View source for Grief

{{Short description|Response to loss in humans and other animals}}
{{Other uses|Grief (disambiguation)}}{{Distinguish|Griefing}}
{{Redirect|Bereavement}}
{{Use dmy dates|date=April 2022}}
{{Infobox medical condition
| name          = Grief
| synonym       = [[Mourning]]; grieving; bereavement<ref name="MedlinePlusGrief">{{Cite web|url=https://medlineplus.gov/ency/article/001530.htm|title=Grief: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=21 July 2019}}</ref>
| image         = Grief - old woman (70-ies).jpg
| image_size    = 220px
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| symptoms      =
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| treatment     = [[Pastoral care]], [[mental health professional]]s, [[social worker]]s, [[support group]]s<ref name="MedlinePlusGrief"/>
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{{emotion}}
'''Grief''' is the response to the loss of something deemed [[important]], particularly to the [[death]] of a person to whom or animal to which a [[Human bonding|bond]] or [[affection]] was formed. Although conventionally focused on the [[emotional]] response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual 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]], [[Disease|ill health]] or the end of a [[Interpersonal relationship|relationship]].<ref>{{Cite web|title=Grief|url=https://hospicefoundation.org/grief|access-date=20 March 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120319211508/http://www.hospicefoundation.org/grief |archive-date=19 March 2012 |website=Hospice Foundation of America}}</ref> Loss can be categorized as either physical or abstract;<ref name = therese>{{cite book |first1=Therese A. |last1=Rando |year=1991 |title=How to go on living when someone you love dies |publisher=Random House Publishing |isbn=978-0553352696}}{{Page needed|date=March 2012}}</ref> 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.<ref name = therese/>

== 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 [[model]]s have previously suggested. The two-track model of bereavement, created by Simon Shimshon Rubin in 1981,<ref>{{Cite journal |last=Rubin |first=Simon |date=January 1981 |title=A two-track model of bereavement: Theory and application in research. |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1939-0025.1981.tb01352.x |journal=American Journal of Orthopsychiatry |volume=51 |issue=1 |pages=101–109 |doi=10.1111/j.1939-0025.1981.tb01352.x |pmid=7212022 |issn=1939-0025|url-access=subscription }}</ref> 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.<ref>{{Cite book |last=Malkinson |first=Ruth |url=https://books.google.com/books?id=V8GAp2zEwUoC&q=Cognitive+grief+therapy%3A+Constructing+a+rational+meaning+to+life+following+loss&pg=PP15 |title=Cognitive Grief Therapy: Constructing a Rational Meaning to Life Following Loss |date=2007 |publisher=W. W. Norton & Company |isbn=978-0-393-70439-6}}</ref>

Track One is focused on the biopsychosocial functioning of grief. This focuses on the [[anxiety]], [[Depression (mood)|depression]], somatic concerns, traumatic responses, familial relationships, interpersonal relationships, self-esteem, meaning structure, work, and investment in life tasks. Rubin (2010) points out, "Track 1, the range of aspects of the individual's functioning across affective, interpersonal, somatic and classical psychiatric indicators is considered".<ref>Shimshon, p. 686</ref>

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.
[[File:Mother of martyr.jpg|thumb|An Iranian mother mourning her son, who was killed in the [[Iran-Iraq war]] over 20 years earlier.]]
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 (shock, searching, disorganized).<ref name="Rubin, 1999">Rubin, 1999</ref> An outcome of this track is being able to recognize how transformation has occurred beyond grief and mourning.<ref name="Rubin, 1999"/> 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.<ref>{{Cite journal | doi=10.1080/07481180802705668| pmid=19368062|title = The Two-Track Model of Bereavement Questionnaire (TTBQ): Development and Validation of a Relational Measure| journal=Death Studies| volume=33| issue=4| pages=305–33|year = 2009|last1 = Rubin|first1 = Simon Shimshon| last2=Bar Nadav| first2=Ofri| last3=Malkinson| first3=Ruth| last4=Koren| first4=Dan| last5=Goffer-Shnarch| first5=Moran| last6=Michaeli| first6=Ella| s2cid=205584637}}</ref>

The authors from ''What's Your Grief?'', Litza Williams and Eleanor Haley, state in their understanding of the clinical and therapeutic uses of the model:

{{blockquote|in terms of functioning, this model can help the bereaved identify which areas of his/her life has been impacted by the grief in a negative way as well as areas that the bereaved has already begun to adapt to after the loss. If the bereaved is unable to return to their normal functioning as in before loss occurred, it is likely they will find difficulty in the process of working through the loss as well as their separation from the deceased.

Along the relational aspect, the bereaved can become aware of their relationship with the deceased and how it has changed or may change in the future (Williams & Haley, 2017).<ref>{{Cite news|url=https://whatsyourgrief.com/rubin-two-track-model-of-bereavement/|title=Understanding The Two-Track Model of Bereavement - What's Your Grief|last1=Williams|first1=Litza|date=2017-01-12|work=What's Your Grief|access-date=2017-12-11|last2=Haley|first2=Eleanor}}</ref>}}

"The Two-Track Model of Bereavement can help specify areas of mutuality (how people respond affectivity to trauma and change) and also difference (how bereaved people may be preoccupied with the deceased following loss compared to how they may be preoccupied with trauma following the exposure to it)" (Rubin, S.S, 1999).<ref>{{Cite journal | doi=10.1080/074811899200731| pmid=10848088|title = The Two-Track Model of Bereavement: Overview, Retrospect, and Prospect| journal=Death Studies| volume=23| issue=8| pages=681–714|year = 1999|last1 = Rubin|first1 = Simon Shimshon| citeseerx=10.1.1.462.2673}}</ref>

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.<ref name = Mihaela>{{Cite journal |last1=Prigerson |first1=Holly G. |last2=Horowitz |first2=Mardi J. |last3=Jacobs |first3=Selby C. |last4=Parkes |first4=Colin M. |last5=Aslan |first5=Mihaela |last6=Goodkin |first6=Karl |last7=Raphael |first7=Beverley |author-link7=Beverley Raphael |last8=Marwit |first8=Samuel J. |last9=Wortman |first9= Camille |last10=Neimeyer |first10=Robert A. |last11=Bonanno |first11=George |date=4 August 2009 |title=Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11 |journal=PLOS Medicine |volume=6 |issue=8 |pages=e1000121 |doi=10.1371/journal.pmed.1000121 |issn=1549-1676 |pmc=2711304 |pmid=19652695 |doi-access= free}}</ref><ref>{{Cite journal|last1=Lundorff|first1=Marie|last2=Holmgren|first2=Helle|last3=Zachariae|first3=Robert|last4=Farver-Vestergaard|first4=Ingeborg|last5=O'Connor|first5=Maja|date=April 2017|title=Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis|url=http://dx.doi.org/10.1016/j.jad.2017.01.030|journal=Journal of Affective Disorders|volume=212|pages=138–49|doi=10.1016/j.jad.2017.01.030|pmid=28167398|s2cid=205643136 |issn=0165-0327}}</ref><ref>{{Cite journal|last1=Boelen|first1=Paul A.|last2=van de Schoot|first2=Rens|last3=van den Hout|first3=Marcel A.|last4=de Keijser|first4=Jos|last5=van den Bout|first5=Jan|date= September 2010|title=Prolonged Grief Disorder, depression, and posttraumatic stress disorder are distinguishable syndromes|url=http://dx.doi.org/10.1016/j.jad.2010.01.076|journal=Journal of Affective Disorders|volume=125|issue=1–3|pages=374–78|doi=10.1016/j.jad.2010.01.076|pmid=20189657|issn=0165-0327|url-access=subscription}}</ref>

== Reactions ==
[[File:Evstafiev-bosnia-sarajevo-funeral-reaction.jpg|thumb|A family mourns during a funeral at the Lion's cemetery during the [[Siege of Sarajevo]] in 1992.]] [[Crying]] is a normal and natural part of grieving. It has also been found, however, that crying and talking about the loss is not the only healthy response and, if forced or excessive, can be harmful.<ref name="americanPsychologistpdf">{{cite journal |doi=10.1037/0003-066X.59.1.20 |title=Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events? |year=2004 |last1=Bonanno |first1=George A. |journal=American Psychologist |volume=59 |pages=20–28 |pmid=14736317 |issue=1|s2cid=6296189 |url=http://rcin.org.pl/Content/60213 }}</ref><ref name="Time_NWTAG">{{Cite magazine |last=Konigsberg |first=Ruth Davis |date=29 January 2011 |url=http://content.time.com/time/magazine/article/0,9171,2042372,00.html |title=New Ways to Think About Grief |magazine=[[Time (magazine)|Time]]}}</ref> Responses or actions in the affected person, 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.<ref name="SA_NTG">{{cite journal|title=The Neuroscience of True Grit|journal=Scientific American|volume=304|issue=3|pages=28–33|doi=10.1038/scientificamerican0311-28|pmid=21438486|year=2011|last1=Stix|first1=Gary|bibcode=2011SciAm.304c..28S}}</ref> Lack of crying is also a natural, healthy reaction, potentially protective of the individual, and may also be seen as a sign of resilience.<ref name="americanPsychologistpdf"/><ref name="Time_NWTAG"/><ref name="nytimes1">{{cite news|url=https://www.nytimes.com/2011/04/12/nyregion/12funerals.html|title=Dance, Laugh, Drink. Save the Date: It's a Ghanaian Funeral.|date=12 April 2011|work=[[The New York Times]]}}</ref>

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.<ref name="Time_NWTAG"/> Genuine [[laughter]] is healthy.<ref name="americanPsychologistpdf"/><ref name="nytimes1"/> 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.<ref>Barusch, A. (2008). ''Love Stories of Later Life''. Oxford University Press. pp. 166–68. {{ISBN|978-0-19-531404-5}}</ref>

== Bereavement science ==
[[File:Bundesarchiv Bild 146-1996-036-01, Flüchtlingsfrau mit Wägelchen.jpg|thumb|Grief can be caused by the loss of one's home and possessions, as occurs with [[refugee]]s.]]

=== Bonanno's four trajectories of grief ===
{{Main|George Bonanno}}

George Bonanno, a professor of [[clinical psychology]] at [[Columbia University]], conducted more than two decades of scientific studies on grief and [[Psychological trauma|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.<ref name="americanPsychologistpdf"/> The first researcher to use pre-loss data, he outlined four trajectories of grief.<ref name="americanPsychologistpdf"/> 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.<ref name="SA_NTG" /> Because grief responses can take many forms, including laughter, celebration, and bawdiness, in addition to [[sadness]],<ref name="nytimes1"/><ref>{{cite web|url=http://www.giftofireland.com/Irishwakes.htm|title=The Irish Wake Tradition – Exploring Irish Wakes|date=13 February 2012|access-date=9 April 2011|archive-date=13 January 2011|archive-url=https://web.archive.org/web/20110113203047/http://www.giftofireland.com/Irishwakes.htm|url-status=dead}}</ref> Bonanno coined the phrase "coping ugly" to describe the idea that some forms of [[Coping (psychology)|coping]] may seem counter intuitive.<ref name="SA_NTG" /> Bonanno has found that resilience is natural to humans, suggesting that it cannot be "taught" through specialized programs<ref name="SA_NTG" /> 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.<ref name="SA_NTG" />
{{clearleft}}
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]] (e.g., symptoms of depression or [[post-traumatic stress disorder]], or PTSD), 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 [[Psychological trauma|trauma]] appears to be a genuine phenomenon.

=== "Five stages" model ===
{{Main|Kübler-Ross 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''.<ref>{{Cite magazine|last=Nuland|first=Sherwin B.|author-link =Sherwin B. Nuland|date=2004-09-06|title=Appreciation: Dr. ELISABETH KUBLER-ROSS|language=en-US|magazine=Time|url=https://content.time.com/time/subscriber/article/0,33009,995057,00.html|access-date=2023-03-10|issn=0040-781X}}</ref> 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:
# [[denial]]
# [[anger]]
# [[bargaining]]
# [[Depression (mood)|depression]]
# [[acceptance]]

This [[model]] found limited empirical support in a study by Maciejewski et al.<ref>{{cite journal |doi=10.1001/jama.297.7.716 |title=An Empirical Examination of the Stage Theory of Grief |year=2007 |last1=MacIejewski |first1=P. K. |last2=Zhang |first2=B. |last3=Block |first3=S. D. |last4=Prigerson |first4=H. G. |journal=JAMA: The Journal of the American Medical Association |volume=297 |issue=7 |pages=716–23 |pmid=17312291|doi-access=free }}</ref> 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.

== Physiological and neurological processes ==

[[File:El Greco Pietà.jpg|thumb|"[[Pietà]]" by [[El Greco]], 1571–1576]]
[[File:019 Sadness and grief symbol - statue at Vienna Zentralfriedhof Cemetery.jpg|thumb|Grief in art: grave statue at [[Vienna Central Cemetery]]]]

Studies of [[fMRI]] scans of women from whom grief was elicited about the death of a mother or a sister in the past 5 years resulted in the conclusion that grief produced a local inflammation response as measured by salivary concentrations of [[pro-inflammatory cytokine]]s. These responses were correlated with activation in the [[anterior cingulate cortex]] and [[orbitofrontal cortex]]. This activation also correlated with the free recall of grief-related word stimuli. This suggests that grief can cause [[stress (biology)|stress]], and that this reaction is linked to the emotional processing parts of the [[frontal lobe]].<ref>{{cite journal |last1=O'Connor |first1=Mary-Frances |author-link=Mary-Frances O'Connor |last2=Irwin |first2=Michael R. |last3=Wellisch |first3=David K. |year=2009 |title=When grief heats up: Pro-inflammatory cytokines predict regional brain activation |journal=NeuroImage |volume=47 |issue=3 |pages=891–96 |doi=10.1016/j.neuroimage.2009.05.049 |pmc=2760985 |pmid=19481155}}</ref> Activation of the anterior cingulate cortex and [[vagus nerve]] is similarly implicated in the experience of [[broken heart|heartbreak]] whether due to [[social rejection]] or bereavement.<!-- refs on linked article -->

Among those persons who have been bereaved within the previous three months of a given report, those who report many [[intrusive thought]]s about the deceased show ventral [[amygdala]] and rostral [[anterior cingulate cortex]] hyperactivity to reminders of their loss. In the case of the amygdala, this links to their sadness intensity. In those individuals who avoid such thoughts, there is a related opposite type of pattern in which there is a decrease in the activation of the dorsal amygdala and the [[dorsolateral prefrontal cortex]].

In those not so emotionally affected by reminders of their loss, studies of [[fMRI]] scans have been used to conclude that there is a high functional connectivity between the dorsolateral prefrontal cortex and amygdala activity, suggesting that the former regulates activity in the latter. In those people who had greater intensity of sadness, there was a low functional connection between the rostral anterior cingulate cortex and amygdala activity, suggesting a lack of regulation of the former part of the brain upon the latter.<ref>{{cite journal |doi=10.1016/j.biopsych.2009.01.019 |title=Neural Mechanisms of Grief Regulation |year=2009 |last1=Freed |first1=Peter J. |last2=Yanagihara |first2=Ted K. |last3=Hirsch |first3=Joy |last4=Mann |first4=J. John |journal=Biological Psychiatry |volume=66 |pages=33–40 |pmid=19249748 |issue=1 |pmc=2782609}}</ref>

== Evolutionary hypotheses ==

From an evolutionary perspective, grief is perplexing because it appears costly, and it is not clear what benefits it provides the sufferer. Several researchers have proposed functional explanations for grief, attempting to solve this puzzle. Sigmund Freud argued that grief is a process of libidinal reinvestment. The griever must, Freud argued, disinvest from the deceased, which is a painful process.<ref>Freud, S. (1957). Mourning and Melancholia. In J. Strachey (Ed. and Trans.), ''The standard edition of the complete psychological works of Sigmund Freud'' (Vol. 14, pp. 152–70). London: Hogarth Press. (Original work published 1917)</ref> But this disinvestment allows the griever to use libidinal energies on other, possibly new attachments, so it provides a valuable function. John Archer, approaching grief from an attachment theory perspective, argued that grief is a byproduct of the human attachment system.<ref>Archer, J. (1999). ''The nature of grief: The evolution and psychology of reactions to loss''. London, England: Routledge.</ref> Generally, a grief-type response is adaptive because it compels a social organism to search for a lost individual (e.g., a mother or a child). However, in the case of death, the response is maladaptive because the individual is not simply lost and the griever cannot reunite with the deceased. Grief, from this perspective, is a painful cost of the human capacity to form commitments.

Other researchers such as Randolph Nesse have proposed that grief is a kind of psychological pain that orients the sufferer to a new existence without the deceased and creates a painful but instructive memory.<ref>Nesse, R. M. (2005). An evolutionary framework for understanding grief. In D. Carr, R. M. Nesse, & C. B. Wortman (Eds.), ''Late life widowhood in the United States: Spousal bereavement in late life'' (pp. 195–226). New York, New York: Springer.</ref> If, for example, leaving an offspring alone at a watering hole led to the offspring's death, grief creates an intensively painful memory of the event, dissuading a parent from ever again leaving an offspring alone at a watering hole. More recently, Bo Winegard and colleagues argued that grief might be a socially selected signal of an individual's propensity for forming strong, committed relationships.<ref>{{cite journal |author1=Winegard B. M. |author2=Reynolds T. |author3=Baumeister R. F. |author4=Winegard B. |author5=Maner J. K. | year = 2014 | title = Grief functions as an honest indicator of commitment | journal = Personality and Social Psychology Review | volume = 18 | issue = 2| pages = 168–86 | doi=10.1177/1088868314521016|pmid=24501093 |s2cid=3580609 }}</ref> From this social signaling perspective, grief targets old and new social partners, informing them that the griever is capable of forming strong social commitments. That is, because grief signals a person's capacity to form strong and faithful social bonds, those who displayed prolonged grief responses were preferentially chosen by alliance partners. The authors argue that throughout human evolution, grief was therefore shaped and elaborated by the social decisions of selective alliance partners.

== Risks ==

Bereavement, while a normal part of life, carries a degree of risk when severe. Severe reactions affect approximately 10% to 15% of people.<ref name="americanPsychologistpdf"/> Severe reactions mainly occur in people with depression present before the loss event.<ref name="americanPsychologistpdf"/> Severe grief reactions may carry over into family relations. Some researchers have found an increased risk of marital breakup following the death of a child, for example. Others have found no increase. John James, author of the Grief Recovery Handbook and founder of [[the Grief Recovery Institute]], reported that his marriage broke up after the death of his infant son.

=== Health risks ===
Many studies have looked at the bereaved in terms of increased risks for stress-related illnesses. [[Colin Murray Parkes]] in the 1960s and 1970s in England noted increased doctor visits, with symptoms such as abdominal pain, breathing difficulties, and so forth in the first six months following a death. Others have noted increased mortality rates (Ward, A.W. 1976) and Bunch et al. found a five times greater risk of [[suicide]] in teens following the death of a parent.<ref>{{cite journal |doi=10.1007/BF00578368 |title=Suicide following bereavement of parents |year=1971 |last1=Bunch |first1=J. |last2=Barraclough |first2=B. |last3=Nelson |first3=B. |last4=Sainsbury |first4=P. |journal=Social Psychiatry |volume=6 |issue=4 |page=193|s2cid=9694619 }}</ref> Bereavement also increases the risk of [[heart attack]].<ref>{{Cite news|url=https://www.bbc.com/news/health-16467182|title = Bereavement raises heart attack risk, says study|work = BBC News|date = 10 January 2012}}</ref>

=== Complicated grief ===

[[Prolonged grief disorder]] (PGD), formerly known as [[complicated grief disorder]] (CGD), is a pathological reaction to loss representing a cluster of empirically derived symptoms that have been associated with long-term physical and psycho-social dysfunction. Individuals with PGD experience severe grief symptoms for at least six months and are stuck in a maladaptive state.<ref>{{cite journal|last=Lichtenthal|first=W. G.|author2=Cruess, D.G.|title=Effects of Directed Written disclosure on Grief and Distress symptoms among bereaved individuals|journal=Death Studies|year=2010|volume=34|issue=6|pages=475–99|doi=10.1080/07481187.2010.483332|pmc=3909885|pmid=24482856}}</ref> An attempt is being made to create a diagnosis category for complicated grief in the [[DSM-5]].<ref name="Mihaela" /><ref name="NYTimes_Frances_2010">{{cite news |title=Good Grief |author=Allen Frances |date=14 August 2010 |url=https://www.nytimes.com/2010/08/15/opinion/15frances.html|work=The New York Times}}</ref> It is currently an "area for further study" in the DSM, under the name Persistent Complex Bereavement Disorder. Critics of including the diagnosis of complicated grief in the DSM-5 say that doing so will constitute characterizing a natural response as a pathology, and will result in wholesale medicating of people who are essentially normal.<ref name="NYTimes_Frances_2010"/><ref>{{cite journal|author=Wakefield, Jerome C|year=2012|title=Should prolonged grief be reclassified as a mental disorder in DSM-5?: reconsidering the empirical and conceptual arguments for complicated grief disorder|journal=The Journal of Nervous and Mental Disease|volume=200|pages=499–511|doi=10.1097/NMD.0b013e3182482155|pmid=22652615|number=6}}<!--|access-date=2014-02-15--></ref>

Shear and colleagues found an effective treatment for complicated grief, by treating the reactions in the same way as trauma reactions.<ref name="Bonanno2006">{{cite journal |doi=10.1111/j.1468-2850.2006.00014.x |title=Is Complicated Grief a Valid Construct? |year=2006 |last1=Bonanno |first1=George A. |journal=Clinical Psychology: Science and Practice |volume=13 |issue=2 |page=129}}</ref><ref>{{cite journal |doi=10.1001/jama.293.21.2601 |pmid=15928281 |pmc=5953417 |title=Treatment of Complicated Grief: A Randomized Controlled Trial |year=2005 |last1=Shear |first1=K. |journal=JAMA: The Journal of the American Medical Association |volume=293 |issue=21 |pages=2601–08 }}</ref>

Complicated grief is not synonymous with grief. Complicated grief is characterised by an extended grieving period and other criteria, including mental and physical impairments.<ref name="Pmid">{{cite journal |doi=10.1016/j.jad.2011.02.021 |title=The prevalence and characteristics of complicated grief in older adults |year=2011 |last1=Newson |first1=Rachel S. |last2=Boelen |first2=Paul A. |last3=Hek |first3=Karin |last4=Hofman |first4=Albert |last5=Tiemeier |first5=Henning |journal=Journal of Affective Disorders |volume=132 |pages=231–38 |pmid=21397336 |issue=1–2|doi-access=free }}</ref> An important part of understanding complicated grief is understanding how the symptoms differ from normal grief. The Mayo Clinic states that with normal grief the feelings of loss are evident. When the reaction turns into complicated grief, however, the feelings of loss become incapacitating and continue even though time passes.<ref name="mayoclinic">{{Cite web|title=Complicated grief|url=https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374|date=September 29, 2011|access-date=2023-03-10|website=Mayo Clinic|language=en}}</ref> The signs and symptoms characteristic of complicated grief are listed as "extreme focus on the loss and reminders of the loved one, intense longing or pining for the deceased, problems accepting the death, numbness or detachment&nbsp;... bitterness about your loss, inability to enjoy life, depression or deep sadness, trouble carrying out normal routines, withdrawing from social activities, feeling that life holds no meaning or purpose, irritability or agitation, lack of trust in others".<ref name="mayoclinic" /> The symptoms seen in complicated grief are specific because the symptoms seem to be a combination of the symptoms found in separation as well as traumatic distress. They are also considered to be complicated because, unlike normal grief, these symptoms will continue regardless of the amount of time that has passed and despite treatment given from tricyclic antidepressants.<ref name="Doiannurevmed">{{cite journal |last1=Rosenzweig |first1=Andrew |last2=Prigerson |first2=Holly |last3=Miller |first3=Mark D. |last4=Reynolds |first4=Charles F. |title=Bereavement and Late-Life Depression: Grief and Its Complications in the Elderly |journal=Annual Review of Medicine |volume=48 |pages=421–28 |year=1997 |pmid=9046973 |doi=10.1146/annurev.med.48.1.421 }}</ref> Individuals with complicated grief symptoms are likely to have other mental disorders such as PTSD (post traumatic syndrome disorder), depression, anxiety, etc.<ref>{{Cite journal|date=June 2012|title=Complicated grief in those bereaved by violent death: the effects of post-traumatic stress disorder on complicated grief|journal=Dialogues in Clinical Neuroscience|volume=14|issue=2|pages=210–14|doi=10.31887/DCNS.2012.14.2/snakajima|pmc=3384450|pmid=22754294|last1=Nakajima|first1=S.|last2=Ito|first2=M.|last3=Shirai|first3=A.|last4=Konishi|first4=T.}}</ref>

An article by the NEJM (The New England Journal of Medicine) states complicated grief cases are multifactorial, and that complicated grief is distinguished from major depression and post-traumatic stress disorder. Evidence shows that complicated grief is a more severe and prolonged version of acute grief than a completely different type of grief. While only affecting 2 to 3% of people in the world, complicated grief is usually contracted when a loved one dies suddenly and in a violent way.<ref>{{Cite journal |last=Shear |first=M. Katherine |date=8 January 2015 |title=Complicated Grief |url=https://doi.org/10.1056/NEJMcp1315618 |journal=New England Journal of Medicine |volume=372 |issue=2 |pages=153–160 |doi=10.1056/NEJMcp1315618 |issn=0028-4793 |pmid=25564898|url-access=subscription }}</ref>

In the study "Bereavement and Late-Life Depression: Grief and its Complications in the Elderly" six subjects with symptoms of complicated grief were given a dose of Paroxetine, a [[selective serotonin re-uptake inhibitor]], and showed a 50% decrease in their symptoms within a three-month period. The Mental Health Clinical Research team theorizes that the symptoms of complicated grief in bereaved elderly are an alternative of post-traumatic stress. These symptoms were correlated with cancer, hypertension, anxiety, depression, suicidal ideation, increased smoking, and sleep impairments at around six months after spousal death.<ref name="Doiannurevmed" />

A treatment that has been found beneficial in dealing with the symptoms associated with complicated grief is the use of [[serotonin]] specific reuptake inhibitors such as Paroxetine. These inhibitors have been found to reduce intrusive thoughts, avoidant behaviors, and hyperarousal that are associated with complicated grief. In addition psychotherapy techniques are in the process of being developed.<ref name="Doiannurevmed" />

=== Disenfranchised grief ===
{{Main page| Disenfranchised grief}}

''Disenfranchised grief'' is a term describing grief that is not acknowledged by [[society]]. Examples of events leading to disenfranchised grief are the death of a friend, the loss of a pet, a trauma in the family a generation prior,<ref>{{Cite journal|doi = 10.2190/IL.16.4.aa|title = Unearthing the Construct of Transgenerational Grief: The "Ghost" of the Sibling Never Known|year = 2008|last1 = Kempson|first1 = Diane|last2 = Conley|first2 = Virginia M.|last3 = Murdock|first3 = Victoria|journal = Illness, Crisis & Loss|volume = 16|issue = 4|pages = 271–84|s2cid = 144807471}}</ref> the loss of a home or place of residence particularly in the case of children, who generally have little or no control in such situations, and whose grief may not be noticed or understood by caregivers.<ref name="NITLC Brief Report" /><ref name="Sociologist B Pettit (U Washington) Working Paper">{{cite web|url=http://crcw.princeton.edu/workingpapers/WP98-04-Pettit.pdf|title=Moving and Children's Social Connections: the critical importance of context|last=Pettit|first=Becky|date=March 2000|work=Center for Research on Child Wellbeing Working Papers|publisher=CRCW, Princeton University|access-date=22 January 2010|archive-url=https://web.archive.org/web/20110720030419/http://crcw.princeton.edu/workingpapers/WP98-04-Pettit.pdf|archive-date=20 July 2011|url-status=dead}}</ref><ref name="Iowa State University paper by Lesia Oesterreich">{{cite web|url=http://www.extension.iastate.edu/Publications/PM1529G.pdf|title=Understanding children: moving to a new home|last=Oesterreich|first=Lesia|date=April 2004|publisher=Iowa State University|access-date=22 January 2010}}</ref> [[Military brat (U.S. subculture)|American military children and teens]] in particular moving a great deal while growing up,<ref name="Wertsch-p10">{{cite book |last=Wertsch |first=Mary Edwards |author-link=Mary Edwards Wertsch |title=Military Brats: Legacies of Childhood Inside the Fortress |edition=1st hardcover |year= 1991 |publisher=Harmony |isbn=051758400X |page=[https://archive.org/details/militarybratsleg00wert/page/350 350] |url-access=registration |url=https://archive.org/details/militarybratsleg00wert/page/350}}</ref> an [[Miscarriage and grief|aborted or miscarried]] pregnancy, a parent's loss or surrender of a child to [[adoption]], a child's loss of their birth parent to adoption, the death of a loved one due to a socially unacceptable cause such as [[suicide]],<ref name="Journal Article">{{cite web|url=http://www.vision.org/visionmedia/grief-and-loss/disenfrachised-grief/2202.aspx|title=Disenfranchised Grief|last=Stepp|first=G|year=2007|work=Vision Journal|access-date=3 November 2011}}</ref> or the death of a [[celebrity]].

There are fewer support systems available for people who experience disenfranchised grief compared to those who are going through a widely recognized form of grief. Therefore, people who suffer disenfranchised grief undergo a more complicated grieving process. They may feel angry and depressed due to the lack of public validation which leads to the inability to fully express their sorrow. Moreover, they may not receive sufficient social support and feel isolated.<ref>{{Cite journal |last=Corr |first=Charles A. |date=February 1999 |title=Enhancing the Concept of Disenfranchised Grief |url=http://dx.doi.org/10.2190/ld26-42a6-1eav-3mdn |journal=OMEGA - Journal of Death and Dying |volume=38 |issue=1 |pages=1–20 |doi=10.2190/ld26-42a6-1eav-3mdn |s2cid=143701184 |issn=0030-2228|url-access=subscription }}</ref>

== Examples of bereavement ==
=== Death of a child ===
{{main|Death of a child}}
{{Quote box|quote=<big>It is a fearful thing to love<br /> What Death can touch.<br /></big><small>[[Josephine Jacobsen]], ''The Instant of Knowing'' (Library of Congress, 1974), 7.</small>|width=15em|fontsize = 100%|bgcolor = #F0F0F0}}
[[File:Schnorr von Carolsfeld Bibel in Bildern 1860 103.png|thumb|right|This 1860 woodcut by [[Julius Schnorr von Karolsfeld]] depicts the death of [[Bathsheba]]'s first child with [[David]]]]
Death of a child can take the form of a loss in infancy such as [[miscarriage]], [[stillbirth]], neonatal death, [[Sudden infant death syndrome|SIDS]], or the death of an older child. Among adults over the age of 50, approximately 11% have been predeceased by at least one of their offspring.<ref>{{Cite news|last=Span|first=Paula|date=29 September 2017|title=A Child's Death Brings 'Trauma That Doesn't Go Away'|work=The New York Times|url=https://www.nytimes.com/2017/09/29/health/children-death-elderly-grief.html|access-date=27 April 2021|issn=0362-4331}}</ref>

In most cases, parents find the grief almost unbearably devastating, and it tends to hold greater risk factors than any other loss. This loss also bears a lifelong process: one does not get 'over' the death but instead must assimilate and live with it.<ref>[https://link.library.curtin.edu.au/ereserve/DC60130697/0?display=1 For discussion of this process, see Brad Stetson, ''Living Victims, Stolen Lives: Parents of Murdered Children Speak to America'', (Amityville, N. Y.: Belsey, A. (1998). Journalism and Ethics: Can They Co-exist? Matthew Kieran (Ed), 1–14. Retrieved from  link.library.curtin.edu.au Press, 2003]{{Dead link|date=March 2022 |bot=InternetArchiveBot |fix-attempted=yes }}{{Page needed|date=March 2012}}</ref> Intervention and comforting support can make all the difference to the survival of a parent in this type of grief but the risk factors are great and may include family breakup or suicide.<ref>{{Cite web|url=https://www.psychologistanywhereanytime.com/emotional_problems_psychologist/psychologist_grief.htm|title=Understanding About Grief|website=psychologistanywhereanytime.com}}</ref><ref>{{Cite journal |last1=Lang |first1=Diana |last2=Cone |first2=Nick |last3=Lally |first3=Martha |last4=Valentine-French |first4=Suzanne |last5=Carter |first5=Sarah |last6=Hoiland |first6=Sarah |date=2022-08-01 |title=Grief, Bereavement, and Mourning |url=https://iastate.pressbooks.pub/individualfamilydevelopment/chapter/bereavement-grief-mourning/ |language=en}}</ref>

Feelings of guilt, whether legitimate or not, are pervasive, and the dependent nature of the relationship disposes parents to a variety of problems as they seek to cope with this great loss. Parents who suffer miscarriage or a regretful or coerced abortion may experience resentment towards others who experience successful pregnancies.<ref>{{Cite journal |last1=Bergner |first1=Annekathrin |last2=Beyer |first2=Reinhard |last3=Klapp |first3=Burghard F. |last4=Rauchfuss |first4=Martina |date=1 January 2008 |title=Pregnancy after early pregnancy loss: A prospective study of anxiety, depressive symptomatology and coping |url=https://doi.org/10.1080/01674820701687521 |journal=Journal of Psychosomatic Obstetrics & Gynecology |volume=29 |issue=2 |pages=105–113 |doi=10.1080/01674820701687521 |issn=0167-482X |pmid=17943588|s2cid=19646272 |url-access=subscription }}</ref>

=== Death of a spouse ===
Many [[Widow|widows and widowers]] describe losing 'half' of themselves. A factor is the manner in which the spouse died. The survivor of a spouse who died of an illness has a different experience of such loss than a survivor of a spouse who died by an act of violence. Often, the spouse who is "left behind" may suffer from depression and loneliness, and may feel it necessary to seek professional help in dealing with their new life.

Furthermore, most couples have a division of 'tasks' or 'labor', e.g., the husband mows the yard, the wife pays the bills, etc. which, in addition to dealing with great grief and life changes, means added responsibilities for the bereaved. Planning and financing a funeral can be very difficult if pre-planning was not completed. Changes in insurance, bank accounts, claiming of life insurance, securing childcare can also be intimidating to someone who is grieving. Social isolation may also become imminent, as many groups composed of couples find it difficult to adjust to the new identity of the bereaved, and the bereaved themselves have great challenges in reconnecting with others. Widows of many cultures, for instance, wear black for the rest of their lives to signify the loss of their spouse and their grief. Only in more recent decades has this tradition been reduced to a period of two years, while some religions such as Orthodox Christianity many widows will still continue to wear black for the remainder of their lives.<ref>See Gerald Rochelle, Goodbye: grief from beginning to end, Cambridge House, 2013.</ref>

=== Death of a sibling ===

Grieving siblings are often referred to as the 'forgotten mourners' who are made to feel as if their grief is not as severe as their parents' grief.<ref>{{Cite web|url = https://www.cancer.net/coping-with-cancer/managing-emotions/grief-and-loss/grieving-loss-sibling/1|title = Grieving the Loss of a Sibling|website = Cancer.Net|date = March 2018|archive-url = https://web.archive.org/web/20231018114704/https://www.cancer.net/coping-with-cancer/managing-emotions/grief-and-loss/grieving-loss-sibling/1|archive-date = 18 October 2023|access-date = 21 December 2021|url-status = live}}</ref> However, the sibling relationship tends to be the longest significant relationship of the lifespan and siblings who have been part of each other's lives since birth, such as twins, help form and sustain each other's identities; with the death of one sibling comes the loss of that part of the survivor's identity because "your identity is based on having them there".<ref>{{Cite web|url=http://www.counselingstlouis.net/page22.html|title=P. Gill White, Ph.D., "Loss of an Adult Sibling" Accessed September 7, 2015.|access-date= 8 September 2015|archive-date=12 August 2015|archive-url=https://web.archive.org/web/20150812120833/http://counselingstlouis.net/page22.html|url-status=dead}}</ref><ref>P. Gill White, ''Sibling Grief: Healing After the Death of a Sister or Brother '' (iUniverse, 2006), 47.{{ISBN?}}</ref>

If siblings were not on good terms or close with each other, then intense feelings of guilt may ensue on the part of the surviving sibling (guilt may also ensue for having survived, not being able to prevent the death, having argued with their sibling, etc.)<ref>"Understanding Sibling Loss", CIGNA; ''Sibling Grief'', P. Gill White, Ph.D.; and ''Surviving the Death of a Sibling'', T.J. Wray.{{Page needed|date=March 2012}}</ref>

=== Death of a parent ===

[[File:D. Maria II (BM 1868,0612.2285).jpg|thumb|Queen [[Maria II of Portugal]] crying and hugging a bust of her late father [[Pedro I of Brazil|King Pedro IV]] (also Emperor of Brazil as Pedro I), 1836]]

==== For an adult ====
When an adult child loses a parent in later adulthood, it is considered to be "timely" and to be a normative life course event. This allows the adult children to feel a permitted level of grief. However, research shows that the death of a parent in an adult's midlife is not a normative event by any measure, but is a major life transition causing an evaluation of one's own life or mortality. Others may shut out friends and family in processing the loss of someone with whom they have had the longest relationship.<ref>{{cite journal|last=Marshall|first=H|year=2004|title=Midlife loss of parents: The Transition from Adult Child to Orphan|journal=Ageing International|volume=29|issue=4|pages=351–67|doi=10.1007/s12126-004-1004-5|s2cid=145804476}}</ref>

In developed countries, people typically lose parents after the age of 50.<ref>{{Cite web|url=https://www.census.gov/library/stories/2019/05/when-do-we-lose-our-parents.html|title = When do We Lose Our Parents?|website = United States Census Bureau|date = 6 May 2019|first = Zachary|last = Scherer}}</ref>

==== For a child ====
For a child, the death of a parent, without support to manage the effects of the grief, may result in long-term psychological harm. This is more likely if the adult carers are struggling with their own grief and are psychologically unavailable to the child. There is a critical role of the surviving parent or caregiver in helping the children adapt to a parent's death. However, losing a parent at a young age also has some positive effects. Some children had an increased maturity, better coping skills and improved communication. Adolescents who lost a parent valued other people more than those who have not experienced such a close loss.<ref>{{cite journal|last=Ellis|first=J|author2=Lloyd-Williams, M|title=Perspectives on the impact of early parent loss in adulthood in the UK: narratives provide the way forward|journal=European Journal of Cancer Care|volume=17|issue=4|date=July 2008|pages=317–18|doi=10.1111/j.1365-2354.2008.00963.x|pmid=18638179|doi-access=free}}</ref>

=== Loss during childhood ===

When a parent or caregiver dies or leaves, children may have symptoms of psychopathology, but they are less severe than in children with major depression.<ref>{{cite journal |doi=10.1097/01.chi.0000215327.58799.05 |pmid=16721318 |title=Childhood Bereavement: Psychopathology in the 2 Years Postparental Death |year=2006 |last1=Cerel |first1=Julie |last2=Fristad |first2=Mary A. |last3=Verducci |first3=Joseph |last4=Weller |first4=Ronald A. |last5=Weller |first5=Elizabeth B. |journal=Journal of the American Academy of Child & Adolescent Psychiatry |volume=45 |issue=6 |pages=681–90}}</ref> The loss of a parent, grandparent or sibling can be very troubling in childhood, but even in childhood there are age differences in relation to the loss. A very young child, under one or two, may be found to have no reaction if a carer dies, but other children may be affected by the loss.

At a time when trust and dependency are formed, even mere separation can cause problems in well-being. This is especially true if the loss is around critical periods such as 8–12 months, when attachment and separation are at their height and even a brief separation from a parent or other caregiver can cause distress.<ref>{{cite journal |first1=Mary D. Salter |last1=Ainsworth |first2=Silvia M. |last2=Bell |title=Attachment, Exploration, and Separation: Illustrated by the Behavior of One-Year-Olds in a Strange Situation |journal=Child Development |jstor=1127388 |pmid=5490680 |pages=49–67 |volume=41 |issue=1 |year=1970 |doi=10.2307/1127388}}</ref>

Even as a child grows older, death is still difficult to fathom and this affects how a child responds. For example, younger children see death more as a separation, and may believe death is curable or temporary. Reactions can manifest themselves in "acting out" behaviors, a return to earlier behaviors such as thumb sucking, clinging to a toy or angry behavior. Though they do not have the maturity to mourn as an adult, they feel the same intensity.<ref>{{Cite book |last=Frankiel |first=Rita V. |url=https://books.google.com/books?id=Tg4WCgAAQBAJ&pg=PA376 |title=Essential Papers on Object Loss |date=March 1994 |publisher=NYU Press |isbn=978-0-8147-2607-5}}</ref> As children enter pre-teen and teen years, there is a more mature understanding.

Adolescents may respond by [[Juvenile delinquency|delinquency]],<ref>{{Cite journal|last1=Hiyoshi|first1=A|last2=Berg|first2=L|last3=Grotta|first3=A|last4=Almquist|first4=Y|last5=Rostila|first5=M|date=1 September 2020|title=Childhood bereavement and adult mortality: A 65-year follow-up of the Stockholm birth cohort|journal=European Journal of Public Health|volume=30|issue=Supplement_5|pages=ckaa165.051|doi=10.1093/eurpub/ckaa165.051|issn=1101-1262|doi-access=free}}</ref><ref>{{Cite journal|last1=Feigelman|first1=William|last2=Rosen|first2=Zohn|last3=Joiner|first3=Thomas|last4=Silva|first4=Caroline|last5=Mueller|first5=Anna S.|date=16 March 2017|title=Examining longer-term effects of parental death in adolescents and young adults: Evidence from the National Longitudinal Survey of Adolescent to Adult Health|journal=Death Studies|volume=41|issue=3|pages=133–43|doi=10.1080/07481187.2016.1226990|issn=0748-1187|pmc=7219956|pmid=27813715}}</ref> or oppositely become "over-achievers". Repetitive actions are not uncommon such as washing a car repeatedly or taking up repetitive tasks such as sewing, computer games, etc. It is an effort to stay above the grief.<ref>{{Cite journal |last1=Maciejewski |first1=Paul K. |last2=Zhang |first2=Baohui |last3=Block |first3=Susan D. |last4=Prigerson |first4=Holly G. |date=2007-02-21 |title=An Empirical Examination of the Stage Theory of Grief |url=http://dx.doi.org/10.1001/jama.297.7.716 |journal=JAMA |volume=297 |issue=7 |pages=716–723 |doi=10.1001/jama.297.7.716 |pmid=17312291 |issn=0098-7484|url-access=subscription }}</ref> Childhood loss can predispose a child not only to physical illness but to emotional problems and an increased risk for suicide, especially in the adolescent period.<ref>{{Cite journal|last1=Cash|first1=Scottye J|last2=Bridge|first2=Jeffrey A|date=October 2009|title=Epidemiology of youth suicide and suicidal behavior|url=https://dx.doi.org/10.1097/MOP.0b013e32833063e1|journal=Current Opinion in Pediatrics|volume=21|issue=5|pages=613–19|doi=10.1097/MOP.0b013e32833063e1|issn=1040-8703|pmc=2885157|pmid=19644372}}</ref>

Grief can be experienced as a result of losses due to causes other than death. For example, women who have been physically, psychologically or sexually abused often grieve over the damage to or the loss of their ability to trust. This is likely to be experienced as [[disenfranchised grief]].<ref>{{Cite journal|last=Bordere|first=Tashel|date=February 2017|title=Disenfranchisement and Ambiguity in the Face of Loss: The Suffocated Grief of Sexual Assault Survivors: Sexual Assault, Loss, and Grief|url=http://doi.wiley.com/10.1111/fare.12231|journal=Family Relations|volume=66|issue=1|pages=29–45|doi=10.1111/fare.12231|url-access=subscription}}</ref>

In relation to the specific issue of child sexual abuse, it has been argued by some commentators that the concepts of loss and grief offer particularly useful analytical frames for understanding both the impact of child sexual abuse and therapeutic ways to respond to it. From this perspective, child sexual abuse may represent for many children multiple forms of loss: not only of trust but also loss of control over their bodies, loss of innocence and indeed loss of their very childhoods.<ref>{{Cite book|author1=Davis, Edna |author2=Kidd, Liz |author3=Pringle, Keith|title=Child Sexual Abuse Training Programme For Foster Parents With Teenage Placements|publisher=Barnardos|year=1987|isbn=|location=Barkingside|pages=}}</ref><ref>{{Cite book|last=Pringle|first=Keith|title=Managing to Survive|publisher=Barnardos|year=1990|isbn=|location=Barkingside|pages=}}</ref><ref>{{Cite book|last=Pringle|first=Keith|title=Men, Masculinities and Social Welfare|publisher=UCL Press/Taylor and Francis|year=1995|isbn=|location=London|pages=}}</ref>

[[Relocation (personal)|Relocation]]s can cause children significant grief particularly if they are combined with other difficult circumstances such as neglectful or abusive parental behaviors, other significant losses, etc.<ref name="NITLC Brief Report">{{cite web|url=http://www.tlcinst.org/Moving.html |title=Moving Can Become Traumatic |last1=Sheppard |first1=Caroline H. |first2=William |last2=Steele |year=2003 |work=Trauma and Loss: Research and Interventions |publisher=Nat'l Inst for Trauma and Loss in Children |access-date=22 January 2010 |url-status=dead |archive-url=https://web.archive.org/web/20090507104808/http://www.tlcinst.org/Moving.html |archive-date=7 May 2009}}</ref><ref name="Iowa State University paper by Lesia Oesterreich"/>

==== Loss of a friend or classmate ====

Children may experience the death of a friend or a classmate through illness, accidents, suicide, or violence. Initial support involves reassuring children that their emotional and physical feelings are normal.<ref>{{cite journal|last=Leek Openshaw|first=L|title=School-based support groups for traumatized students|journal=School Psychology International|date=April 2011|volume=32|issue=2|pages=163–78|doi=10.1177/0143034311400830|s2cid=220161595}}</ref>

[[Survivor guilt]] (or survivor's guilt; also called survivor syndrome or survivor's syndrome) is a mental condition that occurs when a person perceives themselves to have done wrong by surviving a traumatic event when others did not. It may be found among survivors of combat, natural disasters, epidemics, among the friends and family of those who have died by suicide, and in non-mortal situations such as among those whose colleagues are laid off.<ref>{{Cite journal |last1=Hutson |first1=Sadie P. |last2=Hall |first2=Joanne M. |last3=Pack |first3=Frankie L. |date=1 January 2015 |title=Survivor Guilt |url=https://www.ingentaconnect.com/content/wk/ans/2015/00000038/00000001/art00005 |journal=Advances in Nursing Science |volume=38 |issue=1 |pages=20–33 |doi=10.1097/ANS.0000000000000058|pmid=25635503 |s2cid=23485053 |url-access=subscription }}</ref>

=== Other losses ===
[[File:FEMA - 29783 - Workers unemployed by the freeze in California.jpg|thumb|People who lose their jobs, such as these people in California, may experience grief.]]

Parents may grieve due to loss of children through means other than death, for example through loss of [[child custody|custody]] in divorce proceedings; legal termination of [[parental responsibility (access and custody)|parental right]]s by the government, such as in cases of [[child abuse]]; through kidnapping; because the child voluntarily left home (either as a runaway or, for overage children, by leaving home legally); or because an adult refuses or is unable to have contact with a parent. This loss differs from the death of a child in that the grief process is prolonged or denied because of hope that the relationship will be restored.<ref>{{Cite book |last=Boss |first=Pauline |url=http://dx.doi.org/10.2307/j.ctvjhzrh4 |title=Ambiguous Loss |date=2009-06-30 |publisher=Harvard University Press |doi=10.2307/j.ctvjhzrh4 |isbn=978-0-674-02858-6}}</ref>

Grief may occur after the loss of a romantic relationship (i.e. divorce or break up), a vocation, a pet ([[animal loss]]), a home, children leaving home ([[empty nest syndrome]]), sibling(s) leaving home, a friend, a faith in one's religion, etc. A person who strongly identifies with their occupation may feel a sense of grief if they have to stop their job due to retirement, being laid off, injury, or loss of certification. Those who have experienced a loss of trust will often also experience some form of grief.<ref>John W. James and Russell Friedman, ''The Grief Recovery Handbook, 20th Anniversary Expanded Edition'' (William Morrow Paperbacks, 2009), 5.</ref>

==== Veteran bereavement ====
[[File:KoreanWarFallenSoldier1.jpg|thumb|A grief-stricken American soldier is comforted by a fellow soldier after a friend is killed in action during the [[Korean War]].]]
The grief of living veteran soldiers is often ignored. Psychological effects and post traumatic syndrome disorder have been researched and studied but very few focus on grief and bereavement specifically. Additionally, there have been many studies conducted about families losing members who were in the military but little about soldiers themselves. There are many monuments paying respect to those who were lost which emphasizes the lack of focus living veterans and soldiers get in regards to grief.<ref>{{Cite journal|last1=Lubens|first1=Pauline|last2=Silver|first2=Roxane Cohen|date=March 2019|title=Grief in Veterans: An Unexplored Consequence of War|journal=American Journal of Public Health|volume=109|issue=3|pages=394–95|doi=10.2105/AJPH.2018.304924|issn=0090-0036|pmc=6366488|pmid=30726138}}</ref>

=== Gradual bereavement ===

Many of the above examples of bereavement happen abruptly, but there are also cases of being gradually bereft of something or someone. For example, the gradual loss of a loved one by Alzheimer's produces a "gradual grief".<ref>{{Cite web|url=https://www.christianitytoday.com/ct/2004/february/8.64.html|title=The Gradual Grief of Alzheimer's|first=Interview by Stan|last=Guthrie|website=ChristianityToday.com|date=February 2004 }}</ref>

The author Kara Tippetts described her dying of cancer, as dying "by degrees": her "body failing" and her "abilities vanishing".<ref>{{Cite web|url=https://www.mundanefaithfulness.com/home/2014/12/29/by-degrees-living-and-dying|title=By Degrees – Living and Dying|website=Mundane Faithfulness|date=29 December 2014 }}</ref> Milton Crum, writing about gradual bereavement says that "every degree of death, every death of a person's characteristics, every death of a person's abilities, is a bereavement".<ref>{{cite web|url= http://www.ahpcc.org.uk/wp-content/uploads/milton-crum---bereavement.pdf|author=Milton Crum|title=Bereavement: Long Term|website= Association of Hospice and Palliative Care Chaplains in the UK|access-date= 7 August 2015}}</ref>

===Sensory experiences of the deceased===
Bereaved people often report having sensory and quasi-sensory experiences of the deceased (SED), which were correlated with pathology like grief complications.<ref>{{cite journal|title=Sensory and Quasi-Sensory Experiences of the Deceased in Bereavement: An Interdisciplinary and Integrative Review|journal=Schizophr Bull|date=4 November 2020|publisher=Oxford University Press|volume=46|issue=6|pages= 1367–81|doi=10.1093/schbul/sbaa113|pmc=7707065|issn=0586-7614|oclc=8874703671|pmid=33099644|last1=Kamp|first1=Karina Stengaard|last2=Steffen|first2=Edith Maria|last3=Alderson-Day|first3=Ben|last4=Allen |first4=Paul|last5=Austad|first5=Anne|last6=Hayes|first6=Jacqueline |last7=Larøi|first7=Frank|last8=Ratcliffe|first8=Matthew |last9=Sabucedo|first9=Pablo}}</ref>

== Support ==

=== Professional support ===

Many people who grieve do not need professional help.<ref>{{Cite web|url=https://www.griefhealingblog.com/2010/04/finding-grief-support-that-is-right-for.html|title=Finding Grief Support That is Right for You}}</ref> Some, however, may seek additional support from licensed [[psychologist]]s or [[psychiatrist]]s. Support resources available to the bereaved may include [[grief counseling]], professional support-groups or educational classes, and peer-led support groups. In the United States of America, local [[hospice]] agencies may provide a first contact for those seeking bereavement support.<ref>{{Cite web|url=http://www.interimhealthcare.com/services/hospice/bereavement-services|archive-url=https://web.archive.org/web/20150406004349/http://www.interimhealthcare.com/services/hospice/bereavement-services|url-status=live|archive-date=6 April 2015|title="Interim Hospice Bereavement and Grief" Accessed September 5, 2015}}</ref>

It is important to recognize when grief has turned into something more serious, thus mandating contacting a medical professional. Grief can result in depression or alcohol- and drug-abuse and, if left untreated, it can become severe enough to impact daily living.<ref name="nlm">{{MedlinePlusEncyclopedia|001530|Grief}}</ref> It recommends contacting a medical professional if "you can't deal with grief, you are using excessive amounts of drugs or alcohol, you become very depressed, or you have prolonged depression that interferes with your daily life".<ref name="nlm" /> Other reasons to seek medical attention may include: "Can focus on little else but your loved one's death, have persistent pining or longing for the deceased person, have thoughts of guilt or self-blame, believe that you did something wrong or could have prevented the death, feel as if life is not worth living, have lost your sense of purpose in life, wish you had died along with your loved one".<ref name="mayoclinic" />

Professionals can use multiple ways to help someone cope and move through their grief. Hypnosis is sometimes used as an adjunct therapy in helping patients experiencing grief.<ref name="Hart">{{Cite journal |title=Hypnotherapy for Traumatic Grief: Janetian and Modern Approaches Integrated |last1= van der Hart |first1=Onno |first2=Paul |last2=Brown |first3=Ronald N. |last3=Turco |journal=American Journal of Clinical Hypnosis |volume=32 |issue=4 |pages= 263–71 |year=1990 |doi=10.1080/00029157.1990.10402833|pmid= 2186612 }}</ref> Hypnosis enhances and facilitates mourning and helps patients to resolve traumatic grief.<ref name="Brown">{{Cite journal |url=http://www.onnovdhart.nl/articles/traumaticgrief.pdf |title=Hypnotherapy for Traumatic Grief: Janetian and modern approaches integrated |journal=American Journal of Clinical Hypnosis |last1=Hart |first1=O. |last2=Brown |first2=P. |last3=Turco |first3=R.N. |date=April 1989 |volume=32 |number=4 |pages=1–6}}</ref> [[Art therapy]] may also be used to allow the bereaved to process their grief in a non-verbal way.<ref>{{cite journal | last1=Buser | first1=Trevor J. | last2=Buser | first2=Juleen K. | last3=Gladding | first3=Samuel T. | title=Good Grief: The Part of Arts in Healing Loss and Grief | journal=Journal of Creativity in Mental Health | publisher=Informa UK Limited | volume=1 | issue=3–4 | year=2005 | issn=1540-1383 | doi=10.1300/j456v01n03_10 | pages=173–183| s2cid=145016908 }}</ref>

Lichtenthal and Cruess studied how bereavement-specific written disclosure had benefits in helping adjust to loss, and in helping improve the effects of [[post-traumatic stress disorder]] (PTSD), prolonged grief disorder, and depression. Directed writing helped many of the individuals who had experienced a loss of a significant relationship. It involved individuals trying to make meaning out of the loss through [[meaning-making]] (making sense of what happened and the cause of the death), or through [[benefit finding]] (consideration of the global significance of the loss of one's goals, and helping the family develop a greater appreciation of life). This meaning-making can come naturally for some, but many need direct intervention to "move on".<ref>{{cite journal|last=Lichtenthal|first=W.G.|author2=Cruess D.G.|title=Effects of Directed Written Disclosure on Grief and Distress symptoms among Bereaved individuals|journal=Death Studies|year=2010|volume=34|issue=6|pages=475–99|doi=10.1080/07481187.2010.483332|pmid=24482856|pmc=3909885}}</ref>

=== Support groups ===
{{further|Support group|Bereavement group}}

Support groups for bereaved individuals follow a diversity of patterns.<ref>{{Cite book|title=Bereavement Groups and the Role of Social Support: Integrating Theory, Research, and Practice|last=Hoy|first=William G.|publisher=Routledge|year=2016|isbn=978-1138916890|location=New York}}</ref><ref>{{cite book|author1=Rosenstein, D. |author2=Yopp, J.|title=The Group: Seven Widowed Fathers Reimagine Life|url=https://books.google.com/books?id=RXI8DwAAQBAJ|date=2018|publisher=Oxford University Press|isbn=978-0190649562}}</ref> Many are organized purely as peer-to-peer groups such as local chapters of the [[The Compassionate Friends|Compassionate Friends]], an international group for bereaved parents. Other grief support groups are led by professionals, perhaps with the assistance of peers. Some support groups deal with specific problems, such as learning to plan meals and cook for only for one person.<ref>{{Cite news|last=Nierenberg|first=Amelia|date=28 October 2019|title=For Many Widows, the Hardest Part Is Mealtime (Published 2019)|work=The New York Times|url=https://www.nytimes.com/2019/10/28/dining/widows-cooking-grief.html|access-date=23 November 2020|issn=0362-4331}}</ref>

== Cultural differences in grieving ==
{{Main|Mourning}}
Each culture specifies manners such as rituals, styles of dress, or other habits, as well as attitudes, in which the bereaved are encouraged or expected to take part. An analysis of non-Western cultures suggests that beliefs about continuing ties with the deceased varies. In Japan, maintenance of ties with the deceased is accepted and carried out through religious rituals. In the Hopi of Arizona, the women go into self-induced hallucinations where they conjure images of the deceased loved one to mourn and process their grief.<ref>{{Cite journal|last=Nagel|date=1988|title=Unresolved Grief and Mourning in Navajo Women|journal=American Indian and Alaska Native Mental Health Research|volume=2|issue=2|pages=32–40|doi=10.5820/aian.0202.1988.32|pmid=3154875 |issn=0893-5394|doi-access=free}}</ref>

Different cultures grieve in different ways, but all have ways that are vital in healthy coping with the death of a loved one.<ref>{{Cite book|last=Santrock|first=John W.|url=https://www.worldcat.org/oclc/968303340|title=A topical approach to life-span development|date=2018|isbn=978-1-259-70878-7|edition=Ninth|location=New York, NY|oclc=968303340}}</ref> The American family's approach to grieving was depicted in "The Grief Committee", by [[T. Glen Coughlin]]. The short story gives an inside look at how the American culture has learned to cope with the tribulations and difficulties of grief. The story is taught in the course, "The Politics of Mourning: Grief Management in a Cross-Cultural Fiction" at Columbia University.<ref>{{cite book |title=The Politics of Mourning: Grief Management in a Cross-Cultural Fiction |first=Rochelle |last=Almeida |year=2004 |publisher=Rosemont Publishing Company, Associated University Press |isbn=0838640273}}</ref>{{Page needed|date=March 2012}}

== In those with neurodevelopmental disorders ==

Contrary to popular belief, people with [[neurodevelopmental disorder]]s, such as [[Autism spectrum|autistic]] individuals and those with an [[intellectual disability]], are able to process grief in a similar manner to non-autistic individuals.<ref>{{cite journal | last1=McRitchie | first1=Robyn | last2=McKenzie | first2=Karen | last3=Quayle | first3=Ethel | last4=Harlin | first4=Margaret | last5=Neumann | first5=Katja | title=How Adults With an Intellectual Disability Experience Bereavement and Grief: A Qualitative Exploration | journal=Death Studies | publisher=Informa UK Limited | volume=38 | issue=3 | date=27 August 2013 | issn=0748-1187 | doi=10.1080/07481187.2012.738772 | pages=179–185| pmid=24524546 | s2cid=205584795 | url=http://nrl.northumbria.ac.uk/id/eprint/18059/1/ID_grief_Author_Version.pdf }}</ref><ref name=":0">{{Cite journal |last1=Mair |first1=Ally Pax Arcari |last2=Nimbley |first2=Emy |last3=McConachie |first3=Doug |last4=Goodall |first4=Karen |last5=Gillespie-Smith |first5=Karri |date=2024-04-03 |title=Understanding the Neurodiversity of Grief: A Systematic Literature Review of Experiences of Grief and Loss in the Context of Neurodevelopmental Disorders |url=https://doi.org/10.1007/s40489-024-00447-0 |journal=Review Journal of Autism and Developmental Disorders |language=en |doi=10.1007/s40489-024-00447-0 |issn=2195-7185|url-access=subscription }}</ref> However, the ways in which others interact with individuals with neurodevelopmental disorders may impact the ways in which they perceive, process, and express their grief; this is typically seen in association with the ''double taboo of death and disability'',<ref name=":1">{{Cite book |last=Oswin |first=Maureen |title=Am I Allowed to Cry?: Study of Bereavement Amongst People Who Have Learning Difficulties |publisher=Souvenir Press |year=1991 |isbn=978-0285650954 |location=London}}</ref> which leads to those with neurodevelopmental disorders often not being appropriately informed of a loss or its significance and excluded or discouraged from attending events related to the loss (e.g. funerals).<ref name=":0" />

Moreover, one of the main differences between those with an intellectual disability and those without is typically the ability to verbalize their feelings about the loss, which is why non-verbal cues and changes in behavior become so important, because these are usually signs of distress and expressions of grief among this population.<ref name=":2">{{cite journal | last1=Gilrane-McGarry | first1=U. | last2=Taggart | first2=L. | title=An exploration of the support received by people with intellectual disabilities who have been bereaved | journal=Journal of Research in Nursing | publisher=SAGE Publications | volume=12 | issue=2 | year=2007 | issn=1744-9871 | doi=10.1177/1744987106075611 | pages=129–144| s2cid=145479747 }}</ref> This difficulty of expressing the emotional impact of a loss in a neuronormative way is seen across neurodevelopmental disorders and often leads to their grief reactions going unrecognized and/or misunderstood by those around them; for example, authentic grief reactions in autistic individuals and/or individuals with an intellectual disability may just be labelled as ''challenging behavior'' by those supporting and caring for them.<ref name=":0" /><ref>{{Cite journal |last1=Fitzgerald |first1=Dominic A. |last2=Nunn |first2=Kenneth |last3=Isaacs |first3=David |date=September 2021 |title=What we have learnt about trauma, loss and grief for children in response to COVID-19 |url=https://doi.org/10.1016/j.prrv.2021.05.009 |journal=Paediatric Respiratory Reviews |volume=39 |pages=16–21 |doi=10.1016/j.prrv.2021.05.009 |issn=1526-0542 |pmc=8437675 |pmid=34229965}}</ref> As such, it is important when working with individuals with neurodevelopmental disorders to remember that they may express and understand their grief in non-neuronormative ways, such as in [[perseveration]] and repeating words related to death (a form of [[Echophenomenon|echophenomena]] known as [[wikt:echothanatologia|echothanatologia]]).<ref name=":0" /> Moreover, it is important that caregivers and family members of individuals with neurodevelopmental disorders meet them at their level of understanding and allow them to process the loss and grief with assistance given where needed, and not to ignore the grief that these individuals undergo and the unique ways in which they may express their grief.<ref>{{cite journal | last1=McEvoy | first1=John | last2=Smith | first2=Elaine | title=Families Perceptions of the Grieving Process and Concept of Death in Individuals with Intellectual Disabilities | journal=The British Journal of Development Disabilities | publisher=Informa UK Limited | volume=51 | issue=100 | year=2005 | issn=0969-7950 | doi=10.1179/096979505799103803 | pages=17–25| s2cid=145265620 }}</ref>

An important aspect of supporting the processing of grief for those with neurodevelopmental disorders is narrative and storytelling, as this can help individuals understand death and loss and express their grief at a level appropriate to their own understanding.<ref name=":0" /> Moreover, another important aspect of support is family involvement where possible, which should focus on promoting inclusion in events before and after the loss (e.g. visiting hospital to see a dying relative, attending the funeral, being able to visit the grave, etc.) and ensuring individuals have information about these events provided to them at their level of understanding and their choices respected, such as whether or not they want to attend a funeral service. <ref name=":0" /> By having the involvement of family and friends in an open and supporting dialogue with the individual, being mindful of the ''double taboo of death and disability'',<ref name=":0" /><ref name=":1" /> it helps individuals with neurodevelopmental disorders to process, understand, and feel included. However, if those supporting the individual are not properly educated on how those with different neurodevelopmental profiles process, understand, and express grief, their involvement may not be as beneficial than those who are aware of the potential differences, and ultimately may prove harmful in areas beyond practical support.<ref name=":2" /><ref>{{Cite journal |last1=Collings |first1=Susan |last2=Strnadová |first2=Iva |last3=Loblinzk |first3=Julie |last4=Danker |first4=Joanne |date=2020-03-15 |title=Benefits and limits of peer support for mothers with intellectual disability affected by domestic violence and child protection |url=https://www.tandfonline.com/doi/full/10.1080/09687599.2019.1647150 |journal=Disability & Society |language=en |volume=35 |issue=3 |pages=413–434 |doi=10.1080/09687599.2019.1647150 |issn=0968-7599|url-access=subscription }}</ref> Furthermore, the importance of the family unit is very crucial in a socio-cognitive approach to bereavement counseling; in this approach the neurodivergent individual has the opportunity to see how those around them handle the loss and have the opportunity to act accordingly by modeling and mirroring behavior. This approach also helps the individual know that their emotions are acceptable, valid, and normal.<ref>{{cite journal | last=Clute | first=Mary Ann | title=Bereavement Interventions for Adults with Intellectual Disabilities: What Works? | journal=OMEGA - Journal of Death and Dying | publisher=SAGE Publications | volume=61 | issue=2 | year=2010 | issn=0030-2228 | doi=10.2190/om.61.2.e | pages=163–177| pmid=20712142 | s2cid=28709815 }}</ref>

== In animals ==
{{More citations needed section|date=April 2011}}
[[File:August Friedrich Albrecht Schenck - Anguish - Google Art Project.jpg|thumb|In [[August Friedrich Schenck]]'s 1878 painting ''[[Anguish (Schenck)|Anguish]]'', a grieving ewe mourns the death of her lamb.]]
Previously it was believed that grief was only a human emotion, but studies have shown that other animals have shown grief or grief-like states during the death of another animal, most notably [[elephant]]s, [[Wolf|wolves]], [[ape]]s, and [[goat]]s. This can occur between bonded animals which are animals that attempt to survive together (i.e. a pack of wolves or mated prairie voles). There is evidence that animals experience grief in the loss of their group member, a mate, or their owner for many days. Some animals show their grief for their loss for many years. When animals are grieving, their life routines change the same as humans. For instance, they may stop eating, isolate themselves, or change their sleeping routine by taking naps instead of sleeping during the night. After the death of their group member or a mate, some of the animals become depressed, while others like the [[bonobo]] keep the dead bodies of their babies for a long time. Cats try to find their dead fellow with a mourning cry, and dogs and horses become depressed.<ref>{{Cite magazine|last=Kluger|first=Jefferey|date=15 April 2013|title=The Mystery of animal Grief|url=https://time.com/597/the-mystery-of-animal-grief/|access-date=18 October 2020|magazine=Time}}</ref>

Since it is more difficult to study emotion in animals because of the lack of clear communication, in effort to study grief, research has been done on hormone levels. One study found that "females [baboons] showed significant increases in stress hormones called glucocorticoids". The female baboons then increased grooming, promoting physical touch, which releases "oxytocin, which inhibits glucocorticoid release".<ref>{{Cite web|title=When Animals Grieve|url=https://www.nwf.org/Home/Magazines/National-Wildlife/2018/Feb-Mar/Animals/When-Animals-Grieve|access-date=21 June 2021|website=National Wildlife Federation}}</ref>

=== Mammals ===
Mammals have demonstrated grief-like states, especially between a mother and her offspring. She will often stay close to her dead offspring for short periods of time and may investigate the reasons for the baby's non-response. For example, some [[deer]] will often sniff, poke, and look at its lifeless fawn before realizing it is dead and leaving it to rejoin the herd shortly afterwards. Other animals, such as a [[lion]]ess, will pick up its cub in its mouth and place it somewhere else before abandoning it.

When a baby [[Common chimpanzee|chimpanzee]] or [[gorilla]] dies, the mother will carry the body around for several days before she may finally be able to move on without it; this behavior has been observed in other [[primates]], as well. The Royal Society suggests that, "Such interactions have been proposed to be related to maternal condition, attachment, environmental conditions or reflect a lack of awareness that the infant has died."<ref>{{Cite journal|last1=Lonsdorf|first1=Elizabeth V.|last2=Wilson|first2=Michael L.|last3=Boehm|first3=Emily|last4=Delaney-Soesman|first4=Josephine|last5=Grebey|first5=Tessa|last6=Murray|first6=Carson|last7=Wellens|first7=Kaitlin|last8=Pusey|first8=Anne E.|date=July 2020|title=Why chimpanzees carry dead infants: an empirical assessment of existing hypotheses|journal=Royal Society Open Science|volume=7|issue=7|pages=200931|doi=10.1098/rsos.200931|issn=2054-5703|pmc=7428235|pmid=32874665|bibcode=2020RSOS....700931L}}</ref> [[Jane Goodall]] has described chimpanzees as exhibiting mournful behavior toward the loss of a group member with silence and by showing more attention to it. And they will often continue grooming it and stay close to the carcass until the group must move on without it. One example of this Goodall observed was of a chimpanzee mother of three who had died. The siblings stayed by their mother's body the whole day. Of the three siblings the youngest showed the most agitation by screaming and became depressed but was able to recover by the care of the two older siblings. However, the youngest refused behavior from the siblings that were similar to the mother.<ref>{{Cite thesis|last=Fiore|first=Robin|date=May 2013|title=What Defines Us: An Analysis of Grieving Behavior in Non-Human Primates as a Potential Evolutionary Adaptation|publisher=University of Colorado at Boulder|page=49|url=https://scholar.colorado.edu/downloads/05741s219}}</ref> Another notable example is [[Koko (gorilla)|Koko]], a gorilla who was taught [[sign language]], who expressed sadness and even described sadness about the death of her pet cat, All Ball.<ref>{{Cite web|date=10 January 1985|title=Gorilla's Pet: Koko Mourns Kitten's Death|url=https://www.latimes.com/archives/la-xpm-1985-01-10-mn-9038-story.html|access-date=21 June 2021|website=[[Los Angeles Times]]}}</ref>

[[Elephant]]s have shown unusual behavior upon encountering the remains of another deceased elephant. They will often investigate it by touching and grabbing it with their trunks and have the whole herd stand around it for long periods of time until they must leave it behind. It is unknown whether they are mourning over it and showing sympathy, or are just curious and investigating the dead body. Elephants are thought to be able to discern relatives even from their remains. When encountering the body of a deceased elephant or human, elephants have been witnessed covering the body with vegetation and soil in what seems to be burial behavior.<ref>{{Cite web|title=The Depths of Animal Grief|url=https://www.pbs.org/wgbh/nova/article/animal-grief/|access-date=23 June 2021|website=www.pbs.org|date=8 July 2015 }}</ref> An episode of the seminal BBC documentary series ''[[Life on Earth (TV series)|Life on Earth]]'' shows this in detail – the elephants, upon finding a dead herd member, pause for several minutes at a time, and carefully touch and hold the dead creature's bones.<ref>{{cite book | last = wen | first = Chu | title = Notes Of A Desolate Man | publisher = Columbia University Press | location = New York | year = 2005 | isbn = 9780231500081 | page=21}}</ref>

=== Birds ===
[[File:Mute swans (Cygnus olor) and cygnets.jpg|thumb|[[Mute swan]]s (''Cygnus olor'') are known to grieve in response to the death or loss of their mate or offspring.]]
Some birds seem to lack the perception of grief or quickly accept it; [[mallard]] hens, although shocked for a moment when losing one of their young to a predator, will soon return to doing what they were doing before the predator attacked. However, some other waterbirds, such as [[mute swan]]s are known to grieve for the loss of a partner or cygnet, and are known to engage in pining for days, weeks or even months at a time.<ref>[http://www.theswansanctuary.org.uk/faq.php Frequently Asked Questions about Swans] {{webarchive |url=https://web.archive.org/web/20150929170937/http://www.theswansanctuary.org.uk/faq.php |date=29 September 2015 }}, The Swan Sanctuary</ref><ref>{{Cite news|url=https://www.telegraph.co.uk/pets/animals-grieve-just-as-people-do/ |archive-url=https://ghostarchive.org/archive/20220112/https://www.telegraph.co.uk/pets/animals-grieve-just-as-people-do/ |archive-date=12 January 2022 |url-access=subscription |url-status=live|title=Animals grieve just as people do|last=Wedderburn|first=Pete|website=The Telegraph|date=3 September 2015|access-date=7 July 2019}}{{cbignore}}</ref> Other species of swans such as the [[black swan]] have also been observed mourning the loss of a close relative.<ref>{{Cite web|url=https://www.treehugger.com/natural-sciences/male-swan-holds-vigil-at-nest-after-teens-kill-his-mate.html|title=Male Swan Holds Vigil at Nest After Teens Kill His Mate|website=TreeHugger|access-date=7 July 2019}}</ref>

== See also ==
{{columns-list|colwidth=25em|
* [[Animal loss]]
* [[Anomalous experiences]]
* [[Anticipatory grief]]
* [[Association for Death Education and Counseling]]
* [[Intuitive–instrumental grief]]
* [[List of counseling topics]]
* [[Major depressive disorder]]
* [[Pet humanization#Pet bereavement|Pet bereavement]]
* {{slink|Postponement of affect#Grief}}
* [[Thanatosensitivity]]
}}

== References ==
{{Reflist|30em}}

== Further reading ==
* {{cite journal |doi=10.1093/geront/gnr148 |pmid=22241808 |title=The Salience of Family Worldview in Mourning an Elderly Husband and Father |year=2012 |last1=Black |first1=H. K. |last2=Santanello |first2=H. R. |journal=The Gerontologist|volume=52 |issue=4 |pages=472–83 |doi-access=free |pmc=3391382 }}
* {{Cite book|last=Cholbi|first=Michael|title=Grief—A Philosophical Guide|publisher=Princeton University Press|year=2022|isbn=9780691201795|location=Princeton}}
* Hoy, William G. (2016). ''Bereavement Groups and the Role of Social Support: Integrating Theory, Research, and Practice''. New York: Routledge.
* {{cite journal |doi=10.1016/j.jad.2011.02.021 |title=The Prevalence and Characteristics of Complicated Grief in Older Adults |year=2011 |last1=Newson |first1=Rachel S. |last2=Boelen |first2=Paul A. |last3=Hek |first3=Karin |last4=Hofman |first4=Albert |last5=Tiemeier |first5=Henning |journal=Journal of Affective Disorders |volume=132 |pages=231–38 |pmid=21397336 |issue=1–2|doi-access=free }}
* {{cite book|author=Rosenstein|title=The Group—Seven Widowed Fathers Reimagine Life|last2=Yopp|first2=Justin M.|first1=Donald L.|url=https://books.google.com/books?id=RXI8DwAAQBAJ|year=2018|publisher=Oxford University Press|isbn=9780190649562|location=New York}}
* Schmid, Wilhelm, ''What We Gain as We Grow Older: On Gelassenheit''. New York: Upper West Side Philosophers, Inc. 2016 (Living Now Gold Award)
* {{Cite journal|last=Shear|first=M. Katherine|date=8 January 2015|title=Complicated Grief|url=https://doi.org/10.1056/NEJMcp1315618|journal=New England Journal of Medicine|volume=372|issue=2|pages=153–60|doi=10.1056/NEJMcp1315618|issn=0028-4793|pmid=25564898|url-access=subscription}}
* Smith, Melinda; Robinson, Lawrence; Segal, Jeanne. (1997). [https://web.archive.org/web/20120313162709/http://helpguide.org/mental/depression_elderly.htm Depression in Older Adults and the Elderly]. Helpguide, Retrieved 8 February 2012.
* Span, Paula. (29 December 2011). [http://newoldage.blogs.nytimes.com/2011/12/29/the-unspoken-diagnosis-old-age/ The unspoken diagnosis: Old age]. ''The New York Times''. Retrieved 8 February 2012
* Stengel, Kathrin, ''November Rose: A Speech on Death''. New York: Upper West Side Philosophers, Inc. 2007 (Independent Publisher Book Award for Aging/Death & Dying)

== External links ==
{{Wikiquote}}
{{Wiktionary}}
* [http://www.slate.com/id/2211257/entry/2211256/ "Grieving: A study of bereavement"] by Megan O'Rourke at ''[[Slate.com]]''
*
{{Medical resources
| ICD11           = {{ICD11|QE62}}
| ICD10           = {{ICD10|F43.2}}
| MedlinePlus     = 001530
| eMedicineSubj   =
| eMedicineTopic  =
| PatientUK       =
| MeshID          = D006117
| Scholia         = Q1026040
| SNOMED CT       = 224965009
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