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Bereavement refers to the period of mourning and grief following the death of a beloved person or animal. The English word bereavement comes from an ancient Germanic root word meaning "to rob" or "to seize by violence." Mourning is the word that is used to describe the public rituals or symbols of bereavement, such as holding funeral services, wearing black clothing, closing a place of business temporarily, or lowering a flag to half mast. Grief refers to one's personal experience of loss; it includes physical symptoms as well as emotional and spiritual reactions to the loss. While public expressions of mourning are usually time-limited, grief is a process that takes most people several months or years to work through.
Bereavement is a highly individual as well as a complex experience. It is increasingly recognized that no two people respond the same way to the losses associated with the death of a loved one. People's reactions to a death are influenced by such factors as ethnic or religious traditions; personal beliefs about life after death; the type of relationship ended by death (relative, friend, colleague, etc.); the cause of death; the person's age at death; whether the death was sudden or expected; and many others. In addition, the death of a loved one inevitably confronts adults (and older adolescents) with the fact that they too will die. As a result of this variety and emotional complexity, most doctors and other counselors advise people to trust their own feelings about bereavement, 0 and grieve in the way that seems most helpful to them.
It is also increasingly understood in the early 2000s that people can experience bereavement with regard to other losses. Some examples of these so-called "silent losses" include miscarriages in early pregnancy, the death of a child in the womb shortly before birth, or the news that a loved one has Alzheimer's disease or another illness that slowly destroys their personality. In addition, many counselors recognize that bereavement has two dimensions, the actual loss and the symbolic losses. For example, a person whose teenage son or daughter is killed in an accident suffers a series of symbolic losses—knowing that their child will never graduate from high school, get married, or have children—as well as the actual loss of the adolescent to death.
Causes and symptoms
The immediate cause of bereavement is usually the death of a loved friend or relative. There are a number of situations, however, which can affect or prolong the grief process:
- The relationship with the dead person was a source of pain rather than love and support. Examples would include an abusive parent or spouse.
- The person died in military service or in a natural, transportation, or workplace disaster. Bereavement in these cases is often made more difficult by intrusive news reporters as well as anxiety over the loved one's possible physical or mental suffering prior to death.
- The person was murdered. Survivors of homicide victims often find the criminal justice system as well as the media frustrating and upsetting.
- The person is missing and presumed dead but their death has not been verified. As a result, friends and relatives may alternate between grief and hope that the person is still alive.
- The person committed suicide. Survivors may feel guilt over their inability to foresee or prevent the suicide, shame that the death was self-inflicted, or anger at the person who committed suicide.
- The relationship with the dead person cannot be openly acknowledged. This situation often leads to what is called disenfranchised grief. The most common instances are homosexual or extramarital sexual relationships that have been kept secret for the sake of spouses or other family members.
- The loved one was an animal rather than a human being. Western societies are only beginning to accept that adults as well as children can grieve for a dead animal; many adults still feel that there is "something wrong" about grieving for their pet. The question of euthanasia may be an additional source of sorrow; even when the pet is terminally ill, many people are very uneasy about making the decision to end its life.
Bereavement typically affects a person's physical well-being as well as emotions. Common symptoms of grief include changes in appetite and weight, fatigue, insomnia and other sleep disturbances, loss of interest in sex, low energy levels, nausea and vomiting, chest or throat pain, and headache. People who have lost a loved one in traumatic circumstances may have such symptoms of post-traumatic stress disorder as an exaggerated startle response, visual or auditory hallucinations, or high levels of muscular tension.
Doctors and other counselors have identified four stages or phases in uncomplicated bereavement:
- Shock, disbelief, feelings of numbness. This initial phase lasts about two weeks, during which the bereaved person finally accepts the reality of the loved one's death.
- Suffering the pain of grief. This phase typically lasts for several months. Some people undergo a mild temporary depression about six months after the loved one's death.
- Adjusting to life without the loved one. In this phase of bereavement, survivors may find themselves taking on the loved one's roles and responsibilities as well as redefining their own identities.
- Moving forward with life, forming new relation-ships, and having positive expectations of the future. Most people reach this stage within one to two years after the loved one's death.
BEREAVEMENT IN CHILDREN. Children do not experience bereavement in the same way as adolescents and adults. Preschool children usually do not understand death as final and irreversible, and may talk or act as if the dead pet or family member will wake up or come back. Children between the ages of five and nine are better able to understand the finality of death, but they tend to assume it will not affect them or their family. They are likely to be shocked and severely upset by a death in their immediate family. In addition to the physical disturbances that bereaved adults often experience, children sometimes begin to act like infants again (wanting bottle feeding, using baby talk, etc.) This pattern of returning to behaviors characteristic of an earlier life stage is called regression.
TRAUMATIC AND COMPLICATED GRIEF. Since the early 1990s, thanatologists (doctors and other counselors who specialize in issues related to death and dying) have identified two types of grief that do not resolve normally with the passage of time. Traumatic grief is defined as grief resulting from a sudden traumatic event that involves violent suffering, mutilation, and/or multiple deaths; appears to be random or preventable; and often involves the survivor's own brush with death. The symptoms of traumatic grief are similar to those of post-traumatic stress disorder (PTSD). Such events as the terrorist attacks of September 11, 2001, the East Asian tsunami of December 2004, and airplane crashes or other transportation disasters may produce traumatic grief in survivors.
Bibliotherapy — The use of books (usually self-help or problem-solving works) to improve one's understanding of personal problems and/or to heal painful feelings.
Biofield healing — A general term for a group of alternative therapies based on the belief that the human body is surrounded by an energy field (or aura) that reflects the condition of the person's body and spirit. Rebalancing or repairing the energy field is thought to bring about healing in mind and body. Reiki, therapeutic touch, polarity balancing, Shen therapy, and certain forms of color therapy are considered forms of biofield healing.
Complicated grief — An abnormal response to bereavement that includes unrelieved yearning for the dead person, the complete loss of previous positive beliefs or worldviews, and a general inability to function.
Disenfranchised grief — Grief that cannot be openly expressed because the death or other loss cannot be publicly acknowledged.
Euthanasia — The act of putting a person or animal to death painlessly or allowing them to die by with-holding medical services, usually because of a painful and incurable disease.
Mourning — The public expression of bereavement; it may include funerals and other rituals, special clothing, and symbolic gestures.
Regression — A return to earlier, particularly infantile, patterns of thought and behavior.
Thanatology — The medical, psychological, or legal study of death and dying.
Traumatic grief — Grief resulting from the loss of a loved one in a traumatic situation (natural or transportation disaster, act of terrorism or mass murder, etc.)
In contrast to traumatic grief, complicated grief does not necessarily result from a specific type of event but rather refers to an abnormally intense and prolonged response to bereavement. While most people are able to move through a period of bereavement and recover a sense of purpose and meaning in life, people with complicated grief feel as if their entire worldview has been shattered. They cannot stop thinking of the dead person, long to be with him or her, and may feel that part of them died along with the loved one. They sometimes start acting like the deceased person, mimicking the symptoms of his or her illness, behaving in reckless ways, talking about "joining" the loved one, or refusing to accept the reality of the death. In general they are unable to function normally. Complicated grief should not be regarded as simply a subtype of clinical depression; the two conditions may coexist or overlap in some patients but are nonetheless distinct entities.
Bereavement is considered a normal response to a death or other loss. A doctor who suspects that a patient is suffering from traumatic or complicated grief, however, may use various psychological inventories or questionnaires to see whether the patient meets the criteria for PTSD, major depression, or acute stress disorder. In addition, there are several specific questionnaires to help diagnose complicated grief.
Most people do not require formal treatment for bereavement. In the early 2000s, however, many people choose to participate in support groups for recently bereaved people or hospice follow-up programs for relatives of patients who died in that hospice. Bereavement support groups are particularly helpful in guiding members through such common but painful problems as disposing of the dead person's possessions, celebrating holidays without the loved one, coping with anniversaries, etc.
Traumatic grief is usually treated in the same way as post-traumatic stress, with temporary use of medications to control sleep disturbances and anxiety symptoms along with long-term psychotherapy. Those suffering from traumatic grief may also be referred to support groups of people dealing with the same type of sudden and violent loss. Some of these organizations are listed below. Complicated grief is usually managed with a combination of group and individual psychotherapy.
Alternative therapies that have been reported to help with the sleep disturbances and other physical symptoms of bereavement include prayer and meditation; such movement therapies as yoga and tai chi; therapeutic touch, Reiki, and other forms of biofield healing; bibliotherapy and journaling; music therapy, art therapy, hydrotherapy, and massage therapy.
Most people move through the stages of the normal grief process within several months to two years, depending on the length and closeness of the relationship. Traumatic grief and complicated grief, however, may take three years or longer to resolve, even with appropriate treatment.
Bereavement is considered a normal response to death and loss, which are universal human experiences. It should ordinarily be allowed to run its course; most counselors maintain that trying to stifle or cut short the grief process is more likely to cause emotional problems later on than to prevent them.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.
Dossey, Larry, MD. Healing Beyond the Body: Medicine and the Infinite Reach of the Mind. Boston and London: Shambhala, 2001. The chapters on "The Return of Prayer" and "Immortality" are particularly relevant to bereavement.
"Mood Disorders." Section 15, Chapter 189 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2005.
Bowles, Stephen B., Larry C. James, Diane S. Solursh, et al. "Acute and Post-Traumatic Stress Disorder after Spontaneous Abortion." American Family Physician 61 (March 15, 2000): 1689–1696.
Kersting, Karen. "A New Approach to Complicated Grief." Monitor on Psychology 35 (November 2004): 51.
Lubit, Roy, MD. "Acute Treatment of Disaster Survivors." eMedicine, 17 June 2004. http://www.emedicine.com/med/topic3540.htm.
Ogrodniczuk, John S., William E. Piper, Anthony S. Joyce, et al. "Differentiating Symptoms of Complicated Grief and Depression among Psychiatric Outpatients." Canadian Journal of Psychiatry/Revue canadienne de psychiatrie 48 (March 2003): 87-93.
Alzheimer's Association. 225 North Michigan Avenue, 17th Floor, Chicago, IL 60601-7633. (312) 335-8700. 24-hour hotline: (800) 272-3900. http://www.alz.org. This website is an excellent resource for anyone with a loved one suffering from Alzheimer's or another dementing illness.
American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. http://www.aacap.org..
American Veterinary Medical Association (AVMA). 1931 North Meacham Road, Suite 100, Schaumburg, IL 60173-4360. http://www.avma.org. The AVMA website includes links to resources about pet loss.
Dougy Center for Grieving Children and Families. 3909 SE 52nd Avenue, Portland, OR 97206. (866) 775-5683 or (503) 775-5683. Fax: (503) 777-3097. http://www.grievingchild.org. Provides age-appropriate support groups, information, and referral services for bereaved children and adolescents.
National Air Disaster Alliance/Foundation (NADA). 2020 Pennsylvania Avenue #315, Washington, DC 20006-1846. (888) 444-NADA. Fax: (336) 643-1394. http://www.planesafe.org. NADA was founded in 1995 following the loss of USAir Flight 427 to meet the needs of people who have lost loved ones in air disasters as well as work for better transportation safety standards.
National Hospice and Palliative Care Organization (NHPCO). 1700 Diagonal Road, Suite 625, Alexandria, VA 22314. (703) 837-1500. Fax: (703) 837-1233. http://www.nho.org. This website is a good source of information about hospice-based bereavement services and support groups.
National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513 or (886) 615-NIMH. www.nimh.nih.gov.
Tragedy Assistance Program for Survivors, Inc. (TAPS). National Headquarters, 1621 Connecticut Avenue NW, Suite 300, Washington, DC 20009. (202) 588-TAPS. Hotline: (800) 959-TAPS. http://www.taps.org. TAPS provides grief support for those who have lost a loved one serving in the Armed Forces.
Alzheimer's Association. Fact Sheet: About Grief, Mourning and Guilt. Chicago, IL: Alzheimer's Association, 2004.
American Academy of Child and Adolescent Psychiatry (AACAP). Children and Grief. AACAP Facts for Families #8. Washington, DC: AACAP, 2004.
American Academy of Child and Adolescent Psychiatry (AACAP). When a Pet Dies. AACAP Facts for Families #78. Washington, DC: AACAP, 2000.
Harper, Linda R., PhD. Healing after the Loss of Your Pet. http://www.bestfriends.org/theanimals/pdfs/allpets/PetLossHarper.pdf.
National Institute of Mental Health (NIMH). Mental Health and Mass Violence: Evidence-Based Early Psychological Interventions for Victims/Survivors of Mass Violence. NIH Publication No. 02-5138. Washington, DC: U. S. Government Printing Office, 2002.
National Organization of Parents of Murdered Children (POMC). Information Bulletin: Survivors of Homicide Victims. http://www.pomc.com/survivor.cfm.
An acute state of intense psychological sadness and suffering experienced after the tragic loss of a loved one or some priceless possession.
[M.E., bireven, to deprive, + -ment]
bereavementThe bereaving or mourning of the loss of a loved one, which is often accompanied by a transient—usually < 6 months—period of depression, which may mimic major depression. Prolonged bereavement may be misdiagnosed as a mental disorder, including major depression.
bereavementPsychology Feelings of deprivation, desolation, and grief at the loss of a loved one; the bereaving or mourning the loss of a 'significant other' or other loved one, which is often accompanied by a transient–usually < 6 months period of depression; it may be misdiagnosed as a mental disorder including major depression. See Complicated bereavement, Depression.
An acute state of intense psychological sadness and suffering experienced after the tragic loss of a loved one or some highly valued possession.
[M.E., bireven, to deprive, + -ment]