infancy & pregnancy loss
Understanding Bereavement By Dr Bill Webster
How are we to understand bereavement?
How are we to understand bereavement?
Over the years, there have been numerous attempts to explain it. Perhaps the most influential and well-known theory has been that of Dr. Elisabeth Kübler-Ross, who in her 1969 book “On Death and Dying” focused on an emotional transition through five stages, beginning with denial and progressing through anger, bargaining and depressionbefore arriving at acceptance. The “stage theory,” as it came to be known, quickly created a paradigm for how people die in our western culture, and eventually a prototype of how we should grieve.
The trouble is that stage theories of grief that make loss sound so controllable turns out largely to be fiction. Though Kübler-Ross captured the range of emotions that mourners experience, more recent research suggests that grief and mourning rarely if ever follow such a checklist; the process of grief is often complicated, untidy and unpredictable, more of a process than a progression, and one that sometimes never fully ends.
Even Dr. Kübler-Ross herself, towards the end of her life, recognized how far astray our understanding of grief had gone. In her book “On Grief and Grieving” (1995) she insisted that the stages were “never meant to help tuck messy emotions into neat packages.” If her injunction went unheeded, perhaps it is because that very messiness of grief is what makes us all so uncomfortable.
The implied suggestion of many traditional grief models seems to be that the person suffering a loss simply has to go through the inevitable process, wait it out, “see it through,” on the assumption that “time heals all wounds,” and that eventually “in time,” they will “get over it.” This would seem to suggest that in the emotional aftermath of a loss, bereaved individuals are essentially passive, having to simply submit to suffering through a series of stages or a certain structured grief system over a defined period of time and incidentally over which they have little or no control and in which there is not much choice.
But this is not what people actually experience after bereavement. We cannot understand the grief process ONLY by some “timeline” system or “set formula” whereby a person goes passively through certain emotions, stages, phases or reactions in order to somehow eventually arrive at this destination we erroneously call acceptance.
So, consider this foundational fact:
We cannot understand bereavement and every individual response to it unless we appreciate how each bereaved person’s world has been forever changed by the loss.
I am suggesting a different paradigm, another way of thinking about our topic. The main focus should not primarily be (as it so often is) on a person’s emotional reactions, or on their behaviours or manifestations of grief, and more specifically how we can “control” these in order to get things “back to normal.” Those who focus on these considerations are trying to “fix” a situation that simply cannot be fixed; trying to get “back to normal” something that has changed forever.
Losing someone we love is often likened to an amputation. But even this analogy tends to be too clinical. The word bereavement comes from the root word “reave” that literally means being torn apart. Losing a loved one has been described as being like a branch that is torn off a limb, not in some nice sanitized surgical way, but literally being ripped away. The emotional and behavioural reactions of the grieving person should be seen as symptoms of this unwelcome change.
I am suggesting that we serve people better if we focus on the significance of this bereavement to the individual rather than on the substance of their specific reaction to the bereavement.Rather than concentrating on the reactions of grieving people and then quantifying their responses, we need to ask the “why” of these reactions. We must understand the meaning of the loss to this individual, which I suggest is being “expressed” through their specific emotions and uniquely individual behaviours.
In other words, the emotions and reactions of grief should be seen symptomatically as behaviours in response to and in protest of the need to search for meaning in what has become a new and unwelcome world. This is the crucial point in understanding bereavement, one which many people do not recognize, understand or perceive. The task is to help the bereaved and grieving person locate themselves in a world that they know nothing about, and that they, and indeed WE, cannot fully understand.
Put simply, instead of trying to get people back to normal by seeking to resolve and rectify their emotions and behaviours, we should rather regard these reactions as a symptom of the much deeper issue, namely, “My world has changed … and I don’t like it.” Grief is a protest against something I didn’t want, don’t like, but can’t change. And the challenge for the helper is in enabling them to come to terms with this new albeit unwelcome reality by beginning to form appropriate new patterns of emotion and behaviour.
We would probably all agree that, in one way, bereavement is a “choiceless event.” Few if any would choose to lose those they love, or suffer through the other life losses that inevitably affect us. Even when the death is “by choice” such as a suicide, the incident is usually “choiceless” for survivors who wish they could have “done something” to change the outcome and feel guilt and regret because that option was not made available to them. Thus, bereavement is an unwelcome intruder in our lives, one which refuses to retreat despite our impassioned protests.
But, from another perspective, while the loss may be a reality we are powerless to avert, the experience of grieving itself involves hundreds of concrete choices that the bereaved person is invited or forced to make, or indeed avoid. It is in another way a call for us to change. To go with it, or to resist the process. We have a choice of whether to attend to the distress occasioned by the loss or to avoid the pain by “keeping busy” or “trying not to think about it,” which is an impossible task, by the way. We have a choice as to whether to feel and explore the grief of our loved one’s absence or to suppress our private pain and focus instead on simply trying to adjust to a changed external reality. Loss may be inevitable, but what we DO about it is optional. We may not have a choice in what has happened, but we do have a choice in what we do about it.
Grieving is something we do, not something that is done to us.
We need to gain a better understanding of not only “what” people experience after a loss, but also “why” grief affects people so uniquely and individually. We have come to realize that people do not passively and inevitably go through a series of stages or tasks. Rather the grief process involves many choices, with numerous possible options to approach or avoid the situation at hand.
In other words, any good paradigm of grief will not simply propose some futile attempt to re-establish pre-loss patterns of emotion or behaviour, expressed in comments like “getting back to normal.” Life has changed and will never be the same again! But that does not mean it cannot be good. The challenge is how we can support the person in integrating these changes into their life as it now is.
Perhaps we can illustrate it this way. We all write a script for our lives. I remember writing the screenplay for my life when I was a teenager. As the main character in the production, my draft scenario included going to school and university, having a career, meeting and marrying the most beautiful woman in the world. As the plot progressed, we would work hard, have children, do things as a family and when the kids were grown we would travel, then retire, and ride off into the sunset together. Think about YOUR script … most of us have one.
Every human being constructs a unique world of meaning. We all make assumptions about “how life is going to be” in the course of daily living. We are sustained by the network of explanations, expectations and enactments that shape our lives with ourselves and others. These assumptions provide us with a basic sense of order regarding our past, awareness regarding our current relationships and predictability regarding our future.
And most of us, at the end of the script, whatever the final details, add the words … “and they lived happily ever after.” Because that is what most of us would like to think is going to happen. While the particulars may change from time to time, we all want to think that life will be orderly, predictable, and go “according to the script.”
But sometimes life does not go according to the script. Not everything works out the way we planned. And then we find ourselves struggling to come to terms with “the grief of unmet expectations.” Any loss can be interpreted as disrupting the continuity of this assumed narrative. When this occurs, we have one of two choices: either we revise the plot by rewriting the script and assimilating the loss into pre-existing frameworks of meaning, ultimately reasserting or justifying the viability of our pre-existing belief system; or we accommodate our life narrative to correspond more closely to what we perceive as a changed reality in the violation of our assumptive world.
It is vitally important to realize that “who we are” is determined not just by genetic makeup, but also by our experiences and how we allow them to affect us. In this statement we find an important key for life and living. We do not have a choice in how we are born and our genetic or cultural influence. We may have a choice over some difficult events and negative experiences that affect us. Stuff happens! But while we may not have a choice over certain circumstances, we do have a choice about how we are going to allow them to affect us. The key is in enabling people to make good choices about what they are going to “do” about what has happened.
So, we need to place the loss in a context of meaning. We can do this in one of two ways. First we can reaffirm what we formerly believed about life; or secondly, we can establish a new belief system about the meaning of life. In other words, does this experience make sense according to what I believed about life before or do I have to adapt my way of interpreting how life can be meaningful. The challenge is to find ways to integrate the experience into life as it now is, and to adopt new assumptions about our world which has been shaken and even violated by the loss.
The implication of this idea for caregivers, families and those seeking to support grieving people is that we need to recognize the unique and personal meanings of loss which will take us beyond clichéd expressions of support or preconceived ideas of what a particular loss “feels like” to any given griever. The particularity of any loss should prompt us to listen intently for clues as to the unique significance of the bereavement experience for each individual.
Thus I contend that helping people through the grief of bereavement is not simply a matter of understanding the emotions that they may be expressing. Rather it involves supporting them through a reinterpretation of “how life can be meaningful even in the light of loss,” and empowering them to define life as it now is and to find ways to make the most of what they have left.