About this leaflet
This leaflet is for anyone who has been bereaved, their family
and friends, and anyone else who wants to learn more.
In this leaflet you will find information about:
- how people normally grieve after a loss
- unresolved grief
- places to get help
- other sources of information
- how friends and relatives can help.
Introduction
Bereavement is a distressing but common experience. Sooner or
later most of us will suffer the death of someone we love. Yet in
our everyday life we think and talk about death very little,
perhaps because we encounter it less often than our grandparents
did. For them, the death of a brother or sister, friend or
relative, was a common experience in their childhood or teenage
years. For us, these losses usually happen later in life. So we do
not have much of a chance either to learn about grieving - how it
feels, what are the right things to do, what is 'normal' - or to
come to terms with it. In spite of this, we have to cope when we
are finally faced with the death of someone we love.
Grieving
We grieve after any sort of loss, but most powerfully after the
death of someone we love. It is not just one feeling, but a whole
succession of feelings, which take a while to get through and which
cannot be hurried.
We most often grieve for someone that we have known for some
time. However, it is clear that people who have had stillbirths or
miscarriages, or who have lost very young babies, grieve in the
same way and need the same sort of care and consideration.
In the few hours or days following the death of a close relative
or friend, most people feel simply
stunned, as though they cannot believe it
has actually happened. They may feel like this even if the death
has been expected.
This sense of emotional numbness can
be a help in getting through all the important practical
arrangements that have to be made, such as getting in touch with
relatives and organising the funeral. However, this feeling of
unreality may become a problem if it goes on too long. Seeing the
body of the dead person may, for some, be an important way of
beginning to overcome this.
Similarly, for many people, the funeral or memorial service is
an occasion when the reality of what has happened really starts to
sink in. It may be distressing to see the body or attend the
funeral, but these are ways of saying goodbye to those we love. At
the time, these things may seem too painful to go through and so
are not done. However, this can lead to a sense of deep regret in
future years.
Soon though, this numbness disappears and may be replaced by a
dreadful sense of agitation, of pining or
yearning for the dead person. There is a
feeling of wanting somehow to find them, even though this is
clearly impossible. This makes it difficult to relax or concentrate
and it may be difficult to sleep properly. Dreams can be very
upsetting.
Some people feel that they 'see' their loved one everywhere they
go - in the street, the park, around the house, anywhere they had
spent time together. People often feel very
angry at this time - towards doctors and
nurses who did not prevent the death, towards friends and relatives
who did not do enough, or even towards the person who has, by
dying, left them.
Another common feeling is
guilt. People find themselves
going over in their minds all the things they would have liked to
have said or done. They may even consider what they could have done
differently that might have prevented the death. Of course, death
is usually beyond anyone's control and a bereaved person may need
to be reminded of this. Some people may feel guilty if they feel
relieved that their loved one has died after a painful or
distressing illness. This feeling of relief is natural,
understandable and very common.
This state of agitation is usually
strongest about two weeks after the death, but is soon followed by
times of quiet sadness or depression, withdrawal and silence. These
sudden changes of emotion can be confusing to friends or relatives,
but are part of the normal process of grief.
Although the agitation lessens, the periods of depression become
more frequent and reach their peak between four and six weeks
later. Spasms of grief can occur at any time, sparked off by
people, places or things that bring back memories of the dead
person.
Other people may find it difficult to understand or be
embarrassed when the bereaved person suddenly bursts into tears for
no obvious reason. At this stage it may be tempting to keep away
from other people who do not fully understand or share the grief.
However, avoiding others can store up trouble for the future, and
it is usually best to start to return to one's normal activities
after a couple of weeks or so.
During this time, it may appear to others as though the bereaved
person is spending a lot of time just sitting, doing nothing. In
fact, they are usually thinking about the
person they have lost, going over again and again both the good
times and the bad times they had together. This is a quiet, but
essential part of coming to terms with the death.
As time passes, the fierce pain of early bereavement begins to
fade. The depression lessens and it is possible to think about
other things and even to look again to the future. However, the
sense of having lost a part of oneself never goes away entirely.
For bereaved partners there are constant
reminders of their new singleness, in
seeing other couples together and from the deluge of media images
of happy families. After some time it is possible to feel whole
again, even though a part is missing. Even so, years later you may
sometimes find yourself talking as though he or she were still here
with you.
These various stages of mourning often overlap and show
themselves in different ways in different people. Most recover from
a major bereavement within one or two years. The final phase of
grieving is a letting-go of the person
who has died and the start of a new sort of life. The depression
clears completely, sleep improves and energy returns to normal.
Sexual feelings may have vanished for some time, but now return -
this is quite normal and nothing to be ashamed of.
Having said all this, there is no 'standard' way of grieving. We
are all individuals and have our own particular ways of
grieving.
In addition, people from different cultures deal with death in
their own distinctive ways. Over the centuries, people in different
parts of the world have worked out their own ceremonies for coping
with death.
In some communities death is seen as just one step in the
continuous cycle of life and death rather than as a 'full stop'.
The rituals and ceremonies of mourning may be very public and
demonstrative, or private and quiet. In some cultures the period of
mourning is fixed, in others not. The feelings experienced by
bereaved people in different cultures may be similar,
but their ways of expressing them are very different.
Children and adolescents
Even though children may not understand the meaning of death
until they are three or four years old, they feel the loss of close
relatives in much the same way as adults. It is clear that, even
from infancy, children grieve and feel great distress.
However, they have a different experience of time from that of
adults, and may go through the stages of mourning quite rapidly. In
their early school years, children may feel responsible for the
death of a close relative and so may need to be reassured. Young
people may not speak of their grief for fear of adding extra
burdens to the grown-ups around them. The grief of children and
adolescents, and their need for mourning, should not be overlooked
when a member of the family has died. They should usually, for
instance, be included in the funeral arrangements.
Bereavement following a suicide
It can be particularly hard to deal with the death by suicide of
someone you know. As well as the usual feelings of bereavement, you
may have a number of conflicting emotions.
You may feel:
- Angry with the person for taking their own life.
- Rejected by what they have done.
- Confused as to why they did it.
- Guilty - most people take their own life as an act of
desperation. How could you not have noticed how they were
feeling?
- Guilty for not having been able to stop their death. You may go
over in your mind the times you spent with them and ask yourself if
you could have prevented it. Of course, even had you managed to
prevent it, there could well have been further attempts which you
could not have stopped.
- Worried about whether they suffered.
- Glad that they no longer have to endure their distress.
- Relieved that you no longer have to be there to support them or
deal with their suicidal thoughts and urges.
- Ashamed by what they did - particularly if your culture or
religion sees suicide as sinful or disgraceful.
- Reluctant to talk to other people about it because:
- the stigma of suicide in your culture;
- you feel that other people are more interested in the drama of
the situation rather than your feelings or the person who has
died.
- Worried about thoughts of suicide that you may have had
yourself.
- Isolated - it can help to talk to other people who have lost a
loved one through suicide.
An autopsy is usually done after any unexpected death. If
this goes against your religious or cultural beliefs, you need to
make the Coroner and any professionals involved, aware of this as
soon as possible.
An inquest will usually follow. Evidence is presented to the
Coroner at a court hearing to try to find out what exactly
happened. You may find it helpful to come to the inquest - but if
you decide not to, you can still get a full report of the inquest
from the Coroner's Office (there is no fee for this).
How can friends and relatives help
- You can help by spending time with the person who has been
bereaved. More than words comfort, they need to know that you will
be with them during this time of pain and distress. A sympathetic
arm around the shoulders will express care and support when words
are not enough.
- It is important that, if they want to, bereaved people can cry
with somebody and talk about their feelings of pain and distress
without being told to pull themselves together. In time,
they will come to terms with it, but first they need to
talk and to cry.
- Others may find it hard to understand why the bereaved person
has to keep talking about the same things again and again, but this
is part of the process of resolving grief and should be encouraged.
If you don't know what to say, or don't even know whether to talk
about it or not, be honest and say so. This gives the bereaved
person a chance to tell you what he or she wants. People often
avoid mentioning the name of the person who has died for fear that
it will be upsetting. However, to the bereaved person it may seem
as though others have forgotten their loss, adding a sense of
isolation to their painful feelings of grief.
- Remember that festive occasions and anniversaries (not only of
the death, but also birthdays and weddings) are particularly
painful times. Friends and relatives can make a special effort to
be around.
- Practical help with cleaning, shopping or looking after
children can ease the burden of being alone. Elderly bereaved
partners may need help with the chores that the deceased partner
used to handle - coping with bills, cooking, housework, getting the
car serviced and so on.
- It is important to allow people enough time to grieve. Some can
seem to get over the loss quickly, but others take longer. So don't
expect too much too soon from a bereaved relative or friend - they
need the time to grieve properly, and this will help to avoid
problems in the future.
Grief that is unresolved
There are people who seem hardly to grieve at all. They do not
cry at the funeral, avoid any mention of their loss and return to
their normal life remarkably quickly. This is their normal way of
dealing with loss and no harm results, but others may suffer from
strange physical symptoms or repeated spells of depression over the
following years. Some may not have the opportunity to grieve
properly. The heavy demands of looking after a family or business
may mean that there just isn't the time.
Sometimes the problem is that the loss is not seen as a 'proper'
bereavement. This happens often, but by no means always, to those
who have had a miscarriage or stillbirth, or even an abortion.
Again, frequent periods of depression may follow.
Some may start to grieve, but get stuck. The early sense of
shock and disbelief just goes on and on. Years may pass and still
the sufferer finds it hard to believe that the person they loved is
dead. Others may carry on being unable to think of anything else,
often making the room of the dead person into a kind of shrine to
their memory.
Occasionally, the depression that occurs with every bereavement
may deepen to the extent that food and drink are refused and
thoughts of suicide arise.
Help from your doctor
- Occasionally, sleepless nights may go on for so long as to
become a serious problem. The doctor may then prescribe a few days'
supply of sleeping tablets.
- If the depression continues to deepen, affecting appetite,
energy and sleep, antidepressants may be helpful; see our leaflet
on
antidepressants for more information. If the depression still
does not improve, your GP may well arrange an appointment with a
psychiatrist.
- If someone is unable to resolve their grief, help can be
arranged through their GP or one of the valuable voluntary or
religious organisations. For some, it will be enough to meet people
and talk with others who have been through the same experience.
Others may need to see a bereavement counsellor or psychotherapist,
either in a special group or on their own for a while.
- Bereavement turns our world upside-down and is one of the most
painful experiences we endure. It can be strange, terrible and
overwhelming. In spite of this, it is a part of life that we all go
through and usually does not require medical attention.
- For those who do run into trouble, help is at hand, not only
from doctors, but from the organisations listed below.
Support and advice
Bereavement
Advice Centre
Helpline: 0800 634 9494
Supports bereaved people on a range of practical issues via a
single freephone number. It offers advice on all aspects of
bereavement from registering the death and finding a funeral
director through to probate, tax and benefit queries.
Breathing Space
Scotland
Helpline: 0800 83 85 87 (6pm -2am).
Experienced advisors available to listen and give advice and
information to those who are depressed and need to talk.
Compassionate
Friends
Helpline: 0845 123 2304; email: info@tcf.org.uk
An organisation of bereaved parents and their families
offering understanding, support and encouragement to others after
the death of a child or children. The helpline is always answered
by a bereaved parent who is there to listen when you need someone
to talk to; you can also email the helpline: helpline@tcf.org.uk.
Child
Bereavement
A national charity which helps grieving families and
the professionals who care for them.
Support and Information Line: 01494 446648.
Cruse
Bereavement Care
Helpline: 0844 477 9400; email: helpline@cruse.org.uk or
info@cruse.org.uk
Exists to promote the well-being of bereaved people and to
enable anyone bereaved by death to understand their grief and cope
with their loss. Provides counselling and support and offers
information, advice, education and training services.
RD4U (Cruse
Bereavement Care's young persons services). Helpline: 0808 808
1677; email: info@rd4u.org.uk
Cruse Bereavement Care Cymru
Tel: 029 2088 6913; email: wales.cymru@cruse.org.uk
Cruse
Bereavement Care Scotland
Tel: 01738 444 178; email: info@crusescotland.org.uk
Offers free bereavement care and support to people who have
experienced the loss of someone close.
Foundation for the
Study of Infant Deaths
Helpline: 020 7233 2090; email: helpline@fsid.org.uk
A charity devoted to preventing infant deaths, and promoting
baby health. They provide support services to those who have lost
an infant, as well as information on cot death and advice on
avoiding potentially dangerous situations.
National
Association of Widows
Tel: 0845 838 2261; email: info@nawidows.org.uk
A self-help organisation, run by widows, for widows, that
offers comfort, friendship and a listening ear to widows and
unmarried women who have lost a partner through bereavement.
National Association of
Widows in Ireland
Tel: (01) 8728814; email: info@nawi.ie
Stillbirth and
Neonatal Death Society (SANDS)
Helpline: 020 7436 5881, email: helpline@uk-sands.org.
A national charity, established by bereaved parents which aims
to support anyone
affected by the death of a baby. It works in partnership with
health professionals to improve the quality of care and
services offered to bereaved families and to promote
research and changes in practice that could help to reduce the
loss of babies' lives.
Samaritans
Helpline: 08457 90 90 90, (Ireland): 1850 60 90 90; e-mail:
jo@samaritans.org
National organisation offering support to those in distress who
feel suicidal or despairing and need someone to talk to. The
telephone number of your local branch can be found in the telephone
directory. Samaritans also provides a widely used e-mail service
(not a chatroom but they endeavour to answer within 24 hours).
The Way
Foundation
Tel: 0870 011 3450; email: info@wayfoundation.org.uk
An organisation for people who have become widows or widowers at a
young age. The Foundation has a support group, and the site has
links to other relevant sites.
Further reading
A grief observed, by C.S. Lewis (Faber).
You'll get over it: the rage of bereavement by
Virginia Ironside (Penguin Books Ltd).
The death of a child by Tessa Wilkinson
(Jonathan Cape).
Aims to help both adults and children to cope with the death of a
child.
Also see Cruse Bereavement Care for recommended materials.
References
Hawton K and Simkin S (2003) Helping people bereaved by
suicide. BMJ;327:177-178.
Help
is at Hand: a resource for people bereaved by
suicide and other sudden, traumatic death
Audiotape
Coping with Bereavement.
A two-cassette audio pack with advice and self-help tips on how to
deal with bereavement (£13.99). Available from
the Royal College of Psychiatrists. Contact Booksales Department on
020 7235 2351 x146.
Produced by the RCPsych Public Education
Editorial Board
Series
Editor:
Dr Phillip Timms
Original
Author: Professor
Brice Pitt
User and Carer
Input:
Sally Dean and Tracey Holley
Illustration: Lo
Cole/inkshed.co.uk
This leaflet is made available through the generosity of the
Charitable Monies Allocation Committee of the mental
health charity St Andrew's, Northampton
© Updated October 2009. Royal College of Psychiatrists.
This leaflet may be downloaded, printed out, photocopied and
distributed free of charge as long as the Royal College of
Psychiatrists is properly credited and no profit is gained from its
use. Permission to reproduce it in any other way must be obtained
from the Head of
Publications. The College does not allow reposting of its
leaflets on other sites, but allows them to be linked to
directly.
A range of materials for carers of people with mental health
problems has also been produced by the Partners in Care campaign.
These can be downloaded from www.partnersincare.co.uk
For a catalogue of public education materials or copies of our
leaflets contact:
Leaflets
Department
The Royal College of Psychiatrists,
17 Belgrave Square, London SW1X
8PG. Telephone: 020 7235 2351
x259
Charity registration number (England and Wales) 228636
and in Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
Please answer the following questions and press 'submit' to send your answers OR
E-mail your responses to dhart@rcpsych.ac.uk
On each line, click on the mark which most closely reflects how you feel about
the statement in the left hand column.
Your answers will help us to make this leaflet more useful - please try to rate
every item.
Did you look at this leaflet because you are a (maximum of 2 categories
please):
Age group (please tick correct box)