bereaved

adj.
Suffering the loss of a loved one: the bereaved family.

n.
One or those bereaved: The bereaved has entered the church. The bereaved were comforted by their friends.

Bereavement is defined as the objective state of having experienced the loss of a loved one. Grief, in contrast, is the psychological and emotional reaction to bereavement. Grief is a healthy, normal, and appropriate response to loss. It is a process of adaptation, with a number of signs or manifestations that are part of the experience. Grief may also precede a loss, in which case it is termed "anticipatory" grief. In this case, grief is the process of slowly coming to terms with the potential loss of a significant person, such as may be seen in a caregiver of a person with a progressive illness.

The duration and expression of "normal" bereavement vary considerably among both individuals and cultural groups. For some individuals, bereavement becomes overwhelming, and grief leads to pathological or complicated mourning, with negative implications for functioning or physical health. Complicated grief entails a failure to return to pre-loss levels of performance or states of emotional well-being within eighteen months after a death, and is manifested by poorer global functioning, depressed mood, poorer sleep quality, and lower self-esteem.

Bereavement is a stressful process that affects morbidity and mortality. The recently bereaved report increased depression, deteriorating physical health, and increased consumption of tobacco, alcohol, and tranquilizers. Studies have found a 40 percent increase in mortality rates among widowers in the first six months after the loss of their spouse. Severe psychological stress secondary to bereavement has been associated with abnormalities in immune function. Between 20 and 25 percent of bereaved persons remain depressed one year after a death, and up to 26 percent of bereaved persons exhibit depressive symptoms after two years.

The experience of grief is described as occurring in phases, with one phase gradually following the next. The process of uncomplicated grief can be thought of as an interwoven pattern of changing emotional states, somatic symptoms, and motivational stages. These phases overlap, as do each of the components within the phases.

The first phase is one of shock. This phase begins immediately after a loss and it generally lasts two weeks or less. During this period the survivor is often in a state of numbed disbelief. Somatic symptoms include crying, dysphagia, chest tightness, nausea, and a sensation of abdominal emptiness. Individuals may feel lost, dazed, stunned, helpless, and disorganized. The shock phase is often more pronounced if the death is sudden or unexpected. Similar experiences may occur after an individual learns of a grave diagnosis, even if death is not imminent.

Phase two consists of preoccupation with the deceased. This phase is marked by a sense of unreality and decrease in the feeling of disbelief. Emotional numbness gives way to fully experiencing the painful sadness of the loss. Crying spells persist. Symptoms include insomnia, fatigue, and loss of appetite. Most characteristic of this period is an intense, almost obsessive, preoccupation with the memory of the deceased, and past grievances, anger, guilt, and other unresolved conflicts are reexamined. Dreams of the dead may be intensely vivid. Transient hallucinatory episodes may occur in which the deceased's voice is heard or strangers may be mistakenly identified as the deceased. A period of social withdrawal and introversion is also typical. This phase is usually well developed by three months and may persist for six months or longer. Recurrences of these symptoms may occur on birthdays, anniversaries, or other special dates that remind the survivor of the deceased.

Phase three is a period of resolution, heralded by the bereaved's being able to recall events with sentimental pleasure and regaining an interest in activities. New social contacts are gradually made and life is reorganized around new activities and interests. Crying spells, feelings of emptiness, and longing for the dead still occur, but begin to diminish in intensity and duration. Somatic symptoms and preoccupation with memories begin to wane. Getting over a death does not mean that sad and empty feelings are never evoked by the memory of the loved one, but rather that the survivor does not remain preoccupied with the deceased and is not restricted socially and psychologically as a result of the death. Bereaved individuals should not expect to, nor be expected to, recover within a specified period of time.

Bereaved individuals may benefit from support services, including bereavement counselors, psychologists, and support groups. Most hospices provide bereavement services, informational materials, and support groups, even if the deceased did not receive hospice services. Local funeral homes are a good source for informational materials about grief and bereavement. AARP offers a number of resources through its web site. Compassionate Friends is a national nonprofit, self-help support group for families who are grieving the death of a child. The National Funeral Directors Association and the National Hospice and Palliative Care Organization offer a variety of resources on bereavement issues.

(SEE ALSO: AARP; Crisis Counseling; Family Health; Widowhood)

Bibliography

Brown, J. T., and Stoudemire, G. A. (1983). "Normal and Pathological Grief." Journal of the American Medical Association 250:378–382.

Lattanzi-Licht, M.; Kirschling, J. M.; and Fleming, S., eds. (1989). Bereavement Care: A New Look at Hospice and Community Based Services. New York: Haworth Press.

Parkes, C. M. "Bereavement." In The Oxford Textbook of Palliative Medicine, 2nd edition, eds. D. Doyle, G. W. Hanks, and N. MacDonald. New York: Oxford University Press.

Prigerson, H. G.; Frank, E.; and Kasl, S. V. (1995). "Complicated Grief and Bereavement-related Depression as Distinct Disorders: Preliminary Empirical Validation in Elderly Bereaved Spouses." American Journal of Psychiatry 152:22–30.

Wass, H., and Neimeyer, R. A., eds. (1995). Dying: Facing the Facts. Washington, DC: Taylor & Francis.

— JEAN S. KUTNER

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Common cause of grief, that 'fierce or violent sorrow' which Robert Burton in his Anatomy of Melancholy referred to as 'the epitome, symptom and chief cause of melancholy'. The relationship between mourning and melancholia was explored in more detail by Sigmund Freud who, in 1917, suggested that depressive illness (melancholia) differs from grief in the prominent part played by feelings of guilt and in the symbolic significance of the loss that preceded it. Subsequent research has confirmed the frequency of guilt and self-reproach among those who develop depressive illnesses after bereavement.

Despite Freud's claims, little attention was paid to bereavement by psychiatrists until Eric Lindemann described the symptomatology and management of acute grief following the Coconut Grove nightclub fire in Boston, Massachusetts, in 1944. Lindemann showed that people who do not 'break down' and express feelings appropriate to a bereavement may suffer from delayed or distorted grief. Such pathological forms of grief, said Lindemann, could be restored to a more normal form in the course of six to eight weekly interviews in which the bereaved person was encouraged to give vent to the feelings of sadness, anger, or guilt which they had repressed. A recent development of this approach has been the use of 'flooding', a technique derived from behaviour therapy in which bereaved people are pressed to vivid recollection of the sight, smell, sounds, and feelings associated with the dead person. R. W. Ramsay (1977, 1979), the originator of this method of treatment, has subsequently toned down the intensity of the approach, which, in its original form, could only be safely carried out in a psychiatric in-patient setting.

While there is now much agreement regarding the efficacy of Lindemann's approaches to delayed or avoided grief, their use in the treatment of the severe and protracted grief which sometimes follows the dissolution of relationships characterized by ambivalence or dependency is more controversial. Alternative strategies have been developed by C. M. Parkes, who has also advocated the introduction of bereavement counselling during the early phases of grief as a means of preventing later difficulties in those who are thought to be at risk. Recent random-allocation studies have confirmed the effectiveness of some counselling services of this kind (Raphael 1984).

The application of Freud's libido theory to grief has been challenged by John Bowlby (1969), whose studies of the development of attachment between mother and child led him to explain the intense pining or yearning of acute grief as a frustrated form of the urge to search for any loved person from whom one has become separated. This urge to search is thought to be an instinctually derived behaviour pattern which conflicts with the awareness of the older child or adult so that such a search is useless and bound to disappointment. Consequently attempts to avoid reminders of the loss, seek distraction, and inhibit thoughts of loss coexist alongside contrary impulses to cry aloud, to drop everything, and to focus one's mind upon the search for the lost person. Individuals, families, and cultures vary in the extent to which one or other aspect of the conflict is permitted, but some form of expression of sorrow is allowed for in the religious ceremonials of all cultures which have been studied (Rosenblatt, Walsh, and Jackson, 1976). G. Gorer (1965) has claimed that the decline in ritual aspects of mourning which has taken place in industrialized countries since the First World War has removed an important source of support for the bereaved and encouraged pathological reactions to bereavement.

In most bereaved people the urge to search for the lost person is reflected in thoughts, actions, and perceptions. Thoughts about the dead person return repeatedly, and the bereaved tend to pine intensely and to go over in the mind the events leading up to the death as if, even at this time, they could find out what has gone wrong and put it right again. The search is reflected in acts concerned to 'keep alive' the memories of the dead, to visit graves or places associated with them, and to treasure possessions which will act as reminders. Clear visual memories of the dead person are kept in mind, and sights and sounds are commonly misperceived as evidence of his or her return.

In the normal course of events the intensity and duration of episodes of pining (the so-called 'pangs' of grief) grow gradually less, and attachment behaviour is extinguished. As this happens, people become more fully aware of the extent to which their basic assumptions about themselves and the world will have to change. The psychosocial transition which results necessitates lengthy revision of the individual's view of the world (world model), and, in the interim, the bereaved remain insecure and relatively helpless. Many withdraw from social relationships and become disengaged from their wider circle of interests and acquaintances. The elderly bereaved may never become re-engaged with the outside world. Younger people more often find their way through to a new identity which may be more mature than the one that preceded it.

Factors which predispose to a successful outcome of this transition include appropriate anticipation and preparation for bereavement, emotional support from friends and others (permitting expression of grief), psychological resilience and confidence in oneself, opportunities for personal growth, and faith in a religious or philosophical system of belief that gives meaning to death. Conversely the process of grieving may be impaired by sudden, unexpected, and untimely deaths, by the dissolution of relationships characterized by ambivalence or dependence, by social isolation or the presence of others who will block attempts to grieve or distract the griever, by the failure of previous attempts to cope with major loss (particularly in childhood), by lack of self-confidence, by physical or other obstacles to self-fulfilment, and by the absence of a system of belief that gives meaning to death.

Although bereavements are commonest in old age, their frequency and predictability reduce the chance that the bereaved will be unprepared for them. Also there is less need for old people to compete for a place in the world that remains to them, and many come through the stress of bereavement without experiencing the lasting distress which characterizes younger bereaved people.

Although most of the published work on bereavement has focused on bereavement by death, the phenomenon of grief follows many of the 'slings and arrows of outrageous fortune'. Hence an understanding of the psychology of bereavement is important to all those involved in the care of people who are undergoing psychosocial transitions.

(Published 1987)

— Colin Murray Parkes

Bibliography
• Bowlby, J. (1969, 1973, 1980). Attachment and Loss, 3 vols.
• Gorer, G. (1965). Death, Grief, and Mourning in Contemporary Britain.
• Lindemann, E. (1944). 'Symptomatology and management of acute grief'. American Journal of Psychiatry, 101.
• Parkes, C. M. (1986). Bereavement: Studies of Grief in Adult Life (2nd edn.).
• — —  (2001). Bereavement (3rd edn.).
• Ramsay, R. W. (1977). 'Behavioural approaches to bereavement'. Behaviour Research and Therapy, 15.
• — —  (1979). 'Bereavement: a behavioural treatment of pathological grief'. In Sjöden, P. (ed.), Trends in Behaviour Therapy.
• Raphael, B. (1984). The Anatomy of Bereavement.
• Rosenblatt, P. C., Walsh, R. P., and Jackson, D. A. (1976). Grief and Mourning in Cross-cultural Perspective.

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Quotes:

"Grief that is dazed and speechless is out of fashion: the modern woman mourns her husband loudly and tells you the whole story of his death, which distresses her so much that she forgets not the slightest detail about it." - Jean De La Bruyere

"Tears are sometimes an inappropriate response to death. When a life has been lived completely honestly, completely successfully, or just completely, the correct response to death's perfect punctuation mark is a smile." - Julie Burchill

"Never does one feel oneself so utterly helpless as in trying to speak comfort for great bereavement. I will not try it. Time is the only comforter for the loss of a mother." - Jane Welsh Carlyle

"It is extraordinary how the house and the simplest possessions of someone who has been left become so quickly sordid. Even the stain on the coffee cup seems not coffee but the physical manifestation of one's inner stain, the fatal blot that from the beginning had marked one for ultimate aloneness." - Coleman Dowell

"The death of a dear friend, wife, brother, lover, which seemed nothing but privation, somewhat later assumes the aspect of a guide or genius; for it commonly operates revolutions in our way of life, terminates an epoch of infancy or of youth which was waiting to be closed, breaks up a wonted occupation, or a household, or style of living, and allows the formation of new ones more friendly to the growth of character." - Ralph Waldo Emerson

"The sorrow for the dead is the only sorrow from which we refuse to be divorced. Every other wound we seek to heal -- every other affliction to forget: but this wound we consider it a duty to keep open -- this affliction we cherish and brood over in solitude." - Washington Irving

See more famous quotes about Bereavement

Dansk (Danish)
adj. - bedrøvet, efterladt
n. - efterladt

Nederlands (Dutch)
rouwend(e), beroofd

Français (French)
adj. - endeuillé, en deuil, affligé
n. - la famille endeuillée

Deutsch (German)
adj. - hinterblieben
n. - Hinterbliebener

Ελληνική (Greek)
n. - τεθλιμμένος συγγενής, βαρυπενθών
adj. - βαρυπενθών

Italiano (Italian)
in lutto, privo

Português (Portuguese)
n. pl. - os enlutados (m pl)
adj. - desolado (pela perda de parente), abandonado (fig.)

Русский (Russian)
родственник покойного, овдовевший

Español (Spanish)
adj. - desconsolado, afligido
n. - desconsolado, afligido

Svenska (Swedish)
n. - efterlämnad, sörjande
adj. - lämnad ensam

中文（简体）(Chinese (Simplified))
丧失的, 刚丧失亲人的人或人们

中文（繁體）(Chinese (Traditional))
adj. - 喪失的
n. - 剛喪失親人的人或人們

한국어 (Korean)
adj. - 빼앗은, 잃은
n. - 사별

日本語 (Japanese)
adj. - 死なれた, 家族をなくした人

العربيه (Arabic)
‏(الاسم) المصاب, المفجوع (صفه) مفجوع, مصاب‏

עברית (Hebrew)
adj. - ‮שכול‬
n. - ‮משפחות השכול, שכול‬

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