Bereavement - RCGP FacSheets 42

FacSheets 42: Bereavement

Information Sheet for Patients

When someone you love dies, you go through a predictable process of grieving.
Your reaction may depend on the circumstances. Was the death expected? Was the death sudden? How old was the deceased? How old are you? What are your personal, family, national or religious customs. No matter what the circumstances, you will suffer some kind of reaction. The emotions described here are regarded as normal responses.

The first stage
- Shock or disbelief
  The immediate reaction is for you to simply feel numb and empty. For a short time you may feel and behave almost as though nothing has happened: everything is a blur. Eventually, extreme grief may take over. during this first stage delusions of seeing or speaking with the dead person may occur: although it may disturb you, these experiences are normal. There is also a tendency to forget that the person is dead and act as though he or she were alive. You will find it difficult to concentrate. You may have outbursts of spontaneous emotions such as crying , screaming or even laughing.
The second stage
- Grief and despair
  At this stage the loss of your loved one will really hit you. This sense of loss is reinforced by constant reminders of lost habits and experiences, and by the clothes and other personal effects left behind. You will feel intensely sad and lonely. Friends and acquaintances will not visit you so much now, and many will feel uncomfortable and embarrassed about approaching you. You may actually feel like withdrawing from people.
  The sense of presence of the deceased will continue. You are also likely to experience feelings of anger or guilt.
- Anger
  This may include anger towards those considered responsible for the death and even at the deceased for dying. Your resentfulness may include blaming and accusing the medical attendants of neglect. You will feel like talking a lot about your loved one and you will probably recall all the vivid memories leading up to the death and constantly churn them over in your mind. Common recurring thoughts include:
  "Why did it happen to me?"
  "If only 'so and so' had been done it would be different"
- Guilt and self-blame:
  You may feel guilty because you did not do more for the person or take more notice of them. Such guilt feelings and intense grief are more common when the death is unexpected. It is common to think "if only I had done such and such ..."
  The feeling of intense grief usually lasts about six weeks and the overall stage of grief for about six months, but it can resurface every now and then over the next few years. During this stage you will feel sad and helpless, then pass into a state of apathy and depression (the third stage).
The third stage
- Adaptation or acceptance
  After about six months you will begin to accept your severe loss. You develop a change in living habits by taking up new roles and activities. You can face up better to disposing of personal effects, establishing new relationships and attending to financial arrangements. This phase often lasts a year or so.
  However, feelings of apathy and depression can be a problem. Feelings of physical illness are also common, including problems such as insomnia, wheezing, diarrhoea and stomach pains. You may wish to consult your doctor about any worrying physical or mental problems. Despite these feelings you will adapt and eventually learn to cope.

Self help
First, you must realise that it is normal to pass through these stages of grieving, so you can't fight it. It is best to acknowledge your loss and not try to 'shut it out'. Talking about the deceased to relatives and friends and sorting out the person's possessions will help enormously in coming to terms with your loss, even though it may be painful at first. At the beginning it is good, if possible, to see the dead person, touch them if you want to, attend the funeral and give expression to your emotions.
If you have doubts about the exact cause of the death you may wish to discuss it with your doctor. If you have prolonged intense feelings of grief or severe depression then seek help from your doctor or minister.You may find considerable support from others who have suffered a similar loss and from various self help organisations. Most people find that it is helpful to have a break away from the home, staying with sympathetic friends or relatives.The first anniversary or the first Christmas spent alone can be a very difficult time. Many people find it helpful to make arrangements to have company at such times.