Grief is the natural response to losing someone or something that mattered, and it affects the body as much as the mind. Most people expect sadness. Many are surprised by exhaustion, poor sleep, loss of appetite, trouble concentrating, irritability, or a flat, numb feeling. None of this means something is going wrong. It means the loss is real.
What normal grief looks like
Many people believe grief follows five stages in a set order. Research has not supported this as a rule. People react in different ways, and the same person can feel anger, relief, longing and calm within a single afternoon. There is no correct sequence and no correct feeling.
A well-known study by Bonanno and colleagues (2002) followed married people before and after the death of a spouse, for eighteen months. Nearly half showed relatively little distress throughout. About one in six stayed in intense grief for the whole period. The rest fell somewhere between. Most participants were older adults, so these figures may not apply to every kind of loss.
Stroebe and Schut (1999) described how bereaved people cope by moving between two kinds of tasks. In one, they face the loss directly by crying, looking at photographs or talking about the person. In the other, they deal with the practical changes, such as bills, work and new routines. Taking a break from the pain to handle daily life is not avoidance. Both kinds of tasks are needed.
Over months, the pain usually becomes less constant. It can still return sharply on birthdays, holidays or anniversaries, or when a certain song or smell appears without warning. These returns are common and do not mean you are going backward.
When grief does not ease with time
For some people, grief stays intense and disabling. Prolonged grief disorder is now a recognized diagnosis. The DSM-5-TR requires that at least twelve months have passed since the death for adults, while the ICD-11 allows the diagnosis after six months. Prigerson and colleagues (2021) reviewed how the diagnosis developed and the evidence supporting it.
The signs are persistent longing for the person or constant preoccupation with them, difficulty accepting the death, a sense of having lost part of oneself, avoiding reminders, and trouble returning to normal activities. Consider a woman whose husband died a year and a half ago. She still sets two places at the table, has stopped seeing friends, and has not been back to work. That level of impairment is a reason to seek help.
Treatment exists. In a randomized trial of 395 adults, Shear and colleagues (2016) tested a structured therapy designed for prolonged grief, with or without the antidepressant citalopram. The therapy reduced grief symptoms more than medication alone. Citalopram did not improve grief itself, though it eased depressive symptoms when combined with therapy.
Grief and depression can occur together, and they are not the same. In grief, the pain usually connects to the person who died, and self-esteem is often intact. In depression, low mood is constant, interest in nearly everything fades, and people often feel worthless. If you have thoughts of ending your life, contact a doctor or crisis service right away. In the United States you can call or text 988.
Grief has no fixed schedule, but its intensity should gradually decrease, and when it does not, effective treatment exists.
Practical ways to get through the weeks after a loss
Start with the basics. Try to go to bed and get up at similar times, eat something at regular hours even without appetite, and walk outside for a few minutes each day. Grief disturbs sleep and eating, and these habits protect your energy. They do not remove the pain, but they make it easier to tolerate.
Be careful with alcohol, sleeping pills and cigarettes. Some people drink or smoke more after a loss because it brings short-term relief. Alcohol worsens sleep and mood within a few hours, and a habit formed in the first months can be hard to undo. If you notice your use rising, mention it to your doctor early.
Where possible, postpone major decisions such as selling a home, changing jobs or moving to another city. Thinking is often clouded in the first months, and choices made then are more likely to be regretted. Urgent legal and financial matters still need attention. Ask a trusted friend or relative to go through them with you.
Allow yourself some time each day to grieve on purpose, for example by looking at photographs or writing a letter to the person. Then return to an ordinary task. This helps the loss-focused and practical sides of coping each get space. Support groups can help too, because talking with others who have lost someone reduces the feeling of being alone with it.
Contact a doctor or therapist if the loss has been more than six months to a year without any easing, if you cannot work or care for yourself or your children, if you feel hopeless, or if you have thoughts of suicide. You do not need to wait for a particular date. Earlier support is easier to use than support sought after months of struggling alone.
If someone close to you is grieving, say the name of the person who died, and offer specific help such as cooking a meal or driving them to an appointment. Then keep in touch after the first weeks. Most visits and messages stop within a month, and that is often when the loss feels most quiet and most real.
References
- Bonanno, G. A., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J., Carr, D., & Nesse, R. M. (2002). Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology, 83(5), 1150–1164.
- Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224.
- Shear, M. K., Reynolds, C. F., Simon, N. M., Zisook, S., Wang, Y., Mauro, C., Duan, N., Lebowitz, B., & Skritskaya, N. (2016). Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry, 73(7), 685–694.
- Prigerson, H. G., Kakarala, S., Gang, J., & Maciejewski, P. K. (2021). History and status of prolonged grief disorder as a psychiatric diagnosis. Annual Review of Clinical Psychology, 17, 109–126.
