bereavement

Bereavement Counselling in the NHS (Taking the sting out of death)

10 October 2011
Charles
2 Comments
Categories: Attitudes to death, bereavement, Death; Good death, End-of-life issues

Posted by Vale

Pat is a Bereavement Counsellor working in an NHS Trust hospital. Her job is to help people affected by a death in a hospital, supporting them through their grieving. Pat is the subject of a long article inSaturday’s Guardian. It can be found here.

It’s a heartening read. Death in a hospital can be a very fraught business. Treatment, perhaps in intensive care, is hard to comprehend, and the workings of the institution are often alienating and frustrating to people who want to support someone they love at the end of their lives. And death comes in so many forms that it’s sometimes difficult simply to come to terms with what has happened.
Pat’s role – carried out, it is clear, with great love and understanding –  is to help people come to terms with what has happened. Sometimes it is a matter of looking at notes, talking to doctors and taking time to explain why someone died. Sometimes it is just about making space for grief. Pat:

“has a mantra that “nothing is wrong in grief”. She almost always honours requests from bereaved relatives, however unusual. A common wish is to touch the body of a loved one: hold their hands, or kiss their foreheads or even wash their face. One woman asked Pat if she could help her retrace the journey her 15-year-old daughter’s body made from the hospital to the mortuary, after she died from a very protracted illness. She then wanted to see where she had been blessed in the mortuary. “And there’s nothing wrong with that,” she says.”

It’s good to know that hospitals are recognising that the death of a patient is both an ending and, for bereaved family and friends, the beginning of another vital process – the need to grieve, mourn and say farewell. Important too that they recognise that their role in this next stage is crucial. Reading about the work that Pat does, however, did make me want to ask more questions about the way that the NHS treats people at the point of death.

If there is recognition of these human issues after death, is there the same concern for people as they die? How well are patients supported at those last moments? How easy is it for people to sit with the person they love; hold them and comfort them; share in the business of dying?
I’ve tried to find the relevant NHS guidance, but with little success. I did, however, turn up a Scottish NHS report called Shaping Bereavement Care – a framework for action. It has 14 recommendations, some of them recognisably relating to the good work that Pat does. The recommendation relating to the process of dying though is this one. It is a commitment to:

“undertake a review of all current policies and procedures relating to care of the dying patient, and care of the deceased, to ensure that they reflect good quality care and to assess and reduce any real or potential negative impact of these processes on those who have been bereaved.”(Recommendation 3)

It suggests that there are important connections yet to be made in this area – in the Scottish NHS at least. Although, surely, it’s not hard to join the dots between the way that people feel when they are not involved in a death and the need to involve them more in the process of dying itself? It seems clear enough to me that if the humanity, care and understanding that Pat so clearly brings to her work after a death could be brought into the hospital itself and allowed to take their place at the bedside of the dying patent, then acceptance, understanding and the grieving process itself would be immeasurably improved.

But maybe the NHS in England is already there?

Keep calm and carry on

23 September 2011
Charles
1 Comment
Categories: Attitudes to death, bereavement, bureaucracy

Posted by Charles

There is a tendency among some visitors to this blog vastly to overrate the significance of death. How salutary it is, therefore, to remind ourselves that our legislators keep mortality both in perspective and in its place.

Maternity leave

As an employee you have the right to 26 weeks of Ordinary Maternity Leave and 26 weeks of Additional Maternity Leave making one year in total. The combined 52 weeks is known as Statutory Maternity Leave. 

Paternity leave

As long as you meet certain conditions you can take either one or two weeks’ Ordinary Paternity Leave. You can’t take odd days off and if you take two weeks they must be taken together. 

Compassionate leave

If you are an ’employee’, you have the right to unpaid time off work to deal with emergencies involving a ‘dependant’ – this could be your husband, wife, partner, child, parent, or anyone living in your household as a member of the family.  

When a dependant dies, you can take time off to make funeral arrangements, as well as to attend a funeral.  

If you need time off to cope with a situation that doesn’t fall under the ‘time off for dependants’ right, you may have a right to time off under your contract of employment. Many employers will have a scheme for compassionate leave and details should be included in your contract or company handbook. If the situation is not covered by any scheme then you can still ask your employer for the time off, although they do not have to agree to your request. 

Source: directgov.co.uk

The bitter spice that sweetens the dish

23 September 2011
Charles
4 Comments
Categories: Attitudes to death, bereavement, celebrants, ceremony

Posted by Jonathan

A celebrant said today:

“Even when funerals are designed to be a celebration of life, I nearly always begin by acknowledging people’s grief and sadness.”

Jose (see his thought provoking blog post of 19th September), ever enquiring and studiously leaving no stone unturned, wants to know about incorporating grieving and celebration of life in the same goodbye ceremony.  His tenaciousness is stimulating for us celebrants, who must every day question our way forward.

His query:  “Which are the elements that you use afterwards to move the mourners and their emotions to a more positive feeling?” is not an easy one to answer.  I never thought of it in terms of involving ‘elements’, and I never thought of grief as being any less positive than celebration of life.

Grief has to do with sadness, not unhappiness.  There’s a big difference between the two. Unhappiness is isolating and unattractive and faces towards depression.  We’ve all been there.  It’s not grieving, it’s self pity.  Sadness, particularly about death, is beautiful even when it’s unbearable.  It’s feeling sorry not for yourself but for your loss – loss is not separate from you, but it is not you; it encompasses you, and it’s helpful to share it with others. We’ve all been there, too.  It is a noble feeling, and one I certainly wouldn’t want to be deprived of after even a tragic loss.

Following the last funeral I conducted, when I was trying to ‘let it go’, I found I couldn’t do so until I’d understood what it had taught me.  I was feeling uncharacteristically sad that it had ended, but I didn’t want to stop feeling sad because I knew if I did I’d miss something very important.  So I sat at the pavement table outside a café, watched the human beings go by with all their inner concerns showing or not showing, had a fag and a double espresso, and I thought deeply and wrote down what these last ten days of ‘funereality’ had given me.  Why was I reluctant to release it, this recent experience that my sadness was holding so close to me? 

It was only then, after I’d understood just what I was losing, that I was prepared to say goodbye to it and feel glad I’d had it while I did.  That’s what a good funeral does, too.  You could say it bequeaths you with a greater energy, a wisdom, as this did for me.  It crystallized into a poem, which I kept to remind me why I do this (and incidentally why, unlike some bereavement workers tell me they feel, I actually find myself energized rather than burnt near the furnace of recent death).  It also approaches the matter of our relationship with, and our role in, others’ grief, so I can happily share it with you here:

‘The funeral nourishes me
by embrace in the humanity of strangers.

I relieve them of their bewilderment
and reveal them to themselves in the majesty of their pain,
with words, with voice, with actions.

I touch their hurting hearts
to know they are not in isolation;
that their own grief is universal;
that healing lets love in and does not banish it;
that anguish is their invited guest;
that tomorrow will still come.

And then I leave.’

OK, I was only losing an experience, not a real live person, but the principle is the same; you have to be aware of what and whom you have lost, and the desirable pain to which love commits you, to move you on from just the raw feeling of pure loss before you can celebrate what you did have and what you still will have.  The pain of loss doesn’t go away with celebration of life.  It just becomes less overwhelming and more manageable when you’ve identified your loss, and understood that you still have something real and priceless, yours to keep.  And it brings to your attention that we are all human, and that this is the deal.

If a bad funeral damages you by making you unhappy, that detracts nothing from the healing value of a good one, even a good sad one.  And I think there’s something to do with loyalty where grief is concerned.  We can’t in good conscience abandon our dead by just getting intoxicated at a hooray party, any more than we could by indulging in the misery of a self pitying orgy, or going through the motions of an irrelevant tradition. 

Our dead leave us through no fault of their own.  We have to include their absence in our funeral for them, painful as it is, and I believe we owe them our mourning as much as our appreciation.

 

A good funeral: part 1

22 September 2011
Charles
8 Comments
Categories: Attitudes to death, bereavement, burial, ceremony, death and funerals, DIY funeral, funeral

Posted by Sweetpea

In the light of our recent discussions about the merits of secular, civil and religious funerals, one interesting thread started to appear.  Namely, what should a funeral not fail to include?  Can a funeral ever really be meaningful to anyone?  Does any funeral do the things that people need it to do? Well, for the sake of clarity, I’d like to leave the actual ritual contents of a civil or secular funeral for another day.  For the moment, I think we should go one step further back, to examine how the foundations of a good funeral rite are laid. Cutting through all the arguments about the contents of a funeral, be it of whatever shade, I think the key to the success of a funeral rite (and I have no doubt that a successful funeral is possible) is one overarching thing:  Relevance.

And the mechanism for allowing the door to open to Relevance?  Well, that begins with well informed people who instinctively know what will be right for them, and just as importantly know where to find it.  Failing that, a knowledgeable and empathetic funeral director who can guide those people towards what is the best path for them.  And failing that, an experienced and skilful celebrant/member of the clergy/friend to offer advice and support to bring them to where they need to be.

The notion of Relevance should permeate the entire proceedings from beginning to end – from funeral preparations to the enactment of the rite itself.  It doesn’t happen by accident, and needs empathetic, practical and experienced people working together to make it happen.  As has been so wonderfully written elsewhere by Jonathan: ‘if you just listen to a family it brings it all down out of the whirlwind in the sky and settles it more easily on the ground.  Stop.  Do nothing.  Tell me how he died; how do you feel about his death; where does that leave you now; let’s look after him gently while we all decide what to do and, far more importantly, why we’re doing it and what we hope it will achieve. Does that involve some choices?  Okay, let’s deal with them in our own good time, it’s not the choices that matter anyway.’    

This simple, intuitive and effective process leads eventually to arrangements which, as Tom Lynch states ‘get the dead where they need to go and the living where they need to be’.  This might be a whole day spent on a hillside, with a grave dug and filled by friends on their own land, singing around a campfire until the early hours, it might be a requiem mass, it might be a twenty minute ceremony at a crematorium, followed by a celebratory knees-up at a favourite pub, it might be a C of E service followed by ham salad and scones in the village hall.  If it’s relevant to these people, then that’s the nearest we are going to get to achieving those aims.

But let’s be under no illusions.  Real emotional pain and damage is caused to grievers when a rite has no relevance to them – it’s traumatic and stays with them until their own dying day.  We are perhaps more familiar with stories of religious rites leaving people disorientated and even more bereft because of a mis-matching of their needs and its expression.  But this can be just as true for civil or secular funerals, something which I have observed when, say, a religiously inclined adult child has been painfully overruled or excluded from religious or spiritual expression by a surviving parent.  Which leads us to part 2 – what should or shouldn’t be included in a successful funeral rite?

Shooting the messenger

2 September 2011
Charles
5 Comments
Categories: Attitudes to death, bereavement, celebrants

Posted by Nicola Dela-Croix

When I meet grieving families in my role as a celebrant, I always try hard not to judge them if their behaviour is less than polite. For example, the initial phone call where you gently introduce yourself, but are made to feel as welcome as a pre-recorded “Do not hang up… you have won a holiday in Bermuda..” Or when you are left standing in the hallway because no-one wants to offer you a seat. As someone said to me recently, “suffering can ennoble or uglify”. This is very true. So I, like many other celebrants, try to face these situations with a compassionate heart. Although sometimes you know that, grief or no grief, these people are just downright rude.

There is, of course, no getting away from the fact that our reasons for visiting are not happy ones. They would rather we weren’t there asking if they’d like to say a few words beside the coffin of their dead wife/brother/dad/daughter etc. And it’s made all the more difficult if their previous experiences of funerals have been memorable for all the wrong reasons, “her name was Sheila but they kept calling her Shirley”…

These negative ‘vibes’ are not the norm, thank goodness. But they are out there. And that sense of being unwelcome can come at you from all angles. The most interesting responses are often from people who enquire what you do for a living. A recent encounter went something like this:

And what do you do?

I write and conduct funeral services

(Horrified face) Could you bury a child?!

I’m not sure if that was a question or an outcry. It was as if I was actually responsible for the death, rather than being the person who would come to the assistance of the child’s parents (or any family for that matter) and help them with all the care, kindness and sensitivity I could muster.

I know this is all down to fear of loss, fear of death, fear of the unknown, bad experiences… I’m not really asking why this happens. It’s just part of doing what we all do. And for every person who reacts with horror, there is someone who finds it admirable. Like everything to do with dying/death/funerals/bereavement there is no ‘right’ way. We’re dealing with individuals who are as unique as they are varied.

Still, a cup of tea would be nice…

Planning for a happy death

31 August 2011
Charles
No comments
Categories: bereavement, Death; Good death, Grief

posted by our religious correspondent Richard Rawlinson

A recently widowed middle-aged woman came in tears to Benedictine monk Fr Christopher Jamison, and thanked him for explaining in a talk based on his book, Finding Happiness: Monastic Steps for a Fulfilling Life, what she had felt since her husband died.

Fr Christopher had shared his thoughts on achieving a happy death, a phrase that is for most people today a contradiction in terms. The woman’s pain at the loss seemed overwhelming but through loving interaction with so many concerned people she had experienced deep consolation too. In the midst of pain, she could still contemplate the good and do good. She had never understood before how she could be experiencing both such grief and such consolation.

Here’s an abridged version of Fr Jamison’s words:

Each of us will have a particular desire for the time of our death: that an estranged relative might be reconciled, for example. The trouble is we cannot control our death.

People can, however, take steps to make death happy by ‘back-planning’. Starting at the end point people need to ask: in order to be in that state, what needs to be done the day before, the week before, the month before and so on.

This vision is at odds with many contemporary understandings of happiness. The most common assumption about happiness is that it is the same as pleasure; so being happy means feeling good.

The ancient Greeks had a better answer. Plato concluded that the contemplation of truth, goodness and beauty was the height of happiness. Our dislike of dishonest politicians, our admiration for the generosity of those serving the sick, and the popularity of art galleries, all show that our appreciation of truth, goodness and beauty is as high as ever.

Aristotle took Plato’s ideas a step further. He said that happiness consists not simply in contemplating the good but in doing good. He wanted people to be taught to act virtuously because virtuous living made both individuals and societies happy.

This approach to happiness is not dependent on religious faith yet all the major faith communities support it. Christianity offers practical steps to live out this view of happiness. The Church’s contemplative tradition shows us how to pray so that we can contemplate the truth, the goodness and the beauty of the Blessed Trinity. The Catholic moral tradition teaches us how to live virtuously and how to find forgiveness when we fail.

People should enjoy feeling good as a bonus that can accompany contemplation and good living.

 

Ask not for whom the bill tolls

29 August 2011
Charles
9 Comments
Categories: bereavement, funeral plans

Posted by our irreligious correspondent Jonathan Taylor

Who is a funeral for? For the living, in the belief that the dead person won’t be there? For the dead, to help them into the afterlife? Or is it for both, so the living and the dead can do something for each other? At the very least, the living can prolong the dead’s pre-posthumous dignity by disposing of her unwanted body since she can’t do it for herself, but it’s less clear what she’s doing for them once she’s dead.

Even some atheists talk about what they want for their funeral. Perhaps we go along with such wishes so the still-living may end their days with a secure feeling about their own eventual event, which they’re going to miss but can at least anticipate meanwhile with some confidence.

You seldom hear it said: “It’s what she wants”, even from those who think she’s still around. Almost everyone feels a seemingly instinctive need to do ‘what she would have wanted’. It’s what funeral plans are sold on. But it is one thing to honour a person’s wishes; it’s quite another to honour a person. One involves ties of loyalty, perhaps even obligation; the other we do entirely of our own volition. When we honour her at her funeral in our own way, they are our needs, not hers, that we are seeing to, and she cannot dictate those needs to us. The question is; what is in whose gift, and to whom?

She can leave some dosh lying around on the off-chance we’ll want a funeral for her; fine, she’s probably right, and it will come in handy thank you. She can let us know her preferences, so we can choose whether to go along with them or not. But if she leaves us a ‘gift’ of a prearranged as well as prepaid funeral plan for her, is she not depriving us of our right to honour the ‘her’ who carries on within us, leaving us as passive mourners intimidated by the sanctity of her ‘arrangements’ (a favourite word of funeral plan sellers)? Grieving is active, not something that happens to us. We need something to do that says this is our party for her, at least as much as hers for us. Doesn’t she disempower us? Doesn’t she actually make it harder to grieve her?

Still, that’s not what she intended when she purchased her own funeral! She thought she was doing what it says in the brochures: ‘…saving us the anguish and grief of doing anything other than remembering her’ (Golden Leaves). She innocently bought the line that says we can sit back and enjoy her choice of hymns and coffin and budget without having to ‘worry’. She also bought into the idea that our having (choosing) to put together a funeral ceremony for her would actually impede our grieving rather than facilitate it.

It plays on and perpetuates the notion that arranging a funeral can only be a burden, best given to others to carry for us while we act like helpless children impatient for it to be all over and done with. It disables us from improving the healing quality of her funeral by our own involvement, and prevents funerals in general from evolving. The fact that it’s sold partly on its being cheaper at today’s prices only cheapens it further.

She is, as I say, entitled to invite us to carry out her ‘wishes’ on her behalf if we like. It’s a different thing to pay someone to arrange things so that we must, because then it would seem an act of defiance on our part, an insult to her love and concern for us, to override her plan. Doesn’t she, then, take for herself what is rightfully ours? Shouldn’t we reclaim it from her, even if that leaves her investment wasted and us out of pocket and feeling guilty?

The wish to be at her funeral is ours; our gift to her, not hers to us. We can hold it, rather than just attend it, to help us understand how we will bring ourselves to face her death. She cannot tell us what she symbolizes for us now; that is our task, to discover once she’s dead. We do it to establish what her life and her death imply to our past and our future; to thank her for her part in our lives, not to be indebted to her for it.

So do funeral plan providers play on the bad reputation of funerals by selling a palliative for what could otherwise be a healing event? Do they perpetuate the image of the funeral as a tired old painful procedure instead of a brand new constructive ritual? And do we play into their hands with our concern for our offspring when we buy them, and undermine our own goodwill by leaving our family with the lasting problem of not having had “…to worry about arranging the funeral and finding the money, at a time when they are coming to terms with their loss” (Cruse Bereavement Care funeral planning leaflet)?

Sob stories

25 August 2011
Charles
4 Comments
Categories: Art and death, bereavement, Books, Grief

Posted by Charles

The misery memoir – awful childhood, frightful beatings, Oliver Twist never had it so good, that sort of stuff, ooh – has, it seems run its course. The torment vultures have flown the well-picked corpse and are now feasting on bereavement. 

I’ve been aware of growth of this new genre and largely ignored it, mostly, I expect, because I am not presently freshly bereaved.  I think I feel very much as Bill Morris does in this very good article: “Is it mere voyeurism, or schadenfreude?  Or is something closer to empathy – a way of preparing ourselves for the unthinkable by witnessing the suffering of another?” I think he might have added that it can be very useful to hang out with others who are going through the same as you.  I’ve nothing against the genre in principle.  The biggest sob-buster out there now, in case you’re interested, is Joan Didion’s Year of Magical Thinking.  Everybody wants to be the next Joan Didion. 

Then I read an article about the grief memoir in the Guardian. It’s written by Frances Stonor Saunders. Ever come across her? Let me tell you, she’s seriously brilliant. Here are some of the things she says: 

“We know that extreme physical pain drives out language,” Julian Barnes writes in Nothing to be Frightened Of, but “it’s dispiriting to learn that mental pain does the same.”  … If grief drives out language, how can language be pressed into its service? How can the writer orient disorientation?  

Elisabeth Kübler-Ross, founder of the modern grief movement (she gave us the “Five Stages of Grief” theory), insisted that “Telling your story often and in detail is primal to the grieving process. You must get it out. Grief must be witnessed to be healed.” This instruction comes straight out of the principle of catharsis, but there is little evidence to support its efficacy over other, possibly more reticent, ways of grieving. Barnes calls it the “therapeuto-autobiographical fallacy” – writing doesn’t help, he testifies gloomily, your suffering is not alleviated. 

Saunders surveys the field with a scholarly, wry eye. You have read it all. 

She also bequeaths us an excellent anecdote. Kerry Packer, recovering from a near-fatal heart attack, whispered to his sons: “I’ve been to the other side, and there’s fuck all there.” 

Read the entire Saunders article here. 

Top Ten Tips for arranging a funeral

15 July 2011
Charles
12 Comments
Categories: bereavement, ceremony, death and funerals, funeral

Posted by Moss

At the risk of seeming rather tabloid, especially during a difficult period for the press, we recently produced a list of tips for people who are arranging or planning a funeral. I presented this to a group of hospice workers and bereavement professionals who had a number of good suggestions to make, so I am hoping that others will be able to add to the list so that we can make it a TOP TWENTY or more… 

1. Don’t panic – there’s no need to be rushed into any decisions. S l o w  things down and allow yourself to take stock of what has happened.

2. Carry on caring for the person who has died and take time to say goodbye.

3. Don’t waste money on things that don’t matter; concentrate on what really counts.

4. Sing songs at the funeral to help people to join in with the ceremony; ask someone to lead the singing.

5. Keep things simple and natural – this can bring beautiful results and can highlight the importance of small individual things.

6. Ask for and accept help – many people would love to help, so give them permission to do so.

7. Consider poems – they can often put into words what we find hard to say.

8. Don’t be a spectator – bear the coffin, decide on music, poems, and memories for the service.

9. Make it personal – include a favourite perfume or flower, photographs or paintings, vehicle, sport, club or hobby – take the children and the dog too.

10. Start now – Don’t wait until it’s hard to talk about it; write down your latest thoughts.

Please help us add to and improve this list…

Need to know, ought to know?

30 June 2011
Charles
9 Comments
Categories: bereavement

By Woody

So many questions!

When is it appropriate for people who work with the bereaved, be they funeral directors, celebrants, (long list of others) to give advice which they suspect might prove helpful even when they are not directly asked for it?  How can you be sure that your gut instinct is right?  To what extent should you have confidence in both your professional and life experience and just go for it?

I’ll try to give an example so that you get the gist without my betraying any confidences or identities.  There are many I could think of but this seems a good one for the purpose of illustration ….

Imagine if the fathers of two young men who died just under a year apart both in their early twenties and in similarly tragic but slightly different circumstances were to meet.  The Dads are from the same town and the boys are buried within one hundred yards of each other.  Is it possible that should these Dads happen to meet and get chatting that one might help the other?  Common ground is why organisations such as Widowed and Young, Survivors of Suicide, The Laura Centre, and similar groups exist but there isn’t a group for everyone and groups are not for everyone.

I am just an average human being working in the funeral business (but not the traditional variety).  I have a large family both biological and logical and a vast number of engaging things to do which amuse me which have nothing to do with my work.  In other words I have a life.  But, here’s the thing.  If anything keeps me awake at night it’s not the fact that I work in the death trade and know too much about the ways in which individuals cease to exist.  It’s this.  Bizarre sets of circumstances frequently come up when I think to myself “if only they (the person or people most affected by someone’s death) knew such and such, I’m sure it would help”.  But how can I be sure and is it any of my business?

Situations like this come up often and sometimes I go with my instinct.  I might just keep doing that until someone tells me I’m wrong.