Coping with bereavement and grief

These are the experiences of three people who have suffered a bereavement.

"My father died six weeks ago after an 18 month struggle with cancer. Now, I can't get the picture of him at his worst, pale, very thin and not able to sit up, out of my mind. I wish I could remember him as he was when he was well 2 years ago, but I can't. I feel so guilty, I wish I could have done more..."

"After 45 years of marriage I lost my wife six months ago, thankfully she only has a short period of illness during which she never regained consciousness. I don't seem to be able to cope with it, I still keep expecting her to walk through the door. I sometimes feel she is present during the night but always wake up disappointed..."

"My husband was killed in a car crash earlier this year, and I am left on my own to bring up my two small children. I feel so lonely and isolated, sleeping is a problem, at times I feel angry with my husband for leaving me to cope on my own - even though I know this is the last thing he would have wanted for us, ..."

As you can see people can have quite different experiences when they loose someone close to them. This leaflet aims to help you to understand some of the emotions which may be faced during a bereavement or loss, to make some practical suggestions which may help you to get through this difficult time and to offer some basic details of what needs to be done when there is a death. At the back of the leaflet there are some addresses and telephone numbers of organisations which may be helpful to you.

Understanding grief

How do people feel when they have experienced bereavement?

Serious loss is something that we will all face at some time in our life. This may be because of the death of someone close to us or it may be because of other circumstances such as the loss of our health or our home.
Many of us will not experience bereavement or loss, until later in life and may have little opportunity to learn about death and about how people are affected by grief. It can seem difficult to know what is "normal" and to understand how we or our families may respond when we face a loss.
You may think you are the only person who has felt the way you do. Whilst everyone's response to a loss is a very individual experience, there are some common experiences that many people will share.

How do people feel in the early hours and days after the death of a close relative or friend?

People often describe shock soon after the death of such a person. You feeling numb, panicky, very weepy or unable to cry at all. Some people find it difficult to sleep, others may have many physical symptoms such as heart palpitations. Some people find they calmly go through the practical tasks surrounding the death, and worry that they may be seen as uncaring. This is just one of the signs of shock and it is most likely that they will feel the impact of the death at a later point. Some people find themselves completely unable to cope and need a lot of practical and emotional support from those around them at this point.

What sorts of feelings do people have weeks and months after a bereavement?

Some people feel a sense of agitation for quite a long time after the death. People may become very active at this time doing things like cleaning out the whole house. This agitation can sometimes amount to panic and symptoms of anxiety such as breathlessness, palpitations, dry mouth, tingling and dizziness can be present.
People may feel they are "going mad" because they have such odd experiences. People often report that they thought they saw, heard or felt the dead person near them or in the distance. These experiences are not unusual following a death.
These feelings may alternate with depression, weepiness, tiredness and low mood.
People may think or wonder "what's the point in going on?" They may feel guilt, and review the circumstances of the death, and their relationship with the deceased. They may wonder what they could have done differently which might of helped the situation. This is also common when there has been relief at someone's death following a painful and prolonged illness. It is worth remembering that many people feel relief when suffering ends.
Anger is another emotion commonly felt following a death. This can be directed at the deceased person "why has he left me?" or at those around. Family members or people involved in caring for the dying person, may receive the anger of the bereaved person, "why did you not do more?"
Other people's reaction may be difficult for the bereaved person. Sometimes people will be clumsy in what they say or do. Occasionally people will avoid contact with the bereaved person. These reactions are usually because people do not know what to do or say in the face of someone's grief. Sometimes other people do not realise that it can take a long time to begin to recover from a death.

When do people begin to recover from a bereavement?

Coming to terms with a death is a very gradual process that can take a considerable time. People usually find that gradually they are able to get on with their lives and think a little less about the person they have lost. Most people begin to feel like this within one or two years of the death of someone close to them. It may be difficult to accept the death of a loved one but nonetheless be able to move on with life in spite of this. It is important not to feel guilty if you are beginning to build a life for yourself following a death. It is quite normal to begin to recover and start to rebuild your life, and is not in any way disloyal to the memory of the person who has died.

Can tablets help?

Tranquillisers may be offered by your doctor to help you through the early phase following the death. They can make you feel calmer and may be helpful to you in the short term but are not helpful for longer term use. Some people find that the numbing effect of tranquillisers does not allow them to experience grief during this time. Antidepressants can be helpful if the depression following bereavement becomes severe or prolonged.

Are there any things that a bereaved person can do to help themselves through this difficult time?

Prepare for the death of someone you are close to. It is important emotionally and practically to talk things over. If it is your partner, discuss the jobs your partner used to do, sort out finances. Say all the things you would want to say.
Carefully consider whether you want to see the body of the dead person. Some people may feel this is too distressing but can regret it at a later point if they have not done this. Follow your own feelings. There is no right or wrong thing to do, but do think it out.
Funeral arrangements should be considered carefully. Try to have someone with you. Don't feel pressured into an over-expensive funeral for your budget. Try and think about what you really want.
Don't make major changes in your life, such as selling your house, moving areas, jobs, etc, until you have had time to adjust to the death. This is a time when people may make changes they can regret.
Do make sure you look after your own health. This is a time when you may become prone to illness. Eat well, rest properly and take extra care. You may want to take vitamin supplements if your appetite is very poor.
Talk to people about how you feel. Don't bottle things up. Go to your doctor if you feel you have no one you can talk to, he or she may suggest speaking to a counsellor.
If your health is not good, consult your doctor.
Keep up contacts and relationships. Accept invitations, invite people keep in touch with family and friends. Find out about local events/clubs/classes. • Ask for help if you feel you are not coping. Talk to family, friends or your doctor.
Do not enter into new financial arrangements without proper advice. Take a friend or family member.
Do not turn to drinking to get you over this difficult time.
Plan what you will do on anniversaries such as birthdays, Christmas, anniversary of death. It will help to decide how you want to spend these occasions which are likely to be emotional times.
If you feel you are stuck or not coping at all well with your grief then contact your doctor to discuss this. Other organisations that may help are listed below.

Are there things that family and friends can do to help?

Spend time with the bereaved person if that is what they want.
Talk and listen to the bereaved person, don't be afraid of saying the wrong thing - this is a situation many of us feel awkward about, it may help to admit that you don't know what to say if that is how you feel.
Don't be surprised if the bereaved person wants to talk over the same ground again and again, this is quite usual.
Don't take anger or irritability personally, its part of the bereavement reaction.
Talking about the dead person can be helpful for the grieving person don't try and avoid mentioning them in everyday conversation.
Offer practical help if the bereaved person wants this. Caring for children, help with shopping etc may be useful especially in the early days following a death.
Don't expect too much of the bereaved person initially even if they look as if they are coping.
Include your relative in social events.
Support your relative in building new links, social contact and interests.
Try to discourage this bereaved person from making any major decisions, such as moving home, soon after the death. Support them in thinking through the options and implications of this.
If your friend or relative seems `stuck` and not coping at all well, encouraged them to seek help, the family doctor is a good place to start. Other organisations that may help are listed at the back of this booklet.

What practical things need to be done when there is a death?

When someone dies at home - doctor must be called to sign a medical certificate. If the death has been sudden the doctor will have to talk to the police who will report it to the coroner. A post mortem examination may be arranged.
When someone dies in hospital the doctor there will give you a medical certificate.
Once you have the medical certificate you must take it and register the death within five days. The registrar will issue a death certificate and notification of disposal which should be given to the funeral director. Make a few copies of the death certificate which you may need for pension and insurance purposes.
A funeral director can be chosen before or after you have registered the death. Most people obtain a name from the telephone directory or by word of mouth. He or she will advise on the procedures for the funeral.
Contact your social security office (local Benefits Agency) to arrange pension and other entitlements. You may be eligible for funeral payment or widows payment. (There are guides to your entitlements available in the benefits agency.
Inform the tax office about your change in circumstances.
You may want to put a death notice in the local or national papers.
If there is a will the executors will make sure it is carried out. Contact the solicitor. If there is no will contact the Probate Registry for an application to administer the `estate`. Your local Citizens Advice Bureau can help you if you are not sure.

Useful organisations

Carers' National Association 29 Chilworth Mews, London, W2 3RG Tel: -71-724 7776
Compassionate Friends 6 Denmark Street, Bristol, BS1 5DQ Tel: 0272-293 778
The Cot Death Society 7 Friars Walk, Thornby, Merseyside, L37 4EU Tel: 0704-879995
CRUSE Bereavement Care 136 Sheen Road, Richmond, Surrey, TW9 1UR Tel: 081-940 4818.
CRUSE Bereavement Line - help line for bereaved people and those caring for bereaved people. Tel: 0181-3327227 (Local Cruse: 01670-353710, Blyth Group)
Family Link - a befriending scheme offering support and a practical approach to families with young children. Tel: 0191-2323741.
Foundation for the Study of Infant Deaths 15 Belgrave Square, London, SW1X 8QB Tel: 071-235 1712 (Help line) Tel: 071-235 0965 (Switchboard)
Jewish Bereavement Counselling Service _ Visitation Committee, Woburn House, Tavistock Square, London, WC1H 0EZ.
Lesbian and Gay Bereavement Project The Vaughan M. William Centre Collindale Hospital, London, NW9 5HG Tel: 081-455 8894
London Association of Bereavement Services 69 Charlton Street, Camden, London, NW1 1JR Tel: 071-388 2158
Miscarriage Association 18 Stoneybrook Close, West Bretton, Wakenfield, WF4 4TP Tel: 0924 200 799 (24 hour answer phone)
Mind - Northern - 158 Durham Road, Gateshead, Tyne and Wear, NE8 4EL Tel: 0191-4900109.
National Association of Bereavement Services _ 68 Charlton Street, London, NW1 1JR Tel: 071-388 2153
National Association of Victim Support Schemes Cranmer House, 39 Brixton Road, London, SW9 Tel: 071-735 9166
National Debt Line. Help for anyone in debt or concerned they may fall into debt. Tel: 0645-500511 (local call rate).
NHS Direct - Telephone Help line/Health Information Service. Talk confidentially to a nurse or information officer. Calls charged at local rate: Tel: 0845-1888
Samaritans 25 North Seaton Road, Ashington Tel: 01670-814222 Link line (local rate). Tel: 0345-909090. Confidential support for anyone in a crisis.
Stillbirth and Neonatal Death Society 23 Portland Place, London, W1N 3DE. Tel: 071-436 5881
Terence Higgins Trust BM Aids, London, WC1N 3XX. Tel: 071-242 1010