Grief refers to the normal, natural reaction to loss--an emotional response,either through a death or from ending a relationship It is a major componentof the human emotional repertoire, affecting how people feel both mentally and physically, how they cope, interact with others, and see the world.

Each year more than 14 percent of Americans 18 and older (about 36 million people) experience the death of either a parent, spouse, sibling or child. Howlong it takes to work through the grief of a death is different for each person. There is no preordained "right" time limit for grieving to take place--there are too many variables to predict with any accuracy how long someone willgrieve. Every person is unique, with a different personality, coping skills,previous experience of loss, relationship with the one who died, and so on.Responses also vary depending upon the circumstances associated with the death. For example, if the person who died suffered from a chronic illness, the death may have been anticipated, and may even come as a relief of suffering. If the death was accidental or violent, coming to a stage of acceptance may take longer.

People also experience losses for which they might grieve other than a person's death. Such losses include the death of a cherished pet, or material losses (for instance, a home) due to conflict or natural disaster. Those who can'treally mourn someone who is not properly gone may struggle with unresolved grief because of the ambiguous loss; for example, a loved one might be physically present but mentally or emotionally absent, as in the case of Alzheimer'sdisease, debilitating stroke, or a serious mental illness. Alternatively, aperson might be physically absent but still emotionally present, as when a person is missing in military action, or a child disappears and is not found.

Many mental health professionals agree that the grieving process typically follows three stages either in sequence or overlapping. The first phase is oneof denial, in which the shock and numbness a person feels may disguise the full pain of their loss. These feelings may occur even when death is expected,but they are likely to last longer and to be more intense if death is unexpected.

The second phase is one of acute anguish once the realization begins to set in that the loss is forever. A person may have physical symptoms (for example,feelings of choking or emptiness). The bereaved may have no desire to see anyone, or may become forgetful or angry. People sometimes doubt themselves oreven God. Parents of a murdered child may not be able to bring themselves toclean out the child's room. The process of grieving is so overwhelmingly intense that even well adjusted people can feel as though they are going insane.Acute anguish may last weeks or months, though gradually people find they areable to go on. For some people this is a period of oscillating between focusing on the pain of the loss and trying to divert themselves through work or planning for the future.

In a final phase called restitution, the bereaved is able to recognize the loss, but also sees that it is possible to have a life apart from the deceased,that is, to return to work, experience pleasure, and seek companionship andlove.

A person's religious faith, support system, the ability to participate in funeral rituals--all of these influence the grieving process. Grief is usually self-limiting; it will end when it naturally comes to a conclusion. For some people, that may be a matter of a few months--for others, grief may take years(even five years or more for unexpected or traumatic deaths).

The symptoms of grief are the same as those for clinical depression, but these symptoms are expected in the wake of an intense loss:

  • sadness
  • anxiety
  • anger
  • guilt
  • tiredness
  • helplessness
  • loneliness
  • shock
  • disbelief
  • numbness
  • fear
  • depression

In addition, some people feel shame, others feel relief. There are also certain physical sensations: tightness in the chest or throat, pain in the heart,heart palpitations, dizziness, nausea, trembling. Grieving survivors sometimes don't. eat or sleep well. They may have unusual dreams or nightmares, be absentminded, withdraw socially, or engage in restless activity. All of these feelings and behaviors are normal during grief.

If the feelings of grief do not go away eventually, the reaction may be regarded as a clinical disorder rather than normal grief. Of the approximately 800,000 Americans widowed each year, up to 160,000 may suffer a pathological grief, according to the National Academy of Science. Refusing to deal with the loss of a loved one, or being unable to face the loss, may also cause an absent grief reaction. Grief not expressed openly comes out in other ways, such asphysical symptoms or erratic behavior, or is displaced onto other persons..It can contribute to depression or excessive use of alcohol or drugs. Major depression is also a complication.

Mourning in children may express itself in different ways from adults. Very young children may express grief in bodily functions, such as bed wetting, difficulty eating, and disturbed sleep, just as they may do in the absence of anadult on whom they depend. Most children five and older, however, understandthe difference between separation and death, and their reactions are more complex. Children who have lost a parent may fear the death of the remaining parent; those who have lost a sibling may worry that any feelings of jealousy or resentment they felt toward their sibling actually caused the person's death. Some children develop behavioral problems.

Research is indicating that some kind of ceremonial farewell can be profoundly helpful in helping the bereaved survivor adjust to the death of someone close. Those who don't take the opportunity to acknowledge publicly and formallythat something significant has happened in their lives may have more problems in the grieving process.

Mourning is the public expression of grief. Since earliest history, every culture has recorded its own beliefs, customs, and behavior related to mourning.The purpose of mourning is to help the bereaved to acknowledge the reality of the death, to provide support for the bereaved, to pay tribute to the dead,and to offer the community an avenue for expressing sorrow. For example, incontemporary North America, the funeral and burial service provide these functions, though the exact practices vary depending on religion and culture. Mass public grieving, like the kind that accompanied the death of Diana, Princess of Wales, allows people to express private feelings in a public way; conversely, people may also use such public mourning as a way of expressing privatelosses.

There are other ways to express grief. What usually helps the most is being able to talk with at least one person about feelings--all the good times and bad, sadness and the fear, the memories and the hopes. Sometimes bereaved people want to talk with several different people about what is happening with them. Others find value in joining a grief support group. Some mourners are more quiet and solitary in their grief and some are more expressive and emotional. Some prefer to work through their grief by immersing themselves in activity, while others are more comfortable giving in to their grief.. Some people find that writing can be helpful--keeping a journal of thoughts and feelings,or writing letters to the one who has died, composing stories, or creating poetry. Some people prefer to express their grief through painting or sculpture, by sewing or woodworking. Others find meaning in working on a project thatwould have been meaningful to the person who died--creating a memorial, or starting a project that will help others.

Emotional support for the grieving process is usually provided by family andfriends. Sometimes outside factors can influence the normal grieving process,and help from mental health experts, clergy, social workers, or self-help groups may be indicated. Counseling may help someone suffering from absent grief reaction, or from depression associated with grieving. The stress of grieving can often be helped by joining a support group where members share commonexperiences and problems. See loss of a child--support group or loss of a spouse--support group.

are many ways to offer support to someone who is grieving:

  • Empathy: Empathy allows the bereaved person to express emotions in a supportive environment.
  • Support: Sensitivity and support are always appreciated
  • Listen: People are often remembered for who they choose to be, not what theychoose to say. It is appropriate to encourage discussion, but don't force conversation from the bereaved individual.
  • Nonverbal support: A touch, gesture, or facial expression

Eventually, most people work through their grief and reach some sense of acceptance of their loss. any people report they have grown stronger as a resultof the loss they have experienced--more mature, more understanding, more self-aware.

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