Dr David Smith: Bereavement and the psychological effects are still taboo subjects, but as Prince Harry’s public bravery showed… it’s good to talk

Aged 12, Prince Harry famously lost his mother to a tragic accident. With a stoic face, and his fists clenched at the funeral, his small figure became an emblem of courage in the face of mortality. Over Easter he showed a lot of public bravery again, this time doing a candid interview with Bryony Gordon about his subsequent struggles with mental health on her Mad World podcast. Among other things he disclosed the value of talking, which he was first loathe to do, and how it had taken 20 years to finally reach “a good place”.

What made the recording so remarkable is that, aside from Death Cafés, speaking about the subject is still a great British taboo. Indeed, I consider myself fortunate to have rarely had to. So far I have only lost family or friends to old age. And whilst it obviously hurts to see them go, it’s not without the knowledge they had first lived very full lives. In the case of Harry, not only was his loss premature, but he had the added pressure of growing up on a world stage. This meant grieving in the spotlight. It’s therefore no wonder it took him decades to really come to terms with it.

The most well-known model for doing so is the Elizabeth Kübler-Ross one i.e. the 5 stages of grief. Although she used these as examples of people coming to terms with their own death, they have since been applied to those of loved ones. First is denial – the idea that what happened can’t have really happened. During this period, people may experience constant reminders of the deceased, including hallucinations, or sometimes not register that they are gone. Next is anger, where the sadness is reversed and redirected at the injustice of it. Bargaining is the superstitious tendency for people to look to a higher power for help, which is followed by a period of depression when such wishes go unfulfilled. Finally, there is the light at the end of the tunnel, as the sufferer reaches acceptance.

Despite this progression appearing all over pop culture, showing up in everything from House and Harry Potter to The Simpsons, there is minimal evidence that mournfulness follows a formula. As the author herself later noted, these steps are not necessarily universal. Rather they were meant to rationalise what people may experience rather than what they necessarily will experience. Like so much psychomythology, this misconception maybe caught on because there’s something reassuring about it: that something seemingly uncontrollable can be controlled and there’s a predictable pattern to the pain. Yet overwhelming the evidence suggests people grieve in their own way.

Physiologically there are common symptoms. For example, there’s an increase in the secretion of stress hormones, such as cortisol, and the immune system is weakened. However, psychologically there are big differences. George Bonanno gathered data from people before and after the death of their spouse, showing a lot of variability in coping. Instead of a standard trajectory, they appeared to follow a multitude of pathways. This finding was backed by grief consultants Russell P. Friedman and John W. James, who point out that no study to date has ever established distinct steps existing. Consequently, there are no processes that will be consistent across any two people. Similarly, Ruth Davis Konigsberg argues that not only are the 5 stages a myth, they are potentially dangerous. Instead of giving an expectation of how people should be feeling and when, she claims her research shows there is “no right way” to cope. Instead each love is as unique as the people behind it.

Among those who have opened up about their personal experiences is Rio Ferdinand. Recently the former England captain made a powerful documentary about getting to grips with his grief. Having lost his wife to breast cancer in 2015, he discussed the trials of seeing her when she wasn’t there, filling in for her and trying to talk to his kids about it. Considering the macho associations of his profession, there’s something powerful about him encouraging communication on the topic. This commendable aim is not dissimilar to when Professor Green went public about his late father’s suicide and his own depression.

Among the strategies Ferdinand adopted was a memory jar: a collection of cherished moments he and his kids would add to every day. A focus on celebrating her life, which supposedly helped a lot, is like an extension of the funeral. Whether it is the local ceremonies I have attended, or the mass scale of the aforementioned Princess’, we gather to say goodbye. All through our species’ history, and across different cultures, death has been met with burial practices. There’s even signs of our distant cousins, the Neanderthals, having such rituals along with other species. That these ceremonies are universal suggests there is some sort of adaptive benefit to them. Perhaps it is a sense of solace from remembering a person’s life, though it may also be the relief of receiving support. In this respect, funerals are more for the living than the dead.

Last month one of my best friends laid his father to rest, following a prolonged fight with cancer. And though it can obviously never make something so hard much easier, the staggering turnout of 700 at the church spoke volumes of his dad’s character and esteem. Thinking of this line of consolers, which saw my friend shake hands at the door for an hour, I’m reminded of our kind’s finer qualities including caring, compassion and empathy. These are just a few of the reasons we readily cross the country to be in the room, and pay our respects, after a person has died. It is also why others will likely do the same for us when we have.

Being there in the aftermath also makes a difference for the bereaved, provided you acknowledge the sorrow is not something you can fix for them. In 2006, Coan and colleagues put people in an fMRI machine, and watched their brain activity when exposed to stressors – in this case, electric shocks. Participants were not always alone though: in some cases they held hands with a stranger, and others their partner. The researchers found that contact, even with an unknown person, reduced stress responses, and this was amplified when the person was close to them. This finding says much about both our ability to comfort others, and the value of letting them try for us. Or as Prince Harry’s experiences, and their overwhelmingly positive response, show – it’s good to share.

This article is dedicated to the memory of Bert Smith. Without his encouragement and generosity I would never have been in a position to write it.

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