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Acquainted with Grief
This study examined the impact of attachment on grief severity following the death of a pet. Seventy-one participants who had lost a dog or cat within the past year completed a set of measures that included an attachment measure assessing individual differences in attachment anxiety and avoidance, strength of the past attachment to the pet, the continuing bond with the deceased pet, social support, and complicated grief symptoms. Attachment anxiety and strength of the past attachment to the pet were each uniquely predictive of more severe grief. Furthermore, the continuing bond to the deceased pet partially mediated the impact of strength of the past attachment to the pet on grief severity. No significant mediators of the effect of attachment anxiety on grief were found, however. The results highlight the importance of distinguishing strength of attachment from attachment security in examining the effect of attachment on response to pet loss.
There are many kinds of crisis service. Most are open only to people who have been diagnosed as mentally ill. They facilitate rapid admission to short-stay in-patient services with the back-up of multidisciplinary teams working in the community. Others attempt to keep patients out of hospital by providing support to patients and their families in the community. Several have demonstrated striking reductions in the rate and duration of hospital admissions without detriment to the subsequent health or social adjustment of the patient.
There is widespread recognition that many who seek or are referred for help to psychiatric and social services are acutely disturbed and require only short-term help if they are to come through a period of transient disruption in their lives. The frequency with which people in crisis consult their GP or visit a local Social Service Department is uncertain but suggests that the primary carers are the first port of call for most of them. Services developed to meet the needs of these people include traditional GPs and psychiatric services directed primarily at ‘patients’ (people who meet criteria for illness), but which often offer additional help to their families; traditional social services which place no such limitation on the individuals who seek their help but are directed mainly at people with problems in living, particularly with housing, employment and money; and counselling and advisory services (such as Relate – formerly Marriage Guidance) which focus on particular problems or client groups. A few special crisis services, most of which provide a multidisciplinary team, visit clients in crisis in their homes. These are usually psychiatric services for patients with acute mental illness (Cooper, 1979).
In drawing together ideas from stress research, crisis studies and loss research a new and more satisfactory conceptual field has emerged—the field of Psycho-social Transitions.Such situations are seen as turning points for better or worse psycho-social adjustment. They often constitute natural experiments of great theoretical and practical importance.Grief is seen as a process of “realization” by means of which affectional bonds are severed and old models of the word and the self given up. It tends to be avoided and accounts for resistance to change and depressive reactions to change.
A previously studied group of newly blind adults was followed up after four years. There was only a slight increase in the acquisition of blind skills, while there was a surprising continuing pervasiveness of depression and poor health. A number of variables from the original study and from the follow-up data predicted outcome measures. Significant predictors of depression and distress were poor health, being married, being nonProtestant in this predominately Protestant London population, and lacking ability to be more independent. Higher social class and an absence of a family history of blindness predicted greater distress. Earlier acceptance of blindness, early learning of blind skills, and better preillness adjustment predicted better coping and greater use of blind skills at follow-up. The extent of the depression and poor health are discussed, and recommendations are made for caregivers.
This study compares terminal cancer care in 1967–69 with care in 1977–79 as evaluated by surviving spouses of patients who died in St Christopher’s Hospice and other local hospitals.
Patients and their surviving spouses reported less personal distress in both settings in 1977–79 than in 1967–69 and the patients were also thought to have suffered less pain. These differences were found before, during and, in surviving spouses, after the period of terminal care. They were confirmed in subsamples of 30-34 patients matched for age, sex, socio-economic status and duration of terminal period.
Improvements may be attributable to the training in terminal care provided by staff of the Hospice since 1967 and augmented in its Study Centre which was opened in 1973.
Although pain and distress in the patient is no longer a major problem in either setting, spouses in 1977–79 remain less anxious at St Christopher’s Hospice than at other hospitals; they play a larger part in the care of the patient and are in closer contact with staff before and after bereavement.
BLINDNESS is a disability that irrevocably changes the course of a formerly sighted person's life. There have, however, been few systematic studies of the psychosocial effects of loss of sight, and none have considered in a comprehensive manner parameters such as the early psychological reaction, changes in socioeconomic status, persisting visual and other intrapsychic phenomenology, and adjustment and rehabilitation factors.
The present investigation was designed to study the reactions to loss of sight in a group of newly blinded adults of working age. For a representative sample, everyone living in a large and contiguous region of metropolitan London meeting the below criteria was selected. On the basis of a survey of the literature on reactions to blindness (see comments), discussions with interested caregivers in the blind welfare field in England, and a pilot study of verbally fluent and intelligent newly blind persons, an interview
During the 100 days which followed the assassination of the Presidents of Rwanda and Burundi on 6 April 1994 up to a million people, mainly members of the Tutsi tribe, were massacred in Rwanda. This paper describes the consequences and provides a personal view regarding the factors that, taken together, explain this awful act of genocide. Factors that are considered include population pressure in a densely populated country, conspiracy by members of a ruling élite whose power was crumbling, brutalization and indoctrination of a local militia, alienation of victims, an escalating cycle of violence, rites of passage, ethnic hatred, repression of affects and collective psychological disorder. Each of these seems to have interacted with the others to bring about a brush-fire effect which resulted, within 2 weeks, in massacres, rapes and other acts of extreme violence in huge numbers in townships across the country. The danger of further violence remains high. If further repetition of the horrors of genocide is to be prevented a proper study should be made of the circumstances and the international actions that need to be taken. In addition to the Trauma Recovery Programme that is currently in train the following interventions should be considered if the cycle of violence is to be broken: economic aid to set up the industrial base that is needed to ease population pressure and allow displaced persons to return; the establishment of a system of justice that ensures that those who organized and incited the genocide will not go unpunished; a programme of re-education to counteract the effects of the programme of indoctrination that has taken place; expansion of the existing psychological support to make it available and acceptable to all of those Rwandans who have been and are continuing to be traumatized by violence and displacement.
Forty-six amputees were interviewed one month and thirteen months after amputation of an arm or leg.Complaints of persisting pain in a phantom limb were found to be significantly correlated with rigid and/or compulsively self-reliant personality, many people at home, illness of over 1 year's duration prior to amputation, persisting illness with threat to life or limb after amputation, pain in stump during first month after operation, pain in phantom limb during the same period, stump complications persisting at 13 months, and unemployment or retirement at 13 months after amputation.It is concluded that it may be possible to predict, at the time of amputation, which patients are likely to have problems with persisting pain in a phantom limb. Two illustrative case examples are described and the possible aetiological and therapeutic implications of the findings are discussed.
A total of 4,486 widowers of 55 years of age and older have been followed up for nine years since the death of their wives in 1957. Of these 213 died during the first six months of bereavement, 40% above the expected rate for married men of the same age. Thereafter the mortality rate fell gradually to that of married men and remained at about the same leveLThe greatest increase in mortality during the first six months was found in the widowers dying from coronary thrombosis and other arteriosclerotic and degenerative heart disease. There was also evidence of a true increase in mortality from other diseases, though the numbers in individual categories were too small for statistical analysis.In the first six months 22.5% of the deaths were from the same diagnostic group as the wife's death. Some evidence suggests that this may be a larger proportion than would be expected by chance association, but there is no evidence suggesting that the proportion is any different among widows and widowers who have been bereaved for more than six months.
Since the full significance of dying, for a patient, includes the anticipated loss of all of his human relationships, a significant element of his response to the awareness of impending death is a type of grief not too different from the anticipatory grief of his potential survivors. This concept of the emotional response to dying helps to clarify some of the individual differences among patients and some of the changes in a patient's reactions as the terminal course progresses. The concept also suggests to the physician that his communication with his dying patient should be couched in terms that will permit the patient either to deny or to accept death, as his current emotional needs require.
1. Among 3,245 patients admitted to a psychiatric unit during 1949-51 there were at least 94 (2.9 per cent.) whose presenting illness had come on within six months of the death of a parent, spouse, sibling or child.
2. The number of patients whose illness followed the loss of a spouse was six times greater than expected and suggests that the bereavement was a causative factor in the development of the illness. The relationship between mental illness and the loss of other kin was not established.
3. Among the bereaved patients there was a preponderance of women over 40. Whilst the age distribution could be explained in terms of the population at risk the sex distribution could not; it seems that women are more inclined than men to develop mental illnesses following bereavement.
4. The incidence of affective disorders, and particularly reactive and neurotic depressions, was significantly greater among bereaved than non-bereaved patients. Nevertheless only 28 per cent. of bereaved patients were diagnosed "Neurotic or Reactive Depression" and further investigation is required to determine the specificity of the reaction to bereavement.