INTRODUCTION

“But I was in pain. I was­­ I thought I would die. Talagang, yung pain na... Ano yung sabi nila. Yung kumikirot yung puso mo. It was true. Kumikirot talaga. And parang may kirot na mabigat na I dunno. I dunno how to explain ano yung feeling na yun. Now in hindsight, I think ano. He is in a better place. Will I say I'm grateful? Na kinuha siya? Hindi, pero ngayon ko lang naintindihan words ni Lord na, na you have to accept, you have to...”

­ Ms. Starbucks

Death is a natural yet inevitable part of life that everyone will have to experience sooner

or later. People know that it is bound to happen but are never really prepared for this certain

reality. We go through our lives as if we will live forever. We think that our parents, siblings,

and children will always be with us, but we have to understand that as humans we are finite

beings, and thus we are always limited by time. The death of a loved one is never easy to handle.

People are left to deal with the reality of the permanence of the loss. The dead will remain dead,

but the living must go on. This traumatic experience leaves the person preoccupied. In some

cases, these people refuse to let go, persistently holding on to those memories they had with their

most cherished ones. These lingering attachments are manifestations of continuing bonds­ when

bereaved persons hold on to the relationship they had with the deceased.

Continuing bonds is a complicated phenomenon that occurs during bereavement.

Bereavement here is not defined as a reaction, but as a state of deprivation­ a state of losing

someone you love. Attig (2004) defines bereavement as the “state of having lost someone we

care about or love through death” (p. 343). He adds that this deprivation people feel during

bereavement “redefines and limits our life consequences and possibilities” (p. 343). This state of

loss often leads to grief, accompanied by pain and anguish. Ang (2010) describes what makes

this stage of bereavement, and grief, so painful. First, the bereaved loses a sense of stability due

to the sudden change caused by the loss of the loved one. Second, the bereaved experiences a

loss of identity along with the loss of his/her loved one because his/her identity was tied to the

deceased. Third, the bereaved loses meaning in his/her life, due to the fact that his life was

centered around that of the one he/she lost. Lastly, the loneliness of losing a physical relationship

is extremely difficult for the bereaved.

Given the state of bereavement, some people find it difficult to deal with the loss, and are

therefore inclined to maintain a relationship with the deceased. This is where continuing bonds

comes in­ as an ongoing relationship with the deceased (Boelen, Stroebe, Schut & Zijerveld,

2006). These continuing bonds are formed when bereaved individuals construct mental

representations of the deceased as a way of incorporating them into their lives (Russac,

Steighner, & Canto, 2002). For the sake of consistency and clarity, the conceptual definition of

continuing bonds for this study will be the one provided in Boelen, Stroebe, Schut, and

Zijerveld’s work.

REVIEW OF RELATED LITERATURE

Given that continuing bonds are manifested in the context of bereavement, grief is

often at the center of the picture; yet continuing bonds and grief are different. Grief entails

having the bereaved’s energy invested onto another object, resulting to the decline and the

complete disappearance of the attachment to the deceased. On the other hand, continuing

bonds entail the bereaved continuing to incorporate the deceased into his life through creating

meaningful mental representations of the loved one (Delespaux, Ryckebosch­Dayek, Heeren

& Zech, 2013). Russac et al. (2012) also describes a difference between grief and continuing

bonds, wherein grief manifested by the bereaved entailed having his perceived similarity with

the deceased decline over time. On the other hand, continuing bonds entailed maintaining this

perceived closeness over time. Furthermore, continuing bonds also means that the death of a

loved one does not necessarily end the bond that they had with the deceased; it redefines the

relationship as something that goes beyond physical presence.

In his psychodynamic theory, Freud discusses bereavement, claiming that the

continuation of the deceased as the bereaved’s “loved­object”, as well as his or her inability

to let go of the death of the loved one leads to pathological grief (Epstein et al., 2006).

Furthermore, he claims that detachment to the deceased is crucial in order to relieve the pain

of the death. However, more recent studies suggest that both grieving and continuing bonds

may be more complicated than first conceived by psychodynamic theory.

One of the more painful types of bereavement and loss is that of a parent’s towards

his/her child­ when a mother or a father is separated with the person whom he/she has loved and

has grown accustomed to taking care of. Some parents choose to cope with this loss they feel

through the relationship they maintain with their deceased child­ a continuing bond. Whether it is

through remembering the memories they had with their child, or the ways in which they were

able to cope with the loss, parents narrate their different experiences in order to process the loss,

as well as keep this relationship with the deceased. Parents construct the meaning of their

relationship with their child through the stories that they tell about their deceased child.

In a study done by Klass (1993), parents nurture three forms of continuing bond

expressions with their deceased child. First, parents link objects to their child’s life, which

gives proof that their child, although already dead, had existed. Second, bereaved parents

usually associate their child’s presence with religion or spirituality, like how they say that

their child has already gone up to heaven. Lastly, parents also find solace in living out their

memories of the child.

Continuing bonds are manifested in many other ways. Field, Nichols, Holen, & Horowitz

(1999), identified four different expressions of continuing bonds. First is a recurrent sense of the

deceased presence, in a way that the bereaved felt that they were being watched or guided by the

deceased. Another is maintaining the deceased’s possessions, in a way that the deceased’s room,

belongings, clothes, and/or furnishings was kept exactly how it was left. Continuing bonds are

also manifested through seeking comfort through contact with belongings, in a way that they

used the deceased’s belongings. Lastly, these were manifested in the way comfort was gained

through keeping memories with the deceased, in a way that they draw comfort from dreaming or

thinking about the deceased.

On the other hand, Ang (2010) delineates two types of continuing bonds. One

way is through spiritual manifestation, where one communicates with the deceased,

prays to the deceased in hoping to see them, and dreams of them. An example of this

is when the bereaved is found to say things such as “magkikita rin tayo” (“We will see

each other again”). There are also non­spiritual manifestations such as showing care,

where the bereaved still cares about the opinion of the deceased, and loyalty, where

widows still choose not to marry despite the loss.

A maintained relationship with their child can at times be helpful and beneficial in

coping, yet at times it can keep the parent from moving on from the loss. While there is no

clear line that establishes adaptive from maladaptive manifestations of continuing bonds,

certain researchers provide explanations as to how these continuing bonds affect the way that

parents are able to cope with the loss of their child.

Manifestations of Maladaptive Continuing Bonds

Lingering attachments to the deceased may be seen as maladaptive if it is seen as a

negative adjustment to the loss of a loved one. Boelen et al. (2006) claims that these

expressions or manifestations are linked to distress, and can even be predictors of poor

outcomes. Furthermore, Field and Filanosky (2010) state that these maladaptive continuing

bonds are generally manifested externally, as evidenced in hallucinations and illusions. These

external expressions of continuing bonds have been linked to bereavement through violent

deaths. Epstein et al. (2006) also gives another perspective, saying that that some of these

externalizations (i.e. “dreaming and yearning for the deceased”) may be maladaptive, as they

are linked to high anxiety, insomnia and pathological grief. This can be explained due to the

fact that these externalizations keep the attachment with the deceased and therefore prevent

the bereaved from adapting to the changes caused by the death. Physical proximity, such as

holding on to the possessions of the deceased, has also been linked to more grief (Boelen et

al, 2006).

Despite this, it is important to consider the cultural background of the bereaved, due

to the fact that some externalizations of the expressions of continuing bonds may be

considered as a cultural norm and may even be adaptive (Klass, 2006). Examples of these

cultural norms include cremation or second burials.

Manifestations of Adaptive Continuing Bonds

The study conducted by Epstein, Kalus, and Berger (2006) suggested that not all

aspects of continuing bonds are unhealthy, as some may be integral in the process of letting

go of the deceased. In their study, one­third of the respondents said that expressing closure

(i.e. saying goodbye to the deceased, reliving the relationship with the deceased, sensing the

presence of the deceased) is beneficial in terms of adjustment to bereavement. Furthermore,

Field and Filanosky’s study (2010) suggests that adaptive continuing bonds expressions are

usually linked to internalization, which means having mental representations of the deceased.

One type of mental representation is identification, wherein the deceased’s traits are

consciously incorporated to the bereaved as if these attitudes were his own. Another is

introjection, where the representation of the deceased is also incorporated into the bereaved’s

personality without them consciously knowing that they have instilled these traits themselves.

This internalization process regarding the death may also be beneficial in helping with the

bereaved’s self­identification (Russac et al., 2002). Some of these internalized expressions

also include a focus on the positive memories with the person, the use of the image of the

deceased as a secure base for making decisions, or the use of the deceased as a role model.

These manifestations of internalization were typically present in people who had a close

relationship with the deceased. Moreover, internalization is suggested to be healthier and

more adaptive is even linked to personal growth.

It is clear from the different manifestations of continuing bonds that people, even

parents, experience bereavement in different manners. While some choose to avoid certain

memories they had with the child, others choose to immerse themselves in these memories.

Certain factors affect these differences on how continuing bonds are manifested.

Factors Affecting Continuing Bonds

Attachment. Attachment theory acts as way to understand certain patterns of how the

bereaved person grieves (Stroebe, Schut, & Stroebe, 2005). Sochos and Bone (2012) claimed

that a person’s attachment to the deceased is similar to his or her attachment style with regards to

his current relationships. Moreover, a study conducted by Wayment and Vierthaler (2002) claim

that an individual’s attachment style is activated when one is placed under a distressing situation.

Attachment theory may then prove to be useful in describing and understanding the continuing

bonds that is experienced by the bereaved as this theoretical framework is one of the most

comprehensive in understanding the way individuals develop certain kinds of grief reactions

(Delespaux, et al., 2013).

A study by Christiansen, Olff, and Elklit (2014) on bereaved parents resulted to the

fact that mothers had more anxiety attachment to their lost child, coped through focusing on

their emotions, and had showed less avoidant symptoms than did the fathers who had lost a

child. Moreover, Wayment and Vierthaler (2002) assert that certain forms of continuing

bonds are typically manifested by people who have a certain attachment style. Firstly,

anxious­ambivalent individuals readily seek the attachment figure, in this case the deceased,

especially in times of distress. Anxious­ambivalent individuals will then express their

continuing bond in the way of having with them an item that represents the deceased, so that

they may hold on to something that will calm them down in a stressful situation. This kind of

continuing bond was suggested to be linked to depression. On the other hand, avoidant

individuals typically have a somatic type of reaction to the deceased (i.e. physical illnesses)

which are suggested to be caused by the repression of feelings of grief. Lastly, secure

individuals express their grief more freely and openly with the deceased loved one.

Table 1.

Kinds of Attachment Styles

Attachment Style

Characteristics Manifestation in CB

Anxious­ Ambivalent

Reluctant to be close with others and in forming new relationships, may be clingy and over­dependent, distraught when relationships end

Holding on to something material (i.e. an old possession of the deceased) for them to calm down in a stressful situation

Avoidant Avoids investing emotions in relationships, does not often share feelings and thoughts with others, express little distress when relationships end

Transfers their grief of the deceased into a somatic manner such as getting a certain illness

Secure Has long lasting relationships, seek out the support of others, can be open about their feelings and thoughts

Freely expresses their grief to friends and relatives

In addition to this, Field as well as Field and Filanosky (2010) provide a pattern for

bereavement, with the attachment theory as basis. In this pattern, the bereaved initially refuses to

accept the loss of the deceased. Eventually, he or she accepts the loss but still retains feelings of

pain and resentment. Finally he grows from this loss and positively integrates this experience

into his own life. Ainsworth, Blehar, Waters, and Wall (1978) also studied a certain pattern for

bereavement. These researchers claim that continuing bonds manifested early on in bereavement

were considered to be indicative of searching attempts to reclaim the dead person, because the

deceased may simply be perceived as missing. This refusal to let go of the relationship with the

deceased supposedly causes maladaptive expressions of continuing bonds.

Once the bereaved person finally accepts the loss, he goes through a “despair” phase

wherein he experiences a sense of hopelessness and withdrawal, attempting to avoid things

that may serve as reminders of the death (Field, Gao & Paderna, 2005). The bereaved’s sense

of identity may be somewhat disrupted during this phase due to the fact that his own goals,

expectations, and interests that were linked to the deceased is gone (Field & Filanosky, 2010;

Field, 2006). Hence, it is during this period that he might feel extreme grief and pain from the

loss.

Finally, the bereaved eventually learns to cope positively with the death, and may

even eventually grow from the experience of bereavement. This becomes possible through an

internalization of the positive image of the deceased, which may endure after the loss of a

valued relationship. Furthermore, viewing the deceased as a secure base to help the bereaved

search for exploratory bases may help him/her build a new life (Field & Filanosky, 2010;

Field, 2006). Due to this, the internalization process constitutes a central part of grief

resolution by enabling the bereaved to preserve a sense of identity and meaningful

connection with the past (Ainsworth, Blehar, Waters, & Wall, 1978).

A person’s type of attachment plays a role in grief, which in turn affects the

adaptiveness (or maladaptiveness) of a person’s manifestations of continuing bonds. Not only

does attachment style affect the way a person expresses continuing bonds, but the way people

grieve and how much they grieve over a death of a loved one also affects their expression of

continuing bonds.

Nature of Separation. In a study by Stroebe, Abakoumkin, Stroebe, and Schut

(2012), they have found that sudden or expected loss were thought to lead to poorer

bereavement outcome. However, vulnerability of the individual (ex. poor self­esteem among

others) can also be a factor. In addition, individuals who were unwilling to relinquish ties

with the dead can be detrimental to adjustment following an unexpected loss. Certain

unwillingness may stem from the sudden loss of a loved one as there might be some

unfinished business with them. This is because they have no time to prepare for living

without the tangible presence of a close loved one, as compared to losing a person with

whom you have a distant relationship to. Moreover, results also showed that people who

experienced an unexpected loss had a harder time in dealing with the pain as compared to

those whose loss was expected (Stroebe, Abakoumkin, Stroebe and Schut, 2012).

Cultures also uphold some morals and practices that affect the way continuing bonds

are expressed by a bereaved. Following a certain cultures’ roots may better give people a

better understanding as to why certain continuing bonds are manifested.

Religion and Culture. Based on an article by Clark (1998), religion, or more specifically

the Catholic faith, is the center of grief and bereavement. When Filipinos grieve for the loss of

their loved ones, they are comforted by the idea that their loved ones are in heaven. In other

instances, they look to the Lord for guidance during times of grieving. Moreover, Guballa (n.d.)

discusses healthy grieving as creating a new life given the loss of the loved one. She also gives

importance to the role of other members of the family, as well as the community, in helping the

bereaved cope with the loss.

The effect of religion on continuing bonds has also been prevalent across different

cultures. In a study by Suhail, Jamil, Oyebode, and Ajmal (2011), people were able to cope

with the death because of some of their religious beliefs (i.e. “the bereaved is already in the

hands of Allah”). Another study on Pakistani Muslims living in the United Kingdom

(Hussein & Oyebode, 2009) claim that manifestations of continuing bonds were affected by

external family structures, communal gatherings, and mourning rituals. These behaviors were

a result of the participants’ religion, and affected how people in the community cope with

death. Given the influence of religion on continuing bonds, the researchers aim to include

religion in the study.

Culture and ethnicity also affect continuing bonds. In another study conducted among

Chinese participants, it was found that these participants perceive continuing bonds as either

initiated by the deceased (i.e. through dreams) or initiated by the bereaved persons

themselves (i.e. through talking to the deceased) (Chan, et al., 2005). Moreover, in Lalande

and Bonnano’s study (2006), they discovered that more expressions of continuing bonds

among the Chinese resulted to better adjustment 18 months after the death of the loved one.

However, participants from the United States who showed strong continuing bonds were

poorly adjusted 18 months after the loss.

Gender. Gender was also seen to affect continuing bonds. Men, in particular, were

found to have more maladaptive ways of expressing continuing bonds than women. Men also

tend to be more avoidant and detach themselves from the memory of the deceased than do

women and that as opposed to bereaved women, bereaved men tend to be more stiff and less

open about the pain of loss during counseling sessions (Sochos & Bone, 2012).

It is clear that many factors, from an individual to his or her surroundings, affect the

way continuing bonds are expressed. The review of related literature now turns to a particular

qualitative methodology that allows for a better understanding of the factors that affect

continuing bonds. It seems that that an interpretative phenomenological analysis is a viable

approach to understanding how continuing bonds are manifested based in different factors,

and how it offers insights as to how individuals make sense of this phenomenon.

THEORETICAL FRAMEWORK According to Smith and Osborn (2007), an Interpretative Phenomenological Analysis

(IPA) is a qualitative approach with a means to explore a person’s way of creating sense in

their personal and social events that happen in their lives. Its purpose is to extract a detailed

examination of the person’s life and delve into their stories in order to seek the person’s own

perception on an event, instead of the objective truth of a situation. The use of this

phenomenological method will give a richer approach to the person’s experiences, as it does

not only focus on the reality of the physical world and how people are passive individuals in

their experiences, but that they also take an active part in interpretating and understanding the

world through their life experiences in which that will make sense to them.

The use of an IPA approach will be most effective for this study as the aim of this

study of continuing bonds will look into, not a step by step approach of the process of

grieving, but the unique experiences of losing a child and how they manifest their continuing

bonds. The IPA approach gives the researchers also an active part in the interview process as

the participants make sense of their experience, while at the same time, the researchers also

try to grasp their experience and make sense of how the participants make sense of their

unique experience. IPA is generally concerned with trying to understand the involvement of

the participant, thus making this a 2­way process as the information being given also depends

on the researcher’s conceptions (Smith & Osborn, 2007). Thus, this joint reflection of the

participant and the researcher forms the analytical approach of the IPA.

A major difference of IPA from other modes of research is that its semi­structured and

flexible nature allows for extensive information to be gained, especially the ones that

researchers do not expect to obtain. As the participants answer the basic questions, follow up

questions may be asked in order to gain more insight on their responses. This allows

participants to make use of their own unique perspectives to communicate their stories and

experiences, providing more information than one can typically obtain from any other form

of data collection. The nature of IPA being qualitative and phenomenological recognizes that

research is a dynamic process (Brocki & Wearden, 2005). It follows that the IPA is bounded

on whatever the participant conveys, through their ability to properly express their thoughts

and feelings towards their experience, and how the researcher also reflects and analyzes these

responses. This kind of analysis would be appropriate to bereavement in terms of how they

deal with the loss of a loved one.

IPA utilizes a purposive way of sampling in order to gain a specific group of people,

which of whom the interview will be significantly relevant to, specifically in this case,

bereaved parents. Gaining information from a semi­structured interview engages an in depth

dialogue with the researcher and participant, in which, after it is transcribed, gives the

researcher running themes from the interviews conducted. Through an IPA method,

researchers will be able to create connections within themes and experiences by each

participant, with the help of verbatim statements made by the participants (Chapman &

Smith, 2002).

Chapman and Smith (2002) also state that an IPA is the same as an anthropologist

conducting a study within a community as it gives a detailed report on their culture, but it

does not generalize on all cultures, as it leaves room for more research to be conducted. Thus,

IPA may aid in the understanding of continuing bonds in a much more broad social context;

and at the same time an individual’s social context might provide more insight as to the

manifestations of continuing bonds in the Philippine context, if ever these are present.

Continuing bonds is a very dynamic concept mainly because it involves a process of

internalizing the loss into the life of the bereaved. This process is based on the idea that these

continuing bonds are predicted by the bereaved’s attachment to the deceased, which

attenuates across time. The researchers feel that IPA would be the most appropriate method

to encapsulate these changes in the continuing bond expressions. IPA allows us to give an

overview of the thoughts and feelings that occurred based on the stories shared by the

bereaved.

RESEARCH PROBLEM

With the research findings and the theoretical framework already discussed above, the

research problem remains to be stated. For this study, the research problem is as follows: How

have continuing bonds of Filipino mothers changed from death until the present?

Given the literature regarding continuing bonds, it can be argued that there are still gaps

and inconsistencies among the present studies. For one, there are limited studies that have been

done about parental continuing bonds in the context of the Philippines, as this topic is fairly new.

Thus, further research can still be done here in the Philippines, with regards to the changes in

continuing bonds manifested by Filipino mothers.

Moreover, understanding continuing bonds can help society find effective

interventions for disaster management programs and counseling here in the Philippines.

Losing a child is not uncommon here in the country. Findings from this topic can serve as

grounds to understand and provide action to those who are in need of help from the

government or NGOs. Moreover, an advocacy approach on the research problem appears to

hold strong with the beliefs of the researchers. With this in mind, the end goal of the current

study is not just to add to the existing knowledge regarding continuing bonds, but also to

create an opportunity to help those who have experienced bereavement, most especially in the

Philippine setting. If fruitful, results gained from this research will provide purposeful means

for certain interventions about coping with the loss of a loved one.

However, this study has a limited scope in terms of the population it covers. Other

limitations will be fully discussed in the next section.

METHODOLOGY

Despite the number of studies on continuing bonds, these studies remain to be limited,

most especially in the Philippine context. Most articles in the present repertoire seem to be

very western in terms of sampling and theory. Given that there are limited studies on

continuing bonds here in the country, the researchers will be using a qualitative design as a

basis for research. This research design was chosen due to the fact that this method was

suggested to be the best way to break new ground on the topic.

The researchers chose a qualitative design over a quantitative design because the data

obtained would also be qualitative in nature. Moreover, given that culture and religion are

unique and therefore important aspects of the way Filipinos manifest continuing bonds, an

outlook of the general themes present can help build theories that are most apt with the

Philippine society. The limited number of studies about parental continuing bonds in the

Philippines, as well as the low generalizability aspect of other studies make the need for

studies on continuing bonds more pressing. Lastly, the limited number of participants, given

the inclusion criteria, would allow for the researchers to conduct a qualitative analysis. More

evidently, there is an apparent lack of data and no concrete theory to run a quantitative

analysis regarding continuing bonds.

PARTICIPANTS

The group obtained a sample size of n = 4 from the population of parents who have

lost a child and have exhibited certain expression of continuing bonds with the deceased.

First and foremost, individuals to be included in the sample must have lost a child at least 5

years prior to the interview. This is patterned from a study by Floyd, Seltzer, Greenberg, and

Song (2013), wherein the average time span between the death of child and the study was 5.5

years. The researchers claim that within this time period, parents still struggle with the loss

for quite a time after the death of their child.

Participants include Filipino mothers. The researchers opted for a female sample due

to the fact that mothers have a special kind of attachment and relationship with their child as

compared to fathers because mothers solely care for their children nine months prior to their

birth. As mentioned previously, women also tend to be more open about their experiences in

dealing with bereavement (Sochos & Bone, 2012). It is stated in a study by Kochanska and

Kim (2013) that there are very few findings and journals on father­child attachments in which

the researcher’s study cannot expound on just yet. Moreover, participants must belong to the

middle adulthood age group, specifically parents in their 40s and 50s. In Erikson’s

Psychosocial Development theory, it states that this is the stage where generativity versus

stagnation is prominent as a basic conflict. This is the period when most parents are very

involved with their children’s lives and have a strong desire to leave a legacy behind (Papalia

& Feldman, 2012).

Moreover, the nationalities of the participants must be considered. The researchers

include individuals who identify themselves as Filipino, so as to make the current study more

applicable. Furthermore, the researchers will also limit the participants to include those from

the urban middle to upper class. The group argues that people in the lower class might have

an easier time in coping faster with the death of a child. This is due to the fact that poverty

affects them in such a way that they cannot afford to dwell on the deceased because they have

to deal with surviving and obtaining resources to be able to live their daily lives. Moreover,

differences between people from urban and rural areas in terms of continuing bonds might

also be prevalent in terms of lifestyle, and even culture. Thus, the sample will be selected

from urban areas (i.e. Manila) for constancy and for practicality.

Factors such as the number of children, birth order, and age of child will be adjustable

depending on the availability of participants. However, the criteria on the manner of death

will not be strictly imposed to give the researchers richer data from the participants. Those

aforementioned will not be strictly established unless the researchers will be able to find

sufficient participants that fit a similar criterion.

MEASURES

Preliminary interviews. A preliminary interview will be held in order to filter out

participants who do not fit into the aforementioned criteria. Demographic information, which

include age, nationality, gender, income, and marital status will be identified. Questions

about the bereavement would also be included in the interview, such as the child’s age,

gender, and cause of death.

Narrative interview schedule

1. How was your relationship with your child prior to his/her death?

2. How did your child pass away?

3. What was it like immediately after your child’s death?

4. How was it like a year after the death of your child?

5. In the succeeding years, how is your relationship with your deceased child?

The interview will be presented in English to avoid problems in translation accuracy.

However, the participants may choose to answer the questions with the language most

comfortable to them.

PROCEDURE

The researchers will be looking for participants that fit the criteria mentioned above.

They will then undergo a preliminary interview to make sure that they fit into the inclusion

criteria. After filtering the prospective participants, these people will be chosen and scheduled

for the continuing bonds interview. The researchers will be conducting the interview, one of

which will be facilitating the interview and the other two taking note of behavioral cues like

facial expressions and body movements, that may or may be aligned to what the participants

may say. Taking note of these behaviors may help the researchers in creating a more

comfortable environment for the participants (i.e., noticing a mother acting uncomfortable

talking about a certain topic, thus researchers will not push the subject matter). Before the

interview, the interviewer will brief the participant regarding nature and confidentiality of the

study.

Interviews will also be recorded (voice and video) for the content. The transcribed

data will then be used for the data analysis which will be discussed in the next section.

DATA ANALYSIS

In a study which also made use of an interpretative phenomenological analysis,

Brocki and Wearden (2005) suggest that meaning­making in their experience is the center of

any IPA. This idea will then be the center of the analysis of the experiences provided by the

participants. For the given study, voice recordings will be the main source of data for the

given study. Given the collection of data, the interview of the first participant will be

transcribed and studied by each researcher individually.

Chapman and Smith (2002) gives importance to the flexibility of the interview

questions so as to give opportunities for the researcher to get into more detail when an

interesting point has been made. With a semi­structured interview, a rapport with the

participant is made as the interview questions do not require short and brief answers,

therefore making it easier for participants to answer more extensively and freely say what is

on their mind.

As mentioned by Smith and Osborn (2007), the analysis of the interviews in an IPA

require multiple times of rereading the transcript as each reading may produce new insights.

It was suggested that the researchers put their comments on the side of each transcript made,

which had been done, that may help create a better understanding towards the preliminary

interpretations. The manner of speaking of the participant (i.e. shift in language, stuttering)

may also be taken into account as to show their comfortability in expressing themselves.

Progressing through the transcript, the researchers will be able to comment on similarities,

differences, and inconsistencies in the interview. After writing comments, reading through

the transcript again will better help the researchers in seeing rising themes in the interview.

It is crucial in this next step to find expressions that are very apparent in the interview

so as to find theoretical connections across the different interviews, yet still be bounded by

the specificities of what the participant has said. After which, a list of themes are made and

the researchers make connections across interviews. Some may group together creating a

bigger umbrella for a theme or some may stand as its own. It is important to note that in

clustering themes, it is backed up by verbatim statements made by the participants in order to

see the connections. It is through this that the researcher creates an interpretation of the

sense­making of the participant’s experience of losing a child. Finally, an extensive analysis

is made with the themes extracted from the interviews of the bereaved mothers (Smith &

Osborn, 2007).

The goal of this method is to completely and thoroughly analyze the behaviors and

sense­making of the participants in their experience of losing a child; more specifically their

expressions of continuing bonds following their bereavement.

RESULTS

Four mothers whom of which have experienced the pain of losing a child from a medical

ailment were interviewed to obtain rich accounts of the process of loss, bereavement, and

continuing with their lives. To better understand the themes surrounding this particular process,

four comprehensive stories are narrated below.

Ms. Caritas and Tricia

Ms. Caritas, at the age of 44, currently works as a paralegal, with the occasional

buy­and­sell business. During her free time, she participates in CFC (Couples for Christ) as a

music ministry volunteer. She is currently separated with her husband, and has five children­ one

of which passed away around 14 years ago.

Her child, named Patricia Janine (or Tricia for short), was her third child and the eldest

girl. Her mother describes her as a very beautiful girl. She was very gentle and obedient, and she

always looked out for her siblings. Whenever her mother would scold her siblings, she would

talk to her mother and calm her down.

Tricia passed away last 2000. Her mother described it as an unexpected event, which

started when she caught a fever from their vacation to Isabela. Ms. Caritas explains how she felt

depressed at the time she lost her child­­ her weight went down to 90 lbs., and she was drinking

up to 13 cups of coffee everyday. She narrates that she would be out of her mind, especially

when her other children were in school. She says how she couldn’t even act out her hysteria,

because she had four other children to feed. She wanted to cry so badly, but she could not due to

the fact that she had to take care of her other children. She also rebelled against God, wondering

why it was her daughter that was taken.

She was only able to cope with the experience through a positive outlook in life,

understanding that she had to get over her depression quickly; not for herself, but for her children

mostly. She constantly thought of her children, and how it wouldn’t help to act out all her

negativity. Moreover, she was also distracted by them and their distinct personalities. Because of

them, she was able to cope with the death of her daughter.

Ms. Caritas says that she was only able to let go six or seven years prior to the death. She

would feel the occasional pain whenever she remembers certain memories with Tricia. Until

now, she claims to still talk to her, most especially when she has grave problems, yet she says

that she does not feel as depressed anymore, and that she has even moved on. During Tricia’s

birthday, she greets her and includes her in the mass for that day. Her faith in God was restored,

and even strengthened. She claims that the whole experience changed her in a way that she had a

better understanding of how to be a loving and fair mother. She also realized how to love more

fully and more deeply.

Mrs. Bo and Russell

Mrs. Bo is currently a housewife whose husband works in the States. She is living with

her son, who is at his third year of college. She is very family­oriented; she always travels with

her family, eats out with them, or even watches movies in the cinema with them. This is why

when her son, Russell, passed away eight years ago, she was extremely heartbroken.

Russell was closer to his mother than his brother was. He was described as very

intelligent and very independent. He was very responsible when it came to duties in his

schoolwork and his household chores. He was also caring towards his family, especially his

younger brother, as well as his friends in school.

Russell was twelve years old when he died due to a very rare disease­­ pulmonary

hypertension. Until now, Mrs. Bo claims that she still has not recovered from the death, saying

that she doesn’t think that the pain will heal. Her initial reaction was to question God­ to try to

comprehend why it was her son who was taken, and at that age as well. She still has a hard time

talking about Russell, and she cries whenever she does talk about him.

Mrs. Bo had Russell cremated, and she brings his ashes wherever she goes, and saves a

seat for him when eating out or when travelling. Russell had a certain fondness for Pluto (the

Disney character), so she has a lot of Pluto stuffed toys with her all the time. Although she threw

out some of his belongings, she still keeps some of them, like his school projects and toys. She

also wears Russell’s t­shirts from time to time. Whenever Mrs. Bo had a problem, she tells

Russell, and believes that her problem gets fixed after a while.

She was able to cope with Russell’s death through distractions from work, as well as

through her responsibilities in the house. Her second son was also extremely helpful­ as a

distraction, as well as a source of strength. Her son was always there with Mrs. Bo whenever she

felt sad or depressed. Moreover, Mrs. Bo participated in therapy sessions with her son for about a

month. She was also active as a co­parent in her son’s high school­ going to soup kitchens and

participating in outreach programs.

After a while, Mrs. Bo claims that her faith in God has already been restored. Because of

the event, she also learned to be more understanding, as well as to have more compassion for the

poor. Despite these things, she claims that she still has not been able to move on.

Mrs. Marikina and Pia

Mrs. Marikina is a business woman with 3 children. Her youngest daughter, Sophia died

at the age of 4. She was very close to her. Pia would always chase her around and cling to her,

even refusing to let her mother out of the house.

They went on a family swimming trip to a nearby resort days before Pia’s death. The

following day, she came down with a fever. Mrs. Marikina rushed her to a hospital to get her

checked. The doctors said that it was just a common cold. Nonetheless, Mrs. Marikina was

uncomfortable about the situation, especially when her daughter refused to drink the medicine,

saying that it was already past its expiration date. She was transferred to St. Lukes the following

day. During the ride, she was beginning to have seizures. At 3pm, Pia passed away. Mrs.

Marikina was only informed after 3 hours. The doctors could not tell her more than that her

daughter had died from contracting an airborne viral disease.

She felt that she wanted to die along with her daughter. She did not want to leave the

house and was always in a daze. After her daughter’s funeral , she did not want to go to places

they had gone before. She said that she had premonitions. Her daughter said that she wanted to

be an angel. She wanted to wear the costume made for a municipal event weeks earlier. So

during the wake, Mrs. Marikina dressed her child in her angel outfit. It was grand as a party, just

like what her daughter asked for days before her death.

It was a difficult time for her. She could not say that her daughter had died. She would

only say that Pia had went on a vacation for a while. When she saw poor children on the street,

she wondered why they were still alive, while her Pia had died. She was surely better groomed

and fed. People tried to console her saying that now, she has an angel that will guide her.

She does not celebrate her child’s birthday or anniversary up until now. She says that she

only prays for her and lights a candle for her. One thing that brought her back to her senses was

the thought of her other children who also need her help. But she never stopped grieving, she still

keeps pictures of her daughter around. Not just small photographs but big tarpaulins. She has

now disposed some of Pia’s clothing but kept a few inside her room. She says that she sniffs it

from time to time. She continues to talk to Pia, especially when she has problems. She

remembers Pia when she is alone or when she sees another kid around. However, when work

comes in, she gets distracted from the thought of her deceased daughter.

Mrs. Marikina says that the death of her child was unlike any other death she has

experienced. She keeps longing for her child. She feels that she has given everything to her child

and that she is now in a better place in heaven.

Ms. Starbucks and Jj

Ms. Starbucks currently works as a Vice President for Human Resources at a business

called Bitmicro. She has three children with her first husband, one of which is Jj, who passed

away, and has one stepson with her second husband. She splits her time here in the Philippines to

take care of her two daughters, and in the United States where her second husband and her

stepson are based.

Jj was the second born and the only boy of Ms. Starbucks. He was born with a congenital

disease called hydrocephalus and has lived as a vegetable ever since. At the age of 10, when Ms.

Starbucks was on a business trip in the United States, Jj passed away. This devastated their

whole family. During the first few years, the doctors would already warn Ms. Starbucks that Jj

could only live for a short time. Unconvinced, Ms. Starbucks moved Jj to another hospital nearer

their home and hopeful to hear different results. Unfortunately, the news was just the same.

When Jj passed away, Ms. Starbucks felt like she lost her mind. “Nagwala talaga ako” (I

had gone crazy), she said. She remembers thrashing everything in her hotel room when she

received the news her son had already passed away. Prior to the call from the Philippines, she

recalled that she had a strange nightmare about a boy telling her to “let go”, in which she was

awakened by her officemates from the adjoining room because of her thrashing.

For a while, Ms. Starbucks shut off the world around her and focused a lot of her time on

work. On a normal day, she would not enjoy working overtime, but after Jj’s death, all she did

was work, work, work. She recalled the times she did not like hearing comforting words from

people, she became less sweet to her daughters, and became numb from the world. She never

touched Jj’s room after his death. Ms. Starbucks mentioned that she was so self­centered after

the death of her son that she forgot that her daughters will also grieving and hurt with the loss.

Ms. Starbucks mentioned she would pass by Jj’s urn at home in their altar and talk to his

urn and would ask him how he is. She also has dreams wherein she would see Jj at his current

age and height playing with his siblings. Eventually, she joined a humanistic group that helped

her cope with the loss of her son.

She also mentioned that because of Jj’s death, she improved relationships with her

ex­husband. She says that they are now the best of friends. This also made Ms. Starbucks realize

the value of company and family that she has here in the Philippines because they are always

here to support you. In addition, Ms. Starbucks’s faith in God became stronger.

13 years has passed and Ms. Starbucks does not mourn any more, but still feels the pain

of losing her son. She imagines where he could be now if he was still alive and comes to a

conclusion that God gave her Jj for a reason­­ to be less selfish from who she was before and that

the world did not revolve around her.

Themes

Upon reviewing the data, the group was able to identify main themes that were applicable

to most, if not all, of the participants interviewed. Themes identified were based on the mothers’

reactions to the death of their child, as well as their ongoing relationship with their child.

Themes Description

Grief Denial of the child’s death, depression, unique experience of losing a child

Feelings of injustice towards God

Questioning God about the death of the child, anger towards God, feelings of injustice

The Halo effect Admiration towards the deceased child, looking up to the child emphasizing the good

qualities of the child, praying to the child, viewing them as their personal angel

Ongoing Relationship Perception of an ongoing relationship with the deceased child, longing for the deceased child, keeping of material possessions

Life after loss Focusing on work to take care of their other children, enjoying time with their other children, joining organizations to cope, acceptance of the death, disposal of deceased’s belongings

Grief: “Kumikirot yung puso mo eh”

One of the themes that were prevalent was intense grief experienced by the bereaved

mother­ “Kumikirot yung puso mo eh (Your heart really aches)”. This grief was evident as the

intense pain felt by the mothers who struggled with the loss of their child. The presence of this

grief was one of the most common prominent among the participants, mostly due to the typical

mother­child relationship they had with the deceased, as well as the close attachment they had

with their child.

Grief was initially present with the denial of the child’s death, as well as the mother’s

struggle to accept the loss. Mrs. Marikina was one of the participants who exhibited this, saying

that her daughter was just away on vacation when she passed away. Seven years after the death

of her child, she still has a difficulty facing the fact that she lost a child. Moreover, some of the

participants also showed signs of hysteria, one of which is Ms. Starbucks who, when finding out

about the loss of his child, destroyed things in her hotel room, like the television set. As expected

with grief, most of the participants also exhibited symptoms of depression, including loss of

appetite and lack of sleep. Some participants had no desire to have any social interaction, and

one participant even had a desire to die with her child. On the case of Ms. Caritas, she went

down to 90 lbs. and was drinking 13 cups of coffee everyday.

Until now, some mothers still grieve for their child, despite the fact that it has been 6 to

13 years since their child passed away. Participants, like Ms. Caritas, choose to avoid these

reminders because reminders they have of their child can somehow still cause pain. “Ngayon,

okay na ko. Wag lang ako may naririnig na mga dinidiscuss tungkol sa kanya ha, ayoko. Ayoko,

dinidismiss ko, yung mga ospital, uhm... burol”. Mrs. Bo, eight years after the death of her son,

is still mourning, even if it is not manifested explicitly. “I'm still crying, I'm still grieving. Pero

alam naman niya na nasasaktan­ nasasaktan ako, alam niya, pero not this, hindi niya [her son]

ako nakikita pag ganito”. Despite the fact that a number of years have already elapsed, the

grieving process for the mothers still continue.

Feelings of injustice towards God:“Why, God?”

An especially striking theme that was noticed during the interviews was the mothers’

tendency to question God. All of the participants thought of this after the death of their child.

“Why God?”, they would ask. Their questioning of God is brought about by feelings of injustice,

which they think they and their children do not deserve, the unique experience of losing a child

that goes against the laws of nature, and the mere curiosity of asking God “why” it had to

happen.

The participants narrated how they felt a sense of injustice after the loss of their child.

The statement “bakit yung anak ko?” was often brought up during the interview. For them, it

was unfair to have their child taken away from them when they were well dressed, properly fed,

and given the medical care they needed. This was explicitly said during the interview with Mrs.

Bo. She felt that her child didn’t deserve to die when “ang dami naman kasing, diba, sa street

children, those who cannot afford to study, those who don't have that, uhm, they don't have that

ambition to, in life eh. And yet, andiyadiyan pa sila.” From the statement, it can be observed how

she feels that her child was more worthy to live in comparison to other children on the grounds

that they had more and have dreams in life. On the other hand, to Mrs. Marikina, the injustice

was focused on her when she said “Di naman ako masamang tao di naman ako ng argabyado ng

tao.” She felt that she didn’t deserve that kind of treatment when she didn’t do anything to

wrong or harm anyone. For Ms. Caritas, she affirms that she has been a good mother to her child

in her statement “Yung mga pabaya diyan na nanay, bakit nabubuhay ang anak, ang dudumi ng

anak? Ako, masipag ako eh.” Moreover, she questions God why those women who do not take

care of their children properly are not the ones who experience their children taken away from

them. Ms. Starbucks also mirrors the three other participants when she said “ang dami daming...

masasamang loob, rapist, killers, murderers... bakit... bakit hindi anak nila?”

The feelings of injustice experienced by the 4 mothers were directed to God whether they

feel that it was unfair for their child or for them. All of them were angry with God directly after

the loss of their children. Why them? Why not other people? However, despite the anger they

felt, they never stopped to be religious. Ms. Caritas found herself “rebelling” against God for a

while but then returned to Him. She even stated that “Napalapit (siya) sa simabahan” after her

ordeal. Mrs. Bo also reconciled with God after a year. She had a “feeling against God during

then” but “bumalik din naman,” similar to Mrs. Marikina. For Ms. Starbucks, it was a learning

experience. She didn’t go to church and was angry for a time but then gradually came back and

even thanked the Lord for “for teaching (her) those values that (she) didn't have, (she) didn't

possess at that time". For the four mothers, questions of injustice eventually turned into

acceptance of “God’s plan” and the their child is now in a “better place.”

The Halo Effect: “Angel siya, eh”

Another theme that was observed was the positive perceptions of the mothers towards

their children. This halo effect experienced by the mothers in relation to their deceased child was

described in terms of the child’s relationships prior to his/her death­ with his/her siblings,

friends, and of course, mother. All of the participants described their child with good qualities­

obedient, responsible, intelligent. Mrs. Marikina even perceived her daughter literally as an angel

during her funeral, dressing up her daughter in thee angel costume she wore for an event.

More than this angelic image, the mothers also perceived their deceased child to be their

“guardian angels”. Ms. Caritas talks to her child in prayer, asking for her intervention whenever

she encounters difficulties in her life. Ms. Starbucks exhibits the same behaviors, constantly

talking to him, telling him about her day and about his siblings, and asking him to help her with

difficulties she may face. Mrs. Bo similarly finds comfort when talking to her son whenever

problems arise. She claims that solutions are somehow provided one way or another within a

span of three days, and she says that it is because her son has helped her. Lastly, Mrs. Marikina

brings up her daughter in everyday conversations: “... pag nagbibiro ako, ‘Pag andiyan si Pia

patay kayo’, kasi ano yun eh, maldita nga. Sabi ko, di kayo uubra pag andiyan si Pia.”

Ongoing Relationship: “I don't know kung if it is being practiced, pero that's­ that's the way I did

it and I'm doing it until now.”

There seems to be a presence of an ongoing relationship between the mothers and their

deceased child across the interviews. Most of the time, material representations of the child like

photographs and clothing are kept inside the house. In Mrs. Marikina’s case, it was not just a

small photograph but a big tarpaulin displayed in their living room and her bedroom. Moreover,

she still keeps some of her deceased child’s clothes in a chest, bringing them out occasionally to

sniff them. Mrs. Bo takes it a step further. She narrates how she has brought the ashes home and

has to greet the urn “Good morning” and “Good night.” She shares her problems with him and

tells him about how her day went. She even brings the urn with her abroad when possible. She

also has a Pluto plush toy to bring when travelling with the ashes is questioned. Most of the time,

when dining out, she brings Pluto and sits him in one of the chairs. Mrs. Bo also keeps her

deceased son’s clothes, sniffing them from time to time. During the interview day, she even wore

one of his shirts.

Ms. Starbucks kept some her deceased child’s belongings. However, her ongoing

relationships seems to be represented in her dreams. She stated how Jj “appears in her dreams a

lot.” She tries to find meaning in these dreams and even follows them for advice. Ms. Caritas,

however, disposed all of her daughter’s belongings as a way to “rebel” against God. The others

were kept by her husband who according to her, is more attached to their deceased daughter.

The ongoing relationship also presents itself in the way the mothers continue to long for

their children. Mrs. Marikina says that “hinahanap mo ung anak mo.” She also insists that her

child is just there or “nandiyan lang siya” and refuses to celebrate death anniversaries. Ms.

Caritas says that “everywhere (she) looks, it’s her that (she) sees,” which implies a feeling of

longing. Mrs. Bo seems talks to her son frequently and asks him for advice stating that “he can

analyze more now, because malaki na rin siya,” as if he were still physically present. Ms.

Starbucks says that she “misses him every day, every second,” especially when she sees his urn.

She talks to the urn quite often as well. This ongoing relationship, as implied by its name,

continues on for years. These behaviors are not just present at the beginning stage after the loss

but all throughout the grief stories of the participants.

Life after loss: “Ang dami nating support sa family, extended family, friends”

The resilient Filipino mother is surrounded by family and friends, thus their way of

moving on from the loss has many avenues. One of which is that the mothers get preoccupied

with their work. Ms. Starbucks explicitly stated that after the death of her child, she “worked and

worked and worked. That was my coping mechanism. I worked so hard.” despite not enjoying

being given a lot of work prior to the death of her child. She reasoned out that working overtime

robbed her of her time of being a mother to her children. The same way, Mrs. Bo also felt that

working helped her get over her grief on the loss of Russell, “ It took a while... my work…

Helped me also in this stage. Yung work ko, and my responsibility in the house”. She also stated,

“staying at home will make you feel more sad” wherein being idle and at home will only remind

her of memories of her passed son.

These working mothers prioritize and keep busy with their work. They work also because

they have other children of theirs to take care of. In Ms. Caritas’ situation, she said, “Alam kong

hindi ako pwedeng mag loka­loka, kasi may apat pa akong anak na kailangan asikasuhin.” Their

other children also serve as a distraction and entertainment from the loss the family has

experienced in which Mrs. Bo said about her youngest son Dwayne, “ If not for Dwayne, maybe

because, I will not be here, like this siguro. I can cope up na rin because of Dwayne. So I have

to be strong for Dwayne.” Being strong for their other children was prevalent after the death of

their child. Ms. Caritas also quipped that she mostly had a positive outlook after the death of her

child because of her other children who were delightful. She said, “nalilibang ako kay Marisse,

kasi ang kulit.” These mothers found their other children as an outlet of their grief. Their children

provided them happiness on the other side of things.

The mothers also have gained a lot of support from their friends and families especially

here in the Philippines where the sense of community is very strong. This is most especially true

for Ms. Starbucks, wherein she felt the support of her loved ones here in the Philippines, She

said, “Siguro ang advantage natin sa Philippines is we have so much support system. That's one

way of coping also. Ang dami nating support sa family, extended family, friends. We have so

much time here.”

Some of them even join support groups, which has a positive change from their

perspective in life. Like Mrs. Bo who joined a Soup Kitchen by the school of her sons, she

explained that it had helped her cope with the loss, “It helps, yes, it helps. Kasi, yung mga

co­parents ko are also there to encourage me, to talk to me, yung ganun. They help me also.”

Supporting this, Ms. Starbucks also joined a humanist movement a year after she lost her son.

She said, “I think that helped me too kasi may mga activities kami na you have to lead.” She also

explained further how this helped her for her own growth and understand other people’s feelings,

as well.

In addition, the mothers also exhibited what they have taken away from this experience,

making them more gentle, but still firm, as mothers who have loved and lost.

“Ngayon ko lang pwede masabi na ‘I’m okay”

A sign of moving on, with help of work, their other children, and support groups, is the

showcasing of the mothers’ gradual letting go and acceptance of their child’s death. The mothers

would say that they are doing okay, but that the pain of losing a child never leaves. As Ms.

Starbucks said, “you don’t forget the pain”. For her, losing Jj, even though it has been thirteen

years, still hurts her. She has said that she does not grieve any more, but she still feels the pain of

the loss of her son. The pain never goes away.

In addition, at first, they would not move the belongings, clothes, or the room of their

deceased child, but as time slowly passes, as they accept the loss, they build up the courage to set

aside the belongings of their deceased child. “‘Yung gamit niya ngayon ko pa lang medyo na

i­dispose eh”, said Mrs. Marikina. Their moving on is manifested in the way they start to tinker

with their child’s rooms, and belongings, eventually signaling their gradual letting go of their

child.

DISCUSSION

The experience of bereavement is a challenge for anyone to handle. For these four

Filipino mothers, the death of their child has been the most difficult trial they had to go through

yet. All the participants had a very close attachment with their child, which was exhibited

through the continuing bonds manifested in each of the mothers’ narrations. Themes that were

found in the results were similar to that of found in the Kubler­Ross’ Stages of Grieving

(Kubler­Ross & Kessler, 2005), such as grief and life after loss. The difference between the

results and these stages was that grieving for the participants was not a linear process, because

although they experienced the same thing, the mothers coped with the loss in different ways.

Moreover, certain themes were present that were not part of the Kubler­Ross stages, such as

feelings of injustice towards God, ongoing relationship with the deceased, and Halo effect. This

signifies the process of grieving is culture­bound in the case of Filipino mothers, mostly due to

the influence of their collectivistic nature, as well as religion, culture.

Manifestations of Continuing Bonds

As mentioned in the beginning of this paper, a continuing bond is described as having an

ongoing relationship with the deceased person (Boelen, et al., 2006). There were different

behaviors in which continuing bonds were manifested by the bereaved mothers. Aforementioned

studies differentiated adaptive continuing bonds (wherein the lingering attachment proves to be

helpful for the bereaved) from maladaptive continuing bonds (wherein the lingering attachment

proves to be unhealthy for the bereaved). Despite the fact that the mothers showed signs of both

adaptive and maladaptive continuing bonds, all of them seem to be able to somehow accept the

death and cope with what happened. Furthermore, the experience of grieving and continuing

bonds seem to be very unique to the individual­ while certain manifestations of continuing bonds

seem to be maladaptive, the mother might find this certain behavior helpful in coping with the

death of her child.

One of the most evident signs of continuing bonds was the perceived continuing

connection that the mothers had with their child. This is in line with Field and his colleagues

Continuing Bonds Interview created in 2004 (Ronen, Packman, Field, Davies, Kramer, & Long,

2010) (see appendix A). Most of the questions asked in the interview were very much relevant to

the Philippine context. Most mothers, like those in the CBI study, experienced a continuing

connection with the deceased child. Almost all of the mothers too, have kept their child’s

possessions and have associated places they have gone to before with the deceased child. They

even described dreams they had of their child.

For most of the participants, manifestation of continuing bonds are shown through

speaking with their passed son or daughter directly to their urn, greeting them good morning, just

asking how they are, and asking them for help in their daily struggles. Having conversations with

the deceased child was also present in the CBI questionnaire.

According to Epstein et. al. (2006), these sort of manifestations are considered

maladaptive, due to the fact that these manifestations of continuing bonds keep the mother

attached to her child, therefore making it more difficult to move on from the death of the child.

Despite this, the participants feel that their rituals, no matter how unusual they might seem, give

them some sense of comfort; that regardless of the absence of their loved one, they are still

somewhat comforted by the presence of their child.

Furthermore, identification with the child, where parents describe their child as role

models and garner a sense of admiration towards the deceased child was apparent across all the

stories. This Halo effect coincides with an item in the CBI interview mentioned above. In this

observed theme, the participants viewed their children in a positive light­ what was remembered

of them were their good qualities. This process, which Russac et al. (2002) calls internalization,

allows for the person to view the deceased as a role model, even to the extent of making these

traits part of the bereaved’s self. An internalization process was evident in the way Ms. Caritas

coped with the death of her daughter. When she was talking about Tricia, she was saying how

her daughter would always made her mother calm down whenever she would be temperamental,

especially when she was dealing with her other siblings. In the same way, Ms. Caritas shared

how she learned to become a more patient and loving mother in terms of her relationship with

her other children.

Other participants also manifested internalization in the way that they focused on positive

memories with the deceased. When asked about their relationship with their children, all of the

participants described a very close relationship with their child, giving short anecdotes of what it

was like before the death of the child. An example of this is Ms. Starbucks, who described how

she had a special bond with their son that was difficult to understand from an outsider’s point of

view. Mrs. Bo also describes having a close relationship with her son, seeing as they did almost

everything together as a family. These sort of internalizations, according to Russel et al. (2002),

are considered as adaptive continuing bonds, because they allow for the participants to have a

secure­base about the death of their children. Furthermore, these attachments can even be an

avenue for personal growth. While Epstein et al. (2006) mentions closure as an important factor

towards adaptive continuing bonds, none of the participants seemed to have expressed a sense of

closure with the deceased, mainly because they derive strength from the comforts of somewhat

still being with their children. Furthermore, other factors have helped the participants have also

allowed the participants to better cope with the death of their child, such as their spirituality, as

well as the comfort of their families and friends.

Religiosity, Spirituality, and Culture

Guballa (n.d.) mentions the concept of healthy grieving, wherein the bereaved creates a

new life for herself, given the loss of her loved one. Despite the fact that some participants

seemed to still be in the grieving process or exhibit maladaptive continuing bonds, healthy

grieving was very helpful for the participants­ mainly because of their religiosity, spirituality and

the comfort of the people surrounding them.

Spirituality is defined as the aspect of life that goes beyond the material or the physical

(Sagberg & Røen, 2011). It is the ability of people to transcend time and space to find and

understand meanings. Religiosity, on the other hand, deals with creeds, rituals, and other outward

forms of belief (Damianakis & Marziali, 2012). For the for Catholic participants, these two seem

to be very large factors as to why they find their manifestations of continuing bonds to work for

them. They’re not just avenues for coping but also for growth.

These two concepts are very apparent in the Philippines. We are known to be very

religious and spiritual. It is plausible that these two traits have also helped buffer the effects of

maladaptive continuing bonds among the four participants, aiding in mental and physical health.

Damianakis and Marziali’s study supported this finding (2012). They discussed that people who

experience loss try to fit everything in their pre­existing religious and spiritual schema. Some

even try to create new schemas to process the meaning of the loss. Therefore, Religiosity and

Spirituality takes on an active role during bereavement.

Looking at the themes, God persists to be a common entity present in all, most obviously

seen in how they questioned God when their children passed away. The loss of their child

emitted a lot of anger and doubt towards God. The theme stood out in the interviews because

every single participant had the same feelings and ideas, just differently stated. They felt

injustice had been done to them if not their child. They compared themselves and/or their child

to other people, whom of which have done so much harm to others. They have also compared

themselves to mothers who have abandoned or failed to take care of their children properly. It is

with this injustice that they release their anger towards God.

This doubt in God did not last very long. They eventually accepted the fact that their

child is in a better place. As religious and spiritual beings, Filipinos tend to believe in the

supernatural, thus seeing the own child as their personal guardian angel to whom they pray to to

look after them and help them with their struggles. Eventually, the mothers had relinquished the

anger they felt towards God with their own reflections and support received from other people.

Especially that Filipinos are very family­oriented. They have realized that everything is part of

God’s plan. Through these realizations, they have become better persons, as well as better

mothers.

Limitations

The most basic limitation for this study is the lack of required participants for the

dissertation. The researchers were only able to interview 4 out of the required 6 for a qualitative

study. It is recommended that future researchers follow the prescribed number of participants in

order to obtain more data. Furthermore, the research only includes mothers from urban Manila

that fall under a specific class. Future researchers can opt to include fathers’ accounts, spread

their sampling to rural areas, and try to get participants across the social classes. This can give a

richer understanding of how continuing bonds and bereavement are manifested by different

people. Future researchers can also try to tap into participants from different religions. All of the

participants in this study were Catholics or Christians, which is probably why spirituality had a

great part in their story. Perhaps interviewing participants from other religions can give a fuller

understanding of the role of spirituality in bereavement. In addition, Our research was only able

to obtain participants who have lost their child through a medical condition. Other causes of

death like accidents, murder, or suicide may perhaps lead to different findings. Interested

researchers may delve into these other perspectives as well.

It must also be taken into consideration that all the stories in this research are based on

oral accounts of events that have happened years ago. Possible tweaks or biases may have been

formed during the re­telling of their stories. These issues regarding accuracy and truthfulness

must be bypassed, and whatever narration is given will be taken. Moreover, analysis of the four

accounts are only based on voice recordings. Future researchers can consider taking videos of the

interviews in order to study the participants’ behavior, as well.

RESEARCH DIARY

Patricia Py’s Reflection

Thesis has always been a learning experience more than a burden to me. True, it was a

difficult process of searching for literature, transcribing interviews, and trying to organize and

make sense of the multitude of data presented before us, but I have always enjoyed the work

while it lasted.

More than the workload, what really struck me while doing this dissertation was the

stories I have heard from our participants. In all honestly, I found myself affected by their grief.

There were times that I had to hold back tears just to give off a facade of professionalism.

However, beyond the emotions, I have experience a kind of renewal to why I am studying

Psychology now. I realized that pursuing this discipline can aid me to help others. There are so

many things that are yet to be discovered, and the knowledge acquired can do so much for

others.

Michelle de Guzman’s Reflection

Honestly, writing this thesis mostly like finishing my requirements­ something I had to

do before I graduated, to give me a sense of being a Psychology major. The concept of death was

very distant to me, as the closest person I have known who has passed away was my

grandmother, and we weren’t even that close. Initially, I was doing this thesis for a general idea

of how painful it would be for a mother to lose her child­ an idea that felt really distant and

abstract.

Unfortunately, this thesis became concrete and real to me when one of my kids in Kythe,

Ashley, passed away. The pain became all too real and inescapable; and then I realized­ what

more for her mother? What more for this woman who has been taking care of her child for 10

years, and then just losing her in the blink of an eye?

And so, I am dedicating this thesis to her­ to Mrs. Sy, who is one of the strongest women

I have ever had the pleasure of encountering. I am also dedicating this thesis to Ashley, who has

taught me so much more than what I learn inside classrooms. And finally, I am dedicating this to

Kythe­ to an organization that keeps on struggling to help these kids, despite the pain that comes

along with this experience of reaching out.

This thesis also dedicated to my friend Sei, who has always inspired me to keep on

working for this advocacy.

Angelina Mendoza’s Reflection

The idea of this thesis had been from a recent personal experience of losing a close friend

of mine and understanding the relationship each person had with this close friend. I had

witnessed first hand how his mother, father, relatives, friends, blockmates, and professors

grieved over his death. It piqued interest in me when I observed how different each person

nourished their relationship with him after his death, thus the emergence of continuing bonds as

the topic of our study.

Aside from the fact that this thesis should give us more information on the behaviors of

how mothers exhibit continuing bonds to their deceased sons and daughters, it most importantly

broadened my perspective in life, and made me more empathetic as I, hope to someday be a

mother, as well. I had gotten to know stories of their greatest pain and heartache, and it humbles

me that these mothers held no information back from us researchers despite this being a very

sensitive topic to share with three strangers. Moreover, it gave me more reason to love my major,

Psychology, as this study may someday help grieving mothers and give a deeper and broader

understanding of continuing bonds here in the Philippines.

In addition, I would like to dedicate this work of love to the Ancheta family, Tita

Cynthia and Tito Mike, to whom my friends and I had gotten close to because of the loss of a

beloved son and friend, Miko Ancheta, to the parents who treated us like their own children, to

the two breathing reminders of Miko to us. To Lyka Gonzales, who had stood strong and

gracefully went through this stormy patch. And lastly to Miko, you will always be remembered.

Thank you for continuing to inspire each and everyone of us. Thank you for your endless Love

and Light.

CONCLUSION

The process of loss, grief, bereavement, coping, and letting go is not as linear as it seems

to be. There is no equation with regards to life after losing a child, particularly here in the

Philippine setting. Culture seems to play a dynamic role in this. Whether mothers exhibit

adaptive or maladaptive continuing bonds, they seem to be living well. Of course, the sadness

will always be there, but they have the capacity to cope with it and live a normal life. Religion

seems to be the defining factor in the process. The type of continuing bonds, coping mechanisms,

anger, and feelings of injustice, and other themes revolve around religiosity, which is a big factor

in the Philippine setting. No matter how jumbled and inconsistent the equation is, God is found

to always be a constant.