Bereavement - by Dr David Delvin

Sadly, nearly all of us have to face bereavement at some time in our lives – and most commonly in the period when we’ve passed the age of 50.

For it’s a sad fact that all human relationships have to end some day.  I find it a sobering thought that no matter how much you love someone, there will come a time when the two of you will be parted by the death of one of you.

Sorry to sound so gloomy!  But actually, it’s best to know about bereavement, and to be prepared for it when it finally happens.   In the UK – and particularly in stiff upper-lipped England – people tend not to talk about this subject.  The result – as I can testify from my experiences as a doctor – is that many men and women are totally unprepared for the loss of a loved one, and so suffer far more than they should do.

What happens when we are bereaved?

When we are bereaved, we grieve.  Everyone does this in his or her own individual way – which is deeply influenced by nationality and culture.

Look for instance at the recent stream of tragic deaths in the Middle East.  From simply watching your TV news, you can see that in that part of the world, people who are bereaved will scream and shout and (very often) beat their chests – as their way of expressing their mental agony.  Such behaviour would be considered almost insane in many parts of Britain – but who is to say that it isn’t a good way of coping with terrible grief?

The Scots, the Irish and the Welsh give more outward signs than the English.  All three Celtic nations are likely to express their sense of loss in talking about the deceased, and perhaps in singing.  Indeed the Irish still often hold ' wakes' – the remarkable social events which enable relatives and friends to give voice to their feelings.

Does this enable them to cope with bereavement better?  I’m not sure.  But what I am sure of is this: if you suffer a bereavement, the worst thing you can do is to try and bottle it up completely, and refuse to discuss it with anybody!  Again and again, I’ve seen that course of action lead to nervous breakdowns and other emotional troubles – sometimes many years later.

How attitudes to bereavement have changed

Curiously enough, the British attitude of ‘don’t mention death’ is relatively a recent one.  Until about 100 years ago, death was a constant reality in people’s lives.  Women regularly died in childbirth, and a high proportion of children didn’t make it to adulthood.  So in late Victorian times, everyone was well used to regular trips to the cemetery.

Things changed dramatically during the 20th Century, as public health and medical science made great strides.  People started living far, far longer, and death became more of an unfamiliar thing.  Today, we have a situation which has never existed before in human history; most of us expect to grow old!  Furthermore most of us are quite an age by the time we lose our parents – or others whom we dearly love.

So it’s no wonder that nowadays we’re not much good at dealing with death, and that when it happens we find ourselves devastated and unsure of what to do.

So in this article, I’m going to try and deal with some of the problems which most commonly cause difficulties and distress for bereaved people.  Here goes.

COMMON PROBLEMS

After a bereavement, how long can you expect to grieve for?

This is very variable.  There’s no time limit on grief, and all sorts of factors may influence it.

For example, some people live for several years with the knowledge that the person they love is going to die soon.  In that situation, a feeling of grief often begins long before the actual death.  However, in these cases the actual passing away is often perceived as ‘a merciful release’.  So sometimes, the subsequent period of grief may be relatively short.

In other cases, we suddenly lose someone special – for instance, through a road accident or an unexpected heart attack.  In these cases, the grieving will obviously begin from the shocking moment when one learns of the death, and may persist for years.

But in general, most people tend to feel that they are able to tolerate their pain better after about six months.  Life tends to gradually feel better after that.

However, not everyone recovers as quickly.  So if you are still grieving after a year or two years and well-meaning friends keep hinting that you should ‘be over all that by now,’ pay no attention to them!  You’re entitled to get over grief in your own way – and in your own time.

On the other hand, be aware of the fact that you may be suffering from a depressive illness – see below.

Do many people get clinically depressed after a death?

Yes, they very definitely do.  However, attitudes to depression and death have changed a great deal.  I can just about remember that 40 years ago, bereaved people were never regarded as ‘depressed’.  No doctor would have dreamed of giving the average bereaved person an anti-depressant drug.

All that has changed.  These days, GPs are very willing to try and help with a prescription for anti-depressant medication – if they think that the bereaved man or woman is clinically depressed.  Useful ‘markers’ of clinical depression include:

  • Uncontrollable misery that goes on for month after month;
  • Gross sleep disturbance – often with inability to stay asleep after about 3am;
  • Inability to eat or to care for oneself;
  • Thoughts of suicide.

After a bereavement, if you have any of those symptoms, I urge you to contact your doctor for help.

Should one cry after a death?

Personally, I’m very much in favour of it.  It lets out certain very important emotions and it’s a natural human reaction.

Yet there are certain circles in which is not ‘done’ to cry.  For instance, I have known a number of public school-educated boys who were told ‘not to blub’ when their parents died!  This seems to me quite crazy and only likely to lead to emotional trouble later on.

Are there various ‘stages’ of grief?

There are very definitely certain phases that one goes through after a loved one has died.  They vary from person to person, but most experts say the commonest pattern is like this:

1.      Shock and feeling stunned

2.      Denial – a feeling that this can’t possibly have happened (‘There must be some mistake…’)

3.      Anger or guilt.  Anger may be directed against doctors – or against someone who is perceived as having caused the death.  Guilt often involves distressing feelings of ‘If only I’d done more..’ or ‘If only I’d spotted the  symptoms…’  or  ‘ if only I’d been nicer to her…’

4.      Long-lasting sadness.  Once these feelings have resolved a bit, there is usually a long-lasting feeling of sadness, emptiness and loss.

5.      Lack of identity.  Some months after the death of a partner, it is common to feel a certain ‘loss of identity’ - as though you really didn’t count as a person now that your other half has gone.

6.      Recovery.  Eventually, nearly everyone reaches a stage where life is more or less ‘normal’ again, and where everything ceases to appear miserable.  But this may take a very long time to achieve.

Summing up

Bereavement is never easy.   But most of us can cope with it – given time and support.  Good tips to remember are:-

  • Talk about your loss – to anyone who is interested.  Don’t bottle it up.
  • Don’t hesitate to cry.
  • If you think you may be depressed, consult your doctor.

Finally, if things are going very badly, don’t hesitate to contact a self-help group.  Best known in Britain is Cruse – which is extremely good at offering support for those who are devastated by the loss of a loved one.  They have about 200 local groups throughout the UK.  Call them on 0844 477 9400

Some bereavement issues are dealt with in the Q & A section below.  Good luck.

Q.        I loved my late wife, but the fact is that she drank herself to death. Is this the reason that – to my horror – I now find myself furiously angry with her?

A.        Yes.  When the dead person has brought about their own demise (say by drink-driving, or by smoking), it’s very common for the partner or relatives to feel angry with him/her.  You will get over this.  But you could help things but asking your doctor to refer you to a good counsellor.  Some of them actually specialise in grief counselling.

Q.      My daughter (aged 30) recently lost her only son in a traffic accident.  She is inconsolable.  Should I advise her to have another one as quickly as possible?

 A.       No.  Bereaved mothers often resent this well-meaning advice.  She needs time to recover – without all the additional stresses of pregnancy.  Get a very good book called ‘Dear Isobel – Coming to Terms with the death of a child.’  It is written by Georgiana Monckton and is published by Vermilion.

Q.       I lost my wife seven years ago.  I have found someone else and would like to marry her.  But the fact is that I am completely unable to have sex with her.  Is this due to grief?

 A.       Probably.  Certainly, I’ve seen it again and again in men who have lost their partners.  The problem is that deep down, they feel guilty about making love to someone else.  Happily most of these poor chaps have been cured, after a number of counselling sessions.  But quite often they do need a little ‘confidence boosting’ with Viagra (or a similar drug) for a while.

©  Dr D Delvin / Retirement Matters Ltd  2007