Growing up with grief: revisiting the death of a parent over the life course

In the era of managed care, evidence-based practice, and short term, solution focused interventions, clinicians in agency based settings generally do not have the luxury of long-term contact with bereaved children. Although a substantial, yet controversial, literature argues that children cannot fully resolve early loss until adulthood, limited attention is given to how children's understandings of early loss shift as their cognitive capacities mature. This article argues the emotional experience of grief shifts: 1) as children grapple with both normative life changes and the tasks of mourning, and 2) as their cognitive and emotional development allow them to understand and question aspects of their deceased parent's life and death in new ways. This article will present an overview of longitudinal and cross-sectional research on the long-term impact of childhood grief. We then suggest the ways bereaved children and adolescents revisit and reintegrate the loss of a parent as their emotional, moral, and cognitive capacities mature and as normative ego-centrism and magical thinking decline. To demonstrate these ideas, we draw on the case of a parentally bereaved boy and his family presenting across agency-based and private-practice work over the course of 14 years. This case suggests the need for coordinated care for children who are moving beyond the initial trauma of parental loss into various stages of grief and reintegration. While the loss of a parent is permanent and unchanging, the process is not: it is part of the child's ongoing experience. (Worden, 1996, p. 16).     

African Americans in bereavement: grief as a function of ethnicity

Few empirical studies have explored the grieving process among different ethnic groups within the United States, and very little is known about how African Americans and Caucasians may differ in their experience of loss. The purpose of this study was to examine the African-American experience of grief, with particular emphasis on issues of identity change, interpersonal dimensions of the loss, and continuing attachments with the deceased. Participants were 1,581 bereaved college students (940 Caucasians and 641 African Americans) attending classes at a large southern university. Each participant completed the Inventory of Complicated Grief-Revised, the Continuing Bonds Scale, and questions regarding the circumstances surrounding his or her loss. Results revealed that African Americans experienced more frequent bereavement by homicide, maintenance of a stronger continuing bond with the deceased, greater grief for the loss of extended kin beyond the immediate family, and a sense of support in their grief, despite their tendency to talk less with others about the loss or seek professional support for it. Overall, African Americans reported higher levels of complicated grief symptoms than Caucasians, especially when they spent less time speaking to others about their loss experience. Implications of these findings for bereavement support services for African Americans were briefly noted.     

Adolescent grief: relationship category and emotional closeness

Bereaved adolescents (N = 90) who had experienced relatively common death losses (e.g., grandparent, friend) completed the Texas Revised Inventory of Grief and the Emotional Closeness Scale and Continuum. Results indicated that present grief was significantly higher for friend than for grandparent death loss. A MANOVA revealed that those in the high closeness group reported significantly higher mean scores on past and present grief than those in the low closeness group. Finally, in a hierarchal multiple regression, after demographic variables were entered (e.g., age, present at death), emotional closeness added significant variance to the prediction of past and present grief. This research contributes to the understanding of grief intensity following adolescents' most common death losses and highlights the importance of counselors' intentionally and directly assessing bereaved adolescents' perceived emotional closeness to the deceased as part of grief-related counseling.     

The fundamental paradox in the grief literature: a critical reflection

A key theme in the bereavement literature is the recognition that every grief experience is unique and dependent on many variables, such as the circumstances of the death, characteristics of the bereaved individual, their relationship with the deceased, the provision and availability of support, and a myriad of sociocultural factors. Concurrently, there are corresponding efforts to define "normal" grief and delineate it from "complicated" grief experiences. The discord between these two potentially opposing statements remains a paradox evident within the three major tensions within the thanatological literature--the dominance of grief theories, the medicalization of grief, and the efficacy of grief interventions. Three recommendations for moving beyond the paradox are discussed--the provision of improved grief education for service providers, the bereaved, and the wider community; the conduct of research that emphasizes the context of grief and is relevant to service provision; and the examination of current grief interventions.     

Therapeutic implications of continuing bonds expressions following the death of a pet

Through the exploration of 12 continuing bonds expressions (CBE), this current study investigated the grief reaction and continuing impact of the death of a pet. Thirty-three individuals were interviewed to determine the degree of connection maintained with the deceased pet and how that affects their coping. Findings emphasize that the majority of respondents frequently maintain ongoing meaningful ties with their deceased pet through the use of CBE such as fond memories, rituals, dreams. The findings suggest that it is not the number of CBE but the degree of adaptability that is significant. The importance of recognizing the unique, total experience of those grieving the death of a pet is addressed. Implications for those working with and supporting those in grief are included. Future directions for research are described.     

The social relations of bereavement in the Caribbean

The objectives of this article are to discuss the various types of behaviors associated with grief and bereavement, and to examine the relationships, consequences, and outcomes of bereavement practices among the various religious and ethnic groups in the English-speaking Caribbean Islands of Jamaica, Trinidad, Grenada, and Barbados. The rituals associated with death and grief differs across cultures and is greatly influenced by religious beliefs and traditions. How these rituals are played out depend on the culture of origin and level of acculturation of the various groups into mainstream society. In the Caribbean region, expressions of grief represent religious and cultural traditions that may have a significant impact on social relations, particularly in multi-ethnic and multicultural societies. In the English-speaking Caribbean Islands of Jamaica, Trinidad, Grenada, and Barbados, mourning follows the patterns of traditional religious practices which have remained consistent over time. While families and friends may offer social support before and after burial or cremation, the social aspects of bereavement may also have implications for inter-group relations. Insights into bereavement practices and what it holds for ethnic and religious groups in contemporary Caribbean are presented.     

Patterns of parental bereavement following the loss of a child and related factors

This study investigated the patterns of parental bereavement in 20 parents who have lost a child to cancer, congenital heart disease, meningitis, or drowning in the last 19 months, using semi-structured interviews and standardized questionnaires of depression and grief. Qualitative content analysis of interviews identified three bereavement patterns: The majority of parents (65%) presented uncomplicated, Integrated Grief five mothers were Consumed by Grief and one mother and one father expressed Minimal Grief. Quotes from parents exemplified these patterns. Parental gender, symptoms of depression, and pre-death relationship between parents and their deceased child differentially related to these patterns. Having surviving children, social support, and being active appeared to help to integrate grief into daily life. These findings illustrate differential patterns of parental bereavement and related factors, information that has important implications for identifying at-risk parents for complicated bereavement.     

Parental bereavement: a panoramic view

This study is aimed at identifying central themes of bereavement. A qualitative approach was employed in the analyses of interviews with 22 bereaved parents. The analyses yielded four central issues or themes of bereavement, each with its own set of sub-themes or categories, as the narrative demanded. The first of these themes, pertaining to the life of the family before the death of a child had taken place, was named the risk factor. Circumstances leading up to the death, surrounding the death, the cause of death, and the events following the death were coded as bereavement circumstances. The grief reactions codes were divided into categories of emotional, physical, behavioral, relational, spiritual, and cognitive reactions, as described by the participants. Finally, the mourning codes described the mechanisms employed by the participants in their attempts to survive and continue living after the death. These findings can be used in the training of support workers and the development of bereavement interventions.     

Problematic emotions and maternal grief

The study was an empirical examination of the relation of personality proneness to "problematic social emotions"--envy (Dispositional Envy Scale), jealousy (Interpersonal Jealousy Scale), and shame and guilt (Personal Feelings Questionnaire-2)--to maternal grief (Perinatal Grief Scale-33) following miscarriage, stillbirth, neonatal death, or infant/child death. The 441 women who participated in the study were enrolled from the Website, e-mail contact lists, and parent support groups of an organization that offers information and support to bereaved parents. All four problematic emotions were positively correlated with maternal grief. Envy, jealousy, and guilt made significant unique contributions to the variance in maternal grief. Overall, time lapse since the loss and the four problematic emotion predispositions explained 43% of the variance in maternal grief following child bereavement.     

Older poor parents who lost an adult child to AIDS in Togo, West Africa: a qualitative study

This study analyzes the difficulties that poor parents faced when they lost an adult child to AIDS in Togo. The death of a child is believed to be more distressful to parents compared to the death of a spouse. Evidence also suggests that parental grief is more lasting and may be the most complicated form of grief. Furthermore, the roles played by the deceased child in the lives of the parents also affect the parental grieving process. For instance, in low income regions where parents tend to be socio-economically challenged and where filial obligations are culturally expected, losing an adult child who provided material and financial assistance to parents will be more disastrous. Four kinds of difficulties were identified: financial and social difficulty, psychological difficulty, caregiving difficulty, and disclosure difficulty. The socioeconomic status of the parents made these issues all the more taxing, as respondents were grieving not only the loss of their children to AIDS but also the loss of financial providers. Policy implications of the findings are discussed.     

"Almost the copy of my child that's dead": Shakespeare and the loss of Hamnet

This article emphasizes the importance of studies which look at changes and similarities in mourning over time. It argues that relevant evidence can come from creative fiction as well as from other sources, provided that this is analyzed rigorously in terms of structures and patterns. As an illustration of this approach, it examines the evidence in recurring features of Shakespeare's plays that his writing was deeply and lastingly affected by the death of his only son Hamnet, a twin, at the age of 11, and identifies five motifs which support this interpretation: the resurrected child or sibling; androgynous and twin-like figures; a growing emphasis on father-daughter relationships; paternal guilt; family division and reunion. The article suggests that this approach could be applied to other instances where a body of creative writing shows traces of overt or buried grief.     

Relationship to the bereaved and perceptions of severity of trauma differentiate elements of posttraumatic growth

The field of bereavement and grief has been expanding to recognise the potential for growth following the loss of a loved one. This study sought to examine the effect of the relationship to the deceased and perceptions of the severity of the trauma on dimensions of posttraumatic growth. Participants were 146 people who had lost either: a) a first degree relative, b) a second degree relative, or c) a non-related friend. Results demonstrated that both severity and the relationship to the bereaved differentiate posttraumatic growth outcomes. For example, participants who had lost a first degree relative reported higher levels of growth than those who had lost a second degree relative. Consistent with previous research in general trauma populations, the more severe the loss was rated, the higher the levels of growth. Implications for practice are discussed.     

Perinatal loss: a qualitative study in Northern Ireland

This article describes the experiences of women in Northern Ireland who have experienced a miscarriage or stillbirth. Pregnancy loss encompasses several dimensions of loss for women, loss of the future, loss of self-identity, and the loss of anticipated parenthood. The study explored how women emotionally responded to loss and the care they received from medical staff. Burial arrangements for the remains of the baby are also explored. The methodology adopted a narrative approach based upon in-depth interviews with 23 women who attended pregnancy loss self-help groups. The women's narratives highlight their emotional responses to loss, the medicalization of perinatal grief, and burial arrangements. Women felt that their experience was emotionally negative in that they had been subjected to a rationalizing process of medicalization. The primary focus for the women was on the need to recover space for their emotions and seek acceptance and recognition of the validity of their grief. The study demonstrated that the women's response to being marginalized led them to make sense of their experiences and to create spaces of resistance to medicalization. The way in which women placed emotion at the center of their narratives is taken to be a powerful indicator that the support they require from professionals should take account of the meanings they have constructed from their experience of loss.     

Participants with prolonged grief--how do they benefit from grief group participation?

Data analyzed in this article is part of a study conducted to explore grief support groups in Norway. Participants that fulfilled the criteria of Prolonged Grief Disorder (PGD) were compared with participants that did not in order to explore whether they differed on satisfaction and experiences with participation. To allow for comparison, a subsample of 22 participants that fulfilled the criteria of PGD were drawn from the total of 262 participants. Demographic and loss-related variables were analyzed to explore factors associated with PGD. Fulfillment of PGD was then analyzed to explore the group's effect on life quality and overall satisfaction. The main finding is that participants who fulfill the criteria of prolonged grief are in general less satisfied with the groups and report less positive effect on life quality. We also found age- and gender-differences regarding fulfillment of PGD, with older bereaved women especially at risk of developing symptoms of PGD.     

Bereavement and the DSM5

Close personal relationships are very important in our lives. Our closest relationships help us regulate our bodies and minds and contribute importantly to our sense of wellbeing (Hofer, 1984; Mikulincer, Orbach, & Iavnieli, 1998; Sbarra & Hazan, 2008). Losing a close attachment is usually one of the most difficult experiences we ever have. Bereavement often leaves us dazed and confused about how to understand the loss and navigate the future. Acute grief takes us out of our ongoing life and focuses our attention on our deceased loved one. Grief is finely tuned to each loss situation with a pattern and course that is unique to each person and each relationship.     

Disenfranchised grief and nonfinite loss as experienced by the families of death row inmates

The families of death row inmates experience grief and loss issues that have been neglected by scholars and clinicians alike. The issues found in this population are unique and require our understanding. The present study uses the concepts of disenfranchised grief and nonfinite loss to uncover the pain experienced by the children and other family members who have a loved one on death row. Kenneth Doka's (1989) concept of disenfranchised grief is utilized to bring attention to the ways in which the circumstances surrounding an execution leave the family members of those condemned to death outside of the "grieving rules" that exist in the United States. Family members are disenfranchised from their grief, as society does not socially validate their pain. The loss that they feel is also nonfinite (Bruce & Schultz, 2001) in that it is continuous and denies the families all of the hopes, dreams, and expectations that they had for their loved one who now sits on death row. The qualitative interview method was utilized by the authors of this study to gather data from 26 family members of death row inmates who are incarcerated along the East Coast of the United States. The reactions of this group of family members are varied and complex, yet they include the following common responses: social isolation due to stigma and their own feelings of criminalization, intensified family conflict between family members who grieve differently from one another, diminished self-esteem, shame, diffused and specific feelings of guilt, and a chronic state of despair. This study explores virtually untapped terrain. An examination of the microlevel effects of the death penalty on families provides insight in to the area of death and dying, especially as it is related to disenfranchised loss and nonfinite grief. In addition, this study provides insight into the death penalty and its effects.     

Qualitative exploration of the nature of grief-related beliefs and expectations

Societal expectations of grief impact the experience of bereavement. The congruence of societal expectations with current scientific understanding of grief is unknown. Therefore two qualitative studies explored community perceptions of grief. In study one, three small focus groups (N = 9) examined grief-related expectations associated with hypothetical scenarios of bereavement. In study two, the impact of grief-related perceptions on the lived experience of bereavement for 11 individuals was explored through semi-structured interviews. Across both studies, elements of a traditional stage model view of grief were evident, with participants viewing emotional expression of grief as important. An avoidant coping style in the bereaved was considered problematic. Findings of study two suggested that grief-related beliefs may impact the bereavement experience via appraisal of the grief response and willingness to support bereaved individuals. The studies suggested that stage model assumptions in the beliefs of the general population persist, although there was a recognition of diversity in the grief response.     

Considerations for grief interventions: eras of witnessing with families

This article describes research that was conducted to articulate interventions with families experiencing grief. Using an interpretive methodology framed by philosophical hermeneutics allowed for a depth of understanding of these therapeutic conversations. The research findings offer explanations of the role of time in relation to grief, particularly the timing of interventions, and describe the significance of working with multiple family members during therapeutic interventions. This research was unique in that it approached grief counseling with a family focus, the participants were interviewed for this study several years after the therapeutic encounter, and the underlying theoretical framework for the interventions focused on grief as a lifelong, life-changing experience, rather than a finite, pathology-laden event.     

Institutional factors affecting offshore business process and information technology outsourcing

Micro and macro level impacts of offshore outsourcing are far from clear. Thus there are some well-founded rationales for and against offshore outsourcing as well as a number of misinformed and ill guided viewpoints. Using institutional theory as a lens, this paper analyzes the drivers of offshore business process and information technology outsourcing. We examine the mechanisms by which regulative rules, social rules, culturally supported habits and subconsciously accepted rules and customs influence assessment, selection as well as continuation of outsourcing projects. Managerial and policy implications are discussed and directions for future research have been suggested.