Journal of Religion and Health, Vol. 31, No. 1, Spring 1992
R e l i g i o n as a R e s o u r c e for B e r e a v e d P a r e n t s K A T H L E E N R. G I L B E R T ABSTRACT: This paper addresses the relationship between bereavement and religious beliefs for parents. In-depth, qualitative interviews of twenty-seven couples were used to address the question of the relative value of religion as a coping resource during grief. Also addressed were ways in which religion was a positive resource (enhancing recovery), a neutral resource (having no impact), or a negative resource (retarding recovery). Conclusions are presented regarding the resource value of religion and ways in which others, primarily clergy, family, and friends, can enhance positive and minimize negative impact of religion during bereavement.
P a r e n t s who e x p e r i e n c e the d e a t h of a child are often d e v a s t a t e d and uncomp r e h e n d i n g in the w a k e of t h e i r loss. The senselessness of such a d e a t h confronts long-held beliefs 9 How could God allow such an e v e n t to t a k e place? In the e v e n t of the d e a t h of a loved one, a belief in a s u p r e m e being is c o m m o n l y t h o u g h t of as a help in resolving and recovering from the loss. Religion is seen as giving s t r e n g t h and providing a m e a n s by which the ber e a v e d m a y organize and m a k e sense of t h e i r t h o u g h t s r e g a r d i n g t h e i r loss experience. 1 This is believed to be especially t r u e w h e n t h e y begin to ask, " W h y me?" W h y should t h e i r loved one die while others, m u c h less deserving, are allowed to live? In order to explore the place of religion in the grief process of b e r e a v e d parents, this p a p e r e x a m i n e s b e r e a v e m e n t as a cognitive process involving a g r a d u a l change in perception, a "redefinition of n o r m a l . " T h r o u g h this process, the individual modifies his or h e r " a s s u m p t i v e world": 9 . . a strongly held set of assumptions about the world and the self which is confidently maintained and used as a means of recognizing, planning and acting 9 . . [this belief structure] is learned and confirmed by the experience of many years. 2 Kathleen R. Gilbert, Ph.D., is an Assistant Professor in the Department of Applied Health Science at Indiana University in Bloomington, Indiana. This is a revision of a paper presented at the Annual Meeting of the National Council on Family Relations in November 1989 in New Orleans. Address requests for reprints to the author at the Department of Applied Health Sciences, HPER 116, Indiana University, Bloomington, Ind. 47405. 19
9 1992 Institutes of Religionand Health
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It is this assumptive world t h a t allows one to organize information encountered in the environment and to anticipate and plan for future events reasonably. 3 When an event occurs t h a t does not fit the assumptive world, the result is that we confront these basic assumptions. As a core element of one's belief structure, religious beliefs must also be confronted. 4 For parents who have lost a child, then, grief is the reaction to the disintegration of that part of the assumptive world t h a t depends on the existence of the child. With the death, bereaved parents are faced with basic assumptions, basic meaning, about life that no longer makes sense. In a very real sense, the world has become meaningless and new ways of understanding their experience must be constructed. 5
The meaning of religion. Researchers have suggested t h a t religious beliefs may be among these assumptions that no longer have meaning after the loss of a significant other. ~ Therefore, these beliefs may not be available to help explain the death. 7 Parents must face the reality t h a t innocence does not protect a child; children can die before their parents, and parents are powerless to affect t h a t reality. Alternatively, a frequently cited benefit of religion is t h a t it helps us to make sense of life. Parkes has suggested that widows resolve their grief by incorporating a religious explanation into an explanation of their loss. ~ This personaP or healing theory 1~acts as a bridge, linking the assumptive world t h a t existed before the loss and the one t h a t exists afterward. It allows them to reestablish the sense of control and predictability felt prior to the event 11 and to regain a new sense of meaning. Therefore, religious beliefs may not be destroyed. Rather, they may provide a structure upon which new assumptions may be based. A contradictory image results. If, in fact, one needs "something to believe in," that is, religious beliefs, to survive the loss of a significant other, they should serve as core elements of the assumptive world. Yet a basic premise of the assault on the assumptive world suggests that the death of a child may cause such basic beliefs to be disrupted, challenged, and possibly destroyed. Thus, one may ask if religion is able to serve as a resource in times of loss. Alternatively, does the assault on the assumptive world create such a meaningless world t h a t religion also becomes meaningless? Might it then act as a hindrance in the recovery process? A hypothesis of this study was t h a t religion had served as a core belief prior to the loss of the child and would continue to do so after the loss, sustaining the respondents and providing a structure of meaning to explain the world they encounter. In considering this hypothesis, several questions come to mind: Did religion serve as a basis for explanation of the loss experience? Were they able to use religious beliefs to organize information after the death? Was it a resource, t h a t is, was it helpful to them? Did it provide comfort to them?
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On the other hand, if the assumptive world was, in fact, shattered by the loss, might the entire structure of religious beliefs, along with other core beliefs, lose meaning? Was it necessary to reconstruct their beliefs? If so, what was the character of these reconstructed beliefs? Did their view of religion and of God change following the loss? Although we thought that, in most cases, religion would have been an important part of the lives of our subjects before the loss, we suspected t h a t there undoubtedly would be some individuals for whom religion did not have a great deal of meaning. We wondered if these men and women discovered religion to be of use in making sense of their loss. Did anyone who h a d previously been nonreligious come to build a religious explanation into his or her beliefs?
Research methods and analysis The data used in this study come from a larger study on dyadic bereavement. ~ Data were collected from a volunteer, convenience sample of 56 bereaved parents (28 married couples); however, the quality of the taped interview of one couple was low enough to make their interviews unusable. The remaining 54 bereaved subjects made up a small sample by quantitative standards. On the other hand, 54 separate interviews are slightly above the size of 20 to 50 interviews recommended for a qualitative study. 13 Owing to the design of the larger study, only currently married couples who had been married at the time of their baby's death and at the time of the interview were eligible to participate. Recruitment sources included: hospital records, bereaved parent support groups, clergy members, nurses, mutual acquaintances, and self-referring couples. The age range for wives was 26 to 42 years with a mean age of 32.1; for husbands, the range was 27 to 42 with a mean of 33.6 years. All respondents were white. Couples had been married for 3 to 14 years with a mean of 8.8 years~ These 27 couples experienced a total of 42 fetal or infant losses. This was due to nine couples reporting more than one loss in pregnancy and/or infancy. Multiple-loss couples were asked to concentrate on one loss, although they were not discouraged from talking about the others. The 27 focus losses consisted of nine fetal deaths and 18 infant deaths. Of the nine deaths t h a t took place during pregnancy: three were early fetal deaths (up to the twenty-first gestational week); three were intermediate fetal deaths (21 to 28 weeks); and three were late fetal deaths (over 28 weeks). I~ For infant deaths: 12 were neonatal deaths (died during the first month after birth); 1~and six died after one month. Time since loss ranged from one month to eight years for all losses and six months to seven years for the focus losses. Median time since the focus loss was between two and three years.
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A minimally structured interview guide was used which tapped the grief experience of parents as well as various aspects of their recovery process. It was organized into the following topic areas: their own experience at the time of their child's death as well as their spouse's experience and ways in which they coped as individuals and as a couple; social support needs; recurring grief experiences; changes in their marriage following the death; and recommendations to persons coping with the death of a child, either directly or as a supporter. This naturalistic interview guide allowed participants a framework within which to describe their experiences without constraining them to specific, predetermined questions. Interviews were conducted by two research teams of two female researchers each; all had been trained in qualitative interviewing techniques. The use of female interviewers was serendipitous; both males and females were recruited, with only females expressing an interest. Although the possibility of gender bias exists, male participants did not appear to feel limited by the presence of a female interviewer. Spouses were interviewed simultaneously in separate rooms. All couples except for one, interviewed at their place of business, were interviewed in their home. Data were interpreted ideographically, that is, the emphasis was on first identifying the unique character of the individual's experience followed by the establishment of patterns across cases. For the purpose of this report, interview transcripts were read for any references to religion or religiosity. Patterns of religious phenomena and their relationship to the grief process were then developed. Based on these analyses, a pattern of three groupings developed regarding the relation between religion and bereavement: (1) a group that found religion to be helpful throughout their bereavement, (2) another group that found religion to be unhelpful, at least for a time, and (3) a final group that did not see religion as relevant to their recovery.
Religion helpful throughout Parents who' spoke of religion and their beliefs in unfailingly positive terms constituted the largest group, which was made up of 14 women and 16 men. Twenty-eight attended church; two did not.
Their view of God. These men and women spoke of finding strength through their religion, of not knowing "how anyone could get through a session like this without having some faith." The image they presented was of a God whose actions may have been difficult to understand, but who ultimately had their best interest in mind. Many spoke of a belief that bad things did not necessarily generate from God: "I feel like I have been cheated by l i f e . . , but I don't feel like God is responsible."
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These parents found comfort in their belief in a strong God who was in control and would make the best decision. In addition, their God was available for th em "to lean on." They spoke of a "relationship with God" and their belief in a "master power." P r a y e r and having such a God to t u r n to brought peace: There's no doubt in my mind . . . if we didn't know that God had it all under control, that things would have been a lot different. I think I would have had a real hard time. In addition to believing God was in control of the situation, they also spoke of God having some reason for their child's death, and their need to accept it as God's will and go on with their lives. Often, they expressed the belief t hat this plan was unknow n and, possibly, unknowable, "There's a reason. God doesn't want us to know." "There is a God. And it's an explanation t h a t th er e' s no explanation." A few parents suggested their child may have had some sort of abnormality and they had to t r us t t h a t God knew best: I accepted that God knew there was something wrong and that's why she had died. And He knew that, whatever was wrong, we couldn't handle it, between ourselves, that it was His will. Others expressed the belief t h a t they had been selected to go through this experience because "God gave it to me 'cause I could handle it more so t han most other people." A central task of developing a healing theory is asking questions. 1~ One of the most critical questions is, "Why me?" What was unique about this group is t h a t when they spoke of asking this question, it was in the context of God helping t h e m to understand why such an event could happen, not because they felt God had failed t hem or they had somehow failed God. None reported believing th ey were being punished. There were no reports of a perception of God as a r b i t r a r y or angry with them. Several members of this group also stated a belief t hat one of God's intended outcomes of the death was for t hem to appreciate their life more. They say there's reasons for God to do everything, you know. I think that's very true because I think I love him [second child, born after the death of first child] a lot more now than I would of had our first son been here. In addition to a greater appreciation of life, the loss experience contributed to a deepening of their religious beliefs. Many of these men and women spoke of delving deeper into their faith, and of finding peace in doing so. Their faith seemed to be strengthened by the loss. Many of these men and women also believed t h a t through this experience
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God was directing them somehow to change their lives for the better. The primary way in which this took place was a greater involvement in churchrelated work. One couple became active in lay ministry. The husband also began to help others, in the context of his beliefs, as a self-described "Christian psychologist." At the time of the interview, one man had decided to enter the seminary, saying: It was at that time that I really got closer to Him through prayer and that, and it was that summer after she died that I surrendered to the ministry. Others reported their involvement in helping others through the ministry. A woman became active in her church's lay ministry for the bereaved, while one couple joined a group t h a t prayed for the health and recovery of disabled children.
Symbols, rituals, and interpretations. Although all three groups made use of memorial or funeral services, this group was unique in t h a t they spoke of symbolic evidence that their child was now safe with God. One father reported seeing a butterfly at the grave service and took that as a message from his child t h a t said, "I'm with God . . . . Everything's going to be all right. You don't have to worry about anything." Another father spoke of wanting to be the last one to hold his daughter so t h a t she could be in his " . . . good strong arms till God sent His strong arms and picked her up and took her with Him." For this group, reading of the Bible, either alone or with one another, prayer, and having a spiritual knowledge of "the will of God" were helpful throughout their ordeal. As stated above, funeral or memorial services were mentioned as helpful in this regard. Depending on their religion, baptism of the baby was also viewed as an important ritual which was carried out. This ritual had further meaning for one couple when they chose to give their daughter a name that had religious significance. Several of those who found religion to be consistently helpful noted their belief in life after death. When they spoke of their picture of their child after death, they depicted images of the child with God, no longer in pain, happier than he or she would have been on earth. As one father noted, "She sees it now and she can see it all the time now, you know, beautiful things . . . . she's in a better place now than she ever would've been here." Overall, the image held by this group was one of a nurturing and caring God. There were no reports from this group of God as a punitive or judgmental entity. Rather, this was a beneficent, gentle, protective God. Religion not helpful This group was predominantly female, made up of eight women and four men. Eleven attended church; one did not.
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Their view of God. As w i t h those who found religion to be helpful, religion h a d h a d v a l u e for t h e s e m e n a n d w o m e n , at the t i m e of t h e loss and/or in t h e i r past. H o w e v e r , for this group, t h e i r i m a g e of God w a s one of a p u n i t i v e , vengeful, j u d g m e n t a l god. Indeed, the m o s t c o m m o n initial e m o t i o n t o w a r d God w a s i n t e n s e a n g e r for H i s a p p a r e n t cruelty. This was one of the m o s t difficult aspects of t h e loss for some p a r e n t s . T h e y could not conceive of how God could let this h a p p e n to t h e m . It was just very hard to be close to God, and I just kind of wanted to turn away, to be angry . . . . At the time, I felt like I wanted to be as far away from God as I could get. Do things to make Him angry, that kind of thing, because I felt He had made me angry. B e c a u s e of this a n g e r w i t h God, s t a t e m e n t s of others i n t e n d e d to be supportive w e r e seen as i n s e n s i t i v e a n d u n c a r i n g . T h e g e n e r a l sense w a s one of t h e s e p a r e n t s saying, " P r o v e it to m e " to others. As one m o t h e r said, "I w o u l d n ' t t a l k . T h e a n g e r w a s u n r e a l . I w a s r e a d y to fight a n y b o d y . " M a n y of the s a m e ideas t h a t the first group found helpful a n g e r e d t h e s e p a r e n t s as the following q u o t a t i o n s indicate: A f t e r h e r t h i r d p r e g n a n c y loss, a w o m a n w a s visited b y a p r i e s t who att e m p t e d to comfort h e r by t a l k i n g a b o u t h e r d a u g h t e r in h e a v e n . [The priest] told me I should be delighted that I had an angel in heaven . . . . He was worse than nothing, the man was a jackass. For a n o t h e r w o m a n , it w a s t h e h o s p i t a l c h a p l a i n whose c o m m e n t s she found to be m o s t a n g e r i n g . I had a preacher come in when [my son] was dying and, oh, you would've thought! I cussed this guy, you know, because he said, "We don't always understand but I, you know, maybe with something you appreciate things more," or something. I can't remember what he said. And I, oh, 1 just went nuts on this guy! And I said, "Let me take you through there and show you these babies with their arms off and their guts hanging off, and if this is supposed to make me appreciate my arms more, you know, if God sent this baby here, I think He's crummy!" . . . I don't believe that God would send a child here to make you appreciate things more. A t h i r d w o m a n spoke of h e r f r u s t r a t i o n w i t h people who told h e r it was "for the b e s t " t h a t h e r b a b y h a d died. Really, would you like to tell me why, what's the best about it? It's for the best and someday you'll know what God's plan was for you and there's a reason for all this. Oh, really! There's no reason for this stuff. You can't tell me there's a reason~
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A majority of parents who did not find religion to be helpful reported that their first contact with the ministry was a negative one. Usually, the minister or priest made insensitive statements like those given above. In other cases, they felt abandoned because no one was willing to speak with them after the death. As with the first group, persons in this group also asked, "Why me?" In their case, however, they felt they had failed and were now being punished. "I thought I had f a i l e d . . , that it was my fault . . . . I also thought, why am I being punished?" Possibly as a result of this sense of failure, this was the only group in which anyone mentioned suicide or expressed a desire to die following a child's death. In both cases, these were women. In one case, a woman spoke of wanting to die in order to be with her daughter. In the other case, the mother considered ending her own life and went through a period of visiting her son's grave at odd hours, once visiting at midnight.
Symbols, rituals, and interpretation. In each religion, certain rituals are carried out that have great meaning. Members of this group spoke of lost opportunities for such rituals. In one case, one father continues to regret his not having had his stillborn daughter baptized. In another case, a minister refused to conduct a memorial service for a baby who was an early fetal loss. As with the first group, these parents had an image of their child after death. For them, however, this was less spiritual, and more of a physical form, in which they saw the child growing up, needing to be taken care of. Because of this interpretation of the afterlife as having a physical form, these individiuals worried about who would be taking care of their child while they, the parents, were still alive~ In addition, they expressed concern about their future ability to provide care to their child following their own death. A change in their view. Over time, their perception of God and their relationship with that image changed. Possibly because they had found religion to be helpful in the past, members of this group found it difficult to remain angry. They began to modify their interpretations of God in relation to the death. For some members, this began very shortly after the death. Although their primary emotion was anger, several spoke of conflicted feelings about God. Indeed, some indicated that this struggle had begun immediately after the death. One man who spoke of moments of intense anger toward God also said, "There was other times that I, you know, felt like, if it wasn't for Him, I couldn't get through it." For others, it was necessary to have a more dramatic return to their faith. Some members of the group were able to identify a specific crisis or turning point when they abandoned their anger with God. For one woman it was when she developed cancer:
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I realized that I had to change my attitude towards life, that I had to forgive myself, forgive [my husband] and praise God that we were all still alive . . . . And I think I turned to God then, too. For others, the change was less t r a u m a t i c but no less noticeable to them. One w o m a n found t h a t , after speaking to a church group about her loss, h e r a n g e r at God was lessened. A n o t h e r w o m a n found her a n g e r at God grew less strong after she spoke to a co-worker whose child had died in a fire: He said, "Who do you blame?" And I said, "Well, I blame God and He caused it to happen." And he made me realize that it wasn't God's fault. Overall, as p a r e n t s in this group b e g a n to lose t h e i r a n g e r t o w a r d God, t h e i r t h o u g h t s b e g a n to c h a n g e as well. In this, t h e i r view b e c a m e more like the group who h a d found religion to be helpful t h r o u g h o u t . God was seen as less p u n i t i v e and more n u r t u r i n g . Bad things were seen to g e n e r a t e from some o t h e r source t h a n God. As one m o t h e r who had gone t h r o u g h a period of intense a n g e r said, " . . . t h i n g s j u s t h a p p e n and t h e n t h e r e ' s not all these little reasons w h y t h i n g s h a p p e n . . , you're h u m a n . Things j u s t happen."
R e l i g i o n not relevant
For this group of five w o m e n and seven men, religion had not been a significant p a r t of t h e i r a s s u m p t i v e world prior to t h e i r child's death, a p a t t e r n t h a t c o n t i n u e d following the death. Only t h r e e a t t e n d e d church; the r e m a i n i n g nine did not. Those who a t t e n d e d c h u r c h appeared to do so more for the social support received t h a n the belief structure. As one w o m a n in this group said about her h u s b a n d and herself: I don't think either one of us considers ourselves terribly religious, so that wasn't something I would fall back on. It wasn't something I would count as something that would help at that time. But, then, even before it wasn't. "Helpful" c o m m e n t s from others based on religious beliefs f r u s t r a t e d and i r r i t a t e d these parents. Possibly because these t h o u g h t s are so alien to t h e initial a s s u m p t i v e world of these parents, t h e y did not help in the w o r k i n g t h r o u g h of emotions. I got "It's God's will" . . . and I finally laid into one person and I said, "What possible good could come from making my wife so sick and killing my child?" And they said, "Well, you don't always understand the plan." And I said, "I'm sorry, but there is no ultimate plan to justify this," and [I said,] "Hitler had a plan." I just remember feeling that frustration . . . . Some people, meaning well but
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doing the typical thing of coming up and telling me that it was God's will and all that stuff and I didn't want to hear it at the time. Possibly because a majority of their support network, especially their family, believed that religion provides comfort, parents who found religion to be irrelevant to their recovery were doubly frustrated by the inability of supporters to accept this. Instead, most of these persons found greater comfort in their relationship with each other and in gaining knowledge about what they could expect in the grief process. In addition, medical information, especially about future pregnancies, was greatly appreciated. View of clergy. These parents saw clergy more in the context of "clergy as social worker," particularly during the time immediately surrounding the death. They spoke positively of hospital chaplains who put aside religious considerations and took care of paperwork, gathered information, and provided emotional and psychological support. The same theme carried on for those who continued to have contact with the clergy after the wife had left the hospital. A father in this group spoke of how helpful the minister he spoke with had been: "Didn't bring in a lot of the heavier religious connotations. Just talked about human emotions and reactions, and that was very helpful to me." Although these individuals did not hold strong religious beliefs, some of them were married to others who did. Of the twelve, three were married to someone who had found religion to be helpful throughout, and three were married to someone who had found religion to be unhelpful for at least a period of time. Also, as indicated above, three of these parents attended church, even though it did not provide a source of spiritual support to them. Thus, a majority of these men and women had some exposure to the clergy. In addition, a majority of them elected to have some sort of church-based memorial service, regardless of their own beliefs. These results suggest that clergy members are well advised not to assume that, simply because someone is participating in religious observances, that person holds the beliefs of that particular denomination.
Conclusions It would appear that neither view of religion, either as a basic assumption destroyed by the loss, or as a positive resource for bereaved parents, fits all cases. Thus, when interacting with bereaved Parents after the death of a child, one cannot safely assume that they will consistently respond in either way. For those who fit the commonly held image of religion as a source of support throughout the ordeal, basic assumptions center around the image of a
Kathleen R. Gilbert
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kind and loving God who is in control and has reasons for doing what He has done. Their God has not punished them for their behavior. Rather, He wants them to appreciate what they have. Finally, they grow to have a greater appreciation of their religion and became more involved. This group may be the easiest to interact with after their child's death, as their assumptive world most clearly dovetails with a religious explanation that brings comfort at this time. The group that seemed most negatively affected were those who went through a time when they did not find religion to be helpful. For them, basic assumptions were disrupted. Clearly, the most central factor in this was their belief in a ~udgmental god who punished evil and rewarded good. When they reconstructed their meaning structure to incorporate a kind, beneficent God, it became possible for them to heal and to retain a belief in a personal God. It is important to note that they reconstructed their beliefs to be more in line with those of the parents who found religion to be helpful throughout. Although it was not possible to determine within the constraints of this study, it may be that these changes were bounded, that is, restricted to the specific situation and not generalized to others. It may be that these individuals retained the image of a judgmental god in the context of other situations and for other persons. For those parents who did not hold a belief in God to be a basic assumption before the death, this continued to be the case. Thus, it would seem that it is possible for some parents to lose a child and recover from the loss without such a belief. It appears from these data that it is important for both formal and informal support networks to remain sensitive to the variability in the meaning of God and religion to parents who have lost a child. Reaction to the loss varies widely. As a result, the response of supporters to the parents must vary. This is particularly critical for the clergy. As they are seen as the emissaries of the church, they must be particularly sensitive to the needs of the parents. If individuals are angry with God, they will likely express that anger to the clergy member. Rather than confront this anger, and possibly alienate the bereaved parent, the best course may be to help the parents to explore their emotions. Clergy and others who interact with parents at this time should be sensitive to their own discomfort at having their basic assumptions questioned. They need to be aware of their own belief structure and of the possibility that they may attempt to force these onto bereaved parents. Based on the findings with these parents, such an action is counterproductive, creating frustration and anger for all parties. The parents have lost the child, and it is the responsibility of the support network to adapt to the beliefs of the bereaved parents and to help them to work through their emotions. Although simplistic, the best advice for supporters is this: ask bereaved parents what they want. They may want someone to pray with them. They
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may not find religion to be helpfu] or relevant; and if this is the case, they will not benefit from pressure to pray. They may, however, profit from someone being available for other needs. Underlying all else, regardless of their view of religion, is their need to have someone listen to them and help them to develop their healing theory so that they may integrate the loss into their assumptive world.
References 1. Berger, P. L., The Sacred Canopy. Garden City, N.Y., Doubleday, 1969; Spilka, B.; Hood, R. W., Jr.; and Gorsuch, R. L., The Psychology of Religion: An Empirical Approach. Englewood Cliffs, N.J., Prentice-Hall, 1983. 2. Parkes, C. M., "What Becomes of Redundant World Models? A Contribution to the Study of Adaptation to Change," British J. Medical Psychology, 1975, 48, 131-137. 3. Ibid.; Janoff-Bulman, R., "The Aftermath of Victimization: Rebuilding Shattered Assumptions." In Figley, C. R., ed., Trauma and Its Wake: The Study and Treatment of Post-traumatic Stress Disorder. New York, Brunner/Mazel, 1985; Gilbert, K., and Smart, L., Coping with Infant or Fetal Loss: The Couple% Healing Process. New York, Brunner/Mazel, in press. 4. Marris, P., "Attachment and Society." In Parkes, C. M., and Stevenson-Hinde, J., eds., The Place of Attachment in Human Behavior. New York, Basic Books, 1982. 5. Parkes, C. M., Bereavement: Studies of Grief in Adult Life. London, Tavistock Pub., 1982. 6. Marris, op. cir.; Parkes, op. cit.; Taylor, S. E., "Adjustment to Threatening Events: A Theory of Cognitive Adaptation." Amer. Psychologist, 1983, 1161-1173. 7. Marris, o19. cit. 8. Parkes, op. cit. 9. Taylor, op. cit. 10. Figley, C. R., "Catastrophes: An Overview of Family Reactions." In Figley, C. R., and McCubbin, H. I., eds., Stress and the Family: Volume H. Coping with Catastrophe. New York, Brunner/Mazel, 1983. 11. Taylor, op. cit. 12. Gilbert and Smart, op. cit~ 13. Lofland, J., and Lofland, L. H., Analyzing Social Settings: A Guide to Qualitative Observation and Analysis (2nd ed.). Belmont, Calif., Wadsworth, 1984. 14. Dorland's Illustrated Medical Dictionary (26th ed.). Philadelphia, W. B. Saunders Co, 1983. 15. Ibid. 16. Figley, op. cit.
R e l i g i o n as a R e s o u r c e for B e r e a v e d P a r e n t s K A T H L E E N R. G I L B E R T ABSTRACT: This paper addresses the relationship between bereavement and religious beliefs for parents. In-depth, qualitative interviews of twenty-seven couples were used to address the question of the relative value of religion as a coping resource during grief. Also addressed were ways in which religion was a positive resource (enhancing recovery), a neutral resource (having no impact), or a negative resource (retarding recovery). Conclusions are presented regarding the resource value of religion and ways in which others, primarily clergy, family, and friends, can enhance positive and minimize negative impact of religion during bereavement.
P a r e n t s who e x p e r i e n c e the d e a t h of a child are often d e v a s t a t e d and uncomp r e h e n d i n g in the w a k e of t h e i r loss. The senselessness of such a d e a t h confronts long-held beliefs 9 How could God allow such an e v e n t to t a k e place? In the e v e n t of the d e a t h of a loved one, a belief in a s u p r e m e being is c o m m o n l y t h o u g h t of as a help in resolving and recovering from the loss. Religion is seen as giving s t r e n g t h and providing a m e a n s by which the ber e a v e d m a y organize and m a k e sense of t h e i r t h o u g h t s r e g a r d i n g t h e i r loss experience. 1 This is believed to be especially t r u e w h e n t h e y begin to ask, " W h y me?" W h y should t h e i r loved one die while others, m u c h less deserving, are allowed to live? In order to explore the place of religion in the grief process of b e r e a v e d parents, this p a p e r e x a m i n e s b e r e a v e m e n t as a cognitive process involving a g r a d u a l change in perception, a "redefinition of n o r m a l . " T h r o u g h this process, the individual modifies his or h e r " a s s u m p t i v e world": 9 . . a strongly held set of assumptions about the world and the self which is confidently maintained and used as a means of recognizing, planning and acting 9 . . [this belief structure] is learned and confirmed by the experience of many years. 2 Kathleen R. Gilbert, Ph.D., is an Assistant Professor in the Department of Applied Health Science at Indiana University in Bloomington, Indiana. This is a revision of a paper presented at the Annual Meeting of the National Council on Family Relations in November 1989 in New Orleans. Address requests for reprints to the author at the Department of Applied Health Sciences, HPER 116, Indiana University, Bloomington, Ind. 47405. 19
9 1992 Institutes of Religionand Health
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Journal of Religion and Health
It is this assumptive world t h a t allows one to organize information encountered in the environment and to anticipate and plan for future events reasonably. 3 When an event occurs t h a t does not fit the assumptive world, the result is that we confront these basic assumptions. As a core element of one's belief structure, religious beliefs must also be confronted. 4 For parents who have lost a child, then, grief is the reaction to the disintegration of that part of the assumptive world t h a t depends on the existence of the child. With the death, bereaved parents are faced with basic assumptions, basic meaning, about life that no longer makes sense. In a very real sense, the world has become meaningless and new ways of understanding their experience must be constructed. 5
The meaning of religion. Researchers have suggested t h a t religious beliefs may be among these assumptions that no longer have meaning after the loss of a significant other. ~ Therefore, these beliefs may not be available to help explain the death. 7 Parents must face the reality t h a t innocence does not protect a child; children can die before their parents, and parents are powerless to affect t h a t reality. Alternatively, a frequently cited benefit of religion is t h a t it helps us to make sense of life. Parkes has suggested that widows resolve their grief by incorporating a religious explanation into an explanation of their loss. ~ This personaP or healing theory 1~acts as a bridge, linking the assumptive world t h a t existed before the loss and the one t h a t exists afterward. It allows them to reestablish the sense of control and predictability felt prior to the event 11 and to regain a new sense of meaning. Therefore, religious beliefs may not be destroyed. Rather, they may provide a structure upon which new assumptions may be based. A contradictory image results. If, in fact, one needs "something to believe in," that is, religious beliefs, to survive the loss of a significant other, they should serve as core elements of the assumptive world. Yet a basic premise of the assault on the assumptive world suggests that the death of a child may cause such basic beliefs to be disrupted, challenged, and possibly destroyed. Thus, one may ask if religion is able to serve as a resource in times of loss. Alternatively, does the assault on the assumptive world create such a meaningless world t h a t religion also becomes meaningless? Might it then act as a hindrance in the recovery process? A hypothesis of this study was t h a t religion had served as a core belief prior to the loss of the child and would continue to do so after the loss, sustaining the respondents and providing a structure of meaning to explain the world they encounter. In considering this hypothesis, several questions come to mind: Did religion serve as a basis for explanation of the loss experience? Were they able to use religious beliefs to organize information after the death? Was it a resource, t h a t is, was it helpful to them? Did it provide comfort to them?
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On the other hand, if the assumptive world was, in fact, shattered by the loss, might the entire structure of religious beliefs, along with other core beliefs, lose meaning? Was it necessary to reconstruct their beliefs? If so, what was the character of these reconstructed beliefs? Did their view of religion and of God change following the loss? Although we thought that, in most cases, religion would have been an important part of the lives of our subjects before the loss, we suspected t h a t there undoubtedly would be some individuals for whom religion did not have a great deal of meaning. We wondered if these men and women discovered religion to be of use in making sense of their loss. Did anyone who h a d previously been nonreligious come to build a religious explanation into his or her beliefs?
Research methods and analysis The data used in this study come from a larger study on dyadic bereavement. ~ Data were collected from a volunteer, convenience sample of 56 bereaved parents (28 married couples); however, the quality of the taped interview of one couple was low enough to make their interviews unusable. The remaining 54 bereaved subjects made up a small sample by quantitative standards. On the other hand, 54 separate interviews are slightly above the size of 20 to 50 interviews recommended for a qualitative study. 13 Owing to the design of the larger study, only currently married couples who had been married at the time of their baby's death and at the time of the interview were eligible to participate. Recruitment sources included: hospital records, bereaved parent support groups, clergy members, nurses, mutual acquaintances, and self-referring couples. The age range for wives was 26 to 42 years with a mean age of 32.1; for husbands, the range was 27 to 42 with a mean of 33.6 years. All respondents were white. Couples had been married for 3 to 14 years with a mean of 8.8 years~ These 27 couples experienced a total of 42 fetal or infant losses. This was due to nine couples reporting more than one loss in pregnancy and/or infancy. Multiple-loss couples were asked to concentrate on one loss, although they were not discouraged from talking about the others. The 27 focus losses consisted of nine fetal deaths and 18 infant deaths. Of the nine deaths t h a t took place during pregnancy: three were early fetal deaths (up to the twenty-first gestational week); three were intermediate fetal deaths (21 to 28 weeks); and three were late fetal deaths (over 28 weeks). I~ For infant deaths: 12 were neonatal deaths (died during the first month after birth); 1~and six died after one month. Time since loss ranged from one month to eight years for all losses and six months to seven years for the focus losses. Median time since the focus loss was between two and three years.
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Journal of Religion and Health
A minimally structured interview guide was used which tapped the grief experience of parents as well as various aspects of their recovery process. It was organized into the following topic areas: their own experience at the time of their child's death as well as their spouse's experience and ways in which they coped as individuals and as a couple; social support needs; recurring grief experiences; changes in their marriage following the death; and recommendations to persons coping with the death of a child, either directly or as a supporter. This naturalistic interview guide allowed participants a framework within which to describe their experiences without constraining them to specific, predetermined questions. Interviews were conducted by two research teams of two female researchers each; all had been trained in qualitative interviewing techniques. The use of female interviewers was serendipitous; both males and females were recruited, with only females expressing an interest. Although the possibility of gender bias exists, male participants did not appear to feel limited by the presence of a female interviewer. Spouses were interviewed simultaneously in separate rooms. All couples except for one, interviewed at their place of business, were interviewed in their home. Data were interpreted ideographically, that is, the emphasis was on first identifying the unique character of the individual's experience followed by the establishment of patterns across cases. For the purpose of this report, interview transcripts were read for any references to religion or religiosity. Patterns of religious phenomena and their relationship to the grief process were then developed. Based on these analyses, a pattern of three groupings developed regarding the relation between religion and bereavement: (1) a group that found religion to be helpful throughout their bereavement, (2) another group that found religion to be unhelpful, at least for a time, and (3) a final group that did not see religion as relevant to their recovery.
Religion helpful throughout Parents who' spoke of religion and their beliefs in unfailingly positive terms constituted the largest group, which was made up of 14 women and 16 men. Twenty-eight attended church; two did not.
Their view of God. These men and women spoke of finding strength through their religion, of not knowing "how anyone could get through a session like this without having some faith." The image they presented was of a God whose actions may have been difficult to understand, but who ultimately had their best interest in mind. Many spoke of a belief that bad things did not necessarily generate from God: "I feel like I have been cheated by l i f e . . , but I don't feel like God is responsible."
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These parents found comfort in their belief in a strong God who was in control and would make the best decision. In addition, their God was available for th em "to lean on." They spoke of a "relationship with God" and their belief in a "master power." P r a y e r and having such a God to t u r n to brought peace: There's no doubt in my mind . . . if we didn't know that God had it all under control, that things would have been a lot different. I think I would have had a real hard time. In addition to believing God was in control of the situation, they also spoke of God having some reason for their child's death, and their need to accept it as God's will and go on with their lives. Often, they expressed the belief t hat this plan was unknow n and, possibly, unknowable, "There's a reason. God doesn't want us to know." "There is a God. And it's an explanation t h a t th er e' s no explanation." A few parents suggested their child may have had some sort of abnormality and they had to t r us t t h a t God knew best: I accepted that God knew there was something wrong and that's why she had died. And He knew that, whatever was wrong, we couldn't handle it, between ourselves, that it was His will. Others expressed the belief t h a t they had been selected to go through this experience because "God gave it to me 'cause I could handle it more so t han most other people." A central task of developing a healing theory is asking questions. 1~ One of the most critical questions is, "Why me?" What was unique about this group is t h a t when they spoke of asking this question, it was in the context of God helping t h e m to understand why such an event could happen, not because they felt God had failed t hem or they had somehow failed God. None reported believing th ey were being punished. There were no reports of a perception of God as a r b i t r a r y or angry with them. Several members of this group also stated a belief t hat one of God's intended outcomes of the death was for t hem to appreciate their life more. They say there's reasons for God to do everything, you know. I think that's very true because I think I love him [second child, born after the death of first child] a lot more now than I would of had our first son been here. In addition to a greater appreciation of life, the loss experience contributed to a deepening of their religious beliefs. Many of these men and women spoke of delving deeper into their faith, and of finding peace in doing so. Their faith seemed to be strengthened by the loss. Many of these men and women also believed t h a t through this experience
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Journal of Religion and Health
God was directing them somehow to change their lives for the better. The primary way in which this took place was a greater involvement in churchrelated work. One couple became active in lay ministry. The husband also began to help others, in the context of his beliefs, as a self-described "Christian psychologist." At the time of the interview, one man had decided to enter the seminary, saying: It was at that time that I really got closer to Him through prayer and that, and it was that summer after she died that I surrendered to the ministry. Others reported their involvement in helping others through the ministry. A woman became active in her church's lay ministry for the bereaved, while one couple joined a group t h a t prayed for the health and recovery of disabled children.
Symbols, rituals, and interpretations. Although all three groups made use of memorial or funeral services, this group was unique in t h a t they spoke of symbolic evidence that their child was now safe with God. One father reported seeing a butterfly at the grave service and took that as a message from his child t h a t said, "I'm with God . . . . Everything's going to be all right. You don't have to worry about anything." Another father spoke of wanting to be the last one to hold his daughter so t h a t she could be in his " . . . good strong arms till God sent His strong arms and picked her up and took her with Him." For this group, reading of the Bible, either alone or with one another, prayer, and having a spiritual knowledge of "the will of God" were helpful throughout their ordeal. As stated above, funeral or memorial services were mentioned as helpful in this regard. Depending on their religion, baptism of the baby was also viewed as an important ritual which was carried out. This ritual had further meaning for one couple when they chose to give their daughter a name that had religious significance. Several of those who found religion to be consistently helpful noted their belief in life after death. When they spoke of their picture of their child after death, they depicted images of the child with God, no longer in pain, happier than he or she would have been on earth. As one father noted, "She sees it now and she can see it all the time now, you know, beautiful things . . . . she's in a better place now than she ever would've been here." Overall, the image held by this group was one of a nurturing and caring God. There were no reports from this group of God as a punitive or judgmental entity. Rather, this was a beneficent, gentle, protective God. Religion not helpful This group was predominantly female, made up of eight women and four men. Eleven attended church; one did not.
Kathleen R. Gilbert
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Their view of God. As w i t h those who found religion to be helpful, religion h a d h a d v a l u e for t h e s e m e n a n d w o m e n , at the t i m e of t h e loss and/or in t h e i r past. H o w e v e r , for this group, t h e i r i m a g e of God w a s one of a p u n i t i v e , vengeful, j u d g m e n t a l god. Indeed, the m o s t c o m m o n initial e m o t i o n t o w a r d God w a s i n t e n s e a n g e r for H i s a p p a r e n t cruelty. This was one of the m o s t difficult aspects of t h e loss for some p a r e n t s . T h e y could not conceive of how God could let this h a p p e n to t h e m . It was just very hard to be close to God, and I just kind of wanted to turn away, to be angry . . . . At the time, I felt like I wanted to be as far away from God as I could get. Do things to make Him angry, that kind of thing, because I felt He had made me angry. B e c a u s e of this a n g e r w i t h God, s t a t e m e n t s of others i n t e n d e d to be supportive w e r e seen as i n s e n s i t i v e a n d u n c a r i n g . T h e g e n e r a l sense w a s one of t h e s e p a r e n t s saying, " P r o v e it to m e " to others. As one m o t h e r said, "I w o u l d n ' t t a l k . T h e a n g e r w a s u n r e a l . I w a s r e a d y to fight a n y b o d y . " M a n y of the s a m e ideas t h a t the first group found helpful a n g e r e d t h e s e p a r e n t s as the following q u o t a t i o n s indicate: A f t e r h e r t h i r d p r e g n a n c y loss, a w o m a n w a s visited b y a p r i e s t who att e m p t e d to comfort h e r by t a l k i n g a b o u t h e r d a u g h t e r in h e a v e n . [The priest] told me I should be delighted that I had an angel in heaven . . . . He was worse than nothing, the man was a jackass. For a n o t h e r w o m a n , it w a s t h e h o s p i t a l c h a p l a i n whose c o m m e n t s she found to be m o s t a n g e r i n g . I had a preacher come in when [my son] was dying and, oh, you would've thought! I cussed this guy, you know, because he said, "We don't always understand but I, you know, maybe with something you appreciate things more," or something. I can't remember what he said. And I, oh, 1 just went nuts on this guy! And I said, "Let me take you through there and show you these babies with their arms off and their guts hanging off, and if this is supposed to make me appreciate my arms more, you know, if God sent this baby here, I think He's crummy!" . . . I don't believe that God would send a child here to make you appreciate things more. A t h i r d w o m a n spoke of h e r f r u s t r a t i o n w i t h people who told h e r it was "for the b e s t " t h a t h e r b a b y h a d died. Really, would you like to tell me why, what's the best about it? It's for the best and someday you'll know what God's plan was for you and there's a reason for all this. Oh, really! There's no reason for this stuff. You can't tell me there's a reason~
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Journal of Religion and Health
A majority of parents who did not find religion to be helpful reported that their first contact with the ministry was a negative one. Usually, the minister or priest made insensitive statements like those given above. In other cases, they felt abandoned because no one was willing to speak with them after the death. As with the first group, persons in this group also asked, "Why me?" In their case, however, they felt they had failed and were now being punished. "I thought I had f a i l e d . . , that it was my fault . . . . I also thought, why am I being punished?" Possibly as a result of this sense of failure, this was the only group in which anyone mentioned suicide or expressed a desire to die following a child's death. In both cases, these were women. In one case, a woman spoke of wanting to die in order to be with her daughter. In the other case, the mother considered ending her own life and went through a period of visiting her son's grave at odd hours, once visiting at midnight.
Symbols, rituals, and interpretation. In each religion, certain rituals are carried out that have great meaning. Members of this group spoke of lost opportunities for such rituals. In one case, one father continues to regret his not having had his stillborn daughter baptized. In another case, a minister refused to conduct a memorial service for a baby who was an early fetal loss. As with the first group, these parents had an image of their child after death. For them, however, this was less spiritual, and more of a physical form, in which they saw the child growing up, needing to be taken care of. Because of this interpretation of the afterlife as having a physical form, these individiuals worried about who would be taking care of their child while they, the parents, were still alive~ In addition, they expressed concern about their future ability to provide care to their child following their own death. A change in their view. Over time, their perception of God and their relationship with that image changed. Possibly because they had found religion to be helpful in the past, members of this group found it difficult to remain angry. They began to modify their interpretations of God in relation to the death. For some members, this began very shortly after the death. Although their primary emotion was anger, several spoke of conflicted feelings about God. Indeed, some indicated that this struggle had begun immediately after the death. One man who spoke of moments of intense anger toward God also said, "There was other times that I, you know, felt like, if it wasn't for Him, I couldn't get through it." For others, it was necessary to have a more dramatic return to their faith. Some members of the group were able to identify a specific crisis or turning point when they abandoned their anger with God. For one woman it was when she developed cancer:
Kathleen R. Gilbert
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I realized that I had to change my attitude towards life, that I had to forgive myself, forgive [my husband] and praise God that we were all still alive . . . . And I think I turned to God then, too. For others, the change was less t r a u m a t i c but no less noticeable to them. One w o m a n found t h a t , after speaking to a church group about her loss, h e r a n g e r at God was lessened. A n o t h e r w o m a n found her a n g e r at God grew less strong after she spoke to a co-worker whose child had died in a fire: He said, "Who do you blame?" And I said, "Well, I blame God and He caused it to happen." And he made me realize that it wasn't God's fault. Overall, as p a r e n t s in this group b e g a n to lose t h e i r a n g e r t o w a r d God, t h e i r t h o u g h t s b e g a n to c h a n g e as well. In this, t h e i r view b e c a m e more like the group who h a d found religion to be helpful t h r o u g h o u t . God was seen as less p u n i t i v e and more n u r t u r i n g . Bad things were seen to g e n e r a t e from some o t h e r source t h a n God. As one m o t h e r who had gone t h r o u g h a period of intense a n g e r said, " . . . t h i n g s j u s t h a p p e n and t h e n t h e r e ' s not all these little reasons w h y t h i n g s h a p p e n . . , you're h u m a n . Things j u s t happen."
R e l i g i o n not relevant
For this group of five w o m e n and seven men, religion had not been a significant p a r t of t h e i r a s s u m p t i v e world prior to t h e i r child's death, a p a t t e r n t h a t c o n t i n u e d following the death. Only t h r e e a t t e n d e d church; the r e m a i n i n g nine did not. Those who a t t e n d e d c h u r c h appeared to do so more for the social support received t h a n the belief structure. As one w o m a n in this group said about her h u s b a n d and herself: I don't think either one of us considers ourselves terribly religious, so that wasn't something I would fall back on. It wasn't something I would count as something that would help at that time. But, then, even before it wasn't. "Helpful" c o m m e n t s from others based on religious beliefs f r u s t r a t e d and i r r i t a t e d these parents. Possibly because these t h o u g h t s are so alien to t h e initial a s s u m p t i v e world of these parents, t h e y did not help in the w o r k i n g t h r o u g h of emotions. I got "It's God's will" . . . and I finally laid into one person and I said, "What possible good could come from making my wife so sick and killing my child?" And they said, "Well, you don't always understand the plan." And I said, "I'm sorry, but there is no ultimate plan to justify this," and [I said,] "Hitler had a plan." I just remember feeling that frustration . . . . Some people, meaning well but
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Journal of Religion and Health
doing the typical thing of coming up and telling me that it was God's will and all that stuff and I didn't want to hear it at the time. Possibly because a majority of their support network, especially their family, believed that religion provides comfort, parents who found religion to be irrelevant to their recovery were doubly frustrated by the inability of supporters to accept this. Instead, most of these persons found greater comfort in their relationship with each other and in gaining knowledge about what they could expect in the grief process. In addition, medical information, especially about future pregnancies, was greatly appreciated. View of clergy. These parents saw clergy more in the context of "clergy as social worker," particularly during the time immediately surrounding the death. They spoke positively of hospital chaplains who put aside religious considerations and took care of paperwork, gathered information, and provided emotional and psychological support. The same theme carried on for those who continued to have contact with the clergy after the wife had left the hospital. A father in this group spoke of how helpful the minister he spoke with had been: "Didn't bring in a lot of the heavier religious connotations. Just talked about human emotions and reactions, and that was very helpful to me." Although these individuals did not hold strong religious beliefs, some of them were married to others who did. Of the twelve, three were married to someone who had found religion to be helpful throughout, and three were married to someone who had found religion to be unhelpful for at least a period of time. Also, as indicated above, three of these parents attended church, even though it did not provide a source of spiritual support to them. Thus, a majority of these men and women had some exposure to the clergy. In addition, a majority of them elected to have some sort of church-based memorial service, regardless of their own beliefs. These results suggest that clergy members are well advised not to assume that, simply because someone is participating in religious observances, that person holds the beliefs of that particular denomination.
Conclusions It would appear that neither view of religion, either as a basic assumption destroyed by the loss, or as a positive resource for bereaved parents, fits all cases. Thus, when interacting with bereaved Parents after the death of a child, one cannot safely assume that they will consistently respond in either way. For those who fit the commonly held image of religion as a source of support throughout the ordeal, basic assumptions center around the image of a
Kathleen R. Gilbert
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kind and loving God who is in control and has reasons for doing what He has done. Their God has not punished them for their behavior. Rather, He wants them to appreciate what they have. Finally, they grow to have a greater appreciation of their religion and became more involved. This group may be the easiest to interact with after their child's death, as their assumptive world most clearly dovetails with a religious explanation that brings comfort at this time. The group that seemed most negatively affected were those who went through a time when they did not find religion to be helpful. For them, basic assumptions were disrupted. Clearly, the most central factor in this was their belief in a ~udgmental god who punished evil and rewarded good. When they reconstructed their meaning structure to incorporate a kind, beneficent God, it became possible for them to heal and to retain a belief in a personal God. It is important to note that they reconstructed their beliefs to be more in line with those of the parents who found religion to be helpful throughout. Although it was not possible to determine within the constraints of this study, it may be that these changes were bounded, that is, restricted to the specific situation and not generalized to others. It may be that these individuals retained the image of a judgmental god in the context of other situations and for other persons. For those parents who did not hold a belief in God to be a basic assumption before the death, this continued to be the case. Thus, it would seem that it is possible for some parents to lose a child and recover from the loss without such a belief. It appears from these data that it is important for both formal and informal support networks to remain sensitive to the variability in the meaning of God and religion to parents who have lost a child. Reaction to the loss varies widely. As a result, the response of supporters to the parents must vary. This is particularly critical for the clergy. As they are seen as the emissaries of the church, they must be particularly sensitive to the needs of the parents. If individuals are angry with God, they will likely express that anger to the clergy member. Rather than confront this anger, and possibly alienate the bereaved parent, the best course may be to help the parents to explore their emotions. Clergy and others who interact with parents at this time should be sensitive to their own discomfort at having their basic assumptions questioned. They need to be aware of their own belief structure and of the possibility that they may attempt to force these onto bereaved parents. Based on the findings with these parents, such an action is counterproductive, creating frustration and anger for all parties. The parents have lost the child, and it is the responsibility of the support network to adapt to the beliefs of the bereaved parents and to help them to work through their emotions. Although simplistic, the best advice for supporters is this: ask bereaved parents what they want. They may want someone to pray with them. They
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Journal of Religion and Health
may not find religion to be helpfu] or relevant; and if this is the case, they will not benefit from pressure to pray. They may, however, profit from someone being available for other needs. Underlying all else, regardless of their view of religion, is their need to have someone listen to them and help them to develop their healing theory so that they may integrate the loss into their assumptive world.
References 1. Berger, P. L., The Sacred Canopy. Garden City, N.Y., Doubleday, 1969; Spilka, B.; Hood, R. W., Jr.; and Gorsuch, R. L., The Psychology of Religion: An Empirical Approach. Englewood Cliffs, N.J., Prentice-Hall, 1983. 2. Parkes, C. M., "What Becomes of Redundant World Models? A Contribution to the Study of Adaptation to Change," British J. Medical Psychology, 1975, 48, 131-137. 3. Ibid.; Janoff-Bulman, R., "The Aftermath of Victimization: Rebuilding Shattered Assumptions." In Figley, C. R., ed., Trauma and Its Wake: The Study and Treatment of Post-traumatic Stress Disorder. New York, Brunner/Mazel, 1985; Gilbert, K., and Smart, L., Coping with Infant or Fetal Loss: The Couple% Healing Process. New York, Brunner/Mazel, in press. 4. Marris, P., "Attachment and Society." In Parkes, C. M., and Stevenson-Hinde, J., eds., The Place of Attachment in Human Behavior. New York, Basic Books, 1982. 5. Parkes, C. M., Bereavement: Studies of Grief in Adult Life. London, Tavistock Pub., 1982. 6. Marris, op. cir.; Parkes, op. cit.; Taylor, S. E., "Adjustment to Threatening Events: A Theory of Cognitive Adaptation." Amer. Psychologist, 1983, 1161-1173. 7. Marris, o19. cit. 8. Parkes, op. cit. 9. Taylor, op. cit. 10. Figley, C. R., "Catastrophes: An Overview of Family Reactions." In Figley, C. R., and McCubbin, H. I., eds., Stress and the Family: Volume H. Coping with Catastrophe. New York, Brunner/Mazel, 1983. 11. Taylor, op. cit. 12. Gilbert and Smart, op. cit~ 13. Lofland, J., and Lofland, L. H., Analyzing Social Settings: A Guide to Qualitative Observation and Analysis (2nd ed.). Belmont, Calif., Wadsworth, 1984. 14. Dorland's Illustrated Medical Dictionary (26th ed.). Philadelphia, W. B. Saunders Co, 1983. 15. Ibid. 16. Figley, op. cit.
