OMEGA, Vol. 29(3) 187-203, 1994

MYTHS AND MISCONCEPTIONS ABOUTBEREA VEMENT: THE OPENING OF A DEBA TE

MARGARETSTROEBE

JAN VAN DEN BOUT

HENKSCHUT

University of Utrecht, The Netherlands

ABSTRACTAssumptions about coping with bereavement were called into question sameyears ago by Wortman and Silver, who argued that many beliefs have beenadhered to by researchers and theoreticians in the area, sometimes contrary toempirical evidence [I]. Their paper has been widely cited, and their con-clusions taken as representative of the current state of knowiedge. The pur-pose of this article is to encourage discussion of Wortman and Silver's con-clusions, to examine empirical evidence and the claims of other researchers.OUT conclusions contrast with many of those of the previous review. Certainso-called assumptions have not been generally made by researchers. For otherassumptions, evidence has sometimes been misinterpreted. Finally, samebeliefs are indeed the subject of continuing controversy. Thus, Wortman andSilver themselves seem to create myths about coping that they set out tocriticize. Implications foT the scientific study of the phenomena of bereave-ment are considered.

The scientific study of bereavement is a comparatively young discipline, anddespite progress ip the last couple of decades it is one which is stilllacking inempirical research on many basic phenomena, in theoretical formulations toexplain pattems of results or even in psychometrically sound instruments ofmeasurement, limitations which have been acknowledged by leading reseachers[2,3]. Given that there bas also been much progress recently within the field, it isimportant to reflect on our current state of knowIedge. In an influential andprovocative paper, Wortman and Silver undertook a detailed examination of basic

187@ 1994, Baywood Publishing Co., Inc

188 / STROEBE, VAN DEN BOUT AND SCHUT

assumptions about coping with loss [1]. This article bas rightly received a greatdeal of acclaim in both lay and academic circles.l Not only bas it become ODe ofthe most influential statements, it bas also come to be seen, by a broad audience,as representative ofthe state ofknowledge about bereavement. Our own examina-tion of the evidence bas led us to conclusions which contrast fundamentally withthose of Wortman and Silver [1]. In our opinion, a fair assessment cao only beachieved by critical and constructive discus sion of scientific endeavors. Hope-fully, this article will open a debate on these issues.

The assumptions that Wortman and Silver call into question are centralones:They concern the inevitability and necessity of distress and depression in grief, theimportance of working through aloss, the expectation of recovery, and the"resolution" of grief. In Wortman and Silver's view, faulty conclusions have beendrawn from empirical studies, wrong hypotheses have been adopted, and mythshave been perpetuated that have no empirical foundation. Long-standing beliefsabout bereavement are adhered to, they claim, even when they fail to be sup-ported, and are sometimes even contradicted, by empirical work.

Thus the purpose of this article is to examine the existence and validity of basicassumptions about symptomatology and coping with loss, taking each of the fivemyths discussed by Wortman and Silver [1] in turn? Underlying our discussionare the following concerns: 1) Do they correctly cite and reflect the scientificliterature? 2) Is it the case that prominent writers in the field adhere to the myth inquestion? 3) Are there any who, like Wortman and Silver [1], similarly drawconclusions that are contrary to general assumptions (myths) or is there really sucha consensus of opinion? 4) Is their use of empirical evidence valid: Cao one-anddid the authors of the original studies themselves-draw the same conclusions asWortman and Silver [I]?

Our concentration is on the scientific literature: Discussion does not extend tobeliefs held about grief and bereavement by health care professionals such asnurses and doctors, a topic also touched on by Wortman and Silver [1] andexplored in some depth more recently by Conway, Hayslip and Tandy [7]. Nor dowe focus on lay beliefs. Nevertheless, it must be emphasized that a basic concernof Wortman and Silver was to wam against oversimplification by lay personsor health-care professionals of the very complex phenomena associated withbereavement. Their identification of this problem is important and their criticismsseem justified: Descriptive accounts (e.g., stages of grief) are frequently inter-preted as normative standards in lay circles and the popular literature.

1 Similar claims are made by Wortman and Silver in a number of other publications [e.g. 4-6].

Discussion here focuses on their 1989 paper, since this hBS been most influential, and since it bestpresents their position on fundamental assumptions. Given the Bims of this article, we par particularattention in discussion to sources available at the time thaI Wortman and Silver wrote their article [I].

2 Wortman and Silver discuss the spinal cord injury literature alongside the bereavement literature

[1]. This wiJl not be examined in this article, since it is not of central interest to bereavement research.

MYTHSABOUTBEREAVEMENT /189

For space reasons, it is necessary to select what we consider to be the mainpoints of disagreement with Wortman and Silver [1]. This raises the concern thatOUT own review will be selective and biased. OUT strategy to overcome thispossibility is to provide sufficient detail foT the reader to evaluate conclusions onthe issues discussed, and give details of sources from the scientific literature foTfurther examination.

Finally, a point of clarification: Wortman and Silver did not confine their sourceof knowledge to the research literature alone [1]. They argued that assumptionsthat people hold about how ODe should respond to losses are derived in part "fromthe theories of loss offered by prominent writers" [1, p. 349] and in partfrom "clinicallore about coping with loss and OUT cultural understanding of theexperience" [1, p. 349]. While this leaves open the question whether they arearguing that each of the five myths actually derive from the scientific literature(making it difficuit to refute any particular oDe), further statements and generalconclusions that they draw imply that each of the myths has been adopted bytheoreticians, researchers, and prominent writers in the scientific literature onbereavement. For example, they refer to the "five assumptions that we believeto be very prevalent in the grief literature" [1, p. 349]. Thus, we feel that thereis justification in assuming that in each case bereavement researchers andtheoreticians are attacked.

THE 5 "MYTHS" ABOUT COPING WITHLOSS OF A LOVED PERSON

"Distress or Depression is Inevitable"1.

Wortman and Silver argued that distress and depression are not inevitable, butthat this is a commonly held assumption in the area: bereavement theories assumeit, reviewers of research draw this conclusion, but empirical evidence does notback up such an assumption [1].

At the outset it will be useful to identify what we consider to be a logical errorin Wortman and Silver's reasoning. They of ten assume absolute (aU or none) fromprobable (may, but also sometimes may not) statements. This is iUustrated in theirfiTst sentence concerning this myth: "It is widely assumed in OUT culture that whena major loss is experienced, the normal war to react is with intense distress ordepression" [1, p. 350]. This statement is intuitively convincing except when takento meao, as Wortman and Silver assume, 1) that there is only ODe, universal warto react, and 2) that whenever a person reacts without intense distress or depres-sion this is abnormal or pathological. Thus, they take "individuals" to meao "aUindividuals"-from which it of course foUows that "universal distress" isassumed, which they then dispute. It does not foUow from either Freud's [8] orBowlby's [9] theories, whom they cite in this context, that aU widow(ers) would

190 / STROEBE, VAN DEN BOUT AND SCHUT

exhibit distress or depression. In cases where no meaningful relationship bas beenlost, or where there bas been no strong attachment, distress or depression wouldnot be predicted. Thus, in this case, and in further instances, there is in factno dispute, but misinterpretation of statements of probability (may) as absolutes

(allor none).It is also essential to draw the distinction between distress and depression.

Wortman and Silver used these terms interchangeably, whereas they are relatedbut distinguishable phenomena. According to DSM-III-R, depression is a term fora clinical syndrome, depressed mood beingjust ODe of its symptoms [10]. Distressrefers to a psychological state without reference to pathology per se. Differentlevels of di stress are expressed in the terms "sadness" and "dysphoria," neither ofwhich necessarily reach an intensity associated with depression.

Thus, when discussing whether "distress or depression are inevitable inbereavement," assumptions about the presence or absence of any such symptoms(from mild upset to more severe dysphoric mood) Deed to be distinguished fromassumptions about the presence of depressive symptoms that are extreme enoughto reach a clinical diagnosis of depression. Not only do we Deed to address thequestion whether bereaved persons are more distressed or depressed than non-bereaved counterparts, but also, whether and how frequently depressivesymptomatology reaches levels that would be diagnosed as "clinical depression."Much confusion derives from the fact that Wortman and Silver assume that, sincedepression is not inevitable (not all bereaved persons suffer from the clinicalsyndrome of depression), this means that distress is not inevitable either.

What then, does empirical research show with regard to di stress and depressionamong the bereaved? Wortman and Silver cite the Glick, Weiss and Parkes [11]study as evidence that sadness or depressed mood are fairly commODo Theseinvestigators found 88 percent of the bereaved to be in a depressed mood. There isfair consistency in the literature. For example, Zisook, Shuchter, and Lyonsreported that a similar percentage in their sample of widows and widowers were"teaifur' in the first months af ter loss [12]. Iq the Clayton projects cited byWortman and Silver [1], "[ow moot!' was found in 75 percent and crying spellsin 89 percent of the recently bereaved [13]. These and many other studies[14] suggest a frequent (though not universal) occurrence of distress, with same10 percent indicating no sadness in several studies.

How frequent is depression among the bereaved? The evidence indicates lowerfrequencies than distress, but greater than rates for the non-bereaved. An examplewill illustrate the usual pattem: In the Tübingen Longitudinal Study [15],42 percent of the widowed sample, compared with only 10 percent of the marriedcontrols, had scores that were at least mildly depressed, using Beck's [16] criteriafor the Beck Depression Inventory. This means that weIl over half of the totalsample did not have mild, moderate or severe depressive symptomatology, evenwithin the first few months of bereavement. an the other hand, the data also showthat 27 percent of the widowed, as compared to only 10 percent of the married

MYTHS ABOUT BEREAVEMENT I 191

controls, still had at least mild depressive symptoms two years af ter their loss.Clearly, ODe could not conclude from such results that depression is "inevitable,"but it is more frequent than among non-bereaved samples.

A further aspect of this myth concerns the assumed universality of distress anddepression following bereavement. In contrast to Wortman and Silver [1], wewould argue that there is no contradiction in concluding on the ODe hand, thatdistress is common and depression rates elevated in comparison with the non-bereaved (as traditional studies claim), as weU as that "such a reaction is by nomeans universai," as they argued had been shown in "more systematic andrigorous assessment of depression or distress" [I, p. 350]. ODe of the two studiescited by Wortman and Silver [1] as evidence that distress is common [17] is,in fact, a report of the same study as that cited for the non-universality of

depression [18].Even if the empirical studies do not show that distress and depression are

"inevitable," is this nevertheless a general assumption? We could fiod no state-ments to this effect in Dur review of the bereavement literature. Wortman andSilver [1] cite Osterweis, Solomon and Green [19], a major review of the bereave-ment area, as staling that there is "near-universal occurrence of intense emotionaldistress following bereavement, with features similar in nature and intensity tothose of clinical depression" [19, p. 18]. This suggests that Osterweis et al. wereadvocating a "distress or depression is inevitable" assumption [19]. However, thisis not the case. The sentence begins: "Human experience through the centuries basrecorded the near-universal occurrence of intense emotional di stress followingbereavement. . ." [19, p. 18]. Thus, Osterweis et al. were reflecting culturalunderstanding of the experience of grief. The section that this statement opensgoes on to consider this lay belief. It cannot beinferred that Osterweis et al. heldthe "distress and depression are inevitable" assumption [19].

To conclude, there is little evidence that bereavement researchers hold the myththat distress or depression is inevitable. Wortman and Silver's interpretationseems to be based on a logical error, a lack of differentiation in definition, andmisrepresentation of theoretical statements and empirical data. Rather, there issome consensus that, while most (though not all) of the bereaved are distressed inthe weeks and months following loss, with symptoms ranging (and of ten chang-jog) from mild upset to severe anguish, only a minority actually suffer fromextreme, or clinical, levels of depression.

2. "Distress is Necessary, and Failure to ExperienceDistress is Indicative of Pathology"

While the fiTst myth concerned the inevitability of distress, the second addressesa closely-related concern: whether it is "necessary," Wortman and Silver arguedthat clinicians particularly advocate that those who rail to respond to losswith intense distress are reacting abnormally, Again they cite the lnstitute of

192 I STROEBE, VAN DEN BOUT AND SCHUT

Medicine's scientific report as underlining their assumption in their conclusionthat "professional help may be warranted for persons who show no evidence ofhaving begun grieving" [19, p. 65]. Yet, Osterweis et al. did not make the absolutestatement that professional help is always needed in such cases, but that it may bewarranted, a statement that seems reasonable on thebasis of scientific evidence

to date [19].What "assumptions" cao be made about long-term consequences of experienc-

ing di stress or depression, versus their absence? Wortman and Silver reasoned that"If, in fact, depression is necessary following loss, those people who experience aperiod of depression should adapt more successfully than those who do notbecome depressed" [1, p. 351]. They claimed that this bas not been substantiatedempirically. However, the studies that they cite compare high with low distress ordepression, which is a different comparison from that with the abs:ence of negativeaffect and its implications for successful adaptation.

Two different sets of predictions derive from the literature, depending on whichof these comparisons is being made: 1) the comparison between presence orabsence of distress/depression: that is, the prediction that absence of grief early inbereavement leads to langer-term problems (following Deutsch [20], and others);2) the comparison between high versus low distress/depression: high distress earlyin bereavement is predictive of high distress later on (following the empiricalwork of Vachon and her colleagues [21]).

Empirica! investigations have consistently shownthat intense distress or highlevels of depression soon af ter bereavement are major predictors of long-termpaar adaptation [19, 22-25]. Overfifteen years ago, forexample, Parkes identified"reactions of severe distress" among factors at early interviews with bereavedpeople, which predicted paar outcome later [26].

Because they review studies comparing high and low distress, and not studies ofhigh- compared with no-distress, the evidence that Wortman and Silver draw uponis not a valid test of their conclusion that "the bulk of research. . . provides littlesupport for the widely-held view that those who fail to exhibit early distress willshow subsequent difficulties" [1, p. 351]. The studies simply show that lowdistress following loss is an excellent predictor of good outcome, a conclusionborne out consistently in empirical research [27, 28].

The second part of the statement of this myth, that failure to experience distressis indicative of pathology, needs closer examination. Deutsch [20], Mams [29],Bowlby [9], and others, identified an absence of grief as indicative of pathology.Empirical evidence for the absent grief syndrome is still sparse (it also seems to bea comparatively rare phenomenon). However, there are a number of clinicalaccounts in the literature supporting the view that, in a small minority of cases, anabsence of grief symptoms cao be pathological [30-32]. Raphael pointed to samecontroversy in the interpretation of absent grief, but drew her own conclusion thatshowing no response, and carrying on as normal af ter the death of a partner, wasrelated to pathology: "Such a pattem bas been seen as evidence of strength and

MYTHSABOUTBEREAVEMENT 1193

coping by many, rather than pathology, but recent understanding suggests that it isprobably related clearly to morbidity, except in a few instances" [23, p. 205].Nevertheless, these statements do not argue that absence of grief, or absence ofintense grief, is assumed to be inevitably pathological.

Sadness and despair are indeed so much part of grief over the loss of a loved ODein oor culture, that pathology is suspected if such symptoms are absent. However,before making such a diagnosis, a number of alternative explanations for absentsymptomatology Deed tc be explored, as bas been acknowledged in the literature[23]. For example, if there is no close attachment to the deceased person, thebereaved will not grieve (see [33] for a reconsideration of the necessity ofattachment for griet). If ODe accepts that assumptions about grief reflect a societalembeddedness ofloss (which Wortman and Silver [1] also acknowledge), and thatbereaved people may respond in certain wars because it is prescribed or expectedofthem, then ODe must also accept that failure to experience distress may, in othercultures, reflect the different assumptions. For example, if the bereaved person basgrown up in a culture where the expression of distress is frowned on, where godswill be angered, or where, as in Bali, the bereaved strive to refrain from expres-sions of distress because " . . . expressing one' s sadness threatens the wellbeing of

all: the self, the other, and the soul of the dead" [34, p. 459], then grief may beapparently absent (see [~:4] for a review of cross-cultural patterns of grieving).

Distress may be appai'ently absent too (i.e., delayed) if the bereaved person isstill experiencing numbness and dis belief at loss in the early days ofbereavement,or is in a state of shock, as, for example, following horrific loss [35, 36]. Finally,distress may be absent if grieving bas ceased. An obvious example is grieffollowing a long-expected death. In such cases anticipatory grief may have takenplace before actual death [37]. It mayalso be that the terminally ill person was insuch pain that feelings of intense sorrow are mitigated, at least in part, by reliefthat the loved ODe no Ionger suffers.

The above explanations of apparently absent grief are plausible alternatives toODe of pathology. If, however, none of these alternatives hold, and a bereavedperson (of western cuitural background and beliefs) seems to show no response tothe Ioss of someone to whom he orshe was very close, and carries on bis or herlife as if nothing bas happened, then there would be justification to suspectpathology. Especially if bereavement follows traumatic loss, severe manifesta-tions of denial (amnesia; feeling Dumb; clinging to oid roles; denial of change,etc.) may be symptomatic of posttraumatic stress disorder [35, 38].

To summarize: We disagree with Wortman and Silver's [1] representation ofresearch for similar reasons to those raised regarding myth 1. The majority ofempirical studies have shown "low distress" not "no distress" to be associatedwith good adjustment (a distinction that Wortman and Silver fail to make in thecontext of drawing this conclusion). The basic assumption that absence of distressis indicative of pathology bas not been unconditionally accepted by researchers orclinicians. Tt has not hl'.l'.n :1~~llml'.cI th:1t thn~e who f:1ill'.cI tn ~hnw intpn~p r\i~trp~~

194 I STROEBE, VAN DEN BOUT AND SCHUT

following loss necessarily have "latent pathology," as Wortman and Silver phrasetheir objection [1, p. 354]. As we illustrated above, a number of different reasonshave been suggested to explain why there is low (or no) distress, including culturalnorms goveming the expression of emotions, and low attachment.

3. "The Importance of 'Working Through' the Loss"

Wortman and Silver query 1) whether it is necessary to wort through grief inorder to come to terms with and adjust to loss, and 2) whether working throughgrief does not, in contrast to traditional assumptions, actually have negative

consequences.The "grief work" hypothesis bas been a central construct in bereavement

research and clinical intervention programming (see [39] for a detailed review).Definitions have been imprecise, but generally speaking the hypothesis states thatin order to adapt to loss and avoid suffering from lasting mental and physicalhealth consequences, ODe must confront and speak of one's personal feelings andreactions to the death of the loved ODe. With the notabie exception of a few[40-42], including Wortman and Silver [5], this was fairly well-accepted amongbereavement researchers at the time that Wortman and Silver [1] published theirmost influential article.

More recently, results from a few studies have provided empirical evidence insupport of the view that "grief work" may not be as essential for adjustment as themajority of theoreticians and clinicians believed. Thus, in a longitudinal study ofbereaved spouses, Schut analyzed the causal relationship between the expressionof emotions and health outcome (psychological/somatic symptomatology) [43].In contrast to predictions from the grief wort hypothesis, result.5 showed thatthe expression of emotions was almost entirely independent of outcome scores:whether ODe did or did not express one's grief had little impact on recovery.Likewise, in the Tübingen Longitudinal Study of Bereavement, the grief worthypothesis was not fully supported [44]. Widowers who did "grief work" hadbetter adjustment scores over an eighteen-month period than those who avoidedconfrontation with their loss. However, widows who avoided confronting theirloss did not differ in depressive symptomatology from widows who workedthrough their grief.

More research on the complex phenomenon of grief wort is needed. Further-more, although the results outlined above seem to support Wortman and Silver'sskepticism regarding the benefits of working through grief, research on compli-cated or pathological grief reactions suggests that this conclusion needs qualifica-tion. The grief wort hypothesis may indeed be applicable for cases of extremedenial, or extreme rumination (i.e., potentially pathological cases), for in suchcases regulation of "working through" may be called for. There is support for thisview: Although methodologically sound studies are rare, intervention strategiesfocusing the bereaved on their loss and guiding them through the tasks of grieving

MYTHSABOUTBEREAVEMENT 1195

have been found to be effective bath in cases of severe [45, 46] and mildlycomplicated [43] bereavement.

Is working through grief detrimental? So far we have only considered the griefwork hypothesis per se, that it is not always necessary to work through grief.Wortman and Silver go further, to reason that working through grief actually basdetrimental consequences. We have found no evidence that those who "workthrough" a loss are less successful in resolving their grief than those who do not.Wortman and Silver [1] based their conclusion on the results of Parkes andWeiss's [47] study of bereaved spouses, and their own study of parents whosuffered a SIDS loss [5].

Examination of these studies leads us to different conclusions. Parkes andWeiss found "high yearning" to be predictive of paar men tal and physical out-come at thirteen months af ter bereavement [47]. Wortman and Silver concep-tualize yearning as an operationalization of working through, and thus concludethat working through grief is maladaptive [1]. However, yearning might better beinterpreted as a symptom of bereavement-related depression rather than a measureof "grief work," particularly in view of Parkes and Weiss's operationalization ofyearning: Examination of the dependent measure shows that it tapped pining andmissing the deceased, which bas less to do with grief work as a coping strategythan with depressive symptomatology in bereavement. Parkes and Weiss reportedthat yearning was "the single most typical feature of grief' [47, p. 47]. In OUT view,it is a good predictor of pOOT outcome precisely because it is associated with highdistress. Thus, while definitions and operationalizations of these concepts are stillin need offurther specification (we return to this discussion later), an attempt mustbe made to distinguish grief work from yearning foT the deceased, and interpretingyearning as an index of "processing" loss is problematic. This study, then, cannotbe taken as strong evidence regarding the issue whether grief work is or is noteffective foT overcoming grief.

In reporting their own study in support of the view that grief work does not helpthe bereaved to recover successfully, Wortman and Silver do not distinguish griefwork from rumination [1]. They operationalized "working through" in this studyin terms of "active attempts . . . to make sense of and process the death, includingsearching foT an answer for why the baby had died, thinking of ways that the deathcould have been avoided, and being preoccupied with the loss" [1, p. 12]. Theyfound that such searching was related to paar, and not good, outcome. However,it seems from their definition that what is termed "working through" is, at least inpart, "worrying." As van den Bout demonstrated, being busy with attributionalquestions concerning loss is closely related to worrying [48]. Likewise, it isrelated to "rumination," even lamentation (although the difference between theseconcepts is not a clear one, see below). The latter implies an inability to put thedeath out of mind; going over the events in a repetitive, set manner; deploring andregretting that the event bas happened to one. In the case of a SIDS death, thecause is mysterious, and self-blame and self-derogatory thoughts are likely to be

196 / STROEBE,VANDENBOUTANDSCHUT

frequent. Distress is, then, likely to be accompanied by ruminations and regrets:the question "Why did it happen?" caD be as much a cry of anguish as it is a searchto make sense of a loss in the sense used, for example, by Marris [49].

Thus, in oor view, these results show that the more depressed parents were moredisturbed and preoccupied with loss initially, they kept mulling over events,wondering if they could have prevented death, worried that they were to blame,and so on. For the reasons outlined above, we cannot agree with the conclusiondrawn that "the more the parents were "working through" the death . . . the moredistressed they were" [1, p. 12] at a later date.

Although we criticize Wortman and Silver [1] above for failing to differen-tiate the terms "yearning," "rumination," "worrying," "working through," and"processing the loss," it is only fair to stress that adequate operationalizations arenot yet available in the literature (for a more detailed discus sion see [39]).

In conclusion, we agree with Wortman and Silver that the benefits of grief workhave not received empirical confirmation. We also agree that there are goodreasons to doubt that it is as beneficial as theorists and clinicians assume. How-ever, we disagree with their interpretation that studies have shown workingthrough grief to have the opposite effect and actually to be detrimental to adjust-ment. Again, lack of conceptual clarification is the cause of some of the supposeddifferences in assumptions.

4. "The Expectation of Recovery"

Wortman and Silver criticize in particular what they call "stage modeis" ofcoping with löss for the expectation that "af ter a relatively brief period of time, theperson is expected to achieve a state of recovery and return to normal falefunctioning" [1, p. 352], and that failure to recover bas been identified as a majortype of pathological mourning.

Do bereavement researchers have rigid expectations about recovery and failto acknowledge the variability that exists in response to löss? Raphael, in hertextbook on bereavement, noted that "each bereaved takes bis own time to grieve"[23, p. 400]. Osterweis et al. stated that an endpoint in time of the bereavementprocess cannot be specified, since the length of time that it takes for persons torecover varies tremendously: "It is not the length of time per se that distinguishesnormal trom abnormal grief, but the quality and quantity of reactions over time"

[19, p. 52].Statements such as these make it clear that individual differences are expected,

and that pathology is not assumed simply because grief happens to be moreattenuated than in most other bereavements. It should also be emphasized thatWortman and Silver misrepresent theoretical contributions in labelling them"stage theories" [1]. They name Bowlby's [9] and Horowitz's [35] theories inthis context. Yet the farmer is a theory of attachment, the latter a cognitivestress model, these aspects being most central and critical for the prediction of

MYTHSABOUTBEREAVEMENT 1197

adjustment. Phasal changes in each case are more descriptive than prescriptive.Bereavement researchers who have suggested time-related regularities in thegrieving process have at the same time also maintained that the array of reactionsis varied and complex: Grief" . . . involves a succession of clinical pictures whichblend into and replace ODe another" [22, p. 27], or " . . . there is much intermesh-

ing of. . . phases" [33, p. 45]. As examination of the popular literature and laybeliefs reveals, these erudite descriptions are of ten misinterpreted in terms ofprescription, a phenomenon that Wortman and Silver rightly criticize.

It is the purpose of empirical research to try to abstract similar features fiomapparently heterogeneous phenomena, rather than document uniqueness ofindividual experiences. Nevertheless, the fact that ODe undertakes this scientificenterprise does not mean that variability in responses is ignored and denied, northat prevailing assumptions "fail to acknowledge the variability that exists inresponse to loss" [1, p. 349]. Nor does it mean, as they also maintain that there basbeen a " . . . perpetuation of unrealistic assumptions about the normal process of

coping with loss" [1, p. 355] in the scientific literature, which might lead thebereaved to perceive their own responses as inappropriate and abnormal. Theycriticize Zisook and Shuchter [50] for such a lack of awareness. Yet Zisook andShuchter acknowledge a wealth of differences: " . . . grief is a highly individual-

ized phenomenon, with differences among cultures as weIl as individuals" [50,p. 288]. Examination of other reports in the area (including Osterweis et al. [19]who are also criticized on this count) indicates awareness of the complexity and

range of "normal" grieving [22, 23, 51, 52].It is nevertheless true that more attention in the scientific literature is given to

mean scores than to individual differences in bereavement reactions. This isdictated by the nature of the scientific endeavor (although ODe must also guardfrom the danger that deviations are only considered in terms of standard devia-tions, risking the neglect of the rich variety of grief reactions). As noted above,the aim of research is to abstract similar features from what appear to beheterogeneous phenomena, and to conceptualize differences as special cases ofthe general categories that are proposed. ODe of the objectives, as Wortmanand Silver agree, is to target individuals who may be in Deed of as si stance [1].Unless ODe is able to abstract from regularities that have been identified, ODe

cannot do this.Turning from diversity of reactions to expectations about the length of time it

takes till a bereaved person "recovers" from bis or her grief, Wortman and Silver[1] cited the classic paper by Lindemann [53] as asserting that bereavement is

relatively transient, taking from four to six weeks. Lindemann was, however,discussing ". . . the psychiatrist's role in assisting patients in their readjustmentafter bereavement. . ." [53, p. 65] af ter they had lost a loved ODe very suddenly,in a fire disaster. Many of these bereaved persons were themselves survivors ofthefire, and were hospitalized. Lindemann himself attended many of them, andsummarized their readjustment as follows: "Within eight to ten interviews in

198 I STROEBE, VAN DEN BOUT AND SCHUT

which the psychiatrist shares the grief work, and with a period from foUT to sixweeks, it was ordinarily possible to settle an uncomplicated and undistorted griefreaction" [53, p. 67]. This does not necessarily meao that grieving was overcompletely af ter this time. It cannot be concluded that Lindemann held theexpectation of recovery to normal functioning af ter such a brief period [53]. Infact, close reading of Lindemann' spaper reveals no clues as to how long the griefprocess was expected to last.

There is, however, continuing debate concerning the length of time thatbereavement usually takes when it runs an uncomplicated course [25]. Wortmanand Silver criticized the failure of theories to "postulate precisely" [1, p. 352] thelength of time that grief should last (which seems surprising, in view of the factthat they also criticize researchers foT postulating norms of recovery).

Researchers acknowledge individual differences in the time course of grief, andwould therefore be reluctant to make precise statements about the duration ofgrief. Summarizing the results of empirical studies, Lund, foT example, drewattention to great diversity in adjustment of older spouses, who experience greatestdifficulty in the fiTst several months but gradually improve, if unsteadily, overtime [51]. He noted that improvement may last foT many years, and foT samemay never end.

It is generally accepted that a few bereaved people continue to suffer intenselyfoT much longer than the majority, and a great deal of research effort bas beeninvested into identifying these persons early on and providing intervention basedon theoretical understanding of bereavement complications [19,22-24, 54}.

Thus, we disagree with Wortman and Silver's representation of research, par-ticularly with the conclusion that "prevailing notions of recovery deserve recon-sideration" [1, p. 353] following evidence that a substantial minority of thebereaved continue to show distress foT much longer than "would commonly beassumed" [1, p. 353]. To us, there is no discrepancy between assumptions aboutthe duration of grief foT the majority, and observations that a minority continue togrieve beyond the period needed by most. Those who take longer are not neces-sarily suffering from "chronic grief," nor cao they be assumed to have a patho-logical form of grieving.

5. "Reaching a State of Resolution"

Cao oDe speak of an ultimate "resolution" of grief? Wortman and Silver statethat this is widely assumed in the area, and that the assumption is false, since astate of resolution is not always achieved [I, 5]. For reasons set out below, wedisagree with them on two counts: their representation of the literature, and withregard to the conclusions they draw.

"Resolution" is just ODe of a number of concepts used to describe the abating ofgrief during the bereavement process, and there is considerable debate in theliterature about the use of such terms and their implications. A citation from

198 / STROEBE, VAN DEN BOUT AND SCHUT

which the psychiatrist shares the grief work, and with aperiod from foor to sixweeks, it was ordinarily possible to settIe an uncomplicated and undistorted griefreaction" [53, p. 67]. This does not necessarily meao that grieving was overcompletely af ter this time. It cannot be concluded that Lindemann held theexpectation of recovery to normal functioning af ter such a brief period [53]. Infact, close reading of Lindemann' spaper reveals no clues as to how long the griefprocess was expected to last.

There is, however, continuing debate conceming the length of time thatbereavement usually takes when it runs an uncomplicated course [25]. Wortmanand Silver criticized the failure of theories to "postulate precisely" [I, p. 352] thelength of time that grief should last (which seems surprising, in view of the factthat they also criticize researchers for postulating norms of recovery).

Researchers acknowledge individual differences in the time course of grief, andwould therefore be reluctant to make precise statements about the duration ofgrief. Summarizing the results of empirical studies, Lund, for example, drewattention to great diversity in adjustment of older spouses, who experience greatestdifficulty in the first several months but gradually improve, if unsteadily, overtime [51]. He noted that improvement may last for many years, and for somemay never end.

It is generally accepted that a few bereaved people continue to suffer intenselyfor much Jonger than the majority, and a great deal of research effort bas beeninvested into identifying these persons early on and providing intervention basedon theoretical understanding ofbereavement complications [19, 22-24, 54).

Thus, we disagree with Wortman and Silver's representation of research, par-ticularly with the conclusion that "prevailing notions of recovery deserve recon-sideration" [I, p. 353] following evidence that a substantial minority of thebereaved continue to show distress for much Jonger than "would commonly beassumed" [I, p. 353]. To us, there is no discrepancy between assumptions aboutthe duration of grief for the majority, and observations that a minority continue togrieve beyond the period needed by most. Those who take Jonger are not neces-sarily suffering from "chronic grief," nor cao they be assumed to have a patho-logical form of grieving.

5. "Reaching a State of Resolution"

Cao oDe speak of an ultimate "resolution" of grief? Wortman and Silver statethat this is widely assumed in the area, and that the assumption is false, since astate of resolution is not always achieved [1, 5]. For reasons set out below, wedisagree with them on two counts: their representation of the literature, and withregard to the conclusions they draw.

"Resolution" is just ODe of a number of concepts used to describe the abating ofgrief during the bereavement process, and there is considerable debate in theliterature about the use of such terms and their implications. A citation from

MYTHS ABOUT BEREAVEMENT / 199

Osterweis et al. illustrates this point: "Completion" is helpful in denoting relativeresolution, "but it suggests that there is a fixed endpoint of the bereavementprocess af ter which there is no more grieving, a notion that is inaccurate" [19,p. 52]. This demonstrates that researchers were aware of the dangers of brandingthe grief process as "resolved," or "completed" when in fact the bereaved continueto think about the loved person, and to dweIl on the implications of loss andmemories of the past. For instance, Brown and Stoudemire [30], who are amongthe few who use the term resolution, did not do so to indicate a definite ending ofgrief, as assumed by Wortman and Silver [1]. "Resolution" is the label they givethe third phase of the grief process. Their description shows that "resolution" isnot intended to meao that the bereaved person bas found an explanation for lossand come to terms completely with what bas happened. Brown and Stoudemireconclude their description of the phase of resolution with the frequent observation:"Youreally don't get over it; rou get used to it" [30, p. 379].

In contrast, Wortman and Silver regard the term resolution as implying adefinitive ending to grief, bath in terms of intellectual aspects (making sense ofwhat bas happened) and so-called emotional ODes ("when the person no langerfeels the Deed to avoid reminders of the loss in order to function" [1, p. 353]).

As the above discussion shows, conclusions about whether or not "resolution"is reached depend heavily on the definition of this concept. "Resolution" bas notbeen used in the strict sense of a completion, or definitive ending, of grief.However, unless careful reference is made to a precise definition, the term lendsitself to such literal interpretations, and, in our view, may best be avoided in thecontext of grief and bereavement.

CONCLUSIONS

Oor conclusions conceming each of the five "myths" about coping with lossare fundamentally different from those reached by Wortman and Silver [1],who, in their representation of research, must consider whether they themselvesdo not create myths that they deplore in other sources. Thus, we have opened adebate which others will hopefully join, for, as in any scientific field, advance-ment CaD be furthe:ed through the process of disagreement and debate, and theconstant revision of hypotheses as new data and novel theoretical formulationscome to light.

Such a strategy is followed, in oor view, by the majority of bereavementresearchers, whose aims are not to create myths but to explore and understand thephenomena of bere~ivement. There is awareness of the limitations of knowiedge,and hesitation in ruiling general claims or making assumptions. Raphael andMiddleton, for example, caution that" . . . much of the theoretical formulation basgone beyond the a"ailable data, sometimes including hypotheses that may beuntestable and concepts that seem incompatible with ODe another" [3, p. 5]. Theyfurther noted that be :eavement researchers in the 1980' s had failed to clarify many

200 / STROEBE, VAN DEN BOUT AND SCHUT

themes arising from earlier writings. Similarly Parkes, in bis review of bereave-ment research, pointed to the limitations of knowiedge, for example, in theestablishment of intermediate variables between bereavement and the widevariety of psychosomatic and somatic disorders that frequently occur during grief[2]. Clearly, then, more empirical research is needed. Wortman and Silver arejustified in drawing the conclusion that knowledge about the phenomena ofbereavement does not always rest on a firm body of empirical evidence. However,it must also be acknowledged, first, that bereavement researchers have sharedthese views about the state of knowiedge, and second, that assumptions have notbeen retained and perpetuated when they have been proven wrong.

Dur evaluation of research in the field is clearly different trom that of Wortmanand Silver, who concluded with an explanation why, in their view, erroneousbeliefs continue in the absence of validating data collected in methodologicallyrigorous research and in the presence of such a variety of responses to loss [1].They argued that there is resistance to disconfirming evidence, citing Nisbett andRoss in support of this, "people tend to seek out, recall, and interpret evidence ina manner that sustains beliefs" [55, p. 192]. Thus, implicit theories that peoplehold are "almost impervious to data" [55, p. 169].

Is this justified when applied to the bereavement area? We hope, in the abovediscussion, that we have backed up our own assumptions with sufficient"evidence" to show that bereavement researchers do not go about their work in amanner that simply sustains beliefs. In our view they do not hold tenaciously to aset of basic assumptions that have been contradicted by empirical research. As wehave also illustrated, there is critical discussion of basic issues and assumptions inthe area. There is an increasing accumulation of empirical research characterizedby "objectivity, standardized and systematic procedures, and replication to verifythe accuracy and generalizability of the knowiedge" [51, p. 217]. Finally, in anarea where deep suffering is encountered and sensitivity and compassion neededon the part of researchers and practitioners, great caution is observed in theapplication of general mIes to particular cases.

ACKNOWLEDGMENTS

The authors wish to thank Robert O. Hansson, Rolf J. Kleber, Arie Kruglanski,James Pennebaker, and Wolfgang Stroebe for their valuable comments on anearlier draft of this article.

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Heidelberglaan IP.O. Box 80.1403508 TC UtrechtThe Netherland~