Saturday, 16 June 2012
Two Big Myths about Grief People are not always devastated by a death and should be allowed to recover in their way By Hal Arkowitz and Scott O. Lilienfeld | January 5, 2012
Virtually all of us experience the loss of a loved one at some point in our life. So it is surprising that the serious study of grief is not much more than 30 years old. Yet in that time, we have made significant discoveries that have deepened our understanding of this phenomenon—and challenged widely held assumptions.
In this column, we confront two common misconceptions about grief. The first is that the bereaved inevitably experience intense symptoms of distress and depression. The second is that unless those who have experienced the death of a loved one “work through” their feelings about the loss, they will surely experience delayed grief reactions, in which strong emotions may be triggered by events unrelated to the loss, even long after it occurred. As we will show, neither belief holds up well to scientific scrutiny.
Most people believe that distress and depression almost always follow the death of someone close, according to psychologists Camille B. Wortman of Stony Brook University and Kathrin Boerner of Mount Sinai School of Medicine. Symptoms of distress include yearning for the deceased, feeling that life has lost its meaning, having anxiety about the future and experiencing shock at the loss. Depression involves feeling sad and self-critical, having suicidal thoughts, lacking energy, and undergoing disturbed appetite and sleep.
To examine this belief, several groups of investigators tracked bereaved people, mostly widows and widowers, for up to five years. Results revealed that between 26 and 65 percent had no significant symptoms in the initial years after their loss; only 9 to 41 percent did. (The variability results partly from differences in how the symptoms were measured.) And the depression of some may be chronic rather than a reaction to the death.
Psychologist George A. Bonanno of Columbia University and his colleagues examined this possibility and other questions in a prospective study published in 2002. They followed about 1,500 elderly married individuals over several years. During that time 205 subjects lost a spouse, after which the investigators continued to track them for 18 months. Surprisingly, about half of the bereaved spouses experienced no significant depression either before or after the loss. Nor did they display serious distress, although some did feel sad for a short time. Eight percent of the participants were depressed before losing his or her partner—and stayed that way. For about 10 percent—individuals who had reported being very unhappy in their marriage—the death actually brought relief from preexisting depression.
The spouse’s death did precipitate depression in 27 percent. Of these individuals, a substantial proportion (about 11 percent of the total) started improving after six months and became symptom-free within 18 months. The rest of that subgroup did not get better—but even so, more than 70 percent of the study’s participants neither developed depression nor became more depressed as a result of their spouse’s demise. (The small number of remaining subjects fit various other patterns.) These results tell a clear story, at least where an elderly partner is concerned: most people are resilient and do not become seriously depressed or distressed when someone close to them dies.
Working It Out
In her 1980 book The Courage to Grieve, social worker Judy Tatelbaum wrote that after the death of a loved one “we must thoroughly experience all the feelings evoked by our loss,” and if we don’t “problems and symptoms of unsuccessful grief” will occur. The idea that people need to work through grief originated with Sigmund Freud and is still pervasive. It usually includes expressing feelings about the loss, reviewing memories about the deceased and finding meaning in the loss. According to this view, those who do not explore their emotions will suffer the consequences later.
Yet grief work may be unnecessary for the large proportion of people who do not become significantly distraught after a loss. And when researchers have tested the common grief-work techniques of writing or talking about the death, some have found small benefits for the procedures, but most have not. In addition, the jury is still out on grief counseling, in which professionals or peers try to facilitate the working-through process. Results from two quantitative reviews of the efficacy of such therapy found no significant gains from it, and a third found just a modest positive effect. One caveat: the benefits might be slightly greater than these studies indicate because most of the subjects were recruited by the researchers, and these individuals may be less in need of counseling than those who seek help.
Finally, two teams of researchers followed bereaved persons, including spouses, adult children and parents, for up to five years after their loss and found little or no evidence of a delayed grief reaction. When such reactions have been found, they occur only in a very small percentage of the bereaved. Thus, the overall risk of reexperiencing a flood of negative emotions appears to be quite minimal.
Given that most people who have experienced the death of a loved one show few signs of distress or depression, many bereaved individuals may need no particular advice or help. The few who experience intense and lasting despair may benefit from interventions, although traditional grief counseling may not be the best choice. Instead people might consider seeking empirically supported psychotherapies for depression [see “The Best Medicine?” by Hal Arkowitz and Scott O. Lilienfeld; Scientific American Mind, October/November 2007].
That said, our conclusions are based largely on studies of Caucasian American widows and widowers. We cannot say for sure that they extend to people of all ages, ethnicities and genders. In addition, reactions to a loss may depend on a person’s relationship to the deceased—be it a parent, sibling or child—as well as whether the death was sudden, violent or drawn out. The consequences of these varying perspectives and circumstances have yet to be carefully explored.
Nevertheless, we can confidently say that just as people live their lives in vastly different ways, they cope with the death of others in disparate ways, too. Despite what some pop-psychology gurus tell us, grief is not a one-size-fits-all experience