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Grief, the mourning after: Dealing with adult bereavement
Journal o/‘A~chosomoric Printed m Great Britain.
M)22-3999/91 $3.00 + .Xl Pergamon Press plc
Research, Vol. 35, No. 2/3, pp 375-382, 1991
BOOK REVIEWS
Grief,
the Mourning
After:
Dealing
with Adult Bereavement.
CATHEKINEM. SANUERS. New
York:
Wiley.
THIS is a good general account of the state of our knowledge of the psychology of bereavement by death. Catherine Saunders is a psychologist who had conducted a thorough review of the literature on bereavement and carried out her own study of the relationship between personality and grief in 115 people bereaved by loss of a spouse, child or parent. She writes well and her text is enriched with vivid case examples. This is not a scientific treatise and contains no statistical data or detailed discussion of methodology. It cannot, therefore, be taken as a serious scientific contribution as there is little new thinking to be found in these pages. The author’s own ‘Integrative Theory of Bereavement’ contains little that has not already been postulated by others but does serve to remind us that several different perspectives need to be taken into account in any attempt to explain the various patterns of grteving. Sanders’ variant of Bowlby’s ‘phases of grief (( 1) shock, (2) awareness of loss, (3) conservation/withdrawal, (4) healing and (5) renewal) mixes description and interpretation in a somewhat confusing way. Thus the first two are essentially descriptive and the last three explanatory. The section on conservation/withdrawal confuses fatigue, hibernation, exhaustion of ‘energy’ and ‘withdrawal’, four very different phenomena. It takes no account of the serious critique of models of mental ‘energy’ made by John Bowlby (1982). The fourth phase ‘healing’ is described as a ‘turning point’ but a point cannot be a phase and the distinction between phases 4 and 5 is not made clear. The ‘turning point’ would seem to be the transition from (3) to (5) and represent a change in attitude from looking back to looking forward. The idea of relating pattern of grieving to personality type is a good one but in opting for the MMPI as her measure of personality Sanders saddles herself with an instrument that is irrevocably linked to medical theory and inappropriate to an interpretation of bereavement that tries to avoid unnecessary ‘medicalization’. Thus in labelling the subgroup of people who see themselves as insecure, inadequate and/or inferior as ‘schizoid personalities with depressive reaction’ she is employing medical diagnostic terms with very little validity and her suggestion that this group need ‘tremendous nurturance and empathy’ is likely to encourage dependence on the counsellor. The assumption that the MMPI administered after a bereavement is a valid measure of personality before bereavement is called in question by the finding that ‘almost invariably’ those bereaved people who MMPI scores caused them to be classed as ‘depressed’ showed a history of multiple family losses. It would seem reasonable to conclude that it is the losses that cause the depression. These criticisms apart there are some excellent chapters particularly 11 which outlines the effects of bereavement on the family and 12 which focuses on the effects on parents of the death of a child. Both of these widen our understanding of aspects of bereavement that have not been well covered elsewhere. The least satisfactory aspect of the book is its coverage of the practical provision of counselling. No account is given of the type of service which is widely employed in hospices throughout the world and which has been developed in the organisation Crusr in the U.K.-the recruitment, training and supervision of volunteer counsellors backed by professionally trained psychologists, social workers and/or psychiatrists. When used to support bereaved people at special risk of lasting disturbance this type of service has been shown to reduce that risk. No mention is made by Sanders of the major evaluations of bereavement services which have been carried out in the U.K. to assess, by random allocation, the value of family support after the death of a parent (Black 1987) and the value of a hospice based service of the type described above (Parkes. 1981). In a book of this length, which attempts so much, it is inevitable that Sander’s reviews of the work of others will be somewhat cursorv and uncritical. Even so this reviewer found most of her generalizations fair and well founded. Overall this is a book which can be recommended to those who want a medium length general review of the topic and would find Raphael’s ‘Anulomy of‘ Berecrrwnent’ too long and Osterweis ‘~crecrcenrent: Recrciion. Consequence and Cure’ too scientific,
COLIN MURRAY PAKKES
The London 375
Hospital
Medical
College
376
Book Reviews REFERENCES
I.
1 5:
BLAW DV. UKHAYOWIC.~MA. Family
intervention with bereaved children. .I i‘hrld Ps,,c/rol P.~t~hicrr 1981; 28: 467 476. BOWLHY J. Atrcrc~hntrn/ Vol 1 of A/ruc~hm~~r rend Lo.vv. 2nd Edition pp. 13 23. London: Hogarth. PAKKES CM. Evaluation of Bereavement Service. J Pret- P.~rchirrr 19X1; 1: 179 188.
The Clinical Application of MMPI Special Scales. Erlbaum. 1989. I32 pp. Prtce &l9.00.
Edited
by EUGENE E LFAITT. New Jersey:
Lawrence
THIS small
book is the product of several years review of the application of scales of the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI has been widely criticized as containing vague, unfocused questions of doubtful validity and as an instrument whose function is unclear. The principal debate has focused on whether the inventory was originally designed for differential diagnosis of psychiatric syndromes or for measuring personality characteristics of normal people. In any event. it has been widely applied for both purposes and, not surprisingly. for a long and detailed questionnaire, the items of the MMPI have been grouped and regrouped into many hundreds of subscales, many of which have not been subjected to rigorous examination of their validity and reliability. This volume attempts to address this problem and deliver what are considered to be the most well validated and helpful subscales for the measurement of adjustment, personality and psychopathology. This is clearly a specialized book for those who apply the MMPI in their research and clinical work. Unfortunately it appears at a time when the MMPI has undergone extensive revision and thus its usefulness must be limited.
DK MICHAEL K ~NC; Book Review Editor Royal Free Hospital London
Males With Eating Disorders. Edited by AKI‘;OLI) E AYDEKSON. Eating Disorders New York: Brunner:‘Mazel, 1990. 288 pp. Price $28.95.
Monograph
Series. No. 4.
THIS
book reviews what is known about the presentation. natural htstory and response to treatment of eating disorders in men. Although most of the contributors are North American. one or two prominent English and Canadian experts have also contributed. The principal theme is that bulimia and anorexia nervosa occur in men. are frequently overlooked or misdiagnosed and appear to run a very similar course to that in women. The real interest lies in attempts to explore the differences between the sexes and draw out possible causal inlluences. An early chapter contains a poignant and insightful personal account by a psychologist who suffered with bulimia nervosa. There is considerable speculation that men with difficulties in sexuality might be more prone to develop an eating disorder. Several authors claim that homosexual men are ovcrrepresented in case series. Other authors disagree. Perhaps conflicts over sexual development. which for many adolescents may include doubt about their sexuality. is a key factor in both sexes rather than homosexuality per :Y. Nevertheless it is suggested that body shape and slimness are of greater importance to homosexual than heterosexual men and therein may lie similar socio-cultural pressures to those already affecting young women in western society. This view assumes a simplistic polarization of sexuality into homosexual and heterosexual and ignores the real complexities inherent to the understanding of sexual orientation. Furthermore. it is hampered by an inadequate knowledge of representative groups of homosexuals and bisexuals in the community. The book closes with a particularly well argued chapter by the editor concermng the origins of these disorders in both sexes. In it he argues strongly for a model of operant conditioning in the development and maintenance of eating pathology. Although useful as a collection of much of the known work on these disorders in men, tt is somewhat repetitive and includes much data already available elsewhere. Basically. however, thts book is a good read. which is saying something for any academic tome. DK MICHAI,L KIW; Book Review Editor Royal Free Hospital London
M)22-3999/91 $3.00 + .Xl Pergamon Press plc
Research, Vol. 35, No. 2/3, pp 375-382, 1991
BOOK REVIEWS
Grief,
the Mourning
After:
Dealing
with Adult Bereavement.
CATHEKINEM. SANUERS. New
York:
Wiley.
THIS is a good general account of the state of our knowledge of the psychology of bereavement by death. Catherine Saunders is a psychologist who had conducted a thorough review of the literature on bereavement and carried out her own study of the relationship between personality and grief in 115 people bereaved by loss of a spouse, child or parent. She writes well and her text is enriched with vivid case examples. This is not a scientific treatise and contains no statistical data or detailed discussion of methodology. It cannot, therefore, be taken as a serious scientific contribution as there is little new thinking to be found in these pages. The author’s own ‘Integrative Theory of Bereavement’ contains little that has not already been postulated by others but does serve to remind us that several different perspectives need to be taken into account in any attempt to explain the various patterns of grteving. Sanders’ variant of Bowlby’s ‘phases of grief (( 1) shock, (2) awareness of loss, (3) conservation/withdrawal, (4) healing and (5) renewal) mixes description and interpretation in a somewhat confusing way. Thus the first two are essentially descriptive and the last three explanatory. The section on conservation/withdrawal confuses fatigue, hibernation, exhaustion of ‘energy’ and ‘withdrawal’, four very different phenomena. It takes no account of the serious critique of models of mental ‘energy’ made by John Bowlby (1982). The fourth phase ‘healing’ is described as a ‘turning point’ but a point cannot be a phase and the distinction between phases 4 and 5 is not made clear. The ‘turning point’ would seem to be the transition from (3) to (5) and represent a change in attitude from looking back to looking forward. The idea of relating pattern of grieving to personality type is a good one but in opting for the MMPI as her measure of personality Sanders saddles herself with an instrument that is irrevocably linked to medical theory and inappropriate to an interpretation of bereavement that tries to avoid unnecessary ‘medicalization’. Thus in labelling the subgroup of people who see themselves as insecure, inadequate and/or inferior as ‘schizoid personalities with depressive reaction’ she is employing medical diagnostic terms with very little validity and her suggestion that this group need ‘tremendous nurturance and empathy’ is likely to encourage dependence on the counsellor. The assumption that the MMPI administered after a bereavement is a valid measure of personality before bereavement is called in question by the finding that ‘almost invariably’ those bereaved people who MMPI scores caused them to be classed as ‘depressed’ showed a history of multiple family losses. It would seem reasonable to conclude that it is the losses that cause the depression. These criticisms apart there are some excellent chapters particularly 11 which outlines the effects of bereavement on the family and 12 which focuses on the effects on parents of the death of a child. Both of these widen our understanding of aspects of bereavement that have not been well covered elsewhere. The least satisfactory aspect of the book is its coverage of the practical provision of counselling. No account is given of the type of service which is widely employed in hospices throughout the world and which has been developed in the organisation Crusr in the U.K.-the recruitment, training and supervision of volunteer counsellors backed by professionally trained psychologists, social workers and/or psychiatrists. When used to support bereaved people at special risk of lasting disturbance this type of service has been shown to reduce that risk. No mention is made by Sanders of the major evaluations of bereavement services which have been carried out in the U.K. to assess, by random allocation, the value of family support after the death of a parent (Black 1987) and the value of a hospice based service of the type described above (Parkes. 1981). In a book of this length, which attempts so much, it is inevitable that Sander’s reviews of the work of others will be somewhat cursorv and uncritical. Even so this reviewer found most of her generalizations fair and well founded. Overall this is a book which can be recommended to those who want a medium length general review of the topic and would find Raphael’s ‘Anulomy of‘ Berecrrwnent’ too long and Osterweis ‘~crecrcenrent: Recrciion. Consequence and Cure’ too scientific,
COLIN MURRAY PAKKES
The London 375
Hospital
Medical
College
376
Book Reviews REFERENCES
I.
1 5:
BLAW DV. UKHAYOWIC.~MA. Family
intervention with bereaved children. .I i‘hrld Ps,,c/rol P.~t~hicrr 1981; 28: 467 476. BOWLHY J. Atrcrc~hntrn/ Vol 1 of A/ruc~hm~~r rend Lo.vv. 2nd Edition pp. 13 23. London: Hogarth. PAKKES CM. Evaluation of Bereavement Service. J Pret- P.~rchirrr 19X1; 1: 179 188.
The Clinical Application of MMPI Special Scales. Erlbaum. 1989. I32 pp. Prtce &l9.00.
Edited
by EUGENE E LFAITT. New Jersey:
Lawrence
THIS small
book is the product of several years review of the application of scales of the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI has been widely criticized as containing vague, unfocused questions of doubtful validity and as an instrument whose function is unclear. The principal debate has focused on whether the inventory was originally designed for differential diagnosis of psychiatric syndromes or for measuring personality characteristics of normal people. In any event. it has been widely applied for both purposes and, not surprisingly. for a long and detailed questionnaire, the items of the MMPI have been grouped and regrouped into many hundreds of subscales, many of which have not been subjected to rigorous examination of their validity and reliability. This volume attempts to address this problem and deliver what are considered to be the most well validated and helpful subscales for the measurement of adjustment, personality and psychopathology. This is clearly a specialized book for those who apply the MMPI in their research and clinical work. Unfortunately it appears at a time when the MMPI has undergone extensive revision and thus its usefulness must be limited.
DK MICHAEL K ~NC; Book Review Editor Royal Free Hospital London
Males With Eating Disorders. Edited by AKI‘;OLI) E AYDEKSON. Eating Disorders New York: Brunner:‘Mazel, 1990. 288 pp. Price $28.95.
Monograph
Series. No. 4.
THIS
book reviews what is known about the presentation. natural htstory and response to treatment of eating disorders in men. Although most of the contributors are North American. one or two prominent English and Canadian experts have also contributed. The principal theme is that bulimia and anorexia nervosa occur in men. are frequently overlooked or misdiagnosed and appear to run a very similar course to that in women. The real interest lies in attempts to explore the differences between the sexes and draw out possible causal inlluences. An early chapter contains a poignant and insightful personal account by a psychologist who suffered with bulimia nervosa. There is considerable speculation that men with difficulties in sexuality might be more prone to develop an eating disorder. Several authors claim that homosexual men are ovcrrepresented in case series. Other authors disagree. Perhaps conflicts over sexual development. which for many adolescents may include doubt about their sexuality. is a key factor in both sexes rather than homosexuality per :Y. Nevertheless it is suggested that body shape and slimness are of greater importance to homosexual than heterosexual men and therein may lie similar socio-cultural pressures to those already affecting young women in western society. This view assumes a simplistic polarization of sexuality into homosexual and heterosexual and ignores the real complexities inherent to the understanding of sexual orientation. Furthermore. it is hampered by an inadequate knowledge of representative groups of homosexuals and bisexuals in the community. The book closes with a particularly well argued chapter by the editor concermng the origins of these disorders in both sexes. In it he argues strongly for a model of operant conditioning in the development and maintenance of eating pathology. Although useful as a collection of much of the known work on these disorders in men, tt is somewhat repetitive and includes much data already available elsewhere. Basically. however, thts book is a good read. which is saying something for any academic tome. DK MICHAI,L KIW; Book Review Editor Royal Free Hospital London