Grief as pathology: The evolution of grief theory in psychology from Freud to the present

"The living need care": Experiences of bereaved workers in precarious employment

Bereavement scholarship predominantly examines psychological aspects of grief, which neglects the role of social, economic, and political factors that shape the space to accommodate these experiences. Responding to calls for enhancing bereavement care, this research explores bereavement accommodation for workers in precarious employment in Ontario, Canada. Drawing on critical qualitative research and feminist ethics, this study employed in-depth interviews to generate knowledge on the everyday experiences of bereaved workers in precarious employment. Participants expressed they were uninformed and unprepared for grief and practical bereavement labor, and that navigating the current context created tension, stress, exhaustion, isolation, and stigma. We argue the systemic neglect of bereavement is driven by socio-political forces that devalue relationality, stigmatize emotions, and render bereavement an individual responsibility. This research informs broad recommendations, including enhancing grief literacy, establishing safeguards for precarious workers, and creating more responsive care pathways and strategies for addressing individual and collective grief.

Examining the Basic Assumption of Psychoanalytic Theory Regarding Normal and Abnormal Grief: Roles of Unfinished Businesses and Bereavement Related Guilt

To date, several theoretical models have been proposed to explain how the expected and natural grief processes turns into psychiatric disorders. Nevertheless, there is a paucity of empirical research examining the basic assumption of psychoanalytic theory regarding pre-death conflict and bereavement related guilt. Accordingly, the current study aimed to investigate the mediator role of bereavement related guilt in the relationship between the pre-death conflict and maladaptive grief process. The sample consisted of 447 bereaved adults who lost a loved one due to death in the last 5 years. The Unfinished Business in Bereavement (UBBS), Bereavement Guilt Scale (BGS), Beck Depression Inventory (BDI), and Prolonged Grief Disorder Scale (PG-13) scales were administered. The results indicated that the UBBS scores were positively correlated with both BDI and PG-13 scores, and BGS scores mediated these relationships. Obtained findings were discussed in relation to psychoanalytic theory and existing studies in the grief literature.

The pain and relief of grief: Mental pain and mental pain acceptance associations with post-loss pathologies and growth among young widows and widowers

Mental pain is a core symptom of bereavement, yet its study with grief pathologies is still scarce. Mental pain acceptance may also affect the associations between mental pain, grief pathologies, and post-loss growth (PLG). The current study aims to investigate the associations between mental pain, mental pain acceptance, and post-loss outcomes in a sample of young widow(er)s. 257 young Israeli widow(er)s completed questionnaires assessing mental pain, mental pain acceptance, depression, complicated grief (CG), suicidal risk and PLG. Paths analyses revealed that depression mediated the positive associations between mental pain and suicidal risk and CG, and mental pain acceptance moderated the positive association between mental pain and depression. Mental pain acceptance also moderated the negative association between mental pain and PLG. The study's findings highlight the crucial role of mental pain and mental pain acceptance in the associations between adverse and favorable post-loss outcomes among bereaved individuals.

Proposing a new history of grief's medicalisation: A critical discourse analysis

Conceptualisations of grief have transformed significantly in recent decades, from an experience accepted and expressed in community spaces to a diagnosable clinical phenomenon. Narratives of this transformation tend to focus on grief's relationship to major depression, or on recent nosological changes. This paper examines the possibility of a new narrative for medicalisation by grounding in the networks of language and power created around 'grief' through a critical discourse analysis of psy-discipline articles (n = 70) published between 1975 and 1995. Focusing on shifts in definitions of, methods used to approach, and rationales motivating study of the experience, it posits that the psy-disciplines exerted exclusive expertise over grief decades before its creation as a diagnosis. By reconceptualising grief in the terms of psy-specific symptoms and functional performance and by approaching it with the decontextualising and interventionist methods of an increasingly scientific psy-discipline, the psy-community medicalised grief between 1975 and 1995. Identifying neoliberal and other cultural influences shaping this process of medical construction and reconsidering narratives of grief's history mindful of the powers exerted in medicalisation, this paper establishes that these moments played a critical role in the development of the present's grief.

The influence of actors on the content and execution of a bereavement programme: a Bourdieu-inspired ethnographical field study in Sweden

Introduction

The death of a parent can have profound negative impacts on children, and a lack of adequate support can exacerbate negative life experiences.

Aim

To explore the influences of various actors on the content and execution of a bereavement programme within a Swedish context, considering relational and contextual perspectives.

Methods

An ethnographic field study involving six children, their parents, and eight volunteers. A theory-inspired thematic analysis was conducted, methodically inspired by Braun and Clarke, theoretically inspired by Bourdieu's concepts of position, power, and capital.

Results

Confidentiality obligation was an essential element in the programme, however, the premisses varied depending on actors' positions. Volunteers and researchers had different outlets to express their experiences in the program. The programme offered the children an exclusive space for talking about and sharing experiences and feelings. Simultaneously, the programme restricted the children by not allowing them to share their experiences and feelings outside the physical space. The physical settings shaped the different conditions for interactions among the actors. The sessions adopted loss-oriented approaches, where communication between volunteers and children was guided by the volunteers. However, children created strategies for additional, voiceless communication with their peers or themselves. During breaks and mingles, shared interests or spaces connected children (and adults) more than their common experience of parental bereavement.

Conclusion

The participants in the programme were significantly influenced by the structural framework of the programme, and their positions within the programme provided them with different conditions of possibility for (inter)acting. Children's daily activities and interests were both ways to cope with parental bereavement and connect them to other people.

The Dynamics of Disease: Toward a Processual Theory of Health

The following article presents preliminary reflections on a processual theory of health and disease. It does this by steering the discussion more toward an ontology of organisms rather than conceptual analysis of the semantic content of the terms "health" and "disease." In the first section, four meta-theoretical assumptions of the traditional debate are identified and alternative approaches to the problems are presented. Afterwards, the view that health and disease are constituted by a dynamic relation between demands imposed on an organism and individual presuppositions for adequate response is developed. In the last section, the paper takes stock of three possible objections to and clarifies some implications of this approach to the notions of health and disease.

The integrated process model of loss and grief - An interprofessional understanding

Despite the vast developments in research on loss and grief, dominant grief models fall short in reflecting the comprehensive issues grieving persons are facing. Three causes seem to be at play: grief is usually understood to be connected to death and other types of loss are under-researched; the majority of research is done from the field of psychology and on pathological forms of grief, hardly integrating research from other disciplines; and the existential suffering related to grief is not recognized or insufficiently integrated in the dominant models. In this paper, we propose an integrated process model (IPM) of loss and grief, distinguishing five dimensions of grief: physical, emotional, cognitive, social, and spiritual. The integrated process model integrates therapies, tools, and models within different scientific theories and paradigms to connect disciplines and professions. The comprehensive and existential understanding of loss and grief has relevance for research, clinical settings and community support.

Continuing Bonds in the Existential, Phenomenological, and Cultural Study of Grief: Prolegomena

The essay makes the case that continuing bonds is a useful perspective for bereavement studies based in existential, phenomenological, and cultural philosophy. First, the idea of continuing bonds has explanatory power for many phenomena in individual and family grief and in the multiple interactions between individual/family grief and larger social/cultural dynamics. Second, in the study of continuing bonds we find concepts that are akin to those in phenomenology and existentialism. Using some of my own scholarship and the scholarship of many others, the essay is structured by themes Edith Marie Steffen and I found in our 2018 anthology on developments in the continuing bonds model in the two decades after it was introduced: Continuing bonds (1) are inter-subjective, (2) are central in constructing meaning, (3) raise questions about the ontological status of our interactions with the dead, and (4) are best understood within their cultural setting.

Hospital-Based Interventions to Address Provider Grief: A Narrative Review

CONTEXT

Provider grief, i.e., grief related to the death of patients, often forms an ongoing and profound stressor impacting healthcare providers' ability to maintain their sense of well-being, avoid feeling overwhelmed, and sustain quality and compassionate patient care over time.

OBJECTIVES

This narrative review presents findings on the types of interventions hospitals have offered to physicians and nurses to address provider grief.

METHODS

Searches of PubMed and PsycINFO were conducted for articles (e.g., research studies, program descriptions and evaluations) focused on hospital-based interventions to help physicians and nurses cope with their own grief.

RESULTS

Twenty-nine articles met inclusion criteria. The most common adult clinical areas were oncology (n = 6), intensive care (n = 6), and internal medicine (n = 3), while eight articles focused on pediatric settings. Nine articles featured education interventions, including instructional education programs and critical incident debriefing sessions. Twenty articles discussed psychosocial support interventions, including emotional processing debriefing sessions, creative arts interventions, support groups, and retreats. A majority of participants reported that interventions were helpful in facilitating reflection, grieving, closure, stress relief, team cohesion, and improved end-of-life care, yet mixed results were found related to interventions' effects on reducing provider grief to a statistically significant degree.

CONCLUSION

Providers largely reported benefits from grief-focused interventions, yet research was sparse and evaluation methodologies were heterogenous, making it difficult to generalize findings. Given the known impact provider grief can have on the individual and organizational levels, it is important to expand providers' access to grief-focused services and to increase evidence-based research in this field.

Grieving in community: Accompanying bereaved parents

This study explored relational grieving in community by examining how community members grieve with bereaved parents after the death of a child. Three bereaved parent couples and their community members were interviewed together using the qualitative action-project method to examine their shared grieving actions. Data was analyzed through top-down and bottom-up processes to understand the shared intentions of their grieving actions together. The findings of this research elicited thick descriptions of relational grieving at a community level. Four main assertions of how communities grieve with bereaved parents emerged, and include: (a) selflessly offering emotional and practical support, (b) engaging in and honouring vulnerability, (c) holding the complexity of grieving, and (d) fostering remembrance of the deceased child together. The novel descriptions of relational grieving in community contributed to the growing area of relational bereavement research. The theoretical, empirical, and clinical implications of this study are discussed.

Prevalence of Prolonged Grief Disorder and Related Clinical Factors Among Turkish Psychiatric Outpatients During the COVID-19 Pandemic

Prolonged grief disorder (PGD), a new diagnosis in some classification systems, has gained prominence due to the high mortality rates observed during the Covid-19 pandemic. Herein, the prevalence of PGD (diagnosed with structured clinical interviews), death-related features, and associated clinical factors were investigated among outpatient psychiatric patients who lost a first-degree relative within the past 12-24 months. PGD was diagnosed in 30/68 patients (44.1%). PGD development did not differ based on cause of death (Covid-19-related vs. other causes) but was associated with higher age of the bereaved, younger age of the deceased, and degree of kinship. Higher rates of depression, insomnia, and anxious attachment were also observed in PGD patients. Finally, the unexpectedness of death predicted the development of PGD. Due to the high prevalence of PGD among psychiatric patients, clinicians should be aware of the disorder, monitor grief processes in high-risk patients, and consider PGD in treatment planning.

Living with Parkinson’s disease: A qualitative study of spousal perspectives

Research has demonstrated that Parkinson’s disease can have adverse psychological effects on caregivers. Very few studies have focused on the experiences of spouses who are not primary caregivers or who do not identify as primary caregivers. The aim of this study was to explore the experiences of spouses who are not primary caregivers or do not identify as primary caregivers. Twelve Israeli women, spouses of men with Parkinson’s disease, were interviewed using a semi-structured in-depth approach. Thematic analysis revealed five themes: before diagnosis, at diagnosis, after diagnosis, interpersonal ways of coping, and intrapersonal ways of coping. A dynamic of oscillation between confronting and avoiding losses was indicated. Non-death losses were mostly unacknowledged among spouses’ social circles. Results were interpreted in the context of grieving processes after diagnosis. Findings suggest a need for psychological interventions aimed at creating safe spaces for spouses to engage in a grieving process after diagnosis.

Does Post-Traumatic Growth Follow Parental Death in Adulthood? An Empirical Investigation

This study looked at the loss of a parent in adulthood and whether this was followed by post-traumatic growth? Participants, 100 bereaved adults, from Pakistan and England, lost parents in the last 10 years. They completed three questionnaires. The study hypotheses were, first, that participants whose bereavement occurred more than five years ago would show significantly higher levels of post-traumatic growth. Second, participants with higher levels of post-traumatic growth would experience significantly higher grief scores. Thirdly, participants with higher levels of post-traumatic growth would show significantly higher levels of coping skills. Two hypotheses were rejected, only one received partial support. Yet, levels of post-traumatic growth were high in this sample. Post-traumatic growth does not follow every bereavement. The authors provide autoethnographic material to challenge this. Circumstances surrounding bereavement during the Covid-19 pandemic, are more likely to lead to increases in complicated grief reactions, rather than post-traumatic growth.

A social ontology of grief

This article outlines a social ontology of grief. With the point of departure in a relational understanding of subjectivity and an intergenerational notion of death awareness, the author develops a nonessentialist and nonpathological understanding of the experience of losing part of oneself following the death of another. Losing part of oneself refers, on the one hand, to a shattered subject trying to understand and come to terms with the death of another and a shared lifeworld that is irremediably altered. On the other hand, the partiality of this loss implies that the surviving person is forced to struggle with the quandaries of living on. Thus, a social ontology of grief captures the irreducible and painful aspects related to the loss of significant others, as well as the ethical predicaments related to continued existence, which are not exempt from possibilities and hope.

Exploring Young Millennials’ Motivations for Grieving Death Through Social Media

Past research has explored social media grief; however, the motivations for using a range of social media sites, specifically by young millennials, to grieve death fail to be explored expansively in existing thanatology research. Fourteen young millennials participated in individual semi-structured interviews, specifically questioning their motivations for using social media sites to grieve. The interviews were analysed using the thematic analysis framework identified by Braun and Clarke (2013). Four themes were generated: online influence, to announce the death, personal benefit and the hypocrisy of online mourning. The online influence theme suggests that individuals are motivated to grieve due to online influence and pressure. The personal benefit theme suggested social media present many benefits for the bereaved, including continuing bonds, which motivated them to use these platforms. The analysis also indicated that within the motivations there was hypocrisy regarding how young millennials perceive their grief posting activity when compared to others.

The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults

OBJECTIVE

Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals.

METHOD

Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk.

RESULTS

Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain.

CONCLUSIONS

Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.

Theoretical and philosophical assumptions behind the concept of anticipatory grief

Anticipatory grief is a concept commonly used by researchers and clinicians when talking about the experience before the death of a loved one. This article offers a critical perspective on the disciplinary, theoretical and philosophical foundations of three distinct and frequently used conceptualisations of anticipatory grief: Lindemann's, Rando's and one derived from sociology. Lindemann's perspective conceived anticipatory grief as an inevitable component of the grieving experience in the situation of impending death. Rando's perspective views anticipatory grief as a multidimensional experience that facilitates post-mortem mourning. The third perspective, offered by sociologists, defines anticipatory grief as an experience highly influenced by the social context of the individual. This review explains how these different perspectives influence research and concludes with a reflection for potential future research.

Grief literacy: A call to action for compassionate communities

The compassionate communities movement challenges the notion that death and dying should be housed within clinical and institutional contexts, and works to normalize conversations about death and dying by promoting death literacy and dialogue in public spaces. Community-based practices and conversations about grief remain marginal in this agenda. We aimed to theorize how grief could be better conceptualized and operationalized within the compassionate communities movement. We develop the concept of Grief Literacy and present vignettes to illustrate a grief literate society. Grief literacy augments the concept of death literacy, thereby further enhancing the potential of the compassionate communities approach.

Life Came to a Full Stop: The Experiences of Widowed Fathers

This study investigated how the death of the mother affected four Danish families. In-depth interviews were undertaken with both children (N = 7, 7-19 years) and fathers (N = 4, average age: 46 years) within the same families. The results presented in this article focus on the experiences of the fathers. Thematic analyses as set out by Braun and Clarke resulted in three overall themes: Coping with Loss, Transitions, and Mismatch between Experienced Needs and Provided Help. The results bear witness to a group of bereaved individuals experiencing heavy demands on their time and mental resources while trying to cope with their own grief and that of their children simultaneously. This is especially the case for the three men with younger children. Implications for practice are highlighted, such as a need for focusing on the individual and not offering a one-size-fits-all approach to bereavement support.

Developing a practice-based research agenda for grief and bereavement care

We aimed to identify practitioners' perspectives on current research priorities in grief and bereavement care. Grief and bereavement care providers were invited to participate in a three-phase Delphi study to create expert consensus on the top priorities for grief and bereavement research. A total of 140 participants completed Phase 1, 84 completed Phase 2, and 70 completed Phase 3. These top 10 research priorities form the basis of a practice-based research agenda for grief and bereavement care to enable researchers to respond to key issues in grief and bereavement care that will ultimately improve the lives of bereaved people.

Grief after suicide: A study of taboo and metaphor

This article analyzes the negotiation of taboo surrounding grief after the suicide of a loved one. It draws on ethnographic fieldwork with a support group and individual interviews with its members. While the topic of taboo was prominent at group meetings, the same group members tended to claim in the interviews that they had not experienced it. To explore the issue of taboo, beyond affirmation or denial of its existence, we analyzed how the bereaved navigated the topic of suicide in language using Werner’s psychological theory of metaphor, which argues that metaphors arise to circumvent explicit reference to tabooed subjects. Members of the grief group clearly developed different strategies of metaphorical and other linguistic rephrasing to deal with the topics of death and suicide. Additionally, their language use differed depending on the person’s attitude toward the suicide, whether he or she was alone or with other group members, as well as whether the general public was being framed as an out-group.

Public Representations of Loss in Death Announcements, 1912 to 2002

This work presents a historical analysis of death announcements ( N = 1,443) posted in the New York Times between 1912 and 2002. Announcements were coded according to two main categories: the genre of the announcement and the presence of emotion words. Four distinct main genres emerged: death notices, memorials, recognition postings by organizations, and recognition postings by nonorganizational parties (friends and family). The proportion of death notices declined steadily from 1912 to 2002, while the proportion of announcements paying tribute to the deceased increased. The announcements were also analyzed in terms of emotion words used, and it is argued that the increasing frequency of emotion words used in the death announcements reflects a progressive emotionalization and psychologization of grief and loss.

(Un) Natural Grief: Novelty, Tradition and Naturalization in Israeli Discourse on Posthumous Reproduction

This article examines Israeli discourse on posthumous reproduction (PR) and the related cultural construction of "(un)natural" grief. Based mainly on an analysis of in-depth interviews with family members who submitted a request for PR, we examine the regimes of justification used by supporters and opponents of this technology. With both sides using the notion of "nature" to support their claim, the dispute centers on whether PR constructs a new social expression of grief (and hence should be seen as unnatural) or is only a reflection of an age-old grieving process (and is thus natural). We argue that by employing a twofold, novel/traditional justification, PR supporters aim to go one step further, from a symbolic continuity of the dead to a so-called real one. This progression highlights the flexibility of the natural category at the intersection of technology and culture and the abandonment of such binary distinctions as life/death and nature/culture.

Exploratory study of metacognitive beliefs about coping processes in prolonged grief symptomatology

Despite research examining the role of metacognitive beliefs about coping processes in maintaining psychological disorders, to date, no studies have explored their role in the maintenance of prolonged grief. Twelve semistructured interviews were conducted with bereavement specialists and bereaved people with elevated grief to identify metacognitive beliefs about coping processes relevant to prolonged grief. Analysis revealed several metacognitive beliefs potentially driving maladaptive coping processes used by people with prolonged grief symptomatology. Findings may underpin the development of interventions that aim to modify unhelpful metacognitive beliefs that perpetuate maladaptive coping processes.

Anticipatory Grief, Proactive Coping, Social Support, and Growth: Exploring Positive Experiences of Preparing for Loss

All mental health professionals will inevitably serve clients who face the expected death of a loved one. Prominent theories on the grieving process tend to begin after a death or other loss has occurred. Many individuals experience anticipatory grief prior to the physical death. Participants in this study consisted of 120 adults who were anticipating the death of a loved one due to terminal illness. The purpose of this investigation was to assess the relationship between the positive disposition of proactive coping and two forms of growth. Both personal and posttraumatic growth were present to a significant degree, and proactive coping illustrated unique predictive power in personal growth. Social support was a significant mediator of proactive coping and growth and was determined to be an outcome of the assertive nature of this disposition. Implications for helping professionals who serve anticipatory grievers as well as directions for future research are discussed.

The therapeutic effectiveness of using visual art modalities with the bereaved: a systematic review

Bereaved individuals are increasingly considered at risk for negative psychological and physiological outcomes. Visual art modalities are often incorporated into grief therapy interventions, and clinical application of art therapy techniques with the bereaved has been widely documented. Although clinicians and recipients of these interventions advocate for their helpfulness in adapting to bereavement, research investigating the efficacy of visual art modalities has produced equivocal results and has not yet been synthesized to establish empirical support across settings. Accordingly, this review critically evaluates the existent literature on the effectiveness of visual art modalities with the bereaved and offers suggestions for future avenues of research. A total of 27 studies were included in the current review. Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that therapeutic application of visual art modalities was associated with positive changes such as continuing bonds with the deceased and meaning making. Modest and conflicting preliminary evidence was found to support treatment effectiveness in alleviating negative grief symptoms such as general distress, functional impairment, and symptoms of depression and anxiety.

The grieving animal: Grief as a foundational emotion

This article introduces the notion of foundational emotions, using grief as a central example. Unlike so-called basic emotions, some of which humans share with other animals, foundational emotions are constitutive of human selfhood and subjectivity. First, anxiety, shame, and guilt are presented as emotions that have been singled out as foundational emotions in philosophical and biblical texts. Second, grief is introduced as a foundational human emotion in the sense that it connects the human being to existential issues of love and death that are uniquely important for us. Some general implications are discussed that follow from the notion of foundational emotions.

The use of pathological grief outcomes in bereavement studies on African Americans

Pathological bereavement outcomes (i.e., complicated grief, traumatic grief, prolonged grief disorder) are a robust and growing research area in the psychological and medical sciences. Although grief is considered to be a universal phenomenon, it is well documented that grieving processes and outcomes are culturally and contextually bound. The objectives of this study were: (a) to examine representations of African Americans in the grief and mourning literature and to assess the extent to which this research utilizes pathological grief outcomes; and (b) to examine the characteristics of pathological grief constructs in the literature to assess their relevance for African American populations. We conducted comprehensive searches of three scientific databases including PsycNET, Medline, and CINAHL, which contain the majority of grief and mourning literature published between January 1998 and February 2014. We found 59 studies addressing grief and mourning in African Americans. Thirteen of these studies used pathological grief outcomes. Pathological grief outcomes that were constructed and validated on White populations were frequently used as outcome variables with African American participants. We discuss the implications for the grief and mourning field and argue that the failure to use culturally sensitive outcome measures in research studies is a form of epistemological violence that may have negative research and clinical implications for African Americans and other ethnic minorities.

The role of religious affiliation in Christian and unaffiliated bereaved emerging adults' use of religious coping

Though research on bereavement has grown, few studies have focused on emerging adults. To add to the literature, the authors administered the RCOPE to a sample of bereaved college students (analyzed sample N = 748) and explored the relationship between self-reported religious affiliation and religious coping strategies used and endorsed as "most helpful." Results highlight the rich topography of bereavement previously unexamined in understudied populations (i.e., emerging adults, religiously unaffiliated). Specifically, the Christians/affiliated used "negative" religious coping strategies most often, yet identified "positive" strategies as "most helpful," whereas the unaffiliated instead used "positive" strategies most often and identified "negative" strategies as "most helpful."

Representations of African Americans in the Grief and Mourning Literature from 1998 to 2014: A Systematic Review

The authors examined representations of African Americans in the grief literature to assess (a) frequencies; (b) content; and (c) use of universalist or a contextualized framework. They conducted searches in 3 databases that target the grief literature published in the last 15 years. Fifty-nine articles met the criteria. There are a small number of studies published on African Americans and these tend to focus on homicide. Many studies had incomplete methods. Comparison studies were common and pathological grief outcomes that were validated on White populations were used as outcome variables with African American participants.

Grief & depression at the end of life

People may experience grief and depression with serious illness at the end of life or as a loved one who survives. While grief is a normal reaction to loss, complicated grief and depression are not. Accurate diagnosis, treatment, and referral are essential clinical tools for practitioners managing this population.

Grief as a Border Diagnosis

Grief is sometimes poetically described as the price of love: An inescapable existential condition of human life. However, throughout the 20th century, grief has increasingly come to be understood as a pathological condition that requires psychological and/or medical intervention. With the release ofDiagnostic and Statistical Manual of Mental Disorders(5th ed.,DSM-5; American Psychiatric Association, 2013), grief came close to being included as a separate mental disorder. However, the diagnostic revisions concerning bereavement have been met with criticism of medicalizing grief and of exceeding the territory of psychiatry beyond its legitimate borders. On this basis, I argue that grief is currently a border diagnosis, that is, a condition whose meanings are informed in heterogeneous ways by medical, psychiatric, and psychological understandings yet constantly challenged by alternative, nonmedicalizing discourses. Drawing on empirical findings from an ongoing interview study with bereaved parents after infant loss, I analyze and discuss 4 different accounts concerning the question of diagnosing grief: (a) diagnosis as a legitimating and normalizing practice, (b) diagnosis as a demarcation practice, (c) diagnosis as pathologization, and (d) diagnosis as a normative ideal. Through the examples, I attempt to demonstrate how bereaved individuals do not merely passively adopt but reflectively use these kinds of understandings to deal with their grief.

Grief, Consolation, and Religions: A Conceptual Framework

Consolation is grief's traditional amelioration, but contemporary bereavement theory lacks a conceptual framework to include it. The article begins to develop that framework. The article argues that grief is inter-subjective, even at the biological level. Consolation and grief happen in the same inter-subjective space. Material from the histories of several religions sets the article in a cross-cultural and historical environment. The article examines consolation in interpersonal relationships, and then moves to consolation in cultural/religious resources that range from the literal image of God as an idealized parent to the abstract architecture of Brahm's Requiem. The most common consolation in the histories of religions comes within continuing bonds that are accessed in a wide variety of beliefs, rituals, and devotional objects. The article closes by briefly drawing the connection between consolation and faith.

Mourning Sickness: The Politicizations of Grief

In this paper, I propose that the politicization of grief falls into 3 categories of what I have termed different types of Mourning Sickness. In Mourning Sickness Type I, the politicization of grief functions to discipline the individual mourner's body into a productive, functioning, and contributing member of a capitalistic society. Moreover, I argue that the individualist ethos that pathologizes grief neuters the rage that can come with mourning and turns the gaze away from social injustices such as poverty, imprisonment, and opportunity gaps that are caused by state neglect. In Mourning Sickness Type II, I suggest that the politicization of grief is about consciously manipulating individual and collective grief in the service of nationalism and military power. The manipulation of grief on this level includes the explicit links made between loss and grief and justification for war, aggression, and violence, but also includes the distinctions made between whose lives are deemed grievable and whose lives are considered worthless and unmournable. Both Mourning Sickness Types I and II are of the pathological variety urgently requiring academic and public critique. In the last type of Mourning Sickness, I suggest that grief is also politicized when it is activated as a motivator toward a social justice agenda that includes peace, reconciliation, nonviolence, and positive social change on behalf of individuals, communities, and nations.

Historical–psychological reflections on emotion and human subjectivity

The changeability of human beings over time is the central theme of this article. Emotion in Western society, in particular grief, is selected to provide a case history of mental change over a long time period. Two historical examples are examined: from Greek Antiquity, a scene from Homer’s Iliad, and from around 90 ce, a consolation letter written by Plutarch to his wife. These are contrasted to modern-day psychological advice given to grieving spouses and parents. It is argued that these three examples show discontinuous changes in lived-through experience, and that the transition to the 20th century is tied to the development of the modern self. Finally, the article suggests that a concept (esthema) similar to Foucault’s episteme is in operation here, which can be used to characterise the differences in ‘emotion’ over the three time periods.

Oncologists' protocol and coping strategies in dealing with patient loss

To identify what protocol and coping strategies oncologists turn to cope with patient loss, the authors interviewed 20 oncologists at 3 hospitals. Using the grounded theory method, findings revealed that their protocol may include meeting with families, participating in bereavement rituals, making a phone call, or sending a condolence card. Coping strategies included social support, activity-oriented coping, turning to faith, compartmentalization, and withdrawing from patients and families. The authors conclude by offering implications from this research on how to address oncologists' grief over patient loss in institutional settings in order to improve bereavement care for families and enhance oncologists' quality of life.

Disciplinary Wounds: Has Grief Become the Identified Patient for a Field Gone Awry?

In the last few decades, grief and loss research in the psychological domain has focused almost exclusively on its dysfunctional nature. I examine what is underneath these questions about pathology and suggest that our discipline is suffering from an attachment wound where we have dissociated from our historical roots when it comes to the study of grief and loss. I argue that we need to ask new questions about grief and loss and present two examples of my collaborative work to illustrate innovative ways of thinking about and researching grief.

Late-life bereavement and complicated grief: a proposed comprehensive framework

OBJECTIVES

The construct of complicated grief (CG) has garnered increased empirical attention since it has been proposed as a diagnostic category for the upcoming Diagnostic and Statistical Manual of Mental Disorders-V. The aim of this article is to critically examine construct validity in light of a proposed conceptual framework, with special emphasis on understanding late-life bereavement.

METHOD

This is a review article that critically examined current bereavement and grief models. We explored discriminant and convergent validity between CG and uncomplicated grief (UG) and other psychopathological constructs in terms of symptom intensity, symptom trajectories, bereavement outcomes, and treatment response.

RESULTS

The findings from this review show mixed support for differentiating CG from other outcomes of bereavement for the following reasons: (1) a clear boundary between CG and UG has not been adequately supported, (2) symptoms of CG and bereavement-related depression and anxiety overlap, although there is some evidence of incremental validity in that CG symptoms predict global functioning above and beyond symptoms of depression, and (3) the treatment literature demonstrated that general grief interventions and treatment targeted for improving depression are ineffective at treating symptoms of CG, whereas interventions specially tailored to treating CG have been moderately effective. The findings also emphasize the importance of considering pre-bereavement circumstances, such as preexisting depression, in the conceptualization of broader bereavement outcome.

CONCLUSION

There were mixed findings supporting the construct validation of CG. A comprehensive framework that emphasizes pre-bereavement circumstances was proposed in order to better predict various grief trajectories and outcomes of late-life loss.

Do clinical psychologists extend the bereavement exclusion for major depression to other stressful life events?

BACKGROUND

In assessing potential cases of major depressive disorder (MDD), to what extent do clinicians interpret symptoms within the explanatory context of major life stressors? Past research suggests that when clinicians know a plausible life event cause for a person's disordered symptoms, they generally judge that person to be less abnormal than if the cause was unknown. However, the current, fourth edition of the Diagnostic and Statistical Manual of Mental Disorders specifies that only bereavement-related life events exclude a client from a diagnosis of MDD, and the upcoming fifth edition of the manual (DSM-V) is currently slated to eliminate this bereavement clause altogether.

OBJECTIVE

To systematically examine whether clinicians' judgments reflect agreement with either of these formal DSM specifications.

METHOD

In a controlled experiment, 72 practicing, licensed clinical psychologists made judgments about realistic MDD vignettes that included a bereavement event, stressful non-bereavement event, neutral event, or no event.

RESULTS

Bonferroni-corrected paired comparisons revealed that both bereavement and non-bereavement life events led MDD symptoms to be rated as significantly less indicative of a depression diagnosis, less abnormal, less rare, and less culturally unacceptable (all P ≤ 0.001) relative to control conditions.

LIMITATIONS

Clinicians made judgments of realistic, controlled vignettes rather than patients.

CONCLUSIONS

The results suggest that practicing clinical psychologists assess symptoms within the explanatory context of bereavement and non-bereavement life stressors, indicating a departure from the DSM's recommendations, both current and proposed.

IMPLICATIONS

for diagnostic decision making and the clinical utility of the DSM's recommendations are discussed.