The term “grief” can even seem sub-par for what you are going through. We are so sorry and just know there are therapists, counselors, and psychologists out there who can help. On this page, we are going to attempt to tackle, with words, the unbearable feelings you may be going through and provide some ideas and a framework around getting through loss in a healthy way. We also try and answer some of the common questions regarding the stages of grief, general ideas of healthy mourning and the differences between normal grieving, complicated grief and pathological grief and depression.
What is Grief
Grief is the word used to name the common, normal, experience of sadness and loss one experiences when losing a loved one, an aspect of the self, or an idea/template of how the future was supposed to go. However, grief and loss aren’t always about losing another person. People grieve when they divorce, experience a sudden change in health status, lose physical abilities, lose a pregnancy, lose a job they love, have to suddenly move, or even when they are affected by another’s significant loss. There are many different types of loss and this list is not exhaustive. Grief is a completely natural and normal response that is both incredibly universal, yet uniquely personal.
What are the Stages of Grief?
You may have heard of the “stages of grief.” It is almost common knowledge and parlance these days. The stages come from the experience and research of an incredible long-time hospice nurse named Elizabeth Kubler-Ross. The stages of grief are as follows:
Denial – Avoidance, confusion, elation, shock, fear
Anger – Frustration, irritation, anxiety
Bargaining – Struggling to find meaning, reaching out to others, Telling your story
Depression – Overwhelmed, helplessness, full peak of sadness
Acceptance – Exploring options, new plan in place, Moving forwards
Do the 5 stages of the grieving process happen in order?
When the stages of grief were developed it was under the idea that these stages happen in sequential order. Since then, additional research has been done and it is clear that people move in and out of different stages at different times. Thinking of the stages as a linear road map to healing is an old notion and not a great idea. For that, we recommend Worden’s Tasks of Mourning.
Worden’s Tasks of Mourning
Worden’s tasks are specific to grief and loss about losing another person and we find this to be more helpful than the framework of Kubler-Ross’s stages of grief. We prefer this model because it gives more of a directive path towards healing rather than descriptive stages. Worden’s tasks are:
Task 1: To accept the reality of the loss
Task 2: To work through the pain of grief
Task 3: To adjust to an environment in which your loved one is missing
Task 4: To find an enduring connection with your loved one while embarking on a new life
Many of our patients have found this framework and advice to be really helpful. Different from the Stages of Grief, it outlines a process one has to move through in order to regain their lives after the death of a loved one.
What is the difference between grief and depression?
Grief and depression can sometimes feel the same but they are very different states. It is important not to pathologize your grief and it’s even more important to work towards opening up to and allowing the pain, sadness, and loss. Any therapist or mental health professional should be able to help you determine which place you might be in. It’s not always obvious and in fact the Diagnostic and Statistical Manual of Mental Disorders (DSM) has wrestled with this for ages. In fact, acute bereavement was recently removed from the diagnostic criteria of depression, demonstrating just how blurry the line is can be between grief and depression. However, the diagnosis of depression includes many features that are often not present in grief. This includes loss of pleasure in activities previously enjoyed, feelings of worthlessness and guilt, indecisiveness and concentration difficulties and suicidal thinking. Shared elements of grief and depression include depressed mood, irritability, fatigue, changes in sleep, and changes in appetite.
Although both states include profound sadness, those with depression report that the experience of sadness is more of a numbing, consistent, sedative type sadness (“sunny days always feel gloomy”) as opposed to the waves of a very activated sadness that accompany a state of grief. In grief, there are still sunny days (or moments, at least). The sadness one experiences in grief is also typically directed at the specific loss as opposed to a more general, consuming state as seen in depression. Grief also includes more tearfulness than depression, neglecting routines and self-care, and anger tends to be more prominent (at the self, the person lost, or god).
It’s our experience that grief has a tendency to turn into depression when people are unable to open to and allow the full experience of loss. Ironically, resisting grief is a frequent cause of depression. Getting stuck in anger, neglecting to find meaning within your personal view of life, incessant questioning, Monday-morning quarterbacking the loss (e.g. “If only I would have stopped by their house last week like I wanted to” or “If I had just texted them this morning”) and isolation can take healthy grief and transition it towards depression.
How long should I mourn?
Many people want an answer about how long they “should” mourn. I wish there was a clear answer to this. Everyone is so unique in how they experience a loss. One of the reasons for this is that when someone experiences a loss of any kind it pulls on all the previous loss they have experienced in life. We don’t “purely” grieve as we would like to think. You may find yourself thinking about previous losses in your life and grieving those again during acute bereavement and that is absolutely ok. In fact, it’s healthy. Feeling guilty for believing you have moved on too quick, believing you haven’t grieved enough, blaming yourself for not feeling “sad enough”, being angry at feeling numb, or fear about the grief persisting indefinitely (although normal) are typically not helpful states of mind. Be careful and if you see elements of yourself in those descriptions, please reach out to us as soon as possible.
There is no such thing as too much grief and we want to make sure you get through this loss in-tact and as a whole person. If you are looking for more of an answer here, some research on grief shows that a big chunk of people start to feel better in 6-8 weeks, where another large chunk reported it took anywhere between 6 months and two years. I remember a woman I saw several years ago, 6 months after a major loss shared, “Doc, I went to the movies this weekend and I actually enjoyed my popcorn. I know this sounds strange but it was the first time since losing X that I felt some enjoyment again. I think it’s a sign that things are finally getting better.” Again, don’t resist, allow, and take it a day at a time. Try your best not to look to the future but open to the emotions that are in your present. Doing this with a licensed therapist can be incredibly helpful – we will tackle this more in the next question.
Do I need professional help for grief?
In our experience, those who see a clinical psychologist to address issues of grief and loss get back on their feet much quicker than those who don’t. If you are finding yourself feeling stuck, overwhelmed, depressed, lonely and without support, struggling to find people who understand, or noticing a flare up in previous mental health issues it may be time to start some therapy sessions. We have a great reputation for helping people get back on their feet and provide the type of therapy that will help. We can also provide a document called a “superbill” so that you can seek reimbursement through your health insurance provider. Our practice is connected to various grief counseling groups in the area and when you are ready, we can help bridge your care to one of those groups if you are open to it or believe group therapy might be helpful. Professional help certainly won’t hurt, please reach out to us if you have any questions. Even if you won’t be seeing a member of our team, we still like to help people get to where they need to go and we can provide grief resources in the community.
What should I do to help me come to terms with grief and loss?
Here are some helpful ideas we have come up with over the years:
-Individual and Group Therapy for Grief. Use therapy to open up fully to your grief/loss. There is something about moving into the feelings, rather than out and away from them that is incredibly healing and even transformative. We know how hard it is but there is a realistic hope for healing and growth if you work through your loss in the right ways. Google the research on “Post Traumatic Growth” its actually pretty amazing what we have come to understand about bearing the unbearable and coming out better on the other side.
-Spending time with others (even when it feels counter-intuitive)
-Connect to other people that knew and loved the person or who can understand your situation
-Spend time outdoors
-Reconnect to activities that bring you joy
-Journaling memories of the person or journaling your experience through a loss
-Adopting a pet. Obviously, if you are up for the work that goes into a new best friend.
-Starting a small outdoor garden. There is something about new life that makes loss more digestible.
-Grieve. Don’t push back on it. Create some space and time in your life to do this. If you need to take time off of work, we suggest 1-2 weeks. It is important to return to your normal routine as soon as possible.
-If your loss is about another person, create a memorial-type space in your home that has important pictures, memories, possessions, flowers, etc. Having it all in one space rather than spread throughout the house has consistently been reported as a helpful step to take when you are ready.
-Go for a walk, get exercise as much as you feel you can. Exercise helps to support mood and research shows can be just as effective, if not more, than antidepressant medications.
-Make sure you are eating. Even if it’s only a little bit, keep up with the routine of regular meals and self-care if possible.
Grief doesn’t have to be the end of your joy. Many who use therapy as a way to navigate their grief come out feeling like they personally grew in processing their loss. With the right approach it becomes an opportunity to evolve into the next version of yourself. We would love help you get there.
Keil Psych Group’s Grief Book Recommendation
Bearing the Unbearable