Bereavement may be induced by anything that creates a severe sense of loss. The death of a close relative or beloved friend and divorce are both triggers for the bereavement response. A person whose treasured house or art collection has been burnt may suffer as much bereavement as they would have done had a loved relative died. While a person is dying, the grieving for those who will be left behind is already beginning. Family and friends are beginning to re-adapt their lives so as to be able to live without the person, but they are already suffering the pangs of separation. This is one of the problems of sudden death. Sudden death not only reminds everyone of their own mortality but also removes the pre-death grieving. How many times have I heard something along the lines of, I was standing there talking to her, doctor; she seemed perfectly all right and we were planning what to do next weekend, when suddenly she said she felt rather tired and collapsed in front of me’?
Sudden death is therefore especially distressing because there is no way in which a family can become accustomed to it. The grief response is a phased one. Even when the death is expected, the reality that someone will have to do without a spouse or a child is more than their psyche can bear; thus, the first stage is often one of denial. In both world wars, many parents were like Rudyard Kipling, often taking years to accept that their sons had been killed and continuing to expect them to return. Others, like Queen Victoria, continue to keep the house and regime just as if their beloved is still alive. It is common for those who have recently been bereaved to have delusions and usually to hear or occasionally to think they have seen the dead person around the house.
The next phase in the grief process is anger and blame. No sooner is a tragedy reported in the papers than there is news that the bereaved are blaming and suing someone for what was often an unfortunate but understandable accident or merely a nasty trick of nature. Doctors can’t save everybody.
Eventually, anger and blame give way to a state of depression. Sometimes this state may continue for a very long while, but it shouldn’t last for years. Grieving is, in fact, quite a dangerous emotion. There is a death rate associated with it. Living alone does nothing for someone’s health. It is not only loneliness and an ensuing sense of rejection that is often felt by the bereaved but even if the unfortunate deceased had no desire to leave his or her family.
In the first week after a death, the expected mortality rate of a spouse doubles. Often these deaths are from heart attacks. After this first week, the mortality rate falls, but even after three months it is forty-eight percent greater in bereaved men than it was before the death; in women, just over twenty percent greater. After a death of a spouse, the death rate for a widow or widower doesn’t return to that expected for their age and social class for ten years.
The third stage of grief, and the end of obvious grieving, is known as the phase of acceptance. In this phase, the deceased is still loved and missed, but not to the extent that whoever has been left behind can’t take up their old life again. In older people – those over sixtyfive – the problem of loneliness compounds grief and adds to the stress. Sixty percent of people over seventy-five say they are lonely. More than a third of the people living alone say that they are depressed, and fifty percent of those who are poor and alone admit to the same emotion. Despite this, most people want to retain their independence.
