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The Royal College of Psychiatrists Improving the lives of people with mental illness

Superficially well, but still grieving - part 1

Every one of us is likely to be touched by the death of someone we know at some stage in our lives. The loss of a family member, friend or anyone else who feels significant can be a bitter blow. The way in which the person has died may lay down its own distressing memories or leave unanswered questions. Death can trouble us soon afterwards, a time when there are also practical issues to sort out, as well as many years later.  Bereavement is the most stressful event we can go through (above moving house and divorce on the scale.). While this fact makes sense it can be a challenging time to get through when feeling raw and already managing mental health problems.

 

I recently lost my father to prostate cancer and had to confront a loss I didn’t expect for some years yet. His illness was diagnosed at a very advanced stage at which all medical help could do was try to make him comfortable. He lived for 18 weeks in a way which was hard for him to endure and for me to witness. His death marked the end of his suffering but a new stage of life for me. I have ongoing mental health difficulties which have affected me for 15 years but this is my first major experience of bereavement. This is my own account of the practical and emotional issues that have come up so far.

The practical things to do after someone’s death depend on the place where they died and will usually be the responsibility of those closest in relationship. My dad died in a hospice where a doctor signed a certificate about the cause of his death the following day.  If the death has been at home a GP would need to be called to complete the death certificate. Unexpected, suspicious deaths (which would include suicides) those in prison and also where the doctor had not seen the person recently, would be reported to the local Coroner who would decide whether to investigate.

 

The practical arrangements were very stressful but I was not the only family member. I found funeral directors to be sensitive and able to assist with any plan for burial or cremation. The death has to be registered at the registry offices of the local council as a priority.  The Department of Work and Pensions may make a funeral payment if someone is on certain means-tested benefits and responsible for organising the funeral, there are also bereavement benefits in some circumstances where the bereaved is a partner. A solicitor may need to be consulted over issues such as wills, probate and legacies where complex. There is information on the website www.direct.gov.uk about all practical issues. You can also contact your nearest Citizens Advice Bureau where trained advisers will be able to help you. The DWP has a booklet called What to do after a death?  

 

My biggest worry then became the funeral and getting through it. I tend to feel faint (a feature of my anxiety disorder) and didn’t know that I would be able to stay standing for the duration of the service at the cemetery. The funeral did pass and provided a sense of closure. I now gain comfort from the fact I have a grave to visit and the peaceful surroundings where my dad’s body has been laid to rest. Funerals have personal significance and spiritual importance depending on that person’s beliefs. Different religions have their own customs around death and its meaning. Talking to a faith leader or minister may be an important part of the grieving process for you. Some people may not want any religious element to their funeral, for example, choosing a Humanist content, there are also natural burial sites in woodland.

 

The emotions that hit me after my dad’s death were a mixture of shock, relief and tearful distress that he had been through so much. Then I began to feel as though I could have done far better for my dad to the extent where anything less than being angelic was not good enough. I remember feeling very empty after the funeral and it seemed as though I had much time on my hands where before this all my thoughts had been focused on my dad’s ill health. I understood not to make big decisions in case I later regret them. Two months later I can feel that ‘no-one understands’ despite knowing otherwise, and as though I am separate from the world because my experiences are so far from everyday conversation. When people remark ‘but you look well’ they have little idea of my intense emotional hurt and inner turmoil. My own recurrent depression feels more intense and now has a tangible cause. I have heard that it will get easier as the days pass, although no time scale can be given.

 

I try to see the positives such as the close relationship with my dad and how I managed to say everything I wanted to him so that nothing felt unresolved. I have relied on my own support network and confided most in my community psychiatric nurse. My consultant psychiatrist has shown real understanding and offered me the opportunity to make appointments as needed. It has been important for me to let go of any guilt as I know I did my best at the time. I need to try to be kind to myself including enough sleep, food and not becoming withdrawn. I also try to resist doing too much of anything, for me this is around my eating as I have a history of severe anorexia. For others it could be drinking, smoking or drug use, as a way of burying or avoiding feelings. Keeping an eye out for any symptoms that may return from previous episodes of mental illness may help to prevent a crisis.

If you feel that you are not coping with your own grief there is bereavement counselling. This may be provided privately, by voluntary organisations such as Local Mind Associations, from NHS primary care or specialist mental health services. GPs can also refer to psychiatrists to diagnose and treat mental illness that may be triggered by bereavement. Cruse Bereavement Care have a national information service and helpline 0844 477 9400. I have found a supportive cancer drop in centre open to anyone affected by cancer. Many hospices or hospitals where the person was cared for until their death offer bereavement support services.

 

While no-one knows exactly how it feels for you at this sad time there are many people, such as friends and professionals who can empathise and want to help towards a sense of recovery where you learn to live with a loved one’s death. There are many emotions and certain well recognised stages of grief though you go through them at your own pace and in no set sequence. I had issues within my own mental health management I was trying to address before my dad’s death and now believe I can’t let this event take away all I was working toward. You can’t be expected to feel on top form whilst going through bereavement, but you don’t have to go it alone on the path to acceptance and moving forward.

Alex

Alex is a service user. Her father died from prostate cancer two months ago

Sept 2009

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In this section of the website we publish personal contributions that focus on peoples' experience of being unwell or on their recovery. Ideally they should contain information that others might find useful. The views expressed in these articles are personal. They do not necessarily reflect the vews of the Royal College of Psychiatrists.

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