Gerontology & Geriatrics Education, 36:124–143, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0270-1960 print/1545-3847 online DOI: 10.1080/02701960.2014.926268
Learning Through Loss: Implementing Lossography Narratives in Death Education CORY BOLKAN Department of Human Development, Washington State University Vancouver, Vancouver, Washington, USA
ERICA SRINIVASAN Department of Psychology, University of Wisconsin LaCrosse, LaCrosse, Wisconsin, USA
ALEXIS R. DEWAR Department of Human Factors, University of Central Florida, Orlando, Florida, USA
STACEY SCHUBEL Department of Human Development, Washington State University Vancouver, Vancouver, Washington, USA
Students may have a greater willingness to discuss issues of death and loss through written assignments; however, there is little guidance for instructors regarding how to manage these sensitive assignments, nor how students benefit from them. The authors implemented and evaluated a “lossography” assignment in an undergraduate thanatology course in which students wrote about their losses and anonymously shared these narratives with their classmates. Although many themes of loss emerged, the most frequently reported significant loss was death of a grandparent. Additionally, most significant losses occurred in childhood/adolescence. Prominent themes related to student learning included gaining self-awareness, knowledge about grief responses, and compassion for others. Students ( N = 64) also completed a survey reflecting on their course learning. Of all aspects of course delivery, 44% identified the lossography as the most beneficial, whereas 97% recommended this assignment for future students. The implications of the assignment for death education are also discussed. Address correspondence to Cory Bolkan, Department of Human Development, Washington State University Vancouver, 14204 NE Salmon Creek Avenue, Vancouver, WA 98686, USA. E-mail: [email protected] 124
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KEYWORDS bereavement, curriculum, end-of-life education, gerontology course assignment, teaching tool, thanatology, undergraduate students “To be human and alive means to absorb loss each day.” (Hooyman & Kramer, 2006, p. 2)
Loss is a fundamental aspect of the human experience, and there is arguably nothing more profoundly human than the awareness of our own mortality and the experience of loss. In addition to grappling with personal mortality, individuals frequently come in contact with others who are grieving, underscoring that issues related to death and loss often emerge at multiple times over the life span. Nonetheless, many are unprepared to address death or loss, and it remains a predominantly taboo topic, particularly in the United States. Although the number of thanatology-related college courses offered in the United States has grown in recent years, overall course offerings and student participation in them remain low (Dickinson, 2006, 2013; Eckerd, 2009), despite the recognition that these courses are beneficial to most students regardless of age, academic major, or intended career goals (Eckerd 2009; Ratner & Song, 2002; Wass, 2004). The stagnation in further growth of course offerings may be due, in part, to a lack of training or few available resources for instructors (Eckerd, 2009). Historically, course offerings in thanatology were low, even among medical and nursing school curricula (Wass, 2004; Wear, 2002). Although most medical training programs now report offering some education on end-of-life and palliative care, the average time devoted to these topics remains minimal (Dickinson, 2006, 2007) and the approaches to teaching inconsistent (Horowitz, Gramling, & Quill, 2014). For faculty to successfully guide students through a culturally sensitive course topic, more formal instruction about course design and assignments is needed. In this study, we evaluated a pedagogical writing assignment for students’ study of loss, death, and bereavement used in a gerontology program curriculum.
The Value of Death Education in the 21st Century Several current trends accentuate the importance of death education. First, the dramatic increase in life expectancy, accompanied by a growth in the number of older adults, will significantly alter the way families and societies function. By 2030, there will be approximately 72.1 million older Americans (U.S. Department of Health & Human Services, Administration on Aging, 2011). Consequently, more people will be living with, and dying from, chronic illnesses. More people will also become family caregivers, providing
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support to loved ones approaching end of life. Increased longevity has also resulted in more multigenerational families, meaning that children today will likely experience the loss of parents, grandparents, and even greatgrandparents. Thus, it is imperative to understand death as a natural process and to effectively cope with multiple losses over the life span. The reshaping of traditional family roles (i.e., caregiving) as a function of the losses of loved ones will affect traditional family structure and norms. Family structures are changing as a result of increased divorce, cohabitation, and reconstituted families (National Academy on an Aging Society, 2013). This dramatic shift has potential to bring up unique grief issues, which should be discussed in death education courses. Overall, as individuals and families continue to live longer, there is a critical demand for professionals with expertise and training in gerontology and thanatology. Secondly, death education provides important information about new policies and practices that have been introduced since the first emergence and wave of death education courses in the 1970s (Fonesca & Testoni, 2011). New areas of legislation-related topics in death education include physicianassisted death, advancements in life-sustaining technologies, novel ways to cope with loss and grief, and documents that allow people to state their end-of-life preferences (e.g., advance directives, physician orders for lifesustaining-treatment). There is also a new demand of addressing the threat of terrorist attacks and an increased fear of mass violence in community and school settings within thanatology courses (Kastenbaum, 2012). All of these topics have changed the process of dying and grieving in the United States. Moreover, death education benefits individuals because it addresses an issue that all humans will inevitably face: coping with loss. The ability to reflect on one’s experiences with death, dying, and loss is relevant to understanding the grief process (Babcock, 1990; Baddeley & Singer, 2009; Caplan, Haslett, & Burleson, 2005; Doll, Kereakoglow, Sarma, & Hare, 2008; Kübler-Ross & Kesseler, 2005; Lattanzi & Hale, 1984; Rosenbaum, Lobas, & Ferguson, 2005). As such, death education courses typically incorporate written assignments to facilitate discussion or reflection. Through these types of assignments, students can gain critical thinking skills that are needed for application to their own lives and future careers. This is particularly crucial for individuals seeking careers in health care, social work, or human services, as they will most likely encounter others facing illness, death, and grief and will need to be prepared to effectively work with this population. Many medical and social work students report insufficient training in end-of-life issues (Berzoff, Dane, & Cait, 2005; Bickel-Swenson, 2007; Hesselink et al., 2010; Litauska et al., 2013), and this can result in inadequate care and support for grieving patients/clients. For example, counselors with minimal death education training reported more discomfort when working with clients facing serious illness or dealing with grief (Kirchberg, Neimeyer, & James, 1998, see also Neimeyer, Wittkowski, & Moser, 2004; Ober, Granello, & Wheaton, 2012).
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It is arguably easier to point out the necessity for death education than to clarify best practices for approaching and teaching this complex topic in classroom settings. More research is needed to guide instructors on how to successfully implement assignments that will achieve positive learning outcomes for students. Furthermore, many prior studies focused on assignments that supported individuals who were actively grieving loss from death (Doll et al., 2008) or to specifically prepare students to work in healthcare (Berzoff et al., 2005; Gould, 1994; Harrawood, Doughty, & Wilde, 2011; Konrad, 2010). We argue that death education courses can benefit most students (beyond those seeking work in health care or social sciences) and can prepare individuals who are not currently grieving for inevitable future encounters with bereavement, grief, and loss in their personal and professional lives.
Current Resources and Pedagogical Tools in Death Education Researchers have explored the use of pedagogical tools and resources for death educators (Csikai & Jones, 2007; Doll et al., 2008; Hill & Stillion, 1995; Rosenbaum et al., 2005; Schiappa, Gregg, & Hewes, 2004). Findings from these studies suggested that students might be more willing to discuss issues associated with death through written assignments rather than oral communication. Self-disclosure and expression of emotional or stressful experiences have also been associated with positive outcomes, including improvements in physical and psychological well-being (Frattaroli 2006; Lichtenthal & Cruess, 2010; Pennebaker & Seagal, 1999). Examples of reflective writing assignments in death and dying education include encouraging students to write about prior funeral experiences or to imagine and visualize their own death process (Doll et al., 2008). Rosenbaum and colleagues (2005) instructed medical students to complete writing exercises related to their first experiences with death and explore how these experiences may have shaped their attitudes toward death. They also asked students to write about feelings that arose throughout the coverage of course material, specifically emphasizing their thoughts about death and caring for dying persons (Rosenbaum et al., 2005). All of these types of assignments can provide instructors with unique insight into students’ learning. They may also facilitate students’ exploration of their own views and experiences with death and loss more effectively than relying solely on traditional class lectures. Although there are many recommendations for student self-reflective activities, few researchers have evaluated the specific benefit of these activities to student learning outcomes in death and dying. Several textbooks on death and dying have introduced a writing concept called a “lossography” as an effective tool for teaching students about loss and grief (Csikai & Jones, 2007; DeSpelder & Strickland, 2009). This assignment is unique because it includes self-disclosure, written communication,
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and sharing narratives with others. This allows students to actively learn about grief and loss, rather than passively take in information, which results in reinforcing their understanding of core course concepts (Gould, 1994). Although this exercise is recommended in several textbooks and promotes an effective design for learning about loss and grief, there is little guidance for instructors regarding how to successfully implement and manage this sensitive assignment, nor how students value this learning opportunity. In this study, we aimed to (a) describe the implementation of the lossography assignment as an educational tool for death education, (b) evaluate salient themes in students’ lossography narratives, (c) assess the usefulness of the assignment, and (d) report students’ perceptions of learning outcomes from this assignment.
METHOD Participants A lossography assignment was incorporated into an upper-level, elective, undergraduate course on Death and Dying at a small, university campus. Class sizes were small to medium (ranging from 12–35 students). Over three semesters of data collection, 64 students completed the lossography assignment and a voluntary, end-of-semester survey regarding their learning from course assignments. The students ranged in age from 21 to 67 years (M = 30.1 years). This age trend is representative of the mix of traditional and nontraditional students on the campus. Most students were women (81%), which is reflective of gender differences in social science courses. For example, in 2012, women earned 77% of bachelor’s degrees in psychology (National Science Foundation, 2012). Although participants’ predominately represented majors from Human Development and Psychology departments (78% overall), many students were also majors in sociology, criminal justice, public affairs, biology, and accounting. Most students also reported seeking careers in helping fields (e.g., teaching, human services, child care, aging services, social work, counseling, law enforcement, health care, or human resources).
Procedures Students were expected to participate in all course-related activities outlined in the course syllabus, which included attending lecture, reflective journal writing on specific course topics, watching videos, listening to guest lectures, taking exams, attending a field trip to a funeral home, and participating in classroom discussions. Additionally, students were assigned the lossography (see Tables 1 and 2). At the end of the semester, students who provided informed consent completed a brief survey developed by the course instructor and research assistants. This survey asked students to evaluate which
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TABLE 1 Lossography Instructions Lossography assignment prompts Instructions Prompt #1
Prompt #2
First, begin by brainstorming and recalling your past experiences with death, dying, and loss. Earliest death or loss • What is the earliest death or loss experience you remember? • How old were you and what are the things you remember most about it (e.g., grief reactions, funeral rituals, who was involved)? • What were your reactions? What were the reactions of those around you? • In what ways do you feel that you were supported or not supported at that time? • What did you learn about death or loss from this experience? • How has this loss affected your attitude toward loss or death and dying? In other words, in what ways did this loss experience influence your reaction to subsequent losses in your life? How so? Most significant death or loss • What is the most significant death or loss experience you remember? (If this is the same as your earliest loss, describe why it is also the most significant.) • How old were you and what are the things you remember most about it? • What did you learn about death or loss from this experience? • How has this loss affected your attitude toward loss or death and dying?
Source: Adapted from Instructor’s Premium Content ©2009 DeSpelder & Strickland, The Last Dance: Encountering Death & Dying. Note: Additional directions for the above assignment read, “In this assignment, you will be asked to (a) think about your past experiences with loss; (b) select and describe the most important losses in your life; and (c) make connections to your beliefs and behaviors today. Be sure to consider who in your life was influential in your experience or attitudes toward the loss. Do you think media or culture also affected your understanding of loss? Some of the topics on which previous students have written included the experience of loss related to a decline in health, loss of home through a move or emigration, child-bearing losses such as miscarriage, menopause, or infertility, or the loss of a relationship through divorce/separation or death.”
assignments they found particularly useful to student learning, with the anchors 0 (little to no help) to 5 (very helpful). Students were informed that participation was anonymous and voluntary (i.e., no extra credit or incentives were provided for participation). The Institutional Review Board determined that the study satisfied the criteria for exempt research.
Analysis Descriptive analyses of students’ survey responses were used to assess their perceptions of learning outcomes and helpfulness of the assignment. For exploratory bivariate analysis, a chi-squared test examined relationships between gender for categorical measures of course evaluation. In addition to analyzing the surveys regarding student learning, a subsample of 43 lossography narratives were qualitatively analyzed using the constant
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TABLE 2 Group Lossography Instructions Group Lossography assignment prompts Instructions Prompts
First, be sure to closely read the Group Lossography document. Upon finishing the reading, please address the following questions. Reflect upon the following in your writing: • Did you notice any similarities and/or differences between the loss experiences you have written about and those of your peers? How so? Did you observe any common themes (e.g., in reactions, rituals, feelings)? • Which loss experiences seemed like ones that might be especially difficult for you to survive? From the experiences of your peers, identify what you believe to be a high-grief loss and why? How do you think we/society can be more supportive and/or sensitive to grieving individuals? • Select at least two examples from the writings of your peers that describe ways of thinking about a death or loss that seem especially useful to you. • Provide at least one description of a ritual that you believe would be helpful to you (or others) as a survivor of loss. Explain why. • What was the most significant learning aspect you took away from this assignment?
Source: Adapted from Instructor’s Premium Content ©2009 DeSpelder & Strickland, The Last Dance: Encountering Death & Dying. Note: Additional instructions for the second part of the lossography assignment read as follows: “In the second half of this assignment, you will be asked to (a) read the Group Lossography document; (b) reflect on your observations/reactions after reviewing the document, and (c) connect this experience to what you are learning in this course. Please be respectful and sensitive when evaluating the Group Lossography. Feelings of loss can be difficult and personal experiences—you should feel honored and privileged that your classmates have chosen to share with you. Out of respect and sensitivity to our fellow classmates, what is shared in our class is always considered confidential and not to be shared outside of the classroom.”
comparative method associated with grounded theory (Creswell, 2013). Three researchers collaborated to iteratively identify the most prominent themes of student learning, thereby finalizing a coding scheme. To reduce bias, two researchers independently coded the narratives into the developed set of themes and discussed any discrepancies (less than 10% of the data) to determine consensus.
Measures Student survey. In addition to collecting demographic information, participants answered multiple-choice and open-ended questions related to their perceptions of the course content and learning activities. First, students were queried, “To what extent did each class activity assist you in the learning process?” and then individually rated each component of the course (e.g., lecture, videos, lossography assignment) on a 5-point Likert scale from 1 (not at all helpful) to 5 (helped a lot). They were also asked an open-ended follow-up question in which they could expand on the activity or activities they felt most helped them in achieving their learning goals. These responses were aggregated. Finally, participants were specifically asked to reflect on the
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lossography assignment: “Would you recommend that future classes partake in the lossography assignment (why or why not)?” Lossography assignment. The lossography was divided into two small writing assignments (approximately three to five pages each) and based on the instructions outlined in the premium content for instructors developed by DeSpelder and Strickland (2009). Students were allowed to choose to write about death (e.g., of a friend, parent, etc.) or loss (e.g., divorce, trust, etc.). Students could delve into as much detail about the death or loss as they desired. The novel facet about this assignment was the freedom that students had in the choice of the topic and the degree of disclosure. Students were reminded that the assignment would be anonymously shared with their classmates (unless they requested to be excluded) and general classroom conduct regarding respect, confidentiality, and sensitivity to others was reinforced. First, students were specifically asked to (a) think about their past experiences with loss, (b) select and describe the most important losses in their lives, and (c) make connections to their beliefs and behaviors about loss today (see Table 1). Before beginning this assignment, we held a class discussion to brainstorm types of losses that adults and children may experience. The Adult Loss Inventory (Maish, M. [American Hospice Foundation], 2000) was also provided to students as a tool to generate recollections about past experiences with death, dying, and loss. Second, after reading through these first narratives, the class instructor and teaching assistant randomly compiled all assignments into one large document in which student names were omitted. We referred to this document as the “Group Lossography” as it included each student’s singular lossography. Students were then asked to read the document and reflect on their classmates’ experiences with death and loss. More specifically, they were asked to (a) read the anonymous Group Lossography document, (b) reflect on their observations/reactions after reviewing the document, and (c) connect this experience to what they learned in the course (see Table 2). In general, students made particular note of which losses stood out to them, how their personal lossography tied in with the overall Group Lossography, and if they observed similarities and/or differences in the grief/loss experience.
RESULTS After evaluating the lossography narratives, we found that students reported a variety of losses related to divorce, relationships, physical and sexual abuse, and serious illness. The most frequently reported experiences with dying involved the death of a grandparent. Almost all participants reported loss experiences during childhood and adolescence, whereas more than one half of the participants described the death of a grandparent as the most significant loss they had experienced in their lives to date. Students were able
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to vividly recall the emotions and cognitions experienced during their earliest and most significant encounters with death/loss. Many described intense emotions such as pain, loss, fear, peace, sadness, or confusion. In addition, four major learning themes emerged from the qualitative data: (a) grief and coping with a variety of losses; (b) universality of death, grief and loss; (c) appreciation of life and loved ones, personal growth, and connectedness; and (d) children, loss, and grief.
Theme 1: Grief and Coping with a Variety of Losses Many students (56%) indicated an understanding that loss is an everyday experience that can arise from various situations and circumstances. For example, one student explained, “When we think of loss and death, we can sometimes think it only means the death of a person. Loss can be experienced in so many different forms.” Students also learned that the categorization of loss and its impact differs based on age, perceptions, life experiences, and resources. One student directly addressed this by stating, “The most significant learning experience I took away from this would have to be that any loss, regardless of what type, can be equally devastating.” Students also acquired an understanding that everyone has unique losses that intensely affect and shape their lives. As one student remarked, “After reading each of the experiences, such as death of a family member, friend and pet as well as divorce, break up, and the rough childhoods that some of the individuals have gone through, it definitely gave me even more perspective on how varied each one of us are in our grief responses.” Students examined their own lives to see how experiences of loss that had previously been dismissed or minimized could potentially be redefined as meaningful losses. For example, one student described how she gained perspective on personal losses, “Seeing how every level of grief is different for everyone helped me gain a wide range perspective for the things that can be considered losses, which has also allowed me to identify some of my own that I have never wanted to consider as being a loss.” The lossography assignment allowed students to gain knowledge about the diversity of losses, coping strategies, and grief responses while also providing a framework for reexamining earlier losses and addressing unresolved grief.
Theme 2: Universality of Death, Grief, and Loss In a death-denying society, the universality of death, grief, and loss frequently remains unacknowledged. Through the lossography assignment, students understood that death, grief, and loss are ubiquitous, natural experiences. This realization had a significant impact on students and was one of the most commonly reported learning outcomes (65%). Overall, many
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reported seclusion in their grief, as well as more empathy toward their peers’ losses. One student described her awe of the collective losses experienced by her classmates, “What struck me the most was that there was not one person in the class who had not experienced a significant loss.” Several students reported viewing their classmates differently, with a more holistic perspective and as people with wide-ranging life experiences. The following statement made by one student was echoed by many: “Sitting in class and looking at the faces of the people in the room, I never would have imagined that every single one of them experienced a loss in some shape or form.” Most students initially felt like the only person who had experienced death or loss, until reading their classmates’ lossographies. One student expressed relief at realizing that others had also felt loss, “We all experienced some type of loss, and it wasn’t just me who kept losing my loved ones.” This recognition helped students feel more connected to one another and less isolated. Consequently, the assignment created a sense of community by requiring students to share their losses with others. Students repeatedly recognized and acknowledged the power in sharing. One student described: The biggest lesson that I have learned from reading these lossographies is the importance of sharing loss. We can learn a lot from loss and from the losses of those around us, and the more we talk about those losses and discuss what they meant to us, the more we learn about ourselves.
Overall, it appeared eye-opening for students to recognize that loss is universal. Sharing losses and realizing that loss is an everyday experience caused some students to feel more equipped to cope with future loss. One student commented, “I am not alone in the suffering of loss . . . I realize that death is inevitable and I will experience loss again, but I feel better prepared.” Students realized that everyone experiences loss and that people may also have similar grieving reactions, including feeling isolated and sad, as well as resilient. They also examined how societal expectations about avoiding death influenced the way in which they coped with loss. One student reflected specifically on isolation that can occur when coping with loss and how that might be connected to societal pressures to be happy, even when dealing with deep or traumatic loss: Many of my classmates felt the same way I did when experiencing loss; they felt alone. . . . I think it could be [that] our society thinks it is weak to be sad, [instead] you [should] pull yourself up by your bootstraps and put on a happy face.
Finally, as part of acknowledgment of the universality of death, loss, and grief, students became more aware of their own mortality. One student
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succinctly explained this by stating, “As hard as it is to say it, we will all die.” Many students accepted that an integral part of life is facing personal mortality. For example, a student noted that, “The one thing that became clear in the readings is that death is inevitable, the very act of dying is part of living and it is unavoidable.” Death and dying can inform life and living; many students made this connection when acknowledging the universality of death.
Theme 3: Appreciation of Life, Loved Ones, Personal Growth, and Connectedness Generating awareness of losses helped students to prioritize what was important in their lives and to clarify their personal values. This was also reflected in students’ relationships with others. For example, almost one half (47%) felt more compassionate and empathetic toward one another or realized that while loss can be difficult, it can also be transformative and result in more appreciation for life. One student focused on the importance of being present, “I learned that loss is hard, but that it is not the end for those still living, and so I should value every moment while I’m still alive.” Another student furthered this thought by observing how loss influenced the lives of others, “Loss can shape our lives, and being considerate of that is very important both to our personal well-being and that of the people around us.” An acknowledgment of mortality, the significance of being present, and the importance of maximizing time also accompanied the increased appreciation for life with friends and family. One student described this by stating, “We do not know when we will lose our loved ones, but we need to value the time that we have.” An appreciation for life and time spent with loved ones may have also naturally led to compassion for others. One student described how the knowledge that time is limited and that our lives are finite prompted empathy toward others, “It is so important to remember to be empathetic and kind to both strangers and loved ones, you never know what moment will be their last (or yours for that matter).” Many students were also very moved by reading about each individual’s loss. One student commented upon the vulnerability in humans dealing with loss and how this increased a sense of compassion for others: I want to give everyone a hug and thank them for sharing the stories of their lives because it has changed my perspective on the way that we should be treating others. Each one of us is fragile in our own way, and sometimes it just takes someone to understand, to be there and to listen so we can continue healing.
In line with this, another student also remarked on the subsequent compassion gained from knowing that everyone deals with loss, “From now on, I
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will definitely be more compassionate towards others in every way I can, just knowing that everyone is fighting their own battle through life, whether you know about it or not.” Lastly, another example of this theme is represented in this student’s description: I want to remember the feelings I had as I read this compilation. I believed all of us experienced loss . . . now I know it. I felt this deep desire to be more patient and kind and non-judgmental of others.
All of these experiences exemplify how the recognition of the universality of loss can lead to behavioral changes in the treatment of others. One benefit of this assignment is that it engendered a stronger sense of community among students and that this feeling may stay with them beyond the classroom setting.
Theme 4: Children, Loss, and Grief Several students (21%) specifically discussed the effect of loss and grief on children. This was likely triggered by self-reflection on losses experienced during their childhood. It was clear that these were profound experiences that still affected them as adults today. Students were especially intrigued that many of their classmates experienced loss during early childhood. One student remarked, “I was pretty surprised at the number of people in the class who experienced a loss of life before the age of five.” Approximately 65% reported that their most significant loss occurred during childhood, with the most frequently reported loss being the death of a grandparent. Reflecting back on childhood losses, students realized that being left out of grieving activities potentially hindered their coping in the present. One student recalled being left out of conversations about the death of a relative and the subsequent grieving activities: I was barely five and they assumed that I did not grasp the concept of death. In retrospect, I feel that this was possibly a poor decision, and I will resolve to not do something of this nature with my future children.
Some students acknowledged that although children may not fully understand the meaning behind social rituals and the inevitability of death and loss, leaving them out of grieving activities is nevertheless harmful, sometimes later resulting in disenfranchised grief. For example, one student observed, “As children, we watch the rituals that are associated with someone dying, but don’t fully understand them. Unfortunately, when we usually ask what is going on, we are quickly hushed and told that we will understand one day.” Consequently, several students observed that although parents sought to shelter children from death, it ultimately resulted in feelings
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of isolation and confusion about the loss. One student discussed the value of talking to children about death, “I believe by not being honest with children about death you pass up an opportunity to help them better prepare for future death and losses.” Students also noticed how the broader topic of children and death is often avoided and that the mortality of children is rarely considered. The denial that children can die leaves individuals and families unprepared for this occurrence. The lossography assignment helped students reconsider how to discuss death more openly with children and families, as well as how to model healthy coping strategies early in life to benefit effective coping in later life.
Student Learning Based on Survey Results The students rated most course activities relatively high (range: 3.7–4.8 out of 5) in helpfulness (see Table 3). Overall, the percentage of participants who rated each activity as helpful did not differ by gender, with the exception of journaling, χ 2 (3) = 9.9, p = .02, and supplemental readings, χ 2 (5) = 12.1, p = .03. Women were more likely than men to evaluate these activities as slightly more helpful. Most helpful course activity. After evaluating how much individuals course activity enhanced their learning, students responded to an openended question by identifying the single most helpful activity. Approximately 44% (n = 28) stated that the lossography assignment was most helpful. Nine additional students reported that all writing assignments, including journaling, were the most beneficial to learning. Taken together, 58% of participants endorsed writing assignments as the most useful learning activity in the course. Students expanded on their responses, by reporting a variety of explanations as to why they chose the lossography assignment as one of the most beneficial learning activities. The following two quotes represent some of these reasons: “[The lossography] helped me to clarify my own losses, which made it easier to examine how they have affected me and reading the others’ [assignments] made me realize that we are all going to experience loss in our lifetimes” and, The reason the lossographies were my most beneficial learning activity is because I got to look at my dad’s death though more mature eyes. . . . Reading everyone’s lossographies made the concept of “not feeling alone regarding grief” more concrete.
Students noted that the assignment was sometimes challenging, yet it provided them with the opportunity to explore personal losses, observe the diversity of human experiences, and apply course material to real-life situations.
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4.08
3.68
Field trip
Sharing personal lossography
Supplemental readings
Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both
Genderb
Note: a Course activity ratings from 5 (helped a lot) to 1 (not at all). b There were 52 women and 12 men.
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4.75
Class lectures
Reading group lossography
4.75
Guest speakers
4.55
4.76
Lossography assignment
Journaling
4.80
Mean ratinga
In-class videos
Item 44 10 54 40 8 48 42 9 51 43 8 51 35 5 40 38 7 45 27 5 32 19 4 23 9 2 11
(85) (83) (84) (77) (67) (75) (81) (75) (80) (83) (67) (80) (67) (42) (63) (73) (58) (70) (52) (42) (50) (37) (33) (36) (17) (17) (17)
A lot 6 (12) 2 (17) 8 (13) 11 (21) 4 (33) 15 (23) 8 (15) 3 (25) 11 (17) 6 (12) 4 (33) 10 (16) 16 (31) 4 (33) 20 (31) 10 (19) 2 (17) 12 (19) 6 (12) 5 (42) 11 (17) 20 (38) 4 (33) 24 (38) 28 (54) 1 (
Learning Through Loss: Implementing Lossography Narratives in Death Education CORY BOLKAN Department of Human Development, Washington State University Vancouver, Vancouver, Washington, USA
ERICA SRINIVASAN Department of Psychology, University of Wisconsin LaCrosse, LaCrosse, Wisconsin, USA
ALEXIS R. DEWAR Department of Human Factors, University of Central Florida, Orlando, Florida, USA
STACEY SCHUBEL Department of Human Development, Washington State University Vancouver, Vancouver, Washington, USA
Students may have a greater willingness to discuss issues of death and loss through written assignments; however, there is little guidance for instructors regarding how to manage these sensitive assignments, nor how students benefit from them. The authors implemented and evaluated a “lossography” assignment in an undergraduate thanatology course in which students wrote about their losses and anonymously shared these narratives with their classmates. Although many themes of loss emerged, the most frequently reported significant loss was death of a grandparent. Additionally, most significant losses occurred in childhood/adolescence. Prominent themes related to student learning included gaining self-awareness, knowledge about grief responses, and compassion for others. Students ( N = 64) also completed a survey reflecting on their course learning. Of all aspects of course delivery, 44% identified the lossography as the most beneficial, whereas 97% recommended this assignment for future students. The implications of the assignment for death education are also discussed. Address correspondence to Cory Bolkan, Department of Human Development, Washington State University Vancouver, 14204 NE Salmon Creek Avenue, Vancouver, WA 98686, USA. E-mail: [email protected] 124
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KEYWORDS bereavement, curriculum, end-of-life education, gerontology course assignment, teaching tool, thanatology, undergraduate students “To be human and alive means to absorb loss each day.” (Hooyman & Kramer, 2006, p. 2)
Loss is a fundamental aspect of the human experience, and there is arguably nothing more profoundly human than the awareness of our own mortality and the experience of loss. In addition to grappling with personal mortality, individuals frequently come in contact with others who are grieving, underscoring that issues related to death and loss often emerge at multiple times over the life span. Nonetheless, many are unprepared to address death or loss, and it remains a predominantly taboo topic, particularly in the United States. Although the number of thanatology-related college courses offered in the United States has grown in recent years, overall course offerings and student participation in them remain low (Dickinson, 2006, 2013; Eckerd, 2009), despite the recognition that these courses are beneficial to most students regardless of age, academic major, or intended career goals (Eckerd 2009; Ratner & Song, 2002; Wass, 2004). The stagnation in further growth of course offerings may be due, in part, to a lack of training or few available resources for instructors (Eckerd, 2009). Historically, course offerings in thanatology were low, even among medical and nursing school curricula (Wass, 2004; Wear, 2002). Although most medical training programs now report offering some education on end-of-life and palliative care, the average time devoted to these topics remains minimal (Dickinson, 2006, 2007) and the approaches to teaching inconsistent (Horowitz, Gramling, & Quill, 2014). For faculty to successfully guide students through a culturally sensitive course topic, more formal instruction about course design and assignments is needed. In this study, we evaluated a pedagogical writing assignment for students’ study of loss, death, and bereavement used in a gerontology program curriculum.
The Value of Death Education in the 21st Century Several current trends accentuate the importance of death education. First, the dramatic increase in life expectancy, accompanied by a growth in the number of older adults, will significantly alter the way families and societies function. By 2030, there will be approximately 72.1 million older Americans (U.S. Department of Health & Human Services, Administration on Aging, 2011). Consequently, more people will be living with, and dying from, chronic illnesses. More people will also become family caregivers, providing
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support to loved ones approaching end of life. Increased longevity has also resulted in more multigenerational families, meaning that children today will likely experience the loss of parents, grandparents, and even greatgrandparents. Thus, it is imperative to understand death as a natural process and to effectively cope with multiple losses over the life span. The reshaping of traditional family roles (i.e., caregiving) as a function of the losses of loved ones will affect traditional family structure and norms. Family structures are changing as a result of increased divorce, cohabitation, and reconstituted families (National Academy on an Aging Society, 2013). This dramatic shift has potential to bring up unique grief issues, which should be discussed in death education courses. Overall, as individuals and families continue to live longer, there is a critical demand for professionals with expertise and training in gerontology and thanatology. Secondly, death education provides important information about new policies and practices that have been introduced since the first emergence and wave of death education courses in the 1970s (Fonesca & Testoni, 2011). New areas of legislation-related topics in death education include physicianassisted death, advancements in life-sustaining technologies, novel ways to cope with loss and grief, and documents that allow people to state their end-of-life preferences (e.g., advance directives, physician orders for lifesustaining-treatment). There is also a new demand of addressing the threat of terrorist attacks and an increased fear of mass violence in community and school settings within thanatology courses (Kastenbaum, 2012). All of these topics have changed the process of dying and grieving in the United States. Moreover, death education benefits individuals because it addresses an issue that all humans will inevitably face: coping with loss. The ability to reflect on one’s experiences with death, dying, and loss is relevant to understanding the grief process (Babcock, 1990; Baddeley & Singer, 2009; Caplan, Haslett, & Burleson, 2005; Doll, Kereakoglow, Sarma, & Hare, 2008; Kübler-Ross & Kesseler, 2005; Lattanzi & Hale, 1984; Rosenbaum, Lobas, & Ferguson, 2005). As such, death education courses typically incorporate written assignments to facilitate discussion or reflection. Through these types of assignments, students can gain critical thinking skills that are needed for application to their own lives and future careers. This is particularly crucial for individuals seeking careers in health care, social work, or human services, as they will most likely encounter others facing illness, death, and grief and will need to be prepared to effectively work with this population. Many medical and social work students report insufficient training in end-of-life issues (Berzoff, Dane, & Cait, 2005; Bickel-Swenson, 2007; Hesselink et al., 2010; Litauska et al., 2013), and this can result in inadequate care and support for grieving patients/clients. For example, counselors with minimal death education training reported more discomfort when working with clients facing serious illness or dealing with grief (Kirchberg, Neimeyer, & James, 1998, see also Neimeyer, Wittkowski, & Moser, 2004; Ober, Granello, & Wheaton, 2012).
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It is arguably easier to point out the necessity for death education than to clarify best practices for approaching and teaching this complex topic in classroom settings. More research is needed to guide instructors on how to successfully implement assignments that will achieve positive learning outcomes for students. Furthermore, many prior studies focused on assignments that supported individuals who were actively grieving loss from death (Doll et al., 2008) or to specifically prepare students to work in healthcare (Berzoff et al., 2005; Gould, 1994; Harrawood, Doughty, & Wilde, 2011; Konrad, 2010). We argue that death education courses can benefit most students (beyond those seeking work in health care or social sciences) and can prepare individuals who are not currently grieving for inevitable future encounters with bereavement, grief, and loss in their personal and professional lives.
Current Resources and Pedagogical Tools in Death Education Researchers have explored the use of pedagogical tools and resources for death educators (Csikai & Jones, 2007; Doll et al., 2008; Hill & Stillion, 1995; Rosenbaum et al., 2005; Schiappa, Gregg, & Hewes, 2004). Findings from these studies suggested that students might be more willing to discuss issues associated with death through written assignments rather than oral communication. Self-disclosure and expression of emotional or stressful experiences have also been associated with positive outcomes, including improvements in physical and psychological well-being (Frattaroli 2006; Lichtenthal & Cruess, 2010; Pennebaker & Seagal, 1999). Examples of reflective writing assignments in death and dying education include encouraging students to write about prior funeral experiences or to imagine and visualize their own death process (Doll et al., 2008). Rosenbaum and colleagues (2005) instructed medical students to complete writing exercises related to their first experiences with death and explore how these experiences may have shaped their attitudes toward death. They also asked students to write about feelings that arose throughout the coverage of course material, specifically emphasizing their thoughts about death and caring for dying persons (Rosenbaum et al., 2005). All of these types of assignments can provide instructors with unique insight into students’ learning. They may also facilitate students’ exploration of their own views and experiences with death and loss more effectively than relying solely on traditional class lectures. Although there are many recommendations for student self-reflective activities, few researchers have evaluated the specific benefit of these activities to student learning outcomes in death and dying. Several textbooks on death and dying have introduced a writing concept called a “lossography” as an effective tool for teaching students about loss and grief (Csikai & Jones, 2007; DeSpelder & Strickland, 2009). This assignment is unique because it includes self-disclosure, written communication,
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and sharing narratives with others. This allows students to actively learn about grief and loss, rather than passively take in information, which results in reinforcing their understanding of core course concepts (Gould, 1994). Although this exercise is recommended in several textbooks and promotes an effective design for learning about loss and grief, there is little guidance for instructors regarding how to successfully implement and manage this sensitive assignment, nor how students value this learning opportunity. In this study, we aimed to (a) describe the implementation of the lossography assignment as an educational tool for death education, (b) evaluate salient themes in students’ lossography narratives, (c) assess the usefulness of the assignment, and (d) report students’ perceptions of learning outcomes from this assignment.
METHOD Participants A lossography assignment was incorporated into an upper-level, elective, undergraduate course on Death and Dying at a small, university campus. Class sizes were small to medium (ranging from 12–35 students). Over three semesters of data collection, 64 students completed the lossography assignment and a voluntary, end-of-semester survey regarding their learning from course assignments. The students ranged in age from 21 to 67 years (M = 30.1 years). This age trend is representative of the mix of traditional and nontraditional students on the campus. Most students were women (81%), which is reflective of gender differences in social science courses. For example, in 2012, women earned 77% of bachelor’s degrees in psychology (National Science Foundation, 2012). Although participants’ predominately represented majors from Human Development and Psychology departments (78% overall), many students were also majors in sociology, criminal justice, public affairs, biology, and accounting. Most students also reported seeking careers in helping fields (e.g., teaching, human services, child care, aging services, social work, counseling, law enforcement, health care, or human resources).
Procedures Students were expected to participate in all course-related activities outlined in the course syllabus, which included attending lecture, reflective journal writing on specific course topics, watching videos, listening to guest lectures, taking exams, attending a field trip to a funeral home, and participating in classroom discussions. Additionally, students were assigned the lossography (see Tables 1 and 2). At the end of the semester, students who provided informed consent completed a brief survey developed by the course instructor and research assistants. This survey asked students to evaluate which
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TABLE 1 Lossography Instructions Lossography assignment prompts Instructions Prompt #1
Prompt #2
First, begin by brainstorming and recalling your past experiences with death, dying, and loss. Earliest death or loss • What is the earliest death or loss experience you remember? • How old were you and what are the things you remember most about it (e.g., grief reactions, funeral rituals, who was involved)? • What were your reactions? What were the reactions of those around you? • In what ways do you feel that you were supported or not supported at that time? • What did you learn about death or loss from this experience? • How has this loss affected your attitude toward loss or death and dying? In other words, in what ways did this loss experience influence your reaction to subsequent losses in your life? How so? Most significant death or loss • What is the most significant death or loss experience you remember? (If this is the same as your earliest loss, describe why it is also the most significant.) • How old were you and what are the things you remember most about it? • What did you learn about death or loss from this experience? • How has this loss affected your attitude toward loss or death and dying?
Source: Adapted from Instructor’s Premium Content ©2009 DeSpelder & Strickland, The Last Dance: Encountering Death & Dying. Note: Additional directions for the above assignment read, “In this assignment, you will be asked to (a) think about your past experiences with loss; (b) select and describe the most important losses in your life; and (c) make connections to your beliefs and behaviors today. Be sure to consider who in your life was influential in your experience or attitudes toward the loss. Do you think media or culture also affected your understanding of loss? Some of the topics on which previous students have written included the experience of loss related to a decline in health, loss of home through a move or emigration, child-bearing losses such as miscarriage, menopause, or infertility, or the loss of a relationship through divorce/separation or death.”
assignments they found particularly useful to student learning, with the anchors 0 (little to no help) to 5 (very helpful). Students were informed that participation was anonymous and voluntary (i.e., no extra credit or incentives were provided for participation). The Institutional Review Board determined that the study satisfied the criteria for exempt research.
Analysis Descriptive analyses of students’ survey responses were used to assess their perceptions of learning outcomes and helpfulness of the assignment. For exploratory bivariate analysis, a chi-squared test examined relationships between gender for categorical measures of course evaluation. In addition to analyzing the surveys regarding student learning, a subsample of 43 lossography narratives were qualitatively analyzed using the constant
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TABLE 2 Group Lossography Instructions Group Lossography assignment prompts Instructions Prompts
First, be sure to closely read the Group Lossography document. Upon finishing the reading, please address the following questions. Reflect upon the following in your writing: • Did you notice any similarities and/or differences between the loss experiences you have written about and those of your peers? How so? Did you observe any common themes (e.g., in reactions, rituals, feelings)? • Which loss experiences seemed like ones that might be especially difficult for you to survive? From the experiences of your peers, identify what you believe to be a high-grief loss and why? How do you think we/society can be more supportive and/or sensitive to grieving individuals? • Select at least two examples from the writings of your peers that describe ways of thinking about a death or loss that seem especially useful to you. • Provide at least one description of a ritual that you believe would be helpful to you (or others) as a survivor of loss. Explain why. • What was the most significant learning aspect you took away from this assignment?
Source: Adapted from Instructor’s Premium Content ©2009 DeSpelder & Strickland, The Last Dance: Encountering Death & Dying. Note: Additional instructions for the second part of the lossography assignment read as follows: “In the second half of this assignment, you will be asked to (a) read the Group Lossography document; (b) reflect on your observations/reactions after reviewing the document, and (c) connect this experience to what you are learning in this course. Please be respectful and sensitive when evaluating the Group Lossography. Feelings of loss can be difficult and personal experiences—you should feel honored and privileged that your classmates have chosen to share with you. Out of respect and sensitivity to our fellow classmates, what is shared in our class is always considered confidential and not to be shared outside of the classroom.”
comparative method associated with grounded theory (Creswell, 2013). Three researchers collaborated to iteratively identify the most prominent themes of student learning, thereby finalizing a coding scheme. To reduce bias, two researchers independently coded the narratives into the developed set of themes and discussed any discrepancies (less than 10% of the data) to determine consensus.
Measures Student survey. In addition to collecting demographic information, participants answered multiple-choice and open-ended questions related to their perceptions of the course content and learning activities. First, students were queried, “To what extent did each class activity assist you in the learning process?” and then individually rated each component of the course (e.g., lecture, videos, lossography assignment) on a 5-point Likert scale from 1 (not at all helpful) to 5 (helped a lot). They were also asked an open-ended follow-up question in which they could expand on the activity or activities they felt most helped them in achieving their learning goals. These responses were aggregated. Finally, participants were specifically asked to reflect on the
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lossography assignment: “Would you recommend that future classes partake in the lossography assignment (why or why not)?” Lossography assignment. The lossography was divided into two small writing assignments (approximately three to five pages each) and based on the instructions outlined in the premium content for instructors developed by DeSpelder and Strickland (2009). Students were allowed to choose to write about death (e.g., of a friend, parent, etc.) or loss (e.g., divorce, trust, etc.). Students could delve into as much detail about the death or loss as they desired. The novel facet about this assignment was the freedom that students had in the choice of the topic and the degree of disclosure. Students were reminded that the assignment would be anonymously shared with their classmates (unless they requested to be excluded) and general classroom conduct regarding respect, confidentiality, and sensitivity to others was reinforced. First, students were specifically asked to (a) think about their past experiences with loss, (b) select and describe the most important losses in their lives, and (c) make connections to their beliefs and behaviors about loss today (see Table 1). Before beginning this assignment, we held a class discussion to brainstorm types of losses that adults and children may experience. The Adult Loss Inventory (Maish, M. [American Hospice Foundation], 2000) was also provided to students as a tool to generate recollections about past experiences with death, dying, and loss. Second, after reading through these first narratives, the class instructor and teaching assistant randomly compiled all assignments into one large document in which student names were omitted. We referred to this document as the “Group Lossography” as it included each student’s singular lossography. Students were then asked to read the document and reflect on their classmates’ experiences with death and loss. More specifically, they were asked to (a) read the anonymous Group Lossography document, (b) reflect on their observations/reactions after reviewing the document, and (c) connect this experience to what they learned in the course (see Table 2). In general, students made particular note of which losses stood out to them, how their personal lossography tied in with the overall Group Lossography, and if they observed similarities and/or differences in the grief/loss experience.
RESULTS After evaluating the lossography narratives, we found that students reported a variety of losses related to divorce, relationships, physical and sexual abuse, and serious illness. The most frequently reported experiences with dying involved the death of a grandparent. Almost all participants reported loss experiences during childhood and adolescence, whereas more than one half of the participants described the death of a grandparent as the most significant loss they had experienced in their lives to date. Students were able
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to vividly recall the emotions and cognitions experienced during their earliest and most significant encounters with death/loss. Many described intense emotions such as pain, loss, fear, peace, sadness, or confusion. In addition, four major learning themes emerged from the qualitative data: (a) grief and coping with a variety of losses; (b) universality of death, grief and loss; (c) appreciation of life and loved ones, personal growth, and connectedness; and (d) children, loss, and grief.
Theme 1: Grief and Coping with a Variety of Losses Many students (56%) indicated an understanding that loss is an everyday experience that can arise from various situations and circumstances. For example, one student explained, “When we think of loss and death, we can sometimes think it only means the death of a person. Loss can be experienced in so many different forms.” Students also learned that the categorization of loss and its impact differs based on age, perceptions, life experiences, and resources. One student directly addressed this by stating, “The most significant learning experience I took away from this would have to be that any loss, regardless of what type, can be equally devastating.” Students also acquired an understanding that everyone has unique losses that intensely affect and shape their lives. As one student remarked, “After reading each of the experiences, such as death of a family member, friend and pet as well as divorce, break up, and the rough childhoods that some of the individuals have gone through, it definitely gave me even more perspective on how varied each one of us are in our grief responses.” Students examined their own lives to see how experiences of loss that had previously been dismissed or minimized could potentially be redefined as meaningful losses. For example, one student described how she gained perspective on personal losses, “Seeing how every level of grief is different for everyone helped me gain a wide range perspective for the things that can be considered losses, which has also allowed me to identify some of my own that I have never wanted to consider as being a loss.” The lossography assignment allowed students to gain knowledge about the diversity of losses, coping strategies, and grief responses while also providing a framework for reexamining earlier losses and addressing unresolved grief.
Theme 2: Universality of Death, Grief, and Loss In a death-denying society, the universality of death, grief, and loss frequently remains unacknowledged. Through the lossography assignment, students understood that death, grief, and loss are ubiquitous, natural experiences. This realization had a significant impact on students and was one of the most commonly reported learning outcomes (65%). Overall, many
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reported seclusion in their grief, as well as more empathy toward their peers’ losses. One student described her awe of the collective losses experienced by her classmates, “What struck me the most was that there was not one person in the class who had not experienced a significant loss.” Several students reported viewing their classmates differently, with a more holistic perspective and as people with wide-ranging life experiences. The following statement made by one student was echoed by many: “Sitting in class and looking at the faces of the people in the room, I never would have imagined that every single one of them experienced a loss in some shape or form.” Most students initially felt like the only person who had experienced death or loss, until reading their classmates’ lossographies. One student expressed relief at realizing that others had also felt loss, “We all experienced some type of loss, and it wasn’t just me who kept losing my loved ones.” This recognition helped students feel more connected to one another and less isolated. Consequently, the assignment created a sense of community by requiring students to share their losses with others. Students repeatedly recognized and acknowledged the power in sharing. One student described: The biggest lesson that I have learned from reading these lossographies is the importance of sharing loss. We can learn a lot from loss and from the losses of those around us, and the more we talk about those losses and discuss what they meant to us, the more we learn about ourselves.
Overall, it appeared eye-opening for students to recognize that loss is universal. Sharing losses and realizing that loss is an everyday experience caused some students to feel more equipped to cope with future loss. One student commented, “I am not alone in the suffering of loss . . . I realize that death is inevitable and I will experience loss again, but I feel better prepared.” Students realized that everyone experiences loss and that people may also have similar grieving reactions, including feeling isolated and sad, as well as resilient. They also examined how societal expectations about avoiding death influenced the way in which they coped with loss. One student reflected specifically on isolation that can occur when coping with loss and how that might be connected to societal pressures to be happy, even when dealing with deep or traumatic loss: Many of my classmates felt the same way I did when experiencing loss; they felt alone. . . . I think it could be [that] our society thinks it is weak to be sad, [instead] you [should] pull yourself up by your bootstraps and put on a happy face.
Finally, as part of acknowledgment of the universality of death, loss, and grief, students became more aware of their own mortality. One student
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succinctly explained this by stating, “As hard as it is to say it, we will all die.” Many students accepted that an integral part of life is facing personal mortality. For example, a student noted that, “The one thing that became clear in the readings is that death is inevitable, the very act of dying is part of living and it is unavoidable.” Death and dying can inform life and living; many students made this connection when acknowledging the universality of death.
Theme 3: Appreciation of Life, Loved Ones, Personal Growth, and Connectedness Generating awareness of losses helped students to prioritize what was important in their lives and to clarify their personal values. This was also reflected in students’ relationships with others. For example, almost one half (47%) felt more compassionate and empathetic toward one another or realized that while loss can be difficult, it can also be transformative and result in more appreciation for life. One student focused on the importance of being present, “I learned that loss is hard, but that it is not the end for those still living, and so I should value every moment while I’m still alive.” Another student furthered this thought by observing how loss influenced the lives of others, “Loss can shape our lives, and being considerate of that is very important both to our personal well-being and that of the people around us.” An acknowledgment of mortality, the significance of being present, and the importance of maximizing time also accompanied the increased appreciation for life with friends and family. One student described this by stating, “We do not know when we will lose our loved ones, but we need to value the time that we have.” An appreciation for life and time spent with loved ones may have also naturally led to compassion for others. One student described how the knowledge that time is limited and that our lives are finite prompted empathy toward others, “It is so important to remember to be empathetic and kind to both strangers and loved ones, you never know what moment will be their last (or yours for that matter).” Many students were also very moved by reading about each individual’s loss. One student commented upon the vulnerability in humans dealing with loss and how this increased a sense of compassion for others: I want to give everyone a hug and thank them for sharing the stories of their lives because it has changed my perspective on the way that we should be treating others. Each one of us is fragile in our own way, and sometimes it just takes someone to understand, to be there and to listen so we can continue healing.
In line with this, another student also remarked on the subsequent compassion gained from knowing that everyone deals with loss, “From now on, I
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will definitely be more compassionate towards others in every way I can, just knowing that everyone is fighting their own battle through life, whether you know about it or not.” Lastly, another example of this theme is represented in this student’s description: I want to remember the feelings I had as I read this compilation. I believed all of us experienced loss . . . now I know it. I felt this deep desire to be more patient and kind and non-judgmental of others.
All of these experiences exemplify how the recognition of the universality of loss can lead to behavioral changes in the treatment of others. One benefit of this assignment is that it engendered a stronger sense of community among students and that this feeling may stay with them beyond the classroom setting.
Theme 4: Children, Loss, and Grief Several students (21%) specifically discussed the effect of loss and grief on children. This was likely triggered by self-reflection on losses experienced during their childhood. It was clear that these were profound experiences that still affected them as adults today. Students were especially intrigued that many of their classmates experienced loss during early childhood. One student remarked, “I was pretty surprised at the number of people in the class who experienced a loss of life before the age of five.” Approximately 65% reported that their most significant loss occurred during childhood, with the most frequently reported loss being the death of a grandparent. Reflecting back on childhood losses, students realized that being left out of grieving activities potentially hindered their coping in the present. One student recalled being left out of conversations about the death of a relative and the subsequent grieving activities: I was barely five and they assumed that I did not grasp the concept of death. In retrospect, I feel that this was possibly a poor decision, and I will resolve to not do something of this nature with my future children.
Some students acknowledged that although children may not fully understand the meaning behind social rituals and the inevitability of death and loss, leaving them out of grieving activities is nevertheless harmful, sometimes later resulting in disenfranchised grief. For example, one student observed, “As children, we watch the rituals that are associated with someone dying, but don’t fully understand them. Unfortunately, when we usually ask what is going on, we are quickly hushed and told that we will understand one day.” Consequently, several students observed that although parents sought to shelter children from death, it ultimately resulted in feelings
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of isolation and confusion about the loss. One student discussed the value of talking to children about death, “I believe by not being honest with children about death you pass up an opportunity to help them better prepare for future death and losses.” Students also noticed how the broader topic of children and death is often avoided and that the mortality of children is rarely considered. The denial that children can die leaves individuals and families unprepared for this occurrence. The lossography assignment helped students reconsider how to discuss death more openly with children and families, as well as how to model healthy coping strategies early in life to benefit effective coping in later life.
Student Learning Based on Survey Results The students rated most course activities relatively high (range: 3.7–4.8 out of 5) in helpfulness (see Table 3). Overall, the percentage of participants who rated each activity as helpful did not differ by gender, with the exception of journaling, χ 2 (3) = 9.9, p = .02, and supplemental readings, χ 2 (5) = 12.1, p = .03. Women were more likely than men to evaluate these activities as slightly more helpful. Most helpful course activity. After evaluating how much individuals course activity enhanced their learning, students responded to an openended question by identifying the single most helpful activity. Approximately 44% (n = 28) stated that the lossography assignment was most helpful. Nine additional students reported that all writing assignments, including journaling, were the most beneficial to learning. Taken together, 58% of participants endorsed writing assignments as the most useful learning activity in the course. Students expanded on their responses, by reporting a variety of explanations as to why they chose the lossography assignment as one of the most beneficial learning activities. The following two quotes represent some of these reasons: “[The lossography] helped me to clarify my own losses, which made it easier to examine how they have affected me and reading the others’ [assignments] made me realize that we are all going to experience loss in our lifetimes” and, The reason the lossographies were my most beneficial learning activity is because I got to look at my dad’s death though more mature eyes. . . . Reading everyone’s lossographies made the concept of “not feeling alone regarding grief” more concrete.
Students noted that the assignment was sometimes challenging, yet it provided them with the opportunity to explore personal losses, observe the diversity of human experiences, and apply course material to real-life situations.
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4.08
3.68
Field trip
Sharing personal lossography
Supplemental readings
Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both Women Men Both
Genderb
Note: a Course activity ratings from 5 (helped a lot) to 1 (not at all). b There were 52 women and 12 men.
4.53
4.75
Class lectures
Reading group lossography
4.75
Guest speakers
4.55
4.76
Lossography assignment
Journaling
4.80
Mean ratinga
In-class videos
Item 44 10 54 40 8 48 42 9 51 43 8 51 35 5 40 38 7 45 27 5 32 19 4 23 9 2 11
(85) (83) (84) (77) (67) (75) (81) (75) (80) (83) (67) (80) (67) (42) (63) (73) (58) (70) (52) (42) (50) (37) (33) (36) (17) (17) (17)
A lot 6 (12) 2 (17) 8 (13) 11 (21) 4 (33) 15 (23) 8 (15) 3 (25) 11 (17) 6 (12) 4 (33) 10 (16) 16 (31) 4 (33) 20 (31) 10 (19) 2 (17) 12 (19) 6 (12) 5 (42) 11 (17) 20 (38) 4 (33) 24 (38) 28 (54) 1 (
