Intended for healthcare professionals

Education And Debate

Coping with loss: Bereavement in adult life

BMJ 1998; 316 doi: (Published 14 March 1998) Cite this as: BMJ 1998;316:856
  1. Colin Murray Parkes, consultant psychiatrist (
  1. St Christopher's Hospice, Sydenham, London SE26 6DZ

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

    Doctors are well acquainted with loss and grief. Of 200 consultations with general practitioners, a third were thought to be psychological in origin; of these, 55—a quarter of consultations overall—were identified as resulting from types of loss.1 In order of frequency the types of loss included separations from loved others, incapacitation, bereavement, migration, relocation, job losses, birth of a baby, retirement, and professional loss.

    After a major loss, such as the death of a spouse or child, up to a third of the people most directly affected will suffer detrimental effects on their physical or mental health, or both.2 Such bereavements increase the risk of death from heart disease and suicide as well as causing or contributing to a variety of psychosomatic and psychiatric disorders. About a quarter of widows and widowers will experience clinical depression and anxiety during the first year of bereavement; the risk drops to about 17% by the end of the first year and continues to decline thereafter.2 Clegg found that 31% of 71 patients admitted to a psychiatric unit for the elderly had recently been bereaved.3

    Despite this there is also evidence that losses can foster maturity and personal growth. Losses are not necessarily harmful.

    Yet the consequences of loss are so far reaching that the topic should occupy a large place in the training of health care providers—but this is not the case. One explanation for this omission is the assumption that loss is irreversible and untreatable: there is nothing we can do about it, and the best way of dealing with it is to ignore it. This attitude may help us to live with the …

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