The Natural Death Handbook

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Chapter 8
'Improving' Grieving

Anything written about grieving is unlikely to suit everybody because grief is an intensely personal emotion. It can be bewildering and surprising and make us do unexpected things. Grief can knock us sideways. The absence of grief, too, can be stunning. It is not always there when we expect it and need it. Grief is a volatile emotion: one moment we are engulfed in it, the next we are coping with everyday life, driving the car, calling on a friend, laughing at jokes over lunch. Like being in love, grief is something that is just there, it happens, it makes us feel we are somehow different from people who are not in that condition. For that reason, anyone who is suffering bereavement might read this chapter differently from someone who isn't. The title, for example: of course we cannot 'improve' your grieving. But society can improve the way it reacts to those who are grieving, and there are certain attitudes and practices, some of them reported below, which obstruct the natural expression of feeling and which could be improved upon, and certain evolving customs in modern life that may be worth sharing.

This chapter is built around the experience of grieving. Academic references and sources are given a secondary position. But see also the Organisations listed in the Resources chapter. For in many particularly hard bereavements, such as when grieving over the loss of a child, a support group can be a great help in gradually learning to cope.

The different levels of grief we experience can be very surprising. A dear friend dies and after the funeral we resume normal existence with an appetite that makes us almost guilty. Where has that person gone? Why don't we feel it more? We probably will experience the sorrow when reminders of past times crop up, but meanwhile the fact that life just goes on as before can seem almost unreal. And then someone dies who has shared our most intimate life and it is as if a part of the self has been removed without warning. Hence the wisdom of saying that when we mourn the other, we mourn the self. Such grief reaches into the part of us where the roles played in our identity by the self and the other - the partner, the mother, the child - seem indistinguishable. One mourner, just when he thought he was recovering from his wife's death, broke out in a violent rash. It took him a further eighteen months to realise what had happened:

Debilitating grief

I was much debilitated; the body had to excrete the accumulated stress of several years. Some mourners, I was to discover, are prey to nervous breakdowns, ulcers and much much worse: chronic arthritic conditions, heart attacks, even cancer. This is probably what accounts for so many instances, in centuries gone by, of persons dying of grief or 'a broken heart'.

From an article by Libby Purves in The Times (April 3rd 1992).

The potential phases of grieving are recorded in many textbooks, the results of professional and academic study of individual experiences. But here is Margaret Chisman's own personal and courageous account. In the first extract she expresses her immediate reaction to the death of her husband Stan.

Picking up the threads

When the hospital phoned at 3am on March 24th to say he had died I was alone in the house as my daughter, by chance, was away that night. After a short bout of numbed weeping I phoned near relatives and then made a cup of tea - remembering to add extra sugar for shock. I asked myself what I should do with the rest of my life now that the bottom had dropped out of it, and told myself that the most important thing was how to get through the rest of the night, and the next few weeks.

Later she wrote about the emotions of the first week:

During the first week after his death I made myself, in the privacy of my home, keep on saying out aloud 'My husband is dead and I'm a widow' until I could say it without weeping.

I am still weeping daily but it is mercifully lessening as I begin to pick up the threads again just a little.

After a few months she was able to write about the experience in a structured way and to begin to share with others and include a view of the future:

It is probable that most survivors experience similar phases of grief. First comes a numb inability to believe it. The reality of the loved one's presence is still so strong inside you that you know they are still alive and that they will return.

This is gradually replaced by an agonising acceptance of irretrievable loss bringing with it almost overwhelming grief. Never again to see, to hear or to touch your loved one. Oh, the unbearable pain of it all! You cry a lot, your face crumples uncontrollably, your whole torso shakes with hollowness, your throat aches with constriction and grief holds you in its iron grip.

Gradually the incidence of these attacks lessen; your horizon begins to open up a little and you begin to enter phase three. This is shot through with conflicting emotions. It is similar to the early stages of convalescence after a major accident or operation (such as the loss of a limb or of a sense resulting in blindness or deafness). You may feel resentment, 'Why should this happen to me?' You may try to reject the whole thing and suppress your feelings; you may be filled with self pity. There is one thing certain, however, about phase three, you have to fight! You have to confront your anger, resentment, rejection, self-pity - to realise that you won't get through to phase four unless you take these negative reactions and, with determination, turn them into something positive. This could include doing some things in a different way, doing new things, taking up a new hobby - you may have to fight a sense of disloyalty. Towards the end of this phase you feel you want to hurry things along, like a child picking away at its scab, only to be dismayed at the still unhealed flesh below. In many life processes there seems to be a natural flow that cannot be hastened, but neither should it be thwarted. You have to steer between nurturing grief beyond its proper bounds, and yet encouraging the first new shoots of post-bereavement independence, not feeling disloyalty to your loved one when you do something different or new.

Phase four shows a calm and serene acceptance of your bereavement and a need to build for the future, but even here there will be occasions when a trigger flashes fiercely your grief into life again - 'They're playing our tune,' a verse of poetry, a flower, a turn of phrase will bring your memories flooding back - even when your love is but a dream on the horizon of the past.

I see the process of bereavement, grief and recovery in pictorial terms. The black centre is the death of your loved one, phase one is shown in purple, two in red, three in orange and four in green. The grey smudge round the edge is your own death which, with the spiral revolution of time, will coalesce into a dense black dot at the centre of someone else's grief. The lesson we would do well to learn is that no previous phase is ever completely finished. You will get flashes of phase 1 even after years of being in phase four, but it is the balance that changes one phase to the next.

Time does heal if we let it. The scar will always be there, but we must not become like medieval beggars who hawked their festering cicatrices. We must do all we can in phases three and four to help the natural healing processes in ourselves and others.

From 'Interim', a private newsletter circulated by Margaret Chisman.

How long does it take to 'overcome' grief? Margaret Chisman quotes one widower in her newsletter:

How long till grief is 'overcome'?

You say that I am further along the path to recovery as my wife died over three years ago. I was told that it would be six months before I would get over the grief. It was much longer than that, about eighteen months before I stopped bursting spontaneously into tears, when driving, preparing lectures, etc. Now after three and a half years the emotions are still there, but more controlled. No doubt other people respond differently.

From 'Interim' by Margaret Chisman.

There is an element of grief we should perhaps not even try to overcome but instead build into our lives. If there is a meaning to life it is amply demonstrated in the emotions we feel for that which we have lost. Yes, there was a meaning after all, if only I could have seen it at the time! What is missing in our lives is not meaning but the ability to perceive it while it is there.

The academic structuring of grief does, after all, have a purpose. It may help us to deal with the overpowering aspects of the emotions we experience in that strange country. Other people have been there before us. We have not been singled out. There are maps. There is a geography of grief and loss:

A tentative 'map' of grieving

Grieving takes place 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.

Although we are all individuals, the order in which we experience these feelings is very similar for most of us. Grief is most commonly experienced after the death of someone 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 suffer a similar experience of grieving and need the same sort of care and consideration.

In the few hours 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 often leads 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 may be extremely disturbing. 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 left them.

Another common feeling is guilt. People find themselves going over in their minds all the things they would like 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. Guilt may also arise if a sense of relief is felt when someone has died after a particularly painful or distressing illness. This feeling of relief is natural, extremely 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 just part of the normal way of passing through the different stages 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 embarrassing 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 try 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 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.

From the Royal College of Psychiatrists' free leaflet on 'Bereavement'. (available for SAE from 17 Belgrave Square, London SW1X 8PG).

This basic structure is fleshed out in many books. Some of it has, however, now been questioned by five different studies of widows and widowers, studies which have found that between a quarter and two thirds of the bereaved are not greatly distressed, and that severe depression need not necessarily follow a loss. Dr Camille Wortman, a psychologist at the University of Michigan who has reviewed recent research in an article in the (American) Journal of Clinical and Consulting Psychology, comments that the absence of extreme distress 'can be a sign of resilience. Many have world views - often a spiritual outlook - that lets them see the loss in a way they can accept.' Those who are most upset after a loss tend also to be among the most upset a year or two later - findings which question the widespread assumption that a period of severe distress leads to a more balanced adjustment.

There is no such thing as 'The Good Grieving Guide'. There is no reason on earth why the bereaved person (ie each and every one of us at some time or another) should become the passive consumer of someone else's advice. We all have our own experience. And grief, as it happens, is a very active emotion - among other things it contains anger and even aggression, it can be sharply critical, and has its own sense of humour! Many of the books about bereavement in the Resources chapter are a mixture of impersonal wisdom and highly personal attitudes. Some come from the heart and offer comfort, however idiosyncratic. Others profess vigorous solutions and guidance. Some are biased towards research, others might touch a personal chord in one's own experience. They are all useful. Browse among them, and choose what is to your own taste. Reject what you don't like.

Suicide

Particularly difficult can be facing grief after a murder or a suicide, and this may require specialist help.

Feeling responsible for a suicide

The toughest question to ask Jill Winters is: 'How many children do you have?' Her son James killed himself when he was 34. If she says she has two children, she feels she is denying his existence. If she says she had three but one died, more searching, and unwelcome, questions may follow.

Eight years after her son jumped from a third-floor window, Mrs Winters has finally stopped blaming herself for his death. The sense of liberation has been, she says, remarkable. But it has taken her a long time to accept what happened and to feel at peace with herself again.

The families of those who have commited suicide have to cope with feelings of distress which go far beyond normal grief. Unlike other deaths, suicide carries with it a heavy social stigma. Those left behind may see it as a violent statement that the love they provided was not enough. Families can become ensnared in a hopeless search to find out why a child, or a parent, felt so desperate; there are profound feelings of guilt to cope with.

'When it happened it was completely unexpected, although looking back I could see it was on the cards,' Mrs Winters recalls. 'We were devastated by it. We were numb to start with. We found it very difficult to talk about; there was a feeling of isolation.'

Her husband came to terms with their son's death better than she did. 'I felt that I hadn't done the right things, that I had been a terrible mother,' she says. 'I wished I had done everything differently. I kept looking for ways that I could have prevented it. I took full responsibility.'

Mrs Winters went to a group for bereaved parents but felt out of place. 'These were people who had lost their children in the normal way. I didn't feel I was one of them,' she says. 'Suicide didn't seem acceptable.'

James was unmarried and had been a solicitor. A psychiatrist had been treating him for schizophrenia. Mrs Winters now realises she was not responsible for his actions. 'I think he was finding life so difficult and stressful that he could not stand it any longer. He was afraid of having another breakdown.'

Support agencies are waking up to the fact that families bereaved in this way often need specialist help. CRUSE, the national bereavement care group, has set up a number of support groups specifically for families of suicide cases and plans to establish more. Forbes Craig, a former nurse and now a counsellor with CRUSE, says that while all families feel loss on the death of someone close, with a suicide there is 'the intensity of the feelings, the inherent violence, the statement being made that whoever is left can't help any more. If it's a natural death we can take it because we all die. But when it's suicide there's a whole history of culture against it.' Suicide was only decriminalised in 1961, she points out. She says that there is no time limit to when someone who has experienced a suicide might need help. One woman sought help nineteen years after her mother killed herself.

Rose Hampton, the director of CRUSE, had a close friend who committed suicide many years ago. 'The experience lives with you for years and years ,' she says. 'I can still see her now as clear as day. In the end you have to realise that you can't be responsible for other people.'

From an article by Bernadette Friend in The Independent (Aug. 11th 1992).

See also the 'Shadow of Suicide' organisation in the Resources chapter.

The bereaved parent

To lose part of yourself ... Perhaps the loss of a child brings this aspect of grieving into real focus more than any other experience. Here is an account, quoted in full, of the loss of a stillborn child and the fierce reactions it provoked towards our modern attitude to death.

The loss of a stillborn child

Four years ago this summer, I was happy, healthy, seven and a half months pregnant and full of expectations. Within the space of 12 hours, struggling to shake off the effects of a general anaesthetic and an emergency Caesarean section, I was left holding my seemingly perfect stillborn daughter, Laura.

The four days that followed were spent being studiously avoided in a corner of the ante-natal ward, desperately trying to shut out the sight of pregnant women and the sound of newborn babies crying. Still quite poorly and in a state of shock, I leapt at the opportunity for the hospital to make all Laura's funeral arrangements for me - anything to have the whole nightmare taken away.

The result was a totally meaningless cremation service taken by a stranger exactly one week to the minute after her birth; there was no gravestone, no special place of hers that I could visit and care for. Most importantly, there was the guilt and regret: I felt I had failed my daughter in the one and only thing I was ever going to be able to do for her.

Four years on, I know that my experience and felings are not uncommon. I run a local branch of Sands, the Stillbirth and Neo-natal Death Society. The aim is to support people whose babies die at or around birth by offering a listening ear and a shared experience. I want to make some good come out of the tragedy of Laura's death by trying to ensure that others don't end up with the same regrets as me.

For example, I had absolutely no idea that I could have asked to hold Laura again a few hours or even a day or more later - at a time when I could have taken her in better and stored my memories of her. As it was, the only time I spent with her I was so dopey that I could barely lift my hand to stroke her face. I had no idea that I could have asked for a lock of her plentiful hair. Things are much better now, professionals much more thoughtful and aware that information may need to be given several times before it sinks in, but there is still room for improvement.

A national Sands survey showed that while some hospitals handle the situation well, others do not. Many foetuses, or 'foetal material', are incinerated with other hospital waste. Parents are not consulted and are totally unaware that they have any choices to make, totally unaware of the fate of their baby's body. Obviously it would be wrong, and in some cases quite inappropriate, to suggest that all babies lost through miscarriage should be held by their mothers. However, babies can be perfectly formed little beings long before they reach 28 weeks; I would suggest that they are most definitely not 'hospital waste fit for incineration only' and it is not the right of hospital staff to decide whether or not a mother should hold her child or decide upon the fate of its body; she should at least be told that she has a choice.

Just as holding your dead child plays an important part in the grieving process, so does saying a formal goodbye in the shape of a funeral or some other social ritual, be it religious or not. It is a way of sharing, of acknowledging the existence of, the child you have lost. This is especially true in the case of babies because society is keen to pretend they never existed ('Oh well dear, you can just have another one' ... 'At least you've got your other children' ... 'As soon as the next one's born healthy everything will be all right'). The more people around me negated Laura's existence, the more they implied that other things would make up for her loss, the more I fought to keep her memory alive.

For women who have had miscarriages or terminations for abnormality, society offers even less opportunity to say goodbye - after all, the baby didn't really ever exist, did it? But a loss is a loss and needs to be grieved for, needs to be acknowledged. Women who lost babies several years ago or more have to live with the fact that they were simply wrapped up and incinerated; there was no choice.

Our society is still singularly bad at dealing with death or allowing for the fact that the grieving process is a necessary part of carrying on with life. In China, they have an annual day set aside for national mourning: people tend graves or simply focus their thoughts on loved ones who have died. God forbid that the stiff British upper lip be subjected to such a public display of emotion!

Feelings of grief (often quite frightening in their ferocity and variety) must be hidden away behind closed doors; until, that is, they burst out, unleashing all sorts of problems and you end up, as I did, crawling desperately to a psychotherapist.

Whenever and however the death of a child occurs, it means shock and disbelief. It may mean regrets about decisions taken at the time; it may mean missed opportunities; it may mean guilt; it may mean anger. One thing is certain; it always means being scarred for the rest of your life.

From 'In Living Memory' by Caroline Jay in The Guardian.

'The Bereaved Parent' by Harriet Sarnoff Schiff and 'Beyond Endurance, When a Child Dies' by Ronald J. Knapp are sensitive explorations of the complex of emotions and realistic living circumstances surrounding the bereaved parent, offering both insight and comfort in great measure. Another book which deals explicitly with this area of loss is 'On Children and Death' by Elisabeth Kübler-Ross. The intensity of grief for the loss of a child is likely to be prolonged and may take half a year to reach its zenith and longer still if it was a violent death. There is an entire sub-culture of shared feelings created by men and women who have suffered the loss of a child from a wide range of causes. Nowhere is this more fully expressed than in the extraordinary and moving series of pamphlets and newsletters issued by The Compassionate Friends (address under Organisations in the Resources chapter - they even do a special newsletter called Sibbs for bereaved brothers and sisters). Here is an explanation of their policy of 'Befriending, rather than counselling':

Befriending

What do we mean by befriending? The Pocket Oxford Dictionary defines it as 'act as a friend; help at need'. Within The Compassionate Friends it takes on a greater meaning. Befriending is also sharing. We are all befrienders. We all share when we write a letter, make a phone call or talk with another bereaved parent at a meeting. We share when we read the Newsletter. Prayer, meditation and positive loving thoughts are a form of sharing.

The necessity to 'share' and 'talk' about our loved ones and emotions is a 'need' within all bereaved that requires to be met. As the pain of grief recedes, so the need to talk endlessly diminishes. We are then in a position to 'share discriminately'. To let the newly-bereaved talk - to be willing to share with a few sentences - to encourage expressions of feelings: 'Yes, I felt that and I also felt...' This is why those who have first contact with the newly-bereaved have been bereaved themselves for at least two years.

Grief is a natural reaction to the death of a loved one/ones. Talking about our dead child/children and the emotion let loose within us is the way forward along the path of grief. Being able to 'befriend' from the time of a death, giving the newly-bereaved permission to grieve, should mean that 'counselling' will be needed by a small minority only: those who become stuck in their grief; people who have other problems within their family; or difficulties within themselves due to past experiences. For these, bereavement counselling is very beneficial and could be viewed as complementary to 'befriending'.

From 'Thoughts on Befriending' by Margaret Hayworth, in The Compassionate Friends Newsletter (Spring '89).

A child's understanding of death

Young children are curious about death. They have to negotiate the reality of death and fit it into their scheme of things. In a child's world, the loss of a pet can assume enormous emotional significance. When Grandma or Grandad dies, or a parent or a sibling, the loss has to be explained in ways the child can come to terms with. Otherwise there may be a hidden morbid element that will affect development and grown-up life. In the following extract, a hospice counsellor helps a father and son to speak about their joint loss. The little boy displays a mixture of childish expression (drawing a picture, as he would at school) and very realistic concerns. These show his awareness of how his dependency has shifted with the loss of his mother.

Coming to terms with a mother's death

A seven year old had been bereaved of his mother a week before. Father sought help for his son. There seemed to be a great deal of apprehension, not just for the boy. However, he happily accepted a large glass of squash - it was a hot day. Father sat slightly apart. In order to understand the outcome of this brief intervention, something of the father's manner and bearing needs to be known. He was a large man who worked with animals. A man who was used to being obeyed by animals and humans alike; this was the tension, I felt. He gave his son instructions to answer my questions honestly. After introductions about who I was and what I did, and the purpose of his visit to the Hospice, I asked about his mother's funeral, including Father in the conversation. Father refused to be drawn, prompting his son instead. The small boy looked at his father as he spoke with a mixture of fear and defiance in his eyes. He spoke of the funeral but quickly went on to say he had visited the grave earlier on his way here. He and his father had discussed the sort of stone they would put on the grave during the drive to the Hospice. I wondered if he would like to draw it for me; he wasn't particularly good at drawing, he said, but he agreed he would have a try when I said I wasn't either.

As he drew, he spoke of his dog which had recently died and the circumstances of its death; 'being put down'. He asked, 'Where was he?' looking all the while at his father. It seemed very hard for the father to be honest about where the body of the pet dog was, though his son did know where his mother's was. This was the theme of the picture. Two tombstones, one a slab and one a cross, drawn very small in the corner of the paper, with a bird in flight above. He spoke very naturally about what was going on the stone and referred to his father for help with the precise detail. I wondered about the cross in the picture.

'Well, that had been part of the talk in the car, about the shape.' The slab seemed to be preferred by the father so that the wording could be better managed.

I wondered what the cross meant.

'That Mummy had gone to be with Jesus.'

'What does that mean for you?' I responded.

'That Mummy no longer suffered great pain and she had left her poor body and was now in Heaven,' he replied.

'Do you know where that is?'

'No - not really.'

I wondered, 'Could you tell me about the bird you have drawn so cleverly?'

He said 'I thought it would make a nice picture. It reminds me of the churchyard in the country with trees around.'

I allowed a pause and then, 'So you are not sure where Heaven is - nor is anybody if they are really honest - none of us is sure - even grown-ups - but the bird is important to you. Could the bird be Mummy's spirit flying free, out of pain, able to go where she liked to the place we are not quite sure where which is called Heaven?' He liked this idea very much and repeated it.

His father softened and tears ran down his cheeks. His son watched.

I asked, 'Do you and your Dad cry together?'

'Yes,' he said, 'we do when we go to the churchyard, to the grave.'

'That's good,' I said, giving lots more permission in my voice.

There was something in the way he watched his father that prompted me to ask him if there was anything he found very hard to say to his dad which he might like to say if he found courage here. It seemed as though he had been longing for this opportunity. There was so much, he was worried about his dad working with bulls - he might get hurt; he was worried when his dad drove too fast - he might crash. He didn't want the goats or the calves to be slaughtered, they were his friends and he missed them. He wanted his bedroom to be the same room when he came home, not to be changed around. It was easy to see how insecure, worried and angry this small boy was towards his father, and how he was asking him to take care of himself in order to care for him. A brief interruption allowed him to say more about a visit to the grandparents which was planned and how dad would be in his absence. All his concerns came tumbling out and his anger was acknowledged.

From 'Brief Interventions in Anticipatory Grief and Bereavement'

by Lizette Pugh, in Counselling (Feb. '92).

What do children need? They need society to open up about death in much the same way as we all do. Children are no problem so long as we try to understand them. Adults are the problem, as one man discovered when he openly shared his bereavement with his children:

'Remembering Mum' book

After Adrian Crimmin's partner, Mandy, died of pneumonia, he made no attempt to conceal his pain from their two boys, Sam, five, and Eddy, three. The children went to Mandy's funeral, sang her favourite Jackson Browne songs at the service, drew pictures on her headstone and shared their father's tears.

But when the family sought to share their grief outside, it was a different story. They met with 'a wall of silence'. Even best friends wouldn't talk about Mandy, close relatives suggested they should have recovered from the death after only three months.

'My kids were confused by other people's strange reactions; a child can't understand that society is conditioned to be embarrassed by death.'

At school children who knew of the death displayed signs of anxiety.

'One child was so upset that he couldn't bear to let his mother out of his sight. If she was a minute late at home time, he broke down in tears. Some of the kids suffered nightmares, others just didn't want to come to school. There was obviously a need to talk about death and to help them to understand.'

It was one of the teachers at school who suggested the idea of collaborating on a children's book about bereavement.

'It was an idea I'd had in my mind for some years,' explains Sam's teacher Ginny Perkins. 'I'd taught classes before when parents had died and I'd felt totally helpless. Although I felt I had no problems now in talking to the children about Mandy's death, I could have done with a prop when I was younger, and I'm sure there are other teachers who wouldn't feel comfortable about tackling the subject by themselves.'

The initial stages of finding a publisher were simple, but again 'grown-up' obstruction was encountered before the book was accepted.

'I could get the idea past the editors, who were mostly young and female,' Perkins explains, 'but as soon as the word "bereavement" was mentioned at a board meeting, that would be the end of it.'

After months of persistence, the book was accepted. The result is a sensitive, true story called 'Remembering Mum'. Using large, colour photographs, it follows the family through a typical day, showing how Mandy's memory still touches every aspect of their lives. There are poignant reminders of her, like the daffodils she loved blooming for the first time since she died. At school, Sam and Eddy are seen making a model to take to her grave. At the cemetery, they are pictured hugging by her headstone. Before bed, the boys pore over snapshots of Mandy, immortalised one sunny afternoon at Hampstead Heath.

From an article by Fiona Cumberpatch in The Guardian (Dec. 17th 1991). 'Remembering Mum', A & C Black, 35 Bedford Row, London WC1R 4JH.

Hopefully this is one of many cases of 'improving' grieving by listening to children, supplying their needs and perhaps learning from them as well! The adult need to 'get rid of' death, to deal with bereavement by 'getting over it' quickly, is countered in that story by a clear demonstration of the fact that the bereaved child has to grow up with his loss. The pain may be lessened, but the reality is still there as part of his life, as a tailpiece to that story shows:

'Three years after Mandy died, they still have some anger and they still ask questions. A month ago Sam said, "I didn't even think she was going to die, Daddy. Why didn't you tell me?" I'd much rather they expressed their feelings now, than carried them on through their lives. But they need other things, too. Sam and Eddy told me that photos of Mandy were very important to them and so was listening to the music she liked, which they used for dancing to.'

Private grief

'We mustn't intrude on private grief,' is a common, jokey saying we use when we want to be a little unkind about the misfortunes of others. Behind the saying, unfortunately, is the assumption that grief is something that should be draped and shrouded from view, and that the rituals of grief are designed to conceal rather than to express feeling. Nothing could be further from the truth.

Listen and be compassionate

My close friends and family were absolutely wonderful when Ernest died. But other people I knew well would cross the road if they saw me coming, and if they did have to speak and ask me how I was, I learned to my cost that I mustn't really tell. They wanted me to say just, 'I'm fine'.

Some people seem to delight in telling me of another bereavement. They asked how my husband died and when I said from a sudden heart attack, immediately told me about a heart attack that killed someone else. I had enough nightmares about my husband's death and I didn't need the harrowing details of anyone else's.

The most helpful thing people can do is listen, just let you talk and be compassionate. People think it will hurt you to talk, but talking keeps the person alive for you. Or they fear they will be reminding you - as if you had forgotten.

It is an absolute safety valve to be allowed to talk, which is why I joined CRUSE, the support group for widows and widowers. There people can cry because everyone understands, but you'll hear gales of laughter too.

Jean Baker, quoted in an article entitled 'Please Don't Say That' in The Sunday Times magazine.

Those who don't know what to say may feel inspired by a lovely Irish tradition, described by Danny Danziger in The Independent (Jan. 27th 1992):

At the very end of the service, before the funeral, the people come up and they hold your hand, and they say a phrase that will ring many bells in Irish ears: that is, 'I am very sorry for your trouble.'

Or, as Elsie Sieben wrote in The Compassionate Friends Newsletter (Spring 1985):

Hug me, tell me you care and that you're sorry this has happened.

Be available to me - often if you can - and let me talk and cry without judging me.

Just love me and I will always remember you as a true friend.

And Virginia Ironside in The Times (July 29th 1992) related how surprised she was to be consoled by letters after her father's death:

I will never let another death go by without dropping the relatives a line. Letters that say things like: 'He will live on for ever in your heart' - trite lines I'd usually wrinkle a lip at - seem to have huge significance, laden with meaning. 'I am down the road if you want an ear,' came from an old schoolfriend I barely know. And a lovely line from my son's godfather: 'These sad deaths are like signposts which direct you into a new and unknown route. I can only wish you well.'

Simply helping the bereaved person with household tasks can be important. Dr Colebrook, who lost his son in a motorbike accident, wrote in the BMJ (Dec 31st 1983) that he felt that he had experienced outstanding support from a local girl, an old college friend of his wife, who simply took over the housekeeping and looked after arrangements at home.

Consolations

Jenny Kander offers consolation of a sort in The Compassionate Friends paper (No. 16) on 'The Death of an Only Child':

Grief, for a time, can seem larger than life. Your anguish is your response to that, but do not relate solely to your pain; remember your child, however painful the memories at first; recall your lives together, however short or long they were, so that restoration may take place and, in time, you will realise that he or she is still with you in the deepest sense, bonded to you and living within your heart. You are parents of your child for eternity. Nothing can alter that. Nothing can take that away.

At some stages of bereavement the sense that the dead person is present is powerful and disturbing. Of course it is psychologically quite accurate to say that someone we love is within us, an indwelling presence. This is in itself a comfort. But when the longed for appearance of the person in the flesh does not occur, then there is anguish. Where is that physical, substantive presence that we miss? To contain the spirit of the dead person within the self is at once a comfort and an agony, but the bereaved person often wants a larger context for this containment, a context that will take some of the burden away and at the same time be soothing and healing. In this sense the child may feel nearer to a dead person whilst up in an aeroplane because he or she has been told that the spirit is 'up there'. The more sophisticated adult may feel the same soothing presence, inside himself or herself, yet enclosed in something larger, in a religious building for example, within the uplifting and inspiring confines of a cathedral. Or in music which has the same grandeur and peace of containing the spirit. Or in the chanted words of prayer. The bereaved person, then, craves some form of communion within which he or she can share the agony and beauty of containing the spirit of the dead. We may call this religious, or we may call it therapeutic. The distinction only matters to the observer. If the bereaved person is religious, the practice of religion will have a therapeutic effect. If he or she seeks comfort in a conventional therapeutic setting, it is likely to have the intensity of a religious experience. Religion, after all, is largely about reconciling life and death.

Professional mourners, women who attend a funeral service and wail or keen, are traditional in many cultures, and this is one way of sharing the burden of the dead spirit. In Crete this method of joining the living to the dead has been brought to a fine art.

Keening

An essential element in the lament singing is that women identify with each other. Each woman's recollection of her own grief serves to remind and intensify the grief of others. A skilled lamenter has to move her audience to 'ponos' (pain) and thus, symbolically, to lead the living to the dead. The depth of these laments has thus a metaphysical dimension.

From a paper by Sonias Greger, sent to The Natural Death Centre, entitled 'Woman - Man - Peasant - Central Administration'.

There are many who claim to join the living to the dead in a more direct sense, through psychic guidance and evocations, or through the gift of vision.

Help from the spirit world?

Suddenly I gasped, as a flash of headlights shot over the hill - the old man was going to walk right out in front of a car. But just then, something strange happened - I stood transfixed, as a ghostly gleaming-white mist appeared behind him. It quickly condensed into the radiant form of a middle-aged spirit woman. Strangely unruffled by the gale, her hair was completely unmoved, not a drop of rain had wet it, and her flowing white spirit robes were bone-dry.

All at once she stooped down, drew back her arm and delivered a swift blow to the back of the man's knees. My heart jumped into my throat as he fell backwards like a collapsing house of cards, landing on the pavement with his legs in the gutter. Just a second later, a reckless car hurled around the blind bend at over 50 miles per hour, missing his feet by half an inch - then zoomed past the bus queue, splashing us with muddy water.

Brushing the rain from my eyelashes, I watched the ghostly woman kneel down, kiss the old man's troubled brow, smile, and then vanish into the dark night - fading back into the spirit world, from whence she came.

I've had these psychic abilities from my earliest years, visions of other worlds beyond death.

From 'Voices from Heaven' by Stephen O'Brien.

There is no reliable guide to life after death. Guidebooks abound, but the paths they indicate are varied to the point of confusion. A theologian asks the question, Where do the dead go when they pass over? He reviews the possibilities, beginning with nowhere:

Living in God

Perhaps there is nowhere to go. Perhaps people, burdened with fear, want and sorrow, just dance into the arms of death, as Schopenhauer said, wondering what the tragic comedy of life is supposed to mean - and finding out it ends in nothing. Those who have died are then shadows of the past. Nothing remains of them except for the loving scratches or hideous scar they etched on our world, and our memories.

Then, he considers the opposite option, that of reincarnation:

Perhaps our inner Atma is made of incorruptible stuff, as Hindus maintain. At death the spark of our soul then divests itself of one mortal body to start life again in another disposable shell. Our deceased relatives and friends could then be at any station on the spiralling track of reincarnation. They might even have reached their destination, nirvana, where they merge back into the infinite ocean of Atmas.

Or maybe the dead await judgement:

Perhaps the dead roam as shades in the netherworld, populating the Old Testament she'ol. The psalms describe this abyss under the earth as a house of darkness, a bottomless pit, a land of forgetfulness. All the dead can do is bide their time till their fate will be sealed at the universal judgement.

He ends by advocating a truly spiritual understanding:

We can meaningfully speak of heaven and hell, as long as we remember that they are dimensions of life, not locations in outer space. We can say the dead merge back into God if we realise She/He is an ocean of love who does not swamp our littleness. Properly understood, the time-honoured phrase coined by Kohelet puts it rather well: those who have died live in God.

From 'Learning to live with life after death' by John Wijngaards

in The Times (Nov. 4th 1991).

Stephen Levine talks of the comfort to be had in facing up to the worst that human life can bring.

Fierce journey towards freedom

I've been with many people whose grief has been beyond bearing. And in some ways it has been the best thing that ever happened to them. For they come to plumb the depths of their being.

When we experience grief, we are not just experiencing the loss of our son or daughter, our husband or wife, our parent or loved one. We are dropped into the very pit of despair and longing. We are touching the reservoir of loss itself. We experience the long-held fear and doubt and grief that has always been there. It is not an experience that most would choose, though the confrontation with this area of deep holding seems to be an initiation often encountered along the fierce journey toward freedom.

Stephen Levine, quoted in Raft, The Journal of the Buddhist Hospice Trust.

Sogyal Rinpoche in his excellent book 'The Tibetan Book of Living and Dying' advises helping your dead friend and the healing of your own grief by invoking, perhaps with a mantra, any enlightened being who inspires you, and imagining tremendous rays of light streaming out towards you from that being, filling up your heart. And then: 'Imagine you are sending this blessing, the light of healing compassion of the enlightened beings, to your loved one who has died.'

If the hardest death to bear is an untimely one, and the hardest untimely death is a child's death, and the hardest child's death is one that is accompanied by feelings of great guilt amongst the survivors, then we can surely trust the parents who report their thoughts and feelings in The Compassionate Friends publications. Yes, Margaret Hayworth warns, if death causes persistent self-accusatory thoughts, then probably professional therapeutic help should be sought (Newsletter, Summer 1992). But a way that helps is to give yourself permission to forgive yourself, by writing a letter to your child listing regrets and stating your need for forgiveness. For the rest, she shares Kübler-Ross and Levine's spiritual perspective on suffering as an opportunity for the soul to develop. The American spiritual teacher Ram Dass developed these arguments in a public talk where he was responding to a father whose son had drowned. The father was in despair: 'They say that God is perfect but all I can think is that God made a mistake. I cannot believe there would be any good reason for Him to allow this to happen.' Ram Dass replied, in part:

I feel such pain for the loss you and your wife have suffered. The grief that parents experience over the loss of a child is perhaps the deepest grief of all because it seems to upset the natural order of things.

What I can share with you from a spiritual vantage point cannot really allay your grief. Perhaps however it may allow you and your son to know each other in a new way, and that other way of knowing may give balance to the grief.

Because your son was attractive and was your son, and so warm and vibrant, you got to know him through his uniqueness and his separateness. There is another way of knowing a person, which we know through our intuitive heart. This way of knowing one another is subtle, so it is often hidden behind the more obvious ways of knowing people through senses and thought. But if we know what to look for and cultivate that intuitive way of knowing, we find out for ourselves that we are each indeed more than just bodies and personalities.

The soul has an agenda in taking birth itself as a human being. It has certain work to do and complete while on the earth plane and it uses the body and personality to carry out that work. And when the work is finished it leaves this plane. The wisest beings with whom I have made contact in this lifetime all assure me that a soul leaves the physical plane neither a moment too early nor a moment too late. Human birth is a bit like entering in the fourth grade, and we stay just as long as it is necessary to achieve what we need from that specific grade or form, and then we are naturally ready to go on for further evolution by leaving this plane.

I can sense from the description and pictures of your son, the purity of his heart and the beauty of his soul. And I suspect that though you considered his work on earth just at the beginning, for his soul the work was completed. Even the manner of his leaving was part of his work. For your personality, the pain is shattering and seemingly unbearable. You wake crying and find life now meaningless. Such suffering is what the personality would avoid at all costs if it were able. For your soul, however, it is an entirely different matter. For your soul, suffering is that which forces you to grow spiritually, and brings you closer to awakening to whom you in truth are. I realise even as I say all these things to you, that it is really too much for me to ask of you that you undertand the way in which the manner of your son's death was his soul's gift to your soul. I suspect all that seems topsy-turvy to you. But you did ask me how I understand such tragic events, and this is my truth that I am honoured to share with you.

Probably your suffering and attachment to him and sense of loss is felt by his soul. Although he now understands what has happened, why it had to happen the way it did and why you are suffering as you are, I am sure he is surrounding you with healing energy; and as you are able to quiet your mind, I suspect that you will feel it. It of course acts to your benefit even if you don't feel it . To the extent that you are able, sit quietly and just hang out with your son, talking to him as you normally would about the many experiences you shared together. In doing so, look to see the thread of spirit that pervaded each experience. Imagine that you and he are souls who met on earth this time as father and son. How many times in your years together did the love between you nearly rend the veil of mystery that would have allowed you to recognise the truth of soul that lay at the root of your relationship? It takes only a moment for two people to recognise their bond as souls. Souls know no time. And now, even though your son is no longer embodied, you and he can recognise each other.
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