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About this book

This edited volume explores the wide range of practice situations across the human services in which issues loss and grief are likely to be important. It also extends understandings of loss and grief beyond death-related losses, encompassing new developments in the theoretical literature. Addressing the social and political dimensions of loss and grief as well as the psychological dimensions, this text brings together contributors from a variety of disciplines, professional background and countries, including such renowned figures as Dame Cicely Saunders and Robert A.Neimeyer.

Table of Contents



In this introductory chapter my task is to set the scene for the book as a whole. I begin by discussing the significance of loss for the human services before providing an overview of theories of loss, drawing comparisons between traditional and contemporary perspectives. This overview paves the way for an account of a model of loss and grief which is proposed as a basis for developing an understanding of the complex interplay of factors that contribute to experiences of grieving and mourning. This model is not presented as ‘the answer’, in any definitive sense, but rather as a framework for drawing together some of the strands of recent developments in loss theory and beginning to develop a more sophisticated understanding than traditional theoretical perspectives allow.
Neil Thompson

Loss in Context


1. The Philosophy of Hospice

‘Philosophy’ may seem a pretentious word to use to refer to a developing specialty, growing as it has out of an older tradition of care based in the western world on a (now less recognized) Christian heri-tage. Approached somewhat tentatively, however, the following definitions lead into a discussion of the basic assumptions on which a now worldwide movement is based, and point out the principles which those with widely varying belief systems can embrace.
Dame Cicely Saunders

2. Spirituality: A Personal Perspective

With a deftness of touch which would be the envy of many a political spin doctor, Alice, in her own wonderland, managed to define her own terms for the discussion, thereby wrong-footing any who would seek to take her to task.
Bernard Moss

3. Meaning Reconstruction Theory

Five years after the death of her infant daughter, Jessica, from congenital heart problems, Helen remains embittered and with- drawn, grieving intensely a loss that seemed to her inexplicable.1 A devout Christian, she struggles to fit the tragedy of her daughter’s untimely death into a belief system that she hoped would sustain her in her bereavement, but did not. As she notes, ‘The only thought that comes to me is that God must have really needed Jessica to be one of his angels in heaven, because she died so suddenly and didn’t show any of the symptoms of the condition she suffered from that caused her death.’ Reflecting on herself, now at the age of 32, Helen notes:
Robert A. Neimeyer, Adam Anderson

4. Race and Culture

This chapter focuses on the use of Thompson’s PCS analysis (Thompson, 2001a) as a framework for understanding the complexities of how racism impacts upon losses experienced by black and ethnic minority people. The usefulness of an analysis within such a Personal, Cultural and Structural understanding is twofold. First, it allows us to examine the impact of racism in a much more interrelated way, thus ensuring that racism is not brought down to some very simplistic analysis (for example, that racism is the sole result of ‘prejudice and power’ — see Sibeon, 1991, for a critique of this) or that understanding people’s cultures is the sole way for better race relations. Second, examining racism from a personal, cultural and structural analysis allows us to move away from seeing a ‘commonsense’ understanding and pathologizing of other people’s cultures and lifestyles as being the ‘truth’ about how such people and communities live. A classic example that continues to be offered as an explanation by many social care agencies for not providing services to many Asian communities, is that such communities prefer to ‘look after their own’ (Patel, 1990). This is a theme picked up within this chapter, which not only shows how Asian communities have been marginalized within many health and social care services because of this ‘fact’, but also how such communities themselves have been pushed into a position where they have to care for their own.
Suki Desai, Denise Bevan

5. Gender and Sexism

Across a range of activities, gender often appears to be a significant predictor of attitudes and social behaviour. Male traits of risk-taking, competitiveness, reluctance to reveal feelings and abdication of primary care tasks to women show up in patterns of loss and reactions to bereavement. According to Field et al. (1997) men are more likely to die from cardiovascular illness, suicide, murder, accident and warfare. In 1999 in the UK, one in five males aged 16–24 was a victim of violence compared with one in ten females of the equivalent age. Men are three times more likely to die through taking their own lives than women. Men die younger than women. In 1997, nearly two out of every three people aged 75 and over in the UK were women. A quarter of all families are headed by a single parent, practically all of whom are women (Gibson, 2001). Women appear to be at greater risk from domestic violence, though, typically, figures reflecting the ‘true’ picture of the victimization of men by female partners are notoriously difficult to obtain. With all victimization, as with mental health problems, men are less likely than women to admit a problem, to seek help or to visit a doctor. Women’s lives are more open to surveillance by the medical profession. They are two and a half times more likely to be treated for depression than men (Gibson, 2001).
Gordon Riches

6. Poverty and Deprivation

This chapter explores the implications of class and poverty in relation to loss, with a particular focus on death-related losses. Western cultural traditions present death as the ‘great leveller’. Underpinning this belief is the view that biologically we share the same inevitable encounter with death and leave this life as we came, with just what we were born with. However, this commonly held assumption is challenged with the depth of growing evidence that people’s experiences of dying, death and grieving are unique and diverse. The experience of death will be affected by differences such as gender, culture, race, sexual orientation, age and class (see Desai and Bevan, Chapter 4 in this volume). Although the major focus here is on death and dying, the analysis also has implications for a wider range of losses.
Denise Bevan

Arenas of Loss


7. Children and Divorce

In this chapter, I explore issues of loss for children in the context of separation and divorce. This will be linked to attachment theory, mourning processes in children, the way in which children manage pain and the possible protective factors that may support a child through the experience of family transitions. I conclude by looking at the implications for practice raised by this particular form of family breakdown.
Brynna Kroll

8. Adoption and Foster Care

This chapter is an examination of the emotional journeys of children, birth parents, foster carers and adopters in family transition. It highlights the importance of supporting them in grieving for unrealized expectations of past relationships so they can bring an enhanced sense of self understanding and confidence to their futures and their future relationships. It is argued that children and adults are more able to manage their transitions and trust in their new relationships if they are supported in grieving for earlier losses. Moreover, new family relationships will be better aspected if practitioners are able to help adults and growing children recognize how their identity, security and ways of relating to people are necessarily bound up with their earlier relationships. It is the job of practitioners to help growing children and their parents or carers to come to a peace with their pasts so they can also come to a trust in their joint and separate futures.
Mary Romaine

9. Disability

In 1988, Raymond Berger, Professor of Social Work at the California State University, published a paper in the magazine Social Work Today, which dealt with the issue of working with people who had experienced some form of traumatic loss. Whilst primarily addressing a social work audience, this paper dealt with the ways in which a wide variety of health and welfare professions work with disabled people. The paper was significant for two reasons. First, it was quite extensively researched in comparison to most articles that appeared in that or other weekly professional magazines. Indeed, the following week one reader cited this paper as partly responsible for him finding that edition to be accurate, practical and analytical. However, the second reason for the paper’s significance was the strength of response it received from Mike Oliver, now Professor of Disability Studies at the University of Greenwich. He bemoaned the disablism within Berger’s paper and in the magazine’s decision to publish it, and compared it to having:
topless social workers on page three as a means of combating sexism in social work, or a pictorial history of the black and white minstrel show as a guide to anti-racist practice (Oliver, 1988, p. 12)
Why should a paper on loss, considered by one person to be accurate, practical and analytical, lead to such a response?
Bob Sapey

10. Ill-health

Much has been written in this book and elsewhere about the impact of loss on human beings, as well as on many other species. The ultimate loss is, of course, death, but the loss of the individual is simply one of many losses encountered by dying people and those who survive them, both prior to and following the death. As other chapters in this book demonstrate, the kinds of losses we experience are multifarious. Every time one makes a change in life, there is a loss involved. This may be welcome, in so far as the future may look rosier, but at the same time, we may be sad to see the end of an era in our lives, bid farewell to a colleague or to a familiar routine.
Jeanne Katz

11. Older People

This chapter seeks to highlight the relative lack of attention given to older people’s experiences of loss and to explore the part that ageism plays in perpetuating a situation in which older people are assumed to be less affected by it than are their younger counterparts. Although loss through death will be a key issue, the discussion will be broadened out to include the myriad of other forms of loss experienced by older people, such as loss of physical or intellectual function, status, dignity, practical and emotional support, relationships, life-chances and so on.
Sue Thompson

12. Losses and Justice: An Australian Perspective

At one level the justice system can be understood as the major institutional way we deal with losses, largely around our expectations of how other people will behave towards us. These losses range from minor slights, where our sense of fairness is challenged, to more serious encounters where our homes are invaded, to severe assaults. This chapter discusses some of our ways of dealing with these losses, taking a narrative therapy approach. Narrative therapy is based on the idea that personal problems are created in social, cultural and political contexts (White and Epston, 1990).
John Dawes

Working with Loss


13. Teaching and Learning About Loss

This chapter seeks to reach two audiences: students and lecturers. As students, having been provoked by some of the ideas in this text, you will now want to learn more but may have no formal taught courses available. This chapter attempts to provide some ideas for self-directed learning, identifying themes, further reading and some experiential exercises for you to undertake on your own or with the support of friends and colleagues.
Jeremy Weinstein

14. A Framework for Working with Loss

It is commonly stated that loss is a pervasive theme in human services and that many recurrent users of welfare services have cumulative and often poorly resolved experiences of loss (Lloyd, 1992; Currer, 2001). Indeed, the primary purpose of this book is to explore that very assertion. Equally common for mainstream practitioners is the experience that they do not know how to accommodate loss work within their overall remit, nor does the available theory seem to ‘fit’ many of the situations with which they are working. It does, however, ring bells with their personal bereavements or relationship losses, sometimes with disturbing accuracy. This mismatch is frustrating. If loss is fundamental to human existence, then an understanding of the experience and the appropriate offer of help, should be integral to everything that human services practitioners do. This chapter explores some of the tensions and dilemmas posed in health, social care and pastoral settings, for multitask and multiple role practitioners seeking to recognize the significance, and work with the consequences, of loss for users of their service. It then suggests a framework which purports to encompass the range of loss experiences, and which might enable the practitioner to connect working with the implicit or explicit loss with those aspects of their intervention which are ostensibly the primary focus.
Margaret Lloyd
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