The 5 stages of grief (i.e., denial, anger, bargaining, depression, acceptance) are a well-known model of grief that was first proposed almost 50 years ago.1 Despite its continued popularity, grief research has demonstrated that each person handles grief in their own distinct way,2,3,4,5,6 and the “stages of grief” do not reflect how the majority of people grieve.
Losses That People Grieve
While the death of a loved one is likely the most common type of loss that people think of when they think of grief, it is not the only type of loss that can lead to significant mind and body grief reactions.
People might find they are grieving for losses other than the actual death of a loved one, such as:
- The death of a beloved pet
- Loss of physical health or abilities (due to illness, accident or other trauma)
- Job loss or loss of financial security
- Ending of an important relationship (e.g., estrangement, conflict, breakup grief)
- Loss of home country/culture/community (among immigrants and refugees)
- The loss of sense of purpose, meaning, or the belief that one can make a difference in the world
- Loss of valued social connections (e.g., due to pandemic lockdowns, moves, changes in school or work)
- Loss of sense of safety (e.g., in one’s home, community, country)
The Grieving Process
The grieving process is a personal experience for each individual, and despite the fact that it can be overwhelmingly painful and debilitating at times, it is a natural and normal response to significant loss.
The grieving process has been likened to “waves.”7 For some, it will feel like the waves—of sadness, shock, regret, anger, anxiety, loneliness, etc.8—are pulling them under, again and again. It will take all of their strength to “keep from drowning” in their sadness and deep longing for the way things were before the loss. They will have times when they function less well than they did before the loss.
For others, the waves may instead feel like ripples of grief. The sadness and yearning is poignant, but neither overwhelming nor debilitating. At different times, individuals might experience each of these types of waves, and other types of waves of grief that fall somewhere in between. Fortunately, most will also experience some relief in moments of comfort, peace, and joy interspersed among the waves of grief.8,9
Most people tend to experience improvements in their grief symptoms, including a return to pre-loss levels of functioning, within about 6 months following the loss.8 It is, nevertheless, quite common for grief symptoms to intensify temporarily when important dates arise (e.g., birthdays, anniversaries of death, special holidays) which trigger reminders of the loss.
Grieving Tasks
It has been proposed that the grieving process might include working through “grief tasks.” These tasks may occur in different orders.10
Potential grief tasks include:
Accepting the Reality of Loss
One of the common ways that people try to avoid accepting a loss (which some consider the acceptance stage) is by focusing on the “why?’” or “how?” a loss occurred. Initially, some will want to try to understand the factors that led to the loss in the hopes of preventing similar losses in the future (if possible) or to process the loss in one’s mind. It is sometimes the case, however, that no answers, or rather, no satisfactory answers will be available. At some point in time, with or without answers, one must come to terms with the fact that the loss has happened and is permanent.
Enduring and Facing the Pain Associated With Loss
The emotional and physical symptoms of grief that one experiences after suffering a substantial loss can sometimes feel unbearable, even leading to real feelings of pain. It is important to trust yourself to survive this normal—albeit, overwhelmingly painful at times—reaction to loss. Compassion, reassurance, and patience can help.
Adjusting to the New Realities Following Loss
Loss can have many levels of impact in one’s life. The changes that result can cause rippling disruptions. Loss might change what you do, and how you do it, on a daily basis. It will likely take some time to notice the changes that are required, and to figure out ways to adapt to your changed realities, so that you are eventually able to fully reengage in your life once again.
Finding New Ways to Feel Connected to the Deceased
Continuing to stay connected to a loved one who has died seems to help many to deal with their grief. Some ways that people keep the connection with their loved one alive is through memories, sentimental items, continued conversations/prayer, or continuing to honor special days related to the loved one (e.g., birthdays, anniversaries).
Embracing a Renewed Sense of Purpose
A major loss can undermine one’s sense of purpose or meaning in life. You could wonder, “what is the point?” or feel like you’ve lost the motivation to move forward in a world in which such pain is possible. Some will find that over time, as their grief subsides, they will again find their sense of purpose and meaning. Others might connect their sense of purpose to the memory of a deceased loved one, or to a cause directly related to their loss (e.g., fundraising for the American Cancer Society, volunteering for the Red Cross, pursuing a college degree).
When Grief Becomes ‘Stuck’
Approximately 20% of individuals experience neither a reduction in intensity of grief symptoms nor a return to pre-loss functioning levels within 6 months following the loss.11 In these cases of “prolonged” or “complicated” grief, it appears that the grieving process has become “stuck.”
Persistent Complex Bereavement Disorder is a diagnosis that might be made when significant debilitating grief-related symptoms have continued beyond 12 months post-loss (PCBD is currently regarded as a condition for further study in the DSM-5). It is estimated that 5% of bereaved individuals will experience this disorder.9
Risk Factors For Complicated or Disordered Grief
There are a number of factors that can increase the risk that one will develop complicated or disordered grief. These include:
- Previous loss12
- Experiencing multiple losses13
- Losing a person whom one had a very close and supportive relationship with9,12
- Death of a child9
- Death of a partner/spouse12
- Witnessing the death or finding the deceased13
- When a loved one is missing and presumed dead, but death has not been confirmed13
- Exposure to trauma – might be due to a violent loss (e.g., suicide, homicide, accidents)12
- Unexpected death12
- Having previously experienced mental illness13
- Lack of social support following the loss12
Of note, women are at higher risk of complicated grief than are men.12
Symptoms that Indicate Complicated or Disordered Grief and the Need for Professional Support
Within 6 months following the loss, if you have not noticed any improvement in your ability to function and are continuing to experience overwhelming emotional pain on more days than not, you may benefit from the support of a professional. Grief reactions that are deeply painful, debilitating, and don’t seem to begin to improve within 6 months post-loss could indicate the presence of complicated or disordered grief.
Unremitting types of symptoms, (i.e., have persisted in intensity beyond 6 months), that indicate complicated or disordered grief include:7,9,14,15,16,17,18
- Grief reactions that are beyond what is typical within the person’s religious or cultural community and/or age group
- Deeply painful emotional distress related to the loss of the loved one
- Inability to accept the reality of the loss and adjust to it
- Loss of meaning, purpose, interest, and/or identity in life
- An unrelenting longing or yearning for the loved one who has died, which might lead to thoughts of suicide, or wishing for death, as a means of reuniting with the deceased
- Experiencing life as unbearable following the loss
- Intolerable loneliness
- Avoidance of anything that reminds one of the deceased
- Experiencing recurring intrusive thoughts and feelings about the deceased
- Persistent, distressing thoughts about the way in which the loved one died
- Inability to recall positive memories of the loved one
- Self-blame, guilt, shame, and more related to the loved one and/or their death
More information on Grief Counseling can be found here.
What You Can do to Help Yourself Through Grief
If you are grieving there are some things you can do to help yourself through this difficult time.
Be Compassionate and Patient With Yourself
Grief can be very disruptive and disabling for a time. You may have trouble thinking clearly, remembering things, and making decisions. You might also have difficulty getting through daily tasks. You could be fatigued and have little energy. These are some of the normal and natural reactions to grief. Don’t blame or belittle yourself for having them.
Take Care of Your Physical Health
Taking care of your physical health is important as you deal with grief-related mind and body reactions. Try to remember to eat regularly—even if it’s just small meals or snacks throughout the day. Drink water to stay hydrated. Rest more because your body and mind will need it. Go for walks or do gentle stretching if you are able to.
Accept Offers of Help From Others
If others are telling you to let them know if there is anything they can do for you, it is because they care about you. Consider that you have likely offered the same to people you care about when they are hurting. Accepting help from others can have at least three positive outcomes. First, it helps others to feel good about themselves because they have been able to lighten your burden. Second, you benefit because it likely lightens your burden some. Third, by accepting help, you give yourself the message that your grief, as well as you as a person, matters.
Allow Yourself to be Happy
Accept and embrace the moments of joy and comfort that still occur during times of grief. It is healthy and good for you to allow yourself to have moments of peace and happiness – to notice beauty, kindness, and humor in the present moment. Being happy isn’t anything to feel guilty about. It doesn’t dishonor the loss. These moments will give you strength and help you to heal.
Notice the Small Improvements Over Time
Remember the first morning you woke up after the loss? There might have been a few seconds where you had forgotten for a moment what had happened, and then all of a sudden you were knocked over by waves of shock and emotional pain as you remembered. Or, maybe you woke up crying… In the weeks and months that followed, those waves of grief in the morning, should be further apart and less intense. You may notice that you are starting to eat again, able to focus on paying bills, or able to go to work or school. You may also notice that you are remembering how to laugh and hope again. All these improvements are important.
If your symptoms continue, and you experience difficulty functioning in one or more areas of your life, beyond 6 months post-loss, consult with your doctor, professional counselor, or psychologist.
What You Can Do to Support a Loved One Who is Grieving
When trying to offer support to a loved one who is grieving, it can be confusing to know what to do. Here are some tips that might be useful:
Listen but Don’t Try to Fix It
Don’t try to get your loved one to look on “the bright side.” Don’t try to minimize the loss. Don’t draw attention to your own stories of grief. Just listen with compassion and empathy (i.e., by non-judgmentally trying to imagine what your loved one is going through).
Reflect Back What You are Hearing
Acknowledge their pain and sorrow, “It sounds like this has been really hard for you.” or “I can only imagine how painful this has been for you.” Let them know you are sorry they are hurting so much.
Offer Practical Help
Activities including making a meal for the bereaved or their family, assisting with childcare, and doing errands can be a big help for people who are grieving. If you ask them what they need, they might find it hard to think of something because they are feeling so overwhelmed. By offering specific types of support, those you are grieving may be more likely to accept your offer.
Educate Yourself
Learn about grief so that you can to reassure your loved one that their reactions are a normal and natural response to significant loss.
Take Good Care of Yourself
You have only so much energy and time. Supporting a loved one who is grieving will require some of your limited time and energy. Thus, you will need to take extra good care of yourself to keep yourself healthy and rested as you try to be there for a loved one who is grieving.
If your loved one’s symptoms do not seem to be improving and they are continuing to have difficulty functioning in their daily life beyond 6 months post-loss, encourage them to consult with a professional (i.e., doctor, counselor). Offering to help them to make the appointment or going with them to the appointment may give them the support they need to take this step.
For Further Reading
The following are helpful resources for anyone grieving:
- Harvard Health Publishing: Harvard Medical School – listing of Grief-related article
- Kids Health
- University of Texas at Austin – Grief and Loss
