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Death, Dying, and Grief in Families

Authors:
4
Death, Dying, and
Grief in Families
Colleen I. Murray, Katalin Toth,
and Samantha S. Clinkinbeard
On September 11, 2001, Kate was working in New York City when she
received a call from her elderly father’s nursing home upstate and learned that
her father had only hours to live. Her efforts to leave the city were slowed
by the chaos of that tragic day, and her father died before she arrived at the
nursing home. She thinks of her grief over missing her chance to say good-bye
to him as selfish and insignificant compared with the losses others suffered
that day.
On the afternoon of September 11, 2001, 16-year-old Dan was killed in
Ohio as he was walking home from school. He was run down by a drunk dri-
ver who, despite a history of drunk driving, claimed he had been drinking that
afternoon in response to the day’s events. Dan’s family believes that Dan’s
death has gone unnoticed.
A Manhattan psychotherapist observes that the initial increases in compas-
sion and existential consciousness he saw in his clients soon after 9/11 have
75
Authors’ Note: Additional material related to this chapter, including suggestions
for clinical, public policy, and educational interventions as well as directions for
research, can be found online at http://equinox.unr.edu/homepage/cimurray/.
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shifted to narcissistic, angry preoccupations. Meanwhile, the mass media
continue to present heroic images of New Yorkers, not the detached people he
sees in his neighborhood (Alper, 2002).
Months after the 9/11 terrorist attacks, Ricardo, who lives in Nevada, learns
that his firefighter uncle has died 2,000 miles away while responding to an act
of environmental terrorism in which a luxury car dealership was bombed.
Everyone talks of his uncle as a young hero, and of the family’s patriotism.
Then the family is left to grieve alone, as the rest of the nation moves on. Two
years later, Ricardo’s neighbor dies in the war in Iraq; Ricardo notices that
there are similarities in how people respond to the neighbor’s family and how
they responded to his family when his uncle died.
Despite terrorism and war, dying and grief have changed little since the
previous edition of Families and Change was published. Most adults
in industrialized countries still die from degenerative illnesses, and most
young people die from sudden or violent causes. Death still “poses the most
painful adaptational challenges for families” (Walsh & McGoldrick, 1991,
p. 25). Changes in the cultural paradigm from narcissistic materialism to
compassion and from a sense of security to vulnerability seem limited in
scope, reflecting most Americans’ experience with single acute tragic events
rather than with recurring large public tragedies. The mass media speedily
convey the details of wartime danger, natural disasters, high-profile acci-
dents, and purposive public acts of violence and provide marathon coverage
of events through technologically enhanced reporting (Blondheim & Liebes,
2002). We live in an environment where death is invisible and denied, yet we
have become desensitized to it. These inconsistencies appear in the extent to
which families are personally affected by death—whether they define loss as
happening to “one of us” or to “one of them.” In this chapter, we address
enduring processes related to death in the family as well as some changes
that have occurred since the terrorist attacks of September 11, 2001.
Annually, there are more than 2.9 million deaths in the United States,
affecting 8 to 10 million surviving immediate family members, including
2 million children and adolescents (Hoyert, Arias, Smith, Murphy, &
Kochanek, 2001). Death is a crisis that all families encounter, and it is rec-
ognized as the most stressful life event families face, although most do not
need counseling to cope (Parkes, 2001). Research that examines loss as a
family system phenomenon has only recently gained visibility (e.g., Shapiro,
1994; Walsh & McGoldrick, 1991), with increased attention paralleling
movement into midlife of “baby boomers.”
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Etiology of “Invisible Death”
and Its Consequences
At least from the Middle Ages through the 17th century, death was viewed as
natural and inevitable (Ariès, 1974). A movement to deny the realities of death
occurred during the 18th and 19th centuries, and by the 20th century a lack
of firsthand familiarity with death in Western culture fostered an era in which
death became sequestered, privatized, and invisible. Factors contributing to
this lack of familiarity with death included increased life expectancy, changes
in leading causes of death from communicable diseases to chronic and degen-
erative diseases (although there is currently some concern about increases in
communicable diseases such as West Nile virus, meningitis, and drug-resistant
tuberculosis, and about the use of smallpox as a bioweapon), redistribution of
death from the young to the old, decreased mortality rates, and increased dura-
tion of chronic illnesses (Miller, Engelberg, & Broad, 2001; U.S. Bureau of the
Census, 1975). In industrialized Western nations, geographic mobility and
social reorganization of families also resulted in reduced intergenerational con-
tact and thus fewer opportunities for younger family members to participate
in death-related experiences (Rando, 1993). In addition, the development of
life-extending medical technologies has had several effects on Americans’ expe-
riences with death: (a) It has moved most dying from people’s homes to insti-
tutions (National Center for Health Statistics, 2001), (b) it has resulted in care
dominated by efforts to delay death by all means available, (c) it has led us to
question our assumptions about what constitutes life and death, and (d) it has
confronted families with decisions about whether to prolong the process of
dying or terminate the lives of loved ones.
Although Western families are distanced from the intimacies of death,
they are bombarded by public presentations of death through the news and
entertainment media (Dolan, 2003; Murray & Gilbert, 1997). These fre-
quent, sensationalized, violent portrayals of death as unnatural contribute to
desensitization, repression, and personal traumatization of bereaved individ-
uals (Alper, 2002; Rando, 1993). Media-orchestrated emotional invigilation
in reporting on the deaths of famous individuals and mass tragedies leave
consumers with illusions of intimacy and grieving (Walter, Littlewood, &
Pickering, 1995). Individuals who did not personally know the deceased can
go through rituals of mourning and “virtually” attend the funeral through
television or the Internet, without feeling the depth of pain and depression
of actual grief. Viewers may confuse their emotional responses (i.e., “virtual
grief”) with the actual grief experienced by the deceased person’s loved ones
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(Cose, 1999). Recovery from virtual grief is quick, so individuals who have
experienced only virtual grief may be insensitive regarding the amount of
time that others need to “return to normal” when actual grief occurs.
The changes described above have increased the stress that families expe-
rience when coping with death. Westerners generally do not view dying and
bereavement as normal life-span experiences; rather, they compartmentalize
death, frequently excluding children from family death-related experiences
(Hurd, 1999). Families’ adaptation to losses through death has been ham-
pered by the lack of cultural supports that could assist family systems in
“integrating the fact of death with ongoing life” (Walsh & McGoldrick,
1991, p. 2) and the lack of instrumental social supports to help them man-
age disruptions in their daily lives, such as assistance with child care, house-
work, and finances (Shapiro, 2001). For many Americans, a minimum of
rituals exist surrounding death, the roles of chronically ill or bereaved indi-
viduals are not clearly defined, and geographic distance hinders the comple-
tion of “unfinished business” (Harvey, 2000; Shapiro, 1994).
Although death and grieving are normal, survivors can experience physi-
cal, psychological, and social consequences that can be viewed either as
stressor experiences (Burnell & Burnell, 1989) or as part of the coping
process (Hall & Irwin, 2001). Bereavement can result in negative conse-
quences for physical health (Prigerson et al., 1997), including physical ill-
ness, aggravation of existing medical conditions, increased use of medical
facilities, and the presence of new symptoms and complaints (Burnell &
Burnell, 1989). During anticipatory bereavement and the months following
a loss through death, physiological changes in survivors are indicative of
acute heightened arousal (i.e., increased levels of cortisol and cathe-
cholamines, change in immune system competence, and sleep complaints);
however, changes in neuroendocrine function, immune system competence
and sleep may endure for years in survivors (Goodkin et al., 2001; Hall &
Irwin, 2001). Intrusive thoughts and avoidance behaviors are correlated
with sleep disturbances, which appear to intensify the effects of grief, result-
ing in decreased numbers and functioning of natural killer cells (Ironson
et al., 1997). Bereavement also appears to be related to increased adrenocor-
tical activity, long-lasting brain changes, and possible long-term changes in
gene expression (Biondi & Picardi, 1996). It should be noted, however, that
Rosenblatt (2000) found sparse reference to any personal health problems in
the narratives of bereaved parents regarding their children’s deaths or dying.
Epidemiological studies cannot assess a direct causal relationship between
bereavement and physical ailments, but researchers have found bereavement
to be an antecedent of disease (Goodkin et al., 2001; Hall & Irwin, 2001).
Risk factors for increased morbidity and mortality during bereavement
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include self-damaging or neglectful behaviors, additional stress symptoms,
elevated physiological arousal, and depression. Physiological resilience appears
to be related to coping strategies, social support networks, and healthy
sleep profile.
The consequences of bereavement for mental health also are difficult to
measure (Attig, 2001). Characteristics typically associated with grief are ones
that would evoke concern in other circumstances. High rates of depression,
insomnia, suicide, and anorexia may exist in conjunction with consumption
of drugs, alcohol, and tobacco (Stroebe, 2000). Individuals with personality
disorders are more likely to exhibit complications (Rando, 1993). Lack of
differentiation among grief, depression, and somatization (Wayment &
Vierthaler, 2002), as well as researchers’ failure to examine traumatic or com-
plicated grief reactions separately from “normal” grief, hinder determination
of mental health consequences (Wortman & Silver, 2001).
Research has suggested that bereaved individuals identify bereavement
as a social stressor, reporting lack of role clarity and support (Rando, 1993;
Rosenblatt, 2000). The changes in social status, conflicts in identity, disputes
over inheritance, and loss of roles, income, or retirement funds that may
result when a family member dies can contribute to social isolation. Changes
in family communication patterns and relationships with people outside the
family are common.
Paradoxically, a body of literature is currently emerging that emphasizes
growth as an outcome of loss. Posttraumatic growth is both a process and an
outcome in which, following trauma, growth occurs beyond the individual’s
previous level of functioning (Schaefer & Moos, 2001; Tedeschi, Park, &
Calhoun, 1998). Growth outcomes may occur in the individual’s perception of
self (e.g., as survivor rather than victim, or as self-reliant yet with heightened
vulnerability), interpersonal relationships (e.g., increased ability to be compas-
sionate or intimate, to self-disclose important information, and to express
emotions), and philosophy of life (e.g., reorganization of priorities, greater
appreciation of life, grappling with the meaning and purpose of life, spiritual
change, and sense of wisdom). In contrast, terror management theory
(Pyszcznski, Solomon, & Greenberg, 2003) suggests that what appears to be
posttraumatic growth is actually cognitive coping, which protects or distances
the individual from traumatic events and buffers his or her fear of death.
Theories of Grieving
Theories of grieving have moved beyond bereaved individuals to the inter-
personal study of the group or societal influences and impacts of grief. They
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include developmental stage and process-based theories focused on individuals’
experiences as family members as well as theories based on the family system.
Individual-Based Theories
Scholars have proposed theories of grieving that focus on developmental
stages or trajectories for the dying (e.g., Kübler-Ross, 1969; Pattison, 1977)
and for survivors (e.g., Rando, 1988; Worden, 1991) derived from the
works of Freud (1917/1957) and Bowlby (1980). Such theories differ in the
numbers of stages they describe, but they all assume that grieving consists of
three basic phases: (a) a period of shock, denial, and disorganization; (b) a
period of extremes including intense separation pain, volatile emotions, and
active grief work; and (c) a period of resolution, acceptance, and (for the
bereaved) withdrawal of energy from the deceased and reinvestment. Critics
of developmental theories question the definition of “normal” grief and
these theories’ assumptions about how people “should” respond, including
the following: (a) Intense emotional distress or depression is inevitable;
(b) failure to experience distress is indicative of pathology; (c) working
through loss is important—intense distress will end with recovery; and (d) by
working through loss, individuals can achieve a state of resolution, includ-
ing intellectual acceptance (Wortman & Silver, 2001).
Stage theories have been criticized for being population specific and for
representing progress toward adjustment as linear (Corr, 1993). Critics con-
tend that progress is not always forward and that grief processes may have
no definite ending (Rosenblatt, 2000; Wortman & Silver, 2001). They assert
that the emphasis should not be on recovery or closure, but on continuing
bonds, relearning relationships, and renegotiating the meaning of loss over
time (Attig, 2001; Klass, 2001). Rather than dichotomizing relinquishing
and retaining bonds, Boerner and Heckhausen (2003) suggest that transfor-
mation involves both disengagement from the deceased’s physical absence
and connection with the deceased through mental representations.
Scholars have also argued that developmental theories view grief as pas-
sive, with few choices for grievers (Attig, 2001). Critics of these theories
contend that grieving is active, presenting bereaved individuals with chal-
lenges, choices, and opportunities. They question the necessity of “grief
work”—traditionally accepted as an essential cognitive process of con-
fronting loss (Bowlby, 1980; Freud, 1917/1957; Lindemann, 1944; Parkes,
2001). Margaret Stroebe and her colleagues suggest that grief work is not a
universal concept and that the definitions and operationalizations of the con-
cept that researchers have used have been problematic. They note that few
studies have yielded substantial conclusions regarding the effectiveness of
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grief work, and researchers have approached these studies with the aim of
understanding the processes of grief rather than developing prescriptions for
recovery (Stroebe et al., 2000).
Models based on varied tasks of grieving have begun to emerge in recent
years. Worden (1991) has moved away from grief as illness to delineate a
model based on the following tasks: (a) acknowledging the reality of loss,
(b) working through emotional turmoil, (c) adjusting to the environment
where the deceased is absent, and (d) loosening ties to the deceased. Horacek’s
(1995) heuristic model identifies tasks related to high-grief deaths and views
grief responses as both reactive and proactive. Attig (2001) presents a model
of grief as active in which the task of the bereaved person is to relearn the
world in terms of physical surroundings, relationships, and who he or she is.
Among individual-centered process-based models is Rando’s (1993) “6 R
model,” which assumes the need to accommodate loss. The “6 R” processes
are recognizing the loss, reacting to separation from the deceased, recollect-
ing (and reexperiencing) the deceased and the relationship, relinquishing old
attachments and the assumptive world, readjusting to move into a new
world without forgetting the old, and reinvesting (p. 45). In contrast, the
dual-process model of coping (M. S. Stroebe & Schut, 2001) suggests that
active confrontation of loss is not necessary for a positive outcome; there
may be circumstances when denial, avoidance of reminders, and repressive
strategies are essential. The dual-process model concurs with the findings of
social-functional research that minimizing expression of negative emotions
and using laughter as a dissociation from distress may improve functioning
(Bonanno, 2001). This model assumes that most individuals experience
ongoing oscillation between loss orientation (coping with loss through grief
work, dealing with denial, and avoiding changes) and restoration orientation
(adjusting to various life changes triggered by death, changing routines, tran-
sitioning to a new equilibrium, avoiding or taking time off from grief). There
is movement between coping with loss and moving forward, with the need
for each orientation differing from individual to individual depending on
such factors as type of loss, culture, and gender.
Family Theories of Coping With Death
Although scholars have focused on dying or bereaved individuals, death
does not occur in isolation. An estimated 70% of deaths in the United States
involve end-of-life decision making negotiated among family members, physi-
cians, and (when competent) dying family members (American Psychological
Association, 2000). Individual process models have not been broadened to
aid in our understanding of families, except for psychoanalytic models, which
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some have argued are suited for dealing with family bereavement because of
their emphasis on ambivalent relationships (Blake-Mortimer, Koopman,
Spiegel, Field, & Horowitz, 2003). Work on grief from a family perspective
has typically utilized elements of systems theories, particularly through inte-
grative approaches to complex issues. Refinement of systemic models recog-
nizes that multiple griefs exist simultaneously for individuals, couples,
families, and communities, and, although some thoughts and feelings are
shared, others are not (Gilbert, 1996).
Family Systems Theory
Family systems theory focuses on dynamics and provides concepts that
are useful for describing relationships (e.g., Jackson, 1965; Kantor & Lehr,
1975), offering a nonpathologizing conceptualization of grief as a natural
process (Nadeau, 2001). The following premises of systems theory can be
useful in examining families’ adaptations to dying and death:
1. A family reacts to loss as a system. Although we grieve as individuals, the
family system has qualities beyond those of individual members (Jackson,
1965), and all members participate in mutually reinforcing interactions
(Walsh & McGoldrick, 1991).
2. Actions and reactions of a family member affect others and their function-
ing. This interdependence exists because causality in systems is circular
rather than linear (Shapiro, 2001).
3. Death disrupts a family system’s equilibrium, modifies the structure, and
requires system reorganization in feedback processes, role distribution, and
functions (Bowen, 1976; Jackson, 1965).
4. Death may produce emotional shock waves of serious life events that can
occur anywhere in the extended family in years following a death (Bowen,
1976). Such waves exist in an environment of denied emotional dependence
and may seem unrelated to the death. They may trigger additional stressor
events and increasingly rigid strategies to maintain stability (Shapiro, 2001).
5. There is no single outcome from death of a member that characterizes all
family systems. Various family characteristics, such as feedback processes
(Jackson, 1965), patterns of relationship (Shapiro, 2001), family schema, and
family paradigm (McCubbin, Thompson, Thompson, Elver, & McCubbin,
1998), influence the outcome.
Scholars have applied systems theory infrequently in examining death-
related reorganization (Shapiro, 2001). Loss has traditionally been identified
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as a historical, individual, or content issue and inappropriate for traditional
family systems work (which focuses on process, homeostasis, differentiation of
self from family, current interaction, and the present) (Nadeau, 2001; Walsh
& McGoldrick, 1991). Recent versions of systems theory have focused on the
balance of change and continuity as well as the negotiated inclusion of differ-
ences to balance self-assertion and cohesion. The application of family systems
theory to the study of grief is now discussed in a framework that includes
intergenerational and family life-cycle perspectives (Walsh & McGoldrick,
1991), focusing on change in structural factors such as boundaries, and family
dynamics such as roles and rules, as well as meaning making and communica-
tion (Nadeau, 2001). In a recent examination of the relationship between indi-
vidual grief and family system characteristics, Traylor, Hayslip, Kaminski, and
York (2003) found that grief symptomatology at 4 to 5 weeks postloss did not
predict any family system characteristics or grief symptomatology 6 months
later. However, individuals’ perceptions of family system cohesion, family
expressions of affect, and communication were predictors of later grief.
Integrative Models
Particularly useful models are those that simultaneously consider individ-
ual, family, and cultural dimensions. Rather than relying on traditional
family systems, these models integrate family systems’ concepts with other
perspectives. Rolland’s (1994) family systems–illness model examines the
interface of individual, family, illness, and health care team. Rather than
taking the ill individual in a family as the central unit of care, it focuses on
the family or caregiving system as a resource that both is affected by and
influences the course of illness. This model can be useful for understanding
the experiences of the ill individual and family members during the terminal
phase of chronic illness, in multiple contexts and across time.
Moos’s (1995) model of the interrelationship of processes involving grief
tasks of individuals and those of their families highlights the interdependence
of family processes and individual perceptions. This model addresses rela-
tionships between individual and family grief symptoms, the influence of each
family member on a family system’s coping strategies and grief reactions, and
the mediating roles of family history, cultural constraints, feedback, and
nuclear family functioning. Shapiro (1994, 2001) has applied a systemic
developmental approach in examining grief as family process. This clinical
model views grief as a developmental crisis influenced by family history,
sociocultural context, and family and individual life-cycle stages. A crisis of
identity and attachment, grief disrupts family equilibrium but makes possible
the development of “growth-enhancing stability” (Shapiro, 1994, p. 17).
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Popular interactionist approaches account for context by incorporating
life-course, social constructionist, and systems concepts. These models rec-
ognize the unique interpretation of internal and external worlds of individ-
uals and families dealing with loss (Harvey, Carlson, Huff, & Green, 2001;
Nadeau, 2001; Neimeyer, 2002; Rosenblatt, 2000). They utilize narrative
methods, focus on meaning making or account making, and recognize
intimate losses as part of changing identity. Such models assume that the
accuracy of the meaning given to any particular event is of limited impor-
tance, because it is meaning itself that influences family interactions.
Interactionist counseling can help families not only to understand and man-
age grief symptomatology, but also to reconstruct meaningful narratives of
self, family, and world.
Factors Related to Family
Adaptation to Death
Characteristics of the Loss
Below, we discuss briefly a number of factors that have been identified as
related to death itself and to how society’s interpretation of a loss influences
family adaptation.
Timing of illness or death. When the duration of time before death is far
longer or shorter than expected, or the sequence of death in a family differs
from the expected order, problems may occur. Elderly individuals are
assumed to experience “timely” deaths. Early parental loss, death of a young
spouse, and death of a child or grandchild of any age are considered tragic
and evoke searches for explanations (Murphy, Johnson, & Lohan, 2003).
Nature of death. Initial grief reaction to sudden or unexpected death may be
more intense than reaction to death related to protracted illness (Bowlby,
1980), with survivors experiencing a shattered normal world and a series of
concurrent stressors and secondary losses (Murray, 2001), with unfinished
business more likely to remain (Lindemann, 1944). Factors existing along a
continuum that can affect coping include (a) whether the loss was natural or
human made; (b) degree of intentionality/premeditation; (c) degree of pre-
ventability; (d) amount of suffering, anxiety, or physical pain the deceased
experienced while dying; (e) number of people killed or affected; (f) degree
of expectedness (Doka, 1996, pp. 12–13); (g) senselessness; and (h) the sur-
vivor’s having witnessed the death or its aftermath or having found out
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about the death through the media. Differences related to suddenness of
death appear to be short-term when internal control beliefs and self-esteem
are taken into consideration (W. Stroebe & Schut, 2001) and are lessened
when families are present during emergency medical procedures, such as
efforts to resuscitate (Kamienski, 2004).
According to the National Center for Health Statistics (2000), 80% of
deaths to adolescents and young adults in the United States result from sud-
den violent accidents, homicide, and suicide. In a longitudinal study of
parents surviving a child’s sudden death, Murphy, Johnson, Wu, Fan, and
Lohan (2003) found that marital satisfaction decreased among the parents
during the 5 years following the death; nearly 70% said that it took them
3 to 4 years to put their children’s deaths in perspective, and at 5 years post-
death, 43% said they still had not found meaning in their children’s deaths.
Although popular works often discuss suicide of a loved one as the most
difficult loss, there is little empirical evidence to support this contention
(W. Stroebe & Schut, 2001). Homicide appears to be most directly related
to posttraumatic stress disorder and grief marked by despair. In a mass
trauma (a potentially life-threatening event experienced by a large number of
people), adaptation appears to be influenced by whether it is a single event
or recurring/ongoing, by emotional or geographic distance (with vicarious
traumatization possible through viewing of media coverage, particularly for
those who have experienced other, unrelated losses), by attribution of
causality, and by the interaction of personal, community, and symbolic
losses (Webb, 2004).
Death following protracted illness can also be stressful. In such cases,
family members have experienced a series of stressors before the death,
including increased time commitments for caring, financial strain as a result
of cost of care and lost employment, emotional exhaustion, interruption of
career and family routines, sense of social isolation, and lack of time for self
or other family members (Rabow, Hauser, & Adams, 2004; Rolland, 1994).
Although research findings on the existence, role, and multidimensionality
of anticipatory grief have been inconsistent, protracted illness appears to be
associated with trauma and secondary morbidity—that is, difficulties in phys-
ical, emotional, cognitive, and social functioning of those closely involved
with the terminally ill person (Rando, 1993). Deaths following chronic illness
may still be perceived as sudden or unexpected by surviving adults who are
not yet “ready,” by children whose developmental stages inhibit their under-
standing that the death is inevitable, and following multiple cycles of relapse
and improvement. Deaths from trauma and illness have much in common.
Similar to families who have witnessed or experienced death through vio-
lence, families experiencing prolonged or complicated grief, multiple deaths
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simultaneously, or a series of deaths in close proximity may display signs of
posttraumatic stress disorder, with family caregivers experiencing secondary
traumatic stress (Bucholz, 2002; Figley, 1999; Rando, 1993).
Losses unacknowledged by society. Recently, scholars have devoted
increasing attention to disenfranchised grief—that is, grief that exists
although society does not recognize the bereaved person’s right, need, or
capacity to grieve (Doka, 2002). Examples include grief over the loss of
unrecognized or unacknowledged family and other relationships (i.e., rela-
tionships not recognized as significant), such as the loss of a former spouse,
lover, cohabitor, or extramarital lover; a foster child or foster parent; a
stepparent or stepchild; a coworker; a partner in a gay or lesbian relation-
ship; or a companion animal. In addition, deaths related to pregnancy (i.e.,
miscarriage, elective abortion, stillbirth, neonatal death) may result in dis-
enfranchised grief. Professional caretakers and emergency first responders,
especially those labeled as “heroes” or those who are competently focused
on tasks of rescue and recovery, also may suffer unacknowledged grief
when they lose those for whom they provide care. Bereaved grandparents,
men in general (Gilbert, 1996), and families of deceased addicts may also
experience disenfranchised grief. Many people see others, such as young
children, older adults, and mentally disabled persons, as incapable of grief
or without a need to grieve (Doka, 2002). Disenfranchisement also occurs
when it is assumed that the circumstances of particular deaths do not war-
rant grief, and when bereaved persons are told that they are experiencing or
expressing grief in inappropriate ways.
Stigmatized losses. People grieving various types of deaths have reported
feeling as though their grief has been stigmatized (Walter, 2003). They feel
that others are uncomfortable around them and so distance themselves, and
they experience direct or indirect social pressure to become “invisible
mourners” (Rosaldo, 1989). Disenfranchised grief often results from stig-
matized losses, particularly when there is an assumption that the death was
caused by the deceased’s disturbed or immoral behavior (Shapiro, 1994) or
a fear of contagion, such as with AIDS- and cancer-related deaths (Doka,
2002). AIDS-related deaths have been stigmatized because of their concen-
tration in the homosexual community and, more recently, in poor inner-city
Latino and African American neighborhoods. Survivors of AIDS-related
deaths may be experiencing multiple losses among family and friends, lack
of legal standing in relation to their deceased loved ones, denial of death
benefits, and isolation. In inner-city neighborhoods many of those infected
with HIV are women, some with infected children, and many have already
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lost companions, siblings, children, and friends. Although the disclosure of
HIV-positive status may sometimes bring relationship partners closer
together, mothers coping with HIV infection must also deal with finding
caregivers for their children and negotiating safer-sex practices with part-
ners reluctant to use condoms. Stigma also occurs in families that have lost
members to suicide or homicide, resulting in altered identities, provoking
feelings of anger and guilt, and leading to isolation, blame, and injustice—
characteristics of revictimization (Bucholz, 2002). The resulting secrecy and
blame can distort family communication, isolate family members, and
diminish social support (Walsh & McGoldrick, 1991).
Factors Affecting Family Vulnerability
Timing and concurrent stressors in the family life cycle. Death-related loss
involves many secondary losses, including personal, interpersonal, material,
and symbolic losses. Families have more difficulty adapting to death if other
stressors are present, as dealing with a loss does not abrogate other family
needs (Murray, 2001). When normative events associated with family life
cycle (e.g., new marriage, birth of child, an adolescent’s move toward
increased independence) are concurrent with illness or death, they may pose
incompatible tasks (Shapiro, 2001).
Function and position of the deceased prior to death. The centrality of the
deceased’s role in the family and the degree of the family’s emotional depen-
dence on that individual influence family adaptation (Shapiro, 2001).
Shock waves rarely follow the deaths of well-liked people who played
peripheral roles or of dysfunctional members unless dysfunction played a
central role in maintaining family equilibrium (Bowen, 1976).
Conflicted relationship with the deceased. Complications in family adapta-
tion can occur when intense and continuous ambivalence, estrangement, or
conflict exists (Elison & McGonigle, 2003). High levels of grief and depres-
sion have been reported by those with anxious-ambivalent attachments;
somatization is more common among those with avoidant attachment styles
(Wayment & Vierthaler, 2002). Grief after the death of an abuser can result
in ambivalence, rage, secrecy, sadness, and shame (Monahan, 2003). During
illness, there may be time to repair relationships, but family members may
hesitate, fearing that confrontation may increase risk of death. Surrogate
end-of-life decision makers report greater ability to resolve family disagree-
ments when they perceive a family as psychologically close or open to
communication (Mick, Medvene, & Strunk, 2003).
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Family Resources, Capabilities, and Strengths
Resources that assist families in meeting demands may be tangible (e.g.,
money or health) or intangible (e.g., friendship, self-esteem, role accumula-
tion, or a sense of mastery) (McCubbin & McCubbin, 1989). The disruption
a bereaved family experiences also is related to the family’s degree of open-
ness (Mick et al., 2003) and is mediated by the intensity and chronicity of
family stress. Adaptation is facilitated by members’ emotional regulation
capacity, nonreactivity to emotional intensity in the system, cohesion and
adaptability, and marital intimacy (Nadeau, 2001; Shapiro, 2001; Znoj &
Keller, 2002). Research findings concerning the importance of open com-
munication about loss are mixed. Pennebaker, Zech, and Rime (2001) sug-
gest that confiding in others is related to health after a loss. Other scholars
assert that the best predictor of emotional well-being is emotional regula-
tion, not emotion-focused coping (Bonanno, 2001; Znoj & Keller, 2002).
Social support networks appear to simultaneously complicate and facili-
tate grieving. Supporters may listen, but they may also hold unrealistic
expectations. The availability of formal or informal networks does not guar-
antee support, especially in a society that does not sanction the expression of
emotions surrounding loss. Some bereaved family members turn to self-help
groups composed of persons who have experienced similar types of losses—
a practice that may be predictive of finding meaning in death during the
years that follow (Murphy, Johnson, & Lohan, 2003). However, the rules
of some family systems discourage members from sharing intimate informa-
tion and feelings with persons outside the family. Religious beliefs also may
simultaneously complicate and facilitate grieving. Belief in “God’s plan” can
help a bereaved individual create meaning from loss, but it can also lead to
anger toward God for unfairly allowing the death, which can isolate the
individual from his or her spiritual roots.
Family Belief System, Definition, and Appraisal
Family paradigm. To understand fully how a family perceives a death or
uses coping strategies following a death, one must determine the family’s
worldview (Boss, 1999). A common paradigm is the “belief in a just
world,” which posits that the self is worthy and the world is benevolent,
just, and meaningful (Janoff-Bulman, 1992; Lerner, 1980). This paradigm
values control and mastery and assumes fit between efforts and outcomes:
One gets what one deserves. Such a view is functional only when something
can be done to change a situation. Challenges to the “just world” assump-
tion make the world seem less predictable and can lead to cognitive efforts
to manage fear of death. Such efforts can lead to blaming chronically ill
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persons for their conditions and lack of recovery, or to linking adolescent
deaths to drug use or reckless behavior as a way of affirming, “It can’t hap-
pen to my child.” In contrast, for those dealing with loss, understanding the
complexities, multiple levels of context, and short- or long-term effects of
the event will facilitate grief (Murray, 2001).
Death’s legacy. Family members share some beliefs that are unintentionally
but collectively constructed. Family history and experiences with death
provide a legacy (a way of looking at loss that has been received from
ancestors) that is related to how the family will adapt to subsequent loss
(McGoldrick, 1991). Particularly in relation to several traumatic untimely
deaths, a family may have a legacy of empowerment (family members see
themselves as survivors who can be hurt, but not defeated) or a legacy of
trauma (family member feel “cursed” and unable to rise above their
losses)—either of which can inhibit openness of the system. Families may
not recognize transgenerational anniversary patterns or concurrence of a
death with other life events, and members may lack emotional memory or
have discrepant memories regarding a death (Shapiro, 2001). Family
members may make unconscious efforts to block, promote, or shift beliefs
to maintain consistency with the legacy.
Family meaning making. Grief can be viewed as a process of meaning con-
struction that evolves throughout the life of the bereaved. Several factors
appear to influence families’ construction of the meaning of their losses,
including family schema, contact, cutoffs, interdependence, rituals, secrets,
coherence, paradigms, divergent beliefs, tolerance for differences, rules
about sharing, and situational and stressor appraisals (McCubbin et al.,
1998; Nadeau, 2001). Researchers are increasingly noting the importance
of making sense of the event, finding benefits from the experience, and
shaping one’s new identity to include the loss (Neimeyer, 2002). Violent
death that is irrational and meaningless may result in meaning making
expressed through activism or intense pursuit of numerous small actions.
Boundary Ambiguity
Boundary ambiguity is the confusion a family experiences when it is not
clear who is in and who is out of the system (Boss, 1999). Ambiguity rises
when (a) facts surrounding a death are unclear, (b) a person is missing but
it is unclear whether death has occurred, and (c) the family denies the loss.
Degree of boundary ambiguity may be more important for explaining
adaptation and coping than the presence of coping skills or resources. Both
denial and boundary ambiguity initially may be functional because they give
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a shocked family time to first deny the loss and then reorganize itself before
it accepts the fact that the loss is real. If a high degree of ambiguity exists
over time, the family is at risk for maladaptation. However, reports that
bonds continue to exist after death, and that conversations with the dead
may be replacing rituals as the normative way of maintaining such bonds
(Klass, 2001), may challenge the notion of boundary ambiguity, suggesting
that individuals can recognize loss while holding psychological, emotional,
and spiritual connections to deceased loved ones.
Factors of Diversity
Gender. Despite Western cultural expectations, most marital couples expe-
rience incongruent grieving, often with one adult whose grief could be
called cognitive and solitary and the other whose grief is more social and
emotional (Gilbert, 1996). Perhaps this incongruence can be understood as
a family system–level manifestation of M. S. Stroebe and Schut’s (2001)
dual-process model. A functional system would require loss orientation and
restoration orientation.
Studies of incongruent grieving have suggested that women display an
intuitive grieving style, with more sorrow, guilt, and depression than men
(Doka & Martin, 2001). Men are socialized to manage instrumental tasks,
such as those related to the funeral, burial, finances, and property. Women
are more likely to take on caregiving roles, which require them to engage in
both of the dual processes. However, men are more able to immerse them-
selves in work and thus block other intuitive tasks. Reasons for gender-
related differences in grieving are not well understood, but they seem to be
influenced by expectations and socialization. Research in this area has been
hampered by reliance on studies completed during acute stages of grief and
a lack of nonbereaved control groups. When bereaved persons who have suf-
fered violent or traumatic losses are examined in longitudinal studies, few
gender differences appear (Boelen & Van Den Bout, 2002–2003).
With gender controls, despite differences in social support, widowers have
been found to experience greater depression and health consequences than
widows (W. Stroebe & Schut, 2001). It has been thought that men have unrec-
ognized problems because their socialization interferes with active grief
processes (Doka & Martin, 2001). Men’s responses to grief typically include
coping styles that mask fear and insecurity, including remaining silent; taking
physical or legal action in order to express anger and exert control; immersion
in work, domestic, recreational, or sexual activity; engaging in solitary or
secret mourning; and exhibiting addictive behavior, such as alcoholism. Cook
(1988) has identified a double bind that bereaved fathers experience: Societal
expectations are that they will contain their emotions in order to protect and
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comfort their wives, but they cannot heal their own grief without sharing their
feelings. Similarly, Doka and Martin (2001) have identified a third pattern of
grief involving dissonance between the way an individual experiences grief and
the way in which he or she expresses it. For example, some males may experi-
ence internal grief feelings but are constrained from expressing them. Much of
the problem may not be in men’s grieving, but in our understanding of the
mourning process (Cook, 1988), which largely has been formulated through
the study of women. As such, concepts of meaning making (Gilbert, 1996) and
the dual-process model (M. S. Stroebe & Schut, 2001) may be more relevant
than concepts of grief work for research with men.
Culture, religion, and ethnicity. Grief is a socially constructed, malleable
phenomenon, and given current levels of immigration and contact among
various cultural and ethnic groups, mourning patterns in the United States
can be expected to change. In addition to commonalities, group differences
in values and practices continue to exist and present a wide range of normal
responses to death. General areas in which differences exist include the fol-
lowing: (a) extent of ritual attached to death (e.g., importance of attending
funerals, degree to which funerals should be costly, and types of acceptable
emotional displays); (b) need to see a dying relative; (c) openness and type of
display of emotion; (d) emphasis on verbal expression of feelings and public
versus private (i.e., solitary or family) expression of grief; (e) appropriate
length of the mourning period; (f) importance of anniversary events; (g) roles
of men and women; (h) role of extended family; (i) beliefs about what hap-
pens after death, particularly related to ideas of suffering, fate, and destiny;
(j) value of autonomy/dependence in relation to bonds after death; (k) cop-
ing strategies; (l) social support for hospice patients; (m) whether certain
deaths are stigmatized; (n) definition of when death actually occurs; (o) bar-
riers to trusting professionals; and (p) interweaving of religious and political
narratives (McGoldrick et al., 1991; Rosenblatt, 2001).
Specific Losses
Death of a Child
The death of one’s child is viewed as the most difficult loss, for it is contrary
to expected developmental progression and thrusts one into a marginal social
role that has unclear role expectations (Klass, 2001; Rubin & Malkinson,
2001). Deaths of offspring ranging from fetal loss to the loss of an adult child
who may also be a grandparent or a caregiver to older parents can cause
reactions similar to posttraumatic stress (Znoj & Keller, 2002). From an
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Eriksonian perspective, young-adult parents grapple with death-related issues
of identity as a parent and spousal intimacy, middle-aged parents deal with
loss of generativity, and elderly parents deal with loss in terms of ego integrity
versus despair. Attachment and psychoanalytic models appear to be inade-
quate to address the experiences of a parent who loses a child to death. Newer
models focus on integrating the deceased child into the parent’s psychic and
social worlds (Klass, 2001; Rubin & Malkinson, 2001).
Society expects spouses to provide support and comfort to each other dur-
ing times of stress; however, this may not be possible for bereaved parents,
who are both experiencing intense grief as individuals, with unique timeta-
bles, and may not be “in sync” (Rando, 1993). Sexual expression between
bereaved spouses can serve as a reminder of the child and elicit additional
distress (Rosenblatt, 2000). However, previous reports of high divorce rates
among bereaved parents appear to be erroneous; the research on which they
were based has been shown to lack longitudinal value and to confuse mari-
tal distress and divorce (Schwab, 1998).
Death of a Sibling
Most research on sibling death is recent, focused on children and adoles-
cents. Prior work on sibling loss generally was confined to clinical studies;
recent work differentiates between normal and complicated sibling grief pat-
terns (Silverman, Baker, Cait, & Boerner, 2003). Even in the same family, sib-
ling grief reactions are not uniform or the same as those of parents; rather,
they can be understood best in relation to individual characteristics (e.g., sex,
developmental stage, relationship to the deceased sibling). Scholars have not
found behavioral or at-risk differences in school-age children who have expe-
rienced parental death or sibling death, but they have found gender differ-
ences, with boys more affected by loss of a parent and girls more affected by
death of a sibling, especially a sister (Worden, Davies, & McCown, 1999).
Initial negative outcomes and grief reactions of siblings include drop in
school performance, anger, sense that parents are unreachable, survivor
guilt, and guilt stemming from sibling rivalry (even when survivor siblings
recognize the irrationality of their beliefs) (Rando, 1988; Schaefer &
Moos, 2001). Parents report more frequent and negative symptoms in
adolescents than in younger children, with mothers and fathers reporting
different problem behaviors (Lohan & Murphy, 2002). Although siblings
report more family conflict than do parents, siblings rarely direct their anger
toward parents, who they perceive to be vulnerable and hence in need of
protection from additional pain. Long-term changes appear to be positive,
especially in terms of maturity, which adolescents relate to appreciation
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for life, coping successfully, and negotiating role changes. Adults who lost
siblings in childhood have reported that these losses fostered greater insights
into life and death (Schaefer & Moos, 2001).
Deceased siblings still play an identity function for triangulated survivors
who may feel a need to fulfill roles the deceased children played for parents
or to act in an opposite manner in an attempt to show that they are differ-
ent (Bank & Kahn, 1975). In later adulthood, sibling death is the most
frequent death of close family members, yet researchers have largely over-
looked this form of loss. Surviving siblings appear to experience functioning
and cognitive states similar to those of surviving spouses (Moss, Moss, &
Hansson, 2001).
Unfortunately, research on sibling grief to date has consisted primarily of
cross-sectional investigations that rely on retrospective data, data no more
than 2 years beyond the loss, and longitudinal data treated as cross-sectional
due to small sample sizes. Research is needed to determine how siblings’ grief
may change over time, particularly in the context of stigmatized losses such
as AIDS-related deaths.
Death of a Parent
Death of a parent can occur during childhood or adulthood. Children’s reac-
tions to parental death vary and are influenced by emotional and cognitive devel-
opment, closeness to the deceased parent, and responses of/interactions with the
surviving parent (Rando, 1988). A recent research trend has been to identify grief
responses and perceptions of social support among children who have lost parents
(Rask, Kaunonen, & Paunonen-Limonen, 2002). Adolescents grieving the death
of a parent appear to have a heightened interpersonal sensitivity, characterized by
uneasiness and negative expectations regarding personal exchanges (Servaty-Sieb
& Hayslip, 2003). Comparisons of retrospective data from adults who experi-
enced a parent’s death during adolescence with data from adults who experienced
parental divorce suggest that both groups received comfort-intended communi-
cation, but bereaved adolescents were more accepting of comments that high-
lighted the lost parent’s positive attributes (Marwit & Carusa, 1998). Adolescents
tend to flee grieving peers, thus family support may be especially important and
instrumental in preventing maladaptive behavior (Balk, 2001; Silverman et al.,
2003). Although many adolescents live in single-parent, divorced, or blended
families, researchers have largely ignored the topic of parental death in those con-
texts or have focused on surviving parents’ grief and adjustment (Scott, 2000).
Death of a parent is the most common form of family loss in middle
age. Adult response to this loss is influenced by the meaning of the
relationship, the roles the parent played at the time of death, anticipation,
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disenfranchisement, circumstances of the death, the impact of the death on
the surviving adult child, and maintenance of the parent-child bond while
letting go (Moss et al., 2001; Rando, 1988). Adults whose parents experi-
enced protracted illness or lived in nursing homes prior to death exhibit
multidimensional responses to their parents’ deaths, including sadness, grief,
relief, persistence of memories about the parents, and a sense that the
protection against death provided by the parents has vanished (Elison &
McGonigle, 2003). Adults who are “orphaned” through parental death may
find their identities as well as their remaining relationships affected.
Adults with mental disabilities who experience parental death have some
aspects of grief in common with others, but they also have unique concerns.
When individuals with psychiatric disabilities are faced in midlife with the
death of a parent, they often have had no preparation for this event. They
may suddenly find themselves faced with making funeral arrangements and
somehow dealing with the financial repercussions of the death as well as
possible residential relocation (Jones et al., 2003).
Death of a Spouse or Life Partner
Death of a spouse is the adulthood loss that scholars have studied most
intensively, although they have paid less attention to spousal death in early or
middle adulthood, including widowed parents with dependent children, and to
death of any other life partner, such as one member of a committed homo-
sexual couple. Loneliness and emotional adjustment are major concerns of a
spouse who has lost a companion and source of emotional support, particu-
larly in a long, interdependent relationship in which both members had a
shared identity based on systems of roles and traditions (Moss et al., 2001).
Conjugal bereavement can be especially difficult for individuals whose rela-
tionships assumed a sharp division of traditional sex roles, leaving them unpre-
pared to assume the full range of tasks required to maintain a household.
Death of one’s spouse brings up issues of self-definition and prompts the need
to develop a new identity. Despite these problems, many bereaved spouses
adjust very well (Schaefer & Moos, 2001). Some derive pleasure from their
new independent lifestyle, feeling more competent than when they were wed.
Conclusion
Dealing with death is a process, not an event. It is an experience that all
families will encounter. As Klass (1987) notes, “Bereavement is complex, for
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it reaches to the heart of what it means to be human and what it means
to have a relationship” (p. 31). Despite its importance in the experiences of
individuals and families, death still appears to be a taboo subject in Western
cultures. Research and theory have focused on the experiences of dying
individuals and on dyadic relationships between bereaved and deceased.
A contextualized multigenerational approach to family systems theory is
well suited to addressing issues of loss and needs further application to
research and clinical practice. Families’ adaptations to death vary; factors
that influence the process include characteristics of the death, family vulner-
ability, history of past losses, incompatible life-cycle demands, resources,
belief systems, and the sociocultural context in which a family lives.
Although loss is a normal experience, theorists and researchers have treated
it as a problem. At this point, scholars need to increase their focus on processes
and strengths associated with loss, such as processes of coping (rather than
problems), and factors that facilitate growth from loss (rather than those that
inhibit growth). Examination of posttraumatic growth is a first step, but this
concept warrants application beyond individuals to entire families.
Suggested Internet Resources
Association for Death Education and Counseling (342 N. Main St., West
Hartford, CT 06117): http://www.adec.org
Center for Loss and Life Transition (3725 Broken Bow Rd., Fort Collins, CO
80526): http://www.centerforloss.com
The Compassionate Friends (P.O. Box 3696, Oak Brook, IL 60522), a non-
denominational support group for bereaved parents and siblings: http://
www.compassionatefriends.org
The Dougy Center: The National Center for Grieving Children and Families
(P.O. Box 86852, Portland, OR 97286): http://www.dougy.org
Grief in a Family Context (online course): http://www.indiana.edu/~famlygrf
GriefNet (online grief support): http://www.griefnet.org
Tragedy Assistance Program for Survivors (2001 S Street SW, Suite 300,
Washington, DC 20009), offers support for all members of the armed services
who have been affected by death: http://www.taps.org
Widowed Persons Service of AARP (601 E Street NW, Washington, DC 20049):
http://www.aarp.org
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... Systems theory and its associated focus on triadic processes has been applied to a consideration of bereavement and can help to offer non-pathologising conceptualisation of grief even when problematic and distressing states are experienced (Murray et al., 2005). It views families as reacting to death as a system (Walsh and McGoldrick, 1991) and that death disrupts a family systems equilibrium, modifies its structure and requires the system to reorganise. ...
... Our analysis suggested that it is important to consider the interactional/family contexts of bereavement and not just the individual narratives, as has historically been done, in order to gain an understanding of the nature of bereavement and its continuing impacts. The idea that the role of the family is important in the bereavement process is not new; many people have previously written about how bereavement needs to be considered from a family perspective (such as Alders et al., 2013;Moos, 1995;Murray et al., 2005;Nadeau, 1998 to name but a few). However, despite this acknowledgement, little research has actually been done with whole families. ...
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There has been considerable research on bereavement and the concept of continuing bonds. However, there is a distinct absence of research considering bereavement, continuing bonds and family dynamics post-bereavement. The paper reports on a study utilising a family systems approach combined with narrative methods, tools of conversation analysis and systemic theory. This integration of approaches is used to consider how one family offers an account of their experience of bereavement. An exploration of their conversation along with visual presentation in the form of button sculpts is employed. The findings support the suggestion that it is useful to consider bereavement experiences as part of a family system. Clinical implications of the research are outlined to consider how best to support bereaved families.
... There are chances for the bereaved to sink into despair, neglect their responsibilities, and behave in ways harmful to themselves and others. Therefore, when death occurs, there is usually an impact on the survivors; however, the bereaved differ in expression and intensity of their grief reactions (Suhail et al., 2011), and the process of mourning also takes many forms; duration and intensity of which is often affected by several factors, such as nature of death, circumstances of death, age of the deceased, role and position of the deceased before death, the kind of relationship shared with the deceased, and so forth (Murray et al., 2005). ...
... This study, however, combines two theoretical models of loss or, to put it simply, the grief of the marginalizeddisenfranchised grief and politics of recognition. Recently, scholars have devoted increasing attention to disenfranchised griefthat is, grief that exists, although society does not recognize the bereaved person's right, need, or capacity to grieve (Murray et al., 2005). Doka (1989, p. 4) defined disenfranchised grief as "the grief that persons experience when they incur a loss that is not or cannot be openly acknowledged, publically mourned, or socially supported." ...
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In the present study, the authors aimed to investigate the experiences of families bereaved by the death of their loved ones at workplaces in Kashmir. 17 families were selected through purposive sampling. Data were collected by using an unstructured interview guide. Thematic analysis of the data revealed that the families had to face severe social, mental, physical, and financial problems, including difficulties in claiming and receiving compensation, immediate and long-term financial difficulties due to the death of the breadwinner, mental and physical health problems, unmet support needs, family disruption, and social, educational and behavioural impact on children. Recommendations for policy development and interventions are suggested to prevent workplace accidents and fatalities at workplaces, reduce the disturbance and sufferings experienced by surviving families and alleviate the multi-dimensional consequences.
... For Bareither's (n.d), the reason ventures do not survive past their founder's generation is because founders do not invite their children (and spouses) to participate in running the enterprise. Besides, Murray, Toth and Clinkinbeard (2005) and Venter, van der Merwe and Farrington (2012) submit that the death of the enterprise founder generates different reactions from family members. The commitment of the family members of an enterprise owner to the future continuity of the enterprise contributes to its sustainability after the founder's death. ...
... The death of the enterprise founder generates different reactions from family members (Murray, Toth and Clinkinbeard, 2005) towards the continuity of the venture he/she owns. The commitment of the family members of an enterprise owner to the future continuity of the enterprise is of priority (Venter van der Merwe and Farrington, 2012) to the post-founder survival of the venture. ...
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The survival of indigenous private enterprises is usually threatened by the demise of their founders. While previous studies on enterprise (dis)continuity have focused largely on business failure before founders’ death, little attention is paid to why indigenous private businesses do not outlive their founders in Nigeria. This study, therefore, examined the factors accounting for post-founder business discontinuity among selected indigenous private enterprises in the South-West, Nigeria. Theory of Loss and continuity in the family firm provided the framework. The research design was exploratory, using qualitative methods of data collection. Three states (Lagos, Ogun and Oyo) were purposively selected on the basis of being home to many defunct indigenous enterprises. Case studies were done on 16 purposively selected indigenous private enterprises (eight discontinued and eight surviving) whose founders had died. The qualitative data were analysed with Nvivo 8. Findings show that disharmony in the deceased founders’ family, ineffective implementation of succession plans as well as inheritance crises emerged as the most prevalent factors that accounted for postfounder enterprise discontinuity. The study recommended that indigenous enterprise founders should make efforts to foster harmonious relationships among members of their families in order to increase enterprise survival after their death.
... Brewer and Sparkes (2010) identified factors that helped young people cope with parental bereavement, many similar to those identified by young people living with missingness. These included finding ways to establish rapport and express emotion, permission to have fun, identifying areas of competence and strength, and dealing with the impact on family and social relationships (Murray, Toth, & Clinkinbeard, 2005). A space where children can be heard, come together to speak of shared experiences and feelings and interact with others without having to be mindful of distressing parents or carers has been found to be helpful in supporting young people to cope with bereavement (Families & Friends of Missing Persons, 2016a; Scaletti & Hocking, 2010). ...
Thesis
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This thesis explores the experience of young people who have a long-term missing loved one – a father, grandfather, sibling or cousin - bringing the experience of young people when a loved one is missing into the spotlight, to remind others of their presence in families and communities affected by the loss of a missing person, and to inform practice and service provider responses. The research is informed by the construct of ambiguous loss as a theoretical framework, and the related concepts of trauma and loss, coping and resilience. Each young person sits within a family, a community, and a wider societal context.
Chapter
Der Beitrag beleuchtet das Feld der soziologischen Sterbe- und Trauerforschung mit Blick auf (aktuelle) familienrelevante Themen und Fragestellungen. Hierzu werden zentrale Begriffe, Konzepte und theoretische Ansätze im Hinblick auf das sterbende und trauernde Individuum und seine Einbindung in die Familie und den gesellschaftlichen Kontext in den Vordergrund gestellt. Als ein spezifisches Forschungsfeld wird Trauer nach dem Verlust eines Kindes, im Besonderen nach Fehlgeburt, Stillgeburt und dem Tod Neugeborener, betrachtet.
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Background Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan. Objective The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan. Methods An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The data were analyzed by using thematic analysis approach. Results The results of this study show that experiencing multiple stillbirths has a devastating impact on women’s mental and social wellbeing. The women who experienced multiple stillbirths are stigmatized as “child-killer” or cursed or being punished by God. They are avoided in social gatherings within the families and community, because of these social pressures these women seek spiritual and religious treatment, and struggle to conceive again to deliver a live baby. It was observed that the psycho-social and medical needs of these bereaved women remain unaddressed not only by the healthcare system but also by the society at large. Conclusions The physical, social and mental well-being of women who experience multiple stillbirth are at stake. These women are being considered social outcast. Health care providers including physicians, lady health workers, and traditional birth attendants should be trained on provision of psychosocial support along with the routine care that they provide in communities and health facilities. The health care providers should also inform the bereaved women about the biomedical causes of stillbirths that would be helpful to mitigate the stigma associated with stillbirths. Moreover, the health care providers should also counsel family members especially in-laws of these sorrowful women about the biomedical causes of stillbirths that would also be helpful to mitigate the stigma associated with stillbirths.
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Thesis
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შესავალი: ტრავმის თაობიდან თაობაში გადაცემის კვლევების დიდმასივში უაღრესად მცირეა - ფაქტობრივად, ერთეულებია - კვლევები,რომლებიც რეპრესიული პოლიტიკური რეჟიმების შედეგად მიღებულიტრავმის ზეგავლენასა და თაობიდან თაობაში გადაცემას ეხება. არ არისგაცემული პასუხი ისეთ კითხვებზე, როგორიცაა - რა არის ტოტალიტარულირეპრესიებით გამოწვეული ტრავმის თაობიდან თაობაში გადაცემისმექანიზმები ინდივიდუალურ, ოჯახურ და საზოგადოებრივ დონეზე.მოცემული კვლევა სწორედ ამ ღიობის შევსებას ცდილობს - საქართველოს,როგორც ერთი ცალკე აღებული პოსტ ტოტალიტარული ქვეყნის მაგალითზე.კვლევის მიზნები და ამოცანები: კვლევის მიზანია ტოტალიტარულიტრავმის გავლენისა და მისი თაობიდან თაობაში გადაცემის შესწავლაინდივიდის, ოჯახისა და საზოგადოების დონეზე, საქართველოს მაგალითზე.ამ მიზნის განსახორციელებლად ვიკვლიე ტოტალიტარულ რეპრესიებთანდაკავშირებული ტრავმის გავლენა რეპრესირებულთა ოჯახების მეორე დამესამე თაობების წარმომადგენლებზე (1), რეპრესირებულთა ოჯახებზე (2),ქართულ საზოგადოებაზე (3) და, ამ სხვადასხვა დონეზე რეპრესიების ტრავმისთაობიდან თაობაში გადაცემის მექანიზმები (4).კვლევის მეთოდოლოგია: კვლევა ეფუძნება ფენომენოლოგიურმიდგომას, იყენებს თვისებრივ მეთოდებს, და შედგება ორი კომპონენტისაგან:1) ჩაღრმავებული ინტერვიუები რეპრესირებული ოჯახების მეორე და მესამეთაობების წარმომადგენლებთან, რომელთა ანალიზიც განხორციელდამონაცემებზე დაფუძნებული თეორიის (Grounded Theory) მიდგომაზედაყრდნობით და, 2) საქართველოში მიმდინარე სოციო-პოლიტიკურიპროცესების ანალიზი ფსიქოტრავმატოლოგიის პერსპექტივიდან, Vamik Page 4 IVVolkan-ის ფსიქოპოლიტიკური ანალიზის პარადიგმაში, Wilfred Bion-ისა დაEarl Hopper-ის საბაზო დაშვებების თეორიაზე დაყრდნობით.კვლევის შედეგები: კვლევამ გამოავლინა, რომ საქართველოშიტოტალიტარული პერიოდის რეპრესიებთან დაკავშირებული ტრავმულიგამოცდილება არის დისოცირებული საზოგადოების ცნობიერებიდან,შესაბამისად გამოუგლოვებელი, და განაპირობებს ტრავმულ(დაქვემდებარების, შებრძოლება-გაქცევის, გამრავლების, არაშეჭიდულობის)საბაზო დაშვებებზე დაფუძნებულ სოციო-პოლიტიკურ ფსიქოდინამიკას.კვლევის საფუძველზე, ასევე, გამოიკვეთა რეპრესიის ტრავმით დაზიანებულიოჯახური სისტემის კონრეტული პატერნები, ხოლო ინდივიდუალურ დონეზეკი - რეპრესირებული ოჯახების მეორე და მესამე თაობების წარმომადგენელთატრავმასთან დაკავშირებული პრობლემები და აღდგენისუნარიანობისსტრატეგიები, რომელთა ურთიერთქმედებაც განაპირობებს ტრავმასთანგამკლავებასა და ცხოვრების ხარისხს. კვლევის შედეგად შემუშავებულ იქნატრავმის თაობიდან თაობაში გადაცემის ფისოქო-სოციო-პოლიტიკურიმოდელი, რომელიც ერთიან ჩარჩოში განიხილავს ტრავმის ზეგავლენასინდივიდუალურ, ოჯახურ, საზოგადოებრივ და სახელმწიფო დონეზე დააჩვენებს ამ დონეებზე მოქმედი ფაქტორების ურთიერთქმედებისმნიშვნელობას ტრავმის თაობიდან თაობაში გადაცემის თვალსაზრისით.მოცემული მოდელი გამოყენებული იქნება რეპრესიების ტრავმის თაობიდანთაობაში გადაცემის კვლევების შემდგომი სერიის დასაგეგმად. (3) (PDF) ტოტალიტარული რეპრესიებით გამოწვეული ფსიქოსოციალური ტრავმის გავლენა და თაობათაშორისი გადაცემა საქართველოს მაგალითზე. Available from: https://www.researchgate.net/publication/350995644_totalitaruli_represiebit_gamotsveuli_psikosotsialuri_travmis_gavlena_da_taobatashorisi_gadatsema_sakartvelos_magalitze [accessed Jun 26 2022].
Chapter
Der Beitrag beleuchtet das Feld der soziologischen Sterbe- und Trauerforschung mit Blick auf (aktuelle) familienrelevante Themen und Fragestellungen. Hierzu werden zentrale Begriffe, Konzepte und theoretische Ansätze im Hinblick auf das sterbende und trauernde Individuum und seine Einbindung in die Familie und den gesellschaftlichen Kontext in den Vordergrund gestellt. Als ein spezifisches Forschungsfeld wird Trauer nach dem Verlust eines Kindes, im Besonderen nach Fehlgeburt, Stillgeburt und dem Tod Neugeborener, betrachtet.