Symptoms Of Complicated Mourning

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Grieving is a normal healthy mental response to loss, a condition that normally does not require specialist intervention. Our mental apparatus always stands guard over life, and works in such a way that we can adapt to the complex and changeable conditions of reality. And mourning is the response that the psyche provides to the traumatic perception of the loss of an object that is valuable to us.

Freud drew the analogy of loss with a bodily wound - it hurts, bleeds, draws our attention to itself with unpleasant sensations, forcing us to renounce everything that is not connected with it. This is a necessary reaction of the organism, which "throws" all its strength to ensure that the wound heals up and there is an opportunity to return to normal life again. If, in these conditions, you do not pay attention to the fact that an important bodily organ is not in order, and try to live the same way as it was before the injury, this can lead to sad consequences. The body needs time and respect for the wound to heal.

It does not occur to us to demand from a person who has broken his leg to "pull himself together", "to distract himself from the problem", "to do something that will help to forget about the fracture", "to work more on himself" - we understand that he rest and time is necessary for his bones to grow together, and we also adequately perceive that the previous way of life is now inaccessible to a person with a fracture.

However, in the case of mental trauma (and trauma is any event, the perception of which is excessive for the human psyche due to various, deeply individual reasons - from its overload and fatigue due to the presence of a large number of traumatic experiences in a given period of time, and ending with fragility mental apparatus, unable to cope with frustrations), for some reason, paradoxically, we can afford to demand from a person an urgent cessation of grieving (or condemn him for the fact that he grieves for so long) and return to the previous level of mental functioning. Forgetting that, like the body, the psyche requires a careful attitude and individual time to adapt to new conditions, restructuring and adapting to new life circumstances.

Today I would like to talk about cases where the work of grief cannot be done for a number of reasons for a relatively long time after the loss. Speaking of duration, I would like to remind you that the work of grief is an intense and costly mental process that encompasses all spheres of a person's life, and the duration of its course is individual for everyone. It depends on many factors that affect the processing time of the loss - the personal structure of the bereaved, the level of his mental functioning at the time of loss, the age at which the loss occurred, the current conditions of his life, the personal significance of the lost object and the role he played in life. bereaved, etc.

Various psychological sources indicate different lengths of the normal mourning process. On average, if we are talking about acute grief, then under favorable conditions, its manifestations become less intense and intrusive six months after the loss, in this case we can say that the process of adaptation to the loss is proceeding in the usual way for most people. DSM-5 states that it is normal for the condition to last up to 12 months. Research by psychoanalytic authors deals with the normal work of grief, which lasts from one to three years. If at the end of this period the well-being of the grieving person does not improve, there is no acceptance of the loss, if his social and mental functioning is still impaired, in this case we can say that the work of grief could not be done, and we are talking about depression or complicated grief. …

In the most recent revision of ICD-11, the section on mental, behavioral and nervous system disorders, among others, included "lingering mourning disorder."Its main feature is a constant reaction of acute grief that spreads to all spheres of a person's life, including a long (in ICD-11 we are talking about a period of time after six months from the moment of loss), excessive in its intensity, clearly exceeding “expected social, cultural or religious norms for society and human context”, a debilitating state. It is characterized by the following symptoms:

* acute and enduring intense longing for the deceased

* excessive feelings of guilt and self-flagellation

* anger

* excessive depression

* inability to do daily activities and function as a member of society, * denial and inability to accept the fact of loss

* feeling of loss of a part of yourself

* loss of emotionality and the ability to experience positive emotions.

In ICD-11, this condition is described as such that it requires the help of specialists.

According to some psychoanalytic researchers, the symptoms described as manifestations of the pathology of the mourning process can accompany the normal process of grief. It should be understood that the main criterion is the intensity and severity of symptoms over a long period of time. An important feature that distinguishes normal from pathological mourning is the ability to experience and experience difficult feelings, the ability to express them in the presence of a supportive listener. This possibility is complicated if the environment cannot help the grieving person to deal with the loss, cannot provide support and endure his feelings.

V. Worden describes the following symptoms, the presence of which may indicate complicated mourning:

* ⇒ An excessively intense or inadequate feeling of guilt that arises immediately after leaving, or a feeling of euphoria, unwillingness to attend the funeral - in the event of the death of a loved one - to recognize the significance of the loss - all this may indicate that the work of grief has not begun.

* ⇒ Intensity of feelings in relation to the departed, when any mention of him can lead to strong feelings, arising after a long time from the moment of loss may indicate that the process of mourning is stuck at some of its stages.

* ⇒ It may also be that a neutral event triggers a mourning process - for example, if the work of grief could not begin immediately after the loss. Or, if a person in everyday conversations constantly returns to the themes of loss, this may indicate a hidden, disguised process of mourning.

* ⇒ Exaggerated unwillingness to part with the belongings of the deceased, or vice versa - the desire to get rid of them immediately after his departure, as well as the desire in a short period after it (for example, within a year) to completely change the situation - to move to another city, to another apartment, to leave work, to change the environment, the field of activity - all this indicates the lack of mental resources to begin work of grief, recognizing the fact of loss.

* ⇒ The grieving person becomes "similar" to the person who has left - he has features of reaction and character traits, or behavior or even features of appearance inherent in the person who left (for example, a mother who has lost a child, after his death begins to look much younger than her real age), - this is evidence of a pathological identification with a departed and not passed work of grief.

* ⇒ This also applies to the fact that the grieving person begins to suffer from the same diseases, or has the same symptoms as the one who left. Also, phobias that have appeared, for example, shame to die from the same disease as the departed one, are evidence of a violation of the normal process of mourning.

* ⇒ An excessive decrease in self-esteem, repeated self-accusations, inadequate feelings of guilt, self-destructive impulses, conversations about the desire to “leave for a loved one,” suicidal thoughts and intentions speak of depression, which does not stop long after the loss of time.

All these manifestations, normal for the first phases of grief, but lasting or suddenly appearing long after the loss, indicate that the work of grief could not be completed (and in some cases even began) and, most likely, a person in these states needs the help of a specialist - a psychologist, psychotherapist, and sometimes - in especially severe cases - and a psychiatrist.

Literature:

1. Trutenko N. A. Qualification work "Grief, melancholy and somatization" at the Institute of Psychology and Psychoanalysis at Chistye Prudy

2. Freud Z. "Sadness and melancholy"

3. Warden W. "Understanding the mourning process"

4. Ryabova T. V. The problem of identifying complicated mourning in clinical practice

5. Article "New mental disorders in ICD-11"