Grief

For other uses, see Grief (disambiguation) and Griefing.

"Bereavement" redirects here. For other uses, see Bereavement (disambiguation).

Grief is the response to loss, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss.

Grief
Other names	Mourning; grieving; bereavement^[1]
Specialty	Psychology
Treatment	Pastoral care, mental health professionals, social workers, support groups^[1]

The grief associated with death is familiar to most people, but individuals grieve in connection with a variety of losses throughout their lives, such as unemployment, ill health or the end of a relationship.^[2] Loss can be categorized as either physical or abstract;^[3] physical loss is related to something that the individual can touch or measure, such as losing a spouse through death, while other types of loss are more abstract, possibly relating to aspects of a person's social interactions.^[4]

Grieving process

Between 1996 and 2006, there was extensive skepticism about a universal and predictable "emotional pathway" that leads from distress to "recovery" with an appreciation that grief is a more complex process of adapting to loss than stage and phase models have previously suggested. The two-track model of bereavement, created by Simon Shimshon Rubin in 1981,^[5] is a grief theory that provided a deeper focus on the grieving process. The model examines the long-term effects of bereavement by measuring how well the person is adapting to the loss of a significant person in their life. The main objective of the two-track model of bereavement is for the individual to "manage and live in reality in which the deceased is absent" as well as returning to normal biological functioning.^[6]

Track One is focused on the biopsychosocial functioning of grief. This focuses on the anxiety, depression, somatic concerns, traumatic responses, familial relationships, interpersonal relationships, self-esteem, meaning structure, work, and investment in life tasks. Rubin (2010) points out, "Track 1, the range of aspects of the individuals functioning across affective, interpersonal, somatic and classical psychiatric indicators is considered".^[7] All of the terms listed above are noted for the importance they have in relation to people's responses to grief and loss.

 

A grief-stricken American soldier is comforted by a fellow soldier after a friend is killed in action during the Korean War.

The significance of the closeness between the bereaved and the deceased is important to Track 1 because this could determine the severity of the mourning and grief the bereaved will endure. This first track is the response to the extremely stressful life events and requires adaptation along with change and integration. The second track focuses on the ongoing relationship between the griever and the deceased. Track two mainly focuses on how the bereaved was connected to the deceased, and on what level of closeness was shared. The two main components considered are memories, both positive and negative, and emotional involvement shared with the decedent. The stronger the relationship to the deceased, the greater the evaluation of the relationship with heightened shock.

Any memory could be a trigger for the bereaved, the way the bereaved chose to remember their loved ones, and how the bereaved integrate the memory of their loved ones into their daily lives.

Ten main attributes to this track include: imagery/memory, emotional distance, positive effect, negative effect, preoccupation with the loss, conflict, idealization, memorialization/transformation of the loss, impact on self-perception and loss process (shock, searching, disorganized).^[8] An outcome of this track is being able to recognize how transformation has occurred beyond grief and mourning.^[8] By outlining the main aspects of the bereavement process into two interactive tracks, individuals can examine and understand how grief has affected their life following loss and begin to adapt to this post-loss life. The Model offers a better understanding with the duration of time in the wake of one's loss and the outcomes that evolve from death. By using this model, researchers can effectively examine the response to an individual's loss by assessing the behavioral-psychological functioning and the relationship with the deceased.^[9]

The authors from What's Your Grief?, Litza Williams and Eleanor Haley, state in their understanding of the clinical and therapeutic uses of the model:

in terms of functioning, this model can help the bereaved identify which areas of his/her life has been impacted by the grief in a negative way as well as areas that the bereaved has already begun to adapt to after the loss. If the bereaved is unable to return to their normal functioning as in before loss occurred, it is likely they will find difficulty in the process of working through the loss as well as their separation from the deceased. Along the relational aspect, the bereaved can become aware of their relationship with the deceased and how it has changed or may change in the future (Williams & Haley, 2017).^[10]

"The Two-Track Model of Bereavement can help specify areas of mutuality (how people respond affectivity to trauma and change) and also difference (how bereaved people may be preoccupied with the deceased following loss compared to how they may be preoccupied with trauma following the exposure to it)" (Rubin, S.S, 1999).^[11]

While the grief response is considered a natural way of dealing with loss, prolonged, highly intense grief may at times become debilitating enough to be considered a disorder.^[12][13][14]

Reactions

 

A family mourns during a funeral at the Lion's cemetery during the Siege of Sarajevo in 1992.

Crying is a normal and natural part of grieving. It has also been found, however, that crying and talking about the loss is not the only healthy response and, if forced or excessive, can be harmful.^[15][16] Responses or actions in the affected person, called "coping ugly" by researcher George Bonanno, may seem counter-intuitive or even appear dysfunctional, e.g., celebratory responses, laughter, or self-serving bias in interpreting events.^[17] Lack of crying is also a natural, healthy reaction, potentially protective of the individual, and may also be seen as a sign of resilience.^[15][16][18]

Science has found that some healthy people who are grieving do not spontaneously talk about the loss. Pressing people to cry or retell the experience of a loss can be damaging.^[16] Genuine laughter is healthy.^[15][18] When a loved one dies, it is not unusual for the bereaved to report that they have "seen" or "heard" the person they have lost. Most people who have experienced this report feeling comforted. In a 2008 survey conducted by Amanda Barusch, 27% of respondents who had lost a loved one reported having had this kind of "contact" experience.^[19]

Bereavement science

 

Grief can be caused by the loss of one's home and possessions, as occurs with refugees.

Bonanno's four trajectories of grief

Main article: George Bonanno

George Bonanno, a professor of clinical psychology at Columbia University, conducted more than two decades of scientific studies on grief and trauma, which have been published in several papers in the most respected peer-reviewed journals in the field of psychology, such as Psychological Science and The Journal of Abnormal Psychology. Subjects of his studies number in the several thousand and include people who have suffered losses in the U.S. and cross-cultural studies in various countries around the world, such as Israel, Bosnia-Herzegovina, and China. His subjects suffered losses through war, terrorism, deaths of children, premature deaths of spouses, sexual abuse, childhood diagnoses of AIDS, and other potentially devastating loss events or potential trauma events.

In Bonanno's book, The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss, he summarizes his research. His findings include that a natural resilience is the main component of grief and trauma reactions.^[15] The first researcher to use pre-loss data, he outlined four trajectories of grief.^[15] Bonanno's work has also demonstrated that absence of grief or trauma symptoms is a healthy outcome, rather than something to be feared as has been the thought and practice until his research.^[17] Because grief responses can take many forms, including laughter, celebration, and bawdiness, in addition to sadness,^[18][20] Bonanno coined the phrase "coping ugly" to describe the idea that some forms of coping may seem counter intuitive.^[17] Bonanno has found that resilience is natural to humans, suggesting that it cannot be "taught" through specialized programs^[17] and that there is virtually no existing research with which to design resilience training, nor is there existing research to support major investment in such things as military resilience training programs.^[17]

The four trajectories are as follows:

• Resilience: "The ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning" as well as "the capacity for generative experiences and positive emotions".
• Recovery: When "normal functioning temporarily gives way to threshold or sub-threshold psychopathology (e.g., symptoms of depression or post-traumatic stress disorder, or PTSD), usually for a period of at least several months, and then gradually returns to pre-event levels".
• Chronic dysfunction: Prolonged suffering and inability to function, usually lasting several years or longer.
• Delayed grief or trauma: When adjustment seems normal but then distress and symptoms increase months later. Researchers have not found evidence of delayed grief, but delayed trauma appears to be a genuine phenomenon.

Five stages theory

Main article: Kübler-Ross model

The Kübler-Ross model, commonly known as the five stages of grief, is a theory first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.^[21] Based on the uncredited earlier work of John Bowlby and Colin Murray-Parkes, Kübler-Ross actually applied the stages to persons who were dying, not persons who were grieving. Her studies involved her work with the terminally ill. The popular but empirically unsupported model describes in five distinct stages how people deal with their impending death.

The five stages are:

1. denial
2. anger
3. bargaining
4. depression
5. acceptance

The theory holds that the stages are a part of the framework that helps people learn to live without what they have lost.

The stages model, which came about in the 1960s, is a theory based on observation of people who are dying, not people who experienced the death of a loved one. This model found limited empirical support in a study by Maciejewski et al.^[22] That is that the sequence was correct although Acceptance was highest at all points throughout the persons experience. The research of George Bonanno, however, is acknowledged as debunking the five stages of grief because his large body of peer-reviewed studies show that the vast majority of people who have experienced a loss are resilient and that there are multiple trajectories following loss.

Physiological and neurological processes

 

"Pietà" by El Greco, 1571–1576. Philadelphia Museum of Art

 

Grief in art: grave statue at Vienna Central Cemetery

Studies of fMRI scans of women from whom grief was elicited about the death of a mother or a sister in the past 5 years resulted in the conclusion that grief produced a local inflammation response as measured by salivary concentrations of pro-inflammatory cytokines. These responses were correlated with activation in the anterior cingulate cortex and orbitofrontal cortex. This activation also correlated with the free recall of grief-related word stimuli. This suggests that grief can cause stress, and that this reaction is linked to the emotional processing parts of the frontal lobe.^[23] Activation of the anterior cingulate cortex and vagus nerve is similarly implicated in the experience of heartbreak whether due to social rejection or bereavement.

Among those persons who have been bereaved within the previous three months of a given report, those who report many intrusive thoughts about the deceased show ventral amygdala and rostral anterior cingulate cortex hyperactivity to reminders of their loss. In the case of the amygdala, this links to their sadness intensity. In those individuals who avoid such thoughts, there is a related opposite type of pattern in which there is a decrease in the activation of the dorsal amygdala and the dorsolateral prefrontal cortex.

In those not so emotionally affected by reminders of their loss, studies of fMRI scans have been used to conclude that there is a high functional connectivity between the dorsolateral prefrontal cortex and amygdala activity, suggesting that the former regulates activity in the latter. In those people who had greater intensity of sadness, there was a low functional connection between the rostral anterior cingulate cortex and amygdala activity, suggesting a lack of regulation of the former part of the brain upon the latter.^[24]

Evolutionary theories

From an evolutionary perspective, grief is perplexing because it appears costly, and it is not clear what benefits it provides the sufferer. Several researchers have proposed functional explanations for grief, attempting to solve this puzzle. Sigmund Freud argued that grief is a process of libidinal reinvestment. The griever must, Freud argued, disinvest from the deceased, which is a painful process.^[25] But this disinvestment allows the griever to use libidinal energies on other, possibly new attachments, so it provides a valuable function. John Archer, approaching grief from an attachment theory perspective, argued that grief is a byproduct of the human attachment system.^[26] Generally, a grief-type response is adaptive because it compels a social organism to search for a lost individual (e.g., a mother or a child). However, in the case of death, the response is maladaptive because the individual is not simply lost and the griever cannot reunite with the deceased. Grief, from this perspective, is a painful cost of the human capacity to form commitments.

Other researchers such as Randolph Nesse have proposed that grief is a kind of psychological pain that orients the sufferer to a new existence without the deceased and creates a painful but instructive memory.^[27] If, for example, leaving an offspring alone at a watering hole led to the offspring's death, grief creates an intensively painful memory of the event, dissuading a parent from ever again leaving an offspring alone at a watering hole. More recently, Bo Winegard and colleagues argued that grief might be a socially selected signal of an individual's propensity for forming strong, committed relationships.^[28] From this social signaling perspective, grief targets old and new social partners, informing them that the griever is capable of forming strong social commitments. That is, because grief signals a person's capacity to form strong and faithful social bonds, those who displayed prolonged grief responses were preferentially chosen by alliance partners. The authors argue that throughout human evolution, grief was therefore shaped and elaborated by the social decisions of selective alliance partners.

Risks

Bereavement, while a normal part of life, carries a degree of risk when severe. Severe reactions affect approximately 10% to 15% of people.^[15] Severe reactions mainly occur in people with depression present before the loss event.^[15] Severe grief reactions may carry over into family relations. Some researchers have found an increased risk of marital breakup following the death of a child, for example. Others have found no increase. John James, author of the Grief Recovery Handbook and founder of the Grief Recovery Institute, reported that his marriage broke up after the death of his infant son.

Health risks

Many studies have looked at the bereaved in terms of increased risks for stress-related illnesses. Colin Murray Parkes in the 1960s and 1970s in England noted increased doctor visits, with symptoms such as abdominal pain, breathing difficulties, and so forth in the first six months following a death. Others have noted increased mortality rates (Ward, A.W. 1976) and Bunch et al. found a five times greater risk of suicide in teens following the death of a parent.^[29] Bereavement also increases the risk of heart attack.^[30]

Complicated grief

Prolonged grief disorder (PGD), formerly known as complicated grief disorder (CGD), is a pathological reaction to loss representing a cluster of empirically derived symptoms that have been associated with long-term physical and psycho-social dysfunction. Individuals with PGD experience severe grief symptoms for at least six months and are stuck in a maladaptive state.^[31] An attempt is being made to create a diagnosis category for complicated grief in the DSM-5.^[32][33] It is currently an "area for further study" in the DSM, under the name Persistent Complex Bereavement Disorder. Critics of including the diagnosis of complicated grief in the DSM-5 say that doing so will constitute characterizing a natural response as a pathology, and will result in wholesale medicating of people who are essentially normal.^[32][34]

Shear and colleagues found an effective treatment for complicated grief, by treating the reactions in the same way as trauma reactions.^[35][36]

Complicated grief is not synonymous with grief. Complicated grief is characterised by an extended grieving period and other criteria, including mental and physical impairments.^[37] An important part of understanding complicated grief is understanding how the symptoms differ from normal grief. The Mayo Clinic states that with normal grief the feelings of loss are evident. When the reaction turns into complicated grief, however, the feelings of loss become incapacitating and continue even though time passes.^[38] The signs and symptoms characteristic of complicated grief are listed as "extreme focus on the loss and reminders of the loved one, intense longing or pining for the deceased, problems accepting the death, numbness or detachment ... bitterness about your loss, inability to enjoy life, depression or deep sadness, trouble carrying out normal routines, withdrawing from social activities, feeling that life holds no meaning or purpose, irritability or agitation, lack of trust in others".^[38] The symptoms seen in complicated grief are specific because the symptoms seem to be a combination of the symptoms found in separation as well as traumatic distress. They are also considered to be complicated because, unlike normal grief, these symptoms will continue regardless of the amount of time that has passed and despite treatment given from tricyclic antidepressants.^[39] Individuals with complicated grief symptoms are likely to have other mental disorders such as PTSD (post traumatic syndrome disorder), depression, anxiety, etc.^[40]

An article by the NEJM (The New England Journal of Medicine) states complicated grief cases are multifactorial, and that complicated grief is distinguished from major depression and post-traumatic stress disorder. Evidence shows that complicated grief is a more severe and prolonged version of acute grief than a completely different type of grief. While only affecting 2 to 3% of people in the world, complicated grief is usually contracted when a loved one dies suddenly and in a violent way.^[41]

In the study "Bereavement and Late-Life Depression: Grief and its Complications in the Elderly" six subjects with symptoms of complicated grief were given a dose of Paroxetine, a selective serotonin re-uptake inhibitor, and showed a 50% decrease in their symptoms within a three-month period. The Mental Health Clinical Research team theorizes that the symptoms of complicated grief in bereaved elderly are an alternative of post-traumatic stress. These symptoms were correlated with cancer, hypertension, anxiety, depression, suicidal ideation, increased smoking, and sleep impairments at around six months after spousal death.^[39]

A treatment that has been found beneficial in dealing with the symptoms associated with complicated grief is the use of serotonin specific reuptake inhibitors such as Paroxetine. These inhibitors have been found to reduce intrusive thoughts, avoidant behaviors, and hyperarousal that are associated with complicated grief. In addition psychotherapy techniques are in the process of being developed.^[39]

Disenfranchised grief

Main article: Disenfranchised grief

Disenfranchised grief is a term describing grief that is not acknowledged by society. Examples of events leading to disenfranchised grief are the death of a friend, the loss of a pet, a trauma in the family a generation prior,^[42] the loss of a home or place of residence particularly in the case of children, who generally have little or no control in such situations, and whose grief may not be noticed or understood by caregivers.^[43][44][45] American military children and teens in particular moving a great deal while growing up,^[46] an aborted or miscarried pregnancy, a parent's loss or surrender of a child to adoption, a child's loss of their birth parent to adoption, the death of a loved one due to a socially unacceptable cause such as suicide,^[47] or the death of a celebrity.

There are fewer support systems available for people who experience disenfranchised grief compared to those who are going through a widely recognized form of grief. Therefore, people who suffer disenfranchised grief undergo a more complicated grieving process. They may feel angry and depressed due to the lack of public validation which leads to the inability to fully express their sorrow. Moreover, they may not receive sufficient social support and feel isolated.^[48]

Examples of bereavement

Death of a child

It is a fearful thing to love
What Death can touch.
Josephine Jacobson, The Instant of Knowing (Library of Congress, 1974), 7.

 

This 1860 woodcut by Julius Schnorr von Karolsfeld depicts the death of Bathsheba's first child with David, who lamented, "I shall go to him, but he will not return to me" (2 Samuel 12:23)

Death of a child can take the form of a loss in infancy such as miscarriage, stillbirth,^[49] neonatal death, SIDS, or the death of an older child. Among adults over the age of 50, approximately 11% have been predeceased by at least one of their offspring.^[50]

In most cases, parents find the grief almost unbearably devastating, and it tends to hold greater risk factors than any other loss. This loss also bears a lifelong process: one does not get 'over' the death but instead must assimilate and live with it.^[51] Intervention and comforting support can make all the difference to the survival of a parent in this type of grief but the risk factors are great and may include family breakup or suicide.^[52][53]

Feelings of guilt, whether legitimate or not, are pervasive, and the dependent nature of the relationship disposes parents to a variety of problems as they seek to cope with this great loss. Parents who suffer miscarriage or a regretful or coerced abortion may experience resentment towards others who experience successful pregnancies.^[54]

Suicide

Parents may feel they cannot openly discuss their grief and feel their emotions because of how their child died and how the people around them may perceive the situation. Parents, family members and service providers have all confirmed the unique nature of suicide-related bereavement following the loss of a child. The difference in suicide-related bereavement is that there are different reactions and ways when we respond to the loss of someone we love dearly.^[55] Some examples are post-traumatic stress, family, and relationship tensions. Post-traumatic stress (PTS) can affect the person severely when witnessing the death of someone. It can give them horrible trauma and nightmares may occur making them have a lack of sleep. Another reaction is family and relationship tensions. Having loved ones by their side could really support them, but some families might lack connections or communications with one another. They feel as if they are going to bring more burden to others. Some have different perspectives on themselves when communicating with others and might keep their feelings to themselves. It's a way to protect their inner feelings as if they're scared to share with others.^[56]

Death of a spouse

Many widows and widowers describe losing 'half' of themselves. A factor is the manner in which the spouse died. The survivor of a spouse who died of an illness has a different experience of such loss than a survivor of a spouse who died by an act of violence. Often, the spouse who is "left behind" may suffer from depression and loneliness, and may feel it necessary to seek professional help in dealing with their new life.

Furthermore, most couples have a division of 'tasks' or 'labor', e.g., the husband mows the yard, the wife pays the bills, etc. which, in addition to dealing with great grief and life changes, means added responsibilities for the bereaved. Planning and financing a funeral can be very difficult if pre-planning was not completed. Changes in insurance, bank accounts, claiming of life insurance, securing childcare can also be intimidating to someone who is grieving. Social isolation may also become imminent, as many groups composed of couples find it difficult to adjust to the new identity of the bereaved, and the bereaved themselves have great challenges in reconnecting with others. Widows of many cultures, for instance, wear black for the rest of their lives to signify the loss of their spouse and their grief. Only in more recent decades has this tradition been reduced to a period of two years, while some religions such as Orthodox Christianity many widows will still continue to wear black for the remainder of their lives.^[57]

Death of a sibling

Grieving siblings are often referred to as the 'forgotten mourners' who are made to feel as if their grief is not as severe as their parents' grief (N.a., 2015).^[58] However, the sibling relationship tends to be the longest significant relationship of the lifespan and siblings who have been part of each other's lives since birth, such as twins, help form and sustain each other's identities; with the death of one sibling comes the loss of that part of the survivor's identity because "your identity is based on having them there".^[59][60]

If siblings were not on good terms or close with each other, then intense feelings of guilt may ensue on the part of the surviving sibling (guilt may also ensue for having survived, not being able to prevent the death, having argued with their sibling, etc.)^[61]

Death of a parent

 

Queen Maria II of Portugal crying and hugging a bust of her late father King Pedro IV (also Emperor of Brazil as Pedro I), 1836

For an adult

When an adult child loses a parent in later adulthood, it is considered to be "timely" and to be a normative life course event. This allows the adult children to feel a permitted level of grief. However, research shows that the death of a parent in an adult's midlife is not a normative event by any measure, but is a major life transition causing an evaluation of one's own life or mortality. Others may shut out friends and family in processing the loss of someone with whom they have had the longest relationship.^[62]

In developed countries, people typically lose parents after the age of 50.^[63]

For a child

For a child, the death of a parent, without support to manage the effects of the grief, may result in long-term psychological harm. This is more likely if the adult carers are struggling with their own grief and are psychologically unavailable to the child. There is a critical role of the surviving parent or caregiver in helping the children adapt to a parent's death. However, losing a parent at a young age also has some positive effects. Some children had an increased maturity, better coping skills and improved communication. Adolescents who lost a parent valued other people more than those who have not experienced such a close loss.^[64]

Loss during childhood

When a parent or caregiver dies or leaves, children may have symptoms of psychopathology, but they are less severe than in children with major depression.^[65] The loss of a parent, grandparent or sibling can be very troubling in childhood, but even in childhood there are age differences in relation to the loss. A very young child, under one or two, may be found to have no reaction if a carer dies, but other children may be affected by the loss.

At a time when trust and dependency are formed, even mere separation can cause problems in well-being. This is especially true if the loss is around critical periods such as 8–12 months, when attachment and separation are at their height and even a brief separation from a parent or other caregiver can cause distress.^[66]

Even as a child grows older, death is still difficult to fathom and this affects how a child responds. For example, younger children see death more as a separation, and may believe death is curable or temporary. Reactions can manifest themselves in "acting out" behaviors, a return to earlier behaviors such as thumb sucking, clinging to a toy or angry behavior. Though they do not have the maturity to mourn as an adult, they feel the same intensity.^[67] As children enter pre-teen and teen years, there is a more mature understanding.

Adolescents may respond by delinquency,^[68][69] or oppositely become "over-achievers". Repetitive actions are not uncommon such as washing a car repeatedly or taking up repetitive tasks such as sewing, computer games, etc. It is an effort to stay above the grief.^{[citation needed]} Childhood loss can predispose a child not only to physical illness but to emotional problems and an increased risk for suicide, especially in the adolescent period.^[70]

Grief can be experienced as a result of losses due to causes other than death. For example, women who have been physically, psychologically or sexually abused often grieve over the damage to or the loss of their ability to trust. This is likely to be experienced as disenfranchised grief.^[71]

In relation to the specific issue of child sexual abuse, it has been argued by some commentators that the concepts of loss and grief offer particularly useful analytical frames for understanding both the impact of child sexual abuse and therapeutic ways to respond to it. From this perspective, child sexual abuse may represent for many children multiple forms of loss: not only of trust but also loss of control over their bodies, loss of innocence and indeed loss of their very childhoods.^[72][73][74]

Relocations can cause children significant grief particularly if they are combined with other difficult circumstances such as neglectful or abusive parental behaviors, other significant losses, etc.^[43][45]

Loss of a friend or classmate

Children may experience the death of a friend or a classmate through illness, accidents, suicide, or violence. Initial support involves reassuring children that their emotional and physical feelings are normal.^[75]

Survivor guilt (or survivor's guilt; also called survivor syndrome or survivor's syndrome) is a mental condition that occurs when a person perceives themselves to have done wrong by surviving a traumatic event when others did not. It may be found among survivors of combat, natural disasters, epidemics, among the friends and family of those who have died by suicide, and in non-mortal situations such as among those whose colleagues are laid off.^[76]

Other losses

 

People who lose their jobs, such as these people in California, may experience grief.

Parents may grieve due to loss of children through means other than death, for example through loss of custody in divorce proceedings; legal termination of parental rights by the government, such as in cases of child abuse; through kidnapping; because the child voluntarily left home (either as a runaway or, for overage children, by leaving home legally); or because an adult refuses or is unable to have contact with a parent. This loss differs from the death of a child in that the grief process is prolonged or denied because of hope that the relationship will be restored.^{[citation needed]}

Grief may occur after the loss of a romantic relationship (i.e. divorce or break up), a vocation, a pet (animal loss), a home, children leaving home (empty nest syndrome), sibling(s) leaving home, a friend, a faith in one's religion, etc. A person who strongly identifies with their occupation may feel a sense of grief if they have to stop their job due to retirement, being laid off, injury, or loss of certification. Those who have experienced a loss of trust will often also experience some form of grief.^[77]

Veteran bereavement

The grief of living veteran soldiers is often ignored. Psychological effects and post traumatic syndrome disorder have been researched and studied but very few focus on grief and bereavement specifically. Additionally, there have been many studies conducted about families losing members who were in the military but little about soldiers themselves. There are many monuments paying respect to those who were lost which emphasizes the lack of focus living veterans and soldiers get in regards to grief.^[78]

Gradual bereavement

Many of the above examples of bereavement happen abruptly, but there are also cases of being gradually bereft of something or someone. For example, the gradual loss of a loved one by Alzheimer's produces a "gradual grief".^[79]

The author Kara Tippetts described her dying of cancer, as dying "by degrees": her "body failing" and her "abilities vanishing".^[80] Milton Crum, writing about gradual bereavement says that "every degree of death, every death of a person's characteristics, every death of a person's abilities, is a bereavement".^[81]

Sensory experiences of the deceased

Bereaved people often report having sensory and quasi-sensory experiences of the deceased (SED), which were correlated with pathology like grief complications.^[82]

Support

Professional support

Many people who grieve do not need professional help.^[83] Some, however, may seek additional support from licensed psychologists or psychiatrists. Support resources available to the bereaved may include grief counseling, professional support-groups or educational classes, and peer-led support groups. In the United States of America, local hospice agencies may provide a first contact for those seeking bereavement support.^[84]

It is important to recognize when grief has turned into something more serious, thus mandating contacting a medical professional. Grief can result in depression or alcohol- and drug-abuse and, if left untreated, it can become severe enough to impact daily living.^[85] It recommends contacting a medical professional if "you can't deal with grief, you are using excessive amounts of drugs or alcohol, you become very depressed, or you have prolonged depression that interferes with your daily life".^[85] Other reasons to seek medical attention may include: "Can focus on little else but your loved one's death, have persistent pining or longing for the deceased person, have thoughts of guilt or self-blame, believe that you did something wrong or could have prevented the death, feel as if life is not worth living, have lost your sense of purpose in life, wish you had died along with your loved one".^[38]

Professionals can use multiple ways to help someone cope and move through their grief. Hypnosis is sometimes used as an adjunct therapy in helping patients experiencing grief.^[86] Hypnosis enhances and facilitates mourning and helps patients to resolve traumatic grief.^[87] Art therapy may also be used to allow the bereaved to process their grief in a non-verbal way.^[88]

Lichtenthal and Cruess studied how bereavement-specific written disclosure had benefits in helping adjust to loss, and in helping improve the effects of post-traumatic stress disorder (PTSD), prolonged grief disorder, and depression. Directed writing helped many of the individuals who had experienced a loss of a significant relationship. It involved individuals trying to make meaning out of the loss through meaning-making (making sense of what happened and the cause of the death), or through benefit finding (consideration of the global significance of the loss of one's goals, and helping the family develop a greater appreciation of life). This meaning-making can come naturally for some, but many need direct intervention to "move on".^[89]

Support groups

Further information: Support group and Bereavement group

Support groups for bereaved individuals follow a diversity of patterns.^[90][91] Many are organized purely as peer-to-peer groups such as local chapters of the Compassionate Friends, an international group for bereaved parents. Other grief support groups are led by professionals, perhaps with the assistance of peers. Some support groups deal with specific problems, such as learning to plan meals and cook for only for one person.^[92]

Cultural differences in grieving

Main article: Mourning

Each culture specifies manners such as rituals, styles of dress, or other habits, as well as attitudes, in which the bereaved are encouraged or expected to take part. An analysis of non-Western cultures suggests that beliefs about continuing ties with the deceased varies. In Japan, maintenance of ties with the deceased is accepted and carried out through religious rituals. In the Hopi of Arizona, the women go into self-induced hallucinations where they conjure images of the deceased loved one to mourn and process their grief.^[93]

Different cultures grieve in different ways, but all have ways that are vital in healthy coping with the death of a loved one.^[94] The American family's approach to grieving was depicted in "The Grief Committee", by T. Glen Coughlin. The short story gives an inside look at how the American culture has learned to cope with the tribulations and difficulties of grief. The story is taught in the course, "The Politics of Mourning: Grief Management in a Cross-Cultural Fiction" at Columbia University.^{[95][page needed]}

In those with cognitive impairment

Contrary to popular belief, people with cognitive impairments are able to process grief in a similar manner to those without cognitive impairment.^[96] One of the main differences between those with an intellectual disability and those without is typically the ability to verbalize their feelings about the loss, which is why non-verbal cues and changes in behavior become so important, because these are usually signs of distress and expression of grief among this population.^[97] It is important when working with individuals with these such impairments that caregivers and family members meet them where their level of functioning is and allow them to process the loss and grief with assistance given where needed, and not to ignore the grief that these individuals undergo.^[98] An important aspect of treatment of grief for those with an intellectual disability is family involvement where possible, which may take the form of a biological family or a family created in a group home or clinical setting. By having the family involved in an open and supporting dialogue with the individual it helps them to process. However, if the family is not properly educated on how these individuals handle loss, their involvement may not be as beneficial than those who are educated. The importance of the family unit is very crucial in a socio-cognitive approach to bereavement counseling. In this approach the individual with intellectual disability has the opportunity to see how those around them handle the loss and have the opportunity to act accordingly by modeling behavior. This approach also helps the individual know that their emotions are acceptable and normal.^[99]

In animals

 

In August Friedrich Schenck's 1878 painting Anguish, held at the National Gallery of Victoria, a grieving ewe mourns the death of her lamb.

Previously it was believed that grief was only a human emotion, but studies have shown that other animals have shown grief or grief-like states during the death of another animal, most notably elephants, wolves, apes, and goats. This can occur between bonded animals which are animals that attempt to survive together (i.e. a pack of wolves or mated prairie voles). There is evidence that animals experience grief in the loss of their group member, a mate, or their owner for many days. Some animals show their grief for their loss for many years. When animals are grieving, their life routines change the same as humans. For instance, they may stop eating, isolate themselves, or change their sleeping routine by taking naps instead of sleeping during the night. After the death of their group member or a mate, some of the animals become depressed, while others like the bonobo keep the dead bodies of their babies for a long time. Cats try to find their dead fellow with a mourning cry, and dogs and horses become depressed.^[100]

Since it is more difficult to study emotion in animals because of the lack of clear communication, in effort to study grief, research has been done on hormone levels. One study found that "females [baboons] showed significant increases in stress hormones called glucocorticoids". The female baboons then increased grooming, promoting physical touch, which releases "oxytocin, which inhibits glucocorticoid release".^[101]

Mammals

Mammals have demonstrated grief-like states, especially between a mother and her offspring. She will often stay close to her dead offspring for short periods of time and may investigate the reasons for the baby's non-response. For example, some deer will often sniff, poke, and look at its lifeless fawn before realizing it is dead and leaving it to rejoin the herd shortly afterwards. Other animals, such as a lioness, will pick up its cub in its mouth and place it somewhere else before abandoning it.

When a baby chimpanzee or gorilla dies, the mother will carry the body around for several days before she may finally be able to move on without it; this behavior has been observed in other primates, as well. The Royal Society suggests that, "Such interactions have been proposed to be related to maternal condition, attachment, environmental conditions or reflect a lack of awareness that the infant has died."^[102] Jane Goodall has described chimpanzees as exhibiting mournful behavior toward the loss of a group member with silence and by showing more attention to it. And they will often continue grooming it and stay close to the carcass until the group must move on without it. One example of this Goodall observed was of a chimpanzee mother of three who had died. The siblings stayed by their mother's body the whole day. Of the three siblings the youngest showed the most agitation by screaming and became depressed but was able to recover by the care of the two older siblings. However, the youngest refused behavior from the siblings that were similar to the mother.^[103] Another notable example is Koko, a gorilla who was taught sign language, who expressed sadness and even described sadness about the death of her pet cat, All Ball.^[104]

Elephants have shown unusual behavior upon encountering the remains of another deceased elephant. They will often investigate it by touching and grabbing it with their trunks and have the whole herd stand around it for long periods of time until they must leave it behind. It is unknown whether they are mourning over it and showing sympathy, or are just curious and investigating the dead body. Elephants are thought to be able to discern relatives even from their remains. When encountering the body of a deceased elephant or human, elephants have been witnessed covering the body with vegetation and soil in what seems to be burial behavior.^[105] An episode of the seminal BBC documentary series Life on Earth shows this in detail – the elephants, upon finding a dead herd member, pause for several minutes at a time, and carefully touch and hold the dead creature's bones.^[106]

Birds

Some birds seem to lack the perception of grief or quickly accept it; mallard hens, although shocked for a moment when losing one of their young to a predator, will soon return to doing what they were doing before the predator attacked. However, some other waterbirds, such as mute swans are known to grieve for the loss of a partner or cygnet, and are known to engage in pining for days, weeks or even months at a time.^[107][108] Other species of swans such as the black swan have also been observed mourning the loss of a close relative.^[109]

Monogamous animals

Another form of grief in animals is when an individual loses its mate; this can be especially brutal when the species is monogamous. So when a pair bonding species, such as a black-backed jackal, loses its mate it can be very difficult for it to detach itself from its dead mate.^{[citation needed]}

See also

• Animal loss
• Anomalous experiences
• Anticipatory grief
• Association for Death Education and Counseling
• Intuitive–instrumental grief
• List of counseling topics
• Major depressive disorder
• Pet bereavement
• Postponement of affect § Grief
• Thanatosensitivity

References

1. "Grief: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 21 July 2019.
2. . Hospice Foundation of America. Archived from the original on 19 March 2012. Retrieved 20 March 2012.
3. Rando, Therese A. (1991). How to go on living when someone you love dies. Random House Publishing. ISBN 978-0553352696.^{[page needed]}
4. Therese A. Rando, P. (1991). How To Go On Living When Someone You Love Dies. Lexington Books.^{[page needed]}
5. Rubin, Simon (January 1981). "A two-track model of bereavement: Theory and application in research". American Journal of Orthopsychiatry. 51 (1): 101–109. doi:10.1111/j.1939-0025.1981.tb01352.x. ISSN 1939-0025. PMID 7212022.
6. Malkinson, Ruth (2007). Cognitive Grief Therapy: Constructing a Rational Meaning to Life Following Loss. W. W. Norton & Company. ISBN 978-0-393-70439-6.
7. Shimshon, p. 686
8. Rubin, 1999
9. Rubin, Simon Shimshon; Bar Nadav, Ofri; Malkinson, Ruth; Koren, Dan; Goffer-Shnarch, Moran; Michaeli, Ella (2009). "The Two-Track Model of Bereavement Questionnaire (TTBQ): Development and Validation of a Relational Measure". Death Studies. 33 (4): 305–33. doi:10.1080/07481180802705668. PMID 19368062. S2CID 205584637.
10. Williams, Litza; Haley, Eleanor (12 January 2017). "Understanding The Two-Track Model of Bereavement - What's Your Grief". What's Your Grief. Retrieved 11 December 2017.
11. Rubin, Simon Shimshon (1999). "The Two-Track Model of Bereavement: Overview, Retrospect, and Prospect". Death Studies. 23 (8): 681–714. CiteSeerX 10.1.1.462.2673. doi:10.1080/074811899200731. PMID 10848088.
12. Prigerson, Holly G.; Horowitz, Mardi J.; Jacobs, Selby C.; Parkes, Colin M.; Aslan, Mihaela; Goodkin, Karl; Raphael, Beverley; Marwit, Samuel J.; Wortman, Camille; Neimeyer, Robert A.; Bonanno, George (4 August 2009). "Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11". PLOS Medicine. 6 (8): e1000121. doi:10.1371/journal.pmed.1000121. ISSN 1549-1676. PMC 2711304. PMID 19652695.
13. Lundorff, Marie; Holmgren, Helle; Zachariae, Robert; Farver-Vestergaard, Ingeborg; O'Connor, Maja (April 2017). "Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis". Journal of Affective Disorders. 212: 138–49. doi:10.1016/j.jad.2017.01.030. ISSN 0165-0327. PMID 28167398. S2CID 205643136.
14. Boelen, Paul A.; van de Schoot, Rens; van den Hout, Marcel A.; de Keijser, Jos; van den Bout, Jan (September 2010). "Prolonged Grief Disorder, depression, and posttraumatic stress disorder are distinguishable syndromes". Journal of Affective Disorders. 125 (1–3): 374–78. doi:10.1016/j.jad.2010.01.076. ISSN 0165-0327. PMID 20189657.
15. Bonanno, George A. (2004). "Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?". American Psychologist. 59 (1): 20–28. doi:10.1037/0003-066X.59.1.20. PMID 14736317. S2CID 6296189.
16. Konigsberg, Ruth Davis (29 January 2011). "New Ways to Think About Grief". Time.
17. Stix, Gary (2011). "The Neuroscience of True Grit". Scientific American. 304 (3): 28–33. Bibcode:2011SciAm.304c..28S. doi:10.1038/scientificamerican0311-28. PMID 21438486.
18. "Dance, Laugh, Drink. Save the Date: It's a Ghanaian Funeral". The New York Times. 12 April 2011.
19. Barusch, A. (2008). Love Stories of Later Life. Oxford University Press. pp. 166–68. ISBN 978-0-19-531404-5
20. . 13 February 2012. Archived from the original on 13 January 2011. Retrieved 9 April 2011.
21. Nuland, Sherwin B. (6 September 2004). "Appreciation: Dr. ELISABETH KUBLER-ROSS". Time. ISSN 0040-781X. Retrieved 10 March 2023.
22. MacIejewski, P. K.; Zhang, B.; Block, S. D.; Prigerson, H. G. (2007). "An Empirical Examination of the Stage Theory of Grief". JAMA: The Journal of the American Medical Association. 297 (7): 716–23. doi:10.1001/jama.297.7.716. PMID 17312291.
23. O'Connor, Mary-Frances; Irwin, Michael R.; Wellisch, David K. (2009). "When grief heats up: Pro-inflammatory cytokines predict regional brain activation". NeuroImage. 47 (3): 891–96. doi:10.1016/j.neuroimage.2009.05.049. PMC 2760985. PMID 19481155.
24. Freed, Peter J.; Yanagihara, Ted K.; Hirsch, Joy; Mann, J. John (2009). "Neural Mechanisms of Grief Regulation". Biological Psychiatry. 66 (1): 33–40. doi:10.1016/j.biopsych.2009.01.019. PMC 2782609. PMID 19249748.
25. Freud, S. (1957). Mourning and Melancholia. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 14, pp. 152–70). London: Hogarth Press. (Original work published 1917)
26. Archer, J. (1999). The nature of grief: The evolution and psychology of reactions to loss. London, England: Routledge.
27. Nesse, R. M. (2005). An evolutionary framework for understanding grief. In D. Carr, R. M. Nesse, & C. B. Wortman (Eds.), Late life widowhood in the United States: Spousal bereavement in late life (pp. 195–226). New York, New York: Springer.
28. Winegard B. M.; Reynolds T.; Baumeister R. F.; Winegard B.; Maner J. K. (2014). "Grief functions as an honest indicator of commitment". Personality and Social Psychology Review. 18 (2): 168–86. doi:10.1177/1088868314521016. PMID 24501093. S2CID 3580609.
29. Bunch, J.; Barraclough, B.; Nelson, B.; Sainsbury, P. (1971). "Suicide following bereavement of parents". Social Psychiatry. 6 (4): 193. doi:10.1007/BF00578368. S2CID 9694619.
30. "Bereavement raises heart attack risk, says study". BBC News. 10 January 2012.
31. Lichtentahl, W. G.; Cruess, D.G. (2010). "Effects of Directed Written disclosure on Grief and Distress symptoms among bereaved individuals". Death Studies. 34 (6): 475–99. doi:10.1080/07481187.2010.483332. PMC 3909885. PMID 24482856.
32. Allen Frances (14 August 2010). "Good Grief". The New York Times.
33. Prigerson, Holly G.; Horowitz, Mardi J.; Jacobs, Selby C.; Parkes, Colin M.; Aslan, Mihaela; et al. (4 August 2009). Brayne, Carol (ed.). "Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11". PLOS Medicine. Public Library of Science (PLoS). 6 (8): e1000121. doi:10.1371/journal.pmed.1000121. ISSN 1549-1676. PMC 2711304. PMID 19652695.
34. Wakefield, Jerome C (2012). "Should prolonged grief be reclassified as a mental disorder in DSM-5?: reconsidering the empirical and conceptual arguments for complicated grief disorder". The Journal of Nervous and Mental Disease. 200 (6): 499–511. doi:10.1097/NMD.0b013e3182482155. PMID 22652615.
35. Bonanno, George A. (2006). "Is Complicated Grief a Valid Construct?". Clinical Psychology: Science and Practice. 13 (2): 129. doi:10.1111/j.1468-2850.2006.00014.x.
36. Shear, K. (2005). "Treatment of Complicated Grief: A Randomized Controlled Trial". JAMA: The Journal of the American Medical Association. 293 (21): 2601–08. doi:10.1001/jama.293.21.2601. PMC 5953417. PMID 15928281.
37. Newson, Rachel S.; Boelen, Paul A.; Hek, Karin; Hofman, Albert; Tiemeier, Henning (2011). "The prevalence and characteristics of complicated grief in older adults". Journal of Affective Disorders. 132 (1–2): 231–38. doi:10.1016/j.jad.2011.02.021. PMID 21397336.
38. "Complicated grief". Mayo Clinic. 29 September 2011. Retrieved 10 March 2023.
39. Rosenzweig, Andrew; Prigerson, Holly; Miller, Mark D.; Reynolds, Charles F. (1997). "Bereavement and Late-Life Depression: Grief and Its Complications in the Elderly". Annual Review of Medicine. 48: 421–28. doi:10.1146/annurev.med.48.1.421. PMID 9046973.
40. Nakajima, S.; Ito, M.; Shirai, A.; Konishi, T. (June 2012). "Complicated grief in those bereaved by violent death: the effects of post-traumatic stress disorder on complicated grief". Dialogues in Clinical Neuroscience. 14 (2): 210–14. doi:10.31887/DCNS.2012.14.2/snakajima. PMC 3384450. PMID 22754294.
41. Shear, M. Katherine (8 January 2015). "Complicated Grief". New England Journal of Medicine. 372 (2): 153–160. doi:10.1056/NEJMcp1315618. ISSN 0028-4793. PMID 25564898.
42. Kempson, Diane; Conley, Virginia M.; Murdock, Victoria (2008). "Unearthing the Construct of Transgenerational Grief: The "Ghost" of the Sibling Never Known". Illness, Crisis & Loss. 16 (4): 271–84. doi:10.2190/IL.16.4.aa. S2CID 144807471.
43. Sheppard, Caroline H.; Steele, William (2003). . Trauma and Loss: Research and Interventions. Nat'l Inst for Trauma and Loss in Children. Archived from the original on 7 May 2009. Retrieved 22 January 2010.
44. Pettit, Becky (March 2000). (PDF). Center for Research on Child Wellbeing Working Papers. CRCW, Princeton University. Archived from the original (PDF) on 20 July 2011. Retrieved 22 January 2010.
45. Oesterreich, Lesia (April 2004). "Understanding children: moving to a new home" (PDF). Iowa State University. Retrieved 22 January 2010.
46. Wertsch, Mary Edwards (1991). Military Brats: Legacies of Childhood Inside the Fortress (1st hardcover ed.). Harmony. p. 350. ISBN 051758400X.
47. Stepp, G (2007). "Disenfranchised Grief". Vision Journal. Retrieved 3 November 2011.
48. Corr, Charles A. (February 1999). "Enhancing the Concept of Disenfranchised Grief". OMEGA - Journal of Death and Dying. 38 (1): 1–20. doi:10.2190/ld26-42a6-1eav-3mdn. ISSN 0030-2228. S2CID 143701184.
49. For a true account of one couples' experience with the stillbirth of their baby, see Brad Stetson, Tender Fingerprints: A True Story of Loss and Resolution, (Grand Rapids, Michigan: Zondervan, 1999).
50. Span, Paula (29 September 2017). "A Child's Death Brings 'Trauma That Doesn't Go Away'". The New York Times. ISSN 0362-4331. Retrieved 27 April 2021.
51. For discussion of this process, see Brad Stetson, Living Victims, Stolen Lives: Parents of Murdered Children Speak to America, (Amityville, N. Y.: Belsey, A. (1998). Journalism and Ethics: Can They Co-exist? Matthew Kieran (Ed), 1–14. Retrieved from link.library.curtin.edu.au Press, 2003^{[permanent dead link][page needed]}
52. "Understanding About Grief | PsychologistAnywhereAnytime.com". psychologistanywhereanytime.com.
53. Lang, Diana; Cone, Nick; Lally, Martha; Valentine-French, Suzanne; Carter, Sarah; Hoiland, Sarah (1 August 2022). "Grief, Bereavement, and Mourning". {{cite journal}}: Cite journal requires |journal= (help)
54. Bergner, Annekathrin; Beyer, Reinhard; Klapp, Burghard F.; Rauchfuss, Martina (1 January 2008). "Pregnancy after early pregnancy loss: A prospective study of anxiety, depressive symptomatology and coping". Journal of Psychosomatic Obstetrics & Gynecology. 29 (2): 105–113. doi:10.1080/01674820701687521. ISSN 0167-482X. PMID 17943588. S2CID 19646272.
55. "How Suicide Bereavement is Different". Alliance of Hope.
56. maple, M; Edwards, H; Minichello V (May 2010). "Silenced Voices: hearing the stories of parents bereaved through suicide death of a young adult child". Health and Social Care in the Community. 18 (3): 241–48. doi:10.1111/j.1365-2524.2009.00886.x. PMID 19793388.
57. See Gerald Rochelle, Goodbye: grief from beginning to end, Cambridge House, 2013.
58. "Grieving the Loss of a Sibling". Cancer.Net.
59. . Archived from the original on 12 August 2015. Retrieved 8 September 2015.
60. P. Gill White, Sibling Grief: Healing After the Death of a Sister or Brother (iUniverse, 2006), 47.^{[ISBN missing]}
61. "Understanding Sibling Loss", CIGNA; Sibling Grief, P. Gill White, Ph.D.; and Surviving the Death of a Sibling, T.J. Wray.^{[page needed]}
62. Marshall, H (2004). "Midlife loss of parents: The Transition from Adult Child to Orphan". Ageing International. 29 (4): 351–67. doi:10.1007/s12126-004-1004-5. S2CID 145804476.
63. "When do We Lose Our Parents?".
64. Ellis, J; Lloyd-Williams, M (July 2008). "Perspectives on the impact of early parent loss in adulthood in the UK: narratives provide the way forward". European Journal of Cancer Care. 17 (4): 317–18. doi:10.1111/j.1365-2354.2008.00963.x. PMID 18638179.
65. Cerel, Julie; Fristad, Mary A.; Verducci, Joseph; Weller, Ronald A.; Weller, Elizabeth B. (2006). "Childhood Bereavement: Psychopathology in the 2 Years Postparental Death". Journal of the American Academy of Child & Adolescent Psychiatry. 45 (6): 681–90. doi:10.1097/01.chi.0000215327.58799.05. PMID 16721318.
66. Ainsworth, Mary D. Salter; Bell, Silvia M. (1970). "Attachment, Exploration, and Separation: Illustrated by the Behavior of One-Year-Olds in a Strange Situation". Child Development. 41 (1): 49–67. doi:10.2307/1127388. JSTOR 1127388. PMID 5490680.
67. Frankiel, Rita V. (March 1994). Essential Papers on Object Loss. NYU Press. ISBN 978-0-8147-2607-5.
68. Hiyoshi, A; Berg, L; Grotta, A; Almquist, Y; Rostila, M (1 September 2020). "Childhood bereavement and adult mortality: A 65-year follow-up of the Stockholm birth cohort". European Journal of Public Health. 30 (Supplement_5): ckaa165.051. doi:10.1093/eurpub/ckaa165.051. ISSN 1101-1262.
69. Feigelman, William; Rosen, Zohn; Joiner, Thomas; Silva, Caroline; Mueller, Anna S. (16 March 2017). "Examining longer-term effects of parental death in adolescents and young adults: Evidence from the National Longitudinal Survey of Adolescent to Adult Health". Death Studies. 41 (3): 133–43. doi:10.1080/07481187.2016.1226990. ISSN 0748-1187. PMC 7219956. PMID 27813715.
70. Cash, Scottye J; Bridge, Jeffrey A (October 2009). "Epidemiology of youth suicide and suicidal behavior". Current Opinion in Pediatrics. 21 (5): 613–19. doi:10.1097/MOP.0b013e32833063e1. ISSN 1040-8703. PMC 2885157. PMID 19644372.
71. Bordere, Tashel (February 2017). "Disenfranchisement and Ambiguity in the Face of Loss: The Suffocated Grief of Sexual Assault Survivors: Sexual Assault, Loss, and Grief". Family Relations. 66 (1): 29–45. doi:10.1111/fare.12231.
72. Davis, Edna; Kidd, Liz; Pringle, Keith (1987). Child Sexual Abuse Training Programme For Foster Parents With Teenage Placements. Barkingside: Barnardos.
73. Pringle, Keith (1990). Managing to Survive. Barkingside: Barnardos.
74. Pringle, Keith (1995). Men, Masculinities and Social Welfare. London: UCL Press/Taylor and Francis.
75. Leek Openshaw, L (April 2011). "School-based support groups for traumatized students". School Psychology International. 32 (2): 163–78. doi:10.1177/0143034311400830. S2CID 220161595.
76. Hutson, Sadie P.; Hall, Joanne M.; Pack, Frankie L. (1 January 2015). "Survivor Guilt". Advances in Nursing Science. 38 (1): 20–33. doi:10.1097/ANS.0000000000000058. PMID 25635503. S2CID 23485053.
77. John W. James and Russell Friedman, The Grief Recovery Handbook, 20th Anniversary Expanded Edition (William Morrow Paperbacks, 2009), 5.
78. Lubens, Pauline; Silver, Roxane Cohen (March 2019). "Grief in Veterans: An Unexplored Consequence of War". American Journal of Public Health. 109 (3): 394–95. doi:10.2105/AJPH.2018.304924. ISSN 0090-0036. PMC 6366488. PMID 30726138.
79. Guthrie, Interview by Stan (February 2004). "The Gradual Grief of Alzheimer's". ChristianityToday.com.
80. "By Degrees – Living and Dying". Mundane Faithfulness. 29 December 2014.
81. Milton Crum. "Bereavement: Long Term" (PDF). Association of Hospice and Palliative Care Chaplains in the UK. Retrieved 7 August 2015.
82. Kamp, Karina Stengaard; Steffen, Edith Maria; Alderson-Day, Ben; Allen, Paul; Austad, Anne; Hayes, Jacqueline; Larøi, Frank; Ratcliffe, Matthew; Sabucedo, Pablo (4 November 2020). "Sensory and Quasi-Sensory Experiences of the Deceased in Bereavement: An Interdisciplinary and Integrative Review". Schizophr Bull. Oxford University Press. 46 (6): 1367–81. doi:10.1093/schbul/sbaa113. ISSN 0586-7614. OCLC 8874703671. PMC 7707065. PMID 33099644.
83. "Finding Grief Support That is Right for You".
84. ""Interim Hospice Bereavement and Grief" Accessed September 5, 2015". from the original on 6 April 2015.
85. MedlinePlus Encyclopedia: Grief
86. van der Hart, Onno; Brown, Paul; Turco, Ronald N. (1990). "Hypnotherapy for Traumatic Grief: Janetian and Modern Approaches Integrated". American Journal of Clinical Hypnosis. 32 (4): 263–71. doi:10.1080/00029157.1990.10402833. PMID 2186612.
87. Hart, O.; Brown, P.; Turco, R.N. (April 1989). "Hypnotherapy for Traumatic Grief: Janetian and modern approaches integrated" (PDF). American Journal of Clinical Hypnosis. 32 (4): 1–6.
88. Buser, Trevor J.; Buser, Juleen K.; Gladding, Samuel T. (2005). "Good Grief: The Part of Arts in Healing Loss and Grief". Journal of Creativity in Mental Health. Informa UK Limited. 1 (3–4): 173–183. doi:10.1300/j456v01n03_10. ISSN 1540-1383. S2CID 145016908.
89. Lichtenthal, W.G.; Cruess D.G. (2010). "Effects of Directed Written Disclosure on Grief and Distress symptoms among Bereaved individuals". Death Studies. 34 (6): 475–99. doi:10.1080/07481187.2010.483332. PMC 3909885. PMID 24482856.
90. Hoy, William G. (2016). Bereavement Groups and the Role of Social Support: Integrating Theory, Research, and Practice. New York: Routledge. ISBN 978-1138916890.
91. Rosenstein, D.; Yopp, J. (2018). The Group: Seven Widowed Fathers Reimagine Life. Oxford University Press. ISBN 978-0190649562.
92. Nierenberg, Amelia (28 October 2019). "For Many Widows, the Hardest Part Is Mealtime (Published 2019)". The New York Times. ISSN 0362-4331. Retrieved 23 November 2020.
93. Nagel (1988). "Unresolved Grief and Mourning in Navajo Women". American Indian and Alaska Native Mental Health Research. 2 (2): 32–40. doi:10.5820/aian.0202.1988.32. ISSN 0893-5394. PMID 3154875.
94. Santrock, John W. (2018). A topical approach to life-span development (Ninth ed.). New York, NY. ISBN 978-1-259-70878-7. OCLC 968303340.{{cite book}}: CS1 maint: location missing publisher (link)
95. Almeida, Rochelle (2004). The Politics of Mourning: Grief Management in a Cross-Cultural Fiction. Rosemont Publishing Company, Associated University Press. ISBN 0838640273.
96. McRitchie, Robyn; McKenzie, Karen; Quayle, Ethel; Harlin, Margaret; Neumann, Katja (27 August 2013). "How Adults With an Intellectual Disability Experience Bereavement and Grief: A Qualitative Exploration" (PDF). Death Studies. Informa UK Limited. 38 (3): 179–185. doi:10.1080/07481187.2012.738772. ISSN 0748-1187. PMID 24524546. S2CID 205584795.
97. Gilrane-McGarry, U.; Taggart, L. (2007). "An exploration of the support received by people with intellectual disabilities who have been bereaved". Journal of Research in Nursing. SAGE Publications. 12 (2): 129–144. doi:10.1177/1744987106075611. ISSN 1744-9871. S2CID 145479747.
98. McEvoy, John; Smith, Elaine (2005). "Families Perceptions of the Grieving Process and Concept of Death in Individuals with Intellectual Disabilities". The British Journal of Development Disabilities. Informa UK Limited. 51 (100): 17–25. doi:10.1179/096979505799103803. ISSN 0969-7950. S2CID 145265620.
99. Clute, Mary Ann (2010). "Bereavement Interventions for Adults with Intellectual Disabilities: What Works?". OMEGA - Journal of Death and Dying. SAGE Publications. 61 (2): 163–177. doi:10.2190/om.61.2.e. ISSN 0030-2228. PMID 20712142. S2CID 28709815.
100. Kluger, Jefferey (15 April 2013). "The Mystery of animal Grief". Time. Retrieved 18 October 2020.
101. "When Animals Grieve". National Wildlife Federation. Retrieved 21 June 2021.
102. Lonsdorf, Elizabeth V.; Wilson, Michael L.; Boehm, Emily; Delaney-Soesman, Josephine; Grebey, Tessa; Murray, Carson; Wellens, Kaitlin; Pusey, Anne E. (July 2020). "Why chimpanzees carry dead infants: an empirical assessment of existing hypotheses". Royal Society Open Science. 7 (7): 200931. Bibcode:2020RSOS....700931L. doi:10.1098/rsos.200931. ISSN 2054-5703. PMC 7428235. PMID 32874665.
103. Fiore, Robin (May 2013). What Defines Us: An Analysis of Grieving Behavior in Non-Human Primates as a Potential Evolutionary Adaptation (Thesis). University of Colorado at Boulder. p. 49.
104. "Gorilla's Pet: Koko Mourns Kitten's Death". Los Angeles Times. 10 January 1985. Retrieved 21 June 2021.
105. "The Depths of Animal Grief". www.pbs.org. 8 July 2015. Retrieved 23 June 2021.
106. wen, Chu (2005). Notes Of A Desolate Man. New York: Columbia University Press. p. 21. ISBN 9780231500081.
107. Frequently Asked Questions about Swans 29 September 2015 at the Wayback Machine, The Swan Sanctuary
108. Wedderburn, Pete (3 September 2015). "Animals grieve just as people do". The Telegraph. Archived from the original on 12 January 2022. Retrieved 7 July 2019.
109. "Male Swan Holds Vigil at Nest After Teens Kill His Mate". TreeHugger. Retrieved 7 July 2019.

Further reading

• Black, H. K.; Santanello, H. R. (2012). "The Salience of Family Worldview in Mourning an Elderly Husband and Father". The Gerontologist. 52 (4): 472–83. doi:10.1093/geront/gnr148. PMC 3391382. PMID 22241808.
• Cholbi, Michael (2022). Grief—A Philosophical Guide. Princeton: Princeton University Press. ISBN 9780691201795.
• Hoy, William G. (2016). Bereavement Groups and the Role of Social Support: Integrating Theory, Research, and Practice. New York: Routledge.
• Newson, Rachel S.; Boelen, Paul A.; Hek, Karin; Hofman, Albert; Tiemeier, Henning (2011). "The Prevalence and Characteristics of Complicated Grief in Older Adults". Journal of Affective Disorders. 132 (1–2): 231–38. doi:10.1016/j.jad.2011.02.021. PMID 21397336.
• Rosenstein, Donald L.; Yopp, Justin M. (2018). The Group—Seven Widowed Fathers Reimagine Life. New York: Oxford University Press. ISBN 9780190649562.
• Schmid, Wilhelm, What We Gain as We Grow Older: On Gelassenheit. New York: Upper West Side Philosophers, Inc. 2016 (Living Now Gold Award)
• Shear, M. Katherine (8 January 2015). "Complicated Grief". New England Journal of Medicine. 372 (2): 153–60. doi:10.1056/NEJMcp1315618. ISSN 0028-4793. PMID 25564898.
• Smith, Melinda; Robinson, Lawrence; Segal, Jeanne. (1997). . Helpguide, Retrieved 8 February 2012.
• Span, Paula. (29 December 2011). The unspoken diagnosis: Old age. The New York Times. Retrieved 8 February 2012
• Stengel, Kathrin, November Rose: A Speech on Death. New York: Upper West Side Philosophers, Inc. 2007 (Independent Publisher Book Award for Aging/Death & Dying)

External links

 

Wikiquote has quotations related to Grief.

 

Look up grief in Wiktionary, the free dictionary.

• "Grieving: A study of bereavement" by Megan O'Rourke at Slate.com
• "Grief & Bereavement – An Overview by Associated Counsellors & Psychologists