Grief is the most common feeling experienced by anyone affected by death. It is normal after a loved one’s death.
You may also experience anticipatory grief, which is grieving associated with an expected event.
In this case, you are aware of and will be grieving your loved one’s impending death and, in addition, you will probably be grieving about things personal to you.
- You may be losing the life you planned and expected with your loved one.
- You are losing the person you loved as the illness takes its toll.
- There may already be things you may have lost, such as your lifestyle, your freedom, your interest in doing the things you enjoy, or seeing your friends.
- There may be a gap that is developing between you and those who are not coping well that is isolating you.
Grief is a very personal process and there is no right way to do it. It can be a long and difficult process full of ups and downs, relapses, confusion, and changing hopes for the future. Your family and friends will also be grieving about what you are going through and the loss of someone who is their loved as well.
Grief can manifest physically, emotionally, and psychologically.
- Other emotions that can be experienced along with grief include shock, sadness, fear, anger, guilt, and regret.
- You may resent your new situation of having to go on without them and envy those who still have what you no longer do.
- Grief can result in obsessions about your loved one or death, prolonged anxiety, trouble thinking and concentrating, restlessness, withdrawal, helplessness, depression, and even thoughts of suicide.
- Physical symptoms are common and may include: crying, abdominal pain, loss of appetite, intestinal upsets, weight loss, sleep disturbances, headaches, chest or throat tightness, dizziness, and/or extreme fatigue.
- Anniversaries, birthdays, holidays, and milestones can intensify grief or trigger a significant grief reaction even if you have previously dealt with your loss.
The well known Kübler-Ross model “Stages of Grief” is a good guide of how feelings and emotions can be mixed together and change over time. Originally, there were five stages of grief observed, but the model has since been updated to include a total of seven stages.
Many grieving people will go through all of these stages, but not all. Each of us experiences the stages of grief in different orders, intensities, and lengths of time. Often the stages overlap and may even take place at the same time. Denial tends to come first and acceptance is typically the last stage.
The ebb and flow of feelings can sometimes make it seem like you are on a roller coaster. Some or all of the following may be experienced while you are grieving.
Traditional Five Stages of Grief
- Although not adaptive, anger is normal given that hearing about a loved one’s terminal illness or death is such terrible news.
- This stage is likely to occur when your feelings about their death are the most intense and painful.
- It can last for days, weeks, or months.
- This stage usually involves sadness about your situation, but may occasionally become clinical depression.
- It usually happens when you are feeling overwhelmed and helpless.
- The depression stage may come and go throughout the process, with grief coming in waves of distress.
Stages of Coping
- Not surprisingly, denial is usually the first stage experienced.
- Disbelief is often the first reaction to any terrible news, such as your loved one’s terminal illness or death.
- You may be in shock and unable to process the news.
- Denial can last anywhere from a few hours to many weeks or more.
- This stage of grief is frequently associated with fear and numbness.
- This news can make you feel emotionally “shut off” from the world, alone and distant from others who would want to help you cope with your situation, even those in the same situation.
- Isolation can result when you completely avoid them.
- While it is normal to want some space, it is best to not isolate yourself.
- You may avoid talking about your loved one’s illness or death with your family and friends.
- Even if you spend time with others, shutting them out could result in emotional isolation.
- While it is fine to not be in the mood to talk about it at first, you should let those close to you know as soon as you can.
- Be willing to talk about anything; the more you share, the more connected you become.
- Sometimes denial can be a buffer that temporarily avoids many of the negative emotions associated with their death while you slowly adapt to the loss.
- During this stage you are usually angry and looking for ways to alter the situation.
- It happens while you are struggling to find meaning in the news or their death.
- This stage is usually the shortest.
- You may pray for it to go away or otherwise make bargains with a higher power to change the prognosis or make the feelings go away.
- By praying and talking to others you may begin to think more clearly about the situation and finally begin acceptance.
- Even though you may still be experiencing anger and depression, you can come to terms with and accept the loss you are anticipating/experiencing.
- This typically occurs slowly over a few to many months. Like other phases, it can come and go.
- Acceptance can be a difficult and ongoing process, as you continue to carry on without them.
Updated Seven Stages of Grief
For this updated model, there are two additional stages that describe the coping response and the creation of a new emotional stage of pain and guilt. Three stages now combine a coping response with the predominant emotion during that stage: shock and denial, anger and bargaining, and acceptance and hope.
Shock and denial – This stage recognizes that denial is usually a result of a state of disbelief, fear, and numbed feelings.
Pain and guilt – In this stage you are now reacting to the situation and may feel that the loss is unbearable, and guilty that you’re making loved ones’ lives harder or that you were somehow responsible.
Anger and bargaining – This stage recognizes that anger is the most likely emotion to make you want to bargain. You may lash at God or a higher power, offering to do anything in exchange for relief from your feelings.
Depression – Depression is not always a psychological condition, but a normal emotional reaction to loss. It usually happens when you are feeling overwhelmed and helpless. This may be a period of isolation and loneliness during which you process and reflect on the loss.
The upward turn – This is a new stage that reflects the ups and downs of grief and recognizes that there is a point that things do begin to improve. During this stage anger and pain have subsided, and you’re left in a more calm and relaxed state.
Reconstruction and working through – This a new stage that recognizes that you can begin to move forward before you have fully accepted your situation. You are now able to start putting pieces of your life back together and carry on.
Acceptance and hope – This stage now combines the feeling of hope with acceptance. For those having lost a loved one this is a gradual acceptance of the new way of life and a feeling of possibility in the future.
There are many major emotions that are mixed into the process of grief. You may need to deal with them before you can move onto another phase. There are general ways to cope, such as talking with sympathetic friends, loved ones, or others who are going through similar experiences, attending support groups, and/or reading books or listening to tapes that may be a guide through grief. In many cases there may be specific ways to help relieve or channel certain emotions or feelings. This table of these emotions includes their possible causes, consequences, and ways to cope with them.
Fear is often the result of the unknown. It can hinder you or motivate you, depending on how you respond to it. There are many fears that can be associated with the death of a loved one.
Some fears that can be dealt with, such as being afraid:
- you will not be able cope and/or carry on;
- to become a burden to loved ones;
- that your life will have no purpose or meaning without them;
- that you will lose your self-image; and/or
- you will not be able to support yourself and/or your family.
In some cases knowing what you fear can help you face it and manage it.
- If you’re afraid of being alone, share this with your family and loved ones so they will spend time with you.
- Allow your family to reassure you that you are not a burden.
- Share your life with family and friends, which will affirm that your life still has meaning and help you keep your self-image.
- Seek financial advice.
While a stage of grief, anger is also a powerful emotion. It’s normal to be angry about death, especially if it is earlier than you expected and you think of all the things you and your loved one will miss. It’s understandable to be mad when you think life has been unfair to you, but consider carefully what or who you are expressing your anger towards.
Anger is frequently a result of frustration, anxiety, loneliness, or uncertainty. It may be associated with agitation, weakness, crying, aimless or disorganized activities, envy at seeing others with their loved ones, or preoccupation with thoughts about life not being fair.
- It is human nature to take your anger out on those around you, even if they are not the cause.
- You may even do so because you are sure they will accept it and forgive you for it.
- However, do you really want to do this to those you need the most support from?
You may express your anger toward life, your loved one’s illness or death, or your situation, but use it in a positive way to motivate yourself to solve problems and take action to get what you need
Guilt and Regret
Life rarely goes how we want, so it is not uncommon to have regrets or feel guilty about things you have or have not done or said to your loved one. You may even feel you have not met their expectations.
Although you may feel regret or guilt about all things done and undone and said or unsaid, the past is gone and it is best to move on.
Try and remember that dwelling on these regrets and guilt:
- won’t resolve them;
- will not improve relationships or ease burdens; and
- will actually hinder everyone’s ability to cope.
This is a time you must try to look forward and control those things you can.
- You must forgive yourself if you want to improve relationships with those who will support you or any others you want to relate to.
- Apologize, ask for forgiveness, and begin to rebuild relationships.
- Only then will you all be able to work together to ease the process of your dying.
Anxiety and Depression
Depression and anxiety are not always a psychological condition, but a normal emotional reaction to loss.
For obvious reasons, they are quite common when a loved one is very ill or has died.
- We have all had feelings of sadness, nervousness, and anxiety, but these feelings can be profound and/or interfere with daily life while you are experiencing the loss of a loved one.
- Depression and anxiety may come and go throughout the process, with grief coming in waves of distress.
- It is usually the result of feeling overwhelmed and helpless.
- As with anyone with depression, you may withdraw, become irritable and hostile, or express extreme sadness.
- Not only may you be sad or anxious, you may experience fear, dread, and anger, feelings of hopelessness, helplessness, uselessness, or extreme irritability, or take no joy in any activity.
- You may also experience symptoms such as your heart beating wildly, shakiness, restlessness, tiredness, nervous/upset stomach, trouble thinking and concentrating, loss of appetite, or weight loss.
- It is not unusual to experience the symptoms and not even realize you are depressed and/or anxious.
- Unlike the previously listed emotions, feelings of depression or anxiety may become psychological diagnoses if severe.
- Unlike grief, severe anxiety and depression are not adaptive and can interfere with relationships and resolution.
- Because of this, they are important to treat.
- They may be relieved by medication and/or counselling.
Although the line between typical depression due to grief and clinical depression may be difficult to recognize, it is important to know if you have crossed it. Symptoms that suggest clinical depression include:
- constant feelings of emptiness and despair;
- intense and pervasive sense of guilt;
- thoughts of suicide or a preoccupation with dying;
- feelings of hopelessness or worthlessness;
- significant irritability or anger;
- difficulty with eating or sleeping;
- neglecting personal hygiene;
- your feelings are disrupting your daily life;
- relying on drugs or alcohol to cope;
- slow speech and body movements;
- being unable to function at home, work, and/or school; and/or
- seeing or hearing things that aren’t there.
After a loved one dies, it is easy to feel that you are alone going through your loss However, your family and friends have probably also lost one of their loved ones and enough people have gone through similar situations that you have available support
Do not isolate yourself from life or your family and friends, no matter how alone you may feel.
Maintaining a connection with your loved ones and making new connections to others in a similar situation are the best way to prevent the loneliness that can come with an end of life experience.
Manifestation of Grief
How your grief manifests will depend on the circumstances. A lot of how you experience grief will depend on how significant your loss was, how your loved one died, and your emotional response, personality, ability to cope, life experience, faith, and support system.
Your grief is likely to be more intense if your loved one dies suddenly or violently. In contrast, if they are dying of or have died from old age or a chronic illness, grief may be less intense.
- Having time to process some of the grief can frequently ease the process after their death.
- You may experience a sense of relief after your loved one has suffered through a long illness.
- Acceptance of death as a natural part of life may reduce grief when an elderly loved one dies.
Grief also tends to be more intense if associated with guilt, shame, and regret.
- These feelings can result from turmoil in your relationship.
- This may include any unresolved issues, no matter how minor.
- Guilt, shame, and regret can happen even if there is no evidence-based reason to feel this way.
- You may be tempted to feel guilt or shame just because you have been able to move on, resulting in more grieving.
Death from suicide can intensify the experience of grief.
- There is likely to be more feelings of shock, disbelief, denial, confusion, and betrayal.
- It combines the shock of being sudden with the burden of guilt and shame.
- Much of these feelings of guilt and shame come from not recognizing your loved one’s suffering in time to have made a difference, despite how difficult this can be.
- You may even feel responsible for their death in some way, such as being the cause of their depression or not recognizing how severe it was.
- With a suicide there can be more unanswered questions, unresolved issues, and unknowns. These can also make moving on much more difficult.
A difficult relationship can also complicate grief, especially if that person has been abusive or neglectful, has abandoned you and/or your family, or you just don’t get along.
- It is natural to feel a complex mix of emotions in such circumstances.
- Often an initial reaction is relief, such as “they’ll never hurt me again.”
- You could feel indifference if they have not been in your life for a long time.
- You may even feel that they got what they deserved.
- Unfortunately, you may also feel regret for not working out differences or guilt that some of the unresolved issues were your fault.
- Despite all these feelings, it is still possible for a difficult relationship to result in a typical grief reaction. However, it sometimes causes a more severe form of grief as you reflect on your initial reactions.
How grief will vary according to your relationship to your loved one
Losing a child, especially a young one, may be the most devastating thing in any parent’s or family’s life.
- As a parent or close family member, you are more likely to have a sense of injustice or the unfairness of life when a child dies. It may result in a lot of anger.
- You are not just grieving for your child, grandchild, sibling, etc, you may also grieve about missed opportunities, lost potential, unfulfilled dreams, and their suffering.
- It is not uncommon for a parent to feel responsible for their child’s death, no matter how irrational that may seem. As their protector, you would believe you failed them somehow, when in reality there was nothing you could have done differently.
- You may feel empty and that you have lost a vital part of your own identity.
- Spouses may become isolated from each other, which only adds to the grief.
- It may also alter your relationship with other members of your family, especially any surviving children.
- For more on this complex topic see:
- For The Newly Bereaved. Bereaved Parents USA.
- Kvarnstrom E. Treating Complicated Grief After the Death of a Child. Bridges to Recovery website. Posted: March 5, 2018.
- When a Child Dies: A Guide for Family and Friends. National Hospice and Palliative Care Organization website.
Losing a spouse is also devastating and may have consequences beyond grief which can affect your lifestyle and make the loss worse.
- Depending on the circumstances you may grieve about missing a part of yourself, lost opportunities, unresolved differences, lost potential, unfulfilled dreams, and their suffering.
- You may be having financial difficulty if your spouse’s salary was the family’s major source of income and be grieving about the loss of your and/or your family’s ability to care for themselves. You may also resent having to get a job or work more hours, especially if it is at the cost of spending less time with your children.
- You may experience extreme loneliness, as you have probably lost your best companion.
- You will have a new identity, such as being single, widow/er, or a single parent, and an entirely different life that you have to adapt to.
When the loved one who dies is elderly, the effect will differ depending on your relationship with them.
- As a spouse, you are losing your closest companion and a lifetime of shared experiences. The feelings of loneliness may even be worse, since deaths of close family and friends are more likely to have occurred.
- As a child you are losing a person who raised you, but you know they have lived their lives and may accept their death as a natural part of life.
The grief of losing a parent is among the most traumatic experiences that can happen to a child. Children, especially young ones, who have lost loved ones will experience and deal with grief very differently than adults. How they do depends on their individual development, which will contribute to their ability to understand the realities and express emotion.
- For children who have progressed beyond the developmental stage where they can begin to comprehend changes in the world around them, the loss may be more easily navigated.
- The lower the developmental level of the child, the less they will be able to understand and the more the vulnerable they are.
Younger children will have a limited attention span and ability to recognize the feelings around them.
The death of a parent can affect their sense of security or survival, especially if the surviving parent seems distant due to their own grief.
Children can add stress to their surviving parent and/or relatives by reverting to behaviors such as bed-wetting, asking questions about their late parent that seem insensitive, invent games about dying, or pretend that death never happened.
Grief in children is a large and complex topic that is too detailed for this site. Helpful resources include:
- Death and Grief (Teens). The Nemours Foundation.
- Ehmke R. Helping Children Deal With Grief. Child Mind Institute.
- Helping Children Cope with the Death of a Loved One National Hospice and Palliative Care Organization
- Helping Your Child Deal With Death. The Nemours Foundation. Reviewed: September 6, 2016.
- Lyness D. 5 Ways to Cope When a Loved One Dies (Teens). kidshealth.org. Reviewed: April 2016.
- Schonfeld D, Quackenbush M. After a Loved One Dies—How Children Grieve. American Academy of Pediatrics.
- Talking to Kids About Death and Grief. The Nemours Foundation. Reviewed: October 22, 2019.
- Wender E, et al. Supporting the Family After the Death of a Child. Pediatrics 2012;130:1164–1169.
Unlike other strong emotions associated with the death of a loved one, grief is an adaptive and healthy reaction to loss. It may happen right away or take time to feel, especially if you are still in shock and feeling numb. Although it may never truly go away, the intense stage of grief may last for months to years. Traditionally, you express your grief in two ways.
- Mourning is the process of expressing your grief and loss to others.
- It can occur both before and after their death.
- Opportunities to express grief include, wakes, funerals, and burials, traditional religious or cultural ceremonies, gathering with friends and family to share your loss, or just talking to others.
- Bereavement (to be deprived by death) is the process of experiencing sadness about your loved one’s absence and the loss of part of yourself.
Complicated or unresolved grief over a loved one’s death occurs when your grief is excessive or does not fade. This is abnormal and gets in the way of you and your family moving on with your lives. It is associated with a high risk of suicide and you should seek help as soon as possible. Symptoms present for at least six months are considered complicated grief and can include:
- intense longing and yearning for them;
- intrusive thoughts or images of them;
- avoiding good memories about them or things that remind you of them;
- denial of their death or continued sense of disbelief;
- imagining they are alive and searching for them in familiar places;
- extreme anger or bitterness over your loss;
- feeling like a significant part of you has died; that your life is now empty, meaningless, or not worth living; and/or wishing you had died with them;
- continually blaming yourself for the death or for not preventing it;
- feeling alone, detached from family and friends, or even distrustful of them;
- inability to pursue interests or plan for the future; and/or
- loss of your identity or purpose in your life.