Types of Mourning
Losses are a natural part of life. After the loss, the individual goes through a biopsychosocial change, and this change is defined as mourning by Freud (1917). Mourning can be described as a restructuring response to the experience of loss. With this reaction, the energy the individual invests in his relationship with the lost is transferred to life outside the loss. Therefore, the grief reaction is a painful giving up that must be experienced. Freud (1917) suggested that this natural reaction should not be interfered with. Lindermann (1944), on the other hand, approached grief as a definite, limited syndrome with psychological and physical symptoms and defined five pathognomonic features of this process.
1- Physical distress
2- Preoccupation with things belonging to the deceased.
3 - Guilt He suggested that its development outside may cause 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- Restructuring
Bowlby and Parkes (1970) described four periods of this process:
1- A general state of unresponsiveness (hours-days) interrupted by a sudden outburst of anger.
2- A state of search-research about the deceased (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. The person's coping abilities, personality structure, life experiences, social support systems, interpersonal relationships, the place and meaning of the deceased in the individual's life; It determines the nature, course and functionality of this process.
Cultural factors are as important as individual factors in the mourning process. In our society, after death, the experience of loss is shared among relatives through some religious and cultural rituals. Rituals shared and experienced on the 7th, 40th and 52nd days, starting from the day of the loss, facilitate the process. � factors. On average, it takes between 6 months and 1 year to support the grieving person and share their problems. But on the other hand, days such as anniversaries 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, establish balance with his social roles within a few months, and begin to give a new direction to his life with new and healthy relationships within approximately 6 months to 1 year.
Pathological Mourning. Approach to the Concept
The mourning process is completed when the individual adequately transfers his energy to life other than the loss. This points to the functionality of the mourning process. However, if the process loses its functionality or develops beyond expectations, pathological grief is mentioned. This situation, for which many expressions have been used to date such as pathological grief, complicated grief, abnormal grief, atypical grief, unresolved grief, has been classified by Lindemann (1944) as follows:
1) Delayed grief reaction: The individual's reaction is delayed, the expected It emerges after time. It does not include abnormal behavior.
2) Distorted grief reaction: The person shows more activity than expected, imitates the complaints of the deceased, the emergence of psychosomatic conditions (such as ulcerative colitis, rheumatoid arthritis), deterioration in interpersonal relationships, It includes situations such as exhibiting a hostile attitude beyond expectations, acting like a robot in order to cope with unacceptable anger and hostile emotions, inadequacy in social relationships, exhibiting self-destructive behavior in economic and social areas, and the emergence of agitated depression with a high risk of suicide.
Later, three different types were identified regarding pathological grief:
1- Chronic grief reaction
2- Hypertrophic grief reaction
3- Prolonged grief reaction
Approach to the Concept of Traumatic Grief
Horovvitz (1997) suggested that pathological grief is a type of stress response syndrome. It is important to point out that the symptoms of denial, anger, shock, avoidance, unresponsiveness, feeling that there is no future, and feeling that one's security is shattered that occur in pathological grief are similar to the symptoms of post-traumatic stress disorder. is work. Therefore, Horovitz and Prigerson (1997) suggested using the term traumatic grief for pathological grief. The word trauma here also points to the traumatizing potential of the separation experience. Thus, they suggested that the term traumatic grief could describe both the symptoms of the traumatic experience and the symptoms caused by the separation experience in pathological grief. On the other hand, Raphael and Martinek (1997) stated that the term traumatic grief; They suggested that it be used for pathological grief that occurs when death occurs due to traumatic experiences defined in the post-traumatic stress disorder diagnostic criteria, such as earthquakes or physical attacks.
The diagnostic criteria, which were created unanimously in 1997 and reshaped by determining their specificity and sensitivity in 350 cases are as follows (Prigerson):
– The individual has lost a significant relative
– At least three of the following symptoms occur from time to time
Unwanted repetitive thoughts about the deceased
Want
Searching for the deceased Loneliness with death
– At least four of the following symptoms often occur
Feeling of not getting any results in the future or a general state of purposelessness
Subjective lethargy , feeling of unresponsiveness or lack of emotional response
Difficulty in grasping the reality of death (disbelief)
Feeling that life is meaningless and empty
Feeling of having a piece of one's own
Disintegration of the existing world (security) loss, loss of control)
Continuing the symptoms of the deceased or exhibiting harmful behavior related to the deceased It must have been present for at least two months (according to Horowvitz (1997), a period of 14 months is required).
-The existing condition causes a significant loss of function in the individual's social and professional life and other important areas.
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, and that clinical differential diagnosis depends on the approach to the patient. They also suggested that both of them can change and open a new door in the approach to traumatic spectrum disorders, as both types of response to traumatic stress. As a result, this new approach may make it easier to detect and differentiate pathological grief cases early, thus providing earlier and more specific treatment, and to investigate the frequency, risk factors, prognosis, neurobiology and ways of preventing this condition.
Loss, Mourning, Pathological Mourning
Mourning is the most natural response to a loss that cannot be reversed throughout life and affects deeply. It is a normal and necessary period in case of the loss of a loved one. Death, as a loss experience in the life cycle, leads to change and restructuring in the individual. With this reaction, the energy that the individual has invested in what was lost is transferred to life again. The natural grief reaction is a necessary and necessary process that must be experienced. In this process: Shock, Anger and Denial, Bargaining with God, Depression, Restructuring with Acceptance and completion of mourning are experienced. The meaning of the lost person in the individual's life, the manner of the loss, whether it was expected or not, the person's individual characteristics, coping skills, experiences, relationships with relatives, affect the mourning process. Cultural factors are also important. For example, in our culture, as in many cultures, there are ritualistic behaviors that help facilitate the process. People gather after the dead, laments are lamented, prayers are said, and feelings are shared again and again with everyone who comes. Food is brought to the mourning house and the family members who have suffered a loss are not left alone. The grieving person is supported by his/her relatives for an average of 6 months to 1 year. These are restorative factors that facilitate the process. However, it is not right to try to ignore a person's pain or not to make them experience the grief that needs to be experienced. A person should mourn, feel grief and cry, not keep it inside. Statements such as "Don't cry, you will get sick if you cry, you will upset others, don't show it, you can't die with the dead, will he come back when you cry?" are faulty approaches that prevent the mourning process of the person who has suffered a loss. Attitudes such as removing pictures of the lost person and not talking about the loss also prevent a healthy mourning process. Often the elderly person returns to work within a few weeks. He has to return to him. With the natural grieving process, it is expected that the person will begin to redirect his life with healthy relationships within approximately 6 months to 1 year. The mourning process is completed when the individual transfers enough energy to life. It is natural for longing and beautiful moments to come to life in the mind. If the lost person continues to be remembered with feelings such as constant pain, extreme sadness, and depression 3-6 months after the loss, and if there is no change or acceptance in the feelings, it turns out that it left a traumatic effect. These prolonged processes should make us think that grief is becoming pathological and intervention should be done. In Pathological Mourning; Delay in grief reaction, imitating the complaints of the deceased, psychosomatic symptoms, hostile attitude or acting as if frozen with anger and hostile emotions, disruptions in social relations, self-destructive behaviors, risk of suicide, and severe depression may occur. The symptoms of shock, denial, anger, avoidance, unresponsiveness, the feeling of having no future, and the feeling that one's security has been destroyed, which occur in pathological grief, have been observed to be similar to the symptoms of Post-Traumatic Stress Disorder, and the term traumatic grief has been suggested to be used for pathological grief. If the person has not been able to enjoy life for a long time, acts as if the deceased person was not dead, loses his/her quality of life and standards, and does not accept that the person is dead, he/she should definitely get help from a specialist. Since pathological grief causes vital problems and a significant decline in quality of life, it must be correctly recognized and treated. Psychotherapies should support the completion of the grief reaction, and support should also be provided with medication, if necessary. Grief and depression are similar in many ways. However, grief is a normal process and not a disease. Although the person in the mourning process may show symptoms of depression, with support, the symptoms of depression decrease. Symptoms gradually decrease and disappear. In depression, there is no change in emotions over time. In mourning, there is the loss of a loved one and there is an expected feeling of badness as a result of this event. In depression, the depressive feelings about the lost person do not go away, and the bad feeling is reflected in many aspects of life. Children's grief response is different from that of adults. Often, it alternates between being unresponsive and overly reactive, as if nothing had happened.
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