Grief and Loss

Defined

Grief is a universal human experience that involves psychological, biological, and behavioral responses, shown through a series of strong emotions, that allow us to adjust to a loss and incorporate it into our daily life (UCSF, 2020).

Grieving is the necessary process of coping with a loss, and it can be extremely painful and long lasting. Individual grieving experiences are strongly influenced by culture, religion, personal beliefs, past experiences and the type of media consumed (Potter, 2020).

Grief may be anticipatory, where the grieving process begins when a person realizes that a loss will inevitably occur in the future. Grief may also be deemed as complex, where the feelings of loss are debilitating and do not resolve over time (Vermeulen, 2020).

A loss is anything that is taken from a person, and can come in every shape and size. Our feelings about the loss is defined more by the value we place on it then by the tangible deprivation we experience (UCSF, 2020).

Losses may occur at any point in life, and be physical (death of loved ones, terminal illness, loss of limb, loss of mental capacity), social (divorce, moving, lost belief in the world or others), or occupational (loss of a job, loss of financial security, loss of skill due to injury) (UCSF, 2020).

Mourning is the outward expression of grief, which may include wearing black, attending funerals, or holding community services. Mourning serves a critical purpose as it allows us to accept our loss, adjust to life without what we lost, and recover within our social support system. Mourning does not serve to provide closure, however (Vermeulen, 2020).

Bereavement is a state of intense grief. This word is used to describe a physical condition that can occur if a person is deprived of something critical to their functioning. When experiencing bereavement, the sufferer is living within a state of desolation (Vermeulen, 2020).

Loss Comes in Many Forms

Most of us have experienced a significant loss in our lives. While some types of loss are easily recognizable, some may be more difficult to identify. Examples of forms of loss include (Vermeulen, 2020):

  • Ambiguous - the experiences and emotions are left unresolved or are lacking in closure.
    • There is little clarity or understanding in these cases. 
    • Those grieving must look for answers before the healing process can begin.
  • Perceived - when something internal to a person is lost. This may be the loss of a deeply held image of a loved one or a loss of trust in the self or others.
  • Disenfranchised - where the experiences or emotions related to a loss are minimized, unspoken or unrecognized by others.
  • Tragic - a sudden, unpredictable loss that occurs before a person is able to prepare themselves mentally, physically or emotionally (Potter, 2020). 

It is important to acknowledge losses as meaningful events that we must grieve, as it allows us the opportunity to make peace with the loss and heal effectively. Consider the following examples of types of losses (Vermeulen, 2020):

  • Death of a loved one(s)
  • Loss of physical health or mobility, due to illness, accident, aging 
  • Loss of future goals due to short term, chronic or terminal illness
  • Loss of cognitive function or reduced mental health status
  • Loss of partner due to divorce, breakup 
  • Loss of family due to abandonment, divorce or a parent moving away 
  • Loss of home through involuntary displacement due to tragedy, disaster, immigration, political conflict or other external circumstances
  • Loss of a dream, ambition or technical skill, potentially due to injury
  • Loss of trust, faith or belief in a just world 
  • Loss of a job, career or loss of financial security 
  • Loss of trust in authorities 
  • Loss of sense of security or safety 
  • Loss of sense of freedom or control 
  • Loss of opportunities 

The Covid-19 pandemic has created unique losses that include:

  • Loss of social interactions 
  • Loss of irreplaceable experiences, large and small
  • Inability to visit loved ones in the hospital, or mourn the loss of our loved ones as a community

How to Recognize the Symptoms of Grief

Grief is a powerful and complicated experience, and it can manifest itself physically and emotionally. Each person will experience grief differently, with varying symptoms of varying intensity. Commonly reported symptoms of grief include (Potter, 2020):

  • Emotional or physical pain, reduced sensations, numbness
  • Feelings of anger, blame, sorrow, or despair
  • Lethargy, emotional detachment
  • Tightness in chest and throat
  • Tiredness, an inability to sleep, or sleeping too much
  • Psychological distress
  • Feelings of relief, personal growth or catharsis
  • Panic behavior, disorganization or forgetfulness
  • Changes in activity level
  • Altered dream content and emotional responses
  • Reduced immune function, getting sick more often 
  • Changes in hormonal regulation
  • Efforts to maintain the connection to the deceased and make meaning of the loss 

Grieving Process

After experiencing a loss, we must find a way to understand what the loss means to us, adapt to life without what we are missing, and cope with the emotions that come up as we process our change in circumstances. There is a well understood, and almost universal, series of emotional milestones that we progress through as we are recovering from a loss, which form the grieving process. Those who are grieving may move between each of the following stages, seemingly at random, or move through phases without showing signs of having done so. Remember, everyone experiences grief in their own way (Potter, 2020).

  1. Denial - During the first stage of the grieving process, the loss is difficult to recognize. External reminders that the loss occurred are rejected, and the individual is preoccupied with maintaining life as if loss has not occurred.
  2. Anger - Once we can no longer deny the loss, we must begin to face it. This can be extremely painful, and we may become easily frustrated, have mood swings, engage in intense emotional outbursts, lean on blame and shame of others and risk turning anger inwards. Release of this emotional build up is essential to maintaining physical health.
  3. Bargaining - Once the anger has run its course, we may begin to seek out ways to return to our normal condition prior to the loss. We may ask ‘what if…’ or think ‘if only…’. We may direct our bargaining inwards, or towards a higher power, in an effort to relieve our suffering and pain. 
  4. Depression - This is often the most challenging phase of the grieving process. In this phase, we may feel overcome with a sense of purposelessness, listlessness, sadness or sorrow. It is often reported that a sense of being punished for past transgressions develops. Pleasurable and joyous experiences may feel hollow or diminished, or may even be perceived as damaging to the memory of what was lost. 
  5. Acceptance - During the final state of grief, we acknowledge the need to move on, and find the internal motivation and strength to adjust to our loss.

Recovery Process

Once acceptance is achieved, we begin the recovery process. During recovery, a complete, permanent adjustment is made on both an emotional and a cognitive level (Vermeulen, 2020).

Emotionally, we begin to recover by developing a loss orientation, where we shift our focus from the pain of the loss and toward our connection to the loss and the meaning that the loss has for us in the larger context of our lives. These feelings can be extremely painful, even though they are productive. A healthy perspective on loss orientation involves incorporating the memory of the loss into our personal identity, and making a place for the loss in our life story (Vermeulen, 2020). 

Cognitively, our recovery from a loss is based in a restoration orientation, where we focus on acceptance of our new reality. This involves confronting the changes and stressors of life after the loss, and adjusting to the altered activities of daily living we now experience. A healthy perspective on restoration orientation is focused on personal development and growth (Vermeulen, 2020). 

How to Support Someone Who is Grieving

When overcome with grief, it is possible that someone may experience symptoms of shock and come to neglect their immediate physical needs. When supporting someone experiencing a loss, be sure that they are in a safe place first and foremost. Once safe, encourage them to eat, drink, and shower. Consider preparing meals they prefer, making warm tea or drawing a warm bath, and offering them comforting physical touch (UCSF, 2020). 

Actively listen to them with empathy, and validate the thoughts and feelings that come up. Do not pass judgment on what someone says while grieving, allow them a safe space to process their emotions and put the pieces into place. Although this process can be uncomfortable, try to verbally recognize and acknowledge the loss. Simply stating “I am so sorry for your loss. Please know that I am here for you” can ease feelings of isolation and sadness. Consider helping them name their feelings using descriptive words from the emotion list (Vermeulen, 2020). To review the emotion list, click here.

When discussing a loss with someone, expect that they will repeat themselves. Repeating certain words and phrases that describe their grief allows the information to be incorporated into their worldview (UCSF, 2020). Be respectful of their needs, especially the need for privacy (Vermeulen, 2020).

Naming the loss is a tool we can use to help validate the reality of those experiencing grief. When talking about the loss with the person who is grieving, try to use the same language that they do when describing the events. This shows we hear them, understand them, and are a safe person for them to describe their experiences to. Some people will not want to talk about the loss at all, and in this event, consider providing a quiet, supportive presence instead of attempting a conversation (UCSF, 2020).

Be honest with the person who is experiencing a loss, and provide them accurate information without concealing or misrepresenting things. Be truthful and specific when describing the help being offered. Transparency in these situations prevents confusion, frustration and a sense of false promises. Help connect the grieving person to their support system, and encourage others to lend support in ways that will be received positively by those in need (UCSF, 2020).

Avoid using dismissive language or  passive platitudes when talking with someone who has experienced a loss. Examples of such language include “you’ll be alright”, “everything happens for a reason”, “you must be strong for others'', “it was god’s will”, “they are in a better place now”. This kind of language is meant to resolve feelings of discomfort on the part of the speaker, and can displace that discomfort onto the mourner (Vermeulen, 2020).

Encourage the individual to perform rituals. This will allow them to honor and grieve their loss, while also serving to prevent avoidance. If we feel comfortable doing so, we can research support groups and encourage attendance. Facilitate a therapeutic relationship with a counselor, community leader or religious figure whom they trust and respect (Vermeulen, 2020). 

Rituals for Recovery

The use of rituals serves us by building up cohesiveness within our social groups, allowing us to honor what was lost, and create a socially acceptable space where we can show and share complicated and difficult emotions. Rituals can be cultural, spiritual, family traditions or entirely personal to us. The loss being mourned does not have to be major to be deserving of a ritual. Choosing to properly grieve our losses, even small ones, allows us to incorporate the loss into our worldview, provides relief from pain, and helps us move past the experience in a healthy way (Vermeulen, 2020). 

When we are unable to perform the rituals that have meaning to us, we tend to show an increased level of emotional distress, a prolonged grieving process, and a reduction in our ability to cope with the current loss, as well as higher sensitivity to future losses. Failing to maintain rituals can lead to feelings of disrespecting the loss, or minimizing the importance of the loss. The negative emotions that come from such a state can have long lasting impacts on our personal identities (Vermeulen, 2020).

Even if we do not personally have a ritual or tradition that has been used in the past to aid in overcoming a loss, we may consider creating one or engaging in one that we feel could have meaning to us. Examples of rituals we may benefit from include hosting a funeral, a wake, sitting shiva, participating in dia de los muertos, wearing black, hosting a vigils, or cooking a communal meal. We may also consider decorating a candle and lighting it in remembrance, planting something to honor our loss, or creating a physical monument (Vermeulen, 2020).

Not everything we mourn is something we want to remember. However, even in these cases, it's important to grieve in a meaningful way to reduce the influence that the loss has over us. Consider the above ritual options but with a focus on release and freedom from what it is that was lost. For example, hold a funeral for something that represents the loss, create a physical monument and break it, or burn mementos of what was lost. We can allow ourselves the opportunity to let go of harsh feelings and emotions in a productive, compassionate way.