Bonanno (2004) reviewed the consistent, robust evidence that following a traumatic event, such as the death of a spouse, the majority of people are well-adjusted and do not have symptoms that are characteristics of post-traumatic stress disorder (PTSD) or other pathological conditions. In meta-analytic studies (analyses of the results of previous studies) of bereavement, “individuals who exhibited relatively low levels of depression or distress have consistently approached or exceeded 50% of the sample” and “10% to 15%” suffered “chronic depression and distress” (p.23).
Bonanno referred to the majority as “resilient. ” Other than experiencing minor sporadic symptoms for no more than a few weeks, there are not “disruptions in their ability to function at work or in close relationships” (p. 20). Bonanno noted that theories based on reports that most people suffer pathological symptoms following loss have resulted from studies using clinical samples of those who have sought therapy because of the severe emotional distress experienced only by a small minority (pp.
20-21). From such samples, theories have excluded the majority who are “resilient,” as well as most others who suffer moderate symptoms and “recover” without intervention (p. 21). Such theorists view trauma as an experience resulting in the need for therapy, in particular, the need for “grief work” following the death of a loved one. Well, “grief work” can’t do any harm, can it?
Based on Bonanno’s review of meta-analytic studies, large percentages of clients have been harmed (as many as 38% in one meta-analysis), most have neither been harmed nor helped, and those who have been helped were the small minority discussed above who suffered severe distress (pp. 21-22). Probably both because women, on average, outlive men and because in Western cultures there has been a tradition of wives being younger than husbands, widows, like white rats and college sophomores, have been readily available for research.
However, while most of the bereavement studies reported in Bonanno have been of widows, he also noted that in a study of those hospitalized after an automobile accident, 79% did not suffer from PTSD, and in a study of Gulf War veterans one year after their return, 62. 5% suffered “no psychological distress” (p. 24). These findings suggested to Bonanno that, as in the studies of therapeutic outcome discussed above using widows, trauma theories proposing blanket intervention, even to those without symptoms, are misguided.
Bonano also reviewed studies that have indicated the recent common practice of “debriefing” (i. e. , offering group therapeutic intervention) all people who even witnessed a public traumatic event, such as 9-11, is “ineffective. . . and can impede natural recovery processes” (p. 22). Bonanno concluded by reviewing recent studies of resilient people that provided evidence that there were differences in the characteristics these people demonstrated that accounted for resilience.
Before considering the implications of these findings for appropriate therapeutic interventions to use with those who are not resilient, the concepts of grief and bereavement following the death of a marital partner discussed above should be compared with the concepts as described in Santrock’s text (2007). Before even reading the article, referenced in Santrock, I found it interesting that the subtitle itself – “Have we underestimated the human capacity to thrive after extremely aversive events? ” – was at odds with the actual information Santrock provided. Concepts of Grief and Bereavement Following the Death of a Partner.
According to Santrock (2007), after the death of a loved one, the form of grief that occurs is defined as “numbness, disbelief, separation anxiety, despair, sadness, and loneliness” (p. 658). Regarding the death of a spouse, in particular, Santrock reported that the surviving partner suffers “profound grief and often . . . psychological disorders, including depression” (p. 661). Clearly, there’s a discrepancy between Santrock and Bonanno (2004), who reported consistent evidence that following the death of a loved one, the majority of people were “resilient” – they did not experience the symptoms Santrock described.
Obviously, resolving the discrepancy required checking sources, and Santrock made the task easier because Bonanno was one of several sources for the first quote and the only source cited for the second quote! The second reference is Bonanno, Wortman, and Nesse (2004), a study of widows that included a measure of depression prior to the death of their husbands, obtained in another study (Changing Lives of Older Couples).
The majority of participants did not fit the above quote from Santrock. Instead, they either demonstrated resilience, “low preloss depression . . . [and] no change at either 6 or 18 months of bereavement” (45.9%) – or “scored high in depression prior to the loss but low in depress.