Bereavement as part of the ‘Mental Health Conversation’

Bereavement as part of the ‘Mental Health Conversation’

Whenever the London Marathon comes around, I always think how lovely it would be to participate. I’d love to run it. And then I remember I can’t run. My PE teacher at school pointed that out, and nothing has changed over the twenty-ish years since. Still, would be nice if…

I followed the build up to this year’s marathon with interest, given its billing as the inaugural ‘mental health marathon’. The coverage garnered by Princes William and Harry and Catherine via their Heads Together charity has really done a lot for the ‘mental health conversation’. The significance for me lies in the attention drawn specifically to bereavement. The references made to loss in the press coverage have highlighted the seriousness of bereavement within the mental health conversation – grief is not a ‘mental health problem’ but it can be a major precursor to difficulties. EVERYone can, and most likely will, be affected by a bereavement during their life time, and that is why it is so important to see loss as a significant part of the mental health conversation more broadly.

There is a myth regarding the effect of suicide, that it runs in families. Research points to the falsehood of this; however, research does show there is increased risk of suicide after exposure to this form of loss. A person bereaved by suicide experiences the pain of separation, the grief and sadness, but they also frequently endure additional facets such as guilt, questioning, anger, relief and/or rejection (Wertheimer, 2014). It is common for those affected by suicide to speak about a loss of identity and a sense of becoming numb, also presenting with symptoms of trauma – the flashbacks and re-livings associated with Post Traumatic Stress Disorder are common. Research shows how the multitude of emotional experiences after a suicide can contribute to a lack of self-worth, damaged self-esteem, a loss of trust in people and professionals. For instance, a study by Pettersen et al. (2015), very clearly outlined the ways in which siblings can perceive and relate to health services after a suicide:

“You get very scared….My brother tried to get help, there was none and he died. You don’t believe in them. Trust is necessary. I want to feel certain that when I call and say I need help, there will be somebody there that is willing to help me.” (2015: 326)

Fear and anxiety (Powell and Matthys, 2013: 322-3) can exist, with many “suffer[ing] from “constant feelings of approaching disaster” (Pettersen et al., 2015: 328). Significant are findings that suggest bereavement by suicide can lead to indifference to death, (“As Jennifer found out after her brother’s suicide, it was not that she actually wanted to die but more a sense that it really would not matter if she did.” (Wertheimer, 2014: 163)), and so it is not entirely surprising that suicidal feelings amongst persons bereaved by suicide are noted as being common. Thus, as Wertheimer points out, “Unravelling these complicated and sometimes conflicting feelings can be hard work for the survivor” (Wertheimer, 2014:161). The ‘legacy of suicide’ is a prevalent idea, illustrating why acknowledgement of bereavement (particularly by suicide) is so crucial as part of a more general conversation about mental health:

“one of the most striking features of suicide bereavement is the way in which [their] unbearable feelings are passed to the survivors. The ‘pyschache’ (Shneidman 1993), the shame, guilt, humiliation, anger, loneliness, angst and other emotions associated with suicidal states frequently become the survivor’s legacy….the suicide victim passes on his [her] psychological ‘skeletons’.” (Wertheimer, 2014: 218)

Thinking about all this from a personal perspective, I applaud the Princes for highlighting talking as important and normal (especially amongst men), for naming bereavement and loss as important, helping to gain increased acknowledgement for the significant life-changing experience that is losing a loved one. But what I wish more focus to fall on now is what can actively and practically be done to help bereaved people. Prince Harry didn’t want to talk and buried his emotions – I was willing and wanted to talk about my loss straight away, but there was no one to actually talk to, which also eventually led to emotion-burying. It was almost five years after the death of my brother before I met another sibling who had experienced the same and could ‘get it’. I wanted a face-to-face talking-support group, and in its place received anti-depressants – there are still no easily accessible support groups in my area of the UK. I didn’t want a telephone line or a website or counselling – I needed a physical ear, a place to vent without judgement. I specifically asked my doctor for advice on where to go, who I could talk to, and they could not help – ‘I don’t know’ was the response I received. I finally found a group (four and a half years after my loss), but still had to go through almost a ‘triage-eligibility’ phone call prior to confirmation of my place, (and, subsequently, the sessions ran for only ninety-minutes weekly over six weeks). I am lucky – I have a research personality that pushed me into seeking out, and demanding(!) help. I also have a very supportive family and network of friends. But for those who don’t, I can see the ease with which bereavement can entangle with mental health and spiral down into complicated grief, major depression, even suicide. Even if the intention and want to talk is there, the resources (charitable or otherwise) are simply not, and in many ways the bereaved are frequently left to ‘sort themselves out’. “Suicide postvention as suicide prevention” (Shneidman 1972) is a statement frequently declared as requiring attention. Linn-Gust has also argued that, “By helping the bereaved through their losses…we are breaking the legacy of suicide in families” (2010). But the actual means to act upon these ideas and the physical spaces available and accessible to allow their achievement are in reality severely limited.

I will watch with interest to see how Heads Together evolves – I hope the public consideration, acknowledgement and discussion of bereavement is not diminished (though obviously ‘mental health’ covers a myriad of conditions and situations that all require attention). I also continue to hope usable-resource-development for the bereaved, (especially, from my perspective, the bereaved by suicide), will become a priority.

 

Sources:

Pettersen, R., Omerov, P., Steineck, G., Dyregrov, A., Titelman, D., Dyregrov, K., and Nyberg, U. (2015). ‘Suicide-Bereaved Siblings’ Perception of Health Services’ in Death Studies. Vol.39, Iss.6.
Powell, K.A. and Matthys, A. (2013). ‘Effects of Suicide on Siblings Uncertainty and the Grief Process’ in Journal of Family Communication. Vol.13, Iss.4.

Wertheimer, A. (2014) A Special Scar: The Experiences of People Bereaved by Suicide. London:Routledge.

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