Determinants of grief

Many factors can affect the way in which someone reacts to being bereaved. These may precede the bereavement, for example, a childhood experience, a previous life crisis like divorce or mental illness, or the nature of the relationship between the bereaved person and the deceased. The reaction may also be influenced by the bereaved person’s present circumstances, for example, his or her age, sex, religion, type of personality or even cultural background. Reactions may also be determined by the circumstances of bereaved people after the death, for example, the amount of support they have, and other stresses in their life, such as young children. Such determinants have been referred to as the antecedent (previous experience), concurrent (present circumstances) and subsequent determinants of grief (Parkes, 1996).

Cultural and religious beliefs affect how people display grief and feel they should behave during bereavement. Strict rules govern the preparation of the body after death and the rituals associated with burial and mourning among different ethnic groups (Firth, 2001) (see pp. 130–131).

The mourning process

In the same way that the dying process has been described as a series of stages (Kubler-Ross, 1970, see pp. 130–131), the process of mourning has similarly been defined as a series of phases or stages that must be passed through grief can be resolved The initial phase of numbness gradually gives way to feelings of pining, yearning and searching, as the bereaved person seeks to recover what has been lost. When the intensity of this second phase diminishes, it is replaced by feelings of depression, disorganization and despair when it becomes apparent that the loss is irretrievable. Finally, the bereaved person moves to a phase of recovery and reorganization when s/he begins to adjust to a new way of life without the deceased (Parkes, 1975; Bowlby, 1998). Worden (1991) describes the process as a series of tasks that must be worked through. He describes these as accepting the reality of the loss, working through the pain, adjusting to an environment in which the deceased is missing and moving on with life. Although these stage and phase theories can be a useful way of beginning to understand the complexity of the grief process, they are not intended to be prescriptive. Individual reactions will vary and may not conform to a specific pattern, i.e. a bereaved person may not pass through these stages sequentially.

More recently, the Dual Process model suggests that bereaved people move between confronting grief (loss-oriented behaviour) and avoiding grief (restoration-oriented behaviour) (Stroebe & Schut 1999). This and other newer models advocate that the bereaved do not return to the way they were before the death as the stage models may have implied but adapt to a new way of living which incorporates a continuing bond with the dead person (Klass et al., 1996; Walter, 1999).