Motivation and emotion/Book/2020/Sorrow

Sorrow:
What is sorrow, how does it function, and how can it be dealt with?

Multimedia presentation (3 min)

Overview

Sorrow is a feeling of deep distress caused by loss, disappointment, or other misfortune suffered by oneself or others. The focus questions are listed in the box below and will be broken down to more deeply understand this topic.

The following will be discussed:

1. The different types of sorrow
2. The causes and function of sorrow
3. The timeline and spectrum of sorrow
4. Treatment and management of Sorrow

Chronic sorrow is the periodic recurrence of permanent, pervasive sadness or grief related feelings associated with significant loss. Although it is viewed as a normal reaction, chronic sorrow can progress to a pathological state such as depression if coping styles are ineffective, however there is a difference between sorrow and depression. The concept of sorrow is in the early stages of understanding and development, but theories focus mainly on four concepts: antecedents, trigger events, internal and external management methods. There are strong theoretical basis to work off, but due to it's early stages and complexity, strong connections between these theories are lacking.

Grief and sorrow go hand in hand as sorrow can be used along with grief, as you have sorrow, when you are grieving. It is important to consider the different types of sorrow, cultural context and it's context, as this will change it's function, treatment and symptoms. In whatever form this emotion is felt, interventions and treatment plans should be catered to this, and a combination of many has become the 'gold standard'.

Focus questions: What is Sorrow? How does it function? How can it be dealt with?

What is Sorrow?

Sorrow is extremely difficult to interpret and analyse; its variety of expression is perhaps greater than that of any other primary emotion, so that sometimes there seems to be a real difference in kind between its diverse manifestations. It is the feeling of deep distress caused by loss, disappointment, or other misfortune suffered by oneself or others.

Howard Becker (1993) describes 3 types of sorrow:

1. Outward violent behaviour
2. Tearless and mute
3. Weakness and discouragement

Sorrow has mental symptoms, which can also manifest in physiological ways. Factors such as temperament and levels of extraversion/intraversion can affect the type of sorrow experienced and displayed. The short term symptoms of sorrow include being sad, tearful and grief, along with physiological symptoms such as changes in appetite, activity, ability to concentrate, engagement with others, and sleep.

It is normal for people to feel sorrow and sadness, and is necessary in order to recover from loss or tragic circumstances. Not grieving of feeling these emotions will make it harder to recover in the long term and can lead to mental illness. Sorrow, in this sense, is dialectical, meaning it generates an inward "conversation" between hopeful possibility and foreclosure of hope.

The difference between Sadness and Sorrow

Sadness is a state of unhappiness while sorrow is a sense of deep distress, disappointment, or sadness. Sadness is a more intense form of sorrow, which can be include intense feelings of unhappiness, manifest outward violent behaviour, tearless and mute, and feeling weakness and discouraged.

The term chronic sorrow, has been used to describe the long-term periodic sadness to chronic illness, circumstance or other long term aversive events which are experienced in reaction to continual losses. In conceptual analyses of chronic sorrow some common identified critical attributes are cyclic sadness over time in a situation with no predictable end; external and internal stimuli triggering the feelings of loss, disappointment, and fear; and, progression and intensification of the sadness or sorrow years after the initial disappointment or loss.

No matter how powerful sadness may feel, it will pass, and duration is the main variable. Sadness is also not to be mistaken with depression, grief etc. as sadness is a feature of state of each of these, and it a commonly felt emotion.

Sorrow to Clinical Depression

Chronic sorrow is not depression, but the two concepts may be related. A few differences between the two are; a depressed individual will typically feel outcast and along, whereas when you experience everyday sorrow, we feel capable of feeling. Another difference is the sense of time, as when we experience sorrow, we feel it will one day go away and the depressed person will feel time is fixed and feel the future is lost. Sorrow unlike depression is ambivalent and has the capacity to contain joyous moments, or find solace in it's essence, meaning it serves a function.

There are two ways in which Sorrow can lead to Depression:

1. a traditional latent variable explanation, in which loss triggers depression, which then leads to symptoms
2. a novel network explanation, in which bereavement directly affects particular depression symptoms, which then activate other symptoms

The symptoms of sorrow are short term and should only last a few weeks. If the symptoms do not slowly go away after several weeks, and begin impacting daily functioning, it is important to consider treatment and the possibility of the progression a mental illness.

Case Study The following is an example of progression from sorrow to clinical depression: Mr Jackson is a middle aged man with a mentally handicapped daughter. He was informed to send his daughter to a mental institution but refused. His daughters lack of mental capacity and watching her unable to perform tasks meant be cried a lot and he was very upset that she would never be able to be on her own. Mr Jackson's sadness was was progressive over time, periodic, and triggered by his daughter's limitations. Over time he believed he had failed as a father, contemplated ending his life and his behaviour and feelings became indicative of depression.

The different types of sorrow

The type of sorrow experienced may be dependant on cultural beliefs, the antecedent, temperament and other internal and external factors. There is not a clear cut definition of the different types of sorrow, and researches have developed their own theories. One of the main ones is listed below:

Howard Becker's (1993) describes 3 types of sorrow:

1. Outward violent behaviour which has close resemblance to a 'frenzied' mourning behaviours
2. Tearless and mute where there is a realisation all is lost. This type of sorrow is too deep for gestures and words
3. Weakness and discouragement- This could be described as 'paralysed of all voluntary muscles' as chronic sorrows have exhausted their body

It is well known that different antecedents can cause greater levels of studying. For example the death of a child is one of the most difficult types of loss, and people are at risk for developing anxiety and depressive disorders. There is a difference between complicated sorrow and successful sorrow. A successful sorrowful/mournful process entails effective emotion regulation and assimilation of new learning in long-term memory. Complicating behaviours include excessive avoidance of reminders of the loss, compulsive proximity seeking, or both.

Contextual Example The following is an example of how culture and religion can bring an entirelty new meaning and purpose to this concept. In the bible, christianity has identified two kind of sorrow. 'Godly sorrow' which brings repentance and leads to salvation. The second is 'worldy sorrow' which is the opposite. You can be full of regret and never change and can be sorry without repenting.

Psychological theories behind Sorrow and Grief

Since Freud the theories behind Sorrow and grief have been focused on adjustment to the reality of loss. Theoretical concepts can help with detection and diagnosis of unresolved issues.

1. The Dual Process Model (Stroebe & Schute- journey through bereavement and allocates time to thinking of loved ones and practical activities
2. The five stages of grief(Kubler Ross)- A non linear way of adjusting to not having someone
3. John Bowlby's Attachment theory- His book speaks about in loss our attachment system is fully activated, to regain our sense of security and cope with adversity. Colin Murray Parkes stages of grief extends on this work, and also taking into account history, relationships and previous experiences

Learned helplessness also has implications in this field and in the diagnosis and treatment of Major Depressive disorder . The theory was first developed by Martin Seligman through his infamous dog experiments. It provides an explanation for some human behaviours that might seem odd or counterproductive, and understanding learned helplessness provides pathways to removing or reducing its negative impacts. The model posits that desired outcomes and are improbable and the individual believes nothing they will do can change the outcome, and remove their sorrows.

The causes and functions of sorrow

Sorrow has both mental symptoms, which can also manifest in physiological ways. Factors such as temperament and levels of extraversion/introversion can affect the type of sorrow experienced and displayed. The short term symptoms of sorrow include being sad, tearful and grief, along with physiological symptoms such as changes in appetite, activity, ability to concentrate, engagement with others, and sleep.

It is normal for people to feel sorrow and sadness, and is necessary in order to recover from loss or tragic circumstances. Not grieving of feeling these emotions with make it harder to recover in the long term and can lead to mental illness. Sorrow, unlike severe depression, is curiously ambivalent: sorrow has the capacity to contain joy within it, or at least to find solace within its own essence. Sorrow, in this sense, is dialectical: it generates an inward "conversation" between hopeful possibility and foreclosure of hope. Postponing the energy of this emotion causes it to grow and the longer it is put off, the greater the fear of it becomes, meaning that sorrow does serve a good function, and can prevent more serious mental disturbances later in life.

Chronic sorrow is not an isolated process in persons' lives but takes place in relation to other events and happenings. The antecedents or events that must occur prior to the onset of sorrow. Here are a few examples of prominent causes of sorrow:

1. The person experiencing chronic sorrow must be involved in a trajectory of chronic illness or disability, either as the one afflicted or as a caregiver.

2. The trajectory has an identifiable beginning such as the birth of an ill baby or a diagnosis of a chronic illness such as Multiple Sclerosis or Alzheimer's disease.

The consequences or events that occur as a result of chronic sorrow are the following:

1. The person is able to move into other phases of the chronic illness situation, having grieved losses of the previous phase. This is more likely if comfort and support have been received.

2. A depressive state or abnormal grief reaction may occur; this is more likely if the supportive network is inadequate.

The timeline and spectrum of sorrow

We cannot rightly understand sorrow unless we bear in mind that though primary, and one of the first emotions, if not the first to be manifested in child-life, it is not independent, but is always related to a frustrated impulse, emotion, or sentiment which is the cause of its emotion; and that even where it wells up as a mood it must still imagine such frustration, in order to render its state intelligible.

Chronic sorrow can be conceptualised as a sense of sadness that occurs at periodic intervals across the entire trajectory or career of illness. The Antecedents or triggers are typically fatalistic in nature; that is, they are outside one's control and require conformity to changing patterns of disease and disability. The trajectory, however, is broken into smaller parts which are experientially manageable. Chronic sorrow is the reflection of the grief work done in the small segments of the trajectory in order to align one's self concept with the new reality.

The five stages of grief.

The five stages of grief were created by Elizabeth Kubler-Ross in 1969 and are displayed in figure 1. This theory came about due to years of work with chronically-ill patients, and quickly became a key guide for individualised and group therapy alike. The stages are in a non-linear format, as grief and sorrow are experienced different for each person. Perhaps an individual may begin coping at the bargaining stage or skip a stage all together. Understanding the stages can help an individual come to terms with thoughts and feelings they are experiencing. The five stages have been briefly described below:

• Denial: in which the bereaved consciously or unconsciously refuses to accept the loss.
• Anger: in which the bereaved experiences feelings of rage or envy. These feelings sometimes manifest in anger with themselves, or anger with others - often with people close to the bereaved.
• Bargaining: in which an individual attempts to postpone or delay death.
• Depression: feelings of sadness, regret, fear or uncertainty that come when the bereaved stops fighting the loss, and lets him- or herself begin to accept the loss.
• Acceptance: in which the bereaved comes to terms with the loss

Case Study 83 Year old women has lost many people recently due to her older age, mainly her sister who she was very close with. The denial stage lasted the longest and she would frequently ask to speak with her sister and try call her on the phone. The anger and depression phases were similar in that she would lash out, get overwhelmed with simple tasks and get irritated very easily. In the bargaining stage she was reaching out to others and telling stories of her and her sister The women slowly began to accept that her sister was gone, stopped calling her and began thinking of fond memories of her sister and her lost friends.

Choose the correct answers and click "Submit":

1 Which term best describes expressing sorrow or being mournful?

	Melancholy
	Morose
	Lugubrious
	Plaintive
	Doleful

2 Which of the below options is not one of the five stages of grief?.

	Denial
	Helplessness
	Depression
	Anger
	Bargaining

How can Sorrow be dealt with

Sorrow is more that just sadness, and more like an unbearable sadness, and at a certain point it is necessary to get a psychologist involved as it may evolve into a mental illness. Commonly at home it is recommended to have a large amount of social support from friends and family, do not drink to excess, especially as a coping mechanism, sleep well, having a healthy diet and distracting yourself with a hobby or holiday etc. If health care professionals are to get involved, it is important to consider the individuality of sorrow and offer appropriate person-centred care and support. Often a blended approach is used to suite many individuals, and has high success rates for severe cases in particular.

Psychological Approaches

Some common Psychological approaches include:

1. Cognitive Behavioural Therapy- challenge and change unhelpful cognitive distortions
2. Psychotherapeutic interventions- provide information and support to help better understand emotions
3. Interpersonal psychotherapy- resolve interpersonal problems and symptomatic recovery
4. Psychodynamic Therapy- repressed behaviours and emotions surface to consciousness. This can involve intense psychoanalysis or a more relaxed and shorter approach with psychotherapy

Group Therapy

Group psychotherapy is a form of therapy in which one or more therapists treat a small group of clients as a group. It may involved art therapy, CBT practices, interpersonal and psychodynamic group therapy. It can be used alone, however is commonly integrated in a comprehensive treatment plan. Some reasons it an effective therapy in these particular situations are that it instills hope as you see others recover, it's universality, interpersonal learning and how altruistic it is. Some advantages of this type of therapy include it's cost effectiveness, the large amount of support, it is less intimidating for people and seeing how people react in a social situation can provide valuable feedback. The way the session is conducted is largely dependant on the goals of the group and the style of the therapist.

Learned helpless is a common roadblock for recovering individuals, and asking individuals to consider the statements below teach them the ways of thinking and acting that we know can boost resilience.

1. Know that suffering is a part of life- Knowing this stops you from feeling discriminated against when challenges arrive.

2. Carefully chose who you are directing your attention- realistically appraise situations and focus on the things you and learn to accept the things they can’t

3. Is what i am doing harming or helping?- This allows for control of decision making and is a strong basic for many therapy types

Criticisms

A lot of counselling practises have negative connotations, and the misunderstanding of empirical evidence has damaged the reputation of grief counselling in particular. A misinformed assumption is that 'interventions are typically ineffective, and perhaps even deleterious, at least for persons experiencing a normal bereavement'. This type of comment shows that the type, duration and approach of therapy has to be carefully chosen, used in more chronic cases and researchers must reinforce the fact that therapy is an effective and valid practise. As discussed previously, sorrow is a necessary and healthy part of healing, and should not be considered a bad thing. In many circumstances and cultures, simply having healthy coping mechanisms, social support and a balanced lifestyle is the most effective way of dealing with sorrow.

Conclusion

Although the concept of sorrow is a relatively new topic in psychology, there is still a lot of valid peer reviewed research, and many well recognised theories that explain and develop both the diagnosis and treatment of this problem. Sorrow is a feeling of deep distress caused by loss, disappointment, or other misfortune suffered by oneself or others. This can develop into mental disorders, chronic / complex sorrow, which affects daily functioning. The type of intervention chosen, the symptoms, duration and type of sorrow are all dependant on a variety of internal and external factors, a long with personality and the antecedent.

Clinicians continue to confuse sorrow with other types of grief and mourning, along with disorders such as dysthymia and MCD. Failing to recognise, understand and identify the differences can lead to severe mishandling of those suffering. While some research has been identified, most studies have attempted to identify it's existence and correlate it with certain response variables, which basic definitions and theory-building are lacking. Many forms of therapy and information on getting thorough sorrowful periods leave individuals totally overwhelmed by the journey ahead and powerless to exert any influence over our grieving whatsoever. Protective and risk factors must be evaluated to create an individualised recovery plan. No two individuals, circumstance and function are the same, so defining sorrow, it's functions and symptoms is not as simple as it may appear.

It is important to recognise both the differences and similarities between sorrow and terms like depression, grief, mourning and sadness. As sorrow is a process of changing emotional reactions over time, the distress or mental suffering that is a part of sorrow is seen in these emotions/processes. This does not mean they should be used interchangeable, more to give more insight into the fluid processes of sorrow. Clarifying and establishing the meaning of sorrow is fundamental to using the concept for theory development and research, and to its pragmatic application in clinical practice

See also

1. Sorrow (Wikipedia)
2. Five stages of grief (Wikipedia)
3. Funerals and grief work (Book chapter 2020)
4. Sadness as the longest lasting emotion (Book chapter 2017)
5. Grief and health (Book chapter 2015)

References

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Eakes, G.G. (1995). Chronic Sorrow: The lived experience of parents of chronically mentally ill individuals. Archives of Psychiatric Nursing, 77-84. https://doi.org/10.1016/S0883-9417(95)80004-2 Engebrigtsen, G. K., & Heap, K.(1998) Short term groupwork in the treatment of chronic sorrow: A Norwegian experience. Groupwork, 1(3), 197-214. https://doi.org/10.1921/gpwk.v1i3.1375

Fried, E. I., Bockting, C., Arjadi, R., Borsboom, D., Amshoff, M., Cramer, A. O. J., Epskamp, S., Tuerlinckx, F., Carr, D., & Stroebe, M. (2015). From loss to loneliness: The relationship between bereavement and depressive symptoms. Journal of Abnormal Psychology, 124(2), 256–265. https://doi-org.ezproxy.canberra.edu.au/10.1037/abn0000028.supp

Hainsworth MA, Burke ML, Lindgren CL, Eakes GG. Chronic sorrow in multiple sclerosis(1993). A case study. Home Healthcare Nurse.11(2):9-13. https://doi-org.ezproxy.canberra.edu.au/10.1097/00004045-199303000-00002.

Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief through the five stages of loss. New York; Toronto: Scribner.

Margaret A. Hainsworth, Georgene G. Eakes & Mary L. Burke (1994) Coping with Chronic Sorrow, Issues in Mental Health Nursing, 15:1, 59-66, https://doi.org/10.3109/01612849409074934

Olwit, C., Mugaba, M., Osingada, C. P., & Nabirye, R. C. (2018). Existence, triggers, and coping with chronic sorrow: a qualitative study of caretakers of children with sickle cell disease in a National Referral Hospital in Kampala, Uganda. BMC psychology, 6(1), 50. https://doi.org/10.1186/s40359-018-0263-y

Pies R. (2008). The anatomy of sorrow: a spiritual, phenomenological, and neurological perspective. Philosophy, ethics, and humanities in medicine: PEHM, 3, 17. https://doi.org/10.1186/1747-5341-3-17

Roos S., Neimeyer R.A. (2007) Reauthoring the Self: Chronic Sorrow and Posttraumatic Stress Following the Onset of CID. In: Martz E., Livneh H. (eds) Coping with Chronic Illness and Disability. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-48670-3_5