1. Three stages of normal bereavement

Duration of normal grief varies, and it is related to multiple factors, which includes the relationship between the deceased and the bereaved, cause of death, and the personality of the bereaved. Generally speaking, the normal response to bereavement goes through three stages, which lasts for around half to one year. Emotional numbness and denial of the death by the bereaved may be present in the first few days after the death. Followed by the settling of funeral matters, more emotional responses appear. This marks the second stage of a normal bereavement. During this period, the bereaved may experience marked guilt, anger, anxiety, loneliness, helplessness, and yearning. On one hand they may still be denying the death of the deceased, while on the other hand they may repeatedly recall the memories with the deceased, and even with searching behavior, for example, they may go to places where they have spent time with the deceased before, or to repeat what they have done together. They may refuse to tidy up the belongings of the deceased, so as to avoid reminding themselves of the reality. Bodily symptoms may also appear in the bereaved, including pain and dyspepsia. Appetite may get worse. During this period, if the bereaved experience severe mood disturbance, persistent insomnia, poor appetite with weight loss, psychotic experience, or suicidal ideas, in which normal work and social activities are impaired, it marks the need for calling for medical attention, as it signifies a condition called “complicated grief”.

In the last stage, the bereaved not only accept the death of the deceased, but also overcome the grief, and is able to move on. They develop the capacity to remember the deceased without excessive pain.

It is not uncommon for the bereaved to experience acute grief reaction again at times of special occasions, for example, festivals or anniversaries. This is called “anniversary reaction”, and it is usually mild and brief.

2. How can I overcome grief?

The first step to overcome grief is acceptance. Support from relatives and friends during this painful period are crucial. Denial or over-suppression of emotions is to be avoided. Involving in funeral matters plays a role in assisting the bereaved to bring the loss to reality, and it in turn helps the bereaved to overcome the grief. Adjusting to the environment in which the deceased is missing is also important, which includes a change in the family role and re-establishment of usual social support, and sometimes a new social circle.

3. What is Complicated Grief?

“Complicated grief” is present if the grief is prolonged, and in some cases excessive, with the presence of persistent depressed mood, hallucinations, excessive guilt or suicidal ideas, which impairs normal life. A recent study shows that about 4% of the bereaved exhibit “complicated grief”, and among them, those who are female, who have either ambivalent or very close relationships with the deceased, are more prone to develop such condition. If the deceased die suddenly, in accidents for example, also places a higher risk for the bereaved to develop complicated grief.

4. What can you do for the bereaved?

As mentioned above, bereavement brings both emotional distress as well as real life problems for the bereaved to tackle. The death of a close relative not only means emotional distress but also a loss of financial income, a family role, and a carer for the bereaved. After the death of the deceased, the bereaved have to take up all the usual family duties of the deceased. This is particularly the case in the widows (and widowers). The presence of this enormous stress prevents the bereaved from overcoming the grief. The relatives and friends can help a lot by sharing their burden, for example, helping them in moving house, or assisting in childcare. To those elderly who lose their spouse, who may be the major carer for the bereaved, you can give a hand by accompanying them for medical appointments, and reminding them on drug taking. Do give an eye on the risk of self-neglect for them being left alone at home. On the other hand, redeveloping a supportive social network is crucial, as the sense of loneliness often serves as a daily reminder for the loss. It is recommended to encourage the bereaved to express their feelings, including some of the deep seated anger and excessive guilt, as this ambivalence often serves as a factor prolonging the grief. What they need is an active listener with non-judgmental attitude. It is also important for you to closely monitor their mood, and to encourage them to seek help in need.

5. When should I seek for professional help?

Majority of the bereaved can overcome normal bereavement, but you should seek help if the above mentioned features of complicated grief appear. There are a number of non-governmental organizations providing grief counseling services in Hong Kong. The Elderly Health Service of the Department of Health provides emotional support to the elderly in need. The Hospital Authority provides both psychiatric and psychological services. Drug treatment may be rendered to relieve symptoms for those with anxiety, hallucinations or depressive symptoms. Psychological intervention, including grief counseling and cognitive behavioral therapy, may help in individual cases.