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Consumer & Family Information
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.1.19
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Grief is a universal human experience. It is a natural reaction to the loss of someone we love, generally because of death. Death is an inescapable part of life, and thus so is grief. Grief may also result from the irreversible loss of a loved one not from death but from war, disaster, societal dislocation, emigration, or irreconcilable family conflicts. Other causes of grief are bodily injury or damage or loss of a job, status, a pet, or a prized possession.

Our first reaction to learning of a loss is a combination of shock and disbelief—a conviction that this cannot have happened. Despite the disbelief, a person may experience tears and agitation. The immediate pain alternates with numbness and withdrawal. Over hours, days, and weeks, the full impact of the loss enters a person's heart and soul, and grief dominates.

Physical symptoms, such as choking, shortness of breath, feelings of emptiness, muscle tension and weakness, and sighing, are common and come in waves that last from a few minutes to an hour or more.

The bereaved person is intensely preoccupied with the lost loved one and is restless with an urge to reunite. Feelings of anger about the loss are also common, as is a search for someone to blame for the loss. Bereaved individuals may blame themselves, as if they could have done something to prevent the loss.

Concentration on everyday life and tasks is limited during grief, and normal patterns of life, such as sleeping and eating, are typically disrupted. Everything becomes an effort, time seems to stand still, and life is bleached of its vitality and meaning. In every experience of grief there is an element of having lost a part of oneself.

As the grief process unfolds, memories of the lost person emerge. The bereaved person feels a need to talk about the lost person and to share memories—an important part of the healing process. In time, interest in people and activities slowly reemerges, and the bereaved person can reinvest in life and in other relationships. For most people, the pain and functional disruption diminish over about six months. But waves of sadness and pain continue to occur, especially when triggered by an event that stirs a memory or by an important date, such as a birthday, a holiday, or the anniversary of the loss. For all the steps forward, there are always some steps back into the abyss of grief.

Grief is different from depression in a number of ways. First and foremost, grief is a natural reaction and not an illness. Grief is self-limited, and symptoms improve with time, while depression persists and may even worsen. People suffering from grief are responsive to social contacts and support. Depressed people are often burdened by social contact and avoid it. When depression is precipitated by the loss of a loved one, feelings about the lost person are characteristically ambivalent; angry sentiments are often present, although the depressed person may not be fully aware of them.

Depressed people often consider suicide, and some act on such thoughts, but people experiencing grief are rarely suicidal. The reactions of others to a bereaved person are usually sympathy and empathy, while depression often evokes feelings of helplessness and irritation in others.

Finally, we know that depression is responsive to antidepressant medications. Uncomplicated grief, on the other hand, generally does not warrant the use of antidepressant medications. Bereaved persons who have intense mental anguish, agitation, or persistent sleep difficulties may benefit from a brief course of antianxiety or sleeping medications. However, if grief is unresolved (see below) and a person shows symptoms of depression, the use of antidepressant medications should be considered.

For some people, grief may not resolve with the healing process enabled by time, support, and human resilience. Grief that does not improve is called unresolved grief. The natural process of recovery may not occur when the person cannot discuss the loss because of shame, as may be the case with suicide, abortion, or miscarriage or the loss of a socially unacceptable partner. Socially isolated people who have no one else to turn to may experience unresolved grief, as may those who are faced with demands to be strong and support others.

Uncertainty about what has happened to the lost person—sometimes called ambiguous loss—can also lead to unresolved grief, which may occur in cases of missing persons or deaths such as those at the World Trade Center.

Emotional problems, such as feelings of anger and guilt or responsibility for the loss, may interfere with the natural recovery process. Sometimes feelings associated with previous or multiple losses are rekindled and compound the grief over the current loss. Intense dependence on the lost person may make the loss more difficult to accept and recover from. Unresolved grief is persistent, deeply painful, and disabling and warrants the attention of a mental health professional.

Humankind has had ages to learn about grief. We can see this in the religious and social rituals that have become part of every society. We know that it is important to surround bereaved persons with those who love and care for them. We know that ventilation of feelings and memories is essential. Sorrow needs to express itself from the wound that loss has created. Both positive and negative feelings and memories need an outlet.

It is not helpful to tell someone not to cry or be angry. We need to pay tribute to the lost person, at the time of burial and during the gatherings that follow. Some people will want to memorialize the loved one through mementos or contributions to worthy causes. Regular visits to the grave, when possible, may serve as important times for tears, memories, and tributes and for coming together with family and friends.

As a family member or friend, you may feel you do not know what to say to someone who has lost a loved one. Remember that being there and your human touch is worth a thousand words.




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