Mummification in a Chinese patient with grief: a morbid symptom or a cultural practice?

Introduction The word 'mummification' is derived from the Latin word 'mumia', which means black bitumen--the substance used for preservation of the body after death in Egypt. However, in psychiatry, mummification is not a religious ritual but a symptom presenting in a minority of patients suffering from grief. Mummification was described by Gorer in 1965 as a grief reaction in which the deceased individual's belongings and, in extreme cases, his or her corpse are preserved as if he or she was still alive, (1) and often the grieving person acts as if the deceased will return at a later date. (2) Mummification is often regarded as a pathological phenomenon in western psychiatric literature. Little research has been done on the cultural differences of patients demonstrating mummification. In the Asian community, a common belief is that there is life after death. The spirits of the dead are believed to exist in the human world, and it is not uncommon for people to burn paper offerings to provide spirits with the comforts required for the afterlife. Taking into account these beliefs, this report discusses a case of grief in a Chinese patient that raised questions about the psychopathology behind this phenomenon and whether mummification is always a morbid symptom in the Chinese population. Case Report A 60-year-old man presented to the psychiatric outpatient clinic at Prince of Wales Hospital with depression in March 1996. His wife had a terminal brain tumour and the patient had chosen palliative care with no further surgical intervention. He presented with a history of insomnia since the diagnosis of his wife's condition. He also demonstrated other depressive symptoms, including persistent low mood, anhedonia, and feelings of guilt, hopelessness, and worthlessness. He denied having suicidal ideas, but expressed that life was no longer meaningful. He sometimes heard his wife's footsteps around the house, but claimed that he knew that they were not real. He denied having psychotic symptoms and had no history of manic symptoms. He was diagnosed with depression, and was consequently referred to the clinical psychologist and given antidepressant, paroxetine 20 mg orally per day. After the death of his wife, his depressive symptoms worsened. He only slept for 1 to 2 hours each night and had frequent crying spells at home. He mostly stayed at home organising photos of his wife and repeatedly watching home videos. Six months after the death of his wife, it was revealed that the patient had 'mummified' his wife's room. A home visit was paid to observe the patient's living environment. He had kept all of her possessions, including personal hygiene products, in their original positions and placed each of her garments into individual plastic bags for better preservation. He turned on the radio in his wife's room when he went out for meals. He had also started making a life-size doll to resemble his wife. He appeared to be cheerful and proud of his accomplishment as he described in great detail his efforts to buy the correct materials and cloths to produce the most realistic doll possible. He did not sleep with the doll, but described feeling comforted when he fondled and looked at the doll in the middle of the night. He sometimes talked to the doll, mainly asking it to give him a sign if the spirits were real. The patient claimed that he understood that his wife had died, but felt that he could not control his response or actions towards her death. He claimed that he believed the doll was not alive and remarked that making the doll was a 3-dimensional form of commemoration instead of the 2-dimensional form of photos. He felt that the doll brought him closer to his wife. He questioned whether spirits existed and hoped that, if they did, his wife's spirit would be pleased with the way he had preserved her belongings and made the doll to commemorate her, and possibly communicate with him via the doll. …