copyright by: Erik L. Buijtendorp Slebos, M.Sc.
Looking into the tears of your crying
INTRODUCTION
The subject of crying seems to be the least addressed subject in the professional literature about mourning. Self-help books
address the subject more frequently, but only as a form or manifestation of emotions. It might be questionable if the value
these kinds of books give to the expression of emotions by way of crying is valid and scientifically supported.
Perhaps the subject of crying should be further investigated and the subject should be given more attention in literature
regardless if crying is a positive or neutral manifestation during a mourning process. Nevertheless it seems that great value
is given to crying in a mourning process. It seems almost as if it is “the more the better”. Reason enough to further
investigate the question of crying in relation to mourning.


HYPOTHESIS
Mourning, whether it is uncomplicated, complicated, or anticipatory, without crying is not good mourning.


ABSTRACT
By questioning if mourning, whether it is uncomplicated complicated or anticipatory, without crying is good mourning, and
reviewing in what context crying should be placed in a mourning process, it might be possible to come to a conclusion about
the hypothesis. The chosen way of the research is describing and defining crying, literature research, and analyzing the
found literature.Only this decade there seems to be a growing interest in the subject. Recent studies show that there is no
recent and new research that supports that there is a chemical difference in tears of sadness compared to other tears. The
therapeutic effect of crying can only be contributed to the cause of the crying and the circumstances under which the
crying took place. Crying in mourning may have for the crying person conscious and subconscious purposes, but those
purposes may be reached through the expression of other emotions than crying just as well. Therefore the hypothesis:
“Mourning, whether it is uncomplicated, complicated, or anticipatory, without crying is not good mourning” cannot be
substantiated.


RESEARCH
What are tears?
A tear is a secretion product of 4):
- the meibomian glands, approximately 75 glands per eye that produce oils, which envelopes the tear and prevents spilling
onto the cheek, and it forms a barrier between the cornea and the eyelid;
- the lacrimal gland, one gland per eye that produces water, electrolytes, and proteins, which promotes  spreading of the tear
film, control of infectious agents and osmotic regulation;
- the goblet cells, which produce a mucus like gel that coats the cornea and allows a better distribution of the tear film.

What types of tears do exist?
There are three types of tears 5):
- basal tears keep the cornea wet, nourished, lubricated, and clear of dust. In a 24-hour period 0.75 to 1.1 grams of tears is
secreted; less at an older age;
- reflex tears result from irritation of the eye by foreign particles or substances, and as a side-effect of vomiting, coughing
and yawning;
- psychic tears, crying or weeping, are an increased secretion of the lacrimal glands, due to either strong negative or positive
emotions. Psychic tears have a different chemical composition than those just for lubrication, and they are controlled by the
hypothalamus.

What is crying?
Crying is the increased production of tears in response to an emotional state in humans, also defined as “a complex
secretomotor phenomenon characterized by the increased production of tears from the lacrimal apparatus, without any
irritation of the ocular structures”.6)

What types of crying do exist? 7)
- Positive Spatial, intense awareness of the location where one is or the presence of one experienced; 
- Negative Spatial, intense awareness of the location where one not is or the presence one misses;
- Positive Temporal, response to a moment as if it is eternal;
- Negative Temporal, looking back to the past with regret or to the future with dread.

How often do people cry? 8)
- women on average between 30 and 64 times per year;
- man on average between 6 and 17 times per year.
How long do people cry? 8)
- women about 6 minutes at a time;
- men about between 2 and 4 minutes at a time.
How intense do people cry? 8)
- for women crying turns into sobbing in 65% of the cases;
- for men crying turns into sobbing in 6% of the cases.
The above is applicable to adolescents and adults, but not to infants and children.
These numbers from 2009 have been predeceased with similar numbers in the 1980’s research by William H. Frey II PhD,
which were later reconfirmed by Lauren Bylsma PhD, University of Pittsburgh in the Journal of Research in Personality
2011.

What is the purpose of crying?
Recognition of sadness and a perceived need for social support have been found in studies to be a purpose of crying. The
tearing effect refers to the relevance of tears as an important visual cue adding meaning to human facial expression.
However, little is known about how people process these visual cues and their mediating role in terms of emotion perception
and person judgment. Therefore two experiments were conducted in which the influence of tears on the identification of
sadness was measured, and the perceived need for social support at an early perceptional level. In two experiments (1 and
2), participants were exposed to sad and neutral faces. In both experiments, the face stimuli were presented for 50
milliseconds. In experiment 1, tears were digitally added to sad faces in one condition. Participants demonstrated a
significant faster recognition of sad faces with tears compared to those without tears. In experiment 2, tears were added to
neutral faces as well. Participants had to indicate to what extent the displayed individuals were in need of social support.
Study participants reported a greater perceived need for social support to both sad and neutral faces with tears than to
those without tears. This study thus demonstrated that emotional tears serve as important visual cues at an early level. 9)

A therapeutic purpose of tears may be present, though researchers say the supposedly cathartic role of "a good cry" has
been overstated. Thirty years ago, Frey, a biochemist at the University of Minnesota, also proposed that people feel "better"
after crying due to the elimination of hormones associated with stress. This, paired with increased mucosal secretion during
crying, could lead to a theory that crying is a mechanism developed in humans to dispose of this stress hormone when levels
grow too high. Frey found that emotional tears carried more protein than non-emotional tears (say, from chopping an onion).
The implication was that when you cry for emotional reasons, you are involved in a healing process. However, it has been
tried twice without success to replicate Frey’s experiment.
Bylsma conducted a daily diary study of female students that also calls Frey's theory into question. She found that only
about 30 percent of students said their moods had improved after crying, with 60 percent reporting no change and about 9
percent saying their moods worsened. Her research offers a new insight into tears: Why you cry and who sees you do it
appear to make a difference in whether crying helps or hurts your emotional state. 10)
It may be concluded from these studies that crying will make feel people better when:
- they had emotional support;
- they were crying due to a positive event;
- their crying led to a resolution or new understanding of the situation that led them to cry in the first place;
- they cried alone or around one other person.
And that crying will make feel people worse when:
- they felt embarrassed or ashamed of crying;
- they were with unsupportive people;
- they cried because they saw suffering,
- they were in the presence of two or more people.

When reviewing the two books that make a fleeting mention of crying, Rando 1) and Worden 2) mention the possible
positive health effects of crying, but the recent studies show that the positive health effect is not related to the removal of
toxins as both Worden and Rando claim in their books. The relation to a positive effect lies in the emotional support the
person received at the moment of the crying.
It is surprising that Rando holds a different and more accurate position about crying in her 1993 book “Treatment of
Complicated Mourning” 3) compared to the “removal of toxins” theory in her 2000 book “Clinical Dimensions of
Anticipatory Mourning” 1). It will be interesting how Rando incorporates the recent studies in upcoming books.

In “Treatment of Complicated Mourning” 3) Rando states: “A prevalent misconception held by caregivers, mourners, and
the general public is that one’s extent of and/or success in mourning is measurable by the amount of tears released.”
She supports her objection to this misconception with the following grounds:
- Different individuals process affect differently based on their interpretation of the loss, their own personalities, and sexual
conditioning, their support systems, and all of the other factors circumscribing them and their loss;
- Although the shedding of tears is an extraordinarily effective release of sadness, it is not the sole one. People can deal
with their sadness and hurt in other ways besides crying;
- Sadness need not be the issue for which the mourner seeks and/or requires treatment. Focus on another issue may obviate
the need for crying at a given point. Thus, the absence of crying should not automatically suggest that mourning is failing to
progress appropriately.
- A mourner may cry copiously but do no more than release tensions. Mourning requires much more that a reaction to the
loss, and to consider crying evidence of the occurrence of mourning is both inappropriate and invalid.
- Abundant evidence documents that those most disturbed early after a loss are the ones heading for certain types of
complicated mourning. From this viewpoint, the amount, the intensity, and duration of mourning, may not so much signal that
healthy mourning is taking place as provide a forewarning of future complications. In many cases, persistent crying is
actually a sign of the chronic mourning syndrome.

What comes into question is where does this misconception about “the amount of tears released” originate from? Has it to
do with the caregiver’s view on their ability to cry?
New research finds the vast majority of clinical psychologists and psychology trainees have cried during therapy sessions
with clients.
One study, by San Diego psychologist Amy Blume-Marcovici, PsyD, found 72 percent of the 568 U.S. psychologists,
postdoctoral psychology fellows and psychology graduate students she surveyed had cried at least once while with a
patient. Of these, 30 percent had cried within the past four weeks 11).
Another, in-progress study by Catelijne ‘t Lam, a psychology doctoral student at Tilburg University in the Netherlands,
suggests that number could be even higher. She found that more than 87 percent of 819 Dutch mental health professionals -
psychotherapists, psychologists, psychiatrists and psychological nurses with at least a year's experience - had cried at some
point while conducting therapy.

The studies discovered unexpected results also:
- Male and female clinicians cried in therapy sessions at about the same rate. While women reported crying twice as much
as men in their private lives, they were more likely to suppress tears in therapy than were men;
- Older, more professionally established participants were more likely to cry than younger ones.
- Therapists with less work experience had more negative attitudes about crying and were more likely to report being
embarrassed about their tears;
- Older psychologists and therapists told her that they grew to see crying as a way to bond with patients, and that they felt
more comfortable with their own tears as they became more secure in their roles as therapists;
- Despite the prevalence of crying, only about one-third of therapists said their training included any discussion of handling
such emotions; and almost all thought it should.

While this is interesting it may not be the answer of the question where the misconception originated. Its origin may sooner
be found in ancient Egyptian, Greek, and Roman cultures whereby the female mourners had the duty to be wailing, tear
their hair, and spread ash on their clothes. In the absence of female mourners professional wailers were hired. In later
centuries particular emphasis was placed on funeral rituals; the more openly expression of grief and largeness of the funeral
the more important was the social status of the deceased’s family. Later the expression of grief and particular the crying of
women became more suppressed. Women wore veils and later were excluded from being present at the funeral; as they
still are in the orthodox Jewish and Muslim culture. But a vocal and visual human expression of emotions, like wailing
sobbing and crying, is still expected of the men during funerals in these cultures. Through the ages tears and death have
become inseparable.   


CONCLUSION

A few conclusions may be drawn;
- Women cry more, longer and more intense than men;
- The chemical difference in tears as argued by Frey has not been substantiated by similar research;
- People who are crying alone or in the presence of one emotional supportive person felt better after their crying;
- Tears may illicit social support;
- Tears may illicit recognition of the sadness;
- Crying by clinicians in therapeutic sessions could be a sign of empathy;
- There exists a misconception that the success in mourning is measurable by the amount of tears released;
-  Available professional literature pays very little attention to the subject of crying

It is not the production of tears that causes a person to feel better but the release of an emotion and the circumstances
under which the release took place. Crying is just an expression of an emotion, being the extraordinarily effective release of
sadness. This emotion may be released in a mourning process, whether it is uncomplicated, complicated, or anticipatory. On
a therapeutic level it is important that any expression of emotion is solicited, not just only the crying, whereby an empathic
tear of the clinician may be helpful.



LITERATURE

1)   Clinical Dimensions of Anticipatory Mourning, Therese Rando, 2000, Research Press, page 433.
2)   Grief counseling and Grief Therapy, Third edition, J. William Worden, 2002, Springer Publishing, page 20.
3)   Treatment of complicated Mourning, Therese Rando, 1993, Research Press, page 353.
4)   “Eye, human”, Encyclopedia Britannica, 2010.
5)   “Eye, human”, Encyclopedia Britannica, 2006.
6)   Crying behavior and psychiatric disorder in adults: a review, V.Patel, 1993, Compr.Psychiatry 34 (3):2016-11.
7)   How Emotions Work, Jack Katz, 1999, University of Chicago Press, page 182.
8)   Women cry more than men and for longer, German Society for Ophthalmology, 2009, The Telegraph.
9)   Emotional tears facilitate the recognition of sadness and the perceived need for social support, Martijn J. H.
      Balsters a/o, 2013, Tilburg Center for Cognition and Communication, Tilburg University, Evolutionary
      Psychology 11(1), pages 148-158.
10) When and for whom does crying improve mood? A daily diary study of 1004 crying episodes, Lauren Bylsma
      PhD a/o, 2011, University of Pittsburgh in the Journal of Research in Personality, pages 385-392.
11) Do therapist cry in therapy? The role of experience and other factors in therapist’s tears, Amy Blume-Marcovici
      a/o, 2013, Psychotherapy Vol.50 (2) June 2013, pages 224-234
12)Research in progress, Catelijne ‘t Lam, 2014, Tilburg University the Netherlands,  American Psychological
     Association, Vol 45, No. 2, page 49.