The world of grief is rich in proverbs. “There is no schedule for grief,” is a popular one. Also, “Don’t let anybody tell you how to grieve.” Another you hear quite often is, “Everybody’s grief is different.”
I think all these are valid to some extent. However, my antenna usually go on alert whenever I run across something that large numbers of people repeat without appearing to pay much attention to what they are saying, or questioning whether it’s accurate. To put it another way, if everybody knows something is right, I tend to assume that it’s wrong. At the least, I figure, it’s probably due for a critical reassessment.
So what about “Everybody’s grief is different?” Strictly speaking, this is surely accurate. Everybody and every life is unique, at least arguably. I would add that some useful grief generalizations do exist, however, and these include forbidden concepts such as the well-supported idea that most people get mostly over most losses after about a year. (For more on this see the post How Long? The Evidence on Grief’s Duration.) Useful generalizations aside, it seems reasonable to accept at the same time that every grief experience is, at a fine enough level of detail, unique.
Next question: What makes everybody’s grief different? Why do some survivors never experience more than mild grief? Why are others laid low for months or years? What about the ones completely debilitated by grief for the rest of their lives? What’s different about these cases?
The answer, naturally, is complicated. But there have been a number of attempts to untangle and identify the factors that influence a grief experience. This post looks at a couple of efforts. These lists are not perfect, no doubt, but they appear to be reasonably comprehensive, sensible and supported by empirical evidence. Reading them may help each of us to understand a little more about why we react the way we have. So let’s do it.
Event, Treatment and People Factors
This first look at factors that contribute to grief’s intensity, duration and outcome was put together by well-known psychologist Donald Meichenbaum. It came out in 2016. You can look at the article here. Meichenbaum split 21 factors into three categories: event-related, treatment-related and person-related.
Event-related factors include:
- Was the death by accident, suicide or homicide as opposed to natural by disease?
- Did the survivor find the loved one’s body?
- Did the survivor view the loved one’s body after a violent death?
- Did the death occur at home or in a hospital or other place?
- Was the survivor present when death occurred?
- Where there multiple deaths, contributing to bereavement overload?
- Did an accident or other event connected to the death involve a threat to the survivor’s own life?
Treatment-related factors cover:
- Was the death seen as preventable and occurring as a result of a perceived failure or negligence of medical treatment of the deceased?
- Did the deceased place a burden on caregivers while living?
- What was the financial burden of medical and other expenses?
- Was the survivor dissatisfied with notification of the death?
Person-related factors include:
- Is the survivor female?
- Is the survivor the mother of the deceased?
- Was the deceased a close relative, especially a spouse or child of the survivor?
- Did a surviving spouse have a high pre-loss level of marital dependency?
- Does the survivor have a history of trauma or prior losses?
- Does the survivor have an insecure attachment history?
- Is the survivor’s current physical health compromised?
- Is the survivor practicing self-care behaviors?
- Is the survivor using coping strategies such as optimism, faith, spirituality or religion?
- Does the survivor have a supportive social network and family relationships?
Meichenbaum doesn’t say this, but I think that it is implied that each additional “yes” answer to most of these questions increases risk of complicated or prolonged grief. Numbers 19, 20 and 21 could be the opposite. That is, a “yes” on these might reduce risk. (I added numbering to make it easier to refer to individual ones, as well as editing Meichenbaum’s wording.)
As far as I can tell, I would answer “yes” to five of the 18 risk-raising factors. I’d also answer “yes” to the last three that, I’m thinking, reduce risk. Without being sure exactly what this means, if anything, I am somewhat reassured that I’m not at overwhelming risk of complicated or prolonged grief.
Circumstance, Background, Relationship, Coping and Social Factors
The next set of grief factors is from Robert Neimeyer, the prominent grief researcher and editor of the Grief Studies scholarly journal. You can see the 2017 article here. Neimeyer breaks his roster of risk factors down similarly, using five categories including circumstances of the death, background of the bereaved, relationship to the deceased, coping style and systemic or institutional factors. Here they are:
- Cause of death. Sudden, violent and traumatic deaths by suicide, homicide, and accident tend to generate more intense and complicated grief.
- Event variables. Viewing a body after violent death and poorer quality of death in hospital care lead to worse bereavement outcomes.
Background of the bereaved:
- Females tend to be more susceptible to complicated grief than men, especially for female caregivers and mothers.
- Demographic disadvantage. Survivors with fewer economic resources and less education tend to have more anguished anticipatory grief before death, and more intense grief after the loss.
Relationship to the deceased:
- Death of immediate, first-degree relatives tends to be harder than losses in the extended family or outside the family, especially for bereaved parents and spouses.
- Marital dependency. Bereaved partners who are more psychologically dependent on deceased partners report more anticipatory grief and more grief after a death.
- Caregiver burden. Family caregivers to someone with a progressive, debilitating illness such as cancer and dementia tend to have more grief. Length and intensity of caregiving predicts how much more.
- Attachment style. People with anxious or insecure styles of attachment tend to show more intense and prolonged grief.
- Meaning making. People who struggle to find meaning in a loss are at risk for longer, more intense grief.
Social systemic and institutional factors:
- Social support. Lower perceived family or social support predicts more upset, Likewise poor family communication and perceived criticism.
- Institutional factors. Lack of informational and emotional support in hospitals, emergency departments and hospices can complicate bereavement adjustment.
Neimeyer winds up with 11 types of risk factors (again, I added the numbers.) The major difference with Meichenbaum’s is the addition of meaning-making. Neimeyer’s research has centered on the importance of meaning-making in grief, so that’s not surprising.
I have exposure to three of Neimeyer’s risk factors — numbers 1, 2 and 5. So again it appears I have a modest risk level.
Is Difficult Pre-Loss Caregiving A Risk Factor?
These sets of risk factors seem to suggest that difficult pre-loss caregiving increases risk of prolonged grief. I had the opposite impression. I thought that sometimes lifting the burden of caring for someone helped survivors identify benefits from loss and that helped relieve grief symptoms. But Neimeyer and Meichenbaum say they have empirical support for the validity of these factors, so I guess I’ll go with it for now at least.
If the docs are right, pre-loss caregiving is a possible risk factor for me. In the month or so before Brady died I was totally committed and involved in taking care of him and trying to help him. Five weeks before his death he’d intentionally crashed a car at high speed. He wasn’t hurt, miraculously, but it was clear after this, his first and only suicide attempt before he died, that he and we faced a serious life threat.
During those five weeks, I attended many hours of group, family and individual therapy with and without him. I worked closely and cooperatively with his mother despite the fact that for many years she had made it clear she is no friend of mine. I tirelessly researched therapies on-line and by reading books. I drove him everywhere and anywhere he wanted to go. I tracked him with his phone when I couldn’t be with him. I got up every 90 minutes to check on him all night long when he was staying with me, just like he was a newborn again. And so on.
It was tiring but it never occurred to me it wasn’t worthwhile and then some. This intense caregiving lasted only five weeks, which is not a long time. What may be most significant about it is that my efforts failed and my son died. That is a burden I have yet to figure out how to bear gracefully. Anyway, number 7 could be a risk factor for me.
What All This Might Be Good For
This post is a look at some of the evidence for various risk factors for prolonged and complicated grief. I’m not trying to say that if you have any or many or all these factors (if that’s possible), then you are doomed to endless, debilitating despair. I’m not trying to say that if you have few or none of these factors (again, seems unlikely) then your grief should be brief and mild. I’m trying to give you some insight into why your grief may be different from other people’s, different from what friends and family may expect, and different from what you expected. These factors interact, with some reinforcing others and some possibly shifting or weakening each other.
I’d like to highlight the point that we can control some of these factors. We can’t change what happened to our loved ones. But we can take care of ourselves (Meichenbaum risk factor number 19), use coping strategies like optimism (Meichenbaum number 20), cultivate a supportive social network and family relationships (Meichenbaum number 21) and try to find some meaning in this experience (Neimeyer number 9.)
The basic premise of Grieve Well is that the evidence suggests certain bereavement grief coping strategies are likely to help many of us get through this with shorter and milder symptoms than if we do nothing. With that in mind, I hope this post has given you some ideas about why you feel as you do, and what you can do to feel better. Thanks for liking, commenting, sharing, re-posting and subscribing. I hope you get some peace today.