Section 3.1: Theories of Grief & Bereavement

Theories of Grief & Bereavement

Understanding the psychological mechanisms of grief, mourning, and bereavement is fundamental to the practice of funeral service. As a funeral director, you are often the first professional to interact with a bereaved family. Mastery of these theories allows you to recognize normal versus abnormal responses and tailor your services to facilitate healthy adaptation to loss.

Differentiating Key Terms

In the context of the National Board Exam (NBE), you must clearly distinguish between three terms that are often used interchangeably in casual conversation:

• Bereavement: The objective state of having experienced a loss. It is a status (e.g., "she is bereaved") resulting from the death of a significant person.
• Grief: The subjective, internal emotional, cognitive, physical, and spiritual response to loss. It is what the individual feels and experiences internally.
• Mourning: The outward, social, and cultural expression of grief. It is the process by which grief is integrated and shared with the community (e.g., wearing black, holding a wake, erecting a monument).

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Elisabeth Kübler-Ross: The Five Stages of Grief

In her seminal 1969 book On Death and Dying, psychiatrist Elisabeth Kübler-Ross introduced the five stages of grief. Although originally developed to describe the psychological process of terminally ill patients facing their own mortality, these stages have been widely applied to the bereavement process.

1. Denial: A temporary defense mechanism where the individual refuses to accept the reality of the loss. It acts as a buffer against overwhelming shock. For instance, denial can manifest as a refusal to make funeral arrangements or speaking of the deceased in the present tense.
2. Anger: The individual projects frustration and rage onto others (family members, medical staff, God, or even the deceased). "Why me?" is a common theme. Anger might be directed at the funeral director regarding pricing or scheduling. Knowing this, the director must remain patient and empathetic, recognizing that this hostility is a symptom of grief rather than a personal attack.
3. Bargaining: An attempt to postpone the inevitable or alter reality through agreements or promises, typically made with a higher power.
4. Depression: The onset of deep sadness and despair as the reality of the loss becomes undeniable. Kübler-Ross distinguished between reactive depression (grief over past losses) and preparatory depression (anticipatory grief for future losses).
5. Acceptance: The final stage, characterized by a quiet expectation and peace. It is not necessarily a happy state, but rather a void of intense feelings, where the individual accepts the new reality.

Critical Considerations for the NBE:

• The stages are non-linear. Individuals may skip stages, repeat them, or experience multiple stages simultaneously.
• Kübler-Ross's model has been criticized for being prescriptive, but it remains a foundational framework for understanding emotional transitions.

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J. William Worden: The Four Tasks of Mourning

J. William Worden proposed a behavioral model in Grief Counseling and Grief Therapy. Unlike stage theories, which imply passive progression, Worden's tasks require active engagement from the mourner. This model is highly relevant to funeral directors, as funeral rites directly assist in accomplishing these tasks.

• Task I: To Accept the Reality of the Loss. When a death occurs, there is a natural tendency to deny the fact. The first task is to overcome this denial and fully realize that the person is dead and will not return. Funeral Service Application: Viewing the body is a primary tool for facilitating Task I, as it provides concrete, sensory evidence of death.
• Task II: To Process the Pain of Grief. Mourners must experience the physical, emotional, and cognitive pain associated with loss. Avoiding or suppressing this pain prolongs the grief process. Funeral Service Application: The funeral director facilitates this by creating a supportive environment where crying and emotional expression are validated.
• Task III: To Adjust to an Environment in Which the Deceased is Missing. This task involves three levels of adjustment:
  • External Adjustments: Learning new daily skills, taking on roles previously held by the deceased (e.g., managing finances, raising children).
  • Internal Adjustments: Redefining one's sense of self-worth and personal identity (moving from "wife" to "widow").
  • Spiritual Adjustments: Re-evaluating one's basic assumptions about the world, fairness, and meaning.
• Task IV: To Find an Enduring Connection with the Deceased in the Midst of Embarking on a New Life. The goal is not to forget the deceased but to find a suitable place for them in one's emotional life—one that allows the mourner to live effectively and form new relationships.

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John Bowlby: Attachment Theory

Psychiatrist John Bowlby developed Attachment Theory, which posits that humans have an instinctive drive to form close emotional bonds (attachments) with significant others for survival. Bowlby, along with Colin Murray Parkes, outlined four phases of the mourning process based on attachment bonds:

1. Numbing (or Protest): The immediate response to loss, lasting from a few hours to a week. The individual feels stunned and may exhibit bursts of anger or distress.
2. Yearning and Searching: The mourner seeks to retrieve the lost attachment figure. Symptoms include restlessness, preoccupation with the deceased, and scanning the environment.
3. Disorganization and Despair: The reality of the loss sets in, leading to the breakdown of normal routines. The individual feels helplessness, depression, and detachment from life.
4. Reorganization (or Recovery): The individual begins to rebuild their life, establishing new routines and forming new attachments while maintaining a healthy mental representation of the deceased.

Bowlby asserted that the intensity of the grief response is directly proportional to the strength of the attachment bond. He identified four primary attachment styles in adults: secure, anxious-preoccupied, dismissive-avoidant, and fearful-avoidant. Individuals with secure attachment styles tend to navigate grief more adaptively, while those with anxious or avoidant styles may experience prolonged, chronic, or suppressed grief reactions. Understanding these attachment styles helps funeral directors anticipate the varying emotional responses of family members during the arrangement conference.

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Erich Lindemann: Grief Symptomatology (Acute Grief)

Following the tragic Coconut Grove fire in Boston in 1942, Dr. Erich Lindemann studied the survivors and their relatives, publishing Symptomatology and Management of Acute Grief (1944). He argued that acute grief is a distinct syndrome with predictable somatic and psychological symptoms:

• Somatic (Physical) Distress: Sighing respiration, lack of strength, exhaustion, digestive issues, tightness in the throat, and shortness of breath.
• Preoccupation with the Image of the Deceased: Hearing, seeing, or dreaming about the deceased; feeling their presence.
• Guilt: Blaming oneself for not doing enough, or imagining how they could have prevented the death.
• Hostile Reactions: Irritability, anger toward doctors, family members, or the funeral director, and a loss of warmth toward others.
• Loss of Patterns of Conduct: Aimless wandering, inability to organize simple daily activities, and restlessness.