Moving on following a bereavement
How do I carry on?
Information for the bereaved
INTRODUCTION 3
WHAT IS MOURNING? 5
THERE ARE AS MANY WAYS OF MOURNING AS THERE
ARE PEOPLE … 5
Various aspects of mourning
Is there such a thing as abnormal grief?
Mourning together or alone?
FREQUENTLY ASKED QUESTIONS ABOUT MOURNING 11
How do you say goodbye?
Do children mourn also?
Does medication or therapy help when you are grieving?
What can I expect from my environment? What can help me move on?
What about a sudden bereavement?
Should we protect certain people from the news that someone has
passed away?
SOURCES20
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Introduction
This brochure is intended for anyone who has lost a loved one
who had spent a brief period or a long time in hospital. The
doctors, nurses and all other care providers, who looked after
your loved one, would like to express their condolences for
your loss.
Because UZ Leuven cares for you, the bereaved and person left
behind, we would like to provide more information about the
mourning process. We hope this brochure will give you some
recognition and something to gain support from.
We all react differently to the loss of a loved one. And there are
cultural differences with respect to our approach to mourning.
The approach described in this brochure is obviously geared
to Western culture, which means that you may not necessarily
identify with it. If you would like more information on the approach to mourning in your own culture, you can contact the
intercultural mediation coordinator in our hospital.
Should you have further questions after reading this brochure,
please refer to the separate leaflet included with it. It provides
general information on books, websites and referral addresses.
It also details how to contact a member of the hospital staff for
consultation. However, your GP remains your first point of call.
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Pericles, the Greek statesman, observed that the civilisation of
a people is determined by the way in which it deals with the
dead. We, at UZ Leuven, try to adhere to this philosophy. We
are well aware that the loss of a loved one is one of the most
momentous events in a person’s life. We hope, therefore, that
this brochure will give you some support and something to
lean on.
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WHAT IS MOURNING?
When someone close to you dies there follows a difficult period characterised by conflicting and sometimes confusing feelings, thoughts
and physical ailments. This process is referred to as mourning. The
process you go through is directly related to the significance to you
of the person you have lost. Even if you often rowed and there was
a lot of tension between you and the deceased, mourning can be
intense. Having said that, there are people who are little, or not, affected by the loss of a person. Once again, this is a normal reaction.
THERE ARE AS MANY WAYS OF
MOURNING AS THERE ARE PEOPLE …
Sooner or later we are all confronted with the loss of someone close
to us Approximately 100,000 people die in Belgium each year. That
equates to 274 people a day. Assuming that every deceased person
leaves four close relatives/friends behind, there are 1,096 people who,
just like you, are confronted with loss every day. That means many
people who are grieving and in some way you are not alone with your
grief. Nevertheless, your mourning process is unique, because you
are different from everyone else. Your relationship and contact with
the deceased were also unique – different from everyone else. That’s
why your feelings and thoughts may differ from other people’s. Widely
varying reactions to loss are quite normal.
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VARIOUS ASPECTS OF MOURNING
When you lose someone, your general wellbeing may be affected, i.e.
your emotions, memory, powers of concentration and bodily functions may change. Below are testimonies from Martine and Pieter.
Pieter relates: “Six years ago we lost Elke, our seven year old
daughter, following a car accident. She was our only child. It
took a few weeks before I realised that we had really lost her.
I barely slept the first few months and my weight dropped by
8 kilos in just two months. Because of the lack of sleep I had
trouble concentrating. My mind used to wander and focus on
memories during conversations. Sometimes I used to hear or
see her and these experiences completely unsettled me. But I
hoped it would happen again because I wanted to be with her.
Every now and again I also used to dream about her, about us
spending time together, for example, in a playground. When I
woke up and realised that is was only a dream, I lost the will to
live. I went through hell and was convinced that no one had ever
felt like me. I often felt very lonely with my grief.”
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Martine relates: “I lost Erik, my husband, following a long
drawn out battle with disease. In the weeks before he died I
used to sometimes be angry with my husband for leaving me
behind. Was he fighting hard enough to conquer the disease?
Sometimes I subsequently felt guilty for what I had said. Even
though I wanted to do nothing but care for him and be with
him, it was sometimes all too much. In some respects it was
a release for me when he died; I was relieved from the care
and responsibilities. During the initial weeks I did nothing but
sleep. It appeared to be a kind of flight mechanism for me. I
couldn’t bear to see other people laugh. I was angered by the
fact that the world carried on as normal, as if nothing had
happened. I couldn’t listen to music either. These periods of
intense irritability alternated with moments during which I felt
numb, couldn’t feel anything. I often felt as if I couldn’t breathe.
My chest felt flattened and swallowing was painful. When I
returned to work after a couple of weeks, I couldn’t concentrate properly on my work. Everything seemed pointless and
commonplace. Giving meaning to things became an important
aspect of my life. I became a volunteer for an organisation that
works with disabled children, which helped me to move on.”
Pieter and Martine obviously mourned in different, individual ways.
Both encountered emotional and physical problems and had difficulty concentrating. Some problems change or lessen as time goes
by. Others occasionally return with a vengeance. Yet other problems
occur later in the process.
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IS THERE SUCH A THING AS ABNORMAL GRIEF?
Although Pieter and Martine each mourned in their own individual
way, one way of mourning is not necessarily ‘better’ than another.
Virtually all reactions to the loss of someone are normal. When you
lose someone, you have lost them for the rest of your life. It is normal, therefore, that you can still feel the pain of losing a loved one
many years later. In fact mourning consists of two aspects that can
alternate throughout the mourning process. The first aspect relates
to looking back to the past. Events, objects, sounds, smells… will
remind you of the deceased. These memories occur spontaneously.
The deceased will be in your thoughts, whether you like it or not.
This can be difficult to bear for some people. Other people like to
evoke memories, either on their own or with others. Sometimes
people reflect on the nature of their relationship with the deceased.
Questions arise, such as “What was our relationship like?” “What
did it mean to have this person in my life?”
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Another part of the mourning process relates to living on without
the person you lost. If the deceased played an important part in your
life, this can be a very difficult process. For example, if the deceased
was your partner as well as your colleague and shared your hobbies,
you are faced with a gaping hole in your life after the bereavement,
which can make it difficult to carry on alone.
Some people find that they become locked in their own thoughts and
feelings after a while. For example, all you can think about is the deceased. You don’t seem to be able to make room for others or pick
up the threads of your life again. You are not interested in the things
around you and consider a life without the other person meaningless. You have difficulty accepting the bereavement. If you recognise
yourself in these statements we would strongly recommend that you
seek help. You can contact your GP or a Centrum voor Algemeen
Welzijnswerk (CAW – Centre for General Welfare Work) in your
area. The latter offers low cost consultations with a therapist.
MOURNING TOGETHER OR ALONE?
As mentioned earlier, we all mourn in different ways and at a different
pace. But we are never alone. We remain connected with other family members, friends, the community, etc. Sometimes different ways of
mourning can lead to tension between you and other people.
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Pieter also experienced this: “When we lost our daughter Elke
my wife, Isabel, and I were initially paralysed. I have always
been an extrovert and wanted to talk about Elke, to keep her
with us by mentioning her name. But my wife preferred not
to talk about it. Sometimes she became irate when I talked
about Elke. She wanted to forget everything; she often went
out with girlfriends and started various activities that took her
out of the house. I, on the other hand, couldn’t bear to go out
and spent a lot of time on my own at home, which I blamed
her for.”
Because of their different approach to mourning, Pieter and Isabel no
longer connect in the same way they used to. Pieter blames Isabel for
leaving him alone. Isabel blames Pieter for living in the past. There is
no ‘better’ way of dealing with grief – people’s approaches are just
different. If you feel that the mourning process is making contact
with other people difficult, it may be useful to start a dialogue with
each other, or ask your GP for advice.
Even if you sometimes think that you are facing your grief alone or
don’t want to be a burden to others, and you feel you want to talk
about what happened to you, you have various options. Martine also
experienced this.
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Martine relates: “Erik and I did not have children together. It
never bothered me but when he was dying, and subsequently
passed away, I sometimes thought: “I wish I had a daughter now
who would be able to share my grief. She would understand
what it feels like.” A couple of months after Erik died, I noticed
that my family and friends increasingly tended to change the subject when I talked about Erik. They also no longer spontaneously
asked how I was. I often felt nobody understood and that I was
alone in my grief.” I talked to my GP about it. He provided me
with information on a self help group, which brought together
people who had all lost someone. They recognised what I was
talking about, the loneliness and lack of understanding. I also
encountered people living alone who had children but weren’t
necessarily supported by them. In some cases the children experienced loss in a different way. I still attend these group meetings every month. It gives me an opportunity to talk about my
problems, which means that I have more scope for other things
with my friends.”
FREQUENTLY ASKED QUESTIONS
ABOUT MOURNING
HOW DO YOU SAY GOODBYE?
Immediately after the bereavement you have to deal with a lot of
things, including the funeral. There has been a tendency in recent
years to leave a number of choices relating to saying goodbye up to
the family. This leads to a number of questions, such as “Do we opt
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for a religious service?”, “Where should the service take place?”,
“Which music should we use during the service?”, “Do we provide
sandwiches or a reception with buffet?” Being able to make these
choices is a good thing, although some people are overawed by it. In
such cases advice from an undertaker, pastor or crematorium representative can prove useful for a number of practical issues. However,
it is important to take your time to decide for yourself how you and
your family want to remember the deceased. Don’t allow others to
make decisions on your behalf if you don’t feel happy with it.
DO CHILDREN MOURN ALSO?
It is often assumed that children are too young to experience loss.
“They don’t know what’s going on, so we don’t have to involve them.”
However, this is not entirely correct. Indeed, up to a certain age children don’t quite understand what ‘being dead’ means, but they often
do perceive that something is going on. What they feel or notice
obviously depends upon their age.
Babies up to one year old are sensitive to an atmosphere, which
means that they thrive on the emotions surrounding them. If there is
tension in their environment they may, for example, cry more, or eat
less, etc. It may help if there is a memento of the deceased for the
child, e.g. a photograph of both of them together, so that the child
subsequently realises it has actually known that person.
Children between one and three are focused on ‘movement’. In
their eyes dying could equate with ‘being broken’. It is important that
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you choose quite specific terms such as ‘dead’, rather than ‘asleep’ or
‘away on holiday’ as this could confuse the child. It could result in the
child thinking that it is dead when it is asleep. Children of this age can
be involved in the process of saying goodbye to the deceased. Allow
them to look at the deceased but prepare them for what they will
see. “He/she will be lying still with his/her eyes closed and will feel
cold to the touch ...” Take them to the funeral so that, at a later date,
you can tell them they were there.
Dying is something of a temporary nature for children between
three and six. They may well consider ‘dying’ as something that
happens when you have behaved badly. It may, therefore, be best to
discuss with them that the death is nobody’s fault. They cannot express their emotions in words; they do it in their behaviour. At this
age children need a familiar environment and familiar people around
them. A set routine will also help them deal with bereavement.
Children between the ages of six and nine start to realise that
death is forever, but might still hold out the hope that the deceased
will return. They often think that death only happens to old people.
If they ask questions about this, it is advisable to listen carefully and
help them find answers themselves, but also respond with honesty.
Because children of this age cannot yet think in abstract terms, they
sometimes have great difficulty coping with what happens around
them. They deal with their loss during play or via drawings.
Between the ages of ten and twelve children recognize that death
is forever and can happen to anyone. Being faced with a bereavement
at this age can consequently have a confrontational effect because they
realise it could happen to them also. At this age children can often
already indicate what they do and do not want. When dealing with
bereavement you can help them by maintaining open communication.
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Adolescents between 12 and 18 have an adult perception of death.
They need security and trust. They also prefer to discuss their feelings with peers rather than their parents. Parents can perceive this
as a sign that their children don’t like to talk about the bereavement.
If they do talk about it with you – in the same way as an adult would
– you can help them identify and accept feelings such as fear, sadness,
guilt, anger, etc. Talking about the loss yourself can also help. Your
child will find it easier to talk about the bereavement because it can
relate to the subject.
Despite the fact that parents sometimes want to keep children away
from the dying process to protect them, it often has the reverse
effect. If the child is not allowed to get involved, it will fill in certain
details from its own imagination, which could lead to feelings of guilt
or an inability to picture what’s happened. This can make it more difficult to deal with the bereavement process. It is advisable to involve
children of all ages in a bereavement. You should also inform the
school of the bereavement. There are many books for children of all
ages that deal with the subject of dying. They might help you talk to
each other about the deceased.
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DOES MEDICATION OR THERAPY HELP WHEN YOU
ARE GRIEVING?
Mourning is a normal reaction to the loss of a loved one. During the
mourning process you will try to integrate the loss into your life.
Moving on after a bereavement is a process that takes time. That’s
why it is generally not recommended to take medication or enter
into therapy when you have recently lost someone. This should be
a last resort when you feel that you can no longer go on (see above:
Is there such a thing as abnormal grief?), of if you know from previous experience that you cannot handle loss very well, in which case
medication or therapy might help. Medication makes the hopelessness you feel more bearable. Therapy demonstrates what will help
you move on. Your GP can give advice on which choices to make.
WHAT CAN I EXPECT FROM MY ENVIRONMENT?
WHAT CAN HELP ME MOVE ON?
When you lose someone both you and your environment are affected.
Most people would like to be there for you, but often don’t know how
to because the people around you still have to find a way to deal with
the bereavement themselves. Or they worry that they might do something wrong, which is why some people don’t talk about the deceased,
or stay away altogether. Obviously, these reactions aren’t exactly helpful for people in mourning. Although it is very difficult to take the initiative during a time when you’re struggling yourself, it can be helpful.
After all, you know best what it is you need. Show others how they can
help you. For example, start talking about the deceased if you feel the
need to do so. If people say “Call me if you need me”, but you don’t feel
comfortable doing that, tell them that you would prefer it if they rang
you. Try to keep in touch with other people – for better or for worse.
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What can also help is to ensure that you maintain the structure of your
former life where possible. Try to sit down for a meal even if you don’t
feel hungry. Try to get up and go to bed at the same time as you used
to. Where possible, try to continue with your former activities, even if
some of your tasks are temporarily managed by others.
Martine relates: “During the initial weeks following the death
of my husband all I wanted to do was sleep. I didn’t want visitors. As far as I was concerned life had come to a standstill.
Eating was the most difficult time of the day for me. I asked
my sister to call in so that we could eat together. One of my
girlfriends used to call me every week. Previously, we often
used to go for a walk together and she kept suggesting that we
should do so again. I often used to say that I didn’t feel like it
yet, but that she should keep on asking me. Eventually, it was
the first activity I took up again. We used to go walking for
hours on end, talk about Erik and wonder, for example, how
he would have dealt with losing me.”
If you, as an onlooker, notice that the bereaved person seems to be unable to cope with the process, it may be a great help to them if you talk
about it. You don’t necessarily have to become their ‘shoulder to lean
on’, but you could, for example, recommend that they seek professional
help from a GP, psychologist or psychiatrist.
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WHAT ABOUT A SUDDEN BEREAVEMENT?
When someone close to you dies suddenly, it is sometimes difficult
to comprehend what’s happened. “I cannot believe it”, “Why now,
why this?”, “I keep thinking I’ll bump into him/her any minute now.”
You cannot comprehend that someone is really dead, will never walk
into the room again, will never laugh again, will never be part of
your life again, etc. Because it happened so suddenly it is even more
important to take the time to say goodbye. Viewing the deceased,
leaving a personal object, saying, writing or drawing something,
talking to others about the past few days, making time to prepare for
a celebration of the deceased’s life, etc. They will all help you realise
that someone has really gone and help you cope with your loss.
If you lose someone who was badly injured it is often not advisable
to view the deceased. We recommend that you follow your instinct
in this case. For most people saying goodbye is a positive thing to do
that will help with the subsequent mourning process, even if they
fear that they will confronted with something awful or will lose the
‘nice’ image they have of the deceased. However, this may not be
right for a minority of people. Ask someone who has seen the deceased what to expect. Talking to family, friends or relevant carers
could help you make a decision.
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With a sudden death people are also frequently faced with the following questions: “Why?” Why is this happening to us? Why did he/
she have to go now? Why did he/she choose to abandon life? These
questions are an attempt to give meaning to it all. This can be a difficult quest and you may never find the answers. Nevertheless, it
is good to reflect on this. For example, by talking to friends of the
deceased; by thinking about his/her approach to life; by considering
what is meaningful in your life. Some people find solace in their faith;
others seek support in a different way. Try to determine what you
need to deal with these questions or ask for support from others.
Talk to someone who had a similar experience, someone who knew
the deceased, your family, friends, GP, etc.
SHOULD WE PROTECT CERTAIN PEOPLE FROM THE
NEWS THAT SOMEONE HAS PASSED AWAY?
You are faced with many different emotions when you lose someone.
Your own emotions may make you inclined to protect others from
what you are having to deal with now. This protective reflex will
be more noticeable if it is someone who, in your opinion, is already
dealing with quite a few problems. For example, because this person
has already lost someone, or is in poor health, in the early stages
of dementia, is disabled, etc. You want to spare them by not telling
them what’s happened. Before making the decision not to tell someone, consider what you aim to achieve. Is it something you want to
keep quiet temporarily? Remember that people who were not present at the funeral but find out afterwards can no longer participate
in the same mourning process. You are actually taking something
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away from them. By not involving them, it is exactly the people we
are trying to protect who become more vulnerable in their mourning process. It can also lead to a breach of trust between you and
the person whom you kept the information from. If you decide not
to tell someone, period, remember that people are more sensitive
than you might think. Even though some people may not be mentally
able to grasp something, they will still perceive certain other things
such as your anxiety. Try to put yourself in their place. “How would I
feel if I was not involved in the loss of a loved one?” People who are
going through a difficult time need your trust more than ever. It gives
them faith in themselves to carry on.
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SOURCES
✗ De Keijser, J., Van Den Bout, J. & Boelen, P. (n.d.). What is
mourning? Consulted on 6 June 2011 via http://www.rouw.nl
✗ Holland, J., Niemeyer, R., Boelen, P. & Prigerson, H. (2009).
The underlying structure of grief: a taxometric investigation of
prolonged and normal reactions to loss. Journal of Psychopathology
& Behavioral Assessment 31 (3) 190-201.
✗ Stroebe M., Hansson, R., Schut, H. & Stroebe, W. (Red.) (2008).
Handbook of bereavement research and practice. Advances in theory
and intervention. Washington: American Psychological Association.
✗ Stroebe M. & Schut, H. (1999). The dual process model of coping
with bereavement: rationale and description. Death Studies 23 (3)
197-224.
✗ Wittouck, C., Van Autreve, S., De Jaegere, E., Portzky, G., & Van
Heeringen, K. (2011). The prevention and treatment of complicated
grief. Clinical Psychology Review 31 69-78.
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© August 2016 UZ Leuven
This text and the illustrations may only be reproduced with prior permission from
the communications office at UZ Leuven.
Design and implementation
This text was written by the palliative support team in conjunction with the communications department.
This brochure is also available at www.uzleuven.be/en/brochure/700369.
Comments or suggestions pertaining to this brochure can be submitted via
[email protected].
Published by
UZ Leuven
Herestraat 49
3000 Leuven
tel. 016 33 22 11
www.uzleuven.be