Dr. John Wilson is recognised as an expert in bereavement counselling, delivering talks and trainings internationally and researching extensively on the nature and processes of grief and bereavement. He is the author of two popular books on grief: Supporting People Through Loss and Grief: An Introduction for Counsellors and Other Caring Practitioners; and The Plain Guide to Grief, which guides readers on managing their grief following a life-changing loss.
In this interview, mindfulness author and licensed counsellor, Sandy Clarke, asks Dr. Wilson to share his thoughts on how we can better understand grief, cultural differences in terms of how grief is viewed, and how we can support people going through their grieving process.
Guide Note: ‘Bereavement’ refers to the experience of losing someone; ‘Grief’ relates to the thoughts and feelings that accompany a loss; and ‘Mourning’ is how our feelings of grief are shown in public.
Why do we grieve? And what is it that we mourn?
The great psychiatrist Colin Murray Parkes said, “Grief is the price we pay for love.” It’s an evolutionary adaptation. The distress we feel when we are parted from those close to us keeps us bonded to them. It’s what keeps children close to their mothers and safe from danger. When we transition into adulthood, we take our attachment with us but transfer it to romantic and other important relationships, which is why it’s so hard to lose a partner. But there is more to it than that. When we lose somebody close, we also lose the life that we had with them, and so we can feel lonely and disorientated. We also lose out on the future life we would have had with the person.
In what way(s) could it be unhelpful to seek help following a loss? And what lets people know they might need help?
When someone is first bereaved, they can easily panic (a bit like a drowning man clutching at anything to stay afloat). But because we know that grief is a normal and natural process, what we actually need is time to get used to what is happening, without someone trying to fix us too quickly. It can also help spending time not facing up to the reality of the death, until some time has passed. There is no research that points to the helpfulness of an early intervention, but lots of research to suggest that it is unhelpful.
How are grief and bereavement treated differently across cultures in terms of practices and expectations? Could you give one or two examples?
Two examples, often found in academic literature, compare Bali with Egypt. The Balinese tradition is for limited grieving and a quick recovery. However, interviews suggest that many Balinese people hide their natural grief for fear of upsetting spirits of their ancestors. In Egypt, there is a cultural expectation to demonstrably grieve for a long time, sometimes for years. This compares with Western traditions that suggest that intense, tearfully expressed grief which lasts longer than six months, could be a mental health disorder.
Can you share one or two common misconceptions about grief and bereavement that you’ve come across in your career as a bereavement specialist?
The first is that you can recover from grief. In fact, people even write books on methods of recovering from grief. You can recover from illness, but grief is not an illness. Our life is punctuated by losses, some of which will be bereavements. Good and bad experiences make us who we are. Over time, bereavements lose their significance and the pain may fade, grief is always there – and that’s okay.
The second is the “Stages of Grief”, which usually come with Elisabeth Kübler-Ross’s name attached. The first thing to say is that her stages originally described patients coming to terms with a cancer diagnosis, not a bereavement. The second thing to say is that Kübler-Ross came up with her ideas after meeting Colin Murray Parkes, who showed her the stages of grief he and John Bowlby had suggested from the work on childhood attachment and separation. While the Bowlby-Parkes stages are based on a scientific theory, Parkes wrote in 2006 they were never intended to be used prescriptively by well-meaning bereavement counsellors. Grief is not a tidy linear process – emotions go up and down, back-and-forth. I see no value in trying to shoehorn your client’s grief into these stage models.
You’ve hypothesised that people would probably grieve in similar ways, regardless of culture/nationality, if they felt free to do so. Could you elaborate on that?
Research by neuroscientist Mary Frances O’Connor, summarised in her excellent book ‘The Grieving Brain’, appears to indicate that the neurology of grief is similar in all humans whatever their cultural background. I am aware of clients of Asian heritage living in England, who were at odds with their cultural expectations, for example, a widow who was expected by her family to grieve in a traditional way, which was totally opposed to how she felt.
This is something I intend to research more closely, but increasingly I suspect that cultural expectations may complicate grief. I hasten to add that it is not for the counsellor to ignore cultural traditions nor be ignorant of them. Indeed, we have a professional responsibility to familiarise ourselves and work with all cultures we will encounter in our work. However, I do think that we need to beware the possibilities that our client’s cultural traditions are not helping them.
Why do you think we often find it difficult to talk about grief and loss, given that it’s something we all face?
In my last job, I wore a large ID badge with the words ‘Bereavement counsellor’ emblazoned across the front. Sometimes, when I went shopping after work, I’d forget to take my badge off. It made me smile in Supermarkets to see people trying to read my badge then backing away as if, in some way, bereavement might be infectious. People are frightened of death, it might be as simple as that. But also, in the West at least, death has become sanitised. People die in hospital or hospices rather than at home. Bodies are prepared by undertakers, and death is talked of in hushed whispers.
You’ve said that most people cope with their grief, given enough time and space. Is there a danger of pathologising grief rather than seeing it as a natural part of life?
The short answer is, “Yes there is.” However, just as it is helpful for some people to have a label for their neurodiversity or their mental health, for some people, a diagnosis of complicated grief can mean they get specialist treatment. As rare as it might be, grief can occasionally be a pathology.
What are some of the psychological effects of not properly addressing or acknowledging grief?
Five in 10 people successfully manage their grief on their own. Four in 10 people just need a little help from friends, family, or maybe a charity volunteer. It’s the remaining one in 10 that should concern us, and many of those don’t come forward for counselling even though they need it. For the first six months after their loss, their health is at risk. Some die from neglecting themselves: not taking medication, not eating properly, missing hospital appointments, excessive alcohol and drug use; and, in some cases, they die by suicide. Generally, the risks diminish after six months.
What role does healthy denial have to play in the grieving process? It tends to be automatically maligned as some terrible thing.
Denial and distraction can play an important part in coming to terms with loss. People need time and space to get used to the idea that their life has changed so drastically. It can help to keep busy and not think about what had happened until you’re ready to do so. There is also a risk that if you’re encouraged by well-meaning people to look closely at your loss, you can be re-traumatised. In my experience, bereavement counselling shouldn’t begin immediately after the loss, and when it does start, it should be taken slowly, at the speed the client is ready to face up to things.
There seems to be several “types” of grief (“normal”, “anticipatory”, “complicated”, and so on). Are these different categorisations useful or do they offer more confusion than clarity?
I think they offer clarity if the person doing the explaining is knowledgeable. Lots of research points to the fact that what we call psychoeducation is useful to grieving people. Anticipatory grief is explained to families by counsellors who work in palliative care settings. I find it gives people hope and reassurance when I explain to them that they haven’t got complicated grief. It can help those who have got complicated grief, providing you are able to offer them some possible way forward, such as a specific treatment regime.
What clients find most helpful is the concept of disenfranchised grief. It can often explain a lot about how they have been treated in the past and can validate their feelings. Sometimes, just explaining the concept actually enfranchises them.
Can you share some Dos and Don’ts when it comes to supporting people through their grief?
The most important thing is to explore your motivation. Are you trying to make them feel better? or are you uncomfortable being with them, and therefore trying to make yourself feel better? Try to avoid clichés. They might have heard “I’m sorry for your loss” so many times it has lost all meaning. Speak from the heart. Sometimes there are no words. I say to people, “There are no words at the moment, but I do feel for you.” If you’re going to say “I’m here for you”, don’t say it unless you mean it, which means making yourself available. If you do mean it, you might need you to check in with them regularly, spending time to stop and talk, and ask if there’s anything they need.
Things not to say to people who are grieving?
“I know how you feel.” (you don’t)
“Perhaps it was the for the best.” (perhaps it wasn’t)
“They’re not suffering any more.”
“They had had a good long life.”
Don’t offer a religious interpretation or message, it’s not your place to do so, as they might not believe what you believe.
To learn more about grief and bereavement, listen to John’s appearance on the Being Human podcast.
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