The vital importance of a last goodbye......and the need for some space to mourn

The way bereaved families are treated after a major disaster makes a big difference to their ability to cope with grief. Our health editor, Jeremy Laurance, says relatives must be handled with care

Past experience shows that the way in which survivors and relatives of the dead and injured are treated after a disaster can make a great difference to the way they cope subsequently. If the situation is handled well it can be a great help, but if handled badly, it may add to the emotional distress.

Catastrophic death or injury destroys our belief that we are in control of our own lives. The best way for the caring professions in New York and Washington to respond to such trauma is to try to restore some of that control to the survivors and the bereaved.

For 11 days after the Lockerbie air crash over Scotland in 1988, Pamela Dix was denied access to the body of her brother, Peter, who was one of the 270 people who died in the disaster. Unable to see her brother or to touch him, she was prevented from coming to terms with her personal loss as the nation recovered from shock. "How my family was treated during those 11 days has remained with me and influenced my life ever since," she says.

Saying goodbye is an important part of coping with bereavement. For many people, though not all, it is helped by seeing and being with the body. Yet in countries where there is a prudishness about death, this is viewed as odd or unhealthy. When the death is sudden, unexpected and traumatic, the opportunities for saying goodbye are sharply reduced and relatives can find themselves patronised and ignored.

Ms Dix, who now works for Disaster Action, the charity that offers support to the bereaved, says that too little attention is still given to the needs of relatives after a catastrophe. The emotional shock caused by the traumatic death of a loved one can be compounded by well-meaning officials who try to protect relatives with false reassurances or by glossing over unsavoury details. She was told her brother "died instantly", when in fact no one was killed by the bomb when it exploded at 31,000 feet.

After the Hillsborough soccer stadium disaster in 1989, relatives were required to identify the bodies from polaroid photos of their faces which were stuck up on the wall of a room. Later, they were allowed to view the bodies – but only through a glass window. They were not allowed to be with them or to touch them. "This turned the experience into a nightmare for the bereaved, who were distraught at not being allowed to do what should have been so natural," said Ms Dix.

After the devastating impact of the falling buildings and fires, many people bereaved by the terrorist attacks in New York and Washington will never see anything like a complete or recognisable body, which will make grieving all the harder. The question is whether they should be "protected" from seeing their loved ones' remains.

Although attitudes have changed slowly over the last decade, whether and how relatives will be granted access to a body still depends on the local official in charge. In Dealing with disaster, the official guide published by the Home Office, there is no mention of it. A spokeswoman said: "We are not saying that people should not have access, but we can't specify every single outcome. A great deal depends on the circumstances at the time and on the scale of the disaster."

Other countries do it differently. After the Swissair crash off Nova Scotia in September 1998, the airline responded swiftly by flying relatives out to the site of the disaster. Those who were unable or did not wish to go were sent pebbles from the beach, a solid memento that helped to anchor the tragedy. "I thought that was remarkable – very far-sighted," said Ms Dix.

Earlier, after the Omagh bomb in Northern Ireland in August 1998, of the 28 people killed, 25 were seen by their families. Identification of the victims was carried out swiftly and relatives were then permitted to visit and be with their loved ones.

Refusing access is always done for the best of motives – to protect relatives from the unpleasant reality, especially where there are visible injuries. "Remember them as they were – in life, not in death," is the usual refrain. Coroners tend to assume that relatives should not see a body if it is less than perfect. Yet much can be done to repair even a grievously injured body to make it presentable. Morticians who worked on the bodies of the Lockerbie victims estimated that 70 per cent could have been shown to the relatives intact and recognisable.

Ms Dix, who wrote about her experience at Lockerbie in The Lancet medical journal, said that once her brother had been released for burial and was taken to the crematorium, she decided that she wanted to see him, against the official advice. Even then, she was denied. Undertakers said it was against crematorium regulations and "medically inadvisable". She said: "This is one of the examples of how the bereaved were distressed and alienated by the supposed good intentions of those managing the disaster."

The lessons apply equally whether one or many have died. Ms Dix says that relatives should be given information about their loved ones and allowed to make up their own minds. "Access should not be denied. People should be able to make an informed choice. Survivors must not be overprotected."

She describes the case of a young police officer who was killed in a bad road accident. His wife wanted to see his body and sit in the car. Instead of preventing her from doing so, his colleagues showed her a photograph of the car taken from a distance, and then another, closer up, taken from a different angle. With this information, she was able to make her own decision – which was not to see him, after all.

It was only when thinking about what it must feel like to be a person bereaved by the terrorist attacks in the States, that I suddenly realised how peculiar it must have been for Harry and William when they saw crowds weeping in the streets for their mum. Was it comforting, knowing so many people were "with them" in their misery? Or was it irritating? After all, the sobbing crowds who lined the streets to say goodbye to Diana had never even met her.

True, there may be a certain comfort, if you have lost someone in the recent tragedy, to feel that you are not alone, that others, too, have lost loved ones in exactly the same mindless way. If ever you wanted to talk to someone else who felt exactly the same as you, you could always try contacting another bereaved person, or meet in one of the self-help groups that surely must be springing up like sycamores.

But the truth is that one of the reasons bereavement so often breaks up families is because it is so difficult for one bereaved person to comfort another. Each is absorbed entirely in their own world of loss. What they need desperately is not to give out, but to be given to.

And you want to be given to in the right way. Imagine what it would be like to be a bereaved widow, right now, in New York. Of course, there'd be very little likelihood of friends and neighbours crossing to the other side of the street, too embarrassed to say anything. No, the real fear would be of virtual strangers rushing up with tears in their eyes, saying things like: "We all know just how you feel! We're all grieving! The whole of America is grieving!"

This idea that you are just part of a huge pool of people bearing loss would surely diminish the importance of your own individual loss. You would want to think of your husband and all his little idiosyncrasies, and how you miss him so much at every turn: when you lay the breakfast table for one, or realise that the bowl that held the sugar he used to have in his coffee will never again be needed. You wouldn't want your special loss to be hijacked by other people, politicians and the media.

The media might be especially painful. It could be that journalists' and experts' responses to the deaths in general seem totally inappropriate to your loss in particular. Perhaps you had a son who believed in forgiveness, who had always campaigned against America's support of Israel. How upsetting it would be to hear Bush's avenging speeches! Or perhaps you, yourself are full of rage against the terrorists. How galling it must be to hear of anyone advocating a calm and measured reaction to these atrocities! Perhaps you feel fury with the suicide bombers, or perhaps you feel fury with a government that made itself so hated. Whatever you feel – and your feelings, fuelled by personal grief, will be burning with intensity – there will be hundreds of people reacting publicly in a diametrically opposite way, all of which will cause you immense pain.

Some bereaved would find great comfort in going to a church service to mourn the loss of all the thousands of people killed. But others would flinch at phrases such as "our dead", and feel furiously angry.

You might feel that your loved one had become public property, simply used to make a huge funeral pyre at which strangers warm their hands, using the flames to light up the poignancy of their own grief over their own dead ones of long ago, or their self-pity or fear of the future.

One of the only pay-offs – well, perhaps the only pay-off – of grief is that in the initial stages, when you grieve, you feel special. In his book Among the Dead, Michael Tolkin wrote of how the bereaved hero, Frank, felt when a friend touched him on the shoulder when he burst into tears. His friend, he realised, "would always know that he could touch someone who had been electrified by tragedy, this force, this angel of death in whose wake everyone close was given a measure of charisma. At last, thought Frank, I am fascinating". But if you are one of many, you are not fascinating. You are just one of many.

But perhaps the worst thing about every one of these deaths is the almost certain knowledge, in every bereaved person's heart, that their loved ones, perfectly healthy people with bright futures, knew for some time that they were going to die. How unbearable it must be to imagine again and again how your son must have felt, strapped into his aeroplane seat, heading for the World Trade Centre. Or might he have been crushed by falling rubble, dying a lingering death? Or was he skinned in a fireball before he died, long moments later, wishing and wishing he could contact you to tell you how much he loved you? You will never know, and you can only imagine – which you do, hour after hour after painful hour. And those whose loved ones did contact them on mobile phones before their deaths – how they must wishthey had said something meaningful and loving, instead of some trite, impatient words like, "Where did you say you were? I'm losing you. Speak up, it's a funny line."

Of course, there will be teams of bereavement counsellors rolling in to be on hand when things get tough, but that is not what you need just after the moment of death. No one needs a bereavement counsellor until they get stuck in irresolvable depression, many months later.

No, what a bereaved person needs now is peace and quiet, surrounded by the loving support of friends and family. Sadly, to be bereaved with so many others at the same time, as has happened in the States, means that a bereaved person loses even more than a relative or friend. They also lose the chance to mourn them in a private, proper, decent way.