The Psychology Service
Grief

What is Grief?

Grieving is a normal process which happens after any major personal loss. Most obviously it occurs after the death of a loved one, although something very similar can happen after other kinds of loss. Although everybody reacts differently to some extent, the feelings that people go through, and the order in which they experience them tend to be very similar for most. In abnormal grief, the person does not go through the normal stages of grieving, but can become stuck at an early stage, such as disbelief (see below). Some people can also suffer from Depression following a significant loss. This is, however, a psychiatric illness, rather than a normal response to loss. Where the loss has been in very traumatic circumstances, such as if the bereaved person survived an accident in which a loved one has died, grieving may be complicated by symptoms of PTSD.

What are the symptoms?

In normal grief people go through different stages, usually in a similar order. These stages are as follows:

Immediately after a loss such as the death of someone close, most people feel almost as if they cannot believe it has happened. They described feeling stunned or numb. This can actually sometimes be helpful practically, in that often there are things to do such as telling people, or organising a funeral, and the feeling of unreality can help them get through this. However if this feeling of unreality and numbness goes on too long it can cause problems. Sooner or later it is necessary to move on to the next stage of grieving. Sometimes seeing the body of the dead person can be important in letting it sink in, and also the funeral can be very helpful

The next stage of normal grief involves very distressing feelings of “pining” or “yearning” for the dead person. A bereaved person can feel very agitated. It is difficult to relax or concentrate, and often people report disturbing dreams and difficulty in sleeping. During this stage, some people actually report that they “see” their loved one, either mistaking someone for them in the street, or even, when going to sleep or just waking, having a kind of “vision” of their loved one being present. This can make them worry that they are maybe getting ill, and can worry friends and relatives, but it is not an abnormal experience.

During this stage people often have very mixed and confusing emotions. They may feel very angry, for example towards doctors and nurses, or towards other friends and relatives, and sometimes even towards the person who has passed away. Another common feeling around this time is guilt, and people find themselves thinking of things that they may be left unsaid, or wondering if they could have done more for the loved one. Sometimes there is actually some relief following the death, for example if the loved one has suffered from a distressing illness, and feeling relieved can lead to feeling guilty.

This phase of agitation is worst about two weeks after the death, but is usually soon followed by feelings of quiet sadness and low mood. The periods of low mood become more frequent and peak at about four to six weeks after the loss. Spasms of grief can occur later, and sometimes it is difficult for others to understand when the bereaved person suddenly becomes upset for no obvious reason.

The intense distress of early bereavement does begin to fade eventually, the low mood lessens and it is possible to think about the future again, although the sense of loss never goes entirely. The final phase of grieving is about “letting go” of the person, and starting a new life. Sometimes people find this stage difficult and they begin to feel guilty again, almost as if they are betraying the loved one, for example if they begin to feel cheerful or have a return of sexual feelings.

People from different cultures deal with death in different ways and have worked out ceremonies for coping with death. The feelings experienced by bereaved people in different cultures may be similar, but they often express them in different ways.

How long does it last?

People go though the stages of grieving in somewhat different ways, and can behave somewhat differently also in each of the stages. Most people, however, recover from a major bereavement within one or two years. In abnormal grief, however, they may become stuck at an early stage of grieving, and do not get over a loss, even after many years have passed.

What is the treatment?

In normal grieving, therapy is usually not necessary, although some people find it helpful to talk their feelings through with a clergyman or counsellor. Some counsellors have specific training in therapy with people who have a blocked grief reactions, which can be useful in helping them move through the stages of grieving. Where there are significant symptoms, or where the person is suffering from Depression or symptoms of PTSD, then CBT, sometimes combined with antidepressant medication, is required.