Grief is multidimensional. It has an impact on behaviour, emotions, cognitive processes, physical health, social functioning, and spiritual beliefs. A major loss forces people to adapt their assumptions about the world and about themselves, and grief is a transitional process by which people assimilate the reality of their loss and find a way of living without the external presence of the person who died. Traditionally, this process has been described as consisting of overlapping phases. While it is more useful to think of grief as characterised by simultaneous change and adjustment, such models provide useful descriptions of the major themes of grief.
The initial reaction is shock and disbelief accompanied by a sense of unreality. This occurs even when death is expected but may last longer and be more intense after an unexpected loss.
Numbness is replaced with waves of intense pining and distress. The desire to recover a loved one is strong and preoccupation with memories, restless searching, dreams, and auditory and sensory awareness of the deceased are common. Bereavement affects the immune system, and physical symptoms may also be caused by anxiety and changes in behaviour such as loss of sleep or altered nutrition, or may mimic the symptoms of the deceased. A crucial factor is the meaning of the loss, and bereaved people search for an understanding of why and how the death occurred. The events surrounding the death may be obsessively reviewed. For some, there may be questioning of previously deeply held beliefs, while others find great support from their faith, the rituals associated with it, and the social contact with others that religious affiliation often brings. Symptoms of depression such as despair, poor concentration, apathy, social withdrawal, lack of purpose, and sadness are common for more than a year after an important bereavement. This reflects the multidimensional impact of loss.
To carry on without what they have lost, bereaved people may need to rebuild their identities, find new purpose, acquire new skills, and take on new roles. Gradually people manage these adjustments more effectively and more positive feelings emerge accompanied by renewed energy and hope for the future. Eventually most bereaved people can remember the deceased without feeling overwhelmed. The deceased continue to be part of their lives, however, and family events and anniversaries may reawaken painful memories and feelings. In this sense there is no definite end point that marks "recovery" from grief.
A central notion of traditional models of grief is that it must be confronted and expressed, otherwise it may manifest in some other way, such as depression or anxiety. Throughout the period of mourning, however, most people cope by oscillating
Dimensions of loss and common expressions of grief
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