Theory

of
Chronic Sorrow
By:
Georgene Gaskill Eakes
Mary Lermann Burke
Margaret A. Hainsworth
 Born in New Bern, North Carolina. She received a
Diploma in Nursing from Watts Hospital School of
Nursing in Durham, North Carolina, in 1966, and in
1977, she graduated Summa Cum Laude from North
Carolina Agricultural and Technical State University
with a baccalaureate in nursing. Eakes completed an
M.S.N. at University of Carolina at Greensboro in
1980, and an Ed. D. from North Carolina State
University in 1988. Eakes was awarded a federal
traineeship for her graduate stud at the masters level
and a graduate fellowship from the North Carolina
League for Nursing to support her doctoral studies.
She was inducted into Sigma Theta Tau International
Honor Society of Nurses in 1979 and Phi Kappa Phi
Honor Society in 1988.
Early in her professional career, Eakes worked in
Georgene both acute and community-based psychiatric and
Gaskill mental health settings. In 1980, she joined the faculty
Eakes at East Carolina University School of Nursing,
Greenvile, North Carolina, and continues there today.
Sometimes in the 1970s, Dr. Eakes was in a car accident that left her
with life threatening injuries. Her experiences while recuperating showed
her how the health care professionals failed to understand the grief
reaction and how ill prepared they were to take care of patients facing
death. This led her to investigate death, dying, grief and loss issues in
her research. In 1983, she came to a better understanding of the
ongoing nature of grief reaction in life threatening and chronic illness
when she established and co-facilitated a community support group for
individuals with cancer and their significant others.

In june 1989, she attended the Sigma Theta Tau International Research
Congress in Taipei, Taiwan where she listened to a presentation by Dr.
Burkes on chronic sorrow experienced by mother of children with
myelomeningocele and realized the similarities to the grief reactions
expressed by her cancer support group members.
Definition of Terms
Chronic Sorrow- Periodic recurrence of permanent, pervasive
sadness or other grief-related feelings associated with ongoing
disparity resulting from a loss experience
Loss Experience- A significant loss, either actual or symbolic, that
may be ongoing with no predictable end or a more circumscribed
single loss event.
Disparity- A gap between the current reality and the desired as a
result of a loss experience.
Trigger Events (or milestone)- A situation or circumstance or
condition that brings the negative disparity resulting from the loss into
focus or exacerbates the disparity.
Internal Management Methods- Positive personal coping strategies
used to deal with the periodic episodes of chronic sorrow.
External Management Methods- Interventions provided by
professionals to assist individuals cope with chronic sorrow.
Ineffective management- results from strategies that increases the
individuals discomfort or heighten the feelings of chronic sorrow
Effective management- results from strategies that lead to increased
comfort of the affected individual.
Theory Proposition
Chronic sorrow continues as long as the disparity formed by a loss
experience remains i.e. The lack of closure sets the stage for grief to be re-
experienced periodically.
Effective internal and external management methods increase comfort and
serve to prolong the time between episodes of chronic sorrow triggered by
milestone events. The reverse is true when management methods are
ineffective.
Chronic sorrow is not pathological. Rather it is a normal response to the
ongoing disparity or gap created by a loss experience.
Normalization of the loss experience does not diminish the validity or
intensity of the grief-related feelings associated with the loss experience.
Chronic sorrow is cyclical in nature.
Health care professionals interventions may or may not be effective in
assisting the individual to regain normal equilibrium.
Humans have inherent and learned coping strategies that may or may not
be effective in regaining normal equilibrium when experiencing chronic
sorrow.
Predictable internal and external triggers of heightened grief can be
categorized or anticipated.
Trigger Events or Milestones
Social anniversaries or special occasions can remind the bereaved person
of the absence of a beloved one

Developmental milestone can serve to remind parents the difference

between a childs performance and the parents normal expectations

Personal for those who are chronically ill, an activity which they could
previously perform easily; for the caregiver or family member, it could be the
realization of the never ending care required by their patient or a crisis that
results from the management of their patients illness
Management Method
Internal Management Methods are personal coping
strategies used by the patient/family member/caregiver. Eakes, et. al (1998)
found five effective internal management methods. The first three were more
commonly described in the studies while the last two were less frequently
described.

1. Action Oriented strategies continuing involvement in hobbies, interests

and other activities, gathering information about the loss, actively
seeking respite opportunities
2. Cognitive strategies adopting an I can do it attitude, focusing on the
positive elements of ones life
3. Interpersonal ways of coping talking with a confidant or a trusted
professional, interacting with others in a support group etc.
4. Emotional ways of coping having a good cry
5. Spiritual ways of coping turning to religious and personal beliefs and
practices for comfort
External Management Methods are supportive
interventions provided by helping professionals based on the premise
that a chronic sorrow is a normal response to a significant loss
situation. They are described as the roles professionals play to help
their patients cope with chronic sorrow.
Who are at risk?
Parents of children with mental or physical disabilities
Family caregivers of adult children, spouses, parents or close relatives
with physical and mental debilitating disease
Persons with chronic conditions, illness or disability (e.g. infertility, MS,
cancer)
Bereaved individual, loss of a loved one or a family member
Metaparadigm
Person- Affects person who have experienced a significant loss.
Whether actual or symbolic.

Environment- The environment that a person lives in may from time to

time introduce events that throw the disparity created by the loss into
sharp focus and trigger the re-experience of the grief-related feelings
associated with chronic sorrow.

Health- Health is facilitated by both internal (personal coping) and

external (professional intervention) management methods.

Nursing- Part of nursing care involves assessing, strengthening and

improving the persons personal coping mechanisms
Research
The majority of the research on chronic sorrow focuses on parents coping with children with
mental retardation or a physical disability. However, chronic sorrow may also be experienced
by parents of children with chronic illness who do not have a developmental handicap.

Damrosch and Perry (1989) conducted a small study comparing mothers and fathers in
families having a child with Downs syndrome on patterns of adjustment, chronic sorrow,
and coping to enable professionals to gain a better understanding of how parents deal
with the birth and rearing of handicapped children. Most fathers in this study illustrated
their adjustment as steady and gradual, while majority of the mothers reported a higher
frequency of chronic sorrow.
Parents of children with disabilities in Griffin and Kearneys (2001) research often felt that
pain and sorrow were integral to the experience of being a parent of a child with
significant disability and were angry that their expressions of optimism were interpreted as
maladaptive. For these parents, chronic sorrow was the more common experience in
comparison to time-bound grief and mourning. These parents were better able to relate to
the concept of chronic and periodic sorrow as part of their everyday life in relation to
their current situations and their childrens future.
Both Damrosch and Perry (1989) and Griffin and Kearney (2001) found that
it is common for parents of children with disabilities to feel chronic sorrow as
a reaction to both the loss of the expectations they had for their child and the
reminders of dependency day by day.

Lowes and Lynes (2000) critical appraisal of grief reactions in parents of

children with diabetes provided support for the presence of chronic sorrow
in relation to children who do not have a developmental disability. Lowes
and Lyne (2000) hypothesized that parents of children with diabetes
mellitus would periodically experience feelings of sadness and guilt due to
daily reminders of loss of health, change in lifestyle, and uncertain future
(p. 44).
Hobdells (2004) research on parental chronic sorrow following the birth of
a child with a neural tube defect suggests that depression could be a
dimension of chronic sorrow, rather than a separate construct. The results
of the study are parents reported a high intensity of acute grief and
sadness. The participants (86% of them) experienced chronic sorrow, with
mothers reporting more sorrow than fathers; and data demonstrated a
statistically significant relationship between chronic sorrow and
depression. In this research, Hobdell believes that depression is a
component of chronic sorrow.
Roos (2002) makes reference to the relationship between depression and
chronic sorrow in her book, Chronic Sorrow, A Living Loss. Roos believes
depression is a complication related to stressors that influence people who
experience chronic sorrow, demonstrating a great contrast with Hobdells
perception on depression and chronic sorrow.
Other noted research outputs on chronic sorrow includes the following:

Managing chronicsorrow: experiences of patients with multiple

sclerosis.(Clinicalreport) by Isaksson A.K. and Ahlstrom G. A study on
a group of patients with multiple sclerosis resulted to more than half of
the participants as having chronic sorrow. The meaning of chronic
sorrow in relation to their disease process was mostly associated with
loss of hope that they will be better in the future.
Chronic Sorrow in the Habitual ED Patient. Heidi Josephs study
(2012) was directed towards emergency nurses deeper understanding
of chronic sorrow and be able to quickly identify patients suffering from
it. The research was a personal statement of a nurse about her mother
in which the nurses played a major role in providing her with effective
coping skills.
Chronic Sorrow: One Mothers Experience withTwo Children With
Lissencephaly. J.M. Scornaienchis research convey that parents
became adept in their childs condition and in performing related
procedure at home. Nevertheless, they may need support in coping
with the demands of their childrens illness.
Critique:
Adequacy -not applicable to all patients, but can include
family/relatives or guardian of the patient.

Clarity The theory was clearly presented and can be easily read and
understood by readers.

Consistency has several key concepts that are defined throughout the
literature

Logical Development the theory was presented in a reasonable

and valid manner. It was presented with the support of 10 qualitative
research by

Level of Theory Development -the theory meets the description

of a middle range theory because it consists of several well-defined
concepts and can be viewed as both general and complex

Complexity can be complex when not defined clearly

Discrimination nurses give care holistically not just to their patients
but also to the family/caregiver, giving them interventions or strategies of
coping or adjusting with the present situation.

Reality Convergence can be applied to selected population. The

essential principles and assumptions were clearly defined and interpreted
for easy application.

Scope the theory is limited and only applicable to some patients.

Utility the theory can be applied to some practice setting. When used
in research, can be able to find new coping strategies for the affected
population.

Significance very significant to the nursing profession.

References
http://groupbn207.blogspot.com/p/application.html
https://prezi.com/yckkk7irzub-/chronic-sorrow-theory/
By:
Paulo Arwin G. Baduria, RN