To understand the difficulties of making death notifications, knowledge of grief, mourning and bereavement is necessary. DeSpelder and Strickland define these as follows: Grief is the reaction to a loss. It encompasses thoughts and feelings, as well as physical, behavioral and spiritual responses. Mourning is the process by which a bereaved person integrates the loss into his or her ongoing life. Bereavement is simply the objective event of loss. According to DeSpelder "bereavement comes from the root word meaning 'shorn off or torn up' thus conveying the feeling of something precious being suddenly yanked away by a disruptive force." (DeSpelder, 2002)
The shock of learning of a family member's death can have serious implications.
It is well documented that survivors can experience symptoms similar
to Post Traumatic Stress Disorder (PTSD) following notification
of an unexpected death. (Janzen,
2003; Miller, 2008b;
Sewell, 1993) According
to Goodrum (2005)
"the range of emotional reactions that bereaved victims experience
following the notification and the strategies they use to cope
with the notification can contribute to the length of the grieving
process. (Goodrum, 2005)
The five stages of dealing with death identified by Dr. Elizabeth Kubler-Ross, based on case studies with terminal patients, are Denial, Anger, Bargaining, Depression and Acceptance. Similar emotions are experienced by someone informed of the death of a loved one. As Dr. Kubler-Ross explained, not everyone experiences each stage, and the experience is not in any specific order. (Kubler-Ross, 1969)
Dr. Margaret Epperson identified six stages experienced by people in sudden crisis after being notified of the unexpected death of a loved one. She used the definition by Dr. Erich Lindemann of sudden crisis as "an upset in a steady state." Epperson's model included High Anxiety as a first stage, and substituted Reconciliation for Acceptance as the final stage. (Epperson, 1977). Epperson found that high anxiety is the first reaction to an unexpected loss families experience following notification of a death. It is characterized by signs of agitation, possibly a high-pitched voice, fainting, nausea and other typical signs of stress. Reconciliation is usually the last to occur. According to Epperson, "reconciliation is used because it differs from acceptance in that it connotes a 'bringing together' or 'harmony' in all that has taken place following the death notification. (Epperson, 1977)
The physiology of grief response differs greatly from person to person. Depending on the many factors involved in the death, stress placed on survivors can vary in intensity and expression. Knowledge and understanding of grief responses can help notifiers avoid misunderstanding reactions expressed by survivors and family members. Law enforcement officers with better training could help grieving families work through the initial notification process and leave the survivors with feelings of emotional support. A hurried exit from the emotionally-charged grieving scene could do the opposite.
R. Maroni Leash identifies some common grief responses to death notification. His models include:
- Holistic Grief - Individuals gather together and openly express their grief, often allowing others who are present to join them.
- Action-oriented Grief - This response is characterized by rapid movement toward organization and activity.
- Inordinately Calm Response - This response usually represents a mild degree of denial. It might appear that the person receiving the news either didn't hear or did not understand the message of death.
- Emotional Withdrawal - The recipient may place barriers to communication and interaction and turn inward, circumventing some or all of the elements of discussion.
- Extreme Guilt - Survivors routinely make statements such as "I shouldn't have let him leave," or "I should have been there."
- Situation Blaming - This is a common response and is quite sensitive to environmental influences and circumstance. Blame is attached to the circumstances that placed the decedent in position to die (i.e. "I shouldn't have loaned him my car," or "I never should have let her go out last night!")
Anger and aggression often occurs in many notification situations. According to Van Bloch in a study of hospital emergency room deaths, "hostility or rage directed toward the hospital and staff is not uncommon; in fact, anticipation of such response may lessen the likelihood of a defensive reaction by Emergency Department Personnel." Bloch also noted that the normal grief reaction usually determined by cultural and sub cultural mores ranges from overtly expressed emotion to quiet stoicism. (Von Bloch, 1996)
Anger is closely associated with the blaming response, according to Leash. One important difference between anger and the blaming response is that the recipient can direct his or her anger at the messenger while blame is usually placed on the decedent, the circumstances or the recipient. Exhibitions of anger may include the throwing and breaking of objects and assaulting the closest object or person available - the messenger. (Leash, 1994)
Knowledge of grief responses is important, if not absolutely necessary. Training
and experience in grief response and reaction can significantly
affect the outcome. Reaction to notifications can range from a
normal response with short recovery period, to a pathological
grief response requiring a long recovery period, lasting years,
and the possible need of psychological treatment. (Miller,
2008b) The words or phrases that were used to give bad news;,
the characteristics of the person who performed the notification
(e.g. physician, police officer, Medicolegal Death Investigator),
the physical setting (e.g. home, hospital, coroner's office, patrol
car) in which the notification occurred, among other aspects,
may all comprise painful memories of the loss that are never forgotten.
Thomas C. Nardi (2006) recommends
the acronym PEWTER as a model for death notification. PEWTER
- P - Prepare
- E - Evaluate
- W - Warn
- T - Tell
- E - Emotional Response
- R - Regrouping
According to Nardi, the communication of bad news begins with the helper (notifier)
being prepared educationally, psychologically, physically and
2006) Loboprabhu (2007)
recommended a problem-solving form of notification. She summarized
her model with the acronym TALK.
Prior to a notification attempt, some knowledge of the victim's family reaction patterns to trauma, especially its legal aftermath, can be helpful in avoiding future conflicts for the family and the messengers.
- T - Think before you speak.
- A - Avoid unnecessary burden to the family by addressing only those issues that need to be dealt with at the present.
- L - Listen (and look) for problems that might not be immediately apparent, such as suppressed grief or rage in a too-quiet family member, a distraught but silent family member in another part of the house, or signs of danger to the notifier.
- K - Know what to say now versus later.
Miller identified five types of family reactions when faced with the trauma of a death notification. They are:
- The Contemptuous Family - They cope with adversity by getting upset, berating and blaming each other and denying the existence of problems.
- The Brittle Family - Members are reluctant to depend on one another for support and understanding.
- The Hierarchical Family - This family functions with a sense of internal unity and purpose but with little flexibility in roles and responsibilities.
- The Enduring Family - This family relies on faith, typically, religious faith to deal with tragedy.
- The Functional Family - When faced with trauma, this family supports and bolsters more severely affected family members while working harmoniously to afford support and caring to one another. (Miller, 2008)
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