Grief: understanding loss

Anticipatory grief is grief that starts before the loss itself. It often begins when someone we love becomes very ill, starts to fade with dementia, or when we know a big change is coming.

It can feel confusing to grieve someone who is still here. You may feel sad, scared, angry or guilty, sometimes all at once. Some people feel tired from “waiting” for the loss.

Gentle ideas

• Make time for the things you still want to say or do together.
• Let yourself feel sad without pulling away from the time you have.
• Take breaks and accept help, especially if you are a caregiver.

Sometimes grief does not hit right away. Shock, or busy tasks like planning a funeral or sorting paperwork, can push feelings aside for a while. They may surface weeks or even months later.

This can catch people off guard. Others may expect you to be “doing better” by now, just when it feels the hardest.

Sometimes losses come close together. A death may also mean losing a home, money or a routine. When grief piles up like this, it is often called cumulative grief.

With many losses, it can be hard to know which one you are crying about. That is okay. You may need extra time, rest and support.

Ambiguous loss is a loss without clear answers or an ending. Someone may be missing. Or a person may still be alive but out of reach, for example because of dementia, prison or deportation.

Without closure, it can be hard to know how to grieve. You may swing between hope and sadness. Both feelings make sense.

Sometimes a whole group grieves together. This can happen after a natural disaster, a school shooting, a war or a pandemic. It is called collective grief.

Even if you did not lose someone yourself, you may feel sad, scared or unsettled. Coming together through vigils, memorials or community events can help people heal side by side.

Broken heart syndrome (also called takotsubo cardiomyopathy) is a real, usually temporary weakening of the heart’s main pumping chamber. Experts think a surge of stress hormones “stuns” the heart.

Grief is a key trigger: the death of a loved one, or the loss of a relationship, a home, money or a pet. Shocking news, intense fear or even very happy surprises can also set it off.

Symptoms look like a heart attack

• Sudden, severe chest pain or pressure
• Shortness of breath
• Fainting or feeling faint
• A racing, pounding or irregular heartbeat

More than 90% of reported cases are in women aged 58 to 75, but it can happen to anyone. Most people recover fully, usually within days to weeks, although some feel low on energy for months.

In a 2012 study of 1,985 heart attack survivors, the risk of a heart attack was about 21 times higher in the 24 hours after the death of someone significant. The risk dropped steadily each day after that.

The extra danger was greatest for people who already had heart risks. Even so, the chance for any one person stays small. This is a reason for care, not fear.

What you can do

• If you have a heart condition, let your doctor know about your loss
• Keep up with your usual health care and check-ups, even when it’s hard to care
• Take chest tightness, breathlessness or dizziness seriously, and get checked
• Friends and family: check in often on bereaved people with heart problems during the first weeks

Grief can weaken your immune system. On top of that, poor sleep, skipped meals and less movement add to the strain, so it is common to feel worn out or run-down.

Simple ways to protect yourself

• Eat something at regular times, even if it is small
• Get outside each day for daylight and fresh air
• Drink water through the day
• Rest when you feel unwell instead of pushing through
• Keep your doctor and dental appointments

Losing sleep, losing your appetite and feeling exhausted are common grief reactions. Many people also dream about the person who died.

Night can feel loneliest, because there are fewer distractions and the bed or house may feel empty. Racing thoughts and replaying memories are common.

A gentle wind-down

1. Keep a similar bedtime and wake-up time, even on weekends.
2. Put your phone away a little while before bed.
3. Write worries or memories in a notebook, so your mind can set them down.
4. If you can’t sleep after a while, get up and do something calm in dim light, then try again.

Research suggests that men generally have a harder time than women after a spouse dies, with more severe depression and more health problems. One reason may be that men often have less social support.

Younger bereaved people can also have more severe health problems and grief symptoms, although they may recover faster because they often have more support and resources.

Protecting your health

• Book a check-up in the months after the loss
• Be careful with alcohol, which can hide grief and harm sleep and health
• Eat with other people when you can
• Stay connected: social support protects both body and mind

Denial is often the first reaction to a loss. It can feel like shock, disbelief or numbness. In a way, it protects you by letting the truth sink in a little at a time.

It may look like

• Expecting the person to walk through the door
• Feeling oddly calm or “fine” at first
• Avoiding talking about what happened

As the numbness fades, pain often rises, and anger can come with it. You might feel angry at yourself, at others, at a higher power, at the situation, or even at the person you lost.

Anger can feel scary or “wrong”, but it is a natural part of grief. Often it is pain wearing a tougher coat.

Safe ways to let anger out

• Go for a fast walk or move your body
• Write an angry letter you never send
• Talk it through with someone who will just listen

Bargaining is trying to get back some control. It often sounds like “what if” or “if only”. Some people make promises or deals in their mind, hoping to undo the loss.

Bargaining can bring a lot of guilt. Remember that you made the best choices you could with what you knew at the time.

This stage is marked by deep sadness as the full reality of the loss sinks in. You may feel heavy, tired, alone or empty. You might want to pull away from people.

This sadness is a natural part of grieving. It is not weakness. It shows how much the loss matters.

Small things that can help

• Keep a simple routine: wake up, eat, go outside for a few minutes
• Let one trusted person know how you are really doing
• Allow yourself to cry

Acceptance does not mean you are “over it” or that what happened was okay. It means you are starting to find a way to live with the loss.

You may still feel pain. But you start to adjust, make new plans and rebuild, while still remembering and loving what you lost.

Worden’s model sees mourning as active work you do over time. The tasks are not in a fixed order, and people often return to them.

The four tasks

• Accepting the reality of the loss
• Experiencing the pain of grief
• Adjusting to life without the person
• Finding a lasting connection with them while moving forward

Thinking of grief as tasks can feel hopeful. It reminds you that you are not just waiting for grief to pass. Each small step, like saying what happened out loud or learning a new routine, is part of the work.

Research by psychologist George Bonanno found that most bereaved people are resilient. After a period of distress, typically several months, most return to healthy day-to-day functioning.

The U.S. National Cancer Institute notes that for most bereaved people, grief symptoms lessen between 6 months and 2 years after the loss.

Grief researchers such as Robert Neimeyer describe “meaning-making”: slowly making sense of the loss and what it means for your life. It can take many forms, from faith to advocacy to memorials and personal causes.

What it can look like

• Finding comfort in your faith or spiritual beliefs
• Raising awareness about the illness or cause of death
• Starting a memorial walk, scholarship or garden
• Telling their story, so others learn from it
• Simply asking, “How has this changed what matters to me?”

Psychologists Richard Tedeschi and Lawrence Calhoun describe “post-traumatic growth”: positive changes some people notice after great loss, like deeper relationships, discovering personal strengths and a new appreciation for life.

Growth and grief can exist side by side. You can be changed for the better in some ways and still wish with all your heart that the loss had never happened.

Grief and depression can share sleep problems, guilt and loss of interest. But in grief, painful feelings tend to come and go in waves rather than stay constant. The main feeling is often emptiness and missing the person, and people usually keep their sense of self-worth.

When low mood stays heavy almost all the time, when you feel worthless, or when nothing brings even a moment of relief, it is worth talking to a professional.

Intuitive grievers experience grief mostly as feelings and express it through words and emotions. They may cry often, want to talk about the person, and find comfort in being with others who are sad too.

What often helps

• Talking with friends, a counselor or a support group
• Journaling or writing letters
• Having permission to cry without being rushed
• People who listen without trying to fix

Instrumental grievers tend to put grief into action-focused tasks. They may plan the memorial, fix things around the house, start a fundraiser or throw themselves into physical activity. Their grief is just as real, even with fewer tears.

What often helps

• A project in their memory, like building a bench or planting a garden
• Running, walking, sport or hands-on work
• Learning about grief and solving practical problems
• Talking side by side while doing something, rather than face to face

Most people fall somewhere in the middle, expressing grief through both feelings and actions. You might cry at night and spend the day sorting paperwork, and both are your way of grieving.

Your style can also shift over time, or with different losses. Notice what actually brings you some relief, and let yourself do more of that.

A feeling-focused griever may think an action-focused griever is “not grieving properly”. An action-focused griever may feel uncomfortable with tears and pull away. These differences can cause friction, especially within families.

Ideas for families and couples

• Say out loud: “We grieve differently, and that’s okay”
• Ask each other, “What helps you most right now?”
• Make room for both: a night of sharing memories, and a day of working on a memorial project
• Don’t judge love by tears, or by the lack of them

Grieving styles aren’t set by gender, but many men grow up hearing they should stay strong and not cry. Some men grieve through action, and others feel deep sadness they don’t feel allowed to show.

Widowed men in particular can face extra health risks, partly because they often have less social support (see “Grief and physical health”). Staying connected really matters.

What can help

• Groups that meet around an activity, like walking, fishing or building
• One trusted friend who will just listen
• Remembering that tears are a healthy release, at any age
• Grief counseling, which is for anyone, not just people who like to talk

Sometimes grief is too big for words. Creative activities give feelings a place to go. Writing, sharing stories and making art are all ways to work through emotions instead of pushing them away.

Ideas to try

• Draw, paint, or make music about how you feel
• Build a memory box with photos, letters and small objects
• Write a letter to the person or thing you lost
• Keep a grief journal, even just a few lines a day
• Read or listen to other people’s stories of grief

Writing letters to someone who has died is part of some grief support programs, and many people find it comforting to keep “talking” to their loved one.

Rituals are actions with meaning, like lighting a candle, saying a prayer, or visiting a grave. People in almost every culture and faith use rituals after a loss.

Research suggests rituals can ease grief. In one set of studies, people who did a ritual after a loss felt less grief, partly because it gave them back a sense of control. This was true even for people who said they didn’t believe in rituals.

Symbolic ideas

• Light a candle on special days, or at a set time each week
• Plant a tree or flowers in their memory
• Give to a charity or cause they cared about
• Hold a celebration of life that fits your faith or culture
• Pray, meditate, or spend quiet time in a place of worship or nature
• Cook their favorite meal or play their favorite song

For many people, faith communities offer comfort, meaning and practical support. If you are part of one, reaching out to a faith leader or members can help.

Grief is hard on the body. Looking after your physical health gives you more energy to cope. Regular exercise can lift your mood and help you sleep. Regular meals keep your energy steady.

Simple ways to care for your body

• Take a short walk each day, or try gentle stretching or yoga
• Eat regular meals, even small ones, when you don’t feel hungry
• Keep a regular sleep routine, going to bed and waking at similar times
• Try slow, deep breathing when your chest feels tight
• Do something soothing, like a warm bath or time in the garden

A simple calming breath

1. Sit or lie somewhere comfortable.
2. Breathe in slowly through your nose for a count of 4.
3. Breathe out gently through your mouth for a count of 6.
4. Repeat for 2 to 5 minutes.

Grief needs room to be felt. Pushing feelings away, or keeping very busy to avoid them, can make grief last longer or come out in other ways, like stomach upset or trouble sleeping.

Ways to care for your feelings

• Talk about the loss with a friend, family member or counselor
• Let all your feelings be valid, without judging them
• Cry when you need to. Tears can be a healthy release
• Focus on good memories and things you are thankful for
• Set small, doable goals instead of trying to do everything at once
• Take time alone if you need it, but try not to cut yourself off