the inner codifications of my experiences. They defy the reductionism of words as they hold and mirror the complexity of my early attachments, link past to present, and point to my future. As organizer of my past, this world of symbol and image holds my polarities of hate and love, bad and good.
It is the vocabulary of creativity that allows for ego flexibility and the revision of seemingly unchangeable patterns of loving and mourning.
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3
Complicated Grief
Briana MacWilliam and Dina Schapiro
A brief history
Complicated grief occurs when an individual experiences prolonged, unabated grief. The neural mechanisms distinguishing complicated grief from non-complicated grief are unclear, but hypothesized mechanisms include both pain-related pathways, related to the social pain of loss, and reward-related pathways, related to attachment behavior (O’Connor et al., 2008). Four principles of attachment functioning are helpful in understanding complicated grief (Shear et al., 2007):
1.Attachment relationships provide support for healthy physical, mental, and emotional functioning.
2.Mental representations of attachment figures shape our expectations for caregiving.
3.Stress activates a need to be close to our attachment figures and receive loving attention, while inhibiting our desire to explore and seek novel stimulation.
4.Among adults, providing care is valued equally or even more so than receiving care.
Acute grief and the process of integrating the loss usually occur naturally and without the need for active effort. Once the loss is integrated, yearning and searching diminish, grief intensity declines, and there is often a deep feeling of connection to the deceased. Individuals suffering from complicated grief fail to experience reprieve from pain and longing. Caught in a loop of prolonged grief symptoms and complicating psychological and/or life problems, time seems to stand still, frozen at the time of the loss or death. Complicated grief also appears most prevalent in individuals engaging in grief-related avoidance behaviors, such as refraining from activities they enjoyed performing with the lost or deceased attachment figure, because of the fear of intensifying sadness and yearning for the person (Shear et al., 2011). For brief periods, this may be helpful in mediating acute distress, but over a prolonged period it could lead to a dysfunctional turning away from reality (see “Six myths about grief,” in Chapter 1).
The concept of pathological mourning has been around since Sigmund Freud’s seminal paper “Mourning and Melancholia,” but it began receiving formal attention more recently. In the 1980s and 1990s, researchers noticed that antidepressant medications relieved such depressive feelings as sadness and worthlessness but did nothing for other aspects of grief, such as pining and intrusive thoughts about the deceased. The finding suggested that complicated grief and depression arise from different circuits in the brain (Hughes, 2011).
Two models of grief have been hypothesized: a detachment model and a reunion model (Bowlby, 1980). In the detachment model, the grief emotion is believed to play a role in the acceptance of the reality of the death and therefore assist in recovery from the loss. In the reunion model, the grief is a form of protest against separation from the deceased, and serves to promote reunion with the lost person, not detachment. Freed and Mann (2007) hypothesize that if the detachment model is correct, the pangs of grief would occur with reduced activity in the brain’s reward system over time, as the acceptance of the loss leads to detachment. If the reunion model is correct, the pangs of grief would continue to occur simultaneously with reward activity in the brain, when exposed to “cues of the deceased” (such as memories, photos, etc.), motivating reunion with the deceased.
In 2008, Mary-Frances O’Connor and a team of researchers scanned the brains of women who had lost their mother or a sister to cancer within the past five years, and compared the results of women who had displayed typical grief with those suffering from complicated grief. While both groups displayed activity in neural pathways related to pain, for those with complicated grief their reward centers lit up as well. This is the part of the brain that lights up on imaging scans when addicts look at photographs of drug paraphernalia and when mothers see pictures of their newborn infant. This doesn’t necessarily mean women are addicted to their feelings of grief, but rather they still feel attached to the deceased. This is significant, because it not only supports the hypothesis that attachment
