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Definition: grief from Stedman's Medical Dictionary for the Health Professions and Nursing

(grēf) A normal emotional response to an external loss; distinguished from a depressive disorder because it usually subsides after a variable but reasonable time.

Summary Article: GRIEF
from A-Z of Death and Dying, The: Social, Medical, and Cultural Aspects

Grief can be defined as a distinct, personal reaction to the loss of any object to which an individual is attached. Grief reactions may occur in any situation of loss, whether the loss is physical or tangible (such as a death, significant injury, or loss of property), or symbolic and intangible (such as the loss of a dream). The intensity of grief will vary, depending upon many variables such as the nature of attachment, the relationship to the lost object, and the meaning of the attachment, prior experiences of losses, physical and psychological health, familial dynamics, informal and formal social support, and other social, spiritual, and cultural factors.

This definition of grief distinguishes it from other terms such as bereavement or mourning. Bereavement refers to an objective state of loss. If one experiences a loss, one is bereaved. Bereavement refers to the fact of loss, while grief is the subjective response to that state of loss. It should be recognized that loss does not inevitably create grief. Some individuals may be so disassociated from the lost object that they experience little or no grief.

Mourning has had two, interrelated meanings within the field. On one hand, it has been used to describe the intra-psychic process where a grieving individual gradually adapts to the loss, a process that has also been referred to as grieving or grief work. It has been used, as well, to refer to the social aspect of grief: the norms, patterned behaviors, and rituals through which an individual is recognized as bereaved and socially expresses grief. For example, in America, wearing black, sending flowers, and attending funerals are common illustrations of appropriate mourning behavior.

Manifestations of Grief

Individuals can experience grief in varied ways. Physical reactions are common. These include a range of physical responses such as headaches, other aches and pains, tightness, dizziness, exhaustion, menstrual irregularities, sexual impotency, breathlessness, tremors and shakes, and oversensitivity to noise. Bereaved individuals, particularly widows, do have a higher rate of mortality in the first year of loss. There may be many reasons for this: the stress of bereavement, the change in lifestyle that accompanies a loss, and the fact that many chronic diseases have lifestyle factors that can be shared by both partners. It is, therefore, important that a physician monitors any physical responses to loss.

There are affective manifestations of grief as well. Individuals may experience a range of emotions such as anger, guilt, helplessness, sadness, shock, numbing, pining, yearning, jealousy, and self-blame. Some bereaved individuals experience a sense of relief or even a feeling of emancipation. This, however, can be followed by a sense of guilt. As in any emotional crisis, even contradictory feelings, such as sadness and relief, can be experienced simultaneously.

There can also be cognitive manifestations of grief. Included here is a sense of depersonalization in which nothing seems real. There can be a sense of disbelief and confusion, and an inability to concentrate or focus. Bereaved individuals can be preoccupied with images or memories of the loss. These cognitive manifestations of grief can affect functioning at work, school, or home. Many people also report experiences where they dream of the deceased, have a sense of the person's presence, or even sense-based experiences of the other.

Grief has spiritual manifestations as well. Individuals may struggle to find meaning and to reestablish a sense of identity and assumptive order in their world. They may be angry at God or struggle with their faith. Others may even become religious as they seek to find solace in their spirituality.

Behavioral manifestations of grief can also vary. These behavioral manifestations can include crying, withdrawal, avoiding or seeking reminders of the loss, searching behaviors, over activity, and changes in relationships with others.

In other cases, there may be dysfunctional behaviors such as self-destructive acts or acts destructive toward others. In other situations, the grieving individual may seem unable, even after time, to function in key social roles (e.g., work, school, or home). In such situations, grieving individuals may benefit from professional help (see Grief Counseling).

The critical point is that reactions to grief are both multifaceted and highly individual. Moreover, grief reactions are likely to occur in waves, sometimes more intense than others. And while there is no timetable to grief, many individuals experience reactions less intensely and less often after the first year or two. However, it is not unusual to have surges of grief years after the loss, often triggered by a significant event. For example, a woman may experience the loss of her father in early adolescence. Her wedding, a decade later, may trigger a surge of grief as she realizes that her father never lived to participate in this event.

The Process of Grief

There have been a number of approaches to understanding the process or course of acute grief. Earlier approaches tended to see grief as proceeding in stages or phases. Colin Murray Parkes, for example, described four stages of grief: (1) shock, (2) angry pining, (3) depression and despair, and (4) detachment. Elisabeth Kübler-Ross described the process of coping with grief much like coping with dying. She believed individuals experienced five stages: (1) denial, (2) anger, (3) bargaining, (4) depression, and finally, (5) acceptance (see also Kübler-Ross, Elisabeth).

Recent approaches have emphasized that grief does not follow a predictable and linear course, stressing instead that it often proceeds in a “roller-coaster” like pattern, full of ups and downs, times when the grief reactions are more or less intense. Some of these more intense periods are predictable—holidays, anniversaries, or other significant days; others may have no recognizable trigger.

More recent approaches have emphasized that acute grief involves a series of tasks or processes. Psychologist William Worden describes four tasks of grief: (1) recognizing the reality of the loss, (2) dealing with expressed and latent feelings, (3) living in a world without the deceased, and (4) relocating the deceased in one's life. Two Dutch researchers, Margaret Stroebe and Henk Schut, described bereaved individuals as oscillating or moving back and forth between two sets of processes: Loss-Oriented Processes that acknowledge the reality of the loss, as well as Restoration-Oriented Processes that assist the bereaved person in adjusting to a life now changed by the loss. These and other similar models reaffirm the very individual nature of grief, acknowledging that these tasks or processes are not necessarily linear and that any given individual may have difficulty with one or more process or task.

Grief reactions can persist for considerable time, gradually losing intensity after the first few years. Recent research emphasizes that one does not “get over the loss.” Rather, over time, the pain lessens, and grief becomes less disabling as individuals function at levels comparable to (and sometimes better than) preloss levels. However, bonds and attachments to the lost object continue. We never, in fact, forget a person who is significant, as that person remains in our memory.

Recent work has also emphasized that a loss, like any significant change, can be a catalyst for growth. Studies have indicated that many individuals struggling with a significant loss reported that, as result of the loss, they experienced greater empathy, enhanced spirituality, heightened the value of relationships, reoriented and reprioritized life, increased skills, or changed their own health practices.

The Study of Grief

Unsurprisingly, since loss is a universal experience, grief has long been the subject of a variety of writings, going back to antiquity. References to grief in loss are found in the scriptures of all faiths, in some of the oldest manuscripts such as the Egyptian Book of the Dead and the Babylonian Gilgamesh Epic. Poets, dramatists, and novelists constantly address the experience of grief.

However, the psychology of grief can be said to begin with Sigmund Freud's 1917 seminal essay “Mourning and Melancholia,” where Freud begins to cover a topic still vexing today—the relationship of grief to depression. Eric Lindemann's research on survivors of the Coconut Grove fire, a night club in Boston, Massachusetts, where many young adults perished, was an early and still influential empirical study. While some research was done in the 1940s and 1950s, much significant research was done after the 1960s, as academic interest in the study of grief significantly increased (see Death Awareness Movement).

Getting Help in Grief

People experiencing acute grieve can help themselves in a number of ways. Since grief is a form of stress, lifestyle management, including adequate sleep and diet, as well as other techniques for stress reduction, can be helpful. Bibliotherapy or the use of self-help books can often validate or normalize grief reactions, suggest ways of adaptation, and offer hope. Self-help and support groups can offer similar assistance, as well as social support from others who have experienced loss. For example, widow-to-widow groups have helped individuals adapt to the death of a spouse, while The Compassionate Friends organization assists parents, siblings, and even grandparents in coping with the death of a child. Other groups exist on both a national and local level, offering self-help for a wide variety of losses, including deaths by homicide, suicide, military deaths, or deaths from particular diseases, such as cancer or HIV/AIDS.

It should be noted that most individuals seem to deal effectively with grief in that, over time, they can remember the loss without the intense reactions experienced earlier and function at similar or even better levels.

However, anywhere between 20 and 33 percent of bereaved individuals seem to experience more complicated grief reactions. Some people, such as those experiencing sudden or traumatic losses, the death of a child, highly ambivalent or dependent relationships, or people with prior psychiatric problems, among other factors, may be especially vulnerable. These individuals may benefit from grief counseling, particularly if their health suffers or their grief becomes highly disabling, impairing functioning at work, school, or home, or if they harbor destructive thoughts toward self or others. A number of specialized approaches have been developed to treat varied complications of grief.

Others may find counseling valuable when other support, from family or friends, is not forthcoming. Such losses may be called disenfranchised. Disenfranchised grief is defined as grief that a person experiences when he or she incurs a loss that is not, or cannot, be openly acknowledged, socially sanctioned, or publicly mourned. The concept of disenfranchised grief integrated a sociological perspective into the study of grief and loss by emphasizing that the grief process is heavily influenced by the degree to which others around, and the society at large, acknowledge and validate that loss. Grief is complicated when others do not acknowledge that the individual has a right to grieve. In such situations, people are not offered the “rights” or the “grieving role” such as a claim to social sympathy and support, or such compensations as time off from work or the diminishment of social responsibilities. Grief may be disenfranchised for a number of reasons: the relationship is not recognized (i.e., friend, coworker, etc.); the loss is not acknowledged (i.e., pet loss, loss of a job, etc.); the griever is not recognized as capable of grief (i.e., a young child, person with developmental disabilities, etc.); the circumstances inhibit support; or the way the person grieves is viewed as inappropriate by the cultural or gender norms of a society.

In recent years, there have been efforts to have categories encompassing complicated grief reactions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that mental health professionals use to characterize disorders. One such proposed category is prolonged grief disorder. At the time of writing, it is likely that a diagnostic category for some form of complicated grief will be included in the DSM-5, but it is premature to assess how grief complications will be recognized.

In helping individuals deal with loss, pharmacological interventions, that is the use of medications to alleviate depression, anxiety, or other manifestations of grief, can sometimes be helpful, particularly when the grief is disabling, that is, severely compromising the individual's health or ability to function. Such interventions should be focused on particular conditions such as anxiety or depression, for example, which are precipitated or exacerbated by the bereavement. Pharmacological interventions generally should be accompanied by psychotherapy.

See also: Bereavement; Mourning.

Further Reading
  • Humphrey, K. Counseling Strategies for Grief and Loss. The American Counseling Association Alexandria VA, 2009.
  • Rando, T. A. How to Go On Living When Someone You Love Dies. Bantam Books New York, 1991.
  • Sanders, C. Grief: The Mourning After: Dealing with Adult Bereavement. John Wiley and Sons New York, 1989.
  • Worden, J. W. Grief Counseling and Grief Therapy: A Handbook for Mental Health Professionals, 4th edition. Springer New York, 2009.
  • Kenneth J. Doka
    Copyright 2014 by Michael Brennan

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