Complicated Mourning Therese A Rando Ph D Caitlin

Complicated Mourning Therese A. Rando, Ph. D Caitlin Vasquez

Complicated Mourning “Complicated” implies that although something has gone wrong, it can potentially be corrected Three main difficulties in defining complicated mourning o First the terminology can be imprecise and inconsistent. o Second knowing what criteria constitutes as complicated mourning. o Third mourning is highly idiosyncratic; an appropriate response in one situation for an individual mourner may be a highly irrational response for a different mourner in another situation. For these reasons it would be best to look at complications in the mourning processes themselves rather than at particular symptomatology. *Symptomatology- study of relationship between symptom and disease *Thanatology- the study of the medical, psychological, and sociological aspects of death and the ways in which people deal with

The Six “R” Processes • Recogniz e • React • Recollec t • Relinquis h • Readjus t • Reinvest The six “R” processes of mourning are: o Recognize the loss • Acknowledge the death • Understand the death o React to the separation • Experience the pain • Feel, identify, accept, and give some form of expression to all the psychological reactions to the loss o Recollect and re-experience the deceased and the relationship • Review and remember realistically • Revive and re-experience the feelings o Relinquish the old attachments to the deceased and the old assumptive world o Readjust to move adaptively into the new world without forgetting the old • Revise the old assumptive world • Develop a new relationship with the deceased • Adopt new ways of being in the world • Form a new identity o Reinvest

Complications in the “R” Processes In all forms of complicated mourning, two things are attempted and are what cause the complications in the “R” processes of mourning: o To deny, repress, or avoid aspects of the loss, its pain, and full realization of its implications for the mourner o To hold onto, and avoid relinquishing the lost loved one

Forms of Complicated Mourning Complicated mourning may take any one or combination of these four forms: o Symptoms o Syndromes o Mental or physical disorder o Death

Forms of Complicated Mourning: Symptoms Refers to any o Psychological symptom o Behavioral symptom o Social symptom o Physical symptom • Can be alone or in combination with another form • Which in context reveals some dimension of compromise, distortion, or failure of one or more of the six “R” processes of mourning.

Forms of Complicated Mourning: Syndrome Only if the symptoms comprising them meet the criteria for the specific syndrome is there said to be a complicated mourning syndrome present. If only some of the symptoms are present, or there is a combination of symptoms from several of the syndromes, but the fail to meet the criteria for a particular complicated mourning syndrome, then they are considered complicated mourning symptoms.

Forms of Complicated Mourning: Death & Disorders A diagnosable mental or physical disorder would include any DSM-III-R 3 diagnosis of a mental disorder or any recognized physical disorder that results from or is associated with a compromise, distortion or failure of one or more of the six “R” processes of mourning. Death may be consciously chosen (i. e. , suicide) or it may stem from the immediate results of a complicated mourning reaction (i. e. , an automobile crash resulting from the complicated mourning symptom of driving at excessive speed) or the long-term results of complicated mourning reaction (i. e. , cirrhosis of the liver secondary to mourning-related alcoholism). • A mental or physical disorder and death may or may not be subintentioned on the part of the mourner.

Seven High-Risk Factors Theses factors can predispose any individual into two categories: o Factors associated with the specific death are known especially to complicate mourning include: • • A sudden death, especially when it’s traumatic, violent, mutilating, or random Death from an overly-lengthy illness Loss of a child the mourner’s perception of preventability. o Factors associated with antecedent and subsequent variables that tend to complicate mourning include: • Premorbid relationship with deceased which has been markedly angry or ambivalent or markedly dependent • The mourner’s prior or concurrent mental health problems and/or accommodated losses and stresses • The mourner’s perceived lack of social support.

Trends Predisposing to Complicated Mourning Three main areas which have significantly increased the prevalence of complicated mourning: • the types of death occurring today • the characteristics of personal relationships that are severed by today’s deaths • the personality and resources of today’s mourner Social change, medical advances, and shifting political realities have spawned the recent trends that have complicated healthy grief and mourning.

Types of Death Occurring Today Three types of death known to be at high risk for complicated mourning: o Sudden and unanticipated deaths, especially if they are traumatic (i. e. , characterized not only be suddenness and lack of anticipation, but violence, mutilation, and destruction; preventability and/or randomness; mutiple death; or the mourner’s personal encounter with death o Deaths that result from excessively lengthy chronic illnesses o Deaths of children Each of these deaths presents the survivors with issues known to compromise the “R” processes of mourning.

Personal Relationships Severed by Death There has been an increase in conflicted and dependent relationships in our society. o Both types are high-risk factors when they characterize the mourner’s premorbid relationship with the deceased. o With more of these types of relationships than ever before, there is relative increase in the prevalence of complicated mourning, which is predisposed to develop after the death of one with whom the mourner has had this type of bond.

Today’s Mourner Personality and resources leave individuals compromised in mourning for three reasons. o The personalities and mental health of today’s mourners are often impaired. o The presence of more loss and stress in the life of today’s mourner as compared to times in the past. o The mourner’s resources. • Disenfranchised mourning is on the rise • the consequent perceived lack of social support