Major depression and complicated grief

Grief, mourning, and bereavement

When a person loses someone important to them, they go through a normal process called grieving. Grieving is natural and should be expected. Over time, it can help the person accept and understand their loss.
Bereavement is what a person goes through when someone close to them dies. It’s the state of having suffered a loss.
Mourning is the outward expression of loss and grief. Mourning includes rituals and other actions that are specific to each person’s culture, personality, and religion. Bereavement and mourning are both part of the grieving process.
Grieving involves many different emotions, actions, and expressions, all of which help the person come to terms with the loss of a loved one. But keep in mind, grief doesn’t look the same for everyone. Every loss is different.

The grief process

Many people think of grief as a single instance or 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. Normal grieving allows us to let a loved one go and keep on living in a healthy way.
Grieving is painful, but it’s important that those who have suffered a loss be allowed to express their grief. It’s also important that they be supported throughout the process. Each person will grieve for their loved ones in different ways. The length and intensity of the emotions people go through varies from person to person.
Although some have described grief as happening in phases or stages, it doesn’t often feel like that to the bereaved person. It may feel more like a roller coaster, with ups and downs that make it hard to see that any progress is being made 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 for them, 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 your grieving are:

The kind of relationship you had with the person who died
The circumstances of their death
Your own life experiences

Studies have identified emotional states that people may go through while grieving. The first feelings usually include shock or numbness. Then, as the person sees how his or her life is affected by the loss, emotions start to surface. The early sense of disbelief is often replaced by emotional upheaval, which can involve anger, loneliness, uncertainty, or denial. These feelings can come and go over a long period of time. The final phase of grief is the one in which people find ways to come to terms with and accept the loss.

Shock, numbness, and disbelief usually come first

Many times, a person’s first response to a loss is shock, disbelief, and numbness. This can last anywhere from a few hours to days or weeks. During this time, the bereaved person may feel emotionally “shut off” from the world. Still, the numbness may be pierced by pangs of distress, often triggered by reminders of the deceased. The person may feel agitated or weak, cry, engage in aimless activities, or be preoccupied with thoughts or images of the person they lost.
The rituals of mourning − seeing friends and family, preparing for the funeral, and burial or final physical separation − often structure this time for people. They are seldom left alone. Sometimes the sense of numbness lasts through these activities, leaving the person feeling as though they are just “going through the motions” of these rituals.

Facing the loss brings out painful emotions

At some point the reality of the loss starts to sink in, and the numbness wears off. This part of the grief process, sometimes called confrontation, is when the feelings of loss are most intense and painful. This is the time the person starts to face the loss and cope with the changes the loss causes in their lives.
People have many different ways of dealing with loss, so there may be many different, equally intense emotions. During this time, grief tends to come in waves of distress. The person may seem disorganized. He or she may have trouble remembering, thinking, and doing day-to-day activities. This can last for weeks to months. Some or all of the following may be seen in a person who is grieving. The person may:

Withdraw socially
Have trouble thinking and concentrating
Become restless and anxious at times
Not feel like eating
Look sad
Feel depressed
Dream of the deceased (or even have hallucinations or “visions” in which they briefly hear or see the deceased)
Lose weight
Have trouble sleeping
Feel tired or weak
Become preoccupied with death or events surrounding death
Search for reasons for the loss (sometimes with results that make no sense to others)
Dwell on mistakes, real or imagined, that he or she made with the deceased
Feel somehow guilty for the loss
Feel all alone and distant from others
Express anger or envy at seeing others with their loved ones

It’s often during this time that a grieving person needs the most emotional support. Finding support can be the key to a person’s recovery and acceptance of the loss. Sources of support can be family members, friends, support groups, community organizations, or mental health professionals (therapists or counselors).

Accepting the loss means learning to live without the loved one

By this time, people have begun to recognize what the loss means to them in day-to-day life. They have felt the pain of grief. Usually, the person comes to accept the loss slowly over the months that follow. This acceptance includes adjusting to daily life without the deceased.
Like the earlier parts of the process, acceptance does not happen overnight. It’s common for it to take a year or longer to 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 after their death. In time, the person should be able to reclaim the emotional energy that was invested in the relationship with the deceased, and use it in other relationships.

Grieving can go on for many years

Still, adjustment does not mean that all the pain is over for those who were very close to the deceased. 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 he or she would have been expected to attend. This can bring back strong emotions, and require mourning yet another part of the loss.

Grief after loss due to a 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 might 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.
Usually, the period just before the person’s death is a time of physical and emotional preparation for those close to them. At this stage, loved ones may feel like they need to withdraw emotionally from the person who is ill.
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.

Grief can take unexpected forms

A person who had a difficult relationship to the deceased (a parent who was abusive, estranged, or abandoned the family, for example) is often surprised after their death because the emotions are so painful. It’s not uncommon to have profound distress as the bereaved mourns the relationship he or she had wished for with the person who died, and lets go of any chance of achieving it.
Others might feel relief, while some wonder why they feel nothing at all on the death of such a person. Regret and guilt are common, too, when the bereaved person had a rocky or distant relationship with the deceased. This is all part of the process of adjusting and letting go.

Getting help through the process of grief

Bereavement counseling is a special type of professional help. You may be able to find it through hospice services or a referral from a health care provider (doctor, nurse, or social worker). This type of counseling has been shown to reduce the level of distress that mourners go through after the death of their loved one. It can help them move more easily through the phases of grief. Bereavement counseling can also help them adjust to their new lives without the deceased.

Last Medical Review: 12/14/2012
Last Revised: 02/04/2013