Embracing grief

"NO ONE ever told me that grief felt so like fear," C S Lewis once wrote, and he was right.

Stepping into the Intensive Care Unit (ICU) ward, I tried to remain calm. But what was waiting behind those tinted-glass panels, I wasn't prepared for. Lying lifelessly on a bed with tubes attached to her body was my beloved aunt, unconscious and quite possibly, brain dead.

Having to pace the hallways of a hospital is something I wouldn't wish on anyone. But grief comes to us all, in one way or another.

"We all deal with loss: jobs lost, loves lost and lives lost. The question is not whether these things will happen. They will, and we will have to face them," says Sheryl Sandberg in her book titled Option B: Facing Adversity, Building Resilience, and Finding Joy, which she wrote after losing her husband suddenly during a trip to Mexico.

According to Dr Ivan Woo, principal medical social worker at Tan Tock Seng Hospital's (TTSH) Care and Counselling department, grief may be broadly defined as an "emotional reaction towards a loss of a significant person or thing".

For the most part, grief comes in waves - it ebbs and rises because it is inherently linked to our memories. It can pull our brains in different directions, causing a fuzziness that comes with short-term memory loss, yet clinging on to recollections of the departed. It leads the body's defence mechanisms to kick in as stress-generated cortisol pumps through.

In fact, grief can actually make us physically ill, as too much cortisol hurts the immune system and opens the door to infection.

Little wonder then, that a single tragedy can so significantly affect one's behaviour and performance.

The hidden costs of heartbreak

Astonishingly, hidden grief costs US companies more than US$75 billion annually, researchers from the Grief Recovery Institute have found.

"When your heart is broken, your head doesn't work right," says the institute's co-director Russell Friedman.

Psychological studies have shown that grief may have a profound impact at the workplace as it can "significantly affect people's emotions and compromise their decision-making skills", says NUS Business School's associate professor of finance, Johan Sulaeman.

Along with other US professors, Prof Sulaeman carried out a study focusing on fund managers who lost a parent while they were actively managing equity funds. The study, first released in 2015, sampled 205 fund managers with parental deaths from 1999 to 2013.

And they found that parental deaths were strongly associated with poorer fund performance, likely due to a decline in the cognitive abilities required to make tough investing decisions.

"Economics has always been driven by rational considerations. We expected professional money managers to be such rational agents. But our research showed that personal life experience can influence people, including professional investors' financial decisions," says Prof Sulaeman.

"Indeed, death left not only a heartache but also less rational decision-making."

Rethinking policies

That people suffering from a recent bereavement need time to recover seems abundantly clear. Perhaps one of the most distressing things that bereaved employees have to worry about is whether they can take time off work to be with their families. For most companies, the common practice is that compassionate leave is only applicable to one's "immediate family". According to the Ministry of Manpower, there is no statutory entitlement for bereavement leave.

Instead, this prerogative depends entirely on "employment contracts or mutual agreements between an employer and employee".

The reality is that there are so many things that can cause one sorrow besides the loss of an immediate family member - loss of a colleague, a pet, or even when a loved one faces grief for instance.

The thing is, when someone close to us feels pain, we feel it too.

Yet many companies lack proper policies to support employees dealing with traumatic events. And it's not just in Singapore where that's the case, it's a worldwide shortcoming.

A Harvard Business Review article titled "Making your workplace safe for grief" cites that in most countries, a stillbirth doesn't warrant bereavement leave, nor does the loss of a best friend, or a beloved nephew, all of which are bound to cause unimaginable anguish.

Encouragingly, some companies are starting to connect the dots between standing by their employees and improving their bottom line.

Following her husband's death, Facebook chief operating officer Sheryl Sandberg doubled the company's bereavement leave policy and introduced paid family sick time. The tech giant now provides staff with up to 20 days paid leave to mourn an immediate family member, 10 days to grieve an extended family member, and six weeks to care for an ailing relative. This stands in stark contrast to the three days that most companies in Singapore offer when an immediate family member passes on.

"People should be able both to work and be there for their families. No one should face this trade-off," Ms Sandberg wrote in a Facebook post.

She also noted that making it easier for employees to be the workers and family members they want to be, will make an economy and country stronger. Undeniably, companies that are committed to their people will in turn make their people committed. And advocates are hoping that Facebook's move will pave the way for more firms to follow suit.

Granted, because everyone deals with grief differently, there might not be a cookie-cutter solution to this conundrum. While some might prefer to dive head-first back into work, others may need a longer time to heal.

A legacy to remember: watch video

TTSH's Dr Woo recommends that compassionate leave be spaced out instead of taken as a whole block. This could enable employees to cope better over time, and make work coverage easier. Citing the Dual Process Coping Model proposed by Margaret Stroebe and Henk Schut, Dr Woo suggests that a good indication of a healthy adjustment to loss is where individuals are able to oscillate between coping with grief (the loss-orientation), and readjusting to life changes (restoration-orientation), instead of ruminating on any one model.

Additionally, he suggests that a public dialogue may be held to determine how much bereavement leave is suitable.

"The whole idea about building a compassionate society is that everyone takes ownership, and as a society you decide what is good enough," says Dr Woo.

He adds that we should not be over reliant on financial levers or legal measures to bring about change, and reiterates that "sustainable healthcare is everyone's business".

"If you look at Singapore's Gross Domestic Product (GDP) right now we're healthy, but that resource may dry up over time. In order for us to have sustainable healthcare, I think it's important to scale up social intervention."

Cultivating a compassionate business culture

Besides policy change, perhaps what companies need to do is to develop flexibility and a compassionate culture. When Kuik Shiao-yin lost her father to cancer, the director of local social enterprise The Thought Collective carried on working. However, she also noted that her workplace is unique in that it is flexible both in time and expectations, and has an "emotionally aware culture".

Asked what policies companies may implement to help bereaved individuals, Ms Kuik who is also a nominated member of parliament, suggests that human resource (HR) departments can start by cultivating high trust and good employee relationships. This is so that when a loss occurs, HR can engage in real human conversations with employees about how they would prefer to be supported, and then go about creating that space. She adds that businesses need to have the humanity to change up policies when a situation calls for it.

Gold in grief and silver in suffering

Given the space and permission to grieve, this powerful emotion has the capacity to grant us new insights, which is why we should learn to embrace grief instead of burying it deep within ourselves.

"There is a gold in grief and a silver in suffering. I deeply believe in that," says Ms Kuik.

"Grief is not something to be ignored, gotten over or covered up. Grief comes from a space of love... Grief reminds us that there is a part of us that is not our own, it was once co-owned with and by someone else."

Likewise, psychologists Richard Tedeschi and Lawrence Calhoun discovered that people can experience post-traumatic growth following an ordeal. These may be displayed in five ways, namely, gaining an appreciation for life, forming deeper relationships, strengthening spirituality, recognising new possibilities and finding personal strength.

Over time, a tragedy need not remain a tragedy, and upheavals in our lives can help build resilience.

"Resilience is not just built in individuals. It is built among individuals - in our neighbourhoods, schools, towns and governments," said Facebook's Ms Sandberg.

"When we build resilience together, we become stronger ourselves and form communities that can overcome obstacles... collective resilience can foster real social change," she added.

Indeed, grief can teach us many life lessons - it not only increases psychological resilience, but enhances social capital as well, says TTSH's Dr Woo.

Dr Woo recalls a study trip to India with the Ministry of Health's (MOH) Healthcare Leadership College where he saw healthcare students go through what is deemed as "guided suffering". In the first year of their unique curriculum, students there do not acquire medical knowledge. Instead, they are assigned to rural centres where infant mortality is high. In other words, they were placed there to witness people's pain, and had to learn how to help patients through their grief in the best way they knew how to.

"Imagine when they return to school in the second year, the kind of hunger that they have for knowledge, because it gives meaning to whatever they learn... Some of these stuff cannot be taught, it has to be caught," says Dr Woo.

"Singapore has done well over the past 50 years. But in recent times we've found that even if we perform well academically, as a society we may not be that gracious, and that is something we have to think about."

At the end of the day, calamities in our lives present us with a choice. As Facebook's Ms Sandberg puts it: "You can give in to the void, the emptiness that fills your heart, your lungs, constricts your ability to think or even breathe. Or you can try to find meaning."

A legacy of love

For some families, a short film is the perfect way to remember the beloved. Called a legacy video or film, these videos aim to preserve the voice of loved ones for both healing sake and remembrance. They offer an avenue for people to revisit memories, and find joy even in the midst of grief.

Filmmaker Brandon Myles, from creative agency Myles & More, says that for him, the inspiration for legacy films came from his mother-in-law when his father-in-law was diagnosed with cancer.

He explains that a legacy is as much about the future as it is the past.

"Their laughter. Their favourite tidbits of wisdom. Their special mannerisms that made them one of a kind. We want them to stay with us long after they are gone," he says.

What (not) to say

MORE often than not, people dish out cliches such as "My condolences" or "I'm sorry for your loss" when they hear of someone dealing with a loss. But grieving needs much more than platitudes, and these phrases don't offer comfort or mean anything really.

The idea is to first acknowledge what bereaved individuals are experiencing, and to pace ourselves with them. Facebook's Sheryl Sandberg advises people not to avoid the heartbroken (except when they want to be alone), and to not tell them that "Everything will be ok" simply because we never know.

Instead, she suggests using the greeting: "How are you today?" This implies that we know someone is having a tough time and getting through each day.

In fact, sometimes our presence, a listening ear, or a hug is the best statement we can make. As Ronan Keating would say - you say it best when you say nothing at all.