Week 10-Bereavement and widowhood Flashcards
Define Bereavement
The state or condition caused by loss through death
Define Grief
The sorrow, hurt, anger, guilt, confusion, or other feelings that arise after a loss
Define Mourning
- The way we express our grief
- Mourning is heavily influenced by cultural norms
Define Widowhood
The loss of a marital partner through death
How can we distinguish between bereavement and widowhood?
Often bereavement and widowhood are used interchangeably.
* However, it is important to distinguish between them
Bereavement is the objective situation or state of having experienced the death of someone significant in one’s life
* It is considered to be a relatively short-term state
* Has primarily personal consequences and meanings.
Widowhood is an ongoing, and frequently long-term state, which has social and personal consequences and meanings (Bennett et al., 2005).
What are the Acute reactions to bereavement?
Behavioural/Emotional/Cognitive:
-Aimless activity/inactivity
-Crying
-Agitation
-Pre-occupation with the image of the
deceased
Physiological:
-Waves of distress lasting minutes
-Sighing respiration
-Muscular weakness
-Fatigue
What are the Chronic reactions to bereavement?
Behavioural/Emotional/Cognitive:
-Social withdrawal
-Decreased concentration
-Restless/anxiety
-Illusions, hallucinations
-Posture of sadness
-Depressed mood
Physiological:
-Sleep disturbance
-Variable food intake
-Decreased weight
-Muscle weakness
-Endocrine
-Cardiovascular
-Immunological
What are the Methods used in Investigating Bereavement?
Recruit individuals after bereavement and follow them longitudinally (Zisook et al., 1997)
Longitudinal studies with a test before bereavement
* E.g. Changing Lives of Older Couples (Carr et al., 2005)
Longitudinal secondary data studies (Bennett & Morgan, 1992)
Cross sectional studies: bereaved people are compared with married subjects and the time since bereavement used as a variable (Spahni et al., 2016)
Qualitative, retrospective studies (Bennett & Vidal-Hall, 2000) (e.g., asking questions such as - what was life like before you were widowed? what did you feel at the start of being widowed?)
What are the Adult Developmental Aspects of Grief?
Society makes judgments about how much grief one should have after different types of losses:
The judgments that society makes impose arbitrary time limits on the grieving process, despite evidence which says we should not do that
Societies also impose expectations about how we should behave when we have been bereaved (e.g., shamed for dressing up nicely - was seen as inappropriate)
Stage Theories: What are the historical views of Attachment and Loss?
The theory of attachment:
* Attachment has its roots in childhood.
* Loss of a secure attachment has negative effects.
Freud: in the face of loss:
* Ties between the survivor and the dead person have to be severed.
* This grief work is effortful but entirely necessary for resolution.
What is the Attachment Theory in regard to Bereavement (Bowlby, 1980)?
Loss response progressed in fixed stages:
* Numbing (lasts from a few hours to a week after the death). May be interrupted by outbursts of extremely intense distress/anger
* Yearning and searching for the lost figure (lasts months or years)
* Disorganisation/ despair
* Reorganisation
-Problematic when framing it as fixed stages as bereavement and grief varies throughout time
What are the Myths of Coping with Loss?
Distress is inevitable
Distress is necessary
Failure to experience it is pathological
One must work through the loss
There are stages to be worked through
Recovery is to be expected
Wortman and Silver’s (1989) conclusions:
* Far from being a stereotyped response bereavement is very individual and depends on many social and psychological factors.
* A state of resolution may or may not be attained
What are Change and Recovery Theories?
More Recent approaches to bereavement
Examine the extent of change and recovery
Examines components of everyday functioning before and after a loss
Empirical tradition rather than psychoanalytic
Emphasis on the biological concomitants of change and recovery
What is Rubin’s Two-Track Model (1999)
The bereaved person recovers along parallel trajectories
Maintaining the relationship:
-Positive and negative towards
deceased
-Preoccupation with loss
-Idealisation
-Imagery and memory
-Emotional distance
-Transforming the loss
-Shock, searching
How the person is functioning:
-Anxiety, depression, psychiatric symptoms
-Somatic concerns
-Family relations
-Self-esteem, self-worth
-Meaning, work, investments in life tasks
What has Research found with Continuing Bonds?
Earlier theories suggested that it was important to cut ties with the
deceased
However, more recent theories suggest that (Klass et al., 1996):
The bonds with the deceased naturally remain for most people
That that those bonds are important for the bereaved person
That the maintenance of those bonds may not be detrimental and may be helpful
The deceased can provide a useful resource for the bereaved.
The bond may be maintained in a variety of ways:
Retaining possessions, talking to others about the deceased
Ongoing conversations, dreams etc.,
Undertaking activities to honour the deceased
What is the Dual Process Model of Bereavement (
There are 2 focuses to everyday life experiences:
1. Loss-oriented coping processes: Grief work, Intrusion of grief, breaking bonds/ties/relocation, Denial/avoidance of restoration changes
- Restoration-oriented coping processes: Attending to life changes, Doing new things, Distraction from grief, New roles/identities/relationships
Oscillation:
* This is the swinging back and forth between loss- and restoration-oriented coping
* Evidence that loss is more common earlier, and restoration later, although both continue (Richardson, 2007
Bennett Studies’: What Qualitative Methods were used?
Participants
* 46 widowers (only 45 interviewed)
* 46 widows
Two Qualitative Questions:
* What did you do?
* How did you feel?
Chronological Interview: Before, at the time, one year later, currently
How did Bennett et al. (2010) investigate coping and the Dual Process Model?
Does the DMP explain good coping or psychological adjustment?
* Assessed as coping well or not (3 independent assessors)
* Coping poorly - 14 women, 12 men
* Coping well - 32 women, 33 men
Fitting existing codes into the DPM
c2 analysis – how often a code was reported by coping status
Codes included:
1. L-F C: Grief work = counselling, Intrusion = Talking to spouse, Breaking bonds = Belongings, Denial = No change
- R-F C: Attending to life changes = life change, Doing new things = Clubs, Distraction from grief = distraction, Denial = Staying away, New roles/identities = Independence
What did Bennett et al (2010) find?
-Loss-oriented coping in regards to intrusion was related to positive coping
-Restoration-oriented coping in regards to new roles was related to positive coping
-Loss-oriented coping in regards to avoidance of change was related to poor coping
-Restoration-oriented coping in regards to distraction was related to poor coping
How does widowhood get under
one’s skin? (Richardson et al., 2013)
How are death context characteristics associated with cortisol levels at 6
and 18 months post bereavement?
* Why is cortisol of interest?
* Biological marker of stress
* Expectation that it is a marker of acute stress
Longitudinal study from a prospective multi-wave study of 1532 married
people (CLOC). Husbands aged 65+
* 151 women, 59 men at wave 1
* 110 women, 45 men at wave 2
* Matched controls (still married)
Dependent variable – overnight cortisol
Independent variables:
* Numbness
* How much physical care prior to death
* Forewarning
How does widowhood get under
one’s skin? (Richardson et al., 2013) RESULTS
Hierarchical Regression Predicting W1 Cortisol (n=64):
-If you were experiencing prolonged grief and a woman, higher levels of cortisol were seen
Hierarchical Regression Predicting W2 Cortisol (n=61):
-Those who were experiencing greater numbness experienced higher levels of cortisol (particularly men)
Other Results:
* Prolonged forewarning associated with higher cortisol at Wave 1
Conclusions:
* Stressful life events are associated with stress-neuroendocrine reactions for longer durations than previously thought
* Specific death-related stressor varies by gender
What are Abnormal Grief Reactions? (Cavanaugh & Blanchard-Field, 2015)
Duration and intensity distinguish abnormal from normal grief, not duration.
Abnormal grief usually involves excessive guilt and self-blame
- Most common problem is depression with can become severe and chronic
- A person’s grief is interfering with his or her daily life if is a person is still having intense grief reactions 2 years after the loss, but this is very individual
What are Prolonged Grief Reactions?
What distinguishes prolonged grief is:
* Symptoms of separation distress
* Symptoms of traumatic distress
Two common manifestations of prolonged grief are:
* Excessive guilt
* Self-blame
What is Non-Spousal Bereavement like?
Death of one’s child in young and middle adulthood:
* Sudden Infant Death Syndrome (SIDS)
* Loss of sons or daughters in war
* Death in traffic accidents
The loss is sudden
Some parents never recover from the loss
Cross-culturally, grief is universal and intense
Death of child before birth (e.g., miscarriage) causes great grief for mothers
and fathers, but most are expected to recover quickly:
* Women grieve for the loss of a child
* Men grieve for their spouses
* [this work is outdated: it might be more how men are talking about it (constrained by social constraints) that shows this rather than how they actually feel] See Cavanaugh
What is the impact of the death of one’s parent?
Perceived as very significant regardless of age of parent
- The death of a parent serves to remind people of their own mortality and deprives them of a very important person in their
lives - Society allows us to grieve for a reasonable length of time
- Pruchno et al. (1995) found that most people were upset about the death of parent even when it was anticipated
- The more stress experienced by the adult before his or her parent’s death, the more difficult the bereavement process
- The greater the mental impairment of the parent before death, the more relief the adult child felt after death
What is the prevalence of widowhood?
What we have learnt already:
* Bereavement experiences are shared by widowed people
* The DPM has been tested with widowed men and women
* The data on cortisol is from widowed people
Widowhood is a common experience:
* 36% of people over 65 are widowed
* 65% of women over 75 are widowed
* 45% of men over 85 are widowed
When speaking of widowhood I encompass long-term committed
relationships
How is widowhood more than grief?
Significant dyadic loss:
* Loss of control over aspects of life
* Sexual partner / companion
* Sensory stimulation
Disruption of biological rhythms (due to social entrainment between dyads):
* Return to the single state
* Loss of social support
* Financial and housing problems, hardship
How do Bereavement patterns differ?
Evidence is that bereavement is dynamic and there are individual differences
Evidence for widowhood is the same
Patterns include:
* Resilience
* So called, common pattern of grief
* Prolonged
* Abnormal or pathological
Note, as we shall see resilience is common
What did Bonanno et al. (2014) investigate when looking at patterns of resilience and maladjustment during widowhood?
Taking one aspect of bereavement, depressive symptoms, what happens
over time?
* CLOC data (as before)
* 319 respondents lost a spouse
- 86% (n=276) one + follow-up interview (6mth)
- 64% (n=205) both follow-up interviews (18mth)
- Present study 185 widowed persons (161 women and 24 men)
What did Bonnano et al. (2014) find?
-Chronic Depression group: depression increases pre-loss up to 6 months and then stabilises at 18 months
-Chronic Grief group + depression-improved group: depression peaks at 6 months and returns to baseline at 18 months
-Common grief group: peak depression at pre-loss but shoots down at 18 months
-Resilient group: depression stays relatively stable
Thinking Back to Before Bereavement:
-Higher marital adjustment rating = better adjustment
-Thinking and talking about the loss negatively decreased over time
What are the Trajectories of Depression in
Bereaved Spouses (Galatzer-Levy & Bonanno, 2012)? CHECK RECORDING
What are the Overall Results? (Bonanno et al., 2014; Galatzer-Levy & Bonanno, 2012)?
Not one pattern of bereavement:
* Some people have stable patterns of depression (resilient)
* Some were depressed before and remain depressed
* Some people become less depressed once bereaved (who might they be?)
* Some people experience chronic (or prolonged) grief
* Patterns vary dependent on variable measured
The data suggest that common grief resolves:
* Perhaps illustrates the difference between bereavement and widowhood
Similar patterns can be found for a variety of bereavement experiences:
* Comfort from positive memories, thinking, talking about loss
What is Resilience like in widowhood?
Deprivation Models:
* Resilience as a response to abnormal stress (Rutter, 1999)
Resilience as a steady state:
* Without fluctuating levels of distress following bereavement (and other traumatic events) (Bonanno, 2004)
Resilience as a long-term outcome
* Initial painful awareness of loss; integrated belief and value system; optimistic and positive personality (Moore & Stratton,
2003)
What did Bennett (2010) find when investigating resilience in widowhood? CHECK RECORDING
Achievement of Resilience
* Gradual or turning point (Bennett, 2010)
60 widowers, 38% resilient
Does Bonanno’s conceptualisation of resilience (already resilient) fit into Moore & Stratton’s and Bennett’s (achieving resilience)
-Bonanno’s data lasts up to 6 months so we don’t know what happens after this
What Components of Resilience did Bennett (2010) identify?
Time:
* Resilience as a process: Facing widowhood with resilience throughout.
* Resilience as a turning point: An event, person, experience which changed the widower’s life.
Agency:
* Widowers as active agents
* Doing something to change their situation
* Others as agents, widowers as passive
* Decisions taken for widowers, or being forced by others to change
What was involved in Bonanno’s Resilience?
Participant I8:
* Had a car crash in which his wife died and he was seriously injured. His wife and daughter had, 10 years earlier, had another serious car crash
* He had to contend with losing his wife and learning to walk again.
* Throughout his interview he seemed so strong and so matter-of-fact.
Gradual and Active:
-You’ve got to get cracking and live your life. (M14)
-I got to, to, the fact that, that I got to get on with life and that was it, the best I could. (Mr. D)
-It’s remarkable how it does heal ….. But part of my character is to adjust
to circumstances. I realise it was a blessing for her and indirectly a blessing for me. (I5)
-That’s how you get through it, having friends …. I can go out and talk to
anybody … Being happy, is that a characteristic? Funny, I have a sense of
humour. (I3)
Turning Point and Active:
-And eventually you go well this won’t do. It’s like in a sense you’ve got a big job to. (M41)
-I’ll get over it in me own way … I started to go out. (Mr. G).
-I mean to say I was very backwards doing anything, I’m not now…. That happened two year after she died. I joined the Labour Party … this Tuesday night, feeling a bit down, so I thought well I’ll just go (M27)
Turning Point and Passive:
-With being a diabetic I shouldn’t do what I did. I had this heartache over it and I just thought, fuck it. I went straight round to the pub… Erh, got around and, they said leave Brown Road, and erh, I don’t know what
strings were … And within an hour she sent me down here the same… to look at this place…that was the first time I’d gone home sober. (Mr. E)
-Well, the person there who was knowledgeable said. “there’s a young
chappie who’s quite brilliant”……He was absolutely brilliant. (M1)
What Patterns of Adaptation was found by Spahni et al. (2015)?
Swiss cross-sectional data (Spahni et al., 2015):
* 402 widowed individuals (228 women) aged 60 - 89 years (mean age 74.41
years), who lost their partner within the last 5 years, and 618 married individuals, who served as controls (312 women; mean age 73.82 years).
- Exploratory profile analysis
- 3 profiles: Resilient; Copers; Vulnerables
- Note Copers and Vulnerables more similar than Resilients.
Predicted by:
* Intrapersonal resources – psychological resilience and the Big Five personality traits
* Quality of former relationship
* How loss was experienced.
What were the Results from Spahni et al’s study (2015)?
Resilients:
-Lower depression, hopelessness and loneliness
-Higher life satisfaction and health
Copers:
-Higher depression, hopelessness and loneliness
-Lower life satisfaction and health
Vulnerables:
-Significantly higher depression, hopelessness and loneliness compared to copers
-Significantly lower life satisfaction and health compared to copers
What did Bennett (2007) find when investigating Reconstructing Identity in Men & Masculinity?
Brannon (1976) – The male sex role — And what it’s done for us lately:
* No Sissy Stuff
* The Sturdy Oak
* The Big Wheel
* Give ‘em Hell
Conflicting social/cultural expectations:
* Hegemonic masculinity (stiff upper lip)
* Bereavement (appropriate grief)
The Sturdy Oak under attack
Bennett’s (2007) findings: Abandoning the Role - at least sometimes
I really kept these things – perhaps wrongly – pretty well to myself and it was only when I started going to this counseling. I found it very beneficial. (Man 6)
* I just wanted to talk about her to everybody. (Man 3)
But put in place by others:
* I mean we got a new guy on the table some months back – he’s not been back since – but he started spouting about how his sisters had let him down and a couple of guys said to him, “We know how you feel but we’re all here.” In other words you know, “I’ve got my load to carry — I
can’t carry yours as well.” (Man 16)
Bennett’s (2007) findings: Reconstructing the Role
Control:
* So it was empty, it was all done, so I decided to take it … I went to the Red Lion and me friend there they, that was the first time I’d gone home sober. (Sturdy Oak, Give ‘Em Hell) (Mr E again)
* Sometimes I felt like ending it all to be honest with you. I mean I don’t think I would have done — I would never do that. Never do that. But I felt that. (M15, age 81, widowed 7 years). (No Sissy Stuff, Sturdy Oak)
Demonstrating both emotionality associated with bereavement and final control, associated with masculinity
Rationality:
* Yeah, felt a bit sorry for myself. [Yeah.] but I intended to get over it and that was it. (Mr C). (No Sissy Stuff, Sturdy Oak)
* I think what went through my mind was, “Well I’ve got to do something about my life”. (Mr H). (No Sissy Stuff, Sturdy Oak)
Responsibility:
* It was the two lads that forced me … and it was just the two lads that kept me going. (Man 3) (Sturdy Oak)
* I’m trying to keep going as long as I can for other people’s sake” (Mr B) (Sturdy Oak, Big Wheel)
Successful Action:
* I said I’m suffering from depression. And the old chap says “There’s only one way of getting rid of it. (…) Do some hard work”. [24 hours a day] (…). He said, “In about a month’s time you’ll feel it going out of
your hair and your fingernails”, which it did. (Man 26)
- Demonstrates the conflict of bereavement and masculinity
How did Bennett (2010) investigate Augmented Identity in Older British Widows?
65 older widows
Identity:
* Not from wife to widow
* But from wife to augmented wife/widow (i.e., they are widows but felt like they were still wives)
What is Identity?
* ‘who are you?’ (Allport, 1961)
* Private identity as “that which is me, mine and personally, uniquely mine” (p.121),
* Public identity is “roles, relationships, and membership in groups” (p. 121). (Buss, 1979)
Widows face challenges to both
What were the key things Bennett (2010) find?
Process:
-Continuing Bonds
-Loosening Bonds
-Personal Growth
-Adaptation
-Independence
-Self-sufficiency
-New challenges
-Freedom of choice
Discourse:
-Personal Struggle
-Resistance
-Empowerment
-Rhetoric
Bennett (2010): Process
Continuing Bonds:
* It’s like losing half yourself (Woman 11)
* I feel I’m doing what he would want me to do (Woman 34)
Loosening Bonds:
* And also I’ve sold the piano which cost me a lot of heartache. But I couldn’t play… And every time I went, actually I couldn’t go in that room, properly really. I used to go in and look away from it because I couldn’t bear to see it sort of. You know, the piano itself. It just made me cry all the time. (Mrs. D)
Bennett (2010): Personal Growth and Development
Adaptation:
* My whole life has changed (Woman 2)
Independence and self-sufficiency:
* [I] clear drains and [laughs] do all the things that a good husband did (Mrs. P)
Meeting new challenges:
* now I do line dancing and you don’t need a partner for that (Mrs. I)
Freedom of choice:
* Now, life’s completely changed now because I just do things when I want
to do them (Woman 18)
Bennett (2010): Augmented Identity: Wife/Widow
- It’s, you see, although I still see, still feel I’m married to Fred, I am single really (Woman 46)
- I still talk around the house. It’s something you can’t spend years with someone and just cast them aside (Mrs. C)
- We all put on this wonderful brave face, err, that’s hiding this big hole inside that’s umm, forever there, Forever there. And er, you just build, …this whole stage there … You can never sort of complete the link. (Mrs. A – where the qualitative work all started)
Bennett (2010): What are the Overarching Themes?
Widowhood is rarely without some negative impact
Most people experience the ugly, the bad and the good
How different themes emerge from the same pieces of text
Heterogenity:
* Between individuals
* Between men and women
* Within individuals
Effects a broad range of life domains – social, health, wellbeing
Factors which contribute to the not so bad and the good:
* Family, social support, personal characteristics, pre-existing physical and mental health, resources
