Grief is a normal emotional response to loss. Every person experiences a manifestation of grief at some point in their life. Bloomfield, Colgrove, & McWilliams (2000) point out that while most people associate grief with the death of someone, there are additional types of losses.For example, a person can grieve over the breakup of an intimate relationship or friendship, a completion of a goal, leaving home, loss of a job, loss of a home, loss of health, loss of safety after a traumatic event, loss of bodily functions, loss of dreams, loss of privacy, loss of independence, moving, or changing schools or teachers. Grief touches every aspect of a person’s life and can be intensive and extensive.
Johnson (2016) identifies three types of grief: Anticipatory, sudden loss, and complicated grief.
Anticipatory Grief: When a loved one has suffered from a long illness and then dies (i.e. an elderly or terminally ill person). Even though the death is expected, it is still painful. With anticipatory grief, people are able to prepare for the death including planning a funeral, completing unfinished business, and saying their “good-byes” to the dying person.
Sudden Loss: Brings about an extreme feeling of shock due to the suddenness of the death. Overwhelming feelings might consume these loved ones. Often, those who are left behind find it harder to deal with their loss and become unable to function, as this type of loss exceeds their coping abilities.
Complicated Grief: This grief is experienced when the intensity of the pain and sadness dramatically interferes with a loved one’s ability to function. Symptoms of depression and anxiety may become dominant and long-drawn-out. It is important to seek help from a mental health professional if you are approaching or are already at your breaking point.
What Grieving Looks Like
There is no right or wrong way to express grief. Johnson (2016), points out that people are affected by grief physically, emotionally, cognitively, behaviorally, and spiritually:
Physical: Sleep, eating, and exercise may become problematic. A grieving person is also at higher risk for sickness and possible death because of the physical and emotional drain to their immune system.
Emotional: A grieving person often experiences a flood of emotions varying in degree and intensity. Emotions range from:
- laughing to crying within minutes
- expressing feelings and finding comfort in good memories of the deceased while at other times feeling the need to isolate themselves from activities, peers, or family.
Cognitive: People might make impulsive decisions or are unable to make any decisions at all. A grieving person could also suffer from short-term memory, have difficulty focusing or concentrating, and feel they are “going crazy.” While some thoughts can be troubling, others can be soothing. The following are common thoughts grieving people experience in order to make sense of their loss:
- “There’s nothing I can do about it.”
- “It’s all my fault.”
- “I could have done more.”
- “She had a good life.”
- “It wasn’t her time.”
- “I wish it had been me instead.”
- “What am I going to do now?”
- “I’m so glad he is no longer in pain.”
- “I could have stopped their death.”
- “If only I hadn’t (_____), then they would still be alive.”
Behavioral: It is common for a person who is grieving to go from one extreme to the other in behaviors (i.e. refusing to leave home versus avoiding being at home; difficulty returning to work versus throwing themselves completely into their work; not motivated to do errands and house chores versus spot cleaning their entire home).
Spiritual: Questions regarding spirituality often come to the surface.
DSM-5 and Grief
The DSM-5 or Diagnostic and Statistical Manual of Mental Disorders (2013), does not define grief as a disorder. Symptoms of grief often resemble those of major depressive disorder (MDD), however, these symptoms typically pass within two months of a loss.
For those who have experienced MDD in the past, the process can prolong and worsen their depression. Grief may also be prolonged depending on a person’s level of dependency on the deceased (p. 161). The following is a chart comparing the differences between grief and MDD according to Rando (1993):
Grief Versus Depression
|Grief||Major Depressive Disorder|
|Diminishes in intensity over time||A consistent sense of depletion|
|Experienced in waves||Moods and feelings are static|
|Healthy self-image||The sense of worthlessness and disturbed self-image|
|Overt expression of anger||Anger not as pronounced|
|Preoccupation with deceased||Preoccupation with self|
|Response to support||Unresponsive to support|
Signs and Symptoms of Grief
While it is normal to experience grief symptoms, they can be scary. Johnson (2016) asserts everyone processes grief differently due to individual factors such as one’s own deceased loved one’s personality, the type of relationship they shared with one another, how the deceased loved one died, a person’s life circumstance, and at what point in time the grieving person seeks help.
Because every person grieves differently, their reactions will vary in strength and intensity. The following are symptoms listed by both Johnson (2016) and Worden (1982) that a grieving person might experience:
- Appetite changes
- Avoidance of reminders of the deceased/loss
- Chest pain
- Desperately seeking to fill the inner void
- Difficulty with concentration
- Difficulty engaging in happy memories
- Flooded memories
- Hair loss
- Identity crisis
- Lack of desire in pursuing personal interests or plans
- Loss of strength
- Low energy or fatigue
- Obsession with memories of deceased
- Racing heart
- Reassessment of friends/activities
- Search for meaning/purpose
- Shortness of breath
- Sleep changes: difficulty going to sleep or waking in the middle of the night
- Social isolation
- Spiritual anger: shattered faith, angry at God, spiritual confusion
- Upset stomach or digestive problems
- Weight loss or gain; over- or under-eating
Model of Grief
The most popular grief model belongs to Elisabeth Kubler-Ross. Kubler-Ross developed the Five Stages of Grief stating that the grieving process takes time, affects people differently and gradually, don’t always occur in the exact order and that not everyone goes through all five stages. The following are her five stages of grief:
Denial: Shock and disbelief regarding loss.
- “It can’t be true.”
- “Did it really happen?”
- “Are they really gone?”
- A loved one might be unable to handle reality.
- Feeling numb and overwhelmed helps a person get through each day.
- Life doesn’t make sense.
Anger: May be expressed towards God, themselves, deceased, relatives, friends, or healthcare providers. Also angry they were left behind. May happen once loved one faces the reality of loss.
- Questions: Why? How?
- It’s not fair!
Bargaining: Occurs when a loved one asks God for more time with the person dying. Known as the “What If I” stage.
- For example: “If I go to church every day or every week, God will you please let my wife live?”
- It provides temporary escape and hope for the loved one.
- It allows time to adjust to the reality that death is inevitable.
- Guilt is bargain’s best friend.
- Negotiating helps one feel they have some form of control, even if it is for a brief second.
Depression: When the reality of the loss sinks in a loved one pulls away from life.
- Sadness, decreased sleep and appetite are common during this stage.
- There is no sustained functional impairment.
- It is not common to have suicidal thoughts.
Acceptance: When the loved one comes to terms with the loss.
- Accepting the reality and fact that nothing can bring the deceased one back.
- It does not mean that the person is okay with the loss.
- Loved one learns to move on. They pay attention to their needs, grow, transform, reach out to loved ones.
- It is the final stage of healing (Kubler-Ross & Kessler, 2000, pp. 78-81).
Recovering from Grief
Grief is not something a loved one will ever recover from; however, with time, it typically lessens its intensity. Recovering from grief means that people have to learn to integrate their loss as a part of their new life.
One must first assess their lifestyle, routine, and relationship loss and then cultivate a new life by adapting to their new role, managing changes, and developing new ways of connecting with family and friends. As suggested by Bloomfield et al. (2000), Evans (2015), Johnson (2016), Metzgar (1984), and other researchers in the field, suggest this is accomplishable by:
- Allowing yourself to accept love
- Allowing yourself to feel emotions
- Attending support groups
- Attending therapy with a mental health professional
- Avoiding major changes at home, work, or marital status
- Being courageous
- Being hopeful
- Confiding in others
- Deep breathing
- Doing something creative
- Eating Well
- Experiencing nature
- Getting enough sleep
- Lighting a candle at a certain time of day in remembrance of your loved one
- Listening to music
- Maintaining connections
- Reading and learning about death-related grief responses
- Repairing relationships
- Seeking comforting rituals
- Seeking spiritual solace
- Showing yourself compassion
- Taking medication if needed (i.e. antidepressants such as Celexa, Lexapro, Paxil, Prozac, Wellbutrin, Zoloft)
- Volunteering in an environment where you are impacting our future generation
- Writing stories and/or poems
Grief CounselingAccording to Johnson (2016) and other specialists in the field, the grieving process varies from one individual to the next but generally lasts a year or more. Metzgar (1984) adds that this is due to surviving many “firsts” without their loved one (i.e. first birthday, Thanksgiving, Christmas, accomplishments, and life challenges).
Grieving can last longer if it is complicated by major depression, if a person finds it difficult to reach out for help, if they feel guilty about receiving attention, if they believe they are a burden to others, or if they are too depressed to reach out.
Complicated grief refers to a persistent form of grieving which dominates a person’s life, interferes with their daily functioning, and lasts for more than a year. Sometimes the grief is too much to bear and so a person attempts to numb their pain with alcohol or drugs; however, these substances hinder one’s healing process.
If you find yourself in this situation, are experiencing thoughts of suicide, have no social supports, have poor physical health, or have already experienced depression prior to your loss, please reach out to a qualified mental health professional for grief counseling. Together, we can work on:
- Adapting healthy coping mechanisms
- Addressing existential and spiritual issues
- Addressing negative cognitions
- Becoming aware of your feelings, thoughts, and behaviors surrounding grief
- Drawing comfort from faith
- Exploring new and old hobbies and interests
- Expressing yourself creatively
- Facing avoiding behaviors
- Identifying changes in your behavior, communication, mood, eating and sleeping pattern
- Deciding whether antidepressant treatment is necessary
- Identifying poor coping mechanisms
- Joining a support group
- Learning better eating and sleep patterns
- Learning how previous losses may be affecting you today
- Learning how to live with the loss
- Learning on what is normal and what is not normal when grieving
- Moving through the stages of grief
- Participating in social activities
- Planning ahead for grief triggers
- Recognizing your capacity for resilience
- Setting boundaries with others
- Turning to family and friends for support
American Psychiatric Association. (2013). DSM-5 Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Association.
Bloomfield, H. H., Colgrove, M., & McWilliams, P. (2000). How to Survive the Loss of A Love. Algonac, MI: Mary Books/Prelude Press.
Johnson, R. (2016). The Five Stages of Grief and Healing Techniques Used for Supporting Someone Who Just Lost a Love One [Kindle IV version. Retrieved from Amazon.com.
Kubler-Ross, E. & Kessler, D. (2000). Life Lessons: Two Experts on Death and Dying Teach Us About the Mysteries of Life and Living. New York, NY: Scribner.
Rando, T. (1993). Treatment of Complicated Mourning. Champaign, IL: Research Press.
Worden, J. W. (1982). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner. New York, NY: Springer Publishing Company.
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