Helping female inmates cope with grief and loss.

There are a growing number of women entering the penal system yet little attention has been paid to the research and programmatic needs of this population. (1) According to the Bureau of Justice Statistics, the female inmate population has doubled since 1990 from 44,065 to 94,336 in 2001. The issues and concerns of female inmates are different from those of their male counterparts. Most women entering state prisons are nonviolent offenders who are victims of sexual and physical abuse, are drug addicts and have a number of mental health problems, according to BJS. In 1991, one in six female inmates received medication for psychological or emotional problems since admission to prison.

Coping With Loss

Dealing with the loss of a loved one can be particularly difficult for female inmates, given the multiplicity of losses they have confronted in their lives thus far. These women will often experience emotional pain as a result of separation from their children. Since women are often the primary caregivers of their children, female inmates are faced with the threat of losing custody of them. The incarceration itself precipitates the experience of loss, and other factors include the loss of material goods, employment and control. Living in a culture that limits inmates' ability to act freely and controls and monitors their every act contributes to their inability to adapt effective strategies for managing stress. When confronted with the death of a loved one, the other multiple losses, which must be dealt with concurrently, can complicate the grieving process. Thus, the loss of a loved one can be particularly traumatic for incarcerated women. The absence of relationships and autonomy, as well as the loss of freedom and physical space can lead to a sense of powerlessness, inadequacy and low self-esteem, which can make incarceration emotionally traumatic. (2) Female inmates must learn to cope in a very stressful environment that can have a negative impact on their mental health (3) and they must learn to deal with and adhere to incessant rules that limit their ability to act freely as adults.

But how do female inmates cope with the death of a loved one? According to Hans Toch, "confinement may amplify the processing of sorrow when a loved one is lost." (4) Since resources are limited in most correctional facilities, individual and group counseling or support groups are not readily available for female inmates who wish to address their concerns. Sometimes, the initial news of an inmate's loss is received in an environment that lacks a support system such as a relative or professional counselor. For inmates, the absence of support can heighten their grief. (5) Their only support at the time may be a cellmate who is willing to listen but who is not trained to work on effectively addressing issues surrounding the loss.

Compared with the general population, women in prison are rarely given the opportunity to deal with their psychological issues. When the system neglects to provide treatment in prison, these offenders will often face difficulties reintegrating back into their community. (6) In a qualitative study investigating the challenges of incarcerated women, Beth Richie reported that the psychological needs of female inmates were not diagnosed or treated. One plausible explanation for this failure may be due to prison budgets, with funds only available to meet essential operating expenses. Addressing the therapeutic needs of female inmates is not recognized as important as the prison's concerns for safety, order and control. (7)

Counseling is essential for women both while in prison and after their release. (8) Providing health programs that are gender- and culture-specific will help to address the particular needs of incarcerated women. Awareness of the need to develop and implement policies and programs to help women cope with grief while in prison and after their release is necessary. Without such interventions, these women will encounter difficulties successfully re-entering society.

Dealing With Grief

The loss of a loved one can be a devastating event and can even produce a number of responses referred to as grief. Grief is a normal response to death and can be defined as an "experience of anxiety that can manifest itself in the individual's behavior, emotions, thinking, interpersonal relationships and one's own spirituality." (9) Grieving seems unnatural since individuals tend to feel they are losing control of their thoughts, emotions or feelings. These feelings are heightened for female inmates who must learn to cope with multiple losses as a result of incarceration. According to Theresa Rando, there are times when individuals experiencing grief may feel vulnerable and powerless. They may also feel overwhelmed because the intention to spend physical time with the person has been stolen by the death of the deceased. (10) For women in prison, these feelings can be experienced with greater intensity because the time that they could have spent with the deceased ended when their prison sentence began. When a sudden death occurs, female inmates are often not given the opportunity to say goodbye or take care of unresolved issues with the deceased. This lack of closure leaves them feeling power-less and cheated. Female inmates may even experience conflicted loss if they had an ambivalent relationship with the deceased, especially where abuse was involved. According to BJS, 60 percent of women in state prisons reported that they were physically or sexually abused at some point during their lives.

The impact of bereavement varies widely, depending on the characteristics of the griever and the nature of the loss. (11) The grief and loss of the incarcerated female can become even more complicated compared with others not in prison. Women in prison, unlike those outside the prison walls, must cope and grieve alone without counseling or other resources needed to complete the grieving process. Not being able to attend the funeral of a loved one, such as a child, parent, relative or friend, is a common occurrence and can be referred to as disenfranchised grief. Kenneth Doka refers to disenfranchised grief as "a person who is not given the opportunity to publicly grieve or acknowledge the loss." (12) The absence of rituals or being excluded from the rituals, such as the funeral, is an example of disenfranchised grief. (13) Even if given the opportunity to attend the funeral, female inmates may be given the permission to privately mourn, but without the emotional support of a family member or counselor, or they may be subject to the humiliation of attending the service in shackles. (14) According to J. William Worden, the grieving process can be thought of as a series of tasks that must be accomplished so that individuals can become actively engaged in their lives again. (15) Worden also states that the grieving process should involve four tasks. First, the female offender must acknowledge the reality of the death. Acceptance of the finality of the loss is a crucial task to be accomplished in the first phase of the mourning process. (16) Second, individuals must experience their grief fully and then learn to adjust to the environment in which the deceased is absent. Finally, individuals must move forward with their lives while keeping the memory of the deceased alive.

Acknowledging the Reality Of the Death

Acknowledging the reality of the death is coming to the realization that the deceased will never come back. According to Worden, if this first stage is not successfully completed, it can result in pathological, unresolved and/or maladaptive grief. For female inmates, the opportunity to begin the grieving process is interrupted by the unique aspects of their incarceration. (17) These unique aspects include lack of support from prison staff, validation of the loss and the opportunity to publicly mourn. The normal grieving process is interrupted because female offenders are restrained from any expression of emotions because of the threat of consequences such as physical punishment or a longer parole. According to Ginette Ferszt, their grieving will often be alone, resulting in social withdrawal and isolation from others. This is due to the lack of support from others and the emphasis on the need to exercise self-control while imprisoned. If female inmates are unable to attend the funeral, which occurs the majority of the time, it may be difficult for them to accept the reality of the death. Attending the funeral is considered a ritual that many grief experts believe must be completed in order to place closure on a person's death. (18) Rando states that "in the absence of proof, grief may be postponed in the hope that the person is still alive." (19)

Fully Experiencing Grief

Grieving is a different experience for each person--individuals grieve for different lengths of time and express a wide range of emotions. In order to experience grief more fully, individuals must be able to feel free to express their feelings and emotions both alone and with others. In addition to feelings of sadness, emptiness and meaninglessness, female inmates will often experience a large degree of guilt associated with the loss. Although guilt is a normal feeling for anyone experiencing grief, female inmates may feel more intense guilt for things that they failed to do or not do with the deceased prior to becoming incarcerated. They may feel guilty and believe that their imprisonment may have caused the deterioration and the eventual death of the deceased. In addition, female inmates may feel guilt for not being present to comfort and/or provide support to the parent, sibling or child who was ill. The death of a child is considered a painful loss that can exist with parents for the rest of their lives. (20) Not being present when a child is dying can make any mother--who is considered by societal standards the nurturer--more vulnerable to feelings of maternal guilt. According to Rando, the normal experience of parental grief closely resembles what it commonly referred to as unresolved, pathological or abnormal. If what Rando reports is true, this can cause the grieving process to be more complicated for female inmates. They will need to learn the meaning of forgiveness and quickly begin to feel less guilty by learning to forgive themselves for what they failed to do or not do in the relationship.

Adjusting to the Environment

Female inmates must learn to adjust in an environment in which the deceased is missing. They will first begin to experience this by no longer receiving letters, visits or pictures from the deceased. It will be difficult for female inmates since they will need to learn to struggle and cope with the pain of their loss in an environment that limits their freedom to express grief in their own way. Interpersonal coping mechanisms will determine their ability to deal with the loss in this environment. They must learn to cope every day with the reality of the loss while experiencing frequent setbacks such as managing their thoughts, emotions and behaviors in prison. In the process of getting over the pain of their loss, these inmates can focus on what they can do to give meaning to their lives or what they would like to achieve. In Treatment of Complicated Mourning, Rando suggests that setting goals provides individuals with purpose, focus and meaning in their lives. (21)

Keeping the Memory of the Deceased Alive

Rando goes on to explain that talking about the loved one, acting on the values and concerns of the deceased and celebrating rituals are examples of keeping memories of the deceased alive. Rituals can be an important part of human existence regardless of life's experience. Setting aside a special time to think about the deceased while in jail or prison is an example of a ritual. (22)

Treatment of Complicated Mourning also suggests that the most effective way of keeping the loved one's memory alive is through actions. In working with female inmates affected by grief and loss, discussions often led to identifying ways to keep memories of the deceased alive through giving back to the community. Contributing to society and aligning themselves with causes for bettering society can provide a renewed sense of meaning and purpose.

Supporting Inmates

Currently, a continuum of care to meet female inmates' mental health needs is missing. Without continued support for incarcerated women, the grieving process can become complicated, resulting in a need for therapeutic intervention. Prison staff and others who come in contact with this population should provide support and assist in making the grieving process as normal as possible. It is recommended that they be trained to identify the signs of complicated grief such as: an absence of mourning (complete denial of the death); distorted mourning in the form of extreme anger and guilt; speaking of the deceased with intense grief; overidealization of the deceased; not being able to talk about her feelings; and signs of anger, depression and radical change in behavior. In these cases, there should be a special watch over the inmate for a certain period of time, especially if there is a history of attempted suicide or severe depression. In order to minimize the possibility of elevated shock at the news of a death, a support system (i.e., chaplain, counselor, relative) should be present to reduce the chance of complicated grief. Given the limited amount of funds and the increase in the number of female inmates, many of these offenders have no access to individual or group counseling to address personal issues such as grief and loss. (23) Support groups or individual counseling should be available to address their issues. The following are recommendations to help female inmates cope with their loss:

* Listen to the inmate's experiences and help her process the meaning of her loss. Help her recognize and accept the reality of the loss. The prison should conduct a private memorial service for the deceased.

* Have the inmate ask a family member or friend to bring her a program or have a video made of the funeral service with permission from the penal institution. This can help to cement the reality of the death and facilitate the normal grieving process. Upon her release, visiting the cemetery is another way she can begin to place closure on the loss.

* Encourage the inmate to share feelings with a counselor, chaplain, volunteers, outside clergy, cellmates or supportive relatives. Assist the inmate in beginning to work through her grief by encouraging the expression of feelings and emotions. According to Phyllis Taylor and Ginette Ferszt, crying in her cell or in front of another person is normal and should not be perceived as a sign of weakness. Support groups can offer understanding and support and foster a willingness to explore members' concerns. Individuals can share their experiences and provide one another with emotional and social support, learn from one another, offer suggestions and also provide direction and hope for those who do not see a future. Taylor and Ferszt believe that sharing thoughts and feelings with other inmates who also experienced grief can help identify what normal grief is.

* Suggest that the inmate keep a journal to express her feelings, thoughts and memories associated with the loss in order to help her move through the grieving process. Some inmates may want to use a tape recorder to express their feelings and thoughts. They can also use photos as a tool to express their feelings and talk to the deceased.

* Ensure that the inmate is eating properly and getting a good night's sleep--self-care is important. Exercise is also important because it can minimize depression and negative feelings. (24)

* Identify ways to keep memories of the deceased alive. Discussing and emphasizing the contributions of the deceased along with the positive impact he or she had on the inmate's life can serve as a catalyst to change her own life. It is important that counselors or other professionals working with women who had an ambivalent relationship with the deceased work with them to help address their unresolved issues.

* Encourage the offender to practice meditation, relaxation exercises or prayer. If the inmate is spiritual or religious, she can ask a higher being to give the deceased a message. It was noted that this was especially cathartic for black women whose spirituality is deeply imbedded in the psyche of the population.

* Suggest that the inmate work on establishing small goals for both inside the prison and upon her release. Goals will help crystallize a future that can provide meaning and purpose.

On the basis of this review, it is clear that there is a need to implement prison resources that will serve to meet the multiplicity of psychological needs of female inmates. These offenders need support from prison staff, family members and friends during their loss. Without permission to participate in important rituals, such as funerals, and the freedom to openly express their feelings and thoughts without severe penalties, their grief can result in complicated or maladaptive grief.

ENDNOTES

(1) Singer, M., J. Bussey, L. Song and L. Lunghofer. 1995. The psychosocial issues of women serving time in jail. Social Work, 40(1):103-113.

(2) Anderson, C., D. Bankson and E. Zephirin-Atkins. 1998. Incarcerated women. In Trauma recovery and empowerment: A clinician's guide for working with women in groups, eds. M. Harris and Community Connections Trauma Work Group, 249-278. New York: Free Press.

(3) Fogel, C.I. 1993. Hard time: The stressful nature of incarceration for women. Issues in Mental Health Nursing, 14:367-377.

(4) Toch, H. 1992. Mosaic of despair: Human breakdowns in prison. Washington, D.C.: American Psychological Association.

(5) Ferszt, G. 2002. Grief experiences of women in prison following the death of a loved one. Illness, Crisis and Loss, 10(3):242-254.

(6) Richie, B. 2001. Challenges incarcerated women face as they return to their communities: Findings from life history interviews, Crime and Delinquency, 47(3):368-389.

(7) Toch, H. 1992.

(8) American Correctional Association. 1990. The female offender. Washington, D.C.: St Mary's Press.

(9) Schwartzberg, S.S. and R.P. Halgin. 1991. Treating grieving clients: The importance of cognitive change. Professional Psychology: Research and Practice 22:(3)240-246.

(10) Rando, T.A. 1984. Grief, dying, and death: Clinical interventions for caregivers. Champaign, Ill.: Research Press.

(11) Schwartzberg, S.S. et al. 1991.

(12) Doka, K.J. 1989. Disenfranchised grief. In Disenfranchised grief: Recognizing hidden sorrow, ed. K.J. Doka, 3-11. Lexington, Mass.: Lexington Books.

(13) Hocker, W.V. 1990. Characteristics of unsanctioned and unrecognized grief, and appropriate helping strategies. In Unrecognized and unsanctioned grief: The nature and counseling of unacknowledged loss, eds. V.R. Pine, O.S. Margolis, K. Doka, A.H. Kutscher, D.J. Schaeffer, M.M. Siegel and D.J. Cherico, 104-117. Springfield, Ill.: Charles C. Thomas.

(14) Ferszt. G. 2002.

(15) Worden, J.W. 1991. Grief counseling and grief therapy, second edition. New York: Springer.

(16) Dickenson, G.E. 1992. First childhood death experience. Omega, 2(3): 169-182.

(17) Ferszt, G. 2002.

(18) Doka, K.J. 1989.

(19) Rando, T.A. 1986. Parental bereavement: An exception to the general conceptualizations of mourning. In Parental loss of a child, ed. T.A. Rando, 45-58. Champaign, Ill.: Research Press.

(20) Schwab, R. 1990. Paternal and maternal coping with the death of a child. Death Studies, 14:407-422.

(21) Rando, T.A. 1988. Treatment of complicated mourning. Champaign. Ill.: Research Press.

(22) Taylor, P. and G. Ferszt. 2001. When death enters your life: A grief pamphlet for people in prisons or jails. National Prison Hospice Association.

(23) Pollack, J.M. 1998. Counseling Women in Prison. Thousand Oaks, Calif.: Sage Publications Inc.

(24) Rando, T.A. 1988.

Victoria Young Junior, Ph.D., L.P.C., is a licensed professional counselor and an adjunct faculty member at Roosevelt University in Schaumburg, Mich., where she teaches clinical courses. She is also director of New Visions Community Resource Center, a nonprofit organization in Southfield, Mich., providing psychological services to individuals, couples, children/adolescents and families.