Survive Your Sorrow

What is the Difference between Grief and Bereavement?

The terms are often used interchangeably, but bereavement really refers to the state of loss – you are bereaved or in a state of bereavement because someone close to you has died. Grief refers to the reaction to loss – your reaction to the death of a loved one is one of sadness or grief.

What is Grief?

Grief is a natural response to loss. It's the emotional suffering you feel when something or someone you love is taken away. You may associate grief with the death of a loved one – and this type of loss often causes the most intense grief – but other losses can also cause grief, including:

• The breakup of a relationship (and the subsequent loss of the hopes and dreams you had for the relationship);

• Loss of a friendship;

• Miscarriage;

• Loss of health – being diagnosed with a chronic or a terminal illness for example;

• Loss of a limb;

• Loss of a job;

• Death of a pet;

• Loss of a cherished dream.

Even less obvious losses can lead to grief. For example, you might experience grief after moving away from home, graduating from university, changing jobs, selling your family home or retiring from a career you loved.

Grief is Unique

People are unique. We all have different personalities and just as we like different music, different food and have our own taste in clothes, we also experience the process of grief in our own way.

How you grieve depends on many factors, such as

• your personality and coping style;

• your life experience;

• your faith;

• the nature of the loss - the more significant the loss, the more intense the grief.

The grieving process takes time. Healing happens gradually; it can't be forced or hurried – and there is no 'normal' timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years (this is usually the case with the death of a loved one). Whatever the grief experience, it's important to be patient and allow the process to take its course.

Common Symptoms of Grief

While loss affects people in different ways, many people experience the following symptoms when they're grieving.

Shock and disbelief
Right after a loss, it can be hard to accept what has happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting them to show up, even though you know they're gone.

Sadness
Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning or deep loneliness. You may also cry a lot or feel emotionally unstable.

Guilt
You may regret, or feel guilty about, things you did or didn't say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.

Anger
Even if the loss was nobody's fault, you may feel angry and resentful. If you lost a loved one, you may be angry at yourself, God, the doctors or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.

Fear
A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person or the responsibilities you now face alone.

Physical symptoms
We often think of grief as a strictly emotional process, but grief often involves physical problems, including fatigue, nausea, lowered immunity, weight loss or weight gain, aches and pains, constipation and insomnia. It often causes temporary changes in women's menstrual cycles.

Searching behaviour
There is not a lot written on this phenomenon, but many people find themselves 'searching' for the person who has died - even though they know they have died. For example, they will perhaps see the same model car as the one the person drove and look to see if it is their loved one driving. They will look for their loved one in places he or she used to frequent.

Almost anything that is experienced in the early stages of grief is normal – including feeling like you're going crazy, feeling like you're in a bad dream or questioning your religious beliefs.

The Five Stages of Grief

In 1969, psychiatrist Elisabeth Kübler-Ross introduced what became known as the 'five stages of grief'. These stages were actually based on her studies of the feelings of patients facing terminal illness. Since then, however, these stages have been generalised to other types of negative life changes and loss, such as the break-up of a relationship or the death of a loved one.

Kübler-Ross herself didn't intend for these stages to be a rigid framework applied to everyone who mourns. In her last book before her death in 2004, she said of the five stages of grief, "They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives."

These Five Stages of Grief are:

Denial
The first typical reaction to the possibility of one's own death is to deny it. For example, the person will say: "This is not possible. This can't be happening to me. There must be a mistake somewhere." Such denial serves as a buffer against a reality the person is not yet able to accept.

Anger
The individual realises that death is approaching and often expresses anger: "Why me? Many other people smoke and they don't get lung cancer!" The anger may be directed at other people – close relatives, the hospital staff, and even God – who is blamed for the individual's condition.

Bargaining
During this stage, individuals try to negotiate, for example with God or medical staff, in an attempt to postpone their death. They will, for example, promise to live a better life if their lives are saved, or even if they can live a little while longer. "Make this not happen, and in return I will ____."

Depression
When the dying person can no longer deny the illness, the anger is replaced with a powerful feeling of loss which may cause severe depression. The person may withdraw - "I'm too sad to do anything" - and cry easily. According to Kübler-Ross, people should not try to cheer up the patient. The person should be allowed the opportunity to work through thoughts of their approaching death.

Acceptance
This occurs when the person has had adequate time and help in working through the other stages. By this time he/she will have come to terms with death. This stage may be relatively without feeling. People who are at this stage give the impression that they are quietly waiting. "I'm at peace with what happened."

If you are experiencing any of these emotions following a loss, it may help to know that your reaction is natural and that you'll heal in time. However, not everyone who is grieving goes through all of these stages – and that's okay. Contrary to popular belief, you do not have to go through each stage in order to heal. In fact, some people resolve their grief without going through any of these stages. And if you do go through these stages of grief, you probably won't experience them in a neat, sequential order, so don't worry about what you 'should' be feeling or which stage you're supposed to be in.

Rather than a series of stages, it is better to think of the grieving process as a roller coaster – it is full of ups and downs, highs and lows. Like many roller coasters, the ride tends to be rougher in the beginning, the lows may be deeper and longer. The difficult periods should become less intense and shorter as time goes by, but it takes time to work through a loss. Even years after a loss, special events such birthdays, Christmas, family weddings and anniversaries may trigger off a strong sense of grief. This is normal and to be expected.

The Tasks of Grief

William Worden created a more modern theory than Elisabeth Kübler-Ross' 'Stages of Grief', This theory is often referred to as the 'Tasks of Grief'.

In his book, 'Grief Counseling and Grief Therapy, Second Edition' (Springer, 1991), J. William Worden, PhD, describes what he calls 'The Four Tasks of Mourning'. These tasks can be the means by which a healthy person works through the pain of grieving for a loved one and moves into the next phase of life.

The concept of tasks implies that effort on the part of the individual is required. These tasks are:

1. To accept the reality of the loss
Coming to terms with the reality that the person is dead and will not return is the first task that needs to be completed. Without accomplishing this, the grieving person will not be able to continue through the grieving process.

2. To experience the pain of grief
Grief is painful, physically and emotionally. We may experience a variety of intense feelings and we must begin to work through them as part of the grieving process, rather than avoid them. It is important to acknowledge the pain and not suppress it.

3. To adjust to the new environment where the deceased person is missing
This is the part where we struggle with all of the changes that happen as a result of the person being gone - including all of the practical parts of daily living (e.g.: more responsibilities at home if it is a parent who died) and all of the effects their loss has upon our sense of who we are and how we see the world. It may require adjusting to the roles that the deceased once carried out. If it is a spouse that has died, it requires the bereaved to accept their new identity as a widow/er.

4. To reinvest energy in life, loosen ties to the deceased and forge a new type of relationship with them based on memory, spirit and love
This means that we begin to acknowledge the value of the relationship we had with the person who died and everything we may have learned or loved or respected or disagreed with about them. We recognise that we don't need to 'forget' them and that it is okay to care about and connect with other people and continue to live our lives, even though we miss them. This task requires letting go of attachments to the deceased, so new relationships can begin to form.

Completing these tasks will help the bereaved come to terms with their loss and return to a new state of normalcy.

How to Move Through the 'Tasks of Grief'

Involvement in bereavement support groups or seeking grief counselling can help individuals to move through these tasks. Palliative care and hospice programmes integrate bereavement care into their comprehensive approach to care. Take advantage of the services they have to offer you.

To accept the reality of the loss
It can be very difficult to take in the reality of the death right away. Many people find that they forget the person is gone and expect them to call. They might even pick up the phone to call them, or think they hear their voice or see them in a crowd. They might find that they are still hoping that there was a mistake and the person is alive...

It's often easier for people who are grieving to have an intellectual understanding of the death (the person is physically gone) than an emotional understanding (the loved one is not coming back). So the first task for the grieving person is accepting that the loved one is really gone.

What can I do?

Write down any experiences YOU have had that are similar to those described above. When you can find a way to gently remind yourself of the loss it will eventually become more real so that you can begin learn to live with your loss and have space for joy in your life again.

To experience the pain of grief
Grief is experienced at every level of our being - physically, emotionally, socially, mentally and spiritually - and unfortunately there's no way to avoid it. Denying the pain of grieving can lead to physical symptoms and can prolong the grieving process.

Some people try to avoid grieving pain by being busy or travelling; others try to minimise their loss by idealising the loved one or refusing to allow negative thoughts about the loved one to enter their minds. Some grieving people use drugs (sleeping tablets, tranquilisers etc.) or alcohol to deaden the pain. Feeling the pain of grieving is difficult, and it takes time and a willingness to explore the intense emotions, thoughts and sensation, but it's an important step toward healing.

What can I do?

Take time to get in touch with your feelings, thoughts and the sensations in your body. Identify where you feel them in your body. Learn to stay with these feelings and find something that helps you to express them and move through them. You can write, draw, paint or play music.

When you find a way to identify the feelings, thoughts and sensations you are experiencing and then find a way to express them, you can begin to move through the experiences. This makes new feelings, thoughts and sensations possible.

To adjust to the new environment where the deceased person is missing
For many people, it is not just the fact that our loved ones are gone that changes our lives, but also the ways we need to change our roles, schedules, behaviours, activities and responsibilities. While we are grieving our loved one, we are also grieving for the parts of our life that will never be the same.

Grieving the loss of shared activities can feel as painful as grieving for the person or pet. It is a natural tendency for some people to feel that their lives are emptier following a loss. This is a normal feeling for a time, but part of the grieving and healing process includes acceptance, and shifting our focus to include other people and activities. This opens the door to finding new opportunities for love and companionship.

What can I do?

Think about or write down all the ways that your life has changed since the loss. Consider family, work, friends and committees you belong to. Are these changes permanent or temporary? Think about how you have changed and how those changes make you feel. Think about who you can talk to about your feelings and think about people in your life who could support you with some of the changes or perhaps share the burden of new responsibilities.

Recognising all of the changes that occur as a result of the loss can feel overwhelming, but it can also help you realise you are not going crazy. It is a time of intense change and turmoil – you are trying to figure out who you are and what your place is. It also makes it easier for others to support you if you can identify and communicate what you are struggling with. For example, "Since John died, I am finding it really hard to take on paying the accounts. Could you please help me set up debit orders for some of them?"

To reinvest energy in life, loosen ties to the deceased and forge a new type of relationship with them based on memory, spirit and love
This task can be especially hard for a grieving person because at first it can feel as though you are being disloyal when you start thinking about enjoying a life that doesn't include your loved one. It is important and helpful to find ways to celebrate and remember the person who has died in a way that has meaning for you. You do not need to 'forget about them' or 'move on'. It's likely that memories of the loved one will stay with you throughout your life. Even years after the death, you may sometimes feel a stab of pain when you think about the beloved person or pet that was so important to you. When this happens, remind yourself that it's a normal part of the grieving and healing process. Allow yourself to have these feelings. Learning to cherish a memory without letting it control you is a very important step in the grieving process.

Take comfort in the knowledge that you keep your cherished memories with you, wherever you go. The important thing is learning how to cherish a memory without getting stuck there.

What can I do?

Find meaningful ways to remember your loved one. Think about how they would want to have their life celebrated and remembered. Do something that honours their memory such as planting a tree in their memory or making a collage of photos. I give lots of ideas under the section: Ways to Remember Loved Ones.

Myths and Facts About Grief

Myth: The pain will go away faster if you ignore it.
Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For real healing to occur, it is necessary to face your grief and actively deal with it.

Myth: It's important to be "be strong" in the face of loss.
Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn't mean you are weak. You don't need to 'protect' your family or friends by putting on a brave front. Showing your true feelings can help them to understand where you are at. It also allows you to feel them, which is important for healing process to take place.

Myth If you don't cry, it means you aren't sorry about the loss.
Fact: Crying is a normal response to sadness, but it's not the only one. Those who don't cry may feel the pain just as deeply as others. They may simply have other ways of showing it or may reserve their tears for when they are in private.

Myth: Grief should last about a year.
Fact: There is no right or wrong time frame for grieving. How long it takes can differ from person to person. One to two years is considered normal for the intense feelings, but grief often lasts longer, with less intense feelings.

The Difference Between Grief and Depression

Distinguishing between grief and depression isn't always easy since they share many symptoms. However, there are ways to tell the difference. Remember, grief is a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you're in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

Other symptoms that suggest depression, not just grief:

• Loss of interest in things you previously enjoyed;

• Intense, pervasive sense of guilt;

• Thoughts of suicide or a preoccupation with dying;

• Feelings of hopelessness or worthlessness;

• Inability to function at work, home, and/or school.

Can Anti-Depressants Help?

As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, anti-depressants delay the mourning process.

When Grief Doesn't go Away

It's normal to feel numb, sad or angry following a loss. But, as time passes (months and years, not days and weeks), these emotions should become less intense as you accept the loss and start to move forward. If you aren't feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief.

Complicated Grief

The sadness of losing someone you love never goes away completely, but it shouldn't remain centre stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred (years) or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.

Symptoms include:

• Intense longing and yearning for the deceased;

• Intrusive thoughts or images of your loved one;

• Denial of the death or sense of disbelief;

• Imagining that your loved one is alive;

• Searching for the person in familiar places;

• Avoiding things that remind you of your loved one;

• Extreme anger or bitterness over the loss;

• Feeling that life is empty or meaningless.

When to Seek Professional Help for Grief

If you recognise any of the above symptoms, talk to a mental health professional right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. Treatment can help you get better.

Contact a psychologist or grief counsellor if you:

• Feel life isn't worth living;

• Wish you had died with your loved one;

• Blame yourself for the loss, or for failing to prevent it;

• Feel numb and disconnected from others for more than a few weeks;

• Are having difficulty trusting others since your loss;

• Are unable to perform your normal daily activities.

 What you can do to Help Yourself Though the Grief Process

 Get Support

The single most important factor in healing from loss is having the support of other people. Even if you are not normally comfortable talking about your feelings, it's important to express them when you're grieving. Sharing your loss makes the burden of grief easier to carry. Wherever the support comes from, accept it and do not grieve alone. Connecting to others will help you heal.

• Turn to friends and family members
  Even if you take pride in being strong and self-sufficient, now is the time to lean on the people who care about you. Accept the assistance that's offered and draw loved ones close, rather than avoiding them. Sometimes people want to help but don't know how, so tell them what you need – whether it's a shoulder to cry on, help with funeral arrangements, lifts for the school run or shopping to be done - let people know what would be helpful. Allow them to do things for you.

• Draw comfort from your faith
  If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you – such as praying, meditating, or going to church – can offer solace. If you're questioning your faith in the wake of the loss, (and this is common), talk to a clergy member or others in your religious community.

• Talk to a therapist or grief counsellor
  If your grief feels too much to bear, call a mental health professional with experience in grief counselling. An experienced therapist can help you work through intense emotions and set you on the path to recovery.

• Join a support group
  Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who are experiencing similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes and counselling centres.

Take Care of Yourself

When you're grieving, it's more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

• Allow yourself to feel your feelings
  You can try to suppress your grief, but you can't avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems. Tears are healing.

• Express your feelings in a tangible or creative way
  Write about your loss in a journal. If you've lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person's life; or get involved in a cause or organisation that was important to him or her.

• Don't let anyone tell you how to feel, and don't tell yourself how to feel either
  Your grief is your own, and no one else can tell you when it's time to 'move on' or 'get over it'. Let yourself feel whatever you feel without embarrassment or judgment. It's okay to be angry, to yell at the heavens, to cry or not to cry. It's also okay to laugh, to find moments of joy, and to let go when you're ready.

• Plan ahead for grief 'triggers'
  Anniversaries, holidays and milestones can trigger memories and feelings. Be prepared for intense emotions to rise up – this is completely normal. If you're sharing a holiday or lifecycle event with others, talk to them ahead of time about their expectations and agree on strategies to honour the person you loved.

• Look after your physical health
  The mind and body are connected. When you feel good physically, you'll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right and exercising. Don't use alcohol or drugs to numb the pain of grief or lift your mood artificially.

• Read and learn about death-related grief responses
  Knowledge helps people regain a sense of control over their experiences and environment and helps reduce feelings of vulnerability. Knowing that what you are going through is normal, takes away the worry that you are going crazy.

• Avoid major changes in residence, job, or marital status
  Major changes can be too burdensome during grief. Wait for about a year after the death of a loved one before making any major changes.

• Create comforting rituals
  These include the ritual of the funeral or memorial service, planting a garden or a tree. Visiting the resting place, placing a bench with a plaque in a beautiful place.

What you can do to Help Others Through the Grief Process

It is often hard to know what to do and say to people who are grieving. Sadly, although we will most certainly be faced with this situation, we are not taught how to deal with it. It's common to feel helpless, awkward or unsure. You may be afraid of intruding, saying the wrong thing or making the person feel even worse. Don't let this prevent you from reaching out to someone who is grieving. Now, more than ever, they need your support. You might not know exactly what to say or what to do, but that's okay. You don't need to have answers or give advice. The most important thing you can do for a grieving person is to simply be there. You can't take away the pain of the loss, but you can provide comfort and support. There are many ways to help someone who is grieving, starting with letting the person know you care.

What to say

It is common to feel awkward when trying to comfort someone who is grieving. Many people do not know what to say. Here are some suggestions to use as a guide.

• Acknowledge the situation
  Example: "I heard that your_____ died." Use the word "died" That will show that you are more open to talk about how the person really feels. Don't hide behind euphemisms like "passed away"," is no longer with us", "has gone to heaven"

• Express your feelings
  Example: "I'm sorry to hear that this happened to you."

• Be genuine in your communication and don't hide your feelings
  Example: "I'm not sure what to say, but I want you to know I care."

• Offer your support
  Example: "Tell me what I can do for you."

• Ask how he or she feels
  Don't assume you know how the bereaved person feels on any given day.

What NOT to say

• "I know how you feel." 
  One can never know how another person may feel. You could, instead, ask your friend to tell you how he or she feels.

• "It's part of God's plan." 
  This phrase can make people angry and they often respond with, "What plan? God doesn't care!"

• "Look at what you have to be thankful for." 
  They know they have things to be thankful for, but right now they are not important.

• "He's in a better place now." 
  The bereaved may or may not believe this. Keep your beliefs to yourself unless asked.

• "This is behind you now; it's time to get on with your life."
  Sometimes the bereaved are resistant to getting on with because they feel this means 'forgetting' their loved one. In addition, moving on is easier said than done. Grief has a mind of its own and works at its own pace.

• Statements that begin with "You should" or "You will."
  These statements are too directive. Instead you could begin your comments with: "Have you thought about. . ." or "You might. . ."

What to do

Listen With Compassion

Knowing how to listen is much more important than knowing what to say. Very often, well-meaning people avoid talking about the death or mentioning the deceased person. This is not only unhelpful, it can actually be hurtful and destructive. The bereaved need to feel that their loss is acknowledged, that it is not too terrible to talk about, and that their loved one won't be forgotten. While you should never try to force someone to talk about the death, it's important to let the bereaved person know that they can talk about it if they want to. Talk openly about the person who died and don't steer away from the subject if the deceased's name comes up. When it seems appropriate, ask sensitive questions – without being nosy – that invite the grieving person to talk about his or her feelings. Try simply asking, "Do you feel like talking?"

• Accept and acknowledge all feelings
  Let the grieving person know that it's okay to cry in front of you, to get angry or to break down. Don't try to reason with them over how they should or shouldn't feel. The grieving person should feel free to express their feelings, without fear of judgment, argument or criticism.

• Be willing to sit in silence
  Don't force the issue if the grieving person doesn't feel like talking. You can offer comfort and support with your silent presence. If you can't think of anything to say, just offer eye contact, a squeeze of the hand or a reassuring hug.

• Let the grieving person talk about how their loved one died
  People who are grieving may need to tell the story over and over again, sometimes in minute detail. Be patient. Repeating the story is a way of processing and accepting the death. With each retelling, the pain lessens.

• Offer comfort and reassurance without minimising the loss
  Tell the grieving person that what they're feeling is okay. If you've gone through a similar loss, share your own experience if you think it would help. However, don't turn the situation in to one about yourself – be there for them. Don't give unsolicited advice, claim to 'know' what the person is feeling, or compare your grief to theirs.

Give Practical Assistance

It is difficult for many grieving people to ask for help. They might feel guilty about receiving so much attention, fear being a burden, or be too depressed to reach out. You can make it easier for them by making specific suggestions – such as, "I'm going to the market this afternoon. What can I bring you from there?" or "I've made beef stew for dinner. When can I come by and bring you some?"

Consistency is very helpful, if you can manage it – being there for as long as it takes. This helps the grieving person look forward to your attentiveness without having to make the additional effort of asking again and again. You can also convey an open invitation by saying, "Let me know what I can do," which may make a grieving person feel more comfortable about asking for help. But keep in mind that the bereaved may not have the energy or motivation to call you when they need something, so it's better if you take the initiative to check in. You can offer to:

• Shop for groceries or run errands;

• Drop off a casserole or other type of food that can just be heated up;

• Help with funeral arrangements;

• Stay in their home to take phone calls and receive guests;

• Help with insurance forms or bills;

• Take care of housework, such as cleaning or laundry;

• Watch their children or pick them up from school;

• Drive them wherever they need to go;

• Look after their pets;

• Go with them to a support group meeting;

• Accompany them on a walk;

• Take them to lunch or a movie;

• Share an enjoyable activity (game, puzzle, art project).

Provide On-Going Support

Grieving continues long after the funeral is over and the cards and flowers have stopped. The length of the grieving process varies from person to person, but in general, grief lasts much longer than most people expect. Your bereaved friend or family member may need your support for months or even years.

• Don't make assumptions based on outward appearances
  The bereaved person may look fine on the outside, while inside he or she is suffering. Avoid saying things like "You are so strong" or "You look so well." This puts pressure on the person to keep up appearances and to hide his or her true feelings.

• Be sensitive to the fact that life may never feel the same
  The pain of bereavement may never fully heal.  You don't 'get over' the death of a loved one. The bereaved person may learn to accept the loss. The pain may lessen in intensity over time. But the sadness may never completely go away.

• Offer extra support on special days
  Certain times and days of the year will be particularly hard for your grieving friend or family member. Holidays, family milestones, birthdays and anniversaries often reawaken grief. Be sensitive on these occasions. Let the bereaved person know that you're there for whatever he or she needs.

Watch for Warning Signs

It's common for a grieving person to feel depressed, confused, disconnected from others or like they're going crazy. But if the bereaved person's symptoms don't gradually start to fade after a few months – or they get worse with time – this may be a sign that normal grief has evolved into a more serious problem, such as clinical depression.

Encourage the grieving person to seek professional help if you observe any of the following warning signs after the initial grieving period – especially if it's been over six months since the death.

• Difficulty functioning in daily life;

• Extreme focus on the death;

• Excessive bitterness, anger, or guilt;

• Neglecting personal hygiene;

• Alcohol or drug abuse;

• Inability to enjoy life;

• Hallucinations;

• Withdrawing from others;

• Constant feelings of hopelessness;

• Talking about dying or suicide.

It can be tricky to bring up your concerns to the bereaved person. You don't want to be perceived as being interfering. Instead of telling the person what to do, try stating your own feelings. For example, "It worries me that you aren't sleeping – perhaps you should look into getting help."

Take Talk of Suicide Very Seriously

If a grieving friend or family member talks about suicide, get professional help right away.

Ways to Remember Loved Ones

From my work as a psychologist doing grief therapy, I have come to realise that one of a bereaved person's greatest fears is that they will forget the person who has died, and 'don't want to move on' for this very reason. The reality is that this is unlikely to happen, but there are things you can do to help you remember your loved ones who have died. It is important to find ways to feel connected to the relationship that you had with your loved one and to all of the good things that were created from it.

• As your friends and family to share their memories of your loved one. You may learn things that you didn't know about your loved one.

• Gather your friends and family together in celebration of your loved one. Perhaps throw a remembrance party on the anniversary of their death, or around the anniversary time.

• Make a memory book of photos and memoirs of your loved one.

• Create a book to pass on to a child about their father / mother / brother / aunt etc. Have people write stories in the book that illustrate what kind of person they were and the impact they made on others.

• Create a memory box containing special items that belonged to you and your loved one. Also place little notes in it with special memories on.

• Buy a beautiful box with a lock on it. Write things down which you wish you had said to your loved one before they passed away and put these messages in the box.

• Write a letter to your lost loved one; tell them everything you are missing about them and everything that you learned from them.

• Make a collage of all your favourite photographs of your loved one and put it up on the wall where you can look at it anytime you like.

• Buy a digital 'photo-frame' and create a slideshow of photos of your loved one – let it run.

• Wear a piece of jewellery which belonged to your loved one, whenever you look at it, you will remember them.

• Honour your loved one's favourite traditions.

• Create a new tradition in remembrance of your loved one. For example you could light a candle and listen to your loved one's favourite music on the last Saturday of every month. Perhaps you could visit people in need once a month to give them friendship and comfort.

• Hang a special bauble or ornament on the Christmas tree.

• Hang a stocking at Christmas containing lots of beautiful memories of your loved one.

• On special occasions, such as birthdays or Christmas, buy a gift for your loved one and then donate it to someone who needs it, such as a homeless person. It will make their day as well as yours.

• On the day of their birthday buy a cake and put a candle on it. Enjoy the cake with friends, talking about the person who has died.

• Donate money to a charity, or donate your time to help those less fortunate than yourself.

• Put a picture of your loved one into a locket to treasure always.

• Start a memorial trust or scholarship fund in memory of your loved one.

• Write a poem or a story about your loved one

• Light a candle in memory of your loved one.

• Plant a tree in memory of your loved one. Place a plaque next to the tree with a message on it.

• Visit a place that you used to like going to together. Remember the good times you had there.

• Listen to your loved ones favourite music.

• Cook your loved one's favourite meal and think of them while you are eating it.

• Make a memorial quilt in your loved one's memory. You could even make it out of their old clothes.

• Release balloons with friends and family in memory of your loved one. Perhaps attach little notes onto the balloons with messages on them.

• Visit your loved one's resting place often and take flowers to leave at their grave or at the memorial wall.

• Leave flowers at your church, or another special spot, such as the place they liked to go to.

• Plant a memory garden for your loved one, plant their favourite flowers and trees.

• If you are hosting an event such as a wedding or christening, do something to remember your loved one at that special time, to show how much you wish they could be there with you. Perhaps light a candle or hold a few moments silence in their memory.

• Put a bench in your garden, in the cemetery garden, or in a beautiful place with a plaque honouring the memory of your loved one.

For many people, the hardest part of losing a loved one and grieving that loss is figuring out what to do with all the love they feel for the person or pet that is gone. Remind yourself that you don't have to stop loving someone just because he or she is no longer with you. When a memory pops up, send a loving thought and know that you are loved in return. You may find comfort in this, and gain the strength to continue on in your journey.

Supporting a Child Through Grief and Bereavement

Even very young children feel the pain of bereavement, but they learn how to express their grief by watching the adults around them. After a loss – particularly of a sibling or parent – children need support, stability and honesty. They may also need extra reassurance that they will be cared for and kept safe. As an adult, you can support children through the grieving process by demonstrating that it's okay to be sad and helping them make sense of the loss.

Answer any questions the child may have as truthfully as you can. Use very simple, honest, and concrete terms when explaining death to a child. Children, especially young children, may blame themselves for what happened and the truth helps them see they are not at fault. Be sure to communicate that they are not to blame.

Open communication will smooth the way for a child to express distressing feelings. Because children often express themselves through stories, games and artwork, encourage this self-expression, and look for clues in those activities about how they are coping.

What to do

• Allow your child, however young, to attend the funeral if he or she wants to.

• Talk about your spiritual beliefs on life and death, or pray with your child.

• Meet often as a family to find out how everyone is coping.

• Help children find ways to remember the deceased person.

• Keep your child's daily routine as normal as possible.

• Pay attention to the way a child plays; this can be one of a child's primary ways of communicating.

What NOT to do

• Don't force a child to publicly mourn if he or she doesn't want to.

• Don't give false or confusing messages, like "Grandma is sleeping now".

• Don't tell a child to stop crying because others might get upset.

• Don't try to shield a child from the loss. Children pick up on much more than adults realise. Include them in the grieving process as this will help them adapt and heal.

• Don't stifle your tears. Crying in front of your child sends the message that it's okay for him or her to express feelings too.

• Don't turn your child into your personal confidante. Rely on another adult or a support group instead.