Losses are a natural part of life, death is the end. The individual enters into a biopsychosocial change after the loss, and this change is defined as mourning work by Freud (1917). Mourning can be described as a restructuring response to the experience of loss. With this reaction, the energy that the individual invests in his relationship with the lost is transferred to the life outside the loss. Therefore, the mourning reaction is a painful renunciation that must be experienced (Freud 1917), and Lindermann (1944) suggested that this natural reaction should not be interfered with. Grief is a strictly limited syndrome with psychological and physical symptoms. He defined five pathognomonic features of this process.
1 Physical distress 2- Preoccupation with things belonging to the deceased 3- Guilt 4- Hostile reactions 5- Changing ongoing behavioral patterns. While Engel (1961) was questioning whether grief is a disease or not, he actually claimed that the development of this process beyond what was expected could lead to a disorder. Engel divided the mourning process into three parts.
1 Shock and denial 2 Gradual acceptance of the loss experience in the process. 3 Reconstruction
Bowlby and Parkes (1970) described four periods of this process.
A general state of unresponsiveness (hours-days) interrupted by a sudden outburst of anger – Search-research about the deceased state (lasting for months) 3- Disorganization and despair experience 4- Restructuring and completion of grief Although researchers define similar process models, there are individual differences in the grief process. This difference is determined by biopsychosocial factors. Winter coping abilities, personality structure, life experiences, social Support systems, interpersonal relationships, the place and meaning of the deceased person in the individual's life determine the nature, course and functionality of this process. Cultural factors are as important as individual factors in the mourning process. In our society, the experience of loss is shared among relatives with some religious and cultural rituals after the death. Starting from the day of the loss, 7, Rituals that are shared and experienced on the 40th and 52nd days are facilitating factors for the process. Supporting the elderly for an average of 6 months-1 year is a matter of sharing their problems. But there is one side. Experiences such as anniversaries also challenge the individual once again. Similar restorative and supportive attitudes and beliefs are experienced in other cultures. In general, during the mourning process, the individual can return to work life within a few weeks, begin to balance his/her social roles within a few months, and continue to work for approximately 6 months to 1 year. Approach to the Concept of Pathological Mourning: The mourning process is completed when the individual adequately transfers his energy to the life other than the loss. This indicates the functionality of the mourning process. However, if the process loses its functionality or develops beyond expectations, pathological mourning is mentioned. Pathological mourning is complicated. This situation, for which many expressions have been used to date with the terms grief, abnormal grief, atypical grief, unresolved grief, has been classified as follows by Lindemann (1944). It does not include abnormal behavior
2 Distorted grief reaction
1.a) Showing more activity than expected b) Imitating the complaints of the deceased c) Emergence of psychosomatic conditions (such as Ulcerative Colitis, Rheumatoid arthritis) d) Deterioration in interpersonal relationships e) Displaying hostile attitudes towards certain people beyond what is expected f) Acting like a robot in order to cope with unacceptable anger and hostile emotions g) Observing inadequacy in social relations h) Exhibiting self-destructive behavior in economic and social areas i) Emergence of agitated depression with a high risk of suicide . Later, three different types of grief were identified regarding pathological grief.
1 Chronic grief reaction, 2 Hypertrophic grief reaction, 3 Prolonged grief reaction. Data showing that pathological grief, defined and classified as similar by independent researchers, constitutes a separate clinical picture.
While Prigerson (1996) argues that pathological grief, as a clinical condition with symptoms distinguishable from depression and anxiety symptoms, is a risk factor for the physical and mental health of the individual, McDermott et al. (1997) pointed out that the EEG findings of pathological mourning cases differ from depression, and Jacobs et al. (1987) reported that pathological grief Schuchter et al. (1986) reported that the response to antidepressants was inadequate compared to depression cases. Schuchter et al. (1986) found that the suppression in the dexamethasone suppression test in pathological grief cases was higher than in phobic and anxiety cases, but lower than in depression cases.
Approach to the Concept of Traumatic Grief
While the data showing that pathological grief is a separate clinical picture are increasing, studies on structuring the diagnostic criteria have also come to the fore.
In January 1997, in a panel organized by Prigerson et al., in the light of the studies on pathological grief, traumatic grief was discussed. It has been suggested that the term mourning be used.
Horovvitz (1997) suggested that pathological grief is a type of stress response syndrome. Denial, anger, shock, avoidance, unresponsiveness, feeling that there is no future, feeling that one's security is destroyed in pathological grief. They drew attention to the similarity of symptoms with post-traumatic stress disorder symptoms. Therefore, Horovvitz and Prigerson (1997) suggested the use of the term traumatic grief for pathological grief. The word trauma here also points to the traumatizing potential of the separation experience. Thus, the term traumatic grief refers to both the traumatic experience symptoms in pathological grief. On the other hand, Raphael and Martinek (1997) suggested that the term traumatic grief be used for pathological grief that occurs when death occurs due to traumatic experiences defined in the diagnostic criteria of post-traumatic stress disorder, such as earthquake and physical attack.
The diagnostic criteria, which were created unanimously in 1997 and reshaped by determining their specificity and sensitivity in 350 cases, are as follows/ (Prigerson)
A.Criteria
1 The individual has lost a loved one who is important to him/her
br /> 2 At least three of the following symptoms occur from time to time
a Unwanted repetitive thoughts about the deceased b Wishing for the deceased c Searching for the deceased d Loneliness that occurs with death
1. Criteria
Most of the following symptoms at least four occur most of the time
1 A feeling of not getting results from anything in the future or a general feeling of r state of purposelessness 2 Subjective feeling of numbness, unresponsiveness or lack of emotional response 3 Difficulty in grasping the reality of death (disbelief) 4 Feeling that life is meaningless and empty 5 Feeling of having a part of oneself 6 Disintegration of the existing world that one believes in (loss of security, feeling of loss of control) 7 Persistence of symptoms related to the deceased or exhibiting harmful behavior related to the deceased 8 Increased arousal, being hurtful towards others, or feeling excessive anger about the death
1.Criteria
The symptoms must have existed for at least two months (According to Horovvitz (1997), a period of 14 months is required).
1st Criterion
The existing situation leads to a significant loss of function in the individual's social and professional life and other important areas.
Stating that they do not have sufficient data for criteria C and D, the researchers stated that the reliability and validity of the duration and loss of function criteria, determination of possible subtypes of traumatic grief, for example, new approaches regarding delayed grief experience, age-gender-cultural characteristics of the cases; They reported that there is a need for studies to determine the effect of variables such as the degree of closeness with the deceased, the manner of death on the clinical picture, the usability of the information here in new approaches to the picture that occurs in other loss experiences, and the international standardization of diagnostic criteria. Researchers who claim that traumatic grief and post-traumatic stress disorder are separate clinical conditions state that there is a high probability that both conditions may coexist, that clinical differential diagnosis can change the approach to the patient, and that both of them, as a type of response to traumatic stress, can open a new door in the approach to traumatic spectrum disorders. They suggested that.
In studies conducted with these newly structured diagnostic criteria, it was determined that there was a significant decrease in the quality of life and an increased risk of suicide in cases diagnosed as traumatic grief with the new pathological approach. As a matter of fact, Prigerson et al. (1997) reported that adolescents who committed suicide In a study conducted by friends (n=76) using traumatic grief criteria, the risk of suicide in the group with this diagnosis (n=15) was five times higher than in the group without the risk of suicide. It has been reported that it is � times higher. Again, in another study conducted by Sılverman et al. (2000) with these diagnostic criteria on people who lost their spouses (n=67), the physical-social-mental functions of the diagnosed cases (63%) were reported to be worse than both the undiagnosed group and major depression. It was reported to be worse than the group.
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