3 - Pathological grief reactions

Summary

In many areas of medicine it is difficult to distinguish normal and abnormal, nonpathological and pathological, or health and disease. The study of bereavement shares this difficulty. This chapter focuses on major theoretical perspectives that might aid in defining or understanding pathological grief. A historical overview is provided, and questions are raised regarding the overlap between grief and defined disorder. In particular, discussion focuses on the problem that research to date has not clearly identified areas of psychopathology that are grief-specific. This reflects in part a lack of operationalized criteria for pathological grief.

Defining pathological grief

The field is still struggling to validate and operationalize the construct of “normal” grief (cf. Shuchter & Zisook, this volume). When the focus is then extended to include a range of “abnormal” forms of grief, the difficulties are compounded. Where grief for a particular individual, in a particular culture, appears to deviate from the expected course in such a way that it is associated with excessive or prolonged psychological or physical morbidity, it may be labeled as pathological. Such classification may be descriptive or it may imply a theoretical construct. Furthermore, often it is not clear as to whether the term grief is intended to pertain simply to the affective reaction to loss, as a commonly accepted meaning, or to refer to all aspects of the bereavement reaction and a range of other states.