Mourning in Japan

Does time heal all wounds? An investigation of time, grief, and attitudes toward death

When experiencing the loss of a loved one, individuals adapt and change how they understand death, how they interpret the meaning of the loss, and how they remember the deceased. In the present study (N = 164), we investigated whether the time since the loss - recent or distant - was associated with individuals' bereavement, attitudes toward death, and their meaning of death. We found that individuals who experienced a recent loss reported more grief and more negative death attitudes compared to individuals who experienced a loss more than 5 years ago. Moreover, the bereavement appeared to completely mediate the time since the loss and the individuals' attitudes about death. The findings suggest that time-dependent adaptations after a loss shifts individuals' death attitudes, grief symptoms, and thoughts about death.

Perceiving those who are gone: Cultural research on post-bereavement perception or hallucination of the deceased

Experiencing the continued presence of the deceased is common among the bereaved, whether as a sensory perception or as a felt presence. This phenomenon has been researched from psychological and psychiatric perspectives during the last five decades. Such experiences have been also documented in the ethnographic literature but, despite the extensive cross-cultural research in the area, anthropological data has generally not been considered in the psychological literature about this phenomenon. This paper provides an overview aimed at bridging these two areas of knowledge, and approaches the post-bereavement perception or hallucination of the deceased in cultural context. Ongoing debates are addressed from the vantage point of ethnographic and clinical case study research focusing on the cultural repertoires (in constant flux as cultures change) from which these experiences are labelled as desirable and normal, on the one hand, or as dangerous and pathological, on the other.

Perceptions of death and memory transmission among residents of Hiroshima and Nagasaki, Japan: A qualitative study

The understanding and materialization of grief and loss in a community are contingent upon cultural norms, historical processes, and dominant political narratives. The processes of public mourning create a localized memory of the deceased which contributes to a collective narrative formation around loss. When death is made public, politicized, or collectively grieved, there exists great momentum for enacting policy change through restorative justice practices. This momentum for resistance is amplified when collective grieving takes place following political or mass deaths. The present study aims to develop a holistic understanding of mourning and memorialization practices as they are locally enacted in Hiroshima and Nagasaki, Japan. These two cities were chosen based on their shared history of mass violence and their diverging cultural customs of mourning. Twelve qualitative interviews were conducted with residents of both cities. The purpose of the interviews was to gain insight to how Hiroshima and Nagasaki residents make meaning out of loss and public memorialization. Narrative interviews based on the Miyabayashi Grief Measurement (MG) allowed participants to explain and reflect on the links between their public and individual mourning practices. Themes identified in the interviews include (1) a routine and automatic engagement with grief rituals specific to Japanese culture; (2) connection and gratitude towards ancestors; (3) methods of engaging with memorial sites to transmit personal memories of the deceased; (4) a sense of duty in passing on the first-hand accounts of survivors of the atomic bombing; (5) recalling memories of the deceased when making decisions; and, (6) transmitting memories of loss in a way that is celebratory and joyous. These results ask us to look past simplified depictions of cultural grief and consider the individual elements that may impact a person's remembrance and memory transmission within societies.

Sensed Presence, Attenuated Psychosis, and Transliminality: At the Threshold of Consciousness

INTRODUCTION

The experience of "sensed presence" or "felt presence" in the absence of "other" has been described as a complex multimodal experience to which meaning is given. Sensed presence (SenP) is a transdiagnostic experience that exists along a continuum that can appear during isolation, spirit quests, exposure to extreme elements, bereavement, anxiety, and psychosis. Given the prevalence and vast heterogeneity of SenP, in addition to a surprising lack of targeted research into this phenomenon, this research examined the interrelationship of SenP, attenuated psychosis symptoms (APS), and transliminality. Transliminality is composed of absorption, fantasy proneness, paranormal belief, mystical experiences, increased creativity, and hyperaesthesia.

METHODS

A completely anonymous online survey of unusual experiences and mental health was distributed via social media (i.e., Twitter, Facebook, Reddit, and mass emailing lists) to recruit participants. Demographic data were analyzed using χ2 tests and one-way ANOVAs. A two-step cluster analysis was conducted to identify distinct sub-categories of transliminality followed by ANOVAs with bootstrapping at 1,000 iterations to compare SenP, increased APS, and transliminality. Pearson's bivariate correlations were conducted to determine the association between SenP, APS, and transliminality.

RESULTS

Together with descriptive findings, we show distinct characteristics between clusters. T1 cluster consisted of individuals with few SenP experiences, low APS, and low transliminality. T2 consisted of individuals with a moderate prevalence of SenP, low APS, moderate transliminality, and increased overall feeling of closeness to G-d. There was no significant difference in APS between T1 and T2 or in the level of distress associated with APS. T3 individuals showed a significantly higher prevalence of SenP in all domains (frequency, distress, vividness, and total score), higher APS, and higher transliminality, compared to T1 and T2. The T3 cluster met criteria for high risk to develop psychosis.

CONCLUSION

Thus, our findings demonstrate a strong association and entanglement of these experiences which suggests that the interrelatedness of transliminality/absorption and APS may serve as a potentially provocative underlying structure in the phenomenology of SenP.

Hallucinations and Hallucinogens: Psychopathology or Wisdom?

Hallucinations are currently associated almost exclusively with psychopathological states. While it is evident that hallucinations can indicate psychopathology or neurological disorders, we should remember that hallucinations also commonly occur in people without any signs of psychopathology. A similar case occurs in the case of hallucinogenic drugs, which have been long associated with psychopathology and insanity. However, during the last decades a huge body of research has shown that certain kinds of hallucinations, exerted by hallucinogenic drugs, may serve to improve mental health. We propose that, in light of historical, epidemiological, and scientific research, hallucinations can be better characterized as a common phenomenon associated sometimes with psychopathology but also with functional and even beneficial outcomes. In the last sections of the manuscript, we extend our argument, suggesting that hallucinations can offer a via regia to knowledge of the mind and the world. This radical shift in the cultural interpretation of hallucinations could have several implications for fields such as drug policy, civil law, and psychiatry, as well as for the stigma associated with mental disorders.

Experience of application of the meaning-centered psychotherapy to Japanese bereaved family of patients with cancer – A mixed-method study

Objectives

This study aimed to adapt the meaning-centered psychotherapy (MCP) to treat post-bereavement grief in Japanese bereaved families who lost their loved ones to cancer and to examine the feasibility of the intervention using both quantitative and qualitative methods.

Methods

A modified version of MCP was developed with cultural consideration. Bereaved individuals aged ≥18 years who had lost their family members to cancer at least 6 months before and had severe or persistent grief with a score of ≥26 on the Inventory of Complicated Grief (ICG-19) were included in the study. The participants received the modified version of MCP, which was provided in a 5-session monthly format. The levels of grief (ICG-19), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), general health (General Health Questionnaire-12), and post-traumatic growth (Post-traumatic Growth Inventory -Short Form) were compared before and after the intervention.

Results

Five bereaved individuals were enrolled, and all the participants completed the program. The mean scores of the ICG-19. The participants’ sense of regret, guilt, and being separated from the deceased person gradually shifted to the reappraisal of the experience, leading to a broadened view of the relationship with the deceased, and rediscovery of the core values, identity, and roles of the participants through the process of rediscovery of the meaning of life.

Significance of results

A modified version of the MCP was well accepted by Japanese bereaved families. The intervention appears to promote the rediscovery of the meaning of life and appears to have the potential to alleviate the bereaved individuals’ depression and grief-related symptoms and to facilitate their post-traumatic growth.

Interpersonal Psychotherapy for Bereavement-Related Major Depressive Disorder in Japan: A Systematic Case Report

Bereavement-related major depressive disorder (MDD) is a common disorder with both mental and physical effects. Specific psychotherapies for bereavement-related MDD remain unavailable in Japan despite its relatively high prevalence. Interpersonal psychotherapy (IPT) is a treatment with established efficacy for MDD, including bereavement-related MDD. There are, however, few studies of IPT for MDD and none at all for bereavement-related MDD in Japan. The efficacy of IPT for bereavement-related MDD needs confirmation in Japanese culture because the expression of emotions during the grieving and mourning process varies across cultures, and the Japanese-specific cultural custom exists of maintaining a relationship with the deceased in the afterlife mainly via a Buddhist memorial tablet, altar, and grave. We present a case study describing the therapist's adaptation of IPT to Japanese culture to treat bereavement-related MDD in a Japanese man with insufficient response to pharmacotherapy who had suddenly lost his mother to heart disease. His mother's death and a dispute with his father both appeared to have contributed to his sustained bereavement-related MDD. The 16-session treatment course for depressive symptoms was monitored using the Beck Depression Inventory-II. Treatment was scheduled weekly, but some sessions unavoidably took place fortnightly because they were conducted in person during the COVID-19 pandemic. The patient's MDD severity continually decreased, functional disability gradually recovered from the beginning until the 3-month follow-up, and the interpersonal relationships with his deceased mother, his wife, colleague, and father changed after IPT. Case studies are inherently limited, but IPT, in consideration of Japanese cultural characteristics for bereavement-related MDD, can be potentially effective in Japan.

Mourners' Dissatisfaction with Funerals May Influence Their Subsequent Medical/Welfare Expenses-A Nationwide Survey in Japan

Japan's super-aged mortality rate bereaves millions of people annually, threatening the mental health of the bereaved population. Previous research suggests that participation in satisfying funeral rituals can protect or improve the health of a bereaved population-but pandemic restrictions threaten traditional funeral assemblies. To determine how bereaved mourners' mental health-and consequent dependence upon medical, pharmaceutical, or social services-are affected by funerals and the aspects of funerals most likely to cause satisfaction or dissatisfaction, we conducted an anonymous nationwide survey across Japan. In total, 1078 bereaved Japanese responded; we analyzed their responses by comparing the 106 citing funeral dissatisfaction with the 972 citing no dissatisfaction. The cohort showing greatest satisfaction with funerals tended to be older widows or parents who lost children; they showed greater grief but spent less on medical, pharmaceutical, or social services thereafter than the dissatisfied. Conversely, mourners with the greatest dissatisfaction toward their interactions with funeral directors and Buddhist priests tended to spend more on medical, pharmaceutical, or social services after bereavement. We conclude that training or education to improve priests' and funeral directors' interactions may reduce dissatisfaction with funerals, potentially reducing subsequent costs of medical, pharmaceutical, or social services for the rapidly growing population of bereaved Japanese.

Sensory and Quasi-Sensory Experiences of the Deceased in Bereavement: An Interdisciplinary and Integrative Review

Bereaved people often report having sensory and quasi-sensory experiences of the deceased (SED), and there is an ongoing debate over whether SED are associated with pathology, such as grief complications. Research into these experiences has been conducted in various disciplines, including psychiatry, psychology, and anthropology, without much crossover. This review brings these areas of research together, drawing on the expertise of an interdisciplinary working group formed as part of the International Consortium for Hallucination Research (ICHR). It examines existing evidence on the phenomenology, associated factors, and impact of SED, including the role of culture, and discusses the main theories on SED and how these phenomena compare with unusual experiences in other contexts. The review concludes that the vast majority of these experiences are benign and that they should be considered in light of their biographical, relational, and sociocultural contexts.

How many bereaved people hallucinate about their loved one? A systematic review and meta-analysis of bereavement hallucinations

BACKGROUND

Bereavement hallucinations (BHs) entail a perception of a deceased in any sense modality or as a quasi-sensory sense of presence. BHs are an associated feature of the proposed Persistent Complex Bereavement Disorder (PCBD) in DSM-5. The goals of this review are to estimate the prevalence of BHs, identify possible moderators, and review the methodological status of this research field.

METHODS

A systematic literature search was conducted through the databases PubMed, PsycINFO, and CINAHL. Studies systematically assessing the prevalence of BHs of a relative or friend were included.

RESULTS

Twenty-one eligible studies were identified and 8 meta-analyses of BHs in different sense modalities were conducted. The prevalence of having one or more BHs was estimated to be 56.6% (95% CI 49.9-63.2), and the estimated prevalence of BHs in specific sense modalities ranged within 7.0-39.7%. Meta-regression analyses revealed associations to age and conjugal bereavement, but results are tentative and dependent on the type of BH in question.

LIMITATIONS

The included studies were methodologically heterogeneous. Limitations included the lack of a valid measure of BHs and low sample generalizability.

CONCLUSION

This first systematic review and meta-analysis of BHs suggests that more than half of the bereaved people experience some kind of BH. However, there are considerable methodological limitations in the research of BHs, which is of pertinent interest as BHs have been linked to the development of a future diagnosis of clinically impairing grief. A valid measure of BHs needs to be developed and used in high-quality epidemiological research using population-based designs.

Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research

KEY POINTS

➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts.

➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond.

➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood.

➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions.

Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research.

Widow's Grief: The Impact of Age and Mode of Death

Two variables (age and mode of death) were tested to discover if they could predict the intensity of the grief reaction. It was hypothesized that widows who experienced anticipatory grief would resolve the bereavement crisis in an easier manner than those experiencing the sudden death of a mate, and that younger widows would experience the effects of acute grief to a greater degree than older widows. Information was obtained by a questionnaire from eighty widows bereaved six to nine months. They were divided into three age groups (young, middle, old) and two mode of death groups (sudden death and prolonged death). It was concluded that anticipatory grief is a mitigating influence on post-mortem grief for the young bereaved widow. It appears, however, that age is a more important factor than mode of death in relating to the intensity of the grief reaction. The restlessness symptom was found to be significantly higher in young widows and the irritability symptom showed an interaction effect-high for young (sudden) and middle (prolonged) widows.

Cultural Diversity in Grief

"Culture in its broadest sense, is what makes you a stranger when you are away from home. It includes all those beliefs and expectations about how people should speak and act which have become a kind of second nature to you as a result of social learning. However, direct exposure to an alien society usually produces a disturbing feeling of disorientation and helplessness that is called 'culture shock.'"1 This article explores various cultures and beliefs and attitudes concerning death and grief. By reexamining attitudes toward patients of different cultures and gaining understanding of their cultures and psychosocial environment, the caregiver begins to develop cultural competence in dealing with cross- cultural issues.

Psychomanteum Research: Experiences and Effects on Bereavement

A Psychomanteum Process involving mirror-gazing was conducted in a research setting to explore apparent facilitated contact with deceased friends and relatives, and to collect data on the phenomena, experiences, and effects on bereavement. A pilot study with five participants resulted in strong experiences and four apparent contacts. The main study took 27 participants through a three-stage process: remembering a deceased friend or relative, sitting in a darkened room gazing into a mirror while thinking of the person, and finally discussing and reflecting on the experience. Data were collected with pre- and post-questionnaires, a follow-up questionnaire at least four weeks after the session, interviews by the facilitators, and two personality measures, the Tellegen Absorption Scale and the Myers-Briggs Type Indicator. Contacts with the sought person were reported by 13 participants. Participants reported that a variety of imagery appeared in the mirror, as well as experiences of dialogue, sounds, light, body sensations, and smell. Several specific messages were reported by participants who believed that they were from the sought persons. Twenty-one self-report items relating to bereavement were analyzed for changes between pre- and follow-up questionnaires. Using a Wilcoxon signed ranks analysis, statistically significant reductions in bereavement responses were found over the entire group ( p=.05 to .0008). These included unresolved feelings, loss, grief, guilt, sadness, and need to communicate. Participants also reported significant impact on their lives following the session.

Dead Men Talking: Evidence of Post Death Contact and Continuing Bonds

Post Death Contact (PDC) is when a living individual feels that a person who is deceased is reaching out to connect with the living. Such experiences may be part of a model of grieving called Continuing Bonds. In order to further investigate the relationship between PDCs and the grieving process, a random telephone survey was developed to determine the ways in which PDCs are experienced in the United States. Most commonly, subjects reported PDCs that included dreams, sounds, feeling a presence, and having conversations.

The results suggest that experiencing PDCs may be a lifelong phenomenon and more widespread than previously thought.

Intimacy in Widowhood

This article explores all intimate relationships potentially available to the widowed woman. Friends, relatives, professionals and non-professional associates are considered, in addition to the deceased spouse, God, and the widow herself. The author concludes that traditional resources are inadequate to meet the widow's intimacy needs. The issue of reciprocity is addressed. The widow's experience stands opposed to human values which needlessly limit definitions of intimacy to dyadic, human relationships among opposite sex age peers. Research is needed to evaluate the correspondence between relationship styles in marriage and those in widowhood, to assess the inter-dependency of the widow's relationships, and to examine individual differences in the intimacy patterns of widows.

Experiences of continued presence: On the practical consequences of 'hallucinations' in bereavement

OBJECTIVES

We document the properties of experiences of continued presence (ECPs) helping to resolve controversies about their significance.

METHOD

We used qualitative methods in data collection and analysis. This enabled us to document the properties of ECPs. Narrative biographic interviews were carried out with 17 bereaved informants, and conversation analysis was used to identify the sources of meaning and functions of these experiences.

RESULTS

Our informants heard voices of the deceased, saw their images, felt their touch, and sometimes felt their presence unspecified in any of the senses. Analysis revealed that ECPs were meaningfully connected to the immediate environments in which they happened but also to the personal histories of the bereaved. The narratives reveal helpful and destructive potentials of these experiences. In all cases, the functions relied on the relationship with the deceased.

CONCLUSIONS

The authors warn against oversimplification of ECPs, as significantly contrasting practical consequences commonly occurred within as well as between cases. The findings support the use of talking therapies based on personal meanings to help those disturbed by their experiences of presence.

PRACTITIONER POINTS

Practitioners should not assume that ECPs are signs of pathology - often they have healing consequences. Where ECPs cause distress, the problem is likely to concern relationship difficulties with the deceased. Therapists can help clients with distressing ECPs by working on the relationship with the deceased.

Meaning Reconstruction Process After Suicide

Although Japan has a high suicide rate, there is insufficient research on the experiences of suicide-bereaved individuals. We investigated the qualitative aspects of the meaning reconstruction process after a loss to suicide. We conducted a life-story interview using open-ended questions with one middle-aged Japanese woman who lost her son to suicide. We used a narrative approach to transcribe and code the participant’s narratives for analysis. The analysis revealed three meaning groups that structured the participant’s reactions to the suicide: making sense of her son’s death and life, relationships with other people, and reconstruction of a bond with the deceased. The belief that death is not an eternal split and that there is a connection between the living and the deceased reduced the pain felt by our participant. Furthermore, the narratives worked as scaffolds in the meaning reconstruction process. We discuss our results in the light of cross-cultural differences in the grieving process.

Mourning 2.0--Continuing Bonds Between the Living and the Dead on Facebook

This study examines the burgeoning phenomenon of Facebook memorial pages and how this research about online social networking environments can contribute to the existing literature related to Klass, Silverman, and Nickman (1996) continuing bonds thesis. I argue that memorial pages constitute a new ritualized and public space for maintaining these continued bonds and that individuals exhibit several types of bonding interactions with the deceased. I conducted a content analysis on a purposively selected sample of 12 public Facebook "pages" where I coded 1,270 individual Wall postings. Analyses demonstrated that many individuals routinely used these Walls to continue their relationships with the deceased. Findings revealed several Wall posting categories, "guidance from beyond and reunion with the deceased," "messages and visitations from the deceased," and "conversations with the deceased," which I then combined under a central thematic heading of "paranormal copresence." There were 267 Wall postings coded under "guidance and reunion," 26 for "messages and visitations," and 340 for "conversations," with the total of 633 Wall postings under the central thematic heading of paranormal copresence. This research highlights how individuals have transcended the limitations of time and physical space in relation to traditional bereavement behavior and rituals and how data found on public websites, such as Facebook, can be used to further theorize bereavement and to demonstrate continue bonds between the living and the dead.

Post-bereavement hallucinatory experiences: A critical overview of population and clinical studies

BACKGROUND

Removal of the "bereavement exclusion" criterion for major depression and proposed research criteria for persistent complex bereavement disorder in DSM-V pose new compelling issues regarding the adequacy of current nosographical boundaries. Post-bereavement hallucinatory experiences (PBHE) are abnormal sensory experiences that are frequently reported by bereaved individuals without a history of mental disorder. Given current uncertainty over the continuum of psychotic experiences in the general population, whether or not they should be considered pathological remains unclear.

METHODS

In order to systemize available knowledge, we reviewed the literature describing general population and clinical studies on PBHEs. Given the relatively low number of articles, all peer-reviewed, published studies in English were included. No study characteristics or publication date restrictions were imposed.

RESULTS

Overall, evidence suggests a strikingly high prevalence of PBHEs - ranging from 30% to 60% - among widowed subjects, giving consistence and legitimacy to these phenomena.

LIMITATIONS

Whereas general population studies had adequate sample size numbers, all studies in the bereaved population had a very small number of subjects. No consensus for method of evaluation exists in the literature, with some studies using a free interview method and others using semi-structured interviews.

CONCLUSIONS

The available literature appears to support an elevated frequency of PBHEs in bereaved individuals, but further research is needed to increase the reliability of these findings and refine the boundaries between physiological and pathological experiences.

[Negative hallucination, self-onsciousness and ageing]

BACKGROUND

Negative hallucinations are characterized by a defect in perception of an object or a person, or a denial of the existence of their perception. Negative hallucinations create blank spaces, due to both an impossible representation and an incapability of investment in reality. They have a close relationship with Cotard's syndrome, delusional theme of organ denial observed in melancholic syndromes in the elderly.

METHODS

Phenomenological approach. The phenomenology of negative hallucinations provides quite an amount of information on the origin of the psychotic symptoms when one is rather old.

RESULTS

The connections between hallucinations, mood disorders and negative symptoms are often difficult to live with for the nearest and dearest. Negative hallucinations require a strict approach to identify their expression that is crucial because a wide heterogeneity exists within the pathological pictures, as in Cotard's syndrome. Although the negative hallucination has an anti traumatic function in elderly people fighting against mental pain, it still represents a deficiency in symbolization. The prevalence of this symptom is without doubt underestimated, although its presence often underlines thymic suffering that is more striking. These hallucinatory symptoms have an important impact on the patients' daily life, and they appear to be prisoners of a suffering, which cannot be revealed.

CONCLUSIONS

We propose in this article to review the clinical symptoms of negative hallucinations in the elderly and the way to manage them. The medicinal approaches are not always effective. A greater place must be given to what is in connection with the body, aiming at a strong impact and thus to offer non-pharmacological approaches, such as somatic ones, which can be either invasive (electroconvulsive therapy) or not (transcranial magnetic stimulation).

Culture and hallucinations: overview and future directions

A number of studies have explored hallucinations as complex experiences involving interactions between psychological, biological, and environmental factors and mechanisms. Nevertheless, relatively little attention has focused on the role of culture in shaping hallucinations. This article reviews the published research, drawing on the expertise of both anthropologists and psychologists. We argue that the extant body of work suggests that culture does indeed have a significant impact on the experience, understanding, and labeling of hallucinations and that there may be important theoretical and clinical consequences of that observation. We find that culture can affect what is identified as a hallucination, that there are different patterns of hallucination among the clinical and nonclinical populations, that hallucinations are often culturally meaningful, that hallucinations occur at different rates in different settings; that culture affects the meaning and characteristics of hallucinations associated with psychosis, and that the cultural variations of psychotic hallucinations may have implications for the clinical outcome of those who struggle with psychosis. We conclude that a clinician should never assume that the mere report of what seems to be a hallucination is necessarily a symptom of pathology and that the patient's cultural background needs to be taken into account when assessing and treating hallucinations.

[Patterns of coping strategies after bereavement among spouses of cancer patients]

The purposes of this study were (1) to identify healthy and unhealthy patterns of coping strategies after bereavement among spouses of cancer patients and 2) to explore the characteristics of patients and spouses associated with these patterns of coping strategies. The participants were 821 bereaved individuals whose spouses had died at the National Cancer Center Hospital East. Three patterns of coping strategies after bereavement were found: "Distraction Focused" (healthy), "Continuing Bonds Focused" (unhealthy), and "General Coping" (almost healthy). Two strategies for improving the unhealthy coping patterns of "Continuing Bonds Focused" were (1) enhancing "Distraction" and reducing "Continuing Bonds" for achieving "Distraction Focused" (healthy) and (2) enhancing both "Distraction" and "Social Sharing/Reconstruction" for achieving "General Coping" (almost healthy). The patients' characteristics associated with the bereaved spouses' coping strategy of "Continuing Bonds Focused" were "under 65 years", "history of psychiatric consultation", "duration of last hospital admission was less than one week", and "time since cancer diagnosis to death was less than one year". These four characteristics of the deceased patients were considered to be risk factors for spouses who would utilize unhealthy coping patterns after bereavement.

Evolutionizing Grief: Viewing Photographs of the Deceased Predicts the Misattribution of Ambiguous Stimuli by the Bereaved

We propose a cognitive-evolutionary model of grief where the function of grief is to reunite a person with an absent partner where this is possible, and where it is not, to disengage and reorientate the individual from the lost agent. The present study investigates the potential factors that affect reunion-promoting symptoms by focusing on the misattribution of external stimuli to the deceased by the bereaved - which we term ‘false recognitions’. We propose three factors that relate to false recognitions: First, we propose that strong attachment to the deceased predisposes one to false recognitions; second, we predict that viewing photographs of the deceased (that were taken when the individual was alive) perpetuates false recognitions; and third, we propose that time elapsing since the death diminishes the frequency of false recognitions. In a survey of 164 recently bereaved (<25 months) pet owners in the U.S. and U.K., predictions concerning the association of the predictor and outcome variables were confirmed. The strongest predictor was the frequency of viewing photographic images of the deceased, a pattern consonant with our premise that, being evolutionarily novel, realistic photographs are treated as reliable cues that the agent remains a viable relationship partner. This research demonstrates the potential of evolutionary theory to inform mainstream bereavement research.

Do grief self-help books convey contemporary perspectives on grieving?

Grief therapy and psychology literatures of the modern Western world conceptualized bereavement and grief as processes to be "worked through" so that other relationships could be pursued. In the last decade or so, however, grief theorists have endorsed the value of attaining new meaning(s) and continuing bonds with our lost loved ones instead of "moving on from," "letting go of" or "achieving closure from" them. This article tracks the evolution of thought pertaining to this shift and examines its relevance to grief self-help books that may offer Americans guidance in the ways of grieving.

Psychological states and coping strategies after bereavement among spouses of cancer patients: a quantitative study in Japan

PURPOSE

The purposes of this study were (1) to characterize psychological states and coping strategies after bereavement among spouses of cancer patients in Japan and (2) to explore the factors associated with psychological states in oncology settings.

METHODS

In March 2009, questionnaires to assess spouses' psychological states, coping strategies, and mental health states (GHQ-28) were sent after patients died at the National Cancer Center of Japan. To address the first purpose, exploratory factor analysis, gender comparison, and calculation of correlation with age, time since bereavement, and mental health states were conducted. Hierarchical regression analysis was conducted to address the second purpose.

RESULTS

A total of 821 spouses experiencing bereavement for 7 months to 7 years participated in the study. Psychological states revealed three factor structures: "Anxiety/Depression/Anger", "Yearning", and "Acceptance/Future-Oriented Feelings". Coping strategies also revealed three factor structures: "Distraction", "Continuing Bonds", and "Social Sharing/Reconstruction". Coping strategies represented 18 % to 34 % of each factor associated with psychological states, whereas the characteristics of bereaved spouses and deceased patients represented 6 % and less than 6 %, respectively. More "Distraction and Social Sharing/Reconstruction" and less "Continuing Bonds" were significantly associated coping strategies for achieving "Acceptance/Future-Oriented Feelings" (p < 0.01).

CONCLUSIONS

Both psychological states and coping strategies after bereavement revealed three factor structures. Coping strategies was the primary, bereaved spouses' characteristics was the secondary, and deceased patients' characteristics was the tertiary factor associated with psychological states. Enhancing "Distraction" and "Social Sharing/Reconstruction", and reducing "Continuing Bonds" might be promising strategies for achieving positive psychological states of the bereaved.

Sense of presence experiences and meaning-making in bereavement: a qualitative analysis

This qualitative study aimed to explore the potential role that might be played by the reported experience of "sensing the presence of the deceased" in meaning-making processes in bereavement. Semistructured interviews were conducted with 12 participants who reported having had such an experience and the transcripts were subjected to thematic analysis. Seven overarching themes were identified, 3 of which were considered central: finding benefit in the continuation of the deceased, finding benefit in the continued relationship, and finding meaning through existential, spiritual, and religious sense-making. While participants found many benefits in what they experienced, finding meaning beyond immediate coping seemed to require the availability of spiritual/religious frameworks that could be adopted or, if available but discrepant, could meaningfully accommodate the experience.

Ghosts, meaning, and faith: after-death communications in bereavement narratives

After-death communications (ADCs) are reported encounters with a deceased loved one, a contemporary type of ghost experience heralded as therapeutic in coping with bereavement. Pertinent literature generally illustrates the healing power of ADCs with brief self-contained episodes. The functions of ADCs over the course of grief need exploration. To that end, this article analyzes 20 published book-length autobiographical stories of bereavement in which authors report ADCs. Two functional patterns are identified--instantaneous relief from painful grief symptoms and reinforcement of a consoling religious worldview. The second dynamic links ADCs to meaning-making and religious coping within Christian and Spiritualist frameworks.

Religion and spirituality in adjustment following bereavement: an integrative review

Surprisingly little research has examined the widely held assumption that religion and spirituality are generally helpful in adjusting to bereavement. A systematic literature search located 73 empirical articles that examined religion/spirituality in the context of bereavement. The authors describe the multidimensional nature of religion/spirituality and use this framework to organize and integrate the findings of these empirical articles. Overall, results suggest that relations between religion and adjustment to bereavement are generally positive but inconsistent and vary depending in part on how religion/spirituality is measured. The authors conclude with a critique of the current research and directions for future research.

Quoth the Raven: Bereavement and the Paranormal

The bereaved often have paranormal experiences: they feel the presence of or see the dead. This article examines the relevance to bereavement of the experiences and of the belief in a life after death. Many professional counselors dismiss the experiences as hallucinatory and the belief as a mark of superstition. This article, however, presents surveys of paranormal experiences and data from physical research that can be used to validate the experiences and belief and to help the bereaved restructure their lives.

Experiencing the Presence of the Dead: Discrepancies in “The Sensing Experience” and Their Psychological Concomitants

Relationships between experiencing “the presence of the dead” and psychological outcome parameters were studied in thirty-nine widows, early in bereavement and twelve months later. Self-evaluation of coping, expectancies about future coping, and scores on psychological standard questionnaires (“Spielberger State-Trait Anxiety Scale” (STAI), “Goldberg Health Questionnaire” (GHQ), “General Well-Being Schedule” (GWB), “Sjõberg Measurement of Mood” (SJO) and “Life Style Index” (LSI) were used as indicators of outcome. A majority of the widows reported “sensing experiences” at both occasions. The sensing experiences were categorized as being “neutral to slightly positive,” “extremely positive,” and “extremely negative.” “Extremely positive,” and “extremely negative” experiences were found to be associated with poor adaptational outcomes, whereas “neutral to slightly positive experiences” and no sensing experiences were associated with good outcomes. The nature of the sensing experience, therefore, seems to predict adaptation after bereavement.

Spiritual bonds to the dead in cross-cultural and historical perspective: comparative religion and modern grief

Contemporary spirituality within continuing bonds with the dead is placed into the comparative context of Western Christianity and Japanese Buddhism. Throughout history, humans have maintained interaction with two kinds of dead: ancestors and sacred dead, the first characterized by symmetrical relationships and the second by asymmetrical. Continuing bonds are deeply connected with, and are often in conflict with, bonds to the nation and (in the West) to God. In this framework, the authors find that continuing bonds in the present function within the private sphere and have very limited functions within the larger society, resemble traditional bonds with the sacred dead, and, at this time, offer a mild critique of the values and lifestyles on which consumer capitalism is based.

Together in spirit: keeping our relationships alive when loved ones die

The premise of this article is that it can be adaptive to maintain bonds with loved ones who have died. The article describes 5 useful strategies for connecting with the deceased, which include recognizing the ways in which the deceased leave an imprint upon our lives, deriving a sense of meaning from the deceased's life, using objects that symbolically link us to persons who have died, identifying ceremonial opportunities for including the deceased in our lives, and reviewing the deceased's life story. Following discussion of these strategies, implications for counseling and outreach are briefly addressed. Finally, discussion focuses on how acknowledging our bonds with the deceased has the potential to aid us in confronting our own mortality.

Ancestor Worship in Japan: Dependence and the Resolution of Grief

Ancestor worship in Japan is ritual, supported by a sophisticated theory, by which the living manage their bonds with the dead. Differing cultural values on autonomy/dependence create differences in interpersonal bonds, thus different dynamics in breaking and continuing bonds after death. This article defines ancestor worship and places in its historical/political context, discusses autonomy and dependence as cultural values in terms of expressions and resolutions of grief, and describes ancestor worship as processes similar to the resolution of grief in the modern West.

Correlates of Sensing the Presence of a Deceased Spouse

Although sensing the presence of a deceased spouse has been a reported phenomenon accompanying bereavement, the question remains as to what factors discriminate those widows who experience the phenomenon from those who do not. The purpose of this study was to explore the social, psychological, and behavioral characteristics correlated with the sensing phenomenon, and to provide a means for predicting the likelihood of such an occurrence. The sample consisted of 294 Arizona widows. Participants responded to a questionnaire concerning health, financial matters, social support networks, depression, drinking behavior, psychosocial problems, and social activities. Respondents were grouped according to whether or not they reported having had a sensing experience. A discriminant analysis was utilized to differentiate between the groups. Findings indicated that fourteen variables formed a function capable of 67.31 percent accurate prediction. An additional analysis, utilizing the five most powerful variables, resulted in a function capable of 66.49 percent accurate prediction.

Toward the Development of a Theory of Bereavement Guilt: Sources of Guilt in Bereaved Parents

Guilt has been reported as a common manifestation of grief, yet bereavement guilt is poorly understood and has not been adequately incorporated into bereavement theory. As a first step in the development of a theory of bereavement guilt, this article presents a conceptual model of sources of guilt in bereaved parents. This model identifies five sources of guilt: Cultural Role Guilt, Death Causation Guilt, Moral Guilt, Survivor Guilt, and Recovery Guilt. A pilot study of twenty-eight bereaved parents was conducted to assess the adequacy of this model. Findings provide partial support for the model and suggest an additional category, Grief Guilt. The most common types of guilt were Death Causation Guilt and Cultural Role Guilt. Rationalizing and sharing were the two most common guilt ameliorating strategies used. Suggestions for continued theory development are presented.

Coping with Bereavement: A Review of the Grief Work Hypothesis

The article challenges the longstanding belief in the importance of “grief work” for adjustment to bereavement (the grief work hypothesis). It examines claims made in theoretical formulations and principles of grief counseling and therapy concerning the necessity of working through loss. Empirical evidence is reviewed, and cross-cultural findings are described to document alternative patterns of coping with grief. It is argued that there are grounds for questioning the hypothesis: 1) existing definitions and operationalizations are problematic; 2) the few empirical studies that have examined the impact of grief work have yielded equivocal results; 3) grief work is not a universal concept. Limitations of the grief work hypothesis as an explanation of coping with bereavement are identified and a differential approach is suggested. Implications for counseling and therapy are discussed.

Natural Death and the Noble Savage

The belief that dying and grieving are natural processes is widely held in modern palliative and bereavement care. The article examines four assumptions often made in this connection: 1) that most primitive cultures deal with death in an accepting way, 2) that this way is different from our own, 3) that it is a good and noble way, and 4) that traditional societies see death as natural. These assumptions are not clearly supported by evidence; they draw their plausibility from the myth of the noble savage. Humane approaches to dying and grieving today should be grounded not in mythical notions of the natural, but in the on-going project to develop ways of dying and grieving appropriate to our own time and place.

Bereavement among elderly people: grief reactions, post-bereavement hallucinations and quality of life

Ratings of grief reactions, post-bereavement hallucinations and illusions and quality of life were made during the first year after the death of a spouse among 14 men and 36 women in their early seventies. In both sexes, the reactions were generally moderate or mild and characterized by loneliness, low mood, fatigue, anxiety and cognitive dysfunctioning. Feeling lonely was the most persistent problem during the year. Post-bereavement hallucinations or illusions were very frequent and considered helpful. Half of the subjects felt the presence of the deceased (illusions); about one third reported seeing, hearing and talking to the deceased (hallucinations). Former marital harmony was found to make a person more prone to loneliness, crying and hallucinations or illusions. The quality of life was significantly lower among the bereaved than among married people and those who never married, but equalled that found among divorcees.