Grief and Grieving

Cause

Grief and grieving are the natural response to a major loss, such as the death of a loved one. Loss can cause feelings of grief, sometimes when you least expect it.

You may find that old feelings of grief from past loss can be triggered by current experiences or anniversaries of that loss. This is normal.

Anticipatory grief is grief that happens in advance of an impending loss. You may feel anticipatory grief because a loved one is sick and dying. Anticipatory grief helps us prepare for loss.

Symptoms

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 and by 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 community.

Grief is expressed physically, emotionally, socially, and spiritually.

• Physical expressions of grief often include crying and sighing, headaches, loss of appetite, difficulty sleeping, weakness, fatigue, feelings of heaviness, aches, pains, and other stress-related ailments.
• Emotional expressions of grief include feelings of sadness and yearning. But feelings of worry, anxiety, frustration, anger, or guilt are also normal.
• Social expressions of grief may include feeling detached from others, isolating yourself from social contact, and behaving in ways that are not normal for you.
• Spiritual expressions of grief may include questioning the reason for your loss, the purpose of pain and suffering, the purpose of life, and the meaning of death. After a death, your grieving process is influenced by how you view death.

Grief can cause prolonged and serious symptoms , including depression, anxiety, suicidal thoughts and actions, physical illness, 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 experienced in grief counseling.

Age and emotional development influence the way a person grieves a death.

• Children younger than age 7 usually perceive death as separation. They may feel abandoned and scared. And they may fear being alone or leaving people they love. Grieving young children may not want to sleep alone at night, or they may refuse to go to day care or school. Children under age 7 usually are not able to verbally express their feelings. Instead, they tend to act out their feelings through behaviors, such as having trouble following directions, having temper tantrums, or role-playing their lives in pretend play. Children younger than age 2 may refuse to talk. And they may be generally irritable. Children between the ages of 2 and 5 may develop eating, sleeping, or toileting and bed-wetting problems.
• Children between the ages of 7 and 12 often perceive death as a threat to their personal safety. They tend to fear that they will die also and may try to protect themselves from death. While some grieving children want to stay close to someone they think can protect them, others withdraw. Some children try to be very brave or behave extremely well. Others behave terribly. A grieving child may have problems concentrating on schoolwork, following directions, and doing daily tasks. Children in this age group need to be reassured that they are not responsible for the death they are grieving.
• Teens perceive death much like adults do. But they may express their feelings in dramatic or unexpected ways. For example, they may join a religious group that defines death in a way that calms their feelings. They may try to defy death by participating in dangerous activities, such as reckless driving, smoking cigarettes, drinking alcohol, taking illegal drugs, or having unprotected sex. Like adults, preteens and teens can have suicidal thoughts when grieving. Warning signs of suicide in children and teens may include preoccupation with death or suicide or giving away belongings.

What Happens

Grieving a significant loss takes time. Depending on the circumstances of your loss, grieving can take weeks to years. Grieving helps you gradually adjust to a new chapter of your life.

Becoming aware of a loss

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.

During this time, you may feel numb and seem distracted. You may search or yearn for your lost loved one. Funerals and other rituals and events during this time may help you accept the reality of your loss.

Feeling and expressing grief

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 you may find 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 if you:

• Had several major losses in a short period of time.
• Lost someone very important in your life. You may feel that you will never get over the loss of someone special.
• Experienced the unexpected or violent death of a loved one, such as the death of a child or a death caused by an accident, a homicide, or a suicide.
• Have special life circumstances that act as obstacles to grieving, such as having to return to work too soon after a death.
• Have a history of depression or anxiety.

Adjusting to a loss

It can take years to go through a grieving process. Feelings of grief may return during holidays, birthdays, and other special events.

With loss, your sense of self and security is disrupted. It may help 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.

Treatment Overview

Grief itself is a natural response that doesn't require medical treatment. But sometimes people need help getting through the grieving process.

Initial grief

• Medicine. During the initial days of grief, anxiety or sleeplessness can make it difficult to function. If you suffer more than a few days of severe agitation, talk to your doctor about whether a short-term prescription sedative medicine can help you. (Doctors disagree about the usefulness of medicines for people who are grieving. Some doctors believe that giving medicines for anxiety or sleep may interfere with the ability to grieve.)
• Counseling. If you find that obstacles to grieving are making it difficult to function after a loss, talk to a grief counselor, attend a bereavement support group, or both. Counseling and support groups can also help you work through unresolved grief from a past loss.

Chronic grief and complications

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.

When to Call a Doctor

If you or someone you know develops complications of grief, such as disturbing or suicidal thoughts, depression, or anxiety, get help.

Call 911 or other emergency services if:

• You think you cannot stop yourself from harming or killing yourself.
• You hear voices that frighten you, especially if the voices tell you to hurt yourself or other people.
• Someone who is grieving tries to harm himself or herself or someone else.
• Someone who is grieving threatens to hurt someone else or makes threats of suicide.

Call a doctor if:

• You feel hopeless and detached for more than a couple of weeks.
• You cannot stop yourself from thinking about death or suicide.
• You have a sudden change in your behavior that concerns you, such as drinking more alcohol than you normally do.
• You have been grieving longer than you think is good for you.
• Someone you know has symptoms of depression. These symptoms include feeling sad and losing interest in most daily activities.

Who to see

Counseling is best done by a mental health professional with experience in grief counseling, such as a:

• Clinical social worker.
• Psychologist.
• Licensed professional counselor.
• Psychiatrist, who can prescribe medicine to control symptoms. Some psychiatrists also offer counseling.

Health professionals who can help you if you are having medical or mental health problems requiring medicine include:

• General practitioners.
• Family medicine doctors.
• Internists.
• Psychiatrists.
• Physician assistants.
• Nurse practitioners.

Home Treatment

Coping with grief

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:

• Get enough rest and sleep. During sleep, your mind makes sense of what is happening in your life. Not getting enough rest and sleep can lead to physical illness and exhaustion. Try activities to help you relax, such as meditation or guided imagery.
• Eat nourishing foods. Resist the urge not to eat or to eat only those foods that comfort you. If you have trouble eating alone, ask another person to join you for a snack or meal. If you do not have an appetite, eat frequent small meals and snacks. Consider taking a multivitamin daily.
• Exercise. If nothing else, take a walk. Brisk walking and other forms of exercise, such as yoga or tai chi and qi gong, can help release some of your pent-up emotions.
• Comfort yourself. Allow yourself the opportunity to be comforted by familiar surroundings and personal items that you value. Special items, such as photos or a loved one's favorite shirt, may also give you comfort. Treat yourself to something you enjoy, such as a massage.
• Try to stay involved. Staying involved in activities that include your support network, such as work, church, or community activities, may help you as you grieve.

To help you work through the grieving process, make sure to:

• Surround yourself with loved ones. You may feel lonely and separate from other people when you are grieving. You may think that no one else can understand the depth of your feelings. Surrounding yourself with loved ones and talking about your feelings and concerns may help you feel more connected with other people and less lonely.
• Get involved. Take part in the activities that occur as a result of the loss, such as making funeral arrangements.
• Avoid quick fixes. Resist the urge to drink alcohol, smoke cigarettes, or take nonprescription medicines (such as sleeping aids). When you are under emotional stress, these may only add to your unpleasant feelings and experiences and may mask your emotions and prevent you from normal, necessary grieving.
• Ask for help. During times of emotional distress it is important to allow other people to take over some of your responsibilities. Other people often feel the need to show you how much they care about you.

• Grief: Coping With Grief

Helping others cope with grief

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 is grieving.

If someone you know is grieving:

• Encourage the person to grieve at his or her own pace. The grieving process does not happen in a step-by-step or orderly fashion. There will be good days and bad days. Do not try to "fix" the person's grief. Provide support and be willing to listen.
• Be sensitive to the effect of your words. But don't ignore the person who is grieving just because you aren't sure what to say. Check in regularly during the first year and beyond, especially on important days, including the anniversary of the death, holidays, and birthdays.
• Recognize that this person's life has changed forever. Encourage the person to participate in activities that involve and build his or her support network.
• Respect the person's personal beliefs. Listen to his or her feelings without making judgments. Do not try to change the person's beliefs or feelings.

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.

• Grief: Helping Children With Grief

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.

• Grief: Helping Teens With Grief

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 develop complications associated with grieving. Older adults may be more likely than other people to experience several losses in a short period of time.

• Grief: Helping Older Adults With Grief