Complicated grief is ...

More to follow ...

I recently wrote a blog post "Grief is our natural human response to bereavement" where I said that mourning may well involve powerful feelings of yearning, disbelief, anger & depression.  When we have lost someone who has been very important to us, we gradually need to learn to live without them. Reconfiguring our inner emotional lives and our outer activities can be such a challenge.  Mostly though people manage.  It may be hard, but like the body healing after injury, emotional pain also resolves as we hold our loved ones in our hearts but engage more fully again in our lives.  Sometimes though after physical injury, wounds don't heal adequately.  Maybe there is infection or non-union of fractures.  In these situations the healing process may need help.

When we're badly physically injured, there may be horrible pain and loss of ability to function normally. Then though there is typically a gradual recovery.  Scars may be left; there may be some persisting vulnerability, but basically our bodies are wonderful at self-healing.  There are parallels between wounds due to physical injury and wounds due to emotional injury.  For example, when we are bereaved, there may be horrible pain and loss of ability to function normally.  Gradually, over time, our minds & hearts can heal.  Of course, if we have lost someone important to us, we will never be quite the same.  We may always miss them, and remember them with sadness, gratitude and love.  The grief resolves though and we can move on with our lives, even though we continue to carry our loved ones in our hearts ... and this resolution is what they would have wanted for us.

I wrote a blog post yesterday morning setting the scene for a two day workshop I was about to go to with Professor Kathy Shear on her treatment approach for complicated grief.  Well, how did the day go?  It was very interesting, inspiring, and also a little too much "simply sitting listening" for my tastes. It's hard to know what the best design for this kind of two day seminar should be. I strongly suspect though that just sitting taking in, even such excellent information with the opportunity for regular questions, isn't the most effective way of transferring knowledge.  Hard to do it, but more active audience participation would probably serve the workshop's goals even better.  Despite this, the material being shared was great ... really fascinating and important.

I was struck by a couple of papers on grief that I read last year.  One was Kathy Shear & colleagues' "Treatment of complicated grief in elderly persons: a randomized clinical trial" and the other was Bryant et al's "Treating prolonged grief disorder: a randomized clinical trial."   I was impressed because Shear's paper showed clear benefits of one treatment over a valid active comparison treatment.  Trials showing better outcomes of treatments that have been compared with "treatment as usual" (TAU) or "waiting list control" are two a penny.  However an intervention that produces an obviously better outcome than a valid alternative intervention makes me sit up and take notice.

A couple of recent research studies have underlined the value of specific forms of psychotherapy for complicated grief reactions: 

The last morning of the group.  I wake a bit "troubled".  This is the ebb and flow of the group.  Feelings tend to be more intense here.  As the "group river" flows its four day course, I know that I'm likely to move through a series of different emotional states.  I lie in bed for a bit sensing what I'm feeling.  What's it about.  The overall "smell/flavour" of my mood seems contributed to by a mix of things.  One factor is that I feel, what seems to me, a low key grumbling unease going on between me and one of the other people in the group.  A second factor is a discomfort I have about how another person expressed themselves for a while in the group yesterday.  A third is a concern I'm feeling about another person seeming to get too "isolated" in the group.  And there's something too about the group ending - both saying goodbye to the people and saying goodbye to this

Here are half a dozen studies on the long-term effects of various forms of abuse & deprivation.  Paras et al systematically reviewed the association between a history of sexual abuse and a lifetime diagnosis of a somatic disorder.  They found significant links with functional gastrointestinal disorders, nonspecific chronic pain, psychogenic seizures, and chronic pelvic pain.  When analysis was restricted to studies where sexual abuse was defined as rape, they also found an association with fibromyalgia.  Abstracts and links, for this research paper and the further papers described, can be found lower down this page.   

In blog postings earlier this month, I've talked about supporting my Mum after her recent couple of strokes.  She's been shipped through three different hospitals and now is more peaceful in a nursing home.  It's sad - very sad at times - and it's great that she seems more comfortable, better looked after, and more content.  I definitely feel easier too.  Less weight on my shoulders, less emotional aching.

Yesterday and today are a check-in time with my friend Larry.  I've written in a previous blog post how Larry and I have met every three or four months for many years specifically to review how our lives are going and to plan and prioritize our goals for the next few months.  "Taking charge" of our lives in this kind of way makes huge sense.  For example the self-determination literature (S-DT)  highlights the importance of making autonomous decisions about what we put our energy into.  This S-DT research and much other work (e.g. a recent study on goal-setting) also emphasises that this kind of approach is a core component of growing wellbeing in one's life.  Yeats wrote something like "A friend is someone who sees the potential in you and helps you to live it."  Meeting with an old friend in the way Larry and I have done, is certainly an example of what Yeats was talking about.