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Bereavement

→ Grief is a normal process, which can become complicated. This is known as prolonged grief disorder. Therapeutic solutions do exist.

→ Certain situations lead to more prolonged grief disorders, such as the loss of a child, or the loss of a loved one in dramatic circumstances(terrorist attack, suicide...).

Relatives can help the bereaved person in everyday life.

Children, too, suffer bereavement. They must not be excluded from funeral rites.

Several associations provide bereaved people with support depending on their situation. They can also refer them to a mental health professional.

Discover the complete file in pdf

What is grief?

In literature, film and song, we talk a lot about death, but very little about mourning. So what exactly are we talking about?

A process that follows the definitive loss of a loved one, a relative, friend or brother, to whom we were very attached and who we can never replace. For the bereaved, the challenge of mourning is to experience their relationship with the deceased differently, with the relationship normally evolving towards an internalized bond, and to feel at peace once again. In short, to be able to live well without him or her.

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Mourning is a natural process, which takes varying amounts of time. How does it play out in everyday life? Again, it depends on the individual. But here are a few of the most common manifestations of grief:

  • A deep distress linked to the separation with an intense nostalgia for the deceased, a longing to see him again or a search for him;
  • Intrusive preoccupations with the deceased, in the form of thoughts, memories or quasi-hallucinatory experiences;
  • Strong feelings of emotional loneliness, emptiness and anxiety about the future without the deceased;
  • Emotions such as anger, guilt and remorse;
  • A loss of interest in others and in taking part in various social activities;
  • A sense of confusion and disorientation about one's identity and social role.

The bereaved person may also show signs of stress: his or her heart rate increases, as does blood pressure, and he or she has difficulty concentrating or remembering little things. The bereaved may find it difficult to sleep, and may even be in physical pain...

The grieving process is not linear. Certain events, such as the deceased's birthday, the first vacation or vacation spent without him or her, the first vacation, etc., can rekindle the pain just when you thought you were feeling better... Each bereavement is unique, lasting more or less time, with different manifestations.

You mustn't feel guilty for not grieving in the same way as someone else.

Thematic dossier - Psychotrauma, the stages of grief

A few tips to help you cope with bereavement

By Marie-Frédérique Bacqué, psychologist and professor of psychopathology at the University of Strasbourg

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  • Talking about death. It's important to talk about death throughout our society, including at school and even from nursery school onwards. We need to understand that death is a way out of life that we delay as long as possible, whether in the case of human life, animal life or plant life. This is what makes life precious.
  • Coming to terms with death, particularly through funeral rites. Funeral rites allow the bereaved to be surrounded and to come to terms with the reality of death. That's why you need to trust the master of ceremonies, whether a funeral director or a clergyman, for example, to help you let go. It is also advisable, where possible, to view the body of the deceased and to offer this to the children as well (please note that children must be accompanied and their questions answered).
  • Tolerating separation. Closing the coffin is an important moment, because it ratifies the fact that the body will disappear. The coffin and the grave become symbolic representations of the dead. In the cemetery, the deceased joins the community of the dead, not alone.
  • Commemorate. Death must be part of culture, because culture protects us from psychopathologies. That's why it's important to commemorate the dead, according to one's own culture and traditions.

Why is mourning so complicated?

Sometimes, mourning can become complicated and encounter obstacles... For some people, mourning will last longer or be more difficult, depending on the circumstances of the death, the nature of their relationship with the deceased, whether they are well surrounded or not (social support), and the possibility of funeral rituals.

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The circumstances of the death can complicate the grieving process, for example in the case of a violent death in a road accident, or after a sudden and unexpected death, a suicide, if the death does not respect the order of generations, and so on.

The nature of the relationship too: whether the bereaved had a fusional relationship with the deceased, whether there were unspoken, unresolved conflicts, or an ambivalent relationship...

If the bereaved lacks social support, if they find themselves alone, unable to talk about it with anyone, this can complicate the grieving process.

The bereaved person's personality also plays a role: their history, their approach to death, their anxiety...

Funeral rites are important because they help people to come to terms with the separation, with the support of the group.

Bereavement affects people both psychologically and physically. Physical health can deteriorate during bereavement, and you should consult your doctor if you have any doubts.

What is prolonged mourning?

Bereavement lasts for varying lengths of time... But here, we're talking about prolonged mourning, long mourning, or complicated mourning, in the sense of the two international medical classifications.

Only a doctor can make a diagnosis. However, as a family member, there are certain signs that should alert you. (See below)

Today, it is estimated that most bereavements evolve positively. One person in ten will experience prolonged mourning at least once in his or her life. The risk is higher in the case of an "unnatural" death (accident, murder, death of an only child, etc.), at 49%.

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Pathologizing grief? Some doctors are against the inclusion of prolonged bereavement in disease classification manuals, believing that the diagnostic criteria are not precise enough and that it is "normal" to suffer in a bereavement situation. Others consider that, compared to falling off a building, it's also "normal" to have a broken leg, but that's no reason not to treat it...

What prolonged mourning is not (because the symptoms are different) and what it should not be confused with:

  • Normal" mourning
  • A depressive disorder
  • Post-traumatic stress disorder
  • Separation anxiety
  • A psychotic disorder

Prolonged mourning, delayed mourning, traumatic mourning, complicated mourning, inhibited mourning, what's the difference?
Understand the difference between the terms used by consulting the full file in pdf HERE.

What does this have to do with post-traumatic stress?

Prolonged grief can go hand in hand with other disorders. The most common are severe depression, post-traumatic stress disorder and substance use disorder. Separation anxiety can also occur.

30% to 50% of people suffering from prolonged bereavement may also have post-traumatic stress disorder (PTSD). This is particularly the case when the death occurs in traumatic circumstances: during an attack, after a murder, during a violent accident...

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On the other hand, even though prolonged grief disorder can only be diagnosed a year after the death and not before, other disorders may arise during this first year.

Post-traumatic stress disorder can be diagnosed if symptoms of reliving, avoidance and hypervigilance last for more than a month.

Signs of depression may appear, even leading to suicide. Don't hesitate to call 3114, the national suicide prevention hotline.

It is therefore necessary to be vigilant at every moment of this period of mourning.

Good to know: some hospitals, such as the CHU de Lille, offer support for people in protracted bereavement. This support takes the form of a helpline or health professionals who call bereaved people back after a death in hospital.

Testimonials

This section presents three testimonials from people who have experienced prolonged bereavement in different circumstances. These stories are currently being collected.

Share your story

Are you experiencing or have you experienced post-traumatic stress disorder or prolonged grief disorder, and would you like to testify? Testimonials can help change the way we look at trauma, and above all help people going through psychotrauma to feel less alone and understood.

You can contact us by e-mail at redaction@cn2r.fr with your first name and telephone number.

Testimonials can be collected in writing, podcast or video, anonymously or not. In all cases, we'll get back to you by e-mail or telephone to discuss the matter.

I am in mourning

Patience and self-indulgence: these are undoubtedly the two best tools for coping with grief in the best possible way. There's no point in comparing the way you grieve with the way others grieve: everyone progresses differently, going through different emotions, for more or less time...

Sometimes we may feel guilty or ashamed at the thought of being unwell. We can't ask anyone for help, and feel we have to bear it alone. Yet those close to you can be attentive and, above all, helpful ears. Simply listening to what they have to say, reminiscing together about happy memories with the deceased, or what you're feeling right now, can help you feel better. It's important to be surrounded during this difficult period.

Grieving does not mean forgetting the deceased, but returning to a life as normal as possible, getting back to one's activities, looking after one's children again, taking up the hobbies that were dear to us. This sometimes takes a lot of time.

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The right question to ask yourself: how would the person who died have liked to see you there, today? What would he or she say about you? What would they like to see you do?

In general, we recommend :

  • Anticipate "birthday" dates and other moments you know will be difficult. By anticipating what you're going to feel, you can better accept it. We can also plan an outing with friends, a family reunion, an activity that will allow us not to be alone during these difficult times.
  • Commemorating the deceased. After death, the bond between you and your loved one changes, but doesn't disappear. This can mean remembering good times, visiting the grave, etc.
  • Find enjoyable activities for yourself and/or your loved ones. Feeling positive emotions helps your grief to evolve.
  • Accept help from others. It's normal to feel a lack of desire, a lack of energy... We can let loved ones take care of us, prepare a meal, look after the children... and even ask them.

I lost my child

Losing one's child is undoubtedly one of the most painful events one can experience. This situation is also more pr one to prolonged grief, especially in the case of the death of an only child. It is estimated that around 59% of bereaved parents develop prolonged grief disorder.

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The manifestations of bereavement in a parent are often a little different in temporality: at first, you go on living almost normally, because you have to be strong, not let go, look after the other children and so on. The pain sometimes comes later and more intensely.

Perinatal bereavement occurs when a child dies during pregnancy, at the moment of delivery or shortly afterwards. The law has evolved considerably to take better account of perinatal bereavement (possibility of registering the child's name in the family record book, maternity/paternity leave, birth bonuses, etc.). A number of cemeteries offer dedicated spaces for meditation.

Associations such as Nos Touts Petits d'Alsace also offer workshops for bereaved fathers, more and more of whom have been expressing their grief through words over the past decade.

Useful links:
- Perinatal bereavement, a guide for parents (Association "Nos touts petits de Nice", 2015).
- Associations such as Vivre son deuil support bereaved parents throughout France, as well as siblings of the deceased.
- The "Nos touts petits" association has regional branches in Alsace, Nice, Normandy, Reunion and Savoie. They offer a wide range of online resources, workshops and discussion groups.
- France 3 Alsace report on perinatal bereavement

My loved one committed suicide

The pain caused by the loss of a loved one to suicide is particularly strong. It's normal to feel alone, devastated, sometimes guilty, and to have nightmares.

The 3114 helpline site offers a wealth of resources for people bereaved by suicide or witnessing a suicide.

If you're having suicidal thoughts yourself, talking about it can change everything. Call 3114, a professional and confidential helpline, 24 hours a day, 7 days a week. Free call.

I'd like to help a bereaved loved one

What can I say?

Sometimes we don't know what to say to a bereaved loved one. Words seem superficial in the face of pain. There is no miracle solution, but we can start by avoiding ready-made phrases such as "With time, it will pass", or "It's time to move on". Bereaved people sometimes feel that they can't talk about the deceased, that they'd be repeating themselves, that others have moved on... In such cases, it's important toinvite your loved one to talk about the deceased and what happened: he or she needs to.

Don't be afraid toevoke the deceased and recall his or her value. You can also reassure the bereaved that you appreciate their suffering.

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What to do?
The best thing to do? Be present. This doesn't mean simply offering to help in the abstract ("Call me if you need anything"), but regularly offering to visit, to help sort things, to do the paperwork, to do the shopping, to look after the children...

Sometimes you have to be proactive and offer to help again, as the bereaved person may not dare to ask for your support.

What if that's not enough?
If you think your loved one is suffering from prolonged bereavement, or if you notice that their grief is not progressing, it may be useful to refer them to a professional, starting with their GP. Once again, it's normal to be affected by bereavement, and this can last for varying lengths of time. We believe that the positive evolution of grief depends on its fluidity and progress, not on its duration. But if you're worried about your loved one, referring him or her to a doctor for advice is never superfluous.

Depending on the situation, support can be provided by a mental health professional at one of the regional psychotrauma centers.

In France, medical treatment is recommended if signs of grief and intense suffering persist beyond the first anniversary of the death.

There are a number of associations dedicated to helping the bereaved. They organize counselling sessions and discussion groups, and most are in contact with psychologists who can help the bereaved (see below).

Are there any treatments for prolonged mourning?

In general, during a period of mourning, the pain gradually subsides until it becomes bearable. In fact, that's what mourning is all about: a process that enables us to go on living peacefully without the deceased. Bereavement evolves in fits and starts: we oscillate between moments when things are going well, and others when the pain takes over again. This is perfectly normal.

What happens when bereavement becomes more complicated? Medication is not recommended for prolonged bereavement. Antidepressants may nevertheless be prescribed if the bereavement is accompanied by a depressive disorder, or if the patient has already experienced depressive episodes during events usually less painful than the bereavement (separation, redundancy...).

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Cognitive and behavioral therapies (CBT), on the other hand, have proven effective for the bereaved. There are a number of therapies adapted to the circumstances of the death.

Prolonged Grief Disorder Therapy (PGDT) is recommended by healthcare professionals. PGDT uses cognitive-behavioral therapy, interpersonal therapy and motivational interviewing techniques.

The first thing to do is always to consult your GP. Specialized associations can then refer you to a qualified therapist.

Beware, malicious people sometimes pretend to be therapists before exerting a hold on their victims. Be cautious, especially when you've been weakened by a death. > Seeking help

What is bereavement in children?

It was long believed that children were protected from grief because of their psychological and cognitive immaturity. We now know that this is not true, and that even the youngest children suffer the loss of a loved one and can go through a period of mourning.

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Children also suffer from prolonged grief disorder, with some age-related specificities:

  • The diagnosis can be made as early as 6 months after death (12 months for adults);
  • The strong, persistent desire/need for the deceased may be reflected in the child's play and behavior (e.g. during separation or reunion with a parent, caregiver or other attachment figure);
  • Concern about the circumstances of death can also be expressed through the theme of games;
  • The difficulty of accepting death depends on the child's ability to understand the meaning and permanence of death.

Find out more by consulting the full dossier in pdf HERE.

The associations

A number of associations offer bereavement support and useful resources. They exist in every region of France. Here are a few of them - the list is, of course, not exhaustive:

- Bereavement
- Coping with grief
- Empreintes
- The "Ecoute deuil" space of the JALMALV association, Grenoble
- Jonathan Pierres Vivantes association
- FAVEC

Questionnaire: Do I suffer from prolonged bereavement?

Do you feel "stuck" in your mourning process? Do you have the impression that you can't move forward, that your loved ones no longer understand you? We've designed a self-assessment questionnaire for you. You'll find it below.

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Please note that this is not a diagnostic tool. Depending on your results, it may be useful to consult a mental health professional to establish a diagnosis and possibly begin therapy.

You can answer the questionnaire by clicking HERE, then click on "Send", then "Show score" and compare your results.

  • If your score is > 25
    If your score is above 25, you have many signs of prolonged grief. It's a good idea to talk to your GP first, so that you can find a healthcare professional who can diagnose your condition and start therapy.
  • Si votre score est < 25
    Si votre score est inférieur à 25, cela veut dire que vous ne montrez pas tous les signes d’un trouble de deuil prolongé. Si au-delà de ça, vous avez l’impression que votre deuil évolue dans le bon sens, il ne s’agit sans doute pas d’un trouble. Toutefois, il s’agit peut-être d’un autre trouble. Dans tous les cas, n’hésitez pas à demander l’avis de voter médecin traitant.
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