Viewing the Body After Bereavement Due to a Traumatic Death
Viewing the Body After Bereavement Due to a Traumatic Death
Objective. Whether bereaved relatives should be encouraged to view the body after a traumatic death is uncertain. This analysis of narrative interviews interprets people’s accounts of why and how they decided whether to view the body and their emotional reactions to this, immediately and at a later stage.
Design. In depth interviews with qualitative analysis.
Participants. A maximum variation sample of 80 people bereaved because of suicide or other traumatic death.
Setting. Most people were interviewed in their homes.
Results. For those who had the option, decisions about seeing the body varied. Some wanted someone else to identify the body, because they feared how it might look or preferred to remember their relative as they had been in life. Those who had wanted to see the body gave various reasons beyond the need to check identity. Some felt they ought to see the body. Others felt that the body had not lost its social identity, so wanted to make sure the loved one was "being cared for" or to say goodbye. Some people wanted to touch the body, in privacy, but the coroner sometimes allowed this only after the postmortem examination, which made relatives feel that the body had become police property. Seeing the body brought home the reality of death; it could be shocking or distressing, but, in this sample, few who did so said they regretted it.
Conclusions. Even after a traumatic death, relatives should have the opportunity to view the body, and time to decide which family member, if any, should identify remains. Officials should prepare relatives for what they might see, and explain any legal reasons why the body cannot be touched. Guidelines for professional practice must be sensitive to the needs and preferences of people bereaved by traumatic death. The way that relatives refer to the body can be a strong indication for professionals about whether the person who died retains a social identity for the bereaved.
Early in the 20th century it was common to view the body after death, but today in the United Kingdom it is usual to have a closed casket for the funeral, and people may not see the body beforehand. People may feel ambivalent about the status of the corpse. They may wish to protect the body yet also fear the corpse because its decay is associated with pollution and disease, and because it is such a powerful symbol of death. Our society emphasises a need for order, with clear classifications and boundaries, so a corpse may also feel dangerous because it leaks bodily fluids. When bodily secretions are not contained people respond negatively to "matter out of place," as the anthropologist Mary Douglas has shown.
In spite of possible fears, people often wish to see the body of their dead relative. However, nurses may not understand that viewing the body may matter to relatives. When a traumatic and perhaps disfiguring event has caused death, professionals may be particularly reluctant to allow viewing because they may fear that relatives will have to live with unpleasant, uninvited memories. There may also be forensic reasons to restrict access to the body. There are no regulations about who is allowed to touch a dead body, but if a criminal offence is suspected most coroners do not allow the body to be touched before the first postmortem examination in case evidence is lost. In 1998, 270 people died when a plane exploded over Lockerbie in Scotland. The procurator fiscal, who has the role of coroner in Scotland, forbade bereaved relatives access to any of the bodies until they had been identified from fingerprints and dental records. Officials then told the funeral directors that it would be better if relatives did not see the bodies. Pamela Dix, whose brother died in the disaster, wrote about her bitter regrets that she was not allowed to make an informed choice about whether to see his body despite the fact that she had been told that her brother was intact and fully recognisable. She wanted to see her brother’s body at the crematorium but was told that this was against crematorium regulations and "medically inadvisable."
Some psychiatrists, such as Worden, argue that viewing the body helps to bring home the reality of loss, and that viewing helps in the grieving process, because bonds with the deceased need to be severed so that the survivor can make new attachments. Worden suggests that a sudden death in particular, leaves the survivor with a sense of unreality, and that seeing the body can help bring home the reality of the loss. He argues that "letting go" of the deceased is an important part of the grieving process and necessary to the client’s wellbeing. Some funeral directors are also convinced that if family members choose to see the body, they will find viewing helpful because they will be confronting reality. Others, including psychiatrists, sociologists, and theologians, have offered an alternative model of grief. Silverman et al, for example, argue that, after a death, bonds with the deceased do not have to be severed and that the resolution of grief involves a "continuing bond" which the survivor maintains with the deceased. Thus, different grief counsellors may argue that viewing the dead body (at least once) may help the bereaved, but for different reasons.
There is little evidence to guide professionals working with bereaved relatives after a sudden traumatic death. In a study conducted two years after the Australian Granville train disaster, 36 of 44 bereaved had not seen the body of their relative or friend. Twenty two of those who had decided not to view the body of their relative or friend had subsequently regretted their decision. Eight people had viewed the body, and only one reported having regrets. Those who viewed the body had better outcomes on a number of measures of psychological recovery than those who did not.
Interesting results emerged from interviews with bereaved relatives after the 1987 Zeebrugge ferry disaster, when 193 people died. Interviewed between three and 12 months after the event, the group of bereaved relatives who said they had viewed the bodies of the deceased were significantly worse off on measures of distress and anxiety than those who did not view. However, two and a half years after the disaster, results were different. Seventy four bereaved relatives returned a questionnaire. Analysis compared those who had viewed or not viewed the body, according to the time taken to recover the body. Some bodies were recovered from the water the first night, others soon afterwards, and some only six weeks after the disaster, when the ship was salvaged. For the two main groups, where the body was recovered on the first night or on when the ship was salvaged, there were no real differences in overall psychological symptoms or measures of grief, but unpleasant images and thoughts were lower in those who viewed the body. Those who had seen the more damaged bodies were not psychologically worse off. Hodgkinson concluded that those who view may be more distressed in the short term but less distressed in the long term.
Our wider aim in this study was to explore the experiences of people bereaved by a traumatic death. As is common practice in qualitative research, we examined themes that emerged during the data collection as well as those anticipated. The issue of viewing the body was raised by the first person who was interviewed. The aim of this paper is to explore and interpret people’s accounts of why and how they decided whether to view the body and their reflections on the consequences. The work has clinical relevance because it is uncertain whether relatives should be encouraged to view the body, particularly if it is disfigured. Extracts and further analyses from the interviews can be found on www.healthtalkonline.org (formerly www.dipex.org), a resource based on qualitative studies of people’s experiences of health and illness.
Abstract and Introduction
Abstract
Objective. Whether bereaved relatives should be encouraged to view the body after a traumatic death is uncertain. This analysis of narrative interviews interprets people’s accounts of why and how they decided whether to view the body and their emotional reactions to this, immediately and at a later stage.
Design. In depth interviews with qualitative analysis.
Participants. A maximum variation sample of 80 people bereaved because of suicide or other traumatic death.
Setting. Most people were interviewed in their homes.
Results. For those who had the option, decisions about seeing the body varied. Some wanted someone else to identify the body, because they feared how it might look or preferred to remember their relative as they had been in life. Those who had wanted to see the body gave various reasons beyond the need to check identity. Some felt they ought to see the body. Others felt that the body had not lost its social identity, so wanted to make sure the loved one was "being cared for" or to say goodbye. Some people wanted to touch the body, in privacy, but the coroner sometimes allowed this only after the postmortem examination, which made relatives feel that the body had become police property. Seeing the body brought home the reality of death; it could be shocking or distressing, but, in this sample, few who did so said they regretted it.
Conclusions. Even after a traumatic death, relatives should have the opportunity to view the body, and time to decide which family member, if any, should identify remains. Officials should prepare relatives for what they might see, and explain any legal reasons why the body cannot be touched. Guidelines for professional practice must be sensitive to the needs and preferences of people bereaved by traumatic death. The way that relatives refer to the body can be a strong indication for professionals about whether the person who died retains a social identity for the bereaved.
Introduction
Early in the 20th century it was common to view the body after death, but today in the United Kingdom it is usual to have a closed casket for the funeral, and people may not see the body beforehand. People may feel ambivalent about the status of the corpse. They may wish to protect the body yet also fear the corpse because its decay is associated with pollution and disease, and because it is such a powerful symbol of death. Our society emphasises a need for order, with clear classifications and boundaries, so a corpse may also feel dangerous because it leaks bodily fluids. When bodily secretions are not contained people respond negatively to "matter out of place," as the anthropologist Mary Douglas has shown.
In spite of possible fears, people often wish to see the body of their dead relative. However, nurses may not understand that viewing the body may matter to relatives. When a traumatic and perhaps disfiguring event has caused death, professionals may be particularly reluctant to allow viewing because they may fear that relatives will have to live with unpleasant, uninvited memories. There may also be forensic reasons to restrict access to the body. There are no regulations about who is allowed to touch a dead body, but if a criminal offence is suspected most coroners do not allow the body to be touched before the first postmortem examination in case evidence is lost. In 1998, 270 people died when a plane exploded over Lockerbie in Scotland. The procurator fiscal, who has the role of coroner in Scotland, forbade bereaved relatives access to any of the bodies until they had been identified from fingerprints and dental records. Officials then told the funeral directors that it would be better if relatives did not see the bodies. Pamela Dix, whose brother died in the disaster, wrote about her bitter regrets that she was not allowed to make an informed choice about whether to see his body despite the fact that she had been told that her brother was intact and fully recognisable. She wanted to see her brother’s body at the crematorium but was told that this was against crematorium regulations and "medically inadvisable."
Some psychiatrists, such as Worden, argue that viewing the body helps to bring home the reality of loss, and that viewing helps in the grieving process, because bonds with the deceased need to be severed so that the survivor can make new attachments. Worden suggests that a sudden death in particular, leaves the survivor with a sense of unreality, and that seeing the body can help bring home the reality of the loss. He argues that "letting go" of the deceased is an important part of the grieving process and necessary to the client’s wellbeing. Some funeral directors are also convinced that if family members choose to see the body, they will find viewing helpful because they will be confronting reality. Others, including psychiatrists, sociologists, and theologians, have offered an alternative model of grief. Silverman et al, for example, argue that, after a death, bonds with the deceased do not have to be severed and that the resolution of grief involves a "continuing bond" which the survivor maintains with the deceased. Thus, different grief counsellors may argue that viewing the dead body (at least once) may help the bereaved, but for different reasons.
There is little evidence to guide professionals working with bereaved relatives after a sudden traumatic death. In a study conducted two years after the Australian Granville train disaster, 36 of 44 bereaved had not seen the body of their relative or friend. Twenty two of those who had decided not to view the body of their relative or friend had subsequently regretted their decision. Eight people had viewed the body, and only one reported having regrets. Those who viewed the body had better outcomes on a number of measures of psychological recovery than those who did not.
Interesting results emerged from interviews with bereaved relatives after the 1987 Zeebrugge ferry disaster, when 193 people died. Interviewed between three and 12 months after the event, the group of bereaved relatives who said they had viewed the bodies of the deceased were significantly worse off on measures of distress and anxiety than those who did not view. However, two and a half years after the disaster, results were different. Seventy four bereaved relatives returned a questionnaire. Analysis compared those who had viewed or not viewed the body, according to the time taken to recover the body. Some bodies were recovered from the water the first night, others soon afterwards, and some only six weeks after the disaster, when the ship was salvaged. For the two main groups, where the body was recovered on the first night or on when the ship was salvaged, there were no real differences in overall psychological symptoms or measures of grief, but unpleasant images and thoughts were lower in those who viewed the body. Those who had seen the more damaged bodies were not psychologically worse off. Hodgkinson concluded that those who view may be more distressed in the short term but less distressed in the long term.
Our wider aim in this study was to explore the experiences of people bereaved by a traumatic death. As is common practice in qualitative research, we examined themes that emerged during the data collection as well as those anticipated. The issue of viewing the body was raised by the first person who was interviewed. The aim of this paper is to explore and interpret people’s accounts of why and how they decided whether to view the body and their reflections on the consequences. The work has clinical relevance because it is uncertain whether relatives should be encouraged to view the body, particularly if it is disfigured. Extracts and further analyses from the interviews can be found on www.healthtalkonline.org (formerly www.dipex.org), a resource based on qualitative studies of people’s experiences of health and illness.
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