Harris, D. L., & Winokuer, H. R. (2016). The social context of loss. In Principles and practice of grief counselling (2nd ed.) (pp. 43-54). Springer Publishing.
While grief is often described as an individual’s unique response to loss, it is shaped and molded to a great extent by the social context in which the grieving individual identifies and resides. These contextual factors have a profound influence on how loss and grief are viewed, including expectations about how grief should be expressed and experienced, and also on the supports and resources that may or may not be available to grieving individuals. As counselors, it is very important to view the client holistically, as a member of many spheres of social interaction, all of which will have an impact on the experience of loss. In this chapter, we look specifically at social influences on the grief experience, including how grief is identified as either normal or abnormal, social norms and rules that affect bereaved individuals’ experiences, and access to potential sources of support and assistance.
Most of the models of grief that have been proposed originate in the psychological literature, which tends to focus on grief as an intrapsychic, individual experience. Although some of these models may include acknowledgement of the role of family, most tend to describe the experience of the individual, measuring levels of distress, possible problematic coping, and screening for mental disorders, such as depression, posttraumatic stress disorder, and generalized anxiety disorder. Grief is seen as an individual’s personal response to loss, and any treatment or support that is proposed is also directed at the individual level. Thompson (2010) proposes that this current dominant psychological model could be compared to soup that is poured into a bowl, where the soup exists within the bowl but the soup and the bowl remain separate. The bowl simply serves as a container for the soup. Applied in our context, the implication is that the soup (representing an individual’s experience) is held by the bowl (society), but does not interact with it. In contrast, Thompson suggests that instead we look at a different analogy, such as coffee that has cream added to it, where the coffee (society) and the cream (individual) are inseparable and mix together in a way that each is changed and affected by the other. We truly are creatures that are meant to exist in social relationships with others, and the influences of our relationships, social norms, and existing social structures on our lives are impossible to ferret out from our ways of thinking, being, and acting. The experience of grief is a profound example of the interplay between individual and social factors.
Most counselors focus on individual clients who come to them for help in dealing with difficulties that are being encountered in their lives. This form of help is often referred to as micro practice in the social work literature (Kirst-Ashman & Hull, 2009; Wronka, 2008). In micro practice, the focus is on the intrapsychic, individual aspects of the client’s experience and what is happening in his or her life, with interventions focused on the individual’s beliefs, perceptions, and feelings. In this practice setting, the professional helper also has the opportunity to “bear witness” to the client’s story, which can be a very powerful healing experience for the client. Mezzo practice focuses on work with small groups at a local level, such as employees of a specific workplace, members of an extended family system, or a support group that has formed around a specific issue or experience. In mezzo practice, the skills of active listening and reflection that are utilized in micro practice are enhanced by under-standing and working with group dynamics as they occur in the interactions and communication among individuals who are present in the group setting. The focus in mezzo practice is on facilitation by the helper. Macro practice looks at larger systems, such as organizations, communities, and even political structures and govern-ments. In macro practice, the focus is on the exploration of social norms and policies, with education and advocacy being the primary ways of addressing organizational, social, and political policies that may have a negative effect on the individuals who are part of these larger groups (Kirst-Ashman & Hull, 2009).
Looking at these levels of intervention is very important, because the strict focus on the individual in isolation (or an atomistic focus; Thompson, 2012) will not address the profound social influences under which an individual must live and function. The emphasis on micro practice can also be problematic because it tends to individualize social problems rather than correctly identify that problematic social norms may actually be at the root of some of the difficulties that individuals experience. As with the image of the cream in the coffee, individual experiences of grief are molded and often profoundly influenced by social messages and norms that have usually been internalized by the grieving individual. This chapter looks at these internalized messages with a “macro lens,” exposing the underlying social norms and rules that may have been adopted into our client’s (and our own) values and self-judgments.
It has often been said that grief is related to our innate tendency to form attachments. This propensity toward attachment identifies human beings as primarily social in nature, needing the acceptance of and affiliation with others in order to feel safe and secure. Thus, the social messages and beliefs held by the dominant group into which an individual belongs will have a powerful influence on how that person perceives himself or herself and also on how the experiences of that individual will be interpreted and either validated or invalidated. If we need to feel socially connected to others in order to feel safe in the world, then experiences that cause us to feel disconnected from our affiliated “group” will be highly disruptive to our sense of safety and security at a very basic level. Feeling isolated or marginalized from our social group increases anxiety, and this anxiety will often motivate us to align ourselves more closely with the values of the group, sometimes even at the expense of our individual feelings and needs (Harris, 2009- 2010; MacDonald & Leary, 2005).
Stop and think about what you consider to be normal, everyday food. What is your typical breakfast? What foods do you think of as comforting? What foods would elicit a strong aversion (negative) reaction from you? And yet, people from other cultures may think the foods that you love are detestable and perhaps even disgusting! The point here is that what we think of as “normal” is socially and culturally mediated, and it is also internalized into our personal point of view. It is impossible to separate out what we might view as a tasty dinner from what we were taught was “tasty” as determined by the social and cultural norms of our family, physical location, and cultural views about food. Likewise with grief, what we may consider as a “normal” and acceptable response to loss is largely determined by the social/cultural values and messages that have shaped our thinking. A society that places a high value on productivity and functionality may see emotional expression as a potential threat to these values. After all, people who are emotionally distraught or deeply engaged in their emotions might not be very productive or functional. If loss of productivity is viewed as a challenge to the valued “way of life,” then there would be a great deal of social pressure to minimize or suppress any experience that interferes with one’s ability to be fully functional.
One example of the interplay of individual and social factors in grief is who decides what is normal and abnormal grief? How does the concept of “normal” vary from one society to another? In some societies, the grieving process involves the expectation that mourners will loudly wail and may even physically fling themselves onto the casket of the deceased person at the funeral in a show of profound grief and despair after a death. In other societies, people who remain stoic and hold in their emotions are commended for being “strong” and for “holding up so well” (Despelder & Strickland, 2015). The point here is that definitions of what is normal and abnormal are going to vary and are deter-mined largely by what is valued by the most dominant group in that society. For example, the values in most Western industrialized societies are based on the capitalist focus on productivity, efficiency, and the market economy. These values narrowly shape what is “normal” grief with an emphasis on being strong and functional, returning to work as soon as possible (with limited leave after a loss), and viewing emotional expression as a very private and inconvenient aspect of grief (Harris, 2009-2010).
I (D.L.H.) began to explore the social influences on grief shortly after I started working with bereaved clients in my clinical therapy practice. I noticed that many of my clients would censor and judge their experiences if they were not aligned with the unspoken social norms and rules related to grief. Most of these norms/rules served to encourage the suppression of grief, which tended to stunt many of my clients’ ability to grieve in the ways they really needed in order to integrate the loss into the fabric of their ongoing lives. I was curious about the role of shame in grief because many of my clients expressed feelings of self-deprecation and loathing because they could not “get over” the grief in a “timely” manner (Harris, 2010). Let us explore a case study to illustrate this discussion:
Jerry was a 57-year-old man whose wife of 35 years (Peggy) had died after a 3-year ordeal with cancer. They were very close, and they did everything together. They loved to travel, planned and cooked gourmet meals together, and were patrons of their local art gallery. They did not have children. Jerry had taken leave from his work in order to be Peggy’s caregiver for the last 6 months of her life. When she died, he was devastated. The house they shared was painfully empty. The friends with whom they had socialized together were kind and attentive, but he felt out of place because they had socialized as a couple. He hated cooking because it was another reminder of Peggy’s absence. Jerry’s boss began to pressure him about returning to work, suggesting that he would be at risk of losing his position if he did not return soon. He told Jerry that “getting back to work will help you to be busy and distracted.” However, Jerry felt unfocused and was concerned about his ability to function in the workplace. He came for counseling 6 months after Peggy’s death, concerned that he was “wallowing” in self-pity and needed help to “just get a grip on life” and go back to work. The pressure from his boss and some of the comments from a few of his friends suggested to him that he just needed to “get on with it” and that perhaps he was not progressing the way he should. In our initial session, I suggested that perhaps his response (“wallowing”) was very appropriate for the significance of the loss of Peggy, and we explored how the loss of his lifelong soul mate affected every area of his life. Much of the work in therapy involved normalizing his feelings and experiences rather than trying to assist him to find ways to “buck up” and be strong.
Interestingly, what seemed to help him the most with his grief was an invitation from Peggy’s friends to join them for coffee one week. When there, they all shared memories about Peggy and how much they missed her. They had set up a foundation in her name with a local art gallery, and they asked Jerry to join them for the first exposition that was sponsored by Peggy’s foundation. Jerry’s sense of isolation and devastation began to lift as he regularly joined these women for coffee and to assist with the work of the foundation. He began to feel more energetic, and he set up a plan to gradually ease back into his workplace.
Was Jerry’s grief “normal?” The current diagnostic criteria would probably indicate that he could readily be diagnosed with complicated grief, a form of disordered grieving that warrants intervention. If Jerry had seen a professional whose model of working with clients was individualistic in nature, he might have been diagnosed with complicated grief (or depression) and begun on a regimen of “treatment” for his disordered grieving response. And yet, what enabled him to begin the journey back into life was the acknowledgment of what was “right” about what he (and many others) had felt was “wrong” with his grief.
What does this mean for individuals who grieve after the experience of profound losses? We are urged to silence our grief or ignore our feelings about our loss experiences. We also feel the pressure to carry on with our lives and our routines as before, being praised for “being strong” in the face of adversity. As a result, individuals who experience profound losses may turn inward, perhaps being able to share their thoughts and feelings with a select few, but still expected to maintain their functionality in the public sphere. We know that raw grief can be temporarily crippling to many individuals, affecting their ability to focus, ability to function, and interest and engagement in the world around them. Thus, it is apparent that the expectations and values of a product-driven society can painfully collide with the individual experience and expression of disabling grief. Social pressures to remain functional, stoic, and strong may not make much sense when your life is decimated by the loss of a loved one or a deeply held part of yourself. In this instance, what is normal? If we go back to the example of Jerry from our previous section, we can see that Jerry felt a great deal of pressure to function and ignore his pain, and he had also internalized these social norms to the point that he felt shame at not being able to return to work and “get on with it” after Peggy’s death.
In the context of grief counseling, it is important for the counselor to help clients to separate out the social expectations of how they are expected to respond to loss (i.e., how they should respond) from the actual reality of their loss experience (how they actually need to respond) and to normalize grief as a potentially adaptive, but socially uncomfortable and often stigmatized process. Gender socialization and stereotyping are also strong social forces that shape the expectations of how individuals should grieve. For example, men who are sensitive or who express vulnerable emotions publically are often stigmatized as “weak” or effeminate. The fact that Jerry needed to talk about Peggy and that his grief affected his ability to focus would be doubly stigmatizing to him as a man, because men are expected to stay in control and to function proficiently, even in the face of extreme adversity. Women who do not cry or express vulnerable emotions outwardly are often labeled as “frigid” or insensitive (Doka & Martin, 2010). Strong emotions of any type are usually stigmatized, and bereaved individuals may express embarrassment for “losing control” of their emotions in front of others (think about how people will say they are sorry when they cry in public places).
Pressure to view grief in purely individualistic terms, overlaid with the values of strongly capitalistically oriented thinking, twists our fundamentally human experience of loss into pathology, making it into a worse (more disabling, more disempowering) experience than it could have been if adequate support and understanding were available. The problem is not with grief, which can help us to adapt and integrate the losses that occur in our lives. Rather, the problem we often find in our clinical work is that grief causes far more pain and difficulty for our clients when it is rigidly defined and socially controlled in ways that suppress the normal and healthy ways that it can be experienced.
In the previous section, we explored how social values can have an impact on the experience of the bereaved individual. Social norms govern appropriate ways of behaving, thinking, and feeling in a particular situation. Norms also may be internalized and thus be considered the “normal” way of behaving, thinking, and feeling by individuals (Brabant, 2002). We continue the discussion to look at the various social “rules” of grief and how they may be applied to bereaved individuals. As grief counselors, we urge you to always bear these issues in mind when you work with clients. In many cases, clients are “stuck” in their grief because they do not have permission to fully enter into their grief in the way that is congruent with their experience of loss. Making these social norms and rules explicit and talking about the ways that grief can be stunted by adherence to expectations that suppress grief rather than supporting it will often create the very space that your grieving clients need in order to address their grief in an open and healing way. Keep in mind that because most people internalize the social norms of the society in which they identify, the “pressure” is often felt within the individual client, even though the issue is rooted in socially mediated values and expectations.
A key component of socially mediated norms in this context is Doka’s (1989, 2002) concept of disenfranchised grief, which states that an individual may have a very significant reaction to a loss, but the loss and the grief are not recognized or validated socially. The implication is that there are norms that provide both social acceptance (and support) or social rejection of a member or group, depending on specific criteria that are identified either overtly (clearly delineated) or covertly (implied). There are several different ways by which the grieving individual is disenfranchised and thus excluded from social support (Doka, 2002):
- The relationship that was lost was not considered valid, socially acceptable, or important
- The loss itself is not recognized or viewed as significant
- The grieving individual is exempted from rituals that might give meaning to the loss or is not seen as capable of grieving for the loss
- Some aspects of the death or loss are stigmatizing, embarrassing, or unacceptable
Central to this concept are implicit social rules that surround grief. Although these rules are not published in a guidebook or formally dictated to grieving individuals, they pervade most industrialized societies because they reinforce the values of capitalism and the emphasis on productivity and functionality. These rules further delineate:
- How long grief should last (we now know that grief may never really end)?
- What are the narrowly accepted expressions of grief for specific members of society, usually delineated along gender lines and social acceptability (men who grieve through their emotions and women who grieve instrumentally through action are often the most socially wounded in their grief)?
- Who is valued and worth grieving versus who/what is not (think of the loss of pets, loss of friends, miscarriage, signify-cant nondeath losses, as well as intangible losses, such as loss of hope, dreams, and innocence)?
- Who may have an exemption from socially expected roles and who may not (bereaved parents and widows often have some leeway after their losses, but you can think about typical workplace policies about funeral leave, family pressures around holiday times, and who is included/excluded from funerals and memorials as examples here)?
These social rules can cause a great deal of difficulty for individuals whose grief does not “meet” the socially sanctioned criteria in some way. As we stated earlier in this chapter, we are social creatures and the need to attach and feel a sense of belonging is a core part of what it means to be human. When grief is disenfranchised, or the griever is socially isolated, the process is made much more painful: In order to become more socially acceptable, and to counteract the potential for social isolation or exclusion from lack of conformity to expectations, grieving individuals may try to “mask” their grief in stoicism or find covert ways to grieve that keep their experience out of the public eye. By so doing, bereaved individuals internalize the oppressive forces that are enforced through the social rules of acceptability after a loss occurs. Death and grief signify vulnerability, which is a sign of weakness. In a social system that is based on competition and acquisition, weakness is not tolerable, and so grief goes underground (Harris, 2009-2010).
As counselors, social influences can have an impact on our ability to offer support to grieving individuals. Most counselors are not in a situation in which public funding is readily available to clients to cover the costs of counseling. Thus, our services may be limited by the lack of recognition by insurers and public policies that not only limit how grief should be experienced and expressed but also limit many bereaved individuals’ ability to access supports that may be needed. A cycle of social exclusion, pressure to conform, and difficulty accessing resources occurs because mental health care and counseling tend to be socially stigmatized and devalued as well. Ironically, grief counselors might not be needed if our society were more realistic and inclusive of the healthy role of grief in everyday life!
As grief counselors, you may truly assist your clients by reframing the aspects of the grieving experience that are socially stigmatized as a problem with unrealistic social expectations and not with the client’s experience. A phrase that I (D.L.H.) often use with clients is, “let’s look at what’s right about what’s wrong.” In other words, in many instances clients’ responses make sense when placed in the context of the losses they have experienced, but their responses are often viewed as “wrong” socially because they do not abide by the dominant social model of how grief should be experienced. Going back to the case study, Jerry was disturbed that he could not be more functional and productive after Peggy died. Yet, when the situation of losing his soul mate of 35 years was considered, along with all the secondary losses associated with her illness and death, his grief made sense and was very appropriate in relation to the magnitude of his loss. Given in the following section are some suggestions for how you might support and empower your grieving clients by your awareness of how social rules and political policies can profoundly affect their experiences.
Application of Diagnostic Criteria to the Grieving Process
In Chapter 10, we explore times when grief goes “awry,” that is, when the loss and the grieving process completely overwhelm and consume someone. We caution counselors to keep in mind that jumping in to intervene may be felt very negatively by clients. Do not be afraid to question how your work may be informed by unhealthy and unrealistic social messages and pressure that reinforce an unrealistic idea of “normal” grief. Mary Friedel-Hunt, a social worker whose husband died 4 years after he was diagnosed with Alzheimer’s disease, articulates this point very well in her blog:
Just how long are we allowed to feel stunned? What are the social norms we “must” honor? How long does society allow we who grieve to have a “diminished sense of self”? How sad that this comes along at a time when so many are working so hard (and making headway) in changing the way society looks at and deals with loss and grief. The losers here are the bereaved themselves . . . I resent it when professionals (or anyone) decide that my (or those of my clients or any bereaved person) normal feelings and responses to such a loss are a medical issue, abnormal (prolonged, complicated, whatever), and that I (or other bereaved people) need treatment versus support (even treatment by meds that are sometimes harmful). I resent it when professionals negate the reality that we grieve a significant loss forever or when they deny that traumatic loss is defined by the traumatized person who needs only (in most instances by far) to be accepted, heard, felt and supported— not judged to be “sick,” “symptomatic” and in need of “treatment.” As a bereaved spouse, I choose not to pretend to “move on” (whatever that means) in order to avoid judgment. Maybe it means I forget the many, many years and sacred moments spent with him. I refuse to tell others I am “fine” to avoid judgment when I am feeling sadness at a given moment or on a given day. I am where I am and I encourage those I support to do/be the same. (Friedel-Hunt, 2015, paras. 4, 7, 8)
Cultivate Self-Awareness
Lee and Hypolito-Delgado (2007) emphasize the need for clinicians to cultivate personal awareness of how they have been and are influenced by social and political forces, in order to be able to identify and disentangle the potential detrimental impact of these forces on their engagement with their clients. Learn to monitor your internal reactions and self-talk to identify your own biases, opinions, and expectations, and consider their impact on how you interact in your everyday world and with your clients. In order to effectively do this work with clients, you need to be congruent with the values and ideals that you espouse. For example, if you suppress or deny your experiences of grief due to social constraints, how can you truthfully bear witness to and facilitate the full expression and experience of grief with your clients?
Work From an Empowerment Model
Most models of professional training imply that a person with the training, schooling, and credentials is an “expert” and the client seeks treatment from the person with expertise in order to feel better. However, if grief is a common human experience, what is being treated? A colleague once observed that hunger is a normal human experience, and he queried whether we are “treating” hunger when we eat (Neil Thompson, personal communication, February 4, 2015). The idea, of course, sounds ridiculous. But you can apply a similar analogy to grief— if grief is a normal human experience, then what is the role of grief counselors and what are we “treating”? Most of the work of grief counseling is focused on empowering grieving individuals to engage with their grief so that the adaptive aspects of the process can do its necessary work. We do not “treat” grieving individuals; rather, we seek to empower them to honor their grief with the support they need in order to do so.
Monitor Your Use of Language
Anyone who has completed a professional training program knows the language and “jargon” that are used among those who practice in that field. However, using this kind of language with clients can create more of a power differential between the counselor and the client, perpetuating the social hierarchical status of “professional” versus “client.” Although it may be important to know this language and to use it as needed in collegial sharing, think about the words and especially the “jargon” that you use with clients and why you use it. Sometimes, clients appreciate being able to have a name to identify their experience in language. Many of our clients know what disenfranchised grief is and how it applies to their situations. Their understanding of terms such as this can be empowering.
However, commonly used words in psycho-logical descriptions, such as dysfunctional, disordered, impaired, pathological, or identifying a person with a diagnosis may reinforce the social vulnerability that an individual experiences after a life-altering loss event (Dietz, 2000). Given the tendency for diagnoses to be utilized as a dividing line between those who are “healthy” and those who are mentally ill, great care must be taken when associating a client’s distress and pain with a reified set of criteria in a diagnosis code. There is often a conflict created for clinicians in this issue because insurance companies often require a diagnostic code to be assigned in order for reimbursement of services.
Using language that opens possibilities helps to encourage people to identify their ability to adapt and create meaning within change. Individuals feel empowered when the focus is on their strengths and resilience rather than on their perceived dysfunction. Focusing on the innate strengths in a client can provide a powerful catalyst for growth in contrast to the paralyzing effects of oppressive social expectations. For some clients, there may be initial resistance to the identification of their strengths and attempts to cope with adversity due to the presence of internalized negative beliefs and attributions toward themselves. In clinical practice, we can gently explore how these negative beliefs began and are reinforced in clients’ daily lives. We often explicitly identify the social rules and expectations that augment these negative self-perceptions, giving clients the opportunity to differentiate their actual experiences and responses from unrealistic social expectations that are intended to serve the purposes of a materialistic culture. By naming these rules and acknowledging their influence on daily life, clients have the opportunity to see their strengths more clearly and identify where they have actively engaged in coping and surviving in the context of situations that have made them feel powerless and helpless.
Validate and Support Subjective Experiences
It is important to be able to enter the reality that is experienced by the client—as the client feels it, understands it, and participates in it—in order to fully appreciate the client’s world (Larson, 2014). The process of validation occurs through an ongoing dialogue, in which the counselor actively listens to the client’s descriptions and feelings and acknow-ledges the impact of these experiences on the client’s world. The client’s descriptions and experiences are what matter the most, and are the most important part of the process. This aspect of the therapeutic relationship is of primary importance, as we have already discussed how disenfranchisement robs people of the ability to experience their grief as it needs to unfold, pressuring conformity with social norms and expectations that often deny and stigmatize their experiences. It is important to name and validate losses for the significance in which clients actually experience them—not because they are expected to do so by the social rules surrounding the loss experiences. In this process, it is important to identify where clients’ experiences have been invalidated, pathologized, or marginalized by social rules and where oppressive factors have robbed the person of his or her subjective expertise and agency.
Cultivate Compassionate Awareness
The phrase “we’re all in this together” may sound trite, but it does speak to the deeper reality that we all experience grief and losses as we go through life, and nobody is immune to pain and suffering at some point. Within the boundary of a professional relationship, clinicians must be able to work from a framework that emphasizes bearing witness to the experience of another human being rather than adopting a role of authority over a client’s experiences. In professional training programs, we are often taught about em-powerment and the role of the therapeutic alliance. Rarely do we have discussions about suffering and compassion, and yet it is our ability to acknowledge this pain and suffering, bear witness to it without turning away, and offer ourselves as instruments to relieve this suffering that forms the foundation of healing during these very difficult times. Loss and pain are a part of life, not experiences to be suppressed and hidden away because they highlight our vulnerability. As grief counselors, you will regularly be reminded of the commonality of human frailty, vulnerability, and fragility that we all share. Allowing yourself to be open to these experiences in yourself and others is an act of healing.
In grief counseling, it is important to be able to identify how social forces influence the process of adaptation to loss. We are social beings, and as such, we all are interconnected by our shared human experiences, with loss being one of these. We cannot define ourselves in isolation, and we all experience the dynamic interplay between our individual selves and the social and political structures in which we live. Grief counselors need to be able to assist their clients to grieve in ways that are congruent with their needs, free from the dictates of social rules that may deny or invalidate the deeply human experience of grief.
