Pathological Grief: An Intensive Case Study

Abstract

Pathological mourning is such an excessive, blocked, or distorted process that psychiatric signs and symptoms develop. Explanation of how and why these signs and symptoms form could deepen an understanding of both normal and pathological mourning. Because many variables are involved in such explanations, intensive case study is a desirable methodology because it permits a detailed look at how various factors interact (Brewer and Hunter 1989; Luborsky and Mintz 1972; Luborsky and Spence 1971; Nessleroade and Ford 1985). While a patient may complain of symptoms as experiences that endure or occur episodically over days and weeks, a clinician observes psychiatric signs in the here-and-now seconds and minutes of an interview. Relating signs and symptoms to each other and to other variables in order to form a theoretical model of their formation requires exploration of data across long and short time frames. It is important to understand how the here-and-now phenomena combine to form patterns across longer periods of the individual's life. Hence, we developed a combined macro- and microanalytic approach to intensive case studies.

Persistent complex bereavement disorder in caregivers of terminally ill patients undergoing supportive-expressive treatment: a pilot study

“…Prigerson has focused attention on the persistence of a specific set of symptoms related to pain about the loss and to significant impairment of physical and mental health for at least six months (Lai et al, 2014a;Prigerson et al, 1995). There is a discrete overlap in the description of the two nomenclature, such as difficulty of adaptation, inability to move forward with lives, difficulty to fulfil responsibilities, somatic symptoms and disinterest in establishing new relationships (Horowitz et al, 1993(Horowitz et al, , 1997Lai et al, 2014a,b;Lombardo et al, 2012Lombardo et al, , 2014. However, there are also some specific differences between the two nomenclature: Prigerson considered the ''separation distress'' and the ''presence of dysfunctioning'' as essential criteria for the diagnosis of prolonged grief disorder including ''loneliness'' and ''emotional (Chiambretto et al, 2008;Prigerson et al, 2008), while Horowitz considered ''sleep disorders'' (Horowitz et al, 1997).…”

“…PCBD has been inserted in a special section of DSM-5 dedicated to conditions for further study (APA, 2013) . Horowitz has underlined the continuity between normal and pathological mourning on the basis of the intensity and duration of the experienced symptoms (Horowitz et al, 1993). Prigerson has focused attention on the persistence of a specific set of symptoms related to pain about the loss and to significant impairment of physical and mental health for at least six months (Lai et al, 2014a;Prigerson et al, 1995).…”

The systematics of psychogenic depressions (reactions of complicated grief)

“…Показатели, отражающие (несмотря на смещение выборки в сторону преобладания пожилых лю-дей) профессиональную активность пациентов, свиде-тельствуют об их достаточно высокой социальной адапта-ции, тем более что они выходят за границы возрастных ограничений (даже пенсионеры по возрасту -10 из 18 -продолжали работать, причем без снижения квалифика-ции). Длительность психогенных депрессий (в среднем 16±6,7 мес) в изученных случаях соотносится с приводи-мыми в литературе [27,34] хронологическими показате-лями как для реакций осложненного горя -в среднем 13 мес, так и для затяжных реакций адаптации (МКБ-10) -24 мес.…”

“…«Эмоциональная дезорганизация», определяющая дебют расстройства, проявляется compartment-диссоциацией, отражающей катастрофический характер стресса и срыв защитных ме-ханизмов с отказом примириться с реальностью [34]. На-рушение контроля над функциями сознания [67] и свя-занная с утратой скорбь сопровождаются преувеличенной заботой о тех, кто все еще связывает с объектом привязан-ности (дети, друзья и даже домашние животные) при за-вистливом или озлобленном отношении к остальному миру, «не испытавшему горя».…”

Expressive and Defensive Behavior during Discourse on Unresolved Topics: A Single Case Study of Pathological Grief

“…A qualitative clinical analysis used the technique of configurational analysis (Horowitz, 1987;Horowitz, Stinson, Fridhandler et al, 1993). The formulation emphasized conflict manifesting in three topics: (a) the death of James and Patricia's sense of dismpted identity in relation to it, (b) the new intimacy with Sidney as a potential replacement of the intimacy she had shared with James, and (c) her resistance to discussing these topics because contemplation was painful and the possibility of resolving the contradiction between being a "we" with James and a "we" with Sidney seemed hopeless.…”