Grief is a common element of bereavement, which care providers must understand well to help family member cope with loss. Understood as an emotional experience or psychological reaction through which individuals adapt to changes resulting to bereavement (Burke et al., 2017), the intensity and duration of grief can have significant implications for physical and mental health. In fact, previous research has shown that prolonged grief is a risk factor in mental and physical health deterioration (Miyabayashi & Yasuda, 2007). So, does grief vary according to the nature of death (acute or chronic)?
There are various factors that influence the duration and intensity of grief, key of which are timing of death and nature of death. In terms of timing of illness or death, when the time of death is seen as being premature, family members may have prolonged and intense grieving. As noted by Miyabayashi and Yasuda (2007), those who die in their old age are seen as having had timely deaths. However, early deaths of promising family members such as Heather in the case study (24 years old), who had just began a promising career as a teacher, can be traumatic. Such grief is likely to be intense and prolonged.
Another factor in the grief differentials is the nature of death itself. However, while there is much evidence showing that unnatural or unanticipated death results in a severer reaction (Burke et al., 2017), the impact on survivors has not received sufficient scholarly focus. In one of the few studies that have delved into this is issue, Miyabayashi and Yasuda (2007) found that chronic bereavement led to more favourable adjustment compared to acute bereavement. This variance can be explained in the sense that initial grief reaction to sudden death (such as that of Heather) may be more intense compared to reactions of death from protracted illness as the survivors of such acute bereavement experience a shattered world of built expectations. For Heather’s Family and loved ones, there are also likely to be secondary losses and concurrent stressors, while unfinished businesses will likely to remain.
Other factors that will influence the grieving of those close to Heather include the degree of premeditation or intentionality, amount of suffering, degree of preventability and the physical pain the deceased may have gone through before her demise. Heather’s accident did not appear intentional, though it may have been caused by the carelessness of the truck driver. However, the death can be attributed to senselessness of the other driver in running the red light. However, when internal control of self-esteem and beliefs are considered the differences relating to suddenness of death appear to be short term (Moon, 2016). The fact that there was a clinical nurse specialist to help the family through the process, helps reduce the impact of the bereavement. In addition, research also shows that the presence of the family during emergency medical procedures helps lessen grief. Heather’s family members were present during attempts to resuscitate her, and had been informed earlier that her chances of survival were minimal, thus limiting expectations. While the argument here contends that acute bereavement results to more severe grief compared to chronic death, it is not to say that chronic bereavement is not stressful. Rather, what is meant is that with protracted illness, family members have had time to prepare for the demise, and may have buffed up their resilience resources.
To conclude, there seems to be a timetable for grief, with the nature and timing of bereavement playing a major role in the severity and duration of grief. The presence of anticipatory grief prior to the loss changes the trauma after the loss. It can be inferred, therefore, that when death has been prepared for by those close to the person, the bereaved will work their way to normal functioning more easily. In other words, anticipatory grief generates an environment, no matter how ineffable, of adjusting to the expected loss.
- Burke, L. A., Neimeyer, R. A., Bottomley, J. S., & Smigelsky, M. A. (2017). Prospective risk factors for intense grief in family members of Veterans who died of terminal illness. Illness, Crisis & Loss, 1054137317699580.
- Miyabayashi, S., & Yasuda, J. (2007). Effects of loss from suicide, accidents, acute illness and chronic illness on bereaved spouses and parents in Japan: Their general health, depressive mood, and grief reaction. Psychiatry and Clinical Neurosciences, 61(5), 502-508.
- Moon, P. J. (2016). Anticipatory grief: a mere concept?. American Journal of Hospice and Palliative Medicine®, 33(5), 417-420.