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Comforting a Grieving
Parent
RICHARD DEW, MD, Mountain Hope Good Shepherd Clinic,
Sevierville, Tennessee
Am Fam Physician. 2011 Jan 1;83(1):79-80.
Case Scenario
A 42-year-old woman has been my patient for 17 years. She has
always been upbeat and cheerful until recently, when her 16-year-old son was
killed in a car wreck. I saw her three weeks later, and she wept throughout the
visit. After a six-week trial of antidepressants, she is no better. What can
physicians do to comfort grieving parents?
Commentary
The death of a child is the most devastating loss any parent can
face. If physicians can help even a little, we will have done something of
lasting value. Most of the things we can do may seem small to us, but are
appreciated by the parents.
When you first talk with a bereaved parent, it is best to simply
say that you are sorry for his or her loss. Nothing we say can remedy the
situation, and platitudes and cliches are seldom helpful. You should refer to
the deceased by name, and not as “your child.” You should also avoid using
phrases such as “closure,” “getting over it,” “moving on,” and “turning loose.”
These phrases imply forgetting, and parents never want to forget their child.
It is important for physicians to be familiar with the grieving
process in bereaved parents.1,2 Healing
varies from person to person, but the average time to fully adapt to the death
of a child is three to four years.3 This may be considerably longer if the child's death was
unexpected or violent. Parents may feel pressured by their friends, family,
employers, and physician to hurry up and get well. Although parents may adapt
to life without their child, they will never be the same again.
The death of a child puts a strain on the entire family unit.
Marital stresses are considerable, but, contrary to popular lore, the divorce
rate among bereaved parents is actually less than that of the general
population.4 It is important to recognize that men and women grieve
differently,5 and
this difference may exacerbate marital problems. Women tend to grieve by
talking, sharing, and crying. They are usually receptive to seeking the help of
physicians and support groups. Men are more reticent about grieving openly.
They tend to maintain a more stoic approach, often choosing to cope by
involving themselves in solitary projects or work. Mothers and fathers both
find it difficult to continue parenting their other children while mourning the
death of a child. As a result, siblings often feel neglected. Teen
Grief Relief: Parenting with Understanding, Support and Guidance is an
excellent information source for parents of surviving siblings.6
Physicians can also help grieving parents by offering simple
reassurance that their emotions are normal. If the parents are established patients,
it is appropriate to attend the child's funeral, if possible. Sending a
personal note is also appreciated. Parents often cite notes from physicians,
nurses, and office staff as being extremely meaningful. You should record the
child's birthday and the day he or she died in the parents' charts. When you
see the parents in the future, you can mention their child by name at the end
of the visit. This and a brief reminiscence show that their child is not
forgotten.
Perhaps the most helpful thing you can do is listen. Parents
need to talk. They need to tell their stories over and over. Friends,
coworkers, and many family members may find it difficult to listen after a
while, and repetitions can be emotionally draining. For this reason, physicians
should be familiar with local support resources. A grief counselor who
specializes in parental grief can be invaluable. Two well-known support groups
are The Compassionate Friends (http://www.compassionatefriends.org) and Bereaved Parents of the USA (http://www.bereavedparentsusa.org). These organizations have more than 700 support groups
nationwide where family members can share with others in the same circumstances.
The Compassionate Friends Web site has a wealth of information, sources of
literature, and online support groups and chat rooms for parents and siblings.
Statements such as “I don't care if I live or die” are common
and should be explored, but almost never indicate suicidal intent. The fact
that grieving parents are sad and often tearful does not necessarily mean that
they have a major depressive disorder (MDD). The primary symptoms of MDD in
bereaved parents are morbid preoccupation with worthlessness and psychomotor
retardation that last longer than two months, as well as suicidal ideation.
Anyone with these symptoms should be screened for MDD.
There are no controlled studies comparing parental
bereavement-related depression, which typically does not respond to
antidepressants, with MDD, which often does respond to antidepressants. The
results of a major study of widows and widowers showed that after the death of
a loved one, MDD can be expected in 13 percent of those who have never had
major depression, 30 percent of those who have had one episode of major
depression, and 43 percent of those who have had two or more episodes.7 Although many parents do not require antidepressant
medication, if it is unclear whether the patient is experiencing normal
grieving or MDD, a trial of an anti-depressant is a reasonable approach. Either
way, improvement may take a long time.
In this scenario, reassure your patient that she is grieving
normally and that you will work with her for as long as she wants. It is
appropriate to see her at two- to four-week intervals. Encourage her to attend
support group meetings and to take her spouse, if possible. Referral to a grief
counselor might also be useful. Finally, be alert for illnesses brought on by
prolonged, severe stress.
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