Grief and Bereavement

What are grief, mourning, and bereavement?

Grief

Grief is normal, and it is a process. Expressing grief is how a person reacts to the loss of a loved one.

Many people think of grief as a single instance or as a short time of pain or sadness in response to a loss – like the tears shed at a loved one’s funeral. But grieving includes the entire emotional process of coping with a loss, and it can last a long time. The process involves many different emotions, actions, and expressions, all of which help a person come to terms with the loss of a loved one.

We may hear the time of grief being described as "normal grieving," but this simply refers to a process anyone may go through, and none of us experiences grief the same way. This is because grief doesn’t look or feel the same for everyone. And every loss is different. 

Mourning

Mourning often goes along with grief. While grief is a personal experience and process, mourning is how grief and loss are shown in public. Mourning may involve religious beliefs or rituals, and may be affected by our ethnic background and cultural customs. The rituals of mourning − seeing friends and family and preparing for the funeral and burial or final physical separation − often give some structure to the grieving process. Sometimes a sense of numbness lasts through these activities, leaving the person feeling as though they are just “going through the motions” of these rituals.

Bereavement

Grief and mourning happen during a period of time called bereavement. Bereavement refers to the time when a person experiences sadness after losing a loved one.

How long does the grieving process last?

Since each person grieves differently, the length and intensity of the emotions people go through varies from person to person. Grieving is painful, and it’s important that those who have suffered a loss be allowed the time they need to express their grief.

Although grief is described in phases or stages, it may feel more like a roller coaster, with ups and downs. This can make it hard for the bereaved person to feel any sense of progress in dealing with the loss. A person may feel better for a while, only to become sad again. Sometimes, people wonder how long the grieving process will last, and when they can expect some relief. There’s no answer to this question, but some of the factors that affect the intensity and length of grieving are:

• Your relationship with the person who died
• The circumstances of their death
• Your own life experiences

It’s common for the grief process to take a year or longer. A grieving person must resolve the emotional and life changes that come with the death of a loved one. The pain may become less intense, but it’s normal to feel emotionally involved with the deceased for many years. In time, the person should be able to use their emotional energy in other ways and to strengthen other relationships.

Grief can take unexpected forms

Difficult relationships with the deceased prior to death can cause unique grieving experiences for loved ones. In addition, prolonged illnesses can also cause grief to take unexpected forms.

Difficult relationships

A person who had a difficult relationship with the deceased (a parent who was abusive, estranged, or abandoned the family, for example) is often surprised by the painful emotions they have after their death. It’s not uncommon to have profound distress as the bereaved mourns the relationship they had wished for with the person who died, and lets go of any chance of achieving it.

Others might feel relief, while some may wonder why they feel nothing at all at the death of such a person. Regret and guilt are common, too. This is all a normal part of the process of adjusting and letting go.

Grief after long illness

The grief experience may be different when the loss occurs after a long illness rather than suddenly. When someone is terminally ill, family, friends, and even the patient might start to grieve in response to the expectation of death. This is a normal response called anticipatory grief. It can help people complete unfinished business and prepare loved ones for the actual loss, but it might not lessen the pain they feel when the person dies.

Many people think they are prepared for the loss because death is expected. But when their loved one actually dies, it can still be a shock and bring about unexpected feelings of sadness and loss. For most people, the actual death starts the normal grieving process.

Stages of grief

People may go through many different emotional states while grieving. And in advanced cancer, the grieving process and stages often start before the loss of a loved one because of anticipatory grief.

Researchers describe grief in stages, but it's important to know that each person moves through the stages differently and at a different pace. Some may go through the stages just as they are described below, and other people may move back and forth between stages. Some people may get stuck in one stage and have trouble reaching the final stage of the grief process.

Experts describe 5 stages that are usually experienced by adults during the grief process.

• Denial and isolation - This first stage may start before the loss occurs if the death of the loved one is expected. Or it may begin immediately at the time or shortly after the loss. It can last anywhere from a few hours to days or weeks. The feelings experienced in the first stage of grief may be fear, shock, or numbness. The person may be have pangs of distress, often triggered by reminders of the deceased. During this time, the bereaved person may feel emotionally “shut off” from the world. The grieving person may avoid others or avoid talking about the loss.
• Anger - The next stage can last for days, weeks, or months. It is when the earliest feelings are replaced by frustration and anxiety. This stage can involve anger, loneliness, or uncertainty. It may be when the feelings of loss are most intense and painful. The person may feel agitated or weak, cry, engage in aimless or disorganized activities, or be preoccupied with thoughts or images of the person they lost.
• Bargaining - This stage is likely to be shorter than others. It happens when a grieving person is struggling to find meaning for the loss of their loved one. They may reach out to others and tell their story. In doing so, they may begin to think more clearly about the changes brought about by the loss of their loved one.
• Depression - As life changes are realized, depression may set in. This stage is used to describe a grieving person who feels overwhelmed and helpless. They may withdraw, become hostile, or express extreme sadness. During this time, grief tends to come in waves of distress.
• Acceptance - This last phase of grief happens when people find ways to come to terms with and accept the loss. Usually, the person comes to accept the loss slowly over a few months to a year. This acceptance includes adjusting to daily life without the deceased.

Children grieve, too, but the process may look different from adults. To learn more about this, see Helping Children When a Family Member Has Cancer.

Some or all of the following may be seen in a person who is grieving:

• Socially withdrawing
• Trouble thinking and concentrating
• Becomes restless and anxious at times
• Loss of appetite
• Looks sad
• Feels depressed
• Dreams of the deceased (or even have hallucinations or “visions” in which they briefly hear or see the deceased)
• Loses weight
• Trouble sleeping
• Feels tired or weak
• Becomes preoccupied with death or events surrounding death
• Searches for reasons for the loss (sometimes with results that make no sense to others)
• Dwells on mistakes, real or imagined, that they made with the deceased
• Feels guilty for the loss
• Feels all alone and distant from others
• Expresses anger or envy at seeing others with their loved ones

Reaching the acceptance stage and adjusting to the loss does not mean that all the pain is over. Grieving for someone who was close to you includes losing the future you expected with that person. This must also be mourned. The sense of loss can last for decades. For example, years after a parent dies, the bereaved may be reminded of the parent’s absence at an event they would have been expected to attend. This can bring back strong emotions, and require mourning yet another part of the loss.