Grief is the normal and natural reaction to significant emotional loss of any kind. Grief is the mixed bag of conflicting feelings caused by the end of, or change in, a familiar pattern of behaviour. Grief is the feeling of reaching out for someone who has always been there, only to find when you need them one more time, they are no longer there.
The following statistics are heart breaking and could be avoided in many cases. Over half a million people die in the UK every year with an average of 5 grievers per death. That’s 2.5 million new grievers each year due to a death. Over 250,000 grievers per year due to divorce. This figure does not include the children grieving this significant loss. 25% of children in the UK are in single parent families1. By the 10th anniversary of moving in together just under 4 in ten couples will have separated. A Harvard study has found that when a husband or wife dies, the remaining spouse’s risk of dying is 66 per cent higher in the three months after their partner’s death.
Unresolved grief is everywhere.
Common myths about grief:
1. Time heals: Time does not heal. Time is an abstract concept – a unit of measurement that has no healing power. We know people who have waited 10, 30 or 40 or more years to feel better. However actions taken over time can heal.
2. Grieve alone: Often this advice is subtly implied “just give her some space” or “he needs a few minutes alone in the other room”. As children we learn that this means sad feelings should be hidden or experienced alone.
3. Be strong: Usually the griever is asked to be strong for others. “You have to be strong for your wife/Mum/children”
4. Don’t feel sad: This is usually followed by an intellectually true statement that is emotionally useless to the griever. “Don’t feel sad, his suffering is over” or “Don’t cry, at least you had him for 20 years”
5. Replace the loss: This is really common with pet loss or the end of a romantic relationship. “We’ll get you a new dog” or “there’s plenty more fish in the sea”
6. Keep busy: “If I just keep busy I won’t have to think about the loss”. This one is sad because some people spend their whole lives with this mentality and never get the chance to grieve and complete what was unfinished with the particular loss.
The G word – Guilt.
The word “guilty” is often used by a griever.
Griever: My son died alone, I feel so guilty.
Grief Recovery Specialist: Did you ever do anything with intent to harm your son? Griever: No, of course not (This is an almost universal response)
Grief Recovery Specialist: The dictionary definition of guilt is “intent to harm” and you didn’t do that. You are devastated enough by his death, please don’t add to it an incorrect word that distorts your feelings. Would it be more accurate to say there are things you wish had been different, or better or that you’d done more of?
Griever: Oh yes! Source: ‘Guide to loss’ , 61 tips on grief: free download from http://info.griefrecoverymethod.com/mainpage-ebook
“I felt like I had been run over by a bus,” says James Moore, a mental health campaigner. When he tried to stop taking his antidepressant, Mirtazapine, he got severe dizziness, headaches and nausea.
Around 1 in 10 people in the UK are on antidepressants. Many find them helpful and even life-saving. Some struggle to stop taking them when they are ready as they experience severe withdrawal symptoms along with panic attacks and memory problems. Cinderella Therapeutics, a Dutch charity helps people safely come off a range of 24 different medications. It creates personalised tapering kits with precisely weighed out tablets that gradually reduce in strength over several months. Since 2014, the project has distributed around 2000 such kits, mostly within the Netherlands as the kits are legal there. The site only sends kits to those with a doctor’s prescription and recommends people use the kits under medical supervision.
Severe withdrawal symptoms are managed by some doctors in the UK by prescribing liquid formulations of their specific medicine which can be measured out in small amounts. Liquid medications are often more expensive, so GPs are reluctant to prescribe them. Switching to Prozac is the other option suggested by some but that does not work for everyone.
“You are well enough to safely go home now”, said the panel.
“But I can’t! I need one more day to complete my church!”, said Di, who was being treated at Bexley hospital for Postnatal Depression in 1966. She had a brilliant occupational therapist who took them to the swimming pool, organised hair-dressing days and helped patients to make things. Di made a church with bits of shattered wind-screen glass, put together with resin but the spire wasn’t on yet. This beautifully tactile piece of art was named ‘Faith’ by Ruth, her daughter.
Ruth was a talented young lawyer. She was an actor and singer. She was kind, generous and gorgeous! She travelled extensively. She was diagnosed with Bipolar Disorder in her late 20s. She coped well with the help of health services, her friends and family but tragically lost her battle at the age of 47.
Di is in her second year of missing Ruth terribly. She has created the most beautiful garden in her memory. Some of the plants there are from Ruth’s house. Her mediterranean wall is stunning.
Being bereaved by suicide is a huge risk factor for suicide. Around 125 youth suicides a year occur soon after the person involved has experienced a bereavement. One in four (25%) of under-20s and 28% of 20 to 24-year-olds had lost a relative, partner, friend or acquaintance around a year or more beforehand. In 11% of suicides among under-20s, the person who those involved had lost had also taken their own life.
People who have been bereaved need greater support to reduce the risk of them killing themselves. Agencies who are meant to help are not good at recognising this risk and need to improve.
This morning I caught up with Di over a cup of tea. We both believe that if Saagar and Ruth have met each other wherever they are, they must get on famously. The link below is a conversation with Di. She talks about her insights on mental health services over 5 decades. Thanks a lot Di!
It’s well known that lack of sunlight has an adverse effect on our brains. It might stop a part of the brain called the hypothalamus from working properly:
Production of melatonin – Melatonin is a hormone that makes us feel sleepy. The hypothalamus may produce it in higher than normal levels.
Production of serotonin – Serotonin is a hormone that affects our mood, appetite and sleep. Lack of sunlight may lead to lower serotonin levels, which is linked to feelings of depression.
Body’s internal clock (circadian rhythm) – Our body uses sunlight to time various important functions such as the time we wake up. So, lower light levels may disrupt our body clock, mood and alertness.
A recent study by Klaus Martiny of the Psychiatric Centre in Copenhagen shows that people being treated for severe depression were discharged almost twice as quickly if their rooms faced south-west in comparison to those whose rooms had a north-west orientation. Depending on time of the year, the intensity of daylight in the south-west rooms was 17-20 times brighter. The results support findings in previous studies of the importance of architectural orientation providing natural daylight as a factor for improvement. “We don’t know the precise mechanism, but I think it’s to do with exposure to the morning light, which advances and stabilises their sleep-wake cycle,” says Martiny.
Light acts as a powerful reset switch, keeping the clocks in our brain synced with the outside world. This clock can weaken as part of ageing, Parkinson’s disease, strokes and depression. To tackle this problem several hospitals are installing dynamic ‘solid state’ lighting which changes like daylight over the course of the day : whitish-blue in the morning, growing warmer and dimmer through the day and turning orange or switching off at night.
In the mid 80s, Dr Vincent Felitti ran an Obesity clinic in America. Many people enrolled and hundreds of pounds were shed by them. But he found that the drop-out rate from his programme was as high as 50% despite good results. He did not understand this and went back to look closely at patient notes.
“I had assumed that people who were 400, 500, 600 pounds would be getting heavier and heavier year after year. In two thousand people, I did not see it once. When they gained weight, it was abrupt and then they stabilized. If they lost weight, they regained all of it or more over a very short time.”
The turning point in Felitti’s quest came by accident. He was running through yet another series of questions with yet another obesity program. How much did you weigh when you were born…when you were in first grade…when you were in high school…when you first became sexually active…
One female patient replied – “Forty pounds” and broke down in floods of tears, “I was four years old.” He found similar common themes emerging from various stories and went on researching this subject for the next 25 years.
The obese people that Felitti was interviewing were 100, 200, 300, 400 overweight, but they didn’t see their weight as a problem. To them, eating was a fix, a solution like IV drug user calls a dose a “fix”.
Eating made them feel better. Eating soothed their anxiety, fear, anger or depression – it worked like alcohol or tobacco or methamphetamines. Not eating increased their anxiety, depression, and fear to levels that were intolerable. For many people, just being obese solved a problem. In the case of the woman who’d been raped, she felt as if she were invisible to men.
Felitti went on to further explore the impact of childhood trauma on people and coined the term – ACE, Adverse Chilhood Experience. He found a strong co-relation between the number of ACEs and early death.
Eighteenth birthday! Yay! No more a child. You are mentally, emotionally, socially, spiritually and physiologically an adult. That’s it. Over to Adult services now. Easy. The number ‘18’ is completely arbitrary. It is designed for the convenience of the service providers, not in the best interest of children. There is a strong case being made now for raising the ‘transition’ age to 25 and rightly so. The recent publication “State of Child Health 2017” has recognised that the transition from Paediatric to Adult services is poorly organised and unsafe for mental and physical health conditions.
This is how one of the parents felt: “In my experience the teams did not work together. They each did their separate thing. When Rebecca left school, she was left with without regular support or advice. When she turned 18 we just stopped receiving information. Emails and phone calls didn’t get answered.”
Chronic conditions such as Epilepsy, Asthma, Diabetes, Juvenile Arthritis and Childhood Obesity are often associated with significant mental health problems. The budget for kids was 6% of the Adult MH services until recently. The government promised an increase and guess what! It has gone up to 7% now. Hurrah! Considering that mental illness most often begins in adolescence and early intervention is of paramount importance, the allocation of funds is highly disproportionate.
‘There was a lot of talk at the CAMHS congress about the Green Paper, but in my view the only green thing that matters here are dollar bills (in this case pounds). Without sound financial and genuine political commitment, structural changes are not to happen.’
‘Children and Young People’s Mental Health – Taking Early Action’ : title of a conference I attended today.
The hall was packed with 350-400 people, working for the well-being of kids as teachers, social workers, decision makers and others. Two speakers mentioned suicide in the passing – Rt. Hon. Norman Lamb MP, who lost his sister through this tragedy 2 years ago and Richard Andrews, who set up the charity Healios after experiencing serious difficulties in accessing support for friends and family affected by serious mental illness.
One of the professors spoke about the reasons for early deaths of people with mental ill-health. He attributed this mainly to physical problems such as hypertension, obesity and smoking related problems. Death by suicide wasn’t mentioned.
I learnt a lot, some of which I shall share in the next few days. A Green Paper is being drawn up to set out proposals for delivering better mental health support for children and young people. During one of the question times, I suggested that bearing in mind that suicide is the biggest killer of young people in this country, 2 things must be included in the Green Paper –
Suicide Prevention Training for all medical and nursing staff and students, just like CPR training, to bring parity of esteem between physical and mental ill-health.
Meaningful sharing of information about para-suicidal young people between medical teams, police, first-responders and families, in the best interest of the patient.
This remark was met with a stunned silence. The room froze. The chairperson mumbled something like ‘eloquent…’ and rapidly moved on to the next person.
Stigma lives here too. Inside the healthcare community.