Perinatal Bereavement Grief Scale: distinguishing grief from depression following miscarriage

The study evaluated the Perinatal Bereavement Grief Scale (PBGS), the first scale designed to measure grieffollowing reproductive loss in terms of yearning for the lost pregnancy and lost baby. Participants included 304 women interviewed by telephone I to 3 times within 6 months aftermiscarriage. The PBGS had high internal consistency and test-retest reliability. It showed convergent validity with measures of attachment and investment in the child and divergent validity against measures of social desirability and depressive symptoms, supporting the conceptual distinction between grief and depression. Cross-cultural validity was acceptable whether tested by language (Spanish vs. English) or ethnicity (Hispanic vs. other). This measure of yearning enables study of the epidemiology and prognostic value of this key feature of mourning.     

Grief and attachment

Loss and grief are universal phenomena with serious potential psychological and physical consequences. Loss results in various reactions that have been identified in a variety of ways. Attachment theory provides a conceptual scheme to understand these processes and consequences. Clergy are in a strategic position to respond to loss, and attachment theory helps inform pastoral intervention. Several program and research issues are posed that emerge from the author's clinical experience.     

Music, mourning, and consolation

The attacks of September 11, 2001, prompt a consideration of the role of music in mourning and trauma. The intrapsychic functions of music in the mourning process are explored, as is music as a unique response to trauma and as a special aesthetic expression of a range of affects connected with grief. Also explored is the allied notion of consolation, a topic underdeveloped in the analytic literature.     

The conflict between mourning and melancholia

Conflict between facing the reality of loss on the one hand, and denying it on the other, is explored in clinical material drawn from an analysis approaching termination. The intrapsychic conflict over loss was expressed as a conflict between morality and reality, and was externalized as a conflict between patient and analyst. For the patient, giving up resentment toward the analyst became tantamount to giving up the ideal object and losing omnipotence. In the course of the analysis, his complaints became less convincing, and the conflict over loss became more conscious, allowing some moves toward mourning to take place.     

Stress and recurrent miscarriage

Our current understanding into the role of stress in unexplained recurrent miscarriages comes from two different research strategies. The majority of research has examined the role of psychological support within this patient population. This support has been provided in a number of ways ranging from weekly interviews with a psychiatrist or gynaecologist and or visual re-assurance in the form of ultrasound scans. A comparison of psychological support with an absence of such intervention has found differences in successful pregnancy outcome varying from as great as 84 versus 26%, respectively. It has been assumed that psychological support reduces the miscarriage rate by reducing “stress”within this patient population. In addition it provides indirect support for a role of stress in the aetiology of unexplained recurrent miscarriage. Other studies have attempted to directly assess the effect of personality characteristics on miscarriage rate; these studies have yielded conflicting results.The mechanism by which stress may be causal in the aetiology of unexplained recurrent miscarriage has not been examined in humans. Animal studies, however, have found that psychological distress can alter immune parameters that may be intricately involved with implantation. These parameters include an elevation of the “abortive” cytokine TNF-a and a reduction in the “anti-abortive” cytokine TGF-P2. Cells that are involved in the release of TNF-a at the feto-maternal interface include T cells, macrophages and mast cells.Mechanisms through which stress may act on these cells are explored and an integrated model is postulated.     

Grief and Recovery: The Prevalence of Grief and Loss in Substance Abuse Treatment

Grief from various losses can underlie the process of recovery from substance abuse disorders. This study identified losses that clients encountered prior to abusing substances, losses that occurred as a result of addiction, and losses that occurred upon entering treatment.     

Search for meaning,finding meaning and adjustment in women following miscarriage: A longitudinal study

Objective: The purpose of this study was to explore the associations between meaning making and psychological adjustment in 127 women who experienced a miscarriage.

Design: A longitudinal and controlled study design was employed.

Main outcome measures: Meaning-making variables and distress outcomes were examined at four, seven and 16?weeks after miscarriage, in two groups of women, one who had medical investigations of the cause of their loss, and a control group receiving standard care.

Results: Search for meaning was very common and it declined with time after miscarriage. By seven weeks post-loss, more than half the women reported that they had found meaning/understood why the miscarriage happened. Providing information about the cause of the loss was associated with finding meaning. A decline in the search for meaning and finding meaning at seven weeks post-miscarriage, predicted levels of distress at 16?weeks, whilst controlling for the initial distress and for significant background factors.

Conclusions: This study provides support for the notion that search for meaning is very common following negative life events, such as miscarriage, and that finding meaning is important in many peoples’ process of adjustment. Providing information about the cause of the loss facilitates finding meaning.     

Aesthetics and the Containment of Grief

My point of departure is the observation that people ubiquitously turn to aesthetic practices in response to the loss of a loved one. I argue that profound loss catapults the bereaved person into an alternate “world” that differs in marked ways from the world we usually occupy, an alternate world lacking even the basic coherence we need to function. Aesthetic practices facilitate restoration of coherence to our experience, as well as reconnection with the social world and recovery from the breakdown that profound loss involves. While the aesthetic notion of closure is frequently invoked in connection with the needs of the bereaved, I suggest that while containing the emotions experienced in connection with loss is vital if they are to be processed, unrealistic aspirations toward closure can encourage expectations that harm the bereaved. By contrast, I suggest that the aims of aesthetically punctuating experience and communicating through aesthetic gestures are beneficial for helping the bereaved adjust to their new circumstances.     

Grief experiences and expectance of suicide

Suicide is generally viewed as an unexpected cause of death. However, some suicides might be expected to a certain extent, which needs to be further studied. The relationships between expecting suicide, feeling understanding for the suicide, and later grief experiences were explored. In total, 142 bereaved participants completed the Grief Experience Questionnaire and additional measurements on expectance and understanding. Results supported the prediction of a link between expecting suicide and understanding the suicide. Higher expectance and understanding were related to less searching for explanation and preoccupation with the suicide. There was no direct association with other grief experiences. We conclude that more attention should be brought to the relation between expecting the suicide of a loved one and later grief responses in research and in clinical practice.     

Genetic Library: Grief and Bereavement

As genetic counselors, we frequently encounter families that have experienced a significant loss, be it a pregnancy, a child, or a parent. The purpose of this Genetic Library is to introduce genetic counselors to some of the research that is currently being conducted in the areas of grief and bereavement support, as well as end-of-life care. Of course, it is impossible to capture the richness of these articles in one or two paragraphs. We therefore encourage interested genetic counselors to request and review the full version of these papers.