Continuing Bonds in the Existential, Phenomenological, and Cultural Study of Grief: Prolegomena

The essay makes the case that continuing bonds is a useful perspective for bereavement studies based in existential, phenomenological, and cultural philosophy. First, the idea of continuing bonds has explanatory power for many phenomena in individual and family grief and in the multiple interactions between individual/family grief and larger social/cultural dynamics. Second, in the study of continuing bonds we find concepts that are akin to those in phenomenology and existentialism. Using some of my own scholarship and the scholarship of many others, the essay is structured by themes Edith Marie Steffen and I found in our 2018 anthology on developments in the continuing bonds model in the two decades after it was introduced: Continuing bonds (1) are inter-subjective, (2) are central in constructing meaning, (3) raise questions about the ontological status of our interactions with the dead, and (4) are best understood within their cultural setting.

Current locoregional therapies and treatment strategies in hepatocellular carcinoma

Locoregional therapies (lrts) play an important role in the treatment of hepatocellular carcinoma (hcc), with the aim of increasing overall survival while preserving liver function. Various forms of lrt are available, and choosing the best one depends on technical aspects, liver morphology, tumour biology, and the patient's symptoms. The purpose of the present review article is to provide an overview of the current evidence relating to the use of percutaneous ablation, transarterial chemoembolization, and transarterial radioembolization for the curative or palliative treatment of hcc. Special situations are also reviewed, including the combined use of systemic therapy and lrt, indications and techniques for bridging to transplant and downstaging, and the use of lrt to treat patients with hcc and macrovascular invasion.

Optimized nerve block techniques while performing percutaneous hepatic ablation:

Percutaneous image guided thermal ablation has become a cornerstone of therapy for patients with oligometastatic disease and primary liver malignancies. Evolving from percutaneous ethanol injection (PEI), thermal ablation utilizing radiofrequency ablation (RFA) and microwave ablation (MWA) have become the standard approach in the treatment of isolated lesions that fit within the size criteria for curative intent therapy (typically 3-4cm). With the evolution of more intense thermal ablation, such as MWA, the dramatic increase in both the size of ablation zone and intensity of heat generation have extended the limits of this technique. As a result of these innovations, intra-procedural and post-procedural pain have also significantly increased, requiring either higher levels of intravenous sedation or, in some institutions, general anesthesia. In addition to the increase in therapeutic intensity, the use of intravenous sedation during aggressive ablation procedures carries the risk of over-sedation when the noxious insult (i.e. the ablation) is removed, adding further difficulty to post-procedural recovery and management. Furthermore, high subdiaphragmatic lesions become challenging in this setting due to issues relating to sedation and compliance with breath hold/breathing instructions. Although general anesthesia may mitigate these complications, the added resources associated with providing general anesthesia during ablation is not cost effective and may result in substantial delays in treatment. The reduction of Aerosol Generating Medical Procedures (AGMP), such as intubation due to the COVID-19 Pandemic, must also be taken into consideration. Due to the potential increased risk of infection transmission, alternatives to general anesthesia should be considered when safe and possible. Upper abdominal regional nerve block techniques have been used to manage pain related to trauma, surgery, and cancer; however, blocks of this nature are not well described in the interventional radiology literature. The McGill University group has developed experience in using such blocks as splanchnic, celiac and hepatic hilar nerve blocks to provide peri-procedural pain control [1]. Since incorporating these techniques (along with hydrodissection with tumescent anesthesia), we have also observed in our high volume ablation center a dramatic decrease in the amount of sedatives administered during the procedure, a decrease in patient discomfort during localization and ablation, as well as decreased pain post-procedure. Faster time to discharge and overall reduction in room procedural time serve as added benefits. The purpose of this publication is to outline and illustrate the practical application and use of nerve block/regional anesthesia techniques with respect to percutaneous hepatic thermal ablation.

Varieties of Transcending Experience at Death: A Videotape Based Study

Using the idea of transcendence taken from the comparative study of religions, the paper is an attempt to find concepts that might help us understand the many ways people transform their relationship with death in the encounter with death. The method was to videotape interviews with dying and grieving people and view them repeatedly describing the process through which they were passing. Thirty tapes were made. Two sets of concepts were found useful to synthesize and differentiate the ways people transcend: the experience of ordinary and nonordinary reality, and the use of a mythic or interpretive mode in which change takes place. Together these concepts yield four kinds of transcending. An example and some bibliographic notes are given for each.

Developing a Cross-Cultural Model of Grief: The State of the Field

The article explores the state of the field in developing a cross-cultural model of grief. Dialogues within several disciplines bear on the question, but those dialogues are very separated from each other. After drawing a distinction between cross-cultural and multi-cultural, the article reviews research from a broad range of psychological and social sciences. The issue of psychic unity vs. cultural diversity had prevented fuller use of anthropologists' work, but sociology of knowledge mediates between those poles. Contemporary work on the universality of emotions provides the concept of innate meta interpretive schemas within cognitive models supplied by culture. Cultural historians trace changes in how death is perceived and in the acceptability of emotional expression. The article concludes with two suggestions to carry the field forward: one a large scale cross-cultural survey and the other qualitative study in both the researcher's culture and in other cultures.

The case for a sociology of dying, death, and bereavement

Dying, death, and bereavement do not occur in a social vacuum. How individuals and groups experience these phenomena will be largely influenced by the social context in which they occur. To develop an adequate understanding of dying, death, and bereavement we therefore need to incorporate a sociological perspective into our analysis. This article examines why a sociological perspective is necessary and explores various ways in which sociology can be of practical value in both intellectual and professional contexts. A case study comparing psychological and sociological perspectives is offered by way of illustration.

Introduction to special issue: Robert Jay Kastenbaum (1932-2013)

The three pieces in this section introduce the Festschrift celebrating the works and influence of Omega: Journal of Death and Dying's founding editor, Robert Kastenbaum. Robert Fulton, an early Associate Editor of the Journal begins with some personal reflections on Kastenbaum. Klass and Doka then describe the nature of the Festschrift. A closing coda by Robert Kastenbaum's wife, Beatrice Kastenbaum, reminds us of the person behind the work.

Continuing bonds, society, and human experience: family dead, hostile dead, political dead

In most times and places, the focus of continuing bonds is on the well-being and activity of the dead that are linked to the well-being and activity of the living. In this article we describe continuing bonds across cultures by focusing on the dead. Three relationships between the living and the dead organize our thinking. First, the family dead in which living and dead offer help to each other. Second, the hostile dead that threaten the well being of the living. Third, the political dead in which the living enlisting the dead in political conflicts, and the dead motivate the living to battle on their behalf. Shifting the focus this way allows us to see that continuing bonds play important roles in larger narratives as well as in individual and family narratives.

Grief, Consolation, and Religions: A Conceptual Framework

Consolation is grief's traditional amelioration, but contemporary bereavement theory lacks a conceptual framework to include it. The article begins to develop that framework. The article argues that grief is inter-subjective, even at the biological level. Consolation and grief happen in the same inter-subjective space. Material from the histories of several religions sets the article in a cross-cultural and historical environment. The article examines consolation in interpersonal relationships, and then moves to consolation in cultural/religious resources that range from the literal image of God as an idealized parent to the abstract architecture of Brahm's Requiem. The most common consolation in the histories of religions comes within continuing bonds that are accessed in a wide variety of beliefs, rituals, and devotional objects. The article closes by briefly drawing the connection between consolation and faith.

A social constructionist account of grief: loss and the narration of meaning

In contrast to dominant Western conceptions of bereavement in largely intrapsychic terms, the authors argue that grief or mourning is not primarily an interior process, but rather one that is intricately social, as the bereaved commonly seek meaning in this unsought transition in not only personal and familial, but also broader community and even cultural spheres. The authors therefore advocate a social constructionist model of grieving in which the narrative processes by which meanings are found, appropriated, or assembled occur at least as fully between people as within them. In this view, mourning is a situated interpretive and communicative activity charged with establishing the meaning of the deceased's life and death, as well as the postdeath status of the bereaved within the broader community concerned with the loss. They describe this multilevel phenomenon drawing first on psychological research on individual self-narratives that organize life experience into plot structures that display some level of consistency over time, whose viability is then negotiated in the intimate interpersonal domain of family and close associates. Second, they explore public communication, including eulogies, grief accounts in popular literature, and elegies. All of these discourses construct the identity of the deceased as he or she was, and as she or he is now in the individual and communal continuing bonds with the deceased. Finally, they consider different cultural contexts to see how expressions of grief are policed to ensure their coherence with the prevailing social and political order. That is, the meanings people find through the situated interpretive and communicative activity that is grieving must either be congruent with the meanings that undergird the larger context or represent an active form of resistance against them.

Sorrow and solace: neglected areas in bereavement research

The author argues that in its focus on finding positive outcomes, bereavement research has neglected or denigrated central phenomena in intense and long-term grief sorrow and solace. Sorrow has two elements: yearning for the dead person and griefs depression. Consolation comes into sorrow in human relationships and from inner resources. The article notes that griefs depression can be, as William James said, the "openers of our eyes to the deepest levels of truth. "The author argues that our research would be more complete were we to include solace that comes into sorrow as one of the outcomes we can help foster.

Hepatic embolotherapy in interventional oncology: technology, techniques, and applications

Embolotherapy continues to play a growing role in the management of primary and secondary hepatic malignancies. In this review article, we examine the basis of therapy with a focus on neovascularization, which makes treatments via the hepatic artery possible. An overview of the three generations of embolic and therapeutic agents follows. The techniques, technologies, and complications of bland embolization, transarterial chemoembolization, drug-eluting beads, and selective internal radiotherapy are covered to give the reader an overview of this exciting field in interventional radiology.

Continuing conversation about continuing bonds

The article is a response to the contributions the special issue of Death Studies on continuing bonds. The contributions indicate that the conversation among scholars has clarified our thinking on how bonds function in individual grief. The author discussed two issues to help keep the conversation moving: (a) the relationship of continuing bonds to the complex we call adjustment to or resolution of grief, and (b) the social and communal nature of continuing bonds. In the first, the author concluded that the hypothesis that continuing bonds either help or hinder grief adjustment too simple to account for the evidence. In the second, he argued that cultural/political narratives are woven into individual grief narratives and if we do not include community, cultural, and political narratives in our understanding of continuing bonds we are in danger building bereavement theory that applies to only a small portion of one population in one historical time.