Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: Dr von Gunten and colleagues1 give important advice for physician communication during end-of-life care. My only criticism of this article is in the section on loss and grief. Most bereavement programs support families for 1 year. These authors perpetuate this notion that normal grief lasts 6 to 12 months. I believe normal grief can go on well past that first year. In fact, I believe the second year is often more difficult because the emotions can be as strong as the first year but the bereaved person feels less comfortable in talking about his or her pain and loss. In that second year fewer friends and relatives talk about the loss or allow the bereaved person to do so. In addition, during that second year bereaved persons perceive the societal message that grief should be finished after 6 to 12 months and respond by keeping their pain more to themselves. Perhaps this is why the first resolution in 1 bereaved parent's "resolutions for bereaved parents" is "I will grieve as much and for as long as I feel like grieving, and I will not let others put a time table on my grief."2 The newer models of grief are starting to criticize and reject this 1-year time frame.3 I believe end-of-life care advocates also need to reject this time frame and that bereavement programs should be willing to extend support beyond this 12-month period.
Davis GF. Loss and the Duration of Grief. JAMA. 2001;285(9):1152-1153. doi:10.1001/jama.285.9.1152