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Grief
Macmillan Encyclopedia of Death and Dying, (2003) by ROBERT KASTENBAUM, KENNETH J. DOKA, JOAN BEDER, REIKO SCHWAB, KENNETH J. DOKA, REIKO SCHWAB, KENNETH J. DOKA, NORMAN L. FARBEROW, MARGARET STROEBE, WOLFGANG STROEBE, HENK SCHUT, LILLIAN M. RANGE
G RIEF
OVERVIEW
A suffering, a distress, a wretchedness, a pain, a burden, a wound. These were among the meanings associated with the word grief in its premodern French origin. The term also referred to wrongs and injuries that have been inflicted upon an individual by others, thereby providing the related word grievance. There are still other associations: greeffe, grefe, and gravis —all denoting a heaviness that weighs one down toward the earth, the very opposite of levity. People who experience grief today are likely to feel many or all of the emotions that were inherent in the earliest definitions of the term.
Grief experts have also identified other facets of the grief response, such as a yearning for the lost person or state of affairs, a need to think repeatedly about past events, a sense of guilt, or even thoughts of suicide. As Kenneth Doka notes, the grief experience can begin even before the loss occurs; another useful distinction can be made between the immediate response to loss and the grieving that sometimes continues long afterward or which does not come to the surface until some time has passed since the death or other loss.
It is now recognized that grief is more than sorrow and emotional turmoil. Five dimensions are receiving particular attention in the mental health community. First, stress reactions include changes in physiological function that can increase one's vulnerability to illness and exacerbate preexisting physical problems. Secondly, perception and thought are also affected, with the increased possibility of making impulsive and potentially harmful decisions and becoming more at risk for accidents. Third, a spiritual crisis often occurs, in which the guiding assumptions and values are called into question. Fourth, family and communal response to loss, often neglected in the past, is a significant factor in grief and grief recovery. And lastly, although the pain of loss may be universal, cultural heritage and influences and current support systems have much influence on the way one expresses and copes with stress.
ACUTE
Grief is a type of stress reaction, a highly personal and subjective response to a real, perceived, or anticipated loss. Grief reactions may occur in any loss situation, whether the loss is physical or tangible—such as a death, significant injury, or loss of property—or symbolic and intangible, such as the loss of a dream. The intensity of grief depends on the meaning of that loss to the individual. Loss, however, does not inevitably create grief. Some individuals may be so disassociated from the lost object that they experience little or no grief or their response is characterized by intense denial.
Acute grief is different from bereavement or mourning. Bereavement is an objective state of loss: If one experiences a loss, one is bereaved. Bereavement refers to the fact of loss, while grief is the subjective response to that state of loss. Mourning has two interrelated meanings in the scholarly literature on the subject. On one hand, it describes the intrapsychic process whereby a grieving individual gradually adapts to the loss, a process that has also been referred to as "grieving" or "grief work." Grief can also denote a social process, the norms, behavior patterns, and rituals through which an individual is recognized as bereaved and socially expresses grief; for example, wearing black, sending flowers, and attending funerals. Acute grief has also been described as the initial, intense reactions to a loss, differentiating it from later, less intense expressions of grief. Such a distinction, given the discussion that follows, is not made here.
Paradigms on the Origin of Acute Grief
Acute grief was first described by Eric Lindemann, a psychiatrist who studied survivors of the 1942 Cocoanut Grove fire, a blaze that swept through a Boston nightclub, killing 492 people. Lindemann described grief as a syndrome that was "remarkably uniform" and included a common range of physical symptoms such as tightness of throat, shortness of breath, and other pain, along with a range of emotional responses (1944, p.145). Lindemann's research was based on a sample of primarily young survivors of sudden and traumatic loss.
This medical model of grief was continued most clearly in the work of George Engel. In 1961 Engel asked if grief was a disease. He believed it could be described as one having a clear onset in a circumstance of loss, a predictable course that includes an initial state of shock; a developing awareness of loss characterized by physical, affective, cognitive, psychological, and behavioral symptoms; and a prolonged period of gradual recovery that might be complicated by other variables. Engel notes that other disease processes also are influenced by psychological and social variables. Even the fact that grief is universal and does not often require treatment, Engel argues, is not unlike other diseases. Engel also notes that whether or not a disease requires medical treatment or is, in fact, recognized as a disease is a social definition. Epilepsy, alcoholism, and many forms of mental illness are now recognized as diseases but were not at other times in human history or in other cultures.
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