Living With Grief

What loss does to body and mind, and what really helps

What grief is and the losses people don't always count, grieving what could have been, what grief does to your body, sleep and memory, what the five stages got wrong, how grief usually unfolds over time, how to get through the days, and how to be there for someone who is grieving

52 minute read  ·  11,770 words

Your phone buzzes and, for half a second, you think it's them. A friend announces her pregnancy in the group chat, and you type "congratulations!" and then sit in the car for ten minutes before you can drive. You pass the office where you worked for twenty years, or the street you grew up on in another country, and something in your chest drops. Or it's three in the morning and you're lying awake, wondering whether what you feel is normal, or whether something is wrong with you for feeling it this much, or this little.

All of these are grief. Grief is what happens when we lose someone or something we were attached to: a person, yes, but also a relationship, a pet, a pregnancy, our health, a home, a job, a country, or a future we'd counted on. Sometimes what we grieve never happened at all, like the child we hoped for, the parent we needed or the life we thought we'd have.

Grief is one of the few things everyone goes through, and one of the things we're least prepared for. Most of us learn about it in the middle of it, from half-remembered ideas about stages and a lot of well-meant advice. This article is about what grief is, what it does to you, what the research says about the ideas you've probably heard, and what helps, both when you're grieving and when someone you love is.

There's no right way to do this!! Whatever brought you here, a death last week, a loss years ago that still catches you off guard, or a loss other people don't seem to count, you're welcome here, and nothing you're feeling needs to be explained or defended first. Grief can make it hard to concentrate, so please don’t feel you have to read all of this, or read it in order. Each part takes three to seven minutes, and the “Where to start” list a little further down shows which parts to read first.

More than sadness

People expect grief to feel like sadness, and it often does. But it can also feel like anger, guilt, numbness, fear, relief, exhaustion, or a strange flatness where you expected tears. Some days you might feel all of them before lunch, and other days you might feel almost nothing and wonder what that says about you.

Grief is the whole response to losing someone or something you were attached to. It's what you feel, and also what happens to your body, your sleep, your thoughts and the shape of your days. At the center of it, for most people, is yearning: the longing for the person, the place or the life you had. In a well-known US study that followed bereaved people through the first two years after a death, yearning was the strongest painful feeling at every point.

That longing tends to be as big as the bond was. Grief isn't a sign that something has gone wrong with you. It's what attachment feels like once what you were attached to is gone.

Grief is about more than death

Most research on grief has been done with people whose loved one died, and a lot of what we know comes from them. But people grieve many other things, and researchers who study those losses find the same shape of feeling.

When people who had been bereaved, people who had lost a job and people who had divorced were compared in one US study, their grief looked remarkably alike, and what mattered most in every group was how central the loss had been to who they were. The yearning that sits at the heart of grief has been measured in the same way after a death, a breakup and even homesickness.

A grief researcher in Canada who has written widely about these losses describes grief as our instinctive response to any loss, because losses break the assumptions that made life feel safe, predictable and meaningful. Some philosophers of grief go further and suggest that all grief, even after a death, is grief for lost possibilities: everything you expected the future to hold.

You don't need anyone to have died to be grieving.

Why it can feel so strange

You reach for your phone to tell them something. You set two plates. You hear the key in the door at the usual time and your heart jumps before your head catches up. After a breakup, a move or a lost job, it can be the same: you take the old route to work, or start a sentence with "we". If this keeps happening to you, you're not losing your grip.

One neuroscientist who studies grief explains it like this: for years, your brain has learned that this person is always there, reachable, part of the map of your world. Then you learn that they've gone. Those two pieces of knowledge don't fit together, and your brain has to slowly update one to match the other, through a thousand small moments of reaching and finding nothing there. It's a model rather than a proven fact, but it describes the experience well, and it explains why grieving takes time.

Part of grieving is your brain slowly learning something it has every reason to resist. That's why the reaching can go on for months, and why it doesn't mean you're stuck.

No two people grieve the same way

Some people want to talk about the loss constantly, cry, look at photos and go over what happened. Others grieve by doing: sorting the paperwork, fixing the fence, building something, going for long runs. Grief researchers call these intuitive and instrumental styles. Most people are a blend, and the styles are shaped by gender but not decided by it.

This matters most when two people share a loss but grieve it in opposite ways. After a miscarriage, one partner may want to talk every night while the other goes straight back to work and seems fine. It's easy to read that as not caring. Usually it's two different ways of carrying the same weight.

Culture shapes grief too: how long mourning lasts, what's said out loud and who is allowed to grieve. When the World Health Organization (WHO) describes grief that has become a disorder, it asks doctors to compare it with what is normal in the person's own culture and religion, because there is no single human standard.

Grieving differently from someone else doesn't mean you loved less.

Grief that doesn't feel allowed

Some losses come with a funeral, time off work and a fridge full of casseroles. Others come with nothing at all. You might be grieving an ex, a friend you weren't officially close to, a colleague, a pet, a pregnancy, or someone who is still alive but no longer the person you knew, and find that nobody around you seems to think it counts.

A grief researcher gave this a name in the late 1980s: disenfranchised grief, meaning grief that isn't openly recognized, publicly mourned or socially supported. Not being allowed to grieve doesn't make the grief smaller. It usually just makes it lonelier. In one study that followed people through the first year after a death, those who felt most cut off from others had more symptoms of grief, trauma and depression, and as that sense of disconnection eased, so did their distress.

If a loss mattered to you, your grief for it is real, whether or not anyone else sees it.

When a pregnancy ends

Miscarriage is common, and it's still rarely talked about. Around one in seven pregnancies that people know about ends in miscarriage, which works out to roughly 23 million every year worldwide. Nearly two million babies are stillborn each year too, most of them in sub-Saharan Africa and South Asia. In many places, women are still made to feel they should grieve in silence.

For many people, a pregnancy loss is the loss of a baby and of a whole future they'd already started to imagine: the name, the due date, the room. In one UK study, about three in ten women had symptoms of post-traumatic stresspost-traumatic stressSymptoms that can follow a frightening or shocking event: the memory pushing back in, avoiding reminders, feeling on edge and sleeping badly. In the study described here they were measured with a questionnaire, which is not the same as a diagnosis. a month after an early loss, and nearly one in five still did nine months later. Partners can be affected too, though fewer of them are, and they're often forgotten in the conversation.

Grieving a pregnancy loss is not an overreaction, however early it happened. Comments like "at least it was early" are usually meant kindly, and they can still hurt. It's completely fair to need time, to talk about the baby, or to mark the loss in your own way.

When a pet dies

Plenty of people have sobbed over a dog or a cat and then felt a bit embarrassed about it. In one study comparing people grieving a pet with people grieving a person, grief after a human death was a little higher on average, but the thing that predicted how hard someone grieved was the same in both groups: how close they had been.

How much you grieve depends on how close you were, not on whether they were human.

People grieving a pet often feel they have to be careful about whom they tell, and in one experiment, people rated grief over a pet as less legitimate than grief over a partner or a child. If you had to decide to have your pet put to sleep, guilt is very common afterward too, even when it was the kindest choice you could make.

Breakups and divorce

It's one in the morning and you're looking at your ex's photos again, and it feels as if you're back at the start. Nobody has died, and it can still feel like grief, because in many ways it is: you've lost a person, a routine and a version of your future.

When researchers asked people to rate their feelings every day for a month after a breakup, sadness and anger faded over those weeks, but not in a straight line. Some days were much worse than others. Staying in touch with the ex slowed the fading of both love and sadness.

Staying in close contact with an ex, even just online, can slow the healing. That doesn't mean you have to cut someone out forever. It might just mean muting, unfollowing or taking a break for a while.

Recovery after a breakup tends to come with two things: a story about what happened that makes some sense to you, and a clearer sense of who you are on your own.

When you've cut someone off

Estrangement is its own kind of loss. If you've stopped speaking to a parent or a sibling, often for very good reasons, you might feel relief and grief at the same time, and then feel confused about the grief. In interviews with adult children who had cut off a parent, many said they didn't miss the person so much as the family they had never had, and they felt that loss for years.

You can be relieved and grieving at the same time. It isn't a sign that the decision was wrong.

It's also more common than it feels from the inside. In one large US survey, about one adult in four had been estranged from their father at some point, and most people who were estranged from a parent later reconnected, at least for a while.

Losses without an ending

Some losses have no clear edges. A family therapist named this ambiguous loss. Sometimes someone is physically gone but still present in your mind, like a person who is missing or a family left behind after moving countries. Sometimes they're physically there but psychologically gone, like a parent with dementia. There's no funeral for these losses, so people can feel frozen, waiting for an ending that doesn't come. Instead of chasing closure, it often helps to hold two truths at once: they're here, and they're gone.

Caring for someone who is dying brings its own grief before the death. It's often called anticipatory grief, and many researchers now prefer "pre-loss grief". You might expect that grieving in advance would use some of it up. Research on family caregivers suggests it doesn't: very heavy grief before a death tends to go with harder grief afterward, while feeling prepared for the death tends to help.

If you're grieving someone who is still alive, that grief deserves support now, not only after they're gone.

When the loss keeps going

Some losses don't happen once. They keep happening. The baby that doesn't come, month after month. The diagnosis that changes what your child's life will look like. The career you trained for and couldn't keep. The day itself may be long past, but the life you expected keeps not arriving, and every so often you feel the gap all over again.

Two Australian researchers called this nonfinite loss: loss that continues over time, because what's lost isn't only a thing or a person but a future. The grief that goes with it has a name too, chronic sorrow. It was first described in 1962 by a US counselor who noticed that parents of children with intellectual disabilities carried a lasting, recurring sadness. He argued that this was a natural response to a real and ongoing situation, not a failure to accept it.

These losses often overlap with the ones in part two. They can be ambiguous, with no clear ending, and they're very often disenfranchised, because nobody sends flowers when an IVF cycle fails or a career ends. The same loss can be all of these at once.

Grief for a future that never arrived is still grief, even when there was never anything anyone else could see.

The child you hoped for

About one in six people of reproductive age experience infertility at some point, according to the WHO, and the rate is similar in rich and poorer countries. In 2025 it published its first global guideline on infertility, which calls for psychological support for everyone affected. Infertility is rarely only a medical problem. It's a pregnancy announcement you have to smile through, a baby shower invitation, or a stranger asking "do you have kids?".

When fertility treatment ends without a child, a review of the research found that people's mental health and well-being were worse on average than those of people who hadn't been through it, and that things tended to improve with time. People who came to accept what had happened, found some meaning in it and set new goals for their lives were doing better. In a large Dutch study, what predicted poorer mental health years later wasn't being childless so much as still holding on to the wish for a child.

Men often grieve this more quietly. In one small UK study, childless men said the longing for fatherhood faded as they got older but never quite stopped, and many felt like outsiders at family gatherings and at work.

Letting a wish go slowly isn't the same as saying it didn't matter. For many people, it's what makes room for the rest of their life to grow.

A diagnosis, yours or someone you love

A diagnosis can divide life into before and after. A sociologist who interviewed people living with chronic illness called what they lost a loss of self: watching the old picture of who they were fall away before a new one had formed. People with invisible illnesses often grieve what once was and what will never be while others doubt anything is wrong, and in one study, simple words like "I believe you" helped them feel their grief was legitimate. People living with dementia describe grieving for the person they used to be, for how others now see them, and for the person they will become.

When the diagnosis is your child's, the grief is often for the future you'd pictured and for the hard parts: the appointments, the worry, the fights for support. A review of research on parents of children with a chronic illness or disability found this sorrow to be a normal part of parenting in that situation, often flaring at health crises and at the milestones other children reach.

Grieving the future you'd pictured isn't the same as wishing your child were someone else. Parents in many countries describe the same pattern, and in one study the sorrow had little to do with how long ago the diagnosis was.

The childhood or the parent you never had

A friend mentions a long, easy phone call with her mom, and something in you aches. Some people grieve a parent who was there but couldn't show up for them because of addiction, illness or their own pain, or grieve a childhood that was spent being the grown-up.

Research on this is still small, but it points the same way. In one study of adults who grew up with a parent who drank heavily, many said that grieving the childhood they'd lost was harder than grieving the parent's death itself. Adults who grew up with a parent's mental illness have described grief and a shaky sense of who they are. Therapists often talk about grieving the parent you needed, and while that's a clinical idea more than a research finding, many people recognize it at once.

You can grieve something you never had.

Who you used to be

Losing a job, retiring, moving to another country or leaving a faith can all mean losing part of who you are. Not every change like this brings grief, and not everyone feels it. In a classic UK study of men who had lost their jobs, about one in four had a clear grief reaction, and it was stronger the more attached they had been to the work. Across many studies, losing a job roughly doubled the share of people with psychological problems. Retirement, by contrast, goes well for most people, although athletes forced to retire by injury often struggle, especially when the sport was their whole identity.

Moving countries can mean losing a language, a landscape, family nearby and the everyday sense of belonging. Separation from family and threats to cultural identity are among the stresses of migration, and psychiatrists call the grief that follows cultural bereavement. Leaving a faith can mean losing a community too: in a small UK study, former members who were shunned described it as grieving the living.

Losing a role can mean losing part of who you are, and that deserves to be grieved too.

The relationship that ended, or never began

Sometimes what you're grieving isn't only the person. It's the future you had with them: the house, the trips, the grown-old-together. In one US study of divorced women, the more they dwelt on the future self their marriage had promised, the lower their well-being. But women who explored that lost future in detail showed more growth in maturity over the following years.

Some relationships end before they ever properly begin. Unrequited love has been studied more than you'd think, and it hurts on both sides: the person who loved often believed the feeling was mutual and was never given a clear no. Grief for a relationship that never happened has barely been studied at all, but that doesn't make it any less real.

Thinking through what might have been, rather than pushing it away, seems to help people grow, even if it stings at first.

Why it comes back at milestones

A school's first day photos. A friend's wedding. Mother's Day. A new hospital letter. For nonfinite losses, grief tends to come back at the moments that show the gap between your life and the one around you. Researchers who studied chronic sorrow found that it returns at trigger events like these, and that being confronted with what's "normal" for everyone else was one of the most common triggers, in bereaved people as well as in parents and people living with illness.

This can be confusing if you thought you'd made peace with something. But acceptance and sorrow can sit side by side. You can accept that your life has gone a different way and still feel the loss when the world reminds you of it.

Grief that comes back at milestones is normal.

Grief is physical

Nobody really warns you how physical grief is. A tight throat, a heavy chest, sighing without meaning to, waves of exhaustion, no appetite or constant snacking, aches that seem to come from nowhere. Doctors described this in the 1940s, and people describe the same things today.

Grief also puts real strain on the body, and most of what we know here comes from people grieving a death. In one US study, the risk of a heart attack was many times higher in the day after the death of someone close, then fell day by day. The chance for any one person stays small, but it matters more if you already have heart disease.

A rare condition sometimes called broken heart syndrome, where sudden stress weakens the heart muscle for a while, can look just like a heart attack. Most people recover within weeks, but it needs medical care. People who have lost a partner also have a higher risk of dying themselves, especially in the first six months, and especially men. Researchers call this the widowhood effect.

Other losses leave a mark too. Divorce is linked to a higher risk of early death, much like widowhood. These are links rather than proof of cause, but they're a reason to take any big loss seriously.

None of this is meant to frighten you. It's why looking after your body counts as part of grieving, not a distraction from it.

Chest pain, breathlessness or fainting are never something to explain away as grief. Get them checked straight away.

Sleep

Sleep is often one of the first things to go. You can't get to sleep, you wake at four and lie there, or you sleep for twelve hours and still wake up exhausted. Nights can be the loneliest part of the day, and in studies where bereaved people rated their grief several times a day, it tended to be worse later in the day and when they were alone.

Poor sleep makes everything harder: your mood, your patience, your ability to cope with the next wave. For most people, sleep does get better. In one study that followed bereaved people for a year, nearly half slept reasonably well throughout and most of the rest improved, while about one in ten kept struggling, and they were also the people whose grief stayed most intense. Treatment for insomnia works well in general, although it has hardly been tested in grieving people specifically.

Memory and concentration

You walk into a room and forget why. You read the same paragraph four times, lose your keys and can't follow a conversation at work. Many people call it grief brain or grief fog, and it makes sense: a mind taken up with longing, poor sleep and stress has less room for everything else. Research that actually measures thinking and memory after a loss is thinner than you'd expect, though.

In one large Dutch study, people going through ordinary grief did just as well on thinking tests as people who weren't grieving, and the small differences that turned up were in people whose grief had become stuck.

Forgetting things while you grieve doesn't mean your mind is failing. In the meantime, write things down, set reminders, and give yourself far more time than usual for anything that needs careful thought.

Seeing, hearing or sensing them

You catch their smell in the hallway. You hear your name in their voice as you're falling asleep, or see them across a crowded street. Experiences like these are rarely mentioned, because people are afraid of being told they're losing their mind.

Studies suggest that somewhere between a third and more than half of people who lose a partner have experiences like these, and most of them have no history of mental illness. How they're understood depends a lot on culture: in many Southern European and Latin American communities, a visit from someone who has recently died is common and can be a comfort.

Sensing someone who has died is common, and it isn't a sign that anything is wrong with your mind. If the experiences are frightening, constant, or come with other things that worry you, it's worth talking them through with a doctor or therapist.

Where the five stages came from

Denial, anger, bargaining, depression, acceptance. Almost everyone has heard of the five stages of grief, and many people measure themselves against them. Am I still in denial? Shouldn't I be at acceptance by now?

The stages come from a Swiss-American psychiatrist, Elisabeth Kübler-Ross, who wrote about them in 1969. She was describing people who were dying themselves, not people grieving someone else. In a sense, the stages were first about grieving your own future. Others later carried them over to bereavement, and they spread everywhere. Decades later, she and a co-author wrote that the stages were never meant to tuck messy emotions into neat packages, and that not everyone goes through all of them or in any set order.

What the research found

The best-known test of the stages was the US study from part one, which followed more than two hundred bereaved people over two years. Acceptance was the most common feeling from the very first month, and it kept growing. Yearning, not denial or anger, was the strongest painful feeling throughout. A stage-like order only appeared after the numbers were adjusted in a way that critics have questioned.

There's no good evidence that grief moves through stages in order, and you're not doing it wrong if yours doesn't. Grief researchers have warned that expecting stages can make people feel they're grieving incorrectly. A newer study didn't find a clear link between believing in stages and grieving worse, so if the stages help you name what you feel, you don't have to throw them away. Just don't let them become a timetable.

Researchers have since offered three ideas that seem to describe grief more closely.

Swinging between the loss and the rest of life

One morning you look through old photos and cry until you're empty. That afternoon you sort out the car insurance, and in the evening you laugh at something on TV and then feel guilty for laughing.

That back and forth is exactly what two grief researchers in the Netherlands describe in what they call the dual process model. On one side is facing the loss itself: missing the person, crying, remembering. On the other is facing everything the loss has changed: new tasks, new roles, a new routine, and also distraction and rest. Their idea is that people cope best by moving between the two, and that time away from grief isn't avoiding it.

The figure below lets you build a day and see that swing for yourself.

It's the best-known model of grief today, and it fits what many bereaved people say, although the swinging itself has been tested less than you might expect, and the model was developed mostly in Western countries and mostly for grief after a death.

Taking a break from grief is part of grieving, not a betrayal of what you've lost.

Keeping a bond

For much of the twentieth century, the advice was to let go: to detach from the person who died so you could move on. That view has changed a lot. Maybe you talk to them, keep their voicemail, wear their sweater or ask yourself what they would say about a decision. For many people these are ways of carrying the relationship forward in a new form, and researchers call them continuing bonds.

The research is mixed about when bonds help. Bonds that live inside you, like drawing on their advice or their values, have generally gone with people adapting well. Experiences of the person as if they're still out there, like hearing or seeing them, have gone with more distress in some studies, especially after sudden or violent deaths. How the bond feels to you seems to matter as much as what it is.

You don't have to let go of someone to heal.

Life grows around it

In 1996, a grief counselor in New Zealand named Lois Tonkin wrote about a picture that a bereaved mother had used to explain her grief. The mother had drawn a circle for her life, completely filled in with grief. She had expected the grief to shrink over time. It didn't. Instead, her life slowly grew bigger around it.

The grief was still there, as large as ever, and a reminder could put her right back in the middle of it. But there was more around it now: new people, new days, new parts of herself.

It fits many losses, not only deaths. The version with jars and balls you may have seen online is a later adaptation of the same idea. The figure below shows both ways of picturing it side by side.

If your grief feels just as big as it did at the start, that doesn't mean nothing has changed. The question isn't only how big the grief is, but how much life there is around it.

Many people cope better than they expect

This part can be hard to read if you're in the thick of it, so please take it gently. It describes what happens across many people, and it isn't a verdict on you.

When researchers follow people after the death of someone close, a few patterns keep turning up. The newest review of these studies found that about half kept going with fairly steady, lower levels of grief from early on. About a third started with intense grief that eased over months. And roughly one person in ten had intense grief that stayed. The figure below draws those three paths.

These paths come from studies of bereavement. Other losses haven't been tracked in the same way yet, although a Dutch study of people who had lost their jobs found different patterns, from people who coped well to some who were mainly grieving.

How often people cope well is debated. The numbers change a lot depending on what researchers measure: when one study required people to be doing well on everything at once, from mood to physical health, only a small minority were. So it's safer to say that many people, often around half, cope fairly steadily, while still missing what they've lost.

If you're coping better than you expected, that isn't a sign it didn't matter. And if you aren't, that isn't a sign you're doing it wrong.

Intense early grief isn't a forecast

In the first months, grief can feel so overwhelming that it's hard to imagine it ever being different. One study measured bereaved people's grief many times over two years. For the first six months, the people who later recovered looked much the same as the people whose grief stayed intense. The difference only appeared between about six months and a year and a half.

So how you feel in the early months doesn't tell you how you'll feel later.

It comes in waves

Grief tends to arrive in waves rather than as a steady weight. In one study, widows rated how they were doing every day for three months. Their days swung up and down, with big swings early on that gradually became gentler, on top of a slow overall rise. The daily ratings after a breakup, in part two, showed the same unevenness.

Waves can also come back years later. A song in a store, a smell, a birthday, a place you used to go together. One grief expert called these subsequent temporary upsurges of grief. They can feel like being thrown right back to the beginning, but they're a normal part of how grief lives on, not a sign that you've gone backwards.

Laughter belongs here too

Laughing at a funeral, or at a story about the person who died, can feel almost forbidden. Yet in one small study, people who had lost their partner were filmed talking about them six months later. Those who laughed genuinely, the kind that crinkles the eyes, felt less distress and anger while talking, and in a follow-up, more positive expressions at six months went with less grief a couple of years on.

Laughter and grief can sit in the same room. A good memory that makes you laugh is still a way of loving someone.

When it's sudden or violent

A phone call in the middle of an ordinary afternoon. An accident, a disaster, a death nobody saw coming. When a death is sudden and violent, grief often arrives tangled up with shock and trauma. Reviews of the research find that depression, post-traumatic stress and grief that gets stuck are all more common after these losses than after natural deaths, and that recovery tends to be slower.

In pooled studies, about half of people whose grief had become stuck also had symptoms of post-traumatic stress. There's a useful line between them: in grief you may be preoccupied with how the person died, but in post-traumatic stress the memory feels as though it's happening again, here and now.

Sudden isn't always worse, though. Among older couples, whether a death from natural causes was sudden or expected made little difference to how grief went overall.

After a sudden or violent loss, grief and trauma can both need care, and grief-focused therapy can help with both.

After a suicide

Losing someone to suicide is more common than most people realize. More than 720,000 people are estimated to die by suicide each year, and every one of those deaths has long-lasting effects on the people left behind. Pooled studies suggest that about one person in five knows someone who died by suicide at some point in their life.

On average, the mental health of people bereaved by suicide looks much like that of people bereaved in other ways. But the grief has its own weight. People describe more rejection, shame and stigma, a need to hide how the person died, and questions of why and of blame that can go round for years. Others' awkwardness often turns into silence, just when support is needed most.

Suicide always involves many factors, so no single person, conversation or missed moment explains it.

If you've lost someone to suicide, support groups with others who have been through it can help. The WHO supports them, as a complement to professional help rather than a replacement, although research on them is still limited. When you talk about it, "died by suicide" or "took their own life" are the kindest words, because they carry no hint of blame. And if the loss has brought thoughts of ending your own life, please tell someone today.

When losses pile up

A third funeral in a year, and you realize you haven't finished crying for the first. A psychologist described this in 1969 as bereavement overload: losses coming too close together to grieve one before the next arrives. The team behind the dual process model later added overload to their model, because it can wear down physical as well as mental health.

Multiple losses seem to raise the risk of grief getting stuck in people living through war and displacement, where several traumatic losses often come together. But an earlier loss isn't always a burden. In a study of Norwegian survivors of the 2004 tsunami, people who had been through losses before actually had less severe grief two years later.

One death can also ripple out further than we think. A US estimate from the COVID-19 pandemic found that every death left about nine close relatives bereaved.

When losses pile up, it's not weakness to feel overwhelmed. It's a lot to carry, and it's worth asking for more help than you'd usually need.

The losses that follow the loss

A death, a divorce or a diagnosis rarely comes alone. It can bring the loss of an income, a home, a role, friends who drift away or plans you'd made together. Researchers call these secondary losses. In one Dutch study, it wasn't how many of these knock-on changes people faced that went with harder grief, but how stressful they felt.

For many widows worldwide, the secondary losses are stark. The United Nations points out that in many places, widows can lose their land, their home or their inheritance under customary law, and that older women are far less likely than men to have a pension.

Help with the practical fallout of a loss is part of grief support, not separate from it.

"If only" and "I should have"

If only I'd pushed for that scan. If only I'd stayed. If only I'd taken the other job. I should have visited more. I should have noticed. I shouldn't have said that last thing. Psychologists call these thoughts counterfactuals, and after something goes wrong, they arrive almost automatically. They sting, but they also have a purpose: they help us learn what to do differently next time.

Regret has a pattern. In the short run, people tend to regret the things they did. In the long run, they regret the things they didn't do, and a newer test of this found the same pattern, only weaker. People's most lasting regrets tend to be about not becoming the person they hoped to be.

After a sudden death, "if only" thoughts are very common, and they're usually about your own actions. In a Dutch study, bereaved people who kept thinking "if only I had done something differently" had more intense grief later on, while the rarer thought "it could have been worse" went with less grief. Going over and over the same question can also become a way of avoiding the harder fact that it happened.

Guilt is one of the most common feelings in grief, and it's heavier for some people than others. A review of the research found that it's linked to worse outcomes. It helps to tell two things apart. Regret is wishing things had been different. Self-blame is deciding it was your fault. In a German study that followed bereaved spouses, self-blame went with more intense grief that eased more slowly, while regret didn't. Guilt about feeling happy again can hold grief in place too, which is why that question has its own answer in part eleven.

What helps is kindness toward yourself. In a set of studies, people who took a self-compassionate view of a regret found it easier to accept and learned more from it.

Guilt in grief is often love looking for something it could have done. If it's turned into blaming yourself, that's worth bringing to a therapist, because it's one of the things grief therapy works on directly.

When the relationship was hard

You might be grieving a parent who hurt you, a partner you'd been planning to leave, or someone you hadn't spoken to in years. It can be one of the most confusing kinds of grief: angry and sad at the same time, relieved and then guilty for feeling relieved.

It's often assumed that a difficult relationship makes grief worse. In a large US study that followed older people from before their spouse died, it was the other way round: yearning was lower after conflicted marriages and higher when couples had been very close or dependent on each other. There's almost no research on grieving a parent who was abusive, but in therapy it's common to grieve both the person and the relationship you wished you'd had.

You don't have to forgive someone to grieve them, and you don't have to grieve them in the way other people expect.

Grief we carry together

Sometimes a loss is shared by a whole community or country. During the COVID-19 pandemic, studies in the Netherlands found that deaths from the virus brought more intense early grief than other natural deaths, much like sudden deaths, largely because they were unexpected and people often couldn't say goodbye.

In war and displacement, grief that gets stuck is very common, and the daily struggle of life afterward, finding work, papers and a home, plays a part too. And some people grieve places, species and ways of life that are disappearing. Researchers who worked with Inuit communities in Canada and farmers in Australia called this ecological grief. It's a real response to real loss, not a diagnosis, and some think it can even move people to act.

When a loss is shared, it can help to grieve it together too, through rituals, memorials or simply naming it out loud.

The first weeks

The first weeks after a big loss are often a blur of phone calls, paperwork and people. Some people feel numb and oddly efficient; others can barely get out of bed. How you are in these first weeks doesn't tell you how the rest of your grief will go.

Talking, and not talking

You might be told that you need to talk about it, cry it out or write down your feelings, or it'll stay bottled up. It's a common belief, and the research doesn't really support it. In two studies of bereaved people, talking about the loss and sharing feelings didn't predict better adjustment over time, and a writing exercise that has helped with other kinds of stress didn't reduce distress after a death either. A review of this area found no clear evidence that expressing feelings is what helps people through ordinary grief.

That doesn't mean talking is bad. If you want to talk, talking to someone who listens well can be a huge comfort. It means that if you're a private person who doesn't want to go over it, you're not damaging yourself by keeping it to yourself.

Talking about it can help if you want to, but it isn't a requirement for healing.

Rituals and remembering

Funerals, memorials, lighting a candle, visiting a grave, cooking their recipe on their birthday. You might expect research to show clearly that rituals ease grief. It's more mixed than that. In one Dutch study, bereaved people said funerals and rituals helped them, but how they rated the funeral didn't predict how their grief went. A review of funeral research found that what seemed to matter was being able to shape the goodbye in a way that felt meaningful.

So the ritual that helps is the one that means something to you. It doesn't have to be grand or traditional, and if you missed the funeral, or it didn't feel right, you can create your own goodbye later. Non-death losses rarely come with any ritual at all, so it can help to make one: planting something for a pregnancy that ended, writing a letter to the life you'd planned, or marking the last day at a job.

Mourning around the world

Every culture has its own ways of mourning, and they vary widely: how feelings are shown, how the dead are remembered, what people believe happens after death, and how long mourning lasts. In some communities formal mourning lasts a year, and in others the rituals are meant to bring grief out and are over quickly. In traditions that see death as a passage, grief can be tied to worry about how the person is doing in the afterlife.

Jewish mourning, for example, moves through a week called shiva, then the first month, the first year and lifelong remembrance. In Mexico's Day of the Dead, which UNESCO recognizes as cultural heritage, families welcome the dead home each year with their favorite foods, flowers and candles.

Researchers have warned that most grief research, and the criteria for grief that has become a disorder, were built in Europe and North America, and may not fit everywhere.

Your own culture's ways of mourning are as valid as any in a textbook, and so is choosing your own.

Going back to work

Going back to work can be a relief: structure, and a few hours of thinking about something else. It can also be exhausting. In a review of research on bereaved parents, returning to work often helped, especially when there was flexibility over when and how, and careless comments from colleagues were one of the hardest parts.

There's no international standard for time off after a death, and the rules vary enormously. In England, Scotland and Wales, employed parents whose child dies before the age of 18, or who have a stillbirth after 24 weeks of pregnancy, have a legal right to two weeks of bereavement leave. New Zealand gives at least three days of paid leave, including after a miscarriage or stillbirth. In the US, there's no national right to bereavement leave. Most other losses, like a divorce, a diagnosis or a failed IVF cycle, come with no leave at all. Many workplaces offer more than the law requires, so it's worth asking.

Anniversaries, birthdays and holidays

The first birthday without them, the first holiday season, the date of the death, or a due date that passes without a baby. A recent review of research on anniversary reactions concluded that grief, physical symptoms and distress really can gather around these dates, even though the studies vary a lot in quality.

In one US study, recently widowed older adults felt worse in the month of their late partner's birthday and in the January after the holidays, but mostly in the first six months after the loss, not later on.

Grief in later life

Later life can bring losses one after another: a partner, friends, siblings, health, a home. After a partner dies, loneliness is often the hardest part. A review of long-term studies found that loneliness peaks right after the death, and that widowers tend to be lonelier than widows. In a US study of older people, losing a partner mainly raised loneliness, which then spread into other low moods.

Grief in older age can also show up in the body more than in words. In older adults, grief that has become stuck may appear mainly as physical complaints.

Loneliness, more than sadness, is often what needs tending in later-life grief, so staying connected matters: regular contact, shared meals, a group or volunteering, whatever fits.

When grief doesn't start to shift

For most people, grief is painful and it lasts, but over time life slowly starts to grow around it. For some people, it doesn't. The longing stays so intense and all-consuming, for so long, that daily life can't restart. Since 2022, both of the world's main diagnostic manuals have included a name for this after a death: prolonged grief disorder.

The WHO's manual, ICD-11, describes it as a persistent, pervasive longing for the person who died, or preoccupation with them, together with intense emotional pain: sadness, guilt, anger, difficulty accepting the death, feeling you've lost part of yourself, numbness, or being unable to feel good. It has to have lasted at least six months, clearly beyond what is expected in the person's culture and religion, and it has to be getting in the way of life. The American manual, DSM-5-TR, uses a similar picture but asks for at least twelve months for adults, and six for children and teenagers.

Prolonged grief disorder isn't a deadline for grief, or a verdict on how much you loved. It describes grief that has become stuck, and it matters because this kind of grief responds to specific treatment. After an expected death from illness or old age, the figure most often quoted is about one person in ten, and careful surveys of whole populations find fewer. It's much more common after a sudden or violent death. The strongest warning signs in the research are very intense grief before the death, for example during a long illness, and depression. Losing a child or a partner raises the risk too.

Some experts worry about turning grief into a diagnosis at all. The people who developed the diagnosis point out that it applies to a small minority, and that those people are the ones most likely to be helped by the right treatment.

When grief after another loss gets stuck

Both manuals use prolonged grief disorder only after a death. If grief after a divorce, a job loss or a diagnosis gets stuck and starts to take over your life, a doctor is more likely to call it an adjustment disorder, or depression or anxiety if those fit better.

ICD-11 describes an adjustment disorder as being preoccupied with a stressful change, such as a divorce, losing a job or a new diagnosis, and struggling to adapt to it, in a way that gets in the way of life. It usually settles within about six months, unless the stress itself keeps going. Some researchers argue that grief after a non-death loss deserves its own diagnosis, and for now that's an open debate.

The name matters less than this: if grief after any kind of loss has taken over your life, you deserve help with it, and help exists.

Grief or depression?

Grief and depression share a lot: tears, low mood, poor sleep, no appetite, trouble concentrating. But they tend to feel different. Grief usually comes in waves linked to what you've lost: reminders, memories, dates. Between the waves there can be moments of warmth, even laughter. Depression is more of a steady gray that colors everything, with a sense of being worthless or hopeless about yourself.

You can have both at once, and depression doesn't have to wait until the grief is over to be treated. Since 2013, the main American diagnostic manual no longer tells doctors to hold off diagnosing depression just because someone has recently lost a person they love.

The treatments that work

Most people don't need professional help to grieve. Guidelines advise against offering structured therapy to everyone who is bereaved, and reviews of the research agree that help offered to everyone makes little lasting difference. But for people whose grief has become stuck, specific treatments help a lot.

The best tested are talking therapies built for prolonged grief. They usually combine understanding grief, gently facing the parts of the loss that are being avoided, such as telling the story of the death or visiting places, working with guilt and painful thoughts, keeping a bond with the person, and rebuilding a life with some meaning in it.

One, developed in the US and now called prolonged grief therapy, has worked better in trials than the therapy and standard care it was compared with. Grief-focused cognitive behavioral therapycognitive behavioral therapyA structured talking therapy that works on the links between thoughts, feelings and what you do. The grief-focused versions add gently facing the parts of the loss you have been avoiding. works well too, and the newest review of the trials found that its benefits held up, and even grew, after treatment ended.

Online versions have helped in some trials, though the results are more mixed. In one Swiss trial, an online grief program helped people after a separation or divorce as much as it helped people whose partner had died.

No medicine is approved to treat grief itself. In the largest trial, an antidepressant didn't ease grief, although it can help with depression when both are present. The WHO also advises against giving sleeping or calming pills from the benzodiazepine family to people simply because they are grieving.

If you think your grief might be stuck, a doctor, a psychologist or a therapist with training in grief is a good place to start. Bringing it up is not a failure. It's the most direct way to get the kind of help that works.

Grief and thoughts of suicide

Grief can bring thoughts that are frightening to have. That you'd like to be with them. That there's no point in going on without them, or without the life you'd planned. Many grieving people have fleeting thoughts like these, and they often pass.

But they're worth taking seriously, because the risk of suicide does go up after losing someone close. It's highest in the first days and weeks, and it rises more after losing a partner or a child, after losing someone to suicide, and when grief becomes stuck. Loneliness seems to be a big part of it, which is one more reason why the people around a grieving person matter so much.

If grief has brought thoughts of ending your life, please tell someone today. Our helplines page will help you find a service in your own country, and if you're in danger right now, call your local emergency number.

If you're worried about someone who is grieving, it's okay to ask them directly whether they're thinking about suicide. Asking doesn't put the idea in their head. Our article on suicidal thoughts goes into what helps, whether the thoughts are your own or someone else's.

When to reach out

You don't need to wait for a diagnosis to get support.

If there's no doctor or therapist you can reach or afford, or you're grieving someone the people around you wouldn't let you grieve openly, support can start somewhere else. A grief support group, a faith or community leader you trust, or a free helpline can all be a way in.

You don't need the perfect words

A friend's parent has died, and you have no idea what to say. So you say nothing, or you avoid them in the hallway because you're afraid of making it worse. Researchers who interviewed bereaved parents found that friends and relatives often wanted to help but didn't know how, and some ended up avoiding them.

When bereaved people have been asked what actually helped, the answers are simple. Someone being there, a chance to talk with someone who listened if they wanted to, and meeting people who had been through something similar. What didn't help included advice, being encouraged to recover or move on, forced cheerfulness, and "I know how you feel".

Turning up and saying something simple matters far more than getting it exactly right.

What to say, and what to skip

Most of the things people say that land badly are said with love. They're an attempt to make the pain smaller, and to a grieving person they can feel like being asked to hurry up.

The figure below gives some common phrases, for all kinds of loss, and what you might say instead.

Simple, honest words work best: "I'm so sorry." "I don't know what to say, but I'm here." "I'm thinking of you today." And don't be afraid to say the person's name or share a memory of them. You won't be reminding a grieving person of their loss, because they haven't forgotten it for a second.

When the loss isn't a death

A friend's IVF has failed again. A colleague's dog has died. Your sister's marriage has ended, or your neighbor's husband no longer recognizes her. These losses are easy to miss, and harder to talk about, because there's no card for them.

The same things help. In a study of women struggling with infertility, what helped was being listened to, having their feelings validated, practical help and talking to people who had been through it. What hurt was toxic positivity, advice and being told how to feel. Don't rank the loss, and don't rush to the silver lining.

Believe people when they tell you something was a loss for them. It costs you nothing, and it can mean a great deal.

Help that doesn't need asking for

"Let me know if you need anything" is kind, but it hands the work back to the grieving person, who then has to work out what they need and ask for it. Research on bereavement support suggests that help works best when it fits what the person needs at the time, in the amount they want.

If it's a colleague, ask how they'd like it handled rather than guessing. A short, private "I'm really sorry about your mom" is almost always better than silence. And if you manage people, it helps to know that in a large survey in Germany, grieving employees said they wanted understanding and availability from their managers, while the managers mostly thought about leave policies.

If you’re worried that their grief has turned into thoughts of suicide, part nine explains how to ask and when to get help.

Helping a grieving child

Children grieve too, and adults often want to protect them from it. The kindest thing is usually honesty in words they can understand. UNICEF and UK children's bereavement charities advise saying that the person has died, rather than "we lost Grandma" or "she's gone to sleep", which can leave a young child searching for her or afraid of going to sleep.

Children under about five may not yet understand that death is permanent, and may ask again and again when the person is coming back. Most grasp it somewhere between about five and seven, sometimes earlier. Children also tend to move in and out of grief: crying one minute, asking what's for dinner the next. UK children's bereavement charities call this puddle jumping, and it's normal. Children grieve other losses too, like a divorce, a move or a pet, and the same honesty helps there.

Most children cope with time and support, although studies from wealthier countries suggest that around one child in five develops a mental health problem in the year after a parent dies. Programs that support the surviving parent too have helped children, some for years afterward. If a child seems to be struggling at home and school for months, ask a doctor about specialist support.

These are the questions people type into a search bar at night, or keep to themselves because they feel wrong to ask. None of them is strange, and each has a short answer.

Is it grief if nobody died?

Yes. Grief is the response to losing something you were attached to, and that can be a relationship, a pet, your health, a job, a home, a country or a future you'd counted on. The research on these losses is thinner than the research on bereavement, but the feelings, the waves and the ways through are much the same. Doctors don't diagnose prolonged grief without a death, but that's a question of labels, not of whether your grief is real.

I feel relieved. Does that make me a bad person?

No. Relief is common, especially after a long illness, after years of caring for someone, or after a relationship that hurt you. In one US study of families who had cared for a relative with dementia, nearly three in four said the death was a relief to them, and more than nine in ten felt it was a relief for the person who died. Relief that their suffering is over, or that yours is, can sit right next to deep grief. It usually means you were carrying something very heavy, not that you didn't love them.

I didn't cry at the funeral. Did I not love them?

Crying isn't a measure of love. Some people cry a lot, some rarely, and some feel numb for weeks. As part one explains, many people grieve by doing rather than by talking or crying. Not crying doesn't mean the grief isn't there.

I still talk to them. Is that okay?

Yes. Talking to someone who has died, writing to them, or asking yourself what they'd think is a very common way of keeping a bond with them, and for many people it's comforting. It's only worth talking through with someone if it feels frightening, or if it's stopping you from living your own life.

Is it wrong to feel happy again?

It isn't wrong. Feeling joy, laughing, making plans or even falling in love again doesn't erase the person or what they meant to you. If you feel a stab of guilt the first time you realize you've had a good day, you haven't done anything wrong. That guilt can soften as you find that remembering them and living your life can happen together.

Is it too late to grieve something that happened years ago?

It's never too late. Grief can come back strongly years later, at a new stage of life, when you have your own children, when you reach the age a parent was, or out of nowhere. Some losses only make sense years afterward, like a childhood you now see differently. If an old loss is still weighing heavily on your life, grief-focused therapy isn't only for recent losses. In fact, across the trials, it has tended to help more when the loss was at least six months behind someone than when it was very recent.

Where can I find support?

Your family doctor is a good first step, if you have one you can reach. Guidelines count bereavement support as part of good end-of-life care, so if the person was looked after by a hospice or a palliative carepalliative careCare for people with a serious illness that focuses on comfort and quality of life rather than cure. The WHO includes support for the family, and bereavement support, as part of it. team, it's worth asking what they offer families. There are also support groups for particular losses, such as the death of a child, a pregnancy loss, infertility, or a death by suicide, where you meet people who understand without explanation.

Will it ever stop hurting?

For most people, the sharpest pain softens with time, even if it never disappears completely. The waves become less frequent and less overwhelming, and there's more room between them. What often happens is what that bereaved mother's picture showed: the grief stays, but life grows around it. Missing someone, or something, for the rest of your life isn't a sign that you haven't healed. It's a sign that it mattered.