To be human is to experience loss. At some point in your life, you will lose someone you love, or something that means a great deal to you. And you will experience grief.
How long or how intensely you grieve depends on a number of factors. Everyone’s journey is unique. But when grief goes on too long, preventing you from resuming your life, it generally indicates a mental health issue that needs to be addressed.
Grief Is a Normal Response
Grief is a normal response to loss. Many types of loss can trigger grief:
- Death of loved ones, including pets
- Divorce
- Loss of social connections; separation from loved ones and friends
- Disasters or traumatic changes resulting in loss of home, routine or way of life
- Loss of a job, involuntarily or through retirement, which can lead to loss of financial security and/or identity
- Loss of things that give you comfort, including friendships, support, “facetime” with others, being present for a sick relative or having them be present for you
General practitioners report that about a quarter of consultations result from some type of loss. Total deaths in the US rose from 2.4 million in 2009 to more than 2.8 million in 2019, to nearly 3.4 million during the pandemic. Every death leaves behind several people who mourn; one recent study found that for every COVID death, nine family members were left grieving.
Grief causes major disruption in the life of the person left behind; common reactions to loss include:
- Shock and confusion
- Disbelief and denial
- Anxiety and general distress
- Sadness and anger, both general and acute
- Poor sleep and loss of appetite
According to Mary-Frances O’Connor, a grief researcher, the adjustment to living without a loved one is painful, takes time and involves changes to the brain. Prior to the loss, our brains were “wired” for togetherness; after the loss, when “we” becomes “I,” we must learn to function without what had been a part of ourselves. Finding your way back from loss is a journey that involves several stages paralleling those identified by psychiatrist Elisabeth Kubler-Ross, who wrote several books about death, dying and grief; co-author David Kessler added a sixth stage:
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
- Finding meaning
These stages follow a somewhat logical progression, but we (as humans) do not—our progress through grief is not linear. You may skip a stage or move back and forth between stages many times until you eventually come to terms with your loss. There are no “rules” for grief, and no “normal” amount of time for grief to “pass.” If you lost your father at an early age, you may grieve for him all over again when you get married and he isn’t there for your wedding.
“Grief is a universal emotion; there is no right or wrong way to experience it, and all losses are significant.”
Centers for Disease Control
In the immediate aftermath of a loss, people usually experience acute grief, marked by strong feelings of sadness, anger, remorse, guilt, shame, bitterness, anxiety, and longing—sometimes (it seems) all at once. You can’t stop thinking about the person who died; grief dominates your life. Gradually, most people adapt to the loss, integrating it into their lives. You don’t get over the loss but learn to live with it. As it becomes a part of you, you’re more able to remember and honor the person who’s gone.
Sometimes, however, something interferes with the process and the griever’s ability to adapt to the loss.
Complicated and Prolonged Grief
“Complicated grief” happens when people cannot adapt to their loss, and their grief becomes disabling. Complicated grief is marked by:
- Profound emotional pain, sorrow, anger, and/or bitterness
- Ruminating endlessly over the loss; unable to return to previous activities
- Problems accepting the death; avoiding reminders of the death
- Inability to trust or engage with others, loneliness, and/or emotional numbness
- Inability to enjoy life; feeling that life is meaningless
These symptoms are similar to those experienced during acute grief, but they linger and possibly even worsen. In 2022, the American Psychiatric Association identified complicated grief that lasts a year or more after the loss (six months for children) as “prolonged grief disorder.”
Factors that contribute to complicated and/or prolonged grief include:
- Simultaneous losses
- A difficult relationship with the deceased, or a particularly dependent relationship
- Sudden, unexpected, and/or traumatic death, including suicide
- Loss of a child
- A history of mental health disorders such as depression, PTSD, and bipolar disorder
- A disruption of the mourning process (which happened during the pandemic when we couldn’t be with others for funerals)
It’s estimated that around 5–10% of those experiencing a loss will have complicated grief. Most (but not all) grief that follows a normal progression peaks around six months. Those still experiencing profound, acute grief after twelve months will most likely benefit from working with a therapist. Without treatment, complicated and prolonged grief can result in depression, suicide ideation, long-term sleep disturbance, anxiety and PTSD, physical illnesses like high blood pressure and heart disease, substance abuse, and trouble with relationships.
Children, Teens and Grief
Children and adolescents may experience or show grief in different ways than adults.
Children often cannot understand the loss of a loved one. They may go back and forth between sadness and normal behavior and activities. Children who are having trouble with grief may lose interest in their usual activities, change their eating or sleeping patterns, act out, or appear anxious, sad, or depressed. To help a child cope with loss, you can encourage them to express their feelings with creative activities like drawing. It helps to maintain routines as much as possible. Spend time with them, ask questions about how they’re feeling and make room for their answers, whether those are immediate or days later. Listen when they’re ready to talk.
“1 in 13 children in US will experience the death of a parent or sibling by age 18.”
Childhood Bereavement Estimation Model
Adolescents may want to be alone, isolating themselves in their room or with technology. Changes in sleep, irritability and withdrawal from people or activities are all signs of their grief. Again, talking with them is important to help them cope with a significant loss and accept it. Those adolescents who are struggling—acting out, having trouble with relationships, and/or withdrawing from life—may need professional help.
Each Grief Journey Is Unique
Grieving does not follow a straight path—you don’t lose someone, mourn for a prescribed amount of time, feel better, and then be done with it. Your process will be affected not only by the factors listed above, but the support system you have in place and your personality.
Good self-care can help the grief process enormously. When we’re under a lot of stress, it’s easy to stop exercising, eat more sugar and fat and consume alcohol. Some “ignore” their grief, but all that does is exacerbate and delay it until your distress becomes impossible to ignore. Find healthy outlets for grief: talk with family and friends, join a support group, create an online memory book, plant a tree in honor of your loved one, acknowledge your feelings.
Grieving is an important process. Without it, we cannot process loss. If you, a friend or a family member is struggling with grief, Best Day’s counselors are ready to help navigate this life transition. Please give us a call.