Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 15 Bereavement and Grief 305
ment is weak. Eberl (2008) found that no rigorous evidence-based recommendations
could be made regarding the treatment of bereaved
persons.
Two trials of manual-based therapies for grief have been reported
(National Cancer Institute, 2009). Shear, Frank, Houch, and Reynolds
(2005) carried out a trial in which they compared their complicated grief
treatment (CGT) with manual-based interpersonal therapy (Klerman,
et al., 1984). CGT was found to produce superior results on several measures.
Boelen, de Keijser, van den Hout, and van den Bout (2007) found
that a version of cognitive-behavioral therapy was superior to supportive
counseling.
ASSESSMENT OF THE RELATIONSHIP BETWEEN
SEVERITY AND POIGNANCY OF GRIEF
Several scales have been devised to measure the severity of grief, such
as the Texas Revised Inventory of Grief (Neimeyer, Hogan, & Laurie,
2008). Such scales attempt to establish prognostic criteria and separate
the component factors. A distinction that can be made both intuitively
and from studies of resulting data is between the poignancy of grief and
its effect on functioning. Consider the following two vignettes:
A prosperous professional couple in the United States has one child.
She is intelligent, happy, healthy, and pretty. When she is 6 years old, she
is killed in a school bus crash.
A 70-year-old woman, living in a country without social security or
state pensions, has suffered years of abuse from a violent, domineering
husband. She cannot read or write or drive a car. Her husband is killed
when her village is bombed.
In the first case, the parents suffer severe pain, but they return to a
kind of functioning that externally appears normal. In the second case,
the pain from the loss of companionship is minimal, but the widow faces
destitution.
Scales such as the Social Readjustment Scale measure the impact of
life events on function (Holmes & Rahe, 1967). On such scales, the effect
of a loss may not have a direct relationship to its poignancy. Widowhood
is considered by Holmes and Rahe to be the most severe of
life-changing events, in spite of the fact that not all husbands are loved.
It is the knowledge that widowhood is often accompanied by a series of
other life-changing events that increases its stressfulness.