After the loss of a loved one, people often enter a period of bereavement filled with grief and mourning of the person they have just lost. Many people experience grief, but the scientific community is yet to make a universal model for grief. Grieve is experienced in different ways. In different cultures, the bereaved have different practices, ceremonies, and ways of coping with grief. Some forms of grief are controversial and others are seen as unhealthy. There is still much more to be known about grief. As research has been done on the topic, they have found more about how grief is similar and different between people. We argue that grief, although experienced in similar patterns, is not able to be put into a universal model. One’s experience of grief is unique to them and is influenced by many factors. Making a universal model for death is not what is needed in further research of this topic.

People experiencing bereavement often experience some form of emotional symptoms and physical symptoms including increased irritability, numbness, bitterness, detachment, preoccupation with loss, inability to show or experience joy, digestive problems, fatigue, headaches, chest pain, and sore muscles during their period of grief.[1] This raises the question, is there physical evidence of grief in the body?

Saavedra Pérez et al. showed that there may be a change in cognitive function during grief. However, they used a small sample of people that they classify as experiencing complicated grief (now classified as Prolonged Grief Disorder in the dsm-5). He studied how people experiencing “complicated grief” performed on cognitive testing (Mini-Mental State Examination, Letter–Digit Substitution Test, Stroop Test, Word Fluency Task, word learning test – immediate and delayed recall) while looking at total brain volume. His results showed that when people experience “complicated grief” they have lower cognitive ability and smaller overall brain volume.[2]

Other researchers including Peter Freed, Ted Yanagihara, Joy Hirsch, and John Mann have looked to see if there is a short term change in neural pathways to explain some symptoms of grief experienced. They had 20 recently bereaved subjects rate the amount of interfering thoughts related to their deceased loved one versus their ability to avoid those thoughts. During the experiment, subjects completed an Emotional Stroop (ES) task that contained words relating to the deceased and control words. The team of experimenters measured reaction time and used functional magnetic resonance imaging (fMRI). The second part of the experiment consisted of subjects visualizing the death of the deceased and rating the emotions elicited. Results of the study showed that there was an attentional bias toward words pertaining to the deceased that correlated with an increase in activity in the amygdala, insula, dorsolateral prefrontal cortex (FLPFC). The increase in brain activity in these regions corresponds with the sadness intensity, a double dissociation between grief style, intrusiveness, avoidance, and lower ability to complete tasks.[3]

Since there is some evidence to indicate that grief is in part a biological function, some might look to doctors as experts on what grief is and how to manage grief. However, Margaret Stroebe Henk Schut, and Kathrin Boerner criticize physicians aiding grieving patients and their use of the stages of grief model. They draw attention to the intent of Elisabeth Kübler-Ross’s model which was for the terminally ill. Elisabeth Kübler-Ross’s was adapted from Bowlby and Parkes’ theory which consisted of 4 stages of grief.

5 stages of grief model expanded

https://www.researchgate.net/publication/307949910_Emotionally_sustainable_change_two_frameworks_to_assist_with_transition [4]

Ross adapted this model to fit what she was seeing in her work with terminally ill patients in their process to cope with their own death. Somehow people accepted this model as a universal model for grief. Physicians explain grief as if it has time limits and universal patterns through the scope of this model.[5]The Cleveland Clinic even has a manual that is supposed to be a resource guide for children’s grief.[6] However, as Maciejewski et al. argue many people do not experience grief in the way Ross describes in her model. If they experience some form of these stages, they often do not present similarly among people and they are rarely chronologically similar.[7]As physicians push this model, it makes bereaving people more likely to feel that they are grieving incorrectly. This also opens up the possibility for the bereaved to think their grief may be abnormal. Because of their unwarranted concern, people out of the scope of Ross’s model may more likely be misdiagnosed with Prolonged Grief Disorder or Major Depressive Disorder.

The DSM was updated and removed the exclusion of people grieving from being diagnosed with Major Depressive Disorder. The change has raised the concerns of many researchers and clinicians in the field. The consensus among many in the field including Richard A. Friedman is that it is important that people that meet the criteria for MDD are treated and should not be excluded if they are experiencing grief.[8]However, moving forward the definition of grief and knowing more about the subject will be important as clinicians try to distinguish between symptoms of grief and depression. It will also be crucial for more studies to collect more diverse samples to get a greater understanding of grief in different cultures as well as learning more about various cultural practices on a broader scale.

As mourning practices and reactions to grief are increasingly researched in the scholarly world, these studies become increasingly aware of the inherent ethnocentrism in believing certain mourning and grieving practices are universal. As a response, more and more interest is being poured into the cross-cultural perspective that compiles accounts of different cultures and analyzes the universal patterns in human mourning and grieving. [9] An interesting subfield is in the study of the transformation of cultural norms and expectations that go along with mourning and grieving practices.

Within the U.S. itself there is already a melting pot of cultures from the diverse amount of ethnic and cultural groups residing in the country. This serves as a unique cultural context for these different groups to take in and transform Western mourning practices along with interaction with their own.This cultural appropriation serves as a way for residents to blend their own cultural ways of mourning and expressions of grief with the traditional Western ways that surround them. For example, when third or fourth generation assimilated ethnic groups like Jews or Italians that choose to identify as their ethnic group after bereavement. [10]

Another example of blending cultures is the cultural context that surrounds digital mourning practices. This includes clicking the ‘Like’ button when somebody posts in honor of a recent death and replying with positive messages about the person who died. Because of the rise of mediatization, specifically emotions, social media has become a place where friends and family can share recent deaths and mourn the social death of the person.[11]Anna J.M. Wagner points out the cultural norms and expectations for digital mourning practices, with an emphasis on the forms of mourning expression and reactions to such expressions on social media.[12]Social media, in turn, has become a digital space for mourning and grief.

A Facebook post of a wife announcing her husband’s death. Words such as “legacy” and “always” emphasize the prolonging of the husband’s social death, past his biological death.

https://www.dailymail.co.uk/news/article-3222086/Rest-beloved-love-forever-Wife-army-trooper-died-aged-36-dementia-caused-roadside-bomb-blast-Iraq-posts-loving-tribute-hero.html [13]

Despite the amount of groups and cultures invested in adopting other cultures and their mourning and grieving practices, there are many cultures that are relatively unbothered and choose to stay true to their roots. In Japanese culture for example, there is an emphasis of death being understood as a natural process and norm of respecting the bodies of the dead and by undergoing Buddhist practices.[14]

In investigating mourning and grieving practices using the cross cultural approach, a question that naturally rises is if there are “good” grief and “bad” grief, and what are the consequences of such definitions? Using the cross-cultural approach is challenging the inherent ethnocentrism present by only focusing on Western practices of bereavement. However, using this approach requires judging other cultures and discriminating what is “universal.”

The ethnocentrism in believing Western mourning practices are common throughout the world poses detrimental implications for medical practitioners and their patients. Medical practitioners that want to guide patients and loved ones through the mourning process should be aware of non-Western practices, as these can cause communication issues when applying Western models of grief and mourning.

Grieving takes many forms. Psychologist Ralph Rayback writes that grief “ can manifest itself in the form… of physical suffering, and we may experience anything from anger to denial…to despair.” [15]These grief stages have ethical consequences. The ethics of grief depend on a few factors: (1) one’s culture and how it views grief, whether it be as a healthy process or a sign of weakness (2) how you grieve and whether you commit unethical acts as a result of your grief (3) how grief affects others in the community. These factors make it difficult to prescribe a one size fits all view on the ethics of grief. Seemingly, no one has objectivity in the matter. In R. Bargo’s book The Ethics of Mourning, he writes “much of the limit placed upon mourning as an ethical act comes from those who stand outside of its perspective.” [16] What he means is that we cannot judge an act of grieving as ethical or unethical because of our limits in perspective. In my section, I will focus on the grieving process in the United States and contrasting it with Ilongot tribe in the Philippines and see if there are ethical dilemmas on the problem of grieving and propose that there is no universal answer for the ethics of grief.

There’s no universal answer on whether grieving is ethical because it brings up the question of who gets grieved and who does not. The United States culture of grief is ethically gray on grief. John Chuckman, a writer for Counterpunch, puts it as, “Death in America does not come easily…unless you are homeless or live on an Indian reservation or in one of the nation’s vast urban ghettos.” [17]This quote cleverly brings up the conundrum we face in the United States of grieving the death of those who the United States exemplifies, but we look the other way when oppressed people such as immigrants or poor people die.

A woman grieving at a traditional US military funeral.

https://www.politico.com/gallery/2014/08/funeral-for-u-s-army-maj-gen-harold-greene/001990-028297.html [18]
A practical example is the death of a member of the military. In the United States, we throw elaborate funerals for those who are killed in action, but when the US military kills a civilian, we look the other way. While we do treat the privileged with compassion and care, we ignore those who are not as valuable to our society. The act of grieving those who are close to us while ignoring the deaths of the oppressed appear to be unethical. Ethics of care states that beneficence and caring for relationships is imperative for human lives, but the US approach to grieving is ethically gray and does not follow this.

There are a variety of cross cultural grief rituals, and some would be considered unethical according to western moral standards, and the United States is not morally neutral in their process of grief. An example of a grieving process the west would deem unethical is the headhunting of the Ilongot tribe in the Philippines. Headhunting is the ritual of decapitating those who they kill. When members of the Ilongot tribe lose a loved one, they will go headhunting and kill other men as a way to process their rage, sadness, and anger. Anthropologist Renato Rosaldo lived with the tribe to understand their process of grief. At first he was dumbfounded by what seems such a heinous act, but as his time went on, he realized that as westerners, we cannot force other cultures to hold to our ethics on grief and death, and there is no universal consensus on the ethics of grief. He wrote, “This book argues that a sea change in cultural studies has eroded once-dominant conceptions of truth and objectivity. The truth of objectivism – absolute, universal, and timeless – has lost its monopoly status.” [19] Rosaldo found that no one can make a moral claim on another culture’s dealing with death in his time with the tribe, and that he had no objectivity over what his views on the ethics of grief were.

In conclusion, the ethics of grieving are morally gray. Not only for the United States and our process of selective grieving, but other cultures that commit what Western cultures would deem as unethical acts are also not in the right. Grieving will always be morally gray because grieving and many of the feelings that come from it are not logical, but they help humanity cope with loss and that should be enough. Dr. Randall Horton, a professor of medical humanities, writes about what all societies should agree on in regards to ethics of grief when he writes, “It is true that people grieve in their own way and their own time, but compassionate care, free from judgment, might help people reach acceptance of the reality of a world that often seems to lack moral order, fairness, and predictability.” [20]There is no one size fits all approach to grieving, and ethical questions come up no matter what culture one examines.

Even with the research from the scientific, cultural, and ethical angles compiled into this post, further research needs to be done in the field of mourning practices and reactions to grief to gain insight into how death affects the living, as well as the implications it poses for medical practitioners and patients.

In addition, when it comes to universal and cross-cultural models of grief there may not be a correct answer that will be able to generalize the majority population, as the vast amount of cultures provide many iterations of mourning and grieving practices. Furthermore, the act of grieving and mourning can be illogical and thus cast a fundamental moral gray ground onto models of grief.

Madelein Ngo

Jason Satterfield

Caroline Vincent

[1]”Grief Symptoms, Causes and Effects.” Psych Guides2019. Accessed April 07, 2019.       https://www.psychguides.com/guides/grief-symptoms-causes-and-effects/

[2] Saavedra Pérez, M. Ikram, N, Direk. H. Prigerson et al. “Cognition, Structural Brain Changes and Complicated Grief. A Population-Based Study.” Psychological Medicine45, no. 7 (05, 2015): 1389-1399. doi:http://dx.doi.org/10.1017/S0033291714002499. or http://libproxy.lib.unc.edu/login?url=https://search.proquest.com/docview/1672117893?accountid=14244.

[3] Peter J. Freed, Ted K. Yanagihara, Joy Hirsch, and John Mann. “Neural Mechanisms of Grief Regulation.” Biological Psychiatry66, no. 1 (2009): 33-40. doi:https://doi.org/10.1016/j.biopsych.2009.01.019. or http://www.sciencedirect.com/science/article/pii/S0006322309001000.

[4] Stephen Leybourne.“Emotionally Sustainable Change: Two Frameworks to Assist with Transition. International Journal of Strategic Change Management 7, no. 1 (2016): 23 doi:10.1504/IJSCM.2016.10000308. https://www.researchgate.net/publication/307949910_Emotionally_sustainable_change_two_frameworks_to_assist_with_transition.

[5] Margaret Stroebe, Henk Schut, and Kathrin Boerner. “Cautioning Health-Care Professionals.” OMEGA – Journal of Death and Dying74, no. 4 (2017): 455-73. doi:10.1177/0030222817691870. https://journals.sagepub.com/doi/10.1177/0030222817691870.

[6] “Understanding Death, Grief & Mourning.” Cleveland Clinic2008. Accessed April 07, 2019. https://my.clevelandclinic.org/ccf/media/Files/bereavement/understanding-death-grief-mourning-resources-manual.pdf?la=en

[7] Paul K. Maciejewski, Baohui Zhang, and Susan D. Block. “An Empirical Examination of the Stage Theory of Grief.” Jama297, no. 7 (2007): 716-23. doi:10.1001/jama.297.20.2200. https://jamanetwork.com/journals/jama/fullarticle/205661.

[8] Richard A. Friedman. “Grief, Depression, and the DSM-5.” The New England Journal of Medicine366, no. 20 (2012): 1855-1857. doi:http://dx.doi.org/10.1056/NEJMp1201794. https://www.nejm.org/doi/full/10.1056/NEJMp1201794?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

[9] Dennis Klass, “Developing a Cross-Cultural Model of Grief: The State of the Field.”OMEGA – Journal of Death and Dying 39, no. 3 (November 1, 1999): 155. doi:10.2190/bdtx-cye0-hl3u-nqqw. https://journals.sagepub.com/doi/pdf/10.2190/BDTX-CYE0-HL3U-NQQW

[10] Maurice Eisenbruch, “Cross-Cultural Aspects of Bereavement. II: Ethnic and Cultural Variations in the Development of Bereavement Practices.” Culture, Medicine and Psychiatry 8, no. 4 (December 1984): 325. doi:10.1007/bf00114661. https://www.ncbi.nlm.nih.gov/pubmed/6499505.

[11] Korina Giaxoglou, and Katrin Döveling. “Mediatization of Emotion on Social Media: Forms and Norms in Digital Mourning Practices.” Social Media Society 4, no. 1 (January 25, 2018):1. doi:10.1177/2056305117744393. https://journals.sagepub.com/doi/full/10.1177/2056305117744393.

[12] Anna J. M. Wagner, “Do Not Click “Like” When Somebody Has Died: The Role of Norms for Mourning Practices in Social Media.” Social Media Society 4, no. 1 (January 25, 2018):1. doi:10.1177/2056305117744392. https://journals.sagepub.com/doi/full/10.1177/2056305117744392.

[13] Teresa Millhouse, “Rest now my beloved. I love you more forever’: Wife of army trooper who died aged 36 from dementia caused by roadside bomb blast in Iraq posts loving tribute as hero is laid to rest,” Daily Mail.com,  (September 4, 2015). https://www.dailymail.co.uk/news/article-3222086/Rest-beloved-love-forever-Wife-army-trooper-died-aged-36-dementia-caused-roadside-bomb-blast-Iraq-posts-loving-tribute-hero.html

[14] Margaret Lock, “Contesting the Natural in Japan: Moral Dilemmas and Technologies of Dying.” Culture, Medicine and Psychiatry 19, no. 1 (March 19, 1995): 18. doi:10.1007/bf01388247. https://www.ncbi.nlm.nih.gov/pubmed/7671618.

[15] Ralph Rayback, “The Ways We Grieve.” Psychology Today. Accessed April 07, 2019. https://www.psychologytoday.com/us/blog/the-truisms-wellness/201702/the-ways-we-grieve

[16] Spargo, R. “The Ethics of Mourning.” The Ethics of Mourning | Johns Hopkins University Press Books. Accessed April 07, 2019. https://jhupbooks.press.jhu.edu/title/ethics-mourning.

[17] Chuckman, J. “America’s Culture of Grief and Dying.” Counter Punch. Accessed April 7, 2019. https://www.counterpunch.org/2002/02/03/america-s-culture-of-grief-and-dying/

[18] M, Mahaskey. Army 1st Lt. Matthew Greene comforts his mother, Dr. Susan Myers, as they prepare to bury Maj. Gen. Harold Greene at Arlington National Cemetery.,  2014. Politico, Arlington National Cemetery. Accessed April 07, 2019. https://www.politico.com/gallery/2014/08/funeral-for-u-s-army-maj-gen-harold-greene/001990-028297.html

[19] Mario D. Zamora and Renato Rosaldo. “Ilongot Headhunting 1883-1974.” Anthropological Quarterly 54, no. 3 (1981): 172. doi:10.2307/3317898. https://www.jstor.org/stable/i274755.

[20] Randal Horton,  “The Ethics of Grief.” Ethics Beyond Compliance. April 06, 2015. Accessed April 07, 2019.