哀悼過程과 精神疾患에 關한 硏究 = A Study on Mourning Process relating to Mental Illness

다국어 초록 (Multilingual Abstract)

大邱市內 綜合病院 精神科 入院患者 933名 中에서 入院前 1年 以內 家族員의 死別歷을 가진 患者 62名에
대한 全般的 槪觀과 著者가 面接, 治療한 病的哀悼患者 36名의 分析에서 얻은 成績을 다음과 같이 要約
한다.
1. 入院患者의 槪觀
1. 綜合病院 精神科 入院患者 中에서 1年 以內 家族員의 死別歷을 가진 例는 全體의 6.6%에 該當하였다.
2. 性別 및 年齡別로 보면 死別群에서는 對照群(非死別群) 보다 平均 約 3歲가 높고 死別群에서는 30代
前半部의 男子患者가 有意하게 많았다.
3. 臨床診斷別로 보면 憂鬱症(神經症的 및 精神症的)이 對照群의 14.5%에 比해 死別群에서 全體의 38.7%
였고 精神分裂症은 相對的으로 對照群에서 많았다.
4. 死亡者와의 關係를 보면 父母死別이 54%였으며 이 中 男子는 父母死別이 67.7%였고 女子는 36.4%였다
.
5. 死別의 狀況은 豫期치 못한 急死가 半數를 차지하였다.
2. 病的 哀悼患者의 分析
1. 發病樣相, 臨床診斷 및 經過를 보아 病的哀悼患程을 세가지 類型으로 區分할 수 있었다. 1) 急性히스
테리型, 2) 遲延性 憂鬱症型, 3) 精神病的 退行型
2. 病的哀悼患者의 症狀을 1)初期反應, 2)一般的症狀, 3)死亡者와 直接關連된 症狀으로 나누었다.
初期症狀은 衝擊, 拒否的 無感動, 히스테리 症狀 形成 및 精神病的 自我崩壞였다.
一般的 症狀은 不安 및 憂鬱感(100%), 睡眠障碍(64%), 頭痛(47%), 身體疼痛 또는 異常感覺(47%) 呼吸器
係統 症狀(47%), 消化器系統 症狀(31%) 過飮 또는 非行(17%), 그리고 精神病的 退行症狀(28%)를 볼 수
있었다.
死亡者와 直接關聯된 症狀은 ①죽음에 對한 所願, 恐怖 및 自殺企圖 ② 死亡者의 最後疾患과의 症狀同一
視 ③ 過去의 다른 死別에 對한 哀悼의 再現 ④ 死亡者와의 마지막 接觸 또는 臨終場面에 대한 執念 ⑤
周忌反應(anniversary reaction) ⑥ 葬禮에서의 不適切한 行動 ⑦ 死亡者가 살아있는듯한 感覺 ⑧ 死亡
者에 對한 過度한 理想化 ⑨ 遺品에 對한 病的 態度 ⑩ 憑依症候群 등을 分析, 討論하였다.
3. 病的 哀悼患者의 꿈 內容은 ① 死亡者와의 再結合, ② 功擊 또는 罪責感, ③ 排斥感, ④ 死亡者로부
터의 援護, ⑤葬禮의 反復, ⑥豫言的 主題 등을 分析하였으며 이들이 보고하는 꿈이 가지는 治療的 意義
를 强調하였다.
4. 患者와 나머지 家族員과의 關係는 ①過度한 依存, ②怨望과 攻擊, ③自責 및 隱遁, ④他家族員의 敵
意의 對象, ④兄第間 紛爭의 表面化를 分析하였다.
5. 病的 哀悼患者의 治療는 靜穩劑, 抗憂鬱劑, 電擊療法과 精神治療로써 多少의 效果를 보았다. 精神治
療面에서는 ①强力한 支持 ②家族員의 理解 및 說得 ③死亡者의 代理役割을 할 수 있는 家族員의 現實的
操整 ④哀悼過程의 促進 등을 主眼點으로 하였다.
以上의 硏究 結果를 討論하고 外國의 硏究들과 몇 가지 點에서 比較 檢討하였다. 마지막으로 追後의 이
方面에 關한 硏究의 必要性과 方向을 提示하였다.

다국어 초록 (Multilingual Abstract)

Of all functional mental illnesses, mourning process is rather unique in that it has a definite
cause and assumes a self-limited clinical course as well as its final outcome. In reviewing the
literature on the subject, numerous psychiatric studies have been done, however, mostly by
Western authors. And these studies are primarily focused on two areas: intensive psychoanalytic
case work and extensive clinical study on symptomatology and management of acutely bereaved
patients.
Furthermore, pathological mourning has also been studied as well by the several authors, again in
the Western culture, especially in relating to other mental illnesses.
In studying mourning process in particular, cultural climate has to be taken into consideration,
as is true in general psychiatric field, culture exerts a great influence on psychiatric
symptomatology.
There has been practically no systematic study done on the subject in Korean cultural context.
This study is aimed at two aspects: Overview on mourning process in relating to mental illness,
and intensive clinical analysis of mourning patients among the mentally ill in our culture.
A. Overview: Out of 933 psychiatric inpatients admitted in general hospital from January 1967 to
August 1974, the bereaved group was studied in comparison with the non-bereaved as a control
group, whose diagnosis was matched with the bereaved.
B. Intensive Study: A clinical analysis of 35 pathological mourners who have been treated by the
author during the last two years.
Summary of this study is as follows;
A. Overview.
1. Out of 933 psychiatric inpatients, 62 cases (6.6%) were indentified as having history of
bereavement within one year prior to their admission.
2. The bereaved was roughly three years older than the non-bereaved and interestingly male
patients in bereaved group were predominant in the early thirties.
3. As to the kinship with the deceased, parental loss accounted the most up to 54% and as to the
circumstance of dying, nearly half of deaths occured suddenly and unexpectedly.
4. The incidence of affective disorders, particularly neurotic and psychotic depression, was far
greater among the bereaved than the non-bereaved:ratio being 2.7:1
B. Clinical Analysis.
1. In view of the onset of symptom, clinical diagnosis and course of the mourning, three rather
distinctive types could be identified in the process of pathological mourning: (1) acute
hysterical type (2) delayed depressive type, and (3) psychotic regressive type.
2. Clinical symptoms were summarized in respect to (1) initial reaction to bereavement (2)
general symptoms and (3) unusual symptoms directly related to the deceased.
Initial symptoms were a startling shock, affective numbness, hysterical symptom formation and
psychotic breaks, which were sooner or later followed by general symptoms, e.g., anxiety and
depression (100%), sleep disturbance (64%), headache or heavy head (47%), painful complaints or
abnormal sensation of body parts (46%), respiratory symptoms (47%), digestive symptoms (31%),
overdrinking or delinquent behavior (17%) and finally psychotic regressive symptoms (28%).
3. The unique symptoms found in pathological mourning process, i.e., symptoms directly related to
the deceased, were summarized as follows; death fear and wish including suicidal attempts,
symptom identification with the terminal illness of the deceased, reactivation of another
previous mourning, guilty preoccupation with the last contacts with the deceased or terminal
scene of dying, anniversary reactions, strange behaviors during the funeral, sense of the
deceased being alive, and posession syndrome, etc.
Dream contents were analyzed into several themes; the deceased returning alive, aggression and
guilt toward and rejection from the deceased, help from the deceased, repetition of the funeral
and prophetic dream. The therapeutic significance of dream interpretation was also discussed.
4. The attitude of the pathological mourners toward the rest of family members had become
significantly changed as follows; (1) overdependence. (2) aggression and resentment. (3)
self-blame and withdrawl, and (4) becoming the target of other family members' hostility as well
as reactivation of previously existed family conflicts.
5. In treating the pathologic mourning patient, the following aspects were particularly
emphasized for a favorable outcome; (1) strong supportive attitude, (2) activation and
acceleration of mourning process, and (3) family intervention.
Finally, some of the findings were compared with the studies done in Western culture, and a
suggestion was made for the future study on this subject in Korean culture.