Aug. 30 is National Grief Awareness Day, an important reminder that our understanding of loss has evolved far beyond the classic five stages introduced in Elisabeth Kübler-Ross‘s 1969 book, “On Death and Dying.” Grief is not a predictable progression through denial, anger, bargaining, depression, and acceptance. Coping with loss may involve all or none of those feelings, and the expectation that grieving follows a set path can make healing harder.
Experts now describe a dual process in which grieving individuals naturally swing between processing their pain and taking small breaks to focus on daily life. This shifting back and forth — feeling intense sorrow one moment and sharing a laugh with a friend the next — is not a sign of denial; it is a hallmark of healing. The aim is adapting to grief: learning to live with a loss, instead of trying to get over it.
The death of a loved one is not the only type of event that causes grief. Experiencing bankruptcy, going through a divorce, or receiving a difficult medical diagnosis can also spark deep feelings of loss. These life changes often bring a wave of conflicting emotions — from anger or apathy to regret or relief. There is no right or wrong way to feel, but acknowledging and accepting these emotions is the first step toward healing.
Grief often triggers physical symptoms, too, such as headaches, insomnia, and gastrointestinal upset. It can compromise the immune system by interfering with the production of antibodies and white blood cells — significantly increasing our susceptibility to infection and illness. More critically, research published in “JAMA Internal Medicine” shows the risk of a stroke and heart attack more than doubles within the first 30 days of losing a loved one, due to the surge in stress hormones (mainly cortisol and adrenaline), poor self-care, and spikes in blood pressure.
Another serious health risk is broken heart syndrome, a temporary weakening of the heart muscle brought on by severe emotional stress. It mimics a heart attack and requires immediate emergency room care. Although a minority of victims can suffer acute complications like heart failure or life-threatening arrhythmias, the majority make a full recovery within four to eight weeks.
The amount of time a person grieves depends on many factors, including the nature of the loss, the available support systems, and the mourner’s physical and mental health. For most, grief intensity slowly dissipates and integrates into daily life over six months to two years.
When intense emotional pain persists, it can become a serious mental health problem. The American Psychiatric Association estimates that up to 10% of bereaved adults experience prolonged grief disorder (PGD), where severe emotional symptoms interfere with normal functioning. This incidence climbs as high as 50% if the loss involves the unnatural death of a loved one, such as an accident, suicide, or homicide.
Those diagnosed with PGD may not believe that the loss has occurred or feel emotionally numb. They often avoid socializing, are unable to work, or feel that a part of themselves has been lost, too. Physical symptoms are common, including severe insomnia, high blood pressure, and malaise.
Neurological studies show that the disorder alters brain structure. The constant flood of stress hormones can reduce the volume of the hippocampus — the brain’s primary center for learning and memory — which heightens the sufferer’s emotional distress, and impairs decision-making, concentration, and recall. PGD also disrupts normal nerve pathways, which can create an addiction-like feedback loop. The nucleus accumbens, the pleasure center deep in the brain, is chronically activated with an unquenchable craving for the lost loved one.
PGD is highly treatable: Roughly two-thirds of sufferers will significantly improve with specialized, short-term psychotherapy, known as complicated grief treatment. However, even if symptoms resolve, brain scans may not return to normal. The long-term consequences of this are unclear.
Coping with normal grief takes time, but you can take steps to ease the pain:
- Prioritize self-care, including adequate sleep (a minimum of seven hours nightly if possible), nutritious meals, and regular exercise.
- Avoid alcohol and other substance use, which can interfere with the healing process. Grieving requires dealing with painful emotions, so don’t be afraid to cry or express your feelings.
- Balance the need for solitude by getting emotional support from family and friends so you do not become isolated.
- Grief counseling can help; a list of therapists can be found on the “Psychology Today” website, or by calling 211 — a free, confidential service run by the United Way that connects people to local health and human services).
If your symptoms severely disrupt your daily life or are overwhelming after six months, call your healthcare provider. For immediate confidential support, call or text the 988 Suicide & Crisis Lifeline.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.
Thanks for focusing on grief and the real health risks it poses. Also, I appreciate your attention to PGD – a very pernicious form of grief. Talking about loss and grief is a great step in healing from it.
Thank you for writing this article Dr. Jenkins. I learned quite a lot of very valuable information which helped explain my own journeys through loss.