Excerpt: Grief Works
Stories of Life, Death and Surviving
A warm, moving and practical guide to grief from a leading bereavement counsellor, Grief Works features deeply affecting case studies of the author's clients, which will appeal to readers of Atul Gawande's Being Mortal, Stephen Grosz's The Unexamined Life and Paul Kalanithi's When Breath Becomes Air.

Death is the last taboo in our society, and grief is still profoundly misunderstood. So many of us feel awkward and uncertain around death, and shy away from talking honestly with family and friends. Grief Works is a compassionate guide that will inform and engage anyone who is grieving, from the "expected" death of a parent to the sudden unexpected death of a small child, and provide clear advice for those seeking to comfort the bereaved.
With deeply moving case studies of real people's stories of loss, and brilliantly accessible and practical advice, Grief Works will be passed down through generations as the definitive guide for anyone who has lost a loved one, and
revolutionize the way we talk about life, loss and death.
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Annie, the first person I ever counselled, lived in London at the top of a high-rise block of flats, behind the Harrow Road. She was in her late sixties and had been devastated by the death of her daughter, Tracey, who’d crashed her car into a truck on Christmas Eve. The cigarette smoke and boiling heat of Annie’s room, with its three-bar electric fire, com­bined with her furious grief, are as alive in me today as they were twenty-five years ago. At that time I was a volunteer for a local bereavement service, and I’d had only ten evenings of training before I found myself sitting opposite Annie. I felt inadequate and frightened in the face of her loss; but I also felt a quiet hum of excitement, for I knew I had discovered the job that I wanted to do for the rest of my life.
     Annie gave me an insight that has proved true for the many hundreds of people I’ve seen since: that we need to respect and understand the process of grief, and acknowledge its necessity. It isn’t something that can be overcome by engaging in battle, as in the medical model of recovery. As humans, we naturally try to avoid suffering, but, contrary to all our instincts, to heal our grief we need to allow ourselves to feel the pain; we need to find ways to support our­selves in it, for it cannot be escaped. Annie railed against the truth of her daughter’s death, blocking it out with bouts of drinking, and fighting with her family and friends who tried to pull her out of her loss. This pain was the very thing that eventually forced her to find a way of living with the reality of her beloved daughter’s death – and it had a course of its own.
     Death is the last great taboo; and the consequence of death, grief, is profoundly misunderstood. We seem happy to talk about sex or failure, or to expose our deepest vulnerabilities, but on death we are silent. It is so frightening, even alien, for many of us that we cannot find the words to voice it. This silence leads to an ignorance that can prevent us from responding to grief both in others and in ourselves. We pre­fer it when the bereaved don’t show their distress, and we say how “amazing” they are by being “so strong.” But, despite the language we use to try to deny death – euphemisms such as “passed over,” “lost,” “gone to a better place” – the harsh truth is that, as a society, we are ill equipped to deal with it. The lack of control and powerlessness that we are forced to contend with go against our twenty-first-century belief that medical technology can fix us; or, if it can’t, that sufficient quantities of determination can.
     Every day thousands of people die, expectedly and unex­pectedly; 500,000 deaths a year occur in England alone. On average, every death affects at least five people, which means that millions of people will be hit by the shock of the news. They will forever remember where they were when they heard that their parent, or sibling, or friend, or child was dying or had died. It will impact on every aspect of their world for the rest of their lives and ultimately alter their rela­tionship with themselves. How successfully they manage their grief will, in turn, come to touch all the family and friends around them.
     The pain we feel is invisible, an unseen wound that is greater or smaller depending on how much we loved the person who has died. It may be that we are grieving a sudden death or an anticipated death. Either way, the sky we look up at is the same sky as before the death, but when we look in the mirror the person we see has changed. We look at a photograph of ourselves, and wonder at the innocence of that smile. Death is the great exposer: it forces hidden fault lines and submerged secrets into the open, and reveals to us how crucial those closest to us have been. But those surrounding us don’t necessarily understand the complexity of what has happened or the depth of the injury we are carrying.
     I have regularly seen that it is not the pain of grief that damages individuals like Annie, and even whole families, sometimes for generations, but the things they do to avoid that pain. Dealing with pain requires work on many differ­ent levels, both physical and psychological. It is not possible to do this work on our own. Love from others is key in help­ing us to survive the love we have lost. With their support, we can endeavour to find a way of bearing the pain and going on without the person who has died – daring to go forward to trust in life again.
     In my profession there is a wealth of well-researched prac­tical strategies as well as psychological understandings that are essential for anyone who is grieving. As a therapist I have witnessed how this knowledge can help the bereaved to avoid worse consequences through inappropriate support; research studies show that unresolved grief is at the root of 15 per cent of psychiatric referrals. The fear that surrounds death and grief is largely caused by lack of knowledge, and the aim of this book is to address this fear and to replace it with confidence. I want people to understand that grief is a process that has to be worked through – and experience has taught me that grief is work, extremely hard work; but, if we do the work, it can work for us by enabling us to heal. The natural process of grieving can be supported in such a way as to allow us to function effectively in our daily lives, and I hope that this book will come to play a useful role in provid­ing this support.
     Here you will find case studies of grief based on real people’s experience. Although they have been grouped according to the relationship of the individual with the person who has died (i.e., the loss of a partner, parent, sibling or child), each is, nonetheless, unique. These stories demonstrate that we need to become more familiar with what is going on inside us; we must learn to recognize our feelings and motivations, and genuinely get to know ourselves. This is necessary if we are to adjust to the new reality brought about by loss. Grief doesn’t hit us in tidy phases and stages, nor is it something that we forget and move on from; it is an individual process that has a momentum of its own, and the work involves find­ing ways of coping with our fear and pain, and also adjusting to this new version of ourselves, our “new normal.” That most people can somehow find a way to bear the unbearable says much about our extraordinary capacity to evolve as we work towards the rebuilding of our lives.
     Although the case studies in this book are framed by my counselling relationship with each individual, the focus is, however, on the grief rather than on the therapy; and they show that really listening to someone is just as important as talking with them – the power of a person being fully heard as they tell their story should never be underestimated. The ability to listen well is by no means the sole preserve of pro­fessional therapists; it is something we can all learn to do, and we may be surprised by how much our friends tell us and how helpful we can be when we take the time to listen to them properly.  
     In my sessions with clients, they explore their previous assumptions about life and their perceptions of the world. They discover words to describe what may never have been voiced before, the freedom not to have to protect me from their deepest pain, their worst fears or thoughts. They voice their worries, their preoccupations; they feel lighter and often make new connections in themselves. They explore the different versions of themselves that may be doing battle, or the whispering critical voice that overlays every action. They have the space to find out what is really going on beneath their defences, defences that may have pro­tected them in the past but are thwarting them now. They reveal themselves more fully, and can come to terms with the parts of themselves that are, for example, like their parent – behaviour they’ve either hated or found themselves imitating. Having a place where they can bring the twisted feelings that have been silently tying them in knots – a place where such feelings can be unravelled and then searched for nuggets of truth – can sometimes alleviate the pain of unalloyed grief.
     The “Reflections” at the end of each section give my broader thoughts on how to approach this kind of loss, as well as practical facts and guidance about the topics that emerged in the stories. Providing readers with the statistics relating to large numbers of those who have been bereaved should dispel inaccurate negative impressions that individuals may have about their grieving that can be undermining them. It may also be useful to read sections of the book not directly relevant to your experience in order to see the uni­versal processes that we go through when a person has died – and even be surprised to see much of ourselves in someone who is grieving an entirely different death.
     Because our attitude to grief is embedded in our culture, I have included a brief outline of how our attitudes have changed since Victorian times; and certainly there are prac­tices in the past that we could do worse than to adopt today. The chapter on friendship contains my cumulative insights into its importance, and I cannot emphasize enough how critical a role friends play in the recovery of anyone who is bereaved, though they have the potential to hinder as much as to help. The final section shows how we can help our­selves, viewed through the image of pillars of strength.
     I would like this book to be a resource that can be con­tinually revisited. I want people to understand their grief, or the grief of the people they care about. I hope it will be used by friends and family to reassure the bereaved that lives can be rebuilt, trust developed. We may no longer be innocently hopeful, and we may always have times when we feel the pain of loss, but the deeper understanding of ourselves that we have gained will, in time, feel like growth.
Publisher: Doubleday Canada