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Some expert advice on dealing with grief (also an issue for birds, elephants and other animals too)

Jennifer Doggett reports from the final day of the 12th Australian Palliative Care Conference:

If there is one message that Dr Amy Chow would like to convey to the community, it is that grieving is a very normal and natural part of life. She says that grief is an emotion that people from all cultures experience after the death of a loved one.

Her research has found that even animals, such as elephants, gorillas and birds, show signs of bereavement similar in many ways to humans.  Yet despite its universality, our society often does not respond well to people experiencing grief.

Even within the health system, which should be better acquainted with the realities of death than many other sectors of society, Dr Chow says there are many barriers to talking directly about death and responding appropriately to people experiencing grief.

Dr Chow, who is an Associate Professor at the University of Hong Kong, specialises in researching grief and bereavement issues.  She is passionate about the need to de-stigmatise death and dying and spends much of her professional life providing education and training to health professionals in how to deal with patients and their families experiencing death, grief and loss.

Dr Chow says that one of the challenges in dealing with people experiencing grief as a health professional is that their presentation can often mirror that of people with certain types of mental illness.  She says:

“It’s normal for people in the process of grieving for a loved one to have difficulties working or in undertaking their normal social activities. But because these symptoms are also common in people who have depression and other mood disorders sometimes health professionals can mistake the normal symptoms of grief for signs of a mental illness (and vice versa). This is a problem because it makes it difficult to provide patients with the appropriate care.”

Diagnostic tools, such as the DSM-5 system of categorising psychiatric illnesses (produced by the American Psychiatric Association), can help clinicians distinguish between grief and mental illness by outlining the specific features of each condition.

For example, an inability to engage with normal social activities may be common to both grief and depression. However, this typically resolves after a short period in the case of grief and is more prolonged in people with depression.

Dr Chow also highlights the importance of understanding the differences in the way various cultures typically express grief.  She describes her own Chinese community as being much more outwardly expressive in grieving than most Western cultures. She says:

“If a Chinese person is grieving openly for a family member who has recently died, someone from an Anglo-Saxon background might think they are being over-the-top in the expression of their feelings.

However, a Chinese person seeing a more restrained expression of grief from an Anglo-Saxon person would mistakenly assume that the person does not have strong feelings of loss.”

In a multicultural society, such as Australia, it is vital that all health professionals are given training in cross-cultural expressions of grief and traditions relevant to death and bereavement.  If health care workers don’t understand the meaning behind the different cultural expressions of grief they cannot respond in a way that is respectful of these traditions and supportive of the patient and their family.

Bereavement in children is another key research interest of Dr Chow, who says that the way children grieve is often poorly understood by their families and by health professionals.

She has found that the grieving process in children varies significantly by age but that there are a number of differences between expressions of grief in children compared with adults. She says:

“For example, young children may not be able to express their grief in words so it is important to look for behavioural changes that may be caused by feelings of sadness and loss. Also, grief in children typically lasts for a shorter period and is more episodic than in adults.

Children may move in and out of their grief in a much more fluid way than do adults. It’s important not to assume that children have moved on from the grieving process just because they appear to have gone back to ‘normal’.  They can came back into a state of grief several times before processing their feelings of loss.

Finally, I have come across many examples of children take on the role of ‘carer’ while their parents grieve for a loss in their family. These children don’t even begin their grieving process until they feel their parent has dealt with their own grief.”

Dr Chow says that understanding the different grieving patterns of children can help health professionals care for children and families who experience the loss of a loved one.

Dr Chow’s commitment to improving the understanding of grief in both the health system and the wider community is based on her view that grief is both a natural and necessary part of life.

One of her favourite quotes is from Queen Elizabeth’s response to the September 11 terrorist attacks: “Grief is the price we pay for love”.

She finds this sentiment inspirational in her work, adding that, “If grief is the price we pay for love, then as health professionals our job is to make that price more bearable.”

• You can track Croakey’s coverage of the conference here.