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For most people residing in England, say the word mental illness and it conjures up images of ‘mad people' going about attacking people indiscriminately. For those of us who have lived in Africa, one might have a slightly different view. Having spent my teenage years in Apapa, Lagos, I can still visualise the local ‘mad man' walking round the area stark naked and behaving irrationally.  However, mental wellbeing is so much more than overt symptoms of ‘madness'. Believe it or not one in three of us will be affected by mental ill health at some point in our lives!

This column is geared towards mental health in all its dimensions whether it's mental illness per se or mental health promotion. I will be looking at anything and everything that affects mental wellbeing. If you have any questions, please send an email to newsletter@amlappublishing.com. If I do not know the answer, I will find someone who does.  Furthermore, if you have any topics that you would like me to comment on, please let me know so that I can cover these in future.

In this edition, I'm getting the ball rolling by looking at "Bereavement".

There's only one certainty in life and that is death will come to all of us at some point. The Bible says "It's appointed unto man once to die and then judgement".

The late Agatha Chrisitie said "I live now on borrowed time, waiting in the anteroom for the summons that will inevitably come. And then - I go on to the next thing, whatever it is......"

Most if not all of you reading this would have been touched by death in some way at some time - the loss of a loved one, a colleague, friend or some-one you knew at your place of worship.  For obvious reasons, bereavement has been studied quite extensively.  A number of individuals have described various stages or components of bereavement.  I also think there are analogies to these stages and the emotions that people feel related to any form of perceived loss.  The description that I personally find all encompassing was outlined by two researchers called Ramsay and Groot in 1977. They described nine components of grief which don't all necessarily happen to each individual, or in any particular order. However, I believe experiencing the last two stages is vital. The components are as follows:

Shock :  This is normally the first stage.  People often describe the feeling as "numbness” or say that the news was "unreal". Some of you may recall being told this by someone who has suffered a loss or experienced it yourselves. It is as if the reality of the news is too much to take on board initially.  Some of us might remember a relationship breakdown and thinking "This is not happening to me. He (or she) promised to love me, stay with me...." This stage can last from seconds to weeks.

Disorganisation : This is exactly what it means -feeling disorganised and having great difficulty organising one's thought or actions.  This is entirely natural and it's a great help if having found yourself in this position, there are people who can literally step in and take over.  Alternatively, others may be overly organised until after the funeral when they seem to literally collapse. For many, it is the funeral that brings the reality of the loss home.

Denial: This is behaving as if the deceased person were still alive. It tends to happen early on, but can occur at any time. It could take various forms e.g. setting his or her place at the dinner table, refusing to get rid of the person's possessions, talking about him or her in the present tense, or a  seemingly inability to rearrange one's life without that person.

Depression: This can occur at any point during the grieving process. However, it usually tends to be most intense as the bereaved person is coming out of the denial stage. It can also reoccur around special occasions i.e. birthdays, an anniversary or holidays.  Even years down the line, a particular song for example can still bring all the same emotions to the fore. The symptoms may include feeling low, pining for the deceased person, not sleeping or eating properly, crying, feelings of helplessness, hopelessness, despondency or despair and in extreme cases not being able to function normally. 

Guilt : These feelings can occur quite commonly. Sometimes these feelings are unrealistic. However, they are entirely normal. There is often the feeling that one should have or could have done more for the deceased person or in some way prevented his or her death. Another side to the coin is feeling guilty about moving on with one's life e.g. the spouse, who feels guilty for embarking on another relationship, or has engaged in an activity and enjoyed themselves.

Anxiety : Anxiety is a very common emotion during the grief process. It may centre on very tangible issues e.g. the practicalities of day to day living without the deceased person, about "loosing control" of one's feelings, not coping or knowing how to appropriately support others who are directly affected by the death.

Aggression : This often occurs earlier on in the grief process. There can be feeling of anger and aggression directed to family, friends and even the deceased. It's a very common emotion to feel anger towards the person who died especially if they died young or their passing will (or has) led to practical difficulties. Some people get angry with God, the church or even doctors and nurses.  I can never forget being on duty in a hospital in Lagos and having to tell relatives of the passing of one of my patients who had died very suddenly and unexpectedly.  They became frighteningly aggressive, almost physically assaulting me and my colleague.  It is also common to be angry when a relationship breaks down either towards the instigator of the break up or oneself. "How dare he (she) treat me so badly, leave me” etc "How could I have been so stupid to get into the relationship in the first place?”

Resolution :  This simply means coming to terms with the death of the person and the acceptance that life must and does go on. This is more of a mental affirmation of one's circumstances.

Reintegration : Essentially, this is the outward evidence of resolution i.e. the reorganisation

of one's life without the deceased person and moving forward. Bereavement and Grief are as individual as people. There is no right or wrong way to grieve and to some extent both may be determined by culture, religious beliefs, or lack of them, social support and or the relationship one had with the deceased.

One's natural temperament may have a part to play.  It goes without saying that the closer the relationship, the more intense and painful the process.  It is also known that if the death was in respect of a child, sudden, unexpected, or occurred in unusual circumstances, the bereavement process can take longer.  This may also apply if a person had an ambivalent

relationship with the deceased or if one may have had a part to play in the death of the deceased i.e. a road traffic accident in which one was driving. People tend to cope better if they have a faith and put the death into some form of eternal perspective. The Bible says for example "O death where is thy sting. O grave where is thy victory?" 

Linda Jo Jackson said "Perhaps my time seems all too brief; don't lengthen it now with undue grief.. God wanted me now, He set me free".  

Generally, one is expected to have reached some form of resolution and reintegration after

six months although it may take considerably longer. If one is not coping with day to day living after six months, one might need additional support. This could be offered by a close family member or friend, or alternatively, the bereaved person might require or feel more comfortable getting outside help from the likes of a GP, Church pastoral team, Bereavement counsellor, or Psychiatrist.  If you are based in England, I would also recommend CRUSE Bereavement, an organisation which specialises in offering free bereavement counselling.

In the next edition, I will be talking to some people who have gone through the bereavement process and gleaning from them some practical tips on how they have managed to cope with their loss.

Dr Shade Olajubu is an Associate Specialist in Forensic Psychiatry and has just taken up a new post at the Farmfield Hospital in Surrey.