Listen to the Cancer.Net Podcast: Understanding Grief and Loss , adapted from this content.
Grief is a natural response to loss. It is a process that occurs over time and involves a range of feelings, thoughts, behaviors, and physical sensations. Although grief often refers to an emotional response 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 have slightly different meanings. Grief is a person's response to and experience of loss. Mourning is the outward expression of that grief, which may include 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. People who have experienced loss may experience a range of feelings, including shock, numbness, sadness, despair, anxiety, anger, guilt, loneliness, helplessness, relief, and yearning. A grieving person may start crying after hearing a song or comment that makes them think of the person who has died. Sometimes, though, someone who is grieving may suddenly start crying for no reason.
Thoughts. Common thought patterns include disbelief, confusion, disorientation, difficulty concentrating, preoccupation, and hallucinations (briefly thinking that you see or hear the deceased person).
Physical sensations. It is 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, and fatigue. It may also cause vulnerability to illness.
Behaviors. When a person is grieving, it may be difficult to fall asleep 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 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. Loss may cause a person to question his or her faith or view of the world, or it may strengthen the person's faith by providing 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, overwhelming grief. 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 of 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 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 that their feelings go back and forth. 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 likely will not last forever.
Tasks of mourning
Researchers have also described the grief process 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: Accept the reality of the loss
Task two: Experience the pain of grief
Task three: Adjust to an environment in which the deceased individual is missing
Task four: 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:
- The nature of the person's relationship with the deceased (The intensity of grieving over the death of a spouse or parent may be different than the intensity of grieving over the death of a neighbor or coworker.)
- The cause of death (The grieving process may differ depending on whether the person died suddenly or was ill for an extended time.)
- The age and gender of the person who is grieving
- The life history of the person who is grieving, including previous experiences with loss
- The personality and coping style of the person who is grieving
- The support available from friends and family, in addition to the family's customs and beliefs surrounding death
- The religious and spiritual beliefs of the person who is grieving
Grieving is often 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. 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 it would be if their relationship with the person had been 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 numbness 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 to allow people to grieve in ways that feel right to them. Learn more about grief among cultures .