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Grieving would seem at first glance to be one of the conditions for
which the physician, especially if the etymology of the name of his
profession be taken strictly, should not be called upon to minister,
nor his remedies be expected to relieve. Grief is usually supposed to
be due to moral ills and, therefore, at most to come under the care of
the alienist, with the feeling that even he can accomplish very little
for what is an affective rather than a true mental disorder. There is
no doubt at all, however, that grieving, especially in the excess that
shows it to be pathological, is always associated with certain
physical and mental conditions for which the physician can accomplish
much. Indeed more often than not the physical condition of the
grief-stricken person is a prominent factor in the production of the
state of feeling which causes grief to be exaggerated, while, on the
other hand, this state of mind itself reacts upon the physical
being so as to make it more sluggish in all its functions, and as a
consequence a vicious circle of cause and effect is formed affecting
unfavorably both the mental and physical conditions. It is when
patients are run down in health that grief becomes extremely difficult
or apparently impossible to bear and grief itself still further brings
about a deterioration of health that makes the mind's reactionary
power against its gloomy feelings still weaker than they were.

Viewed in this way, grief is an ailment that should properly come to
the physician for treatment and with regard to which that important
principle is eminently true that the physician cannot always cure, but
he can nearly always relieve, and he can always console his patients.
On the one hand, an improvement in the general health always make
grief easier to bear because it increases the resistive vitality of
both mind and body. On the other, any diversion of mind that lifts the
burden of grief even to some degree, releases new stimuli and physical
powers for the restoration of bodily function to the normal and this
brings about an immediate lessening of the depressive condition. In a
word, for the vicious circle of unfavorable influences ever pushing
the victim farther into depression, a virtuous circle, in the Latin
sense of the word virtue, meaning courage, favoring strength, must be
formed, that brings about an immediate improvement in the patient's
mental and physical well-being. This is not a pretty bit of theory but
is the result of the experience of every physician who has ever taken
seriously the problems of caring for the grief-stricken.

Natural and Pathological Grief.--It is, of course, not easy to
distinguish between grief that may be called morbid in the sense of a
melancholy, that is, more than natural--a true mental disease--and
that which represents only an affective state accompanied by
depression from which there will be complete reaction. A mother loses
a favorite, it may be an only son, and is plunged into grief. For
days, even weeks, she refuses to take any interest in life, she thinks
moodily about the awful affliction that has come to her and how blank
the future is, and she cannot be aroused to attend either to her own
affairs or to the duties of life around her. Such a grief is, in many
cases, not more than the normal depression incident to such a loss. If
after months, however, the mother still continues to refuse to take
interest in life and the things around her, especially if, besides,
she now talks of having been visited with this punishment because of
some unpardonable sin in her own life, or because the Deity has been
offended beyond all hope of propitiation, then the case verges over
into one of true melancholy in which the mental depression is not
merely a symptom of a passing condition, but partakes of the nature of
a mental disease, or is the consequence of a profound neurotic

It must not be forgotten that there is always the danger that
exaggerated grief, as it seems for the moment to be, may be only the
first symptom of a true melancholic condition. Only too often friends
and physicians have been deceived by this. Some of the sad cases of
self-destruction and a few cases of homicide and suicide have followed
a condition that seemed to be only abnormal grief for the loss of a

Etiology.--The cause of exaggerated, prolonged grief is, in a
considerable proportion of the cases, a melancholic tendency, that is,
a failure on the part of the mind to react against depression.
The weakness of mind that predisposes to this may be inherent or
acquired. Sometimes no special loss is needed to produce melancholia
in susceptible individuals, while occasionally it is precipitated by
some misfortune, inasmuch as this is a mental disease, very little can
be done directly, and yet the patient can be helped and diversion of
mind may bring a good measure of relief. More often, however, the
reason for persistent grieving is that before the disturbing loss came
into the life of the individual there had been a serious deterioration
in health. This was due to the conditions preceding the unfortunate
event. Wives sometimes have worn themselves out physically and
mentally while nursing husbands, or mothers their children, and this
has produced a lack of physical force which prevents them from
reacting with healthy mentality against the subsequent shock of loss.

Prophylaxis..--For the melancholic tendency prophylaxis cannot be
special, but must be general. We cannot prevent people from suffering
serious losses, but we can foresee the possibility of a loss proving
very depressing, and can, therefore, try to keep the individual in
reasonably good physical condition. If this is done the subsequent
depression will be much less than it otherwise would be. Very often
there is little or no recognition of the fact that there is a definite
tendency in some patients to too great an inclination toward
melancholic thoughts, and it is not until an exaggerated manifestation
of it comes that the danger is realized. It is not easy to make
patients realize the dangers, but where the physician talks with
assurance and points out definite things to do in order to prevent
serious developments, patients, or at least their friends, can be made
to appreciate the dangers.

The best demonstration that I know of the value of work as a remedy
for grief is my experience with members of religious orders. For them,
as a rule, there is no interruption in life no matter what the loss
may be. Their work goes on the day after the funeral just as before.
This is the most precious possible arrangement, time and occupation of
mind are the two factors that will dull the edge of grief and while
humanly we may resent the consolation that is thus brought by such
conventional things as the passage of time and humdrum occupations,
they represent nature's resources. Above all, patients must be given
something to do and if that something concerns other suffering human
beings, there is every reason to expect relief.

Treatment.--The most important element in the treatment of grief cases
is to prevent physical running down as far as possible and to build up
the physical condition. Depression that comes to patients who have
lost considerable weight, even though it may show some of the signs of
melancholia, is always hopeful. Where patients are twenty or thirty
pounds under weight the recovery of weight up to the normal condition
will often mean the relief of their depressed condition. The one hope
lies in this physical improvement. Mental treatment by diversion of
mind must, of course, be practiced. This does not mean getting the
patients interested once more in trivial things, but to be successful
it means arousing the deeper feelings of their nature. Above all, the
solace of tears will often save depressed and grieving persons from
themselves. An interest in the sufferings of other people that awaken
their sympathy will do the most to end exaggerated grieving over their
own loss. The self-centeredness of their grief is the principal reason
for its exaggeration. It is because of overestimation of their
own importance and of the importance of their loss that these people
suffer severely.

Motives of Consolation.--The main resource of the physician who
would employ psychotherapy for the treatment of those who are grieving
beyond the limit of what is normal, is to supply motives by which they
can understand the real significance of their loss. Very often,
especially in young folks, there is no proper estimation of values in
life and no recognition of the fact that human life was evidently not
meant for happiness since that comes to but few, while suffering and
partings are inevitable. They come to all, and apparently will always
continue to do so. It is the young or, at least, those under middle
age, who are most likely to be affected by exaggerated depression over
losses and disappointments. Older folks have grown more accustomed to
such incidents. These patients must be made to see how many motives
there are to take their grief philosophically and while permitting
themselves the luxury of sorrow, not to let this interfere either with
their physical condition or their mental state to such a degree as to
prevent them from taking the proper interest in their duties in life.

The ethical motives that may be urged to keep people from grieving
over-much are many, but there is sometimes the feeling in the
physician's mind that it is scarcely his business to emphasize them in
any way. It is supposed that to the clergyman must be committed the
task of consoling people for losses in life. This has always seemed to
me a serious mistake. As physicians we know how much the mind
influences the body and since it is our duty to care for the body, we
must, above all and first of all, care for the mind as far as we can.
Mens sana in corpore sano is a very old motto and is usually taken
only in the sense that to have a healthy mind one must have a healthy
body. In its Latin form, however, it might very well also be taken to
mean that to have a healthy body one must have a healthy mind. Since
grief has an untoward influence on the body, physicians are bound to
learn what to do for it in any and every possible way and to exercise
every faculty they have for its relief. This is all the more true
because in recent years many persons have no regular religious
attendant who would come to offer them consolation or to whom they
would go in their trouble. It is not at all with the idea of
infringing on the rights of the clergy or invading his territory that
I would insist not only on the right of the medical man, but even his
duty, to afford consolation to the mind as well as relief for the

The Family Physician.--In older times the family physician was a
friend of the family to whom people turned in all troubles where he
might possibly be of aid, with just as much confidence and as promptly
as they did to their religious attendant. Unfortunately, in the
progress of medicine, though still more because of the social
vicissitudes that have taken place in recent years, this relationship
of the family physician has been largely diminished, but that
constitutes only one more reason why every physician, to whose
attention the grief of a patient for any loss is presented as a cause
of ill-health, should know all the means and be ready to employ them
for the amelioration of the condition. As a matter of fact, there is
often a feeling on the part of patients that it is more or less the
business of the clergyman to afford consolation and that the
performance of his duty in this matter is somewhat conventional, not
as if he performed it less thoroughly because of this, but as if
the feeling of the routine practice detracted from its effectiveness.
Some of the motives for consolation advanced by the clergyman, then,
lose in significance, in some persons' minds at least, because of this
feeling, while motives presented by the physician rather gain in
weight because of the impression that he is a thoroughly practical
man, deeply interested in life's problems from a common-sense
standpoint, and who knows the motives for consolation because he has
realized that losses are inevitable, suffering unavoidable, and grief
sure to come, though somehow we must learn to bear up bravely under
life as we find it.

Physicians have always done this in the past, but in more recent years
either they have lost the habit, or have considered it unworthy of
their profession, or else, perhaps, only too often they themselves
have had no motives to offer that might seem sources of consolation
for those in suffering and especially those who are grieved for the
loss of friends. If life were a mere chance, if there were not an
evident purpose in it, if, as Lord Kelvin insisted, science did not
demonstrate (not "suggest" but "demonstrate" is the word he used) the
existence of a Creator and a Providence, Who, while caring for the
huge concerns of the universe, can just as well employ Himself with
the little details of human life, then there would be some reason for
physicians thinking that their science kept them from seeking
consolation from the ordinary motives. Even if they occupy an advanced
agnostic position, however, they may still find sources of consolation
that, if not so effective as those attached to the old beliefs, at
least will provide something for the forlorn to take hold of, that
will mitigate their grief and sense of loss and make the present and
the future look not all too blank.

Few men have been so thoroughly agnostic as Prof. Huxley, yet on the
death of his wife he found that some of the thoughts of the old
beliefs might prove a source of consolation. Huxley had loved his wife
very dearly and their separation by death meant very much. The epitaph
that he wrote for her sums up his doubts yet plucks out of them
something to console, expressed in old Scriptural language:

And if there be no meeting past the grave.
If all is darkness, silence, yet 'tis rest.
Be not afraid, ye waiting hearts that weep.
For God still giveth His beloved sleep;
And if an endless sleep He wills, so best.

Attitude Toward Death.--The ordinary attitude of people toward death
is a very curious one. Death is the one absolutely certain thing in
life after birth, yet most of us live our lives without much regard to
it, and whenever it comes and under whatever circumstances, at
whatever age, it is always a shock to us. No matter how old people are
it always comes a little before it is expected. When death comes it is
always a shock and all that can be said of it is what Hamlet resents
when the commonplace consolations for the loss of his father, who also
lost a father and so on all down the course of history, are offered to
him. Perhaps, however, as much the reason for his resentment was the
person who offered the consolation as the form of the consolation
itself, which, after all, exhausts nearly all that we can say in this
matter for grief for near and dear ones:

'Tis sweet and commendable in your nature, Hamlet,
To give these mourning duties to your father:
But, you must know, your father lost a father;
That father lost, lost his; and the survivor bound
In filial obligation, for some term
To do obsequious sorrow: but to persevere
In obstinate condolement, is a course
Of impious stubbornness: 'tis unmanly grief:
. . . Fie! 'tis a fault to heaven,
A fault against the dead, a fault to nature.
To reason most absurd, whose common theme
Is death of fathers, and who still hath cried,
From the first corse, till he that died to-day,
"This must be so."

Death and Pain.--One of the most effective consolations in our day
for all classes of people, quite apart from religious affiliations or
beliefs, is the sociological import of death and suffering in the
world. Life, without suffering and death in it, would be a riot of
selfishness. Men, as a rule, would not care for others at all, the
weak would go to the wall, the individuals who possess less efficiency
than others would simply have to make out as best they could, and bad
as social conditions are now, they would be intolerably worse. As it
is the young and strong and vigorous have very little of true
sympathy. Nothing makes a man feel for others like having gone through
some suffering himself. On the other hand, nothing makes him feel the
impotence of struggling ceaselessly for vain success and the futile
rewards of life than to lose near and dear friends whose share in that
success and joy over the rewards would constitute their only real
value and justification. As a man grows older and has gone through
some of the sufferings and has had to bear the losses of life, he
learns more and more to feel for others, he is ready even to make
sacrifices that others may not have to suffer as he has suffered, he
has charity for them for the sake of his own suffering and that of
near and dear ones, and things are much better than they could
possibly be without suffering and death.

Therapy by Example.--Many men have taken losses so seriously as to
think that life held no more for them, and have foolishly given up
their occupations, yet have found that Time, the great healer, could
work his marvels in their case as well as in most others and that new
interests and, above all, their life work, could arouse them to a
sense of duty and bring them back to the old routine of life. Dr.
Mumford, in his "Sketch of Sir Astley Cooper," tells the story of how
even that veteran surgeon gave up everything at the death of his wife
and yet found, after a year of idleness, that he had to come back to
the old life again. Dr. Mumford says: "Sir Astley Cooper was an
emotional man. In 1827 his wife died, and the event prostrated him
with grief. He felt that all the interests of life were over for him.
He fell into an acute physical decline, sold his town house, threw up
his practice and other professional employments, and retired to his
country place to pass his last days. Within a year of the sad event he
had returned to town, taken another house, resumed practice with
increased vigor, and married again. He was then sixty years old, he
lived on until 1841, and died in his seventy-fourth year."

A typical example of how much a strong man whose diplomatic ability
had stamped him as one of the large men of his generation may yet be
afflicted beyond measure by a loss of this kind is to be found in the
life of the second Lord Lytton. I have told it somewhat in detail in
the chapter on Periodic Depression. After the death of his boy Lord
Lytton, who for more than a week of anguish had watched unceasingly at
the death-bed of his dying son, came to the conclusion that God was
not in His world or, at least, that the arm of Providence was
shortened if such (as it seemed to him) needless suffering was
permitted. The boy had probably suffered much less than the bystanders
thought and much less than he seemed to, for in these cases nearly
always there is a merciful deadening of the senses that to a great
extent eliminates suffering, but Lord Lytton could not understand and
refused ever to look at life from the same standpoint afterwards. This
is, of course, only what happens in many cases, but it represents an
exaggeration of grief since death and suffering have always been in
the world and sometimes they will come to those near and dear to us,
much as we may resent it.

Neither profound intelligence nor the sympathetic genius of the poet
or artist is sufficient to safeguard men against the severer forms of
griefs for loss. Louis, the distinguished French physician (to whom we
in America are indebted so much as the Master of the Boston and
Philadelphia schools of diagnosis, and, above all, for his teaching of
the differentiation between typhoid and typhus fever), suffered so
much from the loss of his son that he could scarcely be consoled.
Dante Gabriel Rossetti was so much affected by the death of his wife
that he put into her coffin the only manuscript copy of his poems that
he possessed. It is interesting to learn that some years later he had
the coffin exhumed and took out his manuscript at the urging of
friends, and published the poems. Many other examples of this kind
might be given, for exaggeration of grief affects all classes and
conditions in life. They are practically always pathological, usually
on a basis of somewhat disturbed mentality, though often the real
underlying and predisposing condition is the physical exhaustion that
has preceded the loss and which makes patients unable to bear the
strain of it after weeks of care, solicitude, anxiety and neglect of
eating and sleep.

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