Machin, L. (2009). Exploring the landscape of loss. In Working with loss and grief: A new model for practitioners (pp. 13-27). SAGE.
Literature and poetry, drama and film are full of themes of loss – lost love, defeat in war, separation from place and people, etc., and yet the scope of attention to the impact of loss within health and social care settings is often limited to that of death, dying and bereavement. It is central to an under-standing of what it is to be human that the broader landscape of loss and the intrinsic grief responses to it are explored. This chapter will look at three dimensions of loss:
- Developmental loss and change across the life course - the impact of some of these psychosocial events may pass almost unnoticed but nevertheless provide rehearsal for more emotionally significant losses.
- Circumstantial loss and change across the life course - these losses are unpredictable and produce more profound and visible distress resulting from broken and damaged relationships, illness and disability, disappointment and untimely death. Such losses may be faced by individuals or, for example at times of war, disability and death are experienced across communities.
- The cultural, social and economic contact of loss will determine whether there are positive opportunities for support and the nurturing of resilience, or whether negative factors, such as poverty, prejudice or social alienation are likely to produce invisible grief and unrecognised grievers.
Autobiographical accounts of loss are used in this chapter to illustrate the experience and the impact of the many forms of loss.
Developmental Loss and Change Across the Life Course
A number of theories have been developed to account for the psychosocial changes which parallel biological maturation and decline over the lifespan (Erikson, 1980; Havighurst, 1972; Newman and Newman, 1995). Erikson conceptualises the life course progression as consisting of eight developmental, psychosocial tasks or crises. If the task at each stage is not completed, this will render the next developmental stage a more complex process. Erikson proposed the following stages:
- Infancy – seen as a period when trust is developed; the child begins to discover, through the quality of their caregivers, the safety (or not) of the world. The spectrum of possibilities within this task centres around BASIC TRUST or BASIC MISTRUST.
- Early childhood – with increasing skills of mobility and social interaction, the child becomes more able to make choices. This experimental phase of develop-ment is characterised by AUTONOMY versus SHAME AND DOUBT, in which learning about self-control without loss of self-esteem is crucial.
- Play age – where a greater sense of autonomy emerges and the child has a more developed sense of self, a new challenge arrives, as they begin to imagine and rehearse for the kind of person they may become. Implicit in this concept of self is the development of conscience resulting in a tension between INITIATIVE and GUILT.
- School age – the formal process of learning brings into consciousness those processes already begun. It engages the growing child with the possibilities of mastery through knowledge and a sense of their own competence in the learning task. It is not without hazard and for many it may be a time of feeling inadequate or a failure. The two ends of the developmental spectrum are characterised as INDUSTRY versus INFERIORITY.
- Adolescence – defined as the time of intense physical change, the growth into physical maturity is a period when a new sense of integrity is sought. The attributes of earlier stages have to be reintegrated into values and beliefs, which are personally as well as socially coherent. It can be a turbulent time when aspirations and the choice of role models can lead to new IDENTITY or ROLE CONFUSION.
- Young adulthood – while earlier developmental tasks centred on the capacity of the child/young person to form a separate identity, at this stage there is a new challenge, that of sacrificing individuality for commitment to another person/people. If this task is unsuccessfully negotiated, it may result in a love relationship made up of a dominant and a subordinate partner. It is a task of INTIMACY versus ISOLATION.
- Maturity - as the adult becomes a parent, so the role of offering guidance to the next generation becomes one with societal importance. Within work and lei sure, creativity and altruism may also feature as ways in which the adult makes a contribution to a wider good. At this stage if the individual continues to be self-centred, personal growth is limited and the tension of GENERATIVITY versus STAGNATION is evident.
- Old age - a time when the emergence of wisdom is characterised as the ability to integrate an acceptance of the realities of experience from the past with contentment in the present. Where this does not occur, there will be discomfort with life and limited possibilities for change, together with fear of death. EGO INTEGRITY versus DESPAIR and DISGUST mark this final life crisis described by Erikson (1980).
Erikson has had his critics, who have variously modified the stages he proposed (Gould, 1978; Levinson et al., 1978) or have judged his assumption about the nature of society and the family as conformist (Buss, 1979). Nevertheless, his formulation remains one which provides an important structure for exploring the psychological and social challenges of development, and explains both the possibilities for success and for more limited achievement. What is clear is that the journey from birth to death is punctuated by challenges which can cumulatively contribute to the development of personal social resources and an increased capacity to face the risks encountered in dealing with life and its losses (Hendry and Kloep, 2002). Central to the developmental process are relationships which shape experience in childhood and throughout the life course. Bowlby’s theory of attachment (1980) has provided significant understanding about the conditions which contribute to wellbeing and the successful management of separation and loss (see Chapter 3).
Figure 2.1 Loss and the life course: the social and cultural factors which influence the experience of loss and the significant circumstantial losses which may occur
Figure 2.1 identifies key points across the life course which incur a mix of loss and gain. An apparent absence of distress is most likely where the process of change is a shared transition, and is seen as a normal part of growing up, such as a peer group moving schools. Some changes may be welcomed, even though they are accompanied by a measure of apprehension and ambivalence, such as leaving home or the birth of a baby. If, however, there are other events which may prompt more overt grief, such as emigration and leaving behind family and friends or retirement and the loss of the ‘self’ as worker/colleague. At the least, temporary discomfort and disturbed feelings often accompany change and the positive and negative aspects of the event are necessarily integrated into life experiences.
James, aged 5, describes his first day at school (Machin and Holt. 1988:8):
When I left Mum I was very scared, I didn’t want to leave Mum. Finding my way in the big building that I’d never been in before was very hard. I can remember the first morning when all the children cried. I felt sad myself as well as other children. Butt was very excited to learn to read and write.
The losses of old age can be harder to bear: ‘When you’re a young soldier you can lose friends but when you’re old you never quite get over losing anyone or anything. I think you know real loss when you’re old’ (Blythe. 1979: 168). Of all of the losses across the life course, death is recognised as profoundly grief-producing. Fred, aged 76, gives a moving account of his growing acceptance of his wife’s death (Machin and Holt, 1988: 32):
I had two dreams. In the first, I was in a busy crowded shopping street with my wife. For some minor reason we became separated. I saw her about 50 yards away and began to move in her direction. Then I realised I was not catching her up. I put on a spurt to do so. Without turning round she did the same. I found that, try as I would, I could not come nearer to her. The dream faded but when I awoke I recalled it vividly. In the second I was seated with her in a familiar park one sunny afternoon. After a time she asked me to go to the shops to make some simple purchases. So I did. When I got back to the park I found the gates locked and I couldn’t get in. I couldn’t find a way of getting her out. From those dreams, I infer that the loss I had sustained had penetrated to that part of my mind which emerged into consciousness in my dreams.
Preparation and Choice as Mitigating Factors
In the process of developmental change, two factors help to mitigate the harsher impact of loss.
First, where there is an opportunity for PREPARATION, the process of anti-cipation and rehearsal provides time to think about the impact of an event and the most appropriate responses to it (Fahlberg, 1994). Understanding of this need to prepare is in evidence, for example, in the availability of books for children about starting school, visiting the dentist or the arrival of a new baby. Such books facilitate conversation and increase readiness for a prospective new experience. It can be equally important for changes later in life. An inevitable move into residential care for an older person, for example, will be more readily accomplished if that person has had the opportunity to think about the physical, practical and emotional consequences of such a move. However, a reluctance to face loss sometimes means that people may be unwilling to prepare, for example, for their own death or for that of someone close to them. This was not the case for Philip Gould (2012), who recorded in detail his life from cancer diagnosis to death, seeing in these overt preparations a disarming of the fears and the opening up of new possibilities for engagement with life. His preparations included choosing his own place of burial: ‘This morning I stood at my grave and I thought: God, I do feel very, very happy to be going to this place. That is a small victory for a different view of death’ (Gould. 2012: 139).
A second factor which cushions the impact of change is where there is a possibility for CHOICE. A chosen change is calculated on the basis of benefits rather than deficits. For example, the losses which may be the consequence of getting married or taking a new job might involve moving house or living away from friends and family, but are chosen for the gains in spite of the losses. Choice may not prevent uncertainty or ambivalence in facing change but it is likely to reduce the sense of powerlessness that comes with loss.
Attitudes Towards Loss and Change Across the Life Course
Wider social attitudes contribute to perspectives on loss and change. In infancy, reaching physical and psychological milestones signals welcome evidence of normal development. In adolescence, the nature of physical and emotional change marks the dawn of adulthood - a turbulent time but one heralding new freedoms. In societies where youth and beauty are synonymous, the decline in reproductive functioning in women and an overall slowing of physical capacity in both men and women is often viewed unfavourably. In contrast, traditional societies see age and wisdom as synonymous and therefore revere older people.
Traditionally, society has provided, through its elders and priests, mechanisms of support in the management of transitions. Ritual has played its part, especially at times of birth, marriage and death, but, increasingly, in more individualistic secular societies, it is the role of professionals who participate in these transitions to help facilitate good outcomes. Teachers may be engaged with transitions through the education system, health professionals may bring bad news and support at times of life-threatening illness, and counsellors may be the new priests at times of death and bereavement. Throughout the life course, loss and change will bring challenge to the individual and to those in the wider social context who support them.
Circumstantial Loss and Change Across the Life Course
Unlike developmental loss and change, which are part of the fabric of human experience, circumstantial losses are not common to everyone. Parka (1993) describes the attributes of these more significantly disturbing life-changing events as made up of one or more of the following:
- The loss or change takes place over a relatively short period of time with little or no opportunity for preparation,
- The implications of the loss or change are lasting rather than transient
- There is a need to revise one’s assumptions about the world in a major way.
Although considered here as four discrete categories (see Figure 2.1), these circumstantial losses are integrated into the life course. The loss consequences may be heightened where a developmental loss/ change and a circumstantial loss coincide, such as the birth of a child coinciding with the break-up of a relationship. Circumstantial losses are not simply private experiences but may be socially or politically generated. For example, a country’s decision to go to war will result in the death of soldiers and civilians; a council’s unwillingness to provide ramps for public buildings will add to the existing limitations of a person with a disability; or an inadequate benefits system will result in some individual poverty.
Broken and Damaged Relationships
Relationships are fundamental to human experience and are shaped by psychological and social development. Within the span of life experience, the ending of relationships is inevitable: the dispersal of friendships at the end of school life, the anguish of a lost love as a teenager, the emigration of loved relatives to Australia, the departure to university of children, etc. As with developmental losses, these may be woven into the fabric of life as hurtful but also strengthening experiences. However, for some people they will constitute damaging events, which influence the making and sustaining of future relationships.
Problematic relationships in childhood are particularly damaging. Mistrust, shame and guilt, the negative end of the developmental spectrum described by Erikson (1980), may typify the responses of a child/young person who has experienced unsupported separation from parents, inconsistent parenting, physical violence, sexual abuse, etc. Fahlberg suggests that the consequences of multiple moves of young children in foster care means that they are ‘particularly vulnerable to severe problems in the development of social emotions, carrying with it long term implications for interpersonal relationships, conscience development and self-esteem’ (1994: 138). The crucial role which relationships play in the healthy development (or not) and the social integration (or not) of individuals will determine much of the individual’s capacity to cope, as an adult, with relationship loss and other life losses (Gerhardt, 2004).
Traumatic relationship experiences include divorce and separation from a partner. The ending of a relationship that has had meaning in the past, but which has changed to one of ambiguity and distress, may be characterised by a sense of abandonment, betrayal and anger. Children whose parents divorce are caught in a situation where they are at the mercy of other people’s choices, while forced into decisions they would prefer not to make – where to live, how to ration leisure time, how to manage their ‘go between’ relationship with their parents.
It is clear that grief, like that experienced in bereavement, is the likely reaction to these experiences and may be seen in children as verbal or physical aggression or turned inwards with an inability to play or speak. Kroll describes her work with Robert, an 8-year-old boy carrying his own anger, as well as that projected by his parents in the aftermath of their separation. Some of Roberts words reveal the venom and hurt he was feeling: ‘Me and mummy will kick him in the teeth’ (Kroll, 1994: 162). In contrast, 5-year-old Beatrice was a retreating child who sat on her mother’s lap with a blanket over her head (1994:162). Adults may show similarly variable reactions, between acted-out anger and silent withdrawal. These reactions echo the grief responses made in bereavement.
Damaged relationships are likely to carry grieving consequences of a disturbing kind. This by malevolence and violence, in a relationship where one person has power over another. Abuse may be characterised by sexual exploitation, physical violence or emotional humiliation – all demeaning experiences for the victim. The perpetrator robs the victim of essential freedoms and human rights, which result in significant and often life-changing losses. The abused child will lose innocence, mistrust other people and feel degraded. These losses are not easily placated. The damage is often perpetuated as the capacity to create and sustain good relationships is confounded for the person for whom good role models and good experience are absent.
Trevane (2005) describes how Shannon and her sister were abused by their father when they were children. Shannon describes the impact of this on her adult sister and her own (mistaken) sense of culpability.
She suffers from depression and is on medication. Her marriage didn’t work because she couldn’t stand to be touched. She moved back in with me and became a virtual recluse, suffering from anxiety attacks, and cutting herself. A psychiatrist worked with her to overcome her demons, but she could not forget. Pappy ruined her life. She hasn’t been able to move on, and she’ll never have children of her own. She remembers the pain when he forced himself inside her, and the horror at the blood the first time. She still cries out in her sleep. If he wasn’t dead, I’d kill him. But he’s not the only one to blame. I should have noticed. I should have taken more care of her, (2005: 229)
Abused children often find themselves in abusive marriages, which is a pattern contin-uing the cycle of violence and victimhood (Harvey, 2000). The abused may also become the abuser and again demonstrate a pattern in which early damaging relationships set in train the incapacity to relate to others through the regulation of emotion and behaviour, and appropriate responsiveness to others. However, it is important to recognise that the pattern of: violence - abuse - violence, is not inevitable (Sandford, 1990).
Elder abuse has received less public attention than child abuse but is now seen as a significant issue for many incapacitated and dependent older people (Pritchard, 1995). A person’s need for care at the end of their life may frustrate the economic and social lifestyle of younger family members. Care may demand competence and sensitivity, which is undeveloped in poorly trained and pressurised care staff, resulting in abuse of older people. Elder abuse often remains undetected but where it has been exposed it is seen to involve the humiliation and degradation that is also associated with abuse and violence against the person in younger age groups. It exploits vulnerability and adds to the other potential losses of old age - loss of independence, control, identity, freedom to choose, etc. (Thompson, 2002).
So far, damaged and broken relationships have been seen to fall within the private domain of interpersonal experience. However, larger groups of people may be implicated in relationships which break down between communities. This may be witnessed as antisocial behaviour, inter-gang violence or tension between ethnic and religious groups. In Western societies, the postmodern trend towards individualism, characterised by aggressive competitiveness and materialism, together with the disaffection of marginalised groups, plays a part in the loss of trust and antagonism between subgroups of people.
On a larger social scale, contentious power disputes between religious and ethnic groups, where political freedoms and human rights are transgressed, result in divisions between peoples and the destruction of relationships, sometimes violent destruction and conflict. Martin Bell, a war correspondent, describes the personal anguish and confusion of individuals caught up in the Bosnian war, which brought dislocation to community life and severed relationships between neighbours:
On this I offer a Bosnian example from the war between Muslims and Croats. At a time when it was raging most fiercely in September 1993, the front line shifted to the grounds of a mental hospital in the old spa town of Fojnica in central Bosnia. The Bosnian army held one side and the Bosnian Croat Defence Force the other. The hospital itself was in no man’s land, its staff fled, and its demented patients were wandering about in both sides’ line of fire as helpless as children, and yet it was notable that there was no operation, no international campaign on their behalf. I had wished to end my report with the thought that this was what the conflict had come to, and there could hardly be a crueller image of it than a madhouse in a war zone. I was told that the use of the word ‘madhouse’ was no longer admissible: there were people who might be offended by it but I tried to make my case. The issue was a small one, but it seemed to me to be symbolically quite important. (Bell, 1995: 225)
The personal cost of conflict in another war, the First World War, is described by Vera Brittain (1978), who experienced, through the death of a brother, fiancé and friends, the destruction of a generation of young men. She expressed outrage at the impact of war upon individuals and the anguish of lost relationships: ‘To the saner mind it seems more like a reason for shutting up half the nation in a criminal lunatic asylum’ (Brittain, 1978: 203). Both Bell and Brittain address the cost of social conflict for individuals and their relationships. They poignantly articulate, through the metaphor of madness, the futility, helplessness and loss which are the consequences of war.
Illness and Disability
Deficits in normal physical and mental functioning may be congenital or acquired. Illnesses and disabilities may be acute or chronic. Across this spectrum of incapacity are huge variations in types of disablement – total incapacity or temporary constraints. The limitations, which come with all disorders, consist of two elements. First, there is the innate reduction in functioning, resulting from the disease or disability. Jean Dominique Bauby describes ‘locked-in syndrome’, the major physical incapacity he suffered following a massive stroke:
Paralysed from head to toe, the patient, his mind intact, is imprisoned inside his own body, but unable to speak or move. In my case, blinking my left eyelid is my only means of communication ... My weekly bath plunges me simultaneously into distress and happiness. The delectable moment when I sink into the tub is quickly followed by nostalgia for the protracted wallowings that were the joy of my previous life. Armed with a cup of tea or a Scotch, a good book or a pile of newspapers, I would soak for hours, manoeuvring the taps with my toes. Rarely do I feel my condition so cruelly as when I am recalling such pleasures. (Bauby, 2004: 12, 24-5)
In this extreme example of disability, Bauby’s account of his illness highlights the impact of multiple physical losses, and the cognitive and emotional challenges to his capacity to cope.
A second dimension of loss is experienced when in the wider social context there is an unwillingness to accommodate the limita-tions of those with an illness or disability. This is a socially imposed handicap. Negative perspectives and apathetic attitudes com-pound innate loss, by passively ignoring needs or actively preventing sick or disabled people from participating fully in the life of the community. The restriction on move-ment and reduced opportunity to make choices are losses imposed by society and its institutions, and constitute disablism (Sapey, 2002). While many people who have a disability will not readily connect with the idea of grief in relation to their physical or mental incapacity, they may experience a profound sense of oppression as a result of their exclusion from full participation in social life (Oliver and Sapey, 1999). Great strides have been made in ensuring equal access to educational and employment opportunities, and in providing access to buildings, etc. but the legislative recognition of the rights of people with a disability is not always matched by the actual opportunities available.
Listening to the impact of disability on the individual and the meanings attached to it, remains essential to understanding what it is like to have reduced physical or mental capabilities. However, it must not be forgotten that the identity of the person may already have been powerfully shaped by external perceptions (see Table 2.1).
| How I see myself | |
|---|---|
| What I am told | What I perceive |
| You are – epileptic, paraplegic, etc. | I am my illness/disability |
| I can’t bear your pain, appearance, etc. | I am not an OK person |
| Your carers know what is best for you | I have no choice/ I have no control |
The perception of self is powerfully evident in the story of Alison Lapper (2005), who was able to move beyond a ‘disabled’ image of herself:
One particular book I was looking at fell open at the photograph of the Venus de Milo. It showed a white marble statue, in the ancient Greek style, of a woman with her arms missing. There was a flash of recognition - hey, that’s me! That moment was the starting point of the Journey I am still on today, looking at my own body and how I feel about myself, and how others feel about me. (Lappet, 2005: 185-6)
Lapper went on to be the inspiration for a statue in Trafalgar Square. She says of the sculpture of her pregnant, naked image: ‘I think it makes the ultimate statement about disability: that it can be as beautiful and as valid a form of being as any other’ (2005: 247).
Reaching this point demands a challenge to socially limiting and negative concepts of disability.
Unfulfilled Ambitions and Disappointment
The postmodern perspective, which emphasises the primacy of the individual and the importance of autonomy and control, has led to an expectation that most personal ambitions can be realised. Scientific advances in the fields of medicine and technology, economic wealth (still relatively true in the West, in spite of the banking crisis and economic recession) and social stability all contribute to the assumption that a long, healthy and happy life is deserved and should be expected. In this climate, it is not easy for people to openly acknowledge those aspir-ations which have been thwarted and which contradict the expectation of a life free of disappointment. It is difficult to admit to any kind of failure. Unfulfilled ambition may be carried as private loss over a long period of time. Morley (1996) calls it ‘grieving for what has never been’. Feelings of grief may only emerge when the vulnerability of another loss provides an opportunity to disclose the emotional cost of an earlier profound disappointment – for example, a highly successful, single, career woman who reveals during a protracted illness the deep disappointment of never having been married or having a family.
Childlessness represents a significant example of human disappointment (Read, 1995). The wish to have children is biologically driven and a reinforced social aspiration for most people. However, in contemporary Western society, making decisions about the timing of parenthood, and even the desirability of having children, is a lifestyle choice. The choice brings dilemmas, and postponed parenthood and fertility problems have become a new phenomenon to challenge pervasive assumptions about being in control of life. In these circumstances, it is not surprising that considerable medical research and resources go into assisted conception and giving people continued reproductive choice. The initial disappointment of being unable to conceive and the ongoing anxiety of pursuing fertility treatment are physically demanding and emotionally stressful experiences.
Therapy has become a way of addressing life’s grief but Craib (1994) and Walter (1996) are critical of some of the underlying assumptions which have grown with this sort of help seeking. They see that sometimes counselling/therapy becomes a way of heightening false expectations rather than assisting in adjustment to some of the inevitabilities of life’s disappointments and losses. They believe it is unhelpful to perceive of things which jeopardise wellbeing as antithetical to the innate nature of human experience. On the contrary, part of what it is to be human is to confront the limitations of experience. It is in the mastery of hurt and disappointment that people find new depth to their potential to be human.
The thwarting of ambitions is of a different order when generated by social, political and economic conditions which disadvantage certain groups and communities. Experiences of poverty and social marginalisation, based on sexism, racism, sexual orientation, etc., produce loss and a deep sense of powerlessness. The consequent emotional and behavioural reactions echo the grief reactions seen in response to other losses, although they may not be described as such. Apathy, underachievement and antisocial behaviour, for instance, may arise from being denied a recognised place in society. Apathy and anger are both known to be symptomatic of grief and they represent a behavioural spectrum at one end of which people are unable to respond to their circumstances and demonstrate helplessness. At the other end of the spectrum, anger and frustration (about perceived injustice) generate an energy which is likely to be expressed in behaviour that is confrontational and/or aggressive. Maya Angelou, a successful and prolific writer, is a black woman who has known discrimination and extreme poverty. She describes in her autobiography her resignation to the hardship of servitude in her early years: ‘Looking through the years, I marvel that Saturday was my favorite day in the week. What pleasures could have been squeezed between the fan fold of unending tasks? Children’s talent to endure stems from their ignorance of alternatives’ (Angelou, 1984: 109).
Angelou describes how communities look to role models to contradict wider misperceptions about their human worth, however, this hopefulness can easily be reversed into identification with the oppressor’s racist attitudes:
If Joe (Louis) lost (his boxing fight) we were back in slavery and beyond help. It would all be true, the accusation that we were lower types of human beings. Only a little higher than the apes. True that we were stupid and ugly and lazy and dirty and, unlucky and worst of all, that God Himself hated us and ordained us to be hewers of wood and drawers of water, forever and ever, world without end. (1984: 131)
But Angelou’s spirit was not quelled by her experience and she rose in rebellion against racism: ‘From disappointment. I gradually ascended the emotional ladder to haughty indignation, and finally to that state of stubbornness where the mind is locked like the jaws of an enraged bulldog’ (1984: 258).
This sequence of actions and reactions lies behind many sorts of political and social unrest. It is the consequence of the struggle to reconcile the powerlessness of loss with the desire for control. It was seen in the suffragettes bid for voting rights in the 1920s, the race riots of America in the 1960s, the miners strikes of the 1980s and many other visible challenges to the economic and political power base of a country or society. Underlying all of these is the thwarting of individual and collective potential, breeding deep-seated disaffection with systems and a sense of unfulfilled ambitions.
Traumatic and Untimely Death
With medical advances extending the possibility for a long and healthy life, the occurrence of traumatic or untimely death is especially disturbing. Sudden and violent deaths at any age, but especially that of children and young people, are profoundly distressing, individually and socially. The news is dominated by such deaths and demonstrates the hazards of much human activity, the arbitrariness of accidents, the malevolence and cruelty of people to each other and the overall fragility of human life, Deaths which people think should not have happened are an affront to the control they believe they should have over their own destiny. Blame and retribution become typical ways in which people react to the powerlessness of such assaults on their invincibility. Traumatic and untimely death produces highly visible grief. Mourning may unite individuals and communities, where the predictability of the day-to-day routine is suddenly turned upside down.
Thompson (2006) describes the ordinariness of the start to a day which turned into a ‘surreal nightmare’ when a train killed his 13-year-old daughter and her friend. There was no footbridge at the station so they were crossing the track to reach the platform for a train to go shopping for the day. Thompson’s description of the personal trauma which resulted from this tragic accident is echoed in the experience of Joan Didion following the sudden death of her husband. In her book, she confronted the devastation and power-lessness of her situation and attempts to make sense of the sudden severing of a long and happy marriage: ‘Life changes fast. Life changes in an instant. You sit down to dinner and life as you know it ends’ (Didion, 2005: 3).
Untimely death is a feature of war and conflict too. In these circumstances, personal, national and international relationships are dislocated, and personal grief is obscured by notions of valour and bravery – qualities extolled by nations to appease loss of life.
Invisible Grief
The grief produced by the losses already described is variably visible and acknowledged. The connection between loss and grief in bereavement is the most clearly understood. To a lesser degree, the inherent emotional pain associated with divorce and disability is recognised. In contrast, individuals and communities marginalised and oppressed are not so readily seen as grieving for either personal or socially induced losses, such as unemployment, poverty, etc. Doka (2001) applies the term disenfranchised grief to those situations and categories of people where grief is unacknowledged and invisible. He argues that prejudice, the consequence of ignorance and fear, and judgemental perspectives create a climate in which some situations do not command the attention or the understanding of policy makers, practitioners and fellow citizens. Categories of disenfranchised grief include:
- people in socially ‘unacceptable’ relation-ships, such as gay partners, who may not have their experience of loss, through separation or death, acknowledged
- people engaging in socially ‘unacceptable’ behaviour, such as alcohol abuse or drug taking, who may face loss of health, loss of relationships or loss of life, and whose losses are likely to be judged harshly with little compassion or understanding
- people experiencing ‘stigmatised’ losses, such as suicide, who may invite mis-understanding and blame
- people in ‘minority’ groups – ethnic or religious minorities, for example, may not be integrated into communities with consequent misunderstanding about how their losses might be the same or different from the mainstream population
- people who are socially vulnerable - both young and old people with a disability are often voiceless and their grief may go unrecognised among their other care needs
- people whose losses are usually not defined in terms of grief, such as childless couples, the unemployed, prisoners, etc., who may command no understanding about the impact of their losses.
Some people may have their grief ignored or misunderstood for several of these reasons. This may be particularly the case for older people who, in Western society especially, do not carry the same economic value as younger people, may have restricted income, may suffer the chronic onset of illness and experience multiple bereavements (Thompson, 2002).
While disenfranchisement may arise from the values and perspectives within society, these views may be echoed or reinforced within the care system, which fails to address the grief of many of its clients/patients/service users. Theories of grief, developed within a medical model of practice, have frequently focused attention on those groups of people perceived to be at ‘risk’. As a result, care provision has tended to portray some categories of bereavement and loss as more significant than others, for example widows have commanded more attention than widowers, grieving parents more than people with a learning disability, etc. This has been a very effective way of addressing majority need, using empirical evidence to anticipate difficult grief reactions and to target care resources. In addition to clinical merit, it also has the important benefit of being cost-efficient (another way in which the meeting of need is socially defined). Against the advantages of focusing on ‘risk’ is the danger that those people who fall outside a broad ‘at risk’ category are unlikely to have their needs met.
Traditional ‘talking therapies’ have depended to a large extent upon the capacity of the grieving person to articulate their needs and have an intellectual capacity to process their thoughts and feelings. In the absence of apparent cognitive competence, psychiatric services have tended to treat people with medication rather than counselling. This makes appropriate bereavement and loss care inaccessible for many people. However, the situation is changing and new approaches are being developed, for example, to provide therapeutic support to people with a learning disability (Read. 2007). These approaches, while clear about the nature of communication difficulties, are developing innovative ways of engaging with previously excluded client groups. An expanded repertoire of artwork, play therapy and storytelling is transforming the possibility of providing support in response to loss.
In the absence of social and professional recognition, it has fallen to individual grieving people to draw attention to their own particular loss and grief experience. For many of these people, neither social support nor professional help has been available to meet their needs. The growing movement of self-help groups has resulted from people seeking self-empowerment in their loss. Groups such as the Gay Bereavement Project, Jewish Bereavement Counselling Service, ChildLine (a phone line for abused children), women’s refuges, etc. are providing individual support and making public statements about overlooked losses.
Many of these self-help projects have established an identity for their members, provided support in situations where none is available and made known their needs to the wider community. The search for charitable funding often makes small specialist projects visible, although their success may still depend on the appeal of their cause – for example, there is a tendency for children to command more support than older people or people with mental health problems.
Practitioners have the responsibility of making the voices of people whose grief has been hidden more widely heard and understood. Awareness needs to be raised through research and in training and supervision. The challenge for professionals is to think more broadly about loss as central to life experience.
Conclusion
In this chapter, the diverse landscape of loss has been examined. Psychosocial developments occurring across the life course incur changes, which can precipitate losses as well as gains (Erikson, 1980). These losses may carry little emotional distress, or they may provide a transitory encounter with grief and rehearsal for more disturbing losses. In contrast, circumstantial losses such as those arising from broken and damaged relation-ships, illness and disability, unfulfilled ambitions such as childlessness, and traumatic or untimely death, carry more profound grieving consequences.
Loss is not just an individual experience. Political and economic disadvantage, conflict and prejudice have a collective impact upon communities. This may produce responses such as apathy or anger, which are less recognisable as grief, compared with the visible and obvious anguish of bereavement (see Figure 2.2). For professionals, the challenge is to appreciate fully the significance of the wide spectrum of loss in the lives of their clients and to raise the profile of unseen grief.
| Visible grief | Obscured grief | Invisible grief |
|---|---|---|
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Figure 2.2 The visibility and invisibility of grief
