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Erich Lindemann's Beyond Grief is an important book, especially for psychoanalysts in private practice who work primarily with individuals. The major theme is a contemporary psychoanalytic message: in understanding a person not only must the unconscious dynamics be appreciated, but the individual's problems must be conceptualized within the larger context of life crisis theory, available support systems, and community social change.
Dr. Lindemann's thesis is direct: the central issue in mental health is the ability to deal with losses. Each person's life is full of major and minor losses and mourning reactions. Those who cope well can again become integrated; those who have difficulties will develop emotional or physical problems.
Early in his career, as a researcher at Iowa Psychopathic Hospital, Lindemann introduced the use of sodium amytal as a “truth serum” or cure for amnesia. Dr. Stanley Cobb invited him to continue this research at Massachusetts General Hospital. While working with surgical patients, he notices that the loss of part of the body (a hysterectomy, for example) produced a depressive reaction with a significant component of anger, analogous to that in grief reactions. He was able to identify patients who would develop pathological reactions upon leaving the hospital and facing new social and emotional relationships. Notably, he found a difference in prognosis between those who viewed the operation with a sense of promised relief in contrast to those who perceived it as a threatening mutilation and loss of pleasure.
Freud's monumental “Mourning and Melancholia” introduced us to the dynamics of bereavement. Twenty-five years later, Dr. Lindemann was the first to systematically explore this area in his “Symptomatology and Management of Acute Grief.” He emphasized the hostility and guilt in grief, and identified pathological reactions: delayed responses, increased intensity and duration, absence of reaction, identification with symptoms of the deceased,