Grief


Grief is the response to the loss of something deemed important, in particular the death of a person or animal to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual, political and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss.
The grief associated with death is familiar to most people, but individuals grieve in connection with a variety of losses throughout their lives, such as unemployment, ill health or the end of a relationship. Loss can be categorized as either physical or abstract; physical loss is related to something that the individual can touch or measure, such as losing a spouse through death, while other types of loss are more abstract, possibly relating to aspects of a person's social interactions.
Modern research has moved beyond rigid stage-based models, such as Kübler-Ross's five stages, toward more flexible frameworks. One influential approach is Simon Shimshon Rubin's Two-Track Model of Bereavement, which focuses on both day-to-day functioning and the evolving emotional relationship with the deceased. George Bonanno's research further shows that most people demonstrate natural resilience, experiencing stable functioning despite significant losses, while acknowledging that grief can manifest as sadness, anger, anxiety, laughter, or even numbness.
In some cases, however, grief can become prolonged or debilitating, leading to complicated grief or prolonged grief disorder, where persistent longing and difficulty resuming normal routines interfere with life. Certain losses, such as the death of a spouse, child, or parent, tend to carry higher risks of depression and other mental health challenges. Studies on biological and cultural differences reveal that expressions of grief are highly diverse, while evolutionary theories suggest grief may help strengthen social bonds and survival behaviors.

Grieving process

Between 1996 and 2006, there was extensive skepticism about a universal and predictable "emotional pathway" that leads from distress to "recovery" with an appreciation that grief is a more complex process of adapting to loss than stage and phase models have previously suggested. The two-track model of bereavement, created by Simon Shimshon Rubin in 1981, provided a deeper focus on the grieving process. The model examines the long-term effects of bereavement by measuring how well the person is adapting to the loss of a significant person in their life. The main objective of the two-track model of bereavement is for the individual to "manage and live in reality in which the deceased is absent," as well as return to normal biological functioning.
Track One is focused on the biopsychosocial functioning of grief. This focuses on the anxiety, depression, somatic concerns, traumatic responses, familial relationships, interpersonal relationships, self-esteem, meaning structure, work, and investment in life tasks. Rubin points out, "Track 1, the range of aspects of the individual's functioning across affective, interpersonal, somatic and classical psychiatric indicators is considered".
The significance of the closeness between the bereaved and the deceased is important to Track 1 because this could determine the severity of the mourning and grief the bereaved will endure. This first track is the response to extremely stressful life events and requires adaptation, change, and integration. The second track focuses on the ongoing relationship between the griever and the deceased. Track two mainly focuses on how the bereaved was connected to the deceased and what level of closeness was shared. The two main components considered are positive and negative memories and emotional involvement shared with the decedent. The stronger the relationship with the deceased, the greater the evaluation of the relationship with heightened shock.
Any memory could be a trigger for the bereaved, the way the bereaved chose to remember their loved ones, and how the bereaved integrate the memory of their loved ones into their daily lives.
Ten main attributes to this track include imagery/memory, emotional distance, positive effect, negative effect, preoccupation with the loss, conflict, idealization, memorialization/transformation of the loss, impact on self-perception and loss process. An outcome of this track is being able to recognize how transformation has occurred beyond grief and mourning. By outlining the main aspects of the bereavement process into two interactive tracks, individuals can examine and understand how grief has affected their life following loss and begin to adapt to this post-loss life. The Model offers a better understanding of the duration of time in the wake of one's loss and the outcomes that evolve from death. Using this model, researchers can effectively examine the response to an individual's loss by assessing the behavioral-psychological functioning and the relationship with the deceased.
The authors of What's Your Grief?, Litza Williams and Eleanor Haley, state in their understanding of the clinical and therapeutic uses of the model:
"The Two-Track Model of Bereavement can help specify areas of mutuality and also difference ".
While the grief response is considered a natural way of dealing with loss, prolonged, highly intense grief may, at times, become debilitating enough to be considered a disorder.

Reactions

Grief can be experienced in a variety of ways. Crying is a normal and natural part of grieving. Crying and talking about the loss is not the only healthy response and, if forced or excessive, can be harmful. Lack of crying is also a natural, healthy reaction, potentially protective of the individual, and may also be seen as a sign of resilience. Grieving people are also likely to become anxious.
Some grief responses or actions, called "coping ugly" by researcher George Bonanno, may seem counter-intuitive or even appear dysfunctional, e.g., celebratory responses, laughter, or self-serving bias in interpreting events. Some healthy people who are grieving do not spontaneously talk about the loss. Pressing people to cry or retell the experience of a loss can be damaging. Genuine laughter is healthy.
When a loved one dies, it is not unusual for the bereaved to report that they have "seen" or "heard" the person they have lost. Most people who have experienced this report feeling comforted. In a 2008 survey conducted by Amanda Barusch, 27% of respondents who had lost a loved one reported having had this kind of "contact" experience. These experiences are correlated with pathology like grief complications.

Bereavement science

Bonanno's four trajectories of grief

George Bonanno, a professor of clinical psychology at Columbia University, conducted more than two decades of scientific studies on grief and trauma. Subjects of his studies number in the several thousand and include people who have suffered losses in the U.S. and cross-cultural studies in various countries around the world, such as Israel, Bosnia-Herzegovina, and China. His subjects suffered losses through war, terrorism, deaths of children, premature deaths of spouses, sexual abuse, childhood diagnoses of AIDS, and other potentially devastating loss events or potential trauma events.
His findings include that a natural resilience is the main component of grief and trauma reactions. The first researcher to use pre-loss data, he outlined four trajectories of grief. Bonanno's work has also demonstrated that absence of grief or trauma symptoms is a healthy outcome, rather than something to be feared as has been the thought and practice until his research. Because grief responses can take many forms, including laughter, celebration, and bawdiness, in addition to sadness, Bonanno coined the phrase "coping ugly" to describe the idea that some forms of coping may seem counter intuitive. Bonanno has found that resilience is natural to humans, suggesting that it cannot be "taught" through specialized programs and that there is virtually no existing research with which to design resilience training, nor is there existing research to support major investment in such things as military resilience training programs.
The four trajectories are as follows:
  • Resilience: "The ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning" as well as "the capacity for generative experiences and positive emotions".
  • Recovery: When "normal functioning temporarily gives way to threshold or sub-threshold psychopathology, usually for a period of at least several months, and then gradually returns to pre-event levels".
  • Chronic dysfunction: Prolonged suffering and inability to function, usually lasting several years or longer.
  • Delayed grief or trauma: When adjustment seems normal but then distress and symptoms increase months later. Researchers have not found evidence of delayed grief, but delayed trauma appears to be a genuine phenomenon.

    "Five stages" model

The Kübler-Ross model, commonly known as the five stages of grief, describes a hypothesis first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying. Based on the uncredited earlier work of John Bowlby and Colin Murray-Parkes, Kübler-Ross actually applied the stages to people who were dying, not people who were grieving.
The five stages are:
  1. denial
  2. anger
  3. bargaining
  4. depression
  5. acceptance
This model found limited empirical support in a study by Maciejewski et al. That is that the sequence was correct although Acceptance was highest at all points throughout the person's experience. The research of George Bonanno, however, is acknowledged as debunking the five stages of grief because his large body of peer-reviewed studies show that the vast majority of people who have experienced a loss are resilient and that there are multiple trajectories following loss.