Grief is a reaction to a major loss. It is most often an unhappy and painful emotion.

Grief may be triggered by the death of a loved one. People also can experience grief if they have an illness for which there is no cure, or a chronic condition that affects their quality of life. The end of a significant relationship may also cause a grieving process.

Everyone feels grief in their own way. However, there are certain stages to the process of mourning. It starts with recognizing a loss and continues until a person eventually accepts that loss. People's responses to grief will be different, depending on the circumstances of the death.

For example, if the person who died had a chronic illness, the death may have been expected. The end of the person's suffering might even have come as a relief. If the death was accidental or violent, coming to a stage of acceptance could take longer.

There can be five stages of grief. These reactions might not occur in a specific order, and can (at times) occur together. Not everyone experiences all of these emotions:

• Denial, disbelief, numbness
• Anger, blaming others
• Bargaining (for instance "If I am cured of this cancer, I will never smoke again.")
• Depressed mood, sadness, and crying
• Acceptance, coming to terms

People who are grieving may have crying spells, some trouble sleeping, and lack of productivity at work.

The doctor will perform a physical exam and ask questions about your symptoms, including sleep and appetite. Symptoms that last for a while may lead to clinical depression.

Family and friends can offer emotional support during the grieving process. Sometimes outside factors can affect the normal grieving process, and people might need help from:

• Clergy
• Mental health specialists
• Self-help groups
• Social workers

The acute phase of grief usually lasts up to 2 months. Some milder symptoms may last for a year or longer. Psychological counseling may help a person who is unable to face the loss (absent grief reaction), or who has depression with grieving.

You can help the stress of grieving by joining a support group where members share common experiences and problems.

See also:

• Loss of a child - support group
• Loss of a spouse - support group

It may take a year or longer to overcome strong feelings of grief, and to accept the loss.

Grief and loss can affect your overall health. It can lead to depression or excessive alcohol or drug use. Grief that lasts for more than two months and is severe enough to interfere with daily life may be a sign of more serious illness, such as major depression. Medication may be helpful.

Call your health care provider if:

• You can't deal with grief
• You are using excessive amounts of drugs or alcohol
• You become very depressed
• You have prolonged depression that interferes with your daily life

Grief should not be prevented because it is a healthy response to loss. Instead, it should be respected. Those who are grieving should have support to help them through the process.

Moore DP, Jefferson JW. Secondary Depression. In: Moore & Jefferson: Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby; 2004:chap 161.

Shuchter SR, Zisook S. Grief and Mourning. In: Jacobson JL, Jacobson AM. Jacobson: Psychiatric Secrets. 2nd ed. Philadelphia, Pa: Hanley and Belfus;2001:chap 32.