Bereavement and grief

What is bereavement?

A dictionary will tell you that bereavement is 'a grievous loss; particularly the loss of a relative or friend by death.' Anyone who has experienced it may well say it was the hardest thing they have had to go through. It can be terrible, overwhelming and very painful emotionally. But it is an event that most will have to be involved in within their lifetime.

People can also feel loss for other events, such as loss of good health, loss of a job or loss of a marriage. The feelings they experience after those events often mirror the grief people feel after a death. The rest of this leaflet will deal with bereavement after a death.

Death and bereavement used to be a more regular occurence in people's lives. As previous generations had lower life expectancy, people could expect the loss of a parent, sibling or friend earlier in their lifespan. Advances in healthcare have prolonged lifespans and moved ill health and dying behind hospital doors. We are not as familiar with death and grief as our great-grandparents were. In addition people do not generally like to discuss death, so we have few opportunities to learn about these essentially normal occurrences, and how to cope with them.

Bereavement and grief

As individuals we all experience bereavement in different ways. There is no right or wrong way. However, most people will feel grief. This is the process and range of emotions people experience as they try to adjust to their loss.

What are the stages of grief?

The stages are often present as people grieve, but they do not always follow the same pattern, and some may be skipped completely. People take different lengths of time to pass through these stages and some stages may return when you think the whole process had finished.

There is some criticism that these stages oversimplify the grieving process. However, they can be useful for people to recognise that what they are feeling is part of a normal process.

Shock

Shock is a common reaction to the news of a death - even when the death is expected. It can be hard to believe that the death has actually occurred. Numbing of the emotions often accompanies the shock. People often say they cannot feel anything at this time and may find it difficult to cry. When looking back to this time people might say this feeling actually enabled them to cope with the tasks that accompany a death, such as telling relatives and arranging a funeral.

Denial

After shock may come a feeling of disbelief - difficulty accepting what has happened, even when you know the facts. During this phase people may find themselves searching for their loved one. They may think they see them in familiar places, or during their dreams. There may be a sense of longing for them and it can be difficult to relax or concentrate.

Seeing the body of the deceased, or attending the funeral can be when the reality of the event starts to sink in.

Anger and guilt

It is not unusual to feel both of these following a death. You might feel angry towards yourself, friends or family who might have done more to help; towards the healthcare staff for not preventing the death, or even towards the person who died - for leaving you. You might have thoughts of 'if only ...' as you think of all the things you wish you had said or done. These can be very distressing.

Sometimes people feel guilty for a sense of relief at the loved one's death - perhaps after a long or difficult illness. They may need to be reminded that this person's suffering is now over.

Sadness

After the initial stages where people can be very distressed and agitated, the next stage is often quiet sadness. This might be just wanting to withdraw to be alone and quiet. These spells might be mixed with times when you are more vocal and distressed. Friends and family might find these changes of mood confusing and be reluctant to leave you on your own. Some people may spend a lot of quiet time just sitting and thinking about the person they have lost.

People may also experience sudden bursts of emotion during this phase and be prone to episodes of crying. This can be provoked by people, places, music, or anniversaries and can last for a long time - sometimes years. People may find it difficult to understand, or be embarrassed by the show of emotion. It can be tempting to withdraw from people who appear not to share your grief, but this can lead to problems with relationships later on. It is better to share your feelings and attempt to return to your normal routine as soon as you feel able. Most people take a couple of weeks or so.

As time passes, the very intense pain of early bereavement will fade. Life will continue and you will be able to think about other things and even plan for the future. For many the feeling that they have lost part of their life will never go away entirely.

All of these phases can overlap, or may be experienced by people in different ways. Some cultures have very different ways of dealing with death, with fixed periods of mourning and ritual behaviours. Some are very public and others are private. Some religions view death as just one step in a continuous cycle of life and death, rather than an ending. Many, regardless of personal belief, find this a comfort.

Acceptance

The final phase of grief is being able to let go of the person you have lost and move on. Most people will recover from a significant bereavement within one to two years. As you move into this stage you might feel your mood lift, and your energy and sleep improve. Perhaps you might start to think about parts of your life that have been put on hold, such as sexual relationships, or hobbies.

How do I help someone dealing with grief?

Friends and relatives can help those who are bereaved by:

• Spending time with them: someone's presence, more than words, can be a great comfort during bereavement. Holding a hand, or putting an arm around them expresses support and care.

• Allow them to show their emotions: people should not necessarily feel that they have to pull themselves together. Talking about pain and crying are ways people work through their grief and it shouldn't usually be suppressed.

• Allow them to keep talking about the person who has died: people may need to repeat certain aspects as they try to understand what has happened. Do not be afraid to keep silent, or just to say you don't know what to say. Give the person space to tell you what they want or need.

• Remember that anniversaries and special occasions can be difficult: acknowledging these occasions, and that someone is no longer there, can be very important to the bereaved. They will probably cry. Be ready for this and don't try to suppress it.

• Practical support with everyday tasks: buying groceries, putting the bins out, and carrying out household chores may have been done by the person who has died. Offering support for these will be appreciated. Remember, people can always say 'no, thanks'.

• Allow time for the process to evolve; try not to impose your expectations on the bereaved. We all cope in our own ways and over different time periods.

How should I support bereaved children?

Children and young people feel loss just as adults do. It is important that they be included and considered when there is a death. Children tend to move through the stages of grief quite rapidly but this does not mean they do not feel it as deeply. Younger children may believe they are somehow responsible for the death. Adolescents may not express their feelings, in the hope of not making older relatives feel worse, or causing them to cry. It is a good idea to make time for them to share their own feelings and thoughts. They should usually be included in any funeral arrangements.

Can bereavement and grief make you ill?

Some people may appear to grieve hardly at all. They show little emotion and quickly return to their normal lives. For some people this is just their way of dealing with loss and they do not have any ill effects from behaving this way.

For others, not being able to grieve properly may result in unusual behaviours, repeated episodes of depression or difficult-to-explain physical symptoms. This may occur for example, if people have heavy demands of normal life that they feel unable to put aside - like childcare or running a business. Alternatively some people feel unable to grieve because it is not a 'proper bereavement'. This sometimes occurs with pregnancy losses (miscarriage or stillbirth) and periods of depression may result.

Sometimes people may get stuck in a particular stage of grief and not be able to move on. They may not be able to think about anything else, and may refuse food and drink. Some may even think of suicide. If someone you know appears to be stuck in their grief, their GP will be able to help.

For many, meeting others in a bereavement support group and talking things things through will be enough. Others may need to speak with a counsellor or psychotherapist.

What if I'm worried about how someone is coping with grief?

Talking it through with that person is usually the best thing initially. Try to be specific about why you are worried about them, rather than talking in general terms. It may also be sensible to share your concerns with other friends or family members, as their experience of being with that person may differ from yours.

Suggesting they talk about their feelings with their GP or a bereavement telephone support line could be helpful. They might not think this is an appropriate subject to discuss with a doctor, but you can reassure them that GPs are used to supporting bereaved families.

Dealing with the loss of a child

The death of an individual at any age is extremely hard, but studies show that where the death involves a child of any age, the stress and grief experienced tend to endure for longer. Something about youth, innocence, and the loss of those experiences they might reasonably have expected, amplifies the grief. Families find it very hard to move on and the pain may never really leave them.

Over time, and often with professional support, the worst parts of grief may be lessened. Research shows that parents are at increased risk of depression and anxiety for 10 years after the death of a child. Seeking help from support groups and mental health professionals is very sensible during this difficult time.

Sources of support

Bereavement advice centre

This offers support for practical issues such as registering the death, arranging a funeral and probate.

Helpline: 0800 634 9494

Child Bereavement UK

A national charity that supports both grieving families and the professionals who care for them.

Helpline: 0800 02 888 40

Cruse Bereavement Care

Face-to-face group support delivered by trained bereavement support volunteers.

Helpline: 0808 808 1677 Helpline Scotland: 0845 600 2227

Samaritans

Help for those experiencing distress or despair who need someone to talk to.

Helpline: 116 123