• Grief is the process and emotions that we experience when our important relationships are significantly interrupted or (more frequently) ended, either through death, divorce, relocation, or some similar process.
• Grief starts when someone or something we care about is lost to us.
• These can be relationships with people that we have strong connections to, such as family members and friends; places we feel attached to, such as the house we grew up in or our hometown; or things that are important to us, such as love letters, a watch that a grandparent gave us, etc.
• There are two types of losses that we may grieve - the actual loss of the person or thing in our lives and then the symbolic loss of the events that can no longer occur in the future because of that actual loss.
• Grief ends when we have gotten past the intense need for the lost person or thing in our lives and are able to function normally without them.
• This doesn't mean that we stop feeling sad when we think about older losses, but instead that we are no longer significantly crippled by the loss.

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• Grief is a normal and natural process that takes work to get through.
• It is not easy to let go of close relationships that have existed in our lives.
• Dealing with the emotions that occur in the grieving process takes much time and energy, and is usually both physically and emotionally demanding.
• It is normal for people to grieve in very different ways - some grieve openly, while others hide their feelings of distress; Some grieve quickly, while others take a long time to "finish."
• There is no "right way" to grieve and each individual comes up with a method of grieving that fits them and their particular loss.
• Some conditions can make it harder for a person to successfully make it through the grief process. For example, sudden losses are harder to deal with than ones that have been anticipated, and the loss of a spouse, lover, child, parent, or best friend is usually more deeply felt than the loss of more distant relations and friends.
• There are different models of grief that have been described to help people understand the stages that many people go through during the grieving process. These include Horowitz?s Model of Loss/Adaptation, Kubler-Ross's Stages of Grief, and Rando's Six R's Model of Grief.

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• Though each person grieves in unique ways, there are common behavioral, emotional, and physical signs and symptoms that people who are grieving typically experience.
• Physically, persons affected by grief may experience:
• Fatigue and exhaustion alternating with periods of high alertness and energy
• Temporary hearing loss or vision impairment
• Difficulty sleeping
• Disturbed appetite (either increased or decreased)
• Muscle tremors
• Chills and/or sweating
• Difficulty breathing or rapid breathing
• Increased heart rate or blood pressure
• Stomach and/or intestinal problems
• Nausea and/or dizziness
• Mentally, persons affected by grief may experience:
• Confusion (memory, concentration, judgment and comprehension difficulties)
• Unwanted thoughts, arousal, and nightmares
• Intense feelings of detachment and denial
• Emotionally, persons affected by grief may experience:
• Shock
• Fear, anxiety or apprehension
• Anger, irritability or agitation
• Guilt
• Numbness, remoteness, depression

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• There are both constructive and destructive ways that people can choose to cope with grief and loss.
• Among the more destructive coping methods are turning to alcohol or other drugs to dull the pain.
• There are many healthy ways to deal with grief including:
• Journaling - Many people find comfort in writing out their thoughts and feelings during the grieving period and this can be a very good way to express feelings that they may not feel comfortable sharing with others.
• Talking - Others find that talking with a close family member or friend is helpful and allows them to share memories about the lost relationship or emotions that they are feeling.
• Getting Professional Help - Some people choose to speak with a professional grief therapist who can help them understand the grief process and deal with the emotions or reactions that are being felt.
• Medication - Grief therapists and other doctors may suggest that a prescription for anti-depressant or anti-anxiety medications would be helpful to take the edge off the worst grief symptoms, especially the physical ones.
• Support Groups - many people find it comforting to speak with others who are experiencing similar types of loss and who are at different stages of the grieving process.
• Good Physical Self-Care - it is important to practice good physical care, which includes getting enough sleep, eating well, and exercising.
• Keep Active and Social - it can actually be helpful for grieving people to stay engaged in other relationships and activities as they provide important opportunities for distraction; allowing grieving people to focus on something other than their grief.
• Putting Off Major Decisions - While grieving a loss, it is generally best to put off any major life decisions, as people's ability to think straight and use good judgment can become clouded by their loss.
• Read - People may find comfort in reading books about grieving, self-help, the meaning of life, and inspirational or religious/spiritual matters.
• Pray - People who find comfort in prayer and religious participation should pray and take part in prescribed rituals as a means of helping themselves cope with their loss.

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• It can be difficult for someone who is grieving to know when grieving will be completed.
• Grief can be an extended process and it has no set timeframe for finishing.
• Important signs that grief is winding down include the slow return of the ability to feel pleasure and joy again, the ability to look forward to things in the future, and the return of desire for reaching out to others and re-engaging in life.
• The transition from a sad focus on the past to a re-engaged hopeful focus on the present and future does not happen all at once.
• Grieving people may start to feel guilty when they realize that they are not wanting to remain grieving.
• They may see their recovery from grief as an abandonment of their past relationship and resist this perceived abandonment.
• In time the guilt feelings tend to subside too as life continues.
• A final sign that grief is ending occurs when grieving people are able to think about their lost person, place or thing more as a happy past memory and less as a painful present absence.
• They may still feel pain at the loss, but it is not as intense as it once was.

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• Many people are unsure what to say or do to be helpful or they worry that they will accidentally cause additional problems for grieving people by saying or doing the wrong thing.
• Reach Out - Many people hesitate to reach out, and instead choose to wait for the grieving person to ask for assistance. Help should be offered in the form of specific tasks that the griever may need assistance with, rather than a general "call if you need anything."
• Don't Minimize the Loss - Often while wanting to make the mourner feel better, we may actually accomplish the opposite by minimizing the loss, or insinuating that the mourner is not behaving as others expect.
• Listen - Instead of trying to offer "helpful" comments, you can help by simply being present and listening to what the grieving person has to say.
• Don't be Afraid to Mention the Lost Person - Often people fear that if they use the deceased person's name or refer to the loss, they will make the mourner upset, but most people feel worse when those around them act as though the deceased person or the relationship never existed and that nothing has changed.
• Suggest Professional Help if you are worried that a griever is "stuck" in their grieving process, experiencing difficulty acknowledging the reality of the loss, or displaying signs of physical or mental illness.

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• Coping with a death can be difficult for the strongest of adults and it can be even more difficult and confusing for children.
• Tell the Child What Has Happened - It is important to communicate this openly and honestly. Many people try to soften the blow by using phrases such as "He's gone to sleep" or "She's gone away." Dodging the issue in this manner suggests that the person had a choice in the matter, and can communicate that other people may abandon the child too.
• It is okay for children to see that adults are upset, and that loss is difficult for anyone to get through, regardless of age and experience. It is important not to feel as though you must have all the answers, or present yourself as invulnerable.
• However, children should not be expected to do or say something to make things better for the adults.
• It is important to take into account a child's developmental level when deciding how much and what to say because it is not until about ages 9 to 12 that a child fully comprehends the meaning and reality of death.
• Very young children may experience death as a loss, but they will not understand the irreversible nature of the loss and will not be able to verbalize that loss.
• Parents may want to step in and provide answers to some common childhood questions about death, even if the child has not asked the questions because the child may be afraid to ask them. But whether or not to offer such information is a judgment call that each parent has to make independently based on their knowledge of their child.

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• The term "Pathological Grief" is sometimes applied to people who are unable to work through their grief despite the passage of time.
• It can take most people up to several years to get past a serious loss.
• A pathological grief reaction may be diagnosed after a long time (one or more years) have passed and the grieving person is not improving.
• By labeling someone's grief as pathological, a doctor is indicating that the grieving process resolution is delayed for some reason and that professional help is needed.
• No disrespect is intended toward the patient in using this term.
• There is no absolute time frame within which grief is considered pathological, although there are cultural norms that serve as guidelines.
• In North America a person might be judged as being "stuck" if they are still actively grieving 18 to 24 months after their loss.
• An 'overly intense' grief process of shorter duration might also be labeled as pathological.
• Keeping these guidelines in mind, know that it is very much appropriate to encourage people who appear to be stuck in their grief process to seek professional grief counseling.

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