an alternative and effective approach
"Grief is the most painful human process..."For I feel there is something that could be exceedingly helpful to those who have lost a loved one - especially parents who have lost a child, the worst grief of all - in navigating through this difficult time...."
K. Paul Stoller, MD
Types of Bereavement
Differing bereavements along the life cycle may have different manifestations and problems which are age related, mostly because of cognitive and emotional skills along the way. Children will exhibit their mourning very differently in reaction to the loss of a parent than a widow would to the loss of a spouse.
Reactions in one type of bereavement may be perfectly normal, but in another the same reaction could be problematic. The kind of loss must be taken under consideration when determining how to help.
When a parent or caregiver dies or leaves, children may have symptoms of psychopathology, but they are less severe than in children with major depression. The loss of a parent, grandparent or sibling can be very troubling in childhood, but even in childhood there are age differences in relation to the loss. A very young child, under one or two, may be found to have no reaction if a carer dies, but this is far from the truth.
At a time when trust and dependency are formed, a break even of no more than separation can cause problems in well-being; this is especially true if the loss is around critical periods such as 8–12 months, when attachment and separation are at their height information, and even a brief separation from a parent or other person who cares for the child can cause distress.
Even as a child grows older, death is still difficult to assimilate and this affects the way a child responds. For example, younger children will find the fact of death a changeable thing: one child believed her deceased mother could be restored with band-aids, and children often see death as curable or temporary, more as a separation. Reactions may manifest themselves in "acting out" behaviors: a return to earlier behaviors such as sucking thumbs, clinging to a toy or angry behavior: they do not have the maturity to mourn as an adult, but the intensity is there. As children enter pre-teen and teen years, there is a more mature understanding.
Adolescents may respond by delinquency, or oppositely become "over-achievers": repetitive actions are not uncommon such as washing a car repeatedly or taking up repetitive tasks such as sewing, computer games, etc. It is an effort to stay above the grief. Childhood loss as mentioned before can predispose a child not only to physical illness but to emotional problems and an increased risk for suicide, especially in the adolescent period.
Death of a Child
Death of a child can take the form of a loss in infancy such as miscarriage or stillbirth or neonatal death, SIDS, or the death of an older child. In most cases, parents find the grief almost unbearably devastating, and while persons may rate the death of a spouse as first in traumatic life events, the death of a child is still perhaps one of the most intense forms of grief, holding greater risk factors. This loss also bears a lifelong process: one does not get 'over' the loss but instead must assimilate and live with the death. Intervention and comforting support can make all the difference to the survival of a parent in this type of grief but the risk factors are great and may include family breakup or suicide.
Feelings of guilt, whether legitimate or not, are pervasive, and the dependent nature of the relationship disposes parents to a variety of problems as they seek to cope with this great loss. Parents who suffer miscarriage or a regretful or coerced abortion may experience resentment towards others who experience successful pregnancies. Because of the intensity of grief emotions, irrational decisions are often made.
Death of a Spouse
Although the death of a spouse may be an expected change, it is a particularly powerful loss of a loved one. A spouse often becomes part of the other in a unique way: many widows and widowers describe losing 'half' of themselves. After a long marriage, at older ages, the elderly may find it a very difficult assimilation to begin anew.
Furthermore, most couples have a division of 'tasks' or 'labor', e.g., the husband mows the yard, the wife pays the bills, etc. which, in addition to dealing with great grief and life changes, means added responsibilities for the bereaved. Social isolation may also become imminent, as many groups composed of couples find it difficult to adjust to the new identity of the bereaved.
Death of a Parent
For a child, the death of a parent, without support to manage the effects of the grief, may result in long term psychological harm. Therefore, it is important that the emotions the child feels are worked through completely and discussed openly.
An adult may be expected to cope with the death of a parent in a less emotional way; however, it can still invoke extremely powerful emotions. This is especially true when the death occurs at an important or difficult period of life, such as when becoming a parent, graduation or other times of emotional stress. It is important to recognize the effects that the loss of a parent can cause and address these. As an adult, the willingness to be open to grief is often diminished. A failure to accept and deal with loss will only result in further pain and suffering.
Death of a Sibling
The loss of a sibling is a devastating event. Sibling grief is often a disenfranchised type of grief (especially with regard to adult siblings). It is overlooked by society as a whole and people in general, thus negating the depth of love that exists between siblings. Siblings who have been part of each other's lives since birth help form and sustain each other's identities; with the death of one sibling comes the loss of that part of the survivor's identity.
The sibling relationship is a unique one, as they share a special bond and a common history from birth, have a certain role and place in the family, often complement each other, and share genetic traits. Siblings who enjoy a close relationship participate in each other's daily lives and special events, confide in each other, share joys, spend leisure time together (whether they are children or adults), and have a relationship that not only exists in the present but often looks toward a future together (even into retirement).
Siblings who play a major part in each other lives are essential to each other. The sibling relationship can be the longest significant relationship of the lifespan, and this loss intensifies their grief. Adult siblings eventually expect the loss of aging parents, the only other people who have been an integral part of their lives since birth, but they don't expect to lose their siblings early; as a result, when a sibling dies, the surviving sibling may experience a longer period of shock and disbelief.
Overall, with the loss of a sibling, a substantial part of the surviving sibling's past, present, and future is also lost. If siblings were not on good terms or close with each other, then intense feelings of guilt may ensue on the part of the surviving sibling (guilt may also ensue for having survived, not being able to prevent the death, having argued with their sibling, etc.)
Parents may grieve due to permanent loss of children through means other than death. This loss differs from the death of a child in that the grief process is prolonged or denied because of hope that the relationship will be restored. In this sense, children may be lost due to many different causes, including loss of custody in divorce proceedings; legal termination of parental rights by the government, such as in cases of child abuse; through kidnapping; because the child voluntarily left home (either as a runaway or, for children over 18, by leaving home legally); or because an adult refuses or is unable to have contact with a parent.
Many other losses predispose persons to these same experiences, although often not as severely. Loss reactions may occur after the loss of a romantic relationship (i.e. divorce or break up), a vocation, a pet (animal loss), a home, children leaving home (empty nest syndrome), sibling(s) leaving home, a friend, a favored appointment or desire, a faith in one's religion, etc.
A person who strongly identifies with their occupation may feel a sense of grief if they have to stop their job due to retirement, being laid off, injury, or loss of certification. While the reaction may not be as intense, experiences of loss may still show in these forms of bereavement. Those who have experienced a loss of trust, will also experience some form of grief. For example, people that have been either physically or sexually abused as children may have issues around trust as an adult.