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Tuesday, February 20, 2007

Yearning is primary emotion after death of a loved one

Contrary to traditional notions of grief after the death of a loved one, a new study finds that yearning is felt more powerfully than depression.

Researchers from Harvard Medical School and Yale University School of Medicine found that yearning was the strongest negative emotion after loss, they report in tomorrow's Journal of the American Medical Association.

Negative emotions associated with grief peaked within six months, meaning people with more prolonged symptoms might need more help after that point. And the researchers recommend that the standard psychiatric reference, the Diagnostic and Statistical Manual of Mental Disorders, be revised to focus less on depression after the death of a loved one.

"Yearning is reacting to the loss of someone or something, and once that is gone, you miss it, you pine for it, you hunger for it, you crave it. That was the primary emotional experience after bereavement, rather than depression," Holly G. Prigerson, one of the authors, said in an interview. "This suggests that the DSM reconsider what the natural response to loss is, especially with respect to depression and yearning."

Prigerson is an associate professor of psychiatry at Harvard and director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute.

Prigerson and her colleagues were testing the theory that people respond to loss by moving through disbelief, yearning, anger, depression and acceptance, with depression being the dominant negative emotion. To do that they interviewed 233 people in the Yale Bereavement Study for up to two years following the death of a loved one from natural causes.

The participants in the study, mostly widows, did experience the five stages of grief in the sequence popularized by Elisabeth Kubler-Ross's description of terminally ill patients, but yearning was the most powerful negative emotion and, on average, participants' worst feelings peaked within six months. The level of acceptance -- the strongest emotion of all -- rose steadily over six months.

In contrast, the DSM focuses exclusively on depressive symptoms, saying they should be expected two months after a loss, Prigerson said.

Prigerson emphasized that the people in the study had lost loved ones to natural causes, reflecting 94 percent of deaths in the United States. People who had lost a child or a loved one after a traumatic death, such as a car crash or suicide, were excluded from the study.

The ones who knew for six months or more that their loved ones had a terminal illness reached acceptance sooner than those who had less time to prepare for the death, the study found.

"People never get over a loss, they just get used to it," Prigerson said. "Even years after someone dies, they get pangs of grief, they need to think about the person, and they miss them with heartache," she said. "That's normal. But intense levels beyond that become problematic."


Posted by Elizabeth Cooney at 04:14 PM
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