Editor's Choice | This Week in BMJ | Press releases
BMJ No 7120 Volume 315 Letters Saturday 29 November 1997
Death of Diana, Princess of WalesPeople experiencing emotional difficulties react in different waysSee Education and debate p 1457
Editor One common response was related to the individual's experience of loss. For example, an HIV positive gay man with a depressive illness in remission had given a friend's funeral eulogy days before the event. He felt he had coped well by 'putting [his] grief behind [him]' despite the resonance with his situation. The public grief resulted in tearfulness and thoughts of his death, leading to a better attitude towards his future. He developed no symptoms of depression. In another instance, a widow unable to progress through her grief found that actively mourning Diana allowed her to express hidden emotions about her partner and her father, who had also died suddenly. In another case a man who had been HIV positive for 13 years reported identifying with Diana's feelings of loneliness at being misunderstood and victimised. This enabled him to deal with his anger at people's response to his diagnosis in the early days of public awareness. Finally, a professional man coming to terms with his homosexuality was driven to strong feelings of anger about the public expression of emotion, which he perceived as threatening because he feared a loss of the carefully established control of his feelings and behaviour. The intense public feeling seems to have influenced the cognitions and affect of people who were already vulnerable. The death of a public figure perceived as psychologically troubled but who seemed to have made a constructive adjustment could, by a process of identification, lead to feelings of loss and grief.(1) These could be magnified by observing others express emotions, a phenomenon recognised in situations such as suicidal behaviour.(4) What remains unclear is what the longer term effect of this public grief will be: life events research shows that there may be an increase in psychiatric morbidity.(5) A formal diagnosis of depression, however, requires symptoms to be present for 2 weeks (international classification of diseases, 10th revision). As in the above examples, this public and constructive expression of feelings may be beneficial, leading to a reduction in psychological distress.
Edwina R L Williams Specialist psychiatric
registrar
Jean Meadows Department and information
coordinator
References
1 Smith R. Death of Diana, Princes of Wales: a special life
forged from adversity. BMJ 1997;315:562. (6 September.)
2 Depression linked to Diana's death. Guardian
1997 September 24:4.
3 Morris B. GPs called into action to help nation recover from
shock of Diana's death. BMA News Review 1997 September
24:18.
4 Gunnell D, Frankel S. Prevention of suicide: aspirations and
evidence. BMJ 1994;308:1227-33.
5 Brown G W, Harris T. The social origins of
depression. London: Tavistock, 1978. Her death and funeral rate as traumatic stressorsEditor,In a report of links between the death of Princess Diana and depression, Dr André Tylee, the director of the Royal College of General Practitioners' mental health unit, was reported as stating that people countrywide were experiencing grief and psychological distress.(1) However, the death of Princess Diana is not characteristic of traumatic events, or stressors, seen in the research literature on post-traumatic stress disorders arising from war combat, assault, and natural and human disasters. Nevertheless, symptoms associated with post-traumatic stress disorder can be found in people not directly exposed to the traumatic event(2) or exposed to stressors that do not meet the DSM-III-R criteria of severity.(3) In light of such findings, we measured the degree of psychological distress that the death and funeral of Princess Diana caused. We used the impact of events scale,(4) which was designed to
assess the impact of any specific traumatic event and has been shown to
have sound psychometric properties. In relation to a specific event,
respondents rate the frequency of intrusive thinking and avoidance
tendencies during the pr Three weeks after Princess Diana's death the scale was administered to
an opportunity sample of 205 respondents drawn from a city in the
midlands. Of those indicating their age (47%), the mean was 40.97
(SD=17.45, range 17-82) years. The death of Princess Diana was used as
the specific traumatic event for 102 respondents and the funeral for
103.
The mean (SD) score on the impact of events scale was 16.94 (12.75) for
the death of Princess Diana and 19.17 (13.32) for the funeral. Scores
ranged from 0 to 44 for the death of Princess Diana (28% scored above
the diagnostic cutoff score of 25) and from 0 to 57 for the funeral
(32% above the cutoff).
These results show that the profound psychological impact of the death
and funeral of Princess Diana can be equated with traditional stressors
identified in the trauma research literature, evidenced by a
substantial percentage (28-32%) of our sample that showed symptoms
indicating post-traumatic stress.
Mark Shevlin Lecturer
References
1 Morris B. GPs called into action to help nation recover from
shock of Diana's death. BMA News Review 1997
September 24:18.
2 Herlofsen P. Group reactions to trauma: an avalanche
accident. In: Ursano B G M, Fullerton C S, eds.
Individual and community responses to trauma and disaster: the
structure of human chaos. Cambridge: Cambridge University
Press, 1994:248-66.
3 American Psychiatric Association. Diagnostic and
statistical manual of mental disorders (DSM III-R). Washington,
DC: APA, 1987.
4 Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a
measure of subjective stress. Psychosom Med
1979;41:209-18.
5 Shapiro F. EMDR: Level 1 training manual. Pacific
Grove, CA: EMDR Institute, 1996:46.
|