What is normal when it comes to grief? And can it become a mental illness?
Airdate: 
Tuesday, April 17, 2012 - 20:30
Channel: 
SBS One

Insight looks at whether it’s possible to put a timeframe around grief, whether it can be managed, whether anti-depressants help, and whether some cultures are better than others at dealing with this powerful emotional state.

Currently, grief reactions are not included in the mental illnesses handbook, DSM (Diagnostic and Statistical Manual of Mental Disorders), as it is considered a normal human response to bereavement. Some psychiatrists argue, however, that acute grief experienced for more than 12 months should be classified as a new psychiatric disorder in the next edition of the DSM in 2013.

As well as experts on both sides of the new proposal, Insight hears powerful personal stories of loss to find out how Australians of all backgrounds are managing their grief and what, if anything, is helping them get through.

Producer: Jane Worthington
Associate Producer: Hannah Meagher and Sarah Allely

Interview with Mohammad Siaj

Mohammad Siaj is a former taxi driver from Wollongong. He was on duty the day nine-year-old Yasmina Bianco was hit by a train at Coledale in January 2011. He met Yasmina’s mother, Julia, shortly after the accident. They both believe their meeting was destiny. Read the interview here.

It's not goodbye, but see you later ...

Insight recently visited Nan Tien Temple, where Buddhism devotees gathered in April to celebrate Qingming or ‘grave sweeping day’. It’s an annual festival where Chinese around the world pay tribute to their departed loved ones. It is not a sad occasion - Buddhists believe you’ll meet your loved ones in another life, so death is only a temporary farewell.

Helplines

Traumatic Stress Clinic - operates out of Westmead Hospital in Sydney.
Ph: (02) 9845 7979

Australian Centre for Grief and Bereavement
Freecall: (Australia wide) 1800 642 066

Immigrant Women’s Health Service
Ph: (02) 9635-8022

GriefLink
Lifeline: 13 11 14
Kids helpline: 1800 55 1800

The Compassionate Friends
– support for bereaved parents and siblings
Ph: (03) 9888 4944
Freecall:1800 641 091

National Association for Loss & Grief NSW (NALAG)
Ph: (02) 9489 6644

Transcript

JENNY BROCKIE: Richard Bryant, I would like to start with you tonight. You're a psychologist. Do you think there is such a thing as a normal amount of time for grief?

PROFESSOR RICHARD BRYANT, PSYCOLOGIST: Normal is a funny word, Jenny. There is a period of time where we all grief. It's a period of time when we lose someone we love and feel intense emotional pain. Nearly everybody will have this and for a decent period of time. Whether there is a normal and an abnormal period is hard to say. But what we do know from the research that about 12 months, if I'm still having that very persistent pain beyond 12 months, it's probably going to be associated with a lot of problems that may not go away unless we actually help that person.

JENNY BROCKIE: So 12 months is a kind of cut off time where you should be shifting, you should be changing in relation to your grief – is that what you’re saying?

PROFESSOR RICHARD BRYANT: I really wouldn't say it's a hard rule like on an anniversary, obviously. It's a statistical cut toff if you like that a lot of research has pointed to that says that most people will tend to have their pain eased to a degree by 12 months.

JENNY BROCKIE: And if they don't?

PROFESSOR RICHARD BRYANT: If they don't, then - and they are still having that very persistent yearning and missing the loved one and if that’s going to be with them every day so that they really can't function – and what a lot of the research from a lot of different countries tells us that across most countries about 10% of people might fall into that category. It's associated with a range of serious problems that we're worried about, psychological disorders, suicide, alcohol, smoking abuse, increased cancer, cardiovascular problems. So it is actually a significant public health issue. This has actually been linked to serious issues that affect many, many people.

JENNY BROCKIE: Gordon Parker, you're a psychiatrist. Do you agree with what Richard is saying?

PROFESSOR GORDON PARKER, PSYCOLOGIST: Not entirely because I think putting a 12-month finite period runs a risk. I think the quite conceivable that you could lose somebody so close to you that you would never effectively completely get over it. And reading that wonderful book by Bert Facey called 'A Fortunate Life’ describing incredible adversity, and yet he said the death of his son was something he would never recover from. So i think it's allowable that you can move on in certain ways over a matter of months and maybe over the first 12 months but there are some times when grief will go on forever. And i think that's not necessarily to say it's a problem or to pathologise it. I think it's part of the normative expressions of grief.

JENNY BROCKIE: Ali, your son Alem took his life after a bullying incident three years ago. How far do you think have you’ve come with your grief in that the years?

ALI HALKIC: Firstly, I would like to say I agree with you totally. I think when we lose something that’s so close to us, I think discovering ourselves is one of the hardest things to do and some people take longer than others. On my side of it, you know, I will never, ever get over the loss of my son - ever. It's a curse that I live with every single day.

JENNY BROCKIE: What does that mean for you day-to-day? Describe to me what that means in practical terms, in terms of your life?

ALI HALKIC: Well, you know, we can go somedays two or three days and not be affected and some days I may just jump in the car and you just breakdown. You know, I think a part of me went with him that day and it's some part that I will never get back and be able to hold and touch ever again. For anybody to come and tell me that, you know, there is a period for me to let go, um, that's um just doesn't sit well with me.

JENNY BROCKIE: Has it lifted at all, the grief?

ALI HALKIC: We, you know, in my time especially with the psychologists and along our journey, you know, the disgusting word for me was "with time" things will get better. In my case with time - it's not getting better, it’s actually the reality and the surreal feeling he is not coming home ever is, you know, really, really affecting me more and more as the years go along.

JENNY BROCKIE: So it's getting worse?

ALI HALKIC: Oh, most definitely. I don't think it will ever get better.

JENNY BROCKIE: Julia, your nine-year-old daughter Yasmina died in an accident just over a year ago. You are coping very differently to Ali. Can you tell us how you are dealing with it?

JULIA BIANCO: Picking up there on the term "getting over it". It's something once you’ve been through, grief, it's a term you suddenly see very differently. Someone once said it to me, "Oh, you will finally get over it" and I said to them, "This is not an illness. I'm not going to get over it. I'm going to live with it." And i think that's what happens. You learn to live with it. I made a very conscious decision not let it live inside me, not to let the misery, the intense pain, not let it live inside me and to eat me away and to eat everything that I had away.

JENNY BROCKIE: How did you manage to do that?

JULIA BIANCO: I, I realised that I had to go on. I did have a period of time, I would say the first three or four months were agonising and it was a physical pain as well as a mental pain. And I, I got to a point where I thought I am either going to keep going down and perhaps never come up again. I did contemplate suicide because I wanted the pain to end. And then I thought really, what is that going to achieve? And I talked to my psychologist about it. He was very good. He said just exactly how far do you go with that thought? And i said, "I really just"¦I think about it, but I'm not going to do it." He said, "OK, well that's fairly normal." So I thought OK it's normal to have suicidal thoughts. And then I got to a point where I thought OK, I'm not going to go down, I have to go up. So how am I going to go up? I have to remember that we had Yasmina for nine and a half years of beautiful positive memories, a loving relationship and loving family and that's what we're going to take with us. I'm not going to spend all of my life on the moments at the train station when she actually passed on. And I made that very conscious decision and around that I made a number of decisions as well about how I was going to travel on that new journey.

JENNY BROCKIE: Ali, you can relate to that at all, to listening to what Julie is saying?

ALI HALKIC: I can. I think one of the most unnatural things that an adult as a parent would have to be to lose your own child. It's some feeling you wouldn't wish upon your worst enemy. But one of the things is trying to learn to adapt and move on. It's a hard thing to do. And especially when something that you created has left your life, it's something that people just don't want to understand.

JULIA BIANCO: I saw Yasmina as a gift. I saw that we were privileged to have her in our lives for nine and a half years and that it was a positive thing and that her life had finished. I can't say that her life was going to be longer. That's maybe all that we had her for.

JENNY BROCKIE: Dean, your younger brother was killed three years ago when he was set upon by a group of men. How are you coping now with the grief of losing your brother?

DEAN SAUNDERS: It still affects me today. I'm on medication and stuff like that to help me get through with depression and stuff. And I take the point where I still feel that because - in the manner in which he died is something that I can't accept. Because he was - for me he was murdered. If he died of natural causes or something else, that's something I could accept. The manner in which my brother was killed is something that I will never accept and I can never forgive those that did it, even though it's all gone through the courts and stuff like that. It's something that I’m never guna ever be able to get over. To me, he was my baby brother... That's why it still affects me now.

JENNY BROCKIE: Because he was younger than you?

DEAN SAUNDERS: Because he was younger than me. You have all those thoughts when it happened to him and stuff like if I would have been there to protect him would that have happened to him. But I have gone through like counselling and all that sort of stuff. For me, the support of my friends and stuff like that has helped me get through. I was the same, I got to the point where suicide I thought was an option for me where I was actually on the drive to where I planned to do it all and stuff like that. And at that point it was lucky I had my mobile phone with me and one of my really good friends rang and she said, "Where are you?" She just asked and said, "There is something wrong. What is going on?" And I woke back up to that I wasn't going to be achieving anything because in the long run it was guna hurt my family and my sisters and stuff that went through it.

JENNY BROCKIE: So that snapped you out of the state you were in?

DEAN SAUNDERS: I haven't had those thoughts again but the pain thatI feel in relation to the way he died...

JENNY BROCKIE: You're still really struggling?

DEAN SAUNDERS: I'm still really struggling with that. Because the environment in which I work, I work in a correctional environment. So those guys that did murder him are getting the same sorts of services that we provide to the offenders I work with and that’s something I struggle with that on a day-to-day basis, trying to accept that.

JENNY BROCKIE: That's really tough, to be in that environment when have you’ve been through something like that.

DEAN SAUNDERS: I think through my work they gave me those opportunities to get by and they provided me with counselling and stuff like that. Yeah, it's just, yeah, it's a day-to-day thing.

JENNY BROCKIE: Day-to-day. So it is literally day-to-day"¦

DEAN SAUNDERS: It is for me with coping and stuff. Because the manner in which he died is not acceptable to me.

JENNY BROCKIE: Mark, you're Dean's brother. What about the rest of the family and what about you?

MARK SAUNDERS: How we sort of coped was the cultural side as well. Like, we're a really big family. And really close. And so when that happened to our brother, um we all sort of came together. But it was amongst ourselves that we drew support.

JENNY BROCKIE: When you look at the way that Dean dealt with it did you deal with it differently to him?

MARK SAUNDERS: Part of my healing was when we went home to country out bush in south-west Queensland and that's where we did our healing.

JENNY BROCKIE: Are you in a different space to Dean do you think in relation to it?

MARK SAUNDERS: Yeah, I am.

JENNY BROCKIE: In what way?

MARK SAUNDERS: Um... Oh, look, including our brother, I have eight brothers. In amongst our family I'm like the spiritual one more so than the other mob, the other boys. And I'm the one that passes things to them and teaches them things and like when we went home to country there were things I did with them and stuff and no-one else could see and all those sorts of things.

JENNY BROCKIE: Amanda, you nursed your mum for four years before she died and she died just 11 weeks ago. Now, I'm interested in how you coped with that and how you dealt with that. Because you had known for a long time she was very ill. Describe for us how it was for you. Because it's very different to some of the other stories we have heard.

AMANDA NARVO: I probably found the dying process was quite a positive experience. Mum's last week at the hospice was brilliant. It was mum and dad and us five kids just hanging out, having lots of laughs, and watching YouTube clips so mum could pick the music that she wanted us kids to carry her out to at her funeral. Having happy hour at the hospice of a Sunday. It was just such a great family environment. I sort of felt like I got know all of my family a little bit better. We all muscled in.

JENNY BROCKIE: So different to all of these stories because it wasn't sudden"¦

AMANDA NARVO: Exactly. And I believe my grief started all those years ago. Because I'm a nurse mum would take me along to appointments. She had a bit of faith in me so she asked me to unravel what the doctors were saying. My grief started when we made the decision to have chemo or not, does mum have radiation or not. You know, being there virtually every day really and seeing her go through the process. Towards the end it was great she had a peaceful death and we were all there. She actually died on my son's birthday. So that to me was the true circle of life. All in one day.

JENNY BROCKIE: What do these stories tell us about grief, Richard?

PROFESSOR RICHARD BRYANT: The notion that ever using terms like letting go or moving on or anything like that - we never lose grief. If you really loved a person and you lose them it's forever. You always miss the person. That person’s always a part of you. It's a different part. Or the relationship changes. But the grief is there.

WILLIAM VERITY: Can I come in on that? The best story I have heard about that, about - certain types of grief has the capacity to destroy you if you let them into your life and you live too close to them. And it think we’ve seen some of that this evening. I once spoke to a woman, a Sudanese refugee, who was fleeing from a refugee camp and was being chased by soldiers. Shooting at her. She had her three-year-old son around her neck and she was running towards the river, which was the border. She got to the river and she was safe. And next to her was her sister in law who also had a three-year-old son similarly around her neck. And suddenly as she was running she felt the hands of her son go limp. And at the same time she saw her sister in law fall dead. But her nephew was still alive. So, she scooped up the nephew, put his arms around her neck and carried on running. And then she eventually came to Australia where she now lives. I was so moved by this story. I said, "How you can possibly live with that?" "How could you live with that grief?" And she said, "I keep it here." So she has it in a container to her side. She doesn't lose it and every so often she will take it and she’ll be with that grief and put the lid back on and she’ll carry on.

JENNY BROCKIE: How does that relate to your experience, because you and your wife lost your three-year-old daughter in a terrible accident eight years ago.

WILLIAM VERITY: Yeah, 2003. Well eventually what I have found - I won't speak for Caroline – what I have found is you find a way of living with the grief. In the end you don't want to get over the grief because the grief - grief is love.

CAROLINE VERITY: The pain is the love.

WILLIAM VERITY: Yeah. You don't suffer grief if you don't love. So as Caroline says, the pain is the love. In the end you don’t want to lose that. But at the same time you can't let it destroy you. You have to carry on.

JENNY BROCKIE: That's a very difficult road to walk, though. That difference between associating it with the love and holding it, as you are Ali, in a way holding it. And somehow trying to put it somewhere else at the same time. I mean - Gordon, when you hear that description, what do you think?

PROFESSOR GORDON PARKER: Well I think we're hearing the richness of human experience. As applied to one of the biggest life events that anyone can face. And we should expect great variation. As well as that, we have heard examples where grief has occurred after the death and we have also heard grief before the death of a mother, anticipatory grief. The latter, I think, really speaks to a celebration of life. I think that is, as was stated, a wonderful tribute for a life well lived. But so opposed to tragic stories of losing a child or losing a relative in abrupt circumstances beyond one's control, without the opportunity for saying what you want to say for any rapprochement for reconciliation.

GAIL KRAAL: My husband had cancer for 40 years. And I thought I was well prepared for his death. We would jump through hoops and land softly and they would tell us we were guna be OK. Jump through hoops, land softly we’ll be OK. And then they finally said, no, you're not going to be OK and I was still coping very well. I was holding him in my arms when he died and when he died I screamed. From that moment on I look back and I would go: there was no way I was prepared for that. There was no way that I had those four years and I thought I was and I was not prepared at all, and I have been struggling for the last three years to cope. But I felt that I'm a strong independent woman.

JENNY BROCKIE: So in a way you have surprised yourself?

GAIL KRAAL: I'm shocked that this is the person I now am and how I have handled it or how I apparently have not handled it. I have been told I'm not normal, that I have a personality fault.

JENNY BROCKIE: By doctors?

GAIL KRAAL: By doctors. One GP told me I should be over this in six months. So I feel like I'm not a normal person.

JENNY BROCKIE: See, this is interesting to me. Because Richard, I know that you're one of the people who is pushing for this idea of a definition around the 12-month period, that you think there should be a definition what have prolonged grief is. Can you do that?

PROFESSOR RICHARD BRYANT: I know this sounds confusing, because on the one hand we're saying we all grieve most of our lives and there will be particular times when it comes on in waves and we don't know why. Then we seem to be doing a bit better and it comes back, and we're all a bit different. But overall we do know that the majority of people, that very intense pain will tend to ease with time. And across many studies across many cultures, if you take the 12-month window - I know you have to draw a line somewhere and that's"¦

CAROLINE VERITY: Why?

PROFESSOR RICHARD BRYANT: That's a great question.

JENNY BROCKIE: It is a good question"¦

PROFESSOR RICHARD BRYANT: It's a great question to ask.

JENNY BROCKIE: It was the sort of the question I was trying to ask but much better.

CAROLINE VERITY: Where and why?

PROFESSOR RICHARD BRYANT: This will sound a little silly and a little technical and I apologise for that. The situation we have at the moment is we have nothing that helps identify people who are actually having a very persistent grief response. Now, they are having persistent pain. The problem that we're facing at the moment is that many of them, we think, and a lot of studies are telling us, is they are getting prescribed pills. They are getting inappropriate treatments because they are getting called depression or anxiety. This is the most important point. Where as the pills don't seem to be doing the job, people are coming up with more psychological interventions that are helping people. So it seems to us, if there are people hurting and it's persisting for a long time and we’ve got ways that can actually ease that pain, isn't it good if we can try to identify those people and give them something that might actually help them rather than just getting pills?

JENNY BROCKIE: I want to throw this open to all of you because you're all dying to make a comment"¦

WOMAN 1: If we’re not to medicalise grief, then giving grief a diagnostic category is actually medicalising grief. I think it's worth considering that and thinking about that.

JENNY BROCKIE: What do other people think about this idea of a disorder?

GAIL KRAAL: I have been going to psychiatrists and psychologists and counsellors for three years, chaplains"¦everybody. I go to these people who say I'm depressed. And I go: I'm not depressed. Look I kayak, I run, I get up in the morning, I look after my house, I'm out in the community, I’m doing all these things, I’m looking after my mum and visiting my family. I'm not depressed. I'm sad. I'm missing my husband that I was married to for 35 years. I'm sad. I need to have moments where I'm able to pay a tribute to him with my pain. I think that's what I do. A pay a tribute with my pain. I'm not depressed.

JENNY BROCKIE: That's a very interesting description, I think.

JULIA BIANCO: I would say the opposite has helped me. Yasmina would not want me to be miserable and crying all the time and pulling my life down and everybody - Loris, my husband with me. Yasmina loved life. So that's what we have to do. We have to honour her. This is not about me. This is not about Loris and myself. It's Yasmina who lost her life. It's not about me.

WILLIAM VERITY: I think it is about you. It's your grief.

JULIA BIANCO: It's grief.

WILLIAM VERITY: It's your grief, not Yasmina's grief.

JULIA BIANCO: But Yasmina would not want me to be like that. She would not want me to carry that burden.

WILLIAM VERITY: That's of the intellect. And grief is far more powerful a man. My experience of grief is that you just - it's like a kind of stormy sea. It's not something you can make intellectual decisions about and say, "I will decide to do it in this way." You do it in whatever way you can.

JULIA BIANCO: Absolutely. You try different things. One of ours was going to India, going backpacking for her 10th birthday. That was one of the things we tried. But I keep in mind all the time, "What would Yasmina want us to be doing?" And that's what keeps me going. She would want me to be positive and so we are.

JENNY BROCKIE: Juliana you were nodding when William was talking then. I'm interested in what you think about this. You lost your mother, sister and cousin in a bus accident in Ghana just last November, so not that long ago. What do you think about what you're listening to and what is your experience of this?

JULIANA NKRUMAH: Kind of a feeling that takes your mind, your whole being. It's shocking. You don't make sense of it. But it's the people around you who help you to sort of put things in the right way. I'm coming to talk about rituals. The rituals that we use to help us with our grief. Not the medication. Not the psychiatrists, I'm sorry. But the rituals. Because we ritualise the grieving process. We didn't have a funeral for my sister, my grandmother and my mother until February, January, February. So we gave ourselves time to think, to prepare, to talk, to prepare music. Because we do things with music. We grieve with music. We happy with music. So we prepared all that and made it meaningful for each one of them and walked the path with the community in that process. That one year mark - traditionally we have that one-year date when we come back together and ritualise their departure and ritualise the fact that from here on we have truly separated. So we have one week, 40 days and one year. So that period is a grieving period and it's a period where we mark each of them with rituals. And these are rituals that we carry with us.

JENNY BROCKIE: I'm interested in getting on to rituals and the things that have helped people. We were talking about this before the break. Julia I know when you first heard the news your daughter had died, and that was very sudden news.

JULIA BIANCO: Yes.

JENNY BROCKIE: An ambulance chaplain asked you if you wanted to talk but you chose to talk to somebody else. Who was it and why?

JULIA BIANCO: I just felt at that moment because I had accepted what had happened - and I think acceptance is a very important thing"¦

JENNY BROCKIE: That early?

JULIA BIANCO: I knew I couldn't do anything. I knew - in fact I kept asking people, "Has she gone?" I needed to know. My neighbour who was there with me, I said, "Please find me someone who will talk to me honestly." They came over and said, "We're very sorry, but she has passed on." I needed to know that. Because I just, I had to accept what had happened. I had seen her, the train had not run over her. She was just lying on her side and she looked like a sleeping angel and I wanted to keep that memory of her. So, when the ambulance chaplain came over to me and said, "Would you like to talk to me?" I surprised myself by saying, "I would actually like to speak to a Muslim." And what was going through my head - for me but also for Yasmina, I wanted to have a Muslim there to say prayers for us. Now, I"¦

JENNY BROCKIE: Are you a Muslim yourself?

JULIA BIANCO: No, no.

JENNY BROCKIE: Where did you get the connection with Islam from?

JULIA BIANCO: From travelling and living in an Arabic countries and living with the Saudi Arabian students. And they accepted us into their community and I learnt to understand there is a lot to be said to not presume you will be living in three or four weeks time. Every time it became a joke – Insha Allah, Insha Allah and that was fun. We used to joke about it, but I really took it too heart. When I said I want a Muslim, I surprised myself. Within minutes a taxi driver came up to bring one of the authorities from the Rail for the investigation because it was a crime scene. That's what they had to do. I looked over and saw a man of Middle Eastern appearance and he had a great big beard. I thought there is my Muslim. So I went over to the taxi, asked him to put his window down and said, "Are you Muslim?" He looked at me and he said, yes, and I said, "This is what has happened, I would like you to say prayers for her." He said, "Are you Muslim?"" I said no, no I’m not, but I believe in destiny. And he said 'get in my Taxi." Everyone just looked at me. I said it's OK, I know what I'm doing. And so I sat in the taxi and Mohammed said prayers for Yasmina. I just found that really helpful. I then said to him, please say prayers when it's your next time to say prayers. Over the radio came a call from his station saying your next passenger is down at the club, he needs to go to a place in Sydney and Mohammed said to me, do you know this place? I said no, it's in Sydney. That next passenger was the train driver. He had to drive him to Sydney. He was able to say to the train driver, the mother does not blame you. The mother does not have any resentment or anything. She just accepts what has happened. So I hope that message went to the train driver.

JENNY BROCKIE: What an extraordinary coincidence.

JULIA BIANCO: You can say it's coincidence or you can say it's destiny. I choose to say destiny. And that's what has helped me all along.

JENNY BROCKIE: Loris, did you react the same way? Did you connect with the way that Julia reacted or did you react differently?

LORIS BIANCO: I certainly connected with her reaction. I was always very conscious of making sure whilst we had lost Yasmina I didn't want to lose Julia at the same time. Because the bond that a mother and daughter have particularly is always very very strong and I was very very conscious of that. Julia could go two ways here. Either she can take a potentially negative path and on a downwards spiral towards suicide or she can make a conscious decision to go the other way. When she started showing these signs of her reactions I was very keen to encourage it and help her. It also made my grieving process a better process than what it could have been.

JENNY BROCKIE: Ali, coming from a Muslim background, did you draw on any rituals? Did any rituals help you?

ALI HALKIC: Look, we had guidance from our Imam when Allem passed away. For us it was important. I have to be honest, I wasn't a committed believer. It wasn't - I wasn't a practising Muslim, far from it, as well. But there is one particular day when I was listening to the lady down the back talk about the 40-day grieving process. We have the 40-day as well. I remember the Imam saying the final prayer for Allem. And I just have to tell you that that was the part, the defining moment for me that Allem was no longer part of this world. It's something that haunts me till today how powerful that message was. I think it opened up a world for me that I needed to understand and would like to believe they are in a better place. I think when that criminal element of that took our children and our brothers and sisters and loved ones, I think we get put in a different category and a different situation more than - as bad as this sounds, I always used to wish my son was on drugs or an alcoholic because I could have had an opportunity to try to save him or help him. The way he lost his life - and he had so much life, he was just, that part - that part of the loss, it's something that it's hard for us to deal with.

JENNY BROCKIE: Gordon, how do you help people through situations like that or help them not through it so much as just navigate it? How do you help people to get through that with grief?

PROFESSOR GORDON PARKER: I think it's very variable. There are clearly differing stages. The first stage of the grief process is one of an impact. One feels stunned. And then after that there is a phase of high level of arousal, agitation, inability to settle, inability to sleep. Inability to allay the disturbing images. Then there is a phase of conservation, withdrawal where the person will go quiet and not say very much. These phases are not depression. I really need to emphasise that. Then there is a phase of slow reorganisation. Over those phases, I think there are arguments for differing interventions - I think sometimes it's a listening ear which could be a relative or a neighbour. Occasionally a professional. I don't think there is any prescriptive strategy. As we have already heard tonight, I think the role of anti depressant drugs is rarely of relevance for managing grief. Again, grief is a state of separation distress. It's not a state of depression. Depression is where we lose our self esteem.

JENNY BROCKIE: I think this is so interesting. Because you were given anti-depressants, Gail, to deal with your situation by a GP?

GAIL KRAAL: Yep. I would say I used them for a little while and have a physical reaction and say I don't want to do that, I want to do this my way, I need to be able to go and talk to people and be able to have tears, I need to be able to go and have cuddles and be touched and I need to have trust in people that they are guna walk alongside me for as long as it's going to take.

PROFESSOR GORDON PARKER: Perhaps I could add to that. What is really unusual about tonight is we're talking very openly about grief. For a lot of the time many of us if not the majority of us, don't know how to talk about grief openly. If somebody comes to a health professional the health professional often feels inadequate. A very easy strategy for medical practitioners is to write out a prescription because it terminates the conversation. It's a way of somehow offering help when in fact it's not real help.

JENNY BROCKIE: That in itself is depressing Gordon, that particular picture"¦

WOMAN 2: Often times, Africa or Ghana we say that overseas they handle grief properly. But it's the opposite. Back home, we have our extended family, right? So when you are grieving, everybody is there to support you. People are in the extended family in the big compound. Everybody is coming. Here you stand alone. You go to your room, it's locked and you don't know even your neighbour. But with us we have the whole community - last Saturday, Julie we met the whole community came. We try to give the best support we can give.

WILLIAM VERITY: I don't know what I want my extended family coming to my compound. I think that's an expression of culture. My culture as a white Anglo Saxon protestant, probably the most individual culture on earth - although I appreciate support, most of the time I just want to do it on my own and that's OK.

WOMAN 2: The wailing and crying part you let go, but here you take a tissue and you think you're OK and you go into your room. Nobody comes around you. You're by yourself.

JULIANA NKRUMAH: When I go to my message and my community go to hear, I have people come to me every day. Before they leave other people are coming in. It's like a revolving door. There were times when I thought, OK, I want to be left alone so I can go to a room and just cry. But there were other times when I sat and allowed people to help me to cry. Music is a very powerful tool in our community. Where we have music for grieving and music for joy. So we put on the music on and we listened and sang together and danced together and cried together. Because that brought out the emotion. That is the way I was able to cope with the death of four people within the space of two weeks. That was really painful.

JENNY BROCKIE: Janet, I'm interested in your experience of this. Because you had a different problem in Zimbabwe with dealing with grief when your brother died 12 years ago. Tell us about that. Because you didn't cry initially. And the community didn't react well to that.

JANET PHIRI: See, because like you know, if there is a death, like the ladies said, people gather. There is that expectation to say, as soon as you get there, you're supposed to cry. Like you know, really scream and yell out and express yourself. But, you know, with me it was a bit different, because like, you know, I just couldn't cry. Like straightaway. Because I had that kind of, you know, delayed reaction. But then, that's not acceptable in my culture because you know, it was my brother. So straightaway because everyone else was like yelling and screaming and carrying on, and - so they called me a witch. They called me names and other things.

JENNY BROCKIE: They called you a witch?

JANET PHIRI: Yeah. A bit later on, that's when it hit me. When I started feeling really, really, yeah, starting to cry and stuff.

JENNY BROCKIE: So you did eventually"¦

JANET PHIRI: Eventually. Like I said, in my culture that wasn't acceptable.

JENNY BROCKIE: Gerald you work as a counsellor. I just wonder about the cultural differences you see with the way people deal with grief.

GERALD CHEUNG, COUNSELLOR: I think there is a big element of cultural inference on how we - influence on how we as individuals respond to losses. But what we are talking about tonight is not just how the culture will affect us but also it's very important to recognise how different individuals respond to the same loss differently. Most people get over the grief, get over the grief. But there is a small minority or small number of people who need more help. Some people become depressed. I think it would be dangerous to set a time limit, because I do see people who need medication well before the 100 days. But there are people who can grieve for over a couple of years.

JENNY BROCKIE: So you're in favour of using medication with grief?

GERALD CHEUNG: When needed. I think a well trained psychiatrist will be able to determine whether medication is necessary.

JENNY BROCKIE: Well, a well trained psychiatrist said it doesn't work.

GERALD CHEUNG: I think my experience is sometimes it does.

JENNY BROCKIE: Richard, what do you think?

GERALD CHEUNG: Some grieving people do become depressed.

PROFESSOR RICHARD BRYANT: I think the difference is that following bereavement following the loss of a loved one we might grieve in the sense we have grief and the main problem is I'm missing the person very much and that's really what we mean by grief. A constant yearning and pain. One can also have depression after losing a loved one. That's not the same thing. We see people who for example have great burdens put on them. They now suddenly are the bread winner and they weren't before. They have all these debts that they didn't have before. They have lost all of their social connections because they used to be part of a couple and now they are a single and now they are alone. Depression can actually occur following the loss of a loved one.

JENNY BROCKIE: But that's separate in a sense to what you were talking about before?

PROFESSOR RICHARD BRYANT: I would suggest it is. They can co-exist, they can happen together or they can happen apart.

JULIA BIANCO: Not only were we grieving but my whole routine had changed from one day to the next. So, we had to move house. And we - I was a mother and still am today but I was not doing the school routine. It was gone. So the medication helped me set up a new routine. I got to yoga. I had something every day. Yoga, Pilates, meditation, coffee. The medication helped me to set up that new routine. I stopped it after we came back to India.

ALI HALKIC: I have a glove box of sleeping tablets and anti-depressants. I only take them to shut them up, to keep them off my back.

JULIA BIANCO: They don't solve anything. They take the edge off it.

ALI HALKIC: That edge that we talk about. That edge will never, ever be taken away, right? You know what, it can calm you down or whatever it may be, but I get the same effect if I drive down to the cemetery where Allem is buried, I sit down to him and speak my mind to him and that's my pill. I have a way to work it out but I refuse take any medication. There is no psychologist out there to tell me I should be taking it to take the edge off.

JENNY BROCKIE: Richard, I’m interested in your reaction listening to that?

PROFESSOR RICHARD BRYANT: I think everybody needs to shape their own grief. I absolutely agree with what Ali is saying, that someone should say you should do this, you should do that. The good news story is now after many years we're starting to realise there are approaches that we're proving at last that we can ease some of the pain while we are still hanging onto the relationship, we’re developing a new relationship.

JENNY BROCKIE: So what sorts of things?

PROFESSOR RICHARD BRYANT: In a nutshell there are two aspects to the therapies that work. They come in sort of part A, part B. Part A is essentially, this is tough. We go back to the death and we go back to the loss and essentially it is reliving it. It's going over it again.

JULIA BIANCO: It's acceptance and commitment therapy. And then they commit you!

ALI HALKIC: Why are people interpreting what we should or shouldn't do and especially the medical professionals out there? It's not the solution always. I don't know why we get it rammed down our throats for.

PROFESSOR RICHARD BRYANT: I would hasten to add most medical professionals - and I would be shot for saying this on television - are doing this wrong.

ALI HALKIC: I agree.

JENNY BROCKIE: Do you agree with that, Gordon? Do you think most people are doing it wrong professionally?

PROFESSOR GORDON PARKER: I think there has been a great difficulty in differentiating grief from depression and I think it has caused a lot of confusion and it will be worse with the new diagnostic manual DSM5. This is the American - The classification system of "mental disorders" because they put in a bereavement disorder as a condition. And I think the concern many people have - there are several concerns. One is pathologising normative states. Secondly, the down stream implications that in fact this may be a disorder and therefore need medication. I think Richard was starting to tell us something important about intervention. And certainly the first phase that he has got to did not have the word "medication" there at all. It was allowing the person or encouraging the person to talk through the circumstances. I would be really interested to hear the second phase. And I suspect it's also not medication.

JENNY BROCKIE: What is the second phase Richard?

PROFESSOR RICHARD BRYANT: So we often refer to the first part as the loss related. It's very important that people are able to really deal with the loss in a sense they feel it and they can talk through the issues. The second stage then is what we call more the restoration phase which is saying, "Now you have done this part. What then do you do about trying to build things up for what else you will do next?" What we find a lot after people who have had prolonged grief is they have had such a period of time of not being able to function, the idea I will actually go out and make new friends and engage in new activities, I will start to nurture positive memories of my loved one. That's a very important part. Because often when people have memories in prolonged grief, even though they were once positive they have now become tinged with some pain. To be able to have those memories and have comfort in them and for them to become part of the relationship, putting those strategies together - I should say there is some very good evidence now - it won't help everybody, but it actually works better than anything else we have at the moment.

JENNY BROCKIE: Ali, where are you up to now?

ALI HALKIC: The reality of it is that, you know, I'm nowhere near close to, you know, resolving my grief with Allem and finding peace with Allem. I can't rest until that coward who put my son to where he was gets his – deserve rights. That's not taking - don't get my wrong. It's not taking revenge in my own hands. But there are other things I'm doing, ensuring that they do proper jail time for violating a minor and instead of community service and being put back into society while my son has been deprived of life. That's the way I deal with things. But on a personal level, to answer your question, it is that this is as raw - as the day I found out why he did what he did and that's something that - it hurts me so much he had to lose his life when he had so much life to give.

JENNY BROCKIE: You haven't changed a thing in his room?

ALI HALKIC: No. No. His room won't be touched until I can find peace with myself. And these cowards get what they deserve.

JENNY BROCKIE: What about you, Dean? What do you think the future holds for you now?

DEAN SAUNDERS: Once these people who perpetrated the crime against my brother - I will say his name, it's hard for me to say his name. Richard. They came to our country because there was something going on in their own country. We invited them in here. We took them in and gave them shelter and this is the way they repaid us. I won't be happy, once they have served their sentence, they are not a citizen of this country, I want them kicked out, I want them sent back to where they come from. And I’m not guna let them, what they did to my brother, defeat me. I'm working through it and I will get there. But at the same time I'm not getting that negativity as before where I didn't want to go to work and all that sort of stuff.

MARK SAUNDERS: Jenny, this is a part of Dean's healing to talk here tonight, it's part of his healing too. It's important. I was listening to the lady talking about community. And you would all know that it is Aboriginal community that comes together to support one another in grief.

JENNY BROCKIE: I just wonder how you feel hearing this Juliana when you hear about this way of dealing with grief.

JULIANA NKRUMAH: The community grieves with you, the family"¦the extended family, the whole town grieves with you, people who are overseas all over the world hear about it. That is why our funerals don't happen a week or two after they are dead. It takes about you know, three to six months before the funeral to take place because everybody has to hear, everybody who can make preparations to attend has to make sure that they attend. It becomes a whole village, a whole town's issue.

JENNY BROCKIE: Do you think it's harder to do it on your own, William? When you think about how you have dealt with this. I have noticed Caroline has been nodding at a lot of the community talk. I just wonder whether at some level Caroline, you're relating to that when William isn't.

CAROLINE VERITY: There is a gender divide without a doubt. Yeah. We actually had quite a community experience as well. Food just came pouring through the door everywhere. There were seats set up outside the church because it couldn't fit the people. There was - the word "support" has come up to many times tonight. Certainly in our little Western civilisation village, that happened too. That really happened. But I think women - I don't know if they are better at it - they are more used to certainly reaching out to each other. I think it's easier in our culture for a man to wind up feeling isolated.

JENNY BROCKIE: Do you agree with that, William?

WILLIAM VERITY: I think that's certainly true. One of the things, after India died, as Caroline and I sort of became distant from each other in some respects, I realised I had relied, like many men, relied on work and family and that was all I needed really. And then stuff I did on my own. And I realised that I did need male friendship. So I rang up essentially the husbands of Caroline's friends and said, "Do you want to come out for a drink with me on Friday night?" They probably wanted to do something and didn't know what and they did. So once a month on a Friday night we would go out for a drink. Not a drunken evening but a drinking evening. It was fantastic. We did that for a couple of years.

JENNY BROCKIE: You created your own ritual really?

WILLIAM VERITY: I guess. One of the things about music, which is the cultural difference, is that where you would have sing together and make music together, I would - like Ali, I think, I would sit in my car on the way to work and put on the particular songs and express my grief on my own in my car, which is my own private space and then arrive at work thinking nobody could see I had been crying for half an hour.

JULIA BIANCO: We opened our funeral to the community. We put a note on the shop window and said, "You're all welcome." I'm still meeting people who now who said, yes, I came to your funeral and it's just that I didn't have the opportunity to meet them. It's been wonderful because our whole community has been involved. I spent probably the first three or four months only in our community. I didn't feel strong enough to move outside. Because I knew everyone knew who I was and so I didn't have to explain myself to anybody. Didn't have to fear anything. And that is home. It's home. And it will always be home. Yasmina is buried there. The train station is still at the end of the street and it has become part of our life.

JENNY BROCKIE: I want to thank you for sharing your stories tonight. Very difficult. I know. But very much appreciated.