Two Models for Understanding Grief

Introduction to Grief and Loss

‘Death is a universal phenomenon, it comes to all of us and when it comes it is final’ (Early 2004, p.12). To a certain degree there is no amount of preparing for the impact a loved one’s death will have on an individual; no amount of organising or understanding noticeably lessens its effects.

‘Bereavement is a turning point in personal development, a psycho-social transition that carries an increased risk to physical and mental health’ (Worden 1983, p. ix), wherein the passage is one of the most severe and painful journeys a person can embark on. There are not many options in the wake of bereavement; deny its reality or consciously find a way to get through it; commonly termed mourning.

However having some understanding as to what this entails, what can be expected and how to support oneself through it can reduce the fear of feeling that there will be no surviving it or that one will lose one’s mind in the meantime. Certainly, each of us will take our own unique path, steering our way through each particular landmark as we go, to eventually arrive at our chosen destination but there are also common threads through the process of mourning that gently signpost each new piece of territory entered into; offering a normalising to what can be experienced as very frightening.

Two Models of Grief; Rando and Murray Parkes

Therese Rando’s Six ‘R’ Processes and Colin Murray Parke’s Four Phases are both models of bereavement in adults which show respectively their developments from earlier models within the field of thanatology, in which the ultimate objective is a completion of the task of mourning in favour of an equilibrium being re-established. Both of these models can serve as topographical maps that reveal the landscape of grief’s highs and lows.

In the first section of this paper I will consider each of these models individually. The second section will compare the nature of the two models in which both parallels and contrast can be found. Finally I will conclude on what has been explored in the preceding pages.

The Six ‘R’ Processes by Rando

Therese A. Rando promoted the Six ‘R’ Processes within three phases of mourning; avoidance phase, confrontation phase and accommodation phase, which are essential in order for there to be a healthy and satisfactory conclusion to grief and mourning.

Avoidance Phase:
1. Recognise the loss.This is done through ;

•  Acknowledging the death by recognising on a cognitive level that the death has happened, entailing an admitting and dispensation of the reality. This occurs through the continual meeting of the non presence of the deceased. Affirming to and perceiving that the loss is permanent avoids there being a mummification of the deceased, allowing for the person to commence their journey of grieving. This is similar to Worden’s (1983, p.29) first task of mourning in which the ‘coming to an acceptance of the reality of the loss takes time since it involves not only an intellectual acceptance but also an emotional one.’ If this does not take place ‘the mourner lacks the pivotal stimulus to catalyse mourning’ (Rando 1993, p.393).
• Understanding the death through having awareness as to how the death took place; the conditions and circumstances relating to it. Establishing the why, how and cause of death contributes to fully comprehending the fact. ‘The death of a loved one must make logical sense if the mourner is to cope with and readjust well to it’ (Rando 1993, p.398).

Confrontation Phase:

2. React to the separation. This encompasses;

• Experiencing the pain of the severance and the nuances of the process of mourning, felt on a physical, behavioural, social, spiritual, psychological, emotional and sexual realm. To the degree that the mourner authorises themselves permission to experience and express these reactions aptly, healthy mourning can take place.
• Feel, distinguish, accept and express the psychological responses to the bereavement, whether positive, negative or ambivalent. This entails consciously managing the range of felt emotional reactions, discriminating each one separately, mentally comprehending their significance and seeking out possibilities that permit the suitable expression of these experiences. Failure to do this ‘leaves mourning incomplete and consequently complicated’ (Rando 1993, p.404).
• Recognise and grieve the secondary losses which can relate to a loss of unmet needs, desires, hopes, dreams, expectations, status, suppositions and fantasies, understood as the assumptive world of the bereft. ‘When we understand the void that has been left, we can go about the business of redefining ourselves’ (Noel 2004, p.118). Included in this are the other offerings that the mourner experienced from the deceased such as fulfilment, acknowledgement, satisfaction, relating and fortification; ‘the sum of all of the losses associated with this death’ (Rando 1993, p.411).

3. Recollect and re-experience the deceased and the relationship
The outcome is a reformation of the relationship from one of company to one of remembrance which is the conclusion of;

• Reassessing and realistically recollecting the entire aspects of the relationship with the lost one; the framework surrounding its formation to begin with, the good and bad features of the relationship and the person, the expectations and the accompanying feelings that were attached to each of these experiences linked to the deceased. This leads to ‘the development of a realistic composite image of the deceased’ (Rando 1993, p.415), thereby allowing the mourner to distinguish the responses that need to be worked through so that the emotional tie and investment in the deceased can be revised and modified.
• Revive and experience the feelings because ‘the ties binding the mourner to the deceased must be untied’ (Rando 1993, p.49). Distinctively, this denotes the mourner re-enlivening and experiencing all the exchanges, moments, cognitions, emotions, responses, wants, expectations and beliefs and the feelings that are correlated with them, that are attached to the relationship to the deceased, ultimately resulting in an ongoing diffusion of the emotional force associated with it and a reduction in intensity of affect. In due course there is a renouncing of old attachments and readjustment to progress and acclimatise to a new way of living, without forgetting the past.

4. Relinquish the old attachments to the deceased and the old assumptive world ;

• The assumptive world can be comprehended as structured cognitions covering all that a person believes to be accurate about themselves and their world, based on past experiences. The crucial elements of the assumptive world are the philosophical, spiritual, religious and existential concerns, with two forms of assumptions existing: specific and global. Specific assumptions directly concern the mourner’s personal expectations and beliefs connected to the deceased, e.g. she will never leave me. While the global assumptions relate to life in general and the people in the world, e.g. bad things only happen to others. In being able to relinquish what was once held to be the total truth of the matter the mourner can be understood to be searching for and replacing their old assumptions with other suppositions or beliefs that can restructure and re-clarify the world that they are still a part of.

Accommodation Phase:

5. Readjust to move adaptively into the new world without forgetting the old.The order of this is to;

• Revise the assumptive world through differentiating what assumptions need to be renounced, altered, maintained and if any, which ones need to be added and the reasons for that. The mourner’s goal is to acquire an understanding about what they have lost or gained within, encompassing how they behave, think and feel. It is necessary that this revising of the assumptive world also mirror the new realities that are an exact outcome to the deceased’s passing e.g. I have no one to call my ‘best friend’ now. In doing so the person can begin to notice and experience themselves in a new way; ‘closely related to success in integrating a new self-image’ (Rando 1993, P.448).
• Develop a new relationship with the deceased, where what follows is an adaptive moving towards ‘choosing life-promoting rather than death-denying reminiscences’ (Rando 1993, p.438). In doing so the person attends to or lets go of their needs that were previously satisfied by the deceased and adjoins, surrenders or amends facets of her life to absorb the exact losses that the death conveys. The mourner surrenders the definite love of an individual who is in attendance physically and exchanges it for the non-figurative love for a missing loved one. This process of re-developing the relationship with the deceased concerns ‘keeping the person alive in memory without interfering with her mourning or progress in life’ (Rando 1993, p.57). This is indicative in carrying on the principles, beliefs and teachings of the deceased that was learned through having once had a relationship with them. Worden (2005) described this as ‘relocating’.
• Adopt new ways of being in the world that replace and recompense in the absence of the   loved one. The mourner finds other means in which her needs are satisfied or alters these desires that mirror the truth of the deceased not being present. This redefining is in the hope that the rebound will be an advantage to the survivor.
• Form a new identity that incorporates the loss of identity that was once connected to the deceased, the part that was us but is now me. This compensation can take the form of a gaining of new abilities, constitute a loss of aspirations or it can result in an amalgamation of different aspects of experience.

6. Reinvest
This undertaking permits that the mourner withdraws and re-invests the emotional energy that was bestowed in the relationship with the deceased. This re-directing warrants it being reciprocated and ‘can connect the mourner with new people, objects, activities…that can provide emotional gratification to compensate for that which was lost’ (Rando 1993, p.449).

The Four Phases of Grief by Murray Parkes

Similar to the phases that Bowlby (1980) proposes a mourner must traverse many stages before mourning is wholly resolved, Colin Murray Parke’s developed a description of what he proposed as the four phases of mourning with associated feelings;

1. Numbness

• This describes the mourner experiencing a sense of there being an unreality; an anesthetising effect resulting in an impression of depersonalisation and alienation. ‘This denial of the existence of feeling is a way of separating and thus ‘protecting’ ourselves from too frightening or too painful feeling’ (Lendrum & Syme 1992, p.10-11). The individual can appear disbelieving and stunned in which there can be impaired judgement and functioning. Emotions for a time are frozen, blunted or cut off with all of the above been seen to ebb and flow as the individual warms up to the reality of having been bereaved. ‘In denying the reality of the loss they provide themselves with the opportunity to prepare for it’ (Parkes 1972, p.92).

2. Yearning and Searching

• The grieving person in pining tries to recover the lost person, experienced alongside episodes of ‘pangs’ in which there is ‘severe anxiety and psychological pain’ (Parkes 1972, p.60). This is a functional venture that is an attempt to reduce the pain associated with there being no possibility of turning back time. This manifests through feelings of anger, searching, guilt, reminiscence, restlessness and ambiguity. ‘Anger can be closely associated with restlessness and tension’ (Parkes 1972, p.98). The restless activity that can be noted in the bereaved person can be understood as a searching in which the person goes in the direction of potential places of a lost object. ‘The pain of mourning is clearly regarded as an unavoidable accomplishment of the persistent and insatiable yearning for the lost object’ (Bowlby 1961, p323). Preoccupation even through dreaming about the lost person and events surrounding their death both before and after is also a common feature of this phase because ‘maintaining a clear visual memory of lost people facilitates the search by making it more likely that they will be located’ (Parkes 1972, p.69). This phase contributes to the person coming to terms with the loss and letting go.

3. Disorganisation and Despair

• Waxing and waning; this phase is associated with the individual experiencing depression, anxiety, loneliness, fear, ambivalence, hopelessness, guilt, helplessness and unfamiliarity; of being lost, confused and full of desolation, ‘a period of uncertainty, aimlessness, and apathy’ (Parkes 1972, p. 111).

4. Reorganisation

• This is identified in there being an absorption and incorporation of the loss, ensuing in a redefining of life and the implications attached to life without the loved one. This characterises an evident repositioning from the phase of disorganisation and despair. There is development of a renewed individuality and a reclassification of the individual’s sense of identity in which there is an acceptance, accompanied by relief. ‘Besides assuming a new identity, it is necessary to give up the old’ (Parkes 1972, p.111). This is denoted in an increase of energy, enhanced decision making and a growing self confidence. It is an occasion of recognition, a time when reality in brought into focus in which although there is never a getting over the death, there is a getting through it.

The Similarities and Differences between the Two Models

Rando’s and Parke’s models are similar in many respects; they both claim that the objective of mourning involves a form of integration of the loss experienced and a processing that leads to adaptation. Each model indicates there being an adaptation from disorganisation to a reorganisation, both of which indicate the importance of there being a conscious engagement with affect.  The last process/phase in each model implies a type of action consistent with the implication of mourning being an active process. Worden’s (1983) depiction of the word ‘tasks’ suitably describes this.

The differences lie in Rando’s model affording an extensive understanding of the engagement in mourning in which there is a wide circumference of effects and affects whereas Parke’s hypothesis is more specific in his naming of particular responses associated with each phase, exclusively focusing on feelings.  Rando states that responses and experiences are not linear and can at times be cyclical and alternating; ‘the sequence is not invariant’ (Rando 1993, p.44),  akin in what Strobe & Schut (1999) distinguishes as being an oscillation between loss-oriented versus restoration-oriented stressors that are a consequence of bereavement.

Loss-oriented being effectively about the feeling aspect of the process and restoration-oriented as being the concentrating on new tasks and the growth of new abilities to be able to manage significant life changes that are an outcome of the death of a significant other. Whereas Parkes declares that it is a succession of phases that blend into and replace one another, ‘how numbness, the first stage , gives place to pining, and pining to disorganisation and despair, and it is only after the stage of disorganisation that recovery occurs’ (Parkes 1972, p.27).

Rando’s use of the word processes encompasses more of the sense ascertained in the term ‘grief work’ which allows the bereaved to come to a full acceptance of their loss, whereas Parke’s use of the word  phase implies a certain compliance that propels the person towards an ending. The term ‘processes’ allow for there to be an understanding as to where the mourner is at, particularly so if an intervention is called for, whereas the term ‘phases’ suggests a timescale and supposes attention being placed on outcomes rather than sequences. There are more complexities than it being a series of processes or phases. Neither models placed emphasis on the adaptive and non-adaptive coping behaviours of the mourner as highlighted by Strobe & Schut (1999).

Conclusion

As I have shown Rando’s Six ‘R’ Process model advocates that there is an incorporation of identity connected to experiences in relation to the deceased with the new identity that the mourner forms. This is in keeping with what Klass et all (2003) have written extensively on; ‘continuing bonds’. For Parke’s however, there is no such implying that it is appropriate to stay attached in some shape or form to the deceased, which clearly we do; we carry the experience of having shared a part f our lives with the person whether we consciously connect with it or not.

While there is beneficial knowledge to be obtained from the empirical patterns and commonalities in grief responses these models should not disguise the notable individuality of each person’s experience of mourning. It is valuable in being mindful that there are many factors that influence the idiosyncratic responses to being bereaved. Worden (2005) stated that some of these factors are who the person was, the nature of the attachment to them, the mode of death, the historical antecedents, personality and social variables and concurrent stresses.

Grief is a multifaceted complex process of revision, adjustment and working through for the bereaved; one size does not fit all in grief work. Although, one things is for sure; ‘in order to move through our grief, we must face it head on’ (Noel 2004, p.31).  Neimeyer’s (2003) Meaning Reconstruction Model (meaning making) aptly proposes what the experience of bereavement for the most part is all about; lessons of loss.

Both good and bad things will happen to all of us, but we have the prospective of being able respond to our destiny in another way than before.

References

Bowlby, J. (1961). Processes of Mourning. London: The International Journal of Psycho-Analysis. Vol XLII. Parts 4-5
Bowlby, J. (1980) Attachment and Loss. Loss, Sadness and Depression. Vol 3. New York: Basic Books.
Early, C. Loss and Bereavement. Learning from other cultures. Eisteach. A Quarterly Journal of Counselling and Psychotherapy. Autumn 2004. Vol 3. No.3.
Klass, D., Silverman, P. R. & Nickman, S. C. (Eds.). (1996) Continuing Bonds. New Understandings of Grief. Washington DC: Taylor & Francis
Lendrum, S. & Syme, G. (1992). Gift Of Tears. A Practical Approach To Loss And Bereavement Counselling. London: Routledge
Neimeyer, R. & Anderson, A. (2002). Meaning Reconstruction Theory. Thompson, N. (ed). Hants: Palgrave
Noel, B. (2004). Grief Steps Workbook. 10 Steps to Regroup, Rebuild and Renew After Any Life Loss. Wisconsin: Champion Press
Parkes, C. M. (1972) Bereavement. Studies Of Grief In Adult Life. London: Penguin Books
Rando, T. A. (1993). Treatment of Complicated Mourning. USA: BookCrafters
Strobe, M. & Schut, H. (1999). The Dual Process Model of Coping with Bereavement. Rationale and Description. Death Studies. 23. 197-224
Worden, J. W. (1983). Grief Counselling & Grief Therapy. London: Tavistock Publications
Worden, J. W. (2003) Grief Counselling And Grief Therapy. 3rd Ed. A Handbook for the Mental Health Practitioner. East Essex: Brunner-Routledge