Grief – what is normal, and when to get help

The five stages of grief are the most-quoted idea in this area and the most misused. They were drawn from people facing their own death, not from the bereaved, and they were never meant as a sequence to be completed. Grief does not move in order, and there is no point at which it should be finished.

What people actually describe is waves — intense for a while, then a period of ordinary functioning, then something small brings it back. Over time the waves usually come further apart rather than becoming smaller.

• Numbness and disbelief, particularly early, which can feel like not grieving 'properly'.
• Physical symptoms: exhaustion, chest tightness, appetite changes, disturbed sleep, aches, getting ill more easily.
• Anger — at the person, at a clinician, at oneself, at nothing in particular.
• Guilt, and going over what could have been done differently.
• Difficulty concentrating and remembering things.
• Briefly hearing or seeing the person, which is common and is not a sign of mental illness.
• Relief, especially after a long illness — which frequently produces more guilt than the loss itself.

1. 1Let it happen rather than managing it. Suppressing grief does not shorten it.
2. 2Keep the basics going: eating, sleeping, some movement, daylight. These are what most reliably slip and they affect everything else.
3. 3Accept specific practical help, and ask for specific things — people want to help and rarely know what to offer.
4. 4Talk about the person, and use their name. Others often avoid it to protect you, and the silence is usually worse.
5. 5Delay big decisions where you can — moving, resigning, giving away belongings.
6. 6Expect anniversaries, birthdays and holidays to be hard, and plan them rather than being ambushed.
7. 7Be careful with alcohol. It is the most common way grief becomes a second problem.

Cultural and religious mourning practices matter here and are worth leaning on. In much of South Africa the funeral, the mourning period and the rituals that follow are structured community support, and they do real work.

Grief is not a mental illness. But it can become depression, and in a minority it becomes prolonged grief — stuck rather than slowly shifting, a year or more on, still dominating daily life.

• ambulance10177Emergency Medical Services
• local_police10111South African Police Service
• sos112Universal Emergency (mobile)
• psychology0800 029 999SADAG Mental Health Crisis Line
• science0861 554 911Poisons Information Helpline

• Show up, and keep showing up. Support is heaviest in the first fortnight and most needed in the months after.
• Do not say 'they are in a better place', 'at least...', or 'everything happens for a reason'. These are said to relieve the speaker's discomfort.
• 'I don't know what to say, but I'm here' is better than anything clever.
• Do something concrete: food, lifts, childcare, admin. Bereavement generates an enormous amount of paperwork.
• Do not put a clock on it, and do not tell them how they should be feeling by now.
• Remember the anniversary, and say the person's name.