Bereavement and Neurosis

Bereavement can play a central role in the aetiology of some neuroses or in the precipitation of acute neurotic conditions in adulthood (Furman, 1974; Gill, 1987; Pollock, 1989; Rando, 1993; Siggins, 1966). The psychoanalytic literature has emphasized disturbance of the mourning process in the analysis of these patients. This article presents a more inclusive perspective. My thesis will be that the psychoanalytic concept of mourning is necessary but not sufficient for the analysis of many disorders resulting from bereavement. Despite the emphasis on object loss and the vicissitudes of mourning, psychoanalysts have always used a broader perspective in the analysis of these patients. Beyond problems in the resolution of their relationship with the deceased, bereaved persons may suffer from conflicts and deficits that are structurally, genetically, and dynamically similar to other neurotic conditions amenable to analysis. I will present a multifactorial perspective on bereavement as a diverse experiential and psychological phenomena, characterized by a variety of elements and causes. Rather than limiting the analysis of bereavement to problems in mourning, I will delineate five factors (vulnerability, trauma, unconscious significance, object relations, defense, and adaptation), which I believe capture the complex nature of these conditions. Bereavement may have a pervasive impact, disturbances in mourning being just some of the possible sequelae. Acknowledging the importance of the mourning process, the proposed model includes mourning as a subcomponent of bereavement.

After a clarification of definitions and a literature review, I will provide an overview of the role of bereavement in neurosis, discussing the above-mentioned five factors. For the purpose of illustration I will show how a multifactorial viewpoint can be used in the analysis of a neurotic patient.