![Pathological Grief](https://mahasoe.com/wp-content/uploads/2020/12/IMG_20201206_061344-1024x683.jpg)
This post limit to discuss the characteristic of Pathological Grief and the Counselling methods in the Context of Pathological Grief.
Types of Grief
There are two types of Grief. They are normal grief and pathological grief.
Pathological grief
Pathological (morbid, atypical, unresolved) grief is that the condition of the bereaved in which he/she does not reach the final stage of the process; or is not continuing to make progress towards a positive resolution within six or eight months after the loss.
Given this approximate period of time; a fixation on a particular symptom or particular segment of a specific stage of the normal grief process may note; with the adoption in a rigid and inflexible manner of one; or a small select number of mechanisms or behaviors of that stage.
Situations Leading to Pathological Grief
Situations that may lead to pathological grief are described below.
Untimely death:
With a sudden death there is usually surprise, shock, and no preparation. By way of contrast, the death of an aged person might be expected.
With an aged person, some of the grieving work has already been completed, and ties to the aged person have loosened.
Suicide:
After a suicide, relatives have a strong tendency to feel guilt and self-blame.
Herzog and Resnick described the parents as refusing to think of the death as a suicide, and preferring to think of it as an ‘accident’.
Altered life situation:
An altered financial situation which leads to feelings of insecurity can also lead to resentment towards the deceased.
Bereavement causes anxiety and generally a sense that the world has become a dangerous place.
Characteristics of Pathological Grief
![Characteristics of Pathological Grief](https://mahasoe.com/wp-content/uploads/2020/12/IMG_20201206_061320-1024x683.jpg)
Self detrimental behaviour and lost social interaction:
Lindemann described these people as lacking initiative and being indecisive and restless. They look to others for direction and want to include in social activities.
They are apathetic and cannot make up their minds to do anything on their own. Nothing brings satisfaction, and it appears that they carry many daily routines out of habit.
Severe psycho pathology
Severe functional somatic symptoms such as persistent insomnia and weight loss indicate that the bereaved person is not resolving his/her loss. Patients with pathological grief may develop an agitated depression; with all of the characteristic symptoms and signs.
Along with other symptoms are the tendency for self-accusation, feelings of worthlessness, and a wish for self-punishment. These patients can be suicidal and require psychiatric intervention.
Volkan specifies the universality of love-hate ambivalence in the persons with pathological grief; whom he treated, through such ambivalence involve at least to some degree in all grief.
It is the presence of intense exaggerated or repressed ambivalence which seems to be involved in pathological grief.
This condition may look like any one of a number of disorders or forms of human unhappiness; depression, bitterness, anxiety, attacks, general irritability and/or outbursts of anger; or even more severe symptoms of emotional disorder.
Among children and adolescents pathological behavior
According to Kliman, if
(1) They exhibit regressive phenomena longer than several weeks, for example, an unusual (manic) cheerfulness;
(2) A disease occurs, lasting longer than six months;
(3) New symptoms appear after a certain period of time; such as diminution of school efforts (which is not uncommon for a child in the regressive stage and does not represent a serious disorder);
(4) Children or adolescents refuse to go to school; (this is a sign that they cannot leave the surviving parent for fear of separate from him or her also, or that they wish to withdraw completely);
(5) In adolescents, falling into sexual promiscuity.
Forms of Pathological Grief
Pathological grief can take various forms, from variants of normal grieving to such reactions as hypomania, dissociative reactions, drug abuse, etc.
Chronic grief
With a resolution of grief, the person should be able to look ahead with op-atomism; although it is not unusual for grief to recur for a short time at anniversaries; or if there are strong reminders of the deceased.
In chronic grief, the reaction is prolonged and the person suffers intense sadness. Guilt and self-blame seem to be frequent symptoms in these people.
Inhibited grief
Parkes described this as a situation in which the total picture of grief is permanently absent and the patient shows little reaction to the death. This type of reaction is most commonly in children or in the elderly but may occur in others.
The inhibition of grief can be seen as a defense against a catastrophic reaction. The patient whose son committed suicide expressed a feeling of fragility; and wanted to “keep on top of things”. She was afraid of condolences from others because she feared being flooded with sadness.
Delayed grief
With this reaction, a period of delay is followed by a typical grief reaction. The period of numbness which is the first stage of grief may be extended, or the numbness may be absent.
Lehr- man said questioning may reveal that patients suffering grief over a recent loss are still grieving for someone; who died many years ago. He gave the example of a 38-year-old woman who suffered a severe reaction over her mother’s death; but deeply engrossed in fantasies about her brother’s death from cancer 20 years earlier.
Atypical grief
Patients can develop a hippomanic reaction. These individuals show joy, over-activity, and rapid thought processes and deny the significance of the loss.
When they are unable to ward off sad thoughts about their lose; their elation may change to sadness, but this is often short-lived.
‘Splitting’
In ‘splitting’, one part of the person is aware of the loss, and another part functions as if the loss never occurred. Volkan gave the following example. A 38-year-old housewife lost her daughter suddenly.
The daughter was a student nurse who had lived in another town and used to come home on Fridays. Although her mother consciously knew her daughter was dead; she continued to act and feel as if her daughter was still alive; and regularly cleaned the daughter’s room for her weekly visit.
In this way, people may fool themselves, believing that the loved object is gone, but behave as if this is not the case. Underlying this process is hope and an attempt to regain the lost love object.
When such a dissociative reaction occurs as part of a pathological grief reaction; the expected emotions of grief separate from the situation of death. Selective amnesia may occur whereby unconsciously the person attempts to avoid the emotional impact of the loss.
Old woman
For instance, a 34-year-old woman admitted to hospital suffering from concussion; and other injuries after a car and train accident. When I saw this patient nine days later, she had amnesia for the accident as well as for the subsequent days.