Grief and Bereavement
Grief and Bereavement
Grief is a normal response to loss; bereavement is the period of mourning. Anticipatory grief occurs before death. Normal grief can include sadness, anger, guilt, relief, waves of yearning, somatic symptoms, and temporary withdrawal; it is not linear, and stage models are not required. Prolonged grief disorder is persistent, disabling yearning or preoccupation with the deceased beyond culturally expected time and with impairment, not simply intense grief. Depression and grief overlap but differ in self-esteem, worthlessness, and persistent anhedonia. Screen for suicide risk, complicated grief, and caregiver vulnerability. Support may include psychoeducation, validation, rituals, support groups, and referral. Children grieve developmentally; use honest, concrete language and reassure them that they are not at fault. Culture shapes expression and mourning rituals.
Traps: imposing a timeline; calling all grief depression; medicating normal grief routinely; assuming children do not understand; and ignoring disenfranchised grief, such as estranged relationships, LGBTQ+ partners, or pet loss. Do not say I know how you feel or at least.
Worked example/rule of thumb: a widow is tearful at one month but functioning and finds meaning in rituals; this is likely normal grief, so validate, educate, and offer follow-up. If she has persistent inability to function, worthlessness, or suicidal ideation, screen and refer. Rule: normalize, assess risk and function, and refer when grief is prolonged or dangerous.