Grief and Loss Although Often

Grief and Loss

Although often very painful, grief is a normal and natural response to loss (What pp). Generally, when most people think of loss and grief, they think of the death of a loved one, however, there are many other significant changes in an individual's life that can involve loss and therefore grief (What pp). Everyone experiences loss and grief at some time during their lifetime, and the more significant the loss, the more intense the grief is likely to be (What pp). Each person experiences and expresses grief differently, for example, one person may withdraw into feelings of helplessness, while another might be angry and desire to take some form of action (What pp). Yet no matter the reaction, the individual who is grieving needs support from others, thus a helper needs to anticipate the possibility of a wide range of emotions and behaviors, and accept the grieving person's reactions and respond accordingly (What pp). Therefore, it is useful for the person in grief and for the helper to have information about the grieving process (What pp).

William Worden writes in his book, "Grief Counseling and Grief Therapy: A Handbook for the Mental Health Professional," that before anyone can comprehend the impact of a loss on human behavior associated with it, it is important that an individual have some understanding of the meaning of attachment (Worden 7). British psychiatrist, John Bowlby's theory of attachment provides a way to conceptualize the tendency in human beings to make strong affectional bonds with others and a way to understand the strong emotional reaction that occurs when those bonds are threatened or broken (Worden 7). Forming attachments with significant others is considered normal behavior not only for children but for adults as well (Worden 7). Bowlby believes that attachment behavior has survival value, citing the occurrence of this behavior in the young of almost all species of mammals, however, he sees attachment behavior as separate and distinct from feeding and sexual behavior (Worden 8).

If the goal of attachment behavior is to maintain an affectional bond, situations that threatened this bond give rise to certain very specific reactions (Worden 8). Bowlby writes, that in such circumstances, "all the most powerful forms of attachment behavior become activated - clinging, crying, and perhaps angry coercion...when these actions are successful, the bond is restored, the activities cease and the states of stress and distress are alleviated" (Worden 8). Yet, if the danger is not removed, withdrawal, apathy, and despair will then ensue (Worden 8).

According to Worden, there is evidence that all human grieve a loss to one degree or another (Worden 9). In fact, anthropologists have studied other societies, their cultures and their reactions to the loss of loved ones, and report that whatever the society studied and in whatever part of the world, there is an almost universal attempt to regain the lost loved object, and/or there is the belief in an afterlife where one can rejoin the loved one (Worden 9). Interestingly however, in preliterate societies, bereavement pathology seems to be less common than in more civilized societies (Worden 9).

Grief occurs in response to the loss of someone or something, and may involve a loved one, a job, or possibly a personal phase or role, such as a student entering the workplace or an employee entering retirement (Coping pp).

Although anyone can experience grief and loss, which can be sudden or expected, however, individuals are unique in how they experience this event (Coping pp). While grief is a normal and natural response to loss, individuals respond in a variety of ways, some are healthy coping mechanisms and some may actually hinder the grieving process (Coping pp). It is important to understand that acknowledging the grief promotes the healing process, and that time and support facilitate the grieving process, thus allowing an opportunity to appropriately mourn this loss (Coping pp). Moreover, it is also important to understand that no two individuals will respond to the same loss in the same way, therefore it is important to note that phases of grief exist, however they do not depict a specific way to respond to loss (Coping pp). Stages of grief reflect a variety of reactions that may or may not surface as an individual makes sense of how this loss affects them, thus experiencing and accepting all feelings remains an important part of the healing process (Coping pp).

People suffering from loss may experience denial, numbness, and shock, all of which serves to protect the individual from the intensity of the loss (Coping pp).

Numbness is a common reaction to an immediate loss and should not be confused with indifference or not caring (Coping pp). As the individual slowly begins to acknowledge the impact of the loss and accepts his or her feelings, denial and disbelief will diminish (Coping pp). Another common reaction is guilt over what could have been done or should have been done to prevent the loss, and again if these feelings are not resolved they will hinder the healing process (Coping pp). Moreover, an individual may experience depression, which in turn can lead to sleep and appetite disturbance, as well as feelings of emptiness and self-pity (Coping pp). These feelings can easily turn into anger and resentment toward others or life in general, as an individual may begin to feel abandoned (Coping pp). All of these feelings are normal common reactions to loss, and must be accepted as part of the grieving process (Coping pp). There is no time limit to the grieving process and each person needs to define his or her own healing process (Coping pp).

However, individuals experiencing loss should avoid minimizing their emotions by self-medicating with alcohol or drugs, or spending more time at work to avoid feelings (Coping pp).

Thus, it is important for an individual to allow time to experience, acknowledge and accept all feelings, both positive and negative, and express these feelings openly, such as crying as a release (Coping pp). It is also important to try to come to a resolution, and often bereavement groups provide an opportunity to share grief with others who have experienced a similar loss, however if the healing process becomes too overwhelming, it may be necessary to seek professional help (Coping pp).

Dr. Elizabeth Kubler-Ross' first book, "On Death and Dying," published in 1969, is considered a classic and is required reading in many academic setting, including medical and nursing schools, theological seminaries, and popular psychology courses (On pp). In this book Kubler-Ross introduced the five "stages of dying" or "stages of grief" model that is still widely quoted today and has been widely adopted by other authors and applied to many other situations where someone suffers a loss or change in social identity (On pp). Although this model is often used in bereavement work, not all workers in the field agree with her model, feeling that the stages are too rigid (On pp). Others, such as John Bowlby, have developed models with different numbers of stages, however regardless of whether one feels the stages are absolute, Kubler-Ross' work is considered mandatory, a "must read," for anyone seriously interested in death and dying issues (On pp).

Elizabeth Kubler-Ross encountered problems when she began her research and interviews in 1965, because there was no real way to study the psychological aspects of dying and although patients were often willing to talk, it was difficult to convince the doctors (Stages pp). However, from her research, Kubler-Ross saw a pattern emerging that she expressed in the way stages, and while believed to be universal, there is certainly room for individual variation, as not everyone goes through each stage and the order may vary for each individual (Stages pp). Kubler-Ross' five stages of dying are:

Denial and Isolation: Used by almost all patients in some form. It is a usually temporary shock response to bad news. Isolation arises from people, even family members, avoiding the dying person. People can slip back into this stage when there are new developments or the person feels they can no longer cope.

Anger: Different ways of expression - Anger at God:

Why me?" Feeling that others are more deserving.

Envy of others: Other people don't seem to care, they are enjoying life while the dying person experiences pain. Others aren't dying. -Projected on environment: Anger towards doctors, nurses, and families.

Bargaining: A brief stage, hard to study because it is often between patient and God. -If God didn't respond to anger, maybe being "good" will work. -Attempts to postpone:

If only I could live to see..."

Depression: Mourning for losses -Reactive depression (past losses): loss of job, hobbies, mobility. -Preparatory depression losses yet to come): dependence on family, etc.

Acceptance: This is not a "happy" stage, it is usually void of feelings. It takes a while to reach this stage and a person who fights until the end will not reach it. It consists of basically giving up and realizing that death is inevitable.

Stages pp).

Yet, Kubler-Ross is not without critics, as many contend that there exists no real evidence that stages are present in coping with death (Stages pp). According to Robert Kastenbaum, using the term "stages" implies that there is a set order of set conditions, and asserts that there is no evidence that dying people go through the exact Kubler-Ross stages in their proper order (Stages pp). He believes that any patient could experience the stages in a different order, or could experience emotions not even mentioned in the Kubler-Ross stages (Stages pp). He explains that in her research Kubler-Ross showed that various patients exhibited qualities from the five different stages, but no one particular patient demonstrated all five stages in order, thus any emotional experience during the dying process of a person could be considered a stage (Stages pp).

Many feel that Kubler-Ross' research needed to be followed up by another form of data gathering, and that had she done this, her theory would be more valid (Stages pp).

Some critics suggested other methods of research, such as behavioral studies and personal diaries kept by patients, might make up for some of the flaws of the interview process, for example, the fact that the information gathered by the interviewer may vary depending on the relationship between the researcher and the patient, and what a patient feels and what a patient reveals in an interview may be two different things (Stages pp). Moreover, many feel that the Stage Theory tends to prescribe rather than describe, and that since the theory has become so popular, it is common for positive value to be place on the attainment of each new stage (Stages pp). Thus, patients may rush themselves or may be pressured by family members to move through the stages on some imaginary schedule (Stages pp). In other words, patients may feel that they must accept their death in order to die properly, simply because that's what the "famous" theory prescribes (Stages pp). Furthermore, the stages of dying can become an easier and more convenient way for patients to deal with their death, rather than doing what comes naturally to them or having to seek answers on their own (Stages pp). Therefore, an individual's entire life may be over-looked in favor of the stages they feel they are supposed to be going through, because as a person nears death, it is easier to focus on the last months or weeks of life rather than to celebrate a person's life as a whole (Stages pp). The unique personality and identity of the person may be lost as they supposedly move through these generic stages (Stages pp). Each individual's experiences are unique and different, thus each person's death process is unique (Stages pp).

However, regardless of her critics, Kubler-Ross' model had an impact on society and motivated people to think about coping with death, and to appreciate that it is important to help understand and care for the needs of those in their final weeks and days (Stages pp). Moreover, many of the problems with the Kubler-Ross model are in society's interpretation and misuse of her research and failure to follow-up her study with more research and data (Stages pp).

Aside from the death of a loved one, there are many circumstances that arise during one's lifetime that may result in loss and grief. In the book, "Many Voices," edited by Doreen Mellor and Anna Haebich, is a compassionate and painful product of Australia's history wars (Rowse pp). The editors brought together a logistically and emotionally challenging research program in response to the Human Rights and Equal Opportunity Commission's 1997 report (Rowse pp). It is also the product of a recently emerged formation within Australian society, an empowered Indigenous middle-class joined with progressive non-Indigenous professionals, dealing with the legacies of colonization strategies known by various terms (Rowse pp). Thousands of Australians experienced sad and angry childhoods and have been left with emotional wounds unhealed (Rowse pp). Embracing assimilation and trained in social science, the authors recalled having witnessed the phasing out of child removals, and that some of these children were neglected and at risk of abuse (Rowse pp). Some officers recall parent's expressions of grief and loss, and no matter whether the removal was short-term or long-term, the pain and suffering caused by the policy was long-term and appears to have been a great burden on the parents and the children (Rowse pp).

Another study by Peter Westoby, published in the May 01, 2003 issue of "Australian Journal of Social Issues," discussed the enormous challenges faced by young people from refugee backgrounds when involved in the settlement process within Australia (Westoby pp). They are forced to locate themselves within a new social cultural geographic and adult space, and also try to find security within the spaces of their own families and ethnic communities (Westoby pp). Wetoby points out that traumas of the past can mix with painful experiences of the present, adding stressors to their lives that are both complex and diverse (Westoby pp). As William James suggested at a psychological level and Agnes Heller at an historical level, it can often be very difficult to neatly separate past, present and future, for although individuals cannot avoid such separations, they know at a deeper level that the past inextricably reaches in the present and future (Westoby pp). Refugees suffer loss of their homes and grief from their experiences, whether fear of persecution or fear of sudden changes that must be faced and accepted before they can move into a comfortable, functioning lifestyle within their new environments (Westoby pp). Thus, much like a death, the past must be dealt with, as well as a coming to terms with acceptance of loss (Westoby pp).

And Robert Ho wrote in the February 02, 1999 issue of "Australian Journal of Social Issues" about the issues associated with euthanasia and the impact on family as associated with the loved one's distress at the loss of dignity and control (Ho pp). Thus, the loved one grieves the loss of a capable body, while the family grieves not only for the loved one's health, but his impending death, and the decision to end it (Ho pp).

Sally N. Ellis Fletcher writes in the September 22, 2002 issue of the "Journal of Cultural Diversity," about the cultural implications in the management of grief and loss (Fletcher pp). According to Fletcher, because people are culturally unique individuals, their culture impact and even dictates their responses to normal events of daily living, such as loss of a loved one, loss of a job, or grief due to separation (Fletcher pp). Fletcher stresses that health care professionals must be culturally sensitive to all individuals, in other words, being aware of the way certain individuals value time, perceive spatial boundaries and communicate with others (Fletcher pp). Thus, culturally diverse nursing care acknowledges the individual's cultural uniqueness and incorporates a variety of approaches to provide culturally sensitive care (Fletcher pp).