Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 15 Bereavement and Grief 299
formed and vivid; panic attacks and phobias; anger to the point of violence;
and a prolonged stage similar to clinical depression with weight
loss, insomnia, and self-neglect.
In spite of the persuasive evidence of a disease model, the idea persists
that grief is not a medical matter. Failure to experience grief is sometimes
regarded as a moral failure rather than a sign of good mental health.
Existentialist philosophers from Kierkegaard to Sartre have regarded
our ability to suffer grief as a sign of our humanity and would have looked
askance at attempts to devise an effective antigrief medicine.
Freud, in Mourning and Melancholia (1917/1982, p. 197), pointed
out that grief could produce severe mental abnormality but felt that any
attempt at medical treatment was inadvisable or even harmful (Freud,
1917/1957, p. 125).
MANAGEMENT OF SYMPTOMS
Agitation and Weeping
Tears and wailing are the most familiar reactions to acute bereavement.
They are described by Darwin (1872, p. 45) as follows, “When a mother
loses her child sometimes she is frantic with grief. . . . She walks wildly
about, tears her clothes or hair and wrings her hands.”
Darwin regards these reactions as the earliest response, but they are
often delayed. Their familiarity does not mean they are easier to deal
with. Shouting, wailing, moaning, and keening occur. The bereaved may
run wildly, disregarding all social restraints. They may throw themselves
on the corpse and refuse to be parted from it. Such extremes are difficult
to witness, and caregivers themselves can become distraught and
tearful.
In spite of these extremes of behavior, such reactions can be expected
and regarded as normal. Many caregivers, often from their own experience,
have learned their own ways of responding. These emotional expressions
of grief are socially sanctioned to such an extent that failure to
manifest them can arouse concern. If numbness is not followed by this
type of reaction, caregivers may believe that emotion is being repressed
and that this is a bad thing. The public, and some professionals, fear that
repressed emotions will eventually surface in harmful ways. Caregivers
may turn to mental health professionals to express their anxiety at this
supposed suppression.