The psychological study of grief is often traced to Freud’s 1917 influential essay, Mourning and Melancholia (1957). In his essay, Freud attempted to differentiate grief from depression—still a source of dissention as the recent controversy over the removal of the “bereavement exclusion” from Major Depressive Disorders in the DSM-5 indicates. Freud developed the notion that in mourning one must work through powerful feelings in order to detach from the deceased, reinvest in life, and recover from and resolve the loss.
A second strong influence was the work of Elisabeth Kübler-Ross. Since the publication of Kübler-Ross’ On Death and Dying (1969), her stage theory has dominated popular thinking about the ways individuals grieve. While both Freud and Kübler-Ross’ work had great heuristic value – spurring interest in the emerging field of thanatology, that is the study of death—much research since then has dramatically changed our understandings of both the grieving process.
In the past two decades, understandings of the grief process have changed in a number of significant ways. These include:
1. Extending the understanding of grief from reaction to a death of a family member to a more inclusive understanding of loss that acknowledges we grieve many types of losses. These may include the loss of possession, positions, pets, or relationships—such as divorce. We may even become attached to people we never met, such as celebrities or political leaders –and grieve their deaths or even other losses;
2. Viewing grief reactions as universal stages to a recognition of personal pathways. That is that we no longer see individuals progressing through stages as they respond to loss but understand that grief reactions will be as unique and individual as fingerprints;
3. Seeing grief as affect to recognizing the multiple and multifaceted reactions that persons have toward loss including physical reactions, cognitive responses , changes in behavior, and spiritual distress, as well as the ways that responses to grief are influenced by development, culture, gender, and spirituality;
4. Coping passively with loss to seeing the possibilities of transformation and growth in grief. Here we understand that grief can be a transforming process where—however painful—individuals may experience significant post-traumatic growth.
5. Relinquishing ties to revising and renewing relationships—that is recognizing that even as we mourn, we never sever a relationship with the object lost but instead retain a continuing bond;
6. Seeing grief as simply a normal transitional issue to recognizing more complicated variants and the necessity for careful assessment. The DSM-5 acknowledges some of these variants in changes to Adjustment Disorders, Separation Anxiety Disorder, and Major Depressive Disorders. In addition, it notes Persistent Complex Bereavement Disorder as a condition for further study. It is likely that as research continues, other forms of complicated grief may be included.
While much has changed and continues to change about our understandings of grief, many psychologists and counselors may still operate from these older models or unsupported assumptions. Ethical practice mandates currency in major areas. It is hoped that this blog will offer a continued conversation about new research and innovative interventions that that are altering how we understand grief, how we counsel bereaved clients, and even how we cope with our own losses.
References
Freud, S. (1957) Mourning and melancholia. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 14, pp. 273-300). London: Hogarth. (originally published 1917).
Kübler-Ross, E. (1969). On Death and Dying. New York: Macmillan.
Kenneth J. Doka, PhD
Professor, The College of New Rochelle
Senior Consultant, The Hospice Foundation of America
Author, Grief is a Journey: Finding Your Path through Loss
