physical health may decline, the estrangement initiator's may improve due to the cessation of abuse and conflict. The social rejection in family estrangement is the equivalent of ostracism which undermines four fundamental human needs: the need to belong, the need for control in social situations, the need to maintain high levels of self-esteem, and the need to have a sense of meaningful existence. The rejected parties suffer adverse psychological consequences such as loneliness, low self-esteem, aggression, and depression. Family estrangement activates the grief response, this is because people who have experienced this often see it as a loss they were not prepared for and happened unexpectedly. However, the rejected family may not achieve the final grief stage of acceptance, given that the social death of the relationship is potentially reversible. The prolonged suffering of the rejected party, together with a perceived or real stigma of having been rejected by a family member, results in isolation and behavioral changes in the rejected party. Social workers who work with the elderly population are at the forefront of a new fallout from the family estrangement. Non-supportive or absent family members during someone's end-of-life acutely increase the pain and stress of the final days. Culture The separation of young adults from their families of origin in order to create families of their own is part of normal human development. According to Bowen theory, this separation can be achieved in a healthy and gradual manner that preserves the intergenerational relationships of the family of origin, providing both the new family and family of origin with a sense of continuity and support. Alternately, a schism can differentiate these life stages. Familial estrangement falls into the second category. The emphasis on the individual over a collective family unit is regarded as contributing to estrangement, as well as a rationale for estrangement. In individualistic cultures, the estranger typically justifies the estrangement in relation to emotional, physical or sexual abuse. Other estrangers may see a lack of emotional support or clash of values as the justification, or may blame the other person for their own unhappiness. Estrangers who have suffered abuse often receive emotional support/validation as it can be easier for them to articulate and get others to understand their experience. For some victims of psychological or emotional abuse the damage has been done over a long period of time by a characteristic pattern of subtle deniable abuse. For