Psychiatric Annals

CME Article 

Bereavement: Signs, Symptoms, and Course

Paula L. Hensley, MD; Paula J. Clayton, MD

Abstract

In his paper “Mourning and Melancholia,” Freud described five features of melancholia, “ … a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings, and culminates in a delusional expectation of punishment. He felt that mourning includes these same symptoms, except for the last. Freud believed that mourning is not a pathological condition and that it subsides with time; interfering with it was useless and potentially harmful. Indeed, the loss of a loved one is a universal experience that may be one of the most significant and traumatic life events that people face. Nevertheless, most people cope with loss with minimal morbidity. For a minority, the death of a loved one may lead to increased use of substances (alcohol, benzodiazepines, and other hypnotics), the development of a psychiatric illness like chronic depression, or even greater mortality.

ABOUT THE AUTHORS

Paula L. Hensley, MD, is with the Department of Psychiatry, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Paula J. Clayton, MD, is with the American Foundation for Suicide Prevention, New York, NY.

Address correspondence to: Paula L. Hensley, MD, 2118 Central Ave. SE Suite 37, Albuquerque, NM 87106; or e-mail: phensley@salud.unm.edu.

Dr. Hensley and Dr. Clayton have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Describe the symptoms of bereavement in adults and children.
  2. Recognize the signs that an individual is experiencing difficulty with the course of bereavement.
  3. Discuss the morbidity and mortality of bereavement in adults.

Abstract

In his paper “Mourning and Melancholia,” Freud described five features of melancholia, “ … a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings, and culminates in a delusional expectation of punishment. He felt that mourning includes these same symptoms, except for the last. Freud believed that mourning is not a pathological condition and that it subsides with time; interfering with it was useless and potentially harmful. Indeed, the loss of a loved one is a universal experience that may be one of the most significant and traumatic life events that people face. Nevertheless, most people cope with loss with minimal morbidity. For a minority, the death of a loved one may lead to increased use of substances (alcohol, benzodiazepines, and other hypnotics), the development of a psychiatric illness like chronic depression, or even greater mortality.

ABOUT THE AUTHORS

Paula L. Hensley, MD, is with the Department of Psychiatry, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Paula J. Clayton, MD, is with the American Foundation for Suicide Prevention, New York, NY.

Address correspondence to: Paula L. Hensley, MD, 2118 Central Ave. SE Suite 37, Albuquerque, NM 87106; or e-mail: phensley@salud.unm.edu.

Dr. Hensley and Dr. Clayton have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Describe the symptoms of bereavement in adults and children.
  2. Recognize the signs that an individual is experiencing difficulty with the course of bereavement.
  3. Discuss the morbidity and mortality of bereavement in adults.

In his paper “Mourning and Melancholia,” Freud described five features of melancholia, “ … a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings, and culminates in a delusional expectation of punishment. He felt that mourning includes these same symptoms, except for the last. Freud believed that mourning is not a pathological condition and that it subsides with time; interfering with it was useless and potentially harmful. Indeed, the loss of a loved one is a universal experience that may be one of the most significant and traumatic life events that people face. Nevertheless, most people cope with loss with minimal morbidity. For a minority, the death of a loved one may lead to increased use of substances (alcohol, benzodiazepines, and other hypnotics), the development of a psychiatric illness like chronic depression, or even greater mortality.

ABOUT THE AUTHORS

Paula L. Hensley, MD, is with the Department of Psychiatry, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Paula J. Clayton, MD, is with the American Foundation for Suicide Prevention, New York, NY.

Address correspondence to: Paula L. Hensley, MD, 2118 Central Ave. SE Suite 37, Albuquerque, NM 87106; or e-mail: phensley@salud.unm.edu.

Dr. Hensley and Dr. Clayton have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Describe the symptoms of bereavement in adults and children.
  2. Recognize the signs that an individual is experiencing difficulty with the course of bereavement.
  3. Discuss the morbidity and mortality of bereavement in adults.

10.3928/00485713-20081001-04

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