Journal of Consulting and Clinical Psychology
1989, Vol. 57, No. 3, 349-357
Copyright 1989 by the American Psychological Association, Inc.
The Myths of Coping With Loss
Camille B. Wortman
The University of Michigan
Roxane Cohen Silver
University of Waterloo
Drawing from theory and clinical lore, we consider how individuals are assumed to cope following
irrevocable loss. Several assumptions are reviewed reflecting beliefs concerning the grieving process.
Specifically, we examine the expectation that depression is inevitable following loss; that distress is
necessary, and failure to experience it is indicative of pathology; that it is necessary to "work
through" or process a loss; and that recovery and resolution are to be expected following loss. Al-
though limited research has examined these assumptions systematically, available empirical work
fails to support and in some cases contradicts them. Implications of our analysis for theoretical
development and research are explored. Finally, we maintain that mistaken assumptions held about
the process of coping with loss fail to acknowledge the variability that exists in response to loss, and
may lead others to respond to those who have endured loss in ways that are unhelpful.
In this article, we focus on how people cope with loss events
that involve permanent change and cannot be altered or un-
done. It is our belief that such experiences provide an excellent
arena in which to study basic processes of stress and coping.
In the health and medical areas, many specific losses might be
considered irrevocable: the permanent loss of bodily function,
the loss of particular body parts, the loss of cognitive capacity,
the death of a loved one, or one's own terminal illness. In an
attempt to advance theoretical development in this rich and
complex area, this article updates an earlier review we com-
pleted on reactions to undesirable life events (Silver & Wort-
man, 1980). Because the most rigorous empirical studies have
been in the areas of physical disability and bereavement, we
shall focus on these two areas in this article.
When a person experiences an irrevocable loss, such as the
death of a loved one or permanent paralysis, how will he or she
react? We maintain that people hold strong assumptions about
how others should respond to such losses. As we have discussed
in more detail elsewhere (Silver & Wortman, 1980; Wortman &
Silver, 1987), such assumptions are derived in part from the
theories of loss offered by prominent writers in the area, and in
part from clinical lore about coping with loss and our cultural
understanding of the experience. As detailed below, individuals
who encounter a loss are expected to go through a period of
intense distress; failure to experience such distress is thought to
The order of authorship was arbitrary.
Research and preparation of this article were supported by U.S. Pub-
lic Health Service Grant MCJ-260470 and by National Institute on
Aging Program Project Grant A605561 to Camille B. Wortman and
Roxane Cohen Silver.
For a more detailed discussion of these issues, the reader is referred
to Wortman and Silver (1987).
The authors wish to thank two anonymous reviewers for helpful com-
ments on an earlier version of this article.
Correspondence concerning this article should be addressed to Ca-
mille B. Wortman, Social Environment and Health Program, Institute
for Social Research, The University of Michigan, Ann Arbor, Michigan
be indicative of a problem. Moreover, it is assumed that success-
ful adjustment to loss requires that individuals "work through"
or deal with their feelings of grief rather than "denying" or "re-
pressing" them. Within a relatively brief period of time, how-
ever, people are expected to resolve their loss and recover their
earlier level of functioning.
Because it is generally assumed that the coping process un-
folds in a particular way, others may evaluate or judge those who
do not conform to these expectations as reacting abnormally or
inappropriately. For example, because they believe that people
should recover relatively soon after the loss, outsiders might re-
act judgmentally to continuing signs of distress (cf. Silver &
Wortman, 1980; Tail & Silver, 1989). In fact, if laypersons hold
unrealistically narrow views of what constitutes a normal grief
response, they may have difficulty offering the appropriate
forms of assistance to friends and family members who are try-
ing to cope with loss. Moreover, because they too may hold as-
sumptions about how one should react when a loss is experi-
enced, individuals who have encountered loss may harshly eval-
uate their own responses and may believe them to indicate
underlying problems or pathology (Silver & Wortman, 1980).
Because assumptions about the grieving process are likely to
have a pervasive impact on how reactions to loss are evaluated,
we feel it is important to identify those assumptions that are
most prevalent in our culture and to consider systematically the
available research data in support of each one. We have identi-
fied five assumptions that we believe to be very prevalent in the
grief literature. In the following sections, the validity of each
assumption is evaluated against the available research data.
While much of the early work in this area suffered from serious
methodological shortcomings (e.g., reliance on subjective im-
pressions of unstructured interview data, unstandardized mea-
surements, and biased samples, etc.; see Silver & Wortman,
1980, for a review), recent research in the bereavement and
physical disability areas has improved on the deficiencies of pre-
vious literature. In the following discussion, we review only
what we believe to be the best empirical work available to test
the assumptions we have identified. Except where indicated, all
of this work has used standardized outcome measures and
CAMILLE B. WORTMAN AND ROXANE COHEN SILVER
structured interviews of relatively large, unbiased samples and
followed them over time. In the concluding sections of this arti-
cle, we explore the implications of the available data for theory,
research, and intervention following loss, and consider why
such myths about coping with loss may have been perpetuated
despite the absence of validating data.
Distress or Depression Is Inevitable
It is widely assumed in our culture that when a major loss is
experienced, the normal way to react is with intense distress or
depression. The most prevalent theories in the area of grief and
loss, such as the classic psychodynamic models (e.g., Freud,
1917/1957) and Bowlby's (1980) attachment model, are based
on the assumption that at some point, individuals will confront
the reality of their loss and go through a period of intense dis-
tress or depression. In the recent authoritative report on be-
reavement published by the Institute of Medicine, it was stated
that there is a "near-universal occurrence of intense emotional
distress following bereavement, with features similar in nature
and intensity to those of clinical depression" (Osterweis, Solo-
mon, & Green, 1984, p. 18). Similarly, depression has been the
foremost reaction reported and discussed in the literature on
spinal cord injury (Bracken & Shepard, 1980; Deegan, 1977;
Gunther, 1971;Knorr&Bull, 1970).
As empirical evidence has begun to accumulate, however, it
is clear that the assumption of intense universal distress follow-
ing a major loss such as bereavement or spinal cord injury may
be unwarranted. It is true that in the bereavement literature,
some studies have reported that feelings of sadness or depressed
mood are fairly common. For example, Glick, Weiss, and
Parkes (1974) have noted that 88% of the widows they studied
experienced depressed mood (see also Clayton, Halikas, &
Maurice, 1971). However, in those investigations that have in-
cluded a more systematic and rigorous assessment of depression
or distress, it is clear that such a reaction is by no means univer-
sal. In one study, Clayton, Halikas, and Maurice (1972) inter-
viewed widows within 30 days of losing their spouse. Using
strict diagnostic criteria to assess depression, Clayton et al.
found that only a minority of respondents (35%) could be classi-
fied as definitely or probably depressed. Similarly, Vachon, Rog-
ers, et al. (1982) found that 1 month after the loss, 30% of the
widows they studied scored below 5 on the General Health
Questionnaire (GHQ)—a score considered insufficient to war-
rant further psychiatric assessment. In their sample of primar-
ily Mormon elderly bereaved individuals, Lund, Caserta, and
Dimond( 1986) reported that only 14.6% of the men and 19.2%
of the women they studied at 3 weeks postloss evidenced "at
least mild" depression on the Zung Depression Scale. In fact,
only 12.5% to 20% of this sample reported scores exceeding the
cutoff score delineated as indicating depression at any of six
different assessment points from 3-4 weeks to 2 years postloss.
Examination of empirical data in the spinal cord injury liter-
ature reveals a similar pattern. For example, Howell, Fullerton,
Harvey, and Klein (1981) conducted a careful assessment of
22 patients who had been injured approximately 1 month, and
followed them for an average of 9 weeks. Each patient was inter-
viewed utilizing the Schedule of Affective Disorders and Schizo-
phrenia and completed the Beck Depression Inventory weekly.
Only a minority of patients (22.7%) experienced a depressive
disorder following injury that met Research Diagnostic Criteria
(see also Fullerton, Harvey, Klein, & Howell, 1981). Similarly,
Lawson (1976) studied 10 spinal-cord-injured patients 5 days a
week for the entire length of their rehabilitation stay. Despite a
multimethod assessment of depression (self-report, profes-
sional ratings, and psychoendocrine and behavioral measures),
there was no clear period of at least a week in which measures
were consistently in the depressive range for any patient (see
also Malec & Neimeyer, 1983). Thus, the few systematic investi-
gations that are available have failed to demonstrate the inevita-
bility of depression following loss.
Distress Is Necessary, and Failure to Experience Distress
Is Indicative of Pathology
The clinical literature is clear in suggesting that those who
fail to respond to loss with intense distress are reacting abnor-
mally (e.g., Deutsch, 1937; Marris, 1958). Bowlby (1980) has
identified "prolonged absence of conscious grieving" (p. 138)
as one of two types of disordered mourning. In the previously
mentioned Institute of Medicine report, "absent grief was
classified as one of two forms of "pathologic" mourning (Oster-
weis et al., 1984, p. 65). This report emphasized that it is com-
monly assumed, particularly by clinicians, "that the absence
of grieving phenomena following bereavement represents some
form of personality pathology" (p. 18). Although the authors
noted that there is little empirical evidence in support of this
assumption, they concluded nonetheless that "professional help
may be warranted for persons who show no evidence of having
begun grieving" (p. 65). The assumption that distress or depres-
sion is a necessary part of the grieving process is also quite prev-
alent in the literature on spinal cord injury (e.g., Karney, 1976;
Kerr & Thompson, 1972; Nemiah, 1957; see Trieschmann,
1978, 1980, for reviews). In fact, authors have maintained that
depression is therapeutic because it signals that the person is
beginning to confront the realities of his or her situation (e.g.,
Cook, 1976;Dinardo, 1971; Nemiah, 1957).
The belief that distress should occur is so powerful that it also
leads to negative attributions toward those who do not show
evidence of it. One such attribution is that the person is denying
the loss. As Siller (1969) has maintained regarding the disabled,
occasionally a newly disabled person does not seem to be particu-
larly depressed, and this should be a matter of concern. . . . A
person should be depressed because something significant has hap-
pened, and not to respond as such is denial. Such obvious denial is
rare except in the case of a retarded person or in the very young,
A second attribution is that the person is emotionally too weak
to initiate the grieving process. Drawing from clinical experi-
ence with patients undergoing psychiatric treatment, Deutsch
(1937) maintained that grief-related affect was sometimes omit-
ted among individuals who were not emotionally strong enough
to begin grieving. A third attribution is that individuals who fail
to grieve are simply unable to become attached to others. For
example, Raphael (1983) suggested that among those who do
not show signs of grief, the preexisting relationship may have
been "purely narcissistic with little recognition of the real per-
son who was lost" (pp. 205-206).
THE MYTHS OF COPING
If, in fact, depression is necessary following loss, those people
who experience a period of depression should adapt more suc-
cessfully than those who do not become depressed. However,
this view has not been substantiated empirically. In contrast,
several studies have found that those who are most distressed
shortly following loss are among those likely to be most dis-
tressed 1 to 2 years later. For example, Vachon, Rogers, et al.
(1982) found that among 162 widows, an elevated score 1
month postloss on the GHQ, a measure of distress and social
functioning, was the most powerful predictor of high distress 24
months later. Similarly, Lund et al. (1985-1986) found that the
best predictor of long-term coping difficulties among elderly
widows and widowers was the presence of strong negative emo-
tional responses to the loss (such as expressing a desire to die
and crying) during the early bereavement period (see also
Bornstein, Clayton, Halikas, Maurice, & Robins, 1973; Parkes
& Weiss, 1983, for similar findings).1 Comparable results have
been obtained by investigators studying spinal cord injury. In a
cross-sectional study of 53 male spinal-cord-injured patients,
Dinardo (1971) assessed depressed mood by self-report and
professional assessments. Results indicated that the absence of
depression was associated with higher self-concepts and with
staff ratings of successful adjustment to the disability, leading
the author to conclude that "those individuals who react to spi-
nal cord injury with depression are less well adjusted at any
given point in their rehabilitation than the individuals who do
not react with depression" (p. 52) (see Lawson, 1976, and Malec
& Neimeyer, 1983, for comparable findings).
An important component of the view that depression is nec-
essary is that if individuals fail to experience distress shortly
after the loss, symptoms of distress will erupt at a later point.
Marris (1958) has commented that "much later, in response to
a less important or trivial loss, the death of a more distant rela-
tive, a pet—the bereaved person is overwhelmed by intense
grief (p. 27) (see also Bowlby, 1980; Rando, 1984). It is also
widely believed that the failure to grieve will result in subse-
quent health problems. The Institute of Medicine report (Oster-
weis et al., 1984) reviewed the work of several clinicians who
suggested that those who fail to grieve outwardly may manifest
their depression through a variety of physical symptoms or so-
Despite its prevalence, available evidence provides little sup-
port for the assumption that those who fail to experience dis-
tress shortly after loss will have difficulties later. In the pre-
viously mentioned study of bereavement by Clayton et al. (see
Bornstein et al., 1973), interviews were conducted with 109
widows and widowers at 1 month, 4 months, and 13 months
postloss. As noted earlier, only 35% of these respondents were
classified as either definitely or probably depressed at the 1-
month interview. However, only 3 of the remaining 71 respon-
dents had become depressed by the 4-month interview. More-
over, only 1 subject evidenced depression for the first time at
13 months postloss, leading the investigators to conclude that
"delayed" grief is relatively rare. Similar findings were obtained
in a longitudinal study of 99 widows conducted by Vachon,
Sheldon, et al. (1982). Thirty-two of these women were classi-
fied as "low distress" by virtue of their scores on the GHQ 1
month postloss, and 94% continued to evidence "low distress"
when interviewed 2 years later. In fact, only 2 women in the
study who had low distress scores at 1 month had high distress
scores at the 2-year interview.
A very similar pattern of findings was obtained in our recent
longitudinal study of 124 parents who had lost an infant to Sud-
den Infant Death Syndrome (SIDS; Silver & Wortman, 1988;
Wortman & Silver, 1987, in press). Parents were classified as
exhibiting low or high distress at the initial interview 3 weeks
postloss on the basis of their scores on the depression subscale
of the Symptom Check List-90 (SCL-90; Derogatis, 1977). As
in the previously described research, most respondents in this
study who showed low distress at 3 weeks also showed low dis-
tress 18 months later. Only a small percentage of the sample
moved from low to high distress over the period of study. Those
parents who were evidencing low distress shortly after their ba-
by's death were no more likely than parents who reported high
distress to indicate that the pregnancy had been unplanned or
difficult to accept; nor did they differ in their evaluation of their
babies as having been beautiful, intelligent, and happy while
alive. Thus, these data fail to support the notion that absence
of distress may be due to insufficient attachment to the lost
In summary, the bulk of research to date provides little sup-
port for the widely held view that those who fail to exhibit early
distress will show subsequent difficulties. The data clearly sug-
gest that "absent grief" is not necessarily problematic, and, at
least as it is assessed in the studies conducted to date, "delayed
grief" is far less common than clinical lore would suggest.
The Importance of "Working Through" the Loss
It is widely assumed that a period of depression will occur
once the person confronts the reality of his or her loss. Then, it
is commonly believed, the person must "work through" or pro-
cess what has happened in order to recover successfully (see,
e.g., Brown & Stoudemire, 1983; Doyle, 1980). Implicit in this
assumption is the notion that individuals need to focus on and
"process" what has happened and that attempts to deny the
implications of the loss, or block feelings or thoughts about it,
will ultimately be unproductive (cf. Bowlby, 1980; Parkes &
Weiss, 1983). Marris (1958) maintained that "if the bereaved
cannot work through this process of grieving they may suffer
' Of course, this does not necessarily imply that it is detrimental to
go through a period of depression following loss. Undoubtedly, some of
the people who are most depressed after the loss may be those who have
enduring psychological difficulties that were present prior to the loss.
In the research that has been conducted to date, it is not possible to
discriminate between those respondents who became depressed primar-
ily as a result of their loss and those who had a lifelong history of psycho-
logical disturbance. Only prospective designs, which assess such con-
founding variables prior to the loss, can help to shed light on this issue.
Because most loss events are relatively infrequent, prospective studies
are prohibitively costly and thus have rarely been attempted.
2 The only evidence for delayed grief that we have been able to un-
cover comes from a study by Parkes and Weiss (1983). These investiga-
tors found that widows who reported having had marriages character-
ized by high conflict displayed little or no emotional distress in the
weeks following their loss. However, at the 13-month and 2- to 4-year
follow-up interviews, these widows were evidencing greater difficulties
than those women whose marriages were characterized by low conflict.
CAMILLE B. WOKTMAN AND ROXANE COHEN SILVER
lasting emotional damage" (p. 29). Rando (1984) concurred
with this assessment, stating that "for the griever who has not
attended to his grief, the pain is as acute and fresh ten years later
as it was the day after" (p. 114).
On the basis of statements such as these, it might be expected
that those who show evidence of "working through" their loss
in the weeks or months following it will be more successful in
resolving the loss than those who do not. However, the limited
evidence that is available suggests that this may not be the case.
Although they did not assess "working through" the loss spe-
cifically, Parkes and Weiss (1983) conducted a comprehensive
study of bereavement that provided data of possible relevance
to this concept. Respondents were rated by coders on the degree
to which they evidenced yearning or pining for the deceased 3
weeks after their loss. Subjects were divided into a "High Yearn-
ing" group, composed of those respondents who appeared to
yearn or pine constantly, frequently, or whenever inactive, and
a "Low Yearning" group, who yearned never, seldom, or only
when reminded of the loss. In fact, high initial yearning was
found to be predictive of poor mental and physical health out-
comes at 13 months postloss. As Parkes and Weiss (1983) ex-
pressed it, "We might suppose that people who avoid or repress
grief are the most likely to become disturbed a year later, yet
this is not the case" (p. 47). Interestingly, high initial yearning
was associated with poor outcome even at the final interview
conducted 2 to 4 years after the loss.
In our previously described study of parents who suffered a
SIDS loss (Silver & Wortman, 1988; Wortman & Silver, 1987),
we also examined the impact of early evidence of "working
through" the loss on subsequent adjustment. "Working
through" was operationalized as active attempts by the parent
to make sense of and process the death, including searching for
an answer for why the baby had died, thinking of ways the death
could have been avoided, and being preoccupied with thoughts
about the loss. Results indicated that the more parents were
"working through" the death at the 3-week interview, the more
distressed they were, as measured by the SCL-90 18 months
later. In addition, those subjects who showed the least evidence
of emotional resolution 18 months after the death of their infant
(measured by distress in thinking and talking about the baby,
feeling bitterness about the loss, and being upset by reminders
of the baby) were those most likely to be processing the loss
shortly after the death.
To date, there is relatively little empirical evidence relevant
to the issue of "working through." If behaviors such as yearning
for the deceased or being preoccupied with thoughts about the
loss are conceptualized as "working through," however, the
available research challenges the assumption that the absence
of this process is necessarily maladaptive. Like early evidence
of intense distress, early signs of intense efforts to "work
through" the loss may portend subsequent difficulties.
The Expectation of Recovery
It is generally assumed that although a person who experi-
ences an irrevocable loss will go through a phase of intense dis-
tress, this will not last indefinitely. In fact, after a relatively brief
period of time, the person is expected to achieve a state of recov-
ery and return to normal role functioning (cf. Silver & Wort-
man, 1980). Almost every stage model of coping with loss pos-
tulates a final stage of adaptation, which may be called recovery
(Klinger, 1975,1977), acceptance (Kubler-Ross, 1969), or reor-
ganization (Bowlby, 1980). "Chronic grief" or failure to recover
is identified as a major type of "pathological" mourning in vir-
tually every major treatise on the bereavement process (e.g.,
Bowlby, 1980;Osterweisetal., 1984;Raphael, 1983). Similarly,
failure to accept the loss of one's abilities is felt to impede moti-
vation and rehabilitation of the spinal-cord-injured patient
(e.g., Heijn & Granger, 1974).
None of the theories postulate precisely how much time
should elapse before recovery from an irrevocable loss. In the
bereavement literature, notions about the length of the recovery
process have been shifting over the last four decades. Early stud-
ies of bereavement suggested that its psychological impact was
relatively transient. In fact, in his study of people who lost a
loved one in Boston's Cocoanut Grove nightclub disaster, Lin-
demann (1944) painted an optimistic picture of the recovery
process, noting that with appropriate psychiatric intervention,
it was ordinarily possible to settle an uncomplicated grief reac-
tion in 4 to 6 weeks. However, recent research evidence suggests
that it may take considerably longer to recover from the loss of
a loved one, especially when the loss is sudden and traumatic
(see Silver & Wortman, 1980; Tail & Silver, 1989, for reviews).
In the previously discussed studies by Vachon and her associ-
ates, 38% of the widows studied were experiencing a high level
of distress after 1 year, and 26% were still classified as exhibiting
high distress at the end of 2 years (Vachon, Rogers, et al., 1982;
Vachon, Sheldon, et al., 1982). In the longitudinal study of wid-
ows and widowers conducted by Parkes and Weiss (1983), more
than 40% of the sample was rated by trained interviewers as
showing moderate to severe anxiety 2 to 4 years after the loss.
Feelings of depression, as well as problems in functioning, were
also quite common at the 2- to 4-year interview, particularly if
the loss was sudden. Zisook and Shuchter (1986) had widows
and widowers complete interviews and questionnaires at 11
points in time, ranging from 3-4 weeks after their loss to 4 years
later. Even at 4 years postloss, at least 20% of the bereaved as-
sessed their own adjustment as "fair or poor," while only 44%
assessed it as excellent (see Lund et al., 1985-1986, for compa-
A study by Elizur and Kaffman (1982, 1983), which exam-
ined behavior changes over a 3'/2-year period among normal
kibbutz children whose fathers had been killed in war, found
negative consequences in response to the deaths. While none of
these children evidenced unusual psychopathology prior to
their loss, they were subsequently found to be at risk for a vari-
ety of problems. Almost 50% showed emotional disturbance in
each phase of the study—6, 18, and 42 months postloss. More
than two-thirds of the bereaved children reacted with severe
psychological problems and impairment in diverse areas of
functioning. Similar findings were obtained in a study by Leh-
man, Wortman, and Williams (1987), which focused explicitly
on the long-term effects of the sudden, unexpected loss of a
spouse or child in a motor vehicle accident 4 to 7 years earlier.
Interviews were conducted with bereaved respondents, who
were matched with a control group of nonbereaved individuals
on sex, age, income, education, and number and ages of chil-
dren. Significant differences between bereaved and control re-
THE MYTHS OF COPING
spondents were found on several indicators of functioning, in-
cluding depression and other psychiatric symptoms, social
functioning, divorce, psychological well-being, and mortality.
Taken together, the aforementioned evidence suggests that
prevailing notions of recovery deserve reconsideration. There
is growing evidence that a substantial minority of individuals
continue to exhibit distress for a much longer period of time
than would commonly be assumed.
Reaching a State of Resolution
It is widely assumed that over time, as a result of "working
through" their loss, individuals will achieve a state of resolution
regarding what has happened. One important type of resolu-
tion involves accepting the loss intellectually. Parkes and Weiss
(1983) argued that people must come up with a rationale for the
loss; they must be able to understand what has happened and
make sense of it (see also Moos & Schaefer, 1986). Similarly,
Craig (1977), in her writings on the loss of a child, maintained
that an essential part of grief work is to resolve the meaningless-
ness of the crisis (see also Marris, 1958; Miles & Crandall,
1983). A second type of resolution involves accepting the loss
emotionally. Emotional acceptance is thought to be reached
when the person no longer feels the need to avoid reminders of
the loss in order to function. The lost person can be recalled, and
reminders can be confronted without intense emotional pain
(Parkes & Weiss, 1983). It is generally expected that much of
the grief work engaged in by those who have endured loss, such
as reviewing the events of the death or the course of the illness
or accident, will aid in resolution.
Although few studies have focused on the issue of resolution,
the limited data that are available suggest that a state of resolu-
tion may not always be achieved (e.g., Silver, Boon, & Stones,
1983). In the study by Parkes and Weiss (1983), 61% of the re-
spondents who had suddenly lost their spouse, and 29% of those
who had had forewarning, were still asking why the event had
happened 2 to 4 years later. More than 40% of those who had
suddenly lost a spouse, and 15% of those with forewarning, con-
tinued to agree with the statement "It's not real; I feel that I'll
wake up and it won't be true." Similar data were obtained in
our aforementioned study of coping with the loss of an infant
to SIDS. At all three of the time points we studied (3 weeks, 3
months, and 18 months postloss), the vast majority of respon-
dents were unable to find any meaning in their baby's death and
were unable to answer the question "Why me?" or "Why my
baby?" (Wortman & Silver, 1987). A particularly intriguing fea-
ture of our data is that we found little evidence that resolution
is achieved over time. In contrast, the number of parents who
were unable to find meaning in their babies' deaths increased
significantly between the first and second interviews.
The aforementioned study of the long-term impact of losing
a loved one in a motor vehicle accident (Lehman et al., 1987)
also found that even after 4 to 7 years, most respondents had
not achieved a state of resolution. In this investigation, almost
half of the sample had reviewed events leading up to the acci-
dent in the month prior to the interview. A majority of the re-
spondents were unable to find any meaning in the loss, had had
thoughts that the death was unfair, and had had painful memo-
ries of their spouse or child during the past month.
In the spinal cord literature, there is a dearth of longitudinal
studies following individuals for very long after their injury.
Nonetheless, there is limited evidence suggesting that it may
take individuals longer to resolve their loss than is commonly
assumed. In a cross-sectional study of patients disabled up to
38 years earlier, Shadish, Hickman, and Arrick (1981) reported
that many of them still thought about the things they could not
do since their injury and "really missed" these things almost
Considered together, these data provide convergent evidence
that, contrary to popular belief, individuals are not always able
to achieve resolution regarding their loss and to come up with
an explanation for the experience that is satisfying to them. Par-
ticularly when the event is sudden, a majority of individuals
appear to have great difficulty in coming to terms with what has
Implications for Theory, Research, and Intervention
Theories of grief and mourning, as well as clinical lore, main-
tain that virtually all individuals who experience an important
loss should go through the grief process, beginning with a phase
of intense distress and followed by ultimate recovery over time
as the person comes to terms with the loss (Donovon & Girton,
1984;Jette, 1983;Osterweisetal., 1984). Alternate patterns are
usually labeled as pathological or deviant (Brown & Stoude-
mire, 1983; Osterweis et al., 1984; Simons, 1985). Our analysis
suggests that, in contrast to this view, there are at least three
common patterns of adaptation to loss. Some individuals in-
deed seem to go through the expected pattern, moving from
high to low distress over time. But others appear not to show
intense distress, either immediately after the loss or at subse-
quent intervals. Still others seem to continue in a state of high
distress for much longer than would be expected.
Traditional theories of grief and loss are able to account for
those who move from high to low distress and resolve their grief
over time. But these theories offer little explanation of why some
people might consistently respond with less distress than ex-
pected and others might fail to recover or resolve their loss over
time. In this section we consider the theoretical, research, and
clinical implications of each of these groups in turn.
Failure to Become Depressed
Because of the assumption that early distress is inevitable,
limited research has carefully examined the range of emotions
that may occur in the first few weeks or months after a loss. Are
there some individuals who show very little, if any, feelings of
distress (Silver & Wortman, 1988), or do virtually all people
experience some feelings of sadness (Wright, 1983)? Can people
show other indications of mourning, such as preoccupation
with the loss or pining for it, without becoming depressed? Are
those individuals who show little distress also likely to show few
signs of positive emotion (Deutsch, 1937)? Among those who
show very little distress, is this best understood as a "shock" or
"denial" reaction, or is it a sign of coping strength and resil-
ience? Research that assesses respondents frequently in the
early period following loss (e.g., Lawson, 1976) would help to
address these questions.
CAMILLE B. WORTMAN AND ROXANE COHEN SILVER
Although failure to become distressed following loss is typi-
cally viewed as indicative of a problem, we have little evidence
to suggest that those who initially show minimal distress follow-
ing loss are likely to become significantly depressed at a later
point. In subsequent studies, it will be important to look closely
at people who show low initial levels of distress. Are such people
more vulnerable to subsequent minor losses, as some theorists
would lead us to expect? Are they more likely to develop so-
matic symptoms or physical health problems (Brown & Stoude-
mire, 1983) or problems in other areas of their lives, such as at
work or in their interpersonal relationships? The data we have
reviewed above provide suggestive evidence that low initial dis-
tress may not signal pathology. However, more systematic data
are needed before we can dismiss the firmly entrenched view
that "absent grief" is a cause for concern. In collecting such
data, it will be important to go beyond the self-report methodol-
ogy that is used almost exclusively in current research on reac-
tions to loss. Individuals who indicate that they are not dis-
tressed immediately after a loss may also be unwilling to admit
subsequent problems in other areas of their lives. Supplement-
ing self-reports of symptomatology with more objective indica-
tors of problems, such as measures of behavioral and physiolog-
ical functioning (e.g., from physical health records or from ob-
servational ratings made by members of the individual's work
and social networks), are important directions for subsequent
work in this area.
If results obtained from further studies are consistent with
the results reviewed herein, we must acknowledge the possibil-
ity that a sizeable minority of people may come through the
bereavement process relatively unscathed. As psychologist Nor-
man Garmezy has indicated, "our mental health practitioners
and researchers are predisposed by interest, investment, and
training in seeing deviance, psychopathology, and weakness
wherever they look" (Garmezy, 1982, p. xvii). By assuming la-
tent pathology among those who fail to show intense distress
following a loss, attention appears to have been deflected away
from identifying strengths (e.g., high self-esteem; Lund et al.,
1985-1986) or coping resources (e.g., premorbid coping styles
or adequate social support systems; see Kessler, Price, & Wort-
man, 1985) that may protect these people from distress. The
data also suggest that some people may have something in place
beforehand—perhaps a religious or philosphical orientation or
outlook on life—that enables them to cope with their experi-
ence almost immediately (Silver & Wortman, 1988). Clearly,
future research is necessary to examine the role that such re-
sources may play in protecting people from the deleterious
effects of loss.
The implications of our analysis for treatment and interven-
tion are straightforward. Rather than recognizing the absence
of grief as a sign of possible strengths of the individual (Gans,
1981), the expectation that individuals must go through a pe-
riod of distress may lead health care providers to provoke such
a reaction, even if it is not warranted. For example, regarding
spinal cord injury, Nemiah (1957) has written, "It is often nec-
essary to confront the patient gently but firmly with the reality
of his situation, and to force him into a period of depression
while he works out his acceptance of his loss" (p. 146). When
dealing with the bereaved, physicians have been reminded to
encourage patients to express their distress, and to bring "latent
anger and guilt to a conscious level of awareness" (Brown &
Stoudemire, 1983, p. 382). In a manual for grief counselors,
Doyle (1980) has discouraged the use of tranquilizers or antide-
pressants by the bereaved during the early stages of grief, since
grief "needs to be felt in all its ramifications" (p. 15) (see also
Failure to Resolve or Recover From the Loss
Because it is widely believed that individuals will recover
from a loss within a year or so, only a handful of studies have
focused on the issue of long-term recovery. Yet, as noted above,
there appears to be considerable variability in the length of time
it may take to recover from a loss, and some people do not seem
to recover despite the passage of many years. This has led to
increasing interest in identifying mediating factors that may
promote or impede psychosocial recovery (Kessler et al., 1985;
Silver & Wortman, 1980). Recent research has, in fact, identi-
fied factors that may enhance the likelihood that individuals will
react to loss with intense and prolonged distress. These include
the nature of the relationship with the deceased, circumstances
surrounding the loss, the presence of concomitant stressors, and
the availability of social support (see Wortman & Silver, 1987,
for an extended discussion).
In our judgment, an unfortunate consequence of the perva-
sive belief in recovery from loss is that attention has been de-
flected away from examining the possible mechanisms through
which loss may produce subsequent and continued mental or
physical health problems. A number of different mechanisms
have been suggested in the literature (Jacobs & Douglas, 1979;
Klerman & Izen, 1977; Osterweis et al., 1984; Stroebe &
Stroebe, 1983). For example, grieving appears to involve
changes to the respiratory, autonomic, cardiovascular, and en-
docrine systems (see Osterweis et al., 1984, for a review). In
fact, the Institute of Medicine report on bereavement concluded
that "preliminary data now available make it clear that trau-
matic loss experiences may have a long-term impact on the bo-
dy's immune system" (Osterweis et al., 1984, p. 170). Such
changes may result in increased susceptibility to illness and in-
fections, as well as long-term health problems, both of which
may also have deleterious psychological effects. Loss may also
result in changes in health maintenance behavior, such as eating
regular meals and exercise. Moreover, loss of a loved one often
removes a major source of social support, and this may account
for the pathogenic effects of bereavement. Finally, experiencing
an irrevocable loss such as bereavement or spinal cord injury
might alter the individual's view of the world (e.g., Lilliston,
1985; Parkes & Weiss, 1983). Indeed, in their study of the long-
term effects of losing a loved one in a motor vehicle accident,
Lehman et al. (1987) found that many of the respondents had
come to see the world as a hostile place where things can be
taken away in a moment. Such an altered world view is likely to
be associated with depression, passivity, and impaired motiva-
tion to engage in subsequent coping efforts. Clearly, evidence
concerning the precise mechanisms through which loss leads to
long-term difficulties is essential not only for theoretical ad-
vancement, but also to guide intervention efforts in the area of
grief and loss.
The expectation that individuals will recover from irrevoca-
ble loss within a limited period of time may unfortunately lead
THE MYTHS OF COPING
health care providers to react negatively to those who fail to
recover. In fact, those who do not recover within the prescribed
time limits have been derogated in the literature (e.g., Falek &
Britton, 1974). And although it has been acknowledged that the
progression to adjustment may be unsteady, health care profes-
sionals are nonetheless often reminded to encourage movement
forward. As Stewart (1977-1978) has written, "To be blunt,
a pat on the back and kick in the pants are often necessary"
As reviewed above, assumptions about the process of coping
with loss fail to be supported and in some cases are contradicted
by available empirical work on the topic. Why might such erro-
neous beliefs continue in the absence of validating data col-
lected in methodologically rigorous research and in the pres-
ence of data indicating extreme variability in responses to loss?
As Silver and Wortman (1980) discussed, even if they are not
supported by data, widespread assumptions about the coping
process may be particularly resistant to disconfirming evidence.
Social psychological research has demonstrated repeatedly that
"people tend to seek out, recall, and interpret evidence in a
manner that sustains beliefs" (Nisbett & Ross, 1980, p. 192).
Thus, the interpretation of data tends to be strongly biased by
the expectations researchers, clinicians, and laypersons may
hold (Nisbett & Ross, 1980; see also Goldiamond, 1975;
Wright, 1983), and these errors in information processing lead
people's implicit theories to be "almost impervious to data"
(Nisbett & Ross, 1980, p. 169).
As noted earlier, the assumption that distress is inevitable
shortly after a loss has resulted in its absence being treated as
pathological, even if there is no objective reason to assume this
to be true. Studies that fail to find problems resulting from the
absence of grief may be dismissed for not looking long enough,
not looking closely enough, or not asking the correct questions
(Volkan, 1966). Such insistence on distress following loss has
been labeled the "requirement of mourning" (Dembo, Leviton,
& Wright, 1956; Wright, 1983). This hypothesis describes the
need of outsiders to "insist that the person they consider unfor-
tunate is suffering (even when that person seems not to be
suffering) or devaluate the unfortunate person because he or she
ought to suffer" (Dembo et al., 1956, p. 21). This requirement
of mourning may explain why health care professionals tend to
assume the presence of significantly more distress following loss
than individuals report experiencing themselves (Baluk &
O'Neill, 1980; Cans, 1981;Klas, 1970; Mason &Muhlenkamp,
1976;Schoenberg,Carr,Peretz,&Kutscher, 1969; Taylor, 1967;
Wikler, Wasow, & Hatfield, 1981).
A series of complementary processes might explain the per-
petuation of the assumption that the presence of long-term dis-
tress is "abnormal." Silver and Wortman (1980) argued that
outsiders may minimize the length of time a loss will affect an
individual who encounters it because they may be unaware that,
in addition to the loss itself, the individual must also contend
with the simultaneous destruction of future hopes and plans
that were vitiated by the loss. Outsiders may also be unaware of
the possible alterations in views of the world that may occur
as a result of a loss (Silver & Wortman, 1980). The fact that
individuals who have experienced loss are often implored to
control their expressions of grief and to stop "dwelling on their
problems" (Glick et al., 1974; Maddison & Walker, 1967) sug-
gests that outsiders also believe that the distressed could behave
more appropriately if they wished. In fact, as Wright (1983)
maintained, society frowns upon open displays of distress and
has a "requirement of cheerfulness" that in fact contradicts its
simultaneous "requirement of mourning." It is likely that this
subtle yet sometimes explicit message discourages the person
who has encountered loss from expressing distress to others at
all. Over time this process may become even more intensified.
Perhaps so as to maintain harmonious social relations and not
to be perceived as abnormal, the individual may continue to
hide the true degree of his or her distress from members of the
social network (Tail & Silver, 1989). Thus, the stigma that is
associated with persistent difficulties following loss may result
in self-presentational strategies that are in line with societal ex-
pectations, resulting in a discrepancy between public expres-
sions and private experience of ongoing distress (Tail & Silver,
1989). The very act of concealing common aspects of the loss
experience is likely to perpetuate the misconception that grief
is time limited for all but the few whose reactions are deemed
In summary, we maintain that a complex mixture of biased
input and interpretation of data by outsiders, their own per-
sonal needs, as well as limited opportunity for open communi-
cation between parties, has led to a perpetuation of unrealistic
assumptions about the normal process of coping with loss. In
addition, unrealistic assumptions held by health care profes-
sionals and the social network may also unnecessarily exacer-
bate feelings of distress among those who encounter loss, and
lead to a self-perception that their own responses are inappro-
priate and abnormal under the circumstances.
Of course, the ability to identify pathological responses to loss
would enable health care professionals to target those individu-
als who may be in need of professional assistance (Bracken &
Shepard, 1980; Falek & Britton, 1974; Silver & Wortman,
1980). Perhaps this goal has overridden acceptance of alterna-
tives to the current views regarding adjustment to loss. As Zi-
sook and Shuchter (1986) have indicated, at the present time
"there is no prescription for how to grieve properly for a lost
spouse, and no research-validated guideposts for what is nor-
mal vs. deviant mourning. . . .We are just beginning to realize
the full range of what may be considered 'normal' grieving" (p.
288, italics added). Recognition of this variability is crucial in
order that those who experience loss are treated nonjudgment-
ally and with the respect, sensitivity, and compassion they de-
Baluk, U., & O'Neill, P. (1980). Health professionals' perceptions of the
psychological consequences of abortion. American Journal of Com-
munity Psychology, 8, 67-75.
Bernstein, P. E., Clayton, P. J., Halikas, J. A., Maurice, W. L., & Robins,
E. (1973). The depression of widowhood after thirteen months. Brit-
ish Journal of Psychiatry, 122, 561-566.
Bowlby, J. (1980). Loss: Sadness and depression (Attachment and loss,
Vol. 3). New York: Basic Books.
Bracken, M. B., & Shepard, M. J. (1980). Coping and adaptation follow-
CAMILLE B. WORTMAN AND ROXANE COHEN SILVER
ing acute spinal cord injury: A theoretical analysis. Paraplegia, 18,
Brown, J. T., & Stoudemire, G. A. (1983). Normal and pathological
grief. Journal of the American Medical Association, 250, 378-382.
Clayton, P. J., Halikas, J. A., & Maurice, W. L. (1971). The bereavement
of the widowed. Diseases of the Nervous System, 32, 597-604.
Clayton, P. J., Halikas, J. A., & Maurice, W. L. (1972). The depression
of widowhood. British Journal of Psychiatry, 120, 71-78.
Cook, D. W. (1976). Psychological aspects of spinal cord injury. Reha-
bilitation Counseling Bulletin, 19, 535-543.
Craig, Y. (1977). The bereavement of parents and their search for mean-
ing. British Journal of Social Work, 7, 41-54.
Deegan, M. J. (1977). Depression and physical rehabilitation. Journal
of Sociology and Social Welfare, 4, 945-954.
Dembo, X, Leviton, G. L., & Wright, B. A. (1956). Adjustment to mis-
fortune: A problem of social-psychological rehabilitation. Artificial
Limbs, 3, 4-62.
Derogatis, L. R. (1977). SCL-90: Administration, scoring and proce-
dures manual-1. Baltimore, MD: Johns Hopkins University School
Deutsch, H. (1937). Absence of grief. Psychoanalytic Quarterly, 6, 12-
Dinardo, Q. (1971). Psychological adjustment to spinal cord injury. Un-
published doctoral dissertation, University of Houston, Houston,
Donovon, M. I., & Girton, S. E. (1984). Cancer care nursing. Norwalk,
Doyle, P. (1980). Grief counseling and sudden death: A manual and
guide. Springfield, IL: Charles C. Thomas.
Elizur, E., & Kaffman, M. (1982). Children's bereavement reactions fol-
lowing death of the father: II. Journal of the American Academy of
Child Psychiatry, 21, 474-480.
Elizur, E., & Kaffman, M. (1983). Factors influencing the severity of
childhood bereavement reactions. American Journal ofOrthopsychi-
atry, 53, 668-676.
Falek, A., & Britton, S. (1974). Phases in coping: The hypothesis and its
implications. Social Biology, 21, 1-7.
Freud, S. (1957). Mourning and melancholia. In J. Strachey (Ed. and
Trans.), The standard edition of the complete original works ofSig-
mund Freud (Vol. 14, pp. 152-170). London: Hogarth Press. (Origi-
nal work published 1917)
Fullerton, D. T., Harvey, R. F, Klein, M. H., & Howell, T. (1981). Psy-
chiatric disorders in patients with spinal cord injury. Archives of Gen-
eral Psychiatry, 38, 1369-1371.
Gans, J. S. (1981). Depression diagnosis in a rehabilitation hospital.
Archives of Physical Medicine and Rehabilitation, 62, 386-389.
Garmezy, N. (1982). Forward. In E. E. Werner & R. S. Smith, Vulnera-
ble but invincible (pp. xiii-xix). New \fork: McGraw-Hill.
Click, I. Q, Weiss, R. S., & Parkes, C. M. (1974). The first year of be-
reavement. New \fork: Wiley.
Goldiamond, I. (1975). Insider-outsider problems: A constructional
approach. Rehabilitation Psychology, 22, 103-116.
Gunther, M. S. (1971). Psychiatric consultation in a rehabilitation hos-
pital: A regression hypothesis. Comprehensive Psychiatry, 12, 572-
Heijn, C., & Granger, G. (1974). Understanding motivational pat-
terns—Early identification aids rehabilitation. Journal of Rehabilita-
tion, 40, 26-28.
Howell, T, Fullerton, D. T., Harvey, R. F, & Klein, M. (1981). Depres-
sion in spinal cord injured patients. Paraplegia, 19, 284-288.
Jacobs, S., & Douglas, L. (1979). Grief: A mediating process between a
loss and illness. Comprehensive Psychiatry, 20, 165-176.
Jette, S. H. (1983). Nursing the person with loss. In J. Lindbergh, M.
Hunter, & A. Kruszewski (Eds.), Introduction to person-centered
nursing (pp. 641-657). Philadelphia: Lippincott.
Karney, R. J. (1976). Psychosocial aspects of the spinal cord injured:
The psychologist's approach. In W. M. Jenkins, R. M. Anderson, &
W. L. Dietrich (Eds.), Rehabilitation of the severely disabled (pp.
201-205). Dubuque, IA: Kendall/Hunt.
Kerr, W, & Thompson, M. (1972). Acceptance of disability of sudden
onset in paraplegia. Paraplegia, 10, 94-102.
Kessler, R. C., Price, R. H., & Wortman, C. B. (1985). Social factors in
psychopathology: Stress, social support, and coping processes. An-
nual Review of Psychology, 36, 531-572.
Klas, L. D. (1970). A study of the relationship between depression and
factors in the rehabilitation process of the hospitalized spinal cord
injured patient. Unpublished doctoral dissertation, University of
Utah, Salt Lake City.
Klerman, G. L., & Izen, J. E. (1977). The effects of bereavement and
grief on physical health and general well-being. Advances in Psychoso-
matic Medicine, 9, 63-104.
Klinger, E. (1975). Consequences of commitment to and disengagement
from incentives. Psychological Review, 82, 1-25.
Klinger, E. (1977). Meaning and void: Inner experience and the incen-
tives in people's lives. Minneapolis: University of Minnesota Press.
Knorr, N. J., & Bull, J. C. (1970). Spinal cord injury: Psychiatric consid-
erations. Maryland State Medical Journal, 19, 105-108.
Kubler-Ross, E. (1969). On death and dying. New York: Macmillan.
Lawson, N. C. (1976). Depression after spinal cord injury: A multimea-
sure longitudinal study. Unpublished doctoral dissertation, Univer-
sity of Houston, Houston, TX.
Lehman, D. R., Wortman, C. B., & Williams, A. F. (1987). Long-term
effects of losing a spouse or child in a motor vehicle crash. Journal of
Personality and Social Psychology, 52, 218-231.
Lilliston, B. A. (1985). Psychosocial responses to traumatic physical dis-
ability. Social Work in Health Care, 10, 1-13.
Lindemann, E. (1944). The symptomatology and management of acute
grief. American Journal ofPsychiatry, 101, 141-148.
Lund, D. A., Caserta, M. S., & Dimond, M. F. (1986). Gender differ-
ences through two years of bereavement among the elderly. The Ger-
ontologist, 26, 314-319.
Lund, D. A., Dimond, M. F., Caserta, M. S., Johnson, R. J., Poulton,
J. L., & Connelly, J. R. (1985-1986). Identifying elderly with coping
difficulties after two years of bereavement. Omega, 16, 213-224.
Maddison, D., & Walker, W. L. (1967). Factors affecting the outcome
of conjugal bereavement. British Journal ofPsychiatry, 113, 1057-
Malec, J., & Neimeyer, R. (1983). Psychological prediction of duration
of inpatient spinal cord injury rehabilitation and performance of self-
care. Archives of Physical Medicine and Rehabilitation, 64, 359-363.
Marris, P. (1958). Widows and their families. London: Routledge and
Mason, L., & Muhlenkamp, A. (1976). Patients' self-reported affective
states following loss and caregivers' expectations of patients' affective
states. Rehabilitation Psychology, 23, 72-76.
Miles, M. S., & Crandall, E. K. B. (1983). The search for meaning and
its potential for affecting growth in bereaved parents. Health Values:
Achieving High Level Wellness, 7, 19-23.
Moos, R. H., & Schaefer, J. A. (1986). Life transitions and crises: A
conceptual overview. In R. H. Moos (Ed.), Coping with life crisis: An
integrated approach (pp. 3-28). New "Vbrk: Plenum Press.
Nemiah, J. C. (1957). The psychiatrist and rehabilitation. Archives of
Physical Medicine and Rehabilitation, 38, 143-147.
Nisbett, R. E., & Ross, L. D. (1980). Human inference: Strategies and
shortcomings of social judgment. Englewood Cliffs, NJ: Prentice-
Osterweis, M., Solomon, F, & Green, M. (Eds.). (1984). Bereavement:
THE MYTHS OF COPING Download full-text
Reactions, consequences, and care. Washington, DC: National Acad-
Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. New
York: Basic Books.
Rando, T. A. (1984). Grief, dying and death: Clinical interventions for
caregivers. Champaign, IL: Research Press.
Raphael, B. (1983). The anatomy of bereavement. New York: Basic
Schoenberg, B. B., Carr, A. C., Peretz, D., & Kutscher, A. H. (1969).
Physicians and the bereaved. General Practitioner, 40, 105-108.
Shadish, W. R., Hickman, D., & Arrick, M. C. (1981). Psychological
problems of spinal cord injury patients: Emotional distress as a func-
tion of time and locus of control. Journal of Consulting and Clinical
Psychology, 49, 297.
Siller, J. (1969). Psychological situation of the disabled with spinal cord
injuries. Rehabilitation Literature, 30, 290-296.
Silver, R. L., Boon, C., & Stones, M. H. (1983). Searching for meaning
in misfortune: Making sense of incest. Journal of Social Issues, 39(2),
Silver, R. L., & Wortman, C. B. (1980). Coping with undesirable life
events. In J. Garber & M. E. P. Seligman (Eds.), Human helplessness:
Theory and applications (pp. 279-340). New York: Academic Press.
Silver, R. C., & Wortman, C. B. (1988). Is "processing"a loss necessary
for adjustment? A study of parental reactions to death of an infant.
Manuscript submitted for publication.
Simons, R. C. (Ed.). (1985). Understanding human behavior in health
and illness (3rd ed.). Baltimore, MD: Williams & Wilkins.
Stewart, T. D. (1977-1978). Coping behaviour and the moratorium fol-
lowing spinal cord injury. Paraplegia, 15, 338-342.
Stroebe, M., & Stroebe, W. (1983). Who suffers more: Sex differences
in health risks of the widowed. Psychological Bulletin, 93, 297-301.
Tail, R., & Silver, R. C. (1989). Coming to terms with major negative
life events. In J. S. Uleman & J. A. Bargh (Eds.), Unintended thought:
The limits of awareness, intention, and control (pp. 351-382). New
York: Guilford Press.
Taylor, G. P. (1967). Predicted versus actual response to spinal cord in-
jury: A psychological study. Unpublished doctoral dissertation, Uni-
versity of Minnesota, Minneapolis.
Trieschmann, R. B. (1978). The psychological, social, and vocational
adjustment in spinal cord injury: A strategy for future research (Re-
port No. 13-P-59011/9-01). Washington, DC: Rehabilitation Ser-
Trieschmann, R. B. (1980). Spinal cord injuries: Psychological, social
and vocational adjustment. New\brk: Pergamon Press.
Vachon, M. L. S., Rogers, J., Lyall, W. A. L., Lancee, W. J., Sheldon,
A. R., & Freeman, S. J. J. (1982). Predictors and correlates of adapta-
tion to conjugal bereavement. American Journal of Psychiatry, 139,
Vachon, M. L. S., Sheldon, A. R., Lancee, W. J., Lyall, W. A. L., Rogers,
J., & Freeman, S. J. J. (1982). Correlates of enduring stress patterns
following bereavement: Social network, life situation and personality.
Psychological Medicine, 12, 783-788.
Volkan, V. (1966). Normal and pathological grief reactions: A guide for
the family physician. Virginia Medical Monthly, 93, 651-656.
Wikler, L., Wasow, M., & Hatfield, E. (1981). Chronic sorrow revisited:
Parent vs. professional depiction of the adjustment of parents of men-
tally retarded children. American Journal of Orthopsychiatry, 51, 63-
Wortman, C. B., & Silver, R. C. (1987). Coping with irrevocable loss.
In G. R. VandenBos & B. K. Bryant (Eds.), Cataclysms, crises, and
catastrophes: Psychology in action (pp. 189-235). Washington, DC:
American Psychological Association.
Wortman, C. B., & Silver, R. C. (in press). Effective mastery of bereave-
ment and widowhood: Longitudinal research. In P. B. Baltes & M. M.
Bakes (Eds.), Successful aging: Research and theory. London: Cam-
bridge University Press.
Wright, B. A. (1983). Physical disability—A psychosocial approach
(2nd ed.). New York: Harper & Row.
Zisook, S., & Shuchter, S. R. (1986). The first four years of widowhood.
Psychiatric Annals, 15, 288-294.
Received April 12, 1988
Revision received May 31, 1988
Accepted May 31,1988 •