Grief and bereavement

Expert reviewer Dr Frances Goodhart, Clinical Psychologist 
Next review due December 2022

At some point in our lives, all of us will experience the loss of a loved one. Here we provide information on how grief and bereavement generally affect people. This page also covers what happens when grieving becomes more complicated and people may become stuck, finding it difficult to move on as they need to.

About grief and bereavement

Being bereaved is a natural part of life, as it happens to all of us at some point. Feeling grief and mourning are reactions to losing someone we love. The death of a loved one is recognised as the most stressful thing people ever face in life. But there are many types of loss, and people may also feel grief and mourn the loss of a relationship after divorce, the loss of a job or the loss of their health after a disabling injury or illness.

There is no right or wrong way to grieve. Nor is there any set length of time for ‘getting over it’.

Having said that, to help to identify those who are having more severe problems coping with the death of someone close, doctors have defined reactions to bereavement as ‘normal’ and ‘abnormal’. Abnormal grief is often called prolonged or complicated grief.

If you need help now

This page is designed to provide general health information. If you need help now, please use the following services.

• Samaritans
  116 123 (UK and ROI) This helpline is free for you to call and talk to someone.
  www.samaritans.org
• NHS Services has a list of where to get urgent help for mental health.
• Mind website. Click on the yellow ‘Get help now’ button at the top left of the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.

If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.

Usual reactions to grief

Grief after the death of someone close will be different for every person. It has been described as like a fingerprint: unique to the individual, but with experiences that are shared and patterns that are familiar to many. It will vary in how long it lasts and how intense it is. How we grieve is influenced by many factors, including our cultural background, individual personalities, age, health and spiritual beliefs. It will also be influenced by our relationship to the person who’s died. We may expect to grieve more intensely for a parent or partner than for a friend and most particularly for the loss of a child. How the loss came about can also have an effect. We may cope differently with a sudden death from one that is expected, after a long illness.

People generally have quite specific symptoms in the first weeks or months after losing someone close. These include:

• feelings of shock and disbelief
• feeling numb
• confusion and difficulty thinking straight
• anger
• guilt
• sadness and tearfulness
• difficulty sleeping
• loss of appetite

You may have heard of the ‘stages’ of grief and be expecting to move from one of these emotions to the next. But it’s not quite like that. Grieving usually happens intermittently and sporadically. Sometimes you may feel angry, sometimes numb and unable to accept what’s happened. You may feel that your emotions are all jumbled up.

It may be more helpful to think in terms of the ‘four tasks of grieving’:

• to accept the reality of the loss
• to work through the pain and grief of the loss
• to adjust to your new environment without your loved one
• to find an enduring connection with your loved one while moving forward with your life

It’s quite normal to feel strong emotional pain when someone dies. You may have such extreme mood swings that you feel as if you’re on an emotional rollercoaster. It’s also quite natural to think that you see or hear the voice of the person you’ve lost. You may find yourself talking to them, as if you’d forgotten for a moment that they’d died.

Usually, these symptoms gradually lessen as time passes since your bereavement. In time, you’re likely to find that you’ve accepted your loss and started to adjust to life without your loved one. There will still be times when the grief comes back to the forefront of your mind. Anniversaries, birthdays and traditionally orientated family times, such as Christmas, Hanukkah or Eid are likely to be difficult, particularly for the first year or two after your loss.

Complicated or abnormal grief

For some people, grief symptoms don’t gradually get better after a bereavement. They carry on and may even get worse. Doctors call this complicated or prolonged grief. This happens in around one in every 10 bereavements.

In complicated grief, intense grieving continues for a long time and prevents you from getting your life back on track. You’re likely to find it very difficult to believe that your loved one is gone. You may also feel very angry and bitter about their death, or feel guilty and that you should have done something to prevent it. You’re likely to find yourself thinking about your loved one much of the time, and may upset yourself often by going over in your mind what happened when they died.

There are some situations where complicated grief may be more likely. You may be more likely to have it if:

• you’ve had other losses or upsetting experiences in your life
• you’ve had (or still have) mental health problems such as depression or an anxiety disorder
• you were the carer for the person who’s died
• you had difficult relationships or lost someone very close to you early in life
• you have little support from family or friends
• the death was as a result of violence or suicide

Complicated grief can lead to you feeling stuck. Some people feel they can’t get back to any sort of normal life and that the pain they feel has no end. Others don’t allow themselves to move on. They may worry about forgetting the person who’s died or feel that not continuing to grieve would betray them in some way. 

Working through grief

After a bereavement, people often find themselves looking through old photos and re-living memories or telling stories about the person they’ve lost. Doing this is important and a healthy thing to do. It’s natural to want to do this although it can be emotionally exhausting. You’re learning to come to terms with your loss and cope with reminders of your loved one. Most people naturally alternate spending time on this with getting on with everyday life, which gives you a break from the strong emotions that these reminders are likely to bring up.

At the same time as processing all the emotions you’re feeling, you may have to get used to taking on new tasks. If you’ve lost someone you live with, or spend a lot of time with socially, your social life will also need to change. That may mean spending more time with friends, or finding new ones through new activities or hobbies.

All this may seem like hard work. And to some extent it is. It’s best not to push it too much. In time, most people come to an acceptance of their new circumstances and are able to spend time enjoying themselves without feeling guilty. It doesn’t mean you’ve forgotten them or stopped missing them and the times you spent together.

Coping with sudden or traumatic loss

Being bereaved is always difficult but it may be even harder if it’s sudden or particularly shocking, such as a death following an accident, sudden illness, suicide or violence. You’ll experience all the emotions that anyone does when bereaved, but they may be more intense. You may feel so confused and overwhelmed that you feel quite disorientated. Anguish and guilt can be particularly intense, and people often have thoughts of ‘if only…’ or berate themselves for not being a good enough partner, parent or child. Grieving also tends to last longer and you’re at greater risk of complicated or abnormal grief.

These intense emotions, the constant questioning of yourself and likely lack of sleep are all exhausting. You may feel despairing and depressed at times. Remember that you don’t have to cope alone. It’s better to ask for help sooner rather than later, particularly if you’re having flashbacks or nightmares about the death. These could be symptoms of post-traumatic stress.

If you’re having difficulty coping, do talk to your GP, or contact a support organisation such as CRUSE or the Samaritans (see ‘Other helpful websites’ below). Your workplace may have an employee assistance plan or similar service that you can use. This will give you space to talk freely without worrying about upsetting family or friends and may identify whether you also need some professional help.

When you may need some treatment

Generally bereavement is considered a natural part of life. It’s a process that you work through and these days doctors know that this takes time, and treatment generally can’t help with that.

The exception to this is complicated grief. This means that your grieving has gone on for many months or even years and you feel that it’s become stuck and that you can’t move on. Your doctor may suggest that you might benefit from a ‘talking therapy’ such as counselling or cognitive behavioural therapy. Therapy can be individually or in a group and should specifically be focused on grief and bereavement.

Depression and anxiety

Low mood and mood swings are common in bereaved people. Many of us might say we ‘feel depressed’. But this generally improves on its own and isn’t the same as developing depression as a condition, which needs treating.

However, sometimes people who’ve been bereaved do develop depression or anxiety. Depression is often associated with complicated grief. As many as half of those with complicated grief may also be depressed. However, it’s likely that most of those will have already been suffering from depression before they developed complicated grief. So, they have a tendency to depression, which has been triggered by their bereavement, rather than the bereavement causing it.

If you have depression, you’ll have been feeling very low and hopeless just about all day, every day for at least two weeks. You lose interest in your normal activities and are unable to find pleasure in anything. Keeping going at work or socially becomes difficult. With complicated grief your thoughts keep coming back to your loss and separation from your loved one. If this tips over into depression, you feel miserable and hopeless about life in general and not just your bereavement.

If you have symptoms of depression, your doctor might suggest a course of antidepressants as well as some therapy and sometimes medicine for anxiety. Antidepressants generally start to work after a week or two, although can take a couple of months to work fully. You should gradually find your mood lightening and symptoms of depression improving.

If you don’t have depression, antidepressants won’t help with symptoms of grief. But they can help to make therapy easier to bear if you are struggling with it.

Post-traumatic stress disorder (PTSD)

PTSD is a condition that is triggered by witnessing one or more traumatic events. You may be at risk of PTSD if you were there when a loved one died or found their body, particularly after a sudden death or suicide. If you have PTSD, you may feel very on edge and nervous a lot of the time. Many people have difficulty sleeping and concentrating and feel irritable or have outbursts of anger. You may have flashbacks or nightmares and may not be able to get pictures of what you’ve seen out of your head.

There are quite specific treatments for PTSD. Most often used is cognitive behavioural therapy. Doctors also sometimes prescribe antidepressants or may suggest another type of talking therapy called eye movement desensitisation and reprocessing (EMDR). There is more about this in our page on PTSD.

Coping with grief

You may not feel like it, but it’s important to take care of yourself while you’re grieving. People who’ve been bereaved are more at risk of physical illness as well as depression and stress. Letting yourself get run down won’t help you feel better.

• Make time to talk to other people. Keeping your feelings bottled up won’t help.
• Remembering and sharing happy memories of your loved one can help you to feel better and work through your loss emotionally.
• Allow yourself to grieve – it’s OK to be upset and there’s no time limit on it. One way to think about it is that ‘the best prescription for grief is to grieve’.
• Make sure you eat properly and get enough rest, even if you can’t sleep.
• If you’re physically able to, getting up and ideally out of your home for some exercise can help. You don’t need to run a marathon or engage in competitive sport. Just a few minutes of brisk walking, raking leaves, gardening or even some physical housework can be helpful.
• Don’t feel guilty or embarrassed about asking for specific help from family and friends. People often don’t know what they can do to support you and will be only too pleased to be able to help practically as well as emotionally. Ask for support if you need to, from family, friends, your GP, your colleagues and manager.

Sometimes, people turn to alcohol or drugs when they’re in emotional pain. Drinking can blunt your feelings and may lessen your grief for a while. But this will only ever be a short-term fix. If you come to rely on drinking or drugs, it will only make things worse and then you’ll have more problems to deal with in the long run.

Where to get support

The following organisations can offer you help and support.

• CRUSE Bereavement Care
  www.cruse.org.uk
  Helpline: 0808 808 1677
• MIND
  www.mind.org.uk
  Helpline: 0300 123 3393
• Survivors of Bereavement by Suicide
  www.uksobs.org
  Helpline: 0300 111 5065
• Child Bereavement UK
  www.childbereavementuk.org
  Helpline: 0800 02 888 40
• Samaritans
  www.samaritans.org
  Helpline: 116 123

How to support someone who’s been bereaved

People sometimes say that other people avoid them when they’ve been bereaved. This is probably because they feel awkward and don’t know what to say. But the most important thing you can do is listen and let them know you’re there to support them when they need it. So start with something like ‘I’ve been thinking of you. How are you coping?’ and take it from there.

• More than anything you can say, going to the funeral will show that you cared for the person who died and their family and friends.
• Do keep in touch – phone, write, visit. You may need to be persistent. Some people tend to isolate themselves after a loss.
• It is also OK to admit that you don’t know what to say, and are afraid of saying the wrong thing. It’s better than avoiding the bereaved person for fear of upsetting them.
• Your presence can be very reassuring to the bereaved person even if they can’t yet talk about their feelings.
• Offer practical help, such as cooking, shopping or helping with household chores. If you make a promise like that, do keep it.
• Encourage the bereaved person to talk and share their feelings by listening and not judging.
• Share positive memories of the person who’s died.
• Do remember difficult days – birthdays, anniversaries and holidays. Call, visit or arrange an outing together.