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 Bereavement and End-of-Life Issues

Chapter 3- Factors Related to Individual Bereavement

 

 III. Factors Related to Individual Bereavement

As was just mentioned, how people perceive death is very significant in their process of bereavement.  One of those factors is the culture of the society. Raphael writes:

 

"The outer behavioral manifestations of this bereavement process may vary according to social and cultural sanctions and prohibitions as well as the accepted rituals of bereavement. Thus, social values may lead to attempts to repress external and even internal manifestations of grief and mourning"

                                                        (1980, p. 151)

 

The repressing of feelings would be evident in the Western and Anglo-Saxon society where men are supposed to be emotional strong and showing grief is perceived as a sign of weakness (Raphael, 1980).  Other cultures may encourage an open expression of grief.  In the Puerto Rican culture for instance crying, screaming and "hysterical convulsive reactions" are common ways of mourning at funerals.  The Puerto Ricans also have an underlying acceptance of death believing that the spirits of the dead live in an invisible world that have influence over the living (Garcia-Preto, 1982).  In Portuguese families, a widow is expected to wear black the rest of her life and not remarry.  The widower wears black clothing for one year and may remarry if he wishes.  Portuguese also make frequent visits to the grave and display picture of the deceased in the coffin (Moitoza, 1982).  British families avoid grief, preferring to look toward the future.  If nothing can be done then they do not worry about it (McGill & Pearce, 1982).  This gives a brief picture of how cultural factors may play into the grieving process. 

 

Another factor is the developmental aspects of the individual.  The age of the individual is significant in this regard.  Nagy's (1959) study lists three stages for children's concepts of death.  In the first stage there is no definitive death.  Children are less than five at this stage and do not see death as irreversible.  In the second stage children between the ages of 5 and 9 conceive death as remote and external in the form of a person.  The third stage is characterized by the recognition at age 9 or 10 that death signifies a cessation of bodily life. 

 

Another dependent factor on bereavement reaction, after obtaining a true concept of death, is the psychological development of the person.  One of the theories useful for predicting probable outcome is attachment theory or object relations.  Much of the adjustment can be based on the attachment the survivor formed with his primary object in his or her infancy '(Bowlby, 1977 and Mahler, 1975).  If there was a poor attachment then it is probable that grief may be more difficult to work through.  The loss may just reinforce the previous mistrust held toward love objects, especially if there are lingering abandonment issues.  Ego strength would be weakened so that differentiation and boundaries may not be established between the survivor and the deceased, and coping mechanisms may not function appropriately in adjustment to the shock (Goldstein, 1984).

 

Loss of a Spouse

 

The Loss of a Spouse may be the most difficult event a person ever suffers through:

 

The impact of loss through death is noted on the Social Readjustment Rating Scale (Holmes & Holmes, 1970), which was designed to measure cumulative stress over a given period of time.

On the scale, the death of a spouse ranks first out of 43 stressful events followed by the death of a family member which ranks 5th and the death of a close friend ranking 17th. Clearly, mental health counselors need to be prepared to work with clients on their adjustment to the loss of their loved ones through death. (Muller & Thompson, 2003)

 

 

The following article further documents the issues surrounding the difficulty of a client losing a spouse.

 

Coping with Loss of a Spouse.

Losing a spouse is one of the most stressful events a person can experience. Nevertheless, most older adults are resilient and bounce back to earlier levels of physical and psychological health within 18 months of their loss, according to bereavement studies from the University of Michigan Institute for Social Research, Ann Arbor. The findings call into question the widespread belief that the sudden death of a spouse is more difficult for the surviving member of the couple than a long-anticipated death. For older men, especially, the sudden death of their wives is actually easier to handle psychologically than a lingering illness.

Moreover, the research debunks a longstanding doctrine of psychologists and bereavement counselors that the more conflicted and unhappy the marital relationship, the more a guilt-ridden surviving spouse is likely to grieve. Instead, it confirms the common-sense view that the closer a marital relationship was, the more depressed the surviving spouse is likely to be.

The research is part of an ongoing analysis of data from the ISR Changing Lives of Older Couples study, a survey of 1,532 married men and women age 65 and older, started in 1987. Over the years, the researchers have monitored the deaths of participants and followed up with interviews of the surviving spouses at six months, 18 months, and four years after their losses. They also reinterviewed members of married couples in the study who had not yet lost their spouses, then matched these still-married elders with the widows and widowers on key demographic variables, including income, education, and health. In addition to detailed information on each person's physical and mental health, collected both before and after a spouse's death, the study contains information on the quality of their marital relationships.

"Collecting data before the spouse dies allows us to avoid both positive and negative recall bias," sociologist Deborah Carr explains. "Some people just can't say anything negative about a spouse who's dead. `Oh, he didn't drink a drop.' `He was a saint.' Other people get so depressed, their current mood colors their assessment of the quality of their marriage. They remember things being a lot worse than they really were."

Carr found that the closer the marital relationship, the more depressed men and women were likely to be after their spouses died. Surviving spouses who were better off economically, as measured by home ownership, were likely to be more depressed than peers who lived in apartments or retirement communities. "Those who own a home may do worse because they have the added strain of caring for a house," she speculates. "They may be more socially isolated, lonely, and even afraid of living in a home alone, compared to surviving spouses who live in apartments and have neighbors close by."

Women who were highly dependent on their husbands for male-stereotyped tasks such as financial management and home repairs were at higher risk for anxiety as widows. "These findings suggest a changing picture for bereavement among older couples," Carr notes, "as more egalitarian divisions of labor make women less dependent on their husbands for home repair and financial management, and as couples are more likely to dissolve dissatisfying marriages and remain in unions with higher levels of marital satisfaction."

Sudden death was more emotionally distressing to women than to men. "Men cope best if their wives' deaths are quick and unexpected, while women cope best if their husbands' deaths come after some period of warning. I think it's because ... women are used to the role of caregivers and don't find it stressful. But men do." Moreover, men and women often have very different types of personal relationships. "Women may have friends to turn to for support during the long and drawn-out process of widowhood, whereas men may withdraw from others and seek closeness only from their dying wives."

USA Today, (Society for the Advancement of Education) Aug. 2001: 6

 

 

In this section it has been shown that many factors can play into a person's bereavement.  In the next section possible treatment approaches will be explored.

 

 

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