Authors' reply

Holly G. Prigerson, Paul K. Maciejewski
2009 British Journal of Psychiatry  
assert that the resolution of grief coincides with increasing acceptance of loss, mainly cognitive and emotional acceptance. The role of spiritual acceptance has not been mentioned directly, although experiences like inner peace, tranquility and letting go, or regaining what is lost or being taken away, are more spiritual rather than emotional or intellectual. Moreover, some of the features which can be considered spiritual are included as criteria for prolonged grief disorder, 2 such as
more » ... on about one's identity and feeling that life is empty and meaningless since the loss. Issues related to culture and the meaning and value of death 3 are relevant to both grief and acceptance, and I wonder whether these should also be considered. Patients diagnosed with terminal cancer often confront existential issues. Experiences with patients with advanced or terminal cancers indicate that not only is cognitive and emotional acceptance essential, but that spiritual aspects are equally important. Spiritual acceptance of grief will help the grieved to understand the meaning and purpose of the loss. As Frankl 4 states 'suffering ceases to be a suffering as soon as it finds a meaning' . Longitudinal studies should clarify not only the way in which grief resolution relates to acceptance of dying and death, but also whether grief relates differentially to cognitive, emotional and spiritual acceptance. Prigerson & Maciejewski 1 conclude that decline in grief-related distress appears to correspond with an increase in peaceful acceptance of loss, which I feel could be enhanced by addressing issues related to purpose and meaning of the loss. There is some small change besides the two sides of the coin! 1 Prigerson HG, Maciejewski PK. Grief and acceptance as opposite sides of the same coin: setting a research agenda to study peaceful acceptance of loss. Br J Psychiatry 2008; 193: 435-7. 2 Prigerson HG, Vanderwerker LC, Maciejewski PK. Prolonged grief disorder: a case for inclusion in DSM-V. In Handbook of Bereavement Research and Practice: 21st Century Perspectives (eds M Stroebe, R Hansson, H Schut, et al): 165-
doi:10.1192/bjp.194.6.561a fatcat:6rrkv2huejfopghsl7zqwkefpm