Education And Debate Coping with loss

Separation and other problems that threaten relationships

BMJ 1998; 316 doi: (Published 28 March 1998) Cite this as: BMJ 1998;316:1011
  1. Robert S Weiss, emeritus professor of sociology
  1. Gerontology Institute, University of Massachusetts, Boston, Boston, MA 02125, USA

    This is the third in a series of 10 articles dealing with the different types of loss that doctors will meet in their practice

    Series editors: Colin Murray Parkes and Andrew Markus

    The secure or insecure attachments made to parents in childhood often prefigure the attachments which we make in adult life and predict the pattern of grief to which they give rise after the death of a partner.1 This article examines the problems of change and loss that can arise within an established “pairbond” relationship and cause it to go wrong and, sometimes, to end. It focuses on the particular problems that may bring people into medical care.

    Although people rarely come to their doctors complaining of problems in living, many psychosomatic and psychiatric disorders are caused by marital stress, and doctors often become aware that a patient is struggling with an unhappy relationship, or dealing with its loss, in the course of a diagnostic inquiry or a discussion of treatment procedures. In such cases an understanding of the emotional causes and consequences of relational problems, and how they might best be responded to, will be useful to the practitioner. I have covered these issues in more detail elsewhere.24

    Summary points

    Relationships are an important source of security and are influenced, for good or ill, by the expectations arising out of secure or insecure attachments earlier in life

    Distrust undermines security and causes grief and anger which may further undermine trust

    Children are often at risk when parental relationships break down

    Relationships that are ending are a cause of grief in both parents and their children and may cause symptoms and requests for help

    Doctors can reassure people of the normality of their grief, provide a safe place for its expression, and assess the need for specialist …

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