ever, to turn the grief process into a psychopathological response. She began to concentrate on her last interaction with her husband until it crowded out all other thoughts from her mind. It even distorted her general memories of her husband.
Sanders associates intense reactions of guilt such as the one experienced by the widow with the pathological experience of grief commonly known as "complicated grief." In order to fully understand the forms of guilt reaction that are delineated in this report (ambivalent introjection, causal guilt, survival guilt), it is helpful to describe the pathological or complicated guilt reaction.
According to Sanders, complicated or pathological guilt can take three forms or patterns. These are: (1) an alarming degree of sadness; (2) an out-of-control rage; or (3) a deflated or hibernative response. In other words, one is inordinately sad, inordinately angry, or inordinately withdrawn.
All of these patterns are said to arise as a result of the fact that the loss of the loved one stimulated negative self-images in the bereaved, self-images that were formed in childhood but were latent in the person's experience because of his/her positive relationship with the deceased. When this relationship ends due to death, the person again experiences the worthless self-image and does so without the balance provided in the admiration and appreciation of the deceased. It is at this point that the response begins to turn pathological.
There are several indicators that someone is experiencing pathological or complicated grief, the two strongest indicators being: an extreme expression of guilt or identification symptoms (tendency to experience the same symptoms which the deceased experienced prior to death); or a greater than two-week delay of grief.
Other indicators listed by Sanders are:
(2) Delayed or prolonged feelings of grief.
(3) Feelings of guilt, self-reproach, panic attacks, and som...