This is a note that I have prepared hoping that it may be useful to bereaved people and to those supporting them, including my colleagues. I would appreciate any feedback that people would like to give. davidjockelson@gmail.com
There is also a very short article in the form of a letter to New Scientist: Successful bereavement processing can be blocked by our trauma responses.
This article is about a twenty minute read. That is usually considered to be too long for a blog or website. So I open with a summary:
1. Bereavements are often much more complicated and chaotic than people expect – so they are shocked and confused.
2. Recovery takes far longer than people expect or society expects: for someone very close and important, it’s not a few weeks or months. One or two years is necessary.
3. Some losses are particularly hard to process and it is good to understand why and be compassionate including with oneself as the bereaved: In this article I explore the fact that bereavement can become problematic and stuck if the loss is complex, premature, unexpected, traumatic, ones involving violence and pain. Very long drawn out ones. And ones without good support after the death.
4. With enough support and with a realistic expectation of time it is possible to arrive at a mellow grief. Sad but calm and valuing what you had together. Nostalgia can be a good word and a safe emotional place.
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1. Bereavements are often much more complicated and chaotic than people expect – so they are shocked and confused.
It may seem obvious to say that people who are bereaved are usually devastated and profoundly sad.
However, they are often surprised and shocked that they do not simply have grief but there are huge complications in the experience of bereavement.
For many there is a whirling experience of emotions that are madly mixed and frequently changing: People can be desperately sad sometimes of course but maybe at other times quite numb, detached and not feeling any emotions at all. And that can make people feel ashamed and guilty.
Then there can be experiences of anger, anxiety, boredom, guilt, coldness and many other emotions. And even moments of happiness and peace – which then ironically sometimes triggers further guilt.
These sudden changes in emotions can be a major source of confusion.
One result is that there is an additional layer of emotions about this surprising confusion. People ask themselves “Is this normal? What’s wrong? Am I going mad? Am I doing something wrong? Will this pain and confusion continue or even get worse? How long is this going to last?”
And people often reach out for some certainties – some structure. And grasp such ideas as Kubler Ross’s five stages of grief: Denial Anger Bargaining Depression Acceptance.
However this is often not very useful. That model was originally not formulated for bereavement but for dealing with a terminal illness. She later accepted that they are not actually sequential stages and that not everyone has all of the emotions. So there isn’t much structure left.
What can help? I find that paradoxically, rather than offering simplistic general formulas or structures, people are more helped by some careful observations about the very complexities of bereavement that are so confusing.
First simply to acknowledge the situation as described above. And to share that shock and bewilderment honestly with others and learn that it is normal and not pathological.
2. Secondly to understand about the time aspect.
In our modern culture we have a totally unreasonable and inhuman attitude to the timing of grief. A week’s compassionate leave if you’re lucky symbolises that. “Back to work and back to normal” is the message. So people are disturbed and given additional stress when they are in shock and grief for weeks and months.
If they go to their GP saying they are still in pain and crying after some weeks or months, they may be diagnosed with pathological grief and given medication.
Medication has its place but it’s more likely to be used if the expectation is for an unrealistically quick return to normal and the pain of grief is not properly shared and is seen as something simply wrong.
It is often better to refer to other cultural norms including the Victorian one. There the first year was one of deep mourning with attendant rituals and conventions as to dress code and restricted socialising. And the second year being less deep mourning. And the end of the second year signalled a return to more normal life.
Another way of experiencing this is that the first year is now often a time of acute, biting pain but also of some distracting activity with the funeral and probate and intense family interactions.
The second year is often also very hard to endure with a long, cold emptiness and the painful ache of the fact they have gone and coming finally to believe and accept they are not coming back.
I have found that having a more realistic timescale like this has been very helpful to many clients – in terms of helping with realism of their expectations and reducing their frustration and anxiety about the slow progress of their grieving.
Another image that people say they have found most useful is comparing a bereavement with a non-fatal and recoverable stroke.
Being very close to someone is to have a part of your brain dedicated to them, focused on them, to some degree enmeshed with them. For that person to die, to cease to exist, is like damage to that bit of the brain.
And it is well known that the brain can repair itself after a stroke – to some degree and sometimes completely. The brain is flexible and plastic and neurones can grow around the damaged area.
Recovery may take months or years and this is generally understood and to some degree accepted.
And there is nothing directly we can do to speed that up. But skilful work around a bereavement can be the equivalent to brain and body stroke recovery exercises. And talking and being with friends and supporters is the key aspect of that.
To make progress is not betrayal.
It is useful to acknowledge the fact that a very common feeling is that any progress, any reduction in the pain of loss is a betrayal of the person who has died, a letting go of any memory. A fear of further loss.
With talking it through and support, someone can see that moving on out of the early acute pain is not betrayal and does not indicate a forgetting of the person who has died. It is what they would have wanted and it does not represent a loss of their memory.
People have found it useful to see that they can achieve a mellowing of grief and the endpoint can be learning to live with a long, aching Nostalgia; a state which respects the sadness of the loss but is able to let in, value and respect the good memories.
3.. Then it’s useful to say that many generalisations are often misplaced. Every death is different and so every bereaved person is different.
So in fact identifying those differences and how they affect the grief experience is a useful starting point in helping to make sense of the situation for the bereaved person.
I try and explore the differing situation of each client by looking at their bereavement under five headings. And it is noticeable that having this structure is in fact itself often useful for clients as something to hang onto.
First: The nature of the death.
Second: The situation immediately following the death, including the funeral and other rituals.
Third: The ongoing situation of the bereaved person, how their life has changed and the degree of support they have.
Fourth: The emotional state of the bereaved person before the death – both in terms of their long term innate personality and in terms of where they were up to in the immediate time before the death.
Fifth: The relationship the bereaved person had with the one who died.
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1. The first therefore is about the death itself.
It can really help a bereaved person to understand that a bereavement is more problematic if the death has any of the following characteristics:
1.1. Premature – ie of a younger person – whether a child or even an adult younger than the normal age of death.
The emotion that aspect triggers is often a sense of being cheated. The unfairness of it. Hence frustration and anger.
1.2. A traumatic death. This can be simply a sudden, unexpected death. The shock element can put it more into the world of a trauma and we need to see it through that lens – post traumatic reactions.
To some extent these points apply to many or most bereavements – because, even in the most expected deaths, there is an unexpected element of shock. This probably more true than it was in earlier time because we are so unused to death and in denial about it Many people will not have seen someone die or seen a dead body. Previous generations were much more familiar with death.
This can all be exaggerated to a huge, additional degrees of shock in the event of violence – an accident or crime or suicide.
Seeing it as a post-traumatic situation is necessary in order to understand that our reactions will certainly include the familiar but hugely important trauma responses of: Freeze, Fight, Flight, Search.
And the key aspect of this is that these are the well known responses to a Threat. These responses to a threat are totally appropriate and relevant to dealing with a challenge that is present at that moment. But they can block the healthy process of grief and bereavement.
They are the ones that equip somebody to solve a problem or a threat we are facing – to avoid detection, to escape, to fight back or to find a solution.
In all deaths many people will experience those reactions. And the more traumatic the bereavement, the more people will experience all of those reactions.
It is worth therefore looking at them carefully and see how they play out now: The Freeze reflex is the hardwired reaction to avoid detection by a threatening person or animal. For our purposes it is useful to understand it as emotional freezing. This can lead to the numbness that many people experience – often to their surprise.
The Fight reflex which fuels anger and is often linked to the Search reflex which amounts to a desperate searching for reasons and detailed information about the death. And, linked with anger, looking for someone to blame. The Flight reflex can sometimes be experienced as depression, running away from the reality and wanting to hide.
These are all hugely important as survival reflexes and therefore millions of years of evolution has ensured that they are deep in the mind. They are crucially important in dealing with immediate threats from wild animals and other hostile humans.
In a society which is not involved in actual war, they are harnessed in a longer time scale and amplified with the urge to fix things, find out more and more information, to solve problems, to win struggles and competition.
So those people who are most successful and rewarded in our society are the people who are best at searching for answers and fixing things.
And it is precisely those people who often find it hardest to process a death because the crucial and unbearable fact is that there is no fixing; there is no escape from the fact, there is no victory and no solution once a death has happened.
This is deeply unfamiliar ground to people whose daily lives consist of fixing and success – not only for themselves in obvious public ways but also in many caring activities for the benefit of others.
“There must be something I can do” is the loud, insistent and persistent voice in the head. People report those thoughts going round and round in their heads, week after week, months after month. Yearning for information and answers as to what might have been different. “If only ….”
It is one of the commonest ongoing sources of distress following a bereavement. People have spoken of “grasping at thin air”.
The resulting bewilderment and frustration are huge and unexpected emotions. And it can turn into anger with themselves.
Simply coming to understand what is happening here can be extremely helpful to people in this situation.
Because crucially these are responses to immediate threats and if the Freeze reflex continues and a person remains in a prolonged and open ended threat response mode, then they are therefore stuck. And therefore blocked from achieving the grief and the acceptance that is the successful outcome in a bereavement; an outcome which can finally allow peace and a return to a normal degree of happiness.
Because a major part of the bereavement process is allowing in that hugely painful reality that a lot of our thinking and feeling is effectively forms of futile activity based on an unspoken delusion that “if we only do something right, then everything will be back to normal.”
Phrasing it like that truly but brutally exposes the degree of delusion – but it is important to respect the fact that it is the safe space for some time for many people. And the question becomes just for how long? And whether someone has got profoundly stuck. And how to come out of it.
And the answer starts here – with an understanding of what is happening emotionally and sharing that understanding with supportive others. (see below for “Grief Companions”)
1.3 An over extended death. This also creates very difficult complications. Maybe it is a situation – in fact a death that has dragged out over month or years. Often it involves hugely complex issues of distress, physical and emotional exhaustion, life being on hold, financial impact and then guilt about thinking about that. Dreading the death but also possibly yearning for it. And then guilt and confusion about that.
1.4. Pain. In either of the two cases above, the level of pain the dying person suffered – the empathic pain the bereaved person will feel in the horror of a sudden or violent death and, in over extended deaths, the extent to which it connects with the mixed emotions which include a wish for the pain to end.
1.5. Suicide. This involves many of the above – often premature, violent, painful, unnecessary and avoidable- endless churning thoughts of what could have stopped it? What we could and should have done? Huge corrosive guilt
1.6. Unnecessary or avoidable death. Medically chaotic and suspicious. Those are triggers for blame ie anger – which often goes down the rabbit hole of action – accusation, complaint, legal action. Or self blame. Guilt that can eat a person up.
1.7. Uncertainties. What was the cause of death? The yearning for information. The delays in waiting for medical or police reports or for the inquest. Even if in cases where the cause was obvious, the delay prevent prompt, healthy closure of at least one aspect of the loss.
The extreme version of that uncertainty is the disappeared or lost person. The open ended agony of hope. And no closure.
Interestingly this can connect with the non-death losses which do not have a clear cut certainty. For example: Losing someone to senility. see above 1.3. The ending of a relationship. This is the death before the death and immensely difficult .
Second: The situation immediately following the death.
It may be best to describe an ideal situation and then compare the one that you are dealing with.
Firstly a death where the problematic issues above are absent but then …
The ideal is for a death where family and possibly friends are closely involved – or as closely as is wished for.
It needs to be stated and repeated: We are social animals and did not evolve to grieve alone.
“Grief Companions” is a useful phrase to refer to people who knew the person who has died and who really understand and can genuinely empathise and feel at least some of the same emotions as those closest and most bereaved. People who can exchange stories or remarks about the deceased person.
An ideal ending would also include a funeral or event where the celebrant knew the deceased and could talk sensitively about them. Where family members and friends were fully involved. And later a gathering or wake where grief companions of varying degrees of closeness could share memories or just be together.
Distribution of property or legacies would go smoothly and without tension or conflict.
This ideal scenario highlights and almost gives a checklist of how things can go wrong in ways that lead to a problematic bereavement which can get stuck for months or years.
Examples are people not being able to be close at the time of the death or soon after. This was very true in covid and can be with very dispersed families or with some need to have a hurried funeral.
Equally family conflicts can prevent many of the aspects of the ideal bereavement, introducing stress and tension at a time when people are hyper sensitive and vulnerable.
Disputes about the funeral, probate or distribution of property can totally sour and compromise a bereavement.
Third: The ongoing situation of the bereaved person and the degree of support they have.
The role of Grief Companions is mentioned above in the context of the immediate aftermath of a death but, to combine it with the realistic time frame also referred to, the question becomes: is there anyone who is there for you in emotional and practical terms for the long journey to normality?
Also consider and acknowledge how the death has impacted including in terms of finance, and lack of other support can truly sharpen the experience of abandonment and loneliness.
Fourth: The emotional state of the bereaved person before the death.
It’s worth looking at this in two time frames. Firstly, the relatively short term issue of the impact that a long illness and decline may have had. There is some exploration of that above but it’s common to hear people say that, after months of hospital appointments and treatments and some progress and then disappointments, the bereaved person is already battered, exhausted and vulnerable. And that needs to be taken into account and that person encouraged to be understanding and compassionate to themselves.
And if that language is difficult for some people, it is often more effective to talk about being more skilful in the process.
And that way of talking and thinking connects unobviously with the second timespan – the longer term issue about the personality of the bereaved person.
As touched on above, for someone who has been dynamic and effective, a problem-solver all their life, the reaction to a death is challenging in a particular way.
People who are strongly and successfully into the searching and fixing reflex very often bring that approach to a death.
“What can be done? How can this be fixed? What was the cause? I need more information. I need to do something. Find someone to blame. Or to sue. Even to spend a lot on the funeral or the headstone or some other memorial. Or to raise money to fight the illness that caused the death.”
And that impulse to blame can turn on oneself – sometimes with explicit and often irrational guilt. An illustrative, extreme example was a client saying of her partner’s death: “It’s my fault – I shouldn’t have let him go to work that day then he wouldn’t have been run over…”
Sometimes for someone who expects things to get better quickly and are impatient, the anger can be directed towards oneself as an unforgiving, critical attitude: “I am just feeling sorry for myself” which has a dismissive tone and can reflect years of conditioning creating the taboo: never feel sorry for oneself.
It can be useful to suggest a re-thinking of that simply as “feeling sorrow for myself” – which is easier to see as legitimate, appropriate and necessary.
The anger and searching for ways to fix things is often automatic and compulsive – which means it is not easily open to rational understanding.
Fundamentally we are talking about the futility of these actions.
But that is brutal and dismissive language and, rather than any rational arguing, it’s often better to suggest that people see the behaviour as symbolic. And legitimately symbolic. And that can be explored and honoured.
However that is not always an easy step for those of us who are more literal minded and not used to respecting the symbolic. And maybe this is most true of the most effective analysing fixers in our culture? Is that familiar?
Fifth: The relationship the bereaved person had with the one who died.
There is something of a paradox here – as quite often in talking about bereavement.
A straightforward, loving relationship can result in a hugely painful wound. But it can be a clean wound unless there are the complications explored above.
But if the relationship was more tense or even conflictual then there are other complications – often of deep regret that there was unfinished business, the missed opportunity to make peace or achieve greater closeness. Which can result in guilt and uneasiness – which connects with the thwarted need and yearning to fix things.
One of the problems here is the honourable instinct we have to idealise the person who has died and the relationship: “speak no ill of the dead” and think no negative thoughts about the relationship.
And that is fine for a time but, after a respectful period, it often helps to spell out some of the tensions there were and even the anger that the bereaved person may have had, and may retain, whether recent or deep rooted.
Mixed feeling are OK and are far less likely to jeopardise the bereavement process if they are acknowledged honestly and healthily.
So – in conclusion and to return to the introduction and think about the future and what is a good endpoint:
What others have said are the most useful ideas:
1. The realisation that Bereavement is very emotionally complicated and this is normal.
2. Some are particularly hard to deal with and it’s a real relief to understand why.
3. The realism around the timespan and that the reassuring cliche “this too will pass” is only convincing if it’s understood in terms of a year or more of huge pain.
4. To make progress is not betrayal. it is possible to achieve a mellowing of grief and arrive at a calmer and happier place of bitter sweet nostalgia.
If you want another short summary – this is one with accompanying illustration.
https://www.arsenal.com/community/stories/bereavement-service?id=106923&utm_source=arsenaldotcom&utm_medium=share_button&utm_campaign=news