Loss : Sadness and Depression

Bowlby's seminal contribution to the way we understand attachment concludes with an examination of loss. He offers not only a new developmental model but also rare insight into the dynamics of mourning, the problems of depression, and the processes of accommodation and healing. An appreciation by Daniel Stern, whose research on the mother/infant bond affirms and expands on Bowlby's work, fittingly graces this new edition.

John Bowlby is honorary staff member of the Tavistock Clinic in London.

Foreword

xiii

Acknowledgments

xv

Preface

1

(6)

Part I: Observations, Concepts and Controversies

The Trauma of Loss

7

(16)

Prelude

7

(2)

Grief in infancy and early childhood

9

(5)

Do young children mourn? a controversy

14

(5)

Detachment

19

(4)

The Place of Loss and Mourning in Psychopathology

23

(15)

A clinical tradition

23

(1)

Ideas regarding the nature of mourning processes, healthy and pathological

24

(10)

Ideas to account for individual differences in response to loss

34

(4)

Conceptual Framework

38

(6)

Attachment theory: an outline

38

(3)

Stressors and states of stress and distress

41

(3)

An Information Processing Approach to Defence

44

(31)

A new approach

44

(1)

Exclusion of information from further processing

44

(2)

Subliminal perception and perceptual defence

46

(6)

Stages at which processes of defensive exclusion may operate

52

(7)

Self or selves

59

(5)

Some consequences of defensive exclusion

64

(5)

Conditions that promote defensive exclusion

69

(3)

Defensive exclusion: adaptive or maladaptive

72

(3)

Plan of Work

75

(6)

Part II: The Mourning of Adults

Loss of Spouse

81

(31)

Sources

81

(4)

Four phases of mourning

85

(18)

Differences between widows and widowers

103

(3)

Note: details of sources

106

(6)

Loss of Child

112

(14)

Introduction

112

(1)

Parents of fatally ill children

113

(9)

Parents of infants who are stillborn or die early

122

(2)

Affectional bounds of different types: a note

124

(2)

Mourning in Other Cultures

126

(11)

Beliefs and customs common to many cultures

126

(6)

Mourning a grown son in Tikopia

132

(2)

Mourning a husband in Japan

134

(3)

Disordered Variants

137

(35)

Two main variants

137

(4)

Chronic mounrning

141

(11)

Prolonged absence of conscious grieving

152

(9)

Mislocations of the lost person's presence

161

(8)

Euphoria

169

(3)

Conditions Affecting the Course of Mourning

172

(30)

Five categories of variable

172

(1)

Identity and role of person lost

173

(5)

Age and sex of person bereaved

178

(2)

Causes and circumstances of loss

180

(7)

Social and psychological circumstances affecting the bereaved

187

(8)

Evidence from therapeutic intervention

195

(7)

Personalities Prone to Disordered Mourning

202

(12)

Limitations of evidence

202

(1)

Disposition to make anxious and ambivalent relationships

203

(3)

Disposition towards compulsive caregiving

206

(5)

Disposition to assert independence of affectional ties

211

(11)

Tentative conclusions

222

Childhood Experiences of Persons Prone to Disordered Mourning

214

(15)

Traditional theories

214

(1)

The position adopted

214

(4)

Experiences disposing towards anxious and ambivalent attachment

218

(4)

Experiences disposing towards compulsive caregiving

222

(2)

Experiences disposing towards assertion of independence of affectional ties

224

(5)

Cognitive Processes Contributing to Variations in Response to Loss

229

(16)

A framework for conceptualizing cognitive processes

229

(3)

Cognitive biases affecting responses to loss

232

(2)

Biases contributing to chronic mourning

234

(5)

Biases contributing to prolonged absence of grieving

239

(1)

Biased perceptions of potential comforters

240

(2)

Biases contributing to a healthy outcome

242

(1)

Interaction of cognitive biases with other conditions affecting responses to loss

243

(2)

Sadness, Depression and Depressive Disorder

245

(20)

Sadness and depression

245

(1)

Depressive disorder and childhood experience

246

(4)

Depressive disorders and their relation to loss: George Brown's study

250

(11)

The role of neurophysiological processes

261

(4)

Part III: The Mourning of Children

Death of Parent during Childhood and Adolescence

265

(11)

Sources and plan of work

265

(6)

When and what a child is told

271

(2)

Children's ideas about death

273

(3)

Children's Responses when Conditions are Favourable

276

(19)

Mourning in two four-year-olds

276

(9)

Some tentative conclusions

285

(5)

Differences between children's mourning and adults'

290

(2)

Behaviour of surviving parents to their bereaved children

292

(3)

Childhood Bereavement and Psychiatric Disorder

295

(16)

Increased risk of psychiatric disorder

295

(5)

Some disorders to which childhood bereavement contributes

300

(11)

Conditions Responsible for Differences in Outcome

311

(9)

Sources of evidence

311

(1)

Evidence from surveys

312

(5)

Evidence from therapeutic studies

317

(3)

Children's Responses when Conditions are Unfavourable

320

(25)

Four Children whose mourning failed

320

(1)

Peter, eleven when father died

321

(6)

Henry, eight when mother died

327

(6)

Visha, ten when father died

333

(5)

Geraldine, eitht when mother died

338

(7)

Deactivation and the Concept of Segregated Systems

345

(5)

Disordered Variants and Some Conditions Contributing

350

(31)

Persisting anxiety

351

(3)

Hopes of reunion: desire to die

354

(4)

Persisting blame and guilt

358

(3)

Overactivity: aggressive and destructive outbursts

361

(4)

Compulsive caregiving and self-reliance

365

(5)

Euphoria and depersonalization

370

(6)

Identificatory symptoms: accidents

376

(5)

Effects of a Parent's Suicide

381

(9)

Proportion of parents' deaths due to suicide

381

(1)

Findings from surveys

382

(1)

Findings from therapeutic studies

383

(7)

Responses to Loss during the Third and Fourth Years

390

(22)

Questions remaining

390

(1)

Responses when conditions are favourable

390

(7)

Responses when conditions are unfavourable

397

(15)

Responses to Loss during the Second Year

412

(13)

A transitional period

412

(1)

Responses when conditions are favourable

412

(4)

Responses when conditions are unfavourable

416

(9)

Young Children's Responses in the Light of Early Cognitive Development

425

(16)

Developing the concept of person permanence

425

(8)

The role of person permanence in determining responses to separation and loss

433

(8)

Epilogue

441

(2)

Bibliography

443

(20)

Author Index

463

(4)

Subject Index

467

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Loss : Sadness and Depression

Summary

Author Biography

Table of Contents

Supplemental Materials