Dividual identity in grief theories, palliative and bereavement care

Abstract

Methods:

As in life at large, ideas of ‘self’ underlie a great deal of theory and practice in palliative care and in bereavement care, they are frequently implicit, being part of shared cultural assumptions, but may assume a degree of theoretical abstraction when fostered by professionals. This article considers the latter, arguing for an interpretation of ‘self’ influenced by the anthropological notion of dividual or composite personhood and not for that of the autonomous, relatively insular individual typified in much postmodern culture.

Results:

After depicting both types of personhood, the article explores Western theories of grief typified in the approaches of attachment and loss, continuing bonds with the dead and narrative approaches to identity.

Discussion:

The dividual approach to personhood then drives a theoretical critique of those grief theories as a means of reflecting upon palliative and bereavement care.

Conclusion

This alignment of palliative and bereavement care is seen as an entailment of the dividual approach to personhood, while further consequences are raised for analysing memory, dreams and visitations of the dead, as well as providing a potential perspective upon memory loss and the dissonance experienced by relatives of someone who no longer recognizes them.

Introduction

What is a person? Just how do we think about personhood, and how does this influence palliative and bereavement care? These key questions implicitly frame critical periods of life, and many may assume the answers are so obvious that the query is not even worth raising, but assumed familiarity with extremely complex topics is potentially unwise. This is especially true when social circumstances change and, perhaps, invite renewed scrutiny of our theoretical presuppositions, including the notion of ‘the self’. Accordingly, this article considers ‘the self’ through the familiar idiom of the ‘individual’ and of the quite unfamiliar notion of ‘dividual’ personhood, it uses that distinction to analyse attachment-loss and continuing-bonds theories of grief and allied aspects of mortality-related identity with the aim of furthering discussion of palliative and bereavement care contexts. At the outset, I stress the exploratory nature of this discussion in highlighting issues for ongoing dialogue, analysis and the need for deeper research.

Primacy in personhood

Concepts of personhood that underlie both daily life and professional contexts of care are among the most complex of all notions in social, psychological, and psychiatric fields as well as in philosophy, theology, comparative religion and in the arts and humanities. This complexity has deep roots extending from Greek mythology and the division of an original single ‘person’ into two separate entities with a lifetime affinity and search for each other, through Plato’s complex and varied division of the soul into a threefold dynamic. Some have even seen that Platonic base echoed in Freud’s triadic structuring of a person as id, ego and superego.¹ Déscartes’s philosophical ideas of a mind–body distinction as well as Durkheim’s sociological concept of a person’s double nature – ‘there are two beings in him, an individual being … and a social being’ (p. 16)² – have also contributed to ideas of identity, as did G. H. Mead’s approach to the ‘social attitudes of others, internalized in “me”’ (p. 101).³ More specifically, Dumont⁴ pursued the ‘individual’ amid Christian theological ideas, a realm where notions of body, soul and spirit align with ideas of a transformation of identity in the afterlife, while Jacobs⁵ exemplifies something similar from a Jewish perspective. Morris⁶ has furnished a broad sweep of Western Conceptions of the Individual, while Giddens⁷ has furnished some influential sociological analysis of the ‘project of the self’ and of its ‘pure relationship’ as a way of describing a person actively seeking to make sense of the world.

It is interesting to see that these more philosophical and sociological notions of identity from the 1980s and 1990s now have firm competition from scholars in cognitive psychology and anthropology as when, for example, Asma⁸ contradicts those who see ‘the lone protagonist – fulfilling his individual destiny’ as ‘more fiction than fact’ (p. 45). Acknowledging our still uncertain knowledge of mental processing yet other contemporary thinkers consider how the mind ‘is capable of sending out mental pseudopodia into the world beyond the body, and is forming networks of interconnections with other minds’ (p. 251).⁹ All this sits astride potential information from other major cultural trends as with Indian-originating traditions that not only speak of atman, a self-force that transmigrates from one incarnation to another under the influence of karma, but in Buddhist traditions dwell extensively on the ‘I’ as ‘just as impermanent and illusory as anything else perceived by the sense’ (p. 74).¹⁰ Many more accounts of identity-construction, emotion and social action come from ethnographies drawn from across the world,^11–14 as do studies more directly focused on palliative and bereavement.^15,16

Suffice it to say that even this range of diversity might induce a sense of intellectual torpor over ‘personhood’, while the anthropologist Mary Douglas’s¹⁷ suspicion of anyone reducing complexity into the relative simplicity of ‘two kinds of people, or two kinds of reality or process’ could terminate many a discussion before it even begins (p. 161). This article will, nevertheless, enter the intellectual reconsideration of personhood, fully alert to the limitations set within a critique of the frequently unquestioned primacy of the ‘the individual’ in many a Western conceptualization of identity, a perspective with significant consequences for both palliative and bereavement care. This ‘individualistic’ perspective will be discussed alongside the less familiar notion of dividual personhood, in a critical dialogue of two contrasting models of identity that are then related to familiar theories of grief, with the hope of illuminating aspects of both palliative and bereavement care. The discussion extends some of my own previous work on meaning making, emotion and identity that was not alert to dividual theories of personhood,^18–20 into more recent studies that have taken it into firm consideration.²¹–²³ This shift of personal perspective marks how my own thought has changed as themes of mortality and grief have challenged previous assumptions. In circling around the familiar theories of attachment and loss, continuing bonds and narrative accounts of loss, this discussion asks how these grief theories might be partly reshaped if their normal ‘subject’ – the individual – is replaced by dividual personhood, a notion I will assume to be unfamiliar to many and requiring explanation. While fully acknowledging that this approach brings no theoretical panacea to the complexity of who we are, how we die or how we grieve, it does provide an opportunity for ongoing considerations.

Cultural contexts

Behind this discussion lies the fact that every society develops its own approach to life, health and illness, as well as to death, afterlife and memory, each depending upon what constitutes a person, and on how relationships are forged and developed in each culture. Over time, we take these cultural assumptions for granted but, occasionally, circumstances may give pause for thought and lead to major shifts in attitude. This is, quite obviously, now the case in most developed societies where ideas of human rights, sex, gender, longevity, cultural diversity and identity alter the dynamics of social expectation surrounding the notion of ‘personhood’. Moreover, the rapidly expanding and survival-aligned issues of environment, ecology and global warming also frame the crucial notion of identity, with the carbon footprint of body-disposal assuming its own new significance. To offer a reconsideration of these issues is, at the same time, to invite critical reflection on the deeply associated notions of grief, memory and emotion, each a particularly complex idea, not least in contemporary society where social and mass media play a significant part in depicting sickness, celebrity and tragic deaths, terminal illness and some desire for euthanasia. At the same time, a rise in formally sponsored and informal interest in death, a growth of academic focus on death across many disciplines^24,25 and the niche marketing of funeral professionals, all provide opportunity for new assessments of mortality. Being alert to the plethora of such literature, this article restricts itself to a narrow range of material drawn, largely but not exclusively, from anthropological contexts, and to the interplay of the ‘individual’ and ‘dividual’ approaches to personhood.

One meeting point for these concerns lies in the patterns of human response swirling around and within terminally ill and bereaved people. In previous eras, these took the cultural and religious forms of a good death,^26,27 but for much of the 20th century, these have been schematized through explicit, and secular, theories of grief, notably of the attachment and loss variety.^28–31 However, the overlap of the 1990 and 2020 decades is marked by the rise of a different emphasis on bereavement captured in the notion of continuing bonds with the dead,^32,33 and involving narrative accounts of bereavement.^34,35 These will be critically analysed here as the notion of ‘the individual’ is measured against that of ‘dividual personhood’ as drivers of attachment loss, continuing bonds and narrative theories of grief.

The questionable ‘individual’

That ‘the individual’ lies at the heart of much thinking about society, philosophy and theology is but an extension of the very notion of individualism that has, equally, come to underlie a great deal of Western-style thinking about the social contract, economics and ethics.³⁶ From the Renaissance and its echoing of classical antiquity’s humanity of the unique nature of persons, through the Protestant Reformation’s religious refocusing the individual before God; through scientific transformations and still more recent shifts in postindustrial, service-based societies, the individual becomes the arena of law, human rights and identity.³⁷ The ubiquitous influence of the theoretical imperialism of postmodernism is, perhaps, its strongest cultural presence. The well-known and popularly rendered philosophical mantra taken from the philosopher Déscartes – ‘I think therefore I am’ – very roughly touches today’s commercial advertising motif of – ‘because I am worth it’. More controversially, perhaps, these also echo the ethics-linked idea – ‘it’s my body and I can do what I like with it’, all reinforcing the idea of the individual as the starting point for understanding ‘myself’.

This perspective has not been without criticism. The distinguished academic, Philip Rieff,^38,39 for example, expressed strong disquiet over this ‘historic Western binge of inwardness’ that he saw lying in, ‘the socialized individual self’, while the influential novelist David Lodge aptly depicts ‘the idea of the autonomous individual’ within a ‘postmodernist deconstruction of personhood (p. 174). Even when ‘individualism’ is so specifically pinpointed as ‘a dirty word’, taken by some to carry negative features of ‘impersonal market forces and consumer choice’, or where ‘expressive individualism’ is aligned with idiosyncratic forms of funeral, the preoccupation with individualism remains (pp. 307–308)⁴⁰ (pp. 141–142).⁴¹ Few better descriptions of this condition exist than David Schneider’s⁴² account of the ‘Western conception of the person as a bounded, unique, more or less integrated motivational and cognitive universe, a dynamic centre of awareness, emotion, judgement and action … set against other such wholes’ (p. 225). One of my early monographs agreed with their criticism of this perspective for social theory in general and religious ideas of salvation in particular (pp. 161–164),¹⁸ with a further caution following a major social survey of death-linked attitudes (pp. 102–108).⁴³ Only much more recently, however, have I seen how to implement that criticism as far as death studies in general and ideas of grief in particular are concerned – through the idea of dividual personhood as outlined in the third, but not previous editions, of Death, Ritual and Belief (pp. 53–78).²¹ It remains for those intimately involved in palliative and bereavement care to evaluate these perspectives in the life experiences and dying contexts of those they serve. For the moment, this article’s task is to give an introductory account of the notion of ‘dividual’ personhood.

The responsive ‘dividual’

Because many may be unfamiliar with the term ‘dividuality’, it demands some explanation as a specialized terminology describing human identity, especially because most Western societies not only take the idea of ‘the individual’ for granted but also assume that everyone knows what it means. The idea of ‘the individual’ belongs to the categories of thought that underlie many a ‘western’ society’s way of understanding life and, as such, may be depicted as a ‘deutero-truth’, a second-order or ‘conventional truth’, something that is taken for granted even though it may be ‘downright vague’ (pp. 304–312).⁴⁴ While everyone in a group ‘accepts’ the idea, any one member may be hard-pressed to give it any sharp definition. However, even if a concept may have first emerged within popular culture, it may develop into more formally defined schemes of thought. This is the case with ‘the individual’ but is far from the case with ‘dividual personhood’ even if, in practice, we are already implicitly familiar with some aspects of its significance not only when alluding to the deep relational nature of human experience but also when seeking to advocate the continuing bonds approach to grief. But, and this is crucial for this article, I propose that ‘the individual’ is a far less potent explanatory concept than that of ‘dividual’ personhood when it comes to grief theories, bereavement, clinical practice and palliative care. To argue this, I have chosen to focus on well-known grief theories and how they depend upon the notion of the individual while, perhaps, awaiting deeper significance through a dividual perspective. It is, then, to a brief background of that concept that we turn before pursuing the grief theory analysis further.

Marriott’s dividuality

A key source for the social scientific conceptual origin for ‘dividuality’ lies with the American anthropologist McKim Marriott’s seminal work on Indian cultural material that has not, as far as I am aware, previously been incorporated into Death Studies. His research paper – ‘Hindu Transactions: Diversity without Dualism’⁴⁵ – proposed that anthropological analysis of numerous aspects of cultural life in India would be enhanced by approaching the notion of a person not as individual but as ‘dividual’. As already intimated above, and now needing expansion, this involves a contrast between the image of a firmly bounded and almost insular person as opposed to one who is much less bounded and much more open to the being, influence, presence and participation of others. Here, we encounter a partible person whose dividuality contrasts with that ‘individual’ who frequently appears in what is now an almost conventional cultural context of ‘postmodernity’. That a concept, depicting a world where people do not share an overarching story or account of what life ‘means’, is one over which I have long been suspicious as a sweeping account of contemporary life (pp. 102–108).⁴³ Pragmatic accounts of people living alone and of loneliness often add to this scene of individualism.

Some sociologists do, of course, depict persons as participating in many interactions with others, and consider identity in terms of networked relationships.⁴⁶ But, despite the rise of social media and the apparent desire to share one’s experience with as many ‘friends’ as possible, some Western attitudes, as in parts of England, for example, still privilege ‘personal space’, and fervently desire ownership of one’s house, preferably with a garden fence signalling ‘independence’ from one’s neighbour, something that differs from, say, parts of Australia. Indeed, the very image of boundaries, whether impermeable or permeable, is conceptually important when considering the ‘individualist’ and ‘dividualist’ models of personhood.

Marriott goes beyond ideas of the networking of isolated and individualistically bounded persons to stress the vital significance of the dynamic environment as one in which elements flow, as it were, in and out of a less strictly ‘bounded’ person. Dividual personhood describes someone whose boundaries with others and the wider environment must be considered as selectively open for a variety of ‘flows’ of materials, relations and the emotions that constitute personhood. In theoretical terms, one major benefit of Marriott’s standpoint is that it allows full scope for the notion of embodiment – itself an increasingly established way of thinking about human existence. This is significant, for example, when ‘interaction’ is a broad term that includes, for example, one’s diet or the green environs of garden, park or ‘nature’ at large. To give just one example, it is now relatively commonplace for some people to say that ‘we are what we eat’, a phrase capturing the idea that what passes into our body helps make us what we are. Junk food is bad, whereas, depending upon someone’s views, veganism, vegetarianism or a considered use of animal flesh is good. In a similar way, popular opinion sees the value of pets, whether as companion animals, a much preferred term that indicates a quality of relationship different from that of ‘pets’. When present in schools, universities or care homes to bring a degree of comfort to anxious or lonely people, their presence as interactive agents available to stroke and talk to, does something for ‘the individual’. The depth of interaction between a companion animal and a human being is, itself, open to a consideration of ‘pet-personhood’ on the part of the human agent (pp. 153–168).²³ The animal becomes part of the human agent. Here, the theoretical emphasis falls more upon participation in human identity rather than on the relation between the animal and human agents. Much the same can be argued for long-term human relationships, and highlights the fact that the mode of discourse adopted for such contexts influences how we think about them, and also, for how we may think about grief: to this we will return.

Substance-code

For Marriott, and especially given his Indian context of research, the significance of the overall context of living becomes deeply significant for how he speaks of people and their basic processes of existence as with questions of food and drink and of those preparing it. These were highly significant in terms of caste, status and identity. Food and drink, in particular, allow us to grasp his emphasis on what ‘flows’ in and out of a person, for they stand as powerful symbols of social circumstance, and something similar can be said about words, as they are spoken, heard, received and prompt responses. Whether for food, words or numerous other aspects of life, Marriott uses the notion of what he calls a ‘substance-code’ for phenomena that help constitute a sense of identity. So it is that he can speak of ‘dividual persons’ as being ‘always composites of the substance-codes that they take in’, indeed the phrase ‘substance-code’ is key to his perspective, and could include, ‘parentage, marriage, trade, payments, alms, feasts’ as well as ‘words’ and ‘appearances’ (p. 111).⁴⁵ It is easy to see in the case of pregnancy and infancy how the child is integral to the mother and vice versa, foetal blood flow and breast-feeding, provide the most literal versions of substance-code and personhood as ‘motherhood’. Here, then, ‘code’ marks an index of participation in, it signifies elements that participate in and help constitute personhood.

In the Indian context, many such substance-codes foster or constrain a sense of ‘ritual purity’, itself a concept that frames the proper nature of things set in an ordered universe of social and ritual action. Someone is ‘ritual pure’ when they are able to engage in set forms of social life, and something is ‘ritually pure’ when it fosters the status of someone able to participate in a customary way. In terms of marriage, for example, it matters who it is that a daughter or son marries because this affects family status, with the very notion of an arranged marriage speaking to dividual personhood and the way numerous people are involved in or party to the marriage contract and its ensuing status. This differs from the Western notion of individualized romantic love. Although, in its own context, that concept of togetherness is also open to interpretation of dividual personhood. The notion of marriage in the Jewish-Christian tradition explicitly speaks of man and wife who ‘become one flesh’ (Genesis 2:24). While this has directly sexual connotations it could, just as well, allude to a mutual influence of each on the other. People become ‘part of’ each other, they ‘grow together’.

Such words are important in expressing the interactive flow between dividual persons that helps constitute personhood within various kinds of partnerships, from the intimate words that lovers may share to those arising in contexts of terminal illness and bereavement. In some Indian traditions, keywords, as in a mantra, are deeply significant when passed by a Guru to a disciple. For many Hindus and Muslims, for example, the passing or recitation of sacred scriptures or creedal statements into the ears of the newly born or just-dying is key. For these are dividual persons for whom and in whom the divine word hosted by the religious community plays a crucial role in existence and for their destiny. Destiny words are dividual words. Similarly, with traditional Indian funerals, when the eldest son cracks the skull of the corpse upon the funeral pyre to release its life-force he symbolizes his participation in the dividual lifetime status of his father whose ongoing destiny will now be shaped by the force of karma generated in and through a lifetime of ‘substance-code’ interaction. Within the Catholic Christian tradition what have often been called ‘the last rites’ also manifest a substance-code, one that draws its potency from the ordinary sacramental life of believers but now focused on context appropriate forms of Eucharistic feeding, body anointing and verbal blessing, as the believer is prepared for the last journey from this world to the next.

While there is a sense in which the food–body link may seem as obvious to ‘western’ as to subcontinental Indian people, I suspect that ‘western’ understanding is actually more superficial than profound, more alert to ‘relationships’ of the individual than to eating, touching or speaking as a dividual partner. We may gain a clearer view of this perspective when, for example, a person becomes committed to a particular diet, and reckon their body to be a composite of what is eaten. What flows into the body becomes part of it. This is more obvious today than ever, given the significance of genetics upon the personal constitution. Even the popular comment on how a baby has its father’s eyes or mother’s nose provides its own cultural example of what theoretically we can identify as a ‘substance-code’ comment. Just as the genetic code underlies aspects of the total human constitution so might we think of the ‘substance-code’ as part of the epigenetic, cultural, environment, fully embracing the cultural world and physical environment and bringing personhood to fuller complexity.

Popular motifs also offer their own insight into notions of personhood. The phrase ‘my body is a temple’ is interesting here, for while it is sometimes used in a loose and secular way to depict a person’s sense of relationship with themselves in terms of health and wellbeing, its original context was early Christian and described the participation of the Holy Spirit with the believer (1 Corinthians 3:17). Indeed, a major perspective on identity in Christian thought lies precisely with a dividual or complex approach to personhood. This is evident, for example, in the Eucharist and the eating and drinking of bread and wine as ‘substance-codes’ of Christ’s body and blood and as symbolic of belonging to the church understood as the ‘Body of Christ’. Although such theological nuances lie beyond this article’s scope, that is not the case for the ‘substance-code’ of, for example, ‘parentage’. As I have sketched elsewhere, parental relationships involving intimacies of care, support, food, words, protection, housing and play, all feed into our embodied sense of our self. So do the circumstances that are sometimes reflected in moments when we find ourselves repeating what our parents said to us, or see in our own bodies and demeanour aspects of their behaviour (pp. 76–77).²¹

Other dividualist theorists

Among notable social theorists who have also considered dividuality is Cambridge anthropologist Marylin Strathern. Although her innovative Melanesian ethnography involves complex outworking lying beyond this article’s scope, we can note how she accounts for ‘Melanesian persons’ in terms of their being ‘as dividually as they are individually conceived’, as containing ‘a generalized sociality within’ and as being ‘frequently constructed as the plural and composite site of the relationships that produced them’ (p. 13).⁴⁷ She is alert to a certain distinction between a ‘person’ who is ‘construed from the vantage points of the relations that constitute him or her’, and ‘the agent’ as the one who acts because of those relationships, who is revealed in his or her actions and who ‘acts with another in mind’ (pp. 272–273).⁴⁷ She is also keenly aware of time as its own medium within which actions take place (pp. 280–282).⁴⁷ Her subtle analyses raise many other issues of how Western ways of thinking influence our approach to understanding of different societies. Here, we have only pinpointed some of her more obvious arguments.

Celia Busby has also made significant use of dividual personhood when focusing on gender-identity and body fluids in a comparison of Melanesian and South Indian notions of identity. Developing some of the terms used above she offers a sophisticated understanding of the, ‘contrast between an internally divided and partible person, a “microcosm of relations,” and a bounded but permeable, fluid person, connected to others through flows of substance’ (p. 275).⁴⁸ This kind of perspective could certainly be developed to advantage in careful and extensive studies of both palliative and bereavement care. Among other anthropologists utilizing similar concepts are Sabine Hess,⁴⁹ and Benjamin R. Smith,⁵⁰ while Chris Fowler⁵¹ has also incorporated dividuality into his archaeological work. In more direct association with bereavement care, the anthropologist Arnar Árnarson⁵² has devoted some significant theoretical analysis to the theme of the roles existing between individuals, and does so to develop the focus on roles into a discussion of how such roles enter into the very embodied nature of people.

Dividual personhood, then, invites a way of thinking and speaking about ourselves that has a grammar of discourse and a quality of significance all of its own. It invites me to think of how others are part of myself, of how ‘they’ help constitute ‘my’ selfhood. My ‘partibility’ is grounded in their participation in me. Not only may I physically resemble my mother or father, or have adopted some of their characteristic traits, but their words, and the very sight and recall of them in different moods and contexts, may become actively present within the dynamics of my identity.⁵³ For some people, this becomes especially important years after their parent has died. This subtle shift of discourse encourages us to rethink such crucial topics as identity and memory. Accordingly, to say that I ‘have a memory’ of my parents is not to highlight the ‘of’, for the stress does not highlight a distance between them and me; on the contrary, it is more a case that memory is a mode of my being. They are present to me as part of me. That is what I am: they are part of me. And it is that participation, accumulated through a multitude of ‘substance code’ moments, events and processes, that constitutes its own form of deep symbolic memory.⁵⁴

It will be obvious that this discussion, as in all theoretically driven debates, much depends on mode, nuance and context when analysing behaviour. In addition to the obvious social scientific approaches just discussed, the ‘dividual’ carries quite different meanings in Milton’s Paradise Lost when he poetically depicts the Sun set amid other heavenly bodies (Book VII: 385). So, too, in the modern philosophical reflection of Deleuze on mass observation society and its capacity to divide persons according to their many contexts.⁵⁵ The latter focuses on forms of social control in prisons, schools and hospitals and can be commended for criticizing how the individual is turned into a ‘number’, or ‘dividual material to be controlled’, but perhaps his French orientation lacks something in understanding the UK’s National Health Service, and is certainly inappropriate for Hospice care (Section 3).⁵⁵ While many other studies of human life, whether sociologically – in the multiple roles played by one person, or psychologically – in ‘ordinary’ and more pathological’ multiple personalities, could be explored as forms of complex identity, these are excluded from this article for brevity’s sake.

Enough, then, has now been said to establish the notion of dividual personhood as offering a somewhat different perspective on ways of thinking about identity, and it remains to ask what this means for bereavement, palliative care and theories of grief, especially the attachment-loss and continuing-bonds schemes.

Dividuality, attachment and loss

While the very phrase ‘attachment and loss’ sits very easily in studies of bereavement and grief, it is important to appreciate that the roots of attachment theory lie in studies of child development and socialization.^29–31 This makes it important to cite some critical studies because ‘attachment’ theory starts from a Western sense that the mother–child bond is the foundational, elementary relationship of identity. But, just what is this ‘bond’? Does it emphasize something of the relationship between the two or a more embodied presence of the one within the other? To address this question adequately as far as this article is concerned is to differentiate between the individual and dividual basis of the theory, with the former dominating over the latter, with attachment-loss being deemed an individualist theory of identity.

However, even if we decide to think of attachment theory as a much more intimate phenomenon, approximating more to dividual identity, we still need some caution, especially if venturing any broad comparison across cultures. So, for example, the ‘mutual gaze, face-to-face interaction’ establishing ‘“attunement” between mother and infant’, something regarded as ‘integral to sensitive mothering as well as a universal and necessary precursor to the development of a strong and secure attachment’ is simply ‘absent from many … caregiving regimes’ in other cultures (p. 21).⁵⁶ That statement may well be remarkable for many Western mothers and serve as its own constraint on attachment theory. It could well be as significant for attachment and loss theory for those concerned with grief. It certainly emphasizes the importance of comparative studies as when attachment in infancy and beyond shows the existence of ‘multiple attachments’ of child to caregivers and how cultural contexts help shape adult identity and relationships.⁵⁷ To reiterate the point, such cases reveal a complexity that can be carried over to our challenge of attachment-loss ideas when focused on bereavement. A great deal of work still needs to be done in this comparative field, not least when we consider the extensive research that has gone into elaborating Western-style attachment ideas.^58,59 Morelli and Henry’s concluding comments on a major comparative, largely ethnographic, account of attachment theory and child development forcefully echo this article’s concerns. They say, for example, ‘[W]hat we take away from this volume is that notions of self do not adequately deal with the different ways an individual’s sense of self in a world of others are conceptualized across cultures’ (p. 247).⁶⁰ And if that is the case for child development, it must be the case for end of life, dying, death and the very nature of bereavement. If it ‘takes a village’ to raise a child, as one African proverb captures the theme, it may also ‘take a village to care for someone as they are dying’ in a Western context (p. 129).⁶¹

What then if we adopt a dividual approach to these criticisms? Might that help relocate the dynamics of ‘attunement’? Indeed, ‘attunement’ then becomes worthy of much wider study in terms of embodiment theory. Here, the ‘substance-codes’ creating and sustaining identity may come from many and not from one primary caregiver, that is a simple enough accommodation to make: it would help interpret an easier response to the death of one figure of attachment. Moreover, because substance-coding could involve wider activities and contexts than only another ‘person’, it is easier to see how ‘grief-work’ as the ensuing behaviours following the death of a significant ‘other’ can take many forms of dynamic changes within the embodied identity of a bereaved person. Attunement may also be considered in relation to the material culture of relationships, as with the belongings and possessions of the dead.

Dividuality, continuing bonds

What then of continuing bonds against the background of dividuality? Since the mid-1990s, the idea of continuing bonds with the dead rather than severing them in active modes of detachment has gained enormous ground. It is, in many respects, a remarkable cultural fact that the attachment-loss model was sustained for the best part of a century, albeit with a number of developments generated through psychiatric and clinical practice. Doubtless, the early psychoanalytic dominance helped sustain this, while more sociological and anthropological concerns modified ongoing interests. This makes Robert Neimeyer’s pinpointing of the ‘paradigm shift … in the field of bereavement research and practice’ all the more poignant (p. xi).⁶² So, too, with Dennis Klass’s ‘Prologue’ observation that, ‘if ever a book was successful, Continuing Bonds: New Understandings of Grief was one of them’; there, as elsewhere in his and Edith Steffen’s later edited collection on Continuing Bonds in Bereavement: New Directions For Research and Practice, Klass recognizes a number of theorists and practitioners who, expressing the spirit of the age, moved towards the idea of ongoing bonding rather than being restricted to of detachment therapies grounded in attachment and loss theory. More specifically, he also portrayed a variety of ways of identifying parent and child, of ‘mother and baby as one unit’, and of how relevant ‘inner representations’ needed to be understood and worked-out in social terms.⁶³

That there has been a paradigm shift in overall approaches to grief theory is undeniable, as is the match between ‘bonds’ and ongoing cultural trends to accepting social and interactive factors in identity development and, indeed, in accommodation to theories of embodiment. Against that background, and the many studies fostering the interactive bond, this article proposes that both the attachment-loss and continuing-bonds approaches, with their essentially individualist base, may gain additional theoretical purchase through the complementary theoretical lens of dividual personhood. Following on from that are some potentially fruitful entailments concerning memories, dreams and experiences of the departed.

Rephrasing attachments and bonding

Increasing numbers of research studies portray local realities of grief and, in the process, demand expansion of appropriate theoretical analyses. This is the case for Christine Valentine’s splendid account of grief embedded in her ‘bereavement narratives’. She brings to

… sharp focus how the self was constructed through social interaction and intimately linked to the selves of others. They represented a more fluid, relational and intersubjective expression of agency and personhood than can be encompassed by the concept of a unitary, bounded, embodied, performative selfhood. (p. 83)⁶⁴

For her, there remains the question of ‘how personhood and agency may transcend the body itself to encompass the continuing social presence’ of the dead ‘in the lives of those they leave behind’ (p. 83).⁶² She returns to the vital topic of personhood when taking up issues of social policy and practice, as she decries ‘the depersonalising treatment of dying people’ and affirms the need for ‘a more flexible and nuanced understanding of personhood … to provide a context for developing policy and practices’ (p. 174).⁶⁴ It may be that the dividual approach might help contribute towards just such a nuanced grasp of personhood, not only in the dying, and in bereaved people, but also in those charged with care for them and for the social policy framing that care. Valentine’s accounts of interview contexts aptly and sensitively speak of the dead as seemingly present within the interview situation, as when ‘Adrian’ speaks of his dead father as being ‘absolutely central to who I am’ (p. 97).⁶⁴ Any number of quotations amount to the same experience of ‘presence’ of the dead with or within the living. While her study is firmly dedicated to an exploration of continuing bonds, its implicit assumption on personhood seems to rest on the individualist model while also straining for a more enhanced interpretation as indicated above. An adoption of the dividual nature of personhood might well make it easier to account for these experiences, most especially when we bring to bear upon the interview situation the interpretative empathy of a researcher like Christine Valentine. A hermeneutical grasp of the way the bereaved person actualizes their deceased relative within them, especially when in a conversation ‘about’ the deceased, would make all the difference. We speak of what we know, and when we express our emotions concerning the significant ‘other’, we are but actualising that ‘person’ and making them available for appreciation by our interviewer as partner in the social moment of conversation. A decade after Valentine, the account of DiCello, Pidano and Mangione concerning Italian-American bereavement includes similarly instructive descriptions of lifetime links with the dead.

As Mary sits and talks with Sam every day, chatting, arguing, sharing, crying, she is living out the intimate, living, breathing bond to him that has been strong almost 70 years. She has also been modelling to her children, grandchildren, great grandchildren and her niece, that in an Italian-American family, a person may die but never really disappear if you keep that person in your heart and mind (p. 276).⁶⁵

To interpret this in terms of continuing bonds and the link between one individual and another makes good sense and echoes our everyday appreciation of relationships between people, but that is not to say that some additional, or even better, sense might be made if it is approached in terms of dividual personhood. For then we can see how Mary is, in effect, not only a complex combination of Sam and herself but is also possessed of a personhood that has, in all probability, been developing and changing as she brings Sam to her many family members and them to his ever-transforming presence as part of her identity.

So it is that attachment and loss theories assume the concept of the individual set in survival-driven relationships with other individuals. At the outset, this involves a child–mother relationship but may open up into numerous relationships with further significant others. The dividual approach need be no less interested in issues of survival, and certainly brings an added significance to the very notion of relationships, in that it brings ‘others’ into the very composition of the ‘self’. Instead of a relationship between individuals, we find personhood to be composed in and through a relational integration of ‘others’ within and ‘as’ ‘the self’. Although lying beyond the immediate scope of this article, a similar train of thought is demanded by contemporary 21st century concerns with the environment, most especially in terms of the carbon and other ‘footprints’ made through a variety of funerary rites, whether traditional burial, cremation, alkaline hydrolysis or other eco-friendly modes of disposal.⁶⁶ In all these, the body of the ‘person’ enters into, or takes into itself, elements of the physical environment in ways that the dividual grammar of discourse makes more intelligible than does that of ‘the individual’.

Rephrasing memories, dreams, visitation and forgetfulness

This kind of configuration then brings its own nuanced meaning to numerous phenomena, a few of which can be mentioned here. Given their relevance for palliative and bereavement care, these embrace memories, dreams, visitation of the dead and the kind of forgetfulness encountered in some mental illnesses that easily brings distress to relatives. These, in a distinctive way, sense that they are already ‘losing’ someone dear to them. When, for example, I say that I ‘remember my dead’ relative or friend, or when I dream about a dead loved one, or sense their presence, what is happening? So, too, in experiences of the terminally ill who experience ‘visits’ of dead relatives in the weeks, days or hours, before they, themselves, die. And, finally, what of those times when a relative no longer recognizes their adult offspring, when remembering is replaced by forgetfulness? All such experiences may be highly relevant here because they are familiar to many engaged in palliative and hospice care, as well as to the bereaved.

Once more, my proposal is that a dividualist perspective will result in nuanced differences offering new insight into complex issues. For example, memories are easily identified as elements of embodied emotions and recognized representations of those we know and who have become ‘part of’ ourselves. Our own sense of self becomes inextricable from our sense of the ‘other’ person and of how we interacted at different times and places. This dividual grammar of discourse allows a distinction to be drawn between memory as a memory of another person, and memory as part of my own constitution. Similarly, my dream of someone is my own representation to myself of a constituent element of myself and my previous experiences derived in and through other people. So too, in those complex contexts when some dead relative is sensed to have visited a living person, not least when someone is close to death themselves. While there are some who believe in the objective existence of the dead in some afterlife domain, and possessing the capacity to revisit the living, it makes more pragmatic sense for those not holding such a belief to think of such a visit as a moment when my dividual personhood becomes alert to those who helped constitute it. Although it may sound rather circular, this argument proposes that I am, as it were, visited by part of my complex self, or that I become aware of an aspect of my own complexity that has emerged from a lifetime of mutual participation with others.

More pragmatically, it is far from uncommon in palliative care, not least in hospice settings, for a terminally ill person to be ill at ease over some family relationship. In answer to that generic question – ‘what is important to you?’ – it might emerge that a person wishes to engage with someone who has been estranged or the like. Ideas of unfinished business, ‘closure’ or resolution arise and pose its own challenge of interpretation: whether grounded in an individualist or dividualist approach to personhood.

A final and similar test topic for the personhood models concerns situations when, for example, an elderly parent suffering memory loss shows no recognition of their own adult and once deeply familiar offspring. Familiar, that is, until now, when recognition is simply absent. He or she does not know who I am – despite a lifetime of close and intimate association. This difficult scenario brings its own pressure to consider interpretations of personhood. For, here, it seems as though the dividual nature of personhood is in decline, retreat or deep abeyance as far as the ill parent is concerned but certainly not for the healthy relative. The mother, we might say, no longer possesses owns, or senses the son as part of herself. Someone has been lost to her: something of herself has been lost to her. She no longer operates on her previous dividual base. At the same time, the unrecognized son experiences a kind of relational dissonance, for the parent who long constituted part of his personhood now offers no feedback, no response of participating in the life and identity of her offspring. This is not simply a case of a breakdown in relationship between persons, but a breakdown of the processes that ordinarily constitute personhood. It is here, I propose, that the force of the dividual over individual model personhood prevails.

Conclusion

From the outset, this article has been exploratory in questioning ideas of personhood, and in assuming that they underlie approaches to both palliative care and bereavement care. I have aligned these two concerns, considering them to share an extensive overlap of relationships, emotions and dynamics of healthcare. I have been alert to some assertions concerning theories of grief and am deeply aware of the potential for serious criticism in making blunt propositions without detailed study of their complexity. This is intentional as an extended reflection on personhood as a concept underlying both theoretical considerations and professional practice. This article offers a potential elaboration of and complement to the continuing bonds and narrative approach to grief, while not abandoning the theme of attachment and loss if given a dividual approach. It invites further theoretical critiques of assumptions underlying palliative and bereavement care as an ongoing process, not least within a journal devoted to these profoundly human and humane aspects of our dying and living.