Whenever I write one of these posts I sneak off to review the existing the literature. Boy was I disappointed with the psychiatric literature on grief – there is zilch! Perhaps because psychiatry is pretty medication orientated these days .
The other thought I had is this. In the rural city I work in the most highly regarded therapist was a GP who did grief counselling (who unfortunately had to retire because of illness). So the public obviously values the grief work highly.
DSM V has a thing called “persistent complex bereavement disorder” (aka complicated bereavement) which describes:
- grief lasting longer than 6 months
- grief impairing socio-occupational ability
- prominent an intense yearning for the lost person/pet/object
- guilt concerning the loss
- avoidance behaviour such as keeping rooms the same , drinking to excess etc
- suicidal thinking
Its different from depression where intense yearning occurring in waves is not present. Depressed people describe more disturbance in sleep and appetite and energy levels typically. ( In practice delineating the two is not easy)
PTSD can also be a differential diagnosis to consider in some circumstances.
Medical Illnesses such as hypothyroidism can look like grief. Covert substance abuse and covert self-injury also need consideration.
What happens in the brain in grief ? MRI studies show a diffuse network involvement –
- posterior cingulate cortex – associated with autobiographical memory
- precuneus – associated with memory related imagery
- dorsal anterior cingulate – engages attentional resources -hence the preoccupation
- insula – visceral pain
- left medial frontal gyrus – empathising
- cerebellum- coordination of emotion and cognition
The components of management are :
- Some form of re exposure to the unresolved aspects of the grief either with hypnosis or EMDR. This helps with self-regulation of the pain of grief
- Correction of irrational beliefs about grief – usually to do with guilt
- Asking the question “what would the deceased want for their loved one to be doing and feeling now?”
- Building social activities and connections
- Strategies for confronting or revisiting previously avoided situations
- Retelling of the story of the patient and the deceased the ups and downs of their life together.
Antidepressants or Sleeping Tablets can be useful .