Grief is a natural response to loss. It is a process that occurs over time and involves a wide range of feelings, thoughts, behaviors, and physical sensations. While grief often refers to the death of a loved one, people with cancer and their families also grieve other possible cancer-related losses, such as the loss of a breast, the loss of fertility, or the loss of independence.

The terms grief, mourning, and bereavement are often used interchangeably; however, they mean different things. Grief is a person’s response to and experience of loss. Mourning is the outward expression of that grief, in addition to cultural and religious customs and rituals surrounding death. Mourning is also defined as the process of adapting to loss and adjusting to the death of a significant person. Bereavement refers to the state of having suffered a loss and the experiences that follow the death of a loved one.

Common grief reactions

Reactions to loss, called grief reactions, vary widely from person to person and vary in the same person over time. Not every person has the same set of reactions, but there are some common ones. Grief reactions include difficult feelings, thoughts, physical sensations, and behaviors.

Feelings. If a person has experienced the death of a close relative or friend, he or she may experience a wide range of feelings. It is common for people to feel a sense of shock, numbness, sadness, despair, anxiety, anger, guilt, loneliness, helplessness, relief, and yearning.

Thoughts. Common thoughts include disbelief, confusion, disorientation, difficulty concentrating, preoccupation, and hallucinations (briefly thinking that you see or hear the deceased person).

Physical sensations. It is also common for grief to cause physical sensations, such as tightness or heaviness in the chest or throat, nausea or an upset stomach, dizziness, headaches, physical numbness, muscle weakness or tension, fatigue, and vulnerability to illness. A grieving person may start crying after hearing a song or comment that made them think of the person who has died. Sometimes, though, someone who is grieving may suddenly start crying for no reason.

Behaviors. When a person is grieving, it may be difficult to fall or stay asleep, and he or she may lose energy for enjoyable activities or lose interest in eating or interacting socially. A grieving person may also become more irritable or aggressive. Other common behaviors and feelings include restlessness, hyperactivity, and listlessness (lack of interest, energy, or spirit).

Religion and spirituality

Grief may also have religious and spiritual effects on a person’s life, as loss can cause one to question his or her faith or view of the world. Grief can also strengthen faith as one may come to a new understanding of the meaning of life.

Stages of grief

Grief is often felt in waves or cycles, with periods of intense and painful feelings that come and go. People who are grieving may feel they are making progress, but then suddenly face renewed grief that is overwhelming. These renewed periods of grief may occur at significant dates, such as holidays or birthdays, or they may occur without reason. Over time, these periods of intense grieving typically become less frequent and less intense as the person adjusts to his or her loss.

Immediately after a loss, a person may experience shock, feelings of numbness, and disbelief or denial that the loss has occurred. The grieving person may feel disconnected from the world around them while going through mourning rituals, such as wakes or funerals. These initial grief reactions may last up to six weeks or more and may help to distance the person who is grieving from the pain of loss and protect him or her from feeling overwhelmed.

Another common reaction that comes after the initial feelings of numbness and disbelief fade is called confrontation. This reaction can be intensely painful as the grieving person comes to accept the reality of the loss. This reaction can last months or longer and is characterized by waves of distress, despair, and emotional upheaval with conflicting and difficult feelings. The person who is grieving may feel angry with the person who has died or feel guilty for still being alive. The grieving person may cry often, feel disorganized, have difficulty sleeping or getting up in the morning, and have trouble concentrating.

During the acceptance phase of grieving, the grieving person adapts to a new life without his or her loved one. Acceptance over the loss of a close person often occurs slowly over the course of a year or more. Life does not return to normal, but the grieving person may be able to create somewhat of a new life with new goals and identity, often including unfamiliar roles. For example, a remaining spouse or partner may start taking care of the car for the first time or learn how to cook.

Grief reactions often do not occur in order and a person may react with the same set of feelings more than once. Reactions may overlap and people may find they go back and forth with their feelings. However, understanding the basic grief process can help people know what to expect and help reassure them that their experiences are normal and that the intense pain of grief may not last forever.

Tasks of mourning

Another way researchers have described the grief process is as a series of tasks that the grieving person may work through to resolve the grief. One model describes four tasks of mourning:

Task one: To accept the reality of the loss

Task two: To experience the pain of grief

Task three: To adjust to an environment in which the deceased individual is missing

Task four: To withdraw emotional energy and reinvest in other activities

Factors affecting grief

Throughout the stages of grief, the nature and intensity of grief reactions and the length of time a person grieves are affected by a variety of factors.

• Nature of the relationship with the deceased—the intensity of grieving the death of a spouse or parent may be different than the intensity of grieving the death of a neighbor or coworker
  
  
• Cause of death—whether the person died suddenly or was ill for an extended time
  
  
• Age and gender of the person who is grieving—men and women often have different reactions to loss
  
  
• Life history of the person who is grieving, including previous experiences with loss
  
  
• Personality and coping style of the person who is grieving
  
  
• Support available from friends and family, in addition to the family's customs and beliefs surrounding death
  
  
• Religious and spiritual beliefs of the person who is grieving

Grieving can often be more difficult and complicated when there are unresolved feelings or conflicts with the person who has died. Sometimes people who are struggling with complicated grief can get help by talking with a counselor, such as a clinical social worker, psychologist, or spiritual counselor. Read about how to find a counselor. People who feel complete and good about their relationship with the person who has died may find that although they are sad, their grieving experience is quite different than if their relationship with the person was strained.

Grief in different cultures

While each person's grief is unique, the experience is shaped by his or her society and culture. Each culture has its own set of rituals and beliefs surrounding death and bereavement that affect the ways one experiences and expresses grief. Funerals and memorial services help people who are grieving connect with their community and share their grief. However, the way a person expresses or experiences grief may be at odds with cultural expectations for bereavement. Someone who is feeling numb or disbelief may not cry as might be expected at a funeral. Another person may experience a level of despair that feels out of step with cultural values or beliefs. It is important that people be allowed to grieve in ways that feel right to them. Read more about grief among cultures.

More Information

Coping With Change After a Loss

How to Cope With Losing a Sibling to Cancer

Additional Resources

National Cancer Institute: Loss, Grief, and Bereavement

Lance Armstrong Foundation: Coping with Grief and Loss

Last Updated: April 09, 2009