Happy Birthday Charlie
Updated: Jan 10
An Alternative Perspective on Grief and Bereavement During Challenging Times
With so much being written about death, dying and bereavement recently, I feel that a post focussing on a more positive narrative might be helpful to counterbalance some of the predictions of negative grief outcomes during this very challenging year.
I’ve chosen today to publish this blog because it's my nephew Charlie’s birthday. Charlie died from cancer when he was three and a half years old in 2005, so today he “would” have been nineteen. So I've written this in his memory to highlight that whilst the depth of loss remains the same, our perspective has changed as we've adjusted over time.
Bereavement “outcomes” may be considered to exist on a spectrum ranging from post-traumatic growth, through a wide range of what may be considered “normal” adjustment to losses and at the rare end what may be considered by some under the umbrella term “complicated” grief. (Although it should be noted that many expert academics do not subscribe to the notion that grief can be pathologised into a "complicated" category; this is a contentious area.)
Death and grief have dominated the headlines this year and affected every part of our lives globally. However, despite some of the polarising views on approaches to policies concerning Covid-19, what is clear to me is our overarching capacity for human empathy and compassion for the vulnerable, for key workers and for the bereaved.
In this short article I’d like to particularly address three items:
The potential impact of Covid-19 restrictions on funerals
The “good” news
What we know helps bereaved people
The Potential Impact of Covid-19 Restrictions on Funerals
The prevailing Western narrative is that the increase in deaths, and restrictions imposed on funerals, will lead to excessive negative bereavement outcomes. One recent study published by Dr Becker and colleagues in Japan report:
Conducting a full funeral (as opposed to an abbreviated or direct cremation) significantly correlated with overall satisfaction at the funeral. Overall dissatisfaction with funerals correlated with an increased amount of time later lost from work for health reasons. Higher dissatisfaction with funerals somewhat significantly correlated with physical symptoms of grief (p = .038).
However, conversely, the same paper also states:
Boelen (2019) and Birrel (2020) found no such correlations. We were unable to show that positive appraisals of funerals result in positive health and productivity, but we did find that negative appraisals and abbreviated funerals correlated with lower productivity and higher medical/social service costs thereafter.
From these two excerpts we might consider that Becker’s study is situated within a Japanese Buddhist environment, whilst the Birrel et al (2020) was predominantly UK based and the Boelen et al (2019) study was conducted in the Netherlands so contextualisation needs to be considered. Every bereaved person will have their own perspective on funeral rituals and what may be considered a ‘positive’ experience by one person may be deemed a ‘negative’ experience by another. With this in mind, we should be aware that we do not yet know what the long term psychological or social impacts of restricted funerals during 2020 will be within a Western environment and whether they will be short term or long term. We can however address some of these potential future costs by providing adequate professional support which includes for example; planning other ritualistic events post “lockdown” such as memorial services or other personalised rituals, providing adequate, accessible bereavement support, or providing additional flexible working practices.
The “good” news
Whilst varying mental health issues as a result of the pandemic are currently being recognised and talked about openly, there are many studies that indicate humans are more resilient than we may recognise. For example, Tony Walter states that; “Shared adversity can foster a sense of community and affinity…”, further, Bonanno and many other academics have published multiple academic texts highlighting the following:
Many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. Unfortunately, because much of psychology's knowledge about how adults cope with loss or trauma has come from individuals who sought treatment or exhibited great distress, loss and trauma theorists have often viewed this type of resilience as either rare or pathological.
Perhaps then we should be questioning the perception that all restricted funerals or all deaths during the pandemic will lead to “complicated” grief? Additionally, with notable experts such as Bonanno, Walter and others publishing extensively on the resilience of individuals, and societies in general, perhaps we should also generate a narrative of positivity post pandemic? “Language is a powerful tool and, used without consideration, can cause emotional and biological damage. Neuroscientists have determined that human brains tend to dwell on negativity (it’s a survival mechanism)…” (Lloyd, 2017, p. 48).
What We Know Helps Bereaved People
But what about those bereaved people that are struggling, particularly those who are isolated during “lockdowns”? For those people who may not have access to technology or are unwilling or unable to engage with it, it may be helpful to reach out to them in other ways such as by telephone, or in extreme circumstances; with a socially distanced personal visit.in general, we know from studies such as Newsom et al’s that there are various levels of support for bereaved people and for most, family and friends are a huge source of shared support, where stories of the loved one are told, retold and memorials/rituals are engaged in. Peer support can also be hugely helpful as is evidenced by organisational support such as Compassionate Friends (bereaved parents), Widowed And Young (Widow/ers under 50), Roadpeace (road crashes), SANDS (stillbirth and neonatal death) and Child Bereavement UK (parental and child bereavement), to name only a few. Professional support is also appropriate for others in the form of specialised grief professionals that can be found at Cruse, Griefchat, and others.
Ester Shapiro eloquently explains in the Handbook Of Bereavement Research why it is important for bereaved people to have social support options available at various levels:
Interventions that use relationship strategically as sources of both emotional regulation and meaning making can help establish more complex perspectives on previously overwhelming experiences as well as more multidimensional and functionally adaptive relationship representations
What is important, in my opinion, is that we, as humans, connect with other humans in the most appropriate way during these unsettled extremely stressful times. We don’t know, as yet, what the long term effects on bereavement may be following this pandemic but we mustn’t lose sight of the fact that a. humans are resilient and b. post traumatic growth will also be an outcome for some. The constant pathologization of grief in the media and prediction of increased “complicated” outcomes due to the events of 2020 may lead to some people literally talking themselves into that frame of mind whereas ordinarily they may not have had that outcome. Supporting the bereaved in the most appropriate way when needed is important for a normal grief adjustment, but we also shouldn’t focus all of our attention on potential disruptive transitions and completely lose sight of resilient or positive outcomes in the long term.
In conclusion, I'd like to thank Professor Schut for his positive feedback on this blog and leave you with a citation from his, and Professor Stroebe's, 2020 journal article on this subject:
"...there is so far absence of empirical evidence linking features of COVID-19 bereavement situations to health outcomes. Severe negative consequences have been consistently predicted by authors. There is still relatively little consideration of positive or compensatory processes or the possibility that these could alleviate the effect of the shocking, traumatic circumstances." (Stroebe & Schut, 2020, p. 500).
Thank you for reading this, and special thanks to Dr Jennie Dayes for her generosity in providing critical feedback on the first draft of this article. I wish you all peace during these challenging times.
For further reading on grief and bereavement you may find my book, Grief Demystified, helpful.
This post was originally published at www.thegriefgeek.com in December, 2020 and I was interviewed by Andy Langford from Cruse Bereavement Support on its contents which are available to view on YouTube.
As always, these blogs are copyright protected and may not be used without my explicit permission. If you'd like to contact me I'd be delighted to hear from you at: firstname.lastname@example.org