International Society for Traumatic Stress Studies

BOOK REVIEW

Posted 1 April 1998 in StressPoints by Irene Smith Landsman, PhD, Catholic University of America

This book, based on a large longitudinal research study, may be the best guide for widows and those who would assist them since Parkes' and Weiss' 1983 Recovery from Bereavement. Lieberman identifies pervasive societal and clinical myths regarding the experience and status of widows, and challenges these assumptions with observations based on interviews with some 600 widows both soon after their bereavement and a year or more later.

Liberman's findings challenge the idea that widowhood always represents a pervasive and permanent diminution in emotional well-being, social status, and personal effectiveness. His findings show instead that a substantial portion of widows, despite experiencing significant suffering in the months following a spouse's death, not only return to previous levels of functioning but often experience profound and positive changes in their lives.

From a medical model perspective (which Lieberman characterizes as typically male), bereavement may be considered a kind of pathogen, the symptoms and distress of grief seen as a disease process and successful recovery defined as a return to baseline level of functioning. While the medical model validates the significant distress and suffering which often accompanies grief, it also limits our understanding of the full range of possible outcomes. Lieberman's existential perspective allows the possibility of benefits (such as personal growth) occurring not despite but because of encounters with the existential realities of human life, most particularly mortality.

Lieberman has detailed the connections between existential awareness and post-bereavement growth, describing how engagement in the experience and meaning of bereavement may be necessary precondition for such growth. In so doing, he makes sense of the empirical evidence that such growth may occur in individuals who have even the stormiest courses of grief. Lieberman describes four psychological processes that promote growth, each of which requires a significant degree of honesty and courage. These processes include developing an understanding of one's own self, confronting one's own mortality as well as that of loved ones, engaging in a review of one's life and relationship with the deceased, and searching for personal meaning in life.

In Liberman's study, these existential tasks were often associated with intense distress and turmoil, as some widows "... looked into, rather than away from, their loss and were willing to endure and fully experience their aloneness" (p. 151). At the same time, these experiences were significantly associated with experiences of post-bereavement personal growth.

In addition to its important theoretical and empirical contributions, Doors Close, Doors Open includes a number of valuable observations and explanations that will be of immense comfort and clarification for widows. These include a cogent discussion of society's confused and often unrealistic expectations for widows, the predictable negative effect on widow's self-esteem of being held to unrealistic and conflicting standards, and an enthusiastic endorsement of bereavement support groups. Lieberman, who has also conducted research on the use and benefits of such groups, asserts strongly that they provide a number of things that widows need in their recovery, including realistic information, acceptance, universality, models, and hope for the future.

This book will be valuable for widows at many different stages of recovery, for their families, and for clinicians and researchers who wish to understand the impact of bereavement more completely. The technical appendices provide welcome information about the research design and results, while freeing the narrative from overly-detailed explanations.