Grief is characterized by a contradiction.
On one hand, it is a complex and painful maelstrom of thoughts and emotions triggered by the loss of someone precious to an individual.
On the other hand, it is a natural and positive healing process that plays an essential role in helping us work through and let go of the often unavoidable trauma of loss.
In this article, you’ll learn how to resolve this contradiction and understand that while grief is challenging and complex, it is ultimately straightforward to understand and navigate.
Before you continue reading, we thought you might like to download our three Grief Exercises [PDF] for free. These science-based tools will help you move yourself or others through grief in a compassionate way.
This Article Contains:
What Is Grief? 5 Symptoms & Common Emotions
Put in the simplest terms, grief is an intense emotional experience triggered by a loss. Grief is most commonly experienced in the context of death, such as the death of someone close to the grieving individual or the individual themselves in the process of dying.
However, loss comes in many forms, and grief can also be experienced following the loss of a relationship, a job, faith, significant material assets, and so on.
It’s appropriate that the word ‘grief’ has its roots in the Latin ‘gravis,’ which roughly translates to ‘a heavy burden.’ Grief emerges from the heavy burden of emotions triggered by the loss (Dunne, 2004).
Before you read any further, it’s important to bear in mind that grief is not a clinical condition. Assuming that your client is experiencing a clinical issue can be a dangerous approach, as it may alienate them during a time when they are already feeling isolated and make them withdraw or feel shame about disclosing experiences that are completely healthy.
After all, everyone is likely to experience grief during their lifetime. Grief can also present differently between individuals. Your client’s experience will be shaped by their personal expectations and beliefs about the nature of grief, which are themselves shaped by the unique combination of your client’s personality, faith, culture, and life history.
With that in mind, several symptoms that are common among grieving individuals can also characterize grief. We can group these symptoms into five different categories: physical, cognitive, emotional, interpersonal, and lifestyle (Stroebe & Schut, 1998).
These are symptoms that have a physiological effect on the grieving individual. They resemble the physical symptoms of depression and include loss of appetite, difficulty sleeping, fatigue and loss of energy, physical pains (which may be psychosomatic), and a suppressed immune system. More acute physical symptoms may be episodes of weeping, wailing, or intense physical agitation.
Grief can also influence how an individual thinks and perceives their world. For example, the grieving individual might feel a sense of dissociation and distance from reality, linked to feelings of disbelief concerning the loss. They may also experience confusion, poor memory, and lack of focus.
The most typical symptom of grief is negative emotion. The spectrum of possible emotions can be diverse, including depression, guilt, anger, hostility, anxiety, despair, hopelessness, and feelings of isolation. These emotions rarely occur simultaneously and may appear in connected but distinct phases.
The effects of grief can spill over into the grieving individual’s relationships with others. For example, grief is often accompanied by social withdrawal and feelings of distance or resentment toward relationships that may have been healthy before.
Finally, symptoms of grief can also be observed in lifestyle changes, such as failing to perform daily routines and self-care and resigning from activities that the grieving individual previously found stimulating.
The role of anger while grieving
It may surprise you to see anger mentioned as one of the possible symptoms of grief. Anger is essentially our brain protesting against something we are experiencing that is perceived as unjust and frustrating.
A grieving individual is beset by a number of confusing and stressful experiences caused by a loss that is often perceived as unfair and frustratingly uncontrollable. In this sense, anger and grief go hand in hand, as anger provides a way of expressing the powerlessness and despair experienced by the grieving individual (Rueth & Hall, 1999).
The consequence of this is that it may seem as though the individual is hostile or bitter toward surrounding people or themselves. But it is important to look past this and recognize that anger may be a necessary expression of the deeper psychological stress of grief.
How long does grief last?
Fundamentally, the duration of grief depends on the nature of what was lost. It stands to reason that the more intensely your client is affected by this loss, the longer it will take them to heal. For example, grief following the loss of a beloved pet or a valued job is no less legitimate than grief following the loss of a loved one, but it is likely to be less intense and, therefore, shorter.
Grief and Loss Theories: 4 Models & Cycles
To understand the processing of an immense loss, various theories have been modeled. Below are four main theories.
Grief response model: The 5 stages of grief
A popular theoretical approach is to structure grief as a progression through a series of stages that follow a systematic and often linear order.
Kübler-Ross (1969) proposed a five-stage theory based on the experiences of terminally ill individuals coming to terms with their death. Here, grief begins with denial, in which the grieving individual is not merely unable to process their loss, but actively unwilling, and they will try in vain to avoid acknowledging what has happened.
This leads to the next stage, in which failure to deny the loss forces the individual to face it, causing acute feelings of frustration and bitterness that manifest as anger and hostility.
When anger does not provide comfort, grief then evolves into attempts to bargain, characterized by the grieving individual seeking means to reverse the loss in return for a sacrifice, often involving appeals to religion or spirituality. This often does not succeed, and the grieving individual may increasingly ruminate over the loss and experience feelings of guilt or despair as they consider how it could have been avoided.
This leads to depression, as the individual resigns to their fate while still fundamentally existing in a state of conflict with their loss. The silver lining of this otherwise bleak stage is that the individual no longer attempts to avoid accepting their grief (through denial, bargaining, etc.), which eventually leads to true acceptance and letting go of their loss, or at least reaching a state of amnesty.
An alternative theoretical perspective is referred to as ‘grief work.’ Grief work assumes that an individual will not be able to overcome their grief unless they actively try to let go of what was lost. Once they do this, they can take the energy that was invested into despair and use it constructively to adapt to any changes that have happened because of the loss (Lindemann, 1944).
Worden (1982) provided a formal description of this process of grief work in the form of a series of tasks that the grieving individual needs to work through in sequence in order to accept their loss and move on.
The first task is to accept that the loss has actually occurred and move past any attempt at denial. The second task is to allow the pain of grief to be experienced without attempting to suppress or redirect this pain elsewhere.
The third task is to accept that life no longer features whatever was lost and begin to adapt to this new life. The final task is to take the energy that was invested into the relationship that was lost and reinvest it into a new or existing relationship.
The grief cycle
Not all theoretical approaches to grief are structured as a linear progression through a series of stages. Some prefer to represent grief as a cyclical process, where the grieving individual repeats phases multiple times on a gradual journey to recovery.
The dual process model of grief (Stroebe & Schut, 1999) is an example of a cyclical model, in which the grieving individual oscillates between two processes of grief. The first, loss orientation, involves acknowledging the loss and experiencing associated pain as a necessary process of emotional healing.
The second, restoration orientation, involves stepping away from emotion and dealing with the more practical lifestyle issues caused by what was lost. These two processes cycle repeatedly, gradually healing the grieving individual, until they can move on from their loss.
The grief curve
The theories described above may be unnecessarily complex for your practice or may not be easily communicated to your client. If this is the case, a much simpler way of thinking about grief is the idea of the grief curve. This concept was originally developed to complement the Kübler-Ross (1969) stage theory described above, but it can be used independently of a specific theory.
The grief curve is a simple representation of grief as a U-shaped curve, moving from high morale and energy, to low morale and hopelessness, and then back to high morale and energy. The high point at the beginning of the curve is characterized by the almost manic energy of denial, shock, and anger.
The low point in the middle of the curve is the depth of despair and depression after the initial investment of energy proves futile. Finally, the high point at the end of the curve is the restoration of energy and morale as the loss is accepted and life resumes.
This can be used as a simple map to represent your client’s journey through the grief experience. They can make an easy estimate of where they feel they are on the curve, without grappling with the more complicated theories of stages, cycles, or tasks.
How Does Grief Affect the Brain and Body?
The severe emotional pain experienced in grief can have a profound effect on the brain and body as well. You may have noted this earlier when potential physical symptoms of grief were described.
This is a stark reminder of the connection between our mental and physical health, and it can be useful to have a sense of the latter when working with your client on the former.
Grief is associated with noticeable changes in brain activity detectable via neuroimaging. These changes are seen in a variety of brain regions linked to different aspects of the grief experience.
When exposed to words related to their loss, grieving individuals exhibited increased activity in the amygdala, an ancient region of the brain strongly implicated in negative emotion and fear. Regions associated with rumination also show increased activity, similar to individuals with clinical depression (Freed, Yanagihara, Hirsch, & Mann, 2009; O’Connor, 2019).
Another study found that recovery from grief was slower in grieving individuals who had higher activity in the nucleus accumbens, a region of the brain associated with the pursuit of desires, which likely reflects ongoing activity to seek out what was lost (O’Connor et al., 2008).
This is a cross-section of grief in the brain, but grief also has longer term effects. Individuals who experience severe long-term grief exhibit greater cognitive decline, which is an early indicator of serious acquired neurodegenerative conditions, such as Alzheimer’s disease (O’Connor, 2019).
Use this to empower your client, by impressing upon them how important their efforts to overcome their grief are and that their grief is legitimized by clear physical fingerprints in their brain.
Terms like heartbreak are used colloquially in the description of grief, and clients may express the subjective feeling of pain in their heart accompanying their despair and anxiety.
But this feeling may be more than subjective. ‘Broken-heart phenomenon’ has been the topic of serious scientific study. This phenomenon refers to the increased risk of mortality following the loss of a loved one and, in particular, the risk of death from cardiovascular disease.
In a large-scale survey of widowers, the risk of coronary heart disease was twice as high in the six months following their loss. Another study suggested this increased risk of heart disease was even more significant than the risk associated with smoking (O’Connor, 2019).
The physical stress associated with heartbreak should therefore be taken quite literally. Again, use this as an opportunity to affirm your client’s choices and potentially explore stress management therapies that may help reduce this risk.
Grief vs Complicated Grief
For most grieving individuals, with time and persistence, their grief passes, and the experience can be viewed in hindsight as a necessary and healthy process of letting go.
However, for some individuals, this process is not so straightforward. The grieving process can become obstructed or set on a trajectory that resembles a downward gradient (as opposed to the U-shaped curve that represents the normal trajectory of grief). This stretches the duration of the grief experience into years and transforms it from a healthy process into a serious mental health issue.
The term ‘complicated grief’ is used to differentiate this form of grief from normal grieving.
Complicated grief represents an issue that warrants a clinical approach, as the grieving individual needs professional intervention to avoid spiraling into deeper trauma. In other words, if normal grief is a medicine, complicated grief is a serious allergic reaction to that medicine that requires medical assistance.
Can grief cause depression?
The fatigue and hopelessness experienced by an individual struggling with long-term complicated grief may be a risk factor for comorbid depression, which may then further complicate their already complicated grief.
However, while complicated grief and depression have a lot in common, it is nevertheless important to view complicated grief as a distinct condition.
Where depression is characterized by a sense of self-loathing, this is not seen in grief, and where depression is a generalized loss of interest in life, grief is characterized by an obsessive but painful interest in returning what was lost.
As a result, treating complicated grief should be seen as the priority and not confused with treating any accompanying depression (Shear, 2012).
Can grief and loss lead to anxiety?
Anxiety is a common emotional symptom of grief, characterized by feelings of separation anxiety, feeling overwhelmed, and social anxiety. An individual with complicated grief may experience significant trauma from the long-term experience of this anxiety, and this trauma may be sufficient to trigger an anxiety disorder.
Unfortunately, it can be difficult to identify what anxiety is because of grief and what might be due to an acquired disorder. If you are concerned about your client’s anxiety, work with them to see whether they could meet the criteria of panic disorder or generalized anxiety disorder. This may help you avoid losing track of your client’s grief amid other conditions they may be experiencing.
Helpful Resources From PositivePsychology.com
As part of our Positive Psychology Toolkit©, for which you can purchase an annual subscription, we offer over 400 tools and exercises, plus access to our community of professionals.
Some of our tools that can assist with grief are mentioned below.
- Acknowledging loss can be difficult, especially if the loss is the death of a loved one. It can be helpful to approach acknowledging this loss through a structured and positive framework, which is exactly what The Life Certificate exercise provides.
- Experiencing the pain of loss is a necessary part of grieving. Fostering acceptance of these emotions may help your client cope with this challenging aspect of grieving. They may benefit from practicing our Acceptance of Emotions Meditation.
- For a more striking demonstration, they may find the Practicing Acceptance With Ice Cubes exercise useful.
- Finally, they may benefit from using our worksheet on Identifying Emotional Avoidance Strategies.
Another resource that is well worth mentioning is our article Coping With Grief for Children.
A Take-Home Message
Grief has a variety of typical symptoms, but these symptoms may appear in a different combination or intensity between individuals.
Grief is a normal and healthy process, but can be associated with negative changes to physical health. Be vigilant for complicated grief, which poses a serious mental health concern.
There are a number of theoretical approaches to understanding grief and complicated grief. Reflect on the theories you’ve read about here, and think about which (if any) you identify with or recognize in your client.
We hope you enjoyed reading this article. Don’t forget to download our three Grief Exercises [PDF] for free.
- Dunne, K. (2004). Grief and its manifestations. Nursing Standard, 18(45), 45–51.
- Freed, P. J., Yanagihara, T. K., Hirsch, J., & Mann, J. J. (2009). Neural mechanisms of grief regulation. Biological Psychiatry, 66(1), 33–40.
- Kübler-Ross, E. (1969). On death and dying. Simon and Schuster.
- Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101(2), 141–148.
- O’Connor, M. F., Wellisch, D. K., Stanton, A. L., Eisenberger, N. I., Irwin, M. R., & Lieberman, M. D. (2008). Craving love? Enduring grief activates brain’s reward center. NeuroImage, 42(2), 969–972.
- O’Connor, M. F. (2019). Grief: A brief history of research on how body, mind, and brain adapt. Psychosomatic Medicine, 81(8), 731–738.
- Rueth, T. W., & Hall, S. E. (1999). Dealing with the anger and hostility of those who grieve. The American Journal of Hospice & Palliative Care, 16(6), 743–746.
- Shear, M. K. (2012). Grief and mourning gone awry: Pathway and course of complicated grief. Dialogues in Clinical Neuroscience, 14(2), 119–128.
- Stroebe, M., & Schut, H. (1998). Culture and grief. Bereavement Care, 17(1), 7–11.
- Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224.
- Worden, W. (1982). Grief counseling and grief therapy: A handbook for the mental health practitioner. Springer.
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Dear Dr. Celestine,
I run a program for the VA, a weekly Zoom meeting group for Vietnam Veterans with PTSD. For this aging population William’s article is very relevant. Unfortunately they are not eager to read longer partly-scientific articles, however beneficial or relevant, but prefer talks, videos, etc. Do you know of any videos, TEDtalks, or other presentations which provide (even parts of) this information?
Thank you, William. I am the founder and senior consultant of Optimum Practice Solutions. My focus is on providing organizational management tools and techniques as well as other solutions to support the veterinary and medical professions.
I write educational articles 3-4 times a month which are sent to my subscriber list via email. With a high rate of mental illness and suicide in veterinary medicine and the healthcare profession, I’d like to reprint this article with you as a Guest in one of my upcoming articles. You’ll find me on LinkedIn https://www.linkedin.com/in/marylemalloy/
Let me know as soon as possible if I have your permission.
Thanks for your interest. Could you please send a few details about your organization, the purpose for which you’d like to republish this article, and the contact for your publishing manager via our contact form here, and we will be in touch 🙂
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can’t seem to download 3 free PDF exercises. It keeps taking me to buy 17 grief exercises, which I already bought.
Sorry for the confusion. The 3 PDF exercises will be automatically sent to your email after entering your address, so please check your inbox (and your junk if they are not there).
Let me know if this helps.
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Thank you so much for the wonderful , detailed information. These resources help in supporting the clients. These kind of resources help the therapist to connect with the clients and help them in their journey.