Colin Murray Parkes

Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11

Holly Prigerson and colleagues tested the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and care of bereaved individuals at heightened risk of persistent distress and dysfunction.

Attachment across the life cycle

A. Bitulco, Royal Holloway and Bedford New College John Bowlby, Tavistock Clinic, London J. Byng-Hall, Tavistock Clinic, London T. Harris, Royal Holloway and Bedford New College R. Hinde, University of Cambridge J. Hopkins, Tavistock Clinic, London Colin Murray Parkes, The London Hospital Medical College Joan Stevenson-Hinde, University of Cambridge K.E. Grossman, University of Regensburg, Germany G. Liotti, Rome M. Ainsworth, University of Virginia, USA J. Bretherton, University of Wisconsin-Madison, USA C.G. Eichberg, Columbia Associates in Psychiatry, USA M. Main, University of California, Berkeley, USA P. Marris, University of California, L.A., USA M. Radke-Yoorow, National Institute of Mental Health, Bethesda, USA R. Weiss, University of Massachusetts, USA

Death and bereavement across cultures

Part I: A Conceptual Framework: Historical and Cultural Themes. C.M. Parkes, P. Laungani, B. Young, Introduction. C.M. Parkes, P. Laungani, B. Young, Culture and Religion. Part II: Major World Systems of Belief and Ritual. P.C. Rosenblatt, Grief in Small-scale Societies. P. Laungani, Death in a Hindu Family. U.P. Gielen, A Death on the Roof of the World: The Perspective of Tibetan Buddhism. E. Levine, Jewish Views and Customs on Death. H.T. Blanche, C.M. Parkes, Christianity. G. Jonker, The Many Facets of Islam: Death, Dying and Disposal Between Orthodox Rule and Historical Convention. T. Walter, Secularization. Part III: Practical Implications and Conclusions. B. Young, D. Papadatou, Childhood, Death and Bereavement Across Cultures. C.M. Parkes, Help for the Dying and Bereaved. P. Laungani, B. Young, Conclusions I: Implications for Practice and Policy. C.M. Parkes, Conclusions II: Attachments and Losses in Cross-cultural Perspective. Bibliography. Index.

Bereavement in adult life

This is the first in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice Doctors are well acquainted with loss and grief. Of 200 consultations with general practitioners, a third were thought to be psychological in origin; of these, 55—a quarter of consultations overall—were identified as resulting from types of loss.1 In order of frequency the types of loss included separations from loved others, incapacitation, bereavement, migration, relocation, job losses, birth of a baby, retirement, and professional loss. After a major loss, such as the death of a spouse or child, up to a third of the people most directly affected will suffer detrimental effects on their physical or mental health, or both.2 Such bereavements increase the risk of death from heart disease and suicide as well as causing or contributing to a variety of psychosomatic and psychiatric disorders. About a quarter of widows and widowers will experience clinical depression and anxiety during the first year of bereavement; the risk drops to about 17% by the end of the first year and continues to decline thereafter.2 Clegg found that 31% of 71 patients admitted to a psychiatric unit for the elderly had recently been bereaved.3 Despite this there is also evidence that losses can foster maturity and personal growth. Losses are not necessarily harmful. Yet the consequences of loss are so far reaching that the topic should occupy a large place in the training of health care providers—but this is not the case. One explanation for this omission is the assumption that loss is irreversible and untreatable: there is nothing we can do about it, and the best way of dealing with it is to ignore it. This attitude may help us to live with the …

Guidelines for conducting ethical bereavement research

Abstract It is unethical to introduce services for the bereaved that are not well founded and evaluated; yet there are special difficulties in conducting research with bereaved people. This situation has deterred some from carrying out research in this field and has caused others to place obstacles in the way of would-be researchers. The ethical difficulties of bereavement research are described, and guidelines are provided that should enable investigators to carry out research without harming those who offer their help and without violating the scientific value of the research.

An exploration of associations between separation anxiety in childhood and complicated grief in later life

Recent studies have suggested that the vulnerability to complicated grief (CG) may be rooted in insecure attachment styles developed in childhood. The aim of this study was to examine the etiologic relevance of childhood separation anxiety (CSA) to the onset of CG relative to major depressive disorder, posttraumatic stress disorder, and generalized anxiety disorder in bereaved individuals. The Structured Clinical Interview for the DSM-IV, Inventory of Complicated Grief-Revised, and CSA items from the Panic Agoraphobic Spectrum Questionnaire were administered to 283 recently bereaved community-dwelling residents at an average of 10.6 months postloss. CSA was significantly associated with CG (OR = 3.2; 95% CI, 1.2–8.9), adjusting for sex, level of education, kinship relationship to the deceased, prior history of psychiatric disorder, and history of childhood abuse. CSA was not significantly associated with major depressive disorder, posttraumatic stress disorder, or generalized anxiety disorder.

GRIEF: LESSONS FROM THE PAST,VISIONS FOR THE FUTURE

Over the last millennium, patterns of mortality have changed and have determined who grieves and how. At all times grief has been recognized as a threat to physical and mental health. More recently the scientific study of bereavement has enabled us to quantify such effects and to develop theoretical explanations for them.This article reviews our evolving understanding of grief, focusing especially on the developments in research, theory, and practice that have come about in the last century.Wars and similar conflicts are associated with repression of grief,but methods of helping by facilitating its expression that developed during the 2 World Wars are less needed and effective at other times. In recent years more attention has been paid to the social context in which grief arises and, particularly, to the nature of the attachments that precede and influence the reaction to bereavement and to other traumatic life events. At the same time a range of caring resources has become available and acceptable to bereaved people and the results of scientific evaluation of these gives promise that we are moving toward an era in which more sensitive and appropriate care will be provided to the bereaved by both voluntary and professional caregivers.

The dying adult

This is the seventh in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice This paper focuses on two common problems that arise when people come close to death, fear and grief. Fear is the psychological reaction to danger; grief the reaction to the numerous losses that are likely to occur in the course of an illness that is approaching a fatal outcome. Both can be expected to arise in patients, their families, and—though we are reluctant to admit it—in their doctors and other carers. Both fear and grief need to be taken into account if we are to mitigate the psychological pains of dying. #### Summary points We should never assume that we know what people with terminal illness fear Most patients will benefit if we can help them to feel secure enough to share their fears Fear can aggravate pain, and pain fear Patients with life threatening illnesses experience a series of losses as the illness progresses Grief is natural and needs to be acknowledged and expressed Though it may seem obvious that people who are dying are likely to be afraid, we should not assume that we know what they fear. The box shows the fears, in approximate order of frequency, expressed to me by patients in a hospice. It is clear that fears of death itself come quite far down on the list. Difficult to quantify but of particular importance is reflected fear, the fear that people see in the eyes of those around them or hear in the questions that are not asked.1 Many problems in communication arise out of fear, and we may need to take time to create trust and a safe place in which people can begin to talk about the things that make …

Symposium on Complicated Grief

The idea of this symposium arose out of correspondence following the publication in Omega of an article by Hogan, Worden, and Schmidt (2003-2004). This presented data which threw doubt on the general applicability of the criteria for Complicated Grief which had been proposed by Prigerson et al. (1999). With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMV) in preparation, it occurred to the editor of Omega, Ken Doka, that, in addition to publishing Prigerson’s response to Hogan et al.’s article, it would be timely to invite other leading researchers who could contribute to the debate, to present their views on three important issues:

Breaking the cycles of violence

ABSTRACT Violence begets violence and it is important to understand how cycles of violence are perpetuated if we are to find solutions to the global problems they present. A multi-disciplinary group of The International Work Group on Death, Dying and Bereavement has developed a model of the cyclical events that perpetuate violence at all levels including the family, community, nation, and world. This includes the Violent Act(s), the Perception of the Violent Act(s), the Immediate Response, Legitimising Authority, Destructive Codes, and Inflammatory/Polarising Strategies. It is possible at each point to break the cycle, examples are given and recommendations made.ABSTRACT Violence begets violence and it is important to understand how cycles of violence are perpetuated if we are to find solutions to the global problems they present. A multi-disciplinary group of The International Work Group on Death, Dying and Bereavement has developed a model of the cyclical events that perpetuate violence at all levels including the family, community, nation, and world. This includes the Violent Act(s), the Perception of the Violent Act(s), the Immediate Response, Legitimising Authority, Destructive Codes, and Inflammatory/Polarising Strategies. It is possible at each point to break the cycle, examples are given and recommendations made.