Grief is not gender-biased. The feeling of grief is often caused by some sort of stressor. The most impactful and life-altering stressor is bereavement. [1] A stressor such as bereavement could be impactful to the point that it becomes a trauma for an individual. When stress becomes trauma, specifically psychological trauma, an individual has a greater risk of becoming depressed.[2]  Depression is a common emotion people experience when they are dealing with grief. However, males and females do have different chances of experiencing depression after a traumatic and stressful loss. Females are “twice as likely as men to experience depression” in their lifetime.[3] While there is not one specific variable that accounts for the gender difference in depression, it can likely be contributed to the fact it is less acceptable for men to outwardly express their emotions[4] and women are more likely to ruminate on their thoughts.[5]  There are theories about the different ways in which men and women grieve, but there is no scientific evidence that men and women grieve differently.

There may not be evidence to support that “women are more prone to depression than men because of negative effects of estrogen…on mood,” but the cause could be due to the hypothalamic-pituitary-adrenal axis which regulates stress responses. Cortisol is a hormone that is released in response to these stressful situations. People with depression have increased levels of cortisol hormones, meaning there is probable dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. It could be likely that women are predisposed to have dysregulated HPA axes because of the increased prevalence of depression among females. However, the relationship between female depression and the HPA axis has not been studied enough, therefore one cannot conclude that hormones are the reason for gender differences in depression.[6]

Bereavement is likely to cause stress regardless of gender. Neither the bodies of men nor women are well-equipped to handle stress. In fact, the body may present “sickness behavior” such as isolation, loss of appetite, etc. as a result of localized inflammation caused by stress.[7]  Uncoincidentally, the “sickness behaviors” that follow the loss of a loved one are nearly identical to the symptoms of depression. The brain plays a role in the development of depression and how one deals with grief. O’Connor et al. conducted a study in which activation of certain parts of the brain, specifically the subgenual anterior cingulate cortex, were associated with increased local inflammation. They studied inflammation in the mouth in particular because “gingival inflammation is correlated with depression.”[8]  The purpose of this study was to pinpoint an area of the brain that deals with depression, which was successful. However, the participants of this study were solely females, and as aforementioned, females are already at a greater risk of depression; therefore, the results of this study are not necessarily generalizable to the entire population. This study did provide insight into how depression and inflammation are correlated and which part of the brain they affect, but does not provide evidence for gender differences in grieving.

Women are often the focus of grieving studies, but men grieve, too.[9]  Men and women actually experience the same emotions when they grieve, men have just been socialized and reinforced to express their emotions differently. Men are expected to grieve internally; whereas it is more acceptable for women to grieve outwardly, especially in American culture.[10]  Men are subjected to a “constricted range of expression” when it comes to grieving.[11]  There is no difference in the brain makeup of men and women, so why is it men are less likely to express emotion and why is it not socially acceptable in American culture?  Most of it comes down to reinforcement of the idea that men are supposed to be independent and stoic, whereas women are more codependent and rely on relationships more. When it comes to dealing with grief, men are more likely to turn to substance use, while women are more likely to seek assistance via therapy. Alcohol, in particular, is commonly used to mask male depression because men are so reluctant to seek help after the loss of a loved one.[12]  Lister proposes that social workers could be the solution to helping males find productive and positive treatment. Once that intervention is successful, male emotional expression will not be shunned as it is now. Males and females experience the same emotions when it comes to grief and the biological makeup of their brains is the same, it just comes down to social reinforcement of acceptable behaviors.

Complicated grief is grief that is prolonged and more debilitating than normal.[13]  Complicated grief poses serious psychological impact for males and females alike. There are two main pathways that are activated in the brain by those experiencing complicated grief. One pathway is the reward pathway, in which the nucleus accumbens is activated; and the other is the pain pathway, in which the dorsal anterior cingulate cortex, insula, and periaqueductal gray are activated. People who are experiencing complicated grief are more likely to have activation of these areas than those experiencing non complicated grief.[14]  Based on the results of O’Connor’s study, one can conclude that men and women both have these pathways, and neither gender is more likely to experience complicated grief versus non complicated grief.[15]

Males and females also experience the same psychological and biological responses when it comes to grief. While there are potential causes for the gender differences in depression and grieving, there is not enough research to support that there is in fact a substantial difference. Therefore, males and females grieve in similar ways; however, the ways in which they outwardly express their grief is different due to social reinforcement.

Let’s say a man who had just recently lost his wife of twenty years to cancer expresses his grief in the form of anger by punching a hole in his bedroom wall. This expression does not appear out of the ordinary because it aligns with the “socially acceptable” behavior males are to exhibit while going through the grieving process. Men are raised to exhibit characteristics that are deemed “acceptable” by society such as; strength, successfulness, and inexpressive of emotion. Expressing grief, or any other overwhelming display of emotion, is often discouraged in men because vulnerability is viewed as feminine. The concept of being vulnerable and expressing emotions among close friends are the expected outlets of grief women are expected to ensue. Traditionally, women have been raised to be dependent on others for support where the expression of emotions, such as crying, is strongly encouraged.[16] These stereotypes suggest that women more strongly register, and express, grief compared to their male counterparts, however, research has yielded inconclusive results as to which of the genders is more strongly impacted by grief.

The development of these stereotypes raises ethical concerns regarding the treatment of different genders during their time of grieving. With research displaying inconsistent results on which gender is more strongly impacted by grief, the societal pressures being placed on men to conceal their emotions is harmful to their mental and social health.

Men are more likely than women to grieve in isolation and employ strategies of avoidance when grieving. They also have a greater tendency to turn their emotional and psychological pain into physical pain by engaging in risk-taking behavior or committing suicide.[17] Although utilizing coping mechanisms such as avoidance tend to belittle the perception of how strongly the grief is being felt, there has been some research indicating that males may feel grief more strongly than females.

One study conducted on spousally bereaved individuals investigated the gender differences in symptoms of traumatic grief. After collecting data from 270 spousally bereaved individuals who had filled out the Inventory of Traumatic Grief, researchers could only conclude that their “findings suggest that widows and widowers do not differ in terms of absolute levels of TG symptomatology throughout their grieving process.” However, their study did find that the widowers had a more difficult time in recovering from the loss of their spouse, but they could not generalize the results due to their small population size.[18]

Another study, conducted by researchers at UCLA, found that men and women had different responses to an emotional stimulus in the right front of their insular cortex. This region of the brain plays an important role in how individuals experience emotion. The male brains showed higher levels of activity in this area, compared to the female brains.[19] This observation suggests that males may feel grief more strongly than females, but they could simply lack the communicational skills to convey these emotions due to social underdevelopment.

Instead of being taught emotion-focused coping strategies, men have been taught to suppress these feelings of grief. Emotion-focused coping strategies have shown promising results in the management of grief. Women who are better able to cope with their grief have fewer health consequences because they confront and express their grief more than men.[20] The inability to express emotions can creates tension within men, which can have detrimental side effects on their overall psychosocial health.

 

Brain scans comparing the insular lobe activity between males and females when exposed to an emotional stimulus. There are higher levels of activity exhibited in the male brains than the female brains. https://www.dailymail.co.uk/sciencetech/article-3689820/Are-male-female-brains-wired-differently-Scans-opposite-responses-area-responsible-experience-emotions.html

This inability to express emotions has also been suggested to contribute to the fact that men suffer relatively greater health consequences than their female counterparts due to the “higher levels of social support” received by widows than widowers. A study conducted by Strobe found that “social causes” were “responsible for the observed sex difference in health findings.”[21] Another study’s findings were consistent with Strobe in that men’s experiences with grief were “less supported” than women’s experiences.[22] This is of  particular ethical concern and importance because the attitudes towards those who are grieving can be adjusted, so that gender is not a factor in the sympathy received.

Grief is a universal experience, yet how men and women both cope and respond to grief can vary widely throughout the world depending on background and cultural perspective. When examining grief, it is important to have an operational definition of it to ensure that everyone is on the same page as it relates to its core definition. Grief has been aptly described as “First, not a state but rather a process. Second, the grief process typically proceeds in fits and starts, with attention oscillating to and from the painful reality of death. Third, the spectrum of cognitive, social, and behavioral disruptions of grief is broad, ranging from barely noticeable alterations to profound anguish and disruption”.[23] It is important to think about grief as a process rather than a simple one-time action, as it oftentimes has a profound emotional impact on both men and women. While the way men and women grieve are often different and unique, there is also a profound difference in the way men and women experience grief based on cultural norms and expectations. This wide culture variation in grief and its impact helps shape both society and culture writ large.

The first step in becoming more culturally aware and inclusive as a society is to recognize that those who come from differing culture backgrounds often have very different ways of grieving than the average Caucasian American. For instance, in a case study involving a sixteen-year-old African-American female who gave birth to two premature twins who later died, cultural understanding and sensitivity would have provided a greater sense of comfort and understanding to the mother of the newborns. In examining Nileen, the African American mother’s responses, it could clearly be seen that she was despondent. However, the nurse continued to try and interact with her and comfort her, as seen in this excerpt: “Nileen initiated no body movements, nor eye-contact that acknowledge the presence of Jill and the preceptor. Nileen merely stared at the television and turned the channel. Instead of understanding Nileen’s body language and cues that she wanted to be left alone, Jill, the nursing student, chose to ignore Nileen and arguably made the situation worse.[24] While understanding the importance of culture and background is vital in respectfully and gracefully interacting with those from differing cultural backgrounds experiencing grief, it also helps to provide greater understanding as to why people from certain cultures and backgrounds differ in the way they respond to and experience grief.

Understanding that men and women experience and react to grief in fundamentally different ways is the first step in trying to further understand the cultural perspectives as it relates to grief. Alan Wolfeit, author, educator, and grief counselor, shrewdly observes that “Even in the face of tragic loss, men in our society still feel the need to be self-contained, stoic, and to express little or no emotion.”  Deb Kosmer, a bereavement support coordinator for Affinity Visiting Nurses, also succinctly observes,” More men are going to the gym and pound a basketball to work it out, where women have.. built-in support systems”.[25] Understanding these key emotional differences between men and women in our society is crucial. However, there remains a great lack of understanding as it relates to grief and the differing ways it is experienced throughout cultures.

While differing cultures may very well have differing ways of expressing and showing grief, one African-American male in a cultural study on grief candidly stated, “I believe we all grieve the same. Any cultural group would probably use different words, but they all mean the same thing.” A native American male also echoed a similar sentiment, observing that “It’s a part of being human.” A woman of African ancestry tersely stated after acknowledging the many differing ways those in her own cultural grieve, “We all feel the same.” It is also notable that in this cultural study, participants “almost universally contended that as an intrapersonal experience, there are no differences based on culture or ethnicity alone. They rather staunchly maintained that the differences are individual both within cultural groups as well as across cultural groups”.[26] This is a key conclusion to make, as it seems to confirm the fact that when it comes to grief, the emotions and feelings one has after loss are shared across cultures and the human experience.

One of the key issues is the extent to which those in different cultures choose to express or hide their grief. For example, in Japan, “Japanese people have rituals to follow after the death of a loved one. Family and extended family gather together and remember and talk about the family member who has died.” However, as the social makeup of Japan has changed and as the extended family has transitioned away from the nuclear family, nurses and other caretakers are often now tasked with memorial plans.[27]

While cultural and gender differences do indeed shape how a person might grieve the loss of a loved one, the overall emotions and feelings one experiences after the passing of a significant other is remarkably similar across gender and culture. While men may lack the social structure and sense of community that women do, it is important to recognize that there is a remarkable amount of overlap when it comes to the emotion they both experience. Scientific studies regarding gender differences in the grieving process do not have sufficient evidence to definitively state that differences exist. “Social norms” are the main influence on gender differences because they lay out what emotions are acceptable to express while grieving. With inconsistent results in the scientific studies conducted, it is unethical to hold males and females to different standards of grief when there is little evidence to support differences exist. Grief is a universal concept that transcends both gender and culture.

Rebecca Bagley

Emma Bumgardner

Brooks Fitts

 

[1]O’Connor, Mary-Frances, Michael R. Irwin, and David K. Wellisch. “When Grief Heats up: Proinflammatory Cytokines Predict Regional Brain Activation.” Neuroimage 47, no. 3 (2009): 891–96. https://doi.org/10.1016/j.neuroimage.2009.05.049.

[2] Nolen-Hoeksema, Susan. “Gender Differences in Depression.” Current Directions in Psychological Science 10, no. 5 (2001): 367–74. https://doi.org/10.1111/1467-8721.00142.

[3] Ibid

[4] Lister, Larry. “Men and Grief: A Review of Research.” Smith College Studies in Social Work 61, no. 3 (1991): 220–35. https://doi.org/10.1080/00377319109517365.

[5] Ibid

[6] Ibid

[7] Ibid

[8] Ibid

[9] Dubose, J. Todd. “The Phenomenology of Bereavement, Grief, and Mourning.” Journal of Religion and Health 36, no. 4 (1997): 367–74. https://doi.org/10.1023/A:1027489327202.

[10] Ibid

[11] Ibid

[12] Ibid

[13] O’Connor, Mary-Frances, David K. Wellisch, Annette L. Stanton, Naomi I. Eisenberger, Michael R. Irwin, and Matthew D. Lieberman. “Craving Love? Enduring Grief Activates Brain’s Reward Center.” Neuroimage 42 (2008): 969–72. https://doi.org/10.1016/j.neuroimage.2008.04.256.

[14] Ibid

[15] Ibid

[16] Versalle, Alexis, and Eugene E. Mcdowell. “The Attitudes of Men and Women concerning Gender Differences in Grief.” OMEGA – Journal of Death and Dying 50, no. 1 (2005): 53-67. Accessed April 1, 2019. https://doi.org/10.2190/r2tj-6m4f-rhgd-c2md.

[17]  Canetto, Silvia Sara, and Anne Cleary. “Men, Masculinities and Suicidal Behaviour.” Social Science & Medicine 74, no. 4 (2012): 461-65. Accessed March 27, 2019. https://doi.org/10.1016/j.socscimed.2011.11.001.

[18] Boelen, Paul A., and Jan Van Den Bout. “Gender Differences in Traumatic Grief Symptom Severity after the Loss of a Spouse.” OMEGA – Journal of Death and Dying 46, no. 3 (2003): 183-98. Accessed March 28, 2019. https://doi.org/10.2190/6c8g-c0xr-f0q4-vr3x.

[19] Mailonline, Shivali Best For. “UCLA Scientists Uses Scans to Prove Male and Female Brains Do React Differently.” Daily Mail Online. July 14, 2016. Accessed April 05, 2019. https://www.dailymail.co.uk/sciencetech/article-3689820/Are-male-female-brains-wired-differently-Scans-opposite-responses-area-responsible-experience-emotions.html.

[20] Stroebe, Margaret, Wolfgang Stroebe, and Henk Schut. “Gender Differences in Adjustment to Bereavement: An Empirical and Theoretical Review.” Review of General Psychology 5, no. 1 (2001): 62-83. Accessed March 27, 2019. https://doi.org/10.1037//1089-2680.5.1.62.

[21] Stroebe, Margaret S., and Wolfgang Stroebe. “Who Suffers More? Sex Differences in Health Risks of the Widowed.” Psychological Bulletin 93, no. 2 (1983): 279-301. Accessed March 28, 2019. https://doi.org/10.1037/0033-2909.93.2.279.

[22] Stillion, Judith M., and Susan B. Noviello. “Living and Dying in Different Worlds: Gender Differences in Violent Death and Grief.” Illness, Crisis & Loss 9, no. 3 (2001): 247-59. Accessed April 1, 2019. https://doi.org/10.1177/105413730100900302.

[23] Zisook, Sidney, and Katherine Shear. “Grief and Bereavement: What Psychiatrists Need to Know.” (2013).

https://doi.org/10.1002/j.2051-5545.2009.tb00217.x

[24] Ellis Fletcher, Sally,N. “Cultural Implications in the Management of Grief and Loss.” Journal of Cultural Diversity 9, no. 3 (Fall, 2002): 86-90. http://libproxy.lib.unc.edu/login?url=https://search-proquest-com.libproxy.lib.unc.edu/docview/219311841?accountid=14244.

[25]Anderson, Cheryl. “How Men Grieve: Understanding Differences between how Men and Women Handle Grief Leads to Fox Valley Support Network.” The Post – Crescent, Jun 05, 2011. http://libproxy.lib.unc.edu/login?url=https://search-proquest-com.libproxy.lib.unc.edu/docview/870567586?accountid=14244.

[26] Cowles, Kathleen V. “Cultural Perspectives of Grief: an Expanded Concept Analysis.” Journal of Advanced Nursing 23, no.2 (1996): 287–94. https://doi.org/10.1111/j.1365-2648.1996.tb02669.x.

[27] Shimoinaba, Kaori, Margaret O’Connor, Susan Lee, and Judi Greaves. “Staff Grief and Support Systems for Japanese Health Care Professionals Working in Palliative Care.” Palliative and Supportive Care 7, no.2 (2009): 245. https://doi.org/10.1017/s1478951509000315.