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Journal of HIV/AIDS & Social Services


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A Comparison of Grief Reactions in Cancer, HIV/AIDS,


and Suicide Bereavement
James A. Houck PhD

Pastoral Counseling Studies at the Department of Pastoral and Theological Studies ,


Neumann College , USA
Published online: 04 Oct 2008.

To cite this article: James A. Houck PhD (2007) A Comparison of Grief Reactions in Cancer, HIV/AIDS, and Suicide
Bereavement, Journal of HIV/AIDS & Social Services, 6:3, 97-112, DOI: 10.1300/J187v06n03_07
To link to this article: http://dx.doi.org/10.1300/J187v06n03_07

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A Comparison of Grief Reactions


in Cancer, HIV/AIDS,
and Suicide Bereavement
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James A. Houck, PhD

ABSTRACT. This study compared the grief reactions of people who


mourned three different types of death: Cancer, HIV/AIDS, and suicide,
and addressed the question whether these bereavement groups can be differentiated on the basis of their grief, as measured by the Grief Experience Questionnaire (GEQ; Barrett & Scott, 1989). The results indicate
that these groups (cancer: N = 50, AIDS-related: N = 50, and suicide:
N = 50) had different grief reactions, specifically, in the areas of stigmatization and unique reactions to suicide. The implications of these results
afford grief counselors, health-care providers, and pastoral professionals,
intervention strategies that enfranchise people, who may experience one
of these types of deaths, to work through their grief. Furthermore, this
understanding of specific grief characteristics can also be assimilated into
a therapists preferred bereavement paradigm, for example, stages of grief
(Kbler-Ross, 1969), phases of bereavement (Parkes, 1972), or tasks of
mourning (Worden, 2004). doi:10.1300/J187v06n03_07 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH.
E-mail address: <docdelivery@haworthpress.com> Website: <http://www.
HaworthPress.com> 2007 by The Haworth Press, Inc. All rights reserved.]

James A. Houck, PhD, is Assistant Professor of Pastoral Counseling Studies at the


Department of Pastoral and Theological Studies, Neumann College.
Address correspondence to: James A. Houck, PhD, Assistant Professor, Department of Pastoral and Theological Studies, Neumann College, One Neumann Drive,
Aston, PA 19014 (E-mail: houckj@neumann.edu).
The author wishes to express special thanks to his mentors and colleagues: Sharon
E. Cheston, EdD, Sr., Suzanne Mayer, PhD, IHM, and J. Sheppard Jeffreys, EdD.
Journal of HIV/AIDS & Social Services, Vol. 6(3) 2007
Available online at http://jhaso.haworthpress.com
2007 by he Haworth Press, Inc. All rights reserved.
doi:10.1300/J187v06n03_07

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KEYWORDS. Cancer, AIDS, suicide, bereavement, disenfranchised


grief, Grief Experience Questionnaire, counseling, and mental health

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INTRODUCTION
A common misconception about grief is that it is one-dimensional, that
is, experienced solely as an emotional turmoil. Instead, grief is a multifaceted experience, causing a disruption in a persons physical, emotional,
spiritual, social, and philosophical well-being. Worden (2004) proposes
that the grief reaction can be categorized into four areas:
1. Feelings: sadness, anger, guilt, anxiety, etc.
2. Physical Sensations: tightness in the chest and throat, lack of energy, dry mouth, etc.
3. Cognitions: disbelief, confusion, preoccupation, sense of presence, etc.
4. Behaviors: sleep and appetite disturbances, social withdrawal, etc.
These experiences are considered normal reactions of grief, which
usually diminish in intensity over time ( Sadock & Sadock, 2003).
Review of Grief Reactions: Normal and Complicated
Although it is affirmed by many in the field of mental health that grief
is considered a normal reaction to any type of loss, and can be experienced on many different levels, there is, however, a point when grief is
considered abnormal. This phenomenon occurs when grief and mourning
become complicated as the level of impairment escalates to the point of
severely limiting the day-to-day functioning of one who mourns a loss.
From a cognitive perspective, Neimeyer, Prigerson, and Davies (2002)
suggest that complicated grief occurs when a person is unable to assimilate the loss into his/her personal life narrative; in other words, reconstruct a meaningful personal reality (p. 236) by relearning assumptions
about the world, roles in the family, etc., challenged by the loss.
Lazare (1979) suggests that abnormal, or pathological, grief occurs
when one or more of the following symptoms are evident: (1) when a
person is not able to talk about the deceased without experiencing a
fresh grief reaction; (2) when minor events trigger an intense emotional
response; (3) when the death of the loved-one is often the topic of conversation; (4) when there is a reluctance to remove the loved ones

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possessions; (5) when the survivor reports physical symptoms similar


to those of the deceased; (6) when a survivor has made radical and sudden lifestyle changes following the loss; or (7) when the survivor becomes preoccupied with the presence of the deceased.
Catalan (1995) affirms that pathological grief can be categorized under several headings. Absence or delayed grief is an absence or delay of
the manifestations of numbness and disbelief, separation distress, and
subsequent features associated with normal grief. Chronic grief occurs
when the most distressing features of mourning persist over time, and
the intensity of emotions escalates as well. For example, although anniversary reactions to the death of a loved-one are considered normal,
even after many years, a person still may feel unable to move on with
their lives, or complain about being stuck in their grief (Worden, 2004).
Inhibited or distorted grief is seen in people with an erratic pattern of
emotional responses and thoughts. Complaints of somatic symptoms,
anxiety, depression, or behavioral manifestations such as hostility, displaced anger, and overidentification with the deceased may become
more prominent than the usual features of grief.
METHODOLOGY
Grief is universal: A normal, human reaction when a person experiences a loss. Much in the same way every human being has a thumbprint,
grief is the common denominator in all societies. However, just as no
two thumbprints are alike, no two people grieve in the same manner, nor
should they be treated the same by grief workers, therapists, clergy, and
other health-care providers. Therefore, I designed a study to identify
specific characteristics of grief that are unique to cancer, HIV/AIDS,
and suicide bereavement.
Social workers, grief counselors, and clinical directors recruited participants for this study from various hospice and HIV/AIDS facilities,
and suicide support groups. Participants included members from adult
bereavement groups, who have lost a loved-one most recently to one of
three causes of death: Cancer (N = 50), AIDS-related (N = 50), or suicide (N = 50). The above agencies distributed take-home packets, which
included a letter of appreciation for their willingness to participate in the
study, an informed consent form, a brief demographic questionnaire,
and the Grief Experience Questionnaire (GEQ; Barrett & Scott, 1989). In
order to maintain confidentiality, the researcher did not have any contact
with the participants, but instructed them in the consent form to mail the

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completed packets in a separate addressed and stamped envelope to the


agency that recruited them for the study. The packets were then collected after 1 month of being distributed.
The purpose of this study was twofold. The first purpose was to determine whether characteristics of group membership could be determined
based on grief reactions, as measured by the GEQ (Barrett & Scott,
1989). Although the participants were previously grouped by the type of
loss they had experienced, a discriminant function analysis (DFA) was
used to identify whether the cut off scores were appropriate to distinguish
grief reactions between cancer, HIV/AIDS, and suicide bereavement.
The null hypothesis was that there are no differences in grief reactions between the groups. Once the null had been rejected, a second purpose was
to identify which grief variables contributed most to discriminating between the groups. Permission for this study was granted by the Institutional Review Board of Loyola College in Baltimore, Maryland.
Instruments
The Grief Experience Questionnaire. The GEQ (Barrett & Scott,
1989) was designed to compare the differences in bereavement experiences of persons who have had a spouse commit suicide versus persons
who had a spouse die an accidental or natural death. The measure consists
of 55 items concerning the frequency of various grief reactions, each with
a 5-point Likert-response scale of (1) Never, (2) Rarely, (3) Sometimes,
(4) Often, and (5) Almost always. The wording was changed from
spouse to loved-one to include a broader sample of other types of relationships to the deceased. Grief reaction subscales included multidimensional aspects of grief, somatic reactions, general grief, search for
explanation, loss of social support, stigmatization, sense of guilt, sense
of responsibility, sense of shame, sense of rejection, self-destructive behaviors, and unique reactions to suicide, and have a Cronbachs Alpha
ranging from .68 to .97. A copy of the GEQ can be obtained through
the Journal of Suicide and Life-Threatening Behavior (1989) 19, pp.
201-215.
RESULTS
Socioeconomic Status
To ensure an equal number in each group, 150 completed packets
(50 per group) were needed for the study. Initially, 350 total packets

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were distributed which provided a 43% return rate. The participants included 105 women (67.9%) and 45 men (32.1%). Ethnicity in the sample was 10% Hispanic, 43% Caucasian, and 47% African-American.
The range of ages was from 19 to 79 years with a mean age of 44.65
years. Income ranged from $20,000 to $60,000, with a mean income of
$36,000. The education levels for the total sample were 30.9% completed high school, 51.2% attended college, and 17.9% attended graduate school. When comparing any of the socioeconomic demographics to
the grief reactions, no significance correlation (.30), which could distinguish one bereavement group from another, was found.
Specific Grief-Related Demographics
Participants were asked to indicate their relationship to the deceased,
how much time had passed since the death of their loved-one, whether
they attended support groups for their grief, and their current HIV status.
Participants relationship to the deceased included the following:
24% lost a parent, 21% lost a spouse, 15.4% lost a sibling, 13.6% lost
children, 10.5% lost a close friend, 7.4% lost a life-partner. Another 9%
lost an extended family member such as an uncle or grandparent. At the
time of completing the testing packet, participants were asked how
much time had passed since their loved ones death. The range for this
question was 3 months to over 5 years with a mean of 24.3 months. These
specific grief-related demographics were evenly distributed throughout
the three bereavement groups.
A stepwise discriminant analysis identified overall significance for
the GEQ variables, p < .001 for each of the group means. This significance indicates that despite the type of the death, these groups have similar grief reactions albeit varying degrees. For example, out of the 11
variables, 2 were identified as contributing to the discrimination between each of the bereavement groups, namely unique reactions to suicide and stigmatization, accounting for 88.6 and 11.4% of the variance,
respectively. In addition, these characteristics were calculated with a combined Chi-square = 217.03, p < .000. Even after removal of the strongest
characteristic, unique reactions to suicide, there was still strong association between the groups and the predictors, Chi-square = 39.097, p <
.000. Therefore, based on the analysis that the grief reactions differed
depending on which type of grief participants were experiencing, the
null hypothesis of no differences between the three groups was rejected.

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In order to determine to what degree the bereavement groups are similar or different, the most significant functions (Unique Reactions to
Suicide and Stigmatization) were analyzed at the group means for each
type of death (Table 1). For example, the variable Unique Reactions to
Suicide (Function 1) separated the responses of the suicide bereavement
group (1.911) from those of the cancer (1.829) and AIDS-related
(.082) bereavement groups. Barrett and Scott (1989) assert that a defining characteristic for unique reactions to suicide is attributed to a survivor concealing the circumstances surrounding the death in order to
avoid the sensitivity of perhaps having the cause of death broadcast in
the media. The expectation was that the suicide group would score
higher in this particular category. In addition, HIV/AIDS bereavement
may have only slight characteristics similar to suicide bereavement.
Stigmatization (Function 2) separates the responses of the AIDSrelated bereavement group (.775) from the cancer (.413) and suicide
bereavement (.362) groups. Again, Barrett and Scott (1989) define stigmatization in bereavement as society having a negative perception of
the survivor as a result of the death of his/her loved-one. It is not surprising that the HIV/AIDS group scored highest in this category, because
the literature spoke of HIV/AIDS as being a highly stigmatized disease
(Burkett, 1995; Shilts, 1988; Snyder, Omato, & Crain, 1999). Yet, what
is noteworthy is how similar cancer and suicide bereavement are in
terms of stigmatization. Unlike HIV/AIDS bereavement, where it appears that the stigma is transferred to surviving loved-ones, suicide and
cancer bereavement did not demonstrate this characteristic as strongly.
Perhaps one reason why stigma appears in the cancer group may be
related to how the person developed the disease (e.g., excessive smoking, not taking care of oneself, etc.). At one time society viewed suicide
as a highly stigmatized death, however, that trend seems to be changing. What may be attributing to this lack of stigmatization currently is
the way society has become more sympathetic in their understanding
TABLE 1. Function of Significant Grief Reactions for Each Group
Type of Death

Function 1
Unique Reactions
to Suicide

Function 2
Stigmatization

1.829

.413

AIDS

.082

.775

Suicide

1.911

.362

Cancer

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regarding the causes of suicide, for example, mental illness, despair,


etc. (Corr, Nabe, & Corr, 2005). In addition, the growing number of
resources and support groups available for surviving loved-ones of
both cancer and suicide bereavement may further indicate why survivors experience less stigmatization than do survivors in HIV/AIDS
bereavement.
A classification table tests the effectiveness of the discriminant analysis in distinguishing three bereavement groups (Table 2). As a statistical tool, the primary purpose of the discriminant analysis is to classify a
set of scores into predefined groups versus randomly assigning participants. Since this study started with participants from three self-identified bereavement groups, the discriminant analysis was used to test
whether their grief reaction scores were indicative of the characteristics
for each type of death they were grieving. Prior to the study, if participants were randomly assigned to one of the three bereavement groups,
there would be a 33.3% chance of predicting them correctly. However,
based on the actual grief reaction scores, the discriminant analysis
matched 82.0% according to the type of death participants reported
experiencing. For example, the cancer bereavement group had a 94%
classification rate with 47/50 cases being classified correctly. The suicide bereavement group had an 86% classification rate with 43/50 cases
classified correctly, whereas the HIV/AIDS group had the lowest classification rate (66%) with 33/50 cases classified correctly. This lower
classification rate for the HIV/AIDS group may indicate that survivors
share bereavement characteristics of the other two groups. As a result,
20% of the HIV/AIDS group may have more in common with cancer
bereavement, that is, traits of a disease model which include anticipatory grief issues (Rando, 2000). Still, the HIV/AIDS group (14%)

TABLE 2. Classification Results


Actual Group Membership Based on Scores
Cancer
n (%)

HIV/AIDS
n (%)

Suicide
n (%)
0 (0)

Self-identified group membership


Cancer (N = 50)

47 (94)

3 (6)

AIDS (N = 50)

10 (20)

33 (66)

7 (14)

3 (6)

4 (8)

43 (86)

Suicide (N = 50)

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may also have some characteristics unique to suicide bereavement


(e.g., concealing the true nature of the death, feeling the death was
senseless and a waste of life, etc.).

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Additional Data
Comparison of Means. When comparing the 11 GEQ variables mean
scores between the three bereavement groups, an obvious separation
between the groups occurred (Table 3). For the most part, the lowest
mean scores occurred in the cancer group, with the HIV/AIDS group
scoring much higher. The highest mean scores of the three occurred
in the suicide group and may be indicative of a more intensified grief reaction resulting from a sudden and unexpected death of a loved-one.
Furthermore, although cancer and HIV/AIDS are classified as lifethreatening diseases, the level of stigmatization is significantly lower
in the cancer group than in the HIV/AIDS group. Yet despite this contrast, the variable search for explanation is slightly higher in the cancer
group mean scores (2.432) than the HIV/AIDS group mean scores
(2.396). Perhaps the higher score in the cancer group may indicate how,
despite research and awareness, many bereft loved-ones still struggle
with not only the mysteries of the origins of cancer, but also perhaps the
rapid spread of this disease within the body.

TABLE 3. Comparison of Group Means


Variables

Cancer (N = 50)

AIDS (N = 50)

Suicide (N = 50)

Somatic reactions

2.176

2.442

2.552

General grief reactions

2.056

2.386

2.720

Search for explanation

2.432

2.396

3.412

Loss of support

1.572

2.322

2.932

Stigmatization

1.172

2.305

2.822

Sense of guilt

1.928

2.517

3.116

Sense of responsibility

1.320

1.890

2.560

Sense of shame

1.316

2.241

2.496

Sense of rejection

1.172

2.212

2.816

Self-destructive behavior

1.348

1.940

2.360

Unique reactions to suicide

1.292

1.992

2.828

5-point response scale: (1) Never, (2) Rarely, (3) Sometimes, (4) Often, and (5) Almost always.

James A. Houck

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DISCUSSION

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Major Contributions
This study examined whether three separate bereavement groups,
cancer, HIV/AIDS, and suicide have their own distinct grief reactions.
Although the discriminant analysis supports three distinct bereavement
groups, one major contribution of this study reveals that stigmatization
is significantly higher in HIV/AIDS bereavement than cancer or suicide
bereavement, accounting for 11.4% of the variance.
According to the GEQ (Barrett & Scott, 1989), stigmatization is defined as how society looks upon people and is measured by the following questions:
1. Think that people were gossiping about you or the (deceased)
person.
2. Feel like people were probably wondering about what kind of personal problems you and the (deceased) person had experienced.
3. Feel like others blamed you for the death.
4. Feel like the death somehow reflected negatively on you or your
family.
5. Feel somehow stigmatized by the death.
The role stigmatization plays in discriminating the HIV/AIDS bereavement group from the other two groups may be attributed to societys
continued discomfort, fear, and intolerance surrounding the disease. For
example, in addition to the deceased, the surviving loved-one also feels
somehow morally depraved and flawed because of his/her association to
the deceased (e.g., spouse, life-partner, parent, sibling, caregiver, etc.).
A second contribution of this study involves the differences between
the HIV/AIDS and suicide bereavement groups. Previously classified
by Doka (2002), as types of death that result in disenfranchised grief,
the HIV/AIDS and suicide groups were further differentiated in this
study by the GEQ category of unique reactions to suicide. This uniqueness accounts for 88.6% of the variance and is measured by the following questions:
1. Wonder about your loved-ones motivation for not living longer?
2. Feel like your loved-one was somehow getting even with you by
dying?
3. Feel that you should have somehow prevented the death?

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4. Tell someone that the cause of death was something different than
what it really was?
5. Feel like the death was a senseless and wasteful loss of life?
In the past, society may have placed some of the blame for the suicide
on the family members, thus offering less social support than it would
for survivors of a natural death. As a result, survivors may have felt
alienated from their friends and acquaintances, because of the blame,
rejection, and lack of understanding on the part of society. Calhoun and
Allen (1991) discovered that surviving family members tended to be
more psychologically disturbed, less trusting, and more blameworthy
than family members grieving nonsuicidal deaths. Therefore, to cope
with the sudden and unexpectedness of the suicide, family members
may have refused to discuss the death with friends or coworkers, or may
have attempted to recreate events mentally leading up to the death. Yet,
a unique feature this study demonstrated by the discriminant analysis
was that those who grieve a loved-ones death from suicide, may not be
experiencing the same level of stigma, versus cancer, or HIV/AIDS
grief, as survivors once did throughout history (Berman & Jobes, 1997;
Rubel, 2003). This change in societys perception toward those whose
loved-one died from suicide, may be attributed to a growing understanding of the complexities surrounding why people commit suicide,
for example, mental illness, inability to cope with overwhelming circumstances, etc.
Implications for Mental Health and Health-Care Providers
Disenfranchised grief poses significant problems for people when
faced with the death of a loved-one, but are not afforded the right, role,
or capacity to openly grieve as other members of society. For mental
health and health-care providers, being aware that such stigma still exists within society is vital to helping people work through their grief. In
fact, this understanding can also be assimilated into a therapists preferred bereavement paradigm (e.g., stages of grief: Kbler-Ross, 1969;
phases of bereavement: Parkes, 1972; or tasks of mourning: Worden,
2004), in order to educate survivors on issues that might inhibit the process of mourning.
For example, people who grieve the loss of a loved-ones death to
cancer, HIV/AIDS, or suicide may often feel neglected and forgotten.
Yet they have specific bereavement needs. One need, in particular, is to
become enfranchised by the therapist (Corr, 1998). Giving people

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permission to grieve openly legitimizes their status as mourners. In fact,


therapists need to communicate to the surviving loved-one that societys perception of the death may not necessarily reflect their own experience (Rando, 2000).
Quite often bereaved loved-ones are forced to wrestle with unanswered questions, withhold their feelings from family members and
friends, etc., and cover up the nature of the death to avoid further judgment and emotional isolation. In the early years of HIV/AIDS, the popular phrase Silence = Death was used to protest societys denial of the
epidemic nature of a disease that was immediately stigmatized (Burkett,
1995). In some instances, suicide may be particularly troubling to reveal
in social settings, especially if the surviving loved-one is in a position of
public authority (Rubel, 2003). Today, silencing the disenfranchised
grievers only further wounds them into possible social isolation, and
placing them at a far greater risk for bereavement complications.
Active listening, normalizing feelings, expressing empathy, educating people on the process of mourning, and providing a safe environment where thoughts, emotions, feelings, and personal stories can be
shared is a crucial step toward healing ones grief. Many clients may
be apprehensive about sharing their stories and feelings because they
may have never been given permission to talk about the death before.
Although therapists may assume this kind of permission-giving will be
attractive to many, disenfranchised grievers may be skeptical about
therapists intentions. Too familiar with guilt by association judgments
rendered by society, they may have difficulty accessing the therapists
empathy. Therefore, disenfranchised grievers need to be reassured that
they not only are viewed by therapists as persons of value and worth,
but they need to know their loved-ones memory will be afforded the
same courtesy.
Intervention Strategies
Rando (2000) states that in working with disenfranchised grievers,
different types of support may be needed not only to facilitate grief, but
also may be required at different times. Such resources include:
Identify the type of support the mourner requires and what support
is desired, for example, individual verses support group.
Work with the mourner to identify unmet needs as secondary
losses, for example, loss of income, role, etc.

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Deal with the mourners feelings about not getting needs for support and why those needs are not getting met.
Review the mourners expectations for support to determine whether
they are appropriate, and help them readjust these if inappropriate,
for example, self-medicating through drugs or alcohol.
Assess the lack of support to determine whether it is owing to a
lack of assertiveness or other psychological issues.
Educate the mourner that support for disenfranchised grief often
can be found in support groups and/or printed material. Refer them
to these sources.
Educate the mourner on unrealistic expectations or incorrect information about the mourners needs.
Religious/Spiritual Needs and Support
Pargament, Koenig, and Perez (2000) notes that a grieving persons
religion and spirituality have become important issues to address in
counseling. Whether it is existential issues related to God or the Divine,
relationships with others, or finding peace, many pastoral professionals
help bereft people understand the significance of religious/spiritual
coping in their grief. As in any bereavement setting, listening to a survivors story, especially ones religious/spiritual story is a critical part of
the process of mourning. To this end, Paragament et al. states that religion/spirituality can function in the following ways:
Preservation: To use religion/spirituality not necessarily to change
but to survive, or to provide stability in everyday life.
Reconstruction: To use religion/spirituality to rebuild prior beliefs
about God and the world that may have been challenged by the
death of a loved-one.
Re-Valuation: Using religion/spirituality to help people discover
new sources of significance, e.g., letting go of old attachments to
the loved-one and discovering new ways to invest themselves in
other people or endeavors.
Re-Creation: Using religion/spirituality as a means of transforming a persons core significance and his/her approach to life, e.g.,
giving up of avoidant strategies in search for a closeness with God
and others.

James A. Houck

109

By focusing on the grieving persons specific religious/spiritual coping methods, pastoral professionals may be able to identify the different
ways religion/spirituality enhances or hinders the mourning process. In
fact, this awareness will make it possible to integrate religion/spirituality
more fully and effectively in counseling.

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Limitations and Future Area of Research


As this study examined the grief reactions, among cancer, HIV/
AIDS, and suicide bereavement groups, there are several limitations to
the study, which lends itself to future areas of research.
Cultural Limitations
This study focused primarily on the grief reactions from a western
cultural perspective. A future area of research would be to compare and
contrast the three bereavement groups in other cultures, for example,
African, Asian, Latino, European, Scandinavian, Pacific Islands, etc.
This research would address specific cultural issues related to bereavement that may or may not be similar to the western culture. In addition,
this type of research would be beneficial particularly in Asia and Africa
where HIV/AIDS is at epidemic proportions (Stine, 2005). Nonetheless,
there are specific cultural groups within the United States, for example,
Asian, African, etc., that would warrant future research in this area.
Specific Groups within Each Group
The study specifically targeted three types of death (cancer, HIV/
AIDS, and suicide). However, there are certainly subgroups within the
main groups. For example, it would be worth studying different types of
grief reactions and religious/spiritual coping between different types of
cancer deaths. Another example would be to differentiate between HIV/
AIDS deaths resulting from different modes of contraction. In other
words, would the level of stigmatization be the same or different for
loved-ones who contracted HIV/AIDS via an accidental stick with an
infected needle, sexual contact, breast-feeding, or sharing needles from
illegal intravenous drug use, from the group at large? Subgroups (different methods of suicide) within the larger suicide bereavement group
might be another area for future research to measure unique reactions
to suicide, for example, how survivors react to loved-ones committing

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suicide by gunshot, hanging, pills, setting themselves on fire, asphyxiation, etc.

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Other Types of Death


This study was limited to examining grief reactions from three specific bereavement groups. There are other types of deaths not included
in this study. Therefore, a future area of research would be to compare
and contrast different types of death including other disenfranchised
groups, for example, accidental, drunk driving, murder, etc. Also, in light
of the recent research on trauma, comparing specific types of death that
result in traumatizing bereaved survivors as defined by Jacobs (1999) or
Rando (2000) would be beneficial to the field.
Longitudinal Studies
This study examined grief reactions among three bereavement groups
within the parameters of 3 months to 5 years. A future area of research
would be to design a longitudinal study among the three bereavement
groups to measure the differences in intensity of grief reactions, levels
of resiliency, use of religious/spiritual coping skills, and sense of disenfranchisement over a 1, 3, 5, and 10-year period of time.
Religious and Spiritual Coping
In recent years, there has been an increasing amount of attention
given to the effects religious and spiritual coping have on mental health
(Pargament et al., 2000; Shafranske, 1997). In times of grief, many
people turn to religion and spirituality to find stability, hope, and meaning (Doka & Morgan, 1993). Therefore, it would be beneficial to the
field of research on disenfranchised grief to study how these groups
cope in terms of religious/spiritual beliefs and practices.
SUMMARY
This study compared the grief reactions of people who mourned three
different types of death: Cancer, HIV/AIDS, and suicide, and addressed
the question whether the three bereavement groups can be differentiated
on the basis of their grief, as measured by the GEQ (Barrett & Scott,
1989). The results indicated that these groups had different reactions,

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specifically, in the areas of stigmatization and unique reactions to suicide. Despite over 20 years of HIV/AIDS education and awareness,
stigma still surrounds this disease. In fact, stigma appears to be transferred to surviving loved-ones in bereavement, to a greater extent than
in cancer and suicide. However, survivors of a loved-ones suicide more
than likely will purposefully conceal the circumstances of the death
from the media in order to avoid societys judgment as distinguished
from cancer and HIV/AIDS deaths. The result is that both the suicide
and HIV/AIDS groups may be forced into a silence regarding grieving
their losses openly. Nonetheless, for those who offer grief counseling,
providing a safe and accepting, nonjudgmental environment where these
survivors can tell their story helps facilitate the steps toward healing.
To this end, the field of research within disenfranchised grief is vast
and limitless. Cultural nuances and societal attitudes may change frequently. In fact, what is considered taboo in one society may be considered normal behavior in the other culture. However, what does not
change is an ongoing commitment to study of disenfranchised grief in
the context of social, political, religious, and economic arenas. Although tremendous strides have been made in the area of education, research, and awareness, fear and public opinion can combine for an
overwhelming way in which stigma and isolation is fed. Nevertheless,
there is hope for grieving people to be empowered to rise above such
shunning behavior when practitioners, researchers, policymakers, and
clergy become more aware of the grief and stigma factors these persons
face, and when thought is given to the types of supports those grieving
persons need at that time.
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Corr, C. (1998). Enhancing the concept of disenfranchised grief. Omega, 38, 1-20.

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Corr, C., Nabe, C., & Corr, D. (2005). Death and dying, life and living (5th ed.).
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