, 1937/1954,
1951) seems naturally related to the development of what other theorists (e.g.,
Furman, 1974; Hartmann, 1952/1964; Mahler etal., 1975; McDevitt, 1975; Pine,
1974) term object constancy, as Bowlby notes, the two terms represent varying
concepts. But while Bowlby differentiates object (and person) permanence from
object constancy, disparaging the latter as a superfluous term, it is useful to note how
the concepts overlap as well as differ, as both are important for an understanding of
how the disappearance and loss of persons, physically and psychically, affect the
loser.
The term "object constancy" was originally used by Hartmann (1952/1964) to
distinguish between the child’s attachment to a real person (with an existence of his or
her own), and the child’s attachment to a person or thing that existed, basically, to
fulfill the child’s needs. From this perspective, when the object (person) is
recognized as existing even when that object is not need-satisfying, object constancy
is said to have been achieved. While Bowlby (1980) objects to Hartmann’s
(1953/1964) linkage of the concept object constancy to Piaget’s concept of object
permanence, the processes have developmental threads in common. In both cases, in
order to attain to the state of either object permanence or object constancy, the child
must be able to see the thing or person as separate from him or herself. In Piaget’s
model, this involves not only an actual, material seeing of a physical object, but a
symbolized and imaginative seeing.
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In Hartmann’s model, however, the seeing as separate seems to involve
something more than a perceptual and cognitive understanding, something a bit
different from placing one thing in the stead of another~it involves as well a kind of
seeing, almost empathically, in the other’ s stead in order to grasp that the other may
not necessarily fulfill one’s needs. Such a movement reflects the fundamental stance
of object relations theorists of development as a movement away from narcissism (and
undifferentiated auto-relations as it were) to object relations (seeing oneself as
separate from other people, and being able to relate to them as if they were separate
instead of part of the self).
Tuttman (1981) sums up Hartmann’s position nicely: An individual’s object
relations develop such that "an initial stage of primary narcissism (in which there are
no objects), [is] followed by an anaclitic stage5 ' (in which the object is experienced
solely as need fulfilling), to a stage of object constancy (where an ongoing cathexis of
the mental representation of the object persists regardless of need or the object’s
presence)" (p. 28). This view of object constancy is also the one adopted by Anna
Freud (1968).
The attainment of object constancy (as opposed to object permanence) may
seem a bit much for an infant; however, as Mahler’s (Mahler et al., 1975) schema
5/ In "On Narcissism," Freud (1914/1959) distinguished between self-love and
love of others, juxtaposing only the two states, both of which he considered as
"object" choices, i.e., narcissistic (when a person loves someone like him or herself),
and anaclitic (when he or she becomes attached to someone who feeds or protects him
or her). Hartmann seems to view the anaclitic state as not the most sophisticated or
differentiated of object relationships.
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implies, object constancy develops gradually from one-and-a-half to two years of age
and may not be complete for years. While we would not wish to ascribe overly
complex internal configurations to an infant’s behavior, as Cushman (1991) points out
in relation to Daniel Stem’s theory of infant development,- the concept of object
constancy is still relevant as a kind of marker for what explains how people gradually
come to deal with separation and loss. As Bowlby indicates, the perceptual
recognition and abstract knowing of object permanence is not the same thing as object
constancy. However, what Bowlby does not fully explore is that what is called object
constancy seems to involve a cathexis or emotional recognition, an internal holding or
preservation of the object that persists even if the object does not fulfill one’s needs,
or if the object is absent.
Bowlby summarizes Spitz’s (1957) contribution by indicating that his "object
constancy" is basically equivalent to Piaget’s "object permanence," therefore an
unnecessary and confusing term. However, Spitz’s (1965) formulations give some
indication as to how the two concepts may be related as he describes a shift in
perception when, as the baby nurses, it switches its focus from a limited contact of
the breast, to a more distanced perception of the mother’s face. In this way, Spitz
explains, the shift in perception involves not only a spatial shift from an immediate
6/ Stem (1985) says that at three to nine months of age, an infant displays a
"sense of authorship of one’s own actions...having control over self-generated action"
(p. 71), also implying that the infant has a sense of separation between itself and
other. Cushman (1991) suggests the observed behavior could be equally construed as
1 1 social dependence" (in contrast to Stem’s term, "self-agency"). Each term,
however, implies a complexity of self— moreover, an innateness, a transhistorical-ness
-which Cushman finds difficult to accept.
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(the mother’s nipple) to a more distant context (the mother’s face and other
attributes), but represents a shift from relating to the object as need-gratifying, to
relating to it as a discriminated, and differentiated, person. This shift to relationship,
he believes, provides the basis for the construction of psychic reality.
Although Bowlby (1980) sees Mahler’s (Mahler & Furer, 1968; Mahler et al.,
1975) formulations of object constancy as different from both Piaget’s concept of
object permanence and other views of object constancy, Mahler’s basic outline of
development-through autistic, symbiotic, and separation-individuation phases coincides
with Hartmann’s (1952/1964, 1953/1964) ideas about the transition from a need-
gratifying object to a separate person, and with Spitz’s (1965) suggestion of the
transition from an autistic perceptual awareness, to an object-related awareness. With
the increase of physical and perceptual abilities, more physical separation is possible,
and cognitive differentiation as well as separation of the self representation from the
self-object (mother-infant) occurs, and it is after rapprochement that emotional object
constancy gets established along with a stable sense of self and boundaries.
According to Blanck and Blanck (1979), this is the first, and most influential, of
many "rounds" of the separation-individuation process that occurs throughout life and
is intrinsic to the development of psychic structure.
A different view of early differentiation is taken by Modell (1993) who
contends that Mahler’s view of the separation-individuation process should be
reversed, at least in its early stages. To begin with, he says, the infant is not fused
with the mother, but separate. And Stem (1985) states that infants "exert major
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control" (p. 21) to begin with regulating engagement or nonengagement with their
mothers. Rather than "moving towards" object constancy, the infant communicates
with its mother with a "mutual comprehension of empathy" (Modell, 1993, p. 106).
The experience of merging with the mother may only later be superimposed upon the
infant’s perceptual system, Modell suggests.
Similarly, Beebe and Stolorow (1995) contend that self-experience is shaped
very early in the mutual interaction of the relationship between the infant and her or
his caretaker and the world. While the infant brings perceptual preferences, schemas,
expectations, etc. to the environment, as humans we "actively construct all
information" (Beebe & Stolorow, 1995). Beebe and her colleagues suggest that in the
infant-mother dyad, as well as other, subsequent dyads, a pattern of both mutual and
self regulation occurs such that organizational patterns are co-constructed according to
time, space, affect and arousal.
Beebe (1995) points out that infants have the capacity to perceive time since
birth, not only responding to facial and other feedback from caretaking figures, but
matching what she calls the "switching pause," which allows for the regulation of
"turn-taking" in verbal and nonverbal dialogue. In such a model, clearly there must
be at least two active parties present. The caretaker is not just a mirror reflecting
the infant’s needs and desires; nor is the infant a passive recipient. Further, this co-
constructional process continues on with development. Thus, according to the work
of Stolorow (1995) and of Beebe (1995) and Beebe and Lachman (1988, 1994),
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recurring patterns of intersubjectivity, serve to construct a contextual and emergent
pattern of organization.
Although facial, other nonverbal feedback, as well as "baby talk," can all be
seen as important in this intersubjective construction, Lacan (1977) suggests that it is
entering the world of formal language that promotes differentiation from a state of
fusion and that insures our seeing our separateness from the other. If we can see the
other as separate, and somehow symbolize that other through language, we can have
some sense that the object remains though it is absent.
While disagreeing with the ego psychology school associated with Hartmann
(1952/1964; 1953/1964), Lacan’s stages of development bear some resemblance to
Hartmann’s articulation of the development of object constancy. Lacan speaks of the
Real, the Imaginary, and the Symbolic. The Imaginary is a state not totally dissimilar
to Hartmann’s narcissism. As Jay (1993) articulately "translates," the infant is "bom
before it has overcome its organic insufficiency," and from a Lacanian perspective,
without language, it is "initially in a state of postnatal ‘fetalization’" (p. 344). Jay
continues,
Between the ages of six and eighteen months, however, the infant achieves a
compensatory sense of selfhood through visual identification with its image in
a mirror. What Freud had called primary narcissism was thus achieved
thorough taking an image for the reality of a coherent self, an image which
compensates for its still dependent and immature body. (p. 344)
For Lacan (1977), this sight of the mirror image "situates the ego, before its social
determination" (p. 2); it is, therefore, an illusion of bodily wholeness based on belief
in a mirror. "The Imaginary" is
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The dimension or realm of images, perceived or imagined, conscious or
not. . . a constant dimension of the human psyche, which can never permit
unimpeded access to "the Real," the realm of raw, unrepresentable fullness
prior to the organization of the drives. (Jay, 1993, p. 350)
Normal and psychotic behavior are differentiated by the partial conversion from the
Imaginary to a further stage, "the Symbolic," which represents the child’s acquisition
of language and coincides with Freud’s phase of oedipal resolution. It is with the
entry into the symbolic world of language that the child is able to differentiate or
overcome the "desire for fusion" with the image in the mirror of the mother, because
of "the father’s ’no’" (Jay, 1993, p. 351). Through symbolization desire is
transmuted such that, as in Hartmann’s (1952/1964, 1953/1964) conception of object
constancy, the other is no longer experienced solely as need fulfilling.
As Sheridan points out in his translation of Lacan (1977, p. viii), while
Freud’s Wunsch, and the English wish, seem more limited to "individual acts of
wishing," the French desir "has the much stronger implication of continuous force."
He notes further that Lacan connects "desire" with "need." The effect of language on
need is that it presupposes an Other who can respond to the need, which becomes
through speech, demand. He describes the gap between need and demand as desire,
which is "perpetual" and "insatiable" (p. viii).
In describing the infant’s experience of her or his first object (the caretaking,
usually maternal figure), Bollas (1987) uses the term transformational object to
illustrate that the experience of the mother is a "process of alteration" (p. 286). The
language between them, spoken and unspoken, is the process which is internalized.
The mother, in his view, is less an object than a process that reflects numerous and
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cumulative inner and outer transformations of the infant. The object is "known," to
begin with, existentially rather than representationally. Bollas, thus, addresses the
"wordless world" which emphasizes the object relations rather than the narrative.
In sum, we might best view the concepts of object permanence and object
constancy as related, yet involving a different kind or degree of emotional
sophistication in the case of object constancy. In the attainment of object/person
permanence the child is able to perceive and to "know," cognitively, that absence
does not imply total loss or non-existence. Things return; they can be located; they
do not disappear forever. However, the capacity to realize the other as cognitively
and emotionally separate, as well as physically separate, may not be complete for
years, reflecting, instead, an ongoing developmental concern. Further, "knowing" the
other (and self) occurs both verbally and nonverbally through a series of
transformational relational processes. We could say that object/person permanence
more clearly refers to both the development and the availability for access of the
representational model of the person or thing; and the concept of object constancy
involves the relationship between self and object as separate and independent entities,
in addition to the necessary fact of there being a separate and recognizable thing or
person at all. Both concepts, however, are concerned, to some degree, with loss and
recovery.
Because of the cognitive achievement of object permanence, the individual is
able to maintain a representation of the lost love object; with the achievement of
object constancy, he or she will not only be able to maintain the representation, but
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can also maintain his or her tie with the object. That is, the love object will not be
rejected or exchanged for another if it can no longer provide satisfactions; and in that
state, the object is still longed for, and not rejected as unsatisfactory simply because it
is absent (Mahler et al., 1975). The latter is obviously an important issue in the
study of bereavement since the dead person is physically absent and therefore cannot
provide the bereaved with all the former satisfactions of his or her presence. Does
this absence meet with complete rejection from the bereaved— i.e., a desire to
renounce and reject the deceased; with increased longing; with resignation; or with all
of these? Although there are conditions which are idiosyncratic both to the griever
and the circumstances of loss which necessarily affect how she or he responds, a
fundamental characteristic of significant or enduring relations is that the attachment
provided by the development of object constancy and intersubjectivity provides for a
paradoxical presence in the midst of loss.
Because of this paradox, grief is characterized by shifts such as longing for or
missing the other, resignation and acceptance, an acknowledgement of goneness, and
reinstatement in the form of memory and imagination, tacit and explicit. In addition,
there are distinctions between similar types of experience and shifts. Therefore,
"longing for" and "missing," for instance, are different experiences, longing implying
more of a hope that the other will return, and missing implying more of an
acknowledgement of absence and loss. Overlap, co-existing or oscillating aspects of
experience include both the acceptance of ultimate loss, hence poignant despair, and
yearning. Agitated despair and yearning, implying recognition of the magnitude of
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the meaning of the loss, may oscillate with some form of acceptance of resignation
which may obscure this meaning. The experience of an oscillating interplay of these
states represents not a straight path, but a dialogue, a dialogue which can also be
found in certain perceptual and interactional patterns that organize reality into
meaning.
Patterns of Oscillation: Dissociation and Engagement
Presence and absence oscillate, complementing each other, in our experience,
perception, memory, fact, and fantasy. Further, our actions in defining the dialogical
self cohere around this paradox. Self-experience is characterized by change, and it is
the dialogue with the other that makes change as well as enduringness possible.
Winnicott (1960) notes that in the beginning the mother-infant initially function
as a unit because the infant requires the maternal ego-support to manage the
environment. The mother (or maternal caretaker) is merged with the infant and able
to sense what the infant needs and provide it empathically, warding off
"environmental impingements" and thereby providing the infant a "continuity of
being" which allows the child’s ego to develop. However, also important in the
"disentanglement" of this unit and the development of the self is what happens with
the end of merging when the infant is becoming more separate.
The mother seems to know that the infant has a new capacity, that of giving a
signal so that she can be guided towards meeting the infant’s needs. It could
be said that if now she knows too well what the infant needs, this is magic and
forms no basis for an object relationship, (p. 50)
If the mother or caretaker is "so good at the technique of mothering that they do all
the right things at the right moments," (p. 51), the infant has no chance of making the
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"creative gesture, the cry, the protest, all the little signs that are supposed to produce
what the mother does" (p. 51) and which allow for the development of self. The
developing infant oscillates between merging with the maternal figure and separating—
engaging and turning away from the object of interest and attention. It is this give-
and-take between mutual engagement or patterns of engagement/disengagement--
tuming to the other and turning within— that is the key to symbolization, the "creative
gesture" which is afforded by the "potential space" created between the self and
another person. The dialogue with the other makes change and the construction of
raw facts into meaning possible.
Similarly, the work of Beebe (1995) and Beebe and Lachman (1988, 1994)
points to patterns of engagement and non-engagement with the other and environment.
Infants take turns in verbal and nonverbal dialogue with their caretakers, thus
matching what Beebe (1995) calls the "switching pause." From her videotaped
examination of infant-mother, and infant-other interactions, Beebe (1995) identifies
three broad interactional and perceptual tracking patterns: (a) a somewhat
dissociated, disorganized, or preoccupied with self-state; (b) a mid-range which is
flexible and shifts back and forth from self and environment; and (c) a hyper-vigilant
tendency to track which may compromise access to inner states. The mid-range
pattern is considered optimal and reflects a kind of oscillation between inner and outer
and a pattern of engagement-disengagement with the environment, coinciding with
Bowlby’s (1980) contention that while most selective exclusion is both necessary and
adaptive, exclusion may be maladaptive depending on what is excluded and why. In
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what Bowlby terms defensive exclusion, a behavioral system is deactivated, and/or a
response is cognitively disconnected from an eliciting interpersonal situation. Of
particular importance in Bowlby’s work is the deactivation of attachment behavior.
Dissociation, in this context, can be seen as interpersonal, and as Grotstein
(1995) suggests, hinged on the paradox of the Real, which would be traumatizing,
unless it were symbolized or forgotten. Therefore, the raw material of reality
remains, for the untraumatized infant, in a state of "blessed ambiguity" or "amnesia."
A movement between remembrance and amnesia, awareness and non- or limited
awareness or dissociation, therefore, revolves around this paradoxical interplay
between the real and the symbolic, between connection (with the other), and
disconnection (or turning within). As dissociation is widely recognized as being
adaptive, as it functions to "separate trauma out of consciousness" (Bellows, 1995),
and as having a normal basis (Braun, 1988) in the form of disengagement,
daydreaming, etc., it may be related to this early oscillation between engagement and
disengagement. Similarly, in bereavement, awareness is cyclical, or oscillating, and
interpersonal, in that the griever needs to retreat, to step back and then return to loss
and whatever grief the loss engenders.
Living With Paradox: Returns and Reverses
The dialogue of presence and absence is found in what Mahler et al. (1975)
describes as the toddler’s "practicing" subphase as well as in Freud’s (1920/1961)
exposition of the game of "fort-da" (gone-there), and is reformulated in the back-and-
forth shifts of the griever from one state to another. Interestingly, in the "practicing"
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subphase described by Mahler et al. (1975), when the toddler practices separating
from mother for short distances, the theme of loss, or rather of being left, is
reversed. Instead of losing or being abandoned, the toddler him or herself practices
losing and leaving. Piaget’s later phase of concrete operations (occurring between
ages seven through eleven) also involves the theme of reversibility as a primary
characteristic (Singer & Revenson, 1978). The inversion of losing and finding, or of
being left and leaving, calls to mind of Freud’s (1920/1961) exposition of the game of
"fort-da" (gone-there), which he associates with the desire to gain mastery over loss.
In his mother’s absence, Freud’s grandson constructed a game involving a wooden
reel with a piece of string tied around it:
What he did was to hold the reel by the string and very skillfully throw it over
the edge of his curtained cot, so that it disappeared into it, at the same time
uttering the expressive "o-o-o-o." He then pulled the reel out of the cot again
by the string and hailed its reappearance with a joyful "da" (there). This,
then, was the complete game-disappearance and return, (p. 9).
Freud continues, "At the outset he was in a passive situation~he was overpowered by
the experience; but, by repeating it, unpleasurable though it was, as a game, he took
an active part" (p. 10). Like the theme of absence and presence, here-and-goneness,
so the theme of reversibility, the idea that things can be converted to a former state,
the end represent a beginning, death lead to life, seems somewhat prototypal, as in
the fairy tales, stories and myths mentioned in Chapter 2.
These imaginary reversals indicate that although things, people, and time itself
actually disappear from our lives, in some other contradictory sense, they remain,
creating a kind of cognitive and emotional dissonance. This is the paradox of
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presence and absence alluded to by certain French philosophers and psychoanalysts
(e.g., Derrida, 1973; Lacan, 1977). The various self theories discussed above imply
not only that people have the capacity to conceive of a self and an other, an inside
and an outside, but that they have the capacity to conceive of, and play with, the
qualities of absence and presence. When something is lost, such as a set of keys, we
know that the keys exist somewhere in the world though we fail to locate them. We
know also that although we may grow old, changing our appearance perhaps
drastically from how we looked twenty years before, that we are the same person.
Something is lost, yet there is a continuity between what was and what is. There is a
continuity to the "now and the not-now, perception and nonperception, in the zone of
primordiality common to primordial impression and primordial retention" (Derrida,
1973, p. 65). The something that was lost still remains somehow in what we have
become, through memory, self-reflection, and our co-construction of experiences with
others. But of course, paradoxically, that something that was lost also remains lost:
We are not the same as we grow older; and the deceased is physically, unalterably
lost. It is questionable whether we could remain "the same" person, externally or
internally, when we continue to respond to new experiences or to reconstructions of
previous ones.
When someone dies, particularly someone we love, who has become a very
real part of our selves, the ultimate paradoxical experience occurs. We cannot negate
the reality of the physical death. Nor can we deny the reality of the emotional loss
caused by this physical annihilation. Yet paradoxically, not only in the first moment
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or first months of the loss, but perhaps on and off for years to come, there is a
presence of the person who has died. A remembrance of what was, in varying
possible levels of concreteness and salience. And there is a reality of that person
inside ourselves which contradicts the fact that he or she is no longer physically alive.
There is both a presence and an absence, each seeming to illuminate the other.
The notion of object constancy explains how it is that we can recognize a dead
person is gone and in some sense "relinquish" her or him, yet also maintain both the
person and the relationship. Preservation is reflected in the internalized, enduring
presence and the dialogical nature of self (Hermans et al., 1992; Modell, 1993)
discussed above. The other becomes possible when we differentiate ourselves from
objects around us, having at the same time taken these objects within us. But even
prior to such differentiation, the other is constructed on the basis of that
intersubjectivity and intercorporeality which is ontologically related to being both
subject and object, viewer and viewed, toucher and touched (Merleau-Ponty, 1962).
The sense of goneness and relinquishment, on the other hand, creates or
allows for an internalized absence. By internalized absence, I mean a sense that
something or someone is missing; this kind of absence reflects that the individual, or
"self," feels a certain emptiness, and is haunted by the sense of this lack. Those
entities characterized as crossing the borders between worlds, partaking of both
absence and presence, symbolized as "ghosts," emblemize this lack which reflects the
traces of a presence. This double state is thematized in Toni Morrison’s (1987) novel
Beloved, where a murdered infant ("Beloved") haunts her family for years, then re-
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emerges in physical (as well as ghostly) form eighteen years older to continue, or to
reconstruct, the relationship prematurely terminated by her murdering mother, Sethe.
In the traumatic history described in Morrison’s novel, the many losses etched
on the characters’ memories have a quality of being both present and absent, an
attribute which is related to the trauma of death and loss, remembering, and
forgetting. "Beloved" is not the only "ghost" in the tale; others are Sethe’s mother,
whom Sethe saw only a few times as a child, her absent husband, Halle, her two run
away boys, and the humiliating, torturous, charred images and presences of slavery
emblemizing Sethe’s life as a slave, and the life of her mother before her. All that
was taken from them in slavery constitutes a huge indelible scar which is
metamorphosed in the large "tree" on Sethe’s back after some White men beat her
with cowhide.
This story illustrates how our personal family and cultural history can be
construed as a kind of enduring, underlying presence, which we may not always put
words to, but which nevertheless pervades. The paradox of absence and presence
allows not only for the missing person to be internalized (as both present and absent),
but fuels an ongoing, dialogical process of memory and "rememory" (Morrison,
1987). In Beloved. Morrison illustrates how a memory will suddenly appear and
replay itself:
She had to do something with her hands because she was remembering
something she had forgotten she knew. Something privately shameful that had
seeped into a slit in her mind right behind the slap on her face and the circled
cross... (p. 77)
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This memory of the long-ago past of her mother’s hanging is, however, also charged
with new information about events of the past, such as the news of Halle eighteen
years after his disappearance, which is converted in (re)memory. As this example
illustrates, presence and absence, being and not being, having and losing, represent
more than the content of what is or is not there (i.e., the missing object or person him
or herself). Rather, it is the process the individual undergoes or transmutes in the
action of recovering and losing and discovering presence and absence that is
represented in a way that is reminiscent of Bollas’ (1987) transformational object. In
Beloved, it is because of the ghost’s presence that Sethe begins to retell the past.
As I have already indicated, the griever’s response to the paradox of absence
and presence, desire and loss, are belief and disbelief, hope and despair, engendering
the searching behavior described by Bowlby (1980) as characteristic of the early
phases of grief. The griever experiences an oscillation between belief and disbelief,
and must continue to "search" for the lost person, almost as if to verify her or his
existence or nonexistence. How can it be that the person we love and who continues
to be a part of us has been lost and cannot be refound? In Freud’s (1920/1961)
description of fort-da, the loser attempts to gain mastery over the loss, asserting
symbolically through the action of letting loose and pulling in the reel of string, that
there is loss, but that the loser has control over it.
Similarly, the bereaved adult may do much in her or his power to avoid giving
up the deceased completely for lost. Although the effort to reinstate the bond wanes,
as Bowlby (1980), indicates, "usually it does not cease" (p. 42). As indicated, there
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may be multiple levels of what is called "acceptance" or "denial," belief or disbelief,
and these "levels" may intermingle and fluctuate. Consciously, or unawares,
therefore, individuals may perform both direct and symbolized searches connected
with the lost, dead person, such as frequenting places the dead person used to go, or
expecting to see him or her in a familiar setting, or trying to remember things he or
she said. Perhaps even such acts as looking at old photographs, reading past letters,
or talking about the deceased are a way of searching for and locating her or him,
renewing and energizing the lost one’s stamp, his or her essence, and trying to
preserve it in ourselves.
In conclusion, there is a paradox implicit in searching for the lost object and
pulling in the ball of string. Because of the dialogical nature of self, the object, or
person, is recognized as both not existing (being lost, absent, gone from sight), and
yet still present. Object loss enhances internalization (Kohut, 1966). Further,
confrontation with death enhances co-construction and transformation in the attempt to
bridge the paradoxical double state of irrevocable physical loss and all that this entails
(non-being, age, illness, the passage of time, etc.), and ongoing love, memory, and
meaning. Because of the paradoxes involved in death and loss, grief includes an
ongoing metamorphosis of what it means to lose, to search for, to find, and to accept
as forever lost.
While loss is about paradox, transformation is about dealing with incongruity
and is a quest to go beyond the Real (in the Lacanian sense) to the Symbolic, and thus
transcend the "facts" which "stupefy" (Bollas, 1992). For this reason, grievers may
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dream not only of searching and finding, but of re-losing and re-searching, dreams in
which the paradoxical dialectics of death and life, youth and age, absence and
presence, self and other, imagined and real are bridged by their very impossibilities.
Such dreams are necessarily both disturbing and enlightening, revealing no resting
place, no static point of solution, but instead posing a continued enigma which
somehow is more satisfying than the "facts" themselves. This sense of the unknown
enigma created by death and loss allows us to realize that we are always in the
process of discovering and constructing reality, and that further, our emotions are
continually undergoing change and so can never be completely "resolved." As I will
discuss below, the reconstructive aspects of the dialogical self and the experience of
paradox are intricately bound up with the uses and apperception of memory and time,
the cognizance of death and personal ending, and how we know, cognitively,
emotionally, tacitly and explicitly, ourselves and the other.
Time. Death. Knowing, and Memory
Time is an implicit and explicit theme in the grief literature in terms of
prognostications about the duration of grief and the assertion that normally, "after a
lapse of time," grief ends. Time in this sense is viewed more or less as a quantifying
instrument, "a line of blocks or regularly spaced points on a clock or calendar" (May,
1983, p. 137). As May indicates, such a view has little to do with the significance,
or "inner meaning," of love: "The nature and degree of one’s love . . . can never be
measured by the number of years one has known the loved one" (p. 137). We could
say the same for love’s corollary, loss, which naturally depends on relationship.
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Further, our awareness of time is necessarily concerned with memory and with
death. Death is associated with time both in terms of the process of sheer physical
decay and degeneration, and the fact that what once was (as time elapses) is no more.
Hoskins (1993) also points out in her study of Kodi culture that our awareness of the
passage of time and our notions of time and time-keeping are inextricably connected
with our awareness of our mortality. Kodi systems of tracking time, she indicates,
represent struggles with mortality, and are "attempts to preserve a sense of a
continuing heritage over the generations by giving a vast authority to the past and to
the ancestors" (p. x). "[A]t my back I always hear / Time’s winged chariot hurrying
near," Marvell (1681/1979, p. 1361) writes. Our apprehension of time signals death,
which is overcome only by the end of time as we know it.
Without time, we would have no obvious reason to classify things as
remembered. And to remember is "to mourn" (Webster’s, 1984, p. 886), to preserve
what no longer exists and transform it into something else which is nevertheless
imbued with the original. Memory imbues meaning to the physicality of presence, as
well as its absence, by reconstructing "facts" to give life meaning and sense. In this
construction, the dialogical, embodied self-other that co-constitutes meaning and
bridges absence and presence is implicit. What I shall discuss as the emotional and
embodied nature of memory and the continual and multileveled nature of emotion also
describe how the lost other is known and re-known and how grief may reappear or
reemerge long after traditional theory says the griever should be "over it" and the lost
one relinquished.
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The Paradox of Mortality and the Self and Other in Time
Time is experienced as having many dimensions in loss, some which co-exist,
and others which transpire gradually. Just as there is a "doubling" of selves in the
"efficient self" who does the things that need to be done (e.g., arrange the funeral;
feed the kids), and the suffering self who agonizes with the weight of loss and
suffering, time also has nonordinary functions. Time is kaleidoscopically doubled or
multiplied by reflecting a recent past of myriad, living, viscerally felt memories in
which the dead still exists, and a present in which those images are challenged and
emptied, only to be reconstituted again. This paradoxical state is especially salient
early on, in the first months and years of loss, as indicated in Chapter 4. In this
state, time is attended to differently in looking for time to pass (and pain to be overh
and other measures of time are also regarded differently. Time may seem more
precious after an encounter with death; although there are things the bereaved may
wish he or she had done before the death, there may also be the sense of a new
appreciation for the shortness of time and the need to do things that are important
2/ Time may be experienced by the griever as excruciatingly difficult to get
through, a muddied and meaningless obstacle course with no purpose or end in sight.
The bereaved therefore frequently seem to adopt the method of "one step at a time,"
one moment at a time, which is one of the few viable ways of getting through time
while experiencing it. Thus, the bereaved may often count time, in the sense of
wanting to be through with this painful period. It is as if in order to continue on, the
bereaved must think that somehow they will feel better and "get over" their loss
(which is a convincing argument for the usefulness of some stage theories). Although
the desire to be beyond the pain of grief is understandable, this does not necessarily
mean that the pain will entirely cease. Often bereaved people do eventually feel, on
the whole, better; however, whether this feeling and functioning better is due to
actually "recovery" from grief, as opposed to learning how to manage it, is open to
question.
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now. In addition, the bereaved may begin marking time from the time of the death.
The death becomes a kind of landmark by which distances in time are measured (e.g.,
"it was before [the loved one] died that such and such happened; it was three years
after her or his death, etc.).
Gradually, the paradox becomes less pronounced and the other, and the past
lived with the other, are is accepted on more and more on an internalized basis.
Time past recedes from time present. Nevertheless, relational and emotional, lived or
tacit memories of the other’s being, as well as the awareness of death, continue to
affect the griever’s sense of time. This is represented in the ongoing felt influence of
the other, awareness of personal mortality, and in one’s changing perspective toward
death and loss. An important aspect of the time/space disjunction is naturally the
paradox between the presence/absence of the deceased. Time continues, while, in
terms of the world and life we know, we do not. This calls to awareness the
fundamental paradox that though we exist in time, it is in a sense because of time that
we cease to exist. This disjunction may feel less disturbing and more resolved if the
deceased is imagined on an alternate time/space plane, as in an afterlife. Others, like
Tittensor (1984), feel they must confront the paradox; thus, "If I am to deal with their
absence from this world I can only do so by confronting the fact. . . not by
consigning it to an after-world in which all our temporal discords are resolved" (p.
36).
Related to the paradox of presence and absence is what existentialists and
humanists view as the paradox of being human, hence mortal. Says Yalom (1980),
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"Though the physicality of death destroys us, the idea of death saves us" (p. 40). It
is because of the reality of death that we may become "mindful" of our being
(Heidegger, 1927/1971); immersed in regular, day to day life, we forget that it is
spectacular that we exist at all, and furthermore, neglect our possibilities and even,
existentialists would say, our responsibilities for self-creation, our potential. Further,
Yalom suggests, death of a loved one is more than "stress," and more than the loss of
an important object. "It is a knock at the door of denial" (Yalom, 1980, p. 64)-
denial that we, too, must die. Yalom points out that Freud also denied the relevance
of mortality to his patients’ traumas:
If, as Freud speculated, Fraulein Elisabeth thought, even for a fleeting
moment, when her sister died, "Now her husband is free again, and I can be
his wife," then most certainly she also shuddered with the thought, "If my
darling sister dies, then I, too, will die" (p. 64).
The griever must on some level confront this existential truth, both in relation to the
one he or she has lost, and in relation to him or herself.
Time also presents a paradox which relates both to the construct of self and
experience overall. In time, the experience of self is both stable and continuous and
different and changing. Death changes our worlds unalterably. At the same time as
the self can be felt as continuous, the shape and pattern of life are broken. A process
of de- and refamiliarization (a key aspect of what Parkes, 1974, 1987, and Bowlby,
1980, refer to as reorganization) occurs. Moreover, although in some sense "the
same," we ourselves are changed, and we cannot change our selves, or our
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perspectives, back to what they were before the loss. Loss is therefore not only a
precursor of any reconstitution or "reorganization" the griever makes of his or her
world; loss itself founds the new order and is consequently a part of it.
Consciousness and our perspective change as we move through time. Using
the image of the train, T.S. Eliot’s (1943/1971) poem "The Dry Salvages" calls to
mind James’ (1890/1950) concept of self as both continuous and unified and always
changing. Though, in some sense "the same," we are altered as soon as the train
leaves the station, and even those who could have verified our identities before our
departure have "left the platform" (their identities, therefore, are also in question):
When the train starts, and the passengers are settled
to fruit, periodicals and business letters
(And those who saw them off have left the platform)
Their faces relax from grief into relief,
To the sleepy rhythm of a hundred hours, (p. 41)
But rather than "escaping the past" "into different lives," or even into the future, Eliot
points out, it is we ourselves, in our movement through time who have changed.
"Fare forward, travellers!" he continues,
You are not the same people who left that station
Or who will arrive at any terminus . . . .
You are not those who saw the harbour
Receding, or those who will disembark, (p. 41)
If we accept that one is not the "same person who left the station," this means not
only that due to changing perceptions and accruing new experiences, grief can abate,
but for the same reasons, we can feel the loss in ways that we may not have been
aware of or experienced at the time of the loss. As we grow, our perspective and
response to loss continues to develop, as do our understanding and construction of the
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loss and of the other. Therefore, the loss has added meanings as time continues.
Memories may be preserved, and yet they change as we ourselves change.
Significant features of grief may be reenacted and reexperienced, but they are not the
same experience.
Rando (1984) notes that there are age-related differences in grief responses
among adults. In widows and widowers, Parkes and Weiss (1983) find those under
40 to be at greater risk for problems ("poor bereavement outcome"), and others (e.g.,
Maddison & Walker, 1967; Parkes & Weiss, 1983; Rando, 1984; Stroebe, Stroebe,
Gergen, & Gergen, 1981-82) suggest that the effect of loss is attenuated with
increasing age. The effect of time is such that the bereaved’s age does not freeze
with the death of the beloved and is therefore amenable to the changes and
reconstructions that come with time. As the bereaved grows older, experiencing not
only additional possible losses of all the kinds described in Chapter 2, but
experiencing more and more her or his own sense of mortality, it is likely that her or
his view of the death of the beloved also changes. The experience which seems
unbelievable, improbable, and even alien becomes more and more recognizable as
likely and inevitable as our experience of life accrues. A woman of fifty has a
different vantage point from which to view death than the woman of twenty or the
woman of eighty. The terminally ill also have a different "platform" from which to
view life and death. We are not "the same people who left the station," as Eliot says,
or the same "who will arrive."
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As we travel along time, like the commuters on Eliot’s (1979) London
Bridge, going through life, to death, we are faced with the end of time, the end of
our personal time. In this sense, Queen Gertrude’s words in the excerpt from Hamlet
cited in Chapter 1 of course make as much sense as all the folk wisdom passed down
throughout generations that says, "All that lives must die." This, then, is another
kind or level of "acceptance" that comes with maturity and experience. The
experience of one’s own life and the changes that occur through time interact with the
experience of loss and the sense of the end of a significant other’s time to produce a
kind of understanding or "acceptance" which also oscillates. We know, for instance,
in a tacit, felt sense, in our bodies as well as our minds, the more we ourselves
experience the effects of life and time, the wrinkles and achievements, changes and
corrosions, as well as the goneness of the other (or others) who has died, that we
ourselves are mortal. As we continue to appreciate and be aware of our own
mortality, the death of the other is put into different perspectives. If or if not we
"join" her or him in some "Beyond," we join them metaphorically in sharing the
characteristic of being mortal. The more we accept our own mortality, the more, on
another level, we accept the other’s, though the effect of this knowledge may also
oscillate from, for instance, "raging against the dying of the light" (as in Dylan
Thomas’ poem), feeling an increased capacity to enjoy the moment, take better care
of ourselves so as to survive better and longer, or perhaps putting the knowledge of
death aside to leave it to the forces of destiny or chance.
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There is an inherent paradox in the notion of time and cure in that while the
passage of time does seem to work some comfort, as novelist Winterson (1987)
suggests, time itself may be viewed as the disease rather than the cure. Time is the
"disease" in that it is the basis both for our mortality and our cognition and
remembrance of our mortality, "healing" wounds by eventually killing the patient. As
Eliot (1943/1971) remarks, "Time is no healer: the patient is no longer there" (p.
41): The "patient" is not the same "I," the same person who was afflicted in the first
place; through the passage of time that "I" changes. Thus, time may work its "cures"
not only by "killing" the patient outright, but through the process of change that
makes the "I" of the patient different. Not only altered perspective, but altered
memory is part of this "cure" as over the passage of time, some things may be
seemingly erased, or at least ameliorated, disguised, or forgotten.
One of the paradoxes of this "cure" is that the "patient" him or herself may
not wish to forget the cause of his or her ailment~in fact, to do so might be totally at
odds with her or his sense of identity and meaning. Pain, which is inherently
traumatic, becomes organized with meaning; and especially when trauma is associated
with the loss or destruction of loved lives, to forget is to deny not only its meaning
and importance, but the importance of those we love. As Stroebe et al. (1992) note
in relation to the romanticist philosophy of the nineteenth century,
To grieve was to signal the significance of the relationship, and the depth of
one’s own spirit. Dissolving bonds. . . would not only define the relationship
as superficial, but would deny as well one’s own sense of profundity and self-
worth. It would make a sham of spiritual commitment and undermine one’s
sense of living a meaningful life. (p. 1208)
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Such a philosophy is potentially as relevant to particular individuals and cultures now
as Stroebe et al. suggest it was in the nineteenth century.- Such also is the outlook
taken by many victims of severe traumatization including genocide, murder, war,
physical and sexual abuse. In Berlin, it is a criminal offense to deny that the
Holocaust happened.
To remember is, therefore, not to deny, but contradictorily, it is also not to
accept. In referring to the Holocaust, Jean-Frangois Lyotard (1988) pits the
preservation of memory against the accomplishment of vengeance. In order to enact
vengeance, one must necessarily remember what one is avenging. Similarly,
ontologically, remembering does not necessarily foster acceptance; to forget is, in
8/ Views of love, time, and death cannot be strictly assigned to any cultural
era, as even times with particularly characteristic reputations, such as the nineteenth
century Victorian or romanticist era, show indications of variability. The enduring
nature of love and grief we see reflected in Emily Dickinson’s poetry (cited in Stroebe
et al., 1992) may be compared, for instance, with how Emerson’s reacts to the death
of his son:
The only thing grief has taught me, is to know how shallow it is. . . . So is
it with this calamity; it does not touch me: something which I fancied was a
part of me, which could not be tom away without tearing me . . . falls off
from me, and leaves no scar. . . . I grieve that grief can teach me
nothing . . . (pp. 35-36)
and Whitman’s (1855, 1881/1994) exuberant embrace of life and death as enduring
but definitely earthy :
r
I bequeath myself to the dirt to grow from the grass I love,
If you want me again look for me under your boot-soles.
You will hardly know who I am or what I mean . . . (p. 64)
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some way, to "forgive." Non-acceptance of death on an emotional and moral level in
the form of non-forgetting preserves the meaning of the other and his or her death.
Says Tittensor (1984), the dead ones’ "memory must be preserved for their sake and
mine. For all our sakes— for if the living cannot remember, cannot give remembrance
its due, then they too are dead" (p. 4). To remember, then, is as much a spiritual
and moral decision or premise as a cognitive and emotional event. Our memories, or
what we make out of them, inform our lives with meaning.
In grief, there is a fundamental tension between remembering and forgetting.
Paradoxically, psychic survival and functionality seems to require both explicit
remembering and reconstructing of trauma such as death, as well as at times an ability
to put this knowledge aside. As indicated above, preserving the other and the loss is
important to self/other construction and to existential meaning. On the other hand,
going on with life requires some measure of temporary forgetting or blunting of the
horror of loss and death. Coping includes dealing with memories and experience
related to grief as they come up, even sometimes "re-living" them, and alternately,
keeping these "at bay" (recognizing as well that not all memories or "triggers" to
grief-ful feelings can be controlled or, again, that one may not want to "control"
them). Coping with death involves different levels of awareness, ranging from the
intense scrutiny described above to a kind of blunting or buffering of memories and
experiences. "Going on with life" does require a "letting go" of the physical reality
of the other and all that this implies. However, while Bowlby (1980), for instance,
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represents this as a struggle which is eventually overcome, I maintain that as a
paradoxical given of life and death, absence and presence must be renegotiated.
There is also a fundamental tension presented by the nature of time, death, and
our ability to remember, construct and preserve. Non-acceptance in the form of non
forgetting (with its stance toward preservation of what is lost and destroyed) is a
battle against the forces of time and oblivion, a theme well portrayed in the film
Hiroshima. Mon Amour (Resnais & Duras, 1959). The protagonists of Hiroshima
indicate that the horror and annihilation of the bombing, and what existed before this
event, are both almost unbearable to retain in memory even while the process of
mourning strives to preserve them.-
In bereavement, the sense of time relates and interacts very importantly with
memory in that the griever can view the reality of the past, strive to preserve,
commemorate and reconstruct it, and still be aware of the present and of the lack of
preservative--the evanescence of time and its own self-destruction, and the fallibility
of our powers to remember. While "respect for reality gains the day," as Freud
(1917/1957, p. 244) indicates, as humans we strive to counteract the existential givens
of death, time, and oblivion, through our will, desire, memory, and imagination. The
physical, embodied self, situated in space and time (Merleau-Ponty, 1945/1962) is
9/ While the horrors of such events as the bombing of Hiroshima and the
Holocaust represent death, loss, and human destruction on a grand scale as compared
to individual losses, like the devastation T.S. Eliot describes in The Waste Land
(1979), they emblemize the meaning of human annihilation, laying bare, as it were,
grief and the process of mourning, with nowhere to hide. The world is literally
demolished and stripped of meaning.
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assailed by the contradiction between physical loss, the act of losing, and the
embodied desire for and memory of the other. There is, therefore, a tension and an
oscillation between different types of remembering, and a struggle with the existential
givens of time, mortality, and eventual oblivion or forgetfulness which makes
remembering, forgetting, and re-remembering an active and dynamic, and a conscious
and unconscious process.
Time. Space, and Lived Memory
The emotional (and embodied) nature of memory and our sense of selves in
space and time partially describes how the lost other is known and re-known.
Hermans et al. (1992) point out that imaginal others are usually conceived as having
their own spatially separate position. That is, they exist in a space, (and perhaps a
time) of their own. That we experience ourselves as embodied makes it likely that we
will imagine and remember others also as embodied, existing somewhere in space and
time. This understanding does not end or change the moment someone dies. In fact,
it is not uncommon for bereaved people to imagine their dead loved ones somewhere-
in the cemetery, in places or situations they used to "haunt" in the past, in "Heaven,"
or in some other sort of cosmic situation. The difficulty we have in imagining the
dead as disembodied and not situated in time or space, is illustrated by personal
tokens, funeral customs, and grand-scale memorials. Some keep ashes in a vase on a
mantelpiece; others imaginatively fill empty coffins; others construct monuments and
parks. With such gestures, the dead (or missing) are placed somewhere and are
concretized in the physical.
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Similarly, the novelist Morrison’s (1987) term "rememory" can be understood
as more than just a variation on the term "remembering." In Beloved, rememory
connotes not only an act (i.e., to remember), but a place, something seen as in a
vision or a dream, and a being. Like Heraclitus’ river of time, these things and
places in rememory exist even as we "step in" or "out" of them. Says Sethe to her
daughter, Denver:
"I was talking about time. It’s so hard for me to believe in it. Some things
go. Pass on. Some things just stay. I used to think it was my rememory.
You know. Some things you forget. Other things you never do. But it’s not.
Places, places are still there. If a house bums down, it’s gone, but the place-
the picture of it-stays, and not just in my rememory, but out there, in the
world. What I remember is a picture floating around out there outside my
head. I mean even if I don’t think it, even if I die, the picture of what I did,
or knew, or saw is still out there. Right in the place where it happened."
(pp. 44-45)
There is a permanent presence to things that have happened, things that are history,
that cannot be erased. This seems to be particularly true of traumatic occurrences,
indicating, on the one hand, the moral, spiritual, emotional perspective described
above that holds we will not forget those things that matter--the Holocaust,
Hiroshima, death of our loved ones, and that and whom we value-and at the same
time, a physical and visceral perspective— that these things exist, somehow, physically,
in our memories and are timeless. Both perspectives relate to our experience of death
in time and the use of memory. In a vein similar to the character Sethe’s (Morrison,
1987) experience of events that remain in time and space in "rememory," Freud
points to the timeless quality of unconscious or subconscious wanderings, as in our
ability to have dreams that combine events or people of the long-ago past with those
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of the present. LeDoux’s (1992) recent investigations also connect emotional
memories with a kind of temporal waywardness.
LeDoux (1992) associates emotional memories with classically conditioned
responses which, even when they are "extinguished," can reoccur spontaneously.
According to him, this is because the "memory" for the response/event is not erased,
merely suppressed. Thus, a memory may be held "in check" but then "reinstated" by
some traumatic event.- Similarly, van der Kolk (1994) writes that intense emotions
at the time of a traumatic event initiate long-term conditional responses to cues
reminiscent of the event.
The temporal waywardness of emotional memories is often associated with the
response to trauma. Van der Hart, Steele, Boon, and Brown (1993) distinguish
traumatic memory from "ordinary or narrative memory" in that it is "characterized by
a sense of timelessness and immutability, has no social function, and is reactivated by
trigger stimuli" (p. 163). As early as 1889, Pierre Janet suggested that traumatic
memories are stored differently than everyday events, being dissociated from
consciousness and expressed in somatosensory, affective and behavioral reenactments
(van der Kolk & van der Hart, 1989). In order to protect an individual from
traumatic affront, experiences that are overwhelming and frightening and thus do not
10/ LeDoux (1992) hypothesizes that neural changes underlying memory take
place at the cell synapses and that emotional memories are formed in the amygdala,
while other types of memory (e.g., declarative memory, developmental memory)
occur in different parts of the brain. Because different circuits are implicated in
declarative and emotional memories, different memories are represented by this view,
although on a cellular level, the memories are formed in the same manner.
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fit into cognitive schemes are said to be split off or dissociated from consciousness
and memory, and the memories may be reactivated when the individual is faced with
situations which resemble or remind him or her of the traumatic circumstance
(Courtois, 1988; Solomon, Garb, Bleich, & Grupper, 1987; van der Kolk, 1994; van
der Kolk & van der Hart, 1989).^ Bowlby (1980) considers a similar process of
what he terms defensive exclusion, wherein a person "deactivates" a particular
behavioral system, disconnecting from the environment, or from certain aspects of
him or herself, and Horowitz and Reidbord (1992) also assert that the use of "control
processes" inhibit the experience of "dreaded states of mind" (p. 355) which may be
unconscious.
It is this dissociative response to trauma, exemplified by such phenomena as
intrusive flashbacks and somatic symptoms (van der Kolk, 1994; van der Kolk & van
der Hart, 1989) which are often considered in addressing the concept of emotional or
visceral memories in relation to traumatic experience. Such responses are certainly
important in considering grief as a response to the trauma. Nevertheless, there is
more than a dissociative aspect to emotional memories, and not all tacit, sub-, or
unconscious states are necessarily pathological. As Janet himself indicated, all kinds
of memories (visual, auditory, gustatory, etc.) are synthesized to provide a matrix of
categorization and integration of future stimuli (van der Kolk & van der Hart, 1989).
11/ Trauma does not fit habitual schemas (Bowlby, 1969, 1973, 1980; Epstein,
1991; Harber & Pennebaker, 1992; Horowitz, 1988, 1991; Horowitz & Reidbord,
1992). In particular, Janoff-Bulman (1989) and Epstein (1991) indicate three basic
assumptions essential to psychic health which trauma threatens severely (i.e., that the
world is good; that the world is meaningful; and that the self is worthy).
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Bowlby (1980) asserts that much information processing is done outside of awareness,
and Janet’s concept of the subconscious includes the idea of "automatic
adaptations . . . actions triggered by ideas and accompanied by emotions" (van der
Kolk & van der Hart, 1989, p. 1531). LeDoux further (1992) contends that
"cognitive processing is itself most appropriately viewed as unconscious processing"
(p. 277). From this, we could consider a majority of experiences and memories, to
some extent, emotional. Further, traumatic and emotional memories may be
conscious as well as dissociated or may exist on both a somatic and sensory and
cognitive level.
As mentioned, although triggers may become less intense as the griever
"leams"or rather reconstructs, what has happened, as LeDoux (1992) indicates,
memories are subject to reactivation. Further, emotion may not be obliterated even
though the griever becomes conscious of triggering factors and is able to construct a
coherent narrative of the traumatic circumstances of death and loss. The multileveled
nature of consciousness allows both for the emotional or irrational and the thought-out
in the griever’s ongoing experience.
Emotion can be viewed as an enhancer or motivator of memory (e.g., Blaney,
1986; Brown & Kulik, 1977; Thompson, 1982), a suppressor or repressor (e.g.,
Breuer & Freud, 1895/1955; Christianson & Nilsson, 1984; Freud, 1915/1957;
Erdelyi & Goldberg, 1979; Lofitus & Bums, 1982), integrally connected, along with
cognitive and perceptual processes, with memory (e.g., Wundt, 1907), and as a
memory process itself, neurally stored (LeDoux, 1992). Research in the areas of
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emotion and memory (see, e.g., Brewer, 1988; Christianson, 1984; Christianson &
Loftus, 1987, 1991; Christianson & Nilsson, 1984) suggests that emotion influences
what aspects of an event are focused on, including better recall of the central theme
of an emotional event than a neutral event, and indicating that the emotional focus of
an event will be remembered but the details may not, suggesting that the emotional
use of memories is partially related to the process of reconstructing our memories to
make sense of and enrich events. Research in the area of mood-state-dependent
memory (Bower, 1981; Eich, 1980; Eich & Metcalfe, 1989) also suggests a
bidirectional influence of mood and memory, particularly when autobiographical or
self-generated material is utilized (Eich, 1980; Eich & Metcalfe, 1989). Both lines of
study indicate the relevance of a personal construction of emotional facts in memory.
As LeDoux (1992) and the above research emphasizes, the memory for
emotional significance of events is different from the memory of the event itself.
That memory may at times be more concerned with feelings than with facts is vital to
understanding grief. As noted, there are seeming incongruities in grief experience
which have to do not only with the paradoxical fact of death and of constructing
absence and presence, but that we respond emotionally and relationally to loss. Thus,
there is shock and disbelief; however, there is also knowledge that the other is gone.
There are many kinds of acceptance, which may partially co-exist in the griever with
feelings such as longing and rage. There are multiple levels at which the bereaved
may remember the deceased which are part of the way we remember the things and
persons we care about generally. A special recipe every time it is cooked may call to
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mind the person who gave it to us; a particular piece of music evokes the person(s)
we know who are fond of it; such are reminiscent of countless experiences which call
to mind other such experiences and the people we associate with them.
Just so, Proust (1913/1934) writes of the special state of mind evoked and
denoted by a taste of tea and madeleines, a state which is sensorily recalled, but
means more to the experiencer than the taste, smell, touch, or sight of that being
recalled, signifying a state of being which is also partially constructed. In
reminiscing about his childhood experiences at Combray, Proust also notes the
specificity of certain memories, as for instance, involving going to bed and waiting
for his mother to say good-night to him, the moment of "undressing, as though all
Combray had consisted of but two floors joined by a slender staircase, and as though
there had been no time there but seven o’clock at night" (p. 33). He continues:
Combray did include other scenes and did exist at other hours than these. But
since the facts which I should then have recalled would have been prompted
only by an exercise of the will, by my intellectual memory, and since the
pictures which that kind of memory shows us of the past preserve nothing of
the past itself, I should never have had any wish to ponder over this residue of
Combray. (p. 33)
which, he concludes, "was in reality all dead." Again, it is the intellectual or
objective facts of reality which "die"; the emotional facts, because they are emotional,
are remembered as vivid.
From the above, two important points may be elucidated: First, that emotional
memories are of a different type than declaratory ones; and second, that emotional
memories are visceral. When we think of what has moved or what moves us, these
moving memories are associated with sensory or visceral recall of different sorts.
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Although such memories are implicated in traumatic experience, they are also
connected with what we find meaningful on a day to day basis. While they are felt
experiences, they may be known too; they do not necessarily need to be "translated."
Once again, for the embodied self, "The senses translate each other without any need
of an interpreter, and are mutually comprehensible without the intervention of any
idea" (Merieau-Ponty 1945/1962, p. 209). Instead of being integrated by means of
cognitive explanation, such memories may be known and integrated (or accounted for
and accepted) in other ways. (This type of knowing is indicated in Janet’s concept of
the subconscious and "automatic adaptations, which . . . are actions triggered by ideas
and accompanied by emotions .... [and] are both psychologically and biologically
encoded," van der Kolk & van der Hart, 1989, p. 1531.) Not simply a device for
dissociation, these implicit, perhaps wordless, memories are part of our system of
associations and our emotional and bodily groundedness in reality.
The concept of emotional memory reverses, or undoes the construction of
memory as relating to facts only that are given (like dates in history, or arithmetic
sums), and to the notion of time as straightforward "like blocks" and unendowed with
subjective experience (which changes the way it is lived), depicting more realistically
how it is that experience that is supposedly dead (e.g., the presence of the other) can
be relived. That it can be relived on multiple levels (e.g., factually, perceptually,
viscerally, emotionally, relationally), and changed in the process, gives the lie to the
notion of memory as a multistorage facility where memories in seemingly discrete
blocks (see, e.g., Atkinson & Shiffrin, 1968; Cohen & Squire, 1980; Tulving, 1972,
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1985, 1986) can be retrieved like an old sock or fountain pen out of a drawer. The
back-and-forth emotional-cognitive quality of memory emphasizes not its factual but
its reconstructive and creative nature, what Loewald (1972) describes as not just an
intellectual or cognitive property which mechanically registers and retains, but a
creative, synthesizing force which "has something to do with separation, loss,
mourning, and restitution" (p. 148). This back-and-forth quality involves telling
stories in a number of ways in order to find meanings that make emotional as well as
logical sense. Here, time may be returned to, relived, and reconstructed. The
fluidity of memory allows for the reconstruction of the lost other, the relationship, as
well as events.
As indicated in Chapter 4, in bereavement and grief there is both the traumatic
aspect of death and loss (including, perhaps, additionally traumatizing circumstances
surrounding the death), and the loss as a missing which exists over a longer term or
perhaps an ongoing time frame. There are memories related to the trauma of death
directly (the death surround), and indirectly (e.g., the person who died), as well as
memories which are non-traumatic in nature that could be construed as emotional
(rather than purely declarative or factual), memories, memories which may be either
conscious or tacit, but which are not necessarily unintegrated or "split off," which are
highly important to the experience of grief. The bereaved may suffer dissociative
types of memories (e.g., in the form of painful and intrusive flashbacks), but in
addition, there are painful and traumatic memories, as well as pleasant (or both
pleasant and painful) memories relating to the lost one and his or her death, which co
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occur with the bereaved’s cognitive/emotional awareness of the circumstances and fact
of death and all the sequelae. In addition to traumatic response, emotional and
visceral memories are part of and give meaning to everyday life, occurring on
multiple levels, incorporating the somatic, sensory, visceral, and intellectual. They
may be "spelled out" or elaborated consciously, or left on a relatively nonverbal
form. (It is the "spelling out" that determines how they are transmuted,
reconstructed, and known.)
When applied to loss, these more tacit everyday processes may highlight the
experience of absence and presence: As object loss enhances internalization (Kohut,
1966), emotional memories illumine not only internalization of the other as one entity
or relationship, but the network of associational links between self and other,
including how the other was perceived as viewing and being in the world and thus
play a part in the griever’s relationship to loss and to the lost other.
Posttraumatic symptomatology may be part of grief, and Harber and
Pennebaker (1992) indicate " fo r most people [italics added], intrusive thoughts are an
ongoing and enduring aspect of loss," recovery being "typically a painful and lengthy
process" (p. 359). Although a fact of life, paradoxically, loss and death represent
realities which are "at odds with basic beliefs." Contemporary theorists (e.g.,
Epstein, 1991; Harber & Pennebaker, 1992; Horowitz, 1986) indicate that traumatic
realities must be accommodated in order to "overcome" trauma and insure psychic
and physical well-being. Such adaptation is perhaps, however, only a partial solution
to the paradox of death. In addition, there may be types of emotional memory which
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do not leave the impression of being cut off from other experience, nor from
awareness, but which coexist, and which may re-fuel, or re-trigger grief responses.
Grieving the lost one and coping with the pain of loss involve different levels of
consciousness and control, as in actively evoking the other, not actively pursuing or
avoiding painful thoughts and feelings related to the death and the other, and not
being able to avoid grief-ful feelings retriggered. LeDoux’s (1986, 1989, 1992) work
further makes sense of how it is that we can cognitively "know" someone is dead and
still not "believe" it; that we may know someone is irrevocably gone, and yet at times
feel a sense of their presence, even like a whiff of perfume. And that loss and
presence may be "replayed" in ways that we may not even be intellectually aware of.
Further, the reconstructive nature of memory is essential to grief. As
indicated earlier, the loss caused by death seems to spur on the impulse to create,
construct, and acknowledge a "joint" reality. On the other hand, it is the lack of the
other, their absolute loss, that represents the foundation point of the pain of death.
Nothing will bring her or him back to the physical, existential reality of the griever.
The essence of grief is this loss and the struggle with absence and presence which
presents a paradox. Even while memory strives to make sense of loss and continues
to reconstruct the lost other, however this reconstruction does not serve to deny the
reality of death and grief. Although memories may be gone over piecemeal (Freud,
1917/1957) and hypercathected or invested with emotional energy (and especially
carefully soon after the death), this process does not excise memories of the lost one.
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Not only do memories remain, but they may even continue to develop or
change. Because memories are not just static photographs, the lost one and the
griever’s relationship with him or her may be remembered emotionally and viscerally,
and in effect lived, even while the griever knows that the loved one is irrevocably
gone. An essential aspect of grief is this discontinuity between past and present
selves: The griever knows that what he or she remembers will never be as it was
before, and this too is the essence of grief.
Preservation of the other’s presence is part of grief, occasioned by her or his
enduring absence, and one of the paradoxes of grief is that this presence and absence
depend upon each other, merging and oscillating in the griever’s experience.
Although reconstruction is a creative and emotional process rather than a factual recall
of objective events, its creative aspect hinges importantly on the reality of loss and
death.
Knowing
That consciousness is not, according to present understandings, a purely
rational activity, but could be instead construed as either a multileveled, overlapping,
or even contemporaneous blend of what we traditionally give such labels as emotion,
sensation, cognition, make the concept of this lived or relived experience more
understandable. Knowing occurs in different ways-ffom what we might consider a
basic kind of existential knowing which interweaves the emotional, the tacit, the
relational, and a knowing which is rational, thought-out, or "postcognitive" (LeDoux,
1992). While there has been much debate over what is primary, and what in fact
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differentiates cognition and emotion (see, e.g., Lazarus, 1982, 1984; Zajonc, 1980,
1984), the difficulty of assigning a unitary label seems to reflect a trend toward
integration and away from dualism.
According to Zajonc (1980, 1984), affect is primary, that is we have a "gut
reaction" before we have any thought about the matter. Therefore, we feel repulsed
or attracted to someone; we pick up the feeling tone of an interaction, spoken or
nonverbal, even if we cannot pick up the content. Very little needs to cognized,
according to Zajonc, for affect to be aroused. Affect is almost if not completely
everpresent; whether we are thinking or perceiving, affect is often part of the process,
such that our cognitive judgments of things are tinged with affect (e.g., seeing a
boring movie, a beautiful flower, an interesting entertainer, etc.). In this way,
Zajonc links the experience of the object to the subject, so that a boring movie
naturally implies a bored movie-goer; a beautiful flower an awe-struck or delighted
flower-viewer. The stimulus situation and how we describe it, or relate to it,
describes our emotional response. This viewpoint has ramifications for both relational
and self aspects of affect. As much as an emotional interchange between subject and
object is a relationship, affect, as Zajonc indicates, "implicates the self": Judgments
"identify the state of the judge in relation to the object of judgment" (p. 157). This
viewpoint is significant in looking at the quality of emotional experience of someone
who is grieving, and his or her connection with the lost person, as any emotion may
be potentially connected with a significant relationship, such as the ongoing
relationship between the griever and the dead person, the variety of feelings including
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pain and joy which may be connected with the lost other. Further, Zajonc (1980)
recognizes the interactive relationship of the individual and his or her world and if not
a cognitive construction, an affective co-constitution of reality. He posits there is
something in the nature of the subject-object relationship that interacts with "some
internal state or condition of the individual," stimulating an affect.
Zajonc distinguishes between thoughts and feelings by classifying cognitions as
"heavier on information" and feelings as "heavier on energy" (p. 154), meaning that
when we analyze thoughts, we see a transformation of information, whereas with
feelings we are concerned with the transformation of chemical or physical energy into
autonomic or motor output. He acknowledges that "in nearly all cases" (p. 154)
neither thought nor feeling is free of the other; yet, Zajonc asserts, although affect is
"always present as a companion to thought" (p. 154), cognition is not always present
with affect.
In seeming contrast, for Lazarus (1982, 1984), thought is a necessary
condition for emotion, although thought, he says, may not be what Zajonc (1980,
1984) represents it as. In Lazarus’ view, the cognitive appraisal preceding an
emotion does not necessarily occur in fixed stages, nor is it necessarily rational,
planned or conscious. However, some form of cognitive appraisal is necessary to
determine whether a stimulus is significant to one’s well-being so that an adaptive
emotional response can be made. If an event is not significant to one’s well-being
then one does not have to make the response.
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In some sense, it is a different kind of level of "knowing" and "thinking" that
Zajonc differentiates when he indicates, "We can like something or be afraid of it
before we know precisely what it is and perhaps even without knowing what it is"
(Zajonc, 1980, p. 154). This early affective response may be gross, he states, and
may be refined by cognitive activity which may produce additional feelings, but since
feeling of this description "arises early in the process of registration and retrieval" (p.
154), Zajonc believes feeling arises from a system (the affective system) which is
separate from the cognitive system.
As Buck (1991) observes, the Lazarus-Zajonc debate has to do with how the
word "cognition" is defined. If we look at the events posited by both Lazarus and
Zajonc to occur in an emotional experience, without labeling these events as
cognitive, affective or even sensorial, a great deal of overlap appears in the nature of
the process. For example, according to Lazarus (1984), a cognitive appraisal may
include a "primitive evaluative perception" (p. 124); Zajonc (1984) argues that this
type of perception is merely "sensory excitation" which must be mentally transformed
into a cognition. A theme which echoes in both their work is a question of different
levels of conscious, subconscious or unconscious levels of experiencing or processing
experience. What Zajonc would call direct experiencing, Lazarus would assert is a
matter of processing that experience. In some sense, it is possible that both views
make sense, if we look at subsidiary levels of consciousness as both below (or above)
conscious awareness (hence less susceptible to "rules" of rational thought, less
formulated and articulated and more automatic).
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Both lines of thought indicate a kind of subceived, subliminal, subconscious
(or perhaps unconscious) level of processing arousing events, which engender
emotions. The concept of the unconscious, or of levels of consciousness, is of course
early associated with Freud and other theorists from all territories of the
psychodynamic tradition (e.g., Jung, Klein, Kohut, and others), and has more
recently had a place in cognitive theories of personality and therapy as well. Further,
important empirical work has been done both in cognitive and neuroscience which
harmonizes with clinical experience and attitudes towards the unconscious. LeDoux’s
(1989, 1992) work supports the notion of integrated, yet differentiated systems (i.e.,
via projections from the thalamus to the amygdala on the one hand, and from the
cortex to the amygdala on the other) and suggests a neurobiological substrate for
emotion and both an integration and separation of conscious and unconscious
processes. Further, when we consider "processing" as postcognitive and as verbally
organized (as van der Kolk & van der Hart, 1989, consider traumatic memories which
have been made into a "neutral narrative", translated into words instead of being
organized on a somatosensory or iconic level), we must consider that this occurs in a
jointly constructive relationship, symbolized first by a shared language and meaning
system and second by participation in the communication. As indicated in Zajonc’s
reference to the object or partial source of our emotional response, these tacit process
are intertwined with the relational.
LeDoux’s (1987, 1992) work, again, highlights the multiple levels of
cognitive/emotional processing. In relatively simplistic schematic form, the neural
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processes and affective-cognitive-physiological sequencing suggested by LeDoux could
be portrayed as follows (the various "steps" are marked (1), (2), etc.):
Insert Figure 2 about here
(2) Cortex
(postcognitive)
(evaluations emotional
significancarof stimulus)
(preconscious)
(1) Sensory
stimulus
(4) Possible mediation
of subjective emotional
experience
(3) Subcortical
areas,
particularly amygdala
Figure 2.
In this way, LeDoux (1992) makes a point of implicating both conscious and
unconscious or preconscious processes and relates these processes to neuroanatomical
structures. According to this view, the amygdala, located in the temporal lobe,
receives sensory inputs from both the neocortex and thalamus and projects them to
areas in the brainstem, inducing behavioral and bodily responses. LeDoux (1992)
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views the amygdala as an extension of the primary sensory system, and equates the
amygdala with emotional processing (while noting it is not the only area associated
with emotional processing). In terms of "primacy" of affect or cognition, LeDoux
broadens the discussion to include the notion of conscious versus unconscious, and
proposes two pathways from the sensory system to the amygdala which partially
account for Lazarus’ and Zajonc’s different ways of viewing emotion. When inputs
leave the sensory system traveling by way of thalmao-amygdala projections to the
amygdala, LeDoux says, emotional processing is begun early and the stimulus
representation is somewhat gross (like the brief exposure time and degraded stimuli
presented in the Kunst-Wilson and Zajonc (1980) study, and represents a
preconscious, precognitive type processing. When, on the other hand, the amygdala
receives complex information by way of cortico-amygdala projections (later in the
sensory processing sequence), the processing is "postcognitive" (LeDoux, 1992, p.
275), raising again the question of whether we can know something without knowing
it rationally or even consciously. (Zajonc, 1980, 1984, would say at least we know
what we like.)
As LeDoux acknowledges in 1986a, both consciousness and feelings are vague
terms. Like Lazarus (1982, 1984), LeDoux (1992) challenges the assumption that
cognition is synonymous with consciousness. Instead, "cognitive processing is itself
most appropriately viewed as unconscious processing" (p. 277). Although what he
calls cognitive processing is unconscious, the end product ("content") is conscious.
Such an understanding of cognitive processes calls to mind Polanyi’s (1967) concept
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of tacit knowing. According to Polanyi, all knowledge and understanding are
basically tacit, and inferences and intuitions derive from the tacit dimension.
LeDoux (1992) argues that the major sequences posited to describe emotional
experience all require "emotional coding" (p. 272) before emotional experience.
Since, he argues, emotional processing precedes conscious emotional experience,
emotional processing must therefore be unconscious. Unconscious emotional
"computations," he indicates, may underlie how emotion is represented in
consciousness, both in terms of behavior and memory. Even though his distinction is
explicitly between affect and cognition rather than conscious from unconscious,
Zajonc (1980, 1984) nonetheless reflects some of LeDoux’s assertions about the
implicit nature of affective processes, their separation from conscious cognitive
processes, and the transformation that occurs when emotions are put into
language/content.—
It seems apt that with this interactive and multileveled possibilities for
emotional/cognitive processing that despite debates over cognitive versus affective
primacy, some models have expanded to render them related if not interchangeable.
In trying to account for the role of cognition in emotional experience, for instance,
12/ E.g., Zajonc’s (1980) assertion that if affect is not transformed into
"semantic content" (p. 158), it may be encoded viscerally or muscularly; that
affective reactions may be separated from content, except when the affective
experience has been communicated to someone else or thought about considerably
(i.e., processed); also his experiments of "affective" versus "cognitive" recognition,
representing two different kinds of knowing (e.g., Moreland & Zajonc, 1979; Kunst-
Wilson & Zajonc, 1980). Brief exposure time to stimuli was sufficient for preference
recognition, not actual recognition of stimuli.
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Buck (1991) expands the concept of cognition to include things that in the past we
might have considered "purely" related to sensation or perception, such as getting a
suntan. Writing from a developmental-interactionist perspective, Buck (1991) argues
that the "body responds with a kind of innate knowledge" (p. 104) to the stimulus of
ultraviolet light, hence releases melanin in its skin cells. He states that the body’s
response partakes of both motivational and emotional systems which are products of
evolution, and that from a developmental-interactionist viewpoint, motivation, emotion
and cognition are part of what he calls the "primes" (i.e., reflexes, instincts, drives,
primary affects, and effectance motivation, p. 102) and therefore are not discrete and
autonomous entities.
While he contends that cognitive appraisal is the necessary and sufficient
condition for emotion, Lazarus (1982) nonetheless points out that in normal
experience, thoughts, impulse to action and somatic disturbance are "fused." (In fact,
Lazarus maintains, to be a "true" emotion, it must manifest at all three levels: bodily
expressions and action impulses, subjectively experienced positive or dysphoric
cognitive-affective states, and physiological changes.) In numerous examples arguing
against an information processing model where affect is accomplished only after
extensive encoding and processing, Zajonc (1980) illustrates this fused and
multilayered nature of emotional and cognitive experience, emphasizing its tacit
dimensions. These examples include transmission of affect via verbal and nonverbal
channels (e.g., through voice tone: when content is obliterated, emotions are still
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encoded by subjects reliably), emotions expressed in other languages, and nonverbal
cues which influence our evaluation of another person.
Zajonc (1980) further points to the "inescapable" (p. 156 or involuntary aspect
of affective reactions. He asserts, "One might be able to control the expression of
emotion but not the experience of it itself" (p. 156). In addition, speaking of
emotions as impressions of or preferences for, people and things, according to
Zajonc, these are both experienced and recalled effortlessly (therefore without
cognition). Affects persist in spite of cognitive invalidation; they are also "true" and
"feel" right despite "evidence" to the contrary. In addition, whatever these feelings
are (and says Zajonc, there are always feelings) they are difficult to verbalize;
nonverbal means are often more effective at conveying affect than verbal ones.
Zajonc further speculates that affect is not necessarily transformed into semantic
content, but may be encoded viscerally or muscularly, which would mean a quite
different categorization, representation and retrieval process.
Another argument Zajonc brings for the separation of affective and cognitive
systems is that affective reactions may be separated from content, as in what he terms
free-floating anxiety or hysteria. As indicated above, in many opinions, such
dissociation is problematic and not indicative of a natural separation between feeling
and thought (information/ content), but rather a problematic or pathological cut-off
(Bowlby, 1980). In fact, a disruption in the integrative functions of memory,
identity, or consciousness is one of the cardinal features of a dissociative disorder
(DSM m-R, 1987; DSM-IV, 1994). However, cognitive-affective separation does
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not happen, Zajonc (1980) says, when the affective experience has been
communicated to someone else or thought about considerably, implying that in order
for the "normal fusion" (Lazarus, 1982, p. 1019) between cognitive and affective
processes to take place, it must be processed at some other level. Whether or not
affect or cognition is "primary," this again suggests a multileveled nature of emotional
experience as well as the processing or generation of emotional/cognitive experience.
What is indicated are different levels of cognitive or affective awareness, including
levels at which one type of sensing or knowing may be transformed into another kind,
also suggesting different ways of knowing, including emotional and rational,
conscious and tacit experience.
Processing or transforming an emotional experience may have to do both with
thinking about it and/or communicating it to someone else, as Zajonc (1980) suggests,
and the ongoing influence of both inner and outer events which Lazarus (1991) refers
to as part of the emotion generating process. This processing enriches the complexity
of conscious and tacit levels. The nature of the transformation occurring in
processing is itself multileveled as Loewald (1979/1980) indicates in describing
therapeutic interpretations which he describes as bridges between two minds and
between different areas and layers of mind. These layers include "islands of
unconscious mentation and between the unconscious and consciousness" (p. 382).
Rather than simply "making the unconscious conscious," Loewald sees the
interpretation process as linking both the form and content of mental life and "going
back and forth between them." Further, as indicated in the dialogical nature of "back
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and forth," a relational aspect facet of knowing is implied, as in Zajonc’s (1980,
1984) contentions regarding the subject-object interaction of an affective response and
the communication or processing of affective responses, and in Lazarus’ (1991) work
concerning the essential person-environment interaction in the generation of emotions.
The recurring and yet changing aspect of grief experience is explained partially
by the multileveled, relational, and environmentally responsive nature of emotional
experiences. The processing of our responses seem to be more than a sequential
move from one type (e.g., affective, cognitive) or level (e.g., tacit, consciously
elaborated) of response to another, but rather represent a kind of back-and-forth
movement which allows for integration or knowing, and reintegration or re-knowing.
Emotional and Relational Knowing. From the perspective of the dialogical
self, we know the world relationally. The complexity of grief must be affected by the
fact that we co-constitute ourselves and reality and that the dead other who helped in
this co-constitution is now silent. Though silent, there many other ways in which the
presence of the dead remains, as memories of the dead are themselves embodied,
rooted in visceral, sensory and emotional experience, shared and in some sense co
created, intersubjectively known.
While the other is physically gone, because of the intercorporeal experience of
self and of implicit, shared experiences, the bereaved can imagine how the deceased
might experience the world although he or she cannot precisely know it as the other
would. Because the world is shared and as Husserl (1913/1967) indicates,
"intersubjectively known in common" though "differently apprehended" (pp. 94-95),
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the loved person’s point of view can be imagined and reconstructed. This knowledge
is neither purely ncognitiven or intellectual. Nor is it unthought. Rather, this
intersubjective knowing exists on an emotional and bodily as well as a cognitive
plane, which again is connected with our earliest relations with otherness. There is a
tacit level of understanding between two people conveyed through what Kohut (1966)
calls empathy:
[T]he mode by which one gathers psychological data about other people and,
when they say what they think or feel, imagines their inner experience even
though it is not open to direct observation, (pp. 450-451)
Kohut describes this act as somewhat spontaneous and tacit, like a single act of
apperception when we recognize someone’s face. Such a definition of empathy bears
striking parallels to Zajonc’s (1980, 1984) understanding of affect, LeDoux’ (1992)
use of the concept of unconscious emotional "computations," and Lazarus’ (1982,
1984) contention that thought does not have to be deliberate, rational or conscious, or
occur in fixed stages as part of information processing. Emotion is not only "linked"
with cognition: Emotion itself is a kind of cognition; alternately, certain cognitions
are emotionally based.
The reconstructive aspect of memory is related to an intersubjective knowing,
or co-construction of reality. It is through imagination, as Kohut describes it, that
empathy is achieved and we "put ourselves in another person’s shoes." This ability to
imagine and to empathize is naturally related to the ability to internalize. Through
our internal object representations of outer-based events and people, we can hold
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those objects inside ourselves and those objects become part of our internal empathic
role/person reversals, exchanges and reconstructions.
With an intimate other, many things can be shared, which include how the
other experiences the world, the taste of coffee, the feel of sunlight. These things are
shared not only through words, but implicitly, through imagination, empathy, and
experiencing reality together. As Bollas’ (1987) work suggests, an intimate’s reality
is experienced tacitly, taken in, and in a sense incorporated, becoming something in-
between him or her and the other. In remembering his life with his two dead
children, Tittensor (1984) quotes Polyani, "... our understanding of living beings
involves at all levels a measure of indwelling; our interest in life is always convivial."
For Tittensor,
Our life together was convivial .... I dwelt in them and they in me, the
three of us creating and recreating and constantly renewing each other .... I
see them now, looking back at me as we share and enjoy each other. How
they sparkle in my mind’s eye! (p. 55)
Wilcox (1995) speaks to this tacit, shared experience which may often be wordless in
describing how core affects, articulated through action, become stories providing a
sense of continuity to the self. Through co-construction and "reverberation" of one’s
affective experience in relationship with another, affect is given language to articulate
the self. The "wordless sense of being in the presence of another" which may occur,
for instance, in psychotherapy, is, he suggests, the core affective subtext which has
not been transformed into words. This "core affective subtext" is symbolized and
embodied in Morrison’s (1987) novel Beloved in the characters’ experience of the
ghost "Beloved" when a visitor experiences such a core affect viscerally as:
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[A] pool of pulsating red light. . . . Walking through it, a wave of grief
soaked him so thoroughly he wanted to cry. It seemed a long way to the
normal light surrounding the table . . . (p. 11).
The visceral connection "reverberates" with "the untold" (Wilcox, 1995), as indicated
earlier. Moreover, as Wilcox indicates, emotions may point to how it is different self
states exist and yet cohere in a continuous and stable sense of self. These different
"self" states are necessarily co-constructed.
What happens to this shared reality when the other person dies? Although we
have no way of knowing if the other continues to exist in a spiritual form or soul,
there is a sense that some part of the other’s way of apprehending reality is present in
the internalized relationship that has been co-constructed and that this way of knowing
is experienced in an embodied way. Thus, even if the other is not physically present,
one may still see things "though the other’s eyes," remember, or reconstitute, their
experiences, and thus extend their presence. Tittensor (1984), a year after the death
of his two children, writes how his children continue to live, not only in his memory
but in the generation of meaning created by the actions his children took in their
lives— "through their ability during their short lives to give and to generate love." He
continues that if there is any meaning to life it is related to "this ability of human
beings to mean something to each other, to take proper cognisance of one another"
(p. 30). From this understanding, as already noted, it would seem that internalization
is the very thing that would insure that a relationship is not severed. Further, such
internalizations are based on a co-constructed reality that is dynamic in nature, which
indicates internalizations of relationships themselves continue to change or evolve.
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This intersubjective and emotional knowing is evidenced in dreams, such as those
described in Chapter 4, in which the griever can emotionally re-member someone
loved and lost. The emotions live for the moment as if that person were really
present. Having imaginary "conversations" with the deceased, evoking their image,
wondering what he or she would think or feel about this or that event or
circumstance, or simply "knowing" or feeling how they would respond, having a tacit
appreciation of their mode of experiencing, are part of this reconstruction. As
Hermans et al. (1992) remark, the stories that we tell each other, create the dialogical
self, imbued of many T 's. The stories the griever tells about the deceased, both to
others and to her or himself, create and recreate the dead person within the griever
and within her or his self-narrative, perhaps more strongly than mere photographs
can. It is this kind of narrative, the stories and dialogues we enact within ourselves
and with others, that creates the other (in this case, the deceased) as knower in the
Jamesian (1892/1923) sense, rather than that other we are concerned with as known.
Although there are many experiences in which the deceased as known other or self
emerges significantly for the griever (as in the remembrance of a particular habit of
the deceased, the way he or she stood or walked), often it is the other’s viewpoint,
opinion, reflection, feeling, experience, and understanding (as it is perceived,
imagined, or constructed by the griever) that comes to the forefront in dreams,
conversations and queries of the bereaved.
The experience of seeing the world through someone else’s eyes, or how we
imagine they perceive it, obviously does not require the physical presence of that
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person to enact and may more often be exercised in the absence of that person. When
the person is still alive, reality-testing can ensue, such that we can check our
impressions with the other person. However, when the other is dead, more ambiguity
is possible, and while the give-and-take play of an ongoing, physical, human
relationship is lost, the dialogical self continues to create some sort of relationship.
Paradoxically, we live in the other’s (co-created) perspective even while his or her
goneness may be experienced as stark. For this reason, it may be extremely upsetting
to a griever when she or he cannot visualize or imagine the deceased loved one.
Regeneration of Emotional Experience. As indicated in Chapter 2, the nature
of emotion generation (Lazarus, 1991) and regeneration contributes to the possibility
of griefs continuance, reemergence, and development, and to temporal boundaries
which are not as easy to predict or delineate as the spasmodic reactions Bower (1992)
refers to as emotions. First, homeostasis is by nature temporary.^' Second, death is
a complex "stimulus" with multiple and enduring meanings and consequences. Loss
of a loved one presents the griever with the kinds of shifts in experiencing, appraising
and coping that Lazarus suggests and is therefore more likely to have long-term
boundaries than a response to stimulus with the likelihood of generating fewer
responses (like a tack in the foot, or a broken fingernail). The more traumatic or
shocking the change to a person’s environment, the more complex will be the
adjustment of the entire person, as it has repercussions on a person’s self picture and
13/ Even in sheer physical terms, it is not unusual or illogical to find a process
recur. To take an elementary example, just because we have eaten dinner and are
temporarily sated does not mean we won’t be hungry again the next day.
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world picture. And finally, the person-environment continues to evolve and present
new "stimuli," "triggers" or evokers of emotion which interact with the entire person,
including her or his experience of death and loss.
To begin with, in grief, the reason for the emotional state(s) does not simply
vanish and so there is good reason for it to endure in some form. Although
"substitutes" for the functions the dead person performed and the role of the griever
may be found, and some of the relationship’s qualities and processes may be evoked
in other relationships, sometimes quite satisfactorily, the specific person him or
herself and the relationship with the griever cannot be replaced. As Freud
(1929/1961) writes to Binswanger,
Although we know that after such a loss the acute stage of mourning will
subside, we also know we shall remain inconsolable and will never find a
substitute. No matter what may fill the gap, if it be filled completely, it
nevertheless remains something else [italics added], p. 386)
Second, as Lazarus (1991) makes clear, a generating process is involved in
emotions such that as the situation and an individual’s appraisal of the situation
changes, engaging also in a process of changing or coping with the situation, emotion
is generated and, I would add, transformed. Everyday experience tells us that some
sort of "homeostasis" is attained after an emotional experience of some sort: Our
anger dissipates, our disappointment shifts, our depression lifts, our excitement
dissolves. This accords with the notion of emotion as a short-lived, "spasmodic"
reaction discussed earlier. Nevertheless, grief as a complex emotional state, or states,
is better reflected by what Izard (1979) and Zajonc (1984) consider the continuous
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nature of emotional experience.- In contrast to the neatly-defined stimulus-response-
homeostasis loop, Zajonc (1984) states, "the individual is never without being in some
emotional state" (p. 121). Rather than occurring "in a vacuum" (p. 121), emotional
reactions represent changes from one emotional state to another. Significantly,
Zajonc references the internal environment, in contrast to the external environment or
stimulus, pointing out that a cognition (such as remembering something sad) may be
the stimulus for such emotional change.
Looking at the sequencing of emotional events or episodes in ever-broadening
circles, whose loops may do more than insure homeostasis (they may for instance
transmute the experience), allows us to view grief as a more complex process. As
indicated, consciousness appears to operate on multiple levels and sequencing of
emotional or cognitive events may appear as nonlinear as well as multicausal (e.g.,
stimulated from within or without). The "ever-broadening circles" or regeneration of
emotion include in grief the stimulation of new internal and external variables, such
as triggers or reminders of the loss, thinking about the other, additional losses,
different forms of support. The stimulus, rather than occurring only before the
14/ For Izard (1979) and Zajonc (1980), the emotion of "interest" may
represent a kind of baseline of emotional experience, which gives way to other
emotions as these enter awareness. "Interest" holds attention and sustains curiosity,
and from an evolutionary perspective this heightened awareness makes survival
possible. The idea of "interest" as a general feature of consciousness compares with
arousal theories of motivation (e.g., Berlyne, 1960; Hebb, 1955). Arousal theories
consider organisms to have an optimum level of arousal which they are motivated to
maintain. One could debate whether arousal and interest are in themselves emotions,
or rather the representation of a readiness for emotion, depicting motivational factors.
In either case, arousal and interest reiterate something which theoretical debates on
affect and cognition continue to turn around: the importance of consciousness.
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response, may be enmeshed with response, as Zajonc (1984) suggests, as response
becomes a further "stimulus," therefore having a recursive quality, and one which
may not be as dramatic in terms of autonomic and endocrinal functions as Bower
(1992) suggests when the "stimulus" or "response" is first, in a sense, "known." As
LeDoux (1992) suggests, subjective emotional experience after the emotional event
may mediate the postcognitive appraisal, influencing the experience of emotion and
the evaluation of the emotional significance.
Further, as Lazarus (1991) indicates, the stress model does not take into
account an individual’s motivation and unique appraisal of a stressful situation, and
the coping process the individual undergoes. The process of coping or dealing may
change the situation and the emotions surrounding it, which is different from
eliminating the situation and dissolving the emotions. Emotion must be considered as
more than a response or a reaction per se, as Lazarus points out, since it includes a
constellation of processes and activities (which Lazarus refers to as the emotion
generating process, p. 17) including the environment, the person, the relation between
them, the person’s appraisal of this relationship, as well as action tendencies,
behavior, and the person’s coping processes. Because of the contributions from all
these sources and continuing appraisals, an emotional process may continue to evolve
rather than remaining in predetermined boundaries. Such a perspective suggests the
ongoing importance of context and appraisal in the individual’s experience of grief.
The process of coping with loss and grief provides a perspective for continued
coping, so that one learns that although one may feel miserable loss and yearning for
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357
the beloved during one particular time frame, at other times, she or he is also able to
go on with life and enjoy it, and at times feel some sense of the other in one’s
everyday activities. With telling the stories of grief and trauma, and retelling them as
desired, the reality of loss though painful may be assimilated, and through living these
stories and remembrances, the painful triggers become more visible, making these
reexperiences of loss both familiar and different. Further, although to the bereaved it
may seem like it for a time, life does not stand still, but presents additional
experiences, some of them stressful or painful, and others nurturing, supportive, or
positive. These experiences do not exist in a vacuum but interact with previous
experiences and recall of experiences so that, for instance, additional losses (of
various kinds, e.g., bereavement, loss of relationship, financial difficulties / loss,
etc.) join the "pool" of previous losses, both with some positive effect (in terms of
our ongoing learning of how to cope with losses) and with negative effect (such as
feeling overwhelmed by losses or remembering and having the traumatic nature of
loss highlighted). In this way, emotions may continually be in the process of being
regenerated, although they are not precisely the same emotions. Also, the "story" of
one’s loss and how it fits into all of one’s life are therefore continually being
regenerated and rewritten, or rather re-understood in light of new experiences and
understandings.
Bower (1992) suggests that it is through habituation that the frequency and
intensity of upsetting memories decreases. He reminds us that we learn through
failure, or by making mistakes, which are connected with our emotional reactions.
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According to this view, the affective reaction causes the "involuntary recycling,
rehearsal, and reimagining of the events leading up the emotional reaction" (p. 14),
serving an adaptive function and enhancing learning of what has been remembered, or
rather, encoded. Nevertheless, Bower does not take into account reasons for
continued "recycling" which include the need to continue to integrate meaning into
ongoing life circumstances, or a moral or spiritual imperative, although he does
indicate that the narrowing and focus of attention on particular and often distressing
aspects of a situation or event, including the physiological state of arousal and
cognitive sequelae (i.e., going over, "rehearsing" or reactivating the event in one’s
mind,) serves an adaptive function (as illustrated in Chapter 4).
As indicated, making sense of the traumatic aspects of loss does involve telling
the stories involving the loss, especially early on (which time frame, however, is
variable depending on the complexity of the circumstances and the relationship). This
process can involve a great deal of verbalization, as it involves communicating the
story and the relationship to the self, others, including the other who has been lost. It
can also occur on many other levels. As indicated by trauma theorists and clinicians,
without this verbalization or telling of the tale, a great deal of psychic difficulty might
likely result if the bereaved is traumatized by the loss. Constructing meaning is an
important aspect of this emotional memorial process. As van der Kolk and van der
Hart (1989) reflect, the "memory traces of trauma linger" until they are "translated
into a personal narrative" (p. 1533); lack of this unifying narrative and thus lack of
integration, is the cause of "terrifying perceptions, obsessional preoccupations, and
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359
somatic reexperiences, such as anxiety reactions." Consciousness from this
perspective, however, is best seen as unitary, rational, and preferably verbal, and
integration as sanitizing: The story must be told, in words; moreover, it must be
"transformed into a neutral narrative" (van der Kolk and van der Hart, p. 1533) in
order to be integrated. Edelman (1987) indicates also that categorization is essential
to free us from the "tyranny of time" (which, ironically, is possible only because
memory relies on time). Nevertheless, as is apparent from this tremendous ability to
categorize and synthesize, to make use of "subconscious" and "automatic adaptations"
(Janet, as cited in van der Kolk & van der Hart, 1989), there are multiple levels of
knowing.
Although the important stories of death, the lost other, and the lost relationship
may have been told verbally and in detail, experienced emotionally and viscerally,
and the story of death is known as a "fact," ties to the other and the loss may still be
reexperienced relationally and emotionally. Further, while telling the stories of grief
may be vital to the griever, this does not mean, as van der Kolk and van der Hart
(1989) and Janet’s (1930) work suggest, that the narrative will become "neutral" once
the "vehement emotions" have been integrated. The "vehement" or strong emotions
of the griever may lessen in intensity and frequency, but the narrative is not "neutral"
in the sense that it retains emotional importance and value. Rosenblatt (1983) finds
that although the frequency of different triggers for grief-ful responses decreases, the
intensity of feelings associated with death changes little.
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The possibility for ongoing emotional responsiveness to loss— that is, for
continued grieving— has to do with the multiple ways in which we know and
remember, and that meaning-making is an ongoing process. "Triggers" of acute grief
responses are of relevance here. While integration or synthesis is generally the goal
in the treatment of traumatic memories (van der Hart, Steele, Boon, and Brown,
1993), the retriggering and processing of traumatic memories can be seen not solely
as dissociative, but an attempt to transform, integrate, and create meaning. As
Harber and Pennebaker (1992) point out, it is bonding or creating associative links of
the trauma to other experience that is important in integration and meaning-making,
which is why telling the story/stories is so important. And, as Pennebaker and
Beall’s (1986) research indicates, it is not just putting the facts into the story that is
important to the psychic and physical well-being of the teller; it is also telling the
emotional significance of those facts. However, although this process may be most
apparent when something terribly "inassimilable" is being dealt with, it occurs on an
ongoing basis as we assess and integrate our previous experiences in line with our
new ones. Therefore, although telling the story is particularly important in trauma, it
is not necessarily enough to tell the story once or several times since the trauma may
infiltrate a person’s life and involves an entire meaning system with numerous
enduring links (as in tacit and relational memories). Because of this connection
between a person’s life and an important loss, painful and traumatic realities are likely
to need to be reassimilated on various occasions and thus are not simply "resolved" or
"overcome," although many of their major deleterious effects are lessened.
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Both Lazarus (1982, 1984) and Zajonc (1980, 1984) point to an experiencing
of reality that does indeed seem primary, and enduring— an experiencing which bears
a direct relationship with our environment and cannot be "thought away.n This, as I
mentioned, seems to represent a more tacit aspect of emotion/cognition/relating which
not only grounds us in the world but is part of our very make-up of responses. Grief
as an emotion, a complex emotion, and actually a number of emotions, thoughts,
constructions, is grounded not only in the relationship with the deceased, and the
foundation of relationship itself to self as well as to survival, but the tacit and less
tacit web of emotional responses which connect how we move in the environment.
As indicated, it is this fluid and constructive process Morrison (1987) illustrates in
refocusing our attention on the back-and-forth, re process of memory. Because
consciousness and memory are not stationary, facts and understandings may
continuously be added to our experience. And because memories may be experienced
and "added to" not only cognitively and intellectually, but emotionally and viscerally,
they are subject not only to being retold or "replayed," but reconstructed and re-felt.
Although triggers may fuel or influence recurrences of grief responses, grief, this
"reexperience" is not necessarily an "automatism" but may be part of a process of
transformation.—
15/ Although I use the word "trigger" for lack of a more precise word, I do
not mean to refer to either internal or external triggers as acting on an individual as if
he or she were a mechanism to be animated. A person brings her or his being,
consciousness and unconsciousness, will and vulnerabilities to an experience and is
affected by internal and external events in a complex way which is not simply like a
button to be pushed or a trigger to be pulled. Therefore, while "anniversaries," for
instance, may act as "triggers," there are many kinds of mediating circumstances both
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362
Culture Versus Biology
Earlier, I described Averill’s (1968) assertion that in bereavement behavior is
both a "stereotyped pattern of psychological and physiological reactions which is
relatively independent of social custom" (p. 722), and on the other, behavior that is
dependent not only on its context (e.g., death of a loved one), but the social
prescription for such contexts. "Any behavior may be interpreted as a manifestation
of grief," Averill continues, explaining this apparent contradiction by ascribing the
label mourning to that behavior which is determined by cultural context, and the
descriptor grief to all that is connected to the subjective (not only emotional and
physical but cognitive, behavioral, and all else) experience of the bereaved.
As Averill is not alone in differentiating mourning from grief (e.g., Bowlby,
1980; Rando, 1984; Rosenblatt, Walsh, & Jackson, 1976), something should be said
here about the definitions and use of such concepts as grief, mourning, and
bereavement. Although all are words that describe the experience of a change in self
and world after someone we know has died, mourning is often defined as pertaining
more specifically to social customs concerning a death while grief is considered the
individual’s biopsychosocial response (e.g., Bowlby, 1890; Rando, 1984). Mourning
within and without the individual that affect the experience, circumstances which he
or she can struggle with, decide to develop, or decide not to. How one continues to
generate and develop an emotional experience may include, for instance, deciding to
perform a ritual which adds to the "original" experience and continues to transform it
It is this interaction between inner and outer, this blending of the tacit or unconscious
and the willed, and the continuous nature of emotional experience that make
"triggers" or interacting variables involving grief so complex and not something we
can simply explain by a stimulus-response approach.
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may also be viewed as the psychological (Bowlby, 1980; Freud, 1917/1957; Rando,
1984) and sociocultural (Averill, 1968; Rando, 1984; Rosenblatt et al., 1976)
expression of both loss and grief. Rando (1984) describes grief as "the process of
psychological, social, and somatic reactions to the perception of loss" (p. 15).
The above terms may be used in contraposition, or alternately to denote
aspects of the same process. Therefore, while Rando maintains that grief is a
"transitional phase in the overarching process of mourning" (p. 16), she also uses the
words grief and mourning interchangeably "because of its [mourning's] connotation of
the same role and experience in that role for the griever" (p. 16). In M ourning and
Melancholia (1917/1957), Freud uses the German, Trauer, meaning both the effect of
grief and its outward manifestation (see Freud, 1917/1957, footnote 1, p. 243).
Clearly, there is much overlap in the use of the various terms. The subtle
toning of definitions differentiating mourning from grief, and in Averill’s (1968) case,
the sharp delineation of the two concepts, exemplifies the time-worn social science
debate over what is biological versus what is culturally determined, as well as the
tendency to search for norms and universals. Such debate has implications in
considering whether grief, or a particular grief response, is universal and therefore
sets the stage for the widespread theoretical acceptance that grief progresses through
predetermined stages to its not untimely conclusion.
Although he acknowledges that most data has been gathered from experiences
in Western cultures (European and North American), Averill asserts that grief is
invariant across culture. Averill’s determinist stance assumes a universalization of
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364
grief responses by "biological-izing" emotion, and by separating emotion itself from
emotional expression, indicating that context (including the context of culture) affects
only the expression of emotion and not the experience of it. Thus, if emotion is what
is tied to grief and to biology, and emotional expression is connected with mourning
rituals and culture, grief may be construed as invariant though its cultural expression
may change. Such is a limited view not only of grief but of emotion in general.
The more recent work of emotions theorists, such as Lazarus (1991) suggests a
modified conceptualization. In order to survive, Lazarus posits, both animals and
humans are biologically constructed in a way that makes it possible for them to
appraise their relationship with the environment and its potential harm or benefit, to
make some sort of adaptation if necessary which might require some sort of action.
In Lazarus’ view, all animals make appraisals of sorts, but human emotional
responses represent an evolutionary advance over reflexes and drives because
emotions require intelligence, learning, and thought. In contrast to Averill, Lazarus
argues that the nature of emotions is that they are distinctive from hardwired
responses-those that follow a rigid, automatic response pattern of responses to only
specific stimuli. Instead, the variability, flexibility and contextual specificity of
emotional response allows for greater adaptability and is necessary for survival of a
complex species such as humans.
Further, Lazarus contends, emotions do not come with neatly processed
affiliations with the environment and culture on the one hand, and human biology and
psychology on the other. Instead, he posits a model of emotional process as based on
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365
a person-environment relationship. For an emotion to come about in the first place,
according to Lazarus, something important has to be at stake for the person
experiencing the emotion. The individual appraises or evaluates situations that occur
in terms of their significance for his or her sense of well-being. An emotional
response is the result of an appraisal being made that the situation is significant.
From this perspective, the individual griever would be responding to a loss which she
or he appraises as significant and therefore feels the loss accordingly.
In terms of biological or genetic influences toward a universal pattern of
emotional response, Lazarus states, there is a commonality in emotional experience
because certain appraisal patterns and core relational themes lead to certain emotions.
Emotions have an "appearance of biological universality" (p. 201), Lazarus adds, in
response to Averill’s 1974 writing, because they share certain core cognitive
properties. An "emotion family" (such as the family of anger) shares a common core
relational theme and appraisal patterns for adaptation.
The question of whether there is a universal grief response and the
interrelation of social custom with biology necessarily brings up the questions of
whether emotions in general are universal, and whether emotions are really emotions
at all or merely expressions of emotion that are socially prescribed. At the beginning
of the twentieth century, Durkheim (1915) described mourning as a "duty imposed by
the group" (p. 397). He describes the "ritual attitude," which may include weeping,
as completely separate from the affective state of the bereaved. Averill takes a
similar position and neatly separates emotion, or grief, into the biological component,
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366
and mourning, or emotional expression, into the cultural component. Much of what
Averill says in regard to the expression of emotion has to do with "role loss," as
opposed to the loss of the person him or herself. It is because of role loss, as Averill
sees it, that individuals mourn, or emotionally express their loss.
As is the case with the research on emotion and facial expression (see, e.g.,
Darwin, 1872/1965; Ekman, 1980, 1984; Ekman & Oster, 1979; Izard, 1971, 1977;
Tomkins, 1961, 1963), without more than one measure it is very difficult to be sure
that the emotion conveyed is the emotion it purports to be, or whether it is instead
instrumental or merely conforming to group norms and expectations. It may also be
debatable as to what it is precisely the emotion is directed at: Is it the loss of a
person in all her or his complexity; the loss of a "companion, accountant. . . bed-
warmer" (Parkes, 1987, p. 27); anger that the person has "left"; upsetness that one’s
social and economic role are now unclear or must be reformed and redefined? The
connection between emotion and emotional expression is closely related with the
debate over whether role loss or object loss is more significant to a griever’s
response.
As mentioned, Averill (1968) maintains that it is the social disruption caused
by loss of roles that is primary in engendering grief, rather than the loss of the
significant person him or herself. Thus, he assumes that the cultural delimitation of
emotional expression in Trobriand Islands widows indicates a widow’s grief is less
intense and genuine than her dead spouse’s maternal relatives’. Because of cultural
attempts to either minimize the dependency of individuals upon each other or provide
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367
for replacement of lost member functions, grief, "although apparently genuine" (p.
725) may be short-lived.
In Averill’s perspective, a woman’s changed role function after her husband
dies is as significant in the etiology of her grief as the loss of her husband. We could
also consider that role loss rather than an essential aspect of grief, changes in
accordance with cultural context, so that a woman may well mourn her secondary
losses extensively if she cannot support herself and perhaps, also, she may not mourn
a husband as deeply in a culture in which parent-child is more highly valued than
adult-adult relations (or, for instance, woman-to-woman relationships provide more
support and are more highly valued).
However, as I mentioned earlier, mourning of a role does not necessarily
imply an absence of mourning of the primary object loss. Significantly, to illustrate
role loss, Averill (1968) uses the example of a wife who has lost her husband:
"Within our culture. . .the function of a wife vis-a-vis her husband is rather well
defined" (p. 724). However, in our, post-’60s, Western culture, this is not the case.
Very few, if any, individuals can be defined in terms of one particular role with
discrete functions. More commonly, people have multiple roles (e.g., husband/wife,
daughter/son, employee, student, homemaker, entrepreneur, etc.) and multiple
functions (e.g., instrumental, nurturing, domestic, worldly). Further, women’s and
men’s entry into less traditionally sex-typed professions, occupations, hobbies,
activities and pastimes, as well as increased visibility of differences in sexual
orientation, nationality and cultural heritage, make roles more fluid and collapsible.
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368
If such is the case, is "social disruption" caused by death still the same agent of grief
that Averill implies it to be?
Averill’s example of widows’ mourning also raises the question as to how
male definitions of women’s roles affect women’s grief and mourning. This issue is
particularly interesting in light of the frequency of studies that have been conducted
about widows rather than widowers, perhaps lending a shade of bias to grief research
It has been suggested that this partial selection has to do with widows’ willingness to
participate in studies (which may in turn be related to other factors, such as women’s
neediness, emotionality, adverse responses to death, etc.). Whether widows as a
group differ in their responses from widowers is beyond the scope of the present
study. However, in considering the grief research that has been conducted, we should
attend to such biases which may lead to generalizations or universalizations about
grief which are rooted in particular grievers’ cultures— for instance, that women
primarily enact a caretaker relationship (Chodorow, 1978) may influence women’s
grief responses.
At issue here is whether emotional expression is fully representative of
emotional feeling (Rosenblatt et al., 1976). When customs require emotional
expression, Rosenblatt et al. (1976) contend, it may be very difficult for an observer,
and even for the participant him or herself, to determine whether the emotions
expressed are real. Research concerning the relationship between emotion and facial
expression of emotions (Darwin, 1872/1965; Ekman, 1980, 1984; Ekman & Oster,
1979; Izard, 1971, 1977; Tomkins, 1961, 1963) raises similar though opposing
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369
questions. Rather than seeing the emotions conveyed as mere expressions without
necessary connection to an internal state, the key position among theorists of facial
expression is that the face expresses primary, innate emotions, such as happiness,
anger, fear and disgust, which are universal within a species, and which provide the
onlooker with a "readout" (Buck, 1985) of a person’s internal emotional state. From
this "readout," the viewer can readily apprehend what the other is experiencing.
Although the evidence-particularly pictorial evidence (e.g., Ekman, 1980)— is
convincing, researchers (Lazarus, 1991; Ekman & Oster, 1979) stress the necessity of
obtaining multiple measures. Research conducted with infants and young children is
particularly open to question as these subjects may be deemed too young to be capable
of experiencing particular emotional states that their faces seem to convey (see, e.g.,
Kagan, 1984; Malatesta-Magai & Izard, 1991).-
On the other hand, emotional expression may be used to mask an internal
state, or paradoxically, may even express it by not expressing it. Tomkins (1980)
contends, for example, that social control over expression of affect (particularly in
terms of breathing and vocalization) leads to "backed-up" or "pseudo" affect (p. 152).
Tomkins contends that this suppression of affect is so general in our society that it
also creates a confusion among theorists and researchers as to what is real and innate
affect and what is pseudo or backed-up.
16/ According to Malatesta-Magai and Izard (1991), part of the reason that
infant emotions are often not considered "true" emotions is the tendency to elevate
cognition over emotion. Therefore, the reasoning goes, since infants are not yet able
to reason as adults, their emotions cannot truly exist.
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370
Wellenkamp (1988) grapples with similar questions in her study of the Toraja
of South Sulawesi when she asks how crosscultural theories of emotion are understood
and what is the relationship between cultural theories, practices, and emotional
expressions to emotions themselves. Wellenkamp links culturally valued conceptions
of emotion and "mind" to experience and expression, noting that theories can deeply
influence behavior, and that dominant cultural values may not "coincide neatly with
personal experience" (p. 488). She notes language as a cultural mode of constraining
or enhancing emotional experience or expression, as in the lack of terms in Tahitian
culture to describe feelings of sadness and depression connected with loss (see Levy,
1973, 1984), making such feelings difficult to identify. She asks in relation to the
Toraja, "do those who cry and wail following a death experience emotional catharsis
in some sense?" (p. 494) and argues that whether or not they are cathartic, these
actions usually involve the expression of "genuinely felt emotion and result in a sense
of relief and release" (p. 495). While grief expressions may be ritualized and
stylized, Wellenkamp points out, this does not mean they are empty. According to
her, the Toraja view themselves as spontaneously releasing emotions, expressed
because "c we cannot endure the feelings any longer. We feel crushed, and we can’t
endure it’" (p. 495) and further report that they may not remember what they say
when wailing and do not feel they are "conscious."
The fact that onlookers are moved by the expression of wailers, Wellenkamp
(1988) sees as another indication of the expression of genuinely felt emotions. Far
more than a ceremonial artifact, wailing may be viewed as a very important aspect of
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grief. Wellenkamp (1988) reports one woman saying, "‘I am not happy if I just sit,
crying, and don’t call out. If .... I call out, even if it’s only ten words, [then I’m]
content’" (p. 496). Such "calling out" seems like it might be related to reaching out
to the other— a cathartic, emotional reaching out~whether it be reaching out to the
deceased, the dead in general in the form of ancestors, or the forces that be. As I
indicated in Chapter 4, such acts as crying, wailing, and pounding the floor may
occur naturally to the griever in an individual context. However, social sanction and
support of such actions may make them easier to perform.
In a related vein, we might consider grief-related actions which originally are
sanctioned by a society, then become either impermissible or dangerous to perform,
such as Ilongot headhunting in response to grief through death. Rosaldo (1993)
describes:
If you ask an older Ilongot man of northern Luzon, Philippines, why he cuts
off human heads, his answer is brief, and one which no anthropologist can
readily elaborate: He says that rage, bom of grief, impels him to kill his
fellow human beings. He claims that he needs a place "to carry his anger."
The act of severing and tossing away the victim’s head enables him, he says,
to vent and, he hopes, throw away the anger of his bereavement, (p. 1)
In 1972 Ferdinand Marcos declared martial law as punishment for headhunting,
forcing the Ilongots to cope with their grief and vanquish their rage in other ways,
including later a turn to evangelical Christianity. In response to Rosaldo’s remarks
about an Ilongot man who had just been bereaved, for the seventh time, of a child,
and then converted to Christianity, an Ilongot friend
[S]napped at me, saying that "I had missed the point: what the man in fact
sought in the new religion was not the denial of our inevitable deaths but a
means of coping with his grief. With the advent of martial law, headhunting
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372
was out of the question as a means of venting his wrath and thereby lessening
his grief .... the pain of the sorrow would simply be too much to bear." (p.
5)
In another instance, playing the tape of a headhunting celebration for Ilongot friends,
Michelle Rosaldo (cited in Rosaldo, 1993) describes the tense atmosphere that arose:
Renato’s Ilongot "brother," then broke into what was a brittle silence, saying
he could make things clear. He told us that it hurt to listen to a headhunting
celebration when people knew that there would never be another. As he put
it: "The song pulls at us, drags our hearts, it makes us think of our dead
uncle." And again: "It would be better if I had accepted God, but I still am
an Ilongot at heart; and when I hear the song, my heart aches . . . . " (p. 6)
If headhunting were only a social expression of grief and not also an aspect of grief as
an emotion, would the Ilongots feel such hardship in negotiating the impasse of its
legal prohibition? Rosaldo reports that despite his very different sociocultural
orientation, after his own experience of a significant loss the emotional force and
meaning of the Ilongot practice became clearer to him.
As Renato Rosaldo (1993) describes, a problem with ethnographic studies of
death is that (like theories of grief) they attempt to "study events that have definite
locations in space with marked centers and outer edges" (p. 12), thus preferring to
write about ritual, which embodies routine. In this way, Rosaldo argues, "death can
be made to appear routine." In contrast to the mourning practices and ceremonies
Averill and others call our attention to, Rosaldo reminds us that "human beings mourn
both in ritual settings and in the informal settings of everyday life" (pp. 13-14).
Focusing primarily on whether the emotions generated in custom are "real" does not
consider that in life there are plenty of other opportunities for emotion; although a
funeral (like the stages proposed by common grief theory) provides boundaries for the
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373
observer of sorrow, the griever’s experience of loss may not fit into these neat
boundaries. Rosaldo cites Godfrey Wilson’s account of burial conventions among the
Nyakyusa of South Africa:
That some at least of those who attend a Nyakyusa burial are moved by grief it
is easy to establish. I have heard people talking regretfully in ordinary
conversation of a man’s death; I have seen a man whose sister had just died
walk over alone towards her grave and weep quietly by himself without any
parade of grief; and I have heard of a man killing himself because of his grief
for a dead son. (Wilson, cited in Rosaldo, 1993, p. 14)
Unfortunately, as Rosaldo indicates, studies of death often confuse the ritual process
with mourning. Similarly, emotional expression is taken as either proving, or ruling
out, emotion.
Further, as Lila Abu-Lughod (1986) describes in her perceptive ethnography
of Bedouin customs and traditions, emotional expression may be shaped by societal
pressures, but society may also present the possibility of divergent forms of emotional
expression. Abu-Lughod portrays a picture of two seemingly contradictory forms of
discourse existing side by side: on the one hand, the everyday discourse which values
strength, independence, and honor, where only those without social position-"mad
people, idiots, and children" (p. 246)-would lose control of their emotions and
express them in an unstructured way; and on the other hand, the discourse of poetry
in which vulnerabilities about weakness and attachment to others, sadness and loss,
and other subversions of the social, political and moral codes, are openly revealed. I
would argue that similarly, one’s personal and idiosyncratic "discourse" of grief may
differ from the way she or he behaves at social gatherings and ceremonies.
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Abu-Lughod’s description of her role as guest and "adopted daughter" in the
house of a community leader (the Haj) and her behavior in grieving a loss in the
Haj’s family, illustrate the difficulty of accepting AverilTs emphasis on the
importance of role in the individual’s social expression and personal experience of
grief. She writes how previously the mother of the Haj was a bit reserved towards
her. The old woman’s brother then dies, and Abu-Lughod goes with the family to
pay their condolences.
When I squatted before the old woman to embrace her and give her my
sympathies, I found myself crying. . . . I later heard from others how touched
the old woman had been that I had come immediately . . . to mourn with her.
Others had told me that it had meant a great deal to her to know that I
genuinely cared and could feel with her the grief over the loss of her only
blood brother. From that time on, she treated me differently . . . (p. 21)
Although in the specific culture of the Trobriand Islands being described by Averill
1968, and originally by Volkart and Michael (1957), role loss may indeed have a
great impact on grief, we cannot assume such is universally the case.
In distinguishing between object loss and role loss and emphasizing the
importance of the role provided to the bereaved by the deceased, Averill does not
appear to consider degree of emotional closeness and attachment in the bereaved’s
relationship with the deceased. He believes that object loss "in the absence [italics
added] of role-loss" (p. 725) explains abbreviated, that is short-lived, grief reactions
which are usually characterized by quick replacement of the lost object or insufficient
attachment (Averill, 1968; Lindemann, 1944; Parkes, 1965; Rando, 1984). As
examples of this type of "abbreviated" grief reaction, Averill points to the responses
to the death of a national leader and the fate of the hero in a tragic drama. He
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accounts for the short-lived grief of the citizen or spectator as a result of little role
loss. While these points are both debatable for various reasons (e.g., the death of a
national leader could conceivably be experienced as a great loss of a role, and a
drama enacted for the theater is make-believe, and usually the theater-goer is well
aware of this), what stands out in both of Averill’s examples is that the object loss per
se is not significant in terms of a real emotional relationship. And secondly, in a
close or emotional relationship our perception of the other is often very much bound
up with our perception of the other’s roles and our roles in relation to him or her, so
cannot be so easily divided as Averill seems to imply.
As the quotation from Shakespeare’s Hamlet at the beginning of this work
implies, theories of grief have been around for a long time. In the cited passage,
Gertrude and Claudius state their "theories," views which were probably not
uncommon in the sixteenth century, and are certainly not uncommon now: That we
all must die and so we must just accept it; after a given period of time, the griever
must go on with her or his life; it is more decorous and proper to contain one’s grief
than continue to express it. Further, various customs suggest that ongoing expression
of grief may even be dangerous. However, Hamlet illustrates another theory when he
says that it is not only "the trappings and the suits of woe," or how we express grief
that defines it, but "that within which passes show" (Shakespeare, 1604/1963, I.ii.85-
86, p. 9), that which may be felt but not always perceived, that which endures
although its outward form may change. Hamlet’s speech further reflects that although
death and loss are common, they are "particular" to the griever-that is, these things
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affect the griever and the human being who must die as painfully unique to him or
her, and as potentially separate from the outward form of grief.
It is beyond the scope of the present study to fully investigate the many
possible variations of grief response found across cultures. I tentatively conclude,
therefore, that while grief may be universal or near-universal in that people of all
social groups, cultures, and dispositions seem to feel a response of some kind to the
loss of a loved one and this response usually involves pain as well as confrontation
with death (either in the form of mourning rituals, or in a more individual way), grief
as a response to loss is manifested differently, interacting with and depending on
personal, circumstantial, and cultural variables. Although certainly "emotional" and
also "biological" in its connection to evolutionary issues based in attachment, grief
must also be considered in the light of a long-term, potentially regenerating, complex
emotional response without firm biologically-driven boundaries for completion, and as
a personal and cultural evolution and construction. Sociocultural customs and
individual expressions of grief are difficult to disentangle and decipher, and the way
grief is experienced may be partially shaped by the way it is expressed or allowed
expression. Social, individual, and circumstantial variables interact with the
experience of grief so that it is not necessarily felt by everyone, and certainly not in
the same way.
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THE PARADOX OF LOSS:
TOWARD A THEORY OF GRIEF
C on tinu ed
by
Marilyn Michelle McCabe
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Counseling Psychology)
May 1997
Copyright 1997 Marilyn Michelle McCabe
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377
Chapter 6
Issues of Definition, Variability, Diagnosis, and Verification
Several points differentiate my model from prevailing theory. Most important,
I suggest that grief for an intimate other may be an ongoing as well as recursive
experience. Although with increased coping, maturity and experience, grief changes
both in frequency and severity of themes, it does not progress linearly and may not
necessarily end. Further, the relationship with the beloved other who has died is
likely to continue in various forms at both explicit and tacit levels, including
reminiscences, imaginary dialogues, sense or evocation of presence, and a
reconstruction of both separate and shared experiences of reality. Remembering and
reconstructing the other is both part of missing and part of coping with loss.
Such a model must be open to continued modification as there are
uniquenesses and intricacies in every bereavement situation and griever which cannot
be pre-formulated. Depending on the closeness of the relationship and other variables
(such as availability of social support, the griever’s maturity, personality, previous
experiences of loss and coping, cultural background, etc.), the griever’s response to
loss will differ in terms of intensity, duration, and how grief is expressed. The
patterns of grieving I note here relate to a deep, caring, and positive relationship and
to the specific type of traumatic circumstance I have described. Nevertheless, the
experiences I have described also correspond to important features and patterns noted
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378
by other theorists, thus providing a basis to modify generalizations and add to
previous understanding (Stake, 1995).
To further develop this alternate view of grief, after summarizing some of its
major points, I here turn to issues of definition, variability, diagnosis, and
applicability. I examine the concept of grief as a descriptive and an emotional term, a
subject which again engages us in the question of grief as biological and/or cultural,
individual and/or universal. I then address types of variability in the situation,
experience and expression of grief, including different types or categories of
relationship (e.g., parent, child, lover, friend), circumstances, and cultural
background, variations which could be incorporated into the proposed approach.
Next, I review issues of pathology and non-pathology. Finally, to provide the reader
with a sense of the aptness and applicability of the suggested approach, I examine the
proposed theory in terms of several case studies drawn from the grief literature and
my own clinical experience, a process which necessarily considers issues of
individual, circumstantial, and cultural variability as well as issues of health and
pathology.
An Alternate View of Grief: A Summary
The movements of grief are founded on the griever’s real and imaginal
relationship with the deceased, her or his response to the existential givens of reality,
and on a regeneration of emotional and memorial experience caused by a dynamic,
ongoing dialogue between self and environment. This exchange affects both coping
and the experience of "triggers" for grief, and allows for similar, but non-identical
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themes and experiences of grief to recur. Rather than a progression from one stage to
another, this model suggests that grief experiences are better described in terms of
oscillations between multileveled states.
The oscillations of grief comprise, for instance, the move between themes such
as belief and disbelief, denial and acceptance, yearning and despair, disintegration and
reintegration of self and world, a sense of absence and a sense of presence. These
themes could be said to occur at different "levels" or have different forms in that
although similar themes and experiences of grief recur, they are not identical. A
variety of kinds of "disbelief" or "acceptance," for instance occur, and co-occur. A
multiplicity of themes, such as despair, sadness, shock, horror, missing, and both
longing for and recognizing the impossibility of recovering the lost one, often occur
together. Perhaps most exemplary of the broad oscillative movements of grief is what
I refer to in Chapter 4 as a pattern of lament. This movement comprises many of the
themes of grief (e.g., missing, yearning, despair, disbelief, sadness, acceptance),
illustrates the renegotiation of the confrontation with death and the paradoxes of love
and loss, and may recur long after the death.
In this example of oscillation, the lament moves toward only a temporary
"resolution" by affirming the paradox of loss through, for instance, such processes as
remembering and appreciating the other; missing and longing for their return;
disbelieving and questioning the contradiction that the other is gone and yet the world
goes on; not wanting to accept the finality of the loss; then driving the physical reality
of loss home; again, appreciating or invoking the other, soliciting an imagined
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dialogue; and finally, affirming the paradox of a strong inner sense of both presence
and absence along with the finality of loss. In this, presence is appreciated as what
can be remembered, reconstructed, and therefore reexperienced. Overlapping this is
the awareness of the reality of death and goneness, the physical reality of the loss,
and fact that the world is fundamentally changed by the other’s death. Such a pattern
may, as I have said, recur long after the death as it is triggered either by internal
constructions and/or outer circumstances, though its recurrence may take place at
wider intervals of time as it is removed from the death and may take modified,
abbreviated forms.
Patterns of oscillation occur along with a process of increased coping so that
while the traumatic, shocking impact of death lessens, multileveled experiences of
different themes (e.g., belief, disbelief, acceptance, horror, yearning, missing, pain,
anxiety, depression, despair, feelings of presence, absence, transformation,
spirituality, enlightenment, and loss) may continue to reemerge. In addition, apparent
opposites (such as belief and disbelief, yearning and despair, hope and hopelessness)
do not obviate each other but rather provide a dialectic which is related to loss and
missing, and to the existential reality of death. Thus, a sense of hope may occur
without necessarily believing or hoping the lost one will be restored; instead there
may be a renewed sense of presence, which is dialectically related to missing, and
which because of the physicality of loss, is counteracted by existential reality of
death, which then evokes a sense of loss and despair, and vice versa.
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Complicating or affecting the entire picture of grief so that it does not follow a
straightforward or linear course are (1) different types of trauma related to the trauma
of death, (2) the impact of the environment-more precisely, the person-environment,
which Lazarus (1991) configures as essential to the emotion generating process; and
(3), related to the above, the passage of time, modifying perceptions and responses in
terms of a continued accrual of experience, or maturity, which affect both a view of
death and of loss. In relation to (1), the trauma of death and the circumstances
surrounding or leading up to death are necessarily entangled. Although the trauma of
the death may be relived, yet the response to the surrounding trauma may be more
apparent in early or acute grief, making later grief at loss of death more differentiated
from the grief of the related trauma.
Thus, the regeneration of the experience of grief or the word "oscillation" is
not used to represent another, but still stereotypical, pattern for grief. Instead, what
is meant is that in the process of regeneration and in the recursive movement of
reconsidering and reconstructing experience, the experience is never quite the same.
That is, grief involves not just a replay of feelings, experiences, or memories, but a
new occurrence of them.
Shifts reveal changes in strength or intensity which are affected both by
internal and external changes. Additional life experiences, some of them stressful or
painful, and others nurturing, supportive, or positive, interact with previous
experiences and recall of experiences so that, for instance, additional losses (of
various kinds, e.g., bereavement, loss of relationship, financial difficulties/loss, etc.)
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join the "pool" of previous losses, both with some positive effect (in terms of our
ongoing learning of how to cope with losses) and with negative effect (such as feeling
overwhelmed by losses or remembering and having the traumatic nature of loss
highlighted). In this way, emotions may continually be in the process of being
regenerated, although they are not precisely the same emotions. Also, the "story" of
one’s loss and how it fits into all of one’s life are therefore continually being
regenerated and rewritten, or rather re-understood in light of new experiences and
understandings.
Some painful triggers can be expected (as with anniversaries, holidays, or
environmental resemblances to the experience) or not expected (as when suddenly one
is reminded of the lost other and this evokes either feelings of trauma or loss).
Although with time and experience one learns how to deal with such events, ongoing
aspects of environment continue to interact with this experience to produce new
emotional experiencing, as in new losses, stresses, etc. Experiences and memories
may also occur at varying levels of cognitive or intellectual awareness, at what might
be described as visceral or emotional levels (see, e.g., LeDoux, 1992; van der Kolk,
1994). Knowledge or construction of how or why these experiences and memories
are occurring is not immediately obvious, or even perhaps irrelevant to the fact that
the emotion continues to be experienced. Therefore, "triggers" can sometimes be
known and even "controlled," but not always. The "vehement emotions" (Janet, cited
in van der Kolk & van der Hart, 1989) related to trauma may reemerge and therefore,
to some extent, be relived. This reliving does not obviate the fact of knowing or of
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consciousness as the bereaved may know death intellectually and emotionally but still
experience tacit and emotional levels of awareness tied to the loved one.
Coping with death involves different levels of awareness, ranging from the
intense scrutiny described above to a kind of blunting or buffering of memories and
experiences, occurring however, not only at these extremes but involving both. The
"scrutiny" involves constructing the story, of death, of the lost other, of trauma, and
of meaning and seems to occur most copiously and distinctly the first several years of
bereavement. This includes reconstructing the relationship, knowing that the
relationship has necessarily changed, but asking, what remains permanent? what parts
are incorporated? what of the self and other remain? This kind of development and
storytelling continues, though gradually on a more tacit level. Whether it be triggered
by internal or external events, however, the development of the self-other relationship
may also be brought into relief.
The patterning of these oscillating or recurring movements of grief can best be
understood in terms of a dialogical (Hermans et al., 1992), intersubjective (see Beebe,
1995; Beebe & Lachman, 1988, 1994; Stolorow, 1995), and multileveled (Modell,
1993) notion of self emerging out of our early negotiations with absence and
presence, self and other, material and symbolic reality, and our confrontation with the
existential paradoxes of death, time, being and non-being. The dialogical nature of
self allows for the other and the relationship to be reconstructed and reconstituted,
and remembered and reexperienced on a variety of levels from the more conscious
and "factual" to the tacit and imagined. The behaviors of grief are necessarily
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relational, and trying to make sense or create meaning from the loss is no different:
Reality becomes unhinged and the world loses its meaning when a loved one dies; this
is because it is an Other who is missing, not a set of keys.
The memories of the beloved one are gone over "piecemeal" not to relinquish
but to place him or her more firmly, to "firm up" what is already internalized of what
has been shared and given of the other and even add to it. "Searching" is as much
concerned with this "firming up" of what we have of the lost one (and what we are
missing) as it is a refusal to believe or an attempt to make sense out of the loss. It
involves re-membering, reconstructing, becoming aware again and again of the person
we have lost and what he or she means to us. This firming up and reconstruction of
the other does not imply a denial of death or of loss, but an awareness of the paradox
that although the other is gone irrevocably, something vital remains. Nor does this
non-relinquishment of the relationship eliminate grief or mourning. As Yalom (1980)
remarks, the fact of death destroys us, while the idea of death saves us by giving our
lives existential meaning. In loss, analogously, the physical relationship with the
other must be relinquished, but the meaning of that relationship is preserved, and
preserved not as a static article but a dynamic co-constituted process.
What seems clear is not that grief necessarily ends, or that some elements of
grief do not persist, but rather that the sense of unrelenting and continuous painfulness
of grief abates, and that meaning in life, including a particular meaning imbued by the
lost one, is instated, and that the ongoing relationship with the lost one, as well as
with others, is an important aspect of how grief is incorporated into the self. There is
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a complexity in this relationship since it occurs at many different levels involving tacit
and less tacit ways of knowing, internalized values, qualities, and ways of being,
different "I" positions (Hermans et al., 1992), a dialogue and a reconstruction of
shared experiences of reality. Further, with increased experience and maturity, one
understands the context of the other’ s life differently and therefore continues to
reconstruct it, both as something apart and in relationship.
There is a distinction between the early or acute response to loss, which also
comprises the immediate response to trauma, and the longer-term response. Grief,
particularly early grief, is partially, and very significantly, a response to trauma.
Bereavement may also be imbricated with additionally traumatizing circumstances
surrounding the death. The immediate response to loss may include all the features I
discussed in relation to traditional grief theory. As theorists imply by not stating a
definite time frame, it may be hard to pinpoint when someone leaves an acute state of
grief. Setting a time frame for the "early" and acute condition of the bereaved is very
difficult, first, because individual circumstances and responses vary, and second,
because acutely felt responses to the loss may recur long after the loss. However,
later traumatic responses reveal some qualitative differences in that the experiencer
has a memory of earlier such responses as well as the situations that elicited them and
memories of how she or he experienced and coped with these responses, all of which
make later experiences different from earlier ones when the loss is still new, highly
unintegrated, and traumatic. At the same time, later responses seem to incorporate
many earlier ones so that the similarity, or connection, between responses stands out.
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What I have tried to begin to portray here is a long-term response to loss that allows
for these recurrences as well as an ongoing relationship of some sort with the
deceased.
While the trauma of death, and potentially the surrounding circumstances of
death, are entangled with the trauma of loss, the first seem to be integrated over time
to the extent that some "answers" seem to have been given, troubling as they are, and
are recognized as unchangeable. Disbelief-type questions are put less frequently,
whereas grief at loss persists. This seems to bear some parallels to Rynearson and
McCreery’s (1993) differentiation of the responses to trauma and loss in proposing
that the experience of numbing and thought/image intrusion experienced by those
suffering traumatic loss belong to the traumatizing aspect of the experience, whereas
longing and sadness are a response to the loss.
On the other hand, significantly, grief at loss is not the only thing that may
endure. The "vehement emotions" (a phrase I think well describes the emotional and
visceral reliving of traumatic experience) may also reemerge connected both with the
death and the lost one, and need to be reexperienced. Visceral and traumatic reliving
of the circumstances of loss may be related to obvious events (like the "anniversary"
of the death) but also to the individual’s reassessment of his or her life and that which
is significant in it. Since the traumas of loss and death are fundamentally tied to
relationship, on a relational level, the griever may not necessarily want to forget or
make these into detached or "neutral narratives" (van der Kolk and van der Hart, p.
1533).
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Although one could say trauma and loss are "learned" in the sense that they
are replayed and the details gone over again and again, this replaying involves a
reformulation and reconstruction which is unique to the person and the situation rather
than a straightforward learning or memorization of facts. The process of trauma may
be played enough that it is "known" inside or incorporated through the interrogations
described above and recurrences of reliving the experience. The process of loss
requires a connected but also different kind of "playing."
As I have pointed out, learning the fact of death and constructing reasons for
its occurrence, as well as a "place" and meaning for the lost other, represents a
reconfiguration of reality which is itself not static but which may reemerge to undergo
further modification. Development and reconstruction of the relationship and of the
death continues, though gradually on a more tacit level. These reconstructions and
the effort to reconstruct may be brought into relief by internal or external events.
Features that stand out besides the reconstructive and co-constitutive nature of
memory and experience in shaping the griever’s relationship with the deceased include
the multileveled nature of certain recurrent aspects or themes (e.g., disbelief,
searching, acceptance), indicating that a development is taking place, but not that
grief necessarily ends. Also important and understated in traditional theory are the
griever’s concerns about the lost other, particularly early in bereavement, and
existential issues, including existential anxiety and rage, that occur early and may
reemerge later.
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Grief represents a complex, nonlinear experience, awareness, and use of time,
memory, and emotion which interacts with the person-environment (Lazarus, 1991) as
well as knowledge of existential givens, resulting in a "regeneration" of emotional
experience which may occur at various and changing levels of awareness. Grief also
involves a fundamental existential confrontation. Rather than learning to relinquish
the person who has died or the relationship (except as physically gone), the griever
must learn to relinquish (or at least amend) fantasies of omnipotence, omniscience,
and immortality and face the limits of being human, growing old, dying, and not
knowing what death means.
In general, an alternate arrangement or differentiation of the process of grief
might include acute grief, comprised of many of the features described above and by
many stage/phase theories; recurrent grief in which grief-ful feelings come up again
and again, which might also include an ongoing sense of loss; no grief, or abbreviated
grief, as Averill (1968) understands it; and constant, acute grief, or grief which is
experienced almost all the time with acute pain. Some people may have acute or
constant grief for a long time.
The above arrangement is based on the idea that the experience of grief is built
on relationship. The nature of the relationship, and how the person views attachment
and self/other affects whether grief will endure or not, and whether the person will
continue or sever his or her relationship with the lost person. Constant, acute grief is
also influenced by the relationship, but is in addition influenced by the circumstances
of the loss, with traumatic circumstances being more likely to maintain or trigger
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states of acute grief. An ongoing versus a finite sense of loss is influenced by the
relationship, and may be affected by new circumstances and new relationships.
Grief as an Emotional Term and a Descriptive Term
The terms bereavement, mourning, and grief are the most commonly used to
describe the response to death of a beloved or intimate other. Both the culture-
biology and universal-individual arguments concerning grief have left a legacy to the
interpretation of grief as an emotional term. The diagnostic nomenclature (i.e., DSM)
has preferred the word bereavement as a descriptor (e.g., complicated/ uncomplicated
bereavement), although theorists have also enjoyed the use of g rief coupled with
adjectives such as "pathological," "healthy," "complicated," "morbid," and the like.
Despite its association with an emotional and universal state driven by biology
(Averill, 1968), I prefer the term grief as the primary term to describe the response to
death and loss for very particular reasons.
As discussed in Chapter 5, although there is overlap between the terms
bereavement, mourning, and grief and the meanings purported to them, there is also
some differentiation. Bereavement can generally be understood to mean the state of
having suffered a loss (Rando, 1984), and like the ritual events Rosaldo (1993)
describes as dominating ethnographic studies of death (illustrated by such words as
"funerary ritual," "mortuary ritual," and "eschatology" in their titles-), bereavement
1/ Rosaldo (1993, p. 12), for example, cites, Douglas’s Death in Murelaea:
Funerary Ritual in a Spanish Basque Village. Huntington and M etcalfs Celebrations
of Death: The Anthropology of Mortuary Ritual. Metcalfs A Borneo Journey into
Death: Berawan Eschatology from its Rituals.
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seems to be a favorite of psychological researchers.- As Rosaldo notes in relation to
anthropological studies, "the general rules seems to be that one should tidy things up
as much as possible by wiping away the tears and ignoring the tantrums" (p. 15).
Words such as bereavement, though apt to describe the material state of having lost
someone, do not describe what this state signifies and contribute to a "detached
observer" stance which pretends to "eliminate emotions" (Rosaldo, p. 15).
As commonly defined, bereavement does not encompass the emotional or
psychological state of the bereaved, but rather defines the relevant cause of that state,
i.e., loss through death, and considers the loser as a passive recipient, in the
etymology provided by Webster’s (1984) dictionary, to be robbed (p. 133).
Bereavement represents a condition as birth or death or even marriage are themselves
conditions, or circumstances, and as such describes the circumstance without
indicating the response to the circumstances.
Both grief and mourning describe the loser’s response to loss. However,
although mourning as Bowlby (1980) sees it also entails the psychological response to
loss, mourning is commonly assigned to the sociocultural expression of loss (Averill,
1968; Rando, 1984; Rosenblatt et al., 1976), that is, the customs and even costumes
2/ E.g., The First Year of Bereavement (Glick et al., 1974); The Bereavement
of the Widowed (Clayton et al., 1971); The Sequelae and Non-sequelae of Conjugal
Bereavement (Clayton, 1979); Depressions of Bereavement (Jacobs et al., 1989);
Bereavement: State of the Art and State of the Science (Middleton & Raphael, 1987);
"Seeking" and "Finding" a Lost Object: Evidence From Recent Studies of the
Reaction to Bereavement (Parkes, 1974); Bereavement: Studies of Grief in Adult Life
(Parkes, 1987) (here, "grief" appears in the subtitle, but "bereavement" is still
prominent).
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one puts on in the face of loss rather than the inner or emotional reaction. As in
Averill’s (1968) sense of the words, grief is often considered the emotional-biological
component, and mourning the cultural component of loss through death. Mourning is
also very much connected in notions about grief with the presupposition of "undoing"
the "ties that bind," which are also connected with rituals which are socially
prescribed to deal with loss through death. As in the English translation of Freud’s
(1917/1959) seminal essay, the "work of mourning [italics added]" is expected to be
"completed" (p. 245) Use of the word mourning therefore predisposes us to see the
results of and response to loss through death as a task that has a prescribed time limit-
-just as socioculturally, in the past at least, mourning dress or costume had a
prescribed time limit. One of the aims of this study has been to dismantle
assumptions which have been socially and scientifically proscribed. As discussed,
what is going on inside a person is not necessarily equivalent to what she or he
expresses; cultural rituals do not necessarily reflect actual emotions, and on the other
hand they do not preclude these.
The word grief also has semantic problems in being tied to the concept of
biologically driven (Averill, 1968) or time-bounded emotion (e.g., Bower, 1992).
However, as I have tried to demonstrate, new ways of looking at emotion and
consciousness in general allow us to view grief as a state, or rather states, that do not
begin and end at easy-to-determine intervals. For this and the other points mentioned
above, the term grief seems preferable in describing the overall, individual response
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to loss. As new directions in outlook emerge, meanings for words can be reassessed
and reinterpreted.
Grief is, as Rando (1984) puts it, "the process of psychological, social, and
somatic reactions to the perception of loss" (p. 15). Moreover, grief can be
considered as consisting of all or any of the features enumerated in Chapter 2 as a
response to loss--the pain of loss, the hopeless yearning for the lost one, sobbing,
searching, despairing, feeing angry, confused, hopeless, anxious, somatically
disturbed, etc. Grief therefore contains both the responses which we can either
observe, infer, or be told about by the bereaved, and the motive for these responses,
the object of loss and the meaning of this loss to the griever.
As an emotional term, grief is usually considered in the short-term. That is,
from the standpoint of emotion as a discrete and short-lived event, grief could be
viewed as simply the response to a stimulus followed by a return to homeostasis.
This is basically what is proposed in the stage models of grief, though on a longer-
term scale: Each emotional hurdle of grief, once mastered, allows the bereaved to
progress to a state of resolution and thus back to the state he or she was in before the
loss. Problems with seeing grief as this type of emotion obviously include the fact
that various grief-ful emotions continue to occur at somewhat regular and irregular
intervals. (A somewhat "regular" interval might be the "anniversary reaction" that
grievers often feel as the date of the beloved’s death re-approaches. An irregular, or
unexpected, reoccurrence of grief-ful feelings would be represented by those feelings
being triggered by either external or internal occurrences or both, for instance,
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hearing a particular song that the lost person was particularly fond of— and most likely
in conjunction with other circumstances, such as having the leisure or desire to reflect
upon the lost person, or feeling particularly sensitive to the nuances of that person’s
life, way of looking at things, or meaning in the relationship with the bereaved). As
discussed, Lazarus’ (1991) concept of an emotion generating process makes sense in
terms of grief as emotional state(s) that are not only complex but are negotiated with
the self and the environment and may be construed as having temporal boundaries
which are either long-term or indefinite.
Grief considered in this fashion can also be viewed as a descriptive term that
can be used to portray both a bereaved’s sense of and response to loss. To be a
pragmatic descriptor, of course, the term needs to be elaborated upon by the user to
explain the context of the griever’s situation, including what temporal framework
appears most relevant. That is, what temporal framework is the bereaved responding
in: Is his or her grief a response to an immediate condition, a recent one, or a
longer-term/ongoing response to loss? The bereaved may, for instance, be responding
to an acute condition of loss--the kind described by Lindemann (1944), for instance,
to a death that has very recently occurred, indicating that the bereaved may be in a
state of traumatic crisis; he or she may be responding to recent but not immediately
precipitating events. Perhaps grief-ful feelings have been triggered by a particular
circumstance in the bereaved’s life; or perhaps these grief-ful feelings are part of a
long-term response to loss which might wax and wane.
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There is a need to enlarge our temporal boundaries for the term grief so that
"grieving" several months or years after a significant loss does not have to be
preceded by the adjective "still." Although in different eras, grief was often
understood as enduring (cf., Stroebe et al., 1992), presently grief is largely
considered an emotion of the present, an immediate response to a loss. That response
enacted, it is considered "done," perhaps without any need to go on. Mourning is
considered more or less descriptive of social custom which lasts for a certain definite
period of time, dependent on culture. There is no name in our current literature,
therefore, for a grief, a response to loss, that endures.
The approach I have proposed takes into account grief as both an immediate
and a longer-term response to loss. The immediate or more immediate response to
loss is fairly well-described by current grief theories when taken as a whole-that is,
when stages/phases are not viewed as necessarily discrete, and when all possible
responses are considered viable (e.g., anxiety alongside depression). As mentioned,
Lindemann’s early (1944) description is especially convincing in relation to the acute
or immediate response to death of a loved one. And almost all of the theories I have
discussed appropriately emphasize shock as an important aspect of the immediate
response to loss. What I have sought to add to this is a longer-range view of the
emotional process of grief, an appreciation of the emotional reverberations that may
continue to be generated after the immediate experience. Grief over this longer-term
is, as I have described, to be considered in the continued re-elaboration of the self-
other relationship both from inner and outer influences.
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Grief, over the long term, may still be all of the behaviors, emotions,
thoughts, sensations briefly described as occurring early on (including those
enumerated by stage/phase theories), and, in addition, in accordance with the model I
have adumbrated, could also be used to denote a sense of loss having to do with
missing someone significant as well as an act or process of remembrance and
reconstitution. This sense of loss may not be continuous, and the griever may not be
constantly attuned to an awareness of loss. However, both the presence and the
absence of the loved lost one are incorporated into the griever’s overall experience,
and the loss may remain an important aspect of the individual’s sense of self and
other. Grief is therefore not only the sense of and response to loss and the grief-ful
feelings (e.g., sadness, distress, anger, anxiety) that this provokes, but the
reconstitution of the loss and the lost other and the oscillation between losing and
(re)finding that occurs in this oscillation. It is when the bereaved is aware of or
responds to her or his loss, to the reconstruction of the loss or the lost other, or to the
oscillation between loss and construction, that grief or grieving could be used to
describe the bereaved’s experience. As indicated, elements of the trauma of death
and the surrounding context of death may or may not be predominant in the ongoing
response to loss.
Factors Influencing Grief and Coping
As indicated, grief seems to be both universal and particular, and its
expression both social and individual. Whether an elaborate funeral ritual, a
prolonged period of mourning with expressions of despair and rage, an attempt to
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bury and "get rid" of the deceased to avoid "pollution," or other psychological,
physical, or spiritual impact, there seems to be some response to ultimate loss. As
indicated by Bowlby (1980) and Shand (1920), as well as by Horowitz (1990), this
response seems to have a partially evolutionary and biological basis, but is also
extremely individual, based on the bereaved’s relationship with the lost person, the
context of the death, and a host of circumstances which affect and interact with the
situation of loss both in the short- and longer-term, and whose expression and
experience is also partially determined by societal influence (e.g., social values about
death and grief, the expression of grief, availability of support, etc.). In addition to
biological and evolutionary constraints, cultural mores, the make-up of what an
individual considers to be her or his self, and the vital role relationships play in the
process of self-experience and construction, the unique context of the death, the
griever’s relationship with the deceased, and the griever’s life contribute to the
complexity and variability of grief response. The unique and preexisting
circumstances of loss include on the one hand personal factors such as individual
disposition, history, desires, abilities, cultural influences, as well as freedom from
social constraint and social support (or their opposites), and on the other, the specific
situational features of the loss. A third category is indicated in the ongoing or
subsequent circumstances (e.g., social support, additional stresses and losses, etc.)
that face the griever.
In all three categories of unique circumstance (preexisting circumstances,
circumstances of the death, and subsequent or ongoing circumstances) categories,
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there is a dynamic interaction of the individual and environment as well as between
the factors themselves, so that, for instance, it is not just that the griever is faced with
additional trauma, but that she or he brings unique coping abilities, or vulnerabilities,
to the specific situation. How an individual responds to a situation or "encounter" is,
as Lazarus (1991) indicates, variable, depending on how she or he regards or
appraises the situation. In confronting death of a loved one, this appraisal is
complex, including such influences as the personality of the bereaved, the relationship
with the dead person, existential awareness and appraisal of the meaning of death, as
well as situational variables.
Although here I propose the notion of a dialogical self, existential awareness,
use of memory reconstructively, and emotional complexity and regeneration as
fundamental to grief, obviously, these processes will differ in terms of individuals and
cultures. The specific situations with grievers of various backgrounds, including
different types or categories of relationship (e.g., parent, child, lover, friend),
circumstances, and cultural background are of significance both because the individual
experience of grief is affected by them, and because in different forms and degrees
they have been implicated in individuals’ risk for psychophysical complaints and
problems following bereavement.
Circumstances of the loss
The situation of the loss (which Rando includes under the heading of
"psychological") includes: (a) the immediate circumstances of the death; (b) the
timeliness (or untimeliness) of the death); (c) the griever’s sense that the death could
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have been prevented; (d) the suddenness versus the unexpectedness of the death; and
(e) the length of illness of the deceased prior to death (Rando, 1984, 1993), as well as
(f) who is lost (the person and relationship lost is both part of the immediate and
subsequent or ongoing circumstances of loss). Trauma is an important consideration,
raising questions about the nature of trauma, the effect of a traumatic experience
coupled with the consequences of loss, and specific kinds of trauma associated with
death (e.g., suicide, homicide). The literature indicates that when trauma and loss
occur together, recovery from grief is delayed (Raphael, 1977; van der Kolk & van
der Hart, 1991; Vargas, Loya, & Hodde-Vargas, 1989). Of the seven risk factors
Rando (1993) describes as predisposing an individual to "complicated mourning," she
includes sudden, unexpected death ("especially when traumatic, violent, mutilating, or
random," p. 453), death from an overly lengthy illness,- and the bereaved’s
perception of the death as preventable.
There are strong reasons to believe that apart from the particular nature of the
death, that loss and death are traumatic circumstances in general. As mentioned,
bereavement and symptoms of posttraumatic stress disorder often overlap (Schut et
al., 1991), and "anniversary reactions" to bereavement, commonly referred to in the
3/ One must question what "overly lengthy" means in the context of the
individual as any life-threatening illness, like any death, may be considered potentially
highly stressful and traumatic. Rando (1993) suggests there might be an "interim
range" when individuals are "most prepared" for death after an illness, and in her
1983 study of family of children who died of cancer, she assessed this range to be
between six and eighteen months. She found family related to children who died of
cancer were "least prepared" for the death when it lasted less than six months or
greater than eighteen months.
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literature on grief (Raphael, 1983; Sanders, 1989) can be viewed as a symptom of
both traumatization and grief (Musaph, 1990). Bowlby (1980) describes major loss as
an "etiological cause or a concomitant variable in any mental disorder" (p. 187).
Fowlkes (1991) calls attention to the traumatizing aspect of loss through death, even if
that loss does not fall within the guidelines of DSM criteria for posttraumatic stress
disorder. Further, with social changes and medical advances, more deaths currently
may be considered traumatic in the sense of being sudden, unexpected, violent, or
random rather than "natural." As Rando (1993) says, today "many person are
exposed to death all the time" (p. 6).
Nevertheless, although it is beyond the scope of this study to analyze responses
to these in depth, there are types of unnatural, unexpected, violent, or otherwise
traumatic death which necessarily "complicate" the trauma of death. These include
"acute" natural deaths such as "dying in one’s sleep from a stroke" or "dropping dead
from a heart attack" (Rando, 1993, p. 506); death resulting after a lengthy terminal
illness (Rando, 1986a, 1993) (illnesses such as AIDS which are socially stigmatizing
present another special type of situation, as not only being horrifying and painful but
disenfranchising, see Doka, 1989); accidental death, either sudden and unanticipated
or sudden and anticipated (in the latter, the deceased may initially survive but die
later, see, e.g., Lehman, Wortman, & Williams, 1987); Rando, 1993, Rynearson,
1987; Worden, 1982); death related to disaster (Raphael, 1986); war deaths (Rando,
1993; Raphael, 1983); suicide (see, e.g., Cain, 1972; Rando, 1993; Rynearson, 1981,
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1987; Shneidman, 1972); and homicide (see, e.g., Masters, Friedman, & Getzel,
1988; Redmond, 1989; Rynearson, 1984, 1987).
Referring to such types of sudden, unexpected, and traumatic deaths as being
stabbed, being hit by a drunk driver, and suicide, Rynearson (1987) points out that
It is the form and context of dying rather than death itself that lends meaning
and structure to the psychologic recapitulation and assimilation of death by die
bereaved . . . unnatural dying demands not only normal and/or pathologic
bereavement, but adjustment to a death that is to some degree characterized by
violence, violation, and volition, (p. 78).
Rynearson also specifically emphasizes the inclusion of posttraumatic stress
symptomatology in such deaths. He emphasizes that the experiences of "post-
traumatic stress, victimization, and compulsive inquiry," rather than being indicative
of unconscious conflict, are the "consequences of overwhelming affect and defensive
collapse (p. 86), thus pointing to the circumstances rather than the person as very
much a part of and responsible for the griever’s reaction.
As Raphael (1983) and Rando (1993) illustrate, sudden and unexpected death
are particularly experienced as traumatic and assaultive, impinging on the bereaved’s
ability to cope, violating her or his assumptive world, leaving no opportunity to "say
good-bye" to the deceased, and is often followed by major secondary losses which
could not be anticipated. Further, factors which are linked most saliently to violent
deaths such as homicide and suicide (e.g., suddenness and lack of anticipation;
violence, trauma, and horror, possibly including physical mutilation; sense of
preventability; anger, guilt, and blame; "shattered assumptions"; randomness, Rando,
1993; Redmond, 1989; Rynearson, 1984, 1987) may also be part of any sudden
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and/or accidental death and thus be an aspect of the bereaved’s traumatization. Post-
traumatic responses may result when the bereaved personally encounters death and
there is a threat to his or her own survival, when confronted with death and
mutilation of others on a massive, shocking, or sudden scale, and when he or she
confronts the traumatic and/or mutilating death of a loved one (Rando, 1993; see also
Horowitz, 1976, 1985, 1986, Raphael, 1983, 1986).
In terms of who is lost, Rando (1993) specifically points to death of a child as
having a high risk potential for complications in mourning. And as indicated earlier,
loss of a child-figure is one of the types of situation Parkes (1987) notes as
particularly stressful and likely to lead to a high state of alarm (the other types of
situation involving either the lack of an escape route, the absence of a safe, secure
place, and particular "danger signals" such as cries or sudden movements).
According to some researchers (Rando, 1986b, 1993), parental mourning of the death
of a child is more acute, enduring, and complicated than other types of bereavement,
and demonstrates many alternations of symptoms over time.
Relationship With the Loved Lost Person and Categories of Role/Relationship
While peoples’ relationships cannot simply be confined to their roles as
"child," "spouse," "parent," etc., these descriptors may be helpful in describing some
of the context for grief. The "role" of the deceased as child has been deemed
particularly important. As indicated above, parental mourning of the death of a child,
whether fully grown or not, is considered by many to be more acute, enduring,
complicated, and distressing than other types of bereavement (Gorer, 1965; Rando,
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1983; Sanders, 1979-1980; Singh & Raphael, 1981). While Rando (1993) finds the
age of the child somewhat irrelevant, she points to the important qualities of the
psychological relationship between parent and child as that which makes this type of
bereavement unique. These relationship qualities include, Rando indicates, the
feelings, hopes, and meanings the parent projects onto the child; the responsibilities of
the parent which are either individually or socially assigned; the roles concerning
being a parent which the bereaved has normally integrated into his or her life; and the
closeness and intensity of the child-parent relationship. Losing a child through death
means not only losing one’s function or role as a parent and encountering secondary
losses, but losing parts of the self including one’s sense of immortality (Rando, 1993).
Sanders (1989) describes despair, confusion, conflict, guilt, anger, as well as somatic
and marital problems as important aspects of parental loss.
In her Tampa study (cited in Sanders, 1989) following 115 bereaved
individuals for the first two years after the death of a close family member, Sanders
found the death of a child evoked the highest intensity of grief. This and other
studies (e.g., Fish, 1986; Rando, 1983) also find that for some parents grief increases
in the first, second, or third years after the loss, with some indications of gender
differences (e.g., escalating for mothers, Fish, 1986).
According to Stephenson (1986) and Brice (1982) the bereaved sibling will
often feel guilt and responsibility as well as ambivalence. Death of a spouse,
however, is also often considered "the number one stressor of all losses" (Sanders,
1989, p. 179) as indicated in Holmes and Rahe’s (1967) stress inventory, and
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countless studies on bereavement (see, e.g., Clayton et al., 1971; Glick et al., 1974;
Helsing et al., 1982; Parkes, 1972, Parkes & Weiss, 1983; Stroebe & Stroebe, 1983)
focus on this type of bereavement as extremely distressing and taxing both physically
and psychologically, with a number of possible secondary losses.
Even while death of a parent may seem more natural than death of a child,
researchers indicate that this does not make it easier for the adult child to accept
(Kastenbaum, 1977; Sanders, 1989; Moss & Moss, 1983-1984). The fact that one’s
parent, in a sense, is the symbolic buffer between ourselves and death is significant.
(As Freud, 1960, p. 400, writes of his mother’s death: "I was not free to die as long
as she was alive, and now I am.") Also the fact, as Sanders (1989) notes, that the
parent-child relationship is the longest relationship of one’s life and represents perhaps
the most unconditional type of love, are significant to this type of loss.
Using mortality as an outcome measure, Rees and Lutkins (1967) found
significantly higher rates of death among survivors of the death of a spouse or child
than death of a sibling or adult parent. Sanders (1979-1980) also reports more intense
grief (with symptoms such as death anxiety, anger, guilt, somatic complaints, and
depression) with bereaved parents than bereaved spouses or children of an elderly
deceased parent. Several studies (e.g., Cleiren, 1991, cited in Jacobs, 1993; Sanders,
1979-1980) point to severe and ongoing grief when the deceased is a child. Both
Clayton, Desmarais, and Winokur (1968) and Cleiren (cited in Jacobs, 1993),
however, find a similar level of intensity of grief in bereaved spouses and bereaved
parents. Again, McHomey and Mor (1988) also found it more likely for a bereaved
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spouse to be depressed four months after a loss than individuals whose parents,
siblings, or other relatives had died, and in Cleiren’s (cited in Jacobs, 1993) study,
more complications were noted in relation to bereaved spouses, parents and siblings,
than adult children. Comparing the death of spouse, parent, or child, with the death
of a sibling, grandchild, or good friend, however, Murrell and Himmelfarb (1989)
find the former more significantly associated with depression within a year after the
bereavement.
As Rynearson (1987) remarks in regard to the meaning of the traumatic event,
it is the nature of the attachment (McHomey & Mor, 1988; Murrell & Himmelfarb,
1989) that gives the meaning to the lost relationship. In a long-term and/or otherwise
significant relationship, there are many possible and varied modes of relating. We
rarely fill only one "role" towards a significant other or in our own self-definition,
and as Parkes (1987) indicates, it is difficult to precisely demarcate what is lost in any
relationship. There is a potential depth or multiplicity of "roles" or "categories" of
relationship a person may hold with a deceased which makes it vital to understand the
particular relationships the griever had with the deceased. Relational factors might
include, as Rando (1984) points out, (a) the unique nature and meaning of the loss or
of the relationship which has been lost; (b) the individual qualities of the relationship;
(c) the roles that the deceased occupied; and (d) the amount of "unfinished business"
between the griever and deceased.
A number of theorists also connect specific relationship factors (which are also
associated with the griever’s personality prior to the loss) with pathological or
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complicated grief. These include the obsessive reproaches and self-blame due to the
griever’s ambivalence towards the deceased noted by Freud (1917/1957), or the
patterns of extreme anger and/or guilt which Rando (1984) identifies with an
ambivalent or previously dependent relationship with the deceased. In 1993, Rando
further identified an either conspicuously angry, ambivalent, or dependent premorbid
relationship with the deceased as one of seven risk factors which she believes
predispose an individual to "complicated mourning." (However, as indicated earlier
and as Freud, 1918/1946, himself suggests, it is not out of the ordinary that
experiencing the death of someone close to us, thus forcing us to acknowledge our
own ultimate death, is mixed with ambivalence.)
Further, as indicated and as illustrated in the film "To Live" (Fu-Sheng &
Yimou, 1994) mentioned earlier, there are many individual ways of expressing loss
which have to do with a number of factors (e.g., attitudes towards death, social
influences) but largely include the relationship of the bereaved to the deceased. The
culturally prescribed and categorical role or bond between the griever and the
deceased in addition to the personal, individual relationship that they created and
existed between them, make for a unique entity which not only cannot be duplicated,
but which influences the cultural and personal rites of grief.
Personality and Relational Attributes of the Bereaved
Rando (1984) considers the following personality or dispositional features as
contributory to an individual’s grief response: (a) coping behaviors, personality and
mental health; (b) maturity and intelligence; (c) past experiences with loss; (d) social,
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cultural, ethnic and religious or philosophical background; (e) sex-role conditioning
(which might be especially salient in terms of expression of feelings and stereotypes
concerning men and women’s alternate forms of grieving); (0 age. A mix of
dispositional and relational qualities is indicated in Rando’s (1984) inclusion of the
characteristics of the deceased and how the griever perceives the deceased "fulfilled"
her or his life, as influential in grief response. Whether or not a griever experiences
anticipatory grief (grief prior to the actual death) has also been considered influential
in how she or he responds in bereavement. In addition to these dispositional
characteristics of the griever, Rando (1993) also considers physiological factors (i.e.,
drugs, nutrition, rest and sleep, exercise, and physical health) as well as social
factors.
As Rando (1993) also notes, not much work as been done in the area of
personality and personality disorders and their connection with grief responses,
although this would obviously bear upon a person’s response to loss, along with his or
her previous psychological and physical health and well-being. There is literature
indicating, however, that certain types of personality disorder or personality
characteristics may be involved in complicated mourning or variable grief responses.
Those who react strongly to separations (Parkes, 1987; Parkes & Weiss, 1983) may
experience grief more intensely. Raphael (1983) specifically alludes to those who
tend to form dependent, clinging, ambivalent relationships or relationships with others
who cannot accept expression of feeling, those who themselves have difficulty
accepting the expression of negative or intense feelings, and those who are vulnerable
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to loss because of early childhood loss. Both Maddison and Viola (1968) and Parkes
(1979) also found the suppression of affect or expression to be a risk factor (in
Parkes’ study it is the family system which inhibits grief expression).
Both Raphael (1983) and Parkes and Weiss (1983) identify over-dependence
with chronic mourning. Finally, Bowlby (1980) identifies individuals he considers
demonstrating pathological grief variants as likely to form affectional relationships
which are either (a) insecure and anxious attachments, (b) related to engaging in
compulsive caregiving, or (c) an assertion of over-independence from affectional
bonds, all representing ambivalent types of attachment relationships.
A few studies (e.g., Alarcon, 1984; Merlis, 1972; Vachon et al., 1982)
indicate a connection between personality disorders or characteristics and what is
considered pathological or complicated grief, and treatment of grief is difficult,
writers indicate, with patients diagnosed with borderline or narcissistic personality
disorders (Gorkin, 1984; Lazare, 1979; Worden, 1982). Merlis (1972) suggests that
often in what is considered pathological grief there may be a preexisting pathological
personality disorder which is exacerbated by bereavement and grief.
Previous Losses and Life Crises
One of Bowlby’s (1980) chief themes is the influence of past losses-
specifically losses of attachment figures during infancy, childhood and adolescence-
on bereaved people’s responses. He asserts that the circumstances and responses to
these earlier losses account for a large proportion of the variance of individual
mourning patterns, and his examples are convincing. Research of widows (Maddison,
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1968; Maddison & Walker, 1967; Parkes, 1987) supports that life crises which are
temporally close to a death may also be related to poor bereavement outcomes. As
Kastenbaum (1969) describes, multiple deaths which either happen simultaneously or
serially over a brief time span, may deplete the griever emotionally and physically
and make it harder to grieve. Nevertheless, other research (e.g., Bomstein et al.,
1973; Vachon, 1976) suggest that coping with a previous loss through death may
facilitate coping with later losses. As Worden (1982) points out, the effect of earlier
crises depends partially on what the crises are and how they are perceived. In
Rando’s (1983) opinion, it is whether the previous loss is considered to have been
successfully coped with; but she finds more optimal bereavement outcomes to be
associated with fewer previous losses.
Social and Cultural Background
As mentioned in Chapter 5, surveys of other cultures reveal how difficult, if
not impossible, it is to disentangle the expressions of grief as conveyed publicly in
mourning practices, from the experience of grief. As Wellenkamp (1988) points out
in her study of the Toraja of South Sulawesi, cultural values and theories about
emotion and self influence experience and expression. Yet various observations and
personal accounts in the anthropological literature provide some inkling of the effect
of culture on grief. While it is beyond the scope of this study to investigate in detail
the patterns of grief observed in multiple cultures, a few examples illustrate both ways
in which grieving is similar across different cultures and ways that it varies. Such
variabilities of course should not be used to generalize about "other cultures," but
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reveal instead the influence of culture in shaping grief or its expression, and the
variability of this experience.
As Wellenkamp (1988) describes, both death and grieving are treated in Toraja
culture with extreme profundity and recognized as requiring or allowing experiences
and expressions which are out of the ordinary. Elaborate funerals, including chanting
and wailing, make up some of the formal expression of grief. In addition, she
indicates, "there are clear notions about such aspects of grief and mourning as the
psychological and physical effects of loss, events that exacerbate or lessen the pain of
grief, and proper and improper ways of handling grief" (p. 489). She describes that
the Toraja conception that the sadness and pain following a death may be "intense and
enduring" and even potentially devastating, possibly leading to illness, premature
death, or insanity, and "loss at death . . . as a common source of emotional turmoil"
(p. 489).
When explaining why her mother waited several years to remarry after the
death of her first husband despite available marriage partners, one young
woman describes how one feels after the death of a close family member:
"Our heart is made bitter. The sadness/difficulty has not yet disappeared. We
are wounded, cut in halves." (p. 489)
Here, cumulative experiences of loss are recognized as adding to the possibly
devastating effects of death. And in addition, as Parkes (1987) also suggests, all
kinds of hardships, physical and emotional, are interwoven with loss of a loved one.
Thus, the responsibilities involved in making funeral arrangements and suffering
funeral expenses, in the Toraja culture involving the provision of pigs and water
buffalo for slaughter at the funeral— represent one type of hardship:
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"If someone dies, we must slaughter buffalo or pigs. We think about that.
Where are we going to get the money to buy them? Because of that, we
become sad . . . .We think like that of the difficulty." (p. 489)
Nevertheless, Wellenkamp also describes providing the livestock for the funeral as a
source of consolation, as one of her informants describes, "‘a little medicine for the
heart. . . . It doesn’t replace the person who has died. [But] it makes one a little bit
happier’" (p. 490). This bears some similarity to the concept of "paying one’s
respect" and affirming the other that I mention in Chapter 4.
While during the funeral, grief (with crying and wailing) is openly expressed,
after entombment, Wellenkamp (1988) reports, "It is hoped that feelings of grief will
have subsided"; nevertheless, it is also "recognized that such feelings may persist" (p.
490). Such responses are perceived as "undesirable but not abnormal," hence not
requiring treatment by healers.
The acceptability of deep, possibly long-lasting, and sometimes debilitating
emotional responses to death is especially striking in a culture which Wellenkamp
describes as minimizing distressing events and restraining feelings related to other
types of losses (e.g., divorce; a child’s move away from home), which she partially
attributes to the Toraja fear that emotional upset is destructive to health. That the
Toraja permit and encourage strong emotion on special occasions like funerals,
Wellenkamp (1988) attributes to a "cathartic theory of emotion." From this
perspective, experience and expression of strong emotion is necessary as long as it is
limited to certain times and forms." Thus, following a death,
[T]here are feelings that are fluttering that he/she wants to release .... it is
better to release them because those who cry, all of the contents of their heart
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is said. Thus, when they have stopped, although usually they are still sad,
they are quiet. But if one does not cry, usually . . . one is attacked by
thoughts." (p. 493)
Some authors (e.g., Holst-Warhaft, 1992; Rosenblatt et al., 1976) indicate the
social function of ritual in bereavement is to control emotion, particularly, Rosenblatt
et al. argue, anger and aggression. In contrast, societies may sanction rituals which
may seem to Westerners quite violent and rageful, if not "out of control" (e.g.,
Ilongot headhunting, Rosaldo, 1993).
In terms of relationship, the possibly enduring though changed nature of
relationship with the loved deceased is illustrated in the Kodi custom of addressing the
ancestors (Hoskins, 1993). However, although in this way the dead remain an active
voice, there is the implication that the dead must change their relationship with the
living (and vice versa). Hoskins describes how the dead are viewed as moving from
the community of living to the "invisible community of the marapu” (p. 247), who
represent the ancestors or spirits of the dead, and how this movement "defines the
particular intimacy and ambivalence that characterizes relations with spirits of the
dead" (p. 247). The rituals of death establish this new relationship:
The dead person is moved from the category of one who speaks as a kinsman,
a person with individual attachments and loyalties, to one who acts as an
ancestor, the detached voice of collective law, who protects and sustains his
descendants with impartial wisdom, (p. 248)
In this way, the individual who has died is transformed to become part of another,
larger scheme of time and collective history.
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Interestingly, Hoskins also describes the Kodi dealing with death as partly a
kind of interrogation similar to my description of the griever’s early search for the
"cause" or the reasons for the death:
A funeral divination has much of the suspense of a detective story, as a whole
array of spirit "suspects" are summoned down to the mat where rice is
scattered, then sequentially interrogated as to their possible motives for
withdrawing protection from the dead man. The real killer might be an
ancestor, a guardian deity of the village or garden hamlet, or a while spirit-
companion who has been inadequately compensated for her gifts of wealth.
(p. 257)
Hoskins points out how this ceremony reveals the diversity of possible "causes" of
death and is not simply a "‘who done it,’ but an investigation of social tensions and
collective history" (p. 266), perhaps similar to the way a griever reviews both the
deceased’s and his or her own past and a multiplicity of memories to arrive at some
sort of understanding of death and loss.
The variability of how grief and relationship with the lost one are experienced
and expressed across culture is illustrated by a counter-example. Hopi Indians of
Arizona believe that death brings pollution, and after a death, say Stroebe et al.
(1992), the effort is to try to forget the deceased. Again, on the other hand, ancestors
remain accessible in Japanese Buddhist and Shinto traditions (Yamomoto, Okonogi,
Iwasaki, & Yoshimura, 1969).
There appears to be degrees to which social prescriptions influence grief, as in
the account of Toraja culture by Wellenkamp (1988) where, she indicates, grieving is
not pathologized if the norms are not met. Further, as Godfrey Wilson’s (1939) and
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Rosaldo’s (1993) work indicates, there are multiple ways of experiencing grief which
are not necessarily representative of a society as a whole.
Ongoing and Subsequent Circumstances
As indicated by Parkes (1987), also related to the griever’s circumstances are
the number and kind of secondary losses produced by the death, and the presence of
additional stressors or crises. Rando (1993) points to four other types of concurrent
stress which may affect mourning: (a) when an event unrelated to the death places
stress and hardship on the griever and thus interferes with mourning; (b) when the
circumstances that caused the death of the loved person interferes with mourning (as
when the griever is preoccupied with his or her own survival); and (c) in cases of
multiple loss. Kastenbaum (1969) describes dealing with multiple deaths as
exhausting the griever emotionally and physically, making it difficult to grieve a
current loss.
As mentioned, a growing body of literature emphasizes that social support is
helpful if not crucial in affecting a person’s responses to bereavement (Bruce,
Leonard, & Bruhn, 1990; Fowlkes, 1991; Maddison & Walker, 1967; Parkes, 1987;
Rando, 1984; Raphael, 1973, 1981). This could be construed as support for grief
"resolution," and/or alternately, a subjective sense of support or "holding" for the
difficulties and changes, sometimes traumatizing, that the loss presents, as well as
support for the individual in her or his own mode of process or travel in grief.
Support is seen as buffering the effects of stressful life events (Schwarzer, 1992).
Lack of support has been attributed to a variety of bereaved people’s psychological,
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adjustment and health problems (Maddison, 1968; Maddison & Walker, 1967; Parkes,
1987; Sheldon et al., 1981; Vachon et al., 1982) as well to their subjective distress,
often composed of loneliness and despair (Gorer, 1965).
Certain researchers (e.g., Gorer, 1965) point out the importance of social
support in what they consider the acute or most intense period of mourning— the first
six to twelve weeks, for instance— at which time Gorer believes the mourner is "in
more need of social support and assistance than at any time since infancy and
childhood" (pp. 134-135). Others (e.g., Parkes & Weiss, 1983; Vachon, Lyall,
Rogers, Freedman-Letofsky, & Freeman, 1980) point to the importance of availability
and utilization of ongoing social support. Fowlkes (1991) goes further than saying
social support is a helpful determinant in healthy grieving: In her opinion, lack of
social support actually constructs mourning and melancholia. A bereaved individual’s
lack of self-regard (a common differentiator between "normal" grief and depression)
represents a social construction of the depressed individual.
Social support may also be expressed in mourning rituals which have the effect
of both (a) making death public, and thus in a sense calling out to others in a
particular society to take notice of the condition of the deceased and the bereaved, and
(b) making physically plain the reality of the loss, thus, as Raphael (1983) suggests,
making real the pain of the loss. Certain cultures seem to allow for a greater amount
of social sharing of feelings and experiences than others, and reflections about the
dead person may follow the funeral in many cultures (e.g., the Irish wake; the Jewish
"shivah," Raphael, 1983).
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Rando (1993) emphasizes the salience of the griever’s perception that he or she
is supported as a positive factor in mourning, and the perception that support is either
unavailable or unforthcoming as a high risk factor for complicated mourning. She
differentiates a number of types of social support as potentially important (emotional,
instrumental, validational, informational, support of presence, relational, and social
activities support). While sometimes it is problematic to say exactly how the
bereaved should be supported, one of the chief modes of support, besides offering
one’s ear, one’s empathy, and practical support, can be to see the bereaved’s situation
as normal (and thereby allow the bereaved to see and be supported by this
knowledge)— that grief is a normal reaction to a situation which, though not abnormal
in the natural scheme of things, is experienced existentially as abnormal, to recognize
that grief responses may vary greatly, and that they may recur at much later intervals
after the death. Further, grievers may require support and specific assistance from
particular people at different times (Bankoff, 1983; Lieberman, 1986).
Although the griever is in great need of support directly after the death, the
pathology model of grief fostered by stage/phase approaches denies much long-term
support unless it is agreed to be under the rubric of mental illness. In the proposed
view, this kind of "support" is counterproductive and may be harmful.
All of the above factors necessarily "complicate" loss or add to its variability.
Some of these variables indicate problems prior to bereavement, some of which are
potentially pathological (e.g., personality, mood disorders). Others (such as the
sudden or traumatic nature of the death, concurrent stress, lack of support) are
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predictive in the problems they add to or with which they complicate grieving. Of
particular value in this line of research is that it serves to illuminate variability of
grief response, to particularize grief responses rather than standardize them, and this
particularity should not be lost in emerging theory but incorporated. However, the
concept of variability is often used to explain why a griever does not achieve a
"normal outcome," or why grieving is thought to be inhibited, delayed, or continued
for too long, and so has not yet affected the view of grief as linear, time-limited, and
focused on relinquishment of the other.
Health and Pathology
As suggested earlier, clinical diagnostic guidelines such as those offered by the
DSM-HI-R (1987) or DSM-IV (1994) are unsatisfactory because their definitions of
"uncomplicated," and by extension "complicated," bereavement are too general and
vague to accurately describe individual grief, and reality itself is too variable.
Further, there is a complexity and multilayered quality to grief response which makes
simple differentiations impractical, and the kind of memorial, imaginal, and emotional
processes I have been describing are much too complex and individual to be included
in the DSM. Nevertheless, such complexity could be considered a healthy aspect of
how loss is perceived and dealt with and appreciating this complexity, there are
important ways in which the proposed approach could be used to improve diagnosis
and treatment of grief-related states. Equally important is our epistemological stance
toward grief and an appreciation of the assumptions and blind spots (some of which
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were described in chapter 2) that contribute to one or another version of health or
pathology.
Making our definitions and diagnoses of pathology more precise and accurate
must stem, first, from an appreciation of the healthiness (or no/ipathology) of variable
and complex grief responses, as well as from an appreciation of the possible length
and depth of grief experience. Lack of resolution should not be the decisive criteria
in considering a person’s responses pathological. Rather, we need to examine a
person’s grief experience in the context of his or her entire life circumstances.
Certain aspects of personality and functioning may be considered maladaptive or
pathological before the individual ever encounters death; her or his response to
bereavement represents an idiosyncratic and overall mode of dealing with reality and
its problems and losses. In this view, "pathological grief is not the problem to be
diagnosed by the clinician; rather, the way a person grieves may be similar to the way
she or he treats other problems and issues. Further, the issue of loss is one that is
encountered throughout life. Grief at the loss of a loved one needs to be appreciated
and respected for and in itself; at the same time, the overall issues that a patient
brings to psychotherapy need to be addressed.
Further, as indicated above, stressful life circumstances both before and after,
as well as during, the death, may impinge upon a person’s ability to cope with loss.
These circumstances, and an individual’s history, naturally may play a part in
personality and coping style. The unique circumstances of a loss that make it
traumatic for the individual are extremely important in this regard, as in addition, are
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the stressors, support or lack of support, that follow the bereavement. We must also
look closely at how grief relates to and interacts with various kinds of disorders, such
as depression, posttraumatic stress response, and anxiety to ascertain how a person’s
response to loss may lead to, or be implicated or entangled with, these problems and
symptoms, and what the unique blend of the overall experience is, thereby helping us
to determine the best course of treatment. In the clinical vignettes I present later in
this chapter, it is apparent how often loss, grieving and other client problems and
diagnostic issues are interwoven, and therefore how important it is to have an
appreciation of grief as a healthy response to loss even as it is implicated in areas that
may be considered pathological or maladaptive. Grief does not occur in a vacuum but
in a particular context.
Grief as a "Problem in Living1 '-7
The position of the present work is that grief in and of itself is not pathological
but, as Rando (1984) states, a natural and expected response to loss, and that death of
a close other, as Bowlby (1980) and the foregoing suggest, is an experience that is
likely to have repercussions for a long, perhaps indefinite amount of time. However,
while grief is not in and of itself pathological, a person’s life experience and way of
coping with that experience and being in the world may reflect a maladaptiveness and
pathology which will be translated into her or his overall mode of living, including
her or his treatment and handling of grief and loss. Further, dealing with dying and
4/ Szasz’ (1974) term to describe psychological, social, and coping difficulties
which are considered by traditional psychiatry as symptomatic of disease.
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with the death of others close to one does represent a serious "problem in living"
(Szasz, 1974). This "problem in living" represents the feelings of extreme distress
and disruption likely to be evoked (as the work of attachment theory, object relations,
and self psychology suggests) when a loved intimate dies, the secondary losses,
deprivations, and ongoing stresses that interact with that loss, as well as the existential
"problem of living," and dying.
As indicated in Chapter 2, language and assumptions concerning pathology or
disease are implicit in much grief literature, helping to inform our notions about the
nature of grief. A medical disease model perspective considers grief as a kind of
disability which (in mild cases) should be "gotten over" like a cold or flu, or (in more
severe cases) requires treatment to be fixed. But while the metaphor of grief or
bereavement as a profound internal wound (Schwartz-Borden, 1992), amputation or
broken limb (Parkes, 1987) can appear subjectively fitting, it would be inaccurate and
misguided to accept the metaphor as the thing itself, or to extend it to other uses
which are taken as factual. The internal "wound" is not, for instance, a lesion in
Szasz’s (1974) conception of the term.
Szasz particularly questions the concept of "mental disorder" as an
inappropriate extension of the concept of physical disorder. "Mental illness," he
asserts, does not objectively exist; rather it is a label that distinguishes behavior
deviating from social norms. Whereas a physical disorder is identifiable, in Szasz’s
view, by some form of lesion, or deviation in anatomical structure, according to him,
no such lesions are found to explain mental disorders. While this second point is
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certainly debate-worthy in the sense that many "mentaT/behavioral conditions (e.g.,
schizophrenia, depression, obsessive-compulsive disorder) have been connected by
researchers with deviations in brain structure and functioning, Szasz’s point about
extending metaphors of physicality to explain a variety of processes merits full
consideration. Using metaphors to transpose objectifiable (i.e., materially
measurable) evidence of disorder, such as lesions, to explain other unlike
(qualitatively different) situations, represents a confused kind of logic, but one which
is used regularly to explain mental "disorder." "Pathological mourning" and
"unresolved grief" are similar identifications.
Further, as the research on variability suggests, the issue of loss itself is
complicated with issues of pathology. Present understandings concerning the effect of
a griever’s particular relationship with the dead person (e.g., as parent, spouse, child)
and the differing circumstances of the death (e.g., accident, "natural," suicide,
sudden, expected, etc.) have contributed most positively to grief research in
illuminating the variability of grief response and how the context of both the
relationship and the death are crucial to understanding grief. Yet researchers have
tended to utilize such differential circumstances as prognosticators of health or
pathology rather than as explicative of the individual’s subjective state of grief.
Because of our tendency to view phenomena in a linear, cause-effect fashion,
it is difficult to refrain from chicken-egg propositions (e.g., pathological grief
engenders depression; a personality disorder results in distorted grief; or what is
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called "distorted grief” must mean a personality disorder, etc.). Thus, Bowlby (1980)
states:
Clinical experience and a reading of the evidence leaves little doubt. . . that
much psychiatric illness is an expression of pathological mourning, (p. 23)
And Rando (1993):
Clearly . . . major loss can be an etiological cause or a concomitant variable
in any mental disorder, (p. 187)
She adds, "Surely, there is no diagnosis that has not at some time been associated
with complicated mourning" (p. 187).
While certainly loss can predispose one to disorders and problems of various
kinds, here I suggest that the term "pathological grief" is a misnomer. Instead,
preexisting disorders and difficulties which characterize the individual may be
complicated by death and other life stresses and reflected in the bereaved’s response
to these. Second, loss of a loved one presents problems of its own kind which then
interact with previous and later stresses. Both conditions might well be described as
"complicated," yet without the connotations placed currently on the term "complicated
grief" to imply pathological grief or a failure to appropriately resolve or complete
grieving. In other words, clearly loss has something to do with future vulnerabilities
(Bowlby, 1980), and how one’s personality has developed has to do with how one
deals with future problems. The problem with labeling grief pathological is that this
places the focus of pathology on grief rather than on the circumstances of loss and the
bereaved’s possibly preexisting pathology. Perhaps more important, such
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pathologizing makes it difficult for the griever to follow her or his unique process and
invalidates her or his grief.
Two issues particularly concern both prevailing views and the proposed one
and are implicated in the treatment of health and pathology. These are their attitudes
toward time and relationship. However, as indicated, there are strong reasons why
time cannot be used as a criterion to determine whether someone is "healthily" or
"unhealthily" grieving, even if the length of time of grief is painful and difficult for
the griever and disquieting or inconvenient for those around him or her. The
temporal experience of grief is connected with the temporal experience of the
relationship with the lost one. This relationship may not only be preserved in
memory, but may continue to be transformed and reconstructed. Therefore, the past
may take an active part in the present and vice versa. Further, the significance of the
relationship may continue to intermittently imbue the griever’s life with a sense of
loss. As mentioned, the griever’s own confrontation with mortality and the changes
of time make loss a subject which is likely to be reopened as one continues on
through life.
Overlaying these experiences is the griever’s personal cultural negotiation with
time, relationship, and loss. As mentioned, while the dead may exist imaginally in a
spatially separate "place" from the bereaved, both in other cultures and our own, the
deceased may be "called upon," as an ancestor, advice-giver, loving memory, and so
forth, actively in the griever’s present, and so in essence may be considered part of
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that present. The dead are paradoxically part of the past and the present as they
continue to influence the living and yet are recognized as gone.
Phenomenologically, therefore, time is not a simple quantity that can be
measured for the griever. Experientially, perhaps the best "yardstick" for the
temporal experience of grief is the significance of the griever’s relationship to the lost
one, and the meanings that this relationship comprised and how these are transfigured
in ongoing life, individually and culturally. This, along with the need to continue to
integrate ongoing life circumstances, is important to the concept of "resolution."
As I have indicated, there is some distinctiveness to early grief as a response
to trauma. What present grief theory has to say about the multitude of symptoms or
themes concerning the bereaved is not hard to find in actual experience when
confronting someone who is recently bereaved; at least some portion of the
characteristics described seem recognizable. However, I maintain that the time frame
or differentiation of these experiences cannot be neatly packaged. In addition to the
dialogical nature of self/other, the paradoxes presented by death, mortality, and time,
and the regenerational nature of emotional experience, later grief or grief-like
experiences have a lot to do with the nature of the bereaved’s relationship with the
dead person, the strength and intimacy of the relationship, the bereaved’s preexisting
and continuing ability to cope, as well as ongoing life circumstances and stressors.
In prevailing theory, the bereaved’s psychological health and coping ability are
measured not only by his or her going through the appropriate sequences of stages,
but are fundamentally tied to the relinquishment of the dead person. Without a final
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despair which makes possible the final acceptance of loss, the bereaved cannot be said
to have "worked through" or resolved his or her grief. The proposed theory, in
contrast, suggests that the relationship does not necessarily end, especially if it played
an important role in the bereaved’s psychic world. If it did play such a role, there is
no reason to believe that this inner role and relationship will stop being important,
although they will probably change. Such a relational view of grief explains why
grief experience is made up of oscillations rather than any abrupt ending point.
As mentioned, coping with death involves different levels of awareness,
ranging from the explicit to the tacit, and not the black-and-white, either-or
experience portrayed in current theory (e.g., either the griever denies or accepts,
believes or disbelieves, relinquishes or refuses to "let go") which correspond to the
prevailing health/pathology dichotomy. Therefore, for instance, the emphasis on
acceptance versus denial is that denial is pathological, and acceptance is the complete
opposite of denial. However, the broad interwovenness of our more conscious and
more tacit, our more rational and more emotional processes, explain how we may
observe that loss may be cognitively acknowledged but emotionally denied (that is the
fact of death is recognized, but the emotional unacceptability of death is registered in
yearning and searching and the agitated, disturbed, responses described above), and
how still at another level, there could be ontological obstacles to complete acceptance
and resolution. Generally, we may say that someone accepts or denies a death, and
speaking very narrowly, the death is "integrated." But in day-to-day life levels of
awareness are interwoven. Further, these are only the broadest of distinctions.
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Involved with these tacit levels of knowing is the effect of visceral and
emotional memory and how much the other and all meaningful circumstances,
including trauma, are literally part of the individual. The other and the trauma
relating to death maybe re-evoked or "re-triggered" by realities inner and outer which
are not only impossible to completely control, but to predict, and which are part of
the fabric of the "self" or the individual’s life. Painful triggers can be somewhat
expected (as with anniversaries, holidays, or environmental resemblances to the
experience) or not (as when suddenly one is reminded of the lost other and this
evokes either feelings of trauma or loss). Although with time and experience one
learns how to deal with such events, ongoing aspects of environment continue to
interact with this experience to produce new emotional experiencing, as in new losses,
stresses, etc.
In addition, a moral, spiritual and emotional dimensions comes into play when
we consider the remembering and forgetting of the lost other. Our lack of
consolation at loss of the other, and the gap caused by the beloved one’s absence, is
as Freud (1929/1961) indicates is as "it should be; it is the only way of perpetuating
that love which we do not want to relinquish" (p. 386).
Although the necessity for "cure" or "resolution" of grief is not recognized in
the model I propose, what might be considered "growth," "development," or
"healing" does occur in that both grief and the relationship with the lost other
continue to be transformed and that coping processes evolve. Development first has
to do with the bereaved’s ability to cope with the loss. A major difficulty (which can
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be both immediate and ongoing) is for the bereaved to be able to experience and
express his or her sense of loss, whatever that may be, with as little negative
interference and as much positive support as possible. While Lindemann (1944) and
others seem to portray this experience and expression as the bereaved’s,
circumscribed, "task" or duty which, if he or she is unable to accomplish, must be the
result of psychopathology or morbidity, here I will suggest that it is also the "duty" of
society, including clinicians as well as friends and relatives, to allow and support this
expression and experience and the needs that arise.
Another major difficulty the bereaved faces is making sense of and in some
way integrating loss through death, and also achieving a partial mode of buffering
from the horror of traumatic reality. In the model proposed here, what might be
considered "development" or "healing" has to do with a dynamic and relational
internalization of the lost other, which provides not only a "finning up" of what has
already been internalized but a dynamic interconnection with the griever’s continued
reconstitution of the world; that is, as her or his life changes, the perspective of
relationship (and loss) also changes. The depth or amount of this internalization and
reconstruction, however, depends on the nature of the individual relationship the
griever has with the deceased. Development, in addition, involves giving up, to some
degree, one’s sense of omnipotence (or at least recognizing one’s human limitations),
and being able to negotiate and renegotiate both the acceptance and difficulty of
accepting a paradoxical reality involving loss, death, absence and presence.
However, this type of development should not be considered linear and is not
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achieved in a step-wise fashion; rather, it is a process that oscillates and must
continue to be renegotiated and dealt with. Therefore, Tittensor (1984) writes that
although his sense of pain and loss are less after a year, he believes they will never
be fully resolved, and that further, it is not "recovery" from grief that occurs, but
one’s "methods of control" which are "polished by full-time practice" (p. 42).
Although all of the above are ongoing processes, the first dealing with integrating,
buffering, and coping emphasizes the traumatic aspect of loss, whereas
internalization, humility, and ability to deal with ambiguity characterize both the
response to trauma and the longer-term response to loss and death.
Because of the dramatic and subtle shifts or oscillations which make up grief
experience, the need to continue to integrate past into ongoing experience, the re
preservation and reconstruction of the other, and the paradox of death in life which
can never be overcome, "resolution" or "completion" of grief is not suggested in the
proposed model. "Resolution" and "acceptance" of loss once and for all, it seems,
could only be possible or even logical if there could be no more remembering or
reconstituting either of the past or of who a particular person was in our lives. At the
same time, paradoxically, there are many types of closure, as for instance, in patterns
of longing and lament, shock and realizing, that emerge, find "resolution," and
reemerge in altered, perhaps diminished, form. As we move through time, there is a
sense of certain kinds of "closure," but this closure is again temporary and somewhat
arbitrary, not definitive. What seems to happen is a process of continued
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reintegration. The need to reassess, renegotiate, and in some sense, reexperience loss
and "reintegrate" it reemerges as other circumstances arise.
When Does Grief Become "Complicated"?: Hindrances and Strengths
All of the factors discussed above, from the situational and individual to the
cultural and social, from the previous history of the bereaved to ongoing life events,
necessarily "complicate" loss or add to the variability of grief. Rando (1993)
specifically points to seven risk factors which she believes predispose an individual to
"complicated mourning": sudden, unexpected, especially traumatic or violent, death;
death from an overly lengthy illness; loss of a child, the bereaved’s perception of the
death as preventable; a preexisting relationship with the deceased that was
conspicuously angry, ambivalent, or dependent; previous or concurrent stresses or
losses; and the griever’s perceived lack of social support. For Rando (1993),
"complicated mourning"
[M]eans that, given the amount of time since the death, there is some
compromise, distortion, or failure of one or more of the six "R"
processes of mourning . . . (p. 149)5 '
This definition differs from the proposed model’s conception which views
"complication" as having to do with the influencing factors discussed above as adding
to the griever’s subjective and pragmatic difficulties in dealing with loss and/or
predisposing him or her to reflect pathologic or maladaptive behavior in the area of
51 Rando’s (1993) "six ‘R’s" are: (1) recognizing the loss; (2) reacting to the
separation; (3) recollecting and reexperience the deceased and the relationship; (4)
relinquishing the old attachments to the deceased and the old assumptive world; (5)
readjusting "to move adaptively into the new world without forgetting the old"; and
(6) reinvesting in other relationships, goals, and interests (pp. 44-60).
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loss as well as in other areas. In Rando’s schema, "complicated mourning" contains
the "syndromes" of absent, delayed, inhibited, distorted, conflicted, unanticipated,
and chronic mourning; it may also potentially lead to a diagnosable mental or physical
disorder, to psychological, behavioral, social, and physical symptoms, as well as to
possible death (Rando, 1993, p. 151). Yet Rando emphasizes that each individual
situation contains a multiplicity of factors which need to be assessed. She further
points out (on a couple of pages) that there are many symptoms which are often
"misconstrued" as constituting complicated mourning, including:
Experiencing a resurrection of issues, feelings, and unresolved conflicts from
past losses ....
Experiencing feelings other than sadness (e.g., anger or guilt) and
reacting . . . in other than psychological ways (e.g., behaviorally, socially,
physically) ....
Feeling that part of the mourner has died along with the loved one ....
Having a continued relationship with the deceased ....
Maintaining parts of the environment in such a way as to stimulate memory of
the deceased ....
Feeling increased vulnerability about the possibility of one’s own death or the
deaths of other loved ones ....
Experiencing some aspects of mourning that continue for many years, if not
forever and/or a course of mourning that does not decline linearly with time .
Experiencing temporary periods of acute grief long after the death . . . (pp.
153-154)
All of which, I claim here, may be significant aspects of grief. Rando’s work
emphasizes complicated (which she construes as pathological) mourning, but the
variability of responses she also reveals (as indicated above) need to be further
highlighted as nonpathological.
As mentioned, affecting the entire picture of grief so that it does not follow a
straightforward or linear course are the different types of trauma related to the trauma
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of death, the impact of the person-environment (Lazarus, 1991) to include the
personality and history of the bereaved as well as past and current environmental
issues such as stress, loss, support, etc., and the continued accrual of experience and
maturity.
The contribution of the traumatic surround of the death and nature of the
relationship are particularly important. There are constellations of variables, which
necessarily include the appraisal process referred to above. The significance and
importance of the relationship combined with the manner of death may contribute to
make the death more difficult to bear. Rando (1993) suggests the death of a child as
most traumatizing, which is mirrored in Anne Morrow Lindbergh’s (1973) statement:
The winds howl at night. I think of last winter. I will never accept it-cannot
accept it-not like Daddy-which I knew would happen sometime. It is not a
normal sorrow. Back of it is always "It need not have happened." And that is
a torture. I suppose I can only swallow it whole. It will not be absorbed but
will always be there, and always hurting, like something in your eyes. Nature
does not absorb it but gradually provides a protective covering which numbs
the sharp pain, but you are always conscious of it. (cited in Sanders, 1989, p.
161)
Once again, however, depending on the nature of the relationship, any "category" of
death could be severely traumatizing, although generally the death of a child may be
viewed as most agonizing and most staggering to our belief systems.
Multiple deaths (see, e.g., Kastenbaum, 1969; Rando, 1993) and deaths which
are atrocities, violent, mutilating, and/or life-threatening to the bereaved (see, e.g.,
Cain, 1972; Lehman, Wortman, & Williams, 1987; Masters, Friedman, & Getzel,
1988; Rando, 1993; Raphael, 1983, 1986; Redmond, 1989; Rynearson, 1981, 1984,
1987; Shneidman, 1972; Worden, 1982) which have a severely traumatizing impact
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on the bereaved in terms of what Rynearson (1987) calls the "three Vs of unnatural
dying" (violence, violation, and volition) are likely to have a long-lasting effect on
griever. Dealing with the often multiple traumas involving the death are particularly
important to the difficulties the griever undergoes as unnatural death is "characterized
by horror, brutality, and calamity— abhorrent acts that are psychosocially dissonant
and to some degree unacceptable" (Rynearson, 1987, p. 77).
The question of when or how grief becomes "complicated" (i.e., becomes
more difficult, painful, debilitating, or intolerable for the griever than it could or
"should" be), raises the complementary question of when or how coping with grief
becomes easier. What promotes a sense of growth and nurturance along with the
sense of loss, as opposed to solely a sense of deprivation, struggle, and impossibility?
As indicated above, there are obviously components to experience that may help to
ameliorate some of the pain of grief, that help the individual continue living first of
all,- to maintain physical health and well-being, and that help her or him to strive to
construct a personally meaningful life and relationships.
In considering the bereaved as she or he comes to or encounters the trauma of
death and loss and the subsequent process of her or his grief, three overall factors in
addition to the circumstances of death seem to be fundamental and intertwined: (1)
the bereaved’s ongoing support system; (2) his or her "resilience" or ability to
integrate and cope with trauma and difficulty; and (3) ongoing or emerging stressors
6/ The "decision to die," Sanders (1989) notes, "is seldom discussed as an
alternative [of the bereaved], but it is selected far more often than is realized" (p. 82).
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(e.g., additional deaths and other losses, financial difficulties, job or relationship
problems, etc.) which may contribute to the difficulty of dealing with the death, its
traumatic nature, and a construction of a viable self/other/reality narrative.
As Rando (1993) asserts, obviously the mourner’s mental health will influence
mourning because,
[T|nasmuch as it describes the mourner, it will also define mourning. No other
factor so accurately describes and delimits who is affected by loss, how loss is
experienced, or what is available for a response to it. . . . To the extent that
the mourner brings sound mental health, achievement of appropriate object
relations, good ego strength, hardiness, healthy self-esteem, effective
communication skills, emotional resilience, appropriate coping resources,
capacity to express emotion, a mature personality, optimism, and a
transcendent belief system to bear upon mourning, it appears clear that the
individual will have an advantage, (p. 461)
A rather tall order, perhaps, yet I agree with Rando that these are advantages and
strengths that one may bring to coping with any stress, although not all features may
be present in the optimum or ideal degree and, as I have indicated, some will develop
in the process of coping.
Therefore, while not in itself a disease, grief may indeed become
"complicated" as the DSM implies, complicated by other life circumstances, including
the griever’s personality, past experience, immediate and ongoing stressors, his or her
resilience or vulnerability in dealing with these issues, and preexisting
psychopathology. These features and the context of the griever’s life can include
other losses, either prior to or subsequent to the death. Other and secondary losses
may merge with loss of the person, and continued stressors, losses, deprivations may
add to the pain of loss. A point here that can be emphasized is that the various kinds
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of losses I discussed in Chapter 2 (e.g., role loss, object/person loss, secondary losses
and deprivations such as loss of income, loss of a companion, loneliness, and
symbolic losses such as loss of the past and recognition of one’s own mortality) do
not function as discrete losses but coalesce into one another. Therefore, loss of the
person is loss of role and, to some extent, loss of self. Loss of the other implies
one’s own eventual death as well as the annihilation of the past. And further, as
Bowlby (1980) so well illustrates in relation to childhood losses, even distinct
object/person losses may, in a sense, blur in the individual’s overall sense of self and
being. As he suggests, additional or cumulative losses, create the likelihood for
increased vulnerability to loss, lower resilience, and difficulty in coping.
Thus, with such complicating factors, although an individual may appear to
"recover," "get over," or otherwise appear to continue functioning reasonably well
after a particular loss, years later the same person may seem to "disintegrate" or
collapse. Though the loss has once been "integrated," it appears that this integration
has come undone. How can this be? As Bowlby (1980) suggests in regard to the
effect of previous losses and stresses on bereavement, there is necessarily an effect of
ongoing and accumulating losses and stresses which continue to interact with the
regeneration and reconstruction of the particular loss first mentioned. Again, it is not
a purely intrapsychic process of reconstruction, but the person-environment gestalt
that accounts for the emotion generating process (Lazarus, 1991). The "facts," both
new and old, must be reintegrated and transformed for the individual to experience
the self-other relationship as coherent and somehow making sense. The harder things
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are to make sense of, the more difficulty the individual will have in experiencing her
or himself as whole, safe, and at ease. On some level of course, as detailed earlier,
the experience of ultimate loss defies sense, and the individual will have to face this.
Further, and importantly, what trauma, loss, and other forms of difficulty
deprive the individual of, even if accepted cognitively, leave an emotional gap which
may or may not be fillable. In bereavement, the individual is literally robbed. Grief
is therefore not only a matter of making sense, but once again a matter of enduring
loss. Any significant loss may be considered irreplaceable. Other aspects of the
person’s life and selfobject matrix may seek to compensate this loss, through other
relationships, "internalized presences," meaningful life goals and activities. If the
internal and external resources for these are lacking, it is more likely the self will be
experienced as fragmented and empty. Also, the individual may not feel that any
satisfactory compensation is possible. If an individual endures more than one,
perhaps many, significant losses, there will be more need for compensation of those
gaps. (Compensation is not considered in the sense of restitution or substitution, but
rather as support for enhancing old and building new forms of fulfillment.)
In contrast to the linear, finite approach to grief, here it is suggested not only
that the ongoing or recursive nature of grief is a fact of experience in many grievers’
lives, but for some it may also be considered requisite to healthy development.
Current models’ emphasis on grief as a finite, time-limited process may actually be
pathonogenic in leading the griever to deny later grief and discontinue integration of
the lost one and the relationship with the self and ongoing life circumstances. If the
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griever has apparently gone through all the "steps," felt disbelief, anger, longing,
yearning, depression, despair, and a new integration of his or her life, has coped, is
therefore deemed healthy, he or she may, according to present standards, consider
him or herself "finished." What happens then, if feelings of disbelief, longing or
missing, and even despair reemerge? Are these feelings pushed aside because one is
"finished"? Or are they attributed to something else? When grief "turns into"
something else, such as depression, is it because it has followed an unhealthy course,
or is it because we refuse to acknowledge that grief-ful feelings reemerge? As I have
argued, in a significant relationship the other is incorporated into the self, not as a
static entity like a photograph, but an other which is dialogical and necessarily part of
one’s world view. If this "other" is deemed dead, what happens to the self (or that
aspect of the self)?
Considering himself decisively not a spiritualist, Tittensor (1984) writes that
"nothing remains" of his children: They are dead. Yet he stresses the importance of
memory; the memory of the dead must be preserved both for the sake of the bereaved
and the dead. "For if the living cannot remember, cannot give remembrance its due,
then they too are dead" (p. 4). Through consciously remembering, he states, we call
the dead back to life, in a sense— we assert the importance and meaning of their lives
and that this meaning continues on. Further, this remembering is not painless, but a
way of being able to face death and tragedy, and affirm the love we feel for those we
have lost.
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I have indicated that it may seem to the griever that what occurs in the
development of grief is not "cure," but that the "methods of control" become
"polished" (Tittensor, 1984), or the "defenses become more sophisticated," that
coping involves learning how to buffer or blunt one’s experience of loss to some
extent. There is, however, a danger in blunting the pain without becoming aware of
it, or of blunting it so much that its awareness is succeeded by denial. An
intermittent re-negotiation or reintegration of grief and loss is essential when the lost
other has formed a significant and deep part of the bereaved’s life. This re
negotiation, or re-confronting the pain of loss and the meaning of this pain and loss,
is an active process which the griever engages but naturally depends on the depth of
the relationship with the deceased and her or his meaning for the griever. Naturally,
one does not always wish to engage in pain, but in order to allow the integration of
ongoing life with the meaning of the significant, lost other, it is necessary to re
experience and reaffirm (and re-embody) the part of the self which is also felt as
missing. This is not a process that is encouraged by society or the standards of
traditional grief theory where the focus on final "resolution" may actually lead to a
blunting of pain and the significance of grief to the extent that it becomes denial.
Tittensor (1984) refers to finding the balance between what I call presence and
absence as finding the balance between love and loss, and "spending] time creatively
with my loss" (p. 40), what he terms a "private ritual," in facing "the clash between
my enduring love for the kids and the fact of their irrevocable absence." He
continues,
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There’s nothing at ail mystical about it and as an exercise it often leaves me in
tears; but it somehow helps me in the struggle to reconcile myself to their
death. Because there is a place where in a particular way I can feel myself
with them, I am able to see the world as still habitable, as a place in which
love and loss can find some sort of balance, (p. 40)
Relation to Other Disorders and Problems of Diagnosis
Clearly, responses to bereavement therefore are necessarily influenced by past
losses as well as the disposition of griever. However, as Merlis (1972) suggests,
often in what is considered pathological grief there may be a preexisting pathological
personality disorder which is exacerbated by bereavement and grief. And, as Rando
(1993) and Sanders (1989) indicate, the nature of the bereaved’s "accommodation"
(Rando, 1993) to previous losses influences the handling of subsequent losses. In
some cases, this could be viewed as facilitative (Bomstein et al., 1973; Vachon,
1976).
In addition, depression is one of the frequently considered diagnostic
alternatives to "uncomplicated" bereavement, as either a criterion for poor outcome,
or a clinical complication of bereavement (e.g., Bomstein et al. 1973; Bruce et al.
1990; Briscoe & Smith, 1975; Clayton et al. 1968; Kim & Jacobs, 1991; Jacobs et al.
1989; Zisook & Shuchter, 1991). Other psychiatric disorders (e.g., anxiety, phobias,
dissociation) have also been considered in association with grief (Jacobs et al. 1990;
Raphael, 1983). Schut, de Keijser, Van den Bout, & Dijkhuis (1991) suggest that
bereavement can trigger posttraumatic stress disorder (PTSD) symptomatology, and
Horowitz (1976) specifically implicates sudden death as sometimes inducing a
traumatic stress syndrome in the bereaved. The overlapping of features of
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bereavement loss and grief with various diagnostic pictures raises the question of
whether we may consider grief as (a) co-occurring with different disorders, (b)
partaking of some of the same features or symptoms as these disorders, and/or (c)
changing from being grief (i.e., "uncomplicated bereavement") into being something
else, such as anxiety or depression.
Both the DSM-IH-R (1987) and the DSM-IV (1994) caution that the duration
of "normal" bereavement may vary considerably among different cultural groups
(DSM- m-R, 1987, p. 362; DSM-IV, 1994, p. 684), but that and the implication that
"symptoms" should abate at the end of two to three months, are the bulk of the
guidelines provided by the DSM. The DSM-IV reflects the tendency to differentially
diagnose grief as depression in adding that "the diagnosis of Major Depressive
Disorder is generally not given unless the symptoms are still present 2 months after
the loss (p. 684). Otherwise, without providing an explicit category for complicated
bereavement or "abnormal reactions" (as Marwit, 1991, remarks regarding the DSM-
m-R), the manual is punctuated with instances of when the clinician should not
diagnose grief as a disorder (see, e.g., DSM-IV, 1994, pp. xxi, 326, 626). Even
with the above exclusions, however, the DSM-IV notes that Major Depressive
Episodes often follow severe psychosocial stressors such as the death of a loved one.
And in describing "normal" bereavement, major depression is the one disorder the
DSM-IV specifically mentions as being symptomatically consistent with bereavement
and pathological variation.
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Use of the American Psychiatric Association’s diagnostic and statistical manual
to determine whether grief is pathological, or whether it represents or has moved into
other diagnosable areas such as depression or obsessive personality disorder, is
problematic for several reasons. On the one hand, grief may appear descriptively and
diagnostically undifferentiated in the variable, somewhat arbitrary time frame DSM
uses to construe it as a disorder. On the other hand, aligning grief on a continuum
with, for instance, depression, (following in the steps of Freud in Mourning and
Melancholia. 1917/1959) fails to consider the types of depression, anxiety, and effects
of trauma likely to occur in grief as opposed to other disorders. Three interconnected
issues present themselves in considering a DSM diagnosis relating to grief, aside from
the question of whether grief or bereavement be included in the DSM at all (that is,
aside from the question of whether grief in itself should be considered
"pathological"). These issues concern whether and how grief co-occurs with other
syndromes or states that are considered disorders, whether parts of these syndromes
or states are inherent aspects of grief responses, and whether grief can be
conceptualized as changing from one form or state into another. Obviously, these are
complex matters which cannot be addressed fully in the present study. However,
since grief is not adequately treated in the DSM, but is mentioned in terms of being
"uncomplicated" or "normal," it follows that diagnosis of grief related to depression
or other symptoms may be imprecise.
Also in respect to anxiety and adjustment disorders, the diagnostic criteria
given by the DSM do not fully articulate the possible role of bereavement and grief in
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these diagnoses, although as with disorders involving depression, the specter of
bereavement, death or severe loss is continually present (e.g., "actual or threatened
death," "serious injury" (p. 424), "threat to physical integrity of self or others" (p.
427). Lack of explicit provision or concern with any relationship between
bereavement and posttraumatic stress disorder reflects, perhaps, a tendency to rely on
a "defect" model (Albee, 1981) in considering grief. Although grief has been
associated with traumatic syndromes in some instances (Musaph, 1990; Horowitz,
1976; Schut et al., 1991), simple bereavement is not included in the DSM as a
possible stressor in the development of posttraumatic stress disorder. As Fowlkes
(1991) indicates, the designation of posttraumatic stress disorder recognizes the
overwhelming, usually gruesome nature of the circumstances of a particular loss; and
in melancholia or depression associated with grief, it is the "flawed individual" (p.
531) who represents the context for the diagnosis. Whether we view an experience as
inherent in a person’s situation or in the person him or herself obviously influences
our notions of normalcy and pathology.
The DSM’s appellation uncomplicated bereavement appears suitable if we
consider that bereavement of any kind is a trauma, and that the more traumatic the
circumstances of death, the more complicated the situation becomes. Very few deaths
are simple.- Bereavement and symptoms of posttraumatic stress disorder often
2/ And "complicated" deaths seem to be on the rise. As Rando (1993)
indicates, with the current social climate as well as medical and technological
advances, more deaths currently may be considered traumatic or un-natural in the
sense of being sudden, unexpected, violent, or random rather than in the recent past,
and Rando attributes these as factors leading to a greater prevalence of complicated
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overlap (Schut et al., 1991), and "anniversary reactions" to bereavement, commonly
referred to in the literature on grief (Raphael, 1983; Sanders, 1989) can be viewed as
a symptom of both traumatization and grief (Musaph, 1990).
There are several ways to view complicating traumatic circumstances. Many
theorists partially account for variability in grief response by referring to such
additional traumatizing circumstances as a source of pathological mourning.
Lindgren, Burke, Hainsworth and Eakes (1992) take the alternative view that chronic
sorrow is a response to a difficult and complicated life situation rather than a variant
of pathological grief or depression. As mentioned earlier, Fowlkes (1991) calls
attention to the traumatizing aspect of loss through death, even if that loss does not
fall within the guidelines of DSM criteria for posttraumatic stress disorder. Fowlkes
also emphasizes that the dichotomization of circumstance and individual in the
diagnostic separation of posttraumatic stress disorder from depression and other
sequelae associated with bereavement conforms to what Albee (1981) refers to as a
defect model.- Here, I take the position that all death is potentially traumatic in that,
mourning. Raphael (1983) also suggests that one out of three bereavements results in
"morbid outcome or pathological patterns" (p. 64). From this vantage point by itself,
the possibility of "pathological" or "complicated" grief would not seem to be atypical.
8/ In a defect model, most problematic experiences in a person’s life are
attributed to problems within himself or herself. Efforts are thus directed at changing
the person, and not the situation. While the situation necessarily involves social,
economic and political constraints, it may also involve existential givens like death
which have also been largely ignored.
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affecting the loser at a basic existential level, death represents the annihilation of
another human being. Further, such annihilation must be traumatic if we care deeply
about the person who has died.
Prevailing grief theories, of which Lindemann’s (1944) might be said to
represent the academic foundation and Kubler-Ross’ (1969) the pop-prototype, are
especially suitable for describing this level of traumatization, as they focus to a large
extent on the griever (or the person dying, in Kubler-Ross’, 1969, case) being unable
and/or unwilling to accept the fact of death and the attempt to refute or disclaim
reality, whether it be through "protest" and anger, "bargaining," or "searching" for
the lost one. The process of "resolution" is really a process of accepting the
traumatic reality of death and loss.
As my experience conveys, the trauma of death and the circumstances
surrounding or leading up to death are necessarily entangled. Yet the response to the
surrounding trauma may be more apparent in early or acute grief, making later grief
at loss of death more differentiated from the grief of the related trauma. I therefore
distinguish two types of trauma, the trauma of death itself and the traumatic
circumstances of loss. In examining grief, we must consider both the strand of
trauma relating to death in itself, and that relating to the particular circumstances of
death. In my experience, although the strands are continuously entangled, there are
some signs that they differentiate.
Finally, the DSM-IV (1994) makes a point of addressing ethnic and cultural
considerations, but one must remember, as Fabrega (1987) notes about the DSM in
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general, that the manual does not reflect real, true entities as much as a set of cultural
assumptions. Dependence on the DSM-m-R to reach the correct diagnosis,
presumably used by the clinician as a tool for understanding the client and
formulating a treatment plan, neglects cultural, familial and individual differences not
adhering to the DSM-ID-R’s assumptions. Yet (at least in the past), as Eisenbruch
(1992) points out, the "culture-free" DSM-in and DSM-IH-R have been used as
clinical templates with professionals subordinating their own cultural and ethnic
knowledge to the authority of the DSM. The categories of culture-bound syndromes
suggested in the DSM-TV provide a gateway but not a precisely delineated road for
the understanding of individual-cultural differences.
Verifying the Proposed Model
While my own case, presented in Chapter 4, is in some sense a "test" of the
suggested approach, here I will examine several additional case studies drawn from
the literature and clinical experience to verify or illuminate how well the proposed
theory might be used to explain the variable experience of grief in contrast to
prevailing views.
A problem in this type of verification is the difficulty of finding cases in the
literature which are not presented as "pathological" or "complicated." The view with
which cases are submitted is often to prove the point of pathology, and this desire
may affect the details selected and the way the material is presented. Many do not
include a lengthy history of the bereaved or one spanning at least several years, so it
is not possible to extrapolate the subtleties, deviations, or recurrences in the person’s
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experience and the meaning of the relationship lost, or the complete context for
ongoing symptoms of depression, anxiety, anger, longing, distress, and other possible
grief-related concerns. Further, the material presented often suggests pathology in
areas which may or may not be discrete from the grief described, thus requiring a
theoretical "jump" to infer that pathological grief causes depression, or a personality
disorder causes pathological grief. Additionally, many of the cases we see presented
in the literature (and perhaps in life) are complicated by one factor or another and
often by several, making it difficult to determine "normal" grief even if we can spot
that something is wrong.- These are excellent reasons for conducting longer-term
case studies of bereaved individuals, including a substantial number who do not
"present for treatment."
Vignette #1 (from Jacobs, 1993, pp. 33-36)
Ms. B. was a 59-year-old businesswoman whose husband died unexpectedly
and suddenly from a cardiac arrhythmia secondary to a pulmonary embolus.
From the room adjoining the one in which her apparently healthy husband was
working, Ms. B. heard a thud and had a premonition that something was
dreadfully wrong.............. within seconds she found him unconscious . . .
"knew immediately that he was dead," .... Ms. B. called an emergency
9/ In one example, for instance, Jacobs (1993) describes a "pattern of coping
that was associated with good mental health outcomes" (p. 127) only to state,
[I]n response to a query about the intensity of his separation distress, Mr. G
flippantly replied, "I haven’t thought about cutting my throat." (p. 128)
and
He was not hospitalized at any time during the first 2 years of bereavement.
All was not well, however. When the same psychiatrist who did the original
psychiatric interview met with him once again 2 years after the death of his
wife, he recognized heavy drinking . . . (p. 129)
Jacobs reports Mr. G dying four-and-a-half years after the death of his wife at age 67
"from a compound fracture .... The circumstances of his death were obscure" (p.
130).
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number, and within minutes an ambulance was there. Her husband was taken
to a local emergency room where he never regained consciousness.
Ms. B’s close-knit family of adult children and their spouses rallied
around, as did the neighbors .... Initially swept up in the funeral
arrangements, she carried herself through the first several weeks with poise
and reserve. She stoically faced and made the best of two major holidays
within 2 months after the death.
[Dr. Jacobs] first saw Ms. B. about 2 1/2 months after her husband’s
death when her separation distress, which was strong though not yet disruptive
of function, was intensifying. There were moments when the distress was so
intense she felt "like crawling out of my skin." She worried that it would get
worse and wondered "how much I can take." In addition, she needed to
periodically review the intellectual dissonance caused by her husband’s sudden
death. This was associated with a different type of distress that she described
as "a stabbing injury" and a "shock." She knew that her husband was dead
and gone; still, she could not believe it. She also had several depressive
symptoms that did not meet enough criteria for a diagnosis of major
depression. On the other hand, she importuned me for some sort of treatment
to relieve the intensity of her distress. She was already using diazepam
intermittently as prescribed by her family doctor, and it did not relieve the
symptoms. She wondered about the use of antidepressants.
The intensity of her grief continued unabated and within a month she
developed more depressive symptoms that now did meet sufficient criteria for
major depression. She began to wonder if she would be able to keep going
and get herself to work every morning. I encouraged her to ride out this
period with psychotherapeutic support but without the use of antidepressants.
This was done with the understanding that if the symptoms did not begin to
subside by 4 months after the loss, I would recommend antidepressant drug
treatment. Within another 2 weeks she began to report nighttime panic attacks
and the fear that she would "lose my mind." She described how she felt
"angry and cheated" by her husband’s death; however, this anger was not
directed at anyone in particular. On the verge of starting antidepressant drugs,
she appeared for the next appointment reporting that she had experienced a
few good days after a recent nighttime panic attack. This pattern of
improvement continued for 3 months while she remained in weekly
psychotherapy. With the end of the school year and an imminent summer
vacation, she ended therapy with the conviction that she could manage on her
own.
Ms. B. had no history of psychiatric disorders. On the other hand, she
believed that her father, who had divorced her mother and left the family when
Ms. B. was 7, had been depressed in his later years, and one of her siblings
had been hospitalized multiple times for major depressions and substance
abuse.
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Ms. B. appeared for treatment again a month after the first anniversary
of her husband’s death. This time she presented with a full-blown depressive
syndrome and persistently intense separation distress. The holidays had been
very difficult for her. She was progressively symptomatic and ruminative
about a winter vacation, a long-standing family tradition that would require her
to leave home, the current locus of most feelings of closeness that she
preserved for her husband. . . . Her family role since the death of her
husband had become a painful reminder of her husband’s absence. She no
longer had a sense of security and safety as part of a stable community to
which she and her husband had belonged. The anniversary of her husband’s
death and the winter vacation served to uncover her unresolved, unremitting
grief.
Ms. B. abandoned the idea of the vacation trip after careful
consideration. She was treated with desipramine unsuccessfully because the
drug precipitated a pharmacological panic attack .... Nevertheless, she made
a slow recovery in psychotherapy over 5 months and again left treatment at the
beginning of the summer vacation.
Ms. B. returned to treatment for a third time at . . . the second
anniversary of her husband’s death with the same symptomatic picture of
major depression and intense separation distress as after the first anniversary.
The salient difference for her, when she compared this with earlier episodes,
was her current preoccupation with "accepting the permanence of being
unmarried and coping with the insecurity of no longer being a member of a
protective community." . . . it became clear that there were still painful
reminders of her husband’s absence on the occasion of births of grandchildren
and on the marriage of one of her children. At these times, her separation
distress continued to be intense. For the first time she reviewed in detail the
circumstances of her husband’s death and how traumatic it had been for her.
She still differentiated the pain of the trauma (like an injury) from that of the
separation distress with which she now "felt more comfortable." though she
knew her husband was permanently gone, she still count not "accept" this fact.
Because of a recurrent depressive syndrome she was started on nortriptyline,
which caused essentially die same adverse reaction that desipramine had the
year before. She described her condition as a state of alarm and panic over
the depressive symptoms with the fear that she would lose control and need
hospitalization. Again the medicine was discontinued after a short, inadequate
trial. She remained in psychotherapy another 5 months during which she
expressed her separation distress and traumatic distress much more openly.
She said the she no longer felt that she had to prove herself by mastering it
promptly. She was prepared to accept her unmarried status and handle the
consequences of her loss as they came up over the course of her life. She
made improvements, despite another failed trial of antidepressant medicine,
and again left treatment at the time of an imminent vacation.
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As illustrated in the above summary, Jacobs (1993) regards separation distress as the
linchpin of pathological grief, which he likens to an adult variety of separation anxiety
disorder in children. Needless to say, Jacobs regards Ms. B’s case as an instance of
pathological grief, mainly however, because of "intense separation distress that felt
overwhelming" (p. 35). Neither the depressive episodes, nor the progression from
numbness to separation distress to depressive symptoms, Jacobs states, were essential
for this diagnosis. Jacobs considers the traumatic element of Ms. B’s distress an
"independent dimension," though he states it may have contributed to prolonged grief.
The complications here, Jacobs says, stem from the loss as a "vector of disease" (p.
36).
From Jacobs’ fairly comprehensive summary of the death of Ms. B’s husband
and the treatment she received, it would be possible to delve into a variety of issues,
but I must confine myself to addressing some of the major points that I assert in the
proposed model: the nonlinearity of grief, its possibly recursive painfiilness
interplaying with both inner and outer events, the interwebbing of trauma related to
death, the particular significance of the relationship lost, the growth of the griever in
continuing to integrate and differentiate loss and accept change on a variety of levels
and at the same time be fundamentally faced with the paradox of loss and death.
From the vantage of the proposed model, it makes sense that Ms. B’s grief
would not simply "abate" after approximately three months, and that the apparent
closeness of her relationship with her husband and the traumatic nature of this sudden
loss would be cause for intense distress including panic, with shock, survival, and
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existential issues all possibly implicated in the latter. As time progresses, she herself
is later able to differentiate the pain of the trauma from the pain of the loss. The fact
that she has a close circle of family and neighbors highlights the significance of her
unique relationship with her husband. Her "non-acceptance" of her husband being
gone seems to be an emotional rather than factual non-acceptance, signalling a
recognition of the uniqueness both of him and their relationship. Secondary losses
and deprivations, including role loss, are added to this burden of relationship loss.
Ms. B returns to therapy twice after the anniversary of her husband’s death, a
"trigger" that in the proposed model makes sense as eliciting not only a resurgence of
grief-ful feelings, but also a reevaluation of Ms. B’s ongoing situation in life and how
the loss affects it. Not only does she come to appreciate and differentiate the
entangled effects of trauma and loss, she seems to become able over time to accept
herself more and the grief-ful feelings that arise intermittently: She "no longer felt
that she had to prove herself by mastering it promptly" (p. 35), an indication of
growth in the proposed model.
A few points concerning treatment may bear on the understanding of this case.
One is the implication that Ms. B left treatment, usually after about five months, for a
summer vacation; but it is not clear whether this was the treatment plan of the clinic
or organization she was being seen in, or whether she herself chose to end therapy.
Second, the problems arising with Ms. B’s experiences with antidepressant medicine
raise issues about the nature of Ms. B’s depression (the differentiation between Major
Depression as described in the DSM and depression resulting from and related to
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grief). Finally, it seems clear from this summary that Ms. B benefitted from
psychotherapy, presumably from talking about her loss, "telling the story" and in this
way expressing her grief as well as disentangling and reintegrating its effects.
Vignette #2 (from Sanders, 1989, pp. 83-84)
[S]ome will opt to maintain their lives with as little change as possible. An
example of this is a 55-year-old widow, Mrs. Walsh, who was married to a
successful television executive for 32 years. Mr. Walsh died suddenly of a
heart attack in his office. The shock and grief Mrs. Walsh experienced were
profound, but she tried to maintain a brave front. She grieved privately, for
as she said, "No one wants to see a sad face." She never cried in front of her
family, but she told me that often she would cry all night in her room when no
one could hear her. Everyone commented on how wonderfully she was getting
along and as she said,
You just have to live through it, that’s what I’ve heard. We always
thought widows were great, that they got along so well, but you don’t
know until you get into that situation. There is no choice ....
Mrs. Walsh had grown up in Tampa, so she was surrounded with a
loving family and friends. There were few changes in her lifestyle. She built
a small home next door to the large family house so that her daughter and her
family could occupy the larger one.
Underlying all this, she said, was a large degree of aloneness, not
loneliness. She went to several parties but felt like she was the "odd man"
during the evening activities when husbands were included, so she decided
only to go out to lunch with her friends. She said that she would rather stay
home in the evenings alone.
There was a sense of desperation in her voice as she told me that she
felt her life was over. . . . She feels old now. It was her husband who had
made her feel young, she said. It was not that she would object to
remarrying, but it would have to be someone who had the same friends, the
same lifestyle .... Even so, she added, she could never start over with
another husband at this late stage.
Mrs. Walsh made the decision to go on as before, maintaining her
contacts with friends and family as always, still feeling married, only with a
missing husband. Grief for a lost lifestyle finally replaced the grief for her
husband.
The tone of this report is markedly different from the one preceding it in that it
empathically joins the griever’s world and instead of focusing on issues of pathology,
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emphasizes developmental change and individual choice. Here, Sanders portrays
nonjudgmentally and positively one of "three choices" of bereaved individuals. She
describes these as a "decision either to move forward— and in doing so relinquish the
past as it had been lived with the deceased— or to remain in the status quo, not making
any changes"; the third choice, "seldom discussed as an alternative, but . . . selected
far more often than is realized . . . [is] the decision to die" (p. 82), which can be a
conscious or unconscious decision.
The present case she describes as deciding to "maintain the status quo."
Interestingly, Sanders makes no comment on the attempt to "maintain a brave front"
or the lack of sharing her tears with others, features which might be considered
pathological or likely to lead to a "poor outcome." While, as the next two examples
demonstrate, such restraint may be associated with difficulties, here Sanders conveys
how the behavior fits into Mrs. Walsh’s personality, coping style, and level of
maturity and experiences. From the point of view of the proposed model, Mrs.
Walsh’s relationship with her husband, as well as her age, experience, and lifestyle
determine how she integrates the death and goes on with her life. While there
appears a sense of some despair and anxiety at death and getting old, it is not clear
from the description how these experiences may have transmuted. At the end of the
description, the focus on the "lost lifestyle" implies an integration of the loss into a
larger existential picture, as well as the realization of important secondary losses.
The fact that the narrative ends here does not indicate that Mrs. Walsh’s future is
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firmly decided and static, only that she has made some decisions up to this juncture
which were consistent with her personality and coping style.
Vignette #3 (from personal clinical experience)
Eve was an intelligent, attractive 20-year-old who was planning to enter the
health care profession when she presented for psychotherapy with the
complaint that she felt she hadn’t completely grieved for her mother and
needed to do this in order to "move on and let go." Her mother had died
when Eve was an adolescent; at this time her parents had been divorced for
several years and Eve was living with her mother. After her mother’s death,
she went to live with her father and stepmother.
Although Eve’s father initially sent her to a counselor, no one in the
family had talked about the loss. Eve stated she had numbed herself after her
mother’s death and had been depressed much of her life. Only recently, she
reported, her symptoms had worsened. She complained of relationship
problems and expressed being angry at her father and felt that he provoked
her. She felt lonely and depressed, had few friends, and felt it hard to be
away from home, although she hated living with her father and stepmother.
She reported eating little, had difficulty sleeping as well as concentrating,
brooded about things, and had crying spells (which she did not view
positively). Eve’s affect was somewhat constricted, and at intake it seemed as
if she had rarely been encouraged to explore or express her feelings.
Nonetheless, she reported some dreams she had felt were intuitive but that she
had difficulty accepting.
Eve agreed to a course of brief therapy in which initially she presented
with a number of "frame" issues, sudden changes in plans/therapy goals and
small "crises" and "emergencies." She soon changed her explicit goals for
therapy and instead of talking about her grief wanted to become more assertive
with her father. Affect at this point was very constricted.
Over the course of the next five sessions, we developed a rapport and a
working alliance using the genogram and family photographs as assessment
and therapeutic tools. Eve appeared, superficially, conventional, organized
and rigid, needing to hold things together and contain herself affectively, while
the chaos she felt within was enacted in the form of "emergencies" and
breaking therapeutic frames. The genogram appeared to have a stabilizing
effect upon her; it brought her history and her family into the room, and it
allowed her to join with me. In our work with the genogram and photographs,
stories about herself and other family members gradually emerged which
increased my understanding and seemed to give Eve more of a solid footing in
the world of object relations and selfobjects, as well as a chance to express her
feelings gradually and without feeling intruded upon.
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The genogram work revealed secrets in the family, death of siblings
nearer Eve’s age than her living brother and sister, patterns of early and
unstable marriages and early childbearing, and a pattern of no or conflicted
communication in sub-families— fathers not speaking to offspring or disowning
them, as now seemed to be Eve’s position with her own father. The
overarching theme was of a big family with no interconnections, emotionally
cut-off, distant, and secretive, mirroring Eve’s constricted affect and chaotic
inner life (rigid and contained on outside but interspersed with sudden changes
in plan, "crises” or "emergencies"). Father emerged as a controlling,
domineering, alcoholic man who gave mixed and inconsistent messages. Eve
was intimidated and angered by him, and when the stepmother and father were
together, she felt overwhelmed. Eve reported still feeling a close relationship
with her dead mother, occasionally smelling her perfume and feeling as if she
was "looking over her shoulder."
Working with Eve’s photographs allowed me to traverse her childhood
with her, looking at them and discussing relationships and family/personal
events she remembered. In one session of looking at photographs, seeing a
picture taken of her bedroom at her old home, Eve recalled the upheaval she
felt when her mother became ill, and relatives came to stay and help, and how
her mother and Eve had moved to a much smaller wing of the house. Upon
her mother becoming more and more fatally ill, Eve described an older
relative who came and whisked Eve away, taking her to her father’s house and
not letting her say good-bye to her mother, whom she never saw again. In
addition, all mementos that had been left in the house were cleared away by
other relatives and Eve was again deprived of a kind of rapproachment with
her loss. The rest of the family, according to Eve, showed no expression of
grief whatsoever and didn’t encourage Eve to.
In the course of the sessions, Eve moved closer to talking about her
mother, and also to her other goal of dealing with anger at her father,
revealing his demanding and inconsistent character and Eve’s dependent yet
unnurtured, conflicted position with him. Eve’s need to become more
autonomous, her growing up, and the way this conflicted with the loss and
feeling of unresolved grief of her mother, her need to be taken care of and her
difficulty expressing this need, as well as her conflicted relationship with
father, became manifest.
At midpoint in therapy, Eve became ill, and this brought many of the
issues of separation, dependency and autonomy to the forefront for her. In the
final 3 sessions, neither genogram nor photos were necessary or called upon.
Eve began to express more affect, recounting her vulnerability, her fear, anger
and loss, and reflecting upon what she wanted in life. She planned to move
home temporarily with father and stepmother, as she did not feel ready to be
so far away from friends, and home itself, and also for financial reasons.
Separating and new strategies for coping then became foci and continued so
the last two sessions. At the treatment’s end, she had begun to deal with both
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her major "goals": She had begun more openly grieving her mother by
remembering her, evoking her presence, expressing her loss, and nurturing a
new relationship with her; she had begun openly expressing her anger toward
her father, exploring their conflicted relationship, and tentatively trying to
assert herself. She realized that in both areas there was more to be done, and
was concerned that her move back home might again frustrate her
development.
From the beginning complaint of this client, it would appear that she was suffering
from a case of "pathological" grief. Lindemann would most likely see something
"morbid" and "distorted" about Eve’s grieving, particularly manifested in her
constricted affect and numerous somatic symptoms. From the perspective of
prevailing grief theory, Eve would undoubtedly be viewed as "stuck." From the
vantage point of the proposed model, however, although Eve presents as depressed
and having psychological difficulties with regard to her relationship with her dead
mother, this is perceived not because she failed to "resolve" or complete her grief,
but rather because she did not begin it, or more accurately, did not continue it.
Further, because Eve suffered a profound loss and displayed constricted affect,
somatic and depressive symptoms, does not mean that her loss per se should be the
linchpin to her malady. Instead, Eve’s particular mode of being in the world could be
viewed as reflective of Eve’s situation even before her mother died. Eve’s grieving
was indeed frustrated and even forbidden at many turns, but rather than labelling her
grief as the problem, it would be more accurate to construe the family dynamics as
contributing to a host of issues, including a non-acceptance of the expression of loss.
As indicated, "the overarching theme was of a big family with no interconnections,
emotionally cut-off, distant, and secretive." Once again, no case is uncomplicated.
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That Eve’s mother died at all necessarily contributed to her having to live with her
father and stepmother, whose way of being and interacting may have been
significantly different from Eve’s mother’s. If Eve’s mother had lived, she may have
exerted a more positive influence in supporting and nurturing Eve with the result that
Eve may have been able to express her feelings more easily and cope better.
However, it is difficult to ascertain whether this would have been so.
Eve’s grief was complicated by events and issues in her past history and by
her way of coping with them. The style she adopted necessarily affected not only her
grief but her life overall-her schooling, her relationships, her love life, etc.
"Pathological grief," therefore, was not the cause of her suffering or problems, but
her problems overall did interfere with grieving her losses.
Nevertheless, Eve’s need to dialogue and internalize her mother continued to
manifest itself, sometimes in dreams, and her attempt to come to terms with the
separation caused by death, the existential givens, and the unknown. These attempts
were more transformative and seemed to have more positive influence with the rest of
her life (her career, relationship, and academic ambitions) when she was socially
supported in recognizing their importance to her and able to express them and their
relation to her self.
Bowlby (1980) provides a vivid example of a comparable familial tendency to
"bottle up" emotional expression in the following.
Vignette #4 (from Raphael, 1975, cited in Bowlby, 1980, p. 159)
Soon after the second anniversary of her husband’s death Mrs. O presented in
a state of psychotic depression. Prior to breakdown she had appeared, at least
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to her children, to be dealing well with her loss. She had neither cried nor
spoken of her husband at any time since his death; but each morning she had
placed his clothes out as usual, and each evening she had set his meal at the
time of his expected return from work. The children described how proud
they were of their mother’s fortitude and how they never referred to their
father because they thought the two had been so close that it would be bad for
their mother to be reminded of him. After her breakdown she confessed that,
unknown to her children, she had carried on long conversations with her
husband every night.
During therapy Mrs. O was encouraged to talk of her husband and their
relationship in considerable detail, aided by family photographs, and to express
her feelings in an atmosphere in which they were accepted as natural. In this
setting she wept for the first time. Initially she dwelt on her husband’s good
qualities and insisted that he had met her every need, loved her and protected
her. Only later was she able to admit how much she had always depended on
him and how angry and helpless she had felt at what had seemed to her to be
his desertion, (p. 159)
From the above two examples, it seems that the public (and sometimes
professional) understanding of criteria for "health," well-being, or social order in
general, may often be at odds with what might be beneficial to the griever. In
particular, many of Bowlby’s (1980) as well as others’ (e.g., Lindemann, 1944;
Jacobs, 1993; Sanders, 1989) case examples illustrate that the inhibition of emotional
expression of grief is painful and stressful to the griever if not pathonogenic.
However, rather than being purely the deficit of the griever (as is implied in such
"diagnoses" as "delayed" or "inhibited" grief), there often seems to be a complicity
with the family and perhaps society as a whole that he or she should not "break
down" or "give way," contributing to the conflicting and difficult position of the
griever who is probably particularly in need of social support. Further, these social
prescriptions may be pathonogenic to the griever. As indicated in the model
proposed, it is the continuing ability to negotiate loss that is indicative of health or
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development, rather than either preserving the deceased statically (as in Mrs. O’s
case, acting initially as if he never had died at all), or severing (or seeming to sever)
the bonds so completely as to not be able to continue to acknowledge the changing
impact of the loss. However, being able to confront and continue to negotiate one’s
response to loss is not accomplished by the bereaved alone, but in cooperation with
society as a whole as well as her or his circle of intimates.
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Chapter 7
Implications
Although what has been suggested here is only the beginning of a theory
which will require continued modification in aligning it to a diversity of possible
experiences, as Stake (1995) remarks regarding case study, the proposed model
provides a basis to modify generalizations and to add to previous understanding. The
most significant implication of the model is what it offers to grievers in terms of the
depathologization and diversification of grief. Developing the model included
questioning the assumptions that have guided grief theory for the better part of a
century, and by explaining why these assumptions do not fit experience, provides
insight into why grief may not end, and why grieving or grief-like experiences may
reemerge at different points in time, perhaps far removed from the death.
By integrating research and theory in the areas of self and other, memory and
emotion, as well as personal material, I have also contributed to an explanation of
how the experience of grief may not necessarily be expunged but instead become
incorporated into the self. This will offer not only a more comprehensive picture that
will connect grief with other bodies of knowledge, but will help ameliorate blind spots
caused by the bifurcation of the researcher and the subject, the neglect of context, and
the presumption of neutrality which in the past may have obscured issues such as
illness, loss and death.
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The proposed model provides a way of understanding grief as something that
cannot be compacted into a rigid time frame, and as an experience with a number of
unique features which may yet bear much resemblance to other psychological
difficulties, such as depression and posttraumatic response. Such a model will
provide clinicians, researchers, and lay people with an alternative to the stage
approach and "‘saying goodbye’ metaphor" (White, 1989) which, though prominent
in our culture, may be invalidating and detrimental to the griever.
Unfortunately, because of the prevalence of the linear stage/phase approach to
grief, individuals in pain often look to this "recipe" for help, as in Hillman’s (1992)
I looked between the rows of books, between
griefs "stages"—
they lied, of course; grief has no stages— (p. 39)
However, not only might they find the theory lacking (presenting them with another
disappointment and loss), but because of the pressure of scientific and pop culture to
accept this recipe, they may find themselves "crazy" or be counseled that they "need"
psychotherapy. White (1989) writes that, "well acquainted with the map for the grief
process that is informed by the ‘saying goodbye’ metaphor," grievers know that they
[H]ave failed, in their grief work, to reach the appropriate destination. They
‘know’ that their arrival at this destination will be evidenced by a fully
experienced ‘goodbye’, acceptance of the permanence of the loss of the loved
one, and a desire to get on with a new life that is disconnected from that
person." (p. 29).
The saying goodbye metaphor, White says, does not enrich or empower persons who
are diagnosed or consider themselves pathologically mournful or delayed, those
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persons who often come to therapy with a sense of desolation at their failure to
complete "grief work," but instead serves only to complicate their situations.
The "saying goodbye" "map" and stage metaphor are ones that clinicians are
also well acquainted with. Rigid adherence to current Western stage/phase models of
grief interferes with the psychoeducational and psychotherapeutic care we provide to
clients, as not being aware of but following the assumptions and values embedded in
much grief literature may lead us to misrepresent grief and mis-diagnose it. An
implication of the present work is that by dismantling some of the assumptions that
inform our literature on grief, and comparing these with the diversity and complexity
of grief, it may help us to recognize when we are imposing our sociocultural/
theoretical value system, or our own personal concerns about death and grief, on our
clients. Further, being more attuned to the variability of individual grief response
will help us differentiate it from and, in some cases, see how it annexes, combines
with, or subsumes other experiences, such as depression or posttraumatic stress
disorder.
In addition to pathologizing people, construing grief as a linear, time-limited,
normative event may shape how they experience themselves and grief and thus hinder
them in their own self-experience. Rather than encouraging people to respect
themselves and their own process, a grief model which rigidly teaches people that
grief is somehow separate from themselves, and that the definition imposed by society
is the correct way to feel, is disempowering.
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One of the major problems of prevailing approaches to grief is the treatment,
explicit or covert, of grief as pathological or needing to be fixed. And one of the
most important implications of this study is the suggestion that it would be more
helpful to the bereaved to view grief not as something wrong to be fixed or cured,
(although the pain of grief will, hopefully, become easier to deal with in time) but a
natural response to the loss of a beloved. That the bereaved does not have to
complete certain "tasks" in order to successfully grieve-namely "letting go" of the
dead person, feeling the requisite emotions such as anger, sadness, shock, but does
have to feel the loss and what it means to her or him.
The most disruptive and damaging of society’s attitudes towards grief and
death are, Gorer (1965) states, its tendencies to deny or ignore grief, to regard it as
morbid, and to maintain very little in the way of ritual to deal with grief. Gorer
states "adults need help in living through the phase of intense grief; but I question
whether they can appeal for help at all explicitly in a society, such as contemporary
Britain, where the majority wish to ignore grief and treat mourning as morbid" (p.
151). Feifel (1977, 1990) asserts that it is lack of community sharing that is
maladaptive. Suppression, minimization and failure to acknowledge grief, he
indicates, makes what could be a healing process, harmful instead. The tendency of
our current ideology toward grief, like the "bottled-up" affect illustrated in some of
the case examples of Chapter 6, is to "put a lid on it" as soon as possible. Like other
traumatic responses, grief may be viewed as extremely uncomfortable, distressing,
and even dangerous to onlookers. (Indeed, there is some research indicating that
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listening to traumatic stories could have a negative effect on the hearer’s physical and
mental well-being, Harber & Pennebaker, 1992.) Nevertheless, not being able to
grieve openly could be pathogenic.
As mentioned, lack of support has been attributed to a variety of bereaved
people’s psychological, adjustment and health problems (Maddison, 1968; Maddison
& Walker, 1967; Parkes, 1987; Sheldon et al., 1981; Vachon et al., 1982) as well to
their subjective distress. While sometimes it is problematic to say exactly how the
bereaved should be supported, one of the chief modes of support, besides offering
one’s ear, one’s empathy, and practical support, is to see the bereaved’s situation as
normal (and thereby allow the bereaved to see and be supported by this knowledge).
That is, to appreciate grief as a normal reaction to a situation which, though not
abnormal in the natural scheme of things, is experienced existentially as abnormal, to
recognize that grief responses may vary greatly, and that they may recur at much later
intervals after the death.
Although the griever is in great need of support directly after the death, the
pathology model of grief fostered by stage/phase approaches denies much long-term
support unless it is agreed to be under the rubric of mental illness. This kind of
"support" may be counterproductive and harmful. On a recent radio program
concerning American attitudes towards death and grief, a female caller described her
experience sitting with a dinner party of acquaintances when, after talking about a
recent bereavement, she began to cry. Another guest promptly suggested she try
"grief therapy." The woman’s discerning reply: "This is it."
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As this caller’s response indicates, our "grief therapy" should first be to allow
ourselves and others to grieve without trying to cordon grief off to specific places and
functions often associated with pathology and needing to be fixed, such as therapy
(although therapy may and should be helpful, nurturing, and supportive). As I
mentioned earlier, and as the examples from Lewis (1961) and Gorer (1965) well
illustrate, bereaved individuals are often ostracized or treated as if they were
"carrying a disease" (Tittensor, 1984, p. 82). One is existentially and socially
isolated as there is no validation, Tittensor complains, "no assistance readily at hand
for the business of accepting that what has happened is possible” (p. 61). True to
Gorer’s (1965) analogy of our death attitudes to the Victorian squeamishness about
sex, even people who have been bereaved often feel embarrassed and at a loss in
confronting someone else who is bereaved.
The sense of the bereaved as having an illness needing to be fixed (requiring
therapy) and to be avoided, is not only an act of denial (of death), indicating another
kind of pathology, but does not help, and possibly injures and obstructs, the
bereaved’s ability to cope with loss. Unfortunately, workshops aimed at educating the
bereaved and the bereaved’s potential comforters also often stress a short-term or
recipe approach— "Saying Good-Bye to Grief," "Resolving Grief in Five Sessions,"
and the like-which enforce the message that grief should end, and preferably end on
time, a postulate which as White (1989) indicates, may cause rather than alleviate the
griever’s problems and difficulties.
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Practice and Support Implications
Many of the practice implications have already been discussed in Chapter 6.
What I have suggested is in line with current trends to view diagnosis in terms of the
person as a whole and needs desperately to be applied to work with both those who
present with recent bereavement and those who have experienced losses in the past.
As implied in Chapters 4 and 6, the best way to do this is to look at the entire context
of a person’s experience, and to adopt a flexible attitude toward grieving to allow for
individual and cultural variations. As Rando (1984) indicates and is known to all
practiced clinicians, one of the most helpful things a psychotherapist, friend, family
or potential comforter can offer is the ability to listen. This should be compounded
with a striving toward openness and flexibility to unique experience. An appreciation
of a dynamic and constructed dialogical relationship with the deceased other (and with
the other in general), as well as an appreciation of context and how ongoing events,
and the resurfacing, re-awareness, and relevancy of past events, influence the
griever’s world, should help this process.
From the perspective of this study, death of a close other is necessarily
traumatic, and grief is entangled with both the trauma of death and the irrevocable
loss of the other. Care and support for the bereaved must be concerned with the
trauma of death and loss, both in the immediate and the long-term. According to
Harber and Pennebaker (1992), trauma victims face two kinds of difficulties: (a) the
intrapsychic conflict between the victim’s basic beliefs and the traumatic realities that
challenge these beliefs; and (b) victim’s desire to talk about their traumas combined
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464
with listeners’ "disinclination to hear" (p. 361) about the victims’ experiences.
Harber and Pennebaker believe that these two issues leave the victim "suspended"
between revealing and inhibiting. They say, "it is in this ambivalent middle ground
that thought intrusions flourish and the health-debilitating stress of inhibition is most
intense" (p. 361). Similarly, our disinclination to hear, theoretically, creates an
ongoing conflict between the experienced reality of grief and our traditional
assumptions. Therefore, we must open a dialogue between the experience of trauma
and the construction of belief. While listeners who are "good," may not be
disinclined until after the first few months of a friend or relative’s grief, it is not
unusual for even good listeners to want to set some sort of time frame for which
grieving should end.
As I have indicated telling the "stories of death" are important in several
respects. The telling of the stories relating to death and loss, as well as the lost one’s
life, are important in order to integrate and "make sense" out of the trauma of loss,
and also to re-search, evoke, or recreate the lost other in the telling. The process of
storytelling, with its potential for multiple narrative voices, enlists in the "reader" or
listener and the teller the assumption of different "I positions" (Hermans et al., 1992)
which relate to the dialogical self and the active internalization of the other. Telling
the story to another seems to be particularly important early on when the trauma of
the loss is least "learned," least integrated, and severely distressing. However, like
other forms of support, telling/listening may be needed much later by the griever,
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465
when experiences of loss and trauma are re-triggered, or when new circumstances
require a more active renegotiation of the lost other and the meaning of the loss.
Needs for Future Research
One of the chief goals of this study has been to promote an awareness of death
and the effects of death on the bereaved and an awareness of our blind spots both as
researchers and clinicians. Future study needs to focus on how our perceptions and
attitudes towards death and grief affect our treatment of clients in order to prevent us
from denying a bereaved client’s reality and process and from labeling him or her
pathological to make it easier to deal with their pain. More openness on the part of
professionals towards death might help in terms of overall attitudes towards death and
grief.
In addition, more needs to be known about trauma relating to death before we
assign the label "pathological mourning." As the imbrication of trauma in loss is a
relatively murky area in current theory, with many of our foundational ideas about it
based on work with trauma victims (e.g., Lindemann, 1944), more needs to be done
to determine how the trauma of death can be differentiated from surrounding traumas,
or if it can be. Recognizing all death, whether it be "natural" or accidental, violent
or quiet, expected or not, as a source of traumatization, would have strong
implications both for diagnosis and treatment. As mentioned, death haunts the DSM
as a kind of specter, thus acknowledged as a natural force and a natural end.
However, those who experience the effects of death are acknowledged only if they are
"sick." In present theory, "complicated" grief, including complications caused by
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466
other trauma, is considered pathological grief. "Normal" grief, conversely, is said to
follow a stereotypical pattern. My position is that no grief can be really normal or
stereotypical as all death is traumatic and therefore potentially complicated. Instead
of labeling bereaved individuals as "sick" because of surrounding circumstances of
loss (whether these be war, murder, a fire, accident etc.), it would be more helpful to
the bereaved if the clinician could consider these other aspects of the traumatic
"story" as part of a complex web interacting with and affecting an individual’s unique
grief response.
For clinical, diagnostic, and theoretical purposes, varied and much longer-term
accounts are needed to see how grief and the relationship with the deceased may
continue to change and to transmute the experience of the bereaved. Further, the
transitional points in co-existing, subsequent, and entangled problems such as
depression and posttraumatic stress need to be explored, again, by conducting, long
term studies of both patients and non-patients, and by revising our epistemological
stance toward grief. The context of both culture and variables idiosyncratic to the
griever, such as the closeness of the relationship, availability of social support, the
griever’s maturity, personality, previous experiences of loss and coping, and the
unique types of traumatizing circumstance of death need to be explored to illuminate
the variability of grief response over the long-term.
The use of my own experience has shown me how valuable case study material
can be. From the amount of detail I gathered from the journals, I could easier
ascertain how interviews of subjects at intervals, though possibly providing other
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467
valuable information, might neglect many of the day-to-day experiences of grief. I
therefore think that journals are a highly valuable resource in conducting grief
research, and although there are still issues of privacy as well as confidentiality
entailed in keeping a journal and offering it for public use, it seems that use of
journals might be less intrusive and painful than conducting face-to-face interviews, as
well as less likely to generate additional effects, and would be a useful adjunct to case
study research in this area.
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468
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Creator McCabe, Marilyn Michelle (author)

Core Title The paradox of loss: Toward a theory of grief

Degree Doctor of Philosophy

Degree Program Counseling Psychology

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