What is grief?

The concept of ‘grief’ is described in the Dutch National Grief Guideline as ‘the entirety of physical, emotional, cognitive, spiritual, and behavioral reactions that occur after the loss of a person with whom a meaningful relationship existed.’ Loss not only means the death of a loved one but also losing a loved one to a serious illness such as dementia. However, grief can also arise from other losses, such as losing a job, relationship, home, or independence (e.g., due to a chronic illness).

• Physical reactions: decrease or increase in sleep and/or appetite, headaches, loss of energy, decrease or increase in the need for intimacy and sexuality.
• Emotional reactions: sadness, loneliness, fear, guilt, shame, aggression, helplessness, pessimism, nightmares, relief, satisfaction.
• Cognitive reactions: decreased concentration or self-esteem, confusion, tension, compulsiveness, being preoccupied with the deceased, hopelessness.
• Spiritual reactions: loss of perspective on life, decrease or increase in faith.
• Behavioral reactions: becoming easily irritated, withdrawal, avoidance of people or situations.

What is a grieving process?

After a loss, there is a period in which you learn to cope with the loss. This is a natural process that everyone goes through in their own way. During this grieving process, you will be confronted with the reality and the pain of the loss. You will notice that you start to sort things out for yourself, try to acknowledge or realize the loss (some say they never realize it), recall memories, and experience many changing emotions or emptiness. It is also very normal to suddenly think about themes such as life and death, the future, your norms and values, family and friends, children, or other ‘big’ topics.

It is difficult to determine when someone has successfully gone through a grieving process, but there are some natural changes that can be a sign. For example, when there is space again for positive feelings or memories of someone alongside the sadness. Or when the loss fades into the background a bit, and it becomes possible to resume daily life. Or the emergence of a new so-called ‘post-mortem’ relationship with the deceased. This is a relationship that promotes growth in which you are aware that someone has physically died, for example, if visiting the grave monthly gives a sense of calm or connection.

Complicated grief

When grief reactions persist for too long or are very severe, and they obstruct your daily functioning, this is also referred to as complicated grief. This happens, for example, when someone suddenly dies in a traumatic or violent way, someone has suffered excessively due to a long illness, someone’s death could have been prevented, with the loss of a child, with multiple deaths at once, or with a lack of social support. There are several forms of complicated grief:

• Absent or denied grief. Grief when death is not confirmed. For example, if the body has not been seen, in disappearances or disasters.
• Delayed grief. When grief (un)consciously is suspended. For example, when you got in a situation where you have to take care of others due to the loss.
• Chronic or prolonged grief. A permanent state of acute grief. For example, when you had a very dependent relationship or don’t get enough space from your environment to grieve.
• Wry grief. A form of grief with aggression or guilt instead of sadness. For example, in an ambivalent relationship if you had cut off contact or if there were conflicts or unfinished business.
• Traumatized grief. A form of grief where you remain stuck in post-traumatic stress.
• Somatic grief. A form of grief where someone develops somatic complaints instead of emotional reactions. These are sometimes even related to the cause of death (e.g., chest pains if someone has died of a heart attack).

Grief and depression

Confusion can sometimes arise between grief and depression because they are very similar. It is possible, however, that someone eventually develops depressive symptoms due to persistent grief symptoms. Below you can see the major differences between grief and depression:

Sources

Keirse, E., & Kuyper, M.B. (2010). Richtlijn Rouw. Versie 2. VIKC, Vereniging van Integrale Kankercentra. (www.oncoline.nl)