The Five Stages of Grief

Grief, with its many ups and downs, lasts far longer than most people realize. Be patient with yourself.

Each person’s grief is individual. You and your family will experience it and cope with it differently.

Crying is an acceptable and healthy expression of grief and releases built-up tension for the bereaved person. Cry as freely as you feel the need.

Physical reactions to the death of a loved one may include loss of appetite or over-eating, sleeplessness and sexual difficulties. The bereaved may find that he/she has very little energy and cannot concentrate. A balanced diet, rest and moderate exercise are especially important for you at this time.

Avoid using drugs and alcohol. Medication should be taken sparingly and only under the supervision of your physician. Many substances are addictive and can lead to a chemical dependency. In addition, they may stop or delay the necessary grieving process.

Friends and relatives may be uncomfortable around you. They want to ease your pain, but do not know how. Take the initiative if you can, and let them know they can be supportive to you. Talk about your loved one so they will feel freer to be able to do the same.

Whenever possible, put off major decisions (changing residences, changing jobs, etc.) for at least a year.

Avoid making hasty decisions about your loved one’s belongings. Do not allow others to take over or to rush you. You can do it little by little whenever you feel ready.

The bereaved may feel he/she has nothing to live for and may think about a release from this intense pain. Be assured that many bereaved persons feel this way, but that a sense of purpose and meaning does return. The pain does lesson.

Guilt, real or imagined, is a normal part of grief. It surfaces in thoughts and feelings of “if only”. In order to resolve this guilt, learn to express and share these feelings, and learn to forgive yourself.

Anger is another common reaction to loss. Anger, like guilt, needs expression and sharing in a healthy and acceptable manner.

Be gentle with yourself.

Guilt is a bizarre thing. It doesn’t matter If what you did was right or wrong. Grief has a job to do and he will latch on to anything to get it done.
What will Grief throw at us today?
Tough love? Guilty! 

No tough love? Guilty!
Strict? Guilty! 

Enabling? Guilty!
Let your kid live at home? Guilty! 

Kicked your kid out? Guilty!
Short term, guilt distracts us so the grief cannot overwhelm us. It builds a wall between us and the rest of the world when we are fragile. It keeps us in the past so we do not contemplate the future.
Long term, it forces us to confront things. Ignoring the things which frighten or shame us allows them to fester.
Guilt made me throw my hands up and scream,”I did the best I could!”
“Did you really?” Guilt demanded.
I wanted him to leave me alone, so I looked closely at everything Guilt was throwing at me to find a way to defend myself.
“I had no control over the situation!”
“Good!” Guilt said. “I cannot help you heal until you look at what happened honestly and admit that you had no power over it.”
I was relieved, but Guilt wasn’t done with me yet. “But what about all those times you should have known something was wrong? What about all those times you were tired or angry or impatient? Why didn’t you save him?”
Guilt kept pushing at me until I finally snapped. “I’m human! I did everything I could, and after I gave it everything I had, I still kept trying. I have a frail body! I have emotions! I have other people and responsibilities in my life! I fought my hardest!”
“Good!” Guilt said. “I cannot help you heal until you understand that some fights cannot be won, and that the love is in the fighting.”
”You’re a bastard! Even when I know I didn’t do anything wrong, I still feel guilty. Is that supposed to help me, too?” I sneered.
“Actually, yes. Making you feel guilty about nothing in particular is my way of letting you know there’s something unresolved in your brain. I force you to figure it out.”
“And this was the easiest way you could go about it? By crushing me?”

“Yes. Because these are things you must understand in order to heal, and you had to find them in yourself in order to believe them. Well, I will leave you now.”
I was more than happy to tell Grief goodbye, but he just laughed.
”Oh, I'll be back. You can bet on it. You may understand now, but you’ll forget. Your emotions and your words will start chasing each other in circles in your head again until they threaten to tear you apart. That’s when I’ll be back to slow you down and make you think again.”
“For how long?” I asked.
Grief shrugged.”Who knows? But don’t worry. You’ll survive.”
As he faded into the background, Grief actually looked at me with some respect. “After what you’ve been through, you can survive anything.”

S.E.K.
(May be shared with permission by author. May only be shared exactly as written and with authors initials at the bottom) 

Surely you have noticed the chill in the air and the turning of leaves from lush green to yellows, oranges, reds and browns. The cooler weather and beautiful fall colors are a sure sign that fall is here and winter will soon follow. This also means that the amount of daylight we have each day is slowly dwindling. 

According to Psychology Today, as many as 10 million Americans will start to feel the effects of Seasonal Affective Disorder (SAD).

Seasonal Affective Disorder (SAD) is a change in mood that happens around the same time each year and affects a person’s ability to function. It’s sometimes referred to as seasonal depression or the winter blues. It can also be attached to a mood disorder diagnosis, like major depressive disorder “with a seasonal pattern.”

SAD is characterized by any combination of the following:

• Feelings of sadness or despair
• Lack of interest in activities you once enjoyed.
• Low energy
• Feeling agitated or irritable
• Difficulty concentrating
• Feeling sluggish
• Increased thoughts of death or suicide

Mayo Clinic cites people with winter onset SAD are more likely to display weight gain, craving of high carbohydrate foods, fatigue and sleeping too much. Spring/summer onset SAD, which is less common than winter onset, is more likely to include insomnia, decreased appetite, weight loss or anxiety. The symptoms must be present at about the same time of year for at least two years to be deemed a “seasonal pattern.”

Grief & SAD

"Grief affects everyone differently" 

Many grief reactions people experience are similar to those of SAD.

Some commonalities include:

• Changes in appetite
• Sleep disturbances
• Fatigue or exhaustion
• Sadness or depressed mood
• Anxiety or irritability
• Hopelessness
• Increased thoughts about death or suicide

Many people experience a resurgence of grief reactions each year near the anniversary of their loved one’s death. If your loss occurred in the fall or winter months, it can be especially difficult to distinguish if a person is experiencing primarily grief, SAD or both simultaneously.

Although it’s not always possible to identify with certainty which symptoms are a result of SAD and which are attributed to grief, it’s worth exploring so you can begin to identify ways to help yourself feel better.

Treatment of SAD
If you have been experiencing a shift in your mood at about the same time each year for at least two years prior to your loss, you may want to talk with your doctor about treatment for SAD.

According to Mayo Clinic, the exact cause of SAD is unknown, but researchers believe that some contributing factors include changes in our sleep/wake cycle, and serotonin and melatonin levels as a result of decreased levels of sunlight exposure in the winter months. The result is altered sleep patterns and a change in mood.

SAD should resolve on its own as the seasons change, but there are treatments available to help you feel better through the winter months. The most common treatments are light therapy, anti-depression medication and counseling.

Light therapy or phototherapy is usually the first treatment option to consider, as it is non-invasive and has few side effects. Light therapy involves using a light therapy box for a certain amount of time each day, usually in the morning, to mimic the sun’s light. You should not look directly at the light, but instead have it enter your eye indirectly. If you can, position the light above your head so that the light would enter your eye at about the same angle as the sun would.

Light therapy boxes do not require a prescription, but you should talk to your doctor about the intensity, timing and duration of using the light, as well as how to choose a good quality light box (one that does not omit UV light).

Helping Yourself Through Grief & SAD
When you are grieving the loss of a loved one, regardless if that grief coexists with SAD, there are steps you can take to ease the burden of grief:

• Recognize that each person experiences grief differently. Try not to compare your own grief experience to others who are coping differently.
• Seek support through friends, family, clergy, a counselor and/or a grief support group. Having at least one person to talk with about your grief and your loved one can make a difference.
• Expose yourself to sunlight, when possible. Outdoor time can be limited during the winter months but try to get outside at least daily even if it’s just a trip to the mailbox or post office. If you are confined to your home, create a cozy space next to a window where you can sit and enjoy the natural light. Open blinds and curtains to let light in during the day.
• Get outside if you can. When snow, ice and wind aren’t keeping you inside, get out of the house and move your body. Go for a walk, snowshoe, cross country ski or go on a sled ride with a child. A short brisk walk can drastically improve your mood and can help fend off the feelings of sluggishness and fatigue.
• Be gentle with yourself through the grief process. Losing a loved one can be incredibly trying and you deserve grace as you process the loss.

Above all else, it’s important to remember that although the season you are in is challenging, it is just that—a season. Before we know it, the trees will wake up, the flowers will bloom, and we will be basking in the warm sunlight as spring arrives in all its glory.

Our hope is that as you come out of the season of deep grief you will enter a new season marked by growth, strength and true joy.

If you are struggling, we can help. For more information about our free community grief support services, visit our website or call 800-237-4629.

Stephanie Pritchard, LPC, NCC, is a grief specialist with Hospice of the Red River Valley.

Is there a “normal” way to feel grief?

Grief is a normal, natural part of the human experience. Every person grieves a loss in their lifetime—whether it’s a loss through death or a loss of a relationship, a job, sense of normalcy or some other facet important to the person. Understanding how grief can affect us and being aware of the commonalities in all our grief experiences can help us cope in more practical, less isolating ways.

Grieving is not a linear process, and the grief journey can be filled with peaks and valleys. Grief can impact people emotionally, physically, cognitively, behaviorally and spiritually. It can also challenge a person’s belief system. It’s normal to go through a range of reactions with varying intensity.

While everyone responds to grief in different ways, it’s helpful to know there are many common grief reactions.

Common grief responses may include:

• Behavioral: Forgetfulness, avoidance of people or situations,      increase or decrease in activity, loss of interest in work or social      activities
• Physical: Sighing, fatigue or exhaustion, hollow feeling in      stomach, sobbing, change in appetite, headache, sleeping more/less or      experiencing interrupted sleep
• Cognitive: Difficulty concentrating or making decisions,      confusion, increase or decrease in dreams
• Emotional: Anger, sadness, mood swings, guilt, relief,      loneliness, numbness, fear, helplessness, longing/yearning for loved one
• Spiritual: Loss or strengthening of faith, need to find      meaning in the loss, asking “why” questions, anger at God or other      religious figures

Grief can be painful and overwhelming; the experience can also feel frightening and worrisome.

Mourning is the process involved in how you adapt to the loss and your grief reactions. Many bereaved describe this experience as a roller coaster ride with a lot of ups and downs and twists and turns.

Grief is a unique experience.

Everyone will have different reactions and journeys when navigating and living with grief.

Some factors that can affect how you deal with grief are your relationship to the person who died, belief systems, circumstances of the death, your own personal coping skills and the resources available to you.  

Working through grief involves accepting the loss, experiencing the pain of that loss, adjusting to life without your loved one and creating a different connection or relationship with the person who has died.

Here are six helpful activities to do while grieving a loss:

1. Reach out to your support system. Stay connected with your family, friends, faith community, social group or therapist. It’s important to look at all the support systems in your life and stay open to new systems that might not have been in your life before the loss. Talking regularly about grief and sharing your feelings and memories with people you trust can be helpful in coping with your grief.
2. Join a support group. You may not feel ready to join a support group      immediately, but over time, you may be open to it and find that sharing your experience with others can offer comfort. You might also learn from others in the groups—sharing coping mechanisms and talking through the difficulties of grief could help you in your own grieving process.
3. Take care of yourself. Get a good night’s rest, 7-9 hours of sleep. Take care      of your nutritional health by eating healthy balanced meals and drinking      plenty of water.
4. Be patient with yourself. You can’t rush grief. It’s going to take as long as it needs to settle. Try not to be too critical of yourself. The grieving process is normal and personal—and you will grieve in your own way and that’s OK. Treat yourself with the same gentle care and kindness that you would offer to a friend going through a similar situation.
5. Practice self-care. Some techniques that can help include journaling,      meditation, daily affirmations, creating a list of things for which you are grateful. You can also try learning a new skill or expressing yourself creatively through a hands-on approach (sewing, woodworking, knitting or other crafts).
6. Get moving. Be active and participate in your favorite physical activities. You can try yoga, golf, pickle ball, jogging or biking. Yardwork and gardening are also great ways to stay active. Spend some time outdoors by going for walks or jogs. You can even just sit outside to enjoy the sunshine and fresh air.

There are many resources available to help you through your grief. Hospice of the Red River Valley offers an extensive grief support program—not only to family members of the individuals who were cared for by the organization—but also for community members.

The grief support team at Hospice of the Red River Valley offers free grief support to individuals and families moving through the grief process by providing support groups, education and training, and individual grief support for community members. The services extend to providing guidance to schools and workplaces, as well. Anyone may attend a grief support group or class regardless of whether or not your loved one was served by Hospice of the Red River Valley.

For more information about how we can help, email grief@hrrv.org or call (800) 237-4629 and ask to speak to someone in the grief support department.

Janel Ruby, LBSW, is a grief specialist with Hospice of the Red River Valley

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Grief Recovery After Substance Passing

GRASP was created to offer understanding, compassion, and support for those who have lost someone they love through addiction and overdose. Too many times we suffer not only the death of the person we love, but we become isolated in our grief. We feel, and too many times it is true, that no one understands our pain. But at GRASP, we do. We have suffered this same kind of loss and we have found the love and connection that only those who have lived this loss can give another. And while the pain of this loss will always be with us, we have found through GRASP that we don't have to walk the road that is our pain alone. We walk it together, hand in hand and heart to heart.

http://grasphelp.org/ 

The Sun Will Rise Foundation provides support to the residents of Massachusetts towns for issues regarding substance use disorder. We help with education. 

Our meetings are monthly, 18 and older, peer to peer, in person grief support for those in Massachusetts, New Hampshire & Rhode Island who have lost someone they love to substance use disorder, addiction and/or overdose. We welcome anyone who has experienced this type of loss.  

http://www.thesunwillrise.org/ 

Hope Floats Healing & Wellness Center offers a variety of groups and services for those grieving the loss of someone they love. www.hopefloatswellness.org/ 

Grief Weavers, LLC is a practice for individuals, couples, and families designed to facilitate the grief process by providing an environment in which bereaved persons can acknowledge, understand, and integrate or “weave” grief & loss into their lives.

http://www.griefweavers.com/

                                                             A Final Word 

                                                            by James E. Miller

This time of loss is a time we will never forget. It is a time that is breaking us open and reshaping us. 

We will never be the same.

Remember: we can shape this time, even as it shapes us. We are not powerless. We are not entirely at the mercy of whatever has happened, even though it may feel that way at the moment. You may wonder if you’ll ever make sense of this situation.

The truth is we will and we won’t. 

For we are coming to know that ultimately much of life is beyond our control, and beyond anyone’s control. 

It can be lived, but it cannot be contained. 

It can be appreciated but it cannot be narrowly defined. 

It can be embraced, but it cannot be held too tightly. 

For life ultimately is a gift. It comes from beyond us and that is also its destiny.

May the experiences we are living through help us toward these realizations. 

May we be on the path of living our lives for all they’re worth. 

May our losing become an occasion for our finding. 

In the process of letting go, may we become even more free to embrace.

by Alan D. Wolfelt

Director, Center For Loss and Life Transition

Fort Collins, Colorado

Many people have a real desire to learn more about the experience of death and grief. Without a doubt we have witnessed an upsurge in interest in bereavement caregiving. However many well-intentioned, yet misinformed, people are still victims of some widely held myths regarding grief.

The purpose of this article is to identify, describe, and dispel five common myths about grief. Providing quality care to the bereaved requires that we as society work to dispel these myths outlined below. People who have internalized these myths become incapable of helping grievers move toward healing.

These myths are not intended to be all-inclusive or mutually exclusive. Observation suggests that many people who believe in any one of these will also believe in many, if not all, of the others. Our joint task is not to condemn these people, but supportively encourage them to broaden their understanding of the complex experiences of grief and mourning.

Identifying The Myths

Myth #1: Grief and mourning are the same experience;

Myth #2: There is a predictable and orderly stage-like progression to the experience of mourning; 

Myth #3: It is best to move away from grief instead of toward it;

Myth #4: Following the death of someone significant to you, the goal is to “get over” your grief;

Myth #5: Tears expressing grief are only a sign of weakness.

Myth #1:  Grief and mourning are the same experience.

The majority of people tend to use the words grief and mourning synonymously. However, there is an important distinction between them. We have learned that people move toward healing not by just grieving, but through mourning. If we want to help the bereaved we can work to understand the semantic distinctions of these commonly used terms. Simply stated, grief is the thoughts and feelings that are experienced within oneself upon the death of someone loved. In other words, grief is the internal meaning given to the experience of bereavement.

Mourning is taking the internal experience of grief and expressing it outside of oneself. The specific ways in which people express mourning are influenced by customs of their culture. Another way of defining mourning is to state that it is “grief gone public” or “sharing one’s grief outside of oneself”.

In reality, many people in our culture grieve, but they do not mourn. As opposed to being encouraged to express their grief outwardly they are often greeted with messages along the lines “carry on”, “keep your chin up” and “keep busy”. So they end up grieving within themselves is isolation, instead of mourning themselves in the presence of loving companions.

Grief and mourning are much more personal experiences than their words describe. They are much more than words. Experiencing the thoughts and feelings of grief is often movement through an unknown territory that is embraced by an overwhelming sense of pain and loss. Only through encouraging ourselves and others to mourn outside of ourselves will we become a catalyst for healing.

Don’t just grieve, mourn too, and be proud of your capacity to do so!

Myth #2:  There is a predictable and orderly stage-like progression to the experience of mourning.

Stage-like thinking about dying and mourning has been appealing to many people. Somehow the “stages of grief” have helped people try to make sense out of an experience that isn’t so orderly or predictable as we would like it to be. Attempts have been made to replace fear and lack of understanding with the security that everyone grieves by going through the same stages. If only it were so simple!

The concept of “stages” was popularized in 1969 with the publication of Elizabeth Kubler-Ross’ landmark text On Death and Dying. However many people have done just that and the consequences have been disastrous.

One such consequence is when people around the grieving person adopt a rigid system of beliefs about grief that do not allow for the natural unfolding of the mourners personal experience. We have come to understand that each person’s grief is uniquely his or her own. As helpers, we only get ourselves in trouble when we try to prescribe what someone’s grief experience should be.

Just as different people die in different ways, people mourn in different ways. Expecting anything less would be to demonstrate a lack of respect for the uniqueness of the person. This author prefers a helping attitude that conveys the following: “teach me about your grief and I will be with you. As you teach me I will follow the lead you provide and attempt to be a stabilizing and empathetic presence”.

To think that one’s goal as a caregiver is to move people through the stages of grief would be a misuse of counsel. A variety of unique thoughts and feelings will be experienced as part of the healing process. For example, disorganization, fear, guilt and anger may or may not occur. Often regression occurs along the way and invariably some overlapping. Sometimes emotions follow each other within a short period of time; at other times, two or more emotions are present in the grieving person simultaneously.

Do not describe how someone should grieve, but allow them to teach you where they are in the process.

Myth #3:  It is best to move away from grief instead of toward it.

The unfortunate reality is the many grievers do not give themselves permission or receive permission from others to mourn, to express their many thoughts and feelings. We continue to live in a society that encourages people to prematurely move away from their grief instead of toward it. The result is that many people either grieve in isolation or attempt to run away from their grief through various means.

During ancient times, stoic philosophers encouraged their followers not to mourn, believing that self-control was the appropriate response to sorrow. Still today, well-intentioned but uninformed people carry on this long-held tradition. A vital task of the helper is to encourage and support the movement toward an outward expression of grief.

One of the reasons for many people’s preoccupation with the very question “how long does grief last?” is often to related society’s impatience with grief and the desire to move people away from the experience of mourning. Shortly after the funeral (if a funeral is held) the grieving person is expected to “be back to normal.”

Persons who continue to express their grief outwardly are often viewed as “weak,” “crazy” or “self-pitying.” The common message is “shape up and get on with your life.” The reality is that many people view grief as something to be overcome rather than experienced.

The result of these kinds of messages is to encourage the repression of the griever’s thoughts and feelings. Refusing to allow tears, suffering in silence, and “being strong,” are thought to be admirable behaviors. Many people in grief have internalized society’s message that mourning should be done quietly, quickly and efficiently.

Returning to the routine of work shortly after the death of someone loved, the bereaved person relates, “I’m fine,” in essence saying, “I’m not mourning.” Friends, family and co-workers often encourage this stance and refrain from talking about the death. The bereaved person having an apparent absence of mourning (having moved away from their grief instead of toward it) tends to be more socially accepted by those around him or her.

However, this type of collaborative pretense surrounding grief does not meet the emotional needs of the bereaved person. Instead the survivor is likely to feel further isolated in the experience of grief, with the eventual onset of the “going crazy syndrome.” Attempting to mask or move away from the grief results in internal anxiety and confusion. 

With little, if any, social recognition related to the pain of the grief, the person often begins to think their thoughts and feelings are abnormal. As a matter of fact, the most frequent initial comment of grieving persons at our Center for Loss and Life Transition in Colorado is the statement, “I think I’m going crazy.”

Our society encourages people to prematurely move away from their grief instead of toward it. If we want to help the bereaved people we must remember that it is through the process of moving toward the pain that we move toward eventual healing.

Myth #4:  Following the death of someone significant to you, the goal is to “get over” your grief.

We have all had the unfortunate experience of hearing people inquire of the bereaved person, “Are you over it yet.” Or even worse yet, we hear people comment “Well they should be over it by now.” To think that we as human beings “get over” our grief is ludicrous!

The final dimension of grief in number of proposed models is often referred to as resolution, recovery, reestablishment, or reorganization. This dimension suggests a total return to “normalcy” and yet in my personal and professional experience, everyone is changed by the experience of grief.

For the mourner to assume that life will be exactly as it was prior to the death is unrealistic and potentially damaging. Recovery as understood by some people, mourners and caregivers alike, is all too often seen erroneously as an absolute, a perfect state of reestablishment.

Reconciliation is a term this author believes to be more expressive of what occurs as the person works to integrate the new reality of moving forward in life without the physical presence of the person who has died. What occurs is a new sense of energy and confidence, an ability to fully acknowledge the reality of the death, and capacity to become reinvolved with the activities of living. Also, an acknowledgement occurs that pain and grief are difficult yet necessary parts of life and living.

As the experience of reconciliation unfolds, the mourner recognizes that life will be different without the presence of the significant person who has died. Beyond an intellectual working knowledge is an emotional working through. What has been understood at the “head” level is now understood at the “heart” level – the person who was loved is dead.

The pain changes from being ever-present, sharp and stinging to an acknowledged feeling of loss that has given rise to renewed meaning and purpose. The sense of loss does not completely disappear yet softens and the intense pangs of grief become less frequent. Hope for a continued life emerges as the griever is able to make commitments to the future, realizing that the dead person will never be forgotten, yet knowing that one’s own life can and will move forward.

We never “get over” grief but instead become reconciled to it. Those people who think the goal is to “resolve” grief become destructive to the healing process.

Myth #5:  Tears expressing grief are only a sign of weakness.

Unfortunately, many people associate tears of grief with personal inadequacy and weakness. Crying on the part of the mourner often generates feelings of helplessness in friends, family and caregivers.

Out of a wish to protect the mourner from pain, those people surrounding the mourner may serve to inhibit the experience of tears. Comments similar to “tears won’t bring him back” and “he wouldn’t want you to cry” discourage the expression of tears. Yet crying is nature’s way of releasing internal tension in the body and allows the mourner to communicate a need to be comforted.

Another function of crying is postulated in the context of attachment theory wherein tears are intended to bring about reunion with the lost person. While the reunion cannot occur, crying is thought to be biologically based and a normal way of attempting to reconnect with the person who has died. The frequency and intensity of crying eventually wanes as the hoped-for reunion does not occur.

While research in this area is still limited, some investigators have suggested that suppressing tears may increase susceptibility to stress-related disorders. This would seem to make sense in that crying is an exocrine process, one of the excretory processes. In reviewing other excretory processes, such as sweating and exhaling, the fact is that they all involve the removal of waste product from the body. Crying may serve a similar function.

In this author’s clinical experience with thousands of people in grief, changes in physical expression have been observed following the expression of tears. While this is purely a subjective observation, seemingly not only do people feel better after crying, they also look better. Expressions of tension and agitation seem to flow out of their body. The capacity to express tears appears to allow for a genuine healing.

The expression of tears is NOT a sign of weakness. The capacity of the mourner to share tears is an indication of the willingness to do the “work of mourning.”

Final Thoughts

Again, beware that the above myths are not intended to be all-inclusive. This author suggests the reader develop a list of any additional “grief myths” observed by our society. 

Being surrounded by people who believe in these myths invariably results in a heightened sense of isolation and aloneness in the grieving person. The inability to be supported in the “work of mourning” destroys much of the capacity to enjoy life, living and loving.

Only when we as a society are able to dispel these myths will grieving people experience the healing they deserve!

Columbia University School of Social Work 

1255 Amsterdam Avenue New York, NY 10027

 info@complicatedgrief.columbia.edu 

212-851-2107 

https://complicatedgrief.columbia.edu/for-the-public/complicated-grief-public/overview/  

Complicated Grief is a form of grief that takes hold of a person’s mind and won’t let go It is natural to experience intense grief after someone close dies, but complicated grief is different. Troubling thoughts, dysfunctional behaviors or problems regulating emotions get a foothold and stall adaptation. Complicated grief is the condition that occurs when this happens. People with complicated grief don't know what’s wrong. They assume that their lives have been irreparably damaged by their loss and cannot imagine how they can ever feel better. Grief dominates their thoughts and feelings with no respite in sight. Relationships with family and friends' flounder. Life can seem purposeless, like nothing seems to matter without their loved one. Others begin to feel frustrated, helpless and discouraged. Even professionals may be uncertain about how to help.  People often think this is depression, but complicated grief and depression are not the same thing. 

Grief is a person’s response to loss, entailing emotions, thoughts and behaviors as well as physiological changes. Grief is permanent after we lose someone close though it’s manifestations are variable both within and between people. Still, there are some commonalities that can help you recognize complicated grief.  

Acute grief occurs in the initial period after a loss. It almost always includes strong feelings of yearning, longing and sadness along with anxiety, bitterness, anger, remorse, guilt and/or shame. Thoughts are mostly focused on the person who died and it can be difficult to concentrate on anything else. Acute grief dominates a person’s life.  

Integrated grief is the result of adaptation to the loss. When a person adapts to a loss grief is not over. Instead, thoughts, feelings and behaviors related to their loss are integrated in ways that allow them to remember and honor the person who died. Grief finds a place in their life.  

Complicated grief occurs when something interferes with adaptation. When this happens acute grief can persist for very long periods of time. A person with complicated grief feels intense emotional pain. They can’t stop feeling like their loved one might somehow reappear and they don’t see a pathway forward.  A future without their loved one seems forever dismal and unappealing.  

Complications get in the way of adapting to the loss There are three key processes entailed in adapting to a loss: 1) accepting the reality, including the finality and consequences of the loss, 2) reconfiguring the internalized relationship with the deceased person to incorporate this reality, and 3) envisioning ways to move forward with a sense of purpose and meaning and possibilities for happiness.  Most people move forward naturally in this way and grief finds a place in their lives as they do. Sometimes there are thoughts, feelings or behaviors that interfere with adaptation. Complicated Grief Therapy (CGT) helps people identify and resolve these interfering issues.  

Troubling thoughts: After a loved one dies, almost everyone has some unsettling thoughts about how things could have been different. People with complicated grief get caught up in these kinds of thoughts.  

Avoidance of reminders: People with complicated grief often think the only way they can manage pain is to stop the emotions from being triggered. To do this they try to avoid reminders of the loss.  Difficulty managing painful emotions: Emotions are almost always strong and uncontrollable during acute grief and managing them is different than at other times in our lives. Most people find a way to balance the pain with respite by doing other things, being with other people or distracting themselves. People with complicated grief are often unable to do this.  

Complicated Grief WHAT IT IS AND WHAT IT FEELS LIKE 

People with complicated grief don’t know what is wrong. They believe their lives have been irreparably damaged by their loss. They can’t imagine how they can ever feel better. A person with complicated grief is unable to adapt to their loss. As a result, grief dominates their life with no respite in sight. Relationships with family and friends flounder. Life seems purposeless and health is jeopardized.  Millions of people have complicated grief – meaning that their grief doesn’t progress. You’re not alone if you’ve  lost someone close and you feel like there is no way forward. The good news is that there’s a proven therapy  that has helped many people like you. It‘s short-term and is highly effective in guiding people to adapt in their own way. The therapy lasts 16 weeks and many people tell us that they start to feel noticeably better in just 6  weeks.  

What does it feel like when you have complicated grief? 

• You’re filled with longing and yearning for the person who died 

• You think about your loss so much that it’s hard to do normal, everyday things that used to be second  nature...like taking good care of others, including children, going to work or concentrating at work,  cooking, shopping, paying bills, exercising 

• You can’t shake the feeling of disbelief

• You can’t accept what happened; it seems so wrong or unfair  

• You feel angry or bitter about the death 

• Your life seems empty 

• You keep feeling ambushed by strong emotions that you can’t control 

• You want to avoid people, places and things that remind you that the person you love is gone 

• You cry a lot whenever your mind wanders - like driving alone in the car 

• You feel like the death just happened even though you know that’s not true 

What happens to your life? 

• You question what happened, over and over, even though you know it won’t change anything; you keep imagining how it could have been different 

• You feel like you should have been more prepared, like other people wouldn’t be struggling as much  

• You continue to do things you did before your loved one died even when they don’t make sense – like  obsessing over how many places to set at the table, keeping their clothes and other possessions ready for  them, continuing to make the deceased person’s favorite meals; you don’t want to do anything differently  than when your loved one was alive 

• You try to escape from reality by drinking too much alcohol, sleeping during the day, over-eating or not  eating enough, ignoring your health.  

• You feel distracted, unable to think clearly, unable to organize the day or plan anything at all complex 

• You feel like there’s nothing to live for; you wish you had died instead of or along with your loved one  

• You don’t feel comfortable living your life even though you know you should and the person you lost would  want you to  Complicated grief affects your relationships with other people 

• You want to keep talking about the person who died even though this makes other people uncomfortable 

• You feel like other people are uncomfortable with your grief and you have to take care of them 

• You feel envious of others that haven’t lost someone close • You want to be a part of things and feeling like it’s no longer possible You feel lonely and isolated even  when you’re with other people  

• You’re not sure if other people really care; you worry that they’re tired of your grief  

• You feel like people always let you down and you can’t trust them 

• You feel like other people want you to get over it and move on.

We want you to know 

• There’s no shame in grief even when it’s very strong 

• Your love for the person who died is important, and you’re important too 

• If you’re feeling stuck in grief, good therapy i

www.complicatedgrief.org training@complicatedgrief.columbia.edu 

212.851.2107 

Complicated grief among parents after the death of a child 

The death of a child is one of the most difficult experiences a parent can have. Taking good care of their children is almost always the most important thing in a parents’ lives. A child’s death triggers feelings of caregiving failure even when it’s really not true. Self-blaming thoughts are virtually universal after a child dies. However, if a parent gets caught up in these kinds of thoughts, this can derail the adaptation process and lead to complicated grief.  

The highest rates of complicated grief occur in parents whose children have died. Intense emotions like sadness, anger, guilt and despair invade the lives of parents coping with a child’s death and these may be difficult to regulate.  

Life is transformed and may seem empty and confusing. Answering a simple question such as “How many children do you have?” is suddenly a problem. Bereaved parents typically wrestle with difficult questions such as “Why did this happen?” or “Why didn’t I prevent it?” or, sometimes, “Why was my child so reckless or negligent?”  These kinds of thoughts and feelings contribute to development of complicated grief and need to be resolved in order for grief to find a place in a parent’s life. A bereaved couple may find themselves unable to support each other after a painful shared experience. Their different ways of grieving may seem jarring to each other. One parent may long to talk about the child and their feelings, while the other parent may feel determined to avoid these very discussions.  

Conflicting needs can deprive a couple of the support they need from each other causing stress in the relationship and adding to the pain of the loss. A parent may cherish memories of the child or long for the memories they had hoped to build.  

Parents may wonder if it is right to feel joy after the loss of a child. They may question whether restoration of a happy, satisfying life is appropriate since their child has been deprived of these.  

Those who can’t imagine a meaningful life or find a way to restore their sense of purpose, joy and satisfaction may be suffering from complicated grief. If so, complicated grief treatment holds the promise of help.  

Providing good grief support for close friends 

1. Be present and available – be aware that feelings of abandonment are usually present; try to be sure that you don’t unintentionally contribute to these feelings.  

2. Take the initiative in making contact; understand that your friend might have difficulty doing so; try to help her tell you what she needs and wants.  

3. Be aware that a grieving person might feel she needs to hide her feelings because she is worried that others can’t deal with the emotions; encourage her not to do that with you. Let her know its ok to cry or be scared, or angry, that you won’t judge.  

4. Encourage your bereaved friend to ask for help; ask her what you can do; if she doesn’t know, make suggestions – help with errands, go with you on a walk, drive you somewhere, just spend some quiet time together – ask what she wants.  

5. Don’t expect reciprocity during acute grief; try to understand that your bereaved friend might not be able to meet expectations and demands as usual.  

6. Listen closely; share knowledge and advice sensitively and honestly if requested; be willing to sit in silence, squeeze your friend’s hand or give them a hug.  

7. Help with problem solving, in a spirit of partnership, not as an authority; be honest when you are uncertain about what will be helpful; share this with your bereaved friend in a respectful way.  

8. Let your bereaved friend lean on you, especially in ways that are not so obvious.  

9. Be respectful of the mourning process and patient with its progress; have faith in this person. 

10. Remember the deceased and talk about this person.  

11. Look for ways to promote positive feelings in the present and hope for the future; don’t feel discouraged by the natural sadness that infuses these feelings.  

12. Show respect for your friend’s need for independence and solitude while making clear your strong commitment to being available and responsive.  

13. Make it clear you are interested in staying in touch for the long haul; make it clear that you know there are certain days of the year that are especially hard and that you want to help with those.  

14. Try to be aware of your own feelings about what you want from your bereaved friend that she can’t give or do right now; don’t try to push these feelings away; do try to find other ways to get your own needs met.