Settembre-Dicembre 2011, Vol. 46, N. 5 doi 10.1708/1009.10982 Scarica il PDF (268,6 kb) Reconstructing meaning in bereavement titolo - split_articolo,controlla_titolo - art_titolo Reconstructing meaning in bereavement title - controlla_titolo - art_title La ricostruzione di significato nell’elaborazione del lutto autori - vau_aut_id ROBERT A. NEIMEYER affiliazione_autori - ignora Department of Psychology, University of Memphis, TN, USA riassunto - art_riassunto SUMMARY. Bereavement, in the form of the loss of a significant attachment figure to death, disrupts the self-narratives of survivors, and typically launches them into an unsought quest for meaning in the loss as well as in their changed lives. A growing body of research on diverse groups – bereaved parents, young people, elders – suffering loss through both natural and violent death, documents the link between inability to find meaning in the experience and the intensity of complicated grief they suffer. This article reviews this literature, arguing that processes of sense-making and benefit-finding play a crucial role in bereavement adaptation for many of the bereaved, and accordingly that interventions that facilitate processes of meaning reconstruction can support effective psychotherapy for those struggling with intense and prolonged grief. parolechiave - lingua - vke_key_id KEY WORDS: bereavement, meaning reconstruction. abstract - art_abstract RIASSUNTO. Il lutto, inteso come la perdita di una figura significativa, altera i processi di auto-narrazione in coloro che sono sopravvissuti, e li proietta in una continua ricerca di significato della perdita e dei cambiamenti nelle loro vite. Una mole crescente di studi condotti su diversi gruppi – genitori, giovani, anziani – che hanno sofferto perdite naturali e violente documenta la relazione fra l’incapacità di trovare un senso all’esperienza luttuosa e l’intensità del dolore provato. Questo articolo esamina la letteratura in tale ambito, evidenziando che i processi di “sense-making” e “benefit-finding” svolgono un ruolo cruciale nell’adattamento alla perdita e, di conseguenza, che interventi tesi a facilitare i processi di ricostruzione di significato possono supportare l’efficace psicoterapia di quanti lottano con il dolore intenso e prolungato. keyword - lingua - vke_key_id PAROLE CHIAVE: perdita, ricostruzione di significato. testo - art_testo To live is to suffer; to survive is to find some meaning in the suffering. Friedrich Nietzsche There is not one big cosmic meaning for all, there is only the meaning we each give to our life, an individual meaning, an individual plot, like an individual novel, a book for each person. Anaïs Nin INTRODUCTION To a far greater extent than other animals, we as human beings are distinguished by living not only in a present, physical world, but also in a world populated by long-term memories, long-range anticipations, reflections, goals, interpretations, hopes, regrets, beliefs, metaphors – in a word, meanings. Indeed, it is this capacity to construct and inhabit a symbolic world that permits us to embroider experience with language, to speak and be heard, to relate, revise and resist stories of the events of our day or the entirety of our lives. In “acts of meaning”, as Jerome Bruner (1) once phrased it, we seek an order, a foundation, a plan, a significance in human existence, and particularly our own. And yet, at times the stubborn physicality of the present moment asserts itself, sometimes brutally, stressing or shredding the delicate tissue of meaning on which our all-too-vulnerable assumptive worlds depend. Never is this clearer than when these fragile expectations, understandings and illusions meet with incompatible yet incontrovertible occurrences – the diagnosis of our own serious illness, betrayal by an intimate partner, news of a love’s sudden death. At such moments we can feel cast into a world that is alien, unimaginable, uninhabitable, one that radically shakes or severs those taken-for-granted “realities” in which we are rooted, and on which we rely for a sense of secure purpose and connection. My intent in writing this brief article is to invite attention to this potential crisis of meaning in the context of bereavement, as well as to offer some principles for assisting with its reconstruction. LOSS AND THE QUEST FOR MEANING Just as philosophers, linguists and theologians emphasize the role of meaning in human life, so too do many psychologists. In particular, both classical and contemporary constructivists (2-4) focus on the processes by which people punctuate the seamless flow of life events, organizing them into meaningful episodes, and discerning in them recurrent themes that both give them personal significance and lead them to seek validation in their relationships with others. Viewed in narrative terms, we ultimately construct a life story that is distinctively our own, though it necessarily draws on the social discourses of our place and time. The result is a self-narrative (5), defined as «an overarching cognitive-affective-behavioral structure that organizes the “micro-narratives” of everyday life into a “macro-narrative” that consolidates our self-understanding, establishes our characteristic range of emotions and goals, and guides our performance on the stage of the social world». From this perspective, identity can be seen as a narrative achievement, as our sense of self is established through the stories that we tell about ourselves and relevant others, the stories that others tell about us, and the stories we enact in their presence. Importantly, it is this very self-narrative that is profoundly shaken by “seismic” life events such as the death of a loved one, instigating the processes of reaffirmation, repair, or replacement of the basic plot and theme of one’s life story (6,7). Consider the experience of Gayle, struggling in the aftermath of the death of her son, Max, in a vehicular accident on his way back to college. As a deeply thoughtful young man exploring both Eastern and Western wisdom traditions, Max had been drawn in the months before his death to the music of Cloud Cult, whose songs, like Journey of the Featherless, captured in a youthful, modern idiom the cosmic “flight” of sojourners skyward, beyond social convention, while in related tracks on the same CD, the voices of the performers intoned repeatedly, I love my mother/I love my father/And when it’s my time to go/I want you to know/I love you all. When Max alone died in the rollover of the SUV in which he was riding as a passenger, the singed backpack containing his reflective journal and poetry was one of the few things that escaped the flaming wreckage. As she searched desperately for some meaning in the seemingly senseless death of her son, Gayle took heart in the Cloud Cult music found in Max’s CD player in his bedroom, in the philosophic tone of the poetry and prose in his miraculously salvaged journal, and in the survival of Max’s girlfriend in the same accident, as the young woman herself was moved to a deep search for significance in the months that followed the tragedy. Together, she and Gayle sought and found some sense in the death through an eclectic spiritual narrative centering on their mutual “soul contracting” with Max, between incarnations, to undergo this trial together in their present lives, so that each might learn what it had to teach them in their respective journeys. Reinforced by a series of memorial services, rituals, and consultations with mediums and various spiritual guides, the new narrative of the meaning of Max’s life and death consolidated into a stable resource for not only the two women, but also for an entire community of relevant others, who joined in spontaneous “strike force philanthropy” in honor of Max, thereby extending the story beyond one of consolation to one fostering social action to mitigate suffering in the world, including a massive medical aid effort to survivors of the earthquake in Haiti. In the aftermath of life-altering loss, the bereaved are commonly precipitated into a search for meaning at levels that range from the practical (How did my loved one die?) through the relational (Who am I, now that I am no longer a spouse?) to the spiritual or existential (Why did God allow this to happen?). How – and whether – we engage these questions and resolve or simply stop asking them shapes how we accommodate the loss itself and who we become in light of it. In Gayle’s case, anguished and intermittent questioning impelled her forward in her search, ultimately deepening and broadening her existing sense of cosmic purpose, and galvanizing her efforts to live authentically and compassionately in relation to others who shared the same objective loss, or who faced losses and struggles in their own lives. The result was a revised self-narrative that found significance in the event story of her son’s death, as well as in the back story of his life, braided together intimately with her own. A growing body of research on meaning reconstruction in the wake of loss supports the broad outline of this model, and is beginning to add clinically useful detail to our understanding of how the bereaved negotiate the unwelcome change introduced into their lives by the loss, both for better and worse, and how we as professional helpers might best support their search for significance. It is worth bearing in mind at the outset, however, that loss does not inevitably decimate survivors’ self-narratives and mandate a revision or reappraisal of life meanings, as many will find consolation in systems of secular and spiritual beliefs and practices that have served them well in the past (8). Indeed, especially when the deaths of loved ones are relatively normative and anticipated, only a minority of the bereaved report searching for meaning in the experience, and the absence of such a search is one predictor of positive bereavement outcome (9). Even in the case of normative losses such as late life widowhood, however, evidence suggests that a significant minority of survivors struggle to find meaning in their loss across an extended period (10). Moreover, in this same prospective longitudinal study of widows and widowers, those who reported a more intense search for meaning in the loss at 6 and 18 months after the death evidenced a more painful and prolonged grief reaction across 4 years of bereavement (11). Indeed, research on complicated, prolonged grief disorder documents that a struggle with meaninglessness is a cardinal marker of debilitating bereavement reactions across many populations (12). In a large cohort of bereaved young adults suffering a variety of losses, for example, inability to “make sense” of the death was associated with marked and preoccupying separation distress across the first two years of adaptation (13). When losses are more objectively traumatic, data suggest that a search for sense or significance in the loss is more common, characterizing the majority of those bereaved by the sudden death of a family member, or parents who lose a child (9). Evidence demonstrates that a crisis of meaning is especially acute for those bereaved by suicide, homicide or fatal accident, who report a far more intense struggle to make sense of the loss than do those whose loved ones died natural deaths. Moreover, the role of sense making – a key form of meaning-making – is so prominent in accounting for the complicated grief symptomatology experienced by the former group that it functions as a nearly perfect mediator of the impact of violent death, accounting for virtually all of the difference between those bereaved by the traumatic as opposed to natural death of their loved ones (14). Research on bereaved parents reinforces the powerful role of meaning making in predicting bereavement outcome. Studying a large group of mothers and fathers whose children had died anywhere from a few months to many years earlier, Keesee and her colleagues found that the passage of time, the gender of the parent, and even whether the child died a natural or violent death accounted for little of their subsequent adaptation, whether assessed in terms of normative grief symptoms (e.g., sadness and missing the child) or complicated grief (e.g., an ongoing inability to care about other people and long-term disruption of functioning in work and family contexts). In contrast, their degree of sense making proved to be a potent predictor of concurrent complicated grief symptoms, accounting for 15 times more of these parents’ distress than any of the abovementioned objective factors (15). A further analysis of qualitative responses to questions about the kinds of meanings made by these parents also proved enlightening. Fully 45% of the parents confessed that they were unable to make sense of their child’s death even an average of 6 years later, and over 20% could identify no unsought benefits (e.g., greater personal strength) to mitigate the great pain of the tragedy. Overall, parents discussed 32 distinct approaches to finding meaning in their child’s death, 14 of which involved sense making and 18 of which involved unsought benefits or a “silver lining” in the loss, each representing a means of finding meaning in a tragic experience. The most common sense making themes involved religious beliefs (such as the conviction that the child’s death was part of a divine plan or a belief in reunion in an afterlife), and the most common benefit finding themes entailed an increase in the desire to help and compassion for others’ suffering. Parents who invoked specific sense making themes, including attributing the death to God’s will or belief that the child was no longer suffering, as well as those who reported benefits such as reordered life priorities, experienced fewer maladaptive grief symptoms (16). Finally, it is worth underscoring that bereavement adaptation entails more than simply surmounting painful symptoms of grief and depression, insofar as significant numbers of people report resilience or even personal growth after loss, outcomes that are no less important to assess and facilitate (17). Here, too, it seems likely that meaning making contributes to adaptive outcomes, as longitudinal research on widowhood demonstrates that sense making in the first 6 months of loss forecasts higher levels of positive affect and well-being a full 4 years after the death of a spouse (11). Fostering reconstruction of a world of meaning would therefore seem to be a therapeutic priority for many bereaved clients, one that could carry benefits not only in alleviating complicated grief symptomatology, but also in renewing a sense of hope and self-efficacy in their changed lives. The recent development of a carefully validated multidimensional measure of the extent to which a survivor can integrate his or her loss into a fuller system of personal meaning should advance this work in both clinical and research contexts (18). How might such meaning reconstruction be facilitated in support group or psychotherapy contexts? Research on bereavement professionals indicates that they routinely draw on a host of strategies to advance this goal, beginning with fostering a sense of presence to the needs of the grieving client, progressing to a delicate attention to the process of therapy, and finding ultimate expression in a great variety of specific therapeutic procedures (19). Presence, in the view of these practitioners, entails chiefly cultivating a safe and supportive relationship, one characterized by deep and empathic listening. Process goals involve psychoeducation about loss, promoting the client’s telling of his or her story, exploration of spiritual and existential concerns, processing of emotions and utilization of existing strengths and resources. And finally, concrete therapeutic procedures include a wide range of narrative, ritual, expressive and pastoral methods for helping clients make sense of the loss and their changed lives, which are beginning to receive support as evidence based treatments in randomised controlled trials (20,21). Accordingly, a good deal of attention has been paid in a meaning reconstruction framework to explaining and exemplifying these methods, in such diverse media as books (22,23), chapters (6,24,25), journal articles (26,27), training videos (28,29) and online continuing education programs (30) for grief professionals, as well as self-help resources for bereaved clients (31). CONCLUSION In summary, a constructivist focus on the role of meaning-making in bereavement has received increasing attention in both the research and clinical literatures, as evidence increasingly documents the important role of reaffirming or reorganising a world of meaning that has been challenged by loss. I hope that this brief introduction to this work encourages investigators and practitioners to attend to the significance of bereavement as well as its attendant symptomatology, and shed further light on the effort of many of the bereaved to reconstruct their life narratives in the wake of loss. biblio_titolo - ignora REFERENCES bibliografia - art_bibliografia 1. Bruner J. Acts of meaning. Cambridge, Mass.: Harvard University Press, 1990. 2. Kelly GA. The psychology of personal constructs. New York: Routledge, 1955/1991. 3. Neimeyer RA. Constructivist psychotherapy. London & New York: Routledge, 2009. 4. Neimeyer RA. Narrative disruptions in the construction of self. In: Neimeyer RA, Raskin JD (eds). Constructions of disorder: Meaning making frameworks for psychotherapy. Washington, DC: American Psychological Association, 2000; pp. 207-41. 5. Neimeyer RA. Fostering posttraumatic growth: a narrative contribution. Psychol Inq 2004; 15: 53-9. 6. Neimeyer RA. 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