Understanding Grief and Loss

Grief is the natural human response to loss. It is a process that occurs over time and involves a wide range of emotions, as well as thoughts, behaviors, and physical sensations. While grief usually refers to the death of a loved one, people with cancer and their families also grieve other possible cancer-related losses, such as the loss of a breast, the loss of fertility, or the loss of independence.


The terms grief, mourning, and bereavement are often used interchangeably, but they mean different things. Grief is one's inner and personal experience of and response to loss. Mourning is the outward expression of that grief, in addition to cultural and religious customs and rituals surrounding death. Mourning is also defined as the process of adapting to loss and adjusting to the death of a significant person. Bereavement refers to the state of having suffered a loss and to the experiences that follow the death of a loved one. It is the time after a loss during which the person experiences grief and exhibits mourning.

Common grief reactions

Reactions to loss, called grief reactions, vary widely from person to person, as well as for the same person over time. Not every individual experiences the same set of reactions, but there are some common reactions. Grief reactions include emotions, thoughts, physical sensations, and behaviors.

Emotions. If people have experienced the death of a close relative or friend, they may experience a wide range of emotions. It is common for people to feel a sense of shock, emotional numbness, sadness, despair, anxiety, fear, anger, guilt, loneliness, helplessness, relief, and yearning.

Thoughts. Common thoughts include disbelief, confusion, disorientation, difficulty concentrating, preoccupation, hallucinations (briefly thinking that you see or hear the deceased person), and thinking that you are "going crazy."

Physical sensations. It is common for grief to cause physical sensations, such as tightness or heaviness in the chest or throat, nausea or stomach upset, dizziness, headaches, physical numbness, muscle weakness or tension, fatigue, and vulnerability to illness. This is not abnormal, and if people are feeling these things, it does not mean they are losing their mind or their grip on reality. Sometimes people who are grieving find that they suddenly burst out in tears, seemingly for no reason, but often after hearing a song, or in response to a stray comment that made them think of the person who has died.

Behaviors. If people are grieving, they may find that they have difficulty falling asleep or staying asleep. They may lose energy for activities they enjoy or lose interest in eating or interacting socially, or they may find that they are irritable or more aggressive. Other common behaviors include crying, restlessness, hyperactivity, and listlessness (lack of interest, energy, or spirit).

Religion and spirituality

Grief may also have religious and spiritual affects on people’s lives, as loss can cause individuals to question their faith or view of the world. Grief can also enhance faith as some people come to a new understanding of the meaning of life.

Factors affecting grief

The nature and intensity of grief reactions and the length of time a person grieves are affected by a variety of factors.

• Nature of the relationship with the deceased—the intensity of grieving the death of a spouse or parent may be different than the intensity of grieving the death of a neighbor or coworker
  
  
• Cause of death—whether the death was relatively sudden or prolonged
  
  
• Age and gender of the person who is grieving—men and women often have different reactions to loss
  
  
• Life experiences of the person who is grieving, including previous experiences with loss
  
  
• Personality and coping style of the person who is grieving
  
  
• Support available from friends and family, as well as the family's customs and beliefs surrounding death
  
  
• Religious and spiritual beliefs of the person who is grieving

It is a common observation that grieving can be more difficult and complicated when there are unresolved feelings or conflicts with the person who has died. Sometimes people who are struggling with complicated grief benefit from working with a clinical social worker, psychologist, or spiritual counselor. On the other hand, people who feel complete and good about their relationship with the person who has died may find that although they are sad, their grieving experience is quite different than if their relationship with the person was strained.

Grief in different cultures

While each person's grief is unique, the experience is shaped by his or her society and culture. Each culture has its own set of rituals and beliefs surrounding death and bereavement that affect the ways individuals experience and express their grief. Funerals and memorial services help individuals who are grieving stay connected to their community and give them an opportunity to share their grief. However, cultural expectations for bereavement may be at odds with an individual's experience of grief. Someone who is experiencing emotional numbness or disbelief may not cry as might be expected at a funeral. Another person may experience a level of despair that feels out of step with his or her culture's belief in life after death. It is important that individuals be allowed to grieve in ways that feel right to them, as grief is a very personal experience.

Grief reactions

Grief is often experienced in waves or cycles with periods of intense and painful emotions that come and go. Individuals who are grieving may feel they are making progress, and then suddenly experience renewed grief that is overwhelming. These renewed periods of grief may occur at significant dates, such as holidays or a birthday, or they may seem to occur without reason. Over time these periods of intense grieving typically become less frequent and less intense as the bereaved individual adjusts to his or her loss.

The initial grief reaction follows immediately after the loss or death and is characterized by shock, emotional numbness, and often disbelief or denial that the loss has occurred. Individuals who are grieving may feel disconnected from the world around them and that they are just "going through the motions" of mourning rituals, such as wakes or funerals. These initial grief reactions may last up to six weeks or more and may help to distance the individual who is grieving from the pain of loss and protect him or her from becoming overwhelmed.

Another common reaction that arises after the initial feelings of numbness and disbelief fade is called confrontation. This reaction can be intensely painful as the individual who is grieving comes to accept the reality of the loss. This reaction can last months or longer and is characterized by waves of distress, despair, and emotional upheaval with conflicting and difficult emotions. The individual who is grieving may experience a sense of anger at the person who has died or feel a sense of guilt for still being alive. The individual who is grieving may cry often, have difficulty sleeping or getting up in the morning, feel disorganized, and have trouble concentrating.

Acceptance over the loss of a loved one often occurs slowly over the course of a year or more. During the acceptance phase of grieving, the individual who is grieving adapts to a new life without his or her loved one. Life does not return to the "old normal", but the individual who is grieving is able to create a "new normal" with new goals and a new identity, often including unfamiliar roles. For example, a widow may have to start taking care of her car for the first time or the remaining spouse may have to learn how to cook, when previously the deceased spouse prepared all meals.

Everyone does not necessarily experience each grief reaction in an orderly progression. Grief reactions are often not sequential and a person may react with the same set of feelings more than once. Reactions may overlap and individuals may find they go back and forth with their emotions. However, understanding the basic grief process can help people know what to expect and help reassure them that their experiences are normal and that the intense pain of grief will not last forever.

Tasks of mourning

Another way researchers have conceptualized grief is as a series of tasks that the individual who is grieving must work through to resolve his or her grief. Dr. J. W. Worden's (1991) four tasks of mourning is a task model of grief work following death.

Task one: To accept the reality of the loss

Task two: To experience the pain of grief

Task three: To adjust to an environment in which the deceased individual is missing

Task four: To withdraw emotional energy and reinvest in other activities