Bereavement describes the sense of grief and loss you experience when someone close to you dies. When this happens, you go through a process of mourning - numbness, anger and sadness can all be a part of this.
Bereavement can also cause physical reactions including sleeplessness, loss of energy and loss of appetite.
Grief Is Normal
When someone is bereaved, they usually experience an intense feeling of sorrow called grief. People grieve in order to accept a deep loss and carry on with their life. Experts believe that if you don't grieve at the time of death, or shortly after, the grief may stay bottled up inside you. This can lead to emotional problems and even physical illness later on.
Working through your grief can be a painful process, but it's often necessary to ensure your future emotional and physical wellbeing.
The Stages of Grief
There is no single way to grieve. Everyone is different and each person grieves in his or her own way. However, some stages of grief are commonly experienced by people when they are bereaved. There is no set timescale for reaching these stages, but it can help to know what the stages are and that intense emotions and swift changes in mood are normal.
The stages of grief aren't distinct, and there is usually some overlap between them.
Feeling emotionally numb is often the first reaction to a loss. This may last for a few hours, days or longer. In some ways, this numbness can help you get through the practical arrangements and family pressures that surround the funeral, but if this phase goes on for too long it can become a problem.
Numbness may be replaced by a deep yearning for the person who has died. For example, every time the phone rings you might expect it to be the person who has died, or you may think you see him or her on the bus or in crowds.
You may feel agitated or angry, and find it difficult to concentrate, relax or sleep. You may also feel guilty, dwelling on arguments you had with that person or on emotions and words you wished you had expressed.
This period of strong emotion usually gives way to bouts of intense sadness, silence and withdrawal from family and friends. During this time, you may be prone to sudden outbursts of tears, set off by reminders and memories of the dead person.
Over time, the pain, sadness and depression start to lessen. You begin to see your life in a more positive light again. Although it's important to acknowledge there may always be a feeling of loss, you learn to live with it.
The final phase of grieving is to let go of the person who has died and carry on with your life, though it may not be exactly the same as it was before. Your sleeping patterns and energy levels return to normal.
Children and bereavement
Children are aware when a loved one dies and they feel the loss in much the same way as adults do. Although children go through similar stages of grief, they may progress through them more quickly. Understandably, some people try to protect children from the death and grieving process. But in fact, it's probably better to be honest with children about your own grief, and encourage them to talk about their feelings of pain and distress.
The grieving process can take some time. How long it takes depends on you and your situation. In general, though, it usually takes one to two years to recover from a major bereavement.
There are many things you can do to help yourself cope during this time. Ask for help and support from family, friends or a support group. Try to express whatever you are feeling, be it anger, guilt or sadness. Accept that some things, like death, are beyond your control. Avoid making major decisions - your judgment may be affected and changes could increase your stress levels. Give yourself the time and space to grieve. By doing so, you are able to mourn properly and avoid problems in the future.
What if you aren't coping?
Sometimes, the grieving process is especially difficult. Some find it impossible to acknowledge the bereavement at all, which can mean that their feelings aren't worked through properly. This sometimes happens after a miscarriage or abortion. It may also happen if you don't have time to grieve properly, perhaps because of work pressures or if you are looking after your family.
Others may be unable to move on from their grief, or remain in the numb stages of grief, finding it hard to believe the person is dead for years.
Such difficult grieving can lead to recurring bouts of depression, loss of appetite and even suicidal feelings. You are more likely to have a difficult grieving process if:
- you are on your own and have no support from your community, family, or friends
- you have unresolved issues with the person who died
- the death was caused by a particularly difficult event such as a national disaster or an unsolved murder
- the person goes missing or it isn't clear exactly what happened
- you are unable to attend the funeral or there isn't one
Other circumstances around the death can lead to a difficult grieving process. These include:
- a sudden or unexpected death
- the death of a parent when you are a child or adolescent
- miscarriage or the death of a baby
- death due to suicide
- the death of a co-habiting partner, same sex partner or partner from an extra-marital relationship, where the relationship may not be legally recognized or accepted by family and friends
- deaths where the bereaved may be responsible
- situations where a post-mortem or an inquest is required
- more than one death at once (for example, in an accident)
- the death of an absent or estranged parent or sibling
Getting help from your Family Physician
Bereavement is probably one of the toughest things we have to face in life. But while it's a very painful time, you can usually pull through it without needing to see a doctor.
However, if, for example, you find that you're sleeping badly, and this goes on for long enough to affect your daily life, talk to your family physician.
He or she may prescribe you with some sleeping tablets for a few nights. These are only for short-term use though.
If your feelings of depression are worsening, and are seriously affecting your energy, appetite and sleep, your physician may prescribe antidepressants
There are also other useful talking therapies that can help. These include bereavement counseling and support groups where you can meet with other people who have been bereaved. These can be invaluable in helping you come to terms with your loss.
If somebody in your family or a friend has been bereaved, the best thing you can do is spend time with them and listen to them work through their grief. Offer practical help, such as cooking dinner or shopping for food - when a person is grieving, it's usually hard to focus on everyday tasks.
You might feel awkward because you don't know what to say to the bereaved, but just being there will be a great help and lets them know that you care and haven't forgotten.
If the person is reacting in extreme ways for a prolonged period, encourage him or her to talk their Family Physician about it.
Answers to questions about bereavement
- This section contains answers to common questions about this topic.
What happens at bereavement counseling?
Bereavement counseling can help to support you through this very difficult time.
Counseling is sometimes called a talking therapy. It can help you to explore your feelings and come to terms with your grief in a place where you can talk openly to someone trained to help you. Counseling takes place in private. You and your counselor meet, usually once a week, to talk for a set amount of time. How many sessions you have will depend on what you feel you need.
Counselors don't give advice as such and they can't tell you what you should do. What they can help you to do is to see things more clearly or assure you that your feelings are normal. Counselors do this by listening to what you say and commenting on it from their perspective.
During a session your counselor can help you to explore and express your feelings, talking about them openly in a way that might not be possible with your family and friends. It's easy to bottle up your feelings after bereavement, especially if you need to 'cope' in order to get back to work or support other family members or your children. These feelings, such as anger, anxiety and grief can become very intense. Counseling can give you an opportunity to explore them and make them easier to understand. Counselors see people in your situation often and are used to listening to people who are distressed - they won't be shocked by what you are feeling or by what you say. Many people find it a relief simply to talk to a stranger. Counseling can also provide a safe environment for you to voice your feelings.
Bereavement counseling isn't about exploring your past. Instead counseling offers help at a specific time when you are going through a major life change and emotional crisis.
Finding a counselor
Your Family Physician can refer you directly to a counselor.. You can also find private counselors in the local yellow pages, libraries, local hospice agencies and on the internet.
How long will I feel like this?
Coming to terms with the death of someone close to you is something that everyone experiences differently. Mourning the loss of someone is a gradual process and it takes time. Some people feel able to move on after a few months, for others this process takes years. It's unlikely that you will wake up one day and find that you have stopped grieving; you are more likely to find that you have good days and bad days - good days when you feel you are moving on and are over the worst and bad days when the grief still feels unbearable.
Eventually you should find that you aren't constantly thinking about the person who has died. When you do think about them you might remember happy times with them as well as feeling sadness. You will also start to make plans for the future. However, sometimes your circumstances can make it harder for you to move on and mean that your grief might take longer to work through. Circumstances that can prolong your grief are if:
- you have very little support, for example, no family or few friends and no religion or beliefs
- you have unfinished business with the person who has died or things left unsaid
- the person is missing and presumed to have died but there is no body - for example during natural disasters or war
- the way that the person died is difficult to come to terms with - for example an unsolved murder or a terrorist act
- you can't go to the funeral or there isn't one - for example if you live far away or aren't acknowledged by family and friends
Most people take between one and two years to come to terms with the death of someone very close to them. During this time your emotions change and there is a general feeling of moving on and getting better. However, sometimes this doesn't happen and then you might need help. Your family physician is a good place to start. You should think about getting help if you:
- have trouble sleeping or have regular nightmares
- feel like you can't handle the strong emotions or physical feelings you are experiencing or you feel overwhelmed by your feelings
- still feel empty and numb months after the death has happened
- have no one that you can talk to about how you feel
- are dealing with your grief by drinking heavily or taking drugs
- are thinking about suicide
I can't seem to move on; could I be depressed?
Feeling very low, sad and depressed is part of mourning for someone who has died. For most people these feelings of depression are part of the grieving process and after a while they do get better. However, grieving for someone is a process and even though things may still feel very bad, you will feel like you are moving on. Becoming depressed while you are grieving can feel as though you have got stuck in the grieving process and can't move on. You may not even realize that you are depressed, rather than grieving. Many of the symptoms of grieving are very similar to the symptoms of depression. You might:
- find your appetite and weight changes - most people lose weight and don't feel like eating, but the reverse can also happen and some people eat more and put on weight
- have trouble sleeping - it can take a long time to get to sleep and you might also wake early in the morning
- feel tired and lethargic and feel you have no energy
- find it hard to concentrate and more difficult to make decisions
- feel you have low self-esteem and that you are worthless, inadequate and hopeless
- think about suicide or harming yourself
- lose interest in life - you feel as though you can't enjoy anything or you lose interest in sex
- be irritable and restless
- isolate yourself and start to avoid other people
If your symptoms don't seem to get any better, if they affect your work life and your relationships or if you start to feel that life isn't worth living, then you should always get help. There are many things that can help with depression, some of which you can do yourself and some of which your Family Physician can help with.
One of the things to be aware of with depression is that it feeds on itself. Once you become depressed then it's easy to become depressed about being depressed. It becomes automatic to think about things in a negative way and difficult for you to change your behavior. It's important to break the hold that the depression has. This won't happen overnight and will take time and commitment from you. The more active you can be in your treatment the better.
The right treatment for you will depend on how bad your depression is. Your doctor can help you to decide which is the best treatment for you. Mild depression usually responds well to talking therapies like counseling but if your depression is more severe, you might also need to take medicines to treat it. Whether your depression is mild or severe, there are also some things that you can do in your day-to-day life that can help to ease the symptoms and make you feel better. The main treatment choices are listed below:
It's important to do things that will help you feel better about yourself. Try some, or all of the following:
- eat well - eating a healthy diet and oily fish may help you feel better
- don't rely on alcohol to make you feel better as it can make depression worse
- try and be positive - keep active and occupy your mind, try and stop negative thoughts
- talk to someone - talk to family and friends, or contact a support group
- be active - for example, going for a walk produces chemicals in your brain called endorphins, which can help you to feel better. Do at least three hourly sessions each week. To get the maximum benefit from this, you will need to keep it going for about 12 weeks
Many people with depression find complementary therapies like acupuncture, massage and homeopathy helpful. A herbal medicine called St John's Wort can be used to treat mild depression and may help to lift your mood. It can be harmful if taken with some other medicines, so tell your doctor and pharmacist if you are taking it. Don't take St John's Wort with any antidepressant medicines that your doctor has prescribed.
There are many different kinds of talking therapies available like counseling, behavioral therapy and psychotherapy. These can help with mild, moderate and severe depression. If you have mild or moderate depression, these therapies are likely to be used on their own with self-help measures. If your depression is more severe, you are likely to have talking therapies as well as antidepressant medicines. Talking therapies are usually very safe, but they can bring up unwanted memories and occasionally they can affect the relationships you have with the people around you. The kind of therapy you are offered will depend on what is available in your local area, how bad your depression is and the kind of therapy you would prefer.
Your Family Physician will only prescribe antidepressants if you have severe depression or if your depression goes on for a long time. Antidepressants don't cure depression but they can improve your symptoms. It can take a few weeks for you to notice an improvement in your mood, though you should start sleeping better after a few days. Like all medicines, antidepressants can cause side-effects and these vary depending on the kind of medicine you are taking. Always ask your Family Physician for advice and read the patient information leaflet that comes with your medicine.
Whichever antidepressant you take, you might get withdrawal symptoms when you stop taking it. Because of this you should stop taking it slowly, cutting down the dose in stages over a few weeks. Ask your Family Physician for advice if you are thinking about stopping your antidepressants.