Chronic Sorrow

Chronic sorrow refers to frequently misunderstood, unrecognized, pervasive, continuing, and resurgent grief responses that result from coping with loss due to significant permanent injury, illness, disability, or progressive deterioration of oneself (self-loss) or another living person (otherloss) to whom there is a deep attachment. As the source of the loss is ongoing, grief responses are usually life-long. The experiential core of this type of grieving is a painful disparity between perceptual reality and thoughts of what might have been, should have been, and still may be hoped for.

Chronic sorrow is frequently inaugurated by trauma, whether it is momentous (e.g., paralysis due to spinal cord injury; birth of a child with previously undetected, obvious anomalies), or consists of gradual, incremental concerns that culminate in a realization of the loss or its true severity (e.g., symptoms being confirmed as multiple sclerosis, worsening condition being diagnosed as schizophrenia). Recognition that life as it has been and was expected to be is forever lost and has been replaced by an initially unwanted, unknown, and often terrifying new reality can be considered a psychological emergency. The onset of chronic sorrow forces a reappraisal of one's assumptive world, that is, the very beliefs in life's predictability and fairness that have defined one's existence. Hence, the self and the world must be relearned, an arduous but potentially beneficial process that is often a focus of concern throughout the life span. In many instances there is a need for constant vigilance, around-the-clock care, expected and unexpected crisis management, and other severe and relentless reality demands.

Chronic sorrow per se is normal, and its manifestations are of interest to many professional human service disciplines, including thanatology, social work, nursing, psychology, psychiatry, family therapy, education, law, religion, rehabilitation, [Page 197]and medicine. It is likely that the prevalence of chronic sorrow is increasing. Many persons with congenital disabilities once thought to signify limited and precarious lives are achieving normal longevity. As a result of technological improvements in health care, life spans of low birthweight infants and persons with many severely disabling conditions are lengthening. Survival rates for stroke victims and persons with major head trauma are increasing. Casualties of war, atrocities, and protracted, large-group conflicts add to this toll.

Conceptual Development

Introduced in the 1960s by Simon Olshansky, a rehabilitation counselor, administrator, and researcher, the concept of chronic sorrow was based on observations of parents of children with developmental impairments. Its applications and intent were clearly articulated, recasting what had been considered pathological as normal. Introduction of this concept heralded a paradigm shift by challenging prevailing professional perceptions, including stereotyping, negative labeling, and pathologizing of parents who were often seen as neurotic, autistogenic, schizophrenogenic, overprotective, and never satisfied. Although functioning devotedly with a paucity of resources to help their children, parents were caught in the currents of pervasive and episodic grief due to losses that were living, ongoing, largely disenfranchised, and that do not lend themselves to resolution or integration in the same way that many losses with finality do.

Following the introduction of the chronic sorrow concept, research activity was intense in validating the concept and assessing some of its aspects. Professional interest, as measured by the number of publications on chronic sorrow, declined somewhat in the 1980s. In the early 1990s, however, a renewed interest occurred, most notably in the field of nursing. The Nursing Consortium for Research on Chronic Sorrow (NCRCS) was established by the faculty of several nursing schools. Through their efforts, a number of important empirical research studies have been conducted with NCRCS support and oversight. An increasing interest in chronic sorrow by other professions as well has led to the recent development of specialized research tools, such as inventories, questionnaires, and scales.

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