The Price of Love

Studies of bereavement show how the defining feature of the pang of grief is pining or missing a lost person. This develops out of, and reflects, the instinctive need to cry aloud and to search when separated from a parent. Patterns of secure and insecure attachments to parents form the blue print out of which later attachments develop. Insecure clinging in childhood was shown to predict separation anxiety and prolonged grief following bereavements in later life; insecure avoidance to be associated with delayed and inhibited grief; and disorganised grief associated with anxiety and depression. A different theoretical model was formulated to explain the reaction to the many changes in the assumptive world that accompany bereavement and other losses. These psychosocial transitions throw light on the basic assumptions that are overturned whenever unexpected major life-change events take place for which we are unprepared. Both models have important implications for services for terminally ill patients and bereaved families, which were introduced and evaluated at St Christopher's Hospice. These influenced similar widespread palliative care and bereavement services. They also proved useful in disaster areas, following genocidal killings in Rwanda and after terrorist attacks in New York and London. Recent work on responses to terrorism present possible approaches to breaking cycles of violence.