Descriptive Psychopathology: The Signs and Symptoms of ...

344 Section 3: Examination domainsNormal bereavement is best understood within the context of the sufferer’sfamily and culture. Cultural rituals, religious and family beliefs associated withdeath and dying, and the person’s family role (e.g. dependent, head-of-household)shape normal bereavement. The circumstances of the death also affect the bereaved(e.g. suicide is less acceptable than accidental death). Patient 14.2 illustrates.Patient 14.2A 22-year-old Asian-American college student committed suicide by jumpingfrom a third floor balcony. He had seen a college counselor for depression,who had recommended treatment. When the patient related his sadness to hisfamily, however, he was told to work hard and pray. Immediately before hisdeath, he asked his roommate to have lunch with him, but the roommate saidhe was busy and unable to go. After his death, the family refused to admit thathe had committed suicide and erroneously maintained that his roommate andbest friend had accidentally killed him by pushing him off the balcony.Bereavement is worsened when the death is unexpected, random (e.g. in drive-byshootings), or involves other deaths (e.g. school shooting). The death of a longtimespouse has adverse social network consequences as well as being a personalloss. The death of a spouse may elicit greater sorrow than the death of a friend.The death of a parent is more traumatic for young children and adolescents thanit is for adult children. 60 The death of one’s child elicits a greater mourning thanthe death of a parent. 61Bereavement also varies in intensity and in associated behaviors across cultures,but is stereotypic within cultures. In Northern Europe, stoicism is thenorm. The Irish typically throw a party where the participants often cry andlaugh simultaneously. Telling humorous stories is in fashion at public memorials.In the Middle East, mourners scream, beat their chests, tear their hair, andcollapse. Political and religious cults demand rapturous behavior in response tothe death of their leaders.Cultures vary in their display rules and have varying degrees of tolerance forexpressing grief. 62 For example, a comparison of grief symptoms in Spanish andUS men and women found that although both groups perceived loss of a lovedone similarly, persons in the USA reported a more negative impact of bereavement,feeling more sense of loss, anger, loneliness, confusion, and guilt. Spaniardswere more likely to accept mortality. 63Terminal illnessPatients during the terminal phase of illness experience anxiety and sadness.Cancer patients are the most studied. They, as other patients when terminally