So I went on a training day about bereavement and loss, because many of the people I treat have experienced one of these, and for some of them it is this loss which stops them from moving forward. I felt I needed the training because I haven’t gone through that much loss myself and I wanted to understand their perspective a little better and how to help them.
What surprised me was that we learnt that we don’t need someone to die to feel bereaved. We can feel that loss at so many things; divorce, diagnosis of a long-term illness, redundancy, when children fly the nest; I could continue ad infinitum. And as a result I learnt that whilst I (luckily) haven’t had so many people die with whom I’m close, I have experienced some of those other losses and this can help me, and others, understand some of what people feel when they feel bereaved.
The most important lesson I learnt is that grief can be delayed or immediate, severe or mild, prolonged or brief because we are all different. And because of that, we should approach those who are grieving with an open mind, without assuming we know what has happened, what they are experiencing and what they will be going through.
How grief works (or doesn’t)
We can use different terms to signify grief but I think the best explanation of what it is is as follows:
- Bereavement = what happens to you
- Grief = the feeling afterwards
- Mourning = what you do
To help us understand grief and mourning we use different models.
The one with which most of us are familiar is the Kubler-Ross model of grief which explains that following a loss, we go through different stages of grief as follows (but not in a any particular order):
• Denial – when we act as if the loved one has not gone, or avoid talking about it
• Anger – we feel angry that this has happened to them and us and dwell on the injustice
• Depression – we feel low and hopeless, demotivated to do anything because what is the point?
• Bargaining – we think of the ‘what if’s and the ‘if only’s which would have prevented it happening in the first place or which might bring them back or prevent worse happening in the future
• Acceptance – we accept that what is gone has gone and we continue with life despite this loss
A lot of us might be able to relate to this model. The difficulty with this model is that it suggests that the stages are part of a process which we go through in order to achieve something or to come out the other side. But for people who have lost someone, there is often no other side, their world is changed permanently and there is no resolution.
The simplest model of grief and mourning is the Dual Process Model of grief (Stroebe & Schut). It explains that when we’re grieving, we move from action to emotion and back again, continuously. For example, we might be consumed with sadness in the morning, but then in the afternoon we might call the funeral directors, but by the evening we might be crying uncontrollably again and then the next week we might decide to take the deceased’s clothes to the charity shop. It suggests that it is natural for us to engage in a little bit of both which I think helps us give ourselves permission to cry, to take time to dwell on things and then to throw ourselves into something practical.
A further model is the Biographical Model of grief (Walter) which simply suggests that as we talk about the lost person, and what happened and what they were like, it helps us understand and process what has happened and ‘write the last chapter’. This can help us come to terms with what has happened so that the distress we experience is reduced.
Another model which helps us understand grief is the Fried Egg model of grief. It explains that, if we imagine our grief to be the yolk of the egg and the white of the egg is the rest of our life, most of us would expect the yolk part to decrease over time; from this:
To this:
Not so. What changes is not the yolk (the grief), but the white (the rest of our life). Sometimes the white gets smaller so that all we can see in our life is the grief.
Sometimes the rest of our life expands, so that there is more white, and so, whilst the grief has not diminished, it is, proportionately, a smaller part of the total of what we are experiencing and focussing on.
In brief; our grief remains but our life expands. I love this model. It’s simple and makes sense and it pays respect to what is lost and does not ask us to ‘move on’.
There is an element of truth in all of these models.
When grief gets more complicated
Some people may have difficulty with some of the things which we do to cope, normally because they are concerned for your wellbeing and may interpret your behaviour as you being stuck in a certain stage of grief and that you are not ‘moving on’. I think this would only normally be a problem if you are struggling to recognise the reality of the loss or the fact that you can’t change the situation after a significant amount of time.
The reality is that when we lose someone, we are at higher risk of mental and physical health problems. So it doesn’t hurt for others to keep an eye out for you, or indeed you for yourself.
Multiple, unexpected or untimely bereavements and lack of support can have a bigger impact on those who are left. These complications can chip away at your capacity to cope, no matter how resilient you are.
If you know someone who is grieving ask yourself:
• Do they feel supported or isolated?
• Are they able to talk about feelings with family and friends?
• If the death was predicted, were they able to plan and talk about their expectations beforehand?
• Are they still in denial?
• Are they still angry?
• Are they experiencing financial or medical difficulties or another life change at the same time?
If the answer above is yes to any of these then the path of grief can be impeded and they may benefit from further support.
What helps when grieving
Support
When we talk about what’s best to do when grieving, the simplest answer is “do what you need to do”.
It means, really, that there is no formula for grieving well, because everyone is different, everyone copes differently and everyone finds different things meaningful or helpful.
We heard of a client who took her childhood teddy to a church the morning after she miscarried a child. We were told of someone who kept their grandma’s room as she left it for a year. If it helps you cope. Do it.
It’s also worth remembering that death often affects more than one person and family dynamics are complex. Everyone has different needs, expectations and desires from the beloved and others affected by the grief and this can cause conflict and confusion. It is normally impossible to manage all of this or help everyone at the same time or in the same way, so try not to make assumptions and be realistic about what you can do.
Importantly, though, the single, most positive factor in encouraging a healthy grieving journey is being able to talk, unconditionally, without judgement, about the loss with someone who listens.
For those supporting someone grieving it can be daunting.
“What should I say to someone grieving?” is something I’ve often asked others when talking with grieving individuals.
What helps, is knowing that if what they need most is someone who listens, we don’t even need to worry about what to say; someone who listens does not give advice, because responses don’t make people better, connections do.
So reaching out to them, being there, or simply saying something like “I don’t even know what to say right now I’m just so glad you told me” can be enough.
When we talk about listening, it’s not just letting someone talk but trying to understand what is happening for them. Doing this takes empathy, and it needs to come from within you (which can be exhausting) but it is, in brief:.
• Perspective taking – try to reach where they’re coming from
• No judgement – your opinion is not needed right now
• Recognising emotion – try to see what they are feeling, it might not be simple sadness
• Communicating that you recognise it – letting them know you’re understanding a little of what’s happening for them
Be mindful though, that the differences between us and the person we are supporting also make a difference to how we interpret the loss, so it’s important to be reflective and aware of this so that we can come ‘alongside’ and not project our perspective on others.
What can also help is validating and normalising what they’re going through so that they don’t feel so alone, or like they’re going out of their mind. This might come from you, but equally, support groups for those who have experienced similar situations can be hugely helpful.
Rituals
Rituals or traditions, or symbolic gestures which we do after a death can help because they mark in a symbolic way a transition from one position to another. They can be almost like a stake in the ground communicating to the world, yourself and others that something has happened and thus the world has changed but that now you are moving on your way forward.
Some different rituals which people might find helpful are:
• Burial within 24 hours
• Washing the body and preparing for the deathbed
• Playing certain music
• Sending cards
• Planting trees
• Letting balloons off
• Making memory boxes
• Funeral
• Sprinkling ashes
• Flowers set somewhere
• Writing a letter
• Lighting a candle
I hope that this article has conveyed what I feel are important and useful ideas in understanding and helping support people who are bereaved.
www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.You can contact her here.
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