Grief trajectories and resilience (Bonanno)
Long-term studies that follow people from before a loss to years after find several distinct paths instead of one shared process. The most common is resilience: steady functioning with waves of sadness that do not disrupt life for long. Others include grief that eases over a year or two, grief that stays high, and depression that was there before the death.
What drives it
It shows that a person who copes well may be in the largest group, with nothing hidden or wrong. For identification it separates people who look ‘too fine’ from those in trouble, and shows that someone who was low before the death may be carrying something older than the grief.
How it shows
Work
Back after compassionate leave and performing well, then hearing colleagues whisper that they must be ‘bottling it up’. Or the reverse: unable to function a year on while the office assumes it has passed.
Relationships
Relatives read calm as coldness at the funeral. A widow is relieved after years of caring and ashamed to say so. One sibling falls apart, another carries on, and each may be on a normal path.
Self
Notice whether the sadness comes and goes while life carries on, or sits on everything. Ask how you were in the year before the death, too.
What tells it apart
Resilience: Resilience is the general capacity to keep functioning after hard events. Grief trajectories are the measured patterns after a death, and a person who keeps working and laughing may be on the resilient path without any special trait.
Denial: Resilient people still feel sadness and can talk about the person. If the death cannot be mentioned at all and every reminder is shut down, denial or avoidance is more likely.
Prolonged grief disorder (ICD-11, DSM-5-TR): The chronic grief path, with high distress at 6 and 18 months, overlaps with prolonged grief. Distress that stays as high as in the first months for a year or more may point there.
A test
Ask how the person was doing in the year before the death and how they are now. Steady before and steady now, with waves of sadness, may be resilience, while low mood that came before the death and carried on may be depression that the loss sits on top of.
Questions to carry
- When someone told me I was coping ‘too well’, what did I feel in that moment?
- How was I in the year before the loss, if I am honest?
Go deeper
- Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
- Watch: 3 secrets of resilient people, Lucy Hone, TEDxChristchurch, 2019. A resilience researcher on the months after her 12-year-old daughter Abi was killed in a car crash, and the three habits she leaned on. She describes the five-stage leaflets she was handed. One family's account, free to watch.
- Study: Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis, Marie Lundorff, Helle Holmgren, Robert Zachariae, Ingeborg Farver-Vestergaard and Maja O'Connor, Journal of Affective Disorders, 2017. Pooled 14 studies of adults bereaved by deaths that were not violent and found about 1 in 10 had prolonged grief disorder (9.8%). Older age went with higher rates. The studies differed widely and few looked at who declined to take part, so the authors ask for caution. The accepted manuscript is free to read.
How strong the research is
moderate. In the Changing Lives of Older Couples study (Bonanno and colleagues, 2002), 205 widowed people whose depression was measured about three years before the death and at 6 and 18 months after fell into five main patterns: 46% resilient, 16% chronic grief, 11% common grief that eased by 18 months, 10% depressed before the death and better after, and 8% chronically depressed. A reanalysis running to four years after the loss (Galatzer-Levy and Bonanno, 2012) put resilience at 66%. Infurna and Luthar (2017), following 421 widowed Australians, found resilience depended on the measure: about 66% for life satisfaction, and only 8% were resilient on all five outcomes they tracked.
Where it comes from
George Bonanno, Camille Wortman, Darrin Lehman and colleagues, Journal of Personality and Social Psychology, 2002. George Bonanno, Loss, trauma, and human resilience, American Psychologist, 2004. Isaac Galatzer-Levy and George Bonanno, Social Science and Medicine, 2012
On the family tree: George Bonanno