Abstract
Grief is an internal process that follows experiences of loss and/or psychic injuries and involves an active engagement of the subject. The grieving person recalls his experiences with the loved one and must recognize the loss as permanent and irrevocable. Acute grief and associated symptoms such as pain, sadness, and anger are considered normal processes after bereavement, generally not needing mental health intervention. Research on prolonged grief disorder or complicated grief as well as means to overcome losses like searching for and attributing meaning, narration, and engaging to achieve the aspirations of the deceased person is discussed.
The grieving process in children and adolescents, different from mourning in adults, is addressed. The child has to mourn his loss at different developmental stages and new life events. A child is not able to accomplish a grieving process alone; he needs help from a meaningful adult person, emotionally available in a continuous relationship to fulfill the process of mourning. Psychic manifestations caused by the loss of a parent or a significant caregiver and mourning a sibling are described. The assessment of pathological grief in children must consider the circumstances of the loss, the grieving process, subsequent events, and the personal developmental changes. Traumatic experience of loss in a family, which could not be dealt with and overcome, often represents the starting point for the emergence of family secrets. The consequences of severe psychic traumata can—under certain circumstances—be transmitted from one generation to the next like a cultural heritage.
Attempts are made to clarify the functional neuroanatomical processes involved in the generation of grief. The networks activated during grieving, which produce negative affects, such as the panic–loss system, will ultimately impair the brain reward system leading to further emotional imbalance and depression. The current thinking is to view depression as a multimodal system-level disorder affecting discrete and specific pathways that are altered in response to negative external stimuli. Different approaches to treat depression are briefly presented.
Give sorrow words; the grief that does not speak,
Whispers the o’erfraught heart and bids it break.
(William Shakespeare (1564–1616), Macbeth, Act 4, Scene 3)
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Notes
- 1.
Hamlet, Act I, Scene 5, by William Shakespeare.
- 2.
Winnicott’s concept of holding means safeguarding and maintaining the continuity of the infant’s or child’s experience of being and being alive over time.
- 3.
“One knows that the acute mourning after such a loss will run its course, but one will remain unconsoled and never find a substitute. Everything that takes its place, even if it should fill that place entirely, remains something else. And actually, it’s good that way. It is the only way to continue the love, which after all one does not want to give up” (Freud in a letter to Binswanger, April 11, 1929. 1960: p. 386).
- 4.
Retrospective attribution (Modell 2006) or deferred action (in German Nachträglichkeit) implies a complex and reciprocal relationship between a significant event and its later reinvestment with meaning, a reinvestment that lends it a new psychic efficacy.
- 5.
As part of intersubjective processes, two minds can transmit and receive unconscious “messages.”
- 6.
Panksepp describes seven basic primary emotional subtypes consisting of SEEKING (reward), RAGE, FEAR, sexual LUST, maternal CARE, separation distress PANIC–GRIEF (simply PANIC), and joyful PLAY.
- 7.
Area 25 of Brodmann is located under the anterior part of the corpus callosum and has extensive connections to the nucleus accumbens, the amygdala, the frontal cortex, the thalamus, and the periacqueductal gray. Dysfunction of this area can therefore result in an imbalance of many functional circuits.
- 8.
The many different targets that are stimulated in depression reflect the conflicting views on the pathogenesis of this condition. For example, if depression is viewed as a consequence of anhedonia, the medial forebrain bundle, part of the reward system, is stimulated. Not all patients undergoing DBS will improve and there is a lack of controlled studies, so that the method remains experimental. How DBS “resets” a circuit or corrects a chemical imbalance remains to be shown (Underwood 2013).
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Steck, A., Steck, B. (2016). Grief. In: Brain and Mind. Springer, Cham. https://doi.org/10.1007/978-3-319-21287-6_14
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