Grief, Loss, and Bereavement
Bereavement refers specifically to the process of recovering from the death of a loved one. Grief is a reaction to any form of loss. Both encompass a range of feelings from deep sadness to anger, and the process of adapting to a significant loss can vary dramatically from one person to another, depending on his or her background, beliefs, relationship to what was lost, and other factors.
Grief is associated with feelings of sadness, yearning, guilt, regret, and anger, among others. Some people may experience a sense of meaninglessness, and others can feel a sense of relief. Emotions are often surprising in their strength or mildness, and they can also be confusing, such as when a person misses a painful relationship.
Thoughts during grief can vary from “there’s nothing I can do about it” to “it’s my fault, I could have done more” or from “she had a good life” to “it wasn’t her time.” They can be troubling or soothing, and people in grief can bounce between different thoughts as they make sense of their loss. Grieving behaviors run from crying to laughter, and from sharing feelings to engaging silently in activities like cleaning, writing, or exercising. Some people find comfort in the company of others, particularly with those who may be similarly affected by the loss, and others may prefer to be alone with their feelings.
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- Instrumental grieving involves focusing primarily on problem-solving tasks while controlling or minimizing emotional expression.
- Intuitive grieving is based on a heightened emotional experience that leads to sharing feelings, exploring the lost relationship, considering mortality, and identifying meaning in life.
There is no right or wrong way to experience grief, though some thoughts and behaviors after a loss can be more helpful or safe than others.
Everyone grieves in their own way and in their own time. Some people recover from grief and resume normal activities within six months, though they continue to feel moments of sadness. Others may feel better after about a year, and sometimes people continue to grieve for years without seeming to improve or find relief even temporarily. Grief can be complicated by other conditions, most notably depression, or by the person’s level of dependency on the departed.
No one way of grieving is better than any other. Some people are more emotional and dive into their feelings; others are stoic and may seek distraction from dwelling on an unchangeable fact of living. While many difficult and complicated emotions are associated with the grieving process, experiences of joy, contentment, and humor are not absent during this difficult time. Self-compassion, physical exercise, and strong social support can all contribute to alleviating some of the most challenging aspects of grief.
One of the many challenges associated with grieving the loss of a loved one, whether to death or the dissolution of a relationship, is adjusting to the new reality of living in the absence of the loved one. This often requires developing a new routine, envisioning a new future, and even adopting a new sense of identity.
- Out of the Darkness: Three Steps to Emotional Healing
- Breathing Lessons for Coping with Grief
- Creating Rituals to Move Through Grief
The experience of grief is not something a person ever recovers from completely, but time typically tempers its intensity. The term complicated grief refers to a persistent form of bereavement that dominates a person’s life, interfering with daily functioning for an extended period of time.
Symptoms of complicated grief are nearly identical to those of acute grief, and again, the length of time it takes for a person to grieve is highly variable and dependent on context. But when symptoms are interminable without improvement, lasting for at least one year or more and interfering with one’s ability to return to routine activities, complicated grief may be implicated. Prolonged symptoms may include:
- Intense sadness
- Preoccupation with the deceased or with the circumstances surrounding the death
- Longing or yearning
- Feelings of emptiness or meaninglessness
- Difficulty engaging in happy memories
- Avoidance of reminders of the deceased
- Lack of desire in pursuing personal interests or plans
- Bitterness or anger
The DSM-5 includes diagnostic criteria for “persistent complex bereavement disorder” in the section of conditions requiring further study.
When a person’s grief-related thoughts, behaviors, or feelings are extremely distressing, unrelenting, or incite concern, a qualified mental health professional may be able to help. Therapy is an effective way to learn to cope with the stressors associated with the loss and to manage symptoms with techniques such as relaxation or meditation.
Each experience of grief is unique, complex, and personal, and therapists will tailor treatment to meet the specific needs of each person. For example, a therapist might help the bereaved find different ways to maintain healthy connections with the deceased through memory, reflection, ritual, or dialogue about the deceased and with the deceased.
In addition to individual therapy, group therapy can be helpful for those who find solace in the reciprocal sharing of thoughts and feelings, and recovery results are often rapid in this setting. Similarly, family therapy may be suitable for a family whose members are struggling to adapt to the loss of a family member.
Psychologists and researchers have outlined various models or phases of grief. In 1969, Elisabeth Kubler-Ross identified five linear stages of grief that most people are now familiar with:
Kubler-Ross originally developed this model to illustrate the process of grief associated with death, but she eventually adapted the model to account for any type of grief. Kubler-Ross noted that everyone experiences at least two of the five stages of grief, and she acknowledged that some people may revisit certain stages over many years or throughout life.
Psychologist J. W. Worden also created a stage-based model for coping with the death of a loved one. He called his model the Four Tasks of Mourning:
- To accept the reality of the loss
- To work through the pain of grief
- To adjust to life without the deceased
- To maintain a connection to the deceased while moving on with life
As an alternative to the linear stage-based model, Margaret Stroebe and Hank Schut developed a dual process model of bereavement. They identified two tasks associated with bereavement:
- Loss-oriented activities and stressors are those directly related to the death. These include crying, yearning, experiencing sadness, denial, or anger, dwelling on the circumstances of the death, and avoiding restoration activities.
- Restoration-oriented activities and stressors are associated with secondary losses with regard to lifestyle, routine, and relationships. These include adapting to a new role, managing changes, developing new ways of connecting with family and friends, and cultivating a new way of life.
Stroebe and Schut suggest that people will invariably oscillate between the two processes.
The Diagnostic and Statistical Manual (DSM) does not define bereavement as a disorder, but preexisting conditions like major depression, or repercussions associated with the trauma of a death, such as acute stress or posttraumatic stress, can complicate bereavement. Normal symptoms of bereavement can mimic those of depression, but these symptoms typically pass within two months of the loss. For those who may be vulnerable to depression, grief has the potential to precipitate a depressive episode, and for those who already experience depression, the bereavement process can be prolonged and worsened by the depression. What distinguishes grief from depression is that the feelings of grief are specifically related to the loss or death, and depression is characterized by a general sense of worthlessness, despair, and lack of joy.
Mourning multiple losses: Rhonda, 57, had a sudden breakdown, stopped working, became anxious and depressed, and sought therapy after her sister passed away. A full history revealed she had been the sole caretaker for her sister, who had been ill for years and required near full-time assistance. During the time of the illness, Rhonda’s parents had both died of natural causes. Rhonda realized she never had time or emotional energy to mourn her parents’ death, and in fact, resented her sister, and had not mourned her death that had just occurred within the past year, and for which Rhonda felt terribly guilty. She had also been so caught up in her family duties that she had had little time to develop other pursuits. Allowing herself to face the great feelings of sadness and loss slowly dissolved her anxiety, and after a time of rest to fully grieve, Rhonda could return to work. With the support of a therapist and a close friend, she found the strength to begin to build a full life.
- Doughty, E. A., Wissel, A., & Glorfield, C. (2011). Current Trends in Grief Counseling. Vistas Online. Retrieved from http://counselingoutfitters.com/vistas/vistas11/Article_94.pdf
- Kersting, K. (2004, November). A New Approach to Complicated Grief. Monitor on Psychology 35(10). Retrieved from https://www.apa.org/monitor/nov04/grief.aspx
- Major Depressive Disorder and the “Bereavement Exclusion”. American Psychiatric Association. Retrieved from http://www.dsm5.org/Documents/Bereavement%20Exclusion%20Fact%20Sheet.pdf
- Wakefield, J. C. (2013). DSM-5 grief scorecard: Assessment and outcomes of proposals to pathologize grief. World Psychiatry. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683270/
Last updated: 05-31-2016
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