Women's Mental Health in Primary Care

By Kathryn J. Zerbe | Go to book overview

Chapter 9 Catastrophic Loss and
Bereavement

Death is an inevitable fact of life. Usually, clinicians can safely distance themselves from the array of maladies experienced by patients—a healthy form of denial that declares, "This is happening to my patient, not to me." Sometimes this defensive strategy serves them well, helping to maintain objectivity. But such is not the case with death. Most physicians as well as others will witness the ravages of fate when someone dear becomes ill, and ultimately, all will themselves be struck down. Few individuals have the pluck of Katherine Hepburn, who quipped, "Death will be a great relief. No more interviews." Most are more in synch with Woody Allen, who incisively observed, "It's not that I'm afraid to die. I just don't want to be there when it happens."

Physicians don't want to be there either—not for their own deaths, nor for the deaths of their patients. Perhaps this is one reason they have such a difficult time helping patients face a fatal illness or the loss of a loved one. Both experiences are such arbitrary levelers of all human beings.

Add to this observation the realization that relatively little is taught in medical school or residency training about how to actually work with dying or bereaved patients, such as the parent who has suffered an obstetric catastrophe or lost a child. Certainly, most clinicians are familiar with Kubler-Ross' (1969) classic review of the stages of death and dying, but as helpful as such guides may be in outlining the issues, they do not teach physicians what to actually say or do to facilitate the healing of those who must learn to deal with their anguish. Most important, clinicians are not taught how to metabolize their own feelings about terminal illness, medical catastrophes, and death. This omission not only robs them of an opportunity to learn about their own humanity but it also has a negative impact on their care for patients. Often, clinicians fail to acknowledge patients' struggles—let alone help them—to bear up through a time of profound adversity.

Fortunately, these mistakes can be rectified. This chapter aims to help the primary care clinician assist the woman who is facing a fatal illness, who has suffered a medical (particularly an obstetric) catastrophe, or who is otherwise bereaved. 1 It demonstrates how this personal involvement can teach clinicians

____________________
1
Although emphasis in this chapter is placed on terminal illness and bereavement, clinicians are reminded that women who divorce also experience acute and unacknowledged losses (see Chapter 13). Because society does not generally perceive her situation as a loss, the woman receives little sympathy or support. Health care providers must attune themselves to the special burdens that divorced patients face, and many of the principles in this chapter apply generally to the divorced patient as well as the bereaved. Divorced women are particularly likely to face severe financial reversals that alter their living circumstances and affect their physical and emotional well-being. Clinicians must remember that the divorced woman loses not only a spouse but also his extended family. Moreover, important friendships are often strained or eroded.

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Women's Mental Health in Primary Care
Table of contents

Table of contents

  • Women's Mental Health in Primary Care *
  • Preface vii
  • Acknowledgments xi
  • Contents *
  • Chapter 1 - Anxiety Disorders 1
  • Chapter 2 - Depression 31
  • Chapter 3 - Bipolar Disorder 55
  • Chapter 4 - Misuse of Substances 73
  • Chapter 5 - Eating Disorders 109
  • Chapter 6 - Trauma and Violence 139
  • Chapter 7 - Insomnia 165
  • Chapter 8 - Somatization 181
  • Chapter 9 - Catastrophic Loss and Bereavement 199
  • Chapter 10 - Major Medical Illness 219
  • Chapter 11 - Menstruation, Pregnancy, and Menopause 247
  • Chapter 12 - Psychosis 273
  • Chapter 13 - Sexuality and Intimacy 291
  • Chapter 14 - The Older Patient 319
  • Afterword 347
  • General Resources for Patients 350
  • Index 353
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