Bereavement and Grief

Kathrin Boerner
Introduction
The field of bereavement and grief focuses on the human experience of loss in response to the
death of a loved one. The term bereavement refers to the objective status of a person who has
suffered the loss of someone significant. Grief, on the other hand, refers to the emotional
experience of the psychological, behavioral, social, and physical reactions to ones loss (see the
first chapter of Stroebe, et al. 2008, cited in General Overviews). Early writings on bereavement
and grief were guided heavily by the psychoanalytic traditions. They were based on clinical
observation and a very limited empirical database. The focus was on the intense distress people
are thought to experience following the death of a loved one, and on the need to work through
this distress in order to recover from the loss and be able to move on with ones life. For a long
time, popular and professional ways of thinking about bereavement were strongly influenced by
this literature, without having been put to any serious empirical test. Over the past few decades,
however, the field has developed into a scientific discipline with high methodological standards
and an accumulating number of sound empirical studies, which have greatly contributed to our
current understanding of grief. One of the most groundbreaking findings from this research is
probably the pervasive insight that there is extraordinary variability in how people react to the
death of a loved one. While some people are devastated and never again seem to regain their
emotional equilibrium, others emerge from the loss relatively unscathed and perhaps even
strengthened. An important focus of current bereavement research is to better understand this
variability in response to bereavement, to find ways of identifying those who are at risk for
developing long-term difficulties following the death of a loved one, and to provide them with
the appropriate support or treatment. The first section of this bibliography introduces general
overviews of the field of bereavement, including three influential handbooks of bereavement
research that appeared in the literature between 1993 and 2008. This is followed by a section on
journals that primarily focus on bereavement issues. The remaining sections examine specific
areas and perspectives in the field of bereavement in more detail. This selective review highlights
works pertaining to what are to date considered traditional views on grief, followed by a
description of current theoretical models and thinking. Next, research areas in which a striking
increase in knowledge has occurred (i.e., grief trajectories, caregiving and bereavement,

continuing bonds, risk factors, and complicated grief) receive particular attention. This is
followed by a selective review of literature with a focus on specific relationship perspectives in
terms of who died (i.e., loss of spouse, child, parent, or sibling), as well as sections dedicated to
often unacknowledged bereavement situations, referred to as disenfranchised grief, and
different cultural perspectives on grief. The bibliography concludes with coverage of discussions
about supportive interventions in the context of bereavement.

General Overviews
The field of bereavement has grown tremendously over the past three decades. The three
handbooks of bereavement research published between 1993 and 2008Strobe, et al. 1993,
Strobe, et al. 2001, and Stroebe, et al. 2008provide a comprehensive account of past and new
developments in the literature. Although each of these handbooks offers a general overview of
the field in a particular time period, it is worthwhile to consider them separately, because the
selection of chapters and focus areas in each is unique. Much of the research and conceptual
discussions reported in the handbooks were influenced by Wortman and Silver 1989, which can
be considered a classic in the field. Wortman and Boerner 2011 gives a comprehensive account
of research evidence on coping with loss that has been accumulated since the original
identification of the myths. Bonanno 2009 targets a broader audience and offers not only an
up-to-date summary of available research evidence but also uniquely new perspectives on life
after loss. Finally, addressing yet another type of audience with interest in grief and bereavement,
the Handbook of Thanatology (Balk, et al. 2007) provides a useful introductory resource for
professionals in thanatology research and practice as well as in death education.

Balk, David E., Carol Wogrin, Gordon Thornton, and David K. Meagher, eds. 2007.
Handbook of thanatology: The essential body of knowledge for the study of death, dying,
and bereavement. London: Routledge.
This handbook, copublished by the Association for Death Education and Counseling
(ADEC), is a helpful resource for professionals in thanatology research and practice and
death education. It provides good introductions into core areas of the field, and points the
reader to additional useful resources.

Bonanno, George A. 2009. The other side of sadness: What the new science of
bereavement tells us about life after loss. New York: Basic Books.
This excellent book uses a combination of rigorous research and compelling cases
examples to share the most up-to-date insights about the grieving process with a broader
audience.

Stroebe, Margaret S., Robert O. Hansson, Henk Schut, and Wolfgang Stroebe, eds. 2001.
Handbook of bereavement research: Consequences, coping, and care. Washington, DC:
American Psychological Association Press.

This handbook provides an updated overview of the literature up to early 2000. In

addition, there are extensive sections on methodological and ethical issues, consequences
of bereavement over the life span, and the role of coping in adaptation to loss.

Stroebe, Margaret S., Robert O. Hansson, Henk Schut, and Wolfgang Stroebe, eds. 2008.
Handbook of bereavement research and practice: Advances in theory and intervention.
Washington, DC: American Psychological Association Press.
This handbook provides the most up-to-date overview, reflecting primary domains of
growth and discussion in the field over the previous decade, such as issues involved in
including a complicated grief diagnosis into the DSM-V, as well as aspects related to
variability in patterns and consequences of grief.

Stroebe, Margaret S., Wolfgang Stroebe, and Robert O. Hansson, eds. 1993. Handbook of
bereavement: Theory, research, and intervention. New York: Cambridge Univ. Press.
This first of a series of handbooks not only gives a general overview of the bereavement
literature up to the early 1990s, it also includes particular focus areas that are unique to
this edition, such as several chapters dedicated to physiological changes following
bereavement.

Wortman, Camille B., and Kathrin Boerner. 2011. Reactions to the death of a loved one:
Myths of coping versus scientific evidence. In The Oxford handbook of health
psychology. Edited by Howard S. Friedman, 414479. New York: Oxford Univ. Press.
This comprehensive book chapter reviews the literature on bereavement with particular
attention to major paradigm shifts that have occurred over the past few decades.

Wortman, Camille B., and Roxane C. Silver. 1989. The myths of coping with loss.
Journal of Consulting and Clinical Psychology 57.3: 349357.
This article was the first to question widely held basic assumptions about grief, to show
that available research evidence does not necessarily support them, and to demand that
these assumptions be more systematically investigated.

Journals
There are only a few journals that specifically focus on issues of death and bereavement. The
most notable ones are Omega: Journal of Death and Dying, Death Studies, and Bereavement
Care. They are all dedicated to disseminating work on death and bereavement, and they target an
interdisciplinary audience. Although these journals are a useful source for tracking developments
in the field, many influential articles on bereavement have been published in other journals,
including psychological (e.g., Journal of Personal and Social Psychology, Journal of Clinical
Psychology) and medical journals (e.g., JAMA). Aging journals are also a common outlet for

articles on bereavement (e.g., Journal of Gerontology: Psychological Sciences, or Psychology

and Aging).

Bereavement Care.
This is the United Kingdoms leading bereavement journal, but it is internationally
recognized and disseminates international work. The journal is intended for all who have
an interest in bereavement care.

Death Studies.
This journal disseminates research, scholarship, and practical approaches in the areas of
bereavement, grief therapy, death attitudes, suicide, and death education. Out of the
existing journals that focus on death and bereavement, this one is a little more researchoriented.

Omega: Journal of Death and Dying.

This journal is dedicated to the topic of death and dying, including papers on terminal
illness, the process of dying, bereavement, mourning, funeral customs, and suicide. It
primarily targets clinicians, social workers, and other health professionals who are faced
with problems in crisis management.

Traditional Views on Grief

Early writings on bereavement were heavily shaped by psychoanalytic thinking. They were also
primarily based on clinical observation and a rather limited empirical database. However, they
have strongly influenced professional and popular ways of thinking about grief for a long time.
Thus, to be able to understand how the literature on grief has evolved, with its major
controversies and research efforts aiming at clarifying the questions raised in these debates, it is
imperative to be aware of these early works. The first major conceptual contribution to the field
of bereavement was Freud seminal paper Mourning and Melancholia (Freud 1957). While
Freuds thinking on grief was based in his clinical experience, one of the earliest well-known
empirical studies on grief was published in Lindemann 1944. However, one of the most widely
read works dealing with grief is Kbler-Ross 1969. Although the focus was on how dying
persons react to their own impending death, by going through five sequential stages, this book
was instrumental in popularizing stage theories of bereavement. (It should be noted, however,
that the empirical evidence available today is largely inconsistent with the notion of stages.)
Another author who proposed stages of grieving was Bowlby, who integrated ideas of
psychoanalysis and the literature on separation distress (see Bowlby 1980). Raphael 1983 also
discussed stages of mourning, and then analyzes how the effects of loss may differ by stage of
life. Finally, Maciejewski, et al. 2007 presents findings from a study examining several grief
indicators for consistency with the stage theory of grief. The conclusion that the findings
represent evidence in support of stage theory was questioned in several critical letters to the
editor (e.g., Silver and Wortman, 2007).

Bowlby, John. 1980. Attachment and loss. Vol. 3, Loss: Sadness and depression. New
York: Basic Books.
In this influential book, the author integrated ideas from psychodynamic thought, from
the developmental literature on young childrens reaction to separation, and from work on
the mourning behavior of primates.

Freud, Sigmund. 1957. Mourning and melancholia. In The standard edition of the
complete works of Sigmund Freud. Vol. 14. By Sigmund Freud. Edited by J. Strachey,
152170. London: Hogarth.
This seminal work was the first major contribution to the field of bereavement. Freuds
view of the grieving process has dominated the bereavement literature over much of the
past century, and only more recently has it been called into question. Originally published
in 1917.

Kbler-Ross, Elisabeth. 1969. On death and dying. New York: Macmillan.

This widely read book focuses how dying persons react to their own impending death,
and posits that people go through stages of denial, anger, bargaining, depression, and
ultimately acceptance. Although it was not developed for the case of bereavement, it was
Kbler-Rosss stage model that popularized stage theories of bereavement.

Lindemann, Erich. 1944. Symptomatology and management of acute grief. American

Journal of Psychiatry 101:141148.
This article presents findings on grief symptomatology from the earliest well-known
empirical study on spousal loss, the Coconut Grove study. Findings suggested that
sudden, unexpected deaths tend to be more distressing than anticipated deaths.

Maciejewski, Paul K., Baohui Zhang, Susan D. Block, and Holly G. Prigerson. 2007. An
empirical examination of the stage theory of grief. JAMA: Journal of the American
Medical Association 297.7: 716723.
This article examines five grief indicators for consistency with the stage theory of grief,
and interprets the presented findings as in line with basic tenets of this theory.

Raphael, Beverly. 1983. The anatomy of bereavement: A handbook for the caring
professions. New York: Basic Books.
This book takes an interesting perspective by going beyond the description of stages of
mourning, analyzing how the effects of loss differ at each stage of life.

Silver, Roxane C., and Camille. B. Wortman. 2007. The stage theory of grief (Letter to
the Editor). JAMA: Journal of the American Medical Association 297.24: 26932694.

This letter to the editor was written as a criticism of Maciejewski, et al., 2007. Major
points made pertain to gaps in the literature review, problematic methodological issues,
and issues with conclusions drawn from the data.

Current Understanding of Grief

Current theorizing on grief has moved away from the assumption of universal stages, and it has
become clear that popular long-standing notions, such as the need to work through grief as part
of healthy adjustment to loss, do not necessarily hold up under every circumstance. Both Archer
2008 and Bonanno and Kaltman 1999 provide a discussion of past and present theories of grief
and highlight ways in which the theoretical thinking in the field has changed. Bonanno and
Kaltman 1999 then draws on several more general social and developmental theories to develop
a new integrative theoretical framework for understanding bereavement. Neimeyer 2001 takes
another unique perspective in thinking about bereavement by focusing of the reconstruction of
meaning following loss. To date, the only existing coping process theory in the field, the dualprocess model of coping with bereavement, has been advanced by Stroebe and Schut 1999. In
Stroebe and Schut 2001, the authors integrate the notion of meaning-making as an essential part
of the grieving process into this model. Finally, further expanding the authors own theoretical
framework, Stroebe, et al. 2006 proposes a more comprehensive model that integrates the
elements stressors, risk and protective factors, as well as coping processes.

Archer, John. 2008. Theories of grief: Past, present, and future perspectives. In
Handbook of bereavement research and practice: Advances in theory and intervention.
Edited by Margaret S. Stroebe, Robert O. Hansson, Henk Schut, and Wolfgang Stroebe,
4565. Washington, DC: American Psychological Association Press.
This chapter provides a concise discussion of past and present theories of grief.

Bonanno, George A., and Stacey Kaltman. 1999. Toward an integrative perspective on
bereavement. Psychological Bulletin 125.6:760786.
In this article, the authors draw on cognitive stress theory, attachment theory, the socialfunctional account of emotion, and trauma theory to develop an integrative theoretical
framework consisting of four fundamental components of the grieving process: context,
meaning, representations of the lost relationship, and coping and emotion-regulation
processes.

Neimeyer, Robert A. 2001. Meaning reconstruction and the experience of loss.

Washington, DC: American Psychological Association Press.
This interesting book fills a gap in the literature by focusing on an often-overlooked
aspect of grief, the reconstruction of meaning following loss. Grief is portrayed as an
idiosyncratic process in which people strive to make sense of what has happened.

Stroebe, Margaret. S., Susan Folkman, Robert O. Hansson, and Henk Schut. 2006. The
prediction of bereavement outcome: Development of an integrative risk factor
framework. Social Science and Medicine 63.9: 24402451.
This article proposes an integrative risk-factor framework, which incorporates an analysis
of stressors, risk and protective factors, as well as appraisal and coping processes that are
thought to affect adjustment to bereavement. The model is meant to encourage more
systematic analysis of individual differences in response to bereavement.

Stroebe, Margaret, and Henk Schut. 1999. The dual process model of coping with
bereavement: Rationale and description. Death Studies 23.3: 197224.
The dual-process model of coping with bereavement indicates that following a loved
ones death, bereaved people alternate between two different kinds of coping: lossoriented coping and restoration-oriented coping. The authors propose that the oscillation
between the two coping modes is necessary for adaptive coping.

Stroebe, Margaret. S., and Henk Schut. 2001. Meaning making in the dual process model
of coping with bereavement. In Meaning reconstruction and the experience of loss.
Edited by Robert A. Neimeyer, 5573. Washington, DC: American Psychological
Association Press.
In this chapter, the authors integrate the notion of meaning making as an essential part of
the grieving process into their dual-process model.

Grief Trajectories
Our understanding of grief has increased tremendously following large-scale studies with
prospective longitudinal data that include data from before the death to years after the loss,
allowing the full range of possible grief patterns to emerge. This section includes citations of
articles that delineate different pathways of grieving. Bonanno, et al. 2002 and Bonanno, et al.
2004 were the first to identify core bereavement trajectories based on prospective longitudinal
data. Mancini, et al. 2011 confirms these trajectory patterns with a larger than usual longitudinal
sample, employing latent growth mixture modeling, an approach that allows trajectory patterns
to emerge in a non-arbitrary and purely empirical manner, overcoming some of the critical
limitations of prior approaches. Whereas the focus of Bonannos and Mancinis work was
conjugal bereavement in the general aging population, several other prospective, longitudinal
studies have addressed grief trajectories in caregiver samples. Aneshensel, et al. 2004; Haley, et
al. 2008; and Zhang, et al. 2008 identify different depression trajectories, as well as risk factors
for developing each of the trajectories. Li 2005 investigates depression trajectories in a general
caregiving sample, but is focused on the individual trajectories of mother and daughter
caregivers.

Aneshensel, Carol S., Amanda L. Botticello, and Noriko Yamamoto-Mitani. 2004. When
caregiving ends: The course of depressive symptoms after bereavement. Journal of
Health and Social Behavior 45.4: 422440.
This article focuses on response to loss following a time of caregiving for a chronically ill
loved one. The study describes depressive symptoms among caregivers following
bereavement and connects these trajectories to earlier features of caregiving using life
course and stress process theory.

Bonanno, George A., Camille B. Wortman, Darrin R. Lehman, Roger G. Tweed, Michelle
Haring, John Sonnega, Deborah Carr, and Randolph M. Neese. 2002. Resilience to loss
and chronic grief: A prospective study from preloss to 18-months postloss. Journal of
Personality and Social Psychology 83.5: 11501164.
This study was the first to identify core bereavement trajectories (common grief, chronic
grief, chronic depression, improvement during bereavement, and resilience) based on
prospective longitudinal data that include data from before the death to years after the
loss, allowing the full range of possible grief patterns to emerge.

Bonanno, George. A., Camille B. Wortman, and Randolph M. Nesse. 2004. Prospective
patterns of resilience and maladjustment during widowhood. Psychology and Aging 19.2:
260271.
Presents findings from additional analyses conducted by Bonanno, et al., to examine
differences in how respondents in each trajectory group reacted to and processed the loss.

Haley, William E., Elizabeth J. Bergman, David L. Roth, Theresa McVie, Joseph E.
Gaugler, and Mary S. Mittelman. 2008. Long-term effects of bereavement and caregiver
intervention on dementia caregiver depressive symptoms. The Gerontologist 48.6: 732
740.
Investigates the joint effects of bereavement and caregiver intervention on trajectories of
caregiver depressive symptoms. Findings suggest that supportive caregiver interventions
have the potential to benefit caregivers both pre- and postbereavement.

Li, Lydia W. 2005. From caregiving to bereavement: Trajectories of depressive symptoms

among wife and daughter caregivers. Journal of Gerontology: Psychological Sciences
60.4: 190198.
Investigates the trajectory of depressive symptoms for wife and daughter caregivers
during the transition from caregiving to bereavement, looking at whether the trajectory
varies depending on caregiving stress, social support, and background characteristics.

Mancini, Anthony D., George. A. Bonanno, and Andrew E. Clark. 2011. Stepping off the
hedonic treadmill: Individual differences in response to major life events. Journal of
Individual Differences 32.3: 144152.

Examines divergent trajectories of response to significant life events (widowhood,

divorce, and marriage), using latent growth mixture modeling. This approach allowed
trajectory patterns to emerge in a non-arbitrary and purely empirical manner, addressing
critical limitations of prior approaches. These analyses offered important confirmatory
support for previously found trajectories.

Zhang, Baohui, Susan L. Mitchell, Kara Z. Bambauer, Rich Jones, and Holly G.
Prigerson. 2008. Depressive symptom trajectories and associated risks among bereaved
Alzheimer disease caregivers. American Journal of Geriatric Psychiatry 16.2: 145155.
Identifies three subgroups of depressive symptom trajectories among bereaved AD
caregivers (persistently syndromal, syndromal-becoming-threshold, and persistently
absent depression), as well as determined risk factors for syndromal and syndromalbecoming-threshold level depression after loss.

Caregiving and Bereavement

Since a majority of deaths now occur as a result of chronic health conditions that require an
extended period of caregiving, the topic of caregiving and bereavement has received increasing
attention over the past decade. Investigators have begun to examine the impact of caregiving on
adjustment to the loss following the loved ones death. This research demonstrates that the
relationship between caregiving and adjustment to bereavement is complex. Although stressful
caregiving is associated with poor psychological adjustment when the spouse is alive, many
overly taxed caregivers seem to rebound to relatively high levels of functioning after the death.
However, a minority of strained caregivers demonstrates intense and prolonged grief, and
investigators are attempting to uncover the determinants of this reaction. Schulz, et al. 2008
offers a comprehensive overview of the available literature on caregiving and bereavement.
Boerner and Schulz 2009 focuses on the relationship between challenging caregiving situations
and difficult grieving processes, and gives practical suggestions for professionals who work with
caregivers. Schulz, et al. 2003 demonstrates that when death is preceded by an extended and
stressful period of caregiving, many caregivers experience relief after the death. However, as one
potential predictor of adjustment difficulties following loss, Hebert, et al. 2006 and Hebert, et al.
2009 address the important but thus far understudied issue of caregiver preparedness for the
death of a loved one. Carr 2003 draws attention to another aspect that may have implications for
the grief experienced by surviving family members: whether the death was perceived as a good
death.

Boerner, Kathrin, and Richard Schulz. 2009. Caregiving, bereavement, and complicated
grief. Bereavement Care 28.3: 1013.
This article describes how the caregiving experience affects bereavement, with an
emphasis on the relationship between challenging caregiving situations and difficult
grieving processes. It offers practical suggestions for what professionals can do to help
caregivers both before and after the death has occurred.

Carr, Deborah 2003. A good death for whom? Quality of spouses death and
psychological distress among older widowed persons. Journal of Health and Social
Behavior 44.2: 215232.
This article characterizes good death by physical comfort, support from ones loved ones,
acceptance, and appropriate medical care. Carr is one of the first bereavement researchers
to suggest that whether a loved one dies a good death may have implications for the
grief experienced by surviving family members.

Hebert, Randy S., Holly G. Prigerson, Richard Schulz, and Robert M. Arnold. 2006.
Preparing caregivers for the death of a loved one: A theoretical framework and
suggestions for future research. Journal of Palliative Medicine 9.5: 11641171.
This thought-provoking article presents the first theoretical model outlining the
relationships between preparedness, caregiverhealth-care provider communication, and
caregiver well-being, and provides recommendations for future research from this model.

Hebert, Randy S., Richard Schulz, V. C. Copeland, and R. M. Arnold. 2009. Preparing
family caregivers for death and bereavement: Insights from caregivers of terminally ill
patients. Journal of Pain Symptom Management 37.1: 312.
Presents data suggesting that preparedness has emotional, pragmatic, and informational
components. Findings indicate that a person could feel prepared with respect to the
informational and pragmatic components, but yet, feel entirely unprepared emotionally.

Schulz, Richard, Kathrin Boerner, and Randy S. Hebert. 2008. Caregiving and
bereavement. In Handbook of bereavement research and practice: Advances in theory
and intervention. Edited by Margaret S. Stroebe, Robert O. Hansson, Henk Schut, and
Wolfgang Stroebe, 265285. Washington, DC: American Psychological Association
Press.
This chapter gives a comprehensive review of the literature on caregiving and
bereavement.

Schulz, Richard, Aaron B. Mendelsohn, William E. Haley, Diane Mahoney, Rebecca S.

Allen, Song Zhang, Larry Thompson, and Steven H. Belle. 2003. End-of-life care and the
effects of bereavement on family caregivers of persons with dementia. New England
Journal of Medicine 349.20: 19361942.
This study, by the Resources for Enhancing Alzheimers Caregiver Health (REACH)
investigators, found that depressive symptoms among caregivers decline on average from
before to after the Alzheimers patients death, and that when death was preceded by an
extended and stressful period of caregiving, caregivers reported considerable relief at the
death itself.

Continuing Bonds
What happens with the relationship to a loved one after this person dies? This question has
received considerable attention in the field of bereavement over the past two decades. Freuds
classic paper Mourning and Melancholia (Freud 1957) expressed the view that the major task
to be accomplished in the grieving process is to relinquish the tie to the deceased in order to be
able to reinvest in new relationships. This position remained fairly unquestioned until it was
challenged by the influential Klass, et al. 1996, causing an initial paradigm shift away from the
necessity of disengagement from the loved one, and toward the belief that continuing bonds are
common and typically comforting and helpful. This was followed by a thrust of research studies
examining all aspects of continuing bonds, including what kind of continuing connections people
may have, and which type of connections might be more or less adaptive for whom. For
example, Field, et al. 2003 assesses the frequency of a wide variety of attachment behaviors,
including attempting to carry out the deceaseds wishes and having inner conversations with the
deceased. Boehlen, et al. 2006 is one of several studies showing that some of these attachment
behaviors are adaptive whereas others are not. Stroebe and Schut 2005 and Field 2008 offer
helpful summaries of this body of empirical evidence, as well as the conceptual conclusions that
have grown out of this work. Finally, Stroebe, et al. 2010 outlines an integrative theoretical
model for predicting the (mal)adaptiveness of continuing or relinquishing bonds to a deceased
loved one, drawing on attachment and coping theory.

Boelen, Paul A., Margaret S. Stroebe, Henk A. Schut, and Annemieke M. Zijerveld. 2006.
Continuing bonds and grief: A prospective analysis. Death Studies 30.8: 767776.
This study found that maintaining bonds through comforting memories, but not
cherishing possessions of the deceased, continued to predict later grief symptoms
severity. Findings demonstrate that continuing bonds should not be regarded as
exclusively adaptive.

Field, Nigel P. 2008. Whether to relinquish or maintain a bond with the deceased. In
Handbook of bereavement research and practice: Advances in theory and intervention.
Edited by Margaret S. Stroebe, Robert O. Hansson, Henk Schut, and Wolfgang Stroebe,
113132. Washington, DC: American Psychological Association Press.
Provides a comprehensive review of the literature on continuing bonds, detailing under
which conditions and for whom maintaining a continuing connection with the deceased
may have adaptive or maladaptive implications.

Field, Nigel P., Eval Gal-Oz, and George A. Bonanno. 2003. Continuing bonds and
adjustment at 5 years after the death of a spouse. Journal of Consulting and Clinical
Psychology 71.1: 110117.
This study found evidence for a wide variety of common attachment behaviors even five
years following the death of a spouse, including attempting to carry out the deceaseds

wishes, having inner conversations with the deceased, and using the spouse as a guide in
making decisions.

Freud, Sigmund. 1957. Mourning and melancholia. In Standard edition of the complete
psychological works of Sigmund Freud. Vol. 14. By Sigmund Freud. Edited by J.
Strachey, 152170. London: Hogarth.
In this classic paper, Freud argued that the psychological function of grief is to withdraw
emotional energy (cathexis), and become detached from the loved one (decathexis).
Originally published in 1917.

Klass, Dennis, Phyllis R. Silverman, and Steven Nickman, eds. 1996. Continuing bonds:
New understandings of grief. Washington, DC: Taylor & Francis.
This influential book caused a paradigm change away from the long-standing belief that
healthy grieving can only occur if the bereaved disengages from the deceased, positing
instead the notion that maintaining a continuing connection to the deceased is not only
common but also adaptive.

Stroebe, Margaret S., and Henk. Schut. 2005. To continue or relinquish bonds? A review
of consequences for the bereaved. Death Studies 29.6: 477494.
Offers a thorough review of both theoretical discussions and empirical evidence on the
(mal)adaptive value of retaining versus relinquishing bonds. The authors conclude that
neither continuing nor relinquishing bonds is necessarily helpful, and that further research
is needed to clarify this issue.

Stroebe, Margaret S., Henk Schut, and Kathrin Boerner. 2010. Continuing bonds in
adaptation to bereavement: Toward theoretical integration. Clinical Psychology Review
30.2: 259268.
Outlines a theoretical model for predicting the (mal)adaptiveness of continuing or
relinquishing bonds, drawing on both attachment and coping theory. The purpose of this
model is to help explain patterns of individual differences in the impact of continuing
bonds.

Risk Factors for Complications in Grief Response

Mounting research evidence has made it increasingly clear that reactions to loss vary
considerably from person to person, but that a significant minority of bereaved individuals show
enduring effects. Therefore, researchers have become particularly interested in identifying
factors that may promote or hinder peoples adjustment to bereavement. Knowledge about risk
factors can not only help recognize those who may be more likely to develop long-term
difficulties, it can also aid in the identification of people who may benefit the most from
bereavement interventions. The three works described in this section all provide useful

summaries of the literature on risk factors. Stroebe and Schut 2001 is helpful from a research
standpoint because it also discusses conceptual and methodological issues that should be
considered when interpreting findings from or planning a study of risk factors in the context of
bereavement. Stroebe, et al. 2007 offers the most comprehensive review of risk factors for health
outcomes of bereavement. Wortman and Boerner 2007 includes a detailed section on risk factors
for bereavement outcomes that does not focus on particular types of outcomes.

Stroebe, Wolfgang, and Henk Schut. 2001. Risk factors in bereavement outcome: A
methodological and empirical review. In Handbook of bereavement research:
Consequences, coping, and care. Edited by Margaret S. Stroebe, Robert O. Hansson,
Wolfgang Stroebe, and Henk Schut, 349371. Washington, DC: American Psychological
Association Press.
Provides a useful perspective on risk factors, because it not only reviews the available
research findings but also discusses conceptual and methodological issues that should be
taken into account in the investigation of risk factors in the context of bereavement.

Stroebe, Margaret S., Henk Schut, and Wolfgang Stroebe. 2007. Health outcomes of
bereavement. Lancet 370.9603: 19601973.
Provides the most comprehensive review of health outcomes of bereavement, with a
detailed discussion of risk factors that increase vulnerability of some bereaved
individuals. The types of risk factors addressed are circumstances of death, intrapersonal
and interpersonal factors, and ways of coping.

Wortman, Camille B., and Kathrin Boerner. 2007. Beyond the myths of coping with loss:
Prevailing assumptions versus scientific evidence. In Foundations of health psychology.
Edited by Howard S. Friedman and Roxane Cohen Silver, 285324. New York: Oxford
Univ. Press.
This chapter has a separate section on risk factors, which summarizes the available
research on a variety of factors, including demographic factors, factors describing the
type and nature of the relationship, personal and social resources, and the context in
which the loss occurs.

Complicated Grief
Most theorists understand complicated grief as a form of grief characterized by persistent,
intense longing and yearning for the deceased, intrusive thoughts or images, emotional
numbness, anger or guilt related to the loss, a sense of emptiness, and reactivity in response to
cues. There is a general consensus that these are typical features of complicated grief. Prigerson,
et al. 1999 and Prigerson, et al. 2008 offer a summary of these consensus criteria. However,
scholars in the field have disagreed on some criteria, such as the role of avoidance in
complicated grieving. The diverging views have resulted in two existing diagnostic systems for
complicated grief. Forstmeier and Maercker 2007 provides a comparison of these two systems.

The perspective stressing the importance of avoidance in complicated grief is presented in

Horowitz, et al. 1997. In a similar vein, Shear, et al. 2007 presents an attachment-based model of
complicated grief, including empirical evidence in support of the assumption that avoidance is a
key element of complicated grief. The assessment tool for complicated grief most commonly
used in research studies was first presented in Prigerson, et al. 1995. Simon, et al. 2010 and
Prigerson, et al. 2009 both provide empirical evidence on which assessment criteria might be the
most informative for the purpose of diagnosing complicated grief, but they come to slightly
different conclusions. To understand the ongoing controversies, it is therefore helpful to read
both of these articles.

Forstmeier, Simon, and Andreas Maercker. 2007. Comparison of two diagnostic systems
for complicated grief. Journal of Affective Disorders 99:203211.
This article makes an important contribution by discussing and testing the two main
diagnostic systems for complicated grief that exist in the literature. Also, the study was
conducted in Switzerland, whereas the bulk of research on complicated grief has been
done in the United States.

Horowitz, Mardi J., Bryna Siegel, Are Holen, George A. Bonanno, Constance Milbrath,
and Charles Stinson. 1997. Diagnostic criteria for complicated grief disorder. American
Journal of Psychiatry 154:904910.
The diagnostic system proposed by these authors differentiates between the categories of
intrusion, avoidance, and failure to adapt. The main difference between this view and that
of Prigerson, et al. 1999 is that avoidance symptoms are considered an important
criterion.

Prigerson, Holly G., Mardi J. Horowitz, Selby C. Jacobs, et al. 2009. Prolonged grief
disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS
Medicine 6.8: e1000121.
Empirical evidence from a longitudinal study supporting the psychometric validity of
criteria for prolonged grief disorder (PGD) that the authors propose for inclusion in the
DSM-V and ICD-11. Criteria considered most informative in this study differ slightly
from Simon, et al. 2010.

Prigerson, Holly G., Paul K. Maciejewski, Charles F. Reynolds III. 1995. Inventory of
complicated grief: A scale to measure maladaptive symptoms of loss. Psychiatry
Research 59.12: 6579.
This was the original article to present the newly developed Inventory of Complicated
Grief (ICG). This well-designed scale has since been widely used in research studies to
assess complicated reactions to bereavement.

Prigerson, Holly G., M. K. Shear, S. C. Jacobs, et al. 1999. Consensus criteria for
traumatic grief: A preliminary empirical test. British Journal of Psychiatry 174:6773.

Presents consensus criteria that reflect two categories of symptoms, separation distress
and traumatic distress; symptoms should be present for at least six months. To date, most
studies on complicated grief have applied these criteria.

Prigerson, Holly G., Lauren C. Vanderwerker, and Paul K. Maciejewski. 2008. Prolonged
grief disorder: A case for inclusion in DSM-V. In Handbook of bereavement research and
practice: Advances in theory and intervention. Edited by Margaret S. Stroebe, Robert O.
Hansson, Henk Schut, and Wolfgang Stroebe, 165186. Washington, DC: American
Psychological Association Press.
This chapter provides a summary of complicated grief research and introduces the new
term prolonged grief disorder. However, it is noted that this term has not been adopted
by all experts, and complicated grief is still the more common term.

Shear, Katherine M., Timothy Monk, Patricia Houck, et al. 2007. An attachment-based
model of complicated grief including the role of avoidance. European Archives of
Psychiatry and Clinical Neuroscience 257.8: 453461.
Presents an attachment-based model of complicated grief and tests the assumption that
avoidance is a key element of complicated grief. Findings support this notion and counter
the perspective of Prigerson and colleagues, who have removed avoidance from their
diagnostic system for complicated grief.

Simon, Naomi M., Melanie M. Wall, Aparna Keshavia, M. Taylor Dryman, Nicole J.
LeBlanc, and Katherine M. Shear. 2010. Informing the symptom profile of complicated
grief. Depression and Anxiety 28.2: 118126.
Empirical evidence from cross-sectional study with a large sample, providing helpful
guidance about the most informative items from the Inventory of Complicated Grief and
their relationship with complicated grief severity. Also includes support for the notion
that behavioral avoidance is an important element of complicated grief.

Relationship Perspectives
One important aspect to consider when thinking about what a particular loss might mean for a
person is who was lost. Regardless of relationship aspects such as closeness or quality of the
relationship, the loss of a spouse, for example, will always have different implications than the
loss of a child. This section includes literature on the major relationship types that have received
research attention: the loss of a spouse, child, parent, and sibling.
Loss of a Spouse
The death of a spouse is by far the most frequently studied type of loss in the field of
bereavement. Parkes and Weiss 1983, a book on conjugal bereavement, is considered a classic in
the field, and it primarily targets clinicians. A more recent book on spousal bereavement in old

age, Carr, et al. 2005, is geared toward a broader audience by including discussions relevant to
researchers and practitioners from various disciplines. The other citations listed here are journal
articles that each offer a unique perspective on spousal loss. Bonanno, et al. 2002 provides a new
perspective on conjugal bereavement by identifying different patterns of grief in response to this
type of loss. Whereas Bonanno, et al. constructs grief trajectories based on a cut-off point for
judging clinically relevant levels of depression, others classified depression into different
categories, including mild depression. Zisook, et al. 1997 is a good example for the latter
approach. Carnelley, et al. 2006 is unique because it investigates the rarely studied issue of
lasting effects of widowhood beyond the first few years after the spouses death. When the
ramifications of spousal bereavement are considered, one of the most concerning types of
consequence is mortality. Lichtenstein, et al. 1998 reports empirical evidence on this issue from
an exceptionally well-designed twin study. Finally, Ong, et al. 2004 is a good example of the
studies that have paid particular attention to an often- overlooked aspect, the role of positive
emotions in coping with loss.

Bonanno, George A., Camille B. Wortman, Darrin R. Lehman, et al. 2002. Resilience to
loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal
of Personality and Social Psychology 83.5: 11501164.
This article was the first to provide a new perspective on conjugal bereavement by
identifying different patterns of grief in response to the death of a spouse.

Carnelley, Katherine B., Camille B. Wortman, Niall Bolger, and Christopher T. Burke.
2006. The time course of adjustment to widowhood: Evidence from a national probability
sample. Journal of Personality and Social Psychology 91.3: 476492.
Most studies on widowhood focus on the first years of bereavement. This study enhances
our understanding of the time course of conjugal bereavement by investigating whether
widowhood has enduring effects, using a nationally representative US sample; deaths
ranged from a few months to sixty-four years prior to data collection.

Carr, Deborah S., Randolph M. Nesse, and Camille B. Wortman, eds. 2005. Spousal
bereavement in late life. New York: Springer.
This book provides a comprehensive and insightful analysis of factors that influence latelife bereavement. Implications for practice, policy, and future research are also discussed
in great detail.

Lichtenstein, Paul, Margaret Gatz, and Stig Berg. 1998. A twin study of mortality after
spousal bereavement. Psychological Medicine 28.3: 635643.
The design of this study made it possible to control for important covariates (e.g., earlier
health status), and use a control group (i.e., the still married co-twins). Results support
the notion of a causal effect of bereavement on mortality but also provide evidence for
psychological growth after bereavement among widows.

Ong, Anthony D., C. S. Bergeman, and Toni L. Bisconti. 2004. The role of daily positive
emotions during conjugal bereavement. Journals of Gerontology: Series B,
Psychological Sciences and Social Psychology 59.4: 168176.
While most existing bereavement studies have focused on negative outcomes, an
important contribution has come from studies that have also paid attention to the role of
positive emotions. This study demonstrates that positive affect is not only quite prevalent
but also appears to ameliorate distress in response to spousal loss.

Parkes, Colin M., and Robert S. Weiss. 1983. Recovery from bereavement. New York:
Basic Books.
This book is a classic in the field. Its discussion of how widows and widowers deal with
the loss of a spouse is geared towards clinicians who work with the bereaved.

Zisook, Sidney, Martin Paulus, Stephen R. Shuchter, and Lewis L. Judd. 1997. The many
faces of depression following spousal bereavement. Journal of Affective Disorders 45.1:
8594.
Bereavement studies often use a clinical cut-off point for judging prevalence of
depression, which may result in overlooking cases of mild depression. This study avoided
this issue by classifying ratings on symptom inventories into DSM-IV categories of major
depression, minor depression, subsyndromal depression, and no depression.

Loss of a Child
The death of a child is probably one of the most difficult loss experiences one could ever face.
Cleiren 1993 is one of the few existing comparative studies examining the impact of death on the
bereaved person depending on relationship type. This study confirmed the widely held
assumption that the death of a child is among the most devastating of all losses. Murphy 2008
offers a comprehensive summary of the literature on the loss of a child, with a separate
discussion of different types of sudden, violent deaths, as well as death after extended illness.
The other citations listed here focus on one particular aspect of parents response to the death of a
child. Dyregrov, et al. 2003 is an investigation of gender differences in parents responses, with
the major finding of generally worse bereavement outcomes for mothers compared to fathers.
Murphy, et al. 2003 is focused on another important aspect, that of whether or not parents found
any meaning in their loss experience. Wijngaards-de Meij, et al. 2008a examines how one
parents adjustment to the loss was affected by the others coping style, and Wijngaards-de Meij,
et al. 2008b is a study of how the grieving process was influenced by the circumstances of the
death, such as being able to say good-bye.

Cleiren, Marc P. H. D. 1993. Bereavement and adaptation: A comparative study of the

aftermath of death. Philadelphia: Hemisphere.

Reports on findings from one of the few studies with comparative bereavement data by
kinship. The major finding to note is that coping with the death of a child is typically
more difficult than the loss of any other family member.

Dyregrov, Kari, Dag Nordanger, and Atle Dyregrov. 2003. Predictors of psychosocial
distress after suicide, SIDS and accidents. Death Studies 27.2: 143165.
Clear gender differences among parents who suffered different kinds of loss have
emerged from several studies. This study demonstrates this pattern for three different
causes of death. In all cases, mothers evidenced higher levels of post-traumatic reactions
and complicated mourning than fathers.

Murphy, Shirley A. 2008. The loss of a child: Sudden death and extended illness
perspectives. In Handbook of bereavement research and practice: Advances in theory
and intervention. Edited by Margaret S. Stroebe, Robert O. Hansson, Henk Schut, and
Wolfgang Stroebe, 375395. Washington, DC: American Psychological Association
Press.
This chapter comprehensively summarizes the literature on the consequences for parents
of two of the most common cases of child death: (1) sudden, violent deaths resulting from
accidents, suicide, or homicide; and (2) cancer.

Murphy, Shirley A., L. Clark Johnson, Janet Lohan. 2003. Finding meaning in a childs
violent death: A five-year prospective analysis of parents personal narratives and
empirical data. Death Studies 27.5: 381404.
This longitudinal study investigates the important issue of finding meaning in a loss that
is among the most difficult losses one could ever face. Many of the parents in this study
reported not finding meaning in the loss at any point, but those who did seemed to benefit
from it.

Wijngaards-de Meij, Leoniek, Margaret S. Stroebe, Henk Schut, et al. 2008a. Parents
grieving the loss of their child: Interdependence in coping. British Journal of Clinical
Psychology 47.1: 3142.
This longitudinal study of bereaved parents provides an interesting new perspective by
examining the relationship between parents own and their partners ways of coping after
the death of their child. Results indicated that for men, having a female partner whose
coping focus was on restoring daily life was related to more positive adjustment.

Wijngaards-de Meij, Leoniek, Margaret S. Stroebe, Henk Schut, et al. 2008b. The impact
of circumstances surrounding the death of a child on parents grief. Death Studies 32.3:
237252.
This longitudinal study addressed the important question of how bereaved parents are
affected by the circumstances surrounding the death of their child. Being able to say

good-bye to the child and presenting the body for viewing at home were associated with
lower levels of the parents grief.
Loss of a Parent
The literature on parental loss can be grouped under at least three perspectives. The bulk of
studies have focused on how young or school-aged children respond to the death of a parent.
Fewer studies have addressed the enduring effects that may extend into adulthood. Another type
of parental loss that has received limited attention is what it means for adults to lose a parent.
Christ 2010 and Silverman 2000 generally focus on how young children cope with parental loss,
highlighting particular stress factors that they may face. Silverman and Nickman 1996 addresses
the important issue of what happens to the childs relationship with their parent after the parent
has died. The authors found that many children actively construct a continuing connection to the
deceased parent, and that this connection is usually comforting. However, Silverman, et al. 2003
also found that this might not be the case when there are any negative legacies coming from this
parent. Umberson 2003 is dedicated to the topic of parental loss in adulthood. As Moss and Moss
19831984 points out, because losing a parent in adulthood is considered an expected and timely
life event, this type of loss tends to be under-acknowledged in terms of its potential significance
for the bereaved. Luecken 2008 combines the first and second perspectives on parental death by
reviewing the literature on short-term consequences for young children who lose a parent, as
well as the long-term consequences that may reach into adulthood. Jacobs and Bovasso 2009
specifically focuses on the latter issue by investigating the role of early parental death on
psychopathology in adulthood.

Christ, Grace H. 2010. Children bereaved by the death of a parent. In Childrens

encounters with death, bereavement, and coping. Edited by Charles A. Corr and David E.
Balk, 169193. New York: Springer.
This chapter highlights important stress factors in dealing with parental death. It draws on
data from two interventions: one focused on children before and after their parent dies of
cancer, the other on families of firefighters who died in the World Trade Center disaster
on September 11, 2001.

Jacobs, John R., and Gregory B. Bovasso. 2009. Re-examining the long-term effects of
experiencing parental death in childhood on adult psychopathology. Journal of Nervous
and Mental Disease 197.1: 2427.
Examines whether the experience of the death of a parent in childhood increases risk for
adult psychopathology. Authors found that the death of a father more than doubled the
risk for major depression in adulthood. This long-term effect was attributed to financial
stresses complicating the familys adaptation to the loss.

Luecken, Linda J. 2008. Long-term consequences of parental death in childhood:

Psychological and physiological manifestations. In Handbook of bereavement research
and practice: Advances in theory and intervention. Edited by Margaret S. Stroebe, Robert

O. Hansson, Henk Schut, and Wolfgang Stroebe, 397416. Washington, DC: American
Psychological Association Press.
This chapter provides a helpful review of the available research evidence on the longterm psychosocial and physiological consequences of early parental loss.

Moss, Miriam S., and Sidney Z. Moss. 19831984. The impact of parental death on
middle-aged children. Omega: Journal of Death and Dying 14.1: 6575.
In this article on parental bereavement in adulthood, the authors note that parent death
can be counted as the type of loss that is typically disenfranchised, as the expectation is
for the bereaved to be fairly unchallenged by the timely occurrence and expected nature
of this loss.

Silverman, Phyllis R. 2000. Never too young to know: Death in childrens lives. New
York: Oxford Univ. Press.
This book generally focuses on the effects of death on children, but chapters 5 and 6
specifically address how children respond to the death of parent. The author draws on
narrative data from bereaved children and the surviving parent to provide an intimate
portray of their experience.

Silverman, Phyllis R., John Baker, Cheryl-Anne Cait, and Kathrin Boerner. 2003. The
effects of negative legacies on the adjustment of parentally bereaved children and
adolescents. Omega: Journal of Death and Dying 46.4: 335352.
This article sheds light on scenarios in which a continuing connection with a deceased
parent can have adverse effects. Specifically, the authors highlight the role of negative
legacies from the deceased parent and their impact on the child.

Silverman, Phyllis R., and Steven L. Nickman. 1996. Childrens construction of their
dead parents. In Continuing bonds: New understandings of grief. Edited by Dennis Klass,
Phyllis R. Silverman, and Steven L. Nickman, 7386. Washington, DC: Taylor & Francis.
This chapter focuses on the impact of parental death on children, with particular attention
to what happens to their relationship with the parent after the death. Research evidence
suggests that most children typically find a way to actively construct a comforting
continuing connection with the deceased parent.

Umberson, Debra. 2003. Death of a parent: Transition to a new adult identity.

Cambridge, UK: Cambridge Univ. Press.
Although parent death in adulthood is common, it is one of the least-studied types of
family loss. This book summarizes the most extensive existing empirical work on adult
childrens loss of a parent.

Loss of a Sibling
The death of a sibling is among the least studied of family losses. At least compared to other
deaths within the family, the available research evidence on sibling death is not extensive. Also,
sibling death is often discussed alongside other losses that can occur in childhood or
adolescence, such as the death of parents or friends. The focus then is more on the developmental
stage during which the child encounters the death. Balk and Corr 2001 is an example of this type
of literature; it offers a general review of how adolescents experience the death of a loved one,
with a separate discussion on different types of loss, including sibling death. This is also the case
in Doka and Tucci 2008, a guide for parents, teachers, and health-care professionals who must
deal with childrens grief. Hogan and De Santis 1996 discusses key constructs that have emerged
from research on adolescent sibling bereavement, such as personal growth and ongoing
attachment to the deceased. The most widely used quantitative measure assessing sibling grief,
the Sibling Inventory of Bereavement, was developed by Nancy Hogan (see Hogan 1990).
However, studies on sibling bereavement usually also include other important indicators. For
example, Balk 1990 investigates how sibling death might affect the self-concept of adolescents,
as well as other aspects of their lives, such as peer relationships and grades in school. Hogan and
Balk 1990 contrasts the perceptions around sibling bereavement of the involved adolescents, as
well as their mothers and fathers. Hogan and DeSantis 1994 uses narrative data to explore what
might promote or impede adolescents coping with sibling bereavement. Finally, Batten and
Oltjenbruns 1999 draws attention to the phenomenon of spiritual development that adolescents
may experience in the course of sibling death.

Balk, David E. 1990. The self-concepts of bereaved adolescents: Sibling death and its
aftermath. Journal of Adolescent Research 5.1:112132.
The research presented here suggests that the self-images of adolescents who experience
sibling death are comparable to those of adolescents who do not have such a loss.
However, there is evidence that the loss may cause changes in other areas, such as peer
relationships, grades in school, and personal maturity.

Balk, David E., and Charles A. Corr. 2001. Bereavement during adolescents: A review of
research. In Handbook of bereavement research: Consequences, coping, and care. Edited
by Margaret S. Stroebe, Robert O. Hansson, Henk Schut, and Wolfgang Stroebe, 199
218. Washington, DC: American Psychological Association Press.
This chapter provides a general review of the literature on how adolescents experience
the death of a loved one, including the deaths of siblings, parents, and friends.

Batten, Michelle, and Kevin Ann Oltjenbruns. 1999. Adolescent sibling bereavement as a
catalyst for spiritual bereavement as a catalyst for spiritual development: A model for
understanding. Death Studies 23.6: 529546.
Addresses the important issue of how an adolescents spiritual development might be
affected by sibling death. The authors argue that the crisis of experiencing such a loss

during this period can result in a quest for new meaning. Narrative data supporting this
view are presented.

Doka, Kenneth J., and Amy S. Tucci, eds. 2008. Living with grief: Children and
adolescents. Washington, DC: Hospice Foundation of America.
This volume in the Living with Grief series from the Hospice Foundation of America is a
helpful guide for parents, teachers, and health-care professionals who deal with grieving
children. It offers many practical suggestions, including recommendations for resources
to support children and adolescents who are exposed to death.

Hogan, Nancy S. 1990. Hogan Sibling Inventory of Bereavement. In Handbook of family

measurement techniques. Edited by John Touliatos, Barry F. Perlmutter, and Murray A.
Strauss, 524. Newbury Park, CA: SAGE.
Using the data from her study on the process of adolescent sibling bereavement and
adaptation, Hogan developed a valid and reliable instrument, the Hogan Sibling
Inventory of Bereavement. This is still the only existing measure of sibling grief in the
field.

Hogan, Nancy, and David E. Balk. 1990. Adolescent reactions to sibling death:
Perceptions of mother, fathers, and teenagers. Nursing Research 39.2: 103106.
Contrasts the perceptions of mother, fathers, and teenagers about sibling bereavement.
The major finding from this study is that the perceptions of mothers and fathers differed
significantly, and that the perceptions of fathers were more in line with their childrens
reports.

Hogan, Nancy, and Lydia De Santis. 1994. Things that help and hinder adolescent sibling
bereavement. Western Journal of Nursing Research 16.2: 132153.
The study reported on in this paper used narrative data from adolescents who had
experienced sibling death to identify aspects within themselves or their social network
that either helped or hindered their coping efforts.

Hogan, Nancy, and Lydia De Santis. 1996. Basic constructs of a theory of adolescent
sibling bereavement. In Continuing bonds: New understandings of grief. Edited by
Dennis Klass, Phyllis R. Silverman, and Steven Nickman, 235254. Philadelphia: Taylor
& Francis.
This chapter offers a review of the research on adolescent sibling bereavement, as well as
a thorough discussion of the constructs, including personal growth and ongoing
attachment, that have emerged from this research.

Disenfranchised Grief

The term disenfranchised grief, coined by Kenneth Doka (see Doka 1989), refers to any type
of loss experience that is not acknowledged by society. This can be the case in any scenario
where the relationship between the mourner and the deceased is not recognized as one that can
legitimately trigger grief (e.g., the death of an unborn child, or the death of a mentor or colleague
in a professional setting). The more recent volume on disenfranchised grief edited by Doka
(Doka 2002) gives an overview of the literature, delineating basic definitions, and the nature of
unacknowledged losses in a variety of contexts. Moss and Moss 2002 draws attention to the
experience of long-term care staff after the death of a patient they have cared for. Rickerson, et
al. 2005 reports findings from one of the few available empirical studies on the prevalence of
grief among long-term care staff. Disenfranchisement of grief can occur when the circumstances
of the loss are ambiguous (e.g., when a person has gone missing). Boss 1999 outlines different
scenarios in which this might be the case, and discusses how it might cause complications in a
persons adjustment to the loss. The lack of recognition for ones loss can also result from a death
that comes with societal stigma, such as suicide. Cvinar 2005 provides an insightful review of
the literature on suicide bereavement. Finally, Elison and McGonigle 2003 takes the opposite
perspective on the issue of acknowledging loss experiences by discussing loss situations that
constitute a positive development for the bereaved, with feelings of liberation and relief, rather
than the appropriate distress expected from someone who would otherwise be considered a
legitimate mourner.

Boss, Pauline. 1999. Ambiguous loss: Learning to live with unresolved grief. Cambridge,
MA: Harvard Univ. Press.
This thoughtful book discusses various types of losses involving ambiguity, either
because the lost person is merely physically present, as in case of severe dementia, or
because the person is physically no longer there, so that it is unclear where the person is
or is not still alive.

Cvinar, Jacqueline G. 2005. Do suicide survivors suffer social stigma: A review of the
literature. Perspectives in Psychiatric Care 41.1: 1421.
Examines the literature to determine whether or not, and in which way, stigma plays a
role in suicide bereavement. The stigma elements highlighted include the societal
perception that the survivors must carry some responsibility for the death, and that there
must have been a failure on their part in terms of dealing with emotional issues
experienced by the deceased.

Doka, Kenneth. J., ed. 1989. Disenfranchised grief: Recognizing hidden sorrow.
Lexington, MA: Lexington.
This book introduced the term and topic of disenfranchised grief into the literature. The
author defined disenfranchised grief as grief that persons experience when they incur a
loss that is not or cannot be openly acknowledged, publicly mourned, or socially
supported.

Doka, Kenneth. J., ed. 2002. Disenfranchised grief: New directions, challenges, and
strategies for practice. Champaign, IL: Research Press.
Gives an excellent overview over the topic of disenfranchised grief, with a helpful
introduction outlining basic definitions of the phenomenon used in the literature and
individual contributions that examine the nature of unacknowledged losses in various
contexts.

Elison, Jennifer, and Chris McGonigle. 2003. Liberating losses: When death brings relief.
Cambridge, MA: Perseus.
This compelling book gives voice to bereavement responses that are not uncommon but
seldom talked about. Feeling liberated by a loss could involve being relieved that a loved
ones death finally put an end to period of intense suffering, or of being free of a troubled
relationship.

Moss, Miriam S., and Sidney Z. Moss. 2002. Nursing home staff reactions to resident
deaths. In Disenfranchised grief: New directions, challenges, and strategies for practice.
Edited by Kenneth. J. Doka, 197216. Champaign, IL: Research Press.
This insightful chapter draws attention to the largely overlooked issue of how long-term
care staff respond to patient death. The authors note that long-term care facilities
typically provide little support to help staff through this time.

Rickerson, Elizabeth M., Carole Somers, Christine M. Allen, Beth Lewis, Neville
Strumpf, and David J. Casarett. 2005. How well are we caring for caregivers? Prevalence
of grief-related symptoms and need for bereavement support among long-term care staff.
Journal of Pain Symptom Management 30.3: 227233.
Most reports of grief among staff have been anecdotal. This article reports on one of the
few studies that have systematically assessed prevalence of grief in nursing home staff.
Self-reported grief symptoms varied depending on number of patient deaths and
closeness of relationship with the patient.

Cultural Perspectives on Grief

Although the experience of grief over the death of a loved one is likely one that can be found in
all cultures, there are many aspects surrounding death and bereavement that can differ by culture.
Among these are interpretations of the meaning of death or what happens after death and how
different expressions of grief are understood. Most importantly, there is considerable variability
across cultures when it comes to mourning rituals. Rosenblatt 2008 provides a comprehensive
review of the literature on all these issues. Klass 1999 proposes a theoretical model in which
Klass distinguishes between the universal nature of core emotions of grief and culturally based
perceptions and expressions of grief. This mode is further discussed in Parkes 2000 and Klass
2000. Finally, mourning rituals of major world religions are described by Parkes, et al. 2000, the

third edition of a popular book targeting the readership of both professionals and lay persons who
are involved in the care of the dying and bereaved.

Klass, Dennis. 1999. Developing a cross-cultural model of grief: The state of the field.
Omega: Journal of Death and Dying 39:153176.
Klass distinguishes between cross-cultural and multicultural perspectives and then
proposes a model that assumes core similarities in grief across cultures, with interpretive
schemes such as how death is perceived and the acceptability of emotional expression
that are thought to differ by culture.

Klass, Dennis. 2000. Response to Colin Murray Parkes comments on my article

Developing a cross-cultural model of grief. Omega: Journal of Death and Dying 41.4:
327330.
Klass contests Parkess proposal of an alternative perspective to the cross-cultural model
of grief previously proposed in Klass 1999.

Parkes, Colin Murray. 2000. Comments on Dennis Klass article Developing a crosscultural model of grief. Omega: Journal of Death and Dying 41.4: 323326.
In this commentary, the author offers an alternative perspective to the cross-cultural
model of grief proposed by Klass 1999.

Parkes, Colin Murray., Pittu Laungani, and Bill Young, eds. 2000. Death and
bereavement across cultures. 3d ed. New York: Routledge.
Describes mourning rituals of major world religions and explains their psychological and
historical context. Written for doctors, social workers, nurses, counselors, and others
involved in the care of the dying and bereaved.

Rosenblatt, Paul C. 2008. Grief across cultures: A review and research agenda. In
Handbook of bereavement research and practice: Advances in theory and intervention.
Edited by Margaret S. Stroebe, Robert O. Hansson, Henk Schut, and Wolfgang Stroebe,
207222. Washington, DC: American Psychological Association Press.
This chapter provides a thorough review of fundamental issues in understanding grief
across cultures, including different perspectives on the meaning of death, the spirit of the
deceased, and the nature of grief. Cultural variations in mourning, and aspects of grief
that might be universal, are also discussed.

Treatment
The most widely read book on grief counseling and therapy, Worden 2008, was first published in
1982 and is now in its fourth edition. This book, which bases its principles and guidelines on the

contested notion of tasks of mourning, is considered the bible of bereavement counseling by

many professionals in the field of grief counseling. Its reputation comes from the fact that it
represents a helpful and straightforward guide for those who work with the bereaved.
Unfortunately, the author has not integrated new advances of bereavement research into its more
recent editions. During the past decade, several reviews of grief and mourning treatment studies
that examined the efficacy of treatment have appeared in the literature. Neimeyer 2000 provides
a summary of meta-analytic reviews that were conducted on grief and mourning treatment
studies in the 1990s. Jordan and Neimeyer 2003 and Stroebe, et al. 2005 are comprehensive
narrative reviews of the literature on treatment. Currier, et al. 2008 reports on findings from a
more recent meta-analysis of treatment studies with children. Taken together, these different
reviews suggest that, in many cases, people may not need therapy following a loved ones death,
but that some subgroups are likely to benefit substantially from treatment. Shear, et al. 2005
developed and tested an intervention designed specifically to address the problems of mourners
in high-risk categories, such as those who have already developed complicated grief. Zhang, et
al. 2006 provides a general review of evidence-based treatments, with particular attention given
to the diagnosis and treatment of complicated grief. Finally, Zisook and Shear 2009 offers
concrete recommendations for clinicians on how to recognize and identify complicated grief, and
on treatment choices.

Currier, Joseph M., Jason M. Hollan, and Robert A. Neimeyer. 2008. The effectiveness of
bereavement interventions with children: A meta-analytic review of controlled outcome
research. Journal of Clinical Child and Adolescent Psychology 36.2: 253259.
Offers a meta-analysis of grief treatment studies that is far more comprehensive than
previous efforts. The key finding is that when interventions target respondents who
experience significant distress as a result of the loss, effect sizes compared favorably with
the positive outcomes shown for psychotherapy in general.

Jordan, John R., and Robert A. Neimeyer. 2003. Does grief counseling work? Death
Studies 27.9: 765786.
Authors identify factors that may influence findings from grief treatment studies,
including that treatment may not show beneficial results if the treatment offered did not
include enough sessions, or if the intervention was not offered at the most appropriate
time.

Neimeyer, Robert A. 2000. Searching for the meaning of meaning: Grief therapy and the
process of reconstruction. Death Studies 24.6: 541558.
In this article, the author provides a summary of meta-analytic reviews conducted of grief
treatment studies. The major conclusion is that interventions are often ineffective and
perhaps even harmful, at least in the case of normal bereavement, and that benefits of
treatment have been found for interventions targeting complicated grief.

Shear, Katherine, Ellen Frank, Patrocoa R. Houck, and Charles F. Reynolds III. 2005.
Treatment of complicated grief: A randomized controlled trial. JAMA: Journal of the
American Medical Association 293.21: 26012608.
Reports on a randomized, clinical trial comparing an intervention designed for people
with complicated grief to a more standard treatment for depression. Although both
treatments produced improvement in grief symptoms, there was a higher response rate
and a faster time to response in the complicated grief treatment.

Stroebe, Wolfgang, Henk Schut, and Margaret S. Stroebe. 2005. Grief work, disclosure,
and counseling: Do they help the bereaved? Clinical Psychology Review 25.4: 395414.
This article reviews the grief treatment literature with an eye for who might benefit from
treatment. One consistent finding emerging from the evaluated intervention studies is that
those who seek treatment are likely to show better results from grief therapy than those
who are recruited into treatment.

Worden, J. William. 2008. Grief counseling and grief therapy: A handbook for the mental
health practitioner. 4th ed. New York: Springer.
This book, first published in 1982, is perhaps the most widely used book on grief
counseling written for clinicians and other mental health professionals. The outlined
recommendations for treatment are based on the (contested) assumption that individuals
must work through their feelings to accommodate the loss.

Zhang, Baohui, Areej El-Jawahri, and Holly G. Prigerson. 2006. Update on bereavement
research: Evidence-based guidelines for the diagnosis and treatment of complicated
bereavement. Palliative Medicine 9.5: 11881203.
Provides a general review of evidence-based diagnosis and treatment but pays particular
attention to the differential diagnosis of complicated grief compared to other mental
disorders, with a discussion of specific treatment options for complicated grief.

Zisook, Sidney, and Katherine Shear. 2009. Grief and bereavement: What psychiatrists
need to know. World Psychiatry 8.2: 6774.
This is one of few articles written directly for clinicians to help them identify complicated
grief and provide guidance for treatment choices. Also discussed are the implications of
patient suicide for clinicians themselves.

LAST MODIFIED: 11/29/2011

DOI: 10.1093/OBO/9780199828340-0011
back to top

Oxford University Press

Powered by:
PubFactory