Psychoanalytic theory:
In psychoanalytic theory, grief work relates to the struggle to sever ties and detach energy
invested in the deceased person, whereas attachment theory is characterized by a response that
many individuals experience when strong affectional bonds are disrupted, for example
attempting to regain a feeling of closeness (Stroebe et al 2004). When death occurs, that
closeness cannot be regained leading to protest and despair. Stroebe (1992) discussed some of
the shortcomings associated with the grief work hypothesis, such as the notion that one has to
confront the experience of bereavement to come to terms with death and avoid detrimental health
consequences, such as sleep disturbance, loss of appetite, absent mindedness and social
withdrawal. Parkes’ (1998) theory of grieving is similar to that described by Bowlby (1973) and
identifies four phases of bereavement. These are: Shock, Yearning and pining, despair and
Recovery. Grief is described as the transition of the bereaved person from ‘incomprehension and
denial, through a distressed state of confrontation with self-reproach.
Death is a situation:
That is frequently encountered by nurses and other healthcare professionals in the course
of their work. It is important that nurses have a good understanding of the reactions and
responses to grief and bereavement so that they are in a better position to support patients, family
members and relatives during the grieving process. Grief is a natural human response to
separation, bereavement or loss, in particular the loss of a loved one. The terms grief, mourning
and bereavement are often used interchangeably, however they have different meanings. Grief
describes an individual’s personal response to loss and has emotional, physical, behavioral,
cognitive, social and spiritual dimensions (Greenstreet 2004). Mourning is the outward and
active expression of that grief. It is through the process of mourning that grief is resolved.
Bereavement refers to the period after loss during which grief and mourning occur. It is the state
of having experienced a loss. Bereavement is a form of depression, which usually resolves
spontaneously over time. The person who is bereaved may experience anxiety, insomnia, inertia,
hyperactivity or a feeling of helplessness.
Bereavement theory:
In recent decades research evidence on the experience of grief has led to a broadening of
attention from the traditional focus on an emotional journey from distress to ‘recovery’. This
article looks at how early stage theories of grief came to be rejected and examines more recent
theories which also consider the cognitive, social, cultural and spiritual dimensions of grief and
loss. It goes on to highlight emerging trends in bereavement theory, potential complications of
grief, and the evidence for the efficacy of grief interventions.
Theory of loss and bereavement:
Since Freud, grieving and mourning have been conceived as the processes where by the
bereaved person adjusts to the reality of their loss, enabling them to disengage from the deceased
and reinvest in new relationships.
John Bowlb’s attachment theory:
Bowlby’s (1973) theory of attachment emphasizes the importance of human attachments
and bonds that are developed early in life. Grief evolves through a sequence of four overlapping,
flexible phases. These are: Shock, Yearning and protest, Despair, Recovery
It provides an explanation for the common human need to form strong affectional bonds with
other people and the emotional distress or reactions caused by the involuntary severing of these
bonds and loss of attachments. Bowlby (1973) relied on childhood experiences to explain
bereavement reactions in adulthood. He viewed attachment as a mutual relationship, occurring as
a result of long-term interactions, which starts in infancy between a child and his or her parents
and later between adults. These bonds and attachments remain active throughout the life cycle.
Bowlby believed that there are four distinguishing characteristics of attachment:
Proximity Maintenance - The desire to be near the people we are attached to.
Safe Haven- Returning to the attachment for comfort and safety in the face of fear or threat.
Secure Base- The attachment figure acts as a base of security from which the child can explore
the surrounding environment
Separation Distress- Anxiety that occurs in the absence of the attachment figure.
The theory implies a cause-effect relationship between early attachment
Patterns and later reactions to bereavement, arguing that ‘whether an individual exhibits a
healthy or problematic pattern of grief following separation depends on the way his or her
attachment system has become organized over the course of development.
References:
Bowlby J (1973)Attachment and Loss: Separation, Anxiety and Anger. Volume II. Hogarth
Bonanno, G. A., & Kaltman, S. (1999). Toward an integrative perspective on
bereavement. Psychological Bulletin, 125, 760–786.
Freud S (1961) Mourning and Melancholia. In Strachy J (Ed) The Complete Psychological
Works. Standard edition, Hogarth Press.
Boerner, K., & Schulz, R. (2009). Caregiving, bereavement, and complicated
grief. Bereavement Care, 28(3), 10–13. doi:10.1080/02682620903355382.
Kubler-Ross E (1969) On Death and Dying, Macmillan, New York NY Parkes CM (1998)
Bereavement. Studies of grief in adult life 3rd (Ed) Penguin publishers.
