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
choking.
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
others.
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
reaction.
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].
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!
* "SYMPTOMATOLOGY AND MANAGEMENT OF ACUTE GRIEF"
ERICH LINDEMANN - American Journal of Psychiatry 1944;101:141-148
