THE RESOLUTION OF PATHOLOGICAL GRIEF AFTER ELECTROCONVULSIVE THERAPY

Abstract

There is a general, although undocumented, impression that somatic therapy interferes with grieving. However, none of the nine cases of pathological grief treated with electroconvulsive therapy (ECT) reported in the literature is discussed in terms of the status of the mourning process in the post-treatment period. To consider this issue, we present the case of a 48-year-old married woman who had a schizophrenic-like reaction apparently precipitated by her sister's impending death and an abnormal grief reaction amounting to a psychotic depressive illness after the death. The patient had an extremely close, interdependent relationship with her sister. This relationship was made more intense by her own husband's neglect. When she learned that her sister had metastatic carcinoma of the bowel, with a grave prognosis, she became delusional, acted bizarrely and demonstrated a schizophrenic thought disorder. She responded well to the use of chlorpromazine in a hospital setting and did well after discharge. When she had her sister admitted to a nursing home, she felt guilty and depressed. She was started on amitriptyline. When her sister died, the depression deepened, with the appearance of marked anorexia, insomnia and constipation. She developed a fixed delusion concerning her responsibility for her sister's death. Despite 5 weeks of chemotherapy, her depression deepened. She felt that the death was unreal, and she was unable to cry or dispose of her sister's belongings. Upon rehospitalization, she showed no evidence of schizophrenic thought disorder. The patient received a total of seven shock treatments and demonstrated marked improvement after three treatments. Despite her obvious delirium, her memory for the events surrounding her sister's death remained intact. One week after discharge, she shed tears for the first time as she told of visiting her sister's grave. One month later, she was able to laugh and joke and was optimistic about the future. She talked freely about her sister; when she did she cried. Four months after treatment she still teared readily when she spoke of her sister and was able to give away some of her sister's possessions. On the anniversary of her sister's death, she appeared sad as she spoke of her. She was doing well, however, without any evidence of depression or thought disorders.