Objective: To examine the grief reactions that may result in patients after a death occurs within a treatment setting for chronic illness, and in particular to look at the applicability of the concept of survivor guilt in these situations.
Clinical picture: Two patients with endstage renal disease are described. Both presented states of pathological grief for fellow patients. Vulnerability existed in both patients in terms of previous unresolved mourning and in terms of strong feelings of comradeship with the dead patients. Both demonstrated features reminiscent of what has been termed the ‘survivor syndrome’.
Treatment: The treatment involved supportive psychotherapy allowing exploration of grief and its relationship to current psychosomatic crises.
Outcome: Supportive psychotherapy successfully aided the resolution in one patient and made some difference in the other.
Conclusion: The impact of death within a treatment unit is emphasised. Surviving patients may have significant distress relating to such bereavement and may need appropriate intervention.
SherwoodRJThe impact of renal failure and dialysis treatment on patients’ lives and on their compliance behavior. In: LevyNB, ed. Psychonephrology 2. Psychological problems in kidney failure and their treatment. New York: Plenum, 1983:53–69.
2.
LevensonJLGlocheskiS.Psychological factors affecting end-stage renal disease. A review. Psychosomatics1991; 32:382–389.
3.
RustomjeeSSmithGCConsultation–liaison psychiatry to renal medicine: work with an inpatient unit. Australian and New Zealand Journal of Psychiatry1996; 30:229–237.
4.
KleinmanA.The illness narratives: suffering, healing, and the human condition. New York: Basic Books, 1988.
5.
LiebermanPBSelbyCJBereavement and its complications in medical patients: a guide for consultation–liaison psychiatrists. International Journal of Psychiatry in Medicine1987; 17:23–38.
6.
RodinGCravenJLittlefieldC.Depression in the medically ill: an integrated approach. New York: Brunner/Mazel, 1991.
7.
Cohen-ColeSBrownFWMcDanielJSAssessment of depression and grief reactions in the medically ill. In: StoudemireAFogelBS, eds. Psychiatric care of the medical patient. Oxford: Oxford University Press, 1993:53–69.
8.
GarbRBleichALererB.Bereavement in combat. Psychiatric Clinics of North America1987; 10:421–436.
9.
GloverH.Survival guilt and the Vietnam veteran. Journal of Nervous and Mental Disease1984; 172:393–397.
10.
HendinHHaasAPSuicide and guilt as manifestations of PTSD in Vietnam combat veterans. American Journal of Psychiatry1991; 148:586–591.
11.
NiederlandW.Clinical observations on the survivor syndrome. International Journal of Psychoanalysis1968; 49:313–315.
12.
BergerDMRecovery and regression in concentration camp survivors: a psychodynamic re-evaluation. Canadian Journal of Psychiatry1985; 30:54–59.
13.
TrautmanE.Violence and victims in Nazi concentration camps and the psychotherapy of the survivors. In: KrystalHNiederlandW eds. Psychic traumatization. Boston: Little Brown, 1971:115–133.
14.
FreudS.Mourning and melancholia. In: StracheyJ, ed. Complete psychological works. Standard edition. London: Hogarth, 1917:152–170.
15.
ParkesCMBereavement and mental illness, part 2: a classification of bereavement reactions. British Journal of Medical Psychology1965; 38:13–26.
16.
MiddletonWRaphaelBMartinekNMissoV.Pathological grief reactions. In: StroebeMSStroebeWHanssonRO, eds. Handbook of bereavement: theory, research, and intervention. Cambridge: Cambridge University Press, 1993:44–61.
17.
ShuchterSRZisookS.The course of normal grief. In: StroebeMSStroebeWHanssonRO, eds. Handbook of bereavement: theory, research, and intervention. Cambridge: Cambridge University Press, 1993:23–43.
18.
BergerDMThe survivor syndrome: a problem of nosology and treatment. American Journal of Psychotherapy1977; 31:238–251.
19.
BarocasHABarocasCBWounds of the fathers: the next generation of holocaust victims. International Review of Psychoanalysis1979; 3:331–340.
20.
BlacherRSParadoxical depression after heart surgery: a form of survivor syndrome. Psychoanalytic Quarterly1978; 47:267–283.
21.
WeizerNWeizmanAShapiraZYussimAMunitzH.Suicide by related kidney donors following the recipients’ death. Psychotherapy and Psychosomatics1989; 51:169–174.
22.
SonnenbergS.A special form of survivor syndrome. Psychoanalytic Quarterly1972; 41:58–62.
