George Bonanno's new book, The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss, is being heralded as the definitive scientific statement on bereavement-related research. Unfortunately, the book fails to live up to this advance praise, especially in its treatment of grief counseling. Bonanno's view is that grief counseling "has…proved to be not only notoriously ineffective but sometimes even harmful" (p. 105). Later in the same paragraph he again raises the specter of harmful effects, this time citing a 2007 article by Lilienfeld in Perspectives on Psychological Science. But what evidence from the new science does Bonanno marshall to support this negative, almost damning view of grief counseling?
Before answering this question, some prefatory comments are in order. First, this is not a book review. Second, this response does not list the positive contributions of The Other Side of Sadness that other commentators are acknowledging. Like these others, I am happy to see the models of grief and mourning inspired by Freud and Kübler-Ross replaced by more robust ones that are a better fit with human experience. I also like the general recommendation to interventionists that it is not a good idea to overrespond to the distress of bereaved persons: Scratching where it doesn't itch does not aid the natural healing process of grief. Also, there are many inspiring stories of people successfully negotiating their losses. These positive ingredients make The Other Side of Sadness appetizing food for thought, but unfortunately, this lovely bowl of soup has a big fly in it -- an egregious flaw that will perpetuate the same kind of biased and baseless thinking that the book purports to dispel. To understand this flaw and its origins, let's go back to our initial question: What evidence from the new science does Bonanno marshall to support his negative, almost damning view of grief counseling?
When we look for this evidence we see that the only empirical work that Bonanno cites for the claim that grief counseling can be harmful is an unpublished 1999 28-page (excluding references and tables) dissertation by Barry Fortner that has never been peer reviewed. Furthermore, as George Bonanno is well aware, this thesis has been the subject of a post-hoc review by the American Psychological Association which determined that both the findings and the "novel" statistic used in the dissertation are invalid. An APA press release (July 29, 2007) summarizes some of these developments. Interested readers can also peruse many of the items posted on the Hospice Home Page to learn more about the details of this research saga. A good starting point would be a 2007 article coauthored by myself and U. Wisconsin professor Bill Hoyt, "What has become of grief counseling? An evaluation of the empirical foundations of the new pessimism."
Those already following this research controversy know that the Fortner findings of treatment-induced deterioration effects (TIDE) were brought into the scientific literature in a 2000 article by Robert Neimeyer, thus effectively circumventing peer review. What followed is that these alarming findings echoed through the scientific literature and beyond (e.g, Boston Legal, Newsweek magazine), with all authors citing the Neimeyer article and none citing the original Fortner thesis. For instance, the Lilienfeld article cited by Bonanno as support for the harmful effects claim cited only Neimeyer.
Stepping back, we can see that a lapse in our standard safeguards (e.g. peer review) for validity in psychological research allowed the TIDE to enter the scientific literature, and now it continues to spread, virus-like, with no end in sight. As Paul Krugman notes in his NYT articles, erroneous ideas often seem zombie-like—unstoppable, and immune to critical thinking. The TIDE is indeed a zombie-like idea, and Bonanno has given this zombie idea new life. We can expect future authors to now cite The Other Side of Sadness as evidence for claims of iatrogenic effects for grief counseling.
Why does Bonanno so cavalierly malign grief counseling, especially when he cannot marshall a single empirical study that supports the case for harmful effects other than an unpublished dissertation that has been challenged by the leading organization in his field? To begin to answer this question it is worth noting that Bonanno's bias against grief counseling is reflected throughout the book. For example, the case of Julia Martinez is used to illustrate how resiliency, if only left unhampered by counseling, can lead to positive coping with loss. However, we see that Julia was virtually forced into counseling by her mother. She was not interested in counseling and it is no surprise that counseling did not work well for her. Grief counselors will agonize when they see virtually no examples of the kinds of healing and growthful experiences they see daily in their group and individual counseling sessions with bereaved persons. I would also like to know how bereavement workers who do effective crisis intervention and critical incident stress debriefing find the characterizations of their work in The Other Side of Sadness.
Perhaps the answer to the why question is that Bonanno needs grief counseling to be inefficacious -- ideally harmful -- for him to make the strongest case for his version of resilience. If we review his earlier publications on resilience, we can see that the harmful effects claim is often a centerpiece of his arguments. However, since he does not have his own data on this issue (his research consists of naturalistic studies that do not include interventions), he, like others using the harmful effects claim to bolster their viewpoints on various issues, needs to cite the Neimeyer article frequently to maintain this counterintuitive position.
Addressing the why question at another level of analysis, we can argue that Bonanno's inability to conceptually integrate two views --- one, that most people are resilient (which I think everyone in the bereavement field shares), and two, that grief counseling can help anyone who seeks help, resilient or not—lead him to a distorted view of both bereavement and grief counseling. As a consequence, his view of resilience is not integrative, veering toward repression and the trivialization of distress, and he also cannot see the value of grief counseling as an expediter of a natural healing process. Interested readers might take a peek at a chapter by Bill Hoyt and myself, "The Bright Side of Grief Counseling: Deconstructing the New Pessimism," for a more in-depth look at some of these issues.
The headline news here is that Bonanno, despite being fully aware of the APA review of the Fortner dissertation, and notwithstanding the absence of any scientific basis for this claim, has chosen to perpetuate the belief that grief counseling is very likely harmful for most bereaved persons (i.e., those without more severe grief reactions). There is some real irony here. Bonanno, frequently portrayed as a myth buster, is promoting a much more insidious and harmful myth than any he is supposedly toppling. Given new impetus and life by Bonanno, the TIDE zombie can continue to inflict its harm—on scientific integrity, on the bereavement field, and on bereaved persons who will be discouraged from seeking the assistance that might be of inestimable value to them.
Although it's never easy to stop a zombie, I think a concerted effort can halt this one and prevent these losses. The stakes in this struggle are obviously high: Success would mean that bereaved persons will be able to seek help without fear and shame, and that bereavement professionals can be accorded the respect and gratitude they so deeply deserve. It's worth the fight, and I think we are resilient enough to win it.
Related content by other Growth House bloggers:
- Les Morgan: The Other Side of Sadness: What the New Science of Bereavement Tells Us about Life after Loss (book review)
- Les Morgan: Grief Counseling Not Bad For You, Experts Say