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Grief
Macmillan Encyclopedia of Death and Dying, (2003) by ROBERT KASTENBAUM, KENNETH J. DOKA, JOAN BEDER, REIKO SCHWAB, KENNETH J. DOKA, REIKO SCHWAB, KENNETH J. DOKA, NORMAN L. FARBEROW, MARGARET STROEBE, WOLFGANG STROEBE, HENK SCHUT, LILLIAN M. RANGE
One thorough research project by Gabriel Silverman and colleagues that was published in Psychological Medicine looked at the quality of life among sixty-seven adults widowed four months earlier. Those with traumatic grief reported significantly impaired quality of life, more so than persons with major depression or PTSD. Another research project by Holly Prigerson and colleagues, published in the American Journal of Psychiatry, focused on a vitally important aspect of traumatic grief—suicidal ideas. Among seventy-six young adults who had a friend commit suicide, those with traumatic grief were five times more likely to consider suicide themselves compared to those who were depressed. Still other research has shown that violent deaths, more than anticipated deaths, lead to problems for bereaved persons. For example, reviewing a broad selection of different research projects on bereavement, George Bonanno and Stacey Kaltman in 1999 concluded that adults whose spouse died unexpectedly (i.e., from suicide, homicide, or an accident) experienced PTSD at a higher rate than those whose spouse died of natural causes (e.g., cancer, congestive heart failure). Apparently, violent deaths may not only lead to the development of trauma reactions, but they also tend to exacerbate the more general grief response. Traumatic grief is different from other disorders and from general grief.
One major research project on grief analyzed twenty-three separate studies of bereaved persons. In each project, some participants were randomly assigned to receive some form of psychosocial intervention (psychotherapy, counseling, or facilitated group support). Others were randomly assigned to a control condition. Overall, treatment helped: Those who received treatment recovered more than those in the (nontreated) control group. However, the difference was small, which suggests that most people were helped, but some were not helped.
One reason for this finding could be time. Those people whose loved one died some time ago recovered more than those whose loved one died recently. Another reason could be age; younger clients fared better than older ones in grief therapy. Still a third reason could be the type of bereavement. Grief counseling for normal grievers had essentially no measurable positive effect, whereas grief counseling for traumatic grief was helpful. Apparently, grief therapy is particularly suitable for mourners experiencing protracted, traumatic, or complicated grief reactions. Conversely, grief therapy for normal bereavement is difficult to justify.
Theory
A useful theory to treating traumatic grief focuses on making meaning in the aftermath of bereavement. A counselor who uses this perspective might help a bereaved daughter to see that her father had lived a full life or accomplished his last major goal before he died. This daughter might find meaning in the fact that her father's life had some purpose, or had come full circle. This perspective to treating traumatic grief is different from a medical model, which might emphasize controlling the symptoms such as crying spells or depression. This approach is also different from the vague though well-intentioned assumption that sharing feelings in a supportive environment will promote recovery. Sharing feelings might help, but making meaning is an added step that involves reconstructing one's individual, personal understanding.
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