Traumatic grief: a case of loss-induced trauma clinical conference

A 59-year-old widow came for treatment of her depressive symptoms in response to a media announcement recruiting subjects for bereavement research. The patient described a series of difficulties and symptoms that had begun when her husband became terminally ill and that had persisted during the 8 years since his death. Despite this patient’s claim that “grieving is for other people, not for me,” shortly after her husband’s death she became depressed, with symptoms of low mood, anhedonia, poor sleep, poor appetite, 15-lb. weight loss, low energy, and poor concentration— symptoms for which a psychiatrist treated her with fluoxetine. After several months of taking fluoxetine, the patient’s depressive symptoms remitted. She then discontinued the medication and moved across the country to begin a business venture that seemed promising to her at the time. She used nearly all of the money that her husband had left to her to open this franchise with the expectation that she would become financially successful on her own and would be able to assume the provider role that had formerly been her husband’s. The patient described how the franchise was “taken from” her; she told convincingly of how she had been the victim of fraud. She provided a summation of the loss of her business by stating simply, “They robbed me of everything.” During this particularly stressful and upsetting period for the patient, her problems were compounded when her apartment was robbed. Many of her most valuable and cherished possessions were stolen, including a pearl necklace that her husband had given to her. Because she was having difficulty coping with these anxiety-provoking events, the patient sought help from a psychologist for symptoms of posttraumatic stress disorder (PTSD). The patient received sertraline and an unspecified psychotherapy. Although she experienced some improvement with this combination therapy, she still remained quite symptomatic. With her finances decimated and a lawsuit pending, the patient decided to return to her hometown, where most of her family still resided. Despite a strong wish to be independent and to maintain the role of a competent and giving matriarch who provided for her family, she was forced to “live off their charity.” The dependence and insecurity she felt as a result of her impoverishment both enraged and depressed her. She complained of feeling victimized, bitter, and helpless. Her confidence was shattered, and she felt unable to care for herself, much less provide for others.