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Harvard Mental Health Letter: December 2011

Articles in this issue:

Understanding grief and loss

Bereavement shares much in common with depression.

Sooner or later, everyone will grieve the loss of a close relative or friend, whether the cause is a sudden heart attack, a car accident, or the more prolonged physical ravages of disease or age. Each year, more than two million men, women, and children die in the United States, leaving behind many others who mourn them.

Although grief is nearly universal, it expresses itself in many different ways and at times resembles major depression. Frequent crying spells, depressed mood, sleep disturbances, and loss of appetite are common during the bereavement process, for ...

The normal process of grieving

People often experience fluctuating emotions for months.

When people talk about grieving, they often describe an experience akin to being at sea. Wave after wave of emotion envelops them, and just when they think they're recovering, a new wave hits them. Yet with time, most people manage to reach equilibrium. While significant losses are never forgotten, the feelings of grief become less intense and more manageable.

The following experiences are all part of the normal spectrum of grieving and can last from six to 12 months.

Yearning. Survivors repeatedly want to reunite with the person who died in some way, ...

Beyond the five stages of grief

The bereavement process is seldom linear and varies from one person to the next.

Dr. Elisabeth Kübler-Ross developed a frequently cited model of bereavement, the "stages of grief," in her landmark book On Death and Dying. She described a linear five-step process — consisting of denial, anger, bargaining, depression, and acceptance — as terminally ill patients became aware of impending death. Dr. Kübler-Ross' work helped legitimize the wide variety of emotions in people who are dying. The five-stage theory was later altered and adapted to cover the reaction to other losses, such as divorce or the death of a loved ...

A guide to getting through grief

Focus on the essentials and try to let people know what support you need.

Losing a close friend or family member can be devastating. All the small details of daily life — getting out of bed, making meals, going to appointments, taking care of children, handling responsibilities at work — may seem monumentally hard or inconsequential. It is important for people to let the nonessentials slide and focus on ways to get through this difficult time.

Dr. Michael Hirsch, a psychiatrist at Massachusetts General Hospital and medical editor of Harvard Medical School's Special Health Report Coping with Grief and Loss: ...

Coping with complicated grief

Recognizing when mental health treatment may be necessary.

Grief can be so intense and long-lasting that it sometimes resembles a psychiatric disorder. As many as 50% of widows and widowers, for example, develop symptoms typical of major depression in the first few months after a spouse dies. They may also have hallucinatory experiences — imagining that the dead are still alive, feeling their presence, hearing them call out.

These symptoms, upsetting as they may be, are usually normal responses to a profound loss. In most people, the symptoms ease over time. One review noted that 15% of people who are ...

In Brief: Handling holidays and difficult times

Holidays, birthdays, and other important dates are more difficult after the loss of a loved one, but there are ways to ease the pain. Read More »

Ask the doctor: How long does grief last?

I lost my brother several months ago, and there are days when I still feel overpowered by sadness. Is it normal to grieve this long?

Ask the doctor: Surprised by anger

I always knew I'd feel sad when my father died, but I wasn't expecting to feel so angry. I snap at everyone. What's wrong with me?

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