Bereavement

Bereavement is a distressing but common experience. Sooner or later most of us will suffer the death of someone we love, yet in our everyday life we talk about death very little, perhaps because we encounter it less often than our grandparents did. For them, the death of a brother or sister, friend or relative, was a common experience in their childhood or teenage years. For us, these losses usually happen later in life, so we do not have much of a chance to learn about grieving- how it feels- what are the right things to do, what’s ‘normal’ – or to come to terms with it. In spite of this we have to cope when we are finally confronted with the death of someone we love. This article describes some of the ways in which people grieve after such a loss, about the ways in which bereaved people can get stuck in the grieving process.

Grieving

Grieving takes place after any sort of loss, but most powerfully after the death of someone we love. It is not just one feeling, but a whole succession of feelings, which take a while to get through and which cannot be hurried.

Although we are all individuals, the order in which we experience these feelings is very similar for most of us. Grief is most commonly experienced after the death of someone we have known for some time. However, it is clear that people who have had stillbirths or miscarriages, or lost very young babies suffer a very similar experience of grieving and need the same sort of care and consideration.

  In the few hours or days following the loss of a close relative or friend, most people simply feel stunned, as though they cannot believe it has actually happened. They may feel like this even if the death has been expected. This sense of emotional numbness can be a help in getting through all the important practical arrangements that have to be made, such as getting in touch with relatives or organising a funeral. However, this feeling of unreality may become a problem if it goes on too long. Seeing the body of the dead person, may, for some, be an important way of beginning to overcome this. Similarly, for many people, the funeral or memorial service is an occasion when the reality of what has happened can begin to sink in. It may be distressing to see the body or attend the funeral, but these are ways of saying goodbye to those we love, if appropriate. At the time, these things may seem too painful to go through, and so are not done, however, this often leads to a sense of deep regret in future years.

  At some point this numbness disappears and may be replaced by a dreadful sense of agitation, of pining or yearning for the dead person; a feeling of somehow wanting to find that person, even though this is clearly impossible. This makes it difficult to relax or concentrate, and it may be difficult to sleep properly. Dreams may be extremely disturbing. Some people may feel as if they “see” their loved one everywhere they go- in the street, in the park, around the house, anywhere they spent time together. People often feel very angry at this time- towards doctors and nurses who did not prevent the death, towards friends and relatives who did not do enough, or even towards the person who has left them.

  It is fairly common to feel guilty, although there is no standard reaction to grief. People find themselves going over in their mind all the things they would have liked to have said or done. They might even consider what they could have done differently that may have prevented the death. Of course, it is usually beyond anyone's control, and a bereaved person may need to be reminded of this. Guilt may also arise if a sense of relief has been experienced after a particularly long, painful or distressing illness. This feeling of relief is natural, extremely understandable and very common.

  The state of agitation is usually strongest about two weeks after the death, and it is soon followed by times of quiet sadness or depression, withdrawal and silence. These sudden changes can be confusing to friends or relatives, but are just normal ways of passing through the different stages of grief, and everyone's experience is unique. There is no set of rules.

  Although the agitation lessens, the periods of low mood can become more frequent, and reach their peak 4-6 months later. Spasms of grief can occur at any time sparked off by places, people or things that bring back memories of the dead person. Other people may find it hard to understand or embarrassing when the bereaved person suddenly bursts into tears for no apparent reason. At this stage it may be tempting to keep away from people who do not fully understand or share the grief, avoiding others can store up trouble for the future. It is best to try and return to one's normal activities after a couple of weeks or so. During this time, it may appear to others as though the bereaved person is spending a lot of time just sitting; in fact, they're usually thinking about the person they've just lost, going over again and again both the good times and the bad times they had together. It is a quite essential part of coming to terms with the death, as is often talking over the loss with friends or family or a counsellor if it feels necessary, as it may help process the loss in order to better manage in the long-term.

  As time passes the fierce pain of early bereavement abates and the low mood begins to lift. It becomes possible to think of other things, and even look to the future; but the sense of having lost a part of oneself never goes away entirely. For bereaved partners, there are constant reminders of their new singleness from seeing other couples together and the deluge of media images of happy families. After some time, it is possible to feel whole again, even though a part is missing. You may find yourself talking years later as if he or she was still with you.

  These various stages of mourning often overlap and show themselves in different ways in different people. Most recover from a major bereavement within 1-2  years depending on the circumstances. The final phase of grieving is a letting go of the person who has died and the start of a new sort of life. The depression clears completely, sleep improves, and energy returns to normal. Sexual feelings may have vanished for some time  but now return, this is quite normal and nothing to be ashamed of. Having said all this, there is no standard way of grieving. We are all individuals, and have our own particular ways of dealing with the process, particularly given the different relationships to ourselves of the person who died.

How Can Friends and Family Help?

Friends and relatives can help by spending time with the person who has been bereaved. It is not so much words of comfort that is needed, but a willingness to be there with them in their pain and distress. It's important for the bereaved to be able to talk about the situation, to cry, to experience their grief, as any effort to hold it back, conceal it or otherwise not experience it may will cause difficulties later on.

  Just a friend or relative listening or putting an arm around their shoulders will express care and support when words are not enough, and often not needed. It is important if they wish it, that a bereaved person is able to cry with somebody and talk about their feelings of pain and distress without being told to pull themselves together, or that they should hide it in order to avoid causing discomfort to others. In time they will get over it, but first they need to talk and probably to cry.

  Others may find it hard to understand why the bereaved need to go over the same ground time and time again, but this is part of the process of resolving grief and should be encouraged.

  If you don't know what to say, or don't even know whether to talk about it or not, be honest. This gives the bereaved person the chance to tell you what they actually want. People often avoid mentioning the name of the person who has died for fear it will be upsetting, but to the bereaved person, it may seem as though others have forgotten their loss, or that they can't trouble others about it, adding a sense of isolation to their painful feelings of grief which can often lead on to significant depression.

  Remember that festive occasions and anniversaries, not only of the death, but also birthdays and weddings, Christmas and New Year are particularly painful times, when friends and relatives can make a special effort to be around. At the time of the loss, practical help with cleaning, shopping or looking after children can ease the burden of being alone. Elderly bereaved partners may need help with the tasks that the deceased partner used to handle- coping with bills, housework, getting the car serviced and so on. It is important to allow people enough time to grieve. Some can get over the loss quickly, but others need longer.

Everyone's circumstances are different, so don't expect too much too soon from a bereaved relative or friend- they need enough time to grieve properly, and this will avoid problems in the future.

Grief That Is Unresolved

  There are some people who hardly seem to grieve at all. They don't cry at the funeral, avoid any mention of their loss, and return to their normal life remarkably quickly. It may be their normal way of dealing with loss and no harm results. In certain cases, some may not have the opportunity to grieve properly due to the heavy demands of family or business, and that may mean that there just hasn't been the time. This can lead to these people developing symptoms or repeated episodes of Clinical Depression over the following years.

  Sometimes the problem is that the loss is not seen as a ‘proper’ bereavement. This happens often to those who have had a stillbirth, a miscarriage, or even a termination. Again, frequent periods of Depression may follow. Some may start to grieve but get stuck, because the early sense of shock and disbelief just goes on and on. Years may pass and still the sufferer may find it hard to believe that the person they loved is dead. Others may carry on being unable to think of anything else, often making the room of the dead person a kind of shrine to their memory.

  Persistent Complex Bereavement Disorder is a diagnosis assigned to individuals who experience an unusually disabling or prolonged response to bereavement. This would probably be well over a year or a number of years after the loss. Sufferers may feel extreme yearning for a deceased loved one, usually over a very prolonged period. Feelings of longing are often accompanied by destructive thoughts and behaviours, as well as general impairment in resuming their normal life. Bereavement is a period of time spent adjusting to loss. During this time, bereaved individuals may experience bouts of grief which can manifest in feelings of shock, numbness, sadness/ yearning for the person who has died. It is typical to experience a mixture of emotions, as well as fatigue, disturbed dreams, distress, agitation and even guilt during the bereavement process before acceptance sets in. For those suffering from Persistent Complex Bereavement Disorder, this final stage may take a lot longer to reach, and may require help.

  Occasionally, the sadness that occurs with every bereavement may deepen to the extent that food and drink are refused, and thoughts of suicide arise.

Help From Your GP

  Occasional sleepless nights may go on for so long as to become a serious problem. Your GP may then prescribe a few days supply of sleeping tablets. If the Clinical Depression continues to deepen, affecting appetite, energy and sleep, antidepressant tablets may be necessary; these are not habit-forming. If the Clinical Depression still does not improve, your GP may well arrange an appointment with a psychiatrist or psychotherapist. If someone is unable to resolve their grief, help can be arranged through your GP or another qualified professional. For some, it may be enough to talk through the experience, others may need to see a bereavement counsellor or get support from one of the registered charities in this field.

  Bereavement turns our world upside down. It is one of the most painful things we endure. It can be strange, terrible and overwhelming. In spite of this, it is a normal part of life that we all go through and does not usually require medical attention, but for those who do have an unusually difficult experience of bereavement, there is help available from various supportive organisations.

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References:

Cruse Bereavement Care https://www.cruse.org.uk/ 0808 808 1677

Compassionate Friends https://www.tcf.org.uk/ 0345 123 2304 (Run by bereaved parents).

The National Bereavement Service http://thenbs.org/ 0800 024 6121

Stillbirth and Neonatal Death Soc. (SANDS) https://www.sands.org.uk/  0808 164 3332

Recommended reading Through Grief by Elizabeth Collick available through CRUSERemember by Christina Rossetti

With grateful thanks to the Royal College of Psychiatrists.