When Does Bereavement Become Pathological?

The death of a loved one is always painful and often devastating. Every culture has its own mourning process and accompanying expected ritual and behaviors. But at some point mourners are expected to return to their usual activities of daily living. Just when is that point and what should you do if someone you know can't get on with their lives after the death of a loved one?

What is expectable and appropriate bereavement?

After a death a mourner may experience a major depression. That means they will have significant changes in their eating and sleeping patterns, have a feeling of worthlessness and hopelessness or feelings of guilt regarding the deceased and their relationship. At times they may hear the voice or believe they see the deceased. It is generally believed that any of these symptoms should be considered appropriate for two months after the death.

Conversely, a mourner may not display any symptoms at all. They return to their normal activities very soon after the death and seem fine. This may be an indication of a lack of emotional connection to the deceased or a defense against allowing themselves to feel pain that they fear will overwhelm them. People who react this way may find themselves experiencing the pain of the loss years down the road.

When should you become concerned that your loved one is not recovering from their loss?

Unless a person is expressing suicidal ideation or a suicidal plan there is no need for mental health intervention for at least two months. By that time the mourner should have resolved most of the symptoms of depression though mood and affect may remain flat and sad. They should no longer be hearing voices or seeing things that are not there though the voice of the deceased may still call to them. Their ability to concentrate should have returned sufficiently enough for them to be able to return to work and focus on familiar tasks. They should not have any suicidal ideation or plans. Personal hygiene and home maintenance should return to whatever was previous to the death. They should not be experience psychomotor agitation - excessive pacing, rocking in their chair, hyperactivity - that was not present before. There should not be psychomotor retardation - a sense of moving in slow motion.

After two months mourning is not over but the mourner should show signs of wanting to get back to their usual activities and a decrease in depressive behavior. It is possible for some people to experience pathologic mourning and not be able to move past the devastation of the loss. Supportive family and friends should consider helping that person to meet with a mental health professional to assess the need for bereavement counseling.