By - February 02, 2021
Grief is often a debilitating and soul-crushing emotional journey. It can bring you to your knees and wipe out any emotional, physical, and mental strength you have. Sometimes you can feel it coming while other times it will catch you by surprise. Grief can come in short episodes or it can take so long you feel you will never resurface. It is a beast of an emotion—a wild animal that is taking over every aspect of your life. But grief has a purpose.
Almost everyone will experience grief during their lifetime, though how we express grief is cultural.1,2,3 Some cultures have a defined mourning period in which the bereaved are grieving (and sometimes where clothes signify their grief).4 Some cultures believe that the deceased are still around in some form, for example in the form of a spirit or ghost.4 The emotions used when grieving also vary from culture to culture—some people grieve through celebration, others express more sadness, and yet other cultures express anger.4
The scientific perspective of grief also has cultural differences.5 For example, different cultures can have different ideas of what can cause death.5 Determining the cause of death through forensic pathology can, therefore, have cultural implications especially if the scientific cause of death is not aligned with the cultural or spiritual. This can, in turn, impact the grieving process of losing a loved one.
Regardless of how it is expressed culturally, grief is an essential component of what differentiates us as humans and is integral to our connection with one another.1,2,3 Most people understand that grief is one of the essential cornerstones that provides significant meaning within our relationships. There is significant data available regarding the symptoms of grief and its complications, including depression, anxiety, and physical illness. Understanding the reasoning behind grief and the circumstances that influence grief can provide important insights into establishing important coping mechanisms.
Biologically, babies that form strong attachments to individuals are proven more likely to survive.1 There is also evidence that biological attachment between romantic partners is based on similar connections, although it is unknown whether those connections are formed because they are useful, or if they emerge from a similar biological mechanism such as the infant-caregiver attachment.1 Importantly, when searching for connections to grief, the evidence suggests that connections are not all equal in function, form, and origin.1,2 Furthermore, although emotions do serve biological necessities, it does not provide an “evolutionary” explanation of why humans experience grief.1,2 Such purposes should center on forming strong social bonds and commitments.2,3 Such solid social bonds are important, albeit misinformed social bonds can be costly in terms of resources (such as time, money, reputation, and emotions).3
Forensic pathologists play a crucial role in modern-day society by performing autopsies and determining causes of death. They provide not only clarity on the cause of death but aid in providing the closure families need during the grieving process. Many families are unfamiliar with the complex medical terminology used in death certification and often turn to forensic pathologists to walk them through what it means, not only for the deceased, but for implications for the living. A hereditary finding diagnosed at autopsy can have life-changing medical consequences for the families. Even the most common causes of death, atherosclerosis and hypertension, can have recommendations of lifestyle changes that can dramatically improve the well-being of the living. The knowledge learned during the grieving process can give families an element of control that death, especially sudden, has stripped from them. Knowledge helps them move forward during the turbulent times. Understanding the cause of death can, therefore, be a crucial component of loss to help the bereaved process loss on an emotional and educational level.
For many families, the forensic pathologist is the person whose words help them find closure. They provide solace in inquiries regarding pain and suffering, and reassurance that death often is a quick and painless process and that their loved one did not suffer. Most importantly, forensic pathologists help families find peace in that there were no additional life-saving treatments or therapies that could have been implemented. Although many may have heard these things from other providers, the autopsy (the act of seeing for oneself) serves as the “final voice” for the deceased and the forensic pathologists help share that final voice with the families.
Through their knowledge and skills, forensic pathologists are able to advocate for the deceased and their families. In cases of abuse or neglect, they are able to share and opine on the circumstances in which death occurred. These cases often leave the living, who were unaware, with tremendous guilt. In controversial cases, such as criminal circumstances, the cause of death can have significant legal implications. Unbiased, accurate, and timely death certification and reports are crucial for families grieving and our medicolegal system. How forensic pathologists communicate both in their reports and with the family, are equally important. In other words, both the “what” and the “how” of the cause of death is powerful.
The graciousness in which families communicate with forensic pathologists during their grief is humbling. In the deepest moment of grief, families express their gratitude for our service and appreciation for our role in the grieving process.
Grief after loss can may lead to a learned experience, especially when the death could have been prevented.1 If a mother loses a child because the child ran into traffic, the mother would spend her life ensuring that fate was not repeated. The question remains if grief is ameliorated when such elements are present.
Data points to a disproportionate experience for loss and bereavement within Black families could be related to discrimination, both individual and institutional.6 Specifically, Black male youth are at risk for premature deaths.6 With such deaths, the grief of surviving families (and friends) is also complicated by external factors such as stigma, media, and the potentially biased legal system.4 Additionally, grief within the Black community is often associated with secondary loss—including loss of safety—that creates more challenges when processing grief4 and discriminatory penalties, systemic oppressions, and cultural contexts of privilege against minorities influence society’s decisions may exacerbate grief.5
Grief is can be a costly phenomenon. It can rob individuals of happiness, fulfillment, personal health, and future well-being. It is also linked to increased mortality rates and drug and alcohol abuse.3 However, grief also underscores strong connections and social bonds.3 Additionally, it can have a profound educational effect, which in turn, can help safeguard others.1 Regarding autopsies, understanding the cause of death can have educational, emotional, legal, and political ramifications.
Forensic pathologists play a pivotal role in providing support for the grieving families of those who have suddenly passed away. Their knowledge and empathy can help families with their grieving process. Forensic pathologists are also advocates for the deceased and as such, provide their surviving family and friends with their last unspoken words. How we enter and leave this world has tremendous implications, so understanding the circumstances is an important role in medicine, especially to those experiencing grief.