Kara Thieleman

When a Child Dies: A Critical Analysis of Grief-Related Controversies in DSM-5

The upcoming fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has incited vociferous debate among academics, clinicians, and the general public. Two contested changes are eliminating the bereavement exclusion from the major depressive disorder diagnosis and creating a new category for intense and prolonged grief called persistent complex bereavement-related disorder. This article critically analyzes research and debate regarding these two changes and considers the likely implications for bereaved parents and other traumatically bereaved groups, who may be especially vulnerable to consequences of the two proposed changes.

Pharmacological Treatment Following Traumatic Bereavement: A Case Series

There is little evidence to guide the use of psychotropic medications immediately following bereavement. This article presents a review of the relevant literature, followed by a case series on the use of psychotropic medication in traumatically bereaved individuals. Of 20 active subjects, nine had been prescribed psychotropic medication in the days and weeks following a traumatic loss. The amount, type, and timing of medication in this sample is explored and compared to the extant literature. Results suggest that clinical practice may not be guided by empirical research in this area.

Women Reentering the Community: Understanding Addiction and Trauma-Related Characteristics of Recidivism

Women represent 26% of those arrested for serious crimes; many have posttraumatic stress and co-occurring substance use disorders, which may influence recidivism. This study examined 57 women residing in a community re-entry program after exiting prison. Participants completed the Trauma Symptom Inventory and Substance Abuse Subtle Screening Inventory. A discriminant function analysis accounted for 34% of between-group variability and provided a profile of women who recidivated. Women who recidivated had greater alcohol dependence and lower rates of sexual dysfunction and sexual concerns. Practitioners should consider potential links between substance abuse, trauma, and sexual behavior in treatment settings.

We Rise Out of the Cradle into the Grave: An Ethnographic Exploration of Ritual, Mourning, and Death on a Hutterite Colony:

The Hutterites are a closed ethnoreligious community whose funeral traditions have remained unchanged for centuries. Few researchers have had the opportunity to study this unique group. This study is an ethnographic exploration into the experience of child death and ritual on a Hutterite colony utilizing participant-observation and interviewing. Three recurrent themes emerged: ritual/tradition, spirituality/faith, and social cohesion and integration/group identity. Observed rituals are situated within the broader framework. While some aspects of the response to death may resemble those of mainstream culture, a deeper evaluation of descriptive and structural specifics reveals some important differences. Most of the cultural contrast is contained in concrete social enactment of death rituals, shared identity, and the immutable faith in God at the center of the Hutterite mourning process. These factors may help account for the low rates of mental disorders seen among Hutterites, even following traumatic events, and would be worthy of further investigation.

“As if Nothing Happened”: Experiences of Bereaved Parents in Romania

Prior research has found high levels of distress in parents who experience the death of a child; however, Romanian parents, whose experiences are influenced by the nation’s shared historical trauma, have not been studied. This mixed-methods study found very high levels of distress in a sample of 237 bereaved parents in Romania, primarily women. Specifically, 89% of respondents scored above the clinical cutoff for trauma responses, 66% did so for anxious responses, and 82% did so for depressive responses. Qualitative analyses of respondents’ narratives suggest that, through complex interactions between political, social, and medical systems, the lack of care after the death of a child seems to incite additional distress in parents. These findings warrant further exploration of traumatic grief in Romania, especially in the context of historical and political trauma, and of ways in which support can be provided to grieving parents in this unique cultural milieu.

The Long Road to Farewell: The Needs of Families With Dying Children

Families of dying children are profoundly impacted by numerous interactions with health-care providers before, during, and after their child’s death. However, there is a dearth of research on these families’ direct, qualitative experiences with health-care providers. This study presents findings from interviews with 18 family members, predominantly parents, regarding their experiences with health-care providers during a child’s terminal illness, from diagnosis to death. The importance of compassion emerged as a salient theme, manifested in myriad ways, and connected to participants’ perception of caregiver presence in multiple domains. Families were likewise negatively affected by a wide variety of situations and behaviors that represented individual or institutional abandonment or nonpresence, and thus compounded the experience of loss. Specifics and implications for practice are explored.

Exhaust All Measures: Ethical Issues in Pediatric End-of-Life Care

ABSTRACT The death of a child may have a profound impact on parents, family members, and health care providers who provided care for the child. Unique challenges are faced by parents of seriously ill children as they must serve as the legal authority for health care decisions of children under age 18, although the child’s wishes must also be considered. Social workers must balance core social work values, bioethical values, and psychosocial issues presented by such situations. While studies have been conducted with physicians and nurses regarding ethical issues in pediatric end-of-life care settings, little is known about how social workers experience these conflicts. This article utilizes two vignettes to illustrate potential ethical issues in this setting and applies the National Association of Social Workers Standards for Palliative and End of Life Care (NASW, 2004) to explore options for their resolution. These vignettes provide descriptions of possible reactions in this setting and can be used as a basis for further exploration of ethics in pediatric end-of-life care from a social work perspective.