Death and Bereavement

Abstract

Death, including dying, and bereavement are difficult stressors. Psychiatrists are often called upon to assist dying patients and their families. The field of palliative care has come a long way since the last half of the 20th century. There are useful, humane, and ethical approaches for caring for people who are afflicted with terminal illness and effective ways to support their caregivers. Pain management, as well as assessment of anxiety, depression, suicidality, and functional impairments are important aspects of the palliative care approach. Psychiatrists take the lead in working with patients with self-inflicted injury. Suicide is a major public health problem. There are now greatly improved methods of assessing suicidality and new treatments including medication and psychotherapy are available. Bereavement and grief have been relatively neglected by medicine, including psychiatry. Acute grief is a highly painful and disruptive state. Some have even said it should be called an illness. However, there is now clear data to show that most people adjust to the death of a loved one and do not need treatment. A subgroup develops a highly distressing syndrome of complicated grief. There are now several reliable ways to identify this syndrome and an efficacious treatment has been developed. Psychiatrists need to attend to patients who are dying or who are bereaved to ensure these patients get the help they require. © 2008 John Wiley & Sons, Ltd.