Variability in Response to the Loss of a Loved One:

Cultural Understanding versus Scientific Evidence

Variability in Response to the Loss of a Loved One:

Cultural Understanding versus Scientific Evidence

Assumptions About the Process of CopingAssumptions About the Process of Coping

1. At some point, most people become intensely distressed or depressed following a major loss.

2. Failure to experience distress is indicative of a problem.

a] If distress is not experienced, it will erupt later (“delayed grief”)

b] If distress is not experienced, the individual will develop subsequent health problems.

3. Individuals must “work through” or process their loss.

4. Over a period of time, individuals should be able to recover from the loss and return to their earlier level of functioning.

CollaboratorsCollaborators

Roxane Silver, Ph.D., University of California at Irvine

Darrin Lehman, Ph.D., University of British Columbia

Ronald Kessler, Ph.D., Harvard University

James House, Ph.D., University of Michigan

George Bonanno, Ph.D., Teachers College, Columbia University

68.73%

14.33%

13.36%3.58%

Minimal (211)

Mild (44)

Moderate (41)

Severe (11)

from Cleiren, 1993

Four months after the loss

Level of Depressive Symptoms Following the Loss of a Spouse, Child, Parent or Sibling Level of Depressive Symptoms Following the Loss of a Spouse, Child, Parent or Sibling

ACL National Cross-Section: Mean CESD Scores of Widowed and Married Respondents at Seven Time PointsACL National Cross-Section: Mean CESD Scores of Widowed and Married Respondents at Seven Time Points

Married (never widowed) 18.8

Ever-widowed 23.8 23.1 22.4 21.6 20.9 20.2 19.5

Mean Difference 5.0 4.3 3.6 2.8 2.1 1.4 0.7

t (1, 3128) 3.37 3.40 3.21 2.66 1.84 1.04 0.42

p < .0008 .0007 .0013 .008 .0663 .2975 .6571

Time Since Widowhood (years)

0 5 10 15 20 25 30

Hypotheses Regarding “Absent Grief” Reflected in the Bereavement LiteratureHypotheses Regarding “Absent Grief”

Reflected in the Bereavement Literature Represents denial or inhibition of distress that will eventually surface.

Represents lack of attachment

Negative evaluation of spouse Survivor incapable of attachment

(avoidant/dismissive of others)

Survivor cold and unfeeling Represents end of a bad marriage Spouse was ill; possible caregiving burden

Main Hypotheses Regarding “Chronic Grief” Reflected in the Bereavement Literature

Main Hypotheses Regarding “Chronic Grief” Reflected in the Bereavement Literature

Marriage was conflictual

Ambivalence toward spouse

Survivor was dependent on spouse

Chronic grief represents coping failure

Survivor has a history of mental health

problems, including depression, which were present before the loss occurred

Patterns of Response to Loss

D

epre

ssio

n (

CE

SD

)

(Depressed-Improved

Resilient

Common grief

Chronic grief

Chronic Depression

Pre-loss 6 mo. 18 mo.

post-loss post-loss

45.90%

10.20%

10.70%

15.60%

7.80%

9.80% Resilient (n=95)

Depressed-Improved(n=21)

Common Grief (n=22)

Chronic Grief (n =31)

Chronic Depression(n=16)

Other (n=20)

Patterns of Response to Loss: Percentage of Respondents Showing Each Pattern

Patterns of Response to Loss

G

rief

Sym

pto

ms

Depressed-Improved

Resilient

Common grief

Chronic grief

Chronic Depression

Pre-loss 6 mo. post-loss 18 mo. post-loss

The Grief BrigadeThe Grief BrigadeWhen tragedy strikes, the counselors rush in. They offer succor, but their methods are up for debate.

from Time, May 17, 1999

“Hard to tell from here. Could be buzzards. Could be grief counselors.”

Pathological grief has different meanings. It can be defined as follows: Chronic grief - The failure to resolve all adverse bereavement-related symptoms within 6 months Inhibited grief - The absense of expected grief symptoms Delayed grief - The avoidance of painful symptoms within the first 2 weeks of a loss

from Gelder, M.G., Lopez-Ibor, J.J., & Anderson, N. (2000). New Oxford Textbook of Psychiatry. Oxford: Oxford University Press

PATHOLOGICAL GRIEF

Absent or delayed grief: occurs when the feelings of loss would be too overwhelming and so are repressed or denied. Such avoidance of affect tends to result in the later onset of much more prolonged grief and a higher risk of depression

Chronic grief: grief that is still symptomatic 1 year after the death from Stoudemire, A. (2001). Clinical Psychiatry for Medical Students. New York: Lippincott-Raven

Unhelpful Responses to the BereavedUnhelpful Responses to the Bereaved

Asking questions

Giving advice

Discouraging expressions of feelings

Minimizing the loss

“I know how you feel” Providing philosophical or religious

perspective