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I attended two funerals this week. One was a 32-year-old who was killed in a motorcycle accident and the other was 78-year-old who died after a long struggle with cancer. What was interesting for me was the response of the mourners at the two funerals.

For the young man who died suddenly, everyone at the funeral appeared to be in shock and the tragic event seemed incomprehensible. At the other funeral, there was a different atmosphere. Obviously sadness pervaded both funerals, but at the old woman’s funeral, the mourners seemed more contained in their pain and there was an air of acceptance.

It is an often overlooked fact that the only thing absolutely guaranteed is that we will die. Death, therefore, becomes an event that we all have to cope with. Many people I have spoken to over the years have expressed their dislike of funerals. This sentiment is easy to understand. Funerals are not happy occasions and are inevitably fraught with sadness, crying, gloom and pain. Inevitably also, funerals push our own mortality in our face, and that is a pretty scary thing.

In terms of our emotional responses to death, we all have to go through the process of grieving. Bereavement refers to the objective state of having lost a loved one, while grief is the internal response to the loss, ie our personal feelings about death. It is unique and depends on the type of relationship we had with the deceased. It is not an event which has a clear start and clearly defined end. It is a process that occurs over a period of time, with many emotional ups and downs.

Mourning is not the same as grief, even though we use it interchangeably. Mourning is the external manifestation of our grief; the public expression of the loss. This is determined largely by culture and religion – what behaviours are acceptable and not. For example, in some cultures, it is perfectly acceptable for the mourners to cry, wail and scream, whereas at the average Western funeral this would generally be frowned upon. At such funerals, you are expected to show “decorum” and “quiet strength”.

Some people put a time period to this process of a few days or a few weeks. In my experience, it is not really possible to properly grieve in that period of time if it is a close loved one who has died. One should resist the pressure to recover too quickly simply because someone says you should. Premature recovery is the equivalent of trying to run with a broken leg that has just come out of a plaster cast. It is likely to break again.

When visiting a bereaved person, a common difficulty experienced is what to say to them. We feel the need to say words of comfort but can end up making things worse. How often have you heard people say “you must be strong now” or “you need to get on with your life” or “he wouldn’t want you to be sad”.

These well-meaning comments can cause more distress to the grieving person as they counteract the natural grief process and contradict what the grieving person may be feeling at the time. Many patients have told me how angry they have felt when people have said this to them. I have found that sometimes it is best to say nothing. Just being there is comforting enough for the person.

Another unhealthy trend, in my opinion, is to tranquillise the grieving person when they are crying a little too loudly or too much for our comfort. I have often found that when others cannot cope with the bereaved person they call in the doctor to “calm the person down”. I do not believe that this is helpful as it sends a message to the person that their grief is abnormal and requires medication. This immediately discourages any future expression of the intense emotions that the bereaved person will undoubtedly experience during their grieving process. Blocking the normal grief process almost always leads to complications later on for the person, such as chronic grief or delayed grief.

In the end, the goal of normal grieving is for the person to adjust to life without the deceased, and to experience “normal” sadness and not the deep pain initially felt, as well as to recall happy memories of the deceased.

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