In my research into liminality and death, I wrote about the discomfort in my culture when people face death. Death, much like birth, has been removed from the home and from the family unit to professional people, distant from the family, who work in care homes, hospices, hospitals, and in funeral homes. Is this shift away from death as a part of family life in a home setting, a contributory factor leading to the ‘strangeness of death’ and the discomfort experienced when people inhabit the death space? By death space I mean the moment in between life and death. Where a person is dying or has died yet their loved ones have not yet come to terms with the death and with their sense of loss. This place exists in space and time as a liminal space. In this space we experience grief and sometimes this grief can last for many years. Can it be said that if those experiencing grief are outside the ‘normal’ human conditions of life and that these people exist in the liminal space? I think it worthwhile exploring what grief is and what the impacts of grief might be. There are two forms of grief which are termed normal grief (also known as uncomplicated grief) and complicated grief (also sometimes known as traumatic grief). Both forms of grief have a massive impact to physical and mental health. The death of our closest loved ones increases risks of “cardiovascular disease, coronary heart disease, stroke, all cancer, smoking-related cancer, and accidents or violence.” (Buckley et al., 2012, p. 129) The mental health impacts include “sadness, crying, preoccupation with thoughts and memories of the deceased person, difficult concentrating, disinterest in daily life” Complicated or traumatic grief is more intense, lasts longer and can be more destructive with more severe and lasting impacts. Complicated grief might be likened to post traumatic stress. It is linked with significant distress, impairment, and negative health consequences such as hypertension, depression, substance abuse and risk of suicide. (Zisook and Shear, 2009)  A study looking at mortality in widowers found that the bereaved experienced a 40% increased mortality rate (Young, Benjamin and Wallis, 1963). In my own experience of the death space, I was rushed to hospital close to death as my pancreas suddenly stopped producing insulin. High levels of stress caused by grief increased my blood sugar while at same time decreased my insulin release. Previous to this episode I was not diabetic at all. In her book on grief, Bridget McNulty speaks of this in terms of being chased by a lion. The lion triggers a fight or flight survival response and the body floods with stress hormones such as adrenaline, cortisol and glycogen. After the danger is past the body can relax, but when the lion is a symbol for grief, there is no escape, the grief is a constant reminder of what been lost. (McNulty, 2021, p. 410). In addition to the two types of grief mentioned above grief can be said to have two states; acute grief and integrated grief. Acute grief is where the most extreme behaviours and emotions occur which might not be considered a normal thing in day-to-day life. Integrated grief is where the bereaved re-integrate with society. Traumatic grief might be where the transition to integrated grief does not happen. When the bereaved transition to integrated grief, they do not forget their loves ones nor give up feelings of sadness, “The reality and meaning of the death are assimilated”, “The loss becomes integrated into autobiographical memory and the thoughts and memories of the deceased are no longer preoccupying or disabling.” (Zisook and Shear, 2009) Interestingly from my studies, this sense of re-integrating with society or not could said to be whether the bereaved inhabit the liminal death space or not. If the grieving process never fully completes and grief can re-appear during significant events such as birthdays or when faced with more loss, then this implies that the bereaved inhabit the liminal space and can rock backwards and forwards from the reality of death. The purpose or perhaps an ending of grief would appear to be the search for a balance between separation from the dead and at the same time finding ways to continue our relationship with the dead. (Zisook and Shear, 2009) Part of this might be in keeping the memory of the dead current.

The death of a child produces amongst the most severe and enduring stress.(Christ et al., 2005) The death of children fits into narrative of changing attitudes towards death and of shifting death out of family setting. Childhood mortality in the past was a much more common thing. Families had many more children than is common today and they might expect several of their children to die. In 1996 in the US, deaths of children up to the age of 14 accounted for only 5% of all deaths. The dying of children is further complicated by improvements in medicine, which might mean more children survive illness, but also means that those who die spend longer dying. This in turn impacts those who will outlive their child as they unable to reduce their child’s suffering. (Christ et al., 2005, p. 553) There is further complexity in the grieving process as it is possible people might not want their grief to come to an end as that might imply, they are cutting ties with their loved one. There are stresses caused by loss of a child related to changes in parent’s hopes and aims for the future or a loss in part of the self, “when a child dies, the dreams may die too.” (Christ et al., 2005) I don’t feel there is an end to grief for my child. Does that place me and many people like me, adrift on the river between life and death in a disjointed place of stress? I wonder how the mix of memory, grief and the relentless shift of time has changed me from what I used to be. What happens when no-one left to remember?

Bibliography

Buckley, T. et al. (2012) ‘Physiological correlates of bereavement and the impact of bereavement interventions’, Dialogues in Clinical Neuorscience, Jun(14(2)), pp. 129–139. doi: 10.4135/9781446251881.n2.

Christ, G. H. et al. (2005) ‘Appendix E Bereavement Experiences after the Death of a Child’, in Field, M. J. and Behrman, R. E. (eds) When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Washington D.C.: National Acadamies Press, pp. 553–664. doi: 10.1097/00005217-198502030-00010.

McNulty, B. (2021) No TitleThe Grief Handbook: A guide through the worst days of your life. London: Watkins.

Young, M., Benjamin, B. and Wallis, C. (1963) ‘THE MORTALITY OF WIDOWERS’, The Lancet, 282(7305), pp. 454–457. doi: 10.1016/S0140-6736(63)92193-7.

Zisook, S. and Shear, K. (2009) ‘Grief and bereavement : what psychiatrists need to know’, World Psychiatry, Jun(8(2)), pp. 67–74.