Grief

Grief is an involuntary emotional and behavioural response to bereavement, the loss through death of a loved person or object (as the loss may not be restricted to persons but may include pets). Mourning in contrast is a voluntary expression of behaviour and rituals that are socially sanctioned responses to bereavement.

Grief is therefore a reaction to bereavement. Grief could be normal or pathological that is abnormal.

Grief reactions may be immediate, early, or late. The Latter may be seen in abnormal grief reactions.

A risk assessment is essential during assessment of grief especially in pathological presentations. The risk is often due to other factors such as associated depression or substance misuse or indeed prolonged self neglect in the presence of underlying medical conditions requiring regular treatments such as diabetes, hypertension or heart disease. The risk of suicide is uncommon but may be increased in the presence of severe depression or personality disorders.

Normal grief.

First stage may last hours to days. It includes:

• Denial- manifests as Numbness, lack of emotional response, +/- derealisation, restlessness as if searching for the dead
• Disbelief
• Shock

Second stage- few weeks to months:

• Anger, guilt, blaming
• Sadness- weeping, yearning/Pining For the dead
• Vivid reaA experiencing of the did, delusions pseudo hallucinations, intrusive images
• Complaints of taking on illness of the dead

The third stage - gradual acceptance. At anniversaries the symptoms may return.

Abnormal or Pathological grief

Should be considered if the symptoms of normal grief become:

• Rather intense and meets depressive disorder criteria
• Prolonged that is greater than six Months
• Delayed, that is the first stage not occurring until after two weeks
• Inhibited or distorted.

A third of persons who are bereaved may become depressed at some point. Most improve within six months. In a fifth depression may persist. The presence of psychomotor retardation, hopelessness or low self esteem may worsen the prognosis. In abnormally intense grief suicidal thoughts may continue from between 1 to 5 years. Young widows and elderly widowers more so than others.

Grief is considered prolonged if 1st or 2nd stage symptoms persist beyond expected period and certainly if greater than 6 months with or without depressive symptoms.

Delayed grief is more common following sudden traumatic or unexpected deaths.

Inhibited grief lacks some of the features of normal grief.

In distorted grief there may be excessive identification or idealisation of the dead. Mummification in which the bereaved continues to preserve personal effects and items of the dead in peculiar ways as if attempting to prevent the dead from departing could be seen as an extreme form of denial -pictures, clothings and favourite objects may be the focus.