To be involved in close relationships inevitably means that one will eventually experience the loss of a loved one. Those who experience such loss are usually surrounded by people in mourning, which is a powerful and stressful emotional state that is rooted in the unconscious psychological reactions to a loss. Grief, although not considered an illness, may nevertheless be so severe as to jeopardize the individual's life. There is no time frame for grief and, in some cases, it involves subtle factors that can result in self-destructive behavior in the grieving person. Such self-destructive behavior may involve alcohol or drug abuse, malnutrition, disorders related to the neglect of oneself, including the disregard of a prescribed medical regimen or commonsense precautions, and even a seemingly unconscious boredom with life. Successful coping with the loss of a loved one is critical to maintaining the course of social activity.
There are different reactions to the death of a loved one, depending on the age, marital status, social class, ethnicity, and the circumstances of those left behind. The death of a child is a devastating experience for parents. The death of a spouse or a partner involves the loss of a chosen relationship, companion, lover, parent of one's children, friend, and soulmate. Such loss can result in feelings of disorientation, uncertainty, and confusion as one may need to take on roles and tasks previously carried out by the deceased.
Premature Death
Premature death may be incurred in various ways-deliberately by human hands (such as in homicide, suicide, war, and death sentences meted out by the State), as a result of nonhuman creatures (e.g., bacteria and animals), or as a result of accidents. Loved ones who have lost a significant other as a result of suicide are generally called "survivors." Among people who have lost a loved one, survivors of suicide represent the largest group of mental health casualties. The loss of a loved one by suicide is often shocking, painful, and unexpected, and the grief that ensues can be intense, complex, and long term.
In the case of the sudden death of a loved one due to unexpected events, such as natural disasters including earthquakes, large-scale explosions, or disasters in general, there are unique reactions to the event. The "disaster syndrome" consists of a combination of emotional dullness, unresponsiveness to outer stimulation, and inhibition of activity. Individuals who have just experienced a disaster are apt to suffer from at least a transitory sense of worthlessness, and their usual capacity for self-love becomes impaired. In other cases, psychic shock is a common reaction followed by motor retardation, flattening of affect, somnolence, amnesia, and suggestibility. Moreover, a process of "psychic closing off" has been reported in loved ones who lost a dear person in a catastrophic event; this closing off can last from days to even months or can become a more lasting psychic numbing.
Although most people adjust to the trauma surrounding the death of a loved one, and are able to successfully move on to live full and satisfying lives, there are circumstances when adjustment to such loss is difficult. In these cases, acute grief does not resolve (thoughts and memories of the deceased remain accessible but are no longer preoccupying)-the permanence of the loss and the thoughts related to it are neither comprehended nor integrated into attachment-related long-term memory.
Adjustment to the death of a loved one can be complicated by maladaptive attitudes and behaviors. Blame of self or others, fear of the intensity of grief, the prospect of living without the deceased, and a disinclination to engage in activities that were shared with the deceased may impede the resolution of grief. Over the past decade, some investigators studying persons who have persistent symptoms and impairment following bereavement have concluded that there is a syndrome of chronic abnormal grief, also called complicated grief, and recently renamed prolonged grief disorder, a disorder occurring after a loss that causes significant impairments in functioning for at least 6 months. Characterized by either separation distress or cognitive, emotional, and behavioral symptoms such as feelings of confusion or emptiness, it is as if a part of the self has died. There is trouble accepting the loss as real, an inability to trust others, extreme bitterness or anger related to the loss, and avoidance of reminders of the loss. Other features include numbness or absence of emotion; a feeling that life is unfulfilling, empty, and meaningless; and a feeling of being stunned, dazed, or shocked by the loss.
Scholars demonstrate that the symptoms of disordered grief form a syndrome that is distinct from those of depression and anxiety. Characteristic features of such a state include persistent preoccupation with thoughts about the lost person, along with yearning, longing, and an inability to accept the death, distressing intrusive thoughts about the death, and avoidance of reminders of the loss. A major issue is the timely recognition of the transition from normal to abnormal grief as well as what risk factors lead to the emergence of complicated grief or lead to the development of comorbid disorders such as major depression, anxiety disorders, or somatoform disorders. Recent studies confirm the hypothesis that post-traumatic stress disorder can occur following a natural death. Violent events are time-limited, threaten one's sense of safety, incite fear, and produce hypervigilance to danger.
The loss of a loved one is a permanent ongoing reality that engenders sadness and longing, and produces hypervigilance for the lost person. Images, thoughts, and memories of the deceased, even when intrusive, evoke a bittersweet mix of sadness and yearning. Failure to integrate the information about a violent event may result in post-traumatic stress disorder, while failure to integrate the permanent loss of a loved one may produce complicated grief.
How Children Cope
Children experience grief after the loss of a parent or someone close. Their grief is different from adult grief, as children do not have the same understanding of death. They need to be informed in simple language, with information appropriate for a given age. They should be involved but never obligated to take part in funerals or to observe dead parents or relatives. Children need reassurance and their usual activities and routines should be maintained. Children's knowledge of death varies with age. Under 9 years of age, death is not completely understood as the end of life, but rather it is equated with fear of abandonment or related to magical thinking.
Postvention
Postvention consists of activities that reduce the aftereffects of a traumatic event in the lives of those left behind. Its purpose is to help survivors live longer, more productively, and with less stress. Postventive efforts are not limited to the initial stage of the shock, but rather should be on a day-to-day basis spanning up to a year following the first shock.
Postvention incorporates many tools of psychotherapy, including talk, abreaction, interpretation, reassurance, directions, and even gentle confrontation. The therapist should avoid banal platitudes or the common mistakes often encountered in psychotherapy such as misapplication of the mental examination, for most people who experience grief are not clinically depressed. Common errors that occur are often based on countertransference or a failure to utilize support from within the community. Suicide assessment should always be performed when exploring grief, for there might be fantasies of reunion that fuel suicide wishes. The counselor should play the role of reality tester. Support groups so useful in the healing process can be a helpful source of guidance and understanding as well.
Maurizio Pompili
https://dx.doi.org.ezproxy.umuc.edu/10.4135/9781412972031.n74
See also
• Bereavement, Grief, and Mourning
• Prolonged Grief Disorder
• Sudden Death
• Thanatology
Further Readings
Maercker, A. When grief becomes a disorder. European Archives of Psychiatry and Clinical Neuroscience 257(2007). 435-436. https://dx.doi.org.ezproxy.umuc.edu/10.1007/s00406-007-0742-2
Shneidman, E. S. (1973). Deaths of man. New York: Quadrangle/The New York Times Book Co.
Shneidman, E. S. (1980). Death: Current perspectives. Palo Alto, CA: Mayfield.
Shneidman, E. S. (2008). A commonsense book of death: Reflections at ninety. New York: Rowman & Littlefield.