Evans A J
Department of Psychology, University of Southampton.
Palliat Med. 1994;8(2):159-65. doi: 10.1177/026921639400800211.
The theories of loss and grief described by Freud and Bowlby have provided considerable interest in anticipatory grief. Anticipatory grief is assumed to be akin to post-death grief, but commencing prior to the loss of the loved one. 'Grief work' completed during the anticipatory period is purported to mitigate against abnormal grief reactions after death and enhance adjustment to loss. Research conducted to investigate the link between anticipatory grief and postbereavement adjustment has not, however, yielded conclusive findings. It is argued that the intellectual vision of researchers has been obscured by the traditional view of grief leading to conceptual confusion in the theoretical literature and equivocal findings of the empirical investigations. The limited view of the 'death event' as the only loss incurred fails to consider the past, present and future losses that may occur as a result of terminal disease. The physiological, psychological, interpersonal and sociocultural factors evident in the terminal situation serve to highlight the existence of many previously unconsidered variables which may determine the anticipatory grief experience. Until the influence of these determining variables is acknowledged and researchers learn to look beyond the parameters of the traditional models of grief, the costs and/or benefits of the anticipatory period will remain largely undefined. A good starting point may be the adoption of the alternative label, 'terminal response'.
弗洛伊德和鲍尔比所描述的丧失与悲痛理论引发了人们对预期性悲痛的浓厚兴趣。预期性悲痛被认为类似于丧亲后的悲痛，但在失去所爱之人之前就已开始。据称，在预期阶段完成的“悲痛工作”可减轻死后异常的悲痛反应，并增强对丧失的适应能力。然而，为探究预期性悲痛与丧亲后适应之间的联系所开展的研究尚未得出确凿结论。有人认为，研究人员的认知视野被传统的悲痛观念所遮蔽，导致理论文献中出现概念混淆，实证研究结果也模棱两可。将“死亡事件”视为唯一的丧失这一狭隘观点，未能考虑到终末期疾病可能导致的过去、现在和未来的丧失。终末期状况中明显存在的生理、心理、人际和社会文化因素，凸显了许多此前未被考虑的变量的存在，这些变量可能决定预期性悲痛的体验。在这些决定性变量的影响得到认可，且研究人员学会超越传统悲痛模型的参数进行观察之前，预期阶段的代价和/或益处将在很大程度上仍不明确。一个不错的起点或许是采用“终末期反应”这一替代标签。
