Table Of ContentBEREAVEMENT
Fourth edition
The loss of a loved one is one of the most painful experiences that
most of us will ever have to face in our lives. This book recognizes
that there is no single solution to the problems of bereavement but
that an understanding of grief can help the bereaved to realize that
they are not alone in their experience.
Long recognized as the most authoritative work of its kind, this
new edition has been revised and extended to take into account
recent research findings on both sides of the Atlantic. Parkes and
Prigerson include additional information about the different cir-
cumstances of bereavement including traumatic losses, disasters,
and complicated grief, as well as providing details on how social,
religious, and cultural influences determine how we grieve.
Bereavement provides guidance on preparing for the loss of a
loved one, and coping after they have gone. It also discusses how to
identify the minority in whom bereavement may lead to impairment
of physical and/or mental health and how to ensure that they get the
help they need. This classic text will continue to be of value to the
bereaved themselves, as well as the professionals and friends who
seek to help and understand them.
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BEREAVEMENT
Studies of grief in adult life
Fourth edition
Colin Murray Parkes and
Holly G. Prigerson
First published 2010
by Routledge
27 Church Road, Hove, East Sussex, BN3 2FA
Simultaneously published in the USA and Canada
by Routledge
270 Madison Ave, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group, an Informa
business
Copyright © 2010 Colin Murray Parkes and Holly G. Prigerson
Typeset in Times by
RefineCatch Limited, Bungay, Suffolk
Printed and bound in Great Britain by
TJ International Ltd, Padstow, Cornwall
Cover design by Anú Design
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
This publication has been produced with paper manufactured to strict
environmental standards and with pulp derived from sustainable
forests.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Parkes, Colin Murray.
Bereavement : studies of grief in adult life.—4th ed. / Colin Murray
Parkes and Holly G. Prigerson.
p. cm.
Includes bibliographical references and index.
1. Bereavement—Psychological aspects. 2. Grief. I. Prigerson,
Holly G. II. Title.
BF575.G7P37 2009
155.9′37—dc22
2009006589
ISBN: 978–0–415–45118–5 (hbk)
CONTENTS
List of Figures vii
List of Tables viii
Foreword to the First Edition by John Bowlby ix
Foreword to the Fourth Edition by Robert Jay Lifton xi
Acknowledgements xiii
Introduction xiv
1 The cost of commitment 1
2 The broken heart 15
3 Trauma 33
4 Attachment and loss 48
5 Continuing bonds 68
6 Anger and guilt 90
7 Changing the assumptive world 100
8 Complications of grief 122
9 Determinants of grief I: Kinship,
gender and age 137
10 Determinants of grief II: Mode of death 152
v
CONTENTS
11 Determinants of grief III: Personal
vulnerability 164
12 Determinants of grief IV: Social and
cultural influences 181
13 Helping the bereaved I: Bereavement
support: History and evaluation 193
14 Helping the bereaved II: Types of help
for types of problem 220
15 Helping the bereaved III: Sources of help 238
16 Reactions to other types of loss 252
17 Disasters 267
Appendices 279
Organizations Offering Help to the Bereaved 305
Recommended Further Reading 307
References 309
Index 337
vi
FIGURES
1 Changes in indicators of grief over two years
post-bereavement 280
2 Mortality rate of widowers after bereavement
as a percentage of rate for married men over ten years
post-bereavement 281
3 Sedative consumption, before and after bereavement,
in forty-four widows in two age groups 291
4 Scores of insecure attachment × overall distress
in 181 persons referred for psychiatric help after
bereavement 293
5 Anxious/ambivalent attachment scores correlated
with other variables 294
6 Score of separations from parents during childhood
correlated with other variables 295
7 Avoidant attachment scores correlated with
other variables 296
8 Disorganized attachment scores correlated with
other variables 297
9 Mean grief/loneliness scores × age group × living
alone or with others 298
10 Severity of emotional disturbance in twenty-five
widows during the first three months of bereavement 298
11 Mean General Health Questionnaire scores before
and after intervention in bereaved persons in two
therapy groups and a control group 300
12 Mean outcome scores in three groups of
hospice bereaved 304
vii
TABLES
1 Psychiatrist’s predictions of cervical cancer and biopsy
diagnosis in fifty-one women admitted for investigation
of suspicious smear test 281
2 London Study: Intercorrelation of health indices
and anger in twenty-two widows 282
3 The Yale Bereavement Study: Prolonged grief disorder
(PGD) at six months predicts impairment at
thirteen months 285
4 London Study: Correlation (r) between
mean year scores on psychological measures among
twenty-two London widows 287
5 Tests of moderation for targeted population 299
viii
FOREWORD TO THE
FIRST EDITION
Some ten years ago a young psychiatrist wrote from the Maudsley
Hospital calling my attention to Darwin’s work on grief. This proved
of great value to me. Soon we had met and discovered that our
thoughts were running along similar lines. When opportunity offered,
therefore, we joined forces and a happy, mutually productive part-
nership has followed. During these years, despite uncertain financial
support, Colin Murray Parkes has devoted himself without reserve
to unravelling the problems of grief and mourning. In this admirable
book we have the fruits of his labours.
Considering the attention given to the subject by Freud half a
century ago and the classical work of Lindemann in the early 1940s,
it is remarkable that psychiatrists have been so long in recognizing
bereavement as a major hazard to mental health. Not until this past
decade has any sustained research been mounted, and hitherto few
books on grief have been published by psychiatrists.
In the understanding of an illness a turning-point comes when the
pathological processes of the illness can be seen as intensifications,
deviations, of prolongations of processes that occur in health. In
keeping with this rule, the increased understanding of grieving and
its pathological variants available today is a direct result of our
greatly increased knowledge of the processes of grieving that occur
in ordinary people. To this advancing knowledge Dr Parkes has
made major contributions. As this book goes to press the detailed
findings of studies he has conducted in the United Kingdom from
the Tavistock Institute of Human Relations and in the United States
from Harvard Medical School are being published in the scientific
journals.
Not only has Dr Parkes furthered our scientific understanding of
grieving, but he has played an active part in trying to develop means
whereby bereaved people can be helped. Through his clinical work
ix
