Bereaved Persons Research Articles

Correlates of public stigma towards prolonged grief disorder

BackgroundPublic stigma for grief may reduce the social support provided to bereaved persons and increase bereavement-related distress. The general public reports more stigmatizing responses towards bereaved persons with prolonged grief disorder (PGD) than towards persons experiencing non-clinical grief. No studies to date have investigated whether personal characteristics of the general public relate to public stigma towards PGD. The present study examined whether participants’ socio-demographic characteristics and personal bereavement experiences are associated with stigmatizing responses towards PGD. MethodWe combined data of three previously published vignette experiments to conduct a secondary analysis. All studies presented members of the general public (N = 452) with a description of a male bereaved person with PGD symptoms and a PGD diagnosis. Participants rated three indicators of public stigma - negative attributes (competence, warmth), emotional reactions (fear, anger), and preferred social distance. First, we examined whether gender, age, and educational level related to public stigma towards PGD. Second, we examined the association of participants’ personal bereavement experiences with public stigma. ResultsRegression analyses demonstrated that participants’ socio-demographic characteristics explained a significant amount of variance for warmth (ΔR² = .03; p < .05) and anger (ΔR² = .05; p < .01): Male participants rated the person in the vignette as less warm (β = -.13, p < .05). Being older related to lower ratings of warmth (β = -.12, p < .05) and higher ratings of anger (β = .18, p < .01). Participants’ educational level was not associated with stigma. Participants’ bereavement experiences explained a significant amount of variance for preferred social distance (ΔR² = .11; p <. 05): Participants reporting higher personal grief severity preferred less social distance from a person with PGD (β = -.29, p < .05). A higher number of experienced losses, the recency of the bereavement, and the cause of death (natural vs. unnatural) did not relate to public stigma. ConclusionsMale and older persons are more likely to demonstrate public stigma towards PGD. Experiencing severe grief oneself is associated with less preferred social distance from a person with PGD. Anti-stigma interventions may advance the public's knowledge about grief and PGD and address specific target groups (men and older persons).

What do Professional Helpers Describe as Important Competence when Supporting Persons Bereaved by a Drug-Related Death.

Bereaved persons following a drug-related death (DRD) experience significant stress, an increased risk of health-related problems, complicated grief reactions and a risk of higher mortality. Despite the support received from professional helpers being important, research has yet to examine their perspectives to understand and meet the bereaved's needs and increase the helpers' competence. Hence, this qualitative study explored professional helpers' perspectives on essential skills and competencies when supporting bereaved following DRD. We conducted focus group interviews with 29 professional helpers from diverse health and welfare services across six Norwegian municipalities. Reflexive thematic analysis generated three main themes: Diversity of competence, Basic human competence and Balancing act between different considerations. It is crucial that municipal services explicitly define the needs of bereaved persons following a DRD and determine the necessary professional competencies and appropriate intervention levels required.

Drug-Death Related Bereavement and Social Support.

The loss of a close one to drug-related death (DRD) has been characterized as a form of stigmatized bereavement, and research has shown that there is a high risk of bereavement complications. Social support can be a buffer against bereavement complications, but because of stigma, DRD bereaved persons access to social support can be challenged. Based on data from a Norwegian sample of DRD bereaved persons (N = 252) the present study examines (1) bereaved persons' perceived access to different aspects of social support, and (2) the association between bereaved persons' experiences of societal stigma, own withdrawal, self-blame, and their perceptions of social support. Results show (1) that bereaved persons' access to contact with persons in the same situation is particularly low compared to other support aspects, and (2) that perceived stigma (4%) and own withdrawal (5%) predict variations in drug-related death bereaved persons' perception of social support.

Understanding the needs for support and coping strategies in grief following the loss of a significant other: insights from a cross-sectional survey in Sweden.

Grief has previously been described in pathological terms, characterized by several stages. In the past three decades, new perspectives on grief as a reaction to the loss of a significant other have emerged. It shows that grief is an individual process based on circumstances surrounding the death and the bereaved person's life situation, rather than being predetermined. The aim of the study was to show how grief is perceived by people who have lost a significant other, and it focuses on bereavement support, how the death affects the bereaved person's living conditions, how the bereaved person deals with grief, and if grief is expressed differently depending on whether it was an expected death (ED) or an unexpected death (UED). A cross-sectional design was used with data collected anonymously using an online survey with semi-structured answers and options for participants to add their own comments, and it was analyzed descriptively. Support in grief was mainly given by family and friends, and the perceived need was primarily for emotional support or emotional support combined with practical support, and to a greater extent for UEDs and women. For some bereaved persons, health caregivers and religious institutions provided support outside their own network. Grief can affect how people socialize with others and change social relationships. People can deal with grief in social as well as religious ways in the company of friends, through everyday conversations, spending time in nature, and having a spiritual outlook on life, and with the help of pets. The results can contribute to an increased understanding of grief after the loss of a significant other and how grief affects the bereaved person's life depending on whether it is an ED or a UED. There was a difference between the genders, with women perceiving a need for and receiving different forms of support and to a greater extent than men.

Help and support for bereaved persons who use drugs: a qualitative study

ABSTRACT Despite high rates of drug-related deaths in many countries across Europe, drug-related bereavement has been sparsely investigated. Given the fact that people using illicit drugs are at particular risk of experiencing bereavement as a result of a drug-related death (DRD), which is then related to increased drug use and the risk of developing complicated grief, there is an urgent need for knowledge about their needs and experiences regarding help and support. The present study aimed to explore the experiences of help and support for DRD bereaved persons who use drugs. Reflexive thematic analysis was used to analyse 13 semi-structured individual interviews. Findings suggest that the bereaved who use drugs are deprived of both social support and professional help. Based on our results, we recommend that social professions gain knowledge of the risk of complicated grief following DRD, and be able to provide adequate help to bereaved persons who use drugs. An important precondition is that the professionals listen to what the bereaved need. Bereaved persons who use drugs can improve their self-care by acknowledging their grief following drug-related death and being open to those around them about what kind of help and support is helpful.

Grief and bereavement in the time of COVID-19: a thematic analysis exploring psychotherapists’ observations of clients’ experiences

ABSTRACT Research published at the outset of the COVID-19 pandemic predicted additional complexity and difficult experiences for those who experience grief and bereavement in this context. The current study aimed to explore the observations of professionals who have worked with grieving clients during the pandemic. This qualitative study targeted psychotherapists with experience of supporting bereaved and grieving clients during the COVID-19 pandemic. A sampling frame of psychotherapists specialising in bereavement was generated from the website of a professional body and potential participants were randomly selected for invitation. Snowball sampling was used as a supplementary method. An inductive thematic analysis was used to generate themes based on 10 interviews. Six key themes were identified; “Restricted access to dying loved ones,” “Cut off from expected supports and ways of grieving,” “Scope to find positives in the changed experience of grief,” “Enhanced emotions,” “Loss of focus on individual grief,” and “Additional complexities surrounding a COVID-19 death.”. The findings provide support for predictions made around additional complexity for grieving persons during the COVID-19 pandemic. However, they also demonstrate the potential for bereaved persons to find positives in their grief experience. These findings have implications for professional practice, policy, and future research directions.

“I lost so much more than my partner” – Bereaved partners’ grief experiences following suicide or physician-assisted dying in case of a mental disorder

BackgroundThere is a lack of existing research on grief following the intentional death of people suffering from a mental disorder. Our study aims to provide insight into grief experiences and social reactions of bereaved persons who lost their life partners, who were suffering from a mental disorder, to physician-assisted dying (PAD) or suicide.MethodsFor this mixed-methods research, we conducted a survey and in-depth interviews with 27 persons living in the Netherlands and bereaved by the death of their life partners. The deceased life partners suffered from a mental disorder and had died by physician-assisted dying (n = 12) or suicide (n = 15). Interviews explored grief experiences and social reactions. In the survey we compared self-reported grief reactions of partners bereaved by suicide and PAD using the Grief Experience Questionnaire.ResultsCompared to suicide, physician-assisted dying was associated with less severe grief experiences of the bereaved partners. Participants reported that others rarely understood the suffering of their deceased partners and sometimes expected them to justify their partners’ death. Following physician-assisted dying, the fact that the partner’s euthanasia request was granted, helped others understand that the deceased person’s mental suffering had been unbearable and irremediable. Whereas, following suicide, the involvement of the bereaved partners was sometimes the focus of judicial inquiry, especially, if the partner had been present during the death.ConclusionWhen individuals suffering from a mental disorder die by suicide or PAD, their bereaved partners may experience a lack of understanding from others. Although both ways of dying are considered unnatural, their implications for bereaved partners vary considerably. We propose looking beyond the dichotomy of PAD versus suicide when studying grief following the intentional death of people suffering from a mental disorder, and considering other important aspects, such as expectedness of the death, suffering during it, and partners’ presence during the death.

Disorganized attachment and prolonged grief.

While the relationship between attachment anxiety and avoidance and the severity of prolonged grief disorder (PGD) has been well-studied, less is known about the relationship between disorganized attachment and PGD. We test the associations between disorganized attachment and the interaction between it and attachment avoidance and anxiety on PGD. Participants (N = 258) who had lost a family member from 0.5 to 8.0 years before the survey completed the experiences in close relationships-revised, the adult disorganized attachment scale, and the PGD-13 scale. The model explaining PGD symptoms through attachment, taking into account the level of disorganized attachment, explained variance in PGD significantly better than the model taking into account only the level of attachment anxiety and avoidance as predictors. Additionally, the relationships between attachment avoidance and PGD were positive, negative, or neither, depending on the configuration of the levels of disorganized attachment and attachment anxiety. Future research into the relationships between attachment and PGD should take into account disorganized attachment. Attachment-informed grief therapy focused on insecure styles of attachment - including the disorganized style - to the deceased person and other loved ones may prove a promising approach for bereaved persons who experience PGD.

How do Professionals in Municipal Health and Welfare Relate to Bereaved Persons During the Acute Phase of a Drug-Related Death? A Qualitative Study

This study aims to broaden our knowledge of how professionals in municipal health and welfare relate to bereaved persons during the acute phase of a drug-related death. A reflexive thematic analysis was applied to six focus group interviews with 27 first responding personnel in Norway. The article describes the complexity and simultaneousness of the professional response. Three main themes were identified: (a) establishing contact, (b) diverse, supportive assistance, and (c) a complex helping context. The analysis showed that experiences from previous encounters and the deceased’s illicit drug use affected many of the professionals’ assessments, and implied an evaluation of the bereaved as not in need of emergency services or psychosocial follow-up. Professionals should be trained to understand drug-related death as a sudden and unnatural death, and to initiate immediate psychosocial crisis intervention. There is a need for further research on the perspective of professionals in the health and welfare services on the drivers and barriers to support (bereaved persons) during the acute phase.

Stages of Grief Portrayed on the Internet: A Systematic Analysis and Critical Appraisal.

Kübler-Ross’s stage model of grief, while still extremely popular and frequently accepted, has also elicited significant criticisms against its adoption as a guideline for grieving. Inaccurate portrayal of the model may lead to bereaved individuals feeling that they are grieving incorrectly. This may also result in ineffectual support from loved ones and healthcare professionals. These harmful consequences make the presentation of the five stages model an important area of concern. The Internet provides ample resources for accessing information about grief, raising questions about portrayal of the stages model on digital resources. We therefore conducted a systematic narrative review using Google to examine how Kübler-Ross’s five stages model is presented on the internet. We specifically examined the prominence of the model, whether warnings, limitations and criticisms are provided, and how positively the model is endorsed. A total of 72 websites were eligible for inclusion in the sample. Our analyses showed that 44 of these (61.1%) addressed the model, indicating its continued popularity. Evaluation scores were calculated to provide quantitative assessments of the extent to which the websites criticized and/or endorsed the model. Results indicated low criticalness of the model, with sites often neglecting evaluative commentary and including definitive statements of endorsement. We conclude that such presentation is misleading; a definitive and uncritical portrayal of the model may give the impression that experiencing the stages is the only way to grieve. This may have harmful consequences for bereaved persons. It may alienate those who do not relate to the model. Presentation of the model should be limited to acknowledging its historical significance, should include critical appraisal, and present contemporary alternative models which better-represent processes of grief and grieving.

Conflicted or close: Which relationships to the deceased are associated with loss-related psychopathology?

Prior studies have shown that pre-loss closeness and conflict with a deceased person are associated with the severity of symptoms of prolonged grief and/or depression. Nevertheless, mechanisms underlying these relationships are not well understood. We propose a theoretical model in which past closeness and conflict are related to prolonged grief and depression via concrete and symbolic continuing bonds (CB). The aim of our study was to test this model in a sample of bereaved family members. Individuals (N = 244) who had lost a family member from 0.5 to 8.0 years before the survey completed the Quality of Relationships Inventory-Bereavement Version, the Continuing Bonds Scale, the Prolonged Grief Disorder-13 scale, and the Patient Health Questionnaire-9. The findings partially confirmed our model. Closeness was positively and moderately associated with symptoms of prolonged grief but not with symptoms of depression. Conflict was positively and weakly associated with symptoms of depression and prolonged grief. All of these relationships were only partially mediated by concrete/maladaptive and symbolic/adaptive CB. The differences in the relationship of past closeness and conflict to prolonged grief and depression symptoms suggest that inter- and intrapersonal mechanisms of prolonged grief and depressive symptoms may be distinct. If future, especially longitudinal studies, confirm our model, CB would be a possible target for interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience loss-related psychopathology. Continuing bonds (CB) are a potential target of interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience symptoms of prolonged grief and/or depression. Internalization of the capacity to care for yourself and feel autonomous in a safe and stable therapeutic relationship may lead to increased self-confidence, promote working through past experiences in the relationship with the deceased, and gradual reduction of concrete forms of CB. Increasing awareness and acceptance of emotional experiences may contribute to the appreciation of past relationship with a deceased person and the growth of symbolic forms of CB. Future research should focus on verifying the effectiveness of the attachment-informed therapeutic approach to working with CB.

Public Stigma of Prolonged Grief Disorder: An Experimental Replication and Extension.

Prolonged grief disorder's (PGD's) recent recognition as a psychiatric diagnosis has elicited concerns about stigmatization. Although prior research demonstrated that PGD elicits public stigma, moderators of this effect are unclear, and the effect requires replication in an English-speaking population. Therefore, we investigated the effects of PGD, sex of the bereaved, and death expectedness on public stigma toward bereaved persons. We randomly assigned 195 Australian adults (77% female; mean age, 35.7 years) to read one of eight vignettes describing a bereaved male or female subject, with or without PGD, after an expected or unexpected death. Participants reported their emotional reactions and negative attributions toward, and desired social distance from, the bereaved person. A person with PGD (vs. without) elicited stronger emotional reactions, negative attributions, and desired social distance. No robust moderator effects emerged. Results validate concerns that PGD causes stigma. Stigmatization may be targeted by information campaigns or psychological treatment.

Reflection: (Not) feeding the bereaved in the time of coronavirus

In this article, I examine the complications to funerary rituals caused by the COVID-19 pandemic. Specifically, I consider the breakdowns of normal systems of community food provisions to bereaved families, while reflecting on both the creativity of populations to create new ritual activities and the lingering effects of being unable to complete expected rituals. Beginning with the death of my father in the early days of the pandemic, I go on to trace the ways in which food provisioning to the bereaved changed alongside developments in understandings of the virus. These changes are contrasted with my previous experiences of food as abundant in funerary situations, in order to draw out the ways in which the COVID-19 pandemic caused a major disruption in how care for bereaved persons is expressed.

Parental Attachment Style and Young Persons\u2019 Adjustment to Bereavement

BackgroundPrevious clinical and theoretical work supports the idea that parental attachment style and complicated grief affect young persons’ mental health, but empirical research investigating their impact on young person’s adjustment to bereavement is lacking.ObjectiveThis study investigated the impact of parental attachment style and complicated grief on young person’s adjustment to bereavement. It was hypothesised that a) parental attachment anxiety, avoidance, and complicated grief would moderate the link between bereavement experience and psychological distress in young persons and b) parental attachment style would moderate the link between parental complicated grief and psychological distress experienced by bereaved young persons.MethodThis was a questionnaire-based case control study, involving two participant groups: 133 parents of young persons who had experienced the loss of the loved one and 101 parents of young persons with no bereavement experience.ResultsBereaved young persons experienced greater externalising and internalising problems than the non-bereaved only when they were raised by an anxiously attached parent, but when parental attachment anxiety was low, bereaved children had fewer problems than the non-bereaved. When parental attachment avoidance was low, bereaved children also had fewer externalising problems than the non-bereaved. Among the bereaved, high levels of parental attachment anxiety and attachment avoidance amplified the link between parental complicated grief and child post-traumatic stress, while in the presence of low parental anxiety, complicated grief was negatively associated with an immediate distressing response and numbing-dissociative symptomatology.ConclusionsPsychological vulnerability in bereaved young persons was associated with an insecure parental attachment style.

Evidence on the Conceptual Distinctness of Normal Grief From Depression

Abstract. Background: The distinctness of grief from depression has been the subject of a long scholarly debate, even influencing definitions of diagnostic criteria. Aims: This study aims at clarifying the issue by a multifaceted analysis of data from a large German sample. Method: A community sample of 406 bereaved persons answered the Wuerzburg Grief Inventory (WGI), a multidimensional grief questionnaire designed to measure normal grief in the German language, and the General Depression Scale – Short Version (GDS-S), a self-report depression scale. Data were analyzed by factor analysis to identify structural (dis-)similarities of the constructs, and analysis of variance (ANOVA) to identify the influence of the factors relationship to the deceased, type of death, and time since loss on grief measures and depression scores. Results: Factor analysis clustered items referring to grief-related impairments and depression into one factor, items referring to other dimensions of grief on separate factors, however. Relationship to the deceased influenced the grief measures impairments and nearness to the deceased, but not depression scores if controlled for impairments. Type of death showed specific effects on grief scores, but not on depression scores. Time since loss influenced grief scores, but not depression scores. Limitations: The analysis is based on a self-selected community sample of grieving persons, self-report measures, and in part, on cross-sectional data. Conclusion: Factor analysis and objective data show a clear distinction of dimensions of grief and depression. The human experience of grief contains a sense of nearness to the lost person, feelings of guilt, and positive aspects of the loss experience in addition to components resembling depression.

Examination of the New ICD-11 Prolonged Grief Disorder Guidelines Across Five International Samples.

Prolonged grief disorder (PGD) is a new disorder included in the 11th edition of the International classification of diseases (ICD-11). An important remit of the new ICD-11 is the global applicability of the mental health disorder guidelines or definitions. Although previous definitions and descriptions of disordered grief have been assessed worldwide, this new definition has not yet been systematically validated. Here we assess the validity and applicability of core items of the ICD-11 PGD across five international samples of bereaved persons from Switzerland (N = 214), China (N = 325); Israel (N = 544), Portugal (N = 218) and Ireland (N = 830). The results confirm that variation in the diagnostic algorithm for PGD can greatly impact the rates of disorder within and between international samples. Different predictors of PGD severity may be related to sample differences. Finally, a threshold for diagnosis of clinically relevant PGD symptoms using a new scale, the International Prolonged Grief Disorder Scale (IPGDS), in three samples was confirmed. Although this study was limited by lack of questionnaire data points across all five samples, the findings for the diagnostic threshold and algorithm iterations have implications for clinical use of the new ICD-11 PGD criteria worldwide.

Validation of a German Version of the Grief Cognitions Questionnaire and Establishment of a Short Form.

BackgroundWhereas the majority of bereaved persons recover from their grief without professional assistance, a minority develops pathological grief reactions. Etiological models postulate that dysfunctional cognitions may perpetuate such reactions. The Grief Cognitions Questionnaire (GCQ) assesses thoughts after bereavement in nine interrelated domains. A short form (GCQ-SF) with four domains is often used. However, an evaluation of the psychometric properties of the GCQ-SF and its utility compared to the GCQ is lacking and these instruments have not been validated in German.MethodGerman bereaved persons (time since loss 35.3 ± 34.6 months) responded to an online survey containing the GCQ, measures of grief severity, grief rumination, symptoms of depression and anxiety, and optimism and pessimism. 585 participants (18–78 years, 88% women) were included. Item analyses and confirmatory factor analyses were conducted. Correlations between the GCQ and GCQ-SF and grief rumination, optimism and pessimism assessed construct validity. Criterion-related validity was assessed by comparing whether the correlation of the GCQ (and the GCQ-SF) with grief severity was higher than with anxious and depressive symptoms. Logistic regression and receiver-operator characteristics (ROC) compared the questionnaires on their ability to predict probable prolonged grief ‘caseness’ (ICG ≥ 25, time since loss ≥6 months).ResultsInternal consistencies for both questionnaires were identical and excellent (α = 0.96). Confirmatory factor analyses obtained a satisfactory fit for models with nine and four correlated subscales and respective higher-order factor models. The GCQ and the GCQ-SF correlated higher with grief severity than with other measures of psychopathology. The logistic regression showed a significant association between the GCQ-SF and prolonged grief ‘caseness’. Of the remaining subscales of the GCQ, only one subscale (‘Others’) contributed to the prediction. The ROC analyses showed nearly identical areas under the curve.ConclusionThe translated GCQ and GCQ-SF demonstrated very good psychometric properties. The correlations with grief severity highlight the questionnaires’ clinical relevance. The questionnaires possessed identical diagnostic specificity and sensitivity. Whenever a timesaving assessment of the most typical grief-specific cognitions is important, the GCQ-SF represents an alternative to the GCQ. The original GCQ may still be superior when a more detailed description of a bereaved person’s cognitions is desirable.

Attachment bonds and adjustment to grief.

The article discusses the attachment bonds or emotional connections between a person and another one alive or deceased. Topics covered include their roles in grief resolution to make bereavement bearable, the uncertain measurement of a healthy adjustment due to varying circumstance of death and attachment bonds, and the latter's cultural and religious links that can change over time. Also noted are nurses' need to accept the uniqueness of bereaved persons and tailor their support accordingly.

Psychological Injury is Not New and Not Normal

Psychological Injury is Not New and Not Normal Claire Pouncey (bio) In "On the Concept of 'Psychiatric Disorder,'" Miriam Solomon strives to resolve the tension between thinking of bereavement as a normal reaction to loss, and recognizing that its most extreme forms look very much like major depressive episodes and benefit from psychiatric treatment. To do this, she introduces the idea that a condition can be both normal and a mental disorder, or in other words, that some mental disorders are normal. Although I very much like the idea that some mental are predictable responses to stressors, I have trouble making sense of the argument Solomon provides. I am going to focus on two reasons why. First, the concept of psychological injury is not new and does not do the work Solomon needs it to do for her. "Psychological injury" is a legal term used in forensic psychology and psychiatry that includes not bereavement, but physical and psychological conditions that can result from harms done by responsible others, such as suffering, exacerbation of a preexisting condition, posttraumatic stress, traumatic brain injury, phobias, adjustment disorders, chronic pain, and depression, depending on the jurisdiction. "Psychological injury" as it already exists does not discriminate the physical from the psychological, whereas Solomon wants to restrict the meaning to "conditions in which brain mechanisms are not disrupted," even though typical psychological functioning may be. What the existing forensic concept of psychological injury and Solomon's version share is the idea that certain harms can be expected to result from specific life stressors. However, to insist on this language would confuse two very different conceptions of psychological injury, which typically is not the goal of analytic philosophy. Second, Solomon fails to engage with the extensive literature on what it is to be a disorder—specifically, a mental disorder—and how the "disordered" relates to "the normal." She says in her abstract, though not in the body of her paper, "The word 'abnormal' is … best avoided [in speaking of the pathological] because of its associations with normative judgments." She does not say why this is, nor does she argue the point. In section 2, she refers to Horwitz and Wakefield's (primarily Wakefield's) position that a mental disorder is a "harmful dysfunction," without acknowledging any conceptual problems with that formulation and the biological unclarity of "dysfunction" on which it relies (Faucher & Forest, 2021). Later, in section 3, Solomon seems to uncritically accept some pre-established and preferred conception of disorder by contrasting it with pathology, "which evokes nineteenth century abnormal microscopic findings" (pp. 334), although psychiatry refers to psychopathology regularly. Again, there is a hint that using the word "disorder" avoids some of the value-ladenness of "pathology" and "pathologizing," [End Page 347] which to Solomon evokes stigma (against mental disorders? the people who have them?). However, Solomon does not explore how the various terms are value laden, and she never addresses how much the conceptions of anomaly, abnormality, or disvalue inhere in the concept of disorder. But, of course, Solomon needs the concept "disorder" to be free of any implicit reference to departures from "the normal" in order to make the crucial distinction she wants to make: to say that in fact, some mental disorders are normal. In the end, she rejects defining "mental disorder" as "harmful dysfunction," but only to make room for her concept of psychological injury as partly constitutive of mental disorder. But she still wants to say that her version of psychological injury (in which brain mechanisms are not interrupted) is normal, without saying how she is defining "normal," and how it avoids the problems of normativity she recognizes but declines to address. In some of her discussion, "normal" seems to mean "appropriate to the circumstances," such as when she compares grief with a bone fracture from a motor vehicle accident. At other times, "normal" seems to mean "predictable," such as the grief response to loss of a loved one. I am left wondering why she limits herself in the way she does. If the goal is to make treatment available to bereaved persons who seek treatment, she need not worry: no mental health professional would ever code for...

“You are Dead, but You are Not”: Social medium (Facebook) is the message in grieving and continuing bonds

Today, one may no longer alive but his social networking sites (SNS) account will still live on. Empirical studies on death and SNS started since 2004 covering issues on grief, bereavement, mourning, relational continuity functions of SNS, and digital legacy. Majority of them applied content and discourse analyses on SNS messages directed to or related to the deceased. Applying McLuhan’s aphorism medium is the message, researcher focused on the interplay among forms and functions of Facebook (FB) as a medium and message that mediates grief and the bereaved persons who are communicators that decided to grieve on FB. This research adopts grounded theory approach where in- depth interviews with 10 bereaved persons who maintain relational continuity with their deceased loved ones through FB were conducted. The conclusions are drawn to prove that bereaved users preferred to engage in a transcoporeal mediated communication with deceased for continuing bonds due to four main reasons – the deceased are perceived “dead but they are not”; maintaining relational continuity via FB is essential to “finish their unfinished business”; they felt aided and embraced when adopting “FB the Public Platform for Private Grief”, and they imagined a mutual communication based on “past experience and religious belief”. The mediated transcopereal communication (TcC) is enabled because the social medium (FB) is the message.