Psychological vulnerability to cancer in bereavement and grief.
Fiche publication
Date publication
décembre 2013
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BACQUE Marie-Frédérique
Tous les auteurs :
Bacque MF
Lien Pubmed
Résumé
Bereavement consequences are not well enough recognized, although international epidemiological studies results are convergent. Loss of a spouse or a child in its first year increases morbimortality in the survivor. Mortality may double in the widower whereas this sustained risk diminishes within two or three decades. Opposite to wrong beliefs, it is not the risk of cancer that increases after a loss but the risk of cardio-vascular diseases rate. Grief has many common manifestations with depression. But grief is not a major depressive disorder. Working through bereavement is a psychodynamic process that changes with persons and losses. In grief, sad feelings alternate with happy memories. There is neither devalorization nor out-of-proportion selfaccusations, and no suicidal ideation, even if death seems desirable to find back the loved one. Finally, suffering alleviates progressively whereas complicated bereavement often becomes a major depressive disorder that may be prolonged without treatment. The link between bereavement and cancer remains in suffering experiences that the author will bring from her clinical practice: minimizing first symptoms of cancer, accepting cancer but as the price to pay for guilt, prolonging grief to keep the dead inside and lack of interest for the actual disease. To set a limit to the psychological vulnerability linked to bereavement in cancer, it seems adequate: 1) to train caregivers and physicians to the psychosomatic consequences of bereavement and to the distinction between uncomplicated and complicated grief; 2) to interview the patient about personal important life events prior to cancer and adjustment to cancer treatments; 3) to propose a psychological support as well as a social support to avoid the medicalization of bereavement; 4) to better know how to manage psychotropic drugs and the articulation between psychotherapy and drugs in case of bereavement complications.
Référence
Psycho-oncologie. 2013 Dec;7(4):228-34.