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Helping Parents Help Children Cope with Cancer in the Family
Cancer & Children continuing education MFT CEUs

Section 14
The Residual Effects of Sudden Death on Self-Identity
& Family Relationships

CEU Question 14 | CEU Answer Booklet | Table of Contents | Cancer
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

Circumstances surrounding death influence the way in which bereaved persons respond, both towards the deceased and to each other (Moos, 1995). The type of death and how it is interpreted, whether it is seen as `blameless' or perceived to be in some way the fault of the deceased, can also have a direct and long-lasting effect upon marital discourse and family paradigms. Moos (1995), for example, has reported how people build up harmful misconceptions about death and aspects of death which ultimately affect their coping mechanisms. Similarly, Lundin (1987) reports that `sudden death' survivors are more likely to experience prolonged psychological and physical repercussions since no anticipatory grief is possible. Coping with the death of a child, whatever the circumstances, requires both a parental and familial readjustment on the part of those left behind. Indeed, the devastating experience of a child's death, one which is considered `off time' rather than `on time' (Cook & Oltjenbruns, 1989), not only challenges a person's need for order and meaningfulness, but also requires a fundamental reassessment of their life strategies.

Borrowing from Timmermans' (1994) autobiographical ethnography of death and dying, this paper will use an introspective ethnographic approach to my experience of coping with the death of a close family member, while simultaneously studying the residual effects of `sudden death' upon the remaining members of the family. According to De Vries (1997: 150), the `stories' of the bereft are rarely heard.

Couples who, for example, participate in bereavement research have reported that the death of a child has a devastating effect upon marital intimacy (Gottlieb et al., 1996). Similarly, studies commonly report major differences in the trajectory of each partner's grieving process and the long-lasting and damaging effect on spousal relationships (Nelson & Frantz, 1996; Riches & Dawson, 1996c). However, the causalities extend beyond the couple and their relationship as the health of the family and all its members is directly and indirectly affected by the marital relationship. Indeed, research suggests that, while some relationships survive and are even strengthened by the tragedy, others deteriorate and suffer irreparable damage (De Vries, 1997). I will, therefore, trace both the positive and negative effects upon parental and sibling relationships in an attempt to show how the sensitivity of the situation has produced a cocktail of hostility and harmony within the family, causing each member to pursue what Giddens refers to as "a reflexive re-ordering of the self-narrative" (Giddens, 1991: 244).

Sudden death: a shock to the family system
Our sense of self is facilitated and influenced on the dual basis of social interaction and multiple relationships, particularly within one's family. Likewise, an individual's sense of identity, their sense of personal worth and purpose in life may be largely based on inter-family relationships. Therefore, to lose a close family member, particularly a son or daughter, precipitates and presupposes constructs of self and self-identity, forcing us to restructure and realign our sense of order, well-being and meaningfulness. Weigert and Hastings have described this identity loss as "the destruction or denial of a particular, meaningful, and positively affective self-other bond which has constituted a central personal identity for self" (Weigert & Hastings, 1977: 1171). With the relinquished relationship comes the simultaneous destruction of a portion of your self, a self never again to be fully reactivated (Kearl, 1998).

While much of the literature on premature death focuses on adjustment to the loss of a child, grief management and the challenge it presents to family relationships (Schwab, 1992; Dyregrov & Mattheisen, 1987; Moos, 1995; Papadatou & Papadatos, 1991; Rando, 1991), `actual' causes of death and their effect upon the individual or family bereavement process remain largely confined to studies of suicide or homicide, showing less attention to death by accident or natural causes (Nelson & Frantz, 1996; Riches & Dawson, 1998b). Sprang and McNeil (1998), for example, studying post-homicide reactions following a drunk driving fatality, found evidence to suggest that the mode of death impacts heavily on the nature and course of bereavement after death, causing deep and lasting complications within family relationships.

Allen et al. (1993-94) found that for suicidal deaths issues of blame and responsibility are more salient than for deaths resulting from accidents or natural causes. By contrast, Nelson & Frantz (1996) found that the actual cause of death, whether through suicide, illness or accident, resulted in no significant difference in family relationships. One of the few studies devoted to the impact of accidental death was carried out by De Vries et al. (1997) who found that parents who had experienced a sudden accidental death reported greater health problems, both psychological and physiological, than parents who had experienced a natural or expected loss. Comparing older bereaved and non-bereaved parents, De Vries et al. found that bereaved parents experienced higher levels of long-lasting depression and anxiety because of their inability to accept the loss. They concluded this was heavily influenced by the context within which the loss had taken place.

Death within a family, especially sudden death, exposes a basic dynamic tension of family systems, as grief occurs within a family on multiple levels, that is, individual, familial and societal. The individual, although experiencing grief autonomously, does in fact project and propel his or her symptoms onto the other members of the system or family. This is likely to result in conflict and divisions within the family, as each person is perhaps seen by the others as not coping adequately, as preoccupied with irrational thoughts, wallowing in self-pity or prolonging the grieving process. The internal `workings' of the family are subsequently placed under a terrific strain.

Family bereavement, however uncomfortable, takes place not in isolation, but on a societal or communal level. Social and cultural norms demand that `life goes on', viewing any excessive grieving as unnatural or pathological. Changing attitudes towards death, along with what Taylor refers to as the "rise of individualism" (1989: 176), further isolate the bereft from previous social networks, as they struggle to `come to terms' with their loss. Indeed, research suggests the more sudden and unexplained the death, the greater the difficulty in expressing support (Talbot, 1996-97). Nevertheless, as part of the transitional experience and, despite not wanting to `face the world', habitual interactional patterns cannot be put off forever and role-relationships with friends and neighbours need to be re-established (Shapiro, 1996). Indeed, Singh and Raphael (1981) have singled out the importance of a well functioning social network for a good outcome of the grief reaction.

Sibling, as well as marital relationships are affected (Riches, 1997). Coming to terms with the sudden death of a brother or sister can postpone the sense of a `secure attachment' as the once mapped out life-course of kinship relationships is temporarily frozen. The ultimate realization that one's familial landscape has irrevocably changed produces an emptiness, a sense of `if only', as any future plans are abandoned. The future is now `read-off' through memories and stories as the deceased sibling, no longer a physical being, becomes an `invisible' member of the family hierarchy. Family change involves realigning and recreating the family without a key family member (Shapiro, 1996). Similarly, bereft family members become more protective of each other, while simultaneously questioning each other's thoughts and actions as they struggle to accept rational explanations as to `Why?'. With the death of a child, many of these questions go unanswered and the once solid foundations of the family system are fractured leaving the bereft struggling to face the unfinished project of family lifecycle development.

Another dimension to the experience of bereavement involves the difference between experiences of men and women. The premature death of an adult child may dichotomize processes of grieving between mothers and fathers, which subsequently affects both marital discourse and intimacy. Mirowsky and Ross (1995), for example, maintain that women genuinely suffer greater distress than men do when confronted with death. Several studies report fathers feeling an obligation to stay strong, suggesting men should support the wife, or partner, during and after the death of a child (Rando, 1983; Dyregov & Matthiesen, 1987; Riches, 1997). Men are more likely to grieve in private and practical ways (Klass, 1999). For example, men protect their vulnerability by staying `manly', internalizing their grief, effectively erecting a barrier to their wives' attempts to talk about the loss. Similarly, reports suggest men become angry and aggressive, whereas women become depressed and withdrawn (Gottleib et al., 1996).
- Handsley, Stephen; “But what about us?” the residual effects of sudden death on self-identity and family relationships; Mortality; Mar 2001; Vol. 6; Issue 1.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #7
The preceding section contained information about the residual effects of sudden death on self-identity and family relationships.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 14
What often causes conflicts and divisions within the family after the death of a family member? Record the letter of the correct answer the CEU Answer Booklet

 
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