In last month’s article in this Exploring Mental Health series, we looked at anxiety. This month, we’re exploring grief and loss. Grief is a very normal reaction to a loss, and for this reason it isn’t a mental illness. But it is something that affects our mental wellbeing in a wide variety of ways. In this article, we explore how grief can affect you, and how to cope after a loss.
 
Different types of loss
 
Loss is something we all experience at some point during our lives. This can come in many different forms, including:

• Death of a person or pet
• Divorce or relationship break down
• Ill health or injury
• Pregnancy, miscarriage or stillbirth
• Sexual difficulties or changes to your sex life
• Menopause or physical body changes
• Redundancy, unemployment or closure of a business
• Retirement
• Changing job
• Moving house or school
• Finishing school or university
• Bankruptcy or change in financial position
• Repossession of house
• Children leaving home
• Imprisonment

 
How grief can affect you
 
How you experience grief following a loss is something that’s individual to each of us, but the symptoms are far broader than feeling sad and upset. Grief can affect you:

• Emotionally – e.g. numbness, shock, disbelief, fear, panic, hopelessness, worry, sadness, helplessness, loneliness, anger, guilt, yearning, resentment, relief

 

• Behaviourally – e.g. sleeplessness, having dreams/nightmares, loss of appetite, absent mindedness, crying, hyperactivity, avoidance of places or people, increase in or development of addictions, risk taking

 

• Physically – e.g. tightness in chest, breathlessness, pain (this may replicate the place of pain in the person who died), lack of energy, dry mouth, hollowness in stomach, lump in throat, oversensitivity to light, noise or smells

 

• Cognitively – e.g. disbelief, confusion, hallucinations, sensing the deceased’s presence, preoccupation (with tasks, the person who died, the circumstances contributing to the loss etc.), questioning the loss or yourself (including questioning your identity)

 

• Spiritually – e.g. loss/discovery of faith or religion, questioning of previously held beliefs, resumption/renewal of former beliefs

 

• Socially – e.g. loss/gain of friendships or social groups, change in role and identity, loss/gain of social status

 

• Practically – e.g. change in financial position, change in living arrangements, change in work, change in routines

 
You may experience some or most of these symptoms, to varying degrees.

How to cope after a loss
 
There’s no quick way to get through the grief process. It takes time, and it’s not uncommon to still be experiencing symptoms of grief two to three years after a loss. To cope, it can be helpful to:

• Allow yourself to be upset – it’s ok to be sad, for many months and years after a loss. Your emotions may come in waves, so if there are times when you feel less sad than others, that’s ok too – it doesn’t mean you’ve moved on or forgotten

 

• Stop putting pressure on yourself – there’s no right or wrong way to move through the grief process, so try not to judge or criticise yourself. Ignore any expectations that come from others about how you should or shouldn’t be feeling; just do what feels right for you

 

• Take one day at a time – looking ahead and picturing the future can seem impossible, and leave you feeling empty or panicky. Focus on one day at a time, and set yourself small, achievable goals. Put aside any larger, more overwhelming decisions until you’re ready to make them

 

• Talk to others – talking about the loss and how you’re coping can help to reduce isolation and give you support. You might want to talk to friends, family, online forums, support groups or to a therapist

 

• Find outlets for your feelings – this might be through doing something creative, such as music, art or writing; or through doing physical activities

 

• Look after yourself – looking after yourself physically can seem unimportant following a loss, but it’s a vital part of helping you cope. Eating well and getting enough sleep can be challenging, but they can make a big difference to your overall wellbeing

 

• Avoid drugs and alcohol – using these to numb the pain of a loss won’t help in the longer term, and can stop you finding more positive coping methods. If you need help managing your drug or alcohol use, make an appointment to see your GP who will be able to refer you to local support services

 

• Learn your triggers – keep a note of things that negatively affect your mood and how you’re coping. Once you know what these triggers are, you can begin to work out what things help you manage them, e.g. having an activity planned for a particular time of day, or seeing a therapist for a couple of weeks/months at particular times of the year

 

• Make a memory box – this can be filled with things that remind you of the person who died (e.g. photos, letters, books, albums, recipes, clothing, keepsakes, perfume/aftershave etc.), and can be something you get out and look at whenever you want to feel close to them

 

• Create a memorial space – this may be a grave or place where ashes are interred, or it may be a plaque in a special place. Alternatively, you may want to buy a plant or tree for the garden, or have a social space online, such as a Facebook memorial page. Whatever it is, the space can be somewhere you go to think about the person who died, connect with them, and to share memories of them with others

When to get further support
 
Sometimes, the experience of grief can be too difficult to manage on your own, and you may need additional support. This might be due to:

• The nature of the loss (e.g. if it’s an unexpected or violent death)
• Past experiences or traumas that re-emerge following a loss
• Existing physical or mental illnesses
  
• Social isolation or lack of a support network
• Other major life stressors (e.g. financial difficulties or having dependents to care for)
  

If any of these sound familiar, the first step is to speak to your GP. They can give you details of support groups or organisations; refer you to a counsellor; or prescribe medication, where relevant. You could also contact support organisations, such as Cruse Bereavement Support who have a free national helpline as well as local bereavement services throughout England, Wales and Northern Ireland.
 
If you’ve experienced a loss and would like some counselling support, get in touch to make an appointment.

Talking about a loss is difficult at the best of times. But what about those losses that can’t be openly acknowledged or shared? The experience of being deprived the chance to openly grieve a loss is known as disenfranchised grief. The article explores when disenfranchised grief can occur, the effects it can have and how to cope with it.
 
When disenfranchised grief can occur
 
1. The relationship with the deceased isn’t recognised

• Death of an ex-spouse or ex-partner
• Death of a same sex spouse or partner
• Death of an unacknowledged partner
• Death of a lover
• Death of a step-child or step-parent
• Death of a foster child or foster parent
• Death of ex-in laws
• Death of a child given up for adoption
• Death of a birth parent of an adopted child
• Death of an unannounced baby (e.g. miscarriage or stillbirth)
• Death of an estranged family member
• Death of an imprisoned family member or friend
• Death of an abuser
• Death of a gang member

 
2. The loss is viewed as unimportant

• Death of a pet
• Death of a co-worker
• Death of a neighbour
• Death of a classmate
• Death of a childhood friend
• Death of an online friend
• Death of an extended family member
• Death of a family member that occurred before you were born
• Death of a professional figure (e.g. doctor or teacher)
• Death of a celebrity or public figure
• Losses that don’t involve death (e.g. moving house, a child moving out of home, physical illness, redundancy or retirement, end of a life stage, infertility, menopause, divorce or relationship breakdown, change in financial status etc.)

 
3. The nature of the death is stigmatised

• Death by suicide
• Death by murder
• Death from substance misuse
• Death from HIV/AIDS
• Death from drink driving or drug driving
• Abortion

 
4. The griever is not acknowledged

• They are physically or mentally unwell
• They are physically or mentally disabled
• They are elderly
• They are a child or young person

 
The effects of disenfranchised grief
 
The disenfranchised grief process is typically more complicated than for socially accepted or acknowledged bereavements. The loss can leave you feeling alone, isolated, unworthy and unsupported.
 
Other effects can include depression, anger, frustration, and intense and prolonged sadness. You may also experience physical, behavioural, cognitive and other emotional changes as you continue to grieve in silence.
 
How to cope with disenfranchised grief
 
If you experience disenfranchised grief, you may become ‘stuck’ in the grief process. Having no opportunity to talk about and work through your thoughts and emotions means it can feel impossible to move forward. It may also be difficult to understand why the loss continues to be so painful.
 
The first step is to confide in someone about how you’re feeling. This may be a friend, family member, co-worker, therapist, your GP, or a support organisation such as Cruse Bereavement Support. Voicing your loss can help to acknowledge its significance, and to validate and normalise how you’re feeling.
 
Other steps may include having your own personal ritual or ceremony to say goodbye, particularly if you were excluded from the public burial or cremation service, or creating a memory box. You should also focus on your own physical and mental health through sleep, diet, exercise and self-care, including requesting compassionate leave from work if applicable.
 
Remember, no loss is insignificant, no matter who or what it is and what the circumstances are. After any loss, you’re entitled to give yourself time and permission to grieve.
 
If you’ve experienced a loss and would like someone to talk to, get in touch for an appointment.

The announcement of the EU referendum result has unleashed a spectrum of emotion in people across the country. Some were pleased, happy, excited and celebratory, while others experienced something very different. Media interviews and social media responses from those voters who lost the result highlighted feelings of disappointment, disillusionment and fear for the future. But more than that, they spoke the language of grief, describing feelings of shock, denial, anger and sadness.
 
Many therapists and thanatologists have proposed grief is a process that involves passing through or between a number of stages, commonly recognised as denial, anger, bargaining, depression and acceptance[1]. But of course bereavement is completely individual and, while the emotions people feel may have some commonality, the strength, duration and order they're experienced in will naturally vary. What's important in the process is that those who are grieving are given support and can speak openly about their loss.
 
Many clients I've worked with have spoken about coming to therapy because they don't feel able to talk about their loss with those around them, or because they feel everyone else has moved on. And it's true that too often grief is still 'the elephant in the room'[2]. But with the predominance of social media in today's culture, perhaps we have the opportunity to change that. 
 
With the creation of Facebook memorial pages and the ability to unite people with Twitter hashtags, we can share our grief more openly, publicly and instantly than ever before. And the EU referendum result is providing an example of that. We're seeing people pour out their grief in Facebook posts, tweets, blogs and vlogs. And perhaps in the midst of the uncertainty over what will happen next we can allow those grief emotions to be openly felt and worked through. For it's simply an amplified example of the personal bereavements we will each inevitably face in our own lives.


[1] Kübler-Ross, E. (2003), On Death and Dying, New York: Scribner

[2] Kettering, T., The Elephant In The Room, Available: http://www.bereavement.co.uk/Media-Centre/?page_id=359