Grief: the continuing theoretical journey

Continuing our chronological journey through grief theories, we have now reached the late 1980s and into the1990s, when lots of changes in approaches were occurring.

Worden 1988

Worden, in his book Grief Counselling and Grief Therapy introduced the notion that the bereaved can take action during the process of grieving, and so feel less helpless. He wrote that there is individuality, autonomy and choice in grieving and that grief is not a linear process, and he also introduced the concept of uncomplicated and complicated grief (a concept that is still being debated today).

He is best known for introducing the 4 tasks of mourning, and they are:

1. To accept the reality of the loss (which can take quite some time)
2. To work through the pain of grief
3. To adjust to an environment where the deceased is missing (e.g. take on new roles and skills and a new identity)
4. To emotionally relocate the deceased and move on with life (e.g. love other people without loving the deceased any less)

Note that these are tasks, not stages, so do not occur in a lineal fashion.

Doka 1989

The concept of Disenfranchised Grief was discussed by Doka, and he defined this as grief from a loss that cannot be openly acknowledged or socially supported (e.g. abortion, suicide). He said that this will impact on the experience of grief, the meaning attached to it and the process of integrating the loss.

He also identified that both males and females show aspects of feminine (later changed to intuitive) grief (intense feelings, sharing with others, seeking help) and masculine (later changed to instrumental) grief (intellectualisation, anger, guilt about not protecting a loved one, self-reliance), and instrumental grieving is less understood (or accepted) than intuitive grieving, although it is just as legitimate.

Rando 1993

Rando built on Worden’s ideas and the concept of assumptive worlds. The major processes of grief were defined as:

• Recognising the loss
• Reacting to the separation
• Recollecting the deceased and the relationship
• Relinquishing old attachments to the deceased and the old assumptive world
• Readjusting to move adaptively into a new world without forgetting the old
• Reinvesting in new relationships and pursuits

Moos 1995

Moos highlighted the social context of grief and said that the social context will impact on the meaning of the loss for the individual. External factors (society, culture and religion) have an impact on the internal experience of loss.

Attig 1996

In How we Grieve: Relearning the World Attig talked about grief being an active process with choices and said it is about re-learning the world. The web of familiar relationships with self, with others and with the environment is temporarily shattered, although the bereaved person previously found meaning in these things. The process of grieving is about re-learning the world in a way that is right for them (e.g. ways of going on, their relationship with the deceased, aspects of themselves and their surroundings). Bereaved people engage in active participation in their grieving rather than remaining helplessly passive – they have no choice about the event, but they can choose how to respond to it.

 In the next post we will look at the late 1990s, but it is worth considering how the theories outlined in today's post might impact on working with grief.

Grief: the early theoretical journey

It is interesting to look at the early grief theorists, as they have influenced a lot of the popular beliefs about grief that still exist today, despite theory having taken a major shift in the interim. I like to remind myself that these are all theories, not facts, and subject to change as new reflections and research occur. Theories also need to be considered in the social contexts of their times.

Definition of bereavement

I like the definition by Dunne, Dunne-Maxim and McIntosh:

Bereavement is all the physiological, psychological, behavioural and social response patterns displayed by an individual following the loss of a significant person or thing.

Lindemann 1944

In Symptomatology and Management of Acute Grief Lindemann identified five features of grief, and these were:

• Somatic distress
• Preoccupation with thoughts of the deceased
• Guilt
• Hostility
• Loss of normal patterns of behaviour

Three tasks necessary to complete grief work were identified as follows:

• Emancipation from the bondage to the deceased
• Readjustment to the environment in which the deceased is missing
• Establishment of new relationships.

A distinction was made between normal and morbid grief and it was claimed that it takes 4-6 weeks to overcome acute grief. I can see an on-going influence here in the popular, but erroneous, beliefs that people should be over their grief in 6 weeks and that people should “let go” of the person who has died.

Freud 1957

In his book Mourning and Melancholia Freud said that mourning is the period of desolation following the loss of a significant “object” (person) and, in order to recover, energy needs to be withdrawn from the “object” and action needs to be taken to reinvest this energy in another “object” to replace the one which has been lost.

This reinforces the concept of the need to “let go”, which current theorists refute. Even so, it does remain as a popular belief in some quarters.

Kubler-Ross 1970

In her book On Death and Dying Elizabeth Kubler-Ross introduced the idea of stages of grief, but she was, in fact, referring to stages of dying, and her work was based on terminally ill patients anticipating their own deaths. However this was also generalised to a grief model for survivors of a major disaster at the time.

The stages of dying that she identified were:

• Denial and isolation
• Anger
• Bargaining
• Depression
• Acceptance

The long held belief that people go through stages of grief followed on from her work and this led to seeing  people who fail to begin or end a stage successfully as “pathological”. Current theorists no longer subscribe to this theory but, once again, it does still exist in popular beliefs.

Bowlby 1980

Bowlby saw grief as a form of separation anxiety in the process of breaking the emotional bonds of attachment and wrote about this in his book Attachment and Loss.

His four phases of grief were:

• Numbing
• Yearning and searching
• Disorganisation and despair
• Re-organisation

This reinforced the ideas that grief has stages/ phases and that, in order to have a new relationship, the person has to let go of the old one. These ideas have, of course, been challenged by current theorists.

Putting the theorists in the contexts of their times

It is important to remember that all of these theorists were influenced by the social contexts of their times. For instance, Lindemann was writing in the context of major losses in relation to WWII, which had occurred in the lifetimes of those who had been through WWI.

During WWl many communities faced unprecedented losses of young men from their communities, and mass mourning was acknowledged in the form of the construction of war memorials in many towns. Around this time there was also a major growth in spiritualism as people attempted to make contact with young men who had been killed in battle (especially where bodies were not able to be returned home).

However, by the time WWll came along, communities could no longer cope with the extent of the losses, and went more into denial in relation to grief and trauma, believing that it was better not to talk about it as this would “upset” those who were affected.

The interesting  journey through grief theories will continue in the next post.

Grief

Over the years I have read lots of theories about grief, worked with many people who are grieving (including in groups) and experienced my own grief journeys. From all of this I have concluded that grief journeys will be unique for each individual and for each instance of grief. Grief will always be part of our lives, just as loss will be.

I plan to write a series of posts on this topic, sharing some of the information I have found, and reflecting on experiences. But first I would like to share some general thoughts.

The nature of the relationship

When someone who has been a part of our lives dies, the grief we feel will depend on the closeness of our relationship with that person, and how much of our lives we spent with them. I find this diagram useful:

Using this diagram, it is understandable that some people will feel major grief over the loss of a pet, and others may feel little grief when a relative, with whom they have had little contact, dies. I remember one client, who had experienced domestic violence, expressing gratitude that she was allowed to feel a sense of relief (amongst other feelings) when her abusive partner died – she had felt guilty about this for years. On the other hand, I have had elderly clients who have spent all day everyday with their partners, in their later years, and they have been totally devastated when their partner dies.

The nature of the loss

Some people relate traumatic experiences around the death of a loved one, and thus have experiences of both trauma and grief to journey through. Some deaths are unexpected (resulting in feelings of shock) and others are lingering (often involving the loss of the carer role as well as that of the loved one).  However we cannot generalise that grief journeys will be similar for similar kinds of loss.

A shattered assumptive world

In a workshop I attended many years ago, Geoffrey Glassock shared this concept. Major changes and losses in our lives can shatter our assumptive world – the assumptions we live by, and we need to then journey through grief towards a new assumptive world (which will incorporate both the shattered former assumptive world and the grief journey). We cannot immediately step into a new assumptive world.  For example, we may no longer be able to live with the assumption that our friends and relatives will live into old age, or that the world is a safe place, or that people can be trusted, or that life will be kind to us.

Geoffrey is one of the editors of an Australian Journal "Grief Matters" and more information can be found in this link:
http://www.grief.org.au/resources/grief_matters

The mindset of the person who is grieving

All of us have unique and individual ways of dealing with the challenges of life, and this will impact of grief journeys too. I have worked with some people who have a positive outlook on life, and others who have become immobilised by challenges (and all kinds in between). A strength based approach may be useful here, as it is people’s individual strengths that help them to journey onwards (although I acknowledge that grief journeys are much more complicated than this).

Grief is a normal reaction to loss

I have found in much of my work with grieving people, that counselling is more about identifying the things that are getting in the way of them feeling free to grieve, and working to deal with these. We cannot hasten or shorten the grief journey of another, but we can normalise reactions (many people have expressed the fear that they are going crazy when they experience grief reactions), and walk alongside of them.

Remember: Everyone can master grief but he who has it.   William Shakespeare

Projection

In my work with domestic violence and other relationship difficulties, I have found that my clients commonly described behaviour from others that fitted into the realm of projection – a common ego defence-mechanism. It was also common for these clients to express confusion about this behaviour and its impact, but to leave with clearer heads once the behaviour had been named as projection and the nature of projection had been explained to them.

What is projection?

It is one of the commonly used ego defence-mechanisms that is employed by some people when their anxiety levels are too high, and they subconsciously choose to not own parts of themselves that they fear, dislike or can’t accept. They then accuse another person of being these things (i.e. project onto another person). However, this occurs with the person projecting believing that the other person really is like this, and having no insight into their own issues.

It is commonly used in emotional abuse.

More information can be found in the following link:

http://changingminds.org/explanations/behaviors/coping/projection.htm

How it feels to be projected upon

It can leave people feeling confused and wondering if they really are, or have done, the things that are being projected onto them.

It can also leave them feeling depressed, discouraged, worried, anxious, stressed, harassed, edgy, alone, ducking for cover and/ or doubting themselves.

A metaphor

I have found that a useful, but old, metaphor to use is that of an old film projector beaming onto a screen, with the person projecting being the “projector” and the receiver being the “screen”. The “projector” owns the light, and it comes from inside that person, but instead of owning the “light” they beam it onto someone else. If the receiver pictures themselves as the “screen” then they can consider ways of moving their “screen” away from the “projector” so they don’t keep receiving their “light”.

Perhaps for those too young for this metaphor to have any meaning, the metaphor of a torch could be used instead.

Ways to deal with projection

The women in the Women’s Support Group that I facilitated had the following ideas about dealing with projection (and I think it is worth sharing their wisdom):

• Recognise when projection is occurring
• Step back from the focus (the image will then be blurry)
• Roll up the “screen” or move it out of the “light”
• Put up a protective wall (metaphorically)
• Ignore them/ be deaf and/or walk away
• Laugh at it
• Know we are not to blame
• Talk it out with someone we trust
• Use confidence and belief in ourselves
• Use a mental image exercise of our confused thoughts settling like sand on the bottom of the ocean floor, until the water is calm and clear.

Remember: we can learn a lot from our clients. 

Spring

Having written posts on Autumn and Winter, I could not let September go by without writing one on Spring. It would be easy to go with clichés about new growth here, but I thought I would try to dig a little deeper here.

The promise of new growth

At the beginning of Spring the promise of growth is apparent, but we have no way of knowing what that new growth will really end up looking like (apart from knowledge gained from past experience). We don’t know if trees will produce usable fruit, or how much they will produce, or whether they will be wiped out by bugs or weather events before maturity. When applying this metaphor to human life, there is even less predictability and more variables, but it is nice to experience new beginnings and initial promises of growth.

The need to prepare and nurture

In the garden, we will benefit more from the new growth if we have prepared the soil well, beforehand, and continue to feed and water the plants. This is so in human lives as well – new skills need to be practised and new ways of thinking repeated until they become familiar.

Cutting out the deadwood

As new leaves began to appear on bare branches in my garden, the deceased wood became much more apparent, and I was more confidently able to use the secateurs to cut it off and make more room for the new healthy growth. In our lives, leaving old deadwood can inhibit our ability to move into the future with confidence, and it can begin to strangle new ways of thinking and being, pulling our minds back into the negatives of the past (thereby inhibiting the new growth).

 A time to sow new things

I have been eagerly waiting for the weather to warm enough to sow seeds for flowers and vegetables and am rejoicing that the time has now arrived!  Sometimes in our lives we too need to wait for the right “climate” to make changes or take on new things, so that our efforts have more chance of succeeding.

Remember: He/ She has half the deed done who has made a beginning.  Horace

Coping with toxic people

All of us have encountered difficult people in our lives, and I have found that issues for clients may include coping with high maintenance or toxic people, who have left them feeling inadequate, unsure and blaming themselves for the problems (e.g. telling themselves that they have not tried hard enough, or that they have done something wrong/ are a fault).

A useful tool

I devised the following diagram to encourage the giving up of self blame and to help us to accept that the problem is not about what we are doing, but about how these toxic people are (they treat most people the same way)

The barriers

The barriers have been created by them, even although they may still intrude on us and we may continue to try hard to reach out to them, but over time we begin to lose trust in them (and maybe in ourselves -- these people can begin to "do our heads in"). The barriers have been created by the behaviours listed under the examples of how they are, and these are behaviours that are unlikely to change. Change involves admitting that there is a problem, and toxic people are very unlikely to do this, tending to blame others rather than themselves. They will also invite us to blame ourselves.

Giving up self-blame

The most important thing here is to see the reality of the relationship, and to understand that the problem is with the nature of the toxic person, not with what we are doing. This shift in thinking allows us to give up self-blame and to stop the tangle of confusing thoughts that can take over our brains. Then we are freer to decide about the nature of the relationship we will or will not have with the toxic person.

Some thoughts to ponder

The whole problem with the world is that fools and fanatics are so certain of themselves but wiser people so full of doubts.      Beryl McMillan

You cannot make a crab walk straight.    Aristophanes

I cannot hear what you say for the thunder of who you are.    Zulu Proverb 

My journey into retirement: the processing

During the past 5 months I have needed to process a number of things as I have journeyed further into retirement. And I think this occurs with any major change we adjust to, although there will be different issues for different people and different circumstances.

These are the things I have needed to process.

Giving up guilt

I was surprised at how guilty I initially felt about no longer being in the paid workforce. There are so many messages out there about us baby boomers being an upcoming problem, and that people need to work until they are 70 years old.

But then I applied a reality check -- my peers and cousins are retiring, systems don't support people working until they are older, I was unable to keep up the pace of full-time work and I had put lots of savings into Superannuation, so was not a burden on society.

Needing to heal emotionally and psychologically

Once I departed from the paid work-force I realised that I had been like the frog in water, who had not noticed the gradual heating of the liquid, and was now damaged by paddling in boiling water (systemic work stress) for too long (or, burnt by the journey). Thus I found myself experiencing trauma reactions that needed to be allowed reactions and then processing and healing.

Needing to replenish

After many years of constant giving, I was fairly jaded and found that I needed time out just to rest and regroup through engaging in non-threatening and familiar tasks, and avoiding challenges if possible. I am not yet quite ready to take on new tasks that involve risk-taking.

Using transition tasks and interests

Before I retired I consciously ensured that I was spending some time in non paid-work related activities so that these could continue as familiar parts of my day, rather than facing more major changes once I left the work force. For now, I am concentrating on growing these rather than taking on new and totally unfamiliar activities I am thankful that I chose to do this as I had not understood the amount of adjusting I would need to do to take on this new life-style. It is not just one big holiday!

Putting more balance into living/ being

It is very easy to substitute paid work activities with home activities and still not achieve a healthy work/ life balance. So I have needed to consciously find ways of "being" instead of just "doing", and it is especially good when they can both occur together.

So that's how it has been for me so far, and I like this quote from Hal Borland:

Year's end is neither and end nor a beginning but a going on, with all the wisdom that experience can instil in us.