Acute Grief : the First Year of Bereavement1

Bereavement is a universal human experience and mourning or grief is the typical response to bereavement. Infact, most cultures have well established mourning rites and patterns of behaviour expected of the survivor who has suffered the bereavement as well as for the community, so as to promote the resolution and recovery from this grief. However, precisely because it is considered a normal and socially accepted pattern of behaviour ̂ it has not been the subject of scientific study except when the grief reaction had become excessive or under unusual circumstances. Freud (1937) identified the characteristics of mourning as painful dejection, loss of interest in the outside world, loss of capacity to adopt any new object of love and inhibition of activity. The first report describing the symptomatology of acute grief is that of Lindemann (1944). He described the characteristic symptoms of normal grief as observed in the 13 relatives of the coconut grove fire victims as (i) somatic distress, (ii) preoccupation with the image of the deceased, (iii) guilt feelings (iv) hostile reaction, and (v) loss of previous patterns of conduct. In the first of the 3 retrospective studies, Marris (1958) interviewed 73 widows in East London whose homes had been traced through the death registeration of their husband. He recorded five reactions that occurred following bereavement i.e. (a) lasting deterioration in health (b) difficulty in sleeping (c) loss of contact with reality (d) withdrawal and (e) hostility. Parkes (1965) carried out a study of recently bereaved adult psychiatric patients seen in OPD or admitted to hospital and information about their mental state was obtained from their hospital case records. On the basis of this, he attempted to identify the various components of the grief reaction following a major bereavement. More recently, Singh and Raphael (1981) in their studies of bereaved relatives from the Granville train disaster noted that bereaved parents seemed to suffer the highest morbidityjas compared to widows or other relatives. Clayton (1974) has also referred to the observation that the bereavement of parents on the loss of their children overshadows the bereavement of the widowed. The only prospective study of normal bereavement is one by Clayton etal . (1968) who studied the relatives of thirty of a total of fifty patients who died in hospital. The relation of the subject to the deceased was a spouse in 19 cases, parent in 9, grand parents in 2 and child in 10. They found that in normal bereavement in their subjects only 3 symptoms—-depressed mood, sleep disturbance and crying, occurred in more than onehalf of the subjects starting either during the terminal illness or after death. Natterson and Knudson (1960) in studying mothers of fatally ill children, found that when a child died within four months after a fatal prognosis had been given, a large