As the science of bereavement studies continues to evolve, researchers are beginning to move away from the long-held theory of the ‘stages of grief’, arguing that its widespread popularity has subjected grievers to an artificial construct which in reality did not reflect the experience of many bereaved persons. In his landmark work ‘Grief Counseling and Grief Therapy’ first published in 1992, William Worden introduced the concept of the ‘tasks of grieving’ as an observation of the grief process as an active set of tasks which grievers tend to complete, not necessarily sequentially, but each of which were essential to fully adapting to the death of a loved one.
Two decades later, a new perspective is demanding the attention of the mental health community. In his 2009 book, ‘The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss’, Columbia University Professor of clinical psychology, George Bonanno asserts that the focus on stages and tasks flies in the face of his research which shows that the average bereaved person recovers fairly quickly from grief and does not need to engage in a long, drawn out process, or grief-work. In fact, he asserts that the emphasis on working through grief, whether by stages or tasks could lead to disenfranchisement of the majority of persons who genuinely recover from loss quickly.
Having observed hundreds of bereaved persons, following some for years before and after the fact, Dr. Bonanno has identifed three general patterns of bereavement. The first is a chronic grief reaction, experienced by only about 1 in 10 grievers. In this case, the individual is overwhelmed by the pain of loss and finds it extremely difficult to resume his/her normal, daily routine. The second pattern involves a heightened grief experience, followed by a more gradual return to functioning, and the third, and most common pattern is the experience of going in and out of grief, with the grieving periods becoming less over the course of a few weeks or months.
Dr. Bonanno believes the concept of a long, drawn out process is fuelled by the literature which is largely written by mental health professionals, who are most likely to see “only those bereaved persons whose lives have been consumed by suffering, people for whom professional help is the only chance of survival.”
The quote above highlights a significant difference in approach to information-gathering by Bonanno and fellow researchers. Instead of drawing conclusions from the stories of persons presenting with emotional issues, he and his team actively recruited bereaved persons, including those who were experiencing no emotional difficulties, to participate in a series of experiments. His conclusion, “Most bereaved persons get better on their own without any kind of professional help. They may be deeply saddened, they may feel adrift for some time but their life eventually finds its way again, often more easily than they thought possible”.
Dr. Bonanno goes further to suggest that efforts by mental health professionals to focus a bereaved person on his/her loss experience can end up being more unhelpful, than helpful. An example of this, he says, is Critical Incident Stress Debriefing. An example he offers is a study done in England with a sample of motor vehicle accident victims. Within 48 hours of hospitalization, the patients were visited by researchers who randomly offered either conversation, or a one hour debriefing. Debriefed accident victims were encouraged to describe the accident and how they felt at each step, and given some information on possible trauma reactions in the days ahead and the importance of expressing their feelings to their loved ones.
He reports, “Well, it turns out that three years later, the people that received that debriefing were much worse off than anybody else in the study. So then, one of the common concerns in this area is, well, what we need to do is find the people who are most distressed, who are really doing poorly, and target those people right away. But these researchers did that, and what they found was, among the people who are most distressed, if they just left them alone, if they gave the control condition, most of them got better. If they didn’t, if they got this one hour debriefing, they were still worse three years later. And they were worse in, literally, every aspect that they had measured. They not only had more distress, they were less likely to report enjoying being in a vehicle again. They had more physical pain, just all kinds of ways in which they were suffering more, all as a result of this simple one hour debriefing”.*
Bonanno does concede that certain types of bereavement, such as suicide, bring their own unique issues that challenge the ability of survivors to adapt. Other factors affecting an individual’s grief response, he says, include available social support systems and how dependent the survivor was on the deceased for physical, psychological well-being.
*Editorial Note: In his comments on the uses of Critical Incident Stress Debriefing, Dr. Jeffery T. Mitchell notes, “Without exception, every negative outcome study on CISD to date has not used trained personnel to provide the service and they have violated the core standards of practice in the CISM field. For example, they have used the CISD for individuals instead of homogeneous groups… When a group process designed for homogeneous groups is used on individuals, it changes the inherent nature of the process itself and also what is being measured.”
