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悲嘆(グリーフ)とは
Readiness of supporters

Not a few bereaved families say, “When I began to tell my story, the person had a troubled look…” When people see bereaved families, some are puzzled about what to say and how to listen to them. If the listener changes subject or encourages them without careful consideration, it can hurt their feelings more.

 

Supporters need to think about the following before providing support:

 

1)Provide support that matches their needs with consideration of what they want and what you can do to help instead of you foreseeing and guessing what they need.

 

2) Look into the person’s eyes when talking to them and speak slower than usual.  Do not show an attitude like, “I’ll do it for you,” or say “You poor person”.

 

3)When the bereaved cannot talk, don’t try to force them to do so. You can just say, “You have been through a difficult time.” It is important to try to understand the pain of the person.

 

4)When they start to talk about their disaster experiences or the person/people they have lost, listen sincerely with sympathy and interest. Do not change the subject in the middle of their story.

 

5)Provide accurate information to the subject that bereaved families want to know. If they ask you questions that you can’t answer, tell them you don’t have the answer. Unless the bereaved family ask, supporters should not talk about their experiences, beliefs, or religious faith.

Behaviors that may hurt bereaved family members

The words and actions of supporters in an attempt to encourage or comfort them may actually cause the bereaved pain. This is called “secondary trauma”. To minimize secondary trauma, supporters should avoid saying the following:

 

〇It will become easier soon. Time will solve it.

・ This does not make bereaved feel any better.

 

〇Don’t just go on crying.

・ It sounds like you are prohibiting the bereaved from expressing their emotions.

 

〇You should cry.

・Some people cannot cry, even when they are sad.

 

〇Your situation is better than some others.

・ Comparisons with others do not provide comfort.

 

〇Pull yourself together.

・ It is hurtful when the bereaved feels the loss of what they were believing and relying on.

 

〇 If you keep feeling sad, the deceased may worry about you.

・ It sounds as though being sad is bad.

 

〇You look better than I thought you would.

・ The bereaved may feel that the supporter does not understand their grief.

 

〇Get over it soon.

・ The bereaved may feel that the supporter does not understand their feeling.

 

〇If it happened to me, it would be unbearable.

・It sounds like somebody else’s problem.

 

Additionally, do not impose your values on the bereaved family, and do not promise anything you cannot deliver.

 

※Referenced from Noriko Murakami [Supervisor] (2011). “Mental Care Learned from the Great Hanshin-Awaji Earthquake and Other Disasters-Advice from the Clinical Field (Japanese)”. Shionogi Pharmaceutical Co., Ltd., and others.

Attitude required of supporters

The needs of bereaved family members vary, but many families are looking for the following types of support:

  •  Confirmation of the safety and whereabouts of loved one or information about the possibility of survival.
  •  Facts about the circumstances of a loved one’s death.
  •  Mental support to alleviate anxiety.
  •  Information about future daily living and other available support.
  •  Resources that can provide consultation for family members about what they can do now and matters they are worried about

(There are various other requests as well)

 

Regardless of your position, when you are involved with them as a supporter, you should understand what is useful for those who lost loved ones in disasters. It is important that you provide support properly with cautious consideration.

 

Bereavement and loss of imperative things can lead to numerous emotional states, such as grief, mistrust, despair, denial, and anger. Some people may become expressionless as if they lost their emotions.  Others may behave as if nothing had happened, or cry and even shout at people supporting them.

These are common reactions that people under difficult conditions show. Supporters need to keep a comprehensive mind and understand the behaviors they show after suffering from disasters and accept their potentially difficult attitudes.

Grief support

1.Grief Support

 

There is no single way to support grief, just as grief-related feelings and subsequent processes are different for each person. Also, sadness of losing a loved one lasts for a long time while changing its strength and form, and completely eliminating sorrow is not a goal. Supporters provide bereaved family the help to go on with a new life while keeping the memories of loved ones in the sorrow.

Provide assistance that is tailored to the bereaved family’s needs at a pace with and in a method suitable for them to recover from their grief. It is very important that the bereaved feel it is safe to spend time with supporters.

 

 

 

2.Before providing grief support

 

In general, talking about death is best considered to be avoided.  It is easy for people to have attitudes toward death which are different from the bereaved. The following are typical of such beliefs. Before you start supporting the bereaved, remember these:

 

☒Sadness will heal over time.

The truth is that time can be a great help, but grief from losing a loved one will stay for life.

 

☒The less you think about loss, the less you suffer.

The truth is that sorrow, grief, and thinking about the lost person are totally normal reactions. One can recover from sorrow through that pain.

 

☒It helps the bereaved more by not mentioning bereavement.

The truth is that too much intrusion on a bereaved family’s feeling should be avoided, but expressing feelings and having opportunities to talk about bereavement can be a great help for them.

 

☒People who cry or share more of their thoughts suffer more than those who do not express their emotions.

The truth is that how a person expresses grief does not reflect the degree of grief in their mind.  Especially for men and children, the degree of grief they express and actually feel are often different.

 

☒Children’s sorrow is not as deep as that of adults. Even if they are sad, they can get over in a short period of time.

The truth is that despite all children being able to experience grief and sorrow, they can only express it in different ways with adults. Because children tend to have difficulty understanding death and being immature in expressing their feelings, they may be hurt more than adults and suffer from the disadvantage of not being able to obtain correct information.

 

※Referenced from Burnell GM, Burnell AL [author] (1994). “The Clinical Practice of Sorrowful Bereavement” (Translated to Japanese by Hiroshi Hasegawa and Masasuke Kawano).

 

Immediately after losing their loved one, the bereaved family may show intense grief and people close to them may be worried. However, a large part of their grief reactions will diminish over time. Please refer to the section of “What is Grief?” on this website before you start grief support. It is much easier for supporters to start reaching out to the bereaved after understanding grief reactions in advance than not knowing them.

 

 

3.Things that supporters should know for providing support

 

What is required for grief support is different for each individual. The following are some factors that supporters should keep in mind:

 

1)Many bereaved families think it is only them feeling so much sorrow or maybe they are not normal because they are taking so long to recover from grief. Let them know it is totally natural to have various emotional reactions that they cannot control or their physical disorder continues. Tell them it is alright to cry if tears form.

 

2)Cases of grief, conditions of their grief, the impact of bereavement, and ways to cope with grief are very different to each person. It is important that supporters understand typical grief reactions. Remember that it can be harmful for supporters to interpret the bereaved’s thoughts and grief reactions or give them easy advice about how to cope with their grief. It is important to respect the way a family accepts bereavement and how they are trying to find meaning in their loss.

 

3)It is very important to spend normal daily life, such as waking up in the morning, changing clothes, eating three meals, and organizing accommodations and work. It is also very important to discuss practical issues, such as holding a memorial service, arranging a grave site, and arranging childcare for busy parents. If there are daily matters that can be supported, ask the bereaved family what they want supporters to do first. Even if that means support for material things, such support will help in their psychological care.

 

4)After losing a loved one, people lose a source of peace in their heart. Keep in mind that the words like “Do your best” can be a burden to them at such a time. Some bereaved family members may need to see medical doctors or to take medication. Note that the idea of “Overcoming through one’s own mental strength” may be inappropriate in many cases.

 

5)When a supporter has built good and trusting relationship with the bereaved family, it may be good for the supporter to provide them with the following information:

  •  The grief period is different for each person, and each member should recover at their own pace.
  • The first and most important matter is to live a normal daily live, getting enough sleep and eating three meals a day.
  • It is more appropriate to talk to someone you trust about your feelings and experiences rather than keeping them to yourself.
  • Anniversary days, including the birth date and death date of the deceased, wedding anniversaries and memorial days may bring back memories and make family members feel sorrow again.
  • It is also effective to consult with experts when they feel troubled.

 

※Referenced from Noriko Setou and Noriko Murakami (2011). “Care of the Bereaved Family Following Traumatic Bereavement – Understanding Loss and Trauma (Japanese)” on “Supplementary Volume of the Latest Medicine: PTSD” edited by Nozomu Asukai. Saishin Igakusha, and others.

Supporters’ burnout

Relief work during and after a disaster can cause many stresses. Witnessing dead bodies and tragic scenes in the course of relief work, being exposed to the grief and other emotions of victims, and feeling guilty for not responding adequately as a provider of support are some of the most common examples.

 

In particular, listening to stories of the bereaved is said to be extremely stressful and accompanied by feelings of helplessness and frustration, even for skillful and experienced supporters. The effort to respond sympathetically to stories of bereavement and to understand their feelings is itself known to be exhausting for supporters, which has recently been referred to by the term ‘compassion fatigue’ or ‘secondary trauma’ (1995 Figlay, 1999 Herman).

This compassion fatigue is a form of burnout, which is one of secondary stress.

 

The way to counter compassion fatigue is to understand in advance that helping people with trauma could cause intense fatigue and helplessness, so you should try to get some rest for yourself. Get enough rest so that you don’t become overworked, and make sure you have a good personal life, including sleep, food, and relationships. Also, recognize that everyone has a limit to what they can do at work. It’s also a good idea to form a support team and share feelings with the support of your colleagues and guidance from your supervisor.

 

Be aware of the distance between you and the bereaved when you provide support. Too much distance between you and the bereaved is not appropriate, but too close is not good for either the family or you. If you have difficulty maintaining a distance from the bereaved in support, talk to the people around you. Maintaining an appropriate distance will help your support last longer.

 

Being able to ensure your own physical and mental safety is the most important thing you can do in bereavement care.

 

Support by family members, relatives and friends

Family members, relatives and friends are among the most important supporters, because they knew the deceased well, and they know how much bereaved family members loved the person.

You may not know what to tell the bereaved family, or, you may avoid talking about the deceased because the sorrow of the bereaved make you feel sad.

But in many cases, it is better to tell them you are also sad and feel sorry rather than avoid talking about the deceased. Sorrows cannot be lifted, but listening to bereaved family and providing support for their needs can help them.

 

Several ways of support

 

1.Do not act as if the loss did not happen.

  • First, acknowledge the loss and grief of the bereaved. Ignoring it as if it did not happen can give them more distress.
  • Phone calls and sudden visits may become burdensome to the bereaved family. Instead, sending an e-mail or letter is one way to contact them without causing strain. You can inform them that you, too, are sad and that you are worried about the bereaved. If you know the deceased person, you can share your memories about him/her and tell them the way he/she was wonderful. In the end of the e-mail or letter, add the line, “Do not worry about sending me a reply,” and show your sensitivity.

 

2.Listening to them

  • Talking to someone who actually listens to you can be a great help. Expressing feelings such as sadness, anger, and suffering can ease anguish. However, sometimes talking about difficult experience becomes hard. When that is the case, do not force them to talk about it.
  • Each person deals with their loss differently. Each person has the answer of how to make a compromise with their sorrow. Respect their own way of thinking and answers.
  • If you sympathize and that brings a tear, you don’t have to feel awkward. Crying is a very natural behavior for both the listener and the speaker, and it is part of the recovery process. Also, it is natural to laugh while remembering the deceased. Expressing your natural feeling is a good thing.

 

3.Keep in touch with short visits, but over a long period

  • The consequences of losing a loved one can last months and years. The ones who have lost their loved ones will remember the deceased on each anniversary including their birthday and day of death. It is very helpful for others to understand that their grief may continue for years and provide support at such occasions.

 

4.Support for daily life

  • Losing loved one can pose problems for a bereaved family’s everyday life. First step of helping their daily life is asking what help they would like to have. Support can be given in many different ways, including going grocery shopping for them, cooking, taking care of their children, and undertaking necessary procedures for them.

 

5.Other things that can help the bereaved

  • When you see the person next time, tell him/her how sorry you are about the incident. The person may have been thinking about the incident over and over, and that is a normal condition in the bereavement process. In many cases, the bereaved often sort out his/her mind by repeatedly telling the same story.
  • Talk about the sadness of the bereaved as much as he/she wants. Also, talk about the deceased in the same way you did before.
  • If the situation allows, attend the funeral ceremony and memorial services.
  • Tell the person to take care of his/her own health. Tell them to eat well, take a rest when required, and when they have any health concerns, ask for medical help. For that, discuss what you can do to help, if possible.
When you go to disaster areas from the outside

Immediately after a disaster, a lot of people from outside areas come to the affected region. While this is very gratifying for the victims, it will create new tasks for them, such as coordinating these outside volunteers and preparing first-time visitors to understand the situation.

 

In recent years, people who come to help disaster struck areas from outside are required to have the capability to provide support so it is easier on the people of the affected area. At the time of a disaster, it is very important to sufficiently understand the circumstances, local culture and people’s situation in the affected area and provide support that meets the needs of the local people without causing any additional burden on them.

 

The following are matters that supporters should consider when they enter disaster struck areas:

 

 

1.Recognize the fact that you can help only for a short period. There are certain types of support that only local people can provide in each disaster area. Try to help those people. Don’t forget to offer words of consolation to local supporters.

 

2.When starting support activities, focus on what the people in the affected areas want and need in order to offer support that can be provided now.

 

3.There are differences between what you should do and what you can do. It is also important to consider the local manpower.

 

4.Handle information with care. Handle information that should be shared with other supporters and those requiring protection of privacy separately.

 

5.Supporters from outside of disaster struck area also should be careful not to overwork or burnout. It is easy to become excessively active in a disaster struck area due to the willingness of providing help and mental strain. Note that people with traumatized experiences can cause intense fatigue and helplessness. Therefore, take sufficient breaks when conducting support activities.

Being involved with children in the affected area

1)When school teachers are involved with a child who has experienced loss

 

The most important thing for children who have experienced a disaster is to regain a usual daily life as early as possible. Establishing an environment for ordinary school days helps children regain a sense of security. In addition, teachers’ considerations at school can be a great help in restoring well-being for children and their parents. Special

consideration is required when a child has lost his/her parent or sibling or is forced to live apart from his/her parents.

 

2)Changes in children’s minds and behavior after experiencing loss in a disaster

 

Children’s behavior after a disaster vary due to age and from individual to individual. These include being startled at the slightest noise, crying at night, being selfish and emotionally dependent, not being able to stay calm, having difficulty concentrating, decreased schoolwork proficiency, having difficulty fitting in a group, and showing physical symptoms such as asthma and allergies. Do not assume they come from temperament, but take these signs seriously. Scolding and attempted persuasion are often counterproductive.

 

When a child loses a parent or sibling, they usually express their grief differently than adults. While some children may continuously cry, others may become mischievous or act as if nothing happened. Often, children think they have lost a loving family member because they were bad or of their own fault. In any case, acknowledge the way they grieve and respect each child’s presence. Also, try to understand that there are feelings that cannot be expressed in words, and communicate with children in a way that gives them a sense of safety.

 

Grieving usually lasts much longer than we expect. Even though their lives settle down as they get used to their new school and are seemingly well, children never forget about the disaster, the place they grew up, the people they lost, their dearest friends and teachers, and the difficult condition their families face. The sadness in their hearts never goes away.

Even years after the incident, some children start feeling they are somewhat different than their friends, being spooked by the slightest tremor or darkness, or feeling uneasy at the sound of an ambulance or fire trucks. It is necessary to provide long-term mental health care for affected children.

 

 

3)Points to keep in mind when supporting children

 

In some cases, children may seem fine but cannot talk about their feeling with their parents and surrounding people. They may be anxious, afraid, or strongly blaming themselves. Teachers should try to talk to those children whenever possible. When needed, repeatedly tell them “If you are worried about something, come and talk to me anytime,” “You are not responsible for what happened,” “You can talk about difficult things,” “You don’t have to be embarrassed by not being able to do this,” and so on.

 

Be interested in children’s words and their emotions. Also, don’t rush them during conversations. It is meaningful for those children to express their feeling. However, do not try to force children to talk about subjects they want to avoid.

 

If children are not feeling well physically or mentally or showing problematic behavior, talk to them using simple words such as, “When a person experiences something like this, anybody can become uneasy.

 

There is no need to actively avoid talking about earthquakes and people who died just because you are afraid of causing emotional trauma. Children usually feel more at ease if these subjects come up in the natural flow of conversations. Always try to answer any questions children ask you politely. If there are questions that you cannot answer, be honest and tell them, “I don’t know the answer.” When adults are always honest with children, they will gradually understand the meaning of the event.

 

Children may suddenly start to cry when remembering earthquakes and family members, or even when nothing is happening. In that time, try to make them feel they are not alone by rubbing their backs or hold their shoulders. This kind of attitude by teachers can help other children to foster compassion.

 

It is common for children who experienced disasters to take things out on objects and other people. They may engage in playing “earthquake” or “tsunami” which may be considered inappropriate to grownups. This is another sign of feelings that they cannot express in words.  But at the same time, it is necessary for them to express their feeling. However, if they engage in impulsive behavior that is dangerous to others, stop them immediately. Tell them about the minimum rules and safe practices and act within the safety framework. Teachers also need to watch over those children.

 

If there are counselors or social workers assigned to the school you work, it is also important to work with them.

 

4)Believe in children’s resilience

 

No matter how great the trauma, children are more resilient than adults when they have enough support from others. Never lie to children. Also, do not make promises that you cannot keep. Watch the process of children accepting reality little by little as the adults around them support the children in cooperation.

 

In the event of a major disaster like the Great East Japan Earthquake, don’t urge children to forget or overcome the event. Also, don’t be impatient and try to help them at too early of a point. It’s important that children learn little by little at their own pace to understand people can live with hope even when an incident out of their control occurs.

 

*Referenced from Daggy Center (USA) [ed.] (2005). “35 Ways to Support a Child Who Lost an Important Person, Pear Tree House”.

Linda Espy [Author], Kaori Shimo Inaba [Translation]. “Our teachers are children! -A book to support children’s grief”, Aomisha.

When we relate to parents of children in a disaster struck area

【When school teachers interact with these parents】

 

Support for parents after a disaster leads to the supporting of children’s emotional well-being.  When teachers help these parents, keep the following in mind:

 

〇 Try to understand the condition of the parents/guardians of disaster affected children. Parental situation has significant impact on the physical and mental safety of children. If parents are extremely tired and sad, have emotional ups and downs, are unable to fully engage with their children in order to rebuild their lives, or reduced to poverty due to the disaster, it may be difficult to change their current home situation or form relationship with their children. That’s why it is very important to support children at school. Try to give consideration to those children so they can spend time as ordinarily as much as possible.

 

〇Maintain contact with parents/guardians after the disaster, even if it comes at intervals. Condition at home may change one after another after the incident and that may affect children. It is important for teachers to know these condition changes.

 

〇It is possible that parents/guardians have suffered great emotional trauma due to the disaster. When talking with them, try to match your mood and tone of voice with theirs. Keep a calm tone of voice and a listening first attitude, and try to ease any tension in the conversation. In talking with parents, you may hear about difficult family situations. When this happens, just being there and listening to them can be a great help.

 

〇For parents/guardians who are overly concerned about their children, provide appropriate information about support organizations, specialists and specialized institutions (pediatricians, psychiatrists and psychosomatic physicians specializing in children, child counseling centers, public health centers, mental health and welfare centers, etc.) and encourage them to contact these supporters.

 

〇When children lose their parents or siblings, or they are separated from their parents, their lives have completely changed. Sufficiently contact current caregivers and discuss ensuring the children’s stable care and normal lifestyle.

 

〇There may be children and parents who seem to do better when consulting medical professionals. If they haven’t been visited medical specialists yet, encourage them to do so. For families with financial difficulties, recommend visits with a school counselor (SC), school social worker (SSW), child counseling center, or welfare office.

 

〇Teachers themselves may have difficulty in dealing with parents and children. If supporting them becomes difficult, consult with supervisors, colleagues, and/or experts (SC, SSW, etc.). In particular, teachers in disaster struck areas are likely to be also suffering from the disaster and/or losing their students, leading to an emotionally burdened, and difficult situation. It is important that teachers don’t carry all the problems and push themselves too much.

Psychological First Aid (PFA)

Psychological First Aid (= PFA) is one of the psychological support methods that is provided by supporters in the acute phase of a disaster. In recent years, Psychological First Aid (PFA) has been recommended in various international guidelines for large-scale disasters.

 

The Japanese version of the Guide of Psychological First Aid (2nd edition), created by the PTSD Center in the U.S. in 2009, is now available for download from the website of the Hyogo Institute for Traumatic Stress. The guide shows the basic proper attitude of supporters for people in detail and is very useful in providing support in the early stages of a disaster.

 

You can see the guide at the following URL.

 

〇Website of the Hyogo Institute for Traumatic Stress

http://www.j-hits.org/english/

“Psychological First Aid Implementation Guide 2nd Edition”