Grief is a part of life. Chances are that you will experience grief at some point, if you haven’t already, and probably more than once. The past two years have been especially full of grief for many families, with nearly 1 million Americans dying of COVID-19.
COVID-19 as a cause of death is new, but the sadness and feeling of emptiness that can come from losing someone aren’t.
From the beginning of time, humans have experienced grief and have overcome it. But it can be hard to see hope when grief is fresh or the loss is especially profound.
We spoke with UNC Health psychiatrist Donald Rosenstein, MD, about grief, each person’s unique experience living with grief, and how to connect with others to help you to get through a difficult time.
There Is No “Right Way” to Grieve
It’s important to know that no two people experience grief the same way, Dr. Rosenstein says. And the loss of one person will often feel very different from the loss of another, even if you loved them both very much.
Researchers have long tried to understand how people experience and survive grief. You’ve probably heard of the “five stages of grief,” which date to psychiatrist Elisabeth Kubler-Ross’ 1969 book On Death and Dying. Kubler-Ross interviewed people dying of a terminal illness and proposed five stages of emotion: denial, anger, bargaining, depression and acceptance—although the stages can overlap, and the journey through them isn’t linear. People tend not to experience all of these stages or move through them in a sequence, Dr. Rosenstein says.
The dual process model of grief describes a two-track process of both actively grieving—feeling deep sadness and yearning—and also engaging in the forward-facing daily tasks of life, such as work, child care and errands. People typically move back and forth regularly between the two modes, and that’s normal, Dr. Rosenstein says.
Researchers have found—and people’s lived experiences confirm—that most people are able to respond to the loss of a loved one with resilience, meaning that they can continue to go to work, take care of children and pets, and function in a “normal” way while experiencing great sadness at times. If you are able to manage the loss of a loved one with sadness but not distress, you may worry there’s something wrong with you. There isn’t.
“Dozens of studies have demonstrated that most people are, in fact, quite resilient, meaning that even though they may be deeply affected by the loss, they continue to carry on and cope well emotionally over time,” Dr. Rosenstein says.
Ways to Cope with Grief
In the first days and weeks after a loss, people may feel adrift in their deep sadness. Over time, these feelings should lessen, but periods of sadness and yearning to be with the person you’ve lost may persist indefinitely, even for a lifetime.
While acknowledging that grief experiences vary, Dr. Rosenstein shares some strategies he recommends to help people cope with grief.
- Allow yourself to experience the loss without judgment or expectation. Try not to worry about what you should or shouldn’t be feeling and how long it should last. “Trying to suppress grief typically doesn’t work well and probably delays the healing process,” Dr. Rosenstein says. If you are doing better than you might expect, that’s OK, too.
- Spend time thinking of your loved one, but stay engaged in your day-to-day life. “There’s nothing wrong with rereading letters, watching videos and reminiscing,” Dr. Rosenstein says, “but you don’t want to get stuck there.” Check in with yourself to make sure you are continuing the important day-to-day responsibilities of taking care of yourself, your children or pets, and other obligations.
- Connect with family and friends or a support group. According to Dr. Rosenstein, “Most people will fare better if they grieve with others than isolating themselves in their grief.” Grief counselors and support groups are available, often based on specific types of loss. This support can be especially helpful when the relationship with the person who has died was complicated or if there were unresolved issues at the time of their death.
- If you have a religious community, seek support. Many religious organizations have rituals to process loss that you might find helpful. But if something doesn’t feel useful or good, it’s OK to stop doing it.
- Take time to grieve before making major decisions. It’s probably best to take some time before quitting your job, moving or making other sudden decisions when grief is new.
- Seek help if you’re engaging in self-destructive behavior. If you’re abusing substances, behaving recklessly or your relationships are suffering, seek out a therapist or counselor who can help.
How to Help Someone When They’re Grieving
- Give them space, but don’t disappear. You may be close to someone grieving and want to help them, and it’s critical for grieving people to have support from family and friends. But it’s important not to overwhelm the person with visits, calls or advice. “They may want some time to themselves and not be told that if you just do X, Y and Z, you’ll be better,” Dr. Rosenstein says. This doesn’t mean, however, that you should avoid the person or the subject of their loss. Try to remain available to them and take their cues on how to proceed.
- Ask them how they’re doing, and if they want to talk about it. Checking in with your friend or family member is important, as is being available to listen when they’d like to talk. Equally important is allowing them to decide if and when they want to talk about their grief. They may prefer to keep some areas of life close to the way they were before—for example, in the office or on the sidelines of their kid’s soccer game.
- Perform acts of service. It’s good to ask people what would be helpful for them, but sometimes it can put a burden on them to come up with something. If you are close to the person, think about things that would lighten their load. Meal Trains are a great idea, and easy to organize online to bring together a community. Offer to pick up their kids after school or take them to and from activities. Be specific about what you can do, including dates and times, to provide practical help in addition to emotional support.
Intense or Long-Term Grieving: When to Get Help
With so much variability in the experience of grieving, you may wonder what’s normal and how to know when you or someone in your life needs help from a professional.
Grief can become problematic because of its intensity or duration.
“If you’re so profoundly sad that there is no joy in your life whatsoever, you might need help,” Dr. Rosenstein says. “If you can’t sleep, can’t eat, if you are so anxious that you start with a drink at night to calm down and then you have two, three or four more … if you are so down and depressed that you can’t function, then you should get help.”
The American Psychiatric Association recently added “prolonged grief disorder,” marked by severe and incapacitating grief that lasts more than a year, to its diagnostic manual.
“This new diagnosis has been the subject of extensive research and in development for a long time. It is also controversial. Some critics fear that adding this diagnosis will lead to viewing grief, a universal human experience, as abnormal or pathological,” Dr. Rosenstein says. “Most mental health professionals are supportive of this new diagnosis and point to compelling evidence that a small percentage of people struggle so profoundly in their grief and are deserving of thoughtful attention and treatment to alleviate their suffering.”
According to Dr. Rosenstein, it’s also common for people who are grieving to have thoughts about death and suicide.
“If you do have thoughts of suicide and feel that you might act on those thoughts, you absolutely need to get help,” he says. If you are thinking about suicide, act now and call the National Suicide Prevention Lifeline at (800) 273-8255.
Talk to your doctor if you are experiencing ongoing feelings of sadness that interfere with your ability to function. If you are thinking about suicide, act now and call the National Suicide Prevention Lifeline at (800) 273-8255.