Understanding Loss, Grief and Bereavement
Angel of Grief
Angel of Grief
What are Loss, Grief and Bereavement?
Although a disorienting, disturbing and distressing process, grief and bereavement are a normal responses to losing something one holds dear; these are emotions that most people can cope with given enough time.
Loss is the disappearance of something cherished, often the death of a person, loss of a relationship, loss of a job or loss of health.
Grief is the entire response—mind, body and spirit—to the loss.
Bereavement is the often term used when the loss is due to the death of a loved one.
On this page we will explore the different types of losses, the normal grief response to loss and ways to cope with bereavement, or the death of a loved one. We will also look at suggestions for how friends and family members can help a grieving person manage his or her grief.
You will also find some of the basic information on loss, grief and bereavement, written so those experiencing a loss might understand what to anticipate with some of the normal responses following a loss, particularly a life shattering loss.
Ignorance is not bliss.
Knowledge returns a sense of control over seemingly random occurrences
and makes it easier to cope.
— Kirsti A. Dyer, MD, MS
Ripples of Grief
Water Ripple
Useful Information on Loss
The information written here is based on material I have written for the Internet and for my undergraduate and graduate courses based on the over 18 years that I have been involved in the field of grief, loss and bereavement.
I have spent many educating people about the normal grief response by teaching, lecturing, writing articles and through the Journey of Hearts website that was created in 1997 to educate people about the normal grief response.
On this page you will also find some helpful quotes and strategies for making it through the first few hours. There are also additional resources for more information to cope in the subsequent days.
Of historical note, this page was one of the early lenses that I wrote for the Squidoo writing platform in 2007 about these topics to help people understand the basics of loss, grief and bereavement.
The information has been presented in small bits and pieces and images, since many people are unable to process a lot of information when they receive bad news.
Basics on Loss Worth Knowing
Loss is the disappearance of something cherished, such as a person, possession or property.
Loss is a common experience common experience that can be encountered many times during a lifetime; it does not discriminate for age, race, sex, education, economic status, religion, culture or nationality.
Most people have experienced some type of personal or professional loss at some point in their life as simply as a byproduct of living.
Grief is a powerful, universal feeling,
but it is survivable.
— Kirsti A. Dyer, MD, MS, FT
Knowledge Helps in Coping with Grief and Loss
I believe that education is one of the best ways to understand the grief response and aid people in incorporating a major loss into their life.
This belief is part of the reason that I have spent many years educating people about loss and the normal response to grief.
A Time to Grieve
What to know about Loss...
Facing a sudden loss can be scary and disorienting. You are suddenly thrust into an unfamiliar territory that is frightening and unsettling.
Knowing that grief is a normal response to a loss and what you can do to make it through the first few days or hours can be very helpful.
Types of Losses
There are many different types of losses that a person may experience in a lifetime, in addition to those experienced following a death. All of these losses have the potential to result in a grief response.
The original list of Types of Losses started on the earliest version of the Journey of Hearts website at "What is a Loss?" It has been revised a few times since 1998.
The types of losses are listed alphabetically.
- Loss of Body Function
Hearing, vision, mental capacities, mobility, communication
- Loss of Body Image
Body part through surgery, accident, change in appearance, aging
- Loss of Control
Natural or human-caused disasters, accidents, social conditions, hospitalization of loved one
- Loss of Freedom
Political, employment, incarceration, stigmatized disease or culture impacting access to health care
- Loss of Health
Medical conditions, illnesses, disability, debilitating or terminal diseases
- Loss of Home, Property
Homelessness, natural or man-made disasters, aging
- Loss of Identity
Marriage, career, new parent, empty nest syndrome, relocation, retirement
- Loss of Independence
Change in living situation e.g. entering nursing home, marriage
- Loss of Innocence
Early sexual experiences, advertising and media influences children to grow up too soon
- Loss of Job, Income
Downsizing, layoffs, retirement, career change
- Loss of One's Own Life
Death, suicide, accident, homicide, murder, war
- Loss of Plans, Hopes & Dreams for the Future
Miscarriage, abortion, stillbirth, adoption, infertility, relationship, job, career
- Loss of Relationship
Death, divorce, pet, breakup, illness, adoption, miscarriage
- Loss of Religious Beliefs
Questioning beliefs, disillusioned with church, organized religion, impact of sexual misconduct scandals
- Loss of Role
Occupation, job, relationship e.g. parent, child, friend
- Loss of Safety
Vulnerable feelings after rape, robbery, betrayal, unanticipated events, crises, traumatic events or disasters
- Loss of Sexual Function
Physical or psychological etiology
- Loss of Significant Person
Death, divorce, illness, relocation, military duty, missing person
- Loss of Treasured Object(s)
Favorite objects, family heirlooms destroyed in fire/flood, theft
- Loss that is Unexpected or Unanticipated
The sudden loss, which is often traumatic, that comes without warning from out of the blue, or the unexpected phone call.
Source: Dyer K. 1998. What is a Loss? Journey of Hearts.
Grief is one of the great common experiences
of human beings,
and yet sometimes
We feel so alone in our sadness.
— Martha Withmore Hickman
Healing After Loss
Alone in Her Grief
Alone in Her Grief
What to know about Grief...
A grieving person may feel like they are going "crazy" with the physical reactions and intense emotions that is like a roller coaster ride.
Yet the emotional and physical responses are really just normal reactions to an abnormal event.
Information on Grief Worth Knowing
In their book "Life after death: A practical approach to grief and bereavement defined grief" Dr. David Casarett, Dr. Jean Kutner and Dr. Janet Abraham defined grief as,
"a multifaceted response to loss that includes psychological, behavioral and physical reactions combined with cognitive, emotional, behavioral, social, spiritual and somatic elements."
Thus the definition that I have used to describe grief over the years is "a multifaceted, normal reaction to a loss; it is the psychological, behavioral, social and physical reactions to loss."
Grief reactions may be seen in response to physical or tangible losses (e.g., a death or disaster) or in response to symbolic or psychosocial losses (e.g., divorce, losing a job).
Source: Cassarett, M., Kutner, J.S. and Abrahm, J. 2001. Life after death: A practical approach to grief and bereavement. Academia and Clinica, 134.
Video: Understanding Grief from HFA's Hospice
Normal Physical Response to Grief
When faced with a major life challenge, a person can experience a wide range of physical and emotional responses. These intense, overwhelming and unbearable responses often come in waves.
The grieving person may feel fine one moment and then depressed, anxious, distressed or angry the next; this causes some people to think that they are "going crazy."
These responses, in the table below, which can last for days to weeks, are not signs of being "crazy" they are normal reactions to an abnormal event.
Common Responses to Grief
| General Responses | Pain Responses | GI Responses | Heart/Chest Responses |
|---|---|---|---|
Fatigue | Headache | Empty stomach | Palpitations |
Trouble sleeping | Abdominal pain | Abdominal pain | Short of breath |
Lightheaded | Back pain | Nausea | Chest heaviness |
Dizziness | General pain | Diarrhea | Throat tightness |
Restlessness |
| Constipation |
|
Crying, sighing |
| Increase/Decrease Weight |
|
Am I going crazy?
Am I going crazy? (Scanner Fear 3)
Grief as a Lasting Companion
She was no longer wrestling with the grief,
but could sit down with it
as a lasting companion
and make it a sharer in her thoughts.
— George Eliot
Emotional and Behaviorial Responses to Grief
In addition to experiencing actual physical responses grieving people can also go through confusing, fluctuating and conflicting emotions that range from joy to profound grief or distress.
Strong emotions such as sorrow, sadness, fear, anger, terror, aching and guilt are among the very normal, common emotional responses for a person in grief.
Some of the more common emotional, behavioral and mental responses are included in the table below.
Many people feel stressed, anxious, nervous and afraid. Finding ways to manage these intense responses is an important part of adjusting to the loss.
Emotional and Behavioral Responses to Loss
| Emotional Responses | Behavioral Responses | Mental Responses |
|---|---|---|
Anger | Irritability | Forgetfulness |
Panic | Anxiety | Slowed thinking |
Fear | Numbness | Difficulty concentrating |
Guilt | Denial |
|
Apathy | Avoiding |
|
Relief | Self Blame |
|
Sadness | Disbelief |
|
Sorrow | Vulnerability |
|
Longing | Helplessness |
|
Emotional | Forgetfulness |
|
Abandoned | Helplessness |
|
| Loneliness |
|
| Meaninglessness |
|
Companion Through the Darkness on Amazon
Grief as a Tidal Wave...
Grief as a Tidal Wave...
Swept Up Into Darkness
Grief is a tidal wave that over takes you,
smashes down upon you with unimaginable force,
sweeps you up into its darkness,
where you tumble and crash against unidentifiable surfaces,
only to be thrown out on an unknown beach, bruised, reshaped...
Grief will make a new person out of you,
if it doesn't kill you in the making.
— Stephanie Ericsson, Companion Through the Darkness
Different Responses to Grief
People experience and respond to a loss in many different ways. Some downplay the event and repress emotions. Some cope with angry verbal or physical outbursts. Others respond more emotionally by sighing, crying or sobbing. Still others cope physically with bodily complaints, pain and physical responses.
It may help to know that each person's reaction to a loss is unique, even if it is the same event. As a result, different people may experience, react and respond very differently when faced with a loss; this can be particular difficult if you and your spouse or family members have different coping strategies and styles.
Knowing that there are different ways of coping may help you to understand someone else's response to the loss. You can then look for ways that you can cope together and ways that you can cope apart.
Continuum of Grief
Continuum of Grief
Image Created by Kirsti A. Dyer
Image Source Continuum of Grief.
© Kirsti A. Dyer. Created from Mokra's Sadness 4 and Martin Boose's Thinking. Both Royalty Free Use.
Grieving Styles - Intuitive, Instrumental or Blended
Professors Terry Martin and Kenneth Doka studied how people respond to a major life challenge and grieve the loss and published some of their results as part of their book, "Men Don't Cry, Women Do: Transcending Gender Stereotypes of Grief."
They determined there are two main ways people respond-the intuitive griever (stereotyped as female) and the instrumental griever (stereotyped as male).
Martin and Doka believe these Patterns occur along a continuum. Those grievers near the center show a third style or a blended style of grieving. The "blended style griever who is somewhere in between a little Intuitive (emotional/feeling) and a little Instrumental (physical/thinking).
What is important to realize about their descriptions of grieving styles is that these patterns may be related to gender, but are not determined by gender. Each coping style has it's own distinctive strengths and weaknesses.
The Continuum of Grief is shown in the graphic above.
Men Don't Cry, Women Do - Transcending Gender Stereotypes of Grief
Same Loss - Different Grieving Styles
Couple Walking at the Beach
The Intuitive Griever
Doka and Martin discuss the differences between intuitive and instrumental grievers in Men Don't Cry Women Do.
The intuitive griever feels the experience intensely and can be helped by expressing his or her grief emotionally often with crying. The intuitive grief style is the one often associated with typical female grief.
One of the best ways for the intuitive griever to cope is to express his or her emotions, possibly even in a group setting.
Characteristics of the Intuitive Griever
Common Characteristics of Intuitive Grievers include:
- Openly expresses feelings.
- Expresses anguish or sorrow with tears.
- Is not afraid to seek support from others.
- Allows time to experience the inner pain.
- May become physically exhausted or anxious.
- May experience prolonged periods of confusion and problems concentrating.
- Is able to discuss the grief.
- May benefit from support groups.
The Instrumental Griever
Doka and Martin discuss the differences between instrumental and intuitive grievers in Men Don't Cry Women Do.
The instrumental griever feels grief, but less intensely and more physically. They tend to think and problem-solve ways of coping with the experience. The instrumental grief style is the one often associated with typical male grief.
The instrumental griever needs physical ways to express the grief and may be reluctant to talk about feelings.
Swallowed by a Snake
Characteristic of the Instrumental Griever
Common characteristics of Instrumental Grievers include:
- Pushes aside feelings to cope with the present situation.
- Chooses active ways of expressing grief.
- Often is reluctant to express feelings.
- Uses humor to express feelings and to manage anger.
- May only express feelings in private.
- Seeks solitude to reflect and adapt to loss.
- May not do well with a support group.
When Men Grieve
Carrying the Burden of Grief
Desolation.
Grief can't be shared.
Everyone carries it alone,
his own burden, his own way.
— Anne Morrow Lindbergh
Reader Feedback on the Grief Response
What do you think about grief? Do we all grieve differently or the same?
Please note that messages of a personal nature may not be approved if the author deems them too personal.
Remember the Basics When Coping with Loss
Following a loss, death or other tragic event it may be difficult to remember to take care for oneself. When facing a loss it is helpful to focus the basics.
This short list provides healthy coping strategies that I recommended to patients and to friends, to keep them moving during the first few days.
- Take it one hour at a time, one day at a time, if need be one moment at a time.
- Get enough sleep or at least enough rest.
- Try to maintain some type of a normal routine.
- Remember that regular exercise helps relieve stress and tension.
- Eat a balanced diet. Limit high calorie and junk food. Drink plenty of water.
- Avoid using alcohol, medications or other drugs in excess or to mask the pain.
- Do those things and be with those people who comfort, sustain and recharge you.
- Talk to others, especially those who have lived through and survived similar experiences.
- Find creative ways-journal, paint, photograph, build, woodwork, quilt, knit, collage or draw-to express intense feelings.
- Remember coping skills you have used to survive past losses. Draw upon these inner strengths again.
Angel of Grief
Angel of Grief
The Annual Cost of Grief
For a 2003 study by the Grief Institute used more than 12 recognized studies to compute the cost of a lost work hours due to grief.
They estimated that grief in the workplace grief costs U.S. businesses over $75 billion a year in reduced productivity, increased errors and accidents.
These numbers get broken down as following:
- Death of a Loved One Cost: $37.6 billion
- Divorce/Marital Woes Cost: $11 billion
- Family Crisis Cost: $9 billion
- Death of an Acquaintance Cost: $7 billion
- Money Trouble at Home Cost: $4.6 billion
- Pet Loss Cost: $2.4 billion
Russell Friedman, the institute's co-director perhaps says it best,
"When your heart is broken, your head doesn't work right."
Source: The Grief Recovery Institute. 2003.
Grief in the Workplace
- Grief in the Workplace
Much as we'd like it to be different, grief and the grieving heart do not take a break when you go to work. Someone grieving a loss still has to keep on going even when the world may be falling apart.
Grief in the Office
Flowers at Work
Heart Ache Leave vs. Bereavement Leave
In Japan, grief in the workplace is recognized in a special way. Japanese workers can take paid time off 'heartache leave,' personal time offf also known as shitsuren kyuka to mend a broken heart after experiencing a bad break-up. The time off allowed increases as you age.
In the United States, bereavement leave is frequently more limited. I remember two weeks after the September 11, 2001 tragedy, the flags were no longer flying at half mast, an indication that we were supposed to be moving on and getting over it.
Perhaps we should be looking at offering shitsuren kyuka in the United States, or a [paid] holiday you take when you feel too devastated to come to the office.
Time to Grieve
People in mourning have to come to grips with death before they can live again.
Mourning can go on for years and years.
It doesn't end after a year, that's a false fantasy.
It usually ends when people realize that they can live again,
that they can concentrate their energies on their lives as a whole,
and not on their hurt, and guilt and pain.
— Dr. Elisabeth Kubler-Ross
How Long Will I Grieve?
A grieving person must recognize that they may never entirely "get over" their grief. Some losses never entirely fade e.g. loss of child, loss of spouse, diagnosis with a terminal illness. Rather in time they learn how to integrate the loss or change into their lives and keep living.
The dual process model is one of the current ways of explaining the grieving process; it is a dynamic struggle between the pain of the death of the loved one (loss-oriented) and recovery (restoration-oriented).
Dr. Elisabeth Kubler-Ross may have described the process of grieving (mourning) best in her quote and how long grief lasts.
Therefore, the grieving process usually ends when people realize that they will survive and begin to focus their energy on living.
Piecing Together a New Life
Piecing Together a New Life (Weaving)
Piece by piece, I reenter the world.
A new phase. A new body, a new voice.
Birds console me by flying, trees by growing,
dogs by the warm patch they leave on the sofa.
Unknown people merely by performing their motions.
It's like a slow recovery from a sickness, this recovery of one's self.
— Tony Talbot
Learning to Live Again
The grieving process involves learning to adapt and adjust to a life forever changed by the loss, a life that can change in many different ways.
This may involve developing new skills, changing a circle of friends, moving, changing jobs, giving up activities and taking on new responsibilities.
Finding healthy ways to cope with the loss day to day can help including ways to take care of yourself and ways to remember.
Preparing for Anniversaries and the Anniversary response that often results is another way of learning to life again.
Healthy Coping Strategies
After making it through the first few days just focusing on the basics, the grieving person may need some helpful suggestions to keep going. This list comes from a lecture that I gave at the California Maritime Academy on "How to Cope with Loss, Grief, Death & Dying - Professionally & Personally" for a course on Dying: The Final Stage.
This short list provides additional healthy coping strategies to keep the person moving and doing something beyond first few days following the loss.
- Create a Memorial. Depending on the circumstances and the person you may want to create roadside memorial, a home shrine or a bulletin board filled with letters, notes, poems and pictures. You may decide to create a sculpture, a collage or fill a scrapbook with memories.
- Help to plan and organize the funeral, memorial service, or celebration of life to honor the person who has died. Planning a service, tending to the details, is something active to do, during a time when people often feel helpless.
- Plant a tree or flowers in a garden in memory of the person lost.
- Donate--money, time, food, clothing or other needed items--to a favorite charity, homeless shelter, animal shelter or home for abused women.
- Donate blood at your local blood center. Donating is another way of doing something active and giving something back.
- Write sympathy and condolence notes, letters of encouragement and support to those affected by the loss.
- Thank the emergency and hospital personnel, highway patrol, police and firefighters for helping if the loss involved an accident or emergency.
- Be kind to others. Make space for the car merging in on the freeway. Don't use your horn unless it is absolutely necessary. Let someone with fewer items go first in the grocery store.
- Perform random acts of kindness. This will help to remind one there is tenderness and thoughtfulness in the world. Pay the bridge toll for the person behind you. Smile at the store clerk. Some choose to perform random acts of kindness in memory of the person lost.
- Volunteer your services or skills. Offer assistance to someone in need.
- Do something that can benefit others. Take a first aid or CPR class.
- Remember to tell your loved ones, friends and family how much you care about them often.
Source: Dyer K. 2002. How to Cope with Loss, Grief, Death & Dying - Professionally & Personally. Presentation for California Maritime Academy's Dying: The Final Stage Course. Journey of Hearts.
Create a Circle of Healing
I have long had the belief that there is a healing power in holding a person in one's thoughts-whether through saying prayers or blessings or lighting candles.
These are the same beliefs echoed by Jim Reeves, the urologist who treated Lance Armstrong who recited the ancient Chinese belief, that when a person is held in the hearts and minds and souls of so many other people, they can do better.
Creating a circle of healing and positive thoughts and positive intention is something that friends and family can do when someone is sick or facing a life crisis to feel a little less helpless.
If nothing else, creating a circle of healing gives everyone something to do during a very difficult time.
Breathe, Just Breathe
Remember to Breathe
Whether is is coping with the loss of a loved one, managing a life changing event or just coping with everyday stressors, remembering to "Breathe, Just Breathe" is a very helpful coping strategy for the grieving person.
Breathe helps get oxygen flowing to the brain so you can think more clearly, which is important during stressful times.
When we are tense during stressful times, we often forget to breathe. Something simple as focusing on breathing can be very helpful.
Several articles on the benefits of breathing as a way to cope with stress and with loss.
More Articles on Breathing as a Coping Strategy
- Breathe to Relax, De-Stress and for Health Benefits
It is something we do automatically every day on average 21,600 times. It is a quick way to calm down, to quiet anger, to lower the heart rate and reduce stress, but do many of us really stop to think about our breath or breathing. In watching the... - Breathe, Breath Work and Breath Walking: Ways to Rel...
Breathing is a powerful relaxation tool that is readily available and under our control. Simply slowing down to focus on the breath can have powerful effects on one's ability to cope with stress.