ó As awful as it is to lose someone we love, the vast
majority of us will begin to reach some level of acceptance
about six months after a death, and will begin to take a
renewed interest in life within the first year to 18 months.
estimated 7 to 10 percent of people will be caught in a more
lasting pain known as complicated or prolonged grief, experts
seems like a modest share, but since 2.5 million people die in
the United States each year, and each death strongly affects
two to three people close to that person, that means nearly
525,000 people annually will be susceptible to prolonged
certain kinds of deaths, the proportion of people who will
struggle with their grief is much larger.
you look at someone who lost a romantic partner, the risk of
complicated grief is double the normal rate," says
Katherine Shear, director of the Center for Complicated Grief
at Columbia University in New York. "If you lose a child
who is a young adult, the risk is much higher."
other thing that seems to be a risk factor is when someone
dies suddenly, especially in some kind of violent way, such as
by suicide or even an accident."
the biggest misunderstandings about prolonged grief, she and
others say, is that itís synonymous with depression.
those going through prolonged grief can have depression as
well, they are actually very different sets of feelings, says
Holly Prigerson, director of the Center for Research on End of
Life Care at Weill Cornell Medical College in New York.
hallmark of depression is a loss of enjoyment and interest in
life. The key characteristic of prolonged grief, on the other
hand, is a deep, unrelenting yearning for the person who is
gone and an inability to get past that point.
is known for developing standards used around the world for
diagnosing and measuring prolonged grief disorder, and the
work she did to develop that scale began in Pittsburgh several
postdoctoral researcher on the epidemiology of aging, she was
asked to sit in on weekly meetings of psychiatrists who were
studying the effectiveness of antidepressants in older widows
and widowers. "So Iíd be sitting there looking at the
charts of the people in the study, and the medications were
working, and their scores for depression were going down, but
their grief scores werenít budging." When she asked
about that, "the response I got from the psychiatrists
was, ĎOh, thatís OK, because grief is normal.í"
suspected something else might be going on. Working with Ellen
Frank, a psychiatry professor at the University of Pittsburgh,
she analyzed peopleís symptoms, and found that patients were
more likely to attempt suicide if they were experiencing
intense grief than if they were depressed.
shocked a lot of people. That was the first time people sensed
that maybe grief is not so benign and normal. Maybe there are
severe levels of pining and yearning for someone who is gone
that do affect how well someone is functioning."
research has shown that a key determinant of whether people
are likely to have prolonged grief is how dependent they were
on the person who died.
a very co-dependent relationship, if the partner was doing a
lot of things for the other person, so if itís a woman, if
she was cooking, orchestrating social life, planning events
and trips, or itís the husband and he was doing things
around the house or doing the taxes, they are not even able to
think about what life will be like when the other person is
almost as if the surviving family member gets stuck in a
recursive loop of wanting the other person to be next to them.
death, says Columbiaís Shear, "you donít end your
relationship with that person, but itís very different and
you have to envision your life moving forward in some way. But
sometimes there are things ó thoughts, feelings and
behaviors ó that get in the way of that process."
example, she says, would be the reaction some people have when
their spouse dies at the moment they left the personís
people would be jarred by that, but the person with
complicated grief will start to think about that as the
central problem of the death. Every time they think about the
death theyíll think ĎWhy didnít I stay?í They fear
their loved one didnít think that they loved them. Someone
who does not have complicated grief might have the thought
that they wish they had been there, but they will quickly
correct that and think, ĎBut Iím sure the person knew how
much I loved them.í"
common problem in prolonged grief, she said, is that the
survivors will avoid all the places that remind them of the
person who died.
say ĎI canít go to a restaurant that I went to with that
person; I canít drive past a ball field where they played
ball; I canít go to the hospital where that person died.í
Those certain places are almost every place, so youíre then
faced with a situation where you have to in a sense reinvent
your entire life."
researcher has found signs of this intense attachment in brain
scans of people going through complicated grief.
Mary Frances OíConnor, a grief researcher at the University
of Arizona, did brain imaging of people while they looked at
photos of the person who died, the ones who were caught in
prolonged grief showed unusual activity in a part of the brain
known as the nucleus accumbens.
the same area that lights up when people look at photos of
their romantic partners or when addicts are craving a drug,
we lose a loved one," OíConnor says, "part of what
has to happen is accepting the idea that when we get reminders
of our loved one, it doesnít mean we are going to get to be
with them anymore. And it takes the brain a while to work that
out. You live with a person for 40 years and the next day youíre
never going to see them again. The brain doesnít expect this
time, she says, "the brain learns this is a memory and
not a lived experience. I think for those folks who are not
adapting, they have not made that transition very well."
years of studying protracted grief, Shear and her colleagues
have devised a specific kind of psychotherapy that is aimed at
the problems that keep people from moving toward healing.
part of the therapy, she says, is getting people to tell and
re-tell the story of how they learned about their loved oneís
death, and what happened afterward. The therapist will record
the personís recollection and ask her to listen to it and
rate how distressed it makes her feel on a scale of 1 to 100.
She is then asked to listen to her own story at home and rate
her pain again.
we do see this distress level come down. It might start at 100
and come down to maybe 60 or 70." Over time, she says,
people will often reshape the story in ways that allow them to
have some sense of healing. She recalled one woman who was
distressed that she had not been at her motherís bedside
when she died, but as she kept retelling the story, "she
began to remember that her mother would have heard the
grandchildren laughing and playing in the next room, and she
could tell when she went back in the room, her mother was at
central technique of the therapy, Shear said, is getting the
person to have an imagined conversation with the person who
died, taking on both sides of the dialogue.
recalled one woman who was in pain because she thought her
mother might have taken her own life, even though it wasnít
clear from how she died.
in the imagined conversation, this woman spoke with her
mother, and her mother said ĎI did take my own life, and I
was ready to do that, because I wanted so much to be with your
father and my siblings, and I did it in this kind of ambiguous
way because I didnít want you to feel bad about it.í
person when she opened her eyes really felt a tremendous
amount of relief. Of course this was something the person had
been thinking, but now she had found a way to comfort herself,
but in a way that felt like the best guess to what really