A few years ago, when Prince Harry talked about seeking out counselling, to come to terms with how he had been feeling many years after the death of his mother, most of the public reaction was sympathetic. But there were some mental health professionals who decried his decision to ask for help, as though something was ‘wrong’ with how he was feeling. ‘Grief is normal, why do we have to pathologize it?’ they said. Well, one has to ask whether, at the age of 12, discovering your mother had died in a crash after being chased by paparazzi, following her coffin through streets of weeping people who never even knew her personally and then having to live with the endless conspiracy theories woven around the incident, could in any way be described as less than traumatic? Perhaps it might affect you afterwards? Maybe you would need some help to cope with the feelings (Harry described it tellingly as ‘chaos’) that erupted later.
I often think of this when listening to the stories that the young women who I am supervising on the Greater Manchester Bereavement Service tell me. This was set up in the heat of the first lockdown, when people first began to die from Covid-19. They are a team who spend their day on the telephone lines listening to the bereaved. Afterwards, I listen to them talk about what they have heard, how it affects them, and how we can help, as well as sometimes contacting other health professionals and agencies on behalf of our clients. I retired several years ago, but the General Medical Council wrote to me to tell me they had restored my license to practice, and hearing that I might be willing to return to work for a few hours a week, old colleagues from the social enterprise I helped to set up a decade ago asked me if I would return.
We hear from those who said goodbye to their husband or wife, or parent, or sibling, as they went into the ambulance, never to be able to see them again before they died. The older people who, despite more than 50 years living with the same person were unable to hold their hand as they slipped away and whisper their last words of comfort; and then have been left living in isolation unable to meet with friends or family to assuage their pain. That’s unimaginable for me, even after only a quarter of a century of marriage. Those for whom the opportunity to go through rituals of death- the funeral and the passing on of condolences from family and community, have been taken away. Their pain is palpable, heart-rending, and sometimes extraordinarily hard to bear. Some have lost more than one family member and feel unable to share their sadness with others grieving too, for fear of causing more distress.
For most people grief is the normal expression of loss. It’s an acute sense of disbelief followed by a period of intense sadness, along with anger at what has happened, guilt as to whether you could have done more, and then a gradual re-engagement with a world from which the deceased person- the one you love- is missing. As when I finally came to terms with the sudden death of my own father, there comes a time when you remember the person you have lost as they really were, both wonderful and irritating, rather than as the idealised image you have taken inside you and dare not let go of for fear of finally losing them. I don’t think we ever really ‘get over’ the loss of loved one (never ask someone if it was difficult to get over their loss) it just ‘normally’ gets easier with each passing month and year. Some have been told they need ‘counselling’ but really want someone to hear their pain and be with them. It doesn’t have to be a professional but if they are already in touch with mental health services its extraordinary how many mental heal staff seem to think they ‘don’t do bereavement’. ‘It’s not in the IAPT manual’ we’ve been told several times. Where does it say you shouldn’t offer basic humanity and kindness? Some people need more than this- having had a complicated relationship with the person who is gone, or other complex problems in living. Then counselling can help.
But when grief is traumatic, as it has been for many people during Covid, grief may not progress as it usually does. It gets stuck- in a frozen state of disbelief, anger, depression or even wanting to join the dead- especially after bereavement by suicide. Then it can be even harder to get the right help. Those with a history of depression may need help before the magical often quoted ‘six months’ are up, and others develop PTSD and need it sooner rather than later too. Some need skilled therapy of the type that we don’t have very much of. More like psychotherapy than counselling, and people trained to offer interventions that help those with prolonged or complicated grief.
In our team, we support people to get access to the right help. We support each other too, even though we all work alone at home (me in Orkney) and most of us have never met in person. There has been much talk of a ‘tsunami’ of mental health problems following the coronavirus epidemic. Many will be coming to terms with losses, of health as they suffer the long-term effects of Covid, loss of jobs, homes, and hopes for the future. Some will be those who found it hard to get the mental health care they needed for severe mental illness during Covid and must not be forgotten again now in the face of rising demand. And some, like those we hear from every day, have been overwhelmed by a torrent of grief and won’t make it through to the other side without our help. That’s nothing to be ashamed of and should not be diminished either. We have, thankfully, begun to have a more informed conversation about grief in our society. Much more will be needed.
My latest book: Finding True North: The healing power of place will be published on 29th April