Grief, the elephant in the room

15 Oct 2018

By Alif Amsyar

NENEK, as I affectionately called my late grandmother, taught me the importance of being thrifty when I was seven years old, but gave in when I shamelessly demanded Pokemon trading cards. When I grew older, she always supported my endeavours quietly but ardently.

As she aged, her health deteriorated and she was eventually diagnosed with a terminal illness. My family had to prepare ourselves for the worst. My grandmother was bedridden for the three months leading up to her death. As I watched her struggle to perform basic movements, I prepared myself mentally by assuring myself that my emotions would be under control if she were to pass away earlier than expected.

I was completely wrong. On my 24th birthday, my grandmother took her last breath. My world crumbled and for the first time in my adult life, I grieved.

The period of sorrow also gave me an opportunity to rethink society’s perception of grief, and I believe that we need to offer more support to the bereaved and allow them to talk about death more openly.


An awkward conversation

My friends were incredibly empathetic during my period of mourning. However, through this experience, I realised that most people, myself included, are unable to express how we truly feel when our loved ones die, perhaps because there is simply a lack of vocabulary to do so.

This stems from the perception that death is often a taboo subject. When my grandmother passed away, many of my family members were reluctant to speak about her passing and were afraid such conversations would make others uncomfortable.

In addition, we are influenced by social and cultural pressures which affect how we process grief, that is, to express it or suppress it. These reactions may vary greatly between individuals and evolve over time, creating constantly changing emotions, according to consultant psychiatrist Colin Murray Parkers in his book Bereavement in Adult Life.

Take my family for instance. Based on our religious customs, offering prayers, as opposed to outward mourning, was seen as the best way to respect the death of my grandmother and to express our grief.

A 2010 study on grieving Malay and Muslim youths in Singapore found that spiritual growth was perceived as their way to getting closer to God and maintaining a spiritual relationship with the deceased. Through prayers, I found myself holding on to a connection with my late grandmother, even if it was an intangible one.

People manage grief in different ways according to their cultures and traditions. They also have their own coping mechanisms. Consultant psychiatrist Parkers’ findings also found that the bereaved often try to avoid reminders of their loss and suppress their expression of grief.

This could be a coping mechanism, or worse, societal pressure to maintain an image of calm and poise. If it is the latter, this elephant in the room could be addressed through open discussions about death which are also sensitive to the feelings of people who are grieving. To enable this discussion, a better support system needs to be established.


Existing support systems

On an institutional level, studies on grief are conducted in Singapore to find out ways to give better. emotional support to grieving caregivers and relatives.

For example, the Singapore Hospice Council commissioned a study last year to find out how people deal with loss, and whether current services are adequate in meeting their needs. The council also set up a grief task committee, comprising healthcare and social sector professionals, to look into this area.

"All of us experience losses in life, be it relationships or our identity or roles in life, and we don't deal with those losses very well," said Dr Angel Lee, who chairs the council.

Separately, the Ministry of Health has also initiated discussions with HCA Hospice care, Singapore’s largest palliative care provider, to improve the support system for family and caregivers of those who have passed on, reported The Straits Times in 2017.

Organisations such as the Institute of Mental Health and Agency for Integrated Care have also set up a variety of channels like live chats on their website, email, social media and hotlines to enable grieving Singaporeans to reach out to them. Individuals can seek professional help in times of grieving through these hotlines.

For instance, Hotline 800 is dedicated to the Mandarin speaking community, while the AMP Hotline caters to grieving Malay and Muslim families and the Singapore Indian Development Association (SINDA) helps Indian families in need of assistance or counselling.

But these channels are not always successful in helping the bereaved.

In 2016, the National Council of Social Service (NCSS) spoke to some 35 widows who were mostly over the age of 50 to find out their needs. The widows said they found it difficult to share their grief with family and friends, whom they felt were not understanding and empathising with them enough, according to The Straits Times in 2017.

The plight of these widows highlighted the lack of support programmes for grieving individuals in Singapore.

“Grieving and bereavement are often seen as private issues. Furthemore, death and dying tends to be taboo in our culture,” said NCSS deputy chief executive Tina Hung.

“Seniors in their grief journey often experience uncertainty, regret and pain, and they may be unable to find closure without external help,” she added.


Improving the way we manage grief

The scope of existing programmes needs to be broadened to reach more people, as this would result in a better support system for the bereaved in Singapore.

Firstly, the government could establish a more accessible system which allows grieving individuals to share their experiences through applications on their mobile phones, instead of through a hotline. The mobile applications can offer functions such as virtual hugs, live chats with professional counsellors, and forums where grieving individuals can empathise with one another.

For example, American mobile application My Grief Angels allows its users to be there for one another during difficult times. Such an application can be tailored to Singapore’s context to cater to the needs of grieving individuals here.

In addition, there needs to be a comprehensive guideline for those offering a listening ear on how to properly support a grieving individual. These guidelines can be taught in schools and through a nationwide campaign. Singaporeans need to be exposed to taboo topics such as death, with teachers and professionals facilitating these conversations.

Pets are a good start. We can encourage individuals to express their thoughts about their pet’s death, if they had one. This strategy is especially suitable for children, who might not fully understand what death is about. If we are able to cope well with the death of a pet, whom we see every day and interact with often, chances are we'll be able to manage the death of a loved one much better.

It is also important for us to have open conversations about the death of a loved one, instead of avoiding the subject. We can also help the bereaved by asking them simple, non-intrusive questions such as “Do you feel like talking?” and “How are you coping?” to let them know we are there for them.

The grieving process is different for every individual, and can be a sensitive topic. Well-planned and thoughtfully designed programmes to comfort the bereaved can help them suffer less emotional stress during a difficult time.

While death is inevitable, we can do more to create a better environment and support network for people who are grieving.