Repost – You Remember You’re a Repat when . . . (Part 1)

Repatriation—to borrow a phrase from John Denver—is coming home to a place you’ve never been before.

Here’s a repost from my first year blogging, with 92 things that remind repats that they’ve been out of the country for a while. As time goes by, more and more of them are happening less and less for me. But some will never go away.

_______________________________

In the hallowed tradition of “You Know You’re an Expat / Third Culture Kid / Missionary when . . .” lists, I offer my own version for repats. This is for the times when you’re reminded that your plug doesn’t always fit the outlet.

Since I’m a former missionary to Asia who’s repatriated back to the US, a lot of my list leans in that direction, but I hope there’s something here for repats of every stripe (or voltage, as it were).

You remember you’re a repat when . . .

1. Your passport is your preferred form of ID.
2. You comment on how cheap gas is in the US.
3. You ask your friends who they’re picking to win the World Cup.
4. Your CNN web page is set on “International.”
5. You accidentally try to pay for something with the strange coins from the top of your dresser.
6. You don’t trust your friends when they say they’ve found a “good” Italian restaurant.
7. You ask the clerk at the convenience store if you can pay your electric bill there.
8. You don’t know how to fill out taxes without Form 2555.
9. You think Americans are loud.
10. You talk about Americans overseas and call them “foreigners.”
11. You find out that living overseas is not the top qualification employers are looking for.
12. You learn to stop talking about the nanny and groundskeeper you used to employ.
13. You have to ask how to write a check.
14. You forgot how many numbers to dial for a local phone call.
15. You tell your toddler, “No seaweed until you finish all your hamburger.”
16. You try to order fried chicken at Burger King.
17. You check prices by converting from what a similar item cost overseas.
18. You think American paper money is boring because it lacks color and the bills are all the same size.
19. You don’t know how to respond when people say, “I bet you’re glad to be back home.”
20. You prefer to hear news reports from someone with a British accent.
21. You wonder why all the commentators on TV are yelling.
22. You wish you’d brought back ten of your favorite kitchen utensil because you didn’t know it’s not sold in the States.
23. You realize international students are you’re kind of people.
24. You ask where you can get a late-model, low-mileage Toyota for around $2000.
25. You turn on the subtitles on an English movie because you don’t want to miss anything.
26. You ask the clerk at the video store if they have VCDs.
27. You wonder if organization should be spelled with an s.
28. You load up your suitcase and you try not to “pack like an American.”
29. You stop bringing your bi-lingual Bible to church.
30. You smirk inside because someone calls a 4.3 earthquake “a big one.”

(Part 2Part 3)

[top photo: “Electrical Outlet,” by grendelkhan, used under a Creative Commons license; bottom photo: “Having It Both Ways,” by Keith Williamson, used under a Creative Commons license]

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The Psychological Health of Missionaries—Adding to the Research

6903821997_e0a95ce498_nHere’s a quick question:

What percentage of returned missionaries and aid workers report psychological disorders during their time overseas or shortly after their return? What do you think? About a quarter, a third, half, two thirds, three quarters?

According to a 1997 study conducted by Debbie Lovell-Hawker of Oxford University, the answer is “about half.” More precisely, Lovell-Hawker’s findings show that among the returned missionaries and aid workers she studied,

46% reported that they had experienced a clinically diagnosed psychological disorder either while working overseas or shortly after returning to the United Kingdom.

Before I went overseas, I would have guessed much lower than half, but after I first heard this statistic referenced in a debriefing I attended, in my mind, the number began to grow much higher than 46%. Statistics have a way of doing that.

Lovell-Hawker’s research included 145 aid and development workers and missionaries from 62 organizations. Though not definitive, the findings are significant as a wake-up call to cross-cultural workers, sending agencies, NGOs, churches, and member-care givers. And they also can assure those repats who are struggling that they are not alone.

Other  findings include

• 18% reported that their problems developed while they were overseas—82% said they began after returning to their home country
• Depression was the most frequently reported problem, occuring in 87% of the cases
• Those who reported having psychological problems had spent significantly longer time overseas than those who reported having none

(Debbie Lovell-Hawker, “Specialist Care: Psychological Input,” Global Connections Member Care Conference, February 18, 2002)

Moving forward from this study, there are some things I’d still like to know: Has anything changed in the 26 years since the findings were published? What would the numbers be for all missionaries and aid workers, not just those who’ve returned? What would the breakdown be among those working in relief and development vs other settings, such as teaching or church planting in developed areas? Are the numbers consistent for workers returning to countries other than the UK? And what about TCKs?

The good news is that there are researchers who are working on these and similar questions.

The Research Continues

One of those researchers is Lynette H. Bikos. Lynette served as a guest editor (along with M. Elizabeth Lewis Hall) of a special issue of Mental Health, Religion & Culture in 2009, titled “Missionaries.” Lynette is director of research and professor of clinical psychology in the School of Psychology, Family, and Community at Seattle Pacific University—and she also happens to be a friend who lived next to me, on an adjoining farm, as we grew up in northeast Missouri. We’ve kept in touch over the years, and she corresponded with my family and me as she worked on her research.

The special issue includes 10 articles dealing with several aspects of cross-cultural adjustment among those whom the editors call “religiously motivated sojourners.” I’d like to highlight four of those articles:

“Social Support, Organisational Support, and Religious Support in Relation to Burnout in Expatriate Humanitarian Aid Workers”
(Cynthia B. Eriksson et al., Mental Health, Religion, & Culture, November 2009)

This assessment found that 40% of expat middle managers in an international faith-based agency were at “high risk” of burnout in one of three areas—lack of personal accomplishment, emotional exhaustion, and disconnection or distance from those being cared for—but less than 4% reported high levels of burnout in all three.

According to the authors of the study, “This suggests that despite intense work and chaotic environments a majority of workers find ways to identify accomplishments, stay connected to others in their work, and rejuvenate. Team relationships, friendships, and positive organisational support may contribute to the resilience for these workers.”

The findings also indicate that younger workers are at a greater risk of burnout, as they register greater negatives in all three burnout areas. But while age was a factor, the number of years serving with the agency was not.

“Resilience in Re-Entering Missionaries: Why Do Some Do Well?”
(Susan P. Selby et al., Mental Health, Religion, & Culture, November 2009)

The authors posed the question ‘‘Why do some re-entering missionaries do well while others do not?’’ and interviewed 15 Australian cross-cultural missionary workers to help find the answer.

All the participants were over 25 years old and had spent at least 2 out of the previous 3 years in a non-Western country. Based on their responses, the researchers divided the missionaries into two categories: “resilient” and “fragile.”

In the interviews, the eight resilient missionaries described having

• flexibility
• higher expectancy and self-determination
• denial in the form of minimization to deal with their distress
• good mental health
• more social support
• a positive reintegration
• a personal spiritual connection to God

In contrast, the seven who were considered fragile described

• less flexibility
• lower expectancy and self-determination
• less use of denial with minimization
• poorer mental health
• less social support
• difficulty reintegrating
• a decreased or fluctuating personal spiritual connection to God

It is interesting that while the results of a questionnaire measuring depression, anxiety, and stress (DASS 21) showed higher levels for the fragile group, the scale showed that only one out of the entire group (including resilient and fragile) had an actual perception of being “personally stressed.”

“Psychological Well-Being and Sociocultural Adaptation in College-Aged, Repatriated, Missionary Kids”
(Michael J. Klemens and Lynette H. Bikos, Mental Health, Religion, & Culture, November 2009)

When the researchers compared a group of MKs to non-MKs at a Christian university, they found that while both groups scored in the healthy range of psychological well-being (PWB),  the missionary kids’ scores were significantly lower.

The missionary kids’ MK status accounted for only 4% of the variance in psychological well-being but was responsible for nearly a quarter (23%) of the difference in sociocultural adaptation (SCA). In this latter area, the MKs reported the most difficulty in “taking a US’ perspective on the culture; seeing things from an American’s point of view; understanding the US’ worldview; understanding the US’ value system; and making yourself understood.”

“Curiously,” report Klemens and Bikos, “neither the age of the participant, nor the number of years abroad, nor the number of years since repatriation was related to PWB or SCA for the MKs.”

“Reduction in Burnout May Be a Benefit for Short-Term Medical Mission Volunteers”
(Clark Campbell et al., Mental Health, Religion, & Culture, November 2009)

This assessment looked at how international short-term mission trips affect burnout among volunteers.

The participants in the study, most of whom were physicians and nurses, travelled to South America for two weeks to provide medical care in a non-disaster-relief setting. Prior to their departure, the group members’ responses to questionnaires showed that they were experiencing moderate burnout. Their burnout levels were again assessed one month and six months after the trip.

“The major finding of this study,” report the researches, “is counter-intuitive: that medical personnel who are emotionally exhausted, have an impersonal response towards their patients, and lack a sense of [personal accomplishments] (moderately burned out) benefit by working hard with numerous patients in an international context.”

They found that levels of emotional exhaustion and perceived personal accomplishments showed significant improvements following the short-term trip and continued in a positive direction in the 6-month followup.

___________________________________________________

All good research builds about what has been learned before and leads to questions for new studies in the future. I join with Lynette and her co-editor in hoping that the information in their special issue of Mental Health, Religion & Culture encourages others to join in the “exploration” of the psychological health of missionaries. There is so much more to be discovered.

(Lynette H. Bikos and M. Elizabeth Lewis Hall, “Psychological Functioning of International Missionaries: Introduction to the Special Issue,” Mental Health, Religion, & Culture, November 2009)

This special journal issue also includes several articles specific to the experiences of female missionaries. I hope to discuss these in a future post.

[photo: “Confused,” by Mary T Moore, used under a Creative Commons license]

Repatriation: We Don’t Have a Clue until We Have a Clue

2265417682_ba2b629871I recently received an email from a friend, Sherrie Russell. She and her husband, Glen, have been missionaries in Panama since 1997, working with an indigenous tribe there. They have also served in Puerto Rico (10 years) and have ministered to international students at the University of Missouri-Columbia (6 years).

Sherrie was responding to an email from me, updating her on our transition back to the States. Looking for full-time work over the last two years has been a disappointing process for us, and she and Glen understand, as they were in a similar place when they came back from Puerto Rico. I can’t say the same for myself back then. I was one of those she is talking about when she says, “No one had a clue about what we were going through.”

Sherrie’s openness and honesty is an encouragement to my wife and me. I am grateful to her for letting me post some of her letter here:

I remember so well coming back from Puerto Rico and moving to Columbia and working with Latins at the campus ministry, how I had to take a job at McDonald’s and Glen had to drive a school bus while trying to reacclimate and keep it all together, and trying to understand “why” God didn’t supply what we needed to stay in Puerto Rico, in a work we loved (although it was hard and slow), with a people we wanted to see come to Christ, and in a place that was home.

I’ll never forget feeling so alone among so many kind people after we moved and began to know all of you. . . . It was like no one had any clue about what we were going through (not your fault and we knew that at the time)!

And eventually, when we did decide to go to the Dominican Republic and started trying to raise support . . . I’ll never forget a conversation I had with a friend at DQ.  We were there talking, and I was expressing my doubt about raising support (I mean, we couldn’t even raise a little more to stay in Puerto Rico) to her and she said something like, “You know the Lord will provide if it’s His will.” Of course she was just trying to encourage me . . . but out of my mouth and heart came this response, “He didn’t!”  And as soon as I said it, I realized how wrong I was!  I was so shocked that I felt that way and knew I had to remember that He does provide . . . but it was a very difficult time for us!

Even thought the Russells had made plans to move to the Dominican Republic, Sherrie says, “God took us to Panama instead.” About their six years in the States, she adds, “We began to learn how to wait on the Lord in Columbia, but it’s one of the hardest lessons in my opinion!”

And living abroad, too, hasn’t been easy for Sherrie. In 2007 she contracted mononucleosis and has suffered from bouts of severe exhaustion since then.

I haven’t been able to go to church or Bible studies this week because of my health situation. It’s been six years now, but I know God is faithful, and He is teaching me so much that I couldn’t have learned any other way.  One thing is that I’ve become so much more content!  Being able to cook sometimes in the morning to help Glen prepare some of the dinner for that day makes me so happy and thankful!!

One morning I posted on my wall on Facebook that I was listening to Andrea Boccelli and making spaghetti sauce with fresh basil and loving it!  A friend from Columbia whose child I taught at the preschool where I worked wrote that I was easy to please!  I thought about that, and I have become easy to please, and that’s good!

My wife and I enjoy Bocelli’s music, and while we were in Taiwan we bought our first Bocelli CD. Sherrie’s letter got me to look him up on YouTube, and I came across a video for his “Canto Della Terra” (“Song of the Earth”). If Steve McCurry made music videos, they might look like this.

[photo: “Loneliness,” by Flavio Spugna, used under a Creative Commons license]

Departures and Repatriations: Crossing the Great Divide

“Never die in Taiwan.”

That’s what the poor man at the American Institute in Taiwan said. AIT serves as a de facto US embassy in Taiwan, and I was there taking care of some routine matters. Others, like the student I met who had been so excited about navigating the city in a taxi by himself that he left his backpack and passport in the cab, had more pressing issues.

The man who turned away from the window in despair, who told us all, “Never die in Taiwan,” had just presented documentation concerning his recently deceased wife. He needed to prove that she had died to show that he wasn’t trying to remove his children from the country against her wishes. This was his second or third visit, and the person behind the window was sending him back for translated copies—from Chinese to English, or from English to Chinese—or for some other paperwork that seemed impossible to obtain. The man looked so defeated. The death of a loved one overseas must truly be a distressing experience, in so many ways. I can only imagine how hard it is.

Recently I was jumping around the Web and looked up repats just to see what was out there on the repatriation process, say, for returning cross-cultural workers. One of the top sites listed was repats.com. That seemed like just what I was looking for, but the text underneath wasn’t what I expected:

Funeral Repatriations – Rapatriements funéraire – Funeraire repatriëring

So repats.com is a funeral site. That means, I thought, that repatriation must refer to sending a person’s spirit back “home,” to heaven. What an interesting use of the word. But as it turns out (as most of you probably already knew), for funeral operators, repatriation means returning the deceased’s remains to the country of origin.

Obviously, there is a lot to take care of in this kind of repatriation process: There are laws to follow, the paperwork, the physical aspect of transporting the body, the expense, the disruption of normal day-to-day life overseas, the stress and grief, and the coordination of cultural and religious customs. Avalon Repatriation Services, located in the United Kingdom, gives the following overview of some of the varied practices around the world:

  • In France for example, a body must be embalmed and placed in a wooden coffin 24 hours after death.
  • In Islamic countries, it is the widely-held belief that the deceased should be buried before sundown or within 24 hours, without embalming.
  • In the United States, embalming is common practice. In many countries—when embalming does take place—it is a qualified embalmer’s job, whereas in some countries, for example Portugal and Spain, it is against the law for anyone but a qualified doctor to undertake this procedure.
  • Those of Jewish faith believe that the body should be returned to the earth it came from and are therefore against cremation.
  • Hindus cremate their dead, believing that the burning of a dead body signifies the release of the spirit and that the flames represent Brahma, the creator.

My misunderstanding the meaning of repatriation reminds me of the Japanese film Departures, winner of the 2009 Academy Award for Best Foreign Language Film. It tells the story of an unemployed cellist, Daigo, who answers a newspaper ad titled “Departures.” He thinks he’s applying for a travel-agency job but instead ends up taking a job as a nokanshi, someone who ceremonially prepares bodies for burial. Daigo learns the trade from Sasaki, his boss, who becomes his mentor. And Daigo learns also to overcome opposition from his family and friends and to face his own fears, finding deep meaning in his new vocation.

This is a great film. It’s been one of my family’s favorites ever since my son brought home a copy. Just listening to the theme song in the trailer reminds me of the deep emotions that are explored in the story. I think it’s about time I watched it again.

(“Catering for Different Religions,” Avalon Repatriation Services)

[photo: “Go West,” by halfrain, used under a Creative Commons license]

You Remember You’re a Repat when . . . (Part 1)

In the hallowed tradition of “You Know You’re an Expat / Third Culture Kid / Missionary when . . .” lists, I offer my own version for repats. This is for the times when you’re reminded that your plug doesn’t always fit the outlet.

Since I’m a former missionary to Asia who’s repatriated back to the US, a lot of my list leans in that direction, but I hope there’s something here for repats of every stripe (or voltage, as it were).

You remember you’re a repat when . . .

1. Your passport is your preferred form of ID.
2. You comment on how cheap gas is in the US.
3. You ask your friends who they’re picking to win the World Cup.
4. Your CNN web page is set on “International.”
5. You accidentally try to pay for something with the strange coins from the top of your dresser.
6. You don’t trust your friends when they say they’ve found a “good” Italian restaurant.
7. You ask the clerk at the convenience store if you can pay your electric bill there.
8. You don’t know how to fill out taxes without Form 2555.
9. You think Americans are loud.
10. You talk about Americans overseas and call them “foreigners.”
11. You find out that living overseas is not the top qualification employers are looking for.
12. You learn to stop talking about the nanny and groundskeeper you used to employ.
13. You have to ask how to write a check.
14. You forgot how many numbers to dial for a local phone call.
15. You tell your toddler, “No seaweed until you finish all your hamburger.”
16. You try to order fried chicken at Burger King.
17. You check prices by converting from what a similar item cost overseas.
18. People say, “football,” and you ask, “Which kind?”
19. You don’t know how to respond when people say, “I bet you’re glad to be back home.”
20. You prefer to hear news reports from someone with a British accent.
21. You wonder why all the commentators on TV are yelling.
22. You wish you’d brought back ten of your favorite kitchen utensil because you didn’t know it’s not sold in the States.
23. You realize international students are you’re kind of people.
24. You ask where you can get a late-model, low-mileage Toyota for around $2000.
25. You turn on the subtitles on an English movie because you don’t want to miss anything.
26. You ask the clerk at the video store if they have VCDs.
27. You wonder if organization should be spelled with an s.
28. You load up your suitcase and you try not to “pack like an American.”
29. You stop bringing your bi-lingual Bible to church.
30. You just smile at people who say, “So I guess you’re all settled in now.”

(Part 2Part 3)

[top photo: “Electrical Outlet,” by grendelkhan, used under a Creative Commons license; bottom photo: “Having It Both Ways,” by Keith Williamson, used under a Creative Commons license]

You Remember You’re a Repat when . . . (Part 2)

(Part 1)

You remember you’re a repat when . . .

31. You stock up on Mountain Dew because you never know when it won’t be available again, and you check the expiration dates.
32. You think the public schools are great because the teachers are all proficient in English.
33. You read all your junk mail because it looks important.
34. You don’t hang pictures on the wall in case you’ll be moving again soon.
35. You still have unopened boxes shipped from overseas, and you don’t have a clue what’s inside them.
36. For Christmas, you open up one of those boxes.
37. Even though you own a house, you still catch yourself turning the music down so you won’t “bother the neighbors downstairs.”
38. You’re invited to a bar-b-que and your first thought is “I hope they don’t give me the fatty part of the goat’s tail.”
39. You hand the cashier at Wal-Mart your credit card instead of swiping it yourself.
40. You put your hand lotion in 3 oz. containers just to drive to visit grandma.
41. You’re frustrated that you have to ask for chopsticks in a Chinese restaurant.
42. You have to ask what’s the right amount to spend on a wedding gift.
43. You give up trying to decide which shampoo to buy.
44. You ask your friends to take off their shoes when they enter your home.
45. People ask where you’re from and you just answer with the name of the city where you live now.
46. You skip reading the Facebook posts of your former coworkers overseas because it’s just too hard.
47. When you buy clothes, you check to see that the brand name is spelled correctly.
48. You stop telling stories about your old host country because people stop asking for them.
49. Now that you’ve returned, your family members can tell you they didn’t know why you went over there in the first place.
50. People who knew you before you left ask if you’ve “gotten that out of your system.”
51. You go to the hospital for surgery and you take your own towels and gauze.
52. Your high schooler is pulled over for a routine traffic stop and gets out of the car before the policeman approaches.
53. You question the waitress’s math skills until you remember she simply added tax.
54. You realize that Taco Bell isn’t quite as good as you remembered it.
55. Your daughter calls herself an “African American” because she was born in Africa.
56. You look forward to mowing the lawn, because you have a lawn.
57. You say “here” and you mean the US, not the town you’re in.
58. You take an umbrella outside when the sun is shining.
59. “Made in Taiwan” labels fill you with nostalgia.
60. People correct you when you pronounce foreign names the way they’re supposed to sound.

(Part 3)

[top photo: “Electrical Outlet,” by grendelkhan, used under a Creative Commons license; bottom photo: “Having It Both Ways,” by Keith Williamson, used under a Creative Commons license]

You Remember You’re a Repat when . . . (Part 3)

(Part 1, Part 2)

You remember you’re a repat when . . .

61. You describe a city as “small” because it has only a million residents.
62. You hear yourself saying at the dinner table, “Where’s the garlic?”
63. You pull out the winter coats when the temperature gets below 70 degrees; or you pull out the shorts when it gets above 40.
64. You get a bill from the doctor and you call to see whose clerical error made the amount so high.
65. Glade’s “Ocean Breeze” scent isn’t any substitute for the real thing.
66. You assume everyplace in the US has WiFi, just like in the city you used to live in.
67. Wearing your traditional ethnic shirt isn’t as much fun now that you’re not going back again.
68. You ask at the grocery store if they have KLIM powdered milk. When they say “No,” you ask when they expect it to be in.
69. You buy three cartons of Hagen Dazs ice cream because it’s one third of the price of Hagen Dazs in your old host country. When you get home, your spouse reminds you it’s still too expensive.
70. You reset your new computer’s clock to military time.
71. You need to convert to the metric system to make sure of distances and temperatures.
72. You get fully dressed to sit in your living room because someone may be peeking in the window.
73. Airports feel like home.
74. The thought of moving again sends you into a panic attack. But your spouse feels the same way about staying put.
75. Your college-age children resent that you took away their opportunity to go “home” for the summer.
76. You can’t remember why anyone would like pineapple from a can, the same for orange juice from concentrate.
77. You understand why the restrooms in LAX have signs saying, “Do not stand on the toilets.”
78. People say, “football,” and you ask, “Which kind?”
79. A friend sends funds to a scammer who sent out an e-mail saying he’s you, stranded abroad, and your friend believes it because, hey, you travel all the time and you’re always needing money.
80. You don’t know what to buy your parents for Christmas now that you can’t give them souvenirs.
81. You shed a tear after finally eating the last package of dried fruit that you brought back with you.
82. You do your happy dance when you find another package of dried fruit in the outside pocket of your carry-on bag a year later.
83. You cringe because you hear someone say she’s “starving to death.”
84. You realize that all the documents on your computer are formatted for A4 paper.
85. You tell your waiter, “I’d like my water with ice . . . if you have any.”
86. You get nervous about buying tickets at the movie theater, because you forgot what the “rules” are.
87. You still can’t drink water straight from the faucet.
88. Your children are happy to see that the US has Costcos, too.
89. You miss the familiar sound of the daily call to prayer . . . or a rooster crowing . . . or late-night traffic . . . or the song the trash truck plays.
90. You show up at a party 2 hours late because you don’t want to be the first one there.
91. You put your favorite DVD in the player and it says, “Region Unsupported.”
92. You understand that some things just take a lot of time.

[top photo: “Electrical Outlet,” by grendelkhan, used under a Creative Commons license; bottom photo: “Having It Both Ways,” by Keith Williamson, used under a Creative Commons license]

Disenfranchised Grief and the Returning Cross-Cultural Worker

Disenfranchised grief, also called “hidden sorrow,” is caused by “a loss that is not or cannot be openly acknowledged, publicly mourned or socially supported.”  This definition comes from an article I recently came across from Australian Family Physician, discussing the response of general practitioners (family physicians) to repatriated cross-cultural workers affected by grief.

What makes their grief disenfranchised is that their losses are not typical to the population at large, so others often discount those losses or don’t understand them. It is difficult to have compassion for a person when you don’t recognize why he is grieving. Others with disenfranchised grief include “ex-spouses, caregivers, nursing home staff, pet owners, children, adoptees, individuals with developmental disabilities, . . . those who may be grieving suicide or AIDs victims or other forms of stigmatised death, . . . victims of sexual abuse, indigenous people and prisoners re-entering their original subcultures.” While this seems to be a list made up of disparate groups, their commonality is that the losses they suffer are often easy to ignore or downplay.

The part of the article that most helped me understand the concept was the authors’ explanation of six types of disenfranchised grief. I am presenting the list here, but I’ve taken the liberty of providing my own examples of how they might apply to repatriated cross-cultural workers:

  • The griever’s relationships are unacknowledged
    [“You can enjoy yourself now that you’re back with your own people.”]
  • Lack of acknowledgment of the griever’s loss
    [“People move all the time. It’s not like somebody died.”]
  • Exclusion of the griever as not being capable of grieving
    [“She’s just a child. She’ll make new friends.”]
  • Exclusion of the griever due to the circumstances of the loss
    [“You knew what you were getting into when you decided to go overseas.”]
  • Exclusion of the griever due to their way of grieving which is not deemed appropriate by the community
    [“The Bible says ‘Consider it pure joy, my brothers, whenever you face trials of many kinds.'”]
  • Self initiated disenfranchised grief where shame plays a significant role
    [“Why don’t I trust God more?”]

The authors go on to stress how important it is that general practitioners understand disenfranchised grief and take steps to deal with it. Not only may family doctors be asked to treat physical symptoms that are a result of grief, but they may also be the only affordable and “safe” help that is available to the re-entering worker.

I wish that we could all understand and acknowledge others’ grief, whatever the source, so that we could “mourn with those who mourn,” giving them the community they need so they don’t have to grieve alone.

(Susan Selby, et al, “Disenfranchised Grievers: The GP’s Role in Management,” Australian Family Physician, Vol. 36, No. 9, September 2007)

[photo: “grief,” by Tomek.pl, used under a Creative Commons license]