Grief reactions treated in a psychiatric out-patient clinic

Grief reactions to the death of a close relative are not commonly treated in psychiatric out-patient clinics in Japan. However, recently our clinic has had a chance to see such cases. I analyzed 11 cases of grief reactions (7 females, 4 males). The first part of this paper focuses on the distinction between normal and abnormal grief reactions, and an attempt was made to classify grief reactions in the nosology. Following this, three factors were specified as enhancing vulnerability to bereavement: (1) sex (female), (2) age (middle-aged), and (3) cause of death (sudden death). The second part focuses on the dependency seen in the subjects, which was their most marked personality traits. Finally, vertical splitting as defined by Kohut and Kasahara was discussed as a defense mechanism in the crisis of bereavement. The bereaved person preserves a positive image of the deceased and his or herself by vertical splitting, thereby eliminating negative experiences and feelings (denial). This manifested itself in a strong feeling of solidarity with the deceased (identification). The treatment of the subjects followed a fairly good course, but five patients required more than 1 year. Four patients visited the clinic after the termination of their treatment because of a relapse of their depression.