A COMPLETE understanding of why grieving people are feeling as they do and acting as they do is essential to enable an appropriate response to their needs.
Much research has been done into the emotions of grief. People go through several stages of emotion before coming to the final stage of acceptance. Not all people experience all the stages, and some may go to and fro between different stages rather than experiencing them in the classical order.
Occasionally, a person will get “stuck” in a stage, and experience the emotion for a prolonged period, even for years.
The stages of grief
1. Denial
Initially when faced with a shocking reality, the brain wants to reject it. “No”, “Never”, “I don’t believe it” are common responses. As we see in small children, the brain’s instinctive belief is that if a fact can be denied strongly enough, it can be made to go away. This is a short-lived stage for most people; an adult’s brain soon concedes to reality.
2. Anger
Once the fact of death or impending death is accepted, it is natural to look for ways in which it could have been prevented, and to be angry with the fact that it was allowed to happen. This anger can be self-directed as guilt, or directed at others – sometimes appropriately, sometimes entirely inappropriately. Veterinary staff may bear the brunt of this, and must understand that this is simply part of the process of grieving and bears no personally directed malice (even though it can sound unpleasant at the time).
3. Bargaining
Often not an outwardly expressed emotion, bargaining is an attempt to buy the desired outcome, via a pact with a deity or, more mundanely, with money: “I don’t care what it costs, so long as you save him”, “I will go to church every Sunday if only…”
4. Depression
As people come to terms with the finality of loss, and realise they are powerless to change the future, depression sets in. This is a feeling of helplessness and great loss, rather than clinical depression. People in this stage will disconnect themselves from those they love, and may appear to push others away. For most people this is a painful but necessary step on the way to the final goal of acceptance.
5. Acceptance
This is not necessarily a “happy” stage. Where the pet and owner have been very close, it can be almost void of feelings – a stage where the struggle is over.
Helping others to cope
There are some very simple ground rules for helping the bereaved to cope with the whirlwind of emotion they are experiencing.
Firstly – and this comes first in any communication scenario – we must listen. Active listening was a phrase first coined in the 1950s but is still an important concept. It involves listening with one’s whole attention, and showing that one is listening with body language and facial expression. An active listener never interrupts, and never feels as if they are “waiting to speak”.
Secondly – never judge. However odd or contentious the grieving person’s views, it is not our place to judge them as correct or incorrect.
Thirdly – be reassuring. Grieving individuals feel isolated and upset, they need to know support is available, but ultimately only they themselves can work through the process. It may help to offer other contacts such as counselling services, etc. No attempt should be made to push a person into accepting this offer.
Fourthly – we should never seek to give advice on how a grieving person should behave. It is most important that people are allowed to find their own way forward. Any attempts, despite the best of intentions, to guide people toward the path we feel is “right” is not likely to be helpful.
Our role is to LISTEN and to SUPPORT, not to try to LEAD the process.
Children – a special case
Children are often experiencing their first brush with the concept of death, and its handling may have huge implications for how they cope both in the immediate and distant future.
While a detailed examination of this area is beyond the scope of this article, it is important that they are told the truth, in a way appropriate to their age. Lies or “truth avoidance” can back re in the future.
When a pet is being euthanased, it can be helpful for them to be present at the clinic, or even in the consulting room in many cases, if they so wish, and their family should be encouraged to offer the choice when a planned euthanasia is to take place.
The loss of a pet can be an important lesson for a young person, giving some experience in dealing with death.
To summarise…
Helping clients deal with death is an everyday occurrence in veterinary practice. For us as veterinary staff, the conversation is just a part of our day’s work. For grieving clients, it is likely that they will remember every detail of the way they are treated that day for many years to come.
Having a “plan” of how to hold the conversation will make it easier and less likely to cause further distress.
- Listen, actively and attentively.
- Remember that anger is natural, and not personal.
- Do not offer specific advice.
- Reassure and support.
