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Key facts

Grief is a response to the loss of someone or something that was important.

Grief can occur after a death, divorce, illness or other significant loss.

Grief can affect your physical and mental health.

The experience of grief is different for everyone.

What are grief and loss?

Grief is the natural emotional response to the loss of someone close, such as a family member or friend. Grief can also occur after a serious illness, a divorce or other significant losses.

Grief often involves intense sadness, and sometimes feelings of shock and numbness, or even denial and anger. For most people, the intensity of grief eases over time and the episodes of grief become less frequent.

Grief is a process or journey that affects everyone differently. It can be exhausting and emotionally draining. This can make it hard to do simple things or even leave the house. Some people cope by becoming more active.

Grief has no set pattern. It is expressed differently across different cultures. Some people like to be expressive and public with their emotions, while others like to keep their feelings private.

Most people find that grief lessens with time. A person who loses a loved one may always carry sadness and miss the person who has died, but they are able to find meaning and experience pleasure again. Some people even find new wisdom and strength after experiences of loss.
Video provided by CarerHelp - Chris Hall: Tips for managing grief.
Are there different types of grief and loss?

Grief is usually described in relation to the death of a loved one, but other types of major loss can also lead to feelings of grief. The more significant a loss, the more intense grief may be.

People may feel grief over:

the death of a loved one - grief can be particularly severe following the death of an infant or child, or a suicide

divorce or separation

the loss of a beloved pet

giving up something that mattered

work changes - for example, unemployment, retirement or retrenchment

the diagnosis of a terminal illness

the loss of good health because of an illness, accident or disability

miscarriage or infertility

having a child with a disability, a terminal illness, a mental illness or a substance abuse problem

moving away or separation from family or friends

having an 'empty nest' when children leave home

What are the effects of grief?

A person may have intense feelings of grief. This can feel overwhelming, making it seem hard or even impossible to think about anything else. For some people, these feelings or thoughts may be so difficult to deal with that they push them down or mask them, either all or some of the time.

The effects of grief can often resemble depression, and some people do develop depression following a significant loss. If you are dealing with a major loss and finding it difficult to cope, see your doctor.

Immediately after a death, those left behind often feel shocked, numb and in denial, particularly if the death was unexpected.

When they begin to understand the reality of death, they can feel intensely sad, empty or lonely, and sometimes angry or guilty.

The feelings can be painful, constant or overwhelming. Grief can come in waves, seeming to fade away for a while before returning. But over time, the feelings gradually subside.

Everybody reacts to grief differently. Common feelings include:

Emotions

People might feel or act differently to usual when they are grieving. They might have difficulty concentrating, withdraw and not enjoy their usual activities. They may drink, smoke or use drugs. They may also have thoughts of hurting themselves or that they can't go on.

Physical health

Grief can be exhausting, and this may weaken the immune system. This makes people prone to colds and other illness. Grief can affect the appetite and lead to changes in weight. It can affect sleep and leave people feeling very tired. It can also lead to stomach aches, headaches and body aches.

Spiritual life

Some people may have dreams about their loved one in which they feel their presence or hear their voice. People who are grieving often search for meaning and examine their spiritual beliefs.

Post-traumatic growth

Some people have positive experiences following grief and loss, such as a new sense of wisdom, maturity and meaning in life.

Complicated grief and depression

In some people, grief can be prolonged or more intense. This may interfere with their ability to cope with everyday life. This may be more likely if the loss was particularly traumatic, such as a suicide or death of a child.

Prolonged grief (also referred to as complex or complicated grief) is a persistent form of intense grief where people find it very difficult to live with the loss. Instead of gradually thinking more positively, thoughts may become stuck in a dark, sorrowful place. Some people may describe this time as being emotionally paralysed and unable to think past the grief and loss. They may feel very lost and alone. In this state, it is common to:

feel confused

feel a sense of overwhelming sadness

have more extreme thoughts and behaviours, which may or may not be linked to the experience

have an ongoing longing for the past

Someone with prolonged grief may have a fixed preoccupation with thoughts and memories of the person who died, making the future seem empty and hopeless.

When should I seek help for my grief?

If you have persistent feelings of sadness and despair, and are unable to experience happiness, you may be experiencing depression. If your feelings are getting in the way of your everyday life, then it's important to seek help.

For some people, grief might not lessen even after time passes. The grief can significantly disrupt their life, affecting jobs, relationships and how they interact in the community.

You may need to seek help if you:

feel like grief makes it very difficult to do anything

have difficulty socialising

have difficulty sleeping

change the way you eat (lose your appetite or overeat)

experience intense and ongoing emotions such as anger, sadness, numbness, anxiety, depression, despair, emptiness and/or guilt

have thoughts of harming yourself

How can I cope with grief?

If you experience grief or loss, you may always feel some sadness and miss a person once they are gone, but the painful, intense feelings should gradually subside. It eventually becomes easier to deal with life.

Griefline supports anyone experiencing different types of grief and offers resources and support so you don't feel alone.

Allow yourself to grieve

It is natural to cry. Many people find crying a relief. Exploring and expressing emotions can be a part of grief. Listening to music or writing can help. Time spent alone can allow you to connect with your emotions.

Live one day at a time

Set a regular daily routine and do something special for yourself every day. Try to go for a walk, eat healthily, meditate and relax. It's a good idea to avoid making any major decisions for a year after the death of someone you love.

Seek help

Talking to your doctor, people at a support group or a relative or friend you trust can be a big help.

Stay connected

It's important to spend time with supportive people. Accept offers of help, talk about your loved one, or simply spend time with others.

Create positive memories

Honour the life of the person who has died. Collect photos or keepsakes, write a journal, write a letter to the person who died, or share stories and rituals with others. These can all help to create meaning after loss.

Look after your health

Get some regular exercise and eat healthy food, and make sure you have enough sleep. Avoid recreational drugs and drink alcohol sensibly.

Experiencing anniversaries

Birthdays, anniversaries or holidays can trigger intense feelings of grief. It may help to mark these occasions with a simple ceremony like lighting a candle, playing music or gathering with family.

How can I support a grieving loved one?

Initiate contact

Get in touch and be available to spend time together. Respect that your friend may need to cry, hug, talk, be silent or be alone.

Listen

It can be difficult to know what to say, particularly if you have not experienced grief before. There may be no words that can really help but listening can be a great support. Don't be afraid to talk about the person who has died - the person you are supporting may want to hear their name. Try to avoid giving advice or using clichés.

Do something together

Spend some time doing ordinary and positive things together, like watching a movie, going for a walk or having a meal.

Practical help

Cooking meals or looking after children can be a great gift to people dealing with grief.

Be aware

Grief may last for a long time. Birthdays and anniversaries may be difficult for a bereaved person, so calling them on that day can let them know you haven't forgotten.

Other questions you might have

How long does grief last?

Every person grieves differently and there is no set timeframe for how long grief may last. Some people may mourn for 6 months, others for several years. There are many factors involved in how long grief may last. It is important to give yourself time to grieve and not feel rushed to 'move on' before you are ready.

How do I move on?

The term 'moving on' can be unhelpful, because as life moves forward you need to move with it. As each day goes by you are moving forward, but the phrase moving on can feel as though you need to get over the passing of a loved one. It's important to remember that moving on does not mean forgetting but learning how to live without that person in your life. Moving on doesn't mean that your grief will end, but that you will learn to live with it.

Resources and support

For more information and support, try these resources:

Lifeline offer 24-hour crisis support. If you need to talk to someone about how you're feeling, call Lifeline on 13 11 14.

Headspace offers excellent resources to help you cope.

Parentline - 8am to 12 midnight, 7 days a week, call 13 22 89.

Australian Centre for Grief and Bereavement - bereavement counselling and support services. Call 1800 642 066.

MensLine Australia - 24 hours, 7 days. Call 1300 78 99 78.

Suicide Call Back Service- 24 hours, 7 days. Call 1300 659 467.

Kids Helpline - 24 hours, 7 days. Call 1800 55 1800.

Griefline - 8am to 8pm (AEST), 7 days a week, Call 1300 845 745.

If you need to know more about grief, and to get advice on what to do next, you can also call healthdirect on 1800 022 222 to speak with a registered nurse, 24 hours, 7 days a week (known as NURSE-ON-CALL in Victoria).

Other languages

Do you prefer other languages to English? These websites offer translated information:

Last reviewed: April 2022

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It's the natural emotional response to losing someone who was close to you, but grief can also follow serious illness, divorce or other loss.

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Two Decades Later, the Enduring Legacy of 9/11

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Twenty years ago, Americans came together – bonded by sadness and patriotism – after the 9/11 terrorist attacks. But a review of public opinion in the two decades since finds that unity was fleeting. It also shows how support for the wars in Afghanistan and Iraq was strong initially but fell over time.

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Given time and space, grieving families can strengthen bonds.

When Sharlee Mullins Glenn (BA '85, MA '89) was 5 years old, her father died in a mining accident. Four months later, her oldest brother drowned. The intense grief that followed for Sharlee, her mother, and her five remaining siblings forged a family strength that has served them well for 50 years now. Not only did they survive, but they grew in understanding, love, and commitment. "We were always a loving and affectionate family, but after those deaths, we became incredibly tight," says Glenn. "We became a family of best friends. People often commented on how close we were, how affectionate. Not that we didn't have our squabbles, but our ultimate devotion to each other was never a question."

But tragedies don't automatically draw families closer, says Karen de la Cruz, an assistant teaching professor in the College of Nursing who specializes in transcultural death and grief. "Whatever the family dynamics are before a death or other stressful event, they're accentuated when a stressor hits. Dysfunctional families may become more dysfunctional without intervention. Healthier families will likely fare quite well and can even thrive," says de la Cruz, who was widowed in her 40s and has learned about death and grief for 30 years as a pediatric-oncology, emergency-room, and intensive-care nurse.

De la Cruz recommends that families prepare for inevitable losses by continuously strengthening their family relationships and learning basic grieving principles.

Companions in Grief

As families grieve together, they can be intentional about supporting one another. They can allow venting, reminisce together about the deceased, and look out for each other. When Glenn's father and brother died, she says all the siblings "watched each other's backs." When she was in the fourth grade, she gave a "good pounding" to a sixth grader who was picking on her little brother.

De la Cruz had two children in middle school when her husband died suddenly in 2004. They would see each other in the halls and check out how they were doing just by looking at each other's faces. "If they reached a point during the day when they couldn't cope, they could flash a signal and the other would step in to help," she says.

This healthy looking out for one another presupposes a family culture where supportive behaviors are already consistent. When tragedy occurs in such families, they can lean on each other when they're feeling shaky. Supportive families, says de la Cruz, remember that "God put us on this earth to help each other and that we're all going to go through tough times."

There's No Right Way

Researchers have suggested many grief models over the years, such as Elizabeth Kübler-Ross's five stages of grief (denial, anger, bargaining, depression, acceptance), but these are just constructs for trying to make sense of an experience that usually doesn't make much sense, says de la Cruz. And they can do harm when used to dictate how a person "ought" to grieve.

"The five stages are rough guidelines," she says. "They don't happen in order, and they're much more fluid than was originally thought. You can go back and forth between them, you can be in more than one stage at once, and not everyone goes through every stage."

People grieve according to their own temperament, coping style, age or stage of life, relationship with the deceased, and previous experiences, especially experiences with death, says de la Cruz. When grieving family members criticize one another for being "too emotional" or "not talking about it enough," they can further injure their already hurting loved one.

When de la Cruz's husband died, their youngest daughter, then age 11, could not face it. "If anyone asked her about her dad, she would say he was on a business trip. That's how she coped with it. It seemed totally bizarre to the rest of us, but we gave her the time and space to deal with her grief in her own way. None of her nine siblings tried to force her to admit that Daddy was dead."

"Your way of grieving is not the 'right way' to grieve. It's just your way. [Another's] way of grieving, even though it might be very different from yours, is just as legitimate."

No Timetable

When her husband died, de la Cruz presumed that because she had dealt so much with death in her work, she could speed up her grieving. "I thought, 'I know how this grieving thing works. I'm just going to go straight to acceptance.' It did not work. Just because you know the process doesn't mean you can take shortcuts. But boy, did I try."

In the American work culture, employees are generally given three days of bereavement leave for the death of a close family member-three days to be with the dying loved one, plan and put on a funeral, and spend time with loved ones who have gathered.

"Then you're expected to get back to work," says de la Cruz. "If someone persists in grieving for any extended length of time, it's not unusual for a boss or colleagues to say, 'Really? It's been six months. Aren't you over this yet? You need to get on with your life.'"

But de la Cruz says that grief is a process, and people need time and space for it. Though society doesn't allow for realistic grieving time, individuals can draw boundaries for themselves, such as working fewer hours if possible or taking a daily nap.

Though grief diminishes over time, the idea that it will simply end is a myth, says de la Cruz. For her, the constant, excruciating rawness of early grief gave way to milder feelings, but even now, 12 years later, she has tough moments. "There are days when I still don't accept his death," she says. "'Where are you? You should be helping me!' It isn't constant, but it still pops up. That's perfectly normal."

The Benefits of Grief

As grieving individuals and families move further from the death of their loved one, they can begin to look back and see the good. "If they're patient, they'll see what they've gained," says de la Cruz. "Now I recognize my grief has made me more compassionate and more understanding. It's also made me quicker to recognize markers of grief in others so I can be supportive to them."

Glenn and her siblings are all now grown and deeply value the resilience they developed after their father's and brother's deaths: "We passed through hard things and survived. We're spread from Utah to Alaska to Washington state to Oregon, but we still have each other's backs. Our oldest sister was recently diagnosed with breast cancer, and it was heartwarming to see the way we all came together to help and support her."

Like Glenn, de la Cruz found that when death arrived in her home, her family rose to the challenge. "We had loving relationships, but I really didn't know how it was going to play out. I was amazed at how these kids nurtured each other and supported each other. We always hope our kids learn what we teach them, and it was beautiful to see that mine had."

How to Mourn with Those That Mourn
From her 10 years as a hospice chaplain and bereavement counselor, author Sue Bergin shares this list of what to do-or not do-to support grieving friends or family.
* Don't assume you have to talk. A hug or a squeeze of the hand can be more comforting than words.

* Don't tell your own grief story unless asked.

* Don't offer advice-of any kind.

* Don't assume that if someone understands the plan of salvation, they will have less need to grieve.

* Don't say things like "He's in a better place" or "At least her suffering is over." Any sentence that begins with the phrase "at least" is received as minimizing and isn't comforting.

* Don't impose your personal beliefs about death and the afterlife on the griever.

* Do give grievers your full, focused attention.

* Do share your memories of the loved one and encourage grievers to share theirs.

* Do invite grievers to short, low-intensity activities, such as lunch, family home evening, or a walk or bike ride.

* Do allow a griever to express his or her honest feelings, including anger at God and anger at the deceased.

* Do share a book or other resource that has helped you with grief.

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When Sharlee Mullins Glenn (BA '85, MA '89) was 5 years old, her father died in a mining accident. Four months later, her oldest brother drowned. The intense grief that followed for Sharlee, her mother, and her five remaining siblings forged a family strength that has served them well for 50 years now.

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Read about different experiences of grief and how it can feel to be bereaved. Learn about the grief cycle, and how grief relates to mental health.

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What is the most common subject people bring up when they first begin a new conversation? Well, in the "good old days" prior to 2020 when "quarantine" was mainly a term from our history books, "six feet" simply described someone taller than the average person and "Corona" referred to a beverage some enjoyed at a barbecue on a sunny Sunday afternoon, the answer was....the weather. Way back then, we might have begun a conversation with, "How about that heat?" or "Cold enough for you?" The weather was the most common experience we shared. Trivial? Usually. However, it provided 5-10 seconds of connection between people who might not have anything else in common.Because of the Coronavirus Pandemic, we are all connected by something far less superficial and exceedingly more painful. Loss. Everyone has lost someone or something important and personal during these unprecedented times and no race, gender or generation is immune. Some have lost loved ones, others their jobs or financial security, students have lost their learning environments. We have all lost the places where we connected regularly with peers and friends. Meaningful events, traditions and rituals have had to be cancelled or postponed such as school plays, family vacations, weddings, funerals, athletic events and graduation ceremonies. And we all have lost the stabilizing force of routine and structure as we do our best to adapt to an ever fluid world landscape. There are countless other examples.However, in this time of disconnection and isolation because of social distancing, this shared experience of loss and its accompanying levels of suffering ironically can be what brings us together. Grief is a uniquely bonding emotion and just being associated with others who have experienced similar losses is healing to some degree. The continued effectiveness for most of grief support groups is testament to this. It doesn't matter how dissimilar we may be in ethnicity, politics, socio-economic standing, sexuality or number of Instagram followers. When we believe that someone else "gets it" and "knows our pain" a connection is formed that goes beyond demographics. It's also a wonderful opportunity to add something positive to a world that desperately needs it, more now than ever: active empathy-not only understanding what another is feeling and experiencing, but having that awareness inspire us to action.This action can be as intentional as doing grocery runs for an elderly neighbor or as subtle and spontaneous as greeting a passerby on your walking path with a friendly smile, ever conscious of your mutual membership in this global grief support group. We have an innate sensitivity to those who are grieving. We would never say to someone at their spouse's funeral, "I'm so sorry for your loss, now what about that 100 bucks you owe me?" All of us likely recognize the dreadfully inappropriate timing of such a remark and cringe at the thought of it. Or when we come to realize that a person-whom we have tended to criticize-has recently lost their child, job, or marriage, we change our attitude. We might say, "Oh wow! I had no idea." A change in our perspective occurs. We exchange our harsh judgement for understanding, patience and compassion.What if we treated everyone with whom we came in contact during this lockdown with such kindness and sensitivity? What if instead of being irritable or judgmental with each other we were consciously aware of each other's suffering and recognized this common ground we all share? The encouraging news is that many of us seem to be doing this already. I've been hearing and reading more and more stories of good will gestures and folks going out of their way to be thoughtful and kind to others who perhaps are suffering more than they are. If this is you, "air high fives" coming your way! But it needs to continue and all of us need to get on board.Here are some suggestions as to how to go about this in your own lives.Be willing to acknowledge and grieve your own losses - Many of us gravitate more to the emotions of anger and anxiety during these times and shy away from sadness as it often causes us to feel more vulnerable. However, empathy is best activated when we are in touch with our own feelings. Go ahead and acknowledge your own losses. Journal about them. Share them with a loved one. Trust me, they will be able to relate to the feeling, and encourage them to share their losses with you.Remember anger is a stage of grief too - Loss can manifest itself in our emotions in ways other than sadness. Notice if you or a loved one seem to be expressing more anger than usual during these times. Since anger is a secondary emotion, meaning a more vulnerable emotion often lies beneath, it may be a sign of unprocessed mourning. Check in with them and ask about losses they are aware of.Don't compare losses - Many of us tend to minimize our own losses by comparing them to the "far greater" losses of others. And although there is an obvious intrinsic difference between the death of a loved one and having to cancel a spring break vacation, your loss is your loss and no one else's. It is appropriate and necessary to grieve your own losses without having to justify your grief and disappointment in light of other's losses that don't belong to you.Be mindful of other's suffering - As mentioned earlier, we are surrounded by people who are enduring losses along with us. The next time you go to the grocery store notice the man in the frozen foods who might be recently unemployed, or the high school senior in the cereal aisle who has already lost her senior trip, prom and is anxious she will soon lose her graduation ceremony too, or the lady in produce who is grieving the death of a loved one and the associated loss of not being able to have a funeral. Allow yourself to feel empathy and compassion for those around you even though you may not know their stories. You don't need to know the specifics, just that they are suffering through losses too, losses that are important to them.Allow active empathy to make a difference - Allow the innate compassion we all have when we are knowingly around the grieving to emerge on a daily and moment to moment basis. Have this active empathy lead you to treat others with more patience, understanding, kindness, thoughtfulness and love.In no way am I encouraging continual somberness around each other, as laughter, smiles and lightheartedness are healing in their own right. However, if all of us could actively look for opportunities to be supportive, positive and kind with one another in the midst of our global mourning, a unity could emerge from COVID19 that perhaps wouldn't have occurred without it.And here's a crazy idea. Let's keep this active empathy alive even after the lockdown is lifted. After all, it's not the heat, it's the humidity. More about Michael Dorren, Ph.D.

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Global Mourning: How shared grief can unite a world — Heritage Professional Associates

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What is the most common subject people bring up when they first begin a new conversation? Well, in the “good old days” prior to 2020 when “quarantine” was mainly a term from our history books, “six feet” simply described someone taller than the average person and “Corona” referred to a beverage some

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Depression is a feeling of sadness or a low persistent mood, lasting for some time. Grief is an emotional response to the loss of a loved one. Both have overlapping symptoms, but depression is a clinical disorder often resulting from a chemical imbalance in the brain.

Grief and depression are separate experiences, but both have symptoms of extreme sadness and can affect a person mentally and physically. Someone with grief may feel like their sadness is depression, but depression can result without any external catalyst.

has shown that grief or social loss, can lead to major depressive disorder and other physiological conditions linking to depression. Theories indicate that the grief neurological pathway can cause neurotransmitters to halt the reward system in the brain, resulting in depression.

According to the Centers for Disease Control and Prevention (CDC), 1 in 6 adults will have depression at some point in their lifetime, with various potential causes such as environmental, situational, genetic, biological, or psychological.

Grief, resulting from losing someone or something close to a person, can result in symptoms that feel like deep sadness, or depression. Complicated grief (CG) or prolonged grief disorder can occur when such feelings do not fade over time.

It is important to remember that both grief and depression are complex feelings for each person, and do not need to fit neatly under labels.

This article explains the differences and similarities between depression and grief. It will also detail ways to cope with both.

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Design by MNT; Photography by Maria Korneeva/Getty Images & Sarah Mason/Getty Images

The National Institute of Mental Health (NIMH) states depression is a severe mood disorder, affecting how a person feels, thinks, or acts. The exact of depression is unknown, but it can result from issues with mood regulation in the brain, stressful life situations, genetics, and the environment.

Grief, however, has an identifiable cause. The meaning of grief is intense sorrow over the loss of a loved one, which may include a person or a pet. Grief may feel, or even result in depression, but the roots of either can differ. Grief can occur in many situations where loss is present. This can include:

a relationship ending or divorce

losing a job

receiving a diagnosis of a chronic or severe illness

Grief is a natural human response to loss, and a result of the emotions a person feels when someone or something that is loved is no longer there. Grief usually moves in stages, resulting in acceptance and a person eventually feeling better. Depression, however, may have no identifiable cause and can last indefinitely.

The main differences include:
Read more about the stages of grief here.
Grief and mental health

Previously, the Diagnostic and Statistical Manual of Mental Disorders (DSM) stated that clinicians should avoid diagnosing someone with major depressive disorder within the first 2 months of the death of a loved one. However, this bereavement exclusion is now removed, so as not to overlook the role of major depression during bereavement, or remove the chance of correct treatment.

Prolonged grief disorder occurs when the natural grieving process persists for more than 1 year and interferes with a person's daily life. According to the American Psychiatry Association (APA), symptoms include:

feeling as though a part of oneself is dead, known as identity disruption

avoiding reminders about the deceased loved one

feeling intense emotions such as anger or deep sorrow

difficulties living life as usual, such as spending time with other family or friends, or going to work

inability to feel emotions, numbness

extreme loneliness or detachment from others

Up to 10% of adults will experience prolonged grief disorder. Those with a previous history of depression or other conditions such as bipolar disorder are more likely to experience prolonged grief disorder.

Having prolonged grief disorder in the DSM allows clinicians to differentiate between standard grief and the type of grief that is persistent and ultimately disabling.

The main similarity between grief and depression is the feeling of emotional pain and deep sadness. Other similarities may include:

crying often

feeling emotional distress

changes in appetite

changes in sleeping habits such as sleeping too much or too little

having angry outbursts

The consequences of grief and depression are also similar. Having either may result in a person becoming withdrawn from loved ones, doing little things that give them pleasure, or finding themselves unable to live daily life.

Often, a person may experience grief so intense that they feel symptoms of depression. Treatment or coping methods for depression can include medications, but it is up to the patient and doctor to decide whether treating grief with medications is right.

The APA says coping with grief can involve:

partaking in self-care

talking openly about the loved one, celebrating their life

accepting the feelings and understanding how they may return in waves

talking with a licensed professional about emotions

helping others cope with their grief also

psychotherapy, which can help a person understand their emotions and find ways to manage them

Depression treatment can also include psychotherapy, but other treatments include:
Learn more about ways to cope with grief here.
Grief and depression share similar symptoms, such as emotional pain. However, grief is a natural human response to loss, and depression is a clinical condition. Someone with grief may experience it so intensely that they feel depressed, along with it lasting longer than 2 months. This may be prolonged grief disorder.

Coping with grief can involve accepting feelings and talking with loved ones. Depression treatment may also include medications such as antidepressants.

Both grief and depression are complex states, and each person will experience them differently. Getting support when a person feels they need it, is important for both.

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Grief and depression share similar symptoms, such as sadness and emotional pain. However, depression is a clinical condition, and grief is a natural human response to loss.

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Last week, NPR's "Talk of the Nation" aired a show that explored the line between grief and depression. Although they are quite different, they look surprisingly alike. Panelist Dr. Michael Miller, editor of the Harvard Mental Health Letter and assistant professor of psychiatry at Harvard Medical School, said that with both grief and depression "People cry. They feel depressed. They're having trouble sleeping. They may not have an appetite. They may not feel like doing anything. They may not take pleasure in anything."

For years, the American Psychiatric Association has urged doctors not to diagnose major depression in individuals who have recently lost a loved one. In the Diagnostic and Statistical Manual of Mental Disorders, sometimes known as the psychiatrist's bible for diagnosing mental illness, grief is specifically listed as an exception to the diagnosis of clinical depression. The organization is now considering dropping that exclusion, raising the question: Is grieving ever pathological?

Prolonged grief

Just as dying is an inevitable part of the cycle of life, bereavement is a necessary aspect of living. There is no timeline for grief. In addition, cultural and circumstantial factors contribute to how people express and cope with it.

Today, advances in medicine allow many people with terminal illnesses to live years after diagnosis, as opposed to the days, weeks, or months of previous decades. As described in in our book Saying Goodbye: A Guide to Coping with a Loved One's Terminal Illness, we refer to the grieving process in these situations as "the new grief" because there is time for patients and their families to get their affairs in order, resolve family issues, and choose how to live during whatever time may remain. This type of grief differs from the sudden shock and chaos that often accompanies a sudden death, which often leaves loose ends loved ones must deal with, as well as any unfinished business they had with the deceased.

During a prolonged illness, or after a death, a community of family, friends, and coworkers often unites to provide ongoing support to those who are grieving. Supporters (professionals, friends, spiritual advisers, family) can help those who are grieving resume functioning, and gradually move on with their lives while maintaining the memory of the lost one.

That is one key difference with depression. People suffering from major depression tend to be isolated and feel disconnected from others, and may shun such support and assistance. People who don't get such support, or who avoid it, may be at greater risk for slipping into clinical depression during the grieving process.

Dr. Miller points out that for some people who have previously struggled with acknowledged or unacknowledged depression, the death of a significant other can be the catalyst that brings depression to the foreground. In such cases, professional treatment such as therapy and/or medication can be helpful. In the interviews we conducted while writing and researching Saying Goodbye, we learned that some people found antidepressant medication to be helpful for restoring sleep and appetite and "taking the edge off." Other people who tried medication stopped taking it because they felt as though their feelings were flattened, and that the medication interfered with their ability to grieve.

Recognizing depression in grief

Bereavement is not linear. It takes multiple forms at different times in one's life. It is influenced, among other things, by the strength of our attachment to the lost loved one and how central he or she was to our lives. Bereavement never really ends. It ebbs after a while, but can then emerge on birthdays and anniversaries, in certain places, or triggered by something like a special song.

If you are in the process of coping with the sudden death of a loved one, or the lengthy grieving process associated with terminal illness, here are a few suggestions:

Expect to feel depressed. Loss of appetite, trouble sleeping, and sadness are all part of the normal grief process, and are best not interfered with.

Expect grief to wax and wane over time. You may feel fine one day, only to slip back into deep grief the next day.

Build and use a support network. Grieving individuals need others to talk to and to care for them - not just for a few days, but over an extended period of time. This is especially true for those people who are primary caretakers for a terminally ill loved one.

If you experience thoughts of suicide, serious weight loss, or are unable to perform daily functions such as getting out of bed or going to work for more than an occasional day, consider seeking additional professional help.

About the Authors

Barbara Okun, PhD, Contributor

Joseph Nowinski, PhD, Contributor

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Can grief morph into depression? - Harvard Health

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Grief and depression can seem similar on the surface, but one key difference is that people suffering from depression tend to be isolated, and are more likely shun the support from others that typically accompanies the experience of losing a loved one.

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Are you feeling a lack of energy or enjoyment in life? These feelings can be common to depression, grief and sadness - terms that often get blended together or used interchangeably. Although these states of being are closely intertwined, there are some distinct differences.

"Grief is a direct response to loss: the death of a loved one, loss of a marriage or loss of a friend," explains Beth Esposito, MS, LPCC-S, LSW, chief of clinical operations with Samaritan Behavioral Health in Dayton, Ohio.

"Depression, on the other hand, doesn't always have a direct cause. It can be triggered by a situation, but it's more of a biological, chemical response in the brain."

She continues, "Sadness over life changes is more of an adjustment disorder. It happens if you're away from family and friends and don't have support. It's a perfectly normal response, but if it goes on for a long length of time, it can cause impairment."

Be patient with yourself as you work to recover, and don't expect to have the energy you normally do.

Esposito notes that sadness and grief can turn into depression over time.

When is It Depression?

Depression is a disorder of the brain that has some well-defined signs and symptoms that last for an extended time - two weeks, a month or longer.

Symptoms of depression can be mild to severe and include:

Sadness or feeling "down"

Tiredness and low energy

Trouble focusing, concentrating or making decisions

Anger, irritability or frustration

Loss of interest or pleasure in activities you once enjoyed

Trouble sleeping or getting too much sleep

Feeling isolated and removing yourself from social activities

Undereating, overeating or craving unhealthy foods

Anxiety, excessive worry or guilt

Missing days or underperforming at work or school

Suicidal thoughts

Headache, stomachache or muscle pain

Drug or alcohol abuse

Scientists know that there's a change in brain chemicals when depression occurs. Neurotransmitters are chemicals that help messages travel from one nerve cell to another and one brain region to another. In particular, norepinephrine and serotonin are connected to mood. When their levels decrease, depression may occur.

Medication and talk therapy are two ways to increase the levels of these neurotransmitters and relieve symptoms of depression.

How Do Grief and Sadness Differ from Depression?

Although grief and depression may both involve intense sadness and lack of enjoyment in activities, they are different in important ways.

If you are feeling grief, you may experience painful feelings in waves, mixed in with good memories of the person you have lost. If you have a major depression, your mood and lack of enjoyment remain consistently low for two weeks or more.

While you are grieving, you tend to maintain your feelings of self-worth. With depression, you tend to have feelings of worthlessness and low self-esteem.

Sometimes, the grief brought on by the death of a loved one, loss of a job or traumatic event can lead to depression. Having the two together intensifies the grief and sadness and causes it to last longer.

Take Care of Yourself

If you have symptoms that are interfering with your ability to function in everyday life and that last longer than two to three weeks, seek professional help. If you don't know where to go, ask your primary care physician or research online. For grief counseling, you can also check with a local hospital, hospice service or church. For mental health counseling, your doctor or local hospital should be able to provide resources.

In addition to seeking professional assistance, you can help yourself by tending to your emotional, physical, mental and social needs. Try incorporating these practices into your daily life:

Be with other people and take part in fun activities. Open up and express your feelings with people you trust.

Don't make major life decisions, such as moving or changing jobs, while you are experiencing negative thoughts that may cloud your judgment.

Be patient with yourself as you work to recover, and don't expect to have the energy you normally do. Set small, realistic goals.

Get enough sleep.

Follow a healthy diet.

Exercise regularly.

Avoid alcohol and drugs.

Practice meditation, tai chi or other relaxation methods.

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Sadness, Grief, Depression: What's the Difference? | Premier Health

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Learn the differences among sadness, grief and depression and know what to do to care for yourself.

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The death of a loved one is not the only loss that can cause grief. Almost any significant change or turning point in your life can cause a sense of loss. Positive or negative, big or small, a meaningful loss can bring on the feelings and process of grief. Increasing your knowledge on the following factors that can cause grief is an important first step in identifying your experience as a loss so you can effectively process and resolve your grief.

Job-related Changes:

Gaining or losing a promotion or career opportunity

New work conditions, hours or responsibilities

Loss of income or of safety or security at work

Retirement

Relationship Changes:

A new baby

A child leaving home

The end of a friendship

Infidelity, separation or divorce

Health Changes:

Changes in habits or lifestyle (such as quitting smoking or drinking)

Personal injury or illness

Changes in a family member's health

Long term or terminal illness

Life Changes:

Graduation transitions

Leaving home or moving to a new location

Pregnancy issues, especially losing a pregnancy

Death of spouse, family member, friend or pet

Learning to cope with the grief that accompanies even small losses gives you the experience and strength to cope with the major losses in your life. Sometimes a combination of minor losses may intensify your grief. Consider the impact of all significant losses when trying to identify your feelings.
Still finding it hard to cope? Best Care EAP is here to help. To schedule an appointment with a licensed counselor, complete our Counseling Registration Form. If you have issues with the form, please call (402) 354-8000 or (800) 801-4182 and we'll be glad to help.

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The death of a loved one is not the only loss that can cause grief. Almost any significant change or turning point in your life can cause a sense of loss. Posi

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What is grief?

Grief is the experience of coping with loss. Most of us think of grief as happening in the painful period following the death of a loved one. But grief can accompany any event that disrupts or challenges our sense of normalcy or ourselves. This includes the loss of connections that define us.

You may grieve the loss of:

A friend, family member, partner or pet.

A marriage, friendship or another form of kinship.

Your home, neighborhood or community.

Your job or career.

Financial stability.

A dream or goal.

Good health.

Your youth.

Fertility.

You may also grieve your own loss of life as you prepare for death. For instance, people diagnosed with terminal illnesses often grieve no longer having the time to experience or achieve things they would've liked to.

Stages of grief

Elizabeth Kubler-Ross describes the five stages of grief in her book On Death and Dying. Although it was published in 1969, it's still the most well-known resource for understanding the grieving process. For her book, Kubler-Ross interviewed over 200 people with terminal illnesses. Through these conversations, she identified five common stages people experience as they grapple with the realities of impending death.

Although Kubler-Ross's work focuses on grief responses from people who are dying, many use these stages to understand grief across multiple types of loss. Stages include:

Denial. You may have difficulty accepting that a loss is real.

Anger. You may direct anger at multiple sources, including people who couldn't save a loved one, God, yourself - or even no one in particular.

Bargaining. You may imagine reaching an agreement, so you don't have to deal with a loss. You may also regret past actions that you imagine could've spared you from loss.

Depression. You may experience the complex emotions associated with depression, including emotional detachment.

Acceptance. Eventually, most people embrace the reality of loss even if the pain's still there.

Many people reduce these stages to linear steps everyone must experience to grieve. But the stages aren't (and were never intended to be) rules. Not everyone who grieves experiences these stages, and they don't have to happen in any particular order.

What are some types of grief?

There are multiple ways to experience grief. Different types of grief describe how varied and complex grief can be.

Anticipatory grief

Anticipatory grief involves grieving before the actual loss. For example, you may begin grieving when you learn that you or a loved one has a terminal illness. Processing grief beforehand can prepare you to face the loss when the time comes. Still, it's important not to allow grieving to distract you from enjoying the precious time you do have.

Abbreviated grief

Sometimes, you're able to move through the grieving process quickly. This is the case with abbreviated grief. Abbreviated grief may follow anticipatory grief. You can grieve a loss quickly because you've already done a lot of emotional labor while anticipating that loss. Grieving for a short time doesn't mean you never truly cared about what you lost. When it comes to grief, we're all on different timelines.

Delayed grief

Instead of experiencing the emotions that accompany grief immediately after a loss, you feel them days, weeks or even months later. In some instances, the shock of the loss pauses your body's ability to work through these emotions. Or you may be so busy handling the practical matters that accompany loss (like funerals and wills) that your body can't grieve until you've handled these responsibilities.

Inhibited grief

Inhibited grief involves repressing emotions. Most of us haven't been taught how to process - or even how to recognize - the confusing emotions that can arise when we're grieving. As a result, many people who repress their emotions don't realize they're doing so. Unfortunately, when you don't allow yourself to pause and feel these emotions, grief often shows up as physical symptoms like an upset stomach, insomnia, anxiety or even panic attacks.

Cumulative grief

With cumulative grief, you're working through multiple losses at once. For example, you're not only grieving the loss of a child. You're grieving the ending of a marriage that followed that loss. Grieving multiple losses simultaneously makes the process difficult and complex in unexpected ways.

Collective grief

Most of us think of grief as personal, but collectives (groups) grieve, too. Major events like wars, natural disasters, school shootings and pandemics create far-reaching losses. They change what counts as "normal" life. As a group, we grieve the shared experiences we've lost as we struggle to imagine a changed future.

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Grief involves coping with loss. Learn more about common responses to grief and ways to process your own grief or support a loved one.

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How Grief Changes Us: Forever & for Now — Grief and Loss Center

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As a community 501(c)3 nonprofit organization, the Grief and Loss Center of North Texas offers hope, purpose and belonging to those who suffer loss. We provide unconditional acceptance, compassion, understanding and confidentiality in a loving, nurturing environment.

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Holidays are never quite the same after someone we love dies. Even small aspects of a birthday or a Christmas celebration - an empty seat at the dinner table, one less gift to buy or make - can serve as jarring reminders of how our lives have been forever changed. Although these realizations are hard to face, clinical psychologist Mary-Frances O'Connor says we shouldn't avoid them or try to hide our feelings.

"Grief is a universal experience," she notes, "and when we can connect, it is better."

O'Connor, an associate professor of psychology at the University of Arizona, studies what happens in our brains when we experience grief. She says grieving is a form of learning - one that teaches us how to be in the world without someone we love in it. "The background is running all the time for people who are grieving, thinking about new habits and how they interact now."

Adjusting to the fact that we'll never again spend time with our loved ones can be painful. It takes time - and involves changes in the brain. "What we see in science is, if you have a grief experience and you have support so that you have a little bit of time to learn, and confidence from the people around you, that you will in fact adapt."

O'Connor's upcoming book, The Grieving Brain, explores what scientists know about how our minds grapple with the loss of a loved one.

Interview highlights
On the grieving process
When we have the experience of being in a relationship, the sense of who we are is bound up with that other person. The word sibling, the word spouse implies two people. And so when the other person is gone, we suddenly have to learn a totally new set of rules to operate in the world. The "we" is as important as the "you" and "me," and the brain, interestingly, really does encode it that way. So when people say "I feel like I've lost part of myself," that is for a good reason. The brain also feels that way, as it were, and codes the "we" as much as the "you" and the "I."
On the difference between grief and grieving
Grief is that emotional state that just knocks you off your feet and comes over you like a wave. Grieving necessarily has a time component to it. Grieving is what happens as we adapt to the fact that our loved one is gone, that we're carrying the absence of them with us. And the reason that this distinction makes sense is, grief is a natural response to loss - so we'll feel grief forever. A woman who lost her mother as a young person is going to experience that grief on her wedding day because it's a new moment where she's having a response to loss.

Grief is like someone turned up the volume dial all of a sudden. The emotion that I think often interferes with our relationships and friendships when we're grieving is anger, because the anger feels so intense.

But "grieving" means that our relationship to that grief changes over time. So the first time, maybe even the first 100 times, you're knocked off your feet with grief, it feels terrible and awful and unfamiliar. But maybe the 101st time, you think to yourself, "I hate this, I don't want this to be true. But I do recognize it, and I do know that I will get through the wave."
On the emotions involved in grieving
The range of emotions that someone experiences when they're grieving is as long a list as the range of emotions we have in any relationship. Commonly there's panic, there's anxiety, there's sadness, there's yearning. But what we sometimes forget is that there's also difficulty concentrating and confusion about what happens next.

I am often struck by the intensity of the emotions. Grief is like someone turned up the volume dial all of a sudden. The emotion that I think often interferes with our relationships and friendships when we're grieving is anger, because the anger feels so intense. You have someone blow up at a dinner party and you think, "What's happening with them?" And then to try and remember, "Oh, they're grieving and everything is amped up a little bit."
On what is happening in our brains
We have neuroimaging studies basically of grief, of the momentary reaction where you have that emotional yearning experience. There are less than a handful of studies looking at more than one moment in the same person across time - so looking at their grieving trajectory. What we know right now in these early days of the neurobiology of grief is really coming from snapshots.

Having said that, one of the things that we know is that grief is tied to all sorts of different brain functions we have, from being able to recall memories to taking the perspective of another person, to even things like regulating our heart rate and the experience of pain and suffering. So lots of different parts of the brain are orchestrating this experience that we have when we feel grief.
On prolonged grief
When you're knocked over by that wave of grief, you want to know, "When will this end?" From a research perspective, there is a very small proportion of people who might have what we now call prolonged grief disorder, something we start looking for after six months or a year [after a death or loss]. ... And what we are seeing, [in such cases], is that this person has not been able to function day to day the way that they wish that they could. They're not getting out the door to work or getting dinner on the table for their kids or they're not able to, say, listen to music because it's just too upsetting. So these types of concerns ... suggest it would be helpful to intervene and get them back on the healing trajectory where they will still feel grief, but they will adapt to it differently.

The older term that we were using for a long time was "complicated grief." And although prolonged grief disorder is the term we've settled on, there's a reason that I like the term complicated - because it makes you think of complications.

With COVID, the loved ones that are left behind made the sacrifice of not being with their loved ones in the hospital in order to stop the spread. And that sacrifice needs to be recognized - they did something for the greater good.

As an example, one of those is the grief-related rumination that people sometimes experience. The better term for that that people will recognize is the "would've, should've, could've" thoughts. And they just roll through your head over and over again. The problem with these thoughts - we sometimes call "counterfactuals" - is that they all end in this virtual scenario where the person doesn't die. And that's just not reality. And so, by spinning in these thoughts, not only is there no answer - there are an infinite number of possibilities with no actual answer of what would have happened - but it also isn't necessarily helping us to adapt to the painful reality that they did die. And so our virtual version is not really helping us to learn how to be in the world now.

It's less than 10% of people who experience prolonged grief disorder. And what that means is 90% of people experience difficult grief and suffering, but don't have a disorder after losing a loved one. I think it's so important to remember that ... because we don't want to hide grief away ... in a psychiatrist's office or a counselor's office, except in indications where that would be helpful to get people back on track.
On how to support grieving people in your life
I think when you care for someone who is going through this terrible process of losing someone, it really is more about listening to them and seeing where they're at in their learning than it is about trying to make them feel better. The point is not to cheer them up. The point is to be with them and let them know that you will be with them and that you can imagine a future for them where they're not constantly being knocked over by the waves of grief.
On losing people to the pandemic
One of the topics I think is not much in the national conversation is that so many of the deaths of our loved ones happened in hospitals, emergency rooms and ICUs - and we weren't there to see it. And that is for a very good reason, because we were trying to stop the spread of COVID. So having family members in hospitals did not make sense.

But it means that people are without these memories of watching their loved one become more ill and watching those changes that happen in their body that prepare our mind for the possibility that they might die. To go through that process without those memories makes it much harder to learn what has happened. So many people feel it hasn't really sunk in yet that they're gone.

What I don't hear very often is the fact that with COVID, the loved ones that are left behind made the sacrifice of not being with their loved ones in the hospital in order to stop the spread. And that sacrifice needs to be recognized, I think. In part to help people heal, so that it's understood why they're having such a difficult time. And to elevate the understanding that they did something for the greater good - and they gave up something while they did it.

An excerpted audio version of this interview first appeared in a recent episode of NPR's daily science podcast, Short Wave, hosted by Emily Kwong and produced by Berly McCoy.

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How your brain copes with grief, and why it takes time to heal

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Grieving is a form of learning, says a scientist who studies the brain's response to loss. When someone you love dies, you have to learn new rules for navigating the world and your brain has to adapt.

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Grief happens to us all. Time is a good healer, but it can help to acknowledge grief and take steps to heal. Here are 5 ideas that might help you cope when someone you love has died:

1. Join in rituals. Memorial services, funerals, and other traditions help people get through the first few days and honor the person who died. Just being in the presence of other people who knew your loved one can be comforting.

2. Let your emotions be expressed and released. Don't stop yourself from having a good cry if you feel one coming on. Don't worry if listening to particular songs or doing certain things is painful because it brings back memories of the person that you lost. It's natural to feel this way. After a while, it becomes less painful. Know that you can (and will) feel better over time.

3. Talk about it when you can. Some people find it helpful to tell the story of their loss or talk about their feelings. But sometimes a person doesn't feel like talking about a loss, and that's OK, too. No one should feel pressured to talk.

Even if you don't feel like talking, find ways to express your emotions and thoughts. Start writing in a journal about the memories you have of the person you lost and how you're feeling since the loss. Or write a song, poem, or tribute about your loved one. You can do this privately or share it with others.

4. Preserve memories. Create a memorial or tribute to the person who died by planting a tree or garden, or honor the person in a fitting way, like taking part in a charity run or walk.

Make a memory box or folder that has reminders of the person who has died. Include mementos, photos, quotes, or whatever you choose. If you want, write a letter to the person. In it, you might want to include your feelings, things you want to say, or perhaps thank your loved one for being a part of your life.

5. Join a support group. If you think you may be interested in going to a grief support group, ask a parent, school counselor, or religious leader how to find one. You don't have to be alone with your feelings or your pain.

Date reviewed: April 2016

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Grief happens to us all. Time is a good healer, but it can help to acknowledge grief and take steps to heal. Here are 5 ideas that might help you cope when someone you love has died: Join in rituals. Memorial services, funerals, and other traditions help people get through the first few days and honor the person who died.

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Coping with Grief and Loss - HelpGuide.org

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The pain of loss can feel overwhelming, but there are healthy ways to cope with your grief and learn to heal. These tips can help.