Multiple Sclerosis and Theory

Chronic sorrow is a continuous, pervasive sadness and also permanent and intermittently intense. An individual often encounters loss experience because of their disability, relative or chronic illness (Isaksson, 2007, p. 18). Chronic sorrow as a concept was introduced by Olshansky (1962) while he was dealing with children with disability of various kinds and their parents or relatives. He noted that the children's parents showed what he referred to as a pervasive reaction of psychological nature to the predicament of parenting mentally defective children (Monsson, 2010, p.16).

Such grief, he observed, was not dissimilar to the type shown by parents that have lost a child. The parents of mentally defective children have it worse because their pain is a continuous one. This is why he referred to the concept as chronic sorrow (Monsson, 2010, p. 16). It has been thought that chronic sorrow entails experiencing intermittent spans of distress and pain, says Hewson. It is pervasive and likely to be continuous. Chronic sorrow is, nevertheless an understandable response to a difficult predicament of multiple losses (cited in Ahlstrom, 2007, p. 77).

There has been plenty of effort by researchers to provide a detailed explanation of grief and loss; since Olshanky (1962) first introduced the idea. There is a difference between the loss that evolves to chronic sorrow and the one that is triggered by bereavement because it is not possible to resolve the former. Uncertainty about the future magnifies chronic sorrow. The grief reaction is heightened because the victims encounter the reality of losing control of their own future. Such loss of control of one's future is expounded for the parents that have to continuously take care of such individuals (Monsson, 2010, p. 16).

Application of a Middle-Range Theory

The theory of chronic sorrow was derived inductively and made valid via qualitative research studies and a careful review of the literature that was in existence. The findings led to redrawing the concept and its current definition. It is now defined as the intermittent recurrence of permanent, sadness that is pervasive or grief-related feelings that are linked to current disparities as a result of the experience of loss. The theory explains that the intermittent revisiting of grief on caregivers and individuals whose life course has been altered is persistent for life as long as that disparity still exists (Peterson & Bredow, 2013, p. 98). The middle range theory of chronic sorrow is instrumental in explaining both responses to the experience of loss and charting a new channel for looking at bereavement (Eakes et al., 1998).

The methods of management cannot be underestimated in the theoretical chronic sorrow model. It is used to refer both to the coping strategies by an individual in the chronic sorrow experience (internal) and the interventions provided to assist professionals (external). If internal and external management are effective, the victims of chronic sorrow experience increased comfort. It may also increase the times between the chronic sorrow bouts. Empathetic presence is believed by professionals to be of great help to individuals experiencing chronic sorrow and those that are going through bereavement moments (Peterson & Bredow, 2013, p. 98).

The Origin of Middle-Range Theory

Nurse scientists and researchers have found the theory helpful. The nurses gain from the theory because it provides a basis for the behaviour of patients, suggests interventions and outlines the strategies to make it effective. The primary goal is to help nurses, researchers and other practitioners to positively promote nursing activities (Dozier, 2015).

The concept of chronic sorrow refers to the recurrent grief episodes that parents of children with mental problems undergo. The sadness seemed to persist for a lifetime; although the intensity tended to vary from time to time and between the affected parties. Olshanky broke away from tradition and avoided viewing these as pathological issues. He saw it as a reaction to a continuous situation. Professionals were consequently guided to support such parents accordingly. It took a long time (two decades) before the concept had any documented back up; even though it had gained popularity (Peterson & Bredow, 2013, pp. 96-97).

The condition of chronic sorrow was confirmed in the 80s by early research. Researchers such as Burke et al. pointed out that since the loss of the ''perfect'' child seemed never to end hindered resolving grief. It was pointed out that such a stalemate was responsible for the intermittent episodes of grief. It is such early research that led to the condition being termed as sadness of pervasive nature that was periodic, progressive and permanent (Peterson & Bredow, 2013, p. 97).

Secondary Literature Review of Application of Middle-Range Theory

It is evident that chronic is a common experience among caregivers related to the individuals with mental defects. NCRCS expanded research work on chronic sorrow. It also examined how chronic sorrow is relevant to people undergoing various loss encounters (Peterson & Bredow, 2013, p. 97).

One of the most common psychiatric disorders among children is Attention Deficit Hyperactivity Disorder (ADHD). It is persistent and frequent. Consequently, it affects a range of developmental and social dynamics. Indeed, the participants that were interviewed confirmed going through the chronic sorrow experience as caregivers of children with ADHD (Borkon, 2008, p. 64).

Isaksson seeks to help us understand the experiences that the patients go through in living with multiple sclerosis and the resulting chronic sorrow. It was found that developing chronic sclerosis was distressful for patients (Isaksson, 2007, p. 37).

Another study by Rosalie Parrish showed that mothers of children with multiple disabilities also experience chronic sorrow beyond the initial diagnosis of the disability. Several daily life triggers that relate to the children's condition cause the feelings of sorrow to resurface frequently (Parrish, 2010, p.1).

There is another research study that was conducted by Whittingham et al. The study sought to examine, the resiliency, coping and grieving experiences of parents with children diagnosed with cerebral palsy (CP). It also seeks to show how suitable the chronic sorrow theory can help us to understand such experiences. The reports from the interviewed parents were consistent with the theory. It was noted that some parents found the diagnosis distressing; while others were relieved by it (Whittingham, 2013).

Discussion

The discussion on middle range theory observes that individuals use a range of strategies to cope with chronic sorrow experience. Lazarus & Folkman (1984), states that effective internal management strategies are those that are used by individuals with chronic sorrow. They should also be identical to the ones proposed in known theories on coping and stress (cited in Eakes et al., 1998).

According to Burke et al. (1989), people cope with chronic sorrow by applying action strategies. This involves maintaining involvement in activities, personal interests, seeking respite opportunities and sourcing for information relevant to the loss experience (cited in Eakes et al., 1998).