Bereavement

Definition

The NHS bereavement and support guide states that bereavement can be defined as ‘a state of loss resulting from death’.

Bereavement affects people in different ways. There’s no right or wrong way to feel.

Experts generally accept that there are four stages of bereavement:

accepting that your loss is real
experiencing the pain of grief
adjusting to life without the person who has died
putting less emotional energy into grieving and putting it into something new (in other words, moving on)
You’ll probably go through all these stages, but you won’t necessarily move smoothly from one to the next. Your grief might feel chaotic and out of control, but these feelings will eventually become less intense. Give yourself time, as they will pass.

 

How you might feel

  • shock and numbness (this is usually the first reaction to the death, andpeople often speak of being in a daze)
  • overwhelming sadness, with lots of crying
  • tiredness or exhaustion
  • anger, for example towards the person who died, their illness or God
  • guilt, for example guilt about feeling angry, about something you said or didn’t say, or about not being able to stop your loved one dying

These feelings are all perfectly normal. Lots of people feel guilty about their anger, but it’s OK to be angry and to question why.

Some people become forgetful and less able to concentrate. You might lose things, such as your keys. This is because your mind is distracted by bereavement and grief – you’re not losing your sanity.

 

Grieving process

Definition

Grief is ‘the psychological and emotional reaction to bereavement (C Murray-Parkes, 2001)

Definition

Grief is ‘the psychological and emotional reaction to bereavement (C Murray-Parkes, 2001)

 

BEREAVEMENT SUPPORT GUIDLINE PDF

 

The more significant the loss, the more intense the grief will be. You may associate grief with the death of a loved one—which is often the cause of the most intense type of grief—but any loss can cause grief.

Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to loss.

Grief is a loss being related to something that the individual can touch or measure, such as losing a spouse through death, while other types of loss are abstract, and relate to aspects of a person’s social interactions.

Every step of the process is natural and healthy. It is only when a person gets stuck in one step for a long period of time that the grieving can become unhealthy, destructive and even dangerous. Going through the grieving process is not the same for everyone, but everyone does have a common goal; acceptance of the loss and to keep moving forward. This process is different for every person but can be understood in four or more stages, depending upon the theory that is being used.

 

In the four step model there are:

Shock and Denial

Shock is the initial reaction to loss. Shock is the person’s emotional protection from being too suddenly overwhelmed by the loss. The person may not yet be willing or able to believe what their mind knows to be true. This stage normally lasts two or three months.

 

Intense Concern

Intense concern often manifests by being unable to think of anything else. Even during daily tasks, thoughts of the loss keep coming to mind. Conversations with one at this stage always turn to the loss as well. This period may last from six months to a year.

 

Despair and Depression

Despair and depression is a long period of grief, the most painful and protracted stage for the griever (during which the person gradually comes to terms with the reality of the loss). The process typically involves a wide range of feelings, thoughts, and behaviors. Many behaviors may be irrational. Depression can include feelings of anger, guilt, sadness and anxiety.

 

Recovery

The goal of grieving is not the elimination of all the pain or the memories of the loss. In this stage, one shows a new interest in daily activities and begins to function normally day to day. The goal is to reorganize one’s life, so the loss is an important part of life rather than its center.

 

Reactions

Crying is a normal and natural part of grieving. It has also been found, however, that crying and talking about the loss is not the only healthy response and, if forced or excessive, can be harmful.

George Bonanno, a professor of clinical psychology at Columbia University states in his book the other side of sadness responses or actions in the affected person, called “coping ugly”may seem counter-intuitive or even appear dysfunctional, e.g., celebratory responses, laughter, or self-serving bias in interpreting events. Lack of crying is also a natural, healthy reaction, potentially protective of the individual, and may also be seen as a sign of resilience. Science has found that some healthy people who are grieving do not spontaneously talk about the loss. Pressing people to cry or retell the experience of a loss can be harmful. Genuine laughter is healthy.

 

Risks

Bereavement, while a normal part of life, carries a degree of risk when severe. Severe reactions affectan estimated 15 percent of the bereaved population, or more than a million people a year.

Dr. M. Katherine Shear, a professor of psychiatry at Columbia states in her book composite psychotherapy for the syndrome of complicated grief, that grief can become what she calls a “a loop of suffering.” In these instances people, can barely function. “It takes a person away from humanity, and has no redemptive value.”

Severe reactions mainly occur in people with depression present before the loss event. Severe grief reactions may carry over into family relations. Some researchers have found an increased risk of marital breakup following the death of a child, for example. Others have found no increase.

Many studies have looked at the bereaved in terms of increased risks for stress-related illnesses. Colin Murray Parkes in the 1960s and 1970s in England noted increased doctor visits, with symptoms such as abdominal pain, breathing difficulties, and so forth in the first six months following a death. Others have noted increased mortality rates (Ward, A.W. 1976) and Bunch et al. found a five times greater risk of suicide in teens following the death of a parent.

 

Examples of bereavement

 

Death of a child

Death of a child can take the form of a loss in infancy such as miscarriage or stillbirth or neonatal death, SIDS, or the death of an older child. In most cases, parents find the grief almost unbearably devastating, and it tends to hold greater risk factors than any other loss. This loss also bears a lifelong process: one does not get ‘over’ the death but instead must assimilate and live with it.

Intervention and comforting support can make all the difference to the survival of a parent in this type of grief but the risk factors are great and may include family breakup or suicide.
Feelings of guilt, whether legitimate or not, are pervasive, and the dependent nature of the relationship disposes parents to a variety of problems as they seek to cope with this great loss. Parents who suffer miscarriage or a regretful or coerced abortion may experience resentment towards others who experience successful pregnancies. Because of the intensity of grief emotions, irrational decisions are often made.

 

Suicide

Suicide is a growing epidemic and over the last thirty years there has been national research trying to curb this phenomenon and gather knowledge about who is “at-risk”. When a parent loses their child through suicide it is traumatic, sudden and affects all loved ones impacted by this child. Suicide leaves many unanswered questions and leaves most parents feeling hurt, angry and deeply saddened by such a loss. Parents feel they can’t openly discuss their grief and feel their emotions because of how their child died and how the people around them may perceive the situation. Parents, family members and service providers have all confirmed the unique nature of suicide-related bereavement following the loss of a child. They report a wall of silence that goes up around them and how people interact towards them. One of the best ways to grieve and move on from this type of loss is to find ways to keep that child as an active part of their lives. It might be privately at first but as parents move away from the silence they can move into a more proactive healing time.

 

Death of a spouse

Although the death of a spouse may be an expected change, it is a particularly powerful loss of a loved one. A spouse often becomes part of the other in a unique way: many widows and widowers describe losing ‘half’ of themselves. After a long marriage, at older ages, the elderly may find it a very difficult assimilation to begin anew.

At younger ages as well, a marriage relationship was often a profound one for the survivor. And finally, it must be taken into account as a factor the manner in which the spouse passed away. The survivor of a spouse who died of an illness has a different experience of such loss than a survivor of a spouse who died by, say, an act of violence. The grief, in all events, however, can always be of the most profound sort to the widow and the widower.

Furthermore, most couples have a division of ‘tasks’ or ‘labor’, e.g., the husband mows the yard, the wife pays the bills, etc. which, in addition to dealing with great grief and life changes, means added responsibilities for the bereaved. Social isolation may also become imminent, as many groups composed of couples find it difficult to adjust to the new identity of the bereaved, and the bereaved themselves have great challenges in reconnecting with others. Widows of many cultures, for instance, wear black for the rest of their lives to signify the loss of their husband and their grief. Only in more recent decades has this tradition been reduced to a period of two years, while some religions such as Christian Orthodox many widows will still continue to wear black for the remainder of their lives.

 

Death of a parent

For a child, the death of a parent, without support to manage the effects of the grief, may result in long-term psychological harm. This is more likely if the adult carers are struggling with their own grief and are psychologically unavailable to the child. There is a critical role of the surviving parent or caregiver in helping the children adapt to a parent’s death. Studies have shown that losing a parent at a young age did not just lead to negative outcomes; there are some positive effects. Some children had an increased maturity, better coping skills and improved communication. Adolescents valued other people more than those who have not experienced such a close loss.

When an adult child loses a parent in later adulthood, it is considered to be “timely” and to be a normative life course event. This allows the adult children to feel a permitted level of grief. However, research shows that the death of a parent in an adult’s midlife is not a normative event by any measure, but is a major life transition causing an evaluation of one’s own life or mortality. Others may shut out friends and family in processing the loss of someone with whom they have had the longest relationship.

An adult may be expected to cope with the death of a parent in a less emotional way; however, the loss can still invoke extremely powerful emotions. This is especially true when the death occurs at an important or difficult period of life, such as when becoming a parent, at graduation, or at other times of emotional stress. It is important to recognize the effects that the loss of a parent can cause, and to address these effects. For an adult, the willingness to be open to grief is often diminished. A failure to accept and deal with loss will only result in further pain and suffering.

 

Death of a sibling

The loss of a sibling is a devastating life event. Despite this, sibling grief is often the most disenfranchised or overlooked of the four main forms of grief, especially with regard to adult siblings. However, the sibling relationship tends to be the longest significant relationship of the lifespan and siblings who have been part of each other’s lives since birth, such as twins, help form and sustain each other’s identities; with the death of one sibling comes the loss of that part of the survivor’s identity.

The sibling relationship is a unique one, as they share a special bond and a common history from birth, have a certain role and place in the family, often complement each other, and share genetic traits. Siblings who enjoy a close relationship participate in each other’s daily lives and special events, confide in each other, share joys, spend leisure time together (whether they are children or adults), and have a relationship that not only exists in the present but often looks toward a future together (even into retirement).

Siblings who play a major part in each other’s lives are essential to each other. Adult siblings eventually expect the loss of aging parents, the only other people who have been an integral part of their lives since birth, but they do not expect to lose their siblings early; as a result, when a sibling dies, the surviving sibling may experience a longer period of shock and disbelief.

Overall, with the loss of a sibling, a substantial part of the surviving sibling’s past, present, and future is also lost. If siblings were not on good terms or close with each other, then intense feelings of guilt may ensue on the part of the surviving sibling (guilt may also ensue for having survived, not being able to prevent the death, having argued with their sibling, etc.)

 

Loss during childhood

When a parent or caregiver dies or leaves, children may have symptoms of psychopathology, but they are less severe than in children with major depression. The loss of a parent, grandparent or sibling can be very troubling in childhood, but even in childhood there are age differences in relation to the loss. A very young child, under one or two, may be found to have no reaction if a carer dies, but other children may be affected by the loss.

At a time when trust and dependency are formed, a breakeven of no more than separation can cause problems in well-being; this is especially true if the loss is around critical periods such as 8–12 months, when attachment and separation are at their height information, and even a brief separation from a parent or other person who cares for the child can cause distress.

Even as a child grows older, death is still difficult to fathom and this affects how a child responds. For example, younger children see death more as a separation, and may believe death is curable or temporary: in one case, a child believed her deceased mother could be restored with band-aids. Reactions can manifest themselves in “acting out” behaviors: a return to earlier behaviors such as sucking thumbs, clinging to a toy or angry behavior; though they do not have the maturity to mourn as an adult, they feel the same intensity. As children enter pre-teen and teen years, there is a more mature understanding.

Adolescents may respond by delinquency, or oppositely become “over-achievers”: repetitive actions are not uncommon such as washing a car repeatedly or taking up repetitive tasks such as sewing, computer games, etc. It is an effort to stay above the grief. Childhood loss as mentioned before can predispose a child not only to physical illness but to emotional problems and an increased risk for suicide, especially in the adolescent period.

Children can experience grief as a result of losses due to causes other than death. For example, children who have been physically, psychologically and/or sexually abused often grieve over the damage to, or loss of, their ability to trust. Since such children usually have no support or acknowledgement from any source outside the family unit, this is likely to be experienced as disenfranchised grief.

Relocations can cause children significant grief, particularly if they are combined with other difficult circumstances, such as neglectful and/or abusive parental behaviors, other significant losses, etc.

 

Loss of a friend or classmate

Children may experience the death of a friend or a classmate through sports, illness, suicide, or violence. Initial support involves reassuring children that their emotional and physical feelings are normal. Schools are advised to plan for these possibilities in advance.

If you need help and support for you or someone else with grieving, then check out the useful websites link HERE.

 

Everyone grieves differently

Grieving is a personal and highly individual experience. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and the nature of the loss. The grieving process takes time. Healing happens gradually; it can’t be forced or hurried—and there is no “normal” timetable for grieving.Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

 

Bibliography

en.wikipedia.org/wiki/Grief

www.cruse.org.uk/

www.macmillan.org.uk

www.stpetershospice.org.uk/

www.mind.org.uk/mental_health_a-z/8046_bereavement

www.nhs.uk/Livewell/bereavement/Pages/coping-with-bereavement

BEREAVEMENT SUPPORT GUIDLINE PDF

www.mccn.nhs.uk

www.nytimes.com

www.helpguide.org/mental/grief_loss.htm

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