Pathological Grief

Dr Tan defined Grief as a highly personal and subjective response to a real, perceived or anticipated loss, whereas Mourning is an intrapsychic process whereby the person adapts to the loss. And Bereavement refers to the fact of loss. When a person experiences complicated grief, health suffers. The psychological outcomes present themselves in depression and anxiety, and worse, suicide ideation. The family relationships suffer too.

Dr Tan used the Bowlby’s Attachment Theory to explain the purpose of grief. It is an instinctive and universal response to separation. Complicated grief may arise as a result of peculiar relationship with the lost person, which may in turn be determined by the nature of attachment with the primary care givers i.e. insecure attachment patterns emanating from parental rejection in childhood. Dr Tan also took us through the Worden (Grief Tasks), Stroebe & Schut (Dual Process Model) as well as Neimeyer’s Meaning/Narrative Reconstruction.

In normal grieving process, the griever may manifest grief in feelings (sadness), physical sensations (breathlessness), cognitions (disbelief), behaviors (sleep disturbance) and spiritual distress (‘Why me?’) Pathological grief may be chronic (excessive in duration), delayed (insufficient emotional reaction at the time of loss), exaggerated (person resorts to maladaptive behavior), masked (symptoms not recognized as related to the loss) & disenfranchised (e.g. EMA)

Dr Tan provided a practical approach to complicated grief. I will have to identify how the grief presents itself. Especially in late bereavement, to assess progress of mourning, identify depression and consider pharmacology. During assessment, I engage the client to talk about the loss – the deceased, the death, social support, chronic stressors (current losses), earlier losses, coping styles as well as any strained interpersonal relationship resulted.

The client needs to be prepared for grief tasks (Worden). After one has accepted the reality of the loss, he/she has to work through the pain of the grief (revive memories of the deceased). The client needs to learn to adjust to an environment in which the deceased is missing and to emotionally relocate the deceased and move on with life.
Client needs to be assured he/she will recover, will be able to continue with life and will find meaning to live on. The deceased will still be remembered even when grieving has stopped. (Permission). Dr Tan provided a list of encouraging narrative reconstruction which I find extremely helpful. The goal is for the client to reconstruct or we collaborate to co-author a coherent and consistent life-script that includes the bereavement, and that will impart resilience as they remake their lives.