Development of the Grief Experience Questionnaire

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  • Development of the Grief Experience Questionnaire

    Terence W. Barrett, PhD Moorhead State University

    Thomas B. Scott, PhD University of North Dakota

    ABSTRACT: The development of the Grief Experience Questionnaire (GEQ) is reported. This questionnaire is an instrument for measuring various components of grief, including somatic reactions, general grief reactions, search for explanation, loss of social support, stigmatization, guilt, responsibility, shame, rejection, self-destructive behavior, and re- actions to a unique form of death. Initial results with the GEQ suggest its potential to differentiate grief reactions experienced by suicide survivors from those experienced by survivors of accidental death, unexpected natural death, and expected natural death. Conclusions support its use in redressing common methodological criticisms of suicide survivor research. Six additional benefits derived from use of this instrument are discussed.

    For many years, clinical opinion has been that the experience of grief and its subsequent resolution in cases of suicide are different from that experienced in grief in general. A common opinion is that those intimately associated with a person who completes suicide suffer bereavement that is both qualitatively and quantitatively different from bereavement accompanying other forms of death (Calhoun, Selby, & Selby, 1982; Cantor, 1975; Hauser, 1987; Saunders, 1981; Shneidman, 1971; Solomon, 1981; Wallace, 1973). How can we determine this? Although the study of suicide bereavement has gained momentum since 1980, there have been few serious attempts to empirically evaluate the suspected dif- ferences between suicide survivorship and other forms of bereavement (McIntosh, 1985). The paucity and limitations of the literature regarding survivors of suicide, including lack of measurement tools, has been noted earlier (Calhoun et al., 1982; Foglia, 1977; Hatton & Valente, 1981; Henley, 1984; Henslin, 1971; McIntosh, 1985; Schuyler, 1973).

    This paper is based on research conducted with an instrument developed for use in Barretts doctoral dissertation, submitted to the University of North Dakota in partial fulfillment of degree requirements. Request for reprints should be sent to Terence W. Barrett, Moorhead State University Counseling Center, Box 417, Moorhead, MN 56560.

    Suicide and Life-Threatening Behavior, Vol. 19(2), Summer 1989 0 1989 The American Association of Suicidology 201

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    Instruments measuring grief reactions have been constructed. Scales such as the Texas Inventory of Grief (Faschingbauer, Devaul, & Zisook, 1977) and the Grief Experience Inventory (Sanders, 1982-19831, and checklists of grief feelings, experiences, and behaviors (Glick, Weiss, & Parkes, 19741, have been applied in select grief studies (e.g., Farberow, Gallagher, Gilewski, & Thompson, 1987; Lund, Caserta, & Dimond, 1986). Unfortunately, such instruments are often narrow in scope, sta- tistically cumbersome, or too general to employ in the study of suicide bereavements specific reactions, and none have been used widely.

    A major outcome from a study (Barrett, 1987) examining attitudinal and experiential differences across bereavement groups was the de- velopment of an instrument for measuring various components of grief. Titled the Grief Experience Questionnaire (GEQ), the development of that instrument and its description are the topics of this paper.

    Instrument Development

    The GEQ was designed as the primary instrument in a study comparing the bereavement experience of suicide survivors with those of natural- death and accidental-death survivors. A primary focus of investigation was upon the presence or absence of certain factors believed to be unique to suicide bereavement.

    The GEQ measures two general types of grief reaction: those expected in any bereavement and those specific to suicide bereavement. Suicide bereavement is, in large part, a natural reaction to a significant loss. In this regard, it is similar to other bereavements. Therefore, suicide bereavement is comprised of grief reactions common to any other be- reavement. Common grief reactions are reflected in two dimensions of the GEQ, Somatic Reactions and General Grief Reactions.

    The literature on suicide survivors consistently suggests that certain grief reactions appear to be unique among these survivors; that is, they are uncommon among all other survivors. The dimensions of the GEQ reflecting unique grief reactions include Search for Explanation, Loss of Social Support, Stigmatization, Guilt, Responsibility, Shame, Rejec- tion, Self-Destructive Behavior, and Unique Reactions.

    Operational Definitions

    Operational definitions of the 11 GEQ dimensions follow. 1. Somatic Reactions. Bereavement is usually a stressful and long-

    enduring experience for most survivors. As such, grief often includes

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    concomitant physical reactions typical of stress. Survivors often become ill during bereavement, and many become concerned about their health. It appears that all survivors are more likely to consult a doctor during bereavement than they might have been before the death. Parkes and Weiss (1983) have suggested several somatic symptoms that are likely to be reactions to bereavement. Included among these are running or clogged nose, lump in the throat, chest pain, palpitations, sick feeling, frequent urination, itching, dizziness or fainting, nervousness, trembling or twitching, hot flashes, and inappropriate sweating. This dimension of the GEQ reflects physical reactions common among most survivors and measures the survivor's general perception of his or her physical condition during the bereavement.

    2. General Grief Reactions. The manner in which individuals grieve has been reported clearly in the literature (e.g., Bowlby, 1961; Hinton, 1972; Lindemann, 1944; Parkes, 1970). Many of the grief reactions that survivors experience after a death are remarkably uniform. These predictable grief reactions have physical, emotional, behavioral, and psychological components. For example, most survivors experience shock reactions such as numbness, denial, and panic attacks. Survivors also typically display extreme behaviors such as crying, wailing, hostility, and aggression. A survivor's thoughts are likely to be preoccupied with the decedent, and feelings of guilt, rage, despair, and emptiness are to be expected. This dimension, then, reflects research findings indicating that certain reactions are common to most grief experiences, regardless of cause of death.

    3. Search for Explanation. Death is most easily accepted when the survivor can intellectually formulate a plausible reason for it. Con- sequently, survivors commonly search for reasons to explain the oc- currence of death. Seeking an understanding for why the death occurred appears to be a significant component of suicide. Frequently concluded is that the many and complex factors involved in suicide make the search for explanation more intense, more solitary, and less easily resolved for suicide survivors than it is in any other form of bereavement (Calhoun et al., 1982; Wallace, 1977). This dimension reflects suicide survivors' engagement in a more difficult and more enduring search for acceptable reasons in the experience of suicidal death.

    4. Loss of Social Support. Bereaved individuals often report that friends and family do not seem to be supportive enough during a period of grief. This may take the form of avoidance, abandonment of friendship, an unwillingness to listen, lack of concern and understanding, or iso- lation. Although the real or perceived loss of support from family and friends is commonly considered concomitant with grief, several authors have reported that a family grieving over a suicide is given even less

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    overt social support than is normal in other bereavements (Calhoun, Selby, & Faulstich, 1980; Hatton & Valente, 1981; Osterweis, Solomon, & Green, 1984; Sheskin & Wallace, 1967). The increased social isolation and alienation of suicide survivors have been noted often (Rando, 1984; Schuyler, 1973; Wallace, 1973, 1977). Danto (1977) has specifically noted that two sources of support offered under normal death circum- stances- that is, support from neighbors and in-laws-are conspicuously absent in most instances of suicide. This dimension reflects the suggestion that generally negative social perceptions of suicide result in more frequent and severe isolation and alienation of the suicide survivor.

    5. Stigmatization. Solomon (1982) has described stigma as a mark upon the survivor that potentially detracts from his or her character or reputation. Hewett (19801, explaining the Greek derivation of the word, states that stigma results from disgrace and reproach expressed by others. A natural death does not typically stigmatize the survivor to any degree. It is frequently suggested, however, that suicide not only stigmatizes the survivor; it also results in more negative views of the family than do other types of death (Calhoun, Selby, & Abernathy, 1984; Charmaz, 1980; Colt, 1987; Hewett, 1980; Rando, 1984; Shneidman, 1976; Worden, 1982). Maris (1981) reports that suicidal death has been routinely stigmatized in our society as cowardly, irresponsible, or nar- cissistic. Therefore, if the suicide survivor encounters gossip, negative attitudes, social avoidance, hints of family discord or mental illness, or overt blame for the death, he or she is likely to feel stigmatized by the suicide. This dimension is based on the common suggestion that suicide reflects negatively upon and permanently marks the survivor as different from other survivors.

    6. Guilt. The experience of self-reproach is a common element of most bereavements (Parkes, 1970). Following any death, survivors might be expected to experience some sense of guilt regarding features of their relationship with the decedent. Such guilt derives from things said or done and from things not said or done in the time before the death occurred. It is not that guilt experienced during suicide bereave- ment is unique, but that such guilt is so frequent and intense. In fact, severe guilt is one of the most commonly reported reactions concomitant to suicidal grief. Unlike that which is experienced in other forms of grief, guilt is reported to be more frequent, more intense, and of longer duration in suicide (Battle, 1984; Danto, 1977; Maris, 1981; Rando, 1984; Solomon, 1981; Worden, 1982). This dimension reflects this sug- gestion that guilt is more frequent and severe among suicide survivors.

    7. Responsibility. Generally, bereaved survivors seldom believe that a death could have or should have been prevented. They are not likely to believe that their interactions with the decedent either led up to or

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    actually caused the death. If a survivor should experience such sensations, they are expected to be of minimal intensity and duration. In contrast, various ways in which a suicide survivor may be burdened with an overwhelming sense of responsibility in the death of a spouse have been described (Battle, 1984; Charmaz, 1980; Fliegel, 1977; Henslin, 1972). Probably the most troubling way a suicide survivor experiences responsibility for the suicide is the perception that somehow he or she directly caused the death. Similarly, a survivor may sense that he or she could have or should have prevented the suicide. A survivor may believe that he or she should have been aware of the suicidal intent of the decedent, or, if the intent had been communicated, should have informed others of such intent. This dimension reflects the suggestion that complicity in the cause of death is often experienced by the suicide survivor.

    8. Shame. Worden (1982) has stated that, of all the specific feelings suicide survivors experience, shame is one of the most predominant. Unlike other survivors, survivors of suicide are likely to experience a sense of shame and embarrassment about the nature of the death and report feelings of shame at having to tell others that a family member died by suicide (Buksbazen, 1976; Fisher, Barnett, & Collins, 1976; Hajal, 1977; Hewett, 1980). Ginsburg (1971) reports that suicide is perceived by many people as a shameful event. The experience of shame may result in a frequent denial of the cause of the death and in an inability to talk openly and honestly about the death. Calhoun et al. (1982) add that this sense of shame may generally lead survivors to experience discomfort in social interactions. This dimension reflects the suggestion that the experience of embarrassment regarding the cause, nature, or circumstances of the death is common to suicide be- reavement.

    9. Rejection. It is not uncommon for a grieving survivor to experience a sense of having been deserted by the deceased. Typically, this is a fleeting sensation. While most survivors report feeling sometimes that their loved ones deserted them by dying, there is little implication that death or desertion is an intentional act on the part of a decedent. Feeling deserted is usually overcome by the realities surrounding the death. As Schuyler (1973) has explained, a survivor rationally under- stands that the deceased did not leave him or her behind intentionally. After a suicide, however, the feeling of being deserted can be a serious and enduring concern. Y&it (1977) states that, though feelings associated with implied rejection may be present in other forms of death, they are not usually as intense or severe as in the case of suicide. In fact, with suicide, rejection is implied by the very specific act of the decedent, and a suicide survivor often experiences the death as an outright and

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    intentional rejection by the decedent (Ostenveis et al., 1984; Rando, 1984; Saunders, 1981). This dimension reflects the suggestion that suicide often implies a deliberate abandonment and rejection of life, the survivor, and the relationship with the survivor by the deceased.

    10. Self-Destructive Behavior. Arnold Toynbee (1976) coined the phrase peril of survivorship to describe the observation that a bereaved survivors life is actually in jeopardy. For at least a year after a death, regardless of the type of bereavement, a survivor is more likely to take less adequate care of himself or herself, to become ill, to be hospitalized, to be involved in accidents, to die, or to be killed. Examples of life- threatening behaviors for which any survivor may be at risk during bereavement include such obvious features as suicide attempts, self- inflicted physical injuries, and driving while under the influence of alcohol or narcotics. More subtle behaviors-lack of appropriate hygiene; food, drug, and alcohol abuse; and lack of concern for health-are also common. The peril to suicide survivors has been reported to be gre...

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