Clinicians Digest Nov/Dec 2008 - Page 3


The DSMND is a compilation of "disorders" described in DSM language by people on the autistic spectrum who are tired of being marginalized and of described in pejorative terms that masquerade as scientifically objective language. After all, if autistic people have flat affects and few social skills, don't normal people have scattershot emotions and an inability to be alone?

Treating Complicated Grief

Researchers in a recent study using neuroimaging to look at the brains of people suffering from complicated grief—unusually long grieving that significantly impairs people's lives—were puzzled by a curious fact: when mourners in the control group, who were experiencing a gradual diminishment of their sorrow, looked at reminders of their deceased loved ones, the reward centers of their brains lit up along with the emotional pain centers. But the mourners suffering from complicated grief, who seemed to be feeling worse and worse about the loss, didn't show any activation of their reward centers, only a response in the pain centers.

This study seems to validate a brief treatment used for years by Boulder, Colorado, therapists Steve and Connirae Andreas, who developed their treatment by talking to "successful" grievers and discovering that such people kept the deceased's presence comfortably alive inside. As one widow reported, "Joe died 10 years ago, and it's like he's still with me when I go to the grocery store."

People who can't get over grieving feel they're supposed to sever their emotional connection with the deceased, a task which they find intolerable, so the Andreases encourage them to create and maintain a positive connection. First they ask the mourner to think about someone important in his life who's alive but not present—perhaps someone important from years ago, or a friend who lives across the country. This shows the mourner that he already knows how to maintain a positive emotional connection with someone who's physically gone. They ask how the mourner imagines the presence of this person. Sometimes the mourner experiences the person as whispering from behind a veil, for example, or as perching inside his head.

Then as they continue through the steps of their process, the Andreases help the mourner reimagine the distant or sorrow-filled image of the deceased person as a felt presence similar to the alive but physically absent person in his life. This usually allows someone experiencing complicated grief to get unstuck fairly quickly and move on to the type of mourning that's so much a part of life. "Grieving isn't about saying good-bye to someone," notes Andreas. "It's about saying hello."

Resources

Affairs: American Journal of Family Therapy 36, no. 4 (July 2008): 265-83; Journal of Marital & Family Therapy (forthcoming 2009). Deep Brain Stimulation: Mt. Sinai Journal of Medicine 75 (June 2008): 263-75; Biological Psychiatry 64, no. 6 (15 September 2008): 461-67. PTSD: Clinical Psychology Review 28, no. 5 (June 2008): 746-58.SSRIs & Love: www.helenfisher.com. Complicated Grief: NeuroImage 42, no. 2 (August 2008): 969-72; Andreas article at http://www.steveandreas.com/Articles/grief02.html.

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