Westberg model of the grieving process

grandchildren and great-grandchildren with gifts, loans, and babysitting.

Because older people are living longer, four and even five generations of families are becoming more common. Papalia et al. (2009, p. 613) note:

Grandparents and great-grandparents are impor- tant to their families. They are sources of wisdom, companions in play, links to the past, and symbols of the continuity of family life. They are engaged in the ultimate generative function: expressing the human longing to transcend mortality by investing themselves in the future generations.

Guidelines for Positive Psychological Preparation for Later Adulthood: The Strengths Perspective Growing old is a lifelong process. Becoming 65 does not destroy the continuity of what a person has been, is now, and will be. Recognizing this should lessen the fear of growing old. For those who are financially secure and in good health and who have prepared thoughtfully, later adulthood can be a period of

at least reasonable pleasure and comfort, if not luxury.

Some may be able to start small home businesses, based on their hobbies, or become involved in mean- ingful activities with churches and other organizations. Others may relax while fishing or traveling around the country. Still others may continue to pursue such inter- ests as gardening, woodworking, reading, needlework, painting, weaving, and photography. Many older peo- ple have contributed as much (or more) to society as they did in their earlier years. One role model in this area is Jimmy Carter; see Highlight 15.1.

Our lives depend largely on our goals and our efforts to achieve those goals. How we live before retiring will largely determine whether later adult- hood will be a nightmare or will be gratifying and fulfilling. The importance of being physically and mentally active throughout life was discussed in Chapter 14. Here are some factors that are closely related to satisfaction in later adulthood:

1. Close personal relationships. Having close rela- tionships with others is important throughout life. Older people who have close friends are more sat- isfied with life. Practically everyone needs a person to whom one can confide one’s private thoughts or feelings. Older people who have confidants are better able to handle the trials and tribulations of

HIGHLIGHT 15.1

Jimmy Carter: Stumbled as President, Excelled in Later Adulthood

Jimmy Carter (James Earl Carter Jr.) was born October 1, 1924, in the small rural community of Plains, Georgia. Carter graduated from the U.S. Naval Academy in Annapolis in 1946. After seven years as a naval officer, he returned to Plains, where he ran a peanut-producing business. In 1962, he entered state politics. Eight years later, he was elected governor of Georgia. In 1976, he was elected president of the United States. Although he had some noteworthy accomplishments as presi- dent, there were serious setbacks economically and in foreign affairs. Inflation, interest rates, and unemployment rates were at near-record highs. During Carter’s four-year administration, the economy went into a recession. In 1979, more than 50 members of the U.S. Embassy staff in Iran were taken as hos- tages by militants. Despite 14 months of trying, the Carter ad- ministration was unable to secure release of the hostages. After a devastating defeat for reelection in 1980, Carter retired from political life—and left being very unpopular.

But the best was yet to come. He did not throw in the towel. Today he is a professor at Emory University in

Georgia and a leading advocate for Habitat for Humanity, which helps build houses for low-income families. He es- tablished the Carter Center, which sponsors international programs in human rights, preventive health care, educa- tion, agricultural techniques, and conflict resolution. Carter and the Carter Center have secured the release of hundreds of political prisoners. He has become an elder statesman, a roving peacemaker, and a guardian of free- dom. He oversaw the Nicaraguan elections that ousted the dictatorship of the Sandinistas. He brokered a cease- fire between the Serbs and the Bosnian Muslims. He has pressured China to release political prisoners. He was the first former U.S. president to visit Communist Cuba. He has helped set up fair elections in China, Mozambique, Nigeria, Indonesia, and several other developing countries. In addition, he has written 14 books. In 2002, at age 78, he was awarded the Nobel Peace Prize. Clearly, Carter’s ac- complishments in later adulthood surpass his accomplish- ments in his earlier years.

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aging. Through sharing their deepest concerns, people are able to ventilate their feelings and to talk about their problems and possibly arrive at some strategies for handling them. Those who are married are more likely than the widowed to have confidants, and the widowed are more likely to have confidants than those who have never mar- ried. For those who are married, the spouse is apt to be the confidant, especially for men.

2. Finances. Health and income are two factors closely related to life satisfaction in later adult- hood. When people feel good and have money, they can be more active. Those who are active— who go out to eat, go to meetings or museums, go to church, go on picnics, or travel—are happier than those who mostly stay at home. Saving money for later years is important, and so is learning to manage or budget money wisely.

3. Interests and hobbies. Psychologically, people who are traumatized most by retirement are those whose self-image and life interests center on their work. People who have meaningful hobbies and interests look forward to retirement in order to have sufficient time for these activities.

4. Self-identity. People who are comfortable and re- alistic about who they are and what they want from life are better prepared to deal with stresses and crises that arise.

5. Looking toward the future. A person who dwells on the past or rests on past achievements is apt to find the older years depressing. On the other hand, a person who looks to the future generally has interests that are alive and growing and is therefore able to find new challenges and new sat- isfaction in later years. Looking toward the future involves planning for retirement, including decid- ing where one would like to live, in what type of housing and community, and what one looks for- ward to doing with his or her free time.

6. Coping with crises. If a person learns to cope ef- fectively with crises in younger years, these cop- ing skills will remain useful when a person is older. Effective coping is learning to approach problems realistically and constructively.

Grief Management and Death Education In the remainder of this chapter, we will discuss re- actions to death in our society, including social work

roles in grief management and guidelines for relating to a dying person and to survivors.

Death in Our Society: The Impact of Social Forces People in primitive societies handle death better than we do. They are more apt to view death as a natural occurrence, partly because they have shorter life ex- pectancies. They also frequently see friends and rel- atives die. Because they view death as a natural occurrence, they are better prepared to handle the death of loved ones. Spotlight 15.3 illustrates the cultural-historical context of death and bereavement.

In our society, we tend to shy away from thinking about death. The terminally ill generally die in institutions (hospitals and nursing homes), away from their homes. Therefore, we are seldom exposed to people dying. Many people in our society seek to avoid thinking about death. They avoid going to funerals and avoid conversations about death. Many people live as if they believe they will live indefinitely.

We need to become comfortable with the idea of our own eventual death. If we do that, we will be better prepared for the deaths of close friends and relatives. We will also then be better prepared to relate to the terminally ill and to help survivors who have experienced the death of a close friend or relative.

Funerals are needed for survivors. Funerals help initiate the grieving process so that people can work through their grief. (Delaying the grieving process may intensify the eventual grief.) For some, funerals also serve the function of demonstrating that the per- son is dead. If survivors do not actually see the dead body, some may mystically believe that the person is still alive. For example, John F. Kennedy was assas- sinated in 1963 and had a closed-casket funeral. Because the body was not shown, rumors abounded for many years that he was still alive.

The sudden death of a young person is more dif- ficult to cope with, for three reasons. First, we do not have time to prepare for the death. Second, we feel the loss as more severe because we feel the per- son is missing out on many of the good things in life. Third, we do not have the opportunity to obtain a sense of closure in the relationship; we may feel we did not have the opportunity to tell the person how we felt about him or her, or we did not get the op- portunity to resolve interpersonal conflicts. (Because the grieving process is intensified when closure does

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not occur, it is advisable to actively work toward closure in our relationships with others.)

Children should not be sheltered from death. They should be taken to funerals of relatives and friends and their questions answered honestly. It is a mistake to say, “Grandmother has gone on a trip and won’t be back.” The child will wonder if other significant people in his or her life will also go on a trip and not come back; or the child may be puzzled about why grandmother won’t return from the trip. It is much better to explain to children that death is a natural process. It is desirable to state that death is unlikely to occur until a person is quite old, but that there are exceptions—such as an automobile acci- dent. Parents who take their children to funerals al- most always find the children handle the funeral better than they expected. Funerals help children learn that death is a natural process.

It is generally a mistake for survivors to seek to appear strong and emotionally calm following the death of a close friend or relative. Usually such peo- ple want to avoid dealing with their loss, and there is a danger that when they do start grieving they will experience more intense grief—partly because they will feel guilty about denying that they are hurting, and partly because they will feel guilty because they de-emphasized (by hiding their pain and feelings) the importance of the person who died.

Many health professionals (such as medical doc- tors) find death difficult to handle. Health profes- sionals are committed to healing. When someone is found to have a terminal illness, health professionals are apt to experience a sense of failure. In some cases, they experience guilt because they cannot do more, or because they might have made mistakes that contributed to a terminal illness. Therefore, do not be too surprised if you find that some health professionals do not know what to say or do when confronted by terminal illness.

The Grieving Process Nearly all of us are currently grieving about some loss that we have had. It might be the end of a ro- mantic relationship, or moving away from friends and parents, or the death of a pet, or failing to get a grade we wanted, or the death of someone.

It is a mistake to believe that grieving over a loss should end in a set amount of time. The normal grieving process is often the life span of the griever. When we first become aware of a loss of great im- portance to us, we are apt to grieve intensively—by crying or by being depressed. Gradually, we will have hours, then days, then weeks, then months when we will not think about the loss and will not grieve. However, there will always be something that reminds us of the loss (such as anniversaries), and we

SPOTLIGHT ON DIVERSITY 15.3

The Cultural-Historical Context of Death and Bereavement

Cultural customs concerning the disposal and remembrance of the dead, the transfer of possessions, and even expressions of grief vary greatly from culture to culture. Often, religious or legal prescriptions about these topics reflect a society’s view of what death is and what happens afterward.

In ancient Greece, bodies of heroes were publicly burned as a symbol of honor. Public cremation is still practiced by Hindus in India and Nepal. In contrast, cremation is prohib- ited under Orthodox Jewish law, as it is believed that the dead will rise again for a “last judgment” and the chance for eter- nal life. To this day, some Polynesians in the Tahitian Islands bury their parents in the front yard of their parents’ home as a way of remembering them.

In ancient Romania, warriors went laughing to their graves, expecting to meet Zalmoxis, their supreme god.

In Mayan society, which prospered several centuries ago in Mexico and Central America, death was seen as a gradual transition. At first a body was given only a provisional burial. Survivors continued to perform mourning rites until the body

decayed to the point where it was thought the soul had left it and transcended into the spiritual realm.

In Japan, religious rituals expect survivors to maintain contact with the deceased. Families keep an altar in their homes that is dedicated to their ancestors; they offer them cigars and food and talk to the altar as if they were talking to their deceased loved ones. In contrast, the Hopi (Native American tribe) fear the spirits of the deceased and try to for- get, as quickly as possible, those who have died.

Some modern cultural customs have evolved from ancient ones. The current practice of embalming, for example, evolved from the mummification practice in ancient Egypt and China about 3,000 years ago that was designed to pre- serve a body so that the soul could eventually return to it.

Today, Muslims in Bali are encouraged to suppress sad- ness, and instead to laugh and be joyful at burials. In contrast, Muslims in Egypt are encouraged to express their grief with displays of deep sorrow.

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will again grieve. The intense grieving periods will, however, gradually become shorter, occur less fre- quently, and decrease in intensity.

Two models of the grieving process will be pre- sented here: the Kübler-Ross (1969) model and the Westberg (1962) model. These models help us to un- derstand the grief we feel from any loss.

The Kübler-Ross Model This model posits five stages of grief:

1. Stage One: Denial. During this stage, we tell our- selves, “No, this can’t be. There must be a mis- take. This just isn’t happening.” Denial is often functional because it helps cushion the impact of the loss.

2. Stage Two: Rage and Anger. During this stage, we tell ourselves, “Why me? This just isn’t fair!” For example, terminally ill patients resent that they will soon die while other people will remain healthy and alive. During this stage, God is some- times a target of the anger. The terminally ill, for example, blame God as unfairly imposing a death sentence.

3. Stage Three: Bargaining. During this stage, peo- ple with losses attempt to strike bargains to re- gain all or part of the loss. For example, the terminally ill may bargain with God for more time. They promise to do something worthwhile or to be good in exchange for another month or year of life. Kübler-Ross indicates that even ag- nostics and atheists sometimes attempt to bargain with God during this stage.

4. Stage Four: Depression. During this stage, those having losses tell themselves, “The loss is true, and it’s really sad. This is awful. How can I go on with life?”

5. Stage Five: Acceptance. During this stage, the person fully acknowledges the loss. Survivors

accept the loss and begin working on alternatives to cope with the loss and to minimize its impact.

The Westberg Model This model is represented graphically in Figure 15.1.

• Shock and Denial. According to the Westberg model, many people, when informed of a tragic loss, are so numb, and in a state of such shock, that they are practically devoid of feelings. It could well be that when emotional pain is unusu- ally intense, a person’s response system experi- ences “overload” and temporarily “shuts down.” The person feels hardly anything and acts as if nothing has happened. Such denial is a way of avoiding the impact of a tragic loss.

• Emotions Erupt. As the realization of the loss be- comes evident, the person expresses the pain by crying, screaming, or sighing.

• Anger.At some point, a person usually experiences anger. The anger may be directed at God for caus- ing the loss. The anger may be partly due to the unfairness of the loss. If the loss involves the death of a loved one, there is often anger at the dead per- son for what is termed “desertion.”

• Illness. Because grief produces stress, stress-related illnesses are apt to develop, such as colds, flu, ulcers, tension headaches, diarrhea, rashes, and insomnia.

• Panic. Because the grieving person realizes he or she does not feel like the “old self,” the person may panic and worry about going insane. Night- mares, unwanted emotions that appear uncontrol- lable, physical reactions, and difficulties in concentrating on day-to-day responsibilities all contribute to the panic.

• Guilt. The grieving person may blame himself or herself for having done something that

Loss/Hurt Healed/New

Strengths

Shock and denial

Emotions erupt

Affirming reality

Anger

Hope

Illness Reentry difficulties

Panic Depression and loneliness

Guilt

FIGURE 15.1 Westberg Model of the Grieving Process

© Ce ng ag e Le ar ni ng

20 13

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contributed to the loss, or feel guilty for not doing something that might have prevented the loss.

• Depression and Loneliness. At times, the grieving person is apt to feel very sad about the loss and also to have feelings of isolation and loneliness. The grieving person may withdraw from others, who are viewed as not being supportive or understanding.

• Reentry Difficulties. When the grieving person makes efforts to put his or her life back together, reentry problems are apt to arise. The person may resist letting go of attachments to the past, and loyalties to memories may hamper the pursuit of new interests and activities.

• Hope. Gradually, hopes of putting one’s life back together return and begin to grow.

• Affirming Reality. The grieving person puts his or her life back together again, and the old feeling of having control of one’s life returns. The reconstructed life is not the same as the old, and memories of the loss remain. However, the recon- structed life is satisfactory. The grieving person resolves that life will go on.

Evaluation of Models of the Grieving Process Kübler-Ross and Westberg note that some people continue grieving and never do reach the final stage (the acceptance stage in the Kübler-Ross model, or the affirming reality stage in the Westberg model). Kübler-Ross and Westberg also caution that it is a mistake to rigidly believe everyone will progress through these stages as diagrammed. There is often considerable movement back and forth among the stages. For example, in the Kübler-Ross model, a person may go from denial and depression to anger and rage, then back to denial, then to bargaining, then again to depression, back to anger and rage, and so on.

How to Cope with Grief The following suggestions are given to help those who are grieving:

• Crying is an acceptable and valuable expression of grief. Cry when you feel the need. Crying releases the tension that is part of grieving.

• Talking about your loss and about your plans is very constructive. Sharing your grief with friends, family, the clergy, a hospice volunteer, or a pro- fessional counselor is advisable. You may seek to become involved with a group of others having

similar experiences. Talking about your grief eases loneliness and allows you to ventilate your feel- ings. Talking with close friends gives you a sense of security and brings you closer to others you love. Talking with others who have similar losses helps put your problems into perspective. You will see you are not the only one with problems, and you will feel good about yourself when you assist others in handling their losses.

• Death often causes us to examine and question our faith or philosophy of life. Do not become concerned if you begin questioning your beliefs. Talk about them. For many, a religious faith pro- vides help in accepting the loss.

• Writing out a rational self-analysis on your grief will help you to identify irrational thinking that is contributing to your grief (see Chapter 8). Once any irrational thinking is identified, you can re- lieve much of your grief through rational chal- lenges to your irrational thinking.

• Try not to dwell on how unhappy you feel. Be- come involved and active in life around you. Do not waste your time and energy on self-pity.

• Seek to accept the inevitability of death—yours and that of others.

• If the loss is the death of a loved one, holidays and the anniversaries of your loved one’s birth and death can be stressful. Seek to spend these days with family and friends who will give you support.