Bereavement, Loss and Grief Essay

[psykitsune]

Attachment Theory: Theoretical formations. Amae: Connected Relatedness

The phenomena known as Amae is unique to Japanese culture. As an observable phenomena distilled within progressive iterations of deeply interconnected social interactions (Kumagai & Kumagai, 1986) Amae, “can be viewed either positively or negatively, depending on what is deemed appropriate with respect to maturity or degree of social intimacy,” (Behrens, 2004, pg.2), and indeed as a way of a child exacting control over their social and physical environment (Yamaguchi, 2004). Amae, ethnographically originating from the word amai meaning sugary or sweet, while unique in its sociological modalities within Japan, has characteristics comparable to attachment theory (Behrens, 2004).

Amae is an example of the interplay between child and caregivers. While a child may amaeru (verb present tense) there must be someone, usually the mother, who provides amayakasu—the capacity, in an affective parental relationship, to dictate the amount of amaeru the child can facilitate of (Behrens, 2004).

Within the context of bereavement, therefore, the obvious question is not necessarily what Amae is behaviourally speaking, but what occurs when the ability to amareu is no longer present? When this dyad between caregiver interwoven so intricately is no longer present, is Amae found in the presence of others, or, in a clinical setting, can therapists provide an substitute for it?
In this essay the concept of death, and bereavement interventions, will be examined with explicit focus to attachment theory. It will examine the relationship between child and their primary caregiver, contextualise this within the terms of the secure base and the loss of such, followed by a few observations regarding clinical treatments, while simultaneously juxtaposing a multi-discipline, holistic, awareness of the Living and the Dead.

Attachment Theory and the Secure Base: An Overview

Firstly, we would like to contextualise the mother child relationship.
The Freudian concept of, “all human behaviour…is explained on the basis of one motivational principle, namely drive,” (Gullestad, 2001, pg5) demarcates the psychanalytical view of object relations. From this perspective all behaviours can be viewed or referred to as either fulfilling—or not fulfilling—a latent, unconscious sexual, or aggressive, motivation. In essence, a human is in constant conflict with their environment; a child only relates to his/her mother because it wants to satisfy itself with the pleasure of having its drive met (Jacobs, 2003, pg.52).

Bowlby’s model differs from the Freudian concept of sexual organisation so far as the concept of the secure base is a symbiotic relationship as opposed to a parasitic-like relationship on the part of the child to their mother in the Freudian case. Bowlby termed it the secure base.
A secure base is any object—usually a mother—whom the child utilises as both a place of stability and comfort, as well as a bridgehead that allows for possible exploration of the child’s environment (Eagle, 2017). Indeed, as opposed to Freud’s emphasis on sexual gratification during nursery, attachment theory considers the spatial conditions, keeping proximity by hugging and clinging, to be paramount to the parental relationship (Gullestad, 2001). When this spatial conditionality is broken, through the absence of the mother, separation anxiety occurs whereby the child feels the lack of his/her mother’s presence thus evoking feelings of distress and alarm (Ainsworth, & Bowlby, 1991); notably fright, a stimulus response to a fearful event that leads to rapid seeking of mother and the secure base. The warm and nurturing predisposition of the mother therefore allows exploratory behaviours that, through the gentle weaning—in successive temporal iterations or events across time—from the mother, as a result develops a mature, and secure, personality (Bretherton, 1997).

It should be noted that a significant proportion of Bowlby’s early work derived from animal experimentation (Ainsworth Bowlby, 1991). Furthermore, while higher primates do exhibit similar behaviours, attachment theory considers the human attachment system to be complicated by the presence of emotions (Wachtel, 2017) though this belief is premedicated on the primacy of human emotions over other non-human. Indeed, the idea of a secure base, at a level of first principles, is further involuted by the human ability to conceptualise an abstracted ideal of a secure base—notable work has been done in this area regarding belief in God and the notion of the divine attachment model (Kam, 2018).

Greif and Mourning: Some Procedural Remarks

These two theories of relationship differ drastically in terms of the primacy of a human’s bond to their primary caregiver, though both assume a naturalistic reflection of human. It is obvious, if not apparent, that death is a veil of separation demarcated either by a personal, religious cosmology, or a universal, naturalist finality.

That being said, even in Christendom, heaven is viewed as the apocatatasis, or restoration, which does not promise reunion of the Living with the Dead but only the transformation of the old and the reunion of God and humankind in the new heaven and the new earth (Ware, 1997). While philosophies present eulogies extoling annihilation, reunion, resurrection, and many shades in-between, it is undeniable that the Livings’ relationship with the Dead changes fundamentally after death. For therapists, therefore, must take care not to stray into philosophical deductions as clinical professionals must live amongst the Living and not the Dead.
A theaprist cannot be the caretaker of the Dead within clinical practice. In terms of attachment, however, a clinician can provide that secure base upon which the client derived such meaning from. But this is only a stepping stone during the grieving process.

Attachment and Loss

The process of grieving is multifaceted. (Kaprio, Koskenvuo, & Rita, 1987) found amongst a population of nearly 100,000 widows that bereavement not only caused emotional distress, but excess mortality as a cascade effect deriving from the psychophysiological hurt of the departing. Juxtaposed this against a child who had a beneficial and balanced relationship with the mother(Stroebe, 2002). In this instance the child will process grief differently than a child who was either distant by a lack of motherly receptibility or was succumbed by an overbearing and protective mother (Bretherton, 1985). Naturally, therefore, there is some relationship between what happens at the beginning of life and what occurs at the end.

The state of bereavement is sometimes called reorganisation (Mikulincer, & Shaver, 2008) this being a follow on state from Bolwby’s three stages of protest, despair and detachment, reorganisation “refer(ing) to a specific phase following separation, characterised by the termination of protest and despair,” (Gullestad, 2001, pg.9). Reorganisation, in an typical individual who experienced the ‘right’ quantity and quality of love and encouragement, comes as a difficult but manageable process in the realising of the loss of a secure base. Whereas, in a less ‘ideal’ relationship, whereby the secure base was dysfunctional, later bereavements may take on an extra layer of complexity, especially if the child was overly attached.

As noted by (Stroebe, 2002), the death of a maternal or paternal role model does not necessarily equate—if these can be so arbitrarily measured—to the death of a spouse. Nevertheless, the way that one related to the former greatly impacts upon how one griefs for the latter. Indeed, as noted by (Eagle, 2017) it is the capacity of the paternal/maternal figure which facilities self-exploration and the development of a self-concept as separate from the paternal/maternal figure. If a child is not gently pushed to explore his/her environment this can, “convey to the child that he is unable to manage on his own,” (Gullestad, 2001, pg.11).
 

Attachment Theory: Clinical Modalities

What is Grieving?

Internally, a child has developed an abstraction of their primary caregivers (Bowlby, 1973) the behaviour of which is acted out in the world in a manner that reflects the child's image of other people,” and, “the child's image of the self,” (Bartholomew, & Horowitz, 1996, pg. 226). In adulthood, as a result, how one deals with others is reflective of their formative years; the way a child related to him/herself as a unique locus of actuality in the world, as a consciousness, a consequence of their interactions with their primary caregiver during childhood. For instance a child who, through the dyad of the right amount of exploration and care will develop an attachment style that can bridge autonomy and intimacy. They will be securely attached.


In terms of the loss of a spouse, a client’s relationship to other—the support of their peer/family group—has a positive effect on negating social loneliness but not emotional loneliness (Stroebe, Stroebe, Abakoumkin, & Schut, 1996) an indication that the loss of a spouse, or even a loved one, leaves a hole in the psyche that, seemingly, cannot be entirely satisfied by the Living.
(Stroebe, 2002, pg.133) says, “excessively clingy, insecure child…will…respond to irrevocable loss by obsessive focusing on the deceased…with detrimental consequences for adjustment”—a preoccupied child attachment style. Whereas securely attached children would experience grief as natural phenomena without justification for intensive clinical intervention (Shaver, & Tancredy, 2001). In the latter example, we can see that the secure base, the ability to Amae and amayakasu, has given the individual the coping mechanisms to process grief. But in extreme cases, especially for clients who are dismissive or fearful (in terms of attachment styles) how can clinicians replicate, or generate with the client, a treatment that can fashion a safe, and secure, base?

Interventions

The example of amae is an epiphonema of Japanese sociocultural interdependence that is a consequence of the gestation of both evolution and local custom; it is impossible to replicate at least proscriptively. Similarly, replicating a maternal caregiver, on an ad hoc, case by case basis, will never be the same as having been loved as a child; and even if it were possible humanity is a temporal species and cannot totally revert to childhood. However, with this in mind, clinicians can provide “the next best thing” to aid a grieving client. (Gullestad, 2001) remarks that a therapist can facilitate this by allowing the therapy session, as such, to become the client’s secure base.

(Kam, 2018) recommends, in respect to divine attachment theory, that clinicians–in this case pastorally motived therapists—to, “help the client understand…their God image must be healed through corrective experiential encounters with a loving God,” (pg.346). Theological consideration aside, one possible postulation for intervention could be the facilitation of a curative secure base that, not replaces, but corrects a false concept of the secure base. In other words, retrospectively examining a relationship with a partner, or parent, that was distant or dysfunctional; recognising the possible hurt but, perhaps, coming to terms as to why things occurred as they did. Naturally, however, divine attachment theory has limited pluralistic applications in secular therapy.

(Stroebe, 1996) concedes that emotional loneliness is evident during bereavement. Finding ways to replicate this amongst the Living are, perhaps, ineffective, as in terms of childhood bereavement it is best to foster the relationship with the deceased symbolically through a continuing relationship (Howarth, 2011) and not replace it.

Following on from this, (Shear, 2010) recommends a 16 week treatment plan that involves items such as a grief monitoring diary/ revisiting avoided places / working with memories and, “conversation(s) with the decease(d)” (pg.5) for older adults. Further still, (Shear, 2010) found that complicated grief therapy (a derivative of attachment theory) was effective in treating symptoms as opposed to standard interpersonal psychotherapy. Medication for complicated grief, antidepressants, play a role in mediating some symptoms (Simon, 2013); individuals presenting with an attachment avoidance schema being prone to depressive like symptoms (Meier, Carr, Currier, & Neimeyer, 2013; Maccallum, & Bryant, 2018).

Attachment theory can also be used to navigate the formation of new paternal/maternal bonds in cases of early childhood loss (Zelenko, & Benham, 2002) although in the aforementioned case this cumulated in jurisdictive intervention; in these instances the attachment figure can often be decided judicially and not clinically, only highlighting that clinicians must work within a legal and sociocultural framework.

This being so, perhaps the treatment of bereavement should not be the management of grief at the end of a life, but the fostering of life at its beginning. Current methodologies place great emphasis on symptoms and the clinical facilitations in the therapy room, but this, usually occurs well after the natural gestation of a child and their primary caregivers’ alliance. Future considerations, prescriptive treatment plans, could examine the nurturing of the holistic interdependence of both child and mother during the formative years. So that, when death finally occurs, clients—humanity as a species—are not left without having never Amaeru-ed.
 

Conclusion

The Amae, the sweetness, will be terminated by a corporeal demarcation known as mortality. The ephemerality of clients loving relationships can be better understood through the prism of Attachment Theory; that clients’ primary caregivers are not only foremost in the development of their relationships across time, but, in death, nurture an internalised image that aids individuals during bereavement. While treatment plans, psychoanalytical/humanistic/pluralistic therapy and pharmacological interventions are shown to be effective, the successive nurturing of a strong child/caregiver bond, aids perspective clients with the grieving process without severe symptoms or long-term clinical treatment as seen in more complex cases.  

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