Mourning

The term mourning is probably the single most inconsistently used term in thanatology. Traditionally it has been used to refer to the cultural and/or public display of grief through one's behaviors. This usage focuses on mourning as a vehicle for social communication. In this regard, mourning can pertain at various times to specific rituals, particular outward signs (e.g., black clothes or an arm-band), the identification of who is to be recognized as bereaved, and a specified time period during which signs of grief can be shown. However, the term has been assigned other meanings that contribute to its being used interchangeably with the terms "grief" and "bereavement" to denote personal and subjective responses to loss. As yet there is no total consensus on the use of the term; however, in this essay mourning is discussed as a distinct phenomenon that is stimulated by the experience of loss (i.e., bereavement). While it encompasses "acute grief," it includes and implies substantially more than that experience.

Conceptual Development

Theories of mourning have changed significantly over time. Initially psychoanalytic conceptualizations held sway. There was particularly strong, early input from Sigmund Freud, whose oft-quoted 1917 paper "Mourning and Melancholia" tends to be cited by scholars erroneously as the first work on the topic. (Among others, there was Karl Abraham's 1911 paper on the treatment of manic depression and allied conditions, which partially prompted Freud's classic paper.) Later substantial psychoanalytic refinement was provided by Erich Lindemann, whose 1944 paper "Symptomatology and Management of Acute Grief" shared with Freud's particular prominence as a basis for later observers's comparisons, agreements, and disagreements. Coming originally out of the psychoanalytic school, John Bowlby, the chief architect of attachment theory, then incorporated the philosophical tenets of that theory into the theory of mourning a number of publications during the 1960s through 1980s. Bowlby dispensed with abstract and unverifiable psychoanalytic concepts and incorporated principles from ethology, control theory, and cognitive psychology. Early-twenty-first-century thanatologists hold views that are strongly influenced, at least in large part, by attachment theory. This makes it the predominant, although not exclusive, perspective from which mourning is currently explained. While Bowlby's protégé, Colin Murray Parkes, has continued to expand understanding of mourning in numerous ways along attachment dimensions, he also has promoted the concept of psychosocial transitions that has been well incorporated into contemporary mourning theory.

Concepts from three theoretically and clinically related domains are being incorporated into the thinking about mourning. Each has generated a number of important implications about mourning, selected examples of which are noted herein.

From the generic psychological arena of stress, coping, and adaptation theory comes the notions that mourning involves more than merely reacting to loss, but active attempts to contend with it; that the individual's cognitive appraisal of the loss, its implications, and one's coping attempts is a critical factor determining response and accounting for its idiosyncrasy; and that successful outcome of mourning appears to require both problem- and emotion-focused coping.

Out of the realm of traumatic stress and victimization theories are being adopted into scientific understanding of mourning the ideas that assumptive world revision is necessary after major loss; that acute grief is a form of traumatic stress reaction; and that posttraumatic growth is possible as a positive consequence of loss.

From the province of cognitive theory, particularly constructivism, stems the belief that much of the painfulness of bereavement comes from disruption of the mourner's personal construct system caused by the death; the expectation that personal meaning reconstruction is at the heart of mourning; and the realization that there is traditionally an insufficient appreciation of cognitive processes in bereavement due to relative overfocus upon affective processing and failure to comprehend the two main sets of cognitive processes (i.e., the mourner's learning about the reality and implications of the loved one's death, and the mourner's transforming to incorporate the changes necessitated by the death).

Eight specific bereavement-related notions are also becoming assimilated into contemporary understanding of mourning:

1. Mourning does not necessarily proceed in invariant sequences; staged-based models of mourning are inaccurate in implying that all mourners undergo the same processes in the same order.
2. Continued connections to the deceased are not necessarily pathological and, if appropriate, can be therapeutic.
3. People do not necessarily "get over" major loss, but learn to live with it, with struggles to do so persisting far longer than previously thought.
4. Routinely suggesting professional intervention for all mourners can be harmful; it tends only to be regularly needed by bereaved persons who are at high risk.
5. There is no one way to respond to loss; Western mental health has been biased in favor of emotional expressiveness and this has been harmful to people with other styles.
6. Mourning and meaning making occur not only on an intrapersonal individual level, but also on an interpersonal familial/social level.
7. Mourning can become complicated; this need not automatically suggest pathology on the mourner's part, but may be due to other factors (e.g., circumstances of the death, the role of the deceased, and availability of support, among others).
8. Mourning is culturally relative.

Taken together, these associated concepts and specific bereavement-related notions have significantly broadened and deepened the comprehension of mourning, and enhanced appreciation of the complex challenges and experiences that it brings to mourners.

Mourning and Grief: Definitions and Distinctions

To comprehend mourning, it is necessary first to understand its distinctions from and relationship to grief. There is much to be gained by distinguishing between acute grief reactions to loss and the psychosocial labors of mourning undertaken over time to live with that loss. To assert that they are the same disregards two very different sets of experiences and demands, and seriously compromises bereavement intervention and research efforts. This discussion is predicated upon Therese A. Rando's 1993 model of mourning, which was developed specifically in relation to Western society. Consistent with the action-oriented nature of mourning, aprocess rather than content focus is maintained in this discussion.

Grief refers to the process of experiencing the psychological, behavioral, social, and physical reactions to the perception of loss. A grief response expresses one or a combination of four things: (1) the mourner's feelings about the loss and the deprivation it causes (e.g., sorrow, depression, guilt); (2) the mourner's protest at the loss and wish to undo it and have it not be true (e.g., anger, searching, preoccupation with the deceased); (3) the effects caused by the assault on the mourner as a result of the loss (e.g., traumatic stress, disorganization, physical symptoms); and (4) the mourner's personal actions stimulated by any of the previous three (e.g., crying, social withdrawal, increased use of medication or psychoactive substances).

However, the ultimate goal in contending with any major loss is for the individual experiencing it to be able to recognize that the loved one truly is gone and to make the necessary internal (psychological) and external (behavioral and social) changes to incorporate that loss into his or her ongoing life. Grief in itself cannot accomplish what is required to reach this goal. As solely a complex set of passive reactions to the loss, it fails to take the individual far enough.

Accommodation suggests an adaptation to make room for a particular circumstance. Clinical experience suggests that it is to be preferred over the term resolution, which insinuates a once-andfor-all closure that typically is not achieved—or even desirable—after the death of a dearly loved one. The bereaved must make a series of readjustments to cope with, compensate for, and adapt to the absence of what has been lost physically and/or psychosocially. Failure to make the proper adaptations and re-orientations necessitated by the loss leaves the survivor related inappropriately to the lost person and the now-defunct old world.

For these reasons, grief is a necessary, but not sufficient, condition to come to successful accommodation of a loss. Grief is to mourning like infancy is to childhood: It is the beginning, but not the entire course, of events. However, it is pivotal because without the experiences and learning provided by acute grief—where the mourner confronts and is taught the reality of the loss and the need for the mourner to change is made clear—the rest of mourning cannot take place.

Mourning, then, encompasses much more than grief, which starts it off. It refers as well to the consequent conscious and unconscious processes and courses of action that promote three operations, each with its own particular focus, that enable the individual ultimately to accommodate the loss. The first operation promoted by mourning is the undoing of the psychosocial ties that had bound the mourner to the loved one when that person was alive, with the eventual facilitation of new ties appropriate to that person's now being physically dead. The focus is internal, upon the mourner's readjustment vis-à-vis the deceased. In the second operation, mourning processes help the mourner to adapt to the loss. The focus again is internal, upon the self and the making of revisions in one's assumptive world and one's identity insofar as the loss invalidates certain of one's assumptive world elements and aspects of one's previous identity. The third operation promoted by mourning helps the mourner learn how to live healthily in the new world without the deceased. Here, the focus is external, upon the physical and social world as the mourner attempts to move adaptively into it without the loved one through the adoption of new ways of being in that world and reinvestment in it.

Uncomplicated reactions of acute grief may last many months and in some cases even longer. In contrast, because of its myriad aspects and demands, uncomplicated mourning can last a number of years, long after acute grief is spent. In fact, it lasts forever for many people, as there often is revisiting and reworking of major loss over time. This does not necessarily mean that the individual is in acute grief all that time (that would be considered pathological), nor that the reality of the loss and its implications were not fully comprehended earlier on. It merely speaks to the ongoing nature of living with major loss.

The distinction between grief and mourning is crucial not only to the maintenance of appropriate expectations for mourners, but also for helping them cope. Many individuals assist the bereaved with the beginning processes of acute grief by enabling their reactions to the loss, but do not assist sufficiently, if at all, with the important latter processes of readjustment. Consequently, mourners are frequently left alone to reshape themselves and their world after the loss of a loved one, and suffer additionally as a result.

Requirements for Healthy Mourning

For healthy mourning to take place, a number of actions must be undertaken. These vary depending upon the model utilized, yet there is remarkable overlap. According to Rando, there are six specific "R" processes that must be completed successfully by the individual in order for the three reorientations—in relation to the deceased, self, and external world—of healthy mourning to occur.

1. Recognize the loss. Recognizing the loss involves acknowledging the reality of the death and understanding what caused it.
2. React to the separation. This process involves experiencing the pain; and feeling, identifying, accepting, and giving some form of expression to all the psychological reactions to the loss. It also involves identifying and mourning the secondary losses that are brought about by the death.
3. Recollect and reexperience the deceased and the relationship. Healthy mourning involves reviewing and remembering realistically, with reviving and reexperiencing being the associated feelings.
4. Relinquish the old attachments to the deceased and the old assumptive world.
5. Readjust to move adaptively into the new world without forgetting the old. This process, involves revising the assumptive world, developing a new relationship with the deceased, adopting new ways of being in the world, and forming a new identity.
6. Reinvest. The emotional energy once invested in the relationship with the deceased eventually must be reinvested into other people, objects, pursuits, and so forth in order that emotional gratification can be received by the mourner.

Each person undertakes these processes (or not) in his or her own fashion and to his or her own depth. This is because each individual's mourning is determined by a constellation of thirty-seven sets of factors that renders the mourner's response as unique as his or her fingerprint. To be able to understand any mourner adequately, one must know the factors circumscribing the particular loss of that individual at that precise point in time. Aresponse that is perfectly appropriate for one person in one set of circumstances may be pathological for another person in those circumstances or for the same person under different circumstances. These factors cluster under three main areas: (1) psychological factors, which are subdivided into characteristics pertaining to the nature and meaning of the specific loss, the mourner, and the death; (2) social factors; and (3) physiological factors.

Duration and Course of Mourning

There is no general time frame for the length of mourning, it is dependent upon the unique constellation of factors associated with the mourner's particular bereavement. It is important to differentiate between the duration of acute grief and of mourning. The former may be very time limited; whereas the latter, technically, can go on forever in some ways. Contrary to the myth that mourning declines linearly over time, its course often fluctuates significantly. Fluctuations occur over both the short (e.g., hourly basis) and long (e.g., a period of months or more) terms. Different types of losses are associated with diverse patterns of fluctuations (e.g., sudden death, parental loss of a child).

Even long after a death has occurred and acute grief has subsided, a wide variety of circumstances can produce within the mourner subsequent temporary upsurges of grief (STUG) reactions. These are brief periods of acute grief for the loss of a loved one that are catalyzed by a precipitant that underscores the absence of the deceased or resurrects memories of the death, the loved one, or feelings about the loss. Although such reactions previously have been inappropriately construed as being pathological, they typically are a normal part of uncomplicated mourning. This is not to say that they cannot be a manifestation of some problem, only that they are not necessarily so. There are fourteen types of STUG precipitants. These are classified under the three categories of cyclic precipitants (i.e., experiences that occur repeatedly over time), linear precipitants (i.e., experiences that are one-time occurrences), and stimulus-cued precipitants (i.e., those that involve stimuli unrelated to time).

Mourning in a Changing Sociocultural Milieu

Any person's mourning is powerfully influenced by the sociocultural context within which it occurs. This affects all manner of factors circumscribing an individual's mourning—from the type of loss that transpires to the reactions exhibited; from the meaning of that loss to the characteristics of the mourner and the types of support received or not.

Twentieth-century sociocultural and technological trends in Western society have significantly increased the prevalence of complicated mourning by causing a rise in virtually all of the seven high-risk factors predisposing to complicated mourning. The trends that have contributed most substantially to this include, among others, urbanization, technicalization, secularization, deritualization, increased social mobility, social reorganization, multiculturalism, escalating violence, wide economic disparity, medical advances, and contemporary political realities.

On the other hand, improved, and improving, bereavement research is providing more accurate information, pointing the way to primary prevention on personal and social levels and to a spectrum of interventions for bereaved persons at all degrees of risk. Socially, bereavement is more accurately understood and more visible as a legitimate topic for discussion than ever before; nevertheless, there remains significant room—and need—for improvement in these areas.

See also: Grief ; Grief and Mourning in Cross-Cultural Perspective ; Thanatology

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THERESE A. RANDO