Freeman and Ward/ DEATH AND BEREAVEMENT 223 PATHOLOGICAL GRIEVING: ABNORMAL GRIEF RESPONSE Mourning is the outward expression of grief and is best dealt with in social settings that provide the bereaved with support and reinforcement in their reactions to the loss. Worden(1991)cited three social conditions that tend to give rise to complications in the grieving process: the loss is socially unspeakable(cg, suicide ) the loss is socially negated. mcaning the person and those around him or her act as if no loss had occurred (e. g, abortion, miscarriage); and the absence of a social support network (e. g. isolation that occurs after the loss when everybody disappe:rs) Horowitz defined pathological or abnormal grief as the intensification of grief to the level where the person is overwhelmed. resorts to maladaptive behavior, or remains interminably in the state of grief without progression of the mourning process toward completion. It involves processes that do not move progressively toward assimilation or accommodation but instead, lead to stereotyped repetitions or extensive interruptions of heal ing( Horowitz, Wilmer, Marmar, Krupnick 1980. p 1 157) Much of the bereavement literature looks at age, relationship to the deceased, and a variety of other situational factors(Campbell. Swank.& Vincent. 1991: de Vries 1997: de vries. Davis. Wortman. Lehman 1997 Grad zavasnik 1996 Rando, 1987: Rubin schechter 1997: Scharlach 1991).Research(de Vries. 1997: Worden. 1991)suggests that complicated bereavement has to do with four primarv factors · Relational factors Circumstantial factors Historical factors · Personality factors Relational factors. according to Worden(1991). define the type of rela onship the person had with the deceased. The most frequent type of lationship that hinders people from adequate grieving is one involving extreme ambivalence coupled with unexpressed hostility (Graug Zavasnik, 1996: Rubin Schechter, 1997). Worden(1991) noted that highly narcissistic relationships, where the deceased represents an exten sion of the bereaved. necessitate confronting a loss of part of one's self. thus making for complications. He also saw highly dependent relation ships difficult to grieve. In this type relationship, the bereaved loses the source of strength that has sustained her or him The result is an over whelming sense of abandonment and helplessness. The sense of helpless- ness and loss of self-concept tend to overwhelm any other feelings includ ing any feelings related to healthy grief(Horowitz. et aL. 1980) Reproduced with permission of the copyright owner. Further reproduction prohibited without permissionReproduced with permission of the copyright owner. Further reproduction prohibited without permission