Hospice and Palliative Care
Quality of life at the end of life
Whatever type of loss you’ve suffered, there’s no right or wrong way to grieve. But by understanding the stages and types of grief, you can find healthier ways to cope.
Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. Often, the pain of loss can feel overwhelming. You may experience all kinds of difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. The pain of grief can also disrupt your physical health, making it difficult to sleep, eat, or even think straight. These are normal reactions to loss—and the more significant the loss, the more intense your grief will be.
Coping with the loss of someone or something you love is one of life’s biggest challenges. You may associate grieving with the death of a loved one—which is often the cause of the most intense type of grief—but any loss can cause grief, including:
Even subtle losses in life can trigger a sense of grief. For example, you might grieve after moving away from home, graduating from college, or changing jobs.
Whatever your loss, it's personal to you, so don't feel ashamed about how you feel, or believe that it's somehow only appropriate to grieve for certain things. If the person, animal, relationship, or situation was significant to you, it's normal to grieve the loss you're experiencing. Whatever the cause of your grief, though, there are healthy ways to cope with the pain that, in time, can ease your sadness and help you come to terms with your loss, find new meaning, and eventually move on with your life.
Whether it’s a close friend, spouse, partner, parent, child, or other relative, few things are as painful as losing someone you love. After such a significant loss, life may never seem quite the same again. But in time, you can ease your sorrow, start to look to the future, and eventually come to terms with your loss.
Read: Bereavement: Grieving the Loss of a Loved One.
Grieving is a highly individual experience; there's no right or wrong way to grieve. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and how significant the loss was to you.
Inevitably, the grieving process takes time. Healing happens gradually; it can't be forced or hurried—and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it's important to be patient with yourself and allow the process to naturally unfold.
|Myths and facts about grief and grieving|
|Myth: The pain will go away faster if you ignore it
Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For real healing, it is necessary to face your grief and actively deal with it.
|Myth: It's important to “be strong” in the face of loss.
Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn't mean you are weak. You don't need to “protect” your family or friends by putting on a brave front. Showing your true feelings can help them and you.
|Myth: If you don't cry, it means you aren't sorry about the loss.
Fact: Crying is a normal response to sadness, but it's not the only one. Those who don't cry may feel the pain just as deeply as others. They may simply have other ways of showing it.
|Myth: Grieving should last about a year.
Fact: There is no specific time frame for grieving. How long it takes differs from person to person.
|Myth: Moving on with your life means forgetting about your loss.
Fact: Moving on means you've accepted your loss—but that's not the same as forgetting. You can move on with your life and keep the memory of someone or something you lost as an important part of you. In fact, as we move through life, these memories can become more and more integral to defining the people we are.
While grieving a loss is an inevitable part of life, there are ways to help cope with the pain, come to terms with your grief, and eventually, find a way to pick up the pieces and move on with your life.
In 1969, psychiatrist Elisabeth Kübler-Ross introduced what became known as the “five stages of grief.” These stages of grief were based on her studies of the feelings of patients facing terminal illness, but many people have generalized them to other types of negative life changes and losses, such as the death of a loved one or a break-up.
Denial: “This can't be happening to me.”
Anger: “Why is this happening? Who is to blame?”
Bargaining: “Make this not happen, and in return I will ____.”
Depression: “I'm too sad to do anything.”
Acceptance: “I'm at peace with what happened.”
If you are experiencing any of these emotions following a loss, it may help to know that your reaction is natural and that you'll heal in time. However, not everyone who grieves goes through all of these stages—and that's okay. Contrary to popular belief, you do not have to go through each stage in order to heal. In fact, some people resolve their grief without going through any of these stages. And if you do go through these stages of grief, you probably won't experience them in a neat, sequential order, so don't worry about what you “should” be feeling or which stage you're supposed to be in.
Kübler-Ross herself never intended for these stages to be a rigid framework that applies to everyone who mourns. In her last book before her death in 2004, she said of the five stages of grief: “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”
Instead of a series of stages, we might also think of the grieving process as a roller coaster, full of ups and downs, highs and lows. Like many roller coasters, the ride tends to be rougher in the beginning, the lows may be deeper and longer.
The difficult periods should become less intense and shorter as time goes by, but it takes time to work through a loss. Even years after a loss, especially at special events such as a family wedding or the birth of a child, we may still experience a strong sense of grief.
Source: Hospice Foundation of America
While loss affects people in different ways, many of us experience the following symptoms when we're grieving. Just remember that almost anything that you experience in the early stages of grief is normal—including feeling like you're going crazy, feeling like you're in a bad dream, or questioning your religious or spiritual beliefs.
Shock and disbelief. Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If a pet or someone you love has died, for example, you may keep expecting them to show up, even though you know they're gone.
Sadness. Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.
Guilt. You may regret or feel guilty about things you did or didn't say or do. You may also feel guilty about certain feelings (feeling relieved when a person died after a long, difficult illness, for example). You may even feel guilty for not doing more to prevent your loss, even if it was completely out of your hands.
Fear. A significant loss can trigger a host of worries and fears. If you’ve lost your partner, your job, or your home, for example, you may feel anxious, helpless, or insecure about the future. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.
[Read: Dealing with Uncertainty]
Anger. Even if the loss was nobody's fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.
We often think of grief as a strictly emotional process, but grief often involves physical problems, including:
Since the experience of grieving following the loss of someone or something important to you tends to be unique to you, it’s difficult to label any type of grief as either “normal” or “abnormal”. However, there are types of grief that fall outside the expected symptoms and reactions described above. These include:
As the name suggests, anticipatory grief develops before a significant loss occurs rather than after. If a loved one is terminally ill, for example, you have an aging pet, or you know that your retirement or job loss is imminent you may start grieving your loss before it has fully unfolded.
[Read: When a Loved One is Terminally Ill]
Like conventional grief, anticipatory grief can involve a mix of confusing emotions, particularly anger. Some people even equate it to giving up hope and refuse to allow themselves to grieve before their loss has occurred. However, anticipatory grief can also give you chance to prepare for your loss, resolve any unfinished business, or say your goodbyes, for example.
Disenfranchised grief can occur when your loss is devalued, stigmatized, or cannot be openly mourned. Some people may minimize the loss of a job, a pet, or a friendship, for example, as something that’s not worth grieving over. You may feel stigmatized if you suffered a miscarriage or lost a loved one to suicide.
Disenfranchised grief can also occur when your relationship to a deceased is not recognized. Some people may consider it inappropriate to grieve for a work colleague, classmate, or neighbor, for example. As a close friend or same-sex partner you may be denied the same sympathy and understanding as a blood relative. This can make it even more difficult to come to terms with your loss and navigate the grieving process.
The pain at a significant loss may never completely disappear, but it should ease up over time. When it doesn’t—and it keeps you from resuming your daily life and relationships—it may be a sign of complicated grief.
Complicated grief usually arises from the death of a loved one, where the loss has left you stuck in a state of bereavement. You may be unable to accept your loved one has gone, search for them in familiar places, experience intense longing, or even feel that life isn’t worth living.
If you’re experiencing complicated grief and the pain from your loss remains unresolved, it’s important to reach out for support and take the steps that will enable you to heal.
The pain of grief can often cause you to want to withdraw from others and retreat into your shell. But having the face-to-face support of other people is vital to healing from loss. Even if you're not comfortable talking about your feelings under normal circumstances, it's important to express them when you're grieving.
While sharing your loss can make the burden of grief easier to carry, that doesn't mean that every time you interact with friends and family, you need to talk about your loss. Comfort can also come from just being around others who care about you. The key is not to isolate yourself.
Turn to friends and family members. Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Rather than avoiding them, draw friends and loved ones close, spend time together face to face, and accept the assistance that's offered. Often, people want to help but don't know how, so tell them what you need—whether it's a shoulder to cry on, a listening ear, or just someone to hang out with. If you don't feel you have anyone you can regularly connect with in person, it's never too late to build new friendships.
Accept that many people feel awkward when trying to comfort someone who's grieving. Grief can be a confusing, sometimes frightening emotion for many people, especially if they haven't experienced a similar loss themselves. They may feel unsure about how to comfort you and end up saying or doing the wrong things. But don't use that as an excuse to retreat into your shell and avoid social contact. If a friend or loved one reaches out to you, it's because they care.
Draw comfort from your faith. If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you—such as praying, meditating, or going to church—can offer solace. If you're questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
Join a support group. Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers, or see the links below.
[Read: Support Groups: Types, Benefits, and What to Expect]
Talk to a therapist or grief counselor. If your grief feels like too much to bear, find a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.
Social media can be useful in letting others know about your loss and reaching out for support. However, it can also attract Internet trolls who post inappropriate, insensitive, or even abusive messages. To spare yourself additional pain and heartache at this time, you may want to limit your social media use to closed groups rather than public postings that can be commented on by anyone.
When you're grieving, it's more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.
Face your feelings. You can try to suppress your grief, but you can't avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.
Express your feelings in a tangible or creative way. Even if you’re not able to talk about your loss with others, it can help to write down your thoughts and feelings in a journal, for example. Or you could release your emotions by making a scrapbook or volunteering for a cause related to your loss.
Try to maintain your hobbies and interests. There's comfort in routine and getting back to the activities that bring you joy and connect you closer to others can help you come to terms with your loss and aid the grieving process.
Don't let anyone tell you how to feel, and don't tell yourself how to feel either. Your grief is your own, and no one else can tell you when it's time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It's okay to be angry, to yell at the heavens, to cry or not to cry. It's also okay to laugh, to find moments of joy, and to let go when you're ready.
Look after your physical health. The mind and body are connected. When you feel healthy physically, you'll be better able to cope emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don't use alcohol or drugs to numb the pain of grief or lift your mood artificially.
[Read: Self-Medicating Depression, Anxiety, and Stress]
Plan ahead for grief “triggers.” Anniversaries, holidays, and important milestones can reawaken painful memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. You can plan ahead by making sure that you’re not alone, for example, or by marking your loss in a creative way.
Use HelpGuide's free Emotional Intelligence Toolkit.
In the U.S.: Crisis Call Center at 775-784-8090
UK: Cruse Bereavement Care at 0808 808 1677
Australia: GriefLine at (03) 9935 7400
Find a GriefShare group meeting near you – Worldwide directory of support groups for people grieving the death of a family member or friend. (GriefShare)
Find Support – Directory of programs and support groups in the U.S. for children experiencing grief and loss. (National Alliance for Grieving Children)
Chapter Locator for finding help for grieving the loss of a child in the U.S. and International Support for finding help in other countries. (The Compassionate Friends)
Seek help immediately. Please read Suicide Help, talk to someone you trust, or call a suicide helpline:
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