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Bereavement and Loss Of A Loved One

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George Bonanno

George A. Bonanno is a professor of clinical psychology at Columbia University,Teachers College. He is responsible for the revolutionary idea of resilience. He is known as a pioneering researcher in the field of bereavement and trauma. The New York Times on February 15, 2011, stated that the current science of bereavement has been "driven primarily" by Bonanno. Scientific American summarized a main finding of his work, "The ability to rebound remains the norm throughout adult life."

An article in Lingua Franca described Bonanno as resembling "the Grim Reaper himself, albeit in tanned, rested form."

His contributions to the field, summarized in his book, "The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss," include the following:

  • The idea of Resilience. Resilience defines the experience of human loss and trauma.
  • Introducing rigorous scientific methods of research to the field of bereavement and trauma;
  • Describing for the first time, a natural resilience as the main component of grief and trauma reactionsin people who face major losses, such as the death of a spouse, the loss of a child, having suffered sexual abuse as a child, or losing a loved one in severe stressor events, such as the World Trade Center collapse of 9-11-01;
  • Replacing with scientific findings the major concepts of grief that are theoretical, unsupported scientifically, but remain popular among practitionersand the lay public today, such as Kübler-Ross model of the stages of grief and the idea of grief work based on the Freud's ideas;
  • Demonstrating scientifically that some practices common in grief counseling, trauma counseling, and among therapists after potentially traumatic events are harmful. These practices include asking people to talk about a loss or to cry about a loss. These practices are common parts of public policy and are based on the underlying assumption that people are not resilient;
  • Showing that genuine laughter and smiling, rather than crying, is a healthy response to a loss or stressor event; not crying is protective;
  • The first and only researcher having obtained and used pre-loss data to understand the processes of grief;
  • Based on pre-loss data, outlining four trajectories of grief;
  • Demonstrating that absence of grief or trauma symptoms is a healthy outcome, rather than something to be feared as has been the thought and practice until his research;
  • Coining the phrase "coping ugly" to describe the idea that coping with grief takes many forms, some of which seem counter intuitive.
  • Because resilience is natural, suggesting that it cannot be "taught" through specialized programs and that there is virtually no existing research to design resilience training nor is there existing research to support major investment in such things as military resilience training programs;

Resilience

Bonanno's research found psychological resilience to be at the core of human grief and trauma reactions. Bonanno's finding of resilience overturns what has been the status quo assumption of a person's experience of grief and trauma in the West since Sigmund Freud nearly a century ago. Bonanno's contribution to the field is to have found resilience through rigorous research and not through anecdotal evidence, theorizing, or simple but unreliable methodology.

Controversy. Many in the field of bereavement have found Bonanno's finding of persistent resilience in the face of potentially traumatic events controversial. Many therapists and psychiatrists, who tend to treat the chronically affected, find it hard to imagine that no treatment is needed for most people who have experienced a loss or even an extreme stressor event, such as during 9-11 or childhood sexual abuse. Further, in contrast to Freud's and his followers' ideas and prevailing popular theories, it is difficult for many people to accept laughter as a more healthy response than crying. Another difficult concept, especially in the face a potentially traumatic event when people feel pulled to help in some way, is to realize that offering treatment to otherwise well people can cause harm, by producing the symptoms they hope to avoid.

Other critics have claimed the opposite, that far from being misguided, the idea that humans are resilient is so obvious that it is simplistic.Others have countered that it may seem simple, but the idea has escaped researchers for the century between Freud's work and Bonanno's. Policy and treatment for the past century has relied on the false idea that humans are not resilient, a costly mistake in human and monetary terms.

Resilience Overturns Stages Model. That people are resilient even when facing extreme stressors or losses contradicts the stages model of grief. Many resilient people show no grief. They therefore have no stages of grief to pass through. Until Bonanno, therapists and psychiatrists considered the absence of grief a pathology to be feared, rather than a healthy outcome.

Importance of Resilience. Resilience has profound implications for people's concepts of themselves, especially after suffering a severe stressor event. The idea also has important implication for how the therapeutic community thinks of bereavement and treats bereavement. Bonanno's research has shown that universal counseling by grief counselors after potentially traumatic events does more harm than good.Resilience being an inherent part of human experience after major stressor events also may have important implications for public policy, such as how to best treat veterans who have served in war situations and whether to counsel large populations after major stressor events, such as tsunamis or mass shootings.

Four Trajectories of Grief and Trauma Reactions

In 2002 and 2004, Bonanno described the four most common trajectories of grief or potential trauma. This research was based on longitudinal data beginning prior to the loss. In subsequent studies, Bonanno and colleagues identified the same trajectories following other potentially traumatic events, such as the September 11th Terrorist Attack in New York and the SARS epidemic in Hong Kong.Contrary to common assumptions about loss and trauma, Bonanno's research may indicate that resilience is the most common pattern and that delayed reactions are rare.

The four trajectories and the percentages of people who tend to fall into each category are summarized and expanded upon in his book, "The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss," The book also includes graphs of the trajectories.

The four trajectories are as follows:

Resilience: "The ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning" as well as "the capacity for generative experiences and positive emotions."

Recovery: When "normal functioning temporarily gives way to threshold or sub-threshold psychopathology (e.g., symptoms of depression or Posttraumatic Stress Disorder (PTSD)), usually for a period of at least several months, and then gradually returns to pre-event levels."

Chronic dysfunction: Prolonged suffering and inability to function, usually lasting several years or longer.

Delayed grief or trauma: When adjustment seems normal but then distress and symptoms increase months later. Researchers have not found evidence of delayed grief, but delayed trauma appears to be a genuine phenomenon.

Coping Ugly

Bonanno coined the phrase "coping ugly" to describe his finding that grief and coping with grief take many forms. Behaviors that may not be healthy ordinarily may be helpful in times of stress, such as self-serving biases.

Bonanno Develops the Path for Scientific Study of Grief

Before Bonanno's work, a prevailing idea was that grief cannot be quantified or studied in a scientifically meaningful way. Bonanno forcefully argued early that scientific study of grief was possible.

The attitude of the field before Bonanno could be summarized by Tom Golden, a prominent bereavement expert who specializes in male grief.He said in 1997, "People who are grieving think that researchers are full of crap - and part of me says, I'm with you. We don't have the tools to measure it yet, there's no grieve-o-meter. We need to develop a sense of not knowing."

"I think that's a ridiculous statement" Bonanno said, heatedly in 1997 in response to Tom Golden's remark. "You can measure grief. People want to take a magical, mystical perspective, but it's very dangerous to assume that they have access to a sacred realm that research can't touch, relying only on their own observations, feelings, and thoughts - things that are very unreliable." This sort of clinical criticism, he argued, is the result of a simplistic attachment to individual patients life stories. "The criticism I most often hear is, 'Your research is very bad, because I have a patient who feels such and such. Well, I've studied hundreds of people."

Research Methodology

Bonanno conducted multi-cultural research into grief and trauma, including studies in Nanjing, China; among war survivors in Bosnia-Herzegovina; and in Israel. He has done multi-dimensional studies of emotion regulation, stressful life events, resilience, and adjustment among college students; a study of emotion and well-being among survivors of childhood sexual abuse (in collaboration with researchers at NIH); and several recent studies of resilience and adjustment in the aftermath of the September 11th terrorist attacks in New York City (funded by the National Science Foundation).

Rigorous Methodology: The fields of bereavement and trauma research rely often on simple measures, such as self-report questionnaires. Self-report measures are simple and inexpensive to give, but are unreliable for several reasons.Of concern to the fields of grief and trauma, self-report measures are biased by how the subject feels at the moment he or she answers the questionnaire. If the subject feels bad at the time of answering the questionnaire, the subject will remember the loss as more devastating. If the subject feels good when taking the questionnaire, the subject will report that the loss was less difficult to endure. This subjectivity can change rapidly.

Recognizing that any single simple measure cannot be accurate, one hallmark of Bonanno's research methodology has relied on several independent measures simultaneously. This ensures convergent validity of any findings. For example, his research studies often simultaneously use, among other measures, skin temperature, heart rate, the Facial Action Coding System or "FACS" pioneered by Paul Ekman, empty chair studies, longitudinal measures over months or years, cortisol, physician and friend reports, and Stroop tests.

In addition, he is known for developing new research techniques, such as a measure of ambivalence and the "empty chair" study with researcher Nigel Field.

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