Coping with Grief and Loss:

Guide to Grieving and Bereavement

Losing someone or something you love is very painful — and it’s something that almost everyone will experience at some point in their lives. Loss that goes unacknowledged or unattended can result in disability. But grief that is expressed and experienced has a potential for healing that eventually can strengthen and enrich life. There is no right or wrong way to grieve — but there are ways to make your grieving more complete and more positive.

 

What is grief?

The definition of grief includes: emotions and sensations that accompany the loss of someone or something dear to you. The English word comes from the Old French grève, meaning a heavy burden. This makes sense when you consider that grief often weighs you down with sorrow and other emotions that can have both psychological and physical consequences.

When someone close to you dies, you don’t just lose that person on the physical level, you also face the loss of what might have been. Your pain can involve missing that person’s presence: sleeping in a bed that’s half empty, craving a scent or an embrace. But knowing that your loved one will miss all of the milestones in your life often lasts longer than the pain of the physical absence. This may include the children that were never born, the trips not taken, colleges not attended, weddings not danced at — every life marker can be a reminder and an occasion for renewed grief.

How you respond to a particular loss

How the person died	Your response to an unanticipated death — a sudden heart attack, an accident, an act of violence — may be very different from the grief you feel when someone you love dies after a long illness. In the latter case, you may experience anticipatory grief, which occurs before the person’s death. You’re just as devastated when the death happens, but because you started grieving earlier, you may be able to recover sooner.
Your relationship with the person	The closeness of the relationship — spouse, parent, sibling, child — plays a role, of course. In the case of a blood relative, another factor is whether the person was a daily or regular presence in your life. Then there’s the psychological nature of the relationship: was it smooth or rocky? If you had unfinished emotional business with the person you lost, if your last interaction was angry or otherwise fraught, that can intensify your experience of grief.
Your personality and coping style	If you’re a normally resilient person, you may feel just as much pain over a loss as someone whose normal state is depressive or emotionally vulnerable, but you may find it easier to recover your equilibrium and to enjoy life again. People who have trouble coping with the setbacks of daily life will have a more difficult time recovering from a serious personal loss.
Your life experience	What you’ve learned about loss from other people and from your own experience can inform how you handle the loss of someone you love.
Support from others	As you’ll see below, it’s essential that you have people in your life who will help sustain you emotionally as you grieve. It’s also important that your friends and family take your loss as seriously as you do. If you lose a cousin or friend who was more like a sibling, your grief shouldn’t be dismissed as less important than that of an immediate relative. Many people downplay miscarriage, even if, to the parents, it represents the death of a baby. Nor does it matter how old the person was who died, or how sick. You lost someone you love, it hurts, and you need the support of people who care about you.

Are there stages of grief?

In 1969, based on her years of working with terminal cancer patients, psychiatrist Elisabeth Kübler-Ross introduced what became known as the “five stages of grief.” While these stages represented the feelings of people who were themselves facing death, many people now apply them to experiencing other negative life changes (a break-up, loss of a job) and to people facing death or experiencing the death of loved ones.

Kübler-Ross proposed these stages of grief:

However, Kübler-Ross herself never intended for these stages to be a rigid framework that applies to everyone who mourns. In her last book before her death in 2004, she said of the five stages, “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”

There is no timetable for grieving. While the sense of loss and the intermittent sadness may never go away completely, people experience the cycle of grief differently. Some find that within a few weeks or months the period between waves of distress lengthens, and they are able to feel peace, renewed hope, and enjoy life more and more of the time. Others may face years of being hit with what feels like relentless waves of grief.

Coping with grief and loss

The single most important factor in healing from loss is having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it is important to talk about them when you’re grieving. Knowing that others know and understand your grieving will make you feel better, less alone with your pain, and will help you heal.

Support can come from a number of different sources:

Finding support after a loss
Friends	Let people who care about you take care of you, even if you take pride in being strong and self-sufficient. Especially when you live away from family, true friends can offer shoulders for you to cry on until you begin to recover.
Family	The death of a relative can create a path for reunion, and even reconciliation, among surviving relatives. (It can also tear families apart, especially in the case of a sudden or violent death, so it’s important to be sensitive to one another’s approaches to grief and to refrain from accusation.) Sharing your loss can make the burden of grief easier to carry. Reminiscing about the person all of you lost may help everyone recover. If you’ve lost a friend or spouse, family members can form a caring community.
Your faith community	If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Allow people within your religious community to give you emotional support. If you’re estranged from your faith community or have none, this may be a good time to reconnect or to explore alternatives.
Support groups	There are many support groups for people who are grieving, including specialized groups (such as, people who have lost children, survivors of suicides).
Therapists and other professionals	Talking with a psychotherapist or grief counselor may be a good idea if the intensity of your grief doesn’t diminish over time — that is, months go by and you still have physical symptoms, such as trouble with eating or sleeping; or your emotional state impairs your ability to go about your daily routine.

Wherever the support comes from, accept it and do not grieve alone. One of the key elements of healthy grieving is allowing your emotions to surface in order to work through them. In the long run, trying to suppress your feelings in the hope that they’ll fade with time won’t work. Blocking the grieving process will delay or disable your ability to eventually recovery.

If people don’t know what they can do to help, tell them — whether it’s going with you to a movie, cooking a meal for you, or just holding you as you cry. If someone is uncomfortable with your displays of emotion or your need to talk about the person you lost, gently let him or her know that talking out your grief is part of your healing process.

Helping yourself cope with grief and loss

• Express your feelings in a tangible or creative way. Write about your loved one in a journal, or write the person a letter saying the things you never got to say. Create a scrapbook or artwork about the person; create an appropriate memorial in his or her honor (for example, if the person loved flowers, plant or fund a garden); get involved in a cause or organization that was important to him or her.
• Take care of yourself physically. Get enough sleep, eat sensibly, and engage in regular exercise. Do not use alcohol or drugs to numb the pain of grief or lift your mood artificially. (That may even apply to antidepressants meant to ease the sadness of grief; because grief, unlike depression, is not a disorder, masking the pain with meds may be less productive than working through the sadness.) Healthy habits will help you with grieving, but substance use will impede recovery and can lead to long-term dependence
• Don’t let other people tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” At the same time, it’s okay to be angry at the person who died, to cry every day if you need to, to yell at the heavens without being embarrassed. Conversely, it’s okay to laugh, too. If watching the entire oeuvre of the Marx Brothers helps you heal, no one has the right to tell you it’s inappropriate.
• Plan ahead. Anniversaries, holidays, and milestones in life can be particularly challenging. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.

Grieving a Suicide

The suicide of a loved one raises painful questions, doubts and fears. Some cultures see it as shameful or an affront to God. Survivors ask themselves: Why wasn’t my love enough to save this person? What could I have done? How did I fail? What will people think? Feelings of failure, shame and blame exacerbate the sorrow of loss.

It’s important that, in addition to the healing strategies described above, you do the following if you lose someone you love to suicide:

• If you have religious concerns, try to find a gentle, nonjudgmental member of your faith, and be open when talking with that person about what happened, and about your feelings.
• Rather than being concerned about the stigma surrounding suicide, concentrate on your own healing and survival.
• Confront the word suicide, difficult as it may be. If you keep the cause of death a secret, you won’t be able to speak freely about the person you lost, and you’ll block a pathway to recovery.
• Talk openly with your family and friends so that everyone’s grief can be expressed.
• Do something that will benefit others in your loved one’s name.

Difference between grief and depression

If you are grieving, you may experience a number of depressive symptoms, such as frequent crying, profound sadness, and depressed mood. However, while major depression is categorized as a psychological disorder, grief is not. Grief is a normal and healthy response to bereavement, not an illness. Its symptoms are painful, but they serve an adaptive purpose.

The American Psychiatric Association states that, as a general rule, normal grief does not warrant the use of antidepressants. While medication may alleviate some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process. When grief continues to be a disruptive and debilitating presence, you may be suffering from depression. If you have a prior history of depression or lack social support, you are particularly at risk.

Symptoms that sugggest a bereaved person is also depressed::

• Intense feelings of guilt.
• Thoughts of suicide or preoccupation with death.
• Feelings of worthlessness.
• Slow speech and body movements.
• Inability to function at work, home, and/or school.
• Finds no pleasure in previously-enjoyed activities.
• Hallucinations of the deceased.

If you develop major depression following the death of a loved one, you may benefit from professional treatment. 

 

How trauma affects the grieving process

Grief tends to be mixed with trauma when a loss is sudden and unexpected — a fatal heart attack, an accident, a murder — or it’s perceived as being outside the normal cycle of life, as in the death of a child. For example, someone who nurses a spouse through a long illness will grieve when the spouse is gone, but the person who witnesses the sudden death of a spouse in a car crash will likely be traumatized as well. A sudden loss can be even more difficult to deal with if you don’t have a socially recognized outlet for mourning, as may be the case with a miscarriage or stillbirth.

While trauma always incorporates grief, the two states are very different in how you experience them and what effect they can have on you. Grief is a normal reaction to loss, with its symptoms diminishing over time. On the other hand, trauma is a disabling reaction that can block the grieving process, disrupt your life, and leave you psychologically vulnerable. If you are coping with a traumatic loss, you may want to think about turning to a counselor or other professional for help.

 

Grief vs. Trauma
The Effects of Grief	The Effects of Trauma
Sadness is the dominant emotion.	Terror is the dominant emotion.
Grief feels real.	Trauma feels unreal.
Talking about grief can help.	Talking about trauma is difficult or impossible.
Pain is related to the loss.	Pain involves not just loss, but terror, helplessness, and fear of danger.
Anger is nonviolent.	Anger often involves violence towards yourself or others.
Guilt involves unfinished emotional business with the deceased.	Guilt includes self-blame for what happened or thoughts that it should have been you who was harmed.
Your self-image and confidence generally remain intact.	Your self-image and confidence are distorted and undermined.
You dream about the person you lost.	You dream about yourself in danger.
Symptoms lessen naturally over time.	Untreated, symptoms may get worse.