Abstract
The grief literature has historically been dominated by a focus on death-related loss, with a more recent emphasis on defining chronically disabling grief as disordered. In this landscape, Darcy Harris’s Non-Death Loss and Grief: Context and Clinical Implications provides a necessary and vital counterpoint first, by highlighting non-death loss but also, by asserting that such loss tends to engender ongoing grief that is not indicative of individual dysfunction because it is “the situation that is problematic and not the individual(s) within the situation” (p. 319). Indeed, Harris systematically and comprehensively establishes non-death loss as “. . . often difficult, painful, and exhausting . . . [but also] part of our shared human experience and not a malady to be treated” (p. 311). Crucially, Harris achieves this expansion of the otherwise death-focused, increasingly medicalized, and individualistic grief literature in a deeply practical and clinically oriented manner thereby offering a book that serves as an unprecedented guide for mental health professionals who inevitably encounter grief stemming from non-death loss.
As a clinical resource, Harris’s book is indispensable following the surge of non-death losses characterizing the events of 2020, including the pandemic, political unrest, and heightened acknowledgement of social injustice. The pandemic alone has caused widespread loss of social support networks, daily routines, childcare, physical health, financial stability, and employment, leading to increased symptoms of depression, anxiety, and post-traumatic stress. For example, a CDC epidemiological survey indicated that 36% of adults reported anxiety symptoms and 28% reported depressive symptoms, compared to 8% and 6.5% in 2019 (National Center for Health Statistics, 2021). In this context, Harris’s book represents a timely clinical resource offering insight and tools for mental health professionals supporting grievers inundated by the non-death losses of 2020.
Harris begins with an introductory chapter that outlines a conceptual lens for understanding non-death loss, drawing on five influential theoretical approaches in the field of grief: attachment theory (Bowlby, 1969), assumptive world theory (Janoff-Bulman, 1989; Parkes, 1975), the dual process model (Stroebe & Schut, 2010), the social-constructivist meaning making model (Neimeyer, 2001), and the broader social and systemic perspective on grief. These theories are presented in a manner that builds a cohesive narrative describing the underlying challenge that defines non-death loss, the consequent grief process of engaging this challenge, and the factors that influence how this grief process is experienced. In short, Harris defines non-death loss as “a change in circumstances, perception, or experience where it would be impossible to return to the way things were before” (p. 2) because “the core beliefs that comprise our assumptive world are challenged, and the entire structure that we have built our lives upon begins to crumble” (p. 10). By extension, grief is then characterized as “a process that is both adaptive and necessary in order to rebuild the assumptive world after its destruction . . . ” (p. 10), allowing us to negotiate our changed life circumstances. This account of non-death loss equips the reader with a conceptual scaffold for understanding the clinical nuances and practical guidance offered in the chapters that follow. Crucially, such a theoretical framework also appears to be in line with emerging research showing that the mental health impact of pandemic non-death loss is mediated by its disruption of individuals’ core beliefs and assumptions (Milman, Lee, & Neimeyer, 2020; Milman, Lee, Neimeyer, et al., 2020). In effect then, Harris’s book provides grief professionals with a nuanced clinical application of pandemic research in the post-pandemic mental health era.
By contrast to the consistent theoretical richness of Harris’s book, there is relatively sparse reference to research on grief following non-death loss. Of course, this is unavoidable given the limited attention non-death loss has been afforded in research. Nevertheless, Chapter 22 in the concluding section of the book, aptly entitled, “Where’s the grief in non-death loss research?”, offers a concise overview of the comparatively recent but compelling scholarship addressing non-death loss.
Following the theoretical foundations established in the first chapter is a section addressing how social context shapes the non-death loss experience. Once again, there is a striking relevance to the losses of 2020, particularly those stemming from political upheaval and the growing awareness of social injustice. For example, in Chapter 4, “Discrimination, Oppression, and Loss,” Neil Thompson discusses the losses that define societally marginalized identities, elaborating on how “it is possible to grieve for something that you have never had, or something you have been denied” (p. 55). Another example is in Chapter 5, “Mourning in Trump’s America: An existential account of political grief,” in which Sheldon Solomon outlines grief associated with and/or driving political upheaval. These and other chapters in this section collectively establish non-death grief as a central experience to be prioritized by clinicians encountering the mental health impact of social change.
The next four sections each begin with an overview of the clinically relevant features, challenges, and considerations that characterize specific forms of non-death loss – these include ambiguous loss, nonfinite loss, chronic sorrow, and tangible/intangible loss. Specific examples of each type of non-death loss are presented, illustrating how they may be experienced by grievers and supported by clinicians. In addition to the obvious clinical utility of these illustrative chapters, they also serve to highlight experiences of loss that are otherwise disenfranchised; among these are losses associated with transitioning and coming out, addiction, missing persons, serious disability, foster care, mental illness, caregiving, adoption, sexual assault, and many more. In so doing, these chapters offer resources, awareness, insight, and a voice where it has been sorely lacking.
At the same time, these illustrative chapters include nearly universal losses, including those associated with emerging adulthood, relationship dissolution, disrupted expectations/plans/hopes, as well as societal and environmental change. Rather than suggesting that we exist in a chronic state of grief, these chapters demonstrate “ . . . the dynamic experience of living with change, loss, and transition in everyday life” (p. 311). In this manner, Harris’s book succeeds in moving the field of grief and mental health more generally toward the recognition that grief is not an incidental, time-limited experience specific to those who have encountered death, but an enduring force that shapes who we become as our lives unfold.
A consistent, defining feature of Harris’s book is its emphasis on engaging clinicians. Didactic activities and resources offer practical tools to support the application of theory, including term summaries, lists enumerating key elements of the concepts being discussed (e.g., assumptions underlying ambiguous loss), as well as tables and figures comparing related concepts (e.g., the overlap between non-death loss types). Experiential exercises and reflection questions are also included throughout, encouraging a lived consideration of the issues being described (e.g., a questionnaire directing readers to review their own non-death losses). Evocative vignettes demonstrate how non-death losses can manifest, and specific clinical direction is offered on relevant therapeutic goals, strategies, processes, and techniques. Herein lies perhaps the most salient contribution of Harris’s book to the field of grief: a deeply practical and experientially engaging clinical companion guiding grief professionals as they encounter non-death loss.