Here is a short guide to the four main stages of mourning. It was originally written for dealing with the loss of friends or loved ones when they die but the stages of mourning apply to any loss, including loss of health to cancer. Hopefully, people who are experiencing difficulties can decide whether they need to see a counsellor to help them if they are suffering abnormal grief reactions or are finding it difficult to move on.

We all suffer loss in our lives, whether loss of a loved one, a loved pet, our health, a way of life or anything that we held dear and which made us happy that we then lose or believe that we have lost. It is known that there are four main stages or tasks involved in mourning any loss: -

1. To accept the reality of the loss  Even if we know that someone we love is going to die or leave us, it is still difficult to come to terms with and to believe that itís happened. Equally, it is difficult to come to terms with the loss of our health. Stage One is the slow realisation that it really has happened and that the person isnít going to come back or that our health won't ever be the same again. Many people think they see or hear loved ones and this is a very normal part of the process of coming to terms with the reality that youíll never see that person again. This first task can sometimes go wrong and people get stuck in denial or they may try to diminish the feelings by rubbishing the importance of the person or that our health will be the same as it always was. It only becomes a real problem if the reality is denied for years or if the person grieving doesnít move onto the next stage. This isn't to say that someone with cancer won't recover completely and eventually regain full health, but it is important to accept the reality.

2. Coming to terms with the pain of grief  The pain of grief can be absolutely unbearable and people often feel that it will never end. Very often, itís the fear of this intensity of grief that holds people in the first stage. However, if this stage of grieving isnít undertaken, the grief can leak into other behaviours or pop up when least expected. It can manifest itself in symptoms of illness or depression. Very often, others around the bereaved will unthinkingly try to hinder this stage because seeing someone elseís pain can be very difficult and a lot of people want to avoid it at all costs, so they might try to jolly the bereaved out of their sorrow or hint that they should be getting over it by now. This could lead to the bereaved feeling guilty or thinking that they shouldnít be feeling what they feel and they may start to suppress what they feel rather than be working through it.

3. Adjusting to life without the deceased or living with the loss Very often, the realisation that the bereaved person is having to cope on their own if, before that, they had the support and presence of the deceased person, creeps up gradually. Relationships often define the people within them i.e. a wife may feel that she is only her real self as a wife or a son may feel that he has no sense of who he is as a man when his father dies. This adjustment has to happen but it may throw the person into feeling like a helpless child again and that society doesnít recognise or respect them without the cloak of their previous role. It can be very scarey if youíve always been loved and protected to suddenly feel that youíre on your own and that whatever decisions that are made in future belong to you alone. It can also be a positive experience, of course. Equally, the person who has cancer which either can be treated successfully or is untreatable will need to go through the painful process of adjustment and to accept that life may never be as it was before.

4. Emotionally relocating the deceased or loss and moving forward  The final stage or task of grieving is when the deceased person or way of life in the case of illness becomes part of the bereaved personís past life and is given an appropriate place within the emotional life of the bereaved but not one where they are interfering with the person moving on. Unless this is achieved, mourners would not feel they could move on with their lives in case they forget the person that they have lost. Wives or husbands might feel they are betraying the previous spouse if they meet someone else and children might feel that they couldnít move on to become adults without being guided and supported by their parent. If someone is suffering from a terminal illness from which they will not recover, this stage is seen as acceptance and coming to terms with what is to happen. Saying goodbye to loved ones, doing something that the person has always wanted to achieve before they die and making sure that they have left everything as they want it is important and some people even like to choose the flowers and hymns that they would like to have at their funeral. Mothers and fathers often leave a scrapbook and photo album leaving precious photographs and telling their children about themselves or things they feel it's important to tell them. Some even leave letters to be opened when the children are older - all is part of the emotional adjustment to dying and not being there for their children as they would have wanted to be. It's important for the person who is dying as well as for the people who are left.