Education and debate

Coping with loss

Facing loss

BMJ 1998; 316 doi: 10.1136/bmj.316.7143.1521 (Published 16 May 1998)
Cite this as: BMJ 1998;316:1521

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  1. Colin Murray Parkes, consultant psychiatrist (cmparkes@aol.com)
  1. St Christopher's Hospice, Sydenham, London SE 26 6DZ

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

    To conclude this series, I examine some of the problems that explain why the care that is needed in situations of bereavement and loss may not be provided, and I suggest some solutions.

    Summary points

    • Losses may go unrecognised because they are concealed or avoided by those who experience them, misrepresented by caregivers, or take place very gradually

    • Losses are often concealed or misrepresented out of kindness, but the supposed harmful consequences of revealing the truth rarely match the harmful consequences of concealment

    • Men military personnel members of emergency services and doctors are often expected to inhibit grief. They are also likely to find it difficult to ask for help

    • Even mothers who have planned for and eagerly anticipated the birth of a child may need to grieve for the many losses that result from it

    • The most important thing that members of the healthcare team have to offer to those who are afraid is a relationship of trust and respect, from which they can explore the situation they face, share the feelings that arise, and review the implications of loss

    Why losses may go unrecognised

    Although the death of a spouse or child is a public event that seldom goes unrecognised, many other types of loss do not attract attention or support to those who suffer them. This has been called disenfranchised grief.1 It is not unusual for more than one of the reasons listed in the box to apply.

    People with unrecognised losses are of particular importance to members of the healthcare professions for three reasons: their physical and mental health may be at risk; they seldom come to the notice of the usual caring agencies; and we often find …

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