New Models of Bereavement Theory and Treatment: New Mourning
People are funny about death, grief, and bereavement. We continue to stick our heads in the sand and pretend that death doesn’t exist – or at least that it won’t happen to us. New Models of Bereavement Theory and Treatment: New Mourning seeks to share what we’ve learned – and how what we’ve learned doesn’t match what we’re doing. Grief, mourning, and bereavement aren’t new topics. I’ve read the classic On Death and Dying as well as The Grief Recovery Handbook, which provide perspectives into death, dying, and grief. I’ve also read Top Five Regrets of the Dying to understand what people regret most before they die and The Denial of Death to learn how we avoid the thought of death in general. However, New Models of Bereavement Theory and Treatment does offer a perspective that the other resources do not: a new way of thinking about the process.
Definitions
Before getting into the meat of the work, it’s important to frame the perspective with some definitions. We start that all death is loss. That loss means something we had – like our relationship with the deceased – is gone. The internal response to loss is grief. It’s the way that we feel the loss. The outward expression of that grief is mourning. Suffering is the process of grief. This is particularly true when the grief is unnecessarily extended, as in cases where people aren’t given the proper support.
These aren’t necessarily the definitions used by the book. I use these definitions here, because they are most likely aligned to the definitions that others have and are more consistent with other literature.
It’s also important to recognize that the grieving process will differ by person and by situation. We cannot force the process towards a natural end; however, we can support people in the process and reduce the suffering.
Detachment and Reattachment
Traditional models of grief are focused around Freud’s work and the need for the individual to detach from the loved one they’ve lost. While this is a part of the process, it neglects an often critical aspect of grieving, which is preserving the other person as well. Instead of completely severing connections with the deceased, the goal is to redefine the relationship with them. In grief, we’re disconnecting the old relationship and replacing it with a new relationship.
This new relationship acknowledges that the person is no longer with us in a physical sense, but rather they remain with us in our memories and in our imaginations. We can maintain a relationship with them by recalling previous memories and by simulating conversations with them.
It’s the critical process of redefining the relationship and creating a new attachment based on that new relationship that seems to have a healing and protective effect for people.
Radically Reorienting World Views
A common, but not universal, experience with people who experience a loss is the radical reorientation of world views. We all use world views to define how we see the world. We consider the world a generally helpful or generally harmful place. We have a belief that the Sun will rise in the East and set in the West. It would be incredibly disorienting if the opposite were suddenly true. This is, in essence, what happens when someone whom you expected to be with for the rest of your life – or at least longer than the time you’ve had with them – dies. This is particularly true when the loss is that of a child.
Children are supposed to bury their parents – not the other way around. When a parent is forced to confront the loss of a child, they must also realize that the grand clockwork of the universe isn’t exactly the way they saw it. When a parent buries a child, there is something profoundly wrong with the order of things.
It’s these world views – the things that are so woven into the fabric of life that we cannot directly see them – that must change when confronting the reality of death and that can be its own pain.
Frozen Feelings
One of the traps that people can fall into is the complete lack of feelings. Because of conditioning while growing up, societal expectations, or our own sense of perfectionism, we can find that we don’t allow ourselves the inward expression of grief or the outward expression of mourning. Instead, we bottle up the feelings. We contain them so they don’t get expressed, and we don’t have to fear what others will think of us – or fear that we’ll never stop crying.
Unfortunately, this approach leads to two problems. The first is that you can’t block out the bad feelings – the sorrow, the grief, and the fear – without also blocking out the good feelings like joy, love, and happiness. While freezing our feelings off into their own space may be appropriate for a time, eventually the ice must thaw, and we must experience our emotions – bad and good.
The other challenge is worse. If these feelings do remain bottled up for too long, the pressure will build, and eventually they’ll come out. It may be as anger or resentment. It might be an explosive outburst. More tragically, it may be a psychotic break that leaves someone disconnected from reality and the love of the world.
The Story
In Trauma and Memory, Peter Levine explains how our implicit memories of an event – including being notified of the death of a loved one – exists outside of time. It’s the process of converting these memories into explicit memories that places them into a time context. Without that, we’re subject to flashbacks and other intrusive thoughts. More broadly, we need to make sense of the trauma.
In The Righteous Mind, Jonathan Haidt explains how prediction is a core part of consciousness. Inside Jokes explains that we’ve got mechanisms in our brain that detect errors in our predictions, and the reward cycle for detecting them is what kicks off laughter. For the prediction engine of our consciousness to continue to run, it needs a new model of prediction, and that means integrating the events into a cohesive story that can make sense. Without this, we’ll be stuck, unable to trust our ability to predict the future, and the world will necessarily become a much scarier, unstable place.
It was James Pennebaker’s work in Opening Up that made me aware of the healing power of writing down a trauma. Writing down the narrative of trauma allows us to weave it into a story that makes sense as well as an opportunity to take a step back and see the potential benefits that can come from a tragedy.
Expectations
We’ve got these expectations about death and loss that aren’t grounded in reality. Ideas like we’re going to completely resolve any bereavement that we have and move on aren’t real. Certainly, it gets better, different, and less painful at times, but anyone who says that it will end isn’t being truthful.
Similarly, we can’t prescribe a flow that all bereavement must go through. There’s no amount of gnashing of teeth or wailing that is mandated for a given type of loss. Instead, we must recognize that everyone will grieve in their own way. A failure to express outward morning or acknowledge inward grief doesn’t mean that the person isn’t going through the bereavement process “correctly.”
It’s similarly not necessary that someone experience a great deal of pain in the loss. It’s quite possible that the loss represents the other person being freed of their burdens in a way that brings them peace. That isn’t to minimize the loss or indicate a lack of attachment but rather is an acceptance of things and how the world really is.
Who Cares for Whom?
Option B shares a model of circles of proximity to the deceased. You provide support for those closer and seek support from those further out. As a general model, it’s fine. However, it breaks down inside of the nuclear family, like Newtonian physics breaks down at a subatomic level. When a parent is lost, both the spouse and the children occupy the closest circle, and both need support from the outside. However, inside the circle, things are not even.
Parents are expected to provide support to their children and not vice versa. The hierarchy of the family unit suggests that this should be the order of things. However, often, the spouse is unable to function at a level that allows them to support the children. Instead of having reserves that allow them to get support for their needs and invest in the children, more frequently, the children must fend for themselves – and sometimes take care of the parent. This causes long-term harm to the children as they’re forced into a parental, caregiving role before they’re supposed to.
Secrets and Security
You’re only as sick as your secrets. Yet, in some families, it seems that secrets are all that there are. Siblings who die at an early age are never spoken of. Grandparents are just “away” with no expectation of return. Even tragic illnesses that everyone knows about are just not discussed.
The problem is that, from a stability and predictability standpoint, children and adults learn that there’s always another shoe that can drop at any time. We can’t feel safe and secure enough to share our feelings, because we can’t see what tragedy is coming around the next bend. We can’t trust that the people we love and those that we depend on to care for us will tell us the truth so that we can predict some sense of stability in our lives.
The New Models of Bereavement Theory and Treatment accepts our need for safety, sense-making, and reconnection.