In the context of loss and grief, the interpersonal influences that have been most examined have been within the family. According to the ecological framework , immediate family members are thought to have an important influence on the way in which individuals negotiate the processing of events such as loss and the ensuing grief [2]. This is because the family system often constructs the interpersonal context for loss and grief to take place. Consistent with this, recently, a shift has been observed from an individual understanding of the grief process towards an interpersonal interactive one, with a particular focus on family members [4, 5]. Within such a model it is acknowledged that grief may present differently for different family members, both in its intensity and its expression [6, 7]. However, this model also accounts for the existence of family-level processes and dynamics through which the grieving members reciprocally influence each others’ grief process [4]. For example, the intensity of a parent’s grief might influence the grief process in their child by impacting their parenting or their interactions with the child.

Nonfamilial social support constitutes another positive source of influence at the interpersonal level. Specifically, social support as a general construct is hypothesized to act as a buffer from the potentially pathological influence of distressing life events such as loss [8, 9]. Two types of social support have been identified: on the one hand perceived social support from friends and relatives and on the other instrumental support, including organizational and financial assistance, etc. [9]. Perceived social support, that is the perception that one is included in a caring interpersonal network, has been found to be associated with less intense and shorter grief reactions [10, 11], perhaps due to the positive effect of social interactions on reengaging with life and the future. Likewise, instrumental supports such as direct financial assistance or material goods and services have also been found to be associated with less chronicity of grief [10, 12].

In contrast to these positive processes, authors have described the concept of disenfranchised grief that can occur when the circumstances are such that the individual’s grief is judged illegitimate or inappropriate by either the griever or the social environment [13, 14]. In such a case, any grief reactions can be judged illegitimate by others regardless of their intensity or duration (as opposed for example to cases of prolonged grief that becomes viewed by others as inappropriate over time). Disenfranchised grief has been described in the context of relational distance from the deceased that is considered too wide (e.g., nonfamily member, or unrecognized affective ties), the characteristics of the bereaved individual are considered to exclude them from experiencing grief (e.g., the young and the elderly), or the circumstances of the death are thought to make grief illegitimate [13]. Importantly, this may prevent the griever from receiving the benefits of social support.

Disclosure of emotional and cognitive experiences of grief constitutes an important component of healthy adjustment following loss. However, bereaved individuals often experience pressure to conform to societal norms that constrict the experience of grief rather than support it. Such a context may hinder, or altogether restrict, an individual from disclosing loss-related thoughts and emotions, especially when they are negative in valence. For example, constrained social interactions may include instances of negative responses to repeated discussions of the loss or may consist of advice that attempts to minimize or otherwise fix the experiences of grief by encouraging reduction of grief reactions. Likewise, individuals may avoid talking about the loss with the aim of decreasing their grief, for example by avoiding rumination or exacerbating their symptoms. These actual or perceived interpersonal barriers to emotional disclosure are referred to as social constraints and manifest as limited opportunities to disclose thoughts and feelings in a supportive and validating context. Ultimately, social constraints create an interpersonal context whereby the bereaved feel alienated, unsupported, or otherwise misunderstood.

Negative consequences of social constraints on emotional adjustment and well-being have been identified among a number of distressing life experiences such as chronic illness [15], traumatic experiences [16], and loss [17, 18]. In the context of bereavement, disclosure of grief-related thoughts and feelings in a supportive and validating interpersonal environment is an important aspect of healthy adjustment following the loss. As such, high social constraints for loss-related disclosure are associated with higher depressive symptoms, somatic symptoms, perceived stress, and overall worse global health [17, 18], and moderate the relationship between loss-related intrusive thoughts and indicators of maladjustment [17]. Furthermore, longitudinal studies have indicated that social constraints 1 year post-loss exert negative effects on adjustment and emotional processing up to 3 years post-loss [18]. Such negative consequences are most typically understood using a Social-Cognitive Processing (SCP) model (see [19] for an overview of SCP and bereavement).

Importantly, social constraints intersect with other levels of the critical feminist ecological model, such as overarching Western beliefs on death and grieving influence individuals’ responses to emotional processing and disclosure. These beliefs include who has permission to be identified as the bereaved, how long grief should last, how grief is manifested, and if the manner of death is considered acceptable or is stigmatized [20]. For example, bereaved individuals typically believe that grief should last 3 months to 1 year post-loss, despite the fact that actual grief reactions can last much longer and may continue to manifest at important milestones throughout one’s life [21]. Such beliefs create a socially constrained interpersonal context whereby the individual may be inclined to inhibit their discussion of loss, therefore having fewer opportunities to process their loss.

A number of aspects of legislation and policy may impact grief reactions in the aftermath of a loss, resulting from the various agencies and systems that interface with grief. In addition to national and local governance, these include bereavement agencies or more broadly the health-care system. These agencies may be involved in the development and evaluation of treatments aiming to support the grief process and reduce prolonged and chronic grief, including research institutes and bodies regulating drugs and medications.

One example of this, that will not be expanded upon here as it will be covered in detail in other sections of this work, is the emerging psychiatric diagnosis of “prolonged grief disorder ” or “complicated grief ” [22, 23]. The recognition of such a diagnostic entity has implications for the provision of services and allocation of resources to individuals experiencing more intense and chronic grief reactions. Furthermore, in the context of other mental health disorders such as eating disorders, it has been noted how symptoms presentation may change at the population level over the course of two decades, as clinical understanding evolves and symptom description changes in disorder classifications [24]. In addition, similar to post-traumatic stress disorder, as a diagnosis, prolonged grief disorder or complicated grief is unique in that it implies causation and therefore in the legal context has the potential to become linked with issues of liability [25].

Another example of the influence of policy are the provisions of compassionate leave of absence, such as allowing an employee to receive paid leave following the death of a relative or close friend. Although the data on the impact of such policies on the experience of grief reactions are scant [26], they constitute an important influence on grief reactions through the implications for social support, both perceived and instrumental, disenfranchisement, and acknowledgement of the loss. On a more general level, policy deficits in compassionate leave invalidate griever’s experience and convey the expectation that grief reactions must be suppressed or otherwise discarded. This message, coupled with the detrimental impact of such policies on the other domains of the exosystem mentioned above, is likely to negatively influence grief reactions in powerful ways.

The Western political and economic systems are related to a number of underlying values and beliefs that are relevant in the context of an examination of grief reactions. At their core, these systems are based on the notion of individuals as consumers within a model of constant growth. In this way, individual worth is tied to materialistic indices and values [20]. Death is increasingly hidden, avoided, and unwelcome in a context in which fulfillment is to be sought through consumption and gain (which, importantly, is literally the opposite to loss), as well as control over one’s life. This denial of death results in its disappearance from rituals and socials interactions, as well as a nonacceptance of death. Relatedly, Western society is characterized by high levels of avoidance of negative emotions, which has been shown to be associated with a focus on materialism [36]. In this way, negative affect even when experienced is unwelcome, poorly tolerated, and considered to interfere with “moving forward” and productivity. This avoidance of the emotional processing of grief may also paradoxically increase the risk of prolonged grief disorder or complicated grief through experiential avoidance [37].

As described above, the disenfranchisement of grief has been described as a contemporary process and is linked to changes in Western society [14]. The focus on economic growth has been associated with a decrease in rituals and social interactions surrounding death, and the progressive restriction of the circle of individuals who partake in any symbolic marking of death. Grieving is both practically (through loss of productivity) and symbolically incompatible with a capitalistic growth model [20]. In addition, death implies a loss of control, a failure to overcome and to achieve that is at odds with capitalist values. This context leads to what has been termed the “oppression” of the bereaved [20], which discourages the expression of grief and isolates those who are grieving.

The denial of death as imminently possible and eventually inevitable, lack of preparedness for the death of a loved one, and then lack of acceptance of such a death are all congruent with Western values, and obstacles to the mourning process. Some authors have described lack of acceptance of a loss as a symptom of grief [38], and later suggested that acceptance and grief might be diametrically opposed, such that as one increases the other decreases by equal measure [39]. Consistent with this, acceptance of a loss has been shown to protect from chronic and persistent grief [12].