Disordered Variants

Sorrow concealed, like an oven stopp'd,

Doth burn the heart to cinders where it is.

A great deal of the literature on disordered mourning derives from the work of psychoanalysts and other psychotherapists who have traced the emotional disturbances of some of their patients to a bereavement suffered at some earlier time. Not only has an enormous amount been learned from these studies about the psycho-pathology of mourning but it was these findings that first drew attention to the field and led on to the more systematic studies of recent years. In this chapter we start by drawing on the findings of these recent studies because, based as they are on fairly representative samples, they present a broader and more reliable perspective in which to view the problems than can findings drawn exclusively from psychiatric casualties. Once the scene is set, however, the therapeutic findings become an invaluable source for deepening our understanding of the processes, cognitive and emotional, that are at work.

Disordered variants of mourning lead to many forms of physical ill health1 as well as of mental ill health. Psychologically they result in a bereaved person's capacity to make and to maintain love relationships becoming more or less seriously impaired or, if already impaired, being left more impaired than it was before. Often they affect also a bereaved person's ability to organize the rest of his life. Disordered variants can be of every degree of severity from quite slight to extremely severe. In their lesser degrees they are not easily distinguished from healthy mourning. For purposes of exposition, however, they are described here mainly in their more extreme versions.

In one of the two disordered variants the emotional responses to