Bearing Witness to Grief

Abigail Driscoll

doi:10.1370/afm.2886

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On Grief: When the Path Goes Tortuous
Sarah Al-Sakkaf

Published on: 10 June 2023

Published on: (10 June 2023)
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On Grief: When the Path Goes Tortuous
Sarah Al-Sakkaf, Master of Family Medicine Candidate, University of Edinburgh, Scotland, UK
Elderly people in my home city in Yemen say "Grief can kill". I always thought that was an exaggeration. It was until I became a medical student that I first heard of "broken heart syndrome". 1 At that stage of my life, I wondered how a soul ailment would mimic an acute myocardial infarction!

In 1994, Erich Lindemann enriched psychosomatic medicine by publishing the earliest research findings on subjects who experienced bereavement over losing their loved ones in a tragic fire. 1 Grieving is responding to a loss, and the Latin root is 'gravāre'; "to burden".2 Bereavement originates from 'reave' which translates to "being torn apart". 3

Although grief is part of humans' lives, not all individuals have grieving processes that follow the common path. One example of grieving gone awry is the "complicated grief" or "prolonged grief disorder". 4 In this type, grieving persists for an extended period that interferes with daily activities.4 It may affect up to 25% of the public.5 Symptoms include severe pain and sadness, and other intense symptoms and signs as listed by Oates and Maani-Fogelman.4

The second type is "absent grief"; a condition in which grief symptoms are not explicitly shown despite the internal emotional storm.1 The difficulty in absent grief is that individuals suppress their symptoms and might be mistaken for resilient population.1 Grieving for lo...
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Elderly people in my home city in Yemen say "Grief can kill". I always thought that was an exaggeration. It was until I became a medical student that I first heard of "broken heart syndrome". 1 At that stage of my life, I wondered how a soul ailment would mimic an acute myocardial infarction!

In 1994, Erich Lindemann enriched psychosomatic medicine by publishing the earliest research findings on subjects who experienced bereavement over losing their loved ones in a tragic fire. 1 Grieving is responding to a loss, and the Latin root is 'gravāre'; "to burden".2 Bereavement originates from 'reave' which translates to "being torn apart". 3

Although grief is part of humans' lives, not all individuals have grieving processes that follow the common path. One example of grieving gone awry is the "complicated grief" or "prolonged grief disorder". 4 In this type, grieving persists for an extended period that interferes with daily activities.4 It may affect up to 25% of the public.5 Symptoms include severe pain and sadness, and other intense symptoms and signs as listed by Oates and Maani-Fogelman.4

The second type is "absent grief"; a condition in which grief symptoms are not explicitly shown despite the internal emotional storm.1 The difficulty in absent grief is that individuals suppress their symptoms and might be mistaken for resilient population.1 Grieving for losses that are considered insignificant or are not socially acknowledged belong to the third entity; "disenfranchised grief".5 Examples include the loss of a home or being excessively emotional in showing grief.5 Individuals in this category may be prone to stigmatization.5

Where there is grief, there is a risk of somatization. During stressful conditions, inflammatory mediators may be linked to mental and somatic disturbances.1 Interestingly, physical symptoms were mentioned in grieving Shakespearean characters.6 Cleopatra, for instance, in the play "Antony and Cleopatra" said "I am quickly ill and well" and that depended on the presence and absence of her Antony. 6

Dr. Driscoll's reflection is a heartfelt note on how a family doctor encounters patients with their loss-related fears, concerns and torment on a regular basis. "As a medical student, I both underestimated and was underprepared for the pain of facing patients experiencing life-changing loss," she says.7

Primary healthcare (PHC) focuses on the "holistic human".8 Compassionate care in PHC means the "willingness to share the patient’s anguish and to attempt to understand what the sickness means to that person".8 Despite its strong association with PHC principles, care for the bereaved and those who are grieving is still overlooked to a great extent in family practice.

References:
1. O’Connor M-F. Grief: A Brief History of Research on How Body, Mind, and Brain Adapt. Psychosomatic Medicine 2019; 81(8): 731–738. DOI: https://doi.org/10.1097/PSY.0000000000000717
2. Grieve-Dictionary.com. https://www.dictionary.com/browse/grieve (accessed 1st June 2023).
3. Will I Grieve Or Will I Mourn? https://www.griefwords.com/?action=page&page=helping36.html&site_id=409 (accessed 1st June 2023).
4. Oates JR and Maani-Fogelman PA. Nursing Grief and Loss. Treasure Island (FL): StatPearls Publishing 2022; https://www.ncbi.nlm.nih.gov/books/NBK518989/
5. Mortell S. Assisting Clients with Disenfranchised Grief: The Role of a Mental Health Nurse. Journal of psychosocial nursing and mental health services. 2015; 53: 52-57. DOI: https://doi.org/10.3928/02793695-20150319-05
6. Heaton KW. Somatic expressions of grief and psychosomatic illness in the works of William Shakespeare and his coevals. Journal of Psychosomatic Research 2012; 73: 301–306. DOI: https://doi.org/10.1016/j.jpsychores.2012.06.005
7. Driscoll A. Bearing Witness to Grief. The Annals of Family Medicine 2022; 20(6): p.564. DOI: https://doi.org/10.1370/afm.2886
8. Hashim MJ. Principles of family medicine and general practice – defining the five core values of the specialty. Journal of Primary Health care 2016; 8(4):283–287. DOI: https://doi.org/10.1071/HC16006
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Competing Interests: None declared.