Coping with bereavement: A review of the grief work hypothesis.
Coping with bereavement: A review of the grief work hypothesis
bereavement: a review of the grief work hypothesis.
Because of the lack of research with this population, many of the clinical implications for adult surviving siblings and their families must be gleaned from the research on loss of less specific and unique relationships in adulthood while considering the research gathered from child and adolescent sibling loss. Multiple studies suggest that ongoing bereavement counseling for surviving siblings is neglected (Arnold & Gemma, 1994; Fanos, 1996; McCown & Davies, 2001). While a full review of how to conduct grief specific therapy is beyond the scope of this article, considerations for grief groups for adult survivors of sibling loss will be presented near the end.
Cultural specificity. Second, we contend that the grief work hypothesis is culture-bound, at least with respect to the overt level of grief. Different conceptualizations of acceptable or "healthy" ways of coping are to be found in non-Western cultures (Stroebe & Schut, 1998; Stroebe & Stroebe, 1987). Some cultures show little or no evidence of "working through" patterns, for apparently this would be considered detrimental to the health of the bereaved and those around them (e.g., among the Muslim community of Bali, according to Wikan, 1990). In other cultures, the bereaved appear to work through normality in very different ways from western understanding of "normality," for example, mutilating the body, or tearing of the hair, as evidenced in some Aboriginal tribal peoples (see Stroebe & Stroebe, 1987).
- Stroebe, Margaret, Schut, Henk; The Dual Process Model of Coping with Bereavement: Rationale and Description; Death Studies, Apr/May 1999, Vol. 23, Issue 3.
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Shortcomings of the Grief Work Hypothesis
As noted above, a number of grief theorists have recognized the limitations of the grief work formulation and questioned the acceptance of it as a dominant principle. In a seminal contribution, Rosenblatt (1983) analyzed 19th-century descriptions of how people dealt with grief, to evaluate contemporary scientific research on coping, and in particular, to assess the validity of the grief work notion: Although the emotional experience was found to be similar in the two centuries, people in the 19th century did not struggle to detach themselves, their memories and hopes, from the deceased. In an influential paper, based on their analyses of some empirical work, Silver and Wortman (1980) argued the case that working through was not only not associated with recovery but even detrimental to it. In a monograph that has helped to redefine principles of grief intervention, Worden (1991) reformulated the process of grieving in terms of distinct tasks that the bereaved have to undertake.
In a review of theoretical and empirical research on grief work, following some of the leads of the earlier theorists, Stroebe (1992) summarized a number of shortcomings associated with the grief work hypothesis. The main points of criticism concerned the lack of clarity in the definition of grief work (e.g., the confounding of negative associated rumination with more positively associated aspects of working through), the poor quality of operationalizations in empirical studies (e.g., grief work operationalized as yearning and pining), the absence of sound evidence for it (some studies failed to confirm that confrontation of grief is a predictor of adaptation) and the lack of apparent application across cultures (prescriptions other than the grief work hypothesis exist: These appear to be associated too with adaptation). These criticisms still pertain today.
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Coping with Bereavement: Evaluation of Contemporary Theories
The Grief Work Hypothesis
Following accounts to be found in the scientific literature, grief work can be defined as a "cognitive process of confronting a loss, of going over the events before and at the time of death, of focusing on memories and working toward detachment from the deceased. It requires an active, ongoing, effortful attempt to come to terms with loss. Fundamental to current conceptions is the view that one needs to bring the reality of loss into one's awareness as much as possible and that suppression is a pathological phenomenon" (Stroebe, 1992, pp. 19-20). From this definition, we can derive the "grief work hypothesis," which refers to the notion that one has to confront the experience of bereavement to come to terms with loss and avoid detrimental health consequences (Stroebe, 1992).
However, whereas the earlier conclusion argued for more empirical testing and refinement of conceptualization, there are now good reasons to argue, in addition, for a revised model of coping. In our view, there are two main reasons for this, namely, limitations in scientific representation of bereavement phenomena within the grief work framework and its lack of general application.
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Likewise, with respect to gender differences in coping styles, women are more confrontive and expressive of their emotions than men, but there has been little validation of the generally accepted grief work hypothesis (working through grief by women brings about their better recovery).
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Inadequate Representation of Bereavement-Related Phenomena
The first concern, whether the observed phenomena of grieving are adequately represented in the grief work hypothesis, can be illustrated by looking at (a) the definition of the stressor bereavement, (b) process, and (c) outcome variables.
Bereavement as stressor: The lack of specification. Lacking in grief work formulations in general is specification of precisely what has been lost and what has changed through bereavement. There has been a lack of recognition of the range of stressors, the multiplicity of losses, integral to the bereavement experience. Not only is there the loss of the person, but adjustments have to be made with respect to many aspects of life (cf. Worden, 1991). Such secondary stressors also need to be dealt with and (re)appraised, just as the meaning associated with the death of the valued person per se needs repeatedly to be thought through, even "pained through" (Lindemann, 1979). As Neimeyer (1998) noted, adaptation to loss involves the restoration of coherence to the narrative of our lives. We return to consider the two types of stressor later on.
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The dynamics of confrontation-avoidance. With respect to process, the grief work hypothesis conveys a sense for the need to confront the pain and work through the loss. This is understood to be an effortful process. Yet, the dynamic process that reflects the realization of loss, on the one hand, and the fight against the reality of loss, on the other hand, is neglected in this conceptualization. Denial too takes place at times, it is likewise effortful and (particularly in earlier formulations) it is claimed to be detrimental to health. Representation of the tendency, even necessity (as we will argue later) to confront combined with the tendency to avoid, deny, or suppress aspects of grieving as part of the coping process is still needed in scientific analysis. We need to examine further the extent to which confrontation and avoidance of primary and secondary stressors takes place and is efficacious.
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Gender specificity. First, the grief work hypothesis does not take adequate account of preferred masculine ways of going about grieving, which are typically less confrontive with respect to the emotion of grief, and less overtly expressive of distress and depression than those found among females (Stroebe, 1998; Stroebe, Stroebe, & Schut, unpublished manuscript). Although male grieving has recently received some scientific attention (e.g., Lund, in press), in the past female grief has been much more studied. As Carverhill and Chartier (1996) have described, this is "A reversal of the usual trend in psychological research to generalize from a largely male sample" (p. 1). The question arises, then, whether the grief work hypothesis that has been derived from the study of a largely female sample is, in fact, generalizable to a male sample: Is what we have at present a "female model of grieving"?
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