For a clearer and deeper understanding of the dynamics of grief, the visitor should be familiar with the results of a psychological study of bereavement. Below is the Lindemann report excerpted and abbreviated by Geoffrey Gorer in his book, Death, Grief and Mourning. Dr. Lindemann describes here the symptomatology of normal grief.

The picture shown by persons in acute grief is remarkably uniform. Common to all is the following syndrome sensations of somatic distress occurring in waves lasting from 20 minutes to an hour at a time, a feeling of tightness in the throat, choking with shortness of breath, need for sighing, and an intense subjective distress described as tension or mental pain. The patient soon learns that these waves of discomfort can be precipitated by visits, by mention of the deceased, and by receiving sympathy. There is a tendency to avoid the syndrome at any cost, to refuse visits lest they should precipitate the reaction, and to keep deliberately from thought all references to the deceased.

Another strong preoccupation is with feelings of guilt. The bereaved searches the time before the death for evidence of failure to do right by the lost one. He accuses himself of negligence and exaggerates minor omissions.

In addition, there is often a disconcerting loss of warmth in relationship to other people, a tendency to respond with irritation and anger, a wish not to be bothered by others at a time when friends and relatives make a special effort to keep up friendly relationships.

These feelings of hostility, surprising and quite inexplicable to the patients, disturbed them and were again often taken as signs of approaching insanity. Great efforts are made to handle them, and the result is often a formalized, stiff manner of social interaction.

The activity throughout the day of the severely bereaved person shows remarkable change. There is no retardation of action and speech; quite to the contrary there is a push of speech, especially when talking about the deceased. There is restlessness, inability to sit still, moving about in an aimless fashion, continually searching for something to do. There is, however, at the same time, a painful lack of capacity to initiate and maintain organized patterns of activity. What is done is done with lack of zest, as though one were going through the motions. The bereaved clings to the daily routine of prescribed activities ; but these activities do not proceed in the automatic self-sustaining fashion which characterizes normal work but have to be carried on with effort, as though each fragment of the activity became a special task. The bereaved is surprised to find how large a part of this customary activity was done in some meaningful relationship to the deceased and has now lost its significance. Especially the habits of social interaction-meeting friends, making conversation, sharing enterprises with others, seem to have been lost.

These five points: 1) somatic distress, 2) preoccupation with the image of the deceased, 3) guilt, 4) hostile reactions, and 5) loss of patterns of conduct, seem to be pathognomic of grief. There may be added a sixth characteristic, shown by patients who border on pathological reactions ... this is the appearance of traits of the deceased in the behavior of the bereaved.

The duration of a grief reaction seems to depend upon the success with which a person does the grief work, namely emancipation from the bondage of the deceased, readjustment to the environment in which the deceased is missing, and the formation of new relationships. One of the big obstacles to this work seems to be the fact that many patients try to avoid the intense distress connected with the grief experience and to avoid the expression of emotion necessary for it. The men victims after the Cocoanut Grove fire appeared in early psychiatric interviews to be in a state of tension with tightened facial musculature, unable to relax for fear they might "break down." It required considerable persuasion to yield to the grief process, before they were willing to accept the discomfort of bereavement.