Paul T. P. Wong, PhD. C.Psych.
Trinity Western University
Langley, BC, Canada

The paper examines the nature of bereavement grief and recognizes the complex pattern of emotional, cognitive, existential and spiritual coping reactions to the disruption of personal meaning systems. It proposes a process approach towards grief work, which encompasses several interrelated processes, such as mourning the loss, adjusting to the loss, accepting the loss and transforming the loss. It also recognizes different levels of acceptance and the paradoxical nature of transformation. Finally, it describes how grief can be transformed through meaning management.

Introduction

Grief is an inevitable, universal experience, more commonly experienced than death. So much of life is about loss. Going through life is to endure a series of losses, which include the loss of health, roles, identity, homeland, and loved ones through betrayal or death. Grief is the normal emotional response to loss. This paper focuses on bereavement grief.

Sooner or later everyone will experience bereavement. Those blessed with longevity are burdened with multiple losses as they outlive their friends and loved ones. Since it is not possible to avoid all human relationships and attachments, there is no escape from grief.

Although grief is common, it is highly specific for each individual because of the unique relationship, personal history and circumstances surrounding the death. The fact that we have experienced the death of a parent does not necessary mean that we can understand what another person has gone through in losing his or her parent. Grieving is something very special for each person. Therefore, when we comfort a grieving person and try to empathize, be careful not to say: "I know how you feel."

Grieving is hard work because it touches every aspect of the person's being. In the case of losing a child, even with many years of grief work, the parents may never fully recover. The death of a child can be like the death of a family, because it means the loss of meaning for living and the shattering of one's fundamental assumptions about life (Janoff-Bulman, 1992).

The impact of grief can be very intensive and extensive. The battle against postmortem grief is often fought on two fronts - internal and external.

Internally, apart from the emotional tumult, mental disorientation and flooded memories, the death of a loved one may also trigger an existential crisis and a spiritual quest. Therefore, religious and philosophical beliefs play a role in the grieving and recovery process.

Externally, the bereaved often has to take care of the aftermath of the death of a loved one and cope with the many demands of life. Funeral arrangements, settling the estates, taking care of the personal effects of the deceased, dealing with relatives and re-igniting past conflicts are all concomitant stressors.

Another external source of stress comes from colliding cultures. Conflicting cultural prescriptions for funeral rites and mourning rituals can become a fertile ground for conflict, especially when family members involve inter-racial marriages and different religious practices. Thus, death may divide rather than unite the family.

The nature of grief

Strictly speaking, grief is more than an emotional reaction to loss. It also involves a complex pattern of cognitive, existential, spiritual coping processes in reaction to the disintegration of existing structures of meaning. This loss of meaning with respect to relationships, life goals, and daily living creates an existential crisis. To the extent that death of a significant other disrupts one's continuity with the past, grief also entails existential struggles regarding the meaning of one's own identify. From this broader perspective, grief work necessarily involves the transformation of meaning structures.

Normal vs. pathological of complicated grief

Normal grief is supposed to be resolved within two years, while complicated grief may last for many years and involve clinical depression, anxiety disorder and other emotional and behavioral disturbances, similar to Post-traumatic Stress Disorder. Such complicated, pathological grief requires grief therapy (Rando, 1993). However, more recent research has shown most do not find complete resolution; there is always some residues, especially at an anniversary or during special occasions. Rando (1988) has reported that significant temporary resurges of grief reactions may still happen for many years in normal healthy grieving. For example, the loss of a mother may be grieved by the daughter for her entire life (Edelman, 1994). But over all, in time, there will be a decrease in the intensity and frequencies of waves of grief.

Anticipatory vs. bereavement grief

Anticipatory grief occurs in anticipation of the death of a loved one or one's self. Unlike bereavement grief, anticipatory grief is not socially sanctioned. Therefore, there is a reluctance in talking about the anticipated death of a love one or one's own eventual demise. However, research has shown that a period of anticipatory grief can soften the blow of bereavement. More research is needed because anticipatory grief is so common and yet so little understood.

Grieving the loss of self vs. others

Grieving the dying self is often a private affair. It is closely linked to one's inner struggle with death anxiety. However, grieving the death of others often evokes death anxiety and grieving regarding one's mortality. Grieving the dying of self often has the salutary effect of evaluating one's priorities and devoting the rest of one's life to something meaningful.

Multiple losses and the accumulation of grief

On the one hand, prior experience in grieving may prepare one for future loss. However, multiple losses and the accumulation of grief may sensitize one to any future loss. It is an empirical question when habituation or sensitization will occur. However, I feel that it may be a cause for concern when people become blasé about the loss of human lives. Just as each individual is unique, each death is to be considered as of special value and significance.

The task of grief work

Lindenmann (1944) first proposed the idea of grief work that is based on three major tasks: severing the ties with the deceased, adjusting to one's new environment, and creating new bonds with others. Some people consider these three tasks as three stages of grieving: release, readjustment and reinvesting.

Rando (1988) proposed a process model. The basic ideas are: (a) the goal of mourning is to a adapt to the loss of the loved one, while maintaining a connection though memory, (b) the process involves three main phases: avoidance, confrontation and accommodation, (c) the grief process is not linear, but rather circular. According to Rando, healthy accommodation is not defined by the absence of grief or mourning, but the ability to accept the reality of death and move forward.

I am proposing that grieving involves several interrelated processes, each of which follows a different path of recovery.

Mourning the loss

This involves primarily the affective process, which begins with numbness and shock, moving thorough the roller-coaster ride of intense emotions, and finally settling into a subdued and serene sense of sadness. This process is not linear; however, the cycles may become less frequent and less intense. Recalling and reliving the positive moments may mitigate against the feelings of loss. Often, grieving involves many emotions, such as guilt, anger, shame, regrets, hostility and sadness. Clarifying emotions is part of the process. Sorting out and reconciling conflicting feelings contributes to recovery.

Accepting the loss

This is the most basic and most complex task. To accept the finality of the loss, the process occurs not just at the cognitive level, but also at the social, behavioural, existential, spiritual and emotional levels.

Cognitive acceptance involves more than an intellectual understanding that death is final; it also requires some level of cognitive resolution to reduce instances of intrusive thoughts and ruminations.

Spiritual acceptance may involve establishing a spiritual connection with the deceased and experiencing an inner vision of a spiritual union.

Emotional acceptance may be most difficult to achieve when the initial emotional attachment is very strong, even when there is a replacement for the attachment. One can truly let go, only when one has achieved acceptance at the emotional level.

Adjusting to the loss

This involves the process of making a series of mental and behavoural changes to adapt to the new dynamics within the family and in the larger social network. It also involves working through personal and interpersonal issues, such as forgiveness of self and others, resolving interpersonal conflicts and re-establishing some relationships.

Transforming the loss

This process is fundamental to recovery. It moves from struggling with the loss to incorporating it into the new reality and future plans, such as redefining one's self-identity and life goals.

This process will involve reinvesting one's psychological energy, making new friends, developing new plans, and engaging in productive activities, Basically, it involves the discovery of new meanings and the reconstruction of existing meaning structures. It requires the re-authoring of one's life story. This transformation is necessary for resolution, restoration and personal growth

The paradox of transformation

The transformation process is complex and paradoxical. However, when it is managed properly, both the process and the outcome can be very rewarding. Since complete recovery is not possible, it can be part of the on-going process of meaning transformation.

Meaning management is essential to this transformative process. We are meaning- seeking and meaning-making creatures. Thus, how we react to loss depends on the meaning we attribute to the loss and the meaning of life without the deceased.

In order to move forward, we have to somehow reconstruct our meaning-systems in order to adapt to different set of realities. This evolution of meaning in response to loss continues so that we can maintain some sense of coherence in the midst of change and loss.

• Healthy grieving is transformed grieving.
• The pain will never go away
• Positive and negative transformation
• Positive changes through the transformation of meanings
• The dead are weaved into the fabric of life
• The past is integrated with the future as the basis for self-identity
• The present is transcended by a vision as the basis for personal growth
• Tragic optimism and post-traumatic growth

Finally, I want to emphasize that grief has a transcendental function. It awakens one's spiritual and existential yearnings, and spurs one to rise above the painful experiences of mourning. Recovery always involves the reconstructing of painful and sorrowful experiences through the transformation of assigned meanings.

One can never go back to the past. Therefore, recovery does not mean a return to the normal life before the bereavement. True recovery actually means that the bereaved person has found a new meaning and propose, which enables the person to reach a higher level of maturity.

C. S. Lewis (1960) A Grief Observed documents the transformation from overwhelming grief and anger at God to a new understanding of God and life. Such transformation can happen to any one who is open to the spiritual reality beyond the physical realm.

References

Edelman, H. (1994). Motherless daughters: The legacy of loss. New York: Dell Publishing

Janoff-Bulman, R. (1992). Shattered assumptions: Toward a new psychology of trauma. New York: Free Press.

Lewis, C. S. (1961). A grief observed. New York: The Seabury Press.

Lindenmann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 1, 141-148.

Rando, T. A. (1988). Grieving: How to go on living when someone you love dies. Lexington, MA: Lexington Books.

Rando, T. A. (1993). Treatment of complicated mourning. Champaign, IL: Reseach Press.

*Keynote address given at the Conference on Life and Death Education, National Changhua University of Education, Changhua, Taiwan, December 15, 2002.