Erich Lindemann Symptomatology and Management of Acute Grief Introduction seem to be a medical or ‘At first glance, acute grief would not t oe prchiae. disorder in the strict sense of the word bul rather 4 Pye reaction to a distressing situation. However, the writ norman of reactions to traumatic experiences whether or not TY semtsmnt clear-cut meuroses has become of everncrensing ie 141-448, by permis of Payehiaury, 101 (1041), Reprint from American Journal of Pyehitry. 101 (MHD, WIN EY Ty peor author and publisher (Copyright 194%, Americun Jour tance to the psychiatrist, Bereavement or the sudden cessation of social interaction seems to be of special interest because it is often cited among the alleged psychogenic factors in psychosomatic dis- orders, ‘The enormous increase in grief reactions due to war casual- ties, furthermore, demands an evaluation of their probable effect on the mental and physical health of our population. “The points to be made in this paper are as follows: 1. Acute grief is a definite syndrome with psychological and somatic symptomatology. 2. This syndrome may appear immediately after a crisi bbe delayed; it may be exaggerated or apparently absent. 3. In place of the typical syndrome there may appear distorted pictures, each of which represents one special aspect of the grief syndrome. 4. By appropriate techniques these distorted pictures can be suc- cessfully transformed into a normal grief reaction with resolution. Our observations comprise 101 patients, Included are (1) psycho- neurotic patients who lost a relative during the course of treatment, (2) relatives of patients who died in the hospital, (3) bereaved disaster victims (Cocoanut Grove Fire) and their close relatives, (4) relatives of members of the armed forces. ‘The investigation consisted of a series of psychiatric interviews. Both the timing and the content of the discussions were recorded. ‘These records were subsequently analyzed in terms of the symptoms reported and of the changes in mental status observed progressively through a series of interviews. The psychiatrist avoided all sugges- tions and interpretations until the picture of symptomatology and spontaneous reaction tendencies of the patients had become clear from the records. ‘The somatic complaints offered important leads for objective study... « it may Symptomatology of Normal Grief ‘The picture shown by i i if m by persons in acute grief is remarkably uniform. Common to all is the following syndrome: sensations ‘of somatic stress occurring in waves lasting from twenty minutes to a ata time a feeling of tightness in the throat, eicking with is of breath, need for sighing, and an empty feeling lack of muscular power, and an intense subjective d 4s tension or menial pain, ‘The patient soon learns th188 Grief and Mourning: The Reaction to Death ee of discomfort can be precipitated by visits, by mentioning the de- chased, and by receiving sympathy. There is a tendency to avoid the syndrome at any cost, to refuse visits lest they should precipitate the reaction, and to keep deliberately from thought all references to the deceased. se ettting features are (1) the marked tendency to sighing respiration; this respiratory disturbance was most conspicuous when The patient was made to discus his grief, (2) The complaint about Teck of strength and exhaustion is universal and is described 3 fellows: “It i almost impossible to climb up a stairway.” | “Every thing T lift seems so heavy.” “The slightest effort makes me foc ie ted.” T can’t walk to the corer without feeling exhausted (3) Digestive symptoms are described as follows: “The food tse A eed “T have no appetite at all.” “I stuff the food down Désause T have to eat” “My saliva won't flow.” “My abdomen feels bellow." “Everything seems slowed up in my stomach.” “The sencorium is generally somewhat altered. There is com, monly a light sense Of unreality, a feling of increased emotions Tiaanee from other people (sometimes they appear shadowy or GMMH!), and there is intense preoccupation with the image of the JRenazed, A. patient who lost his daughter in the Cocoanut Grove