Good Grief

The world has changed. We cannot go back to where we were, nor continue to head in the same direction we were set upon before this crisis. But that is easier said than done and will be impossible if we do not embrace the grief of what we are journeying through together. There has been and continues to be painful loss. We have lost dear friends, family members, neighbours and colleagues. We have lost jobs, income, holidays and social gatherings. We have missed births and birthdays, key social events, final goodbyes and funerals. We are bereaved of whole ways of behaving – our ways of life, everything we’ve known has been entirely interrupted.

 

For me, as a type 7 on the Enneagram, it’s all too easy to engage in the future, to think about the ‘what next?’, to avoid the pain of the here and now, by letting my imagination run wild of what the world might be like instead. But we cannot and must not miss the vital part of our current journey, which is to recognise, embrace and partake in the grieving process. Grief is not comfortable, it is not easy, it is not enjoyable – in fact it is both tumultuous and painful…..but it is good. Refusing to enter into it, or trying to suppress it, will only lead to a deepening of the trauma and a delay of this inevitable experience.

 

The thing about grief is that it is unpredictable and what makes it even more so in this current experience is that it is both personal and corporate. However, the cycle of grief is well known and although each of us will go through the cycle differently, it’s worth recognising where in the cycle we might be, both as individuals and as a wider community/society.


This is the classic ‘grief cycle’ (I’ve borrowed the graphic from psychcentral.com) and it demonstrates well how the experience of grief is neither straightforward nor easy. However, psychologists agree that each of us will pass through each of these phases, no matter how briefly – though we can remain stuck in some areas for quite some time.

 

The isolation of this time has been the starting place for most of us. For some that was coupled with an acceptance that we are where we are, but for others there was a denial that this could be real and a refusal to engage with the idea of social distancing (although with police enforcement, this quickly began to change!).

 

The anger phase is clearly present for many at the moment, and understandably so. Anger is not wrong, it’s how we respond to it that becomes the issue. Sadly, in many households we’re seeing a rise in Domestic Violence , particularly towards women and children and this is something we need to take really seriously. Learning to control our anger and find a positive outlet for it is absolutely key. There are all kinds of online resources to help with this, but the deep cuts to social services and policing over recent years have made it difficult to work with families in a more proactive way. The Violence Reduction Unit in Lancashire, led by Detective Chief Superintendent Sue Clarke, who is a brilliant leader,  have done some incredible work in this area over the past couple of years, which is well worth learning from. The approach is much more productive than traditional methods of dealing with this issue and involves being with families more proactively to bring restoration and redemption into broken situations.

 

We’re also seeing the rise of a corporate anger. Tony Blair stated the other day that this is the most difficult time to contemplate being in government, and it’s true that we are in unprecedented times, but he feels our response nationally was slow. However, many feel that more serious questions, now being asked across the media spectrum, still need an answer:

 

These are all important questions that require an answer. Anger can be used to facilitate the right kind of conversations to bring challenge to the status quo and demand that it never leads us here again. The outcomes we are seeing were not inevitable – so what will we learn? What will be different? How will we change? If people in positions of power are willing to own up to mistakes, are we willing to forgive? I hope so…..how do we rebuild society otherwise? We must be able to learn and change our ways. It’s at the heart of what it means to love. But we must also recognise that some of this anger is simply part of the grief cycle and there may be no answers. We’re angry in part, because we are grieving. Sometimes our anger brings challenge and change, but sometimes we yell into the night and are met with silence.

 

Depression in grief can become clinical depression, but the word, in the context of grief, more describes a sense of deep sadness, loss, numbness, apathy and is often accompanied by tears. We must not try and keep a stiff upper lip, or push this away. Some of us will feel this more acutely than others, depending on our personality type, but this is a vitally important part of the process. This deep sadness can catch us unawares. It can come almost out of nowhere and we can find ourselves having a good cry in the bath or struggling to find the motivation to get out of bed of a morning. Talking about these feelings is absolutely vital, and it’s important that those of us who listen, ensure that the person experiencing these emotions feels heard. They don’t need fixing. They need validating. They need to know it’s OK to feel like this. We can’t just wish it away or get back on with things. There is a certain wallowing in this place that is extremely healthy and right. It’s true, we don’t want to get stuck here, and by putting some positive measures in place, like exercising, eating well, mindfulness and keeping a positive sense of routine, we can avoid becoming more mentally unwell. However, we must not try and rush through this phase or refuse to embrace the pain of it.  But this can become a very dark experience and some people will wonder if life is even worth living. We can find ourselves asking searching questions: Can we really go on without our loved one? Will we ever get through the brokenness of this current situation, when we have lost so much? If this becomes overwhelming or there are serious thoughts of not wanting to carry on with life, this is where therapeutic interventions or medical treatment in the form of medication can be really important and literally life-saving.

 

At a corporate level, we share a sadness that 20000 people in the UK and 200000 people globally have lost their lives so far, due to COVID-19 – and that is just the recorded deaths. We will potentially feel lost that a whole way of being together is no longer possible, nor perhaps, desired. The artists will help us the most here. Songwriters, painters, choreographers and playwrights. Are we mature enough to embrace the songs and dances of lament? DO we know how to do this?

 

Bargaining is about us trying to begin to formulate some meaning or sense of what has happened/is happening. We might find that we want to talk about our experiences more, tell our stories, reach out to others and explore some of the ‘why’ questions we’re wrestling with. We might find we start ‘big conversations’ with God or ‘the universe’ – some thing like – ‘if you help me get my job back, then I’ll live a good life from now on’ or we might find we’re dealing with several regrets in our interactions or relationship with the person we have lost.

 

Acceptance is about realising that we are where we are and we cannot change a thing. It allows us to breathe deeply into the reality of the horrors we have walked through and begin to face into the future. Some people think of the grief cycle as more like a river with the grief cycle being a whirlpool that we get stuck in for a while. We go round and round, but eventually we come out the other side. On a personal level, perhaps, before we entered the whirlpool, we had a dearly loved one in our boat with us and we entered this whirlpool once that person became sick or was no longer in the boat with us, because they had died. The whirlpool can feel overwhelmingly difficult, with the stages above. We come out of the whirlpool with an acceptance that this dearly loved person is no longer in the boat with us….but there are other boats that we travel alongside, and perhaps there are others who still remain in our boat. We must now learn to live in this boat, without the person who was with us before but knowing we can face the future with our other companions. At a corporate level, this is about us sense making that the future cannot be like the past. Things have fundamentally changed. We cannot go back to how things were and so together we can build an altogether fairer and kinder future for our global population and the planet we inhabit together. This becomes what some refer to as the 6th stage of grief – ‘Meaning’. We begin to make sense of what we have journeyed through and use it to transform our experience of the world and how we want to live in it. My next blog will explore some of the meaning we may find the other side of COVID-19.

 

Whatever your experience of grief at this time, embrace it and talk about it, but don’t try and hurry it away. Good grief is a part of life and enables to process our loss, feel our pain, heal our wounds, accept our scars and find a new future. The ‘Good Grief’ movement is something I would really recommend exploring, especially if you are struggling to process your own grief. There is also lots of mental health support available through your local GP or online via nhs.uk. Grieving allows us not only to engage with the pain we are going through, but allows us to let go, so that we can reset and rediscover a way forward together. It’s impossible to walk through it alone, which is why as the city of Liverpool reminds us in the amazing song, sung at Anfield, friendship is everything.

 

 

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How Does Change Happen? Part 2

This question has become extremely important to me, in my work around how we tackle health inequalities and social injustice. It’s all too easy to take sides, point fingers and play the blame game. But if our political system teachers us anything, it is that this kind of didactic, oppositional approach to life, brings about little change, if any.

 

Over the last few years in Morecambe Bay, we’ve been exploring the power of Social Movements and how we can best work with our communities to effect real and lasting change. As, I said in part one of this series, we’ve been very affected by the need for personal change and the need for deep listening. Change begins with us and this requires genuine humility and deep listening, putting ourselves into uncomfortable situations and surroundings. How can we possibly make decisions for communities with whom we have never spent any time? It’s important that we do our own work and reflect on what we hear and be willing to change our way of working as a result. Series 3 of The Crown, highlights this beautifully with the inauguration of Prince Charles as The Prince of Wales. His relationship with his Welsh tutor utterly transforms the way he sees the plight of the welsh people and indeed his understanding of power, but it only comes from being immersed in Wales and having some significant challenge brought to his world-view.

 

Personal change does not just happen through encounters. The encounter with ‘the other’ invites us into a deeper journey of change. It’s why I have personally also found The Enneagram to be such a helpful tool when it comes to dealing with my own internal issues and mechanisms. For me, as a type 7, it has helped me to understand why I run away from pain and needlessly distract myself from the present in search for ever more stimulation. I have had to face this head on, in order to learn to become more fully human and the best gift I can be (nowhere near there yet!)….

 

I believe we will not see societal change if we are not, ourselves, willing to be changed. Personal transformation, however, is not enough, vital though it is. In thinking about wider social change, I have been really influenced by the philosopher, Valerie Fournier. She talks about three key components which are necessary to drive change within communities. Firstly, she says we must cultivate anger. Initially this seems like quite a strong statement, but what she is referring to is the need to stir a corporate sense of passion around injustice. I have certainly found this to be an important aspect of enabling change in our communities. If we’re not careful, we can spend much of our waking life asleep. If we are to be truly woke to the issues we’re facing across our communities then we must create a space in which people can become stirred to care enough about the reality of the status quo. We have found that people across Morecambe Bay really care about the fact that people living only a few miles apart can have a 15 year difference in life expectancy and an even bigger gap when it comes to years lived in good health. Our experience is that if we give no voice to the discontent within the communities, especially for those at the receiving end of systemic injustice, then we can end up going round in circles, unable to move forward. We definitely don’t want to remain in the place of anger, but it can be harnessed as an incredible energy for good. 

 

The expression of anger is an important part of The Poverty Truth Commission process. Those who are subject to poverty and at the receiving end of the coldness of ‘the system’ need to be given voice to express what that means for them and how it impacts their sense of wellbeing. I think in Britain, we’re not particularly good at ‘anger’. It’s uncomfortable for us. It doesn’t feel polite. We would much rather keep things under wraps and hide away that which makes us feel ashamed. However, when we choose to be present enough to suspend what we think we know about poverty and the experience of it, and really listen to the harrowing reality of it, in another human being and then go on to build relationship and even friendship with that person….then we too are invited into that same anger, not to rage against the machine, but to use the power of our ‘fileo’ (friendship) love to become an agent of radical change. 

 

Anger harnessed in this way leads to Fournier’s second step in social change: ‘Challenge inevitability’ – challenge the inevitability that things must always be this way. When we think about issues like poverty, health inequality, social injustice, adverse childhood experiences – things which feel ‘too hard to change’, it’s easy to resign ourselves to the notion that things will always be this way – therefore we should just ‘keep calm and carry on’, and just do what we can to ‘help those less fortunate than ourselves’….but all this does is reinforce the same old story. Social change requires that we challenge the inevitability of the status quo and that means challenging the world views we hold and the stories we tell ourselves. It doesn’t mean that we must therefore create a greater division between rich and poor or make enemies of ‘the elite’. It’s about taking ideologies that we hold to be ‘true’ and asking probing questions of them. In fact, it’s about giving them a really good shake and uprooting those that are deeply damaging and throwing them on the fire. There are great examples of this kind of work in economics – Kate Raworth in her book ‘Doughnut Economics’, or Katherine Trebeck in her book ‘The Economics of Arrival’ – both challenging economic theory built on GDP and obsessed with growth. We see it in Hilary Cottam’s tour de force ‘Radical Help’ in her challenge to the transactional basis of the welfare state. Bev Skeggs and Imogen Tyler, sociologists both challenging the way society is set up. Rob Barratt, challenging the way we think about education. 

 

At the same time as challenging inevitability we just also incept our thinking with possibility of an alternative future, asking ourselves some powerful ‘what if?’ questions. I wonder what an economy might be like if it held wellbeing of people and the planet as it’s core principles? – a question they are asking in Scotland, New Zealand and Iceland. What if we had a society in which women (change women for any other subjugated group) were treated as true equals? I wonder what education might be like if it were truly future orientated and took climate change seriously? If we challenge what is, it allows us to reimagine what might be.

 

New ideas though, are not enough. The undermining of our current realities opens up the possibility for Fournier’s third aspect of social change, which is to ‘Create moral alternative economies’. We must move from anger and challenge, into experiment. Appreciative Enquiry is a great approach to help us move into this space. It allows communities to focus on what is strong, rather than what is wrong. If we’re going to experiment with new ways of building society, politics, economics etc, we need to so on strong foundations. Once we have cleared the ground in our minds of what has been stopping us find kinder ways forward, we can then focus in on – ok – so what is good?

 

As a result of this approach in the Poverty Truth Commission, for example, we’ve been able to work together on designing the kind of job roles that would really help someone navigate the complexities of the health, social care and welfare system, when they are on the ropes. We heard the anger about where it isn’t working, challenged our own thinking that we can’t really change things and have begun to experiment with the ideas put forward by people on the receiving end of unkind and punitive processes. We’re creating a moral alternative economy. When our city council in Lancaster, recently voted to protect the rights of gypsy-travellers by buying their land and promising to ensure it is fit to live on – they also responded to the anger of deep injustice at what was being proposed (the selling of their land), challenged the inevitability that they had no choice in solving the matter and instead intervened with a moral alternative economy, that protected the ‘poor’ and actually worked for the benefit of everyone. Or, we could take an example from education: When a teacher refuses to tow the line to isolate a student and have them face a wall all day and instead finds a more creative way to understand their student’s anger, challenging the inevitability of school exclusion (and all that will lead onto) and finds an alternative way to help them process their trauma and make the system work for them, rather than the other way round – that teacher is creating a moral alternative economy. You see? We can begin to do it everywhere! And when we begin to experiment with new ways of being together in communities, we begin to tell each other a new and altogether more loving story than the one we’re currently living in. The more we experiment and either fail or succeed, the more we discover how to build a society that works for the wellbeing/peace of everyone and the planet. 

 

So, where do you need to listen more deeply, to allow yourself to be made uncomfortable by the palpable anger that is underneath the surface, or sometimes erupting onto our streets? Why is the anger there? What does it tap into? Where is it coming from? Who is it aimed at? Is that anger able to be channelled in a way that can leverage an altogether more loving and kind society? What inevitability in your personal or our corporate thinking needs to be challenged as a result? What ‘truths’ need to be questioned? What space might that clear for new experiments to emerge? What if those experiments began to interconnect and learn from each other, sharing resources and encouragement along the way? What might then become possible? What if we actually took a breath and decided to genuinely think and work in this way? Can you see the change ahead?! Go ahead and start creating it!

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Wisdom From My Nanna

Tweet Last week, I was on the closing plenary panel at The Kings Fund, as we reflected on what we had learned together about ‘PopulationHealth’ across the UK. There were some really excellent contributions throughout the day.   Councillor Matthew Brown, leader of Preston City Council, talked powerfully about the new economic models they are using [Continue Reading …]

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A Fallow Year

Tweet This coming year of 2019, I am letting my garden have a rest – letting the ground be fallow. It gives space for the soil to replenish and to have its nutrients restored.   I am personally trying to allow much more space this year for contemplation, silence, reflection and the deeper work of stillness. [Continue Reading …]

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A-Z of Health and Wellbeing

Tweet Happy New Year!   We often start a New Year with resolutions, things which we would like to change for the better. so, I thought I’d start this year of blogging with a vlog about my perspective on the A-Z of what affects your Health and Wellbeing the most.   It’s longer than most [Continue Reading …]

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The Extraordinary (Healing) Power of Forgiveness

Tweet There are many times when people come to see me, as a GP, and I cannot find a physical cause for their pain. There are various other conditions when people have what we call “medically unexplained symptoms”. For others, they can get stuck in a rut with their mental health and feel unable to [Continue Reading …]

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Wake Up to Our Health Crisis

Tweet It’s all over our news today – our health is in a real mess, and this is our wake-up call moment – we really do need to take it seriously. It’s all very well us protesting about the under-funding and under-recruitment in our NHS (and we are right to do so), but we can [Continue Reading …]

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Solutions Focused Thinking in Population Health

Tweet My last blog focused on how we can think about solutions instead of problems in the NHS. Well the same is true in thinking about the health of our whole population. Yes there are some problems! We have growing health concerns with obesity and diabetes. We have huge health inequalities. There are major issues [Continue Reading …]

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A Conversation in Response to ‘Living with Illness’

Tweet After my last blog post, I got a couple of responses from people who felt I misrepresented them. I am always happy when people come back to me in discussion. We are never changed if we cannot receive challenge or we do not really encounter ‘the other’. So here is a conversation between me [Continue Reading …]

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