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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
The family is a social system in which members are interdependent and interact with one another in organized, predictable, and repetitive patterns. It is not a collection of individuals in isolation, but consists of individuals and their relationships. Because of interdependence among members, one member's behavior or whatever happens to one member affects the entire family. The family makes continuous adjustments in response to internal and external demands and tries to maintain its equilibrium. The family, like individuals, develops over time. While every family experiences stresses as it moves through different phases of development, events that occur out of sync with normative development, such as the premature death of a member, disrupt the process and produce added stress.
Families may be conceptualized along three dimensions: cohesion, flexibility, and communication. Cohesion, emotional bonding among members, ranges from disengaged (very low) to enmeshed (very high), a moderate level of cohesion being optimal under normal circumstances. Moderately cohesive families are those with members who are able to be both independent from, and connected to, their families. In disengaged families, members are emotionally distant and unable to rely on one another for support or problem solving while in enmeshed families members are excessively close, demanding loyalty and lacking personal separateness. Flexibility refers to the family's ability to change structurally and functionally, its levels ranging from rigid (very low) to chaotic (very high). Moderately flexible families are able to make changes effectively while rigid and chaotic families lack an ability to change when necessary.
Central to family functioning is communication, verbal as well as nonverbal, by which members relate to one another. How members communicate is a good measure of the health of the family. Communication facilitates the family in making adjustments on the dimensions of cohesion and flexibility in order to maintain levels suitable to the situational demands and developmental needs of members and the family as a whole. Good communication is characterized by attentive and empathic listening, speaking for self, and an open expression of feelings about self and relationships.
In general, families with moderate levels of cohesion and flexibility supported by good communication make for optimal family functioning. Those families are able to cope more effectively with a family crisis. Too much or too little cohesion or flexibility tends to be dysfunctional. There is some research evidence to indicate that cohesive families deal with grief more effectively than those families characterized by conflict, low cohesiveness, low expressiveness, and poor organization.
When a family member has a serious illness, both the ill member and others in the family face the enormous challenge of living with the uncertainty of chronic illness from initial crisis through the terminal phase. They cope with an emotional roller coaster as they live with the uncertain trajectory of illness, the demands of illness and caregiving, exhaustion, financial burdens, and thoughts of their final separation. Family members lose their "normal" life and must learn to live with ambiguities over a long period of time, well members sometimes vacillating between a desire to be close to the ill member and a desire to escape from the unbearable situation.
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