"From Mourning to Mending" ™ -

Early Grief Research:

In my opinion, Dr. Lindemann conducted one of the best, most indepth examples of research into how grief affects people.

Dr. Erich Lindemann*  spent  a  great  deal  of  time (1941-1944) seeking  to  help  people  who  were  suffering  from  grief  and  the effects of mourning.  His  work  was  both groundbreaking and very thorough.  He  worked with people who were injured both physically and mentally  due  to severe  trauma. He also studied the relatives of patients  who  died  at  the  hospital  where  he  practiced. 

Many people  believe  that  Lindemann’s  work,  on  what has come to be called  “Post-traumatic  Stress  Disorder”  (PTSD),  was  the  real beginning of our understanding of the long lasting effects of grief on humans.
Lindemann’s research revealed 4 main aspects of grief management:
1. Acute grief is an actual syndrome with both psychological and
         physical  symptoms.
2. Symptoms may appear immediately after the crisis; they may
         be delayed ; they may be exaggerated  or they may be 
        apparently absent.
3. In place of a normal grief syndrome– distorted responses
         may appear that represent special problems or aspects of
         the grief syndrome – known as Morbid Grief Reactions.
4. Getting appropriate help (from a health-care professional) can
         help these distorted reactions to be changed into normal
         grief reactions with resolution.
Normal Grief Reactions (symptoms):
1. Waves of physical distress lasting from 20 minutes to an 
          hour at a time.
2. Shortness of breath, tightness in the throat, or the feeling of
3. The need for sighing (deep breaths exhaled rapidly).
4. Empty feeling in stomach – sometimes nausea.
5. Lack of muscular power, or excessive tiredness.
6. Serious mental pain or tension.
Persons who have suffered a loss  (death of a  loved one or other traumatic event)  may  have  additional  symptoms  that  make life difficult.
A. Feelings of being in an “altered state”. Time seems to slow
        down, there may also be a slight sense of unreality and
        increased emotional distance from others.
B. An intense preoccupation with the deceased
       Often they may visualize the lost loved one in some way, or be
       expecting to see them come home. There can be denial of the
       fact that the event has actually happened (e.g. “Maybe it was
       a mistake.” “This didn’t really happen.” “When I wake up – this
        will all have been a bad dream.”)
C. There can be a strong preoccupation with feelings of
        guilt. The bereaved may believe or convince themselves that
         they somehow failed, thus causing the loss. They may
         accuse themselves of negligence or exaggerate minor
         omission. This may be especially true if there was conflict
         with the person before the loss.
D. The bereaved may distance themselves emotionally from
        others during the time of mourning. They may become
         irritable and angry easily, and not want to be bothered even
         by family and friends. Feelings of hostility may frighten the
         person who is mourning, sometimes they may question their
         own sanity.
E. There may be dramatic changes in activity levels .
        One may become very restless and unable to sit still –
         moving about in an aimless way.  Others may not do
         anything at all, preferring to sit and stare at nothing. They
         may be unable to maintain organized patterns of activity.
         Some may develop a dependency on persons who stimulate
         them to activity.

Pathological Aspects of Grief may include:

1) Ongoing physical distress.  
2) Preoccupation with the image of the deceased. 
3) Ongoing feelings of guilt. 
4) Hostile reactions to those seeking to help the bereaved. 
5) Loss of normal patterns of conduct. 
6) In the most serious cases – Traits of the deceased may appear
         in the conduct of the severely bereaved.

Dr. Lindemann coined the phrase “Grief Work” to describe the process by which people can progress through the normal Grief Process (GP) and begin to live with quality of life after a traumatic loss.

He stated that the “duration of grief seems to depend upon the success with which a person does the “grief work” of:
   1. Emancipation from the bondage** to the deceased.
   2. Readjustment to the environment without the deceased.
   3. The formation of new relationships [after the loss].
** Dr. Lindemann equates the strong connections one feels toward a lost  loved  one  (or other loss) as being “in bondage” to the past and all the negative  feelings  and  reactions  associated  with said loss. He believes that a person must accept the loss, face the pain and then move on  in order  to  be  free from morbid grief reactions that can occur when this process does not take place.
Potential Roadblocks to Grief Work:
A. Many try to avoid the intense feelings of loss and distress
           connected with the grief experience.
B. Some refuse to express the emotions necessary for grief work
           (i.e. sadness, crying, etc…)
C. Particularly male patients were noticed displaying stress and
           tightened facial muscles to avoid “breaking down” in front of 
D. Frequently, much persuasion is needed before patients will
           accept the grief process.
E. Some patients even become hostile towards the professional
            seeking to help them, refusing to discuss their feelings or
            talk about their loss.
Morbid Grief Reactions (MGR): Only a few of the more common reactions are listed here due to limited space.
1. Delay of Reaction: the most common MGR is the delay or
           postponement of grief.
       a) If the patient is confronted with important tasks or  
                responsibilities, they may show little or no reaction for
                weeks or much longer.
    Example: A woman who had just lost both parents was
                      completely preoccupied with the death of her brother
                      20 years before.
        b) This was repeatedly encountered while dealing with
                   patients about a current crisis. Many patients showed
                   all the traits of true grief about a former loss that had
                   not been dealt with.
2. Distorted Reactions: alterations in behavior that are
          considered to be manifestations of an unresolved grief
         a) Over Activity– staying busy without a sense of loss.
               Sometimes conducting activities of the deceased person.

          b) Acquisition of Symptoms: patient may display
                symptoms suffered by the deceased.
          c) Acquisition of a recognized disease: Ulcerative colitis,
                rheumatoid arthritis, and asthma.
                  (1) Extensive studies produced evidence that 33 out of
                       41 patients with ulcerative colitis developed the
                        disease after the loss of an important person.
                  (2) The course of ulcerative colitis was strikingly altered
                        in a positive way when this grief reaction was
                        resolved by psychiatric technique [Counseling].
                                (See "How Grief Affects the Human Body")

          d) Progressive Social Isolation
          e) Furious Hostility
          f) Activities detrimental to social and financial survival.
          g) Self-medication through the use of drugs or alcohol:
                  persons suffering from morbid grief reactions will often
                   hide from the pain and the reality of the loss by the use
                   or abuse of alcohol, prescription medications or illegal
                   street drugs – leading to chemical dependency.

Delay  and  denial  of  the  grief  process (GP) or refusal to do the “grief work”  only  prolongs  the  pain and causes deeper physical  and  psychological  complications. The grieving person will have to pick up the GP wherever they left off.

The only way out is through!

     ERICH LINDEMANN  - American Journal of Psychiatry   1944;101:141-148