Before and After the Death: Book Excerpt
Chapter Excerpt:
Challenging the Paradigm: New Understandings of Grief
Kenneth J. Doka
In 1989, Wortman and Silver published a controversial yet influential article entitled “The Myths of Coping With Loss,” in which they identified five “myths” that were widely accepted by professionals treating bereavement:
- Depression and distress are inevitable in grief.
- Distress is necessary, and its absence is problematic.
- Survivors must “work through” a loss.
- Survivors can expect to recover from a loss.
- Survivors can reach a state of resolution.
The research, in Wortman and Silver’s evaluation, did not support the widespread acceptance of these propositions.
Wortman and Silver’s article crystallized a challenge to what might be called the grief work hypothesis. This hypothesis was really a conceptual belief that one must work through powerful feelings in order to detach from the deceased, reinvest in life, and recover from and resolve the loss. Originally derived from Freud’s seminal 1917 article “Mourning and Melancholia,” (Freud, 1917) the concept is pervasive in self-help books. Staudacher (1991), for example, expresses this notion:
Simply put, there is only one way to grieve [emphasis in original]. That way is to go through the core of grief. Only by experiencing the necessary emotional effects of your loved one’s death is it possible for you to eventually resolve the loss. (p. 3)
Although the grief work hypothesis was evident in much work in the field, especially in trade and self-help literature, it was not universally accepted. In the professional literature, the hypothesis was continually challenged in one way or another and coexisted with other ideas and approaches. In many ways, Wortman and Silver had oversimplified some very subtle and nuanced approaches to the understanding of grief and loss, but their article had great heuristic value, bringing forth many modifications and challenges to these early and popular understandings of grief.
The past 15 years have seen an increasing number of challenges to the early paradigms. In this chapter, I will describe five significant ways in which earlier understandings or paradigms of grief have been challenged.
I will also discuss three current challenges to the field and two others that are likely to occur in the not-too-distant future.
(. . .)
On the Horizon
Two additional issues are likely to affect future understanding of grief. The first one is the move to add a “grief” category to the forthcoming DSM-V. One of the proposals before the American Psychiatric Association is on complicated grief (formerly called traumatic grief). Jacobs and Prigerson and others (see Jacobs & Prigerson, 2000; Prigerson & Maciejewski, 2006) suggest that certain symptoms evident early in the process of grieving predict problematic outcomes, and they recommend early intervention. For years, the field has eschewed a medical model of grief and avoided using terms like “symptoms.” Grief, it is argued, is a normal part of the life cycle, not an illness. These proposals challenge that notion, asserting that at least some experiences of grief show evidence of psychiatric illness. The proposals are a sign of increasing recognition that there is a need for correction, that the emphasis on the normalcy of loss and grief has led to the neglect of problematic variants. Receptiveness to these proposals is probably also fueled by the growth of managed care in the United States and the need to have a clear grief-related diagnostic code. Regardless of the motivation, adding a diagnostic category for grief will constitute a paradigm shift.
The second issue is the demographic change as the Baby Boomers age. Many of them are experiencing the loss of their parents; in a few decades, they will face their own deaths. Also, each generation develops unique forms of attachment; many boomers have developed extremely close attachments to their children, so their deaths may create different problems for their offspring than in previous generations. This is a generation that has challenged and changed every institution it has experienced in its collective journey through the life cycle. Boomers demand choices in programs and avoid programs that ignore individual differences. They tend to trust individuals rather than institutions. They want to be active participants in programs rather than passive recipients. The Baby Boomers will surely change the ways we encounter loss, death, and grief.
Over the past 15 years, our understanding of grief has experienced major modifications. Changes and challenges are likely to continue to affect how we think about and respond to loss. As a popular baby boomer song, Dylan’s “The World It Is a Changin” put it “the wheel is still in spin.”
Kenneth J. Doka, Ph.D., M.Div., is a Professor of Gerontology at the Graduate School of The College of New Rochelle. He is also a senior consultant to Hospice Foundation of America and helps direct the annual Living with Grief teleconference. Dr. Doka has written or edited 17 books, including HFA’s Living with Grief® series, and has published 60 articles and book chapters. He is editor of Omega, a professional journal, and Journeys, HFA’s monthly bereavement newsletter. Dr. Doka was elected president of the Association for Death Education and Counseling (ADEC) in 1993, and in 1998, ADEC presented him with an Award for Outstanding Contributions in the Field of Death Education. He was elected to the Board of the International Work Group on Dying, Death and Bereavement in 1995, and served as chair from 1997 to 1999. His alma mater, Concordia College, presented him with its first Distinguished Alumnus Award. In 2006, Dr. Doka was recognized as a mental health counselor under New York State’s first licensure of counselors. Dr. Doka is an ordained Lutheran minister.
References
Attig, T. (1987). Grief, love and separation. In C. Corr and R. Pacholski (Eds.), Death: Completion and discovery. Lakewood, OH: Association for Death Education and Counseling.
Bonnano, G. (2004). Loss, trauma and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20-28.
Calhoun, L. G., & Tedeschi, R. G. (2004). The foundations of posttraumatic growth: New considerations. Psychological Inquiry, 15, 93-102.
Doka, K. J. (1984). Grief. In R. Kastenbaum and B. Kastenbaum (Eds.), Encyclopedia of death. Phoenix, AZ: Oryx Press.
Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA: Lexington Press.
Doka, K. J. (1993). The spiritual crises of bereavement. In K. J. Doka (with J. Morgan) (Ed.), Death and spirituality (pp. 185-195). Amityville, NY: Baywood Publishing Co.
Doka, K. J. (2002). Disenfranchised grief: New directions, challenges, and strategies for practice. Champaign, IL: Research Press.
Doka, K. (2006). Fulfillment as Sanders’ sixth phase of bereavement: The unfinished work of Catherine Sanders. Omega: The Journal of Death and Dying, 52,141-149.
Freud, S. (1957). Mourning and melancholia. In Standard Edition, Vol XIV. London: Hogarth.
Harvey, J. (1998). Perspectives on loss: A sourcebook. Philadelphia: Brunner/Mazel.
Jacobs, S., & Prigerson, H. (2000). Psychotherapy of traumatic grief: A review of evidence for psychotherapeutic treatments. Death Studies, 21, 471-498.
Klass, D., Silverman, P., & Nickman, S. (Eds.). (1996). Continuing bonds: New understandings of grief. Washington, DC: Taylor & Frances.
Kubler-Ross, E. (1969). On death and dying. New York: Macmillan.
LaGrand, L. (1999). Messages and miracles: Extraordinary experiences of the bereaved. St. Paul, MN: Llewellyn Publications.
Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141-148.
Martin, T., & Doka, K. J. (2000). Men don’t cry, women do: Transcending gender stereotypes of grief. Philadelphia: Brunner/Mazel.
Neimeyer, R. A. (2000). Grief therapy and research as essential tensions: Prescriptions for a progressive partnership. Death Studies, 24, 603-610.
Neimeyer, R. A. (2001). Meaning reconstruction and the meaning of loss. Washington, DC: American Psychological Association.
Nolen-Hoeksema, S., McBride, A., & Larson, J. (1997) Rumination and psychological distress among bereaved partners. Journal of Personality and Social Psychology, 72, 855-862.
Prend, A. (1997). Transcending loss. New York: Berkley Books.
Prigerson, H., & Maciejewski, P. (2006). A call for sound empirical testing and evaluation for complicated grief proposed for DSM-V. Omega, The Journal of Death and Dying, 52, 9-20.
Order Living With Grief: Before and After the Death
