‘If you bottle it up, grief will find a way out'

‘If you bottle it up, grief will find a way out'

LukeDr Luke Pratsides has dealt with many patients struggling to cope with bereavement. He tells us what he’s learned about grief during his time working as a GP.

Grief manifests itself in many ways. This is something that Dr Luke Pratsides has seen throughout his professional career. Lead GP at Numan, he also works for the NHS in East London.

Heartache affects everyone differently, but Dr Pratsides has picked up on a few commonalities while working as a GP...

As a GP, what’s your professional experience with grief been like?

Bereavement can be a trigger for poor mental health. This is something I’ve seen a lot of as a GP. A bereaved person becomes ridden with anxiety. They feel like they lack control and have extreme dips in mood.

I’ve seen the way this changes how a person engages with their daily life. There’s a lack of motivation to get out of bed, nevermind going about their day in a functional manner. It becomes a bit of a spiral. Someone who’s trying to motivate themselves to do these things, whether it’s organising a funeral or informing family members, starts to feel guilty because they can’t find the drive to do it, which makes them feel worse. It’s a slippery slope.

You mentioned ways that mental health is affected by grief… Can grief affect you physically as well?

I feel that a lot of the physical effects of grief I’ve seen have manifested from extreme low mood. A lot of people have come to me complaining about muscle aches and pains, or stomach soreness.

I have noticed that people with certain cultural backgrounds, where mental health isn’t often discussed, might complain of physical joint pain. After running some tests, looking for signs of arthritis, I’ve realised that in some cases, mental stress may be the problem.

How often do you find this sort of thing occurs, where a bereaved person complains of physical pain?

It’s quite common. When it comes to bereavement, sleep is often disrupted which can trigger some physical symptoms. People don’t sleep well or might go to sleep at a normal time then wake up in the early hours of the morning. Things like this disturb your everyday functionality.

Having dealt with these sorts of complaints while working as a GP, have you come across any useful coping strategies for grief?

One of the most important things to do when losing a loved one is allowing oneself to grieve. If you’re feeling sad or tearful, cry. If you have a few days when you don’t want to do anything, don’t. If you can’t face engaging with the outside world sometimes, that’s ok. People that get badly affected by grief tend to try and be strong when they lose someone. They don’t allow themselves to feel those emotions that will inevitably come to the surface at some point. You can bottle it up but it’s got to come out sometime.

The majority of the time if you lose someone, you’re not the only one feeling that grief. Sharing your feelings can be a real relief for some people - even just to know that others are feeling the same.

Is there such a thing as a broken heart?

I don’t believe that you can die from a broken heart in the sense that a healthy person’s body doesn’t just shut down due to intense mental trauma. However, people with pre-existing heart conditions, such as blocked coronary arteries or an irregular heartbeat, may find their condition is exacerbated and symptoms like palpitations chest pain or even a heart attack are brought on by a period of intense distress. So in that sense, an episode of grief could spiral into a so-called ‘broken heart’.

“Exercising outdoors is probably the biggest mood booster.”

Another coping mechanism for poor mental health that’s often discussed is exercise. Can you explain the physical and mental benefits of exercising?

Physically, exercise is good for cardiovascular and muscle health, among many many other things. When it comes to mental health, exercise is phenomenal because it releases endorphins that make us feel happy. After exercising, you’ll have a surge of hormones such as dopamine and serotonin, which will boost your mood.

There are other benefits too. Often the bereaved don’t want to do anything so stay shut up in a dark room. When you exercise you have to go outside or to a gym. Just getting out of bed and outside in the sunlight will lift your mood. Exercising outdoors is probably the biggest mood booster.

Nutrition and fitness often come hand in hand. What nutritional advice would you give to someone going through grief?

You must be considerate about alcohol consumption. Often people turn to substances to help with grief - no doubt that after a few drinks, you’ll probably feel a bit better for a short time. But alcohol is a depressant drug so after the initial period of feeling better, there’s no doubt you’re going to feel more anxious - even lower.

Even drinking small amounts of alcohol can cause a depressant feeling. If you consume 4 to 6 units in one evening, you might not think it’s much but you’re bound to wake up feeling a little bit lower than you would have done without alcohol. So alcohol is a big thing to keep an eye on when you’re grieving.

A common symptom of grief is a loss of appetite, so it’s important to make sure you’re eating well. Some people end up skipping meals altogether and this has a knock-on effect on your physical health. You might start to feel nauseous, light-headed and unable to participate in physical activities. It’s a downward spiral so make sure you eat regularly and healthily.

“Day or night, it doesn’t matter.
Support is always there when you need it.”

For someone dealing with grief, what first steps would you suggest for taking action and getting over the first few hurdles of recovery?

The first thing is allowing yourself to feel low. Allow yourself to grieve. The second thing is sharing it with others. Know that there’s lots of support out there - whether that’s going to talk to your GP or bereavement counselling. Many people find a few sessions of counselling over a few weeks or months gives them the tools to deal with grief. If you’re having suicidal thoughts or wanting to self-harm then you can call the NHS on 111, who can advise you and if needed get you in touch with your local mental health crisis team which is available 24 hours everyday . If it’s an emergency, you can go to A&E where you’ll be seen by a mental health professional. Day or night, it doesn’t matter. Support is always there when you need it.

What about if you know someone else who’s grieving? What steps can you take to help them?

It’s not easy. But a check-in from a friend can help, even if the person who’s grieving doesn't want to talk in-depth about what they’re feeling. Just knowing that people care about you is a positive thing. Give them a call even if it’s to talk about something else. The distraction from grief can be really helpful. If friends become worried about someone then you can contact emergency numbers such as 111 on behalf of someone else.

Lockdown is making dealing with grief particularly difficult, especially when it comes to the coping mechanisms you’ve mentioned, such as speaking to friends. Do you have any advice for how someone who’s grieving over lockdown can get over this obstacle?

It’s a difficult time. You can’t have the number of people that you probably hoped for at a funeral. Social distancing is in place, so it’s difficult to comfort one another. All you can do is the best that you can in the situation you’ve been given. Have as many people as you can go to the funeral. Make sure that if you need support, you seek it. Whether it’s a chat with a friend or professional support, it’s there for you if you seek it out.

All health care professionals are very aware that people are struggling at this time so those support services are actually running really well. You may have heard lots of stuff about the NHS, for example, that people are having appointments cancelled and operations are being pushed back. But for things like counselling and mental health support, it works very well on a remote basis, so they’re actually running almost the same service except via telephone or video. It’s one of the few services that are actually running well during COVID times so don’t think ‘I won’t bother professionals if I’m grieving and really struggling’ - the service is still there.

Do you have any final advice for someone who’s grieving?

I just want to stress the point of not bottling up feelings. Share your experience with loved ones and get in touch with healthcare professionals. They’re there to offer the support that you need.

Dr Luke Pratsides works for digital healthcare company Numan and the NHS in East London.