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Grief is your emotional reaction to
a significant loss. The words sorrow and heartache are often used to describe
feelings of grief. Whether you lose a beloved person, animal, place, or object,
or a valued way of life (such as your job, marriage, or good health), some
level of grief will naturally follow.
Anticipatory grief is grief
that strikes in advance of an impending loss. You may feel anticipatory grief
for a loved one who is sick and dying. Similarly, both children and adults
often feel the pain of losses brought on by an upcoming move or divorce. This
anticipatory grief helps us prepare for such losses.
Grieving is the process of
emotional and life adjustment you go through after a loss. Grieving after a
loved one's death is also known as bereavement.
Grieving is a
personal experience. Depending on who you are and the nature of your loss, your
process of grieving will be different from another person's experience. There
is no "normal and expected" period of time for grieving. Some people adjust to
a new life within several weeks or months. Others take a year or more,
particularly when their daily life has been radically changed or their loss was
traumatic and unexpected.
wide range of feelings and symptoms are common during grieving. While you are feeling
shock, numbness, sadness, anger, guilt, anxiety, or fear, you may also find
moments of relief, peace, or happiness. And although grieving is not simply sadness,
"the blues," or
depression, you may become depressed or overly anxious
during the grieving process.
The stress of grief and grieving can
take a physical toll on your body. Sleeplessness is common, as is a weakened
immune system over time. If you have a chronic
illness, grieving can make your condition worse.
Social support, good
self-care, and the passage of time are usually the best medicine for grieving.
But if you find that your grief is making it difficult to function for more
than a week or two, contact a grief counselor or bereavement support group for
If you have trouble functioning for longer than a couple of
weeks because of depression or
anxiety, talk to your doctor. Treatment with medicines
or counseling can help speed your recovery.
Learning about grief and grieving:
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grieving are the natural response to a major loss. But any loss can cause
feelings of grief, sometimes when you least expect it.
Losses that may cause grief include:
Grief can be also caused by a loss related to a normal,
seemingly positive life change. Examples of such life events include:
You may find that old feelings of grief from past loss can
be triggered by current experiences or anniversaries of that loss. This is
Your experience of
grief is likely to be different from another person's.
Similarly, you will probably grieve somewhat differently each time you
experience a significant loss. Your reaction to loss is influenced by the
relationship you had with the lost person, object, or situation, and your
general coping style, personality, and life experiences. How you express grief
is influenced in part by the cultural, religious, and social rules of your
Grief is expressed physically, emotionally, socially,
Grief can cause prolonged and serious symptoms,
anxiety, suicidal thoughts and actions, physical
and post-traumatic stress disorder.
Intense grief can bring
on unusual experiences. After a death, you may have vivid dreams about your
loved one, develop his or her behaviors or mannerisms, or see or hear your
loved one. If you feel fearful or stressed by any of these experiences, talk to
your doctor and a mental health professional or clergy person
Age and emotional
development influence the way a person grieves a death.
Grieving a significant loss takes time. Depending on
the circumstances of your loss, grieving can take weeks to years. Ultimately,
passing through the major stages of grieving helps you gradually adjust to a
new chapter of your life.
Full awareness of a major
loss can happen suddenly or over a few days or weeks. While an expected loss
(such as a death after a long illness) can take a short time to absorb, a
sudden or tragic loss can take more time. Similarly, it can take time to grasp
the reality of a loss that doesn't affect your daily routine, such as a death
in a distant city or a diagnosis of a cancer that doesn't yet make you feel
During this time, you may feel numb and seem distracted. You
may search or yearn for your lost loved one, object, or way of life. Funerals
and other rituals and events during this time may help you accept the reality
of your loss.
Your way of feeling
and expressing grief is unique to you and the nature of your loss. You may find
that you feel irritable and restless, are quieter than usual, or need to be
distant from or close to others, or that you aren't the same person you were
before the loss. Don't be surprised if you experience conflicting feelings
while grieving. For example, it's normal to feel despair about a death or a job
loss yet also feel relief.
The grieving process does not happen
in a step-by-step or orderly fashion. Grieving tends to be unpredictable, with
sad thoughts and feelings coming and going, like a roller-coaster ride. After
the early days of grieving, you may sense a lifting of numbness and sadness and
experience a few days without tears. Then, for no apparent reason, the intense
grief may strike again.
While grieving may make you want to
isolate yourself from others and hold it all in, it's important that you find
some way of expressing your grief. Use whatever mode of expression works for you. Talking, writing, creating art or music, or being physically active are
all ways of expressing grief.
Spirituality often is part of the
grieving process. You may find yourself looking for or questioning the higher
purpose of a loss. While you may gain comfort from your religious or spiritual
beliefs, you might also be moved to doubt your beliefs in the face of traumatic
or senseless loss.
Grieving problems. In
this complex and busy world, it can be hard to fully grieve a loss. It is
possible to have
unresolved grief or
complications associated with grieving, particularly
It can take 2 or more years to
go through a grieving process. The length of time spent grieving depends on
your relationship with the lost person, object, or way of life. Even after 2
years, you may again experience feelings of grief, especially over the loss of your
loved one. Be prepared for this to happen during holidays, birthdays, and other
special events, which typically revive feelings of grief.
grief experts consider grieving to be the slow recovery from a crisis of
attachment: after losing something or someone to whom you are deeply attached,
your sense of self and security is disrupted. So as you adjust to a major loss,
your goal is to develop or strengthen connections with other people,
places, or activities. These new parts of your life are not meant to replace
what you have lost. Instead, they serve to support you as you begin to start a
new phase of your life.
Grief itself is
a natural response that doesn't require medical treatment. But sometimes people
need help getting through the grieving process.
If you or someone
you know exhibits
suicidal behavior (such as thinking you cannot stop yourself from harming
or killing yourself), call 911 or other emergency services immediately.
If you find that a major loss has
caused complications, such as
depression, prolonged anxiety,
post-traumatic stress disorder (PTSD), or severe
and prolonged grief, see your doctor and a grief counselor for treatment.
If you have a chronic medical condition that has been made worse by the
emotional and physical stress of grief, see your doctor immediately.
If you or someone
you know develops
complications of grief, such as disturbing or suicidal
anxiety, get help.
Call 911 or other emergency services if:
Call a doctor if:
Counseling is best done by a mental
health professional with experience in grief counseling, such as a:
Health professionals who can help you if you are having
medical or mental health problems requiring medicine include:
Home treatment plays an
important role in working through the
grieving process. Talking about the loss, sharing
cares and concerns, and getting support from others are very important
components of healthy grieving.
If you are caring for a dying
loved one, it is important to take good care of yourself also. When you know
that a loss is approaching, especially if you are able to participate in the
care of a loved one who is dying, you may be better able to recognize and deal
with your feelings of grief. It is important that you get
caregiver support to help you care for your loved one
as well as to help you prepare for your loss.
If you have just
had a major loss in your life, it is important to:
To help you work through the grieving process, make sure
There are many ways
that family members and other people close to a person who is grieving can give
help and support. The best way to help a grieving person often depends on how
well the person was prepared for the loss, the person's perception of death,
and his or her personality and coping style. The person's age and stage of
emotional development are also important to think about when you are helping a person who
If someone you know is grieving:
Helping young children who are
grieving can be challenging for adult caregivers. The best way to help a child
varies according to age and emotional development.
Teens may need special
consideration and care when they are grieving. Many times it is hard to
know how to approach and help a teen in these circumstances.
Older adults may not express grief
in the same way as other adults. Older adults are more likely to become
physically ill after a major loss. They may already have a chronic physical
illness or other conditions that interfere with their ability to grieve or that
become worse when they are grieving. Also, older adults may be likely to
complications associated with grieving. Older adults
may be more likely than other people to experience several losses in a short
period of time.
The American Hospice Foundation strives to improve access to
quality hospice care through public education, professional training, and
consumer advocacy. The organization supports programs that serve the needs of
terminally ill and grieving individuals of all ages. It publicizes hospice
concepts through training, education, and outreach, promoting services, and
initiating research on consumer needs and preferences in end-of-life
The Web site offers information about death and dying and related
grief and grieving processes. The "Grief Zone" has links to readings grouped
into categories such as grief and kids, grief on the job, hospice information
and support, and grief and faith.
Caring Connections, a program of the U.S. National Hospice and Palliative Care Organization (NHPCO), seeks to improve care at the end of life. Caring Connections provides free resources, including educational brochures, advance directives and hospice information, and a toll-free help line for people looking for quality end-of-life information.
Compassionate Friends is an organization that helps family members
through the grieving process when they have lost a child.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
Mental Health America (formerly known as the National
Mental Health Association) is a nonprofit agency devoted to helping people of
all ages live mentally healthier lives. Its website has information about
mental health conditions. It also addresses issues such as grief, stress,
bullying, and more. It includes a confidential depression screening test for
anyone who would like to take it. The short test may help you decide whether
your symptoms are related to depression.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
Other Works Consulted
Cordts GA, et al. (2007). Care at the end of life. In LR Barker et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 192–207. Philadelphia: Lippincott Williams and Wilkins.
Glazer JP, Schonfeld DJ (2007). Children's concepts of death section of Life-limiting illness, palliative care, and bereavement. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 971–890. Philadelphia: Lippincott Williams and Wilkins.
Shear K, et al. (2005). Treatment of complicated grief: A randomized controlled trial. JAMA, 293(21): 2601–2608.
October 17, 2011
Anne C. Poinier, MD - Internal Medicine & Sidney Zisook, MD - Psychiatry
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