1. Variability in Response to the Loss of a Loved One: C ultural U nderstanding versus S cientific E vidence Variability in Response to the Loss of a Loved One: C ultural U nderstanding versus S cientific E vidence

2. Assumptions About the Process of Coping 1.At some point, most people become intensely distressed or depressed following a major loss. 2.Failure to experience distress is indicative of a problem. a]If distress is not experienced, it will erupt later (“delayed grief”) b]If distress is not experienced, the individual will develop subsequent health problems. 3.Individuals must “work through” or process their loss. 4.Over a period of time, individuals should be able to recover from the loss and return to their earlier level of functioning.

3. Collaborators Roxane Silver, Ph.D., University of California at Irvine Darrin Lehman, Ph.D., University of British Columbia Ronald Kessler, Ph.D., Harvard University James House, Ph.D., University of Michigan George Bonanno, Ph.D., Teachers College, Columbia University

4. from Cleiren, 1993 Four months after the loss Level of Depressive Symptoms Following the Loss of a Spouse, Child, Parent or Sibling

5. ACL National Cross-Section: Mean CESD Scores of Widowed and Married Respondents at Seven Time Points Married ( never widowed) 18.8 Ever-widowed 23.823.122.421.620.920.219.5 Mean Difference 5.0 4.3 3.6 2.8 2.1 1.4 0.7 t (1, 3128) 3.37 3.40 3.21 2.66 1.84 1.04 0.42 p <.0008.0007.0013.008.0663.2975.6571 Time Since Widowhood (years) 05 10 15 20 25 30

6. Hypotheses Regarding “Absent Grief” Reflected in the Bereavement Literature  Represents denial or inhibition of distress that will eventually surface.  Represents lack of attachment  Negative evaluation of spouse  Survivor incapable of attachment (avoidant/dismissive of others)  Survivor cold and unfeeling  Represents end of a bad marriage  Spouse was ill; possible caregiving burden

7. Main Hypotheses Regarding “Chronic Grief” Reflected in the Bereavement Literature  Marriage was conflictual  Ambivalence toward spouse  Survivor was dependent on spouse  Chronic grief represents coping failure  Survivor has a history of mental health problems, including depression, which were present before the loss occurred

8. Patterns of Response to Loss Depression ( CESD ) (Depressed-Improved Resilient Common grief Chronic grief Chronic Depression Pre-loss 6 mo. 18 mo. post-loss post-loss

9. Patterns of Response to Loss: Percentage of Respondents Showing Each Pattern

10. Patterns of Response to Loss Grief Symptoms Depressed-Improved Resilient Common grief Chronic grief Chronic Depression Pre-loss 6 mo. post-loss 18 mo. post-loss

11. The Grief Brigade When tragedy strikes, the counselors rush in. They offer succor, but their methods are up for debate. from Time, May 17, 1999

12. “Hard to tell from here. Could be buzzards. Could be grief counselors.”

13. Pathological grief has different meanings. It can be defined as follows:  Chronic grief - The failure to resolve all adverse bereavement-related symptoms within 6 months  Inhibited grief - The absense of expected grief symptoms  Delayed grief - The avoidance of painful symptoms within the first 2 weeks of a loss from Gelder, M.G., Lopez-Ibor, J.J., & Anderson, N. (2000). New Oxford Textbook of Psychiatry. Oxford: Oxford University Press

14. PATHOLOGICAL GRIEF Absent or delayed grief: occurs when the feelings of loss would be too overwhelming and so are repressed or denied. Such avoidance of affect tends to result in the later onset of much more prolonged grief and a higher risk of depression Chronic grief: grief that is still symptomatic 1 year after the death from Stoudemire, A. (2001). Clinical Psychiatry for Medical Students. New York: Lippincott-Raven

15. Unhelpful Responses to the Bereaved  Asking questions  Giving advice  Discouraging expressions of feelings  Minimizing the loss  “I know how you feel”  Providing philosophical or religious perspective