Toward an Integrative Perspective on Bereavement

Abstract

For nearly a century, bereavement theorists have assumed that recovery from loss requires a period of grief work in which the ultimate goal is the severing of the attachment bond to the deceased. Reviews appearing in the 1980s noted a surprising absence of empirical support for this view, thus leaving the bereavement field without a guiding theoretical base. In this article, the authors consider alternative perspectives on bereavement that are based on cognitive stress theory, attachment theory, the social–functional account of emotion, and trauma theory. They then elaborate on the most promising features of each theory in an attempt to develop an integrative framework to guide future research. The authors elucidate 4 fundamental components of the grieving process—context, meaning, representations of the lost relationship, and coping and emotion-regulation processes—and suggest ways in which these components may interact over the course of bereavement.

Full text

Psychological Bulletin
1999, Vol. 125,
No. 6,
760-776
-an
Psychological
Association, Inc.
0033-2909/99/S3.00
Toward
an
Integrative Perspective
on
Bereavement
George
A.
Bonanno
and
Stacey
Kaltman
Catholic University
of
America
For
nearly
a
century, bereavement theorists have
assumed
that recovery
from
loss requires
a
period
of
grief
work
in
which
the
ultimate goal
is the
severing
of the
attachment bond
to the
deceased. Reviews
appearing
in the
1980s noted
a
surprising
absence
of
empirical support
for
this
view,
thus leaving
the
bereavement
field
without
a
guiding theoretical base.
In
this article,
the
authors consider alternative
perspectives
on
bereavement that
are
based
on
cognitive
stress
theory, attachment theory,
the
social-
functional
account
of
emotion,
and
trauma theory. They
then
elaborate
on the
most promising features
of
each theory
in an
attempt
to
develop
an
integrative
framework
to
guide
future
research.
The
authors
elucidate
4
fundamental
components
of the
grieving
process—context,
meaning, representations
of the
lost
relationship,
and
coping
and
emotion-regulation
processes—and
suggest
ways
in
which
these
components
may
interact over
the
course
of
bereavement.
The
death
of a
loved
one is a
ubiquitous human experience;
most
people,
at
some point
in
their lives, must confront
the
inevitable,
and in
many cases enduring, pain
of
interpersonal loss.
Over
the
past century,
a
considerable body
of
literature
has
been
generated
to
describe
the
phenomenology
of the
grieving
process
and
the
methods
by
which
people might best cope with loss. Much
of
this literature owes
a
debt
to
Freud's (1917/1957) seminal
article,
"Mourning
and
Melancholia,"
in
which
he
described
the
"work
of
mourning"
as
that
of
severing "attachment
to the
non-
existent
object"
(p.
166).
In
normal mourning, according
to
Freud,
this
work takes
the
form
of
repeated "reality testing," which
gradually
allows
the ego to
free
its
investment
in the
"lost
object"
(p.
163). Complicated
or
"pathological"
mourning
was
seen
as
arising
out of
intense
ambivalence
that
impeded
this detachment
process.
Although Freud proposed these ideas with caution
and
was
concerned
primarily
with
the
etiology
of
depression rather
than
grief,
his
views have dominated
the
bereavement literature
over much
of the
past century.
In
recent years,
the
bereavement
field
has
witnessed consider-
able conceptual
and
empirical
ferment
(Bonanno, 1999b).
To
some
extent,
this change
may be
attributed
to the
rapid
influx
of new
ideas
and
research
on the
general nature
of
stress
and
trauma
reactions.
However, much
of the
impetus
has
come
from within
the
bereavement
field
itself.
W.
Stroebe
and
Stroebe (1987)
first
called
attention
to the
fact
that, despite
the
widespread endorsement
of
the
grief work view
of
mourning
in the
literature, there
was
little
in
the way of
solid empirical evidence
for
such
an
approach. This
stance
was
repeated more strongly several years later
in
Wortman
and
Silver's (1989)
highly
influential
critique, "The
Myths
of
George
A.
Bonanno
and
Stacey
Kaltman,
Department
of
Psychology,
Catholic
University
of
America.
This article
was
supported
in
part
by
Grant 1-R29-MH57274-01
from
the
National
Institute
of
Mental Health.
Correspondence concerning
this
article should
be
addressed
to
George
A.
Bonanno,
who is now at the
Department
of
Counseling
and
Clinical
Psychology, Teachers College, Columbia University,
Box
218,
525
West
120th
Street,
New
York,
New
York 10027. Electronic mail
may be
sent
to
gbab38@columbia.edu.
Coping With
Loss."
Although these challenges have
not
been
without
controversy (cf.
M. S.
Stroebe,
van den
Bout,
&
Schut,
1994), reviewers have increasingly acknowledged
the
limitations
of
the
grief work approach (Bonanno,
1998,
1999a;
Bonanno
&
Siddique, 1999;
M. S.
Stroebe, 1992;
M. S.
Stroebe
&
Stroebe,
1991).
As a
result,
a
considerable body
of new
bereavement
research
has
been generated, guided primarily
by
theoretical per-
spectives that were originally developed
to
explain other psycho-
logical phenomena (e.g., emotions, attachment, etc.).
In
the
present article,
we
evaluate
the
grief work approach
as
well
as
evidence relevant
to
application
of the
cognitive stress
perspective, attachment theory, social-functional accounts
of
emo-
tion,
and the
trauma perspective
to
bereavement.
We
then
elabo-
rate
on the
most relevant
theoretical
features from
these
ap-
proaches
in an
attempt
to
develop
an
integrative framework
to
guide subsequent bereavement research
and
theory. Specifically,
we
elucidate
four
primary aspects
of the
grieving
process—the
context
of the
loss,
the
continuum
of
subjective meanings
associ-
ated
with
the
loss,
the
changing representation
of the
lost relation-
ship,
and the
role
of
coping
and
emotion-regulation
processes—
and
consider
how
these
different
aspects
may
interact with each
other over
the
course
of
grieving.
Methodological
Considerations
in
Bereavement
Research
Before
we
begin this analysis,
two
methodological issues war-
rant
consideration. First, bereavement researchers have used both
cross-sectional
and
longitudinal designs. Cross-sectional designs
do not
allow
for
examination
of
predictor variables
but
have
proved
useful
in
identifying
the
phenomenological features
and
correlates
of
grieving
at
different
points
in the
mourning
process.
Longitudinal
designs,
on the
other hand,
are
limited
by the
mini-
mal
amount
of
experimental control they
afford,
but do
allow
for
prospective assessment
of
predictor variables
and
generally
offer
increased ecological validity.
In
addition, longitudinal designs
make
it
possible
for
researchers
to
address
a
number
of
different
empirical questions
from
the
same data set. This practice offers
the
advantage
of
multidimensional assessments (Bonanno, 1998,
1999b; Zisook
&
Shuchter,
1993)
but
also increases
the
likelihood
760
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