Treatment for complicated grief

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

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No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

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Mourning and loss - Articles

Our life is a series of losses and hardships. In each of its periods, acquiring something new, we lose the old. None of us is destined to escape both the approaching end of our own lives and the death of those around us. This is the theme of sadness - the theme of experiencing the loss of the death of a loved one. If you are reading it, have you ever felt grief, a shroud of shock, have you ever lost a loved one, or are you afraid to lose. Unfortunately, those whom we love are with us only for a time, which is measured by a force beyond our control. (K. Yagnyuk)

It is difficult to talk about this, not only because the shadow of pain and suffering shines through in every appeal about loss and grief, but also because in our culture there is an unspoken prohibition on this topic of death. We try to avoid the word "death". We try to avoid those who are deeply grieving and consumed with grief. We say: “he is no longer with us”, “he has left us”. Even doctors who ascertain the fact of death say: "the patient died", but did not die, the clergy use the word "deceased".

The course of life for each of us depends on the ability to cope with such changes, adapt to losses and use these changes as a means of personal growth.

Grief is a strong emotion experienced by a person in connection with the loss of a loved one. At the same time, grief is a necessary process through which a person works with the pain of loss, regaining a sense of balance and fullness of life.

FE Vasilyuk in his work “Surviving grief” considers grief as an anthropological phenomenon. Among all living beings, only man buries, which means that to bury = to be a man. But “to bury” in a broader sense of the word is also “to keep, preserve”. And on a psychological level, it is important to bury the image of the deceased in memory. F. E. Vasilyuk introduces the meaning of "remembrance" and "remembrance" in the work of grief.

Not being able to grieve, we remain outside the present and are hostages of old values, attitudes. It is believed that three circumstances are fundamental in understanding grief: each experience inevitably causes grief, each loss resurrects all past losses in our memory, each loss, if fully experienced, gives impetus to personal growth and renewal.

Each grief is unique, but there are laws according to which the grief develops, stages through which it proceeds, approximate dates and the essence strikes with amazing uniformity. The main help for a person experiencing a loss is to give them the opportunity to grieve.

Several factors influence the ability to deal with grief:

  1. For those who experienced a lack of care in childhood or faced a series of losses, the experience of grief can be especially difficult.
  2. Loss is hard to endure if the relationship with the deceased was dependent or burdened with unfinished business (conflicts).
  3. When the death of a loved one occurs suddenly or under aggravating circumstances, it is more difficult to accept death.

Researchers view grief as uncomplicated and complicated.

Since we live in a culture that denies death, we are all predisposed in one way or another to complicated and delayed mourning.

Uncomplicated grief.

Researchers currently distinguish four phases of the mourning process:

  1. 1. The stupor phase.
  2. 2. Phase of longing for the lost (search phase).
  3. 3. Disorganization (phase of acute grief).
  4. 4. Reorganization (phase of sharp shocks and reorganizations).

J. William Vorden in his book "Counseling and Grief Therapy" proposes to work with grief through four tasks that must be performed by mourners in the normal course of grief:

  • recognize the fact of loss;
  • experience the pain of loss;
  • establish an environment in which the absence of the deceased is felt;
  • build a new relationship with the deceased and continue to live.

Supporters of the psychoanalytic approach Vamik Volkan and Elisabeth Zintr, following J. Polok, consider the process of mourning as two main stages:

  1. Crisis of grief.
  2. The work of grief.

Crisis of grief.

Begins with the moment of loss or with the discovery of the fact of imminent loss (for example, when a terminal illness is diagnosed and the days are numbered).

“… I recently lost a loved one with whom I lived for 6 years. Now he is gone. I don’t know how to live on and what to do, I’m in limbo, all fears are gone, I’m not afraid of anything, I was afraid of death before, now I’m not afraid, I don’t see reality, I never thought that it could be so bad, I still can’t believe it, that this person is no more. And as consciousness comes, it becomes more and more painful for me. I don’t know how to survive this, I know one thing that it will get worse, because every day reality comes more and more and shock is replaced by despair . .. "

“My grandmother recently died. Something happens to me after her funeral. Everything became indifferent to me, I constantly want to cry, and my physical health also worsened ... "

Our body and consciousness reject the fact of loss. We toss and turn between denial, splitting, persuasion, anxiety, and anger. This phase ends when we accept the terrible reality.

The loss strikes at our illusory belief that we control our life and can foresee its course of events. In the first hours after the loss, the following symptoms occur: shortness of breath, a lump in the throat, the need to take a deep breath, muscle weakness and loss of appetite. Then these reactions are replaced by shock and numbness. Some of the mourners may unconsciously reproduce the characteristic features of the deceased - gait, speech, some may experience symptoms of illnesses suffered by the deceased shortly before death.

These phenomena, described as "identification" are the unconscious expression of an emotional connection with another person. When the first shock passes, and we begin to realize the reality of what is happening, the physical reactions weaken, and, often, there is a desire to return everything to its place. At this time, people often talk about what they think is that "if they wake up, they will realize that it was all just a bad dream." This phenomenon is associated with the fact that in the unconscious there is no sense of time, logical laws do not operate in it.

We just thought that our loved one died, and the next moment we can dial his phone number to talk.

When describing a crisis of grief, we may encounter concepts such as denial, splitting, persuasion, anxiety, and anger. All of them are simply necessary for living grief in this difficult period.


Denial, softening the shock, helps us to gradually accept the terrible truth. We go to the funeral service or stand at the edge of the grave, feel a handful of earth in our hand, hear the sound of its impact on the coffin lid, eat funeral food, accept words of condolence, and such moments make us accept the death of a loved one as a fait accompli.

Without such contact with reality, denial can persist. This is well demonstrated by the cases of missing relatives, whose death is very often difficult to accept for loved ones.

FE Vasilyuk connects the denial at this stage of mourning not as a denial of the fact that he (the deceased) is not here, but with the denial of the fact that I, the “mourner”, are here. “Death breaks the connection of times, divides life into unconnected “before” and “after”. The shock leaves the person in this "before" where the deceased was still alive."


Splitting is a type of denial, a psychological mechanism that allows one part of our mind to be aware of the loss while another part is in denial. This is when we understand with our mind that a person has died, but we hear his steps, his voice, we see an image in the crowd, we feel an invisible presence.

Splitting is such a common phenomenon that in some societies such "phenomena" are culturally embedded and accepted as part of the normal process of grief - people find comfort in them, the last chance to say goodbye. Vasilyuk F.E. writes: "Hope, which constantly gives birth to faith in a miracle, coexists in a strange way with a realistic attitude that guides all the external behavior of the mourner."

Persuasion (bargaining stage).

The resistance to awareness of what happened remains at such a level that, trying to deceive fate, we seem to conclude an internal deal, again and again scrolling in our memory the last days, weeks, hours before parting, wanting to change the course of events. “Oh, if only…, I would give everything to…” Rituals arise, often unconscious, when we try to negotiate with someone invisible so that there would be no death and everything turned out to be a bad dream…

We list what we did not have time to do during our lifetime for the departed, we regret that we paid little care, did not fulfill any requests, were not affectionate, did not have time to say “I love you”, unfairly offended and did not have time to ask for forgiveness.

Anxiety, restlessness, fear.

Loss causes a feeling of helplessness, we feel anxiety when the reality of loss hits us. Sometimes it looks like an incomprehensible fear of something, hitherto familiar objects can carry a threat, the city can become hostile and cold, the world can become deadly. People often start behaving accordingly. It is no coincidence that long-planned trips are canceled during this period, business trips and the departure of children to the camp, for example, are canceled.

Fear has many faces. This may be the fear of sleeping in the same bed or room, the fear of leaving housing or continuing to live in the same house. People are afraid of the loneliness that comes with death, and at the same time they are afraid of starting a new relationship. For a person who feels very insecure without their loved one, life is full of fears, and every day is, in fact, the ordeal of time.


Guilt can sometimes be real, more often far-fetched or exaggerated, but it must always be taken with great seriousness. Death exacerbates the problems that have ever existed in a relationship, and previously unnoticed "stumbling blocks" are now turning into an insurmountable obstacle. A person experiencing loss constantly uses the word "should" as a spell: "I should have done this" or "I should not have done this." Over time, a rational explanation will alleviate the guilt, but it usually returns until there is complete relief from suffering.


Any loss infuriates us, even if it happened by coincidence.

In the event of the loss of a family member as a result of, for example, a divorce, there are many ways to express anger - from changing locks to litigation. In the case of death, everything is different, there are even sayings symbolizing this: “the dead are either good or nothing.”

We rarely realize that we are angry with someone who has died or left us. Instead, we shift our anger onto others, scolding the orderlies, the mortuary service, the organizers of the funeral, etc. etc. And often the anger is incommensurable with what we think causes it.

A certain amount of anger is a healthy indicator that we are starting to accept the facts as they are. “The first strong feeling that breaks through the veil of numbness and deceptive indifference is often anger” (F. E. Vasilyuk)

These processes come in waves, one wave of anger - denial - splitting - persuasion is rarely enough for acceptance. Over time, they change qualitatively and the impulse to “call my mother” is gradually replaced by an awareness of a more acute need - “I need to be able to call my mother.” The weight of the loss begins to be felt.

During a crisis of grief, many processes occur at the level of the unconscious, and echoes of dreams tell us that there is a serious inner spiritual work to accept and overcome. During this period of mourning, dream storylines reflect the conflict associated with accepting death.

Dreams - denials - in which we create happy endings, where there is no death, a loved one is saved or returns alive.

Dreams in which anger is manifested are especially frequent when we are not aware of it on a conscious level and do not give it a place in real life.

Dreams reflecting our gradual acceptance of death. These dreams solve the main problem of the crisis of grief - the recognition of the need to accept death.

Work grief

Begins when a person accepts the fact of death. Complex processes of overcoming begin, as a result of which the lost relationships gradually become memories that do not completely absorb, but give a state of light sadness.

After we accept the death of loved ones, we want to move forward, stop feeling pain and plunge into life again. The emotional presence of the deceased person still makes itself felt, forcing us to build new and more suitable relationships. This period is known as the "work of grief" - a term proposed by Z. Freud to describe the internal and external adaptation that must be carried out after a loss. Researchers note two main components of successful grief work: re-examine relationships to assess what they mean to us, then "translate" them into the category of "memories without a future. "

Even Sigmund Freud, in his famous work “Sorrow and Melancholy”, emphasized that we never voluntarily give up our emotional attachments, and the fact that we have been abandoned, rejected or left does not mean that we stop relationships with those who did it. After the death of a loved one, we, one way or another, continue to respond to his emotional presence, realizing that the person is not with us. In order to understand what we lost with the departed and what these relationships were for us, we return to them, look through them over and over again and play again in memory, dreams, daydreams. Warm memories cause feelings of happiness, unfinished disputes and conflicts make us experience disappointment, anger, sadness again and again. The task of the work of grief is to return us again and again to those situations and states, until we calmly look at these facts and accept them as they were.

“A person very close to me has died. In general, the depressed state never goes away, as soon as you remember something or see a photo, hysteria immediately begins. Relatives explain that it’s impossible to do this, “you need to let go of the situation,” but how to do this?

Psychologist's answer. Your loved one has passed away. And it would seem that 7-8 months have passed, and you do not feel any better at any reminder of this person. Your emotional state is natural for experiencing the loss ... "To survive" does not mean at all to forget the departed, stop talking about him, or learn to pretend that nothing happened. To survive means to realize what happened, to accept the changes in life that have taken place, to adapt to the changed situation. This means not pushing the feeling of pain inward, because it does not get rid of it. This means gradually replacing the feeling of suffering and pain with a calm memory. The total duration of the stages of experiencing the loss of a loved one, on average, can last a year. Allow yourself to talk about the departed person, about your feelings, allow yourself to show them. It helps to cope with the loss. If you realize that you can’t cope on your own, contact a psychologist for a full-time consultation.

The ability to perform the work of grief depends, among other things, on age and on the degree of personal maturity. In the absence of healthy breakups in the past, the work of grief is much slower. Before we come to terms with a new loss, we are forced to turn to the previous unfinished losses.

The work of grief is exhausting. Unconsciously, we return again and again to the past and are under its constant weight, and as we return to the elements of former lost relationships, we are constantly faced with loneliness and acute longing.

No wonder we feel exhausted.

“…I am 21 years old, I study, I work in my specialty, I live in a civil marriage. Less than 2 weeks ago I lost my dear, beloved, close person - my father. Not suddenly. Dad was sick for a long time, so I was somehow ready for this. In fact, my father died in my arms. With my brain, I understand that you need to support your family, continue to live. I go to work, take a session, walk the dog in nature. But, there is a strange state of affairs. I can forget words, terms. As they say, "on the tongue" spins, but is remembered only after an hour of reflection. Restless dreams. Sometimes fear or tearfulness rolls in "waves". Unfortunately, you can't rewrite life. Tell me how to accept this life situation, return the speed of reactions and the adequacy of actions? How to recover as quickly as possible and what to do so as not to stop remembering the last breaths of a loved one every five minutes?

Response from a psychologist: You have experienced the loss of a loved one. And although it was not sudden - the pain and experiences make themselves felt. There is such wisdom among the people: you need to live a year for the pain to subside. To accept this life situation, there are rituals: mourning, farewell, burial. There is a simple way to take the first step towards acceptance - to allow yourself everything that you now forbid yourself: to be uncollected, imperfect, with a slow reaction. Take care of yourself, not just others...

But little by little the demands of the present begin to assert themselves. We want to release the loss and move on. However, a part of us is still gripped by grief, not yet fully ready to be freed. The desire to end mourning and only occasionally remember the deceased can be unconsciously perceived as a betrayal, cause a feeling of guilt and slow down the processes of grief.

Long-term emotional stress, which for a long time has no way out and explanation for the mourner, creates the prerequisites for the manifestation of symptoms of physical diseases, dependence on alcohol, drugs and drugs.

Manifestations of the work of grief inexorably enter our daily lives. Our mental suffering during this period is often projected onto objects belonging to the deceased or reminiscent of him. It takes a long time before people who have lost their loved ones begin to sort out clothes and sort out personal belongings. The so-called "general cleaning", thus, finally confirms the fact of death. It is a symbol of revision and reorganization going on deep within.

Dreams can symbolize a longing to be reunited with the deceased, in which we oscillate between the desire to end the grief and the guilt caused by this desire (the deceased may appear in dreams complaining of loneliness and abandonment). Dreams may reflect the feeling that when we end mourning, we leave the deceased. Often dreams symbolize the end of the work of grief - everything that reflects the beginning of a new one or the energy of awakening is dreamed (the ice melts, the bud blossoms). When does the work of grief end? We must be aware that we never voluntarily let go of someone we hold dear. Loss can always "come to life" and again cause acute pain, it can return on anniversaries; or when our children reach the age when we experienced loss; in those moments when we reach important life milestones in our lives (graduation from university, marriage, birth of children).

The stages of the practical end of grief are accompanied by processes of identification. This unconscious process is described as helping the mourner to acquire the traits, ideals, and functions of another person. There is a certain paradox in this - by adopting the features, ideals, values ​​and functions of another, we become less dependent on him.

By identifying with the individual features of the psychic double of the deceased, we become like those aspects of the other that we most need. We accept it, assimilate it and make it part of our identity.

We keep for ourselves what we once received, and this helps us separate. Some of these identifications are very common: after the death of her husband, an elderly widow, who was afraid to drive during his lifetime, becomes a real racer; husband - never involved in finance, finds himself prone to calculations; a modest daughter gains the confidence of an overbearing mother, and so on.

Complicated grief.

Sometimes external circumstances can influence the ability to grieve. To experience grief, we need time and space - this, among other things, explains the presence of a funeral rite in most cultures and religions. Funeral rituals address the psychological need for mourning and trigger it, legalizing many internal processes. For the mourner involved in the funeral process, the planning of the funeral, it becomes increasingly difficult to deny death.

The shock that accompanies sudden death can slow down the process of mourning. Sudden death robs us of the feeling that the world is a safe place and our life is stable, makes us look for an explanation for what happened and feel guilty for not preventing the loss.

“…Three months ago my grandfather died in front of my eyes, it was a shock for me, it all happened in a matter of seconds. Now I just can’t get rid of the bad thoughts that constantly haunt me, that a person is mortal, that no one knows when this will happen to him and why. These thoughts constantly haunt me, and I bring myself and my health to the limit ... I can walk, watch TV, and thoughts of this nature can come to my mind: “What if I die now, or in an hour, I even I don't know and I get really scared. …Help me please.

Psychologist's answer. The death of your grandfather was a great shock to you. It seems that this event stirred up many difficult feelings and questions in your soul... It is especially painful that feelings and thoughts about mortality are obsessive, you cannot distract yourself from them. As far as I understand, you are asking for help in not being so obsessed with the problem of death. One way to get rid of this obsession can be to solve the problem of death for yourself. There is no general solution, but each person can decide something for himself. You complain about the fear of your own death. He wears you down. Try to treat this fear as a feeling that asks you: "What are you doing with your life, knowing that you will die?" There are not many answers to this question. There are people who devalue life, believing that everything is empty once it ends. Others believe that if everything ends, then it makes sense to live in all its fullness and fulfillment, trying to fill every moment of this gift with taste, understanding the value of every moment. Which of these two options would you choose?

Violent death (when a loved one leaves as a result of a murder) - grief can be complicated by the repression of anger necessary to experience it.

“…my son was killed. He was 13 years old. I go crazy, drink and just die. Help"

Psychologist's answer. ... Accept my deep and sincere sympathy. A terrible grief has befallen you. The death of a son is an irreparable loss. And if it's murder, it's all the more scary. There are probably no words that could comfort you. Only solidarity with you as a woman. Children are the most precious, the most sacred. I mourn with you…”

When we are isolated from a deceased loved one at the time of his death and funeral, or focused on other circumstances and forced to suppress our grief until a better coincidence (a soldier on the battlefield who has lost a friend).

When death imposes a "shameful stain" (suicide, drug overdose, AIDS).

One of the obvious paradoxes of grief is that the happier and more mature the relationship, the easier it is to leave them, although this does not free from mental anguish.

The more we depended on the deceased during our lifetime, the more we need him.

“How to cope with the loss of the closest person? I am 51 years old, I was not married, we lived with my mother together. She is sick and I lived for her, and now she is gone ... how to cope with insomnia and longing?

Psychologist's answer. ... I sympathize with your grief. You lived with your mother alone, throughout your life she was the closest person to you, the most dear and the only one. Now she is gone, a whole layer of life has gone with her. You experience a feeling of longing and sadness, you grieve, grief is not just a complex feeling, it is a whole mechanism that helps to survive the irreparable event that happened - death. Grief has its stages, its time. According to religious and universal canons, the third day, the ninth day, the fortieth day, half a year and a year are the most important periods of farewell to the dead. It is important to fulfill the will of a person, to carry out on the last journey, to perform all the ritual and religious actions adopted in your family. Sorrow, sadness, love and a heavy feeling of loss are replaced by a state of shock, then a feeling of light sadness should come in their place. ... Try to support yourself, give yourself time to recover: do not forget to eat and sleep on time, consult a doctor if necessary. At a time like this, it doesn't seem to matter at all, compared to what happened. You will need the strength to solve legal issues, employment issues, sometimes such a “distraction” is simply necessary.

Complicated grief symptoms.

Getting stuck in denial. A person denies the fact of death partially or completely, this is often evidenced by reservations in speech - the deceased is spoken of in the present tense, etc.

Absence of grief. People suffering from this do not deny the fact of death, they deny the emotions associated with it. Often these people may complain of a painful indifference to life, and some time later (months, even years) may react with anger, sadness or irritation to an unrelated loss.

"Eternally Mourners". When the loss has no resolution, no way out, or the loss is too great, the mourning can go on forever, the mourner may never come to terms with it. The degree of obsession with grief varies, this process can be completely superseded: mourners can remarry or have new children, have a successful career, but part of their energy is elsewhere. Often their preoccupation is found in reservations: they can talk about the deceased in the present tense. They create a corner of the house that serves as a kind of place of worship, maintain rituals in which the anxiety-laden relationship can continue. These relationships are contradictory in nature - the conflict between the passionate desire to maintain a connection with the lost and the desire to be freed from it. In their dreams, three storylines are very often traced: they reflect a feeling of immobility, immobility; display the illusion that the loss can be eliminated and the deceased person continues to live; a lost person is in danger, or dreams of those fighting for their lives.

"Consumed" in grief. Sometimes grief can turn into depression. A person experiencing grief for some time can attribute to himself the features of the deceased, his physical features. This identification can be unhealthy, it occurs when the mourner adopts the symptoms of the illness of the deceased.

...My mother died six months ago. since then I can’t sleep, it seems that if I start to fall asleep, I will suffocate ... my mother died of pulmonary edema, poor thing! how to imagine this picture ... how abruptly my mother stopped short of air. I'm afraid to die, it always seems that I'm suffocating, now I'm afraid to be alone in the dark ... although I used to love twilight very much. ... How to be? Psychologist's answer: ... The death of a mother is a heavy loss for every person. And while the parents are alive, they seem to protect us from their own death by the very fact of their lives. Your grief paints before you pictures of how mother left. You, most likely, try on these pictures for yourself. It becomes scary, fear drives sleep. The main task of grief is to keep in the memory of a person alive, not dying. Most likely, when your soul comes to terms with the fact of loss, this will mean that grief has finished its work. If you subjectively feel that you cannot cope with your own experience, then it makes sense to consult a doctor.

Those consumed by grief direct anger and guilt inward, the main question of the work of grief - "can we come to terms with lost relationships" can be regarded by them as a painful and insoluble dilemma - "how to kill a part of ourselves in order to save another part?"

Death in the family.

Each grief is unique, but it is impossible to consider loss without the context of the family. Any discussion of the consequences of loss in the family should involve all of its members. The script of family life is written on the basis of common events, myths, traditions, previous losses and personal expectations. So when a family member leaves, the family dynamic needs to be re-evaluated. The bereaved must transfer this role to another adult or child, or else return the side of himself that he once projected onto the now lost member of his family.

“…When I was finishing school, my mother died of acute leukemia. It was very unexpected, this is a great grief, my mother was the closest and beloved person on this Earth for me ... I tried to be strong, entered a prestigious university, did everything myself .... I sobbed at night, .... I woke up in the morning and I thought: “I wish this day would pass sooner” .... 5 years have passed, and this time has changed me a lot .... I am very withdrawn into myself, I have absolutely no friends, I understand that I don’t love myself, I don’t value myself, I understand that I have a lot of complexes, but I don’t show I keep it all inside...

…Father did not support me at that difficult moment (the death of my mother), did not even comfort me, did not give advice on how to live on, how to act in this or that situation…. If he had given me at least a little care, my life would have turned out a little differently, and I would probably have been different. And he abstracted from us, children, then began to meet with a woman, a Muslim, then they began to live together, separately from us ....

…I am very worried about my loneliness, I feel alone with this World. I am under constant stress and cannot learn to enjoy life the way I used to. I feel that I am capable of more, but I cannot be liberated, become free from my experiences! I feel resentment towards my father…for leaving me alone to “sail through life”…it’s very hard for me without someone’s support…

Psychologist's answer: “…You have experienced a serious loss, and what happened in the family after the death of your mother left an imprint on you.

It so happened that you experienced grief alone. Your family didn't get to do it together. Since then, you have carried a bitter resentment against your father in your soul. And something else happened. Since that sad time, you seem to have split. Outwardly, you show yourself calm, sociable, joyful, but inside you experience bitterness, resentment, low value, humiliation. You suspect that it is precisely because of your depressing experiences that your physical health suffers. It seems to me that you have defined very precisely what exactly you lack. You lack support. Apparently, trying to compensate for this shortcoming, you please others, looking for praise. But you feel like it's not the same. When support is scarce It is important to start building a support system for yourself. And you can start by seeking psychotherapeutic help.

Suicide. If a family member commits suicide, that death can cause feelings of guilt, shame, and disgrace, which are added to the factors of suddenness and violence. Family members are forced to struggle with guilt over not doing their best to save the victim.

“…my loved one committed suicide. ... After his death, I learned a lot of bad things - that I didn’t love me, that I didn’t believe, I didn’t even find the words to say goodbye to me. We were together for 10 months, he was the closest person to my soul, I could not even imagine. That he might commit suicide and leave me. … How to live on? very offended by him, angry, pain, all in a bunch. There is a hole in my chest, I don’t understand how he could do this to me ...

Psychologist's answer: ...You have lost a loved one. This is always unexpected and sad. Close people occupy a place in the soul of each of us, and when they die, it becomes empty. This is, as you write, a hole in the chest. It will gape and hurt while you grieve for the loss, until this place in your soul becomes a secret repository of the memory of the deceased. It seems paradoxical, but only grief and its experience can make a treasure of memory out of the emptiness in the soul. With suicide, everything is much harder. There is something terrifying about suicide. This event, as if, seals all loved ones, as if it puts a mark of involvement on them. And you, too, seem to feel this seal on yourself in the form of a painful combination of resentment and guilt. You rush between: "what have I not done yet to..." and "how dare he do this to me".... The death of a loved one hardly finds excuses, especially if it comes by way of suicide. But I think there is truth in every death. The truth is that he did not do this to you, but only to his life. …Give your soul time to mourn through his death.”

Children who lose a parent by suicide often believe that they were involved in the misfortune, or feel guilty for not being able to alleviate the pain of the deceased. Phrases ever uttered by a parent are deeply embedded in the memory of the child and can torment the child throughout his life. The loss of a parent due to suicide can give rise to suicidal intentions in a child. The one who chooses to leave the family provokes anger in those he leaves. This anger is often suppressed, in a situation of suicide, among other things, because the deceased has already "suffered a lot" and has been "punished" enough.

Honest and respectful relationships in the family will help to overcome grief, each family member should be allowed to express their feelings and ask questions. Ideally, each family member learns the details of the death - in an age-appropriate form - and takes part in the funeral rituals.

When parents lose their children. Surviving a child is one of the hardest losses a person can ever experience. From the moment of conception of a child, parents, as a rule, unconsciously build their own idea of ​​the future, which necessarily includes the child. With the death of a child, parents lose not only a connection that is dear to them, but also a planned future, the meaning of life ... It is impossible to reconcile with such a death, even if the child has not become an adult, because, as parents, we are convinced that we had to protect children. Even if they are out of our care. The death of a child who lived with his parents upsets the balance in the family. If such a loss does not unite the family, it can lead to an irreversible break, because family members, trying to understand the meaning of the loss, give vent to their anger or guilt, transferring it to the spouse.

“…Good night! Please tell me how you can help a person in such a situation: ... People have been married for 25 years, a tragedy happened in their family, their son drowned, the spouses lost all interest in life, but instead of supporting each other, and continue to live .. overcoming terrible grief .. they became strangers, each of them treat this grief as their own .. and they are thinking of getting a divorce ... how to help? ...

Psychologist's answer: ... You write about people close to you, you try to understand what is happening with them now in order to help. It is terrible for parents to lose their children, because in them is the continuation of life, and without them, the meaning of this life is lost. No one can say exactly what forces are separating them now. One can only make assumptions. It may be that the son was a very important link in the family, and with his departure, the connection between the parents was broken. Or, perhaps, now, against the background of the loss, what united the couple for a quarter of a century seems meaningless. It is also known that people each experience grief in their own way (one openly shows his feelings, the other closes in, suffers silently), and it happens that each of the spouses is simply unable to understand and feel his partner. In addition, faced with the death of a loved one, people tend to look for the guilty or blame themselves - this is an obligatory stage of experiencing the loss. The accusation can be directed at anyone, including a spouse. ... This can also be the reason for the breakdown of relations. Unfortunately, this often happens when a couple who has lost a child feels the urge to leave. This desire may be temporary, taken under the influence of grief. … Your participation is already an important support for loved ones, and your presence next to them without judgment and evaluation of their feelings, thoughts and actions will help them accept this support…”

Loss of an unborn child. We often do not realize that during the development of a child in utero, parents have already established a deep connection with him and need to mourn this lost connection. The loss of a child late in pregnancy can often cause a sense of failure and failure in both parents, but especially in the mother, and if she is not allowed to grieve, she may have long-term complications associated with the loss.

Hello, I need at least some help, it's just that I can't discuss this problem with my husband, … we both try to forget about it. ... I was pregnant, we had our first children - two girls. We were looking forward to them. At 29week, labor began. They lived for two days. … I can’t remember this without tears. ... But I really want my child, I'm already going to extremes, I ask my husband to take a foster ...

Psychologist's answer: ... Heavy trials have fallen on your shoulders. It is always painful and hard to lose loved ones, especially for children. You did not manage to enjoy motherhood, but you faced the pain of losing your long-awaited children. You want to forget everything like a bad dream, but you can't. Yes, this is impossible. You can try not to think about what happened, you can avoid talking about painful things, but the pain will not go anywhere, it can only decrease. A spiritual wound is like a wound on the body - it heals over time, but the scar remains ... You look with bitterness at the children of your friends and cannot come to terms with your loss. You are ready to take a baby from the Orphanage. Psychologists recommend not to rush to make such a responsible decision during the period of experiencing acute grief. Allow yourself to live through this period, and discuss the issue of a foster child with your husband later.

When we lose a brother or sister. When we mourn for them, we mourn for ourselves. Losing them, we mourn the companion of our life, her witness, the proof that "nothing will happen to us." Childhood experiences come to life, unconsciously we resurrect in our minds all the stages of our childhood. This loss symbolizes the end of the childhood illusion that "we will grow and grow old together." Death is a threat, because "I could be next."

“I have terrible depression, 5 months. ago, a person close to me died tragically and stupidly - my brother, he was 23 years old. We had a trusting relationship, we were friends, consulted with each other. He is gone and it seems to me that a part of me has died, I feel very bad and sorry for him without him, he was a wonderful little man, kind, sympathetic, and besides him I have no one else, neither brother nor sister. Despite the fact that I have my own family, husband, son, mother, I remember him every day and fall into apathy. Psychologist's answer: ... You have lost a loved one, a soul mate, and it hurts so much that it seems that a part of you has gone with him, a part of you has died. ... Try not to isolate yourself in your experiences, but talk about them, ask and accept the help and support of your loved ones, observe rituals, commemorations, allow yourself to talk about your brother with mutual friends and relatives, visit the grave if such a desire arises ... "

Child's reaction to loss. A small child experiences even a short-term separation from a significant adult as a loss. The more the child had joint experiences with the lost person, the longer he is able to keep the image in his memory, the more the grief of the child will resemble the grief of an adult. As children age, their perceptions of death change.

If a child loses a parent at the age of 2-3 years, he only feels that he lacks something. Growing up, the child creates a fantasy image of the lost adult and will try to keep it for a long time. The child is not yet able to understand what “death” is, this can be expressed in such statements: “You said that mom would not return, but I want to call her on the phone.”

At the age of 5-10 - death is seen as reversible and temporary, the child's secret belief that an important person for him has not died. The child learns that there is death, but does not think that this can happen to him. At the age of about six years, children often idealize their parents, draw their mother as exceptionally beautiful and powerful.

If a child experiences a loss before he has a realistic image of his mother, it will be difficult for him to find someone who can compare with her.

At the age of 10-12, children have a more realistic idea of ​​death and its irreversibility. A child may be more open at this age to express grief over the death of a pet than over the death of a family member.

Adolescence itself is a specific "rehearsal" of mourning. Adolescents, not realizing this, weaken their ties with their parents, become less dependent on them, more free, transferring their attachment to their peers.

"... I lost the closest person - my mother, and there is no one besides her, and I'm only 16 years old and I don't want to live at all ..".

Psychologist's answer: …It is very difficult to survive the loss of your mother at 16. You experience pain and grief. And it is impossible to turn off these feelings, you have to go through them in order to keep in your heart a kind warm memory of the closest person. This memory will give you the strength to live on your own. Everyone loses their parents sooner or later. And it is at this moment that we truly become adults ... "

The adult pattern of grief is established after the successful completion of adolescence. The ability of the remaining parent to adequately respond to the loss affects how the child copes with the loss. This is the ability to experience grief, to comfort the child, to provide him with a suitable replacement for the deceased.

Loss of friends.

Hello! A friend suddenly died ... How to cope with the pain of loss? I really miss ... We have not seen each other for a long time, due to circumstances. But they were still very close. All my memories of my youth are with her. Yes, everything I love...

Psychologist's answer. Alena, you are now hurting and lonely, a sudden loss is doubly difficult. Dear, close person, memories of youth... How to cope with pain... Allow yourself to grieve as you need. Only by experiencing, and giving yourself the opportunity and time to remember, regret, cry, get angry, say goodbye, and leave her a place in your heart forever. This will take time and effort, it's good if you have someone with whom you can share feelings and memories, and just be there. Maybe you would like to write a farewell letter to your friend, where you will express everything that you did not have time to…”

If a friend has a problem.

“...My friend's brother was killed. He is 25 years old. From close people he left his mother and other relatives. I really want to help him in this difficult situation. Where to begin? How can you ease his pain?

Psychologist's answer: ... Faced with a loss, a grieving person experiences very complex, often conflicting feelings: despair, anger, and guilt; and the need for support, and the desire to speak out, to pour out your feelings, and at the same time an unbearable desire to be alone ... the best thing you can do for your friend is just offer him your support, just be there, be a good listener, offer help with household chores. An attempt to help another person survive grief is a very, very difficult matter, requiring from the "assistant", first of all, great spiritual tact ... ".

Report grief.

“…We need SOMETHING to inform the grandmother (she is 80 years old) that her daughter has died, the funeral has already taken place, the daughter lived in another region. How to build a conversation in order to prepare a person for this? What to say, how to say?

Psychologist's answer.

It is impossible to prepare a person for the news of death. Rather, the readiness of the one who will tell the grandmother this bitter news is needed. And you have to be ready to talk about what happened simply, without frills. I can only guess whether you will go to your grandmother, one of your relatives or a group of relatives. In any case, when meeting with a grandmother, of course, not on the very threshold, you can tell a kind of short story. The story of how her daughter died. "It was this and that, then this and that, the doctors could not help and she died." After that, take a break, giving the grandmother the opportunity to comprehend the news and ask questions. Of course, you can expect an older woman to react emotionally to the news. Then you have to be there, support, have water, validol on hand, be ready to call an ambulance. Then continue your short story. How the funeral was prepared, how they were buried, to answer possible questions. It would be nice, if possible, to have something confirming the death with you (photos from the funeral, death certificate). To be ready to silently and calmly ask for forgiveness for not informing about death earlier… Death is a part of life. Elderly people like no one else understand this. You just need to tell your grandmother about the death of your daughter and be ready to support her ... ".

Most mourners do not need professional help. As a rule, people need the support of others and in such a social environment where they would feel free to express any emotions. The person is relieved to know that feelings of guilt and anger, timing, stages and intensity of experiences are typical in this situation. That the experience of grief is a period of strong emotional excitement and pain, that even the usual experience of grief sometimes takes on bizarre forms. We can help by encouraging frank conversations with family and friends about the experience and the feelings that go with it. Even a small child needs to know that grief is an experience that has a beginning and an end, it is important that the child sees that adults are immersed in grief, and then gradually come out of it and move on; so that the child can share his feelings and experiences with adults and gain invaluable experience of parting.

Bereavement — Such cases

For the first time in Russia, the book Fundamentals of Palliative Care, edited by Robert Twycross and Andrew Wilcock, is published — the first fundamental manual on palliative care in Russian, prepared for publication by the Vera Hospice Fund. Cases Like This publishes a chapter from this book

Fundamentals of Palliative Care, a comprehensive guide covering all aspects of caring for terminally ill people. This manual has been used by European specialists for more than 20 years, and now it is available to Russian-speaking medical students, doctors, and nurses. The book Introducing Palliative Care was first published in 1995 and after it was repeatedly reprinted in different languages ​​of the world. The fifth edition of the book was translated into Russian in the 2016 edition.

Dr. Robert Twycross is one of the pioneers of the hospice movement in the world. He taught a course in palliative medicine at Oxford and directed the WHO Collaborating Center for Palliative Care for 17 years. In Fundamentals of Palliative Care, Twycross has put together a detailed and comprehensive guide to managing palliative patients: treating painful symptoms associated with their illnesses, as well as communicating with relatives and loved ones.

Andrew Wilcock is Fellow of the Royal College of Physicians and Fellow in Palliative Medicine and Oncology with the Macmillan Service at the University of Nottingham in the UK. Editor and one of the creators of the International Palliative Care Formulary, scientific consultant on prescribing drugs in palliative care of the British National Formulary.


The experience of loss is one of the most severe crises in life, which affects the health of a significant number of people. Bereavement support is one of the main elements of palliative care. It includes both caring for the patient's body after his death, and helping relatives and friends of the deceased. If the death of a person is expected, some of his relatives may experience "anticipatory (anticipatory) grief", in which case help in experiencing the loss can begin to be provided even before death.

The period of bereavement is the time of experiencing the death of a loved one, and grief is a reaction to longing and anguish that occurs after death. Grief is a transitional process during which people adjust to the reality of loss and learn to live without a deceased loved one. Grief is not just an emotional experience; it highlights behavioral, cognitive, physical, social and spiritual aspects. Thus, grief requires a holistic approach.

The experience of loss is associated with increased mortality, in particular from cardiovascular diseases, in the first months after the loss of a loved one. There is an increase in the frequency of somatic and mental illness, infections and alcohol abuse, as well as seeking medical help and psychotropic drugs.

Grief patterns

Grief is a deeply personal experience that people experience in different ways. Nevertheless, several typical stages can be distinguished, and on their basis, a number of models of grief experience.

They can be used to support those who are grieving, but the model is always a simplification and should therefore be used with caution. The sequential passage through the stages of experiencing grief is not typical. Usually people vacillate between different stages of such a path, which can lead to confusion both for themselves and those around them.

Grief is not a stable process. A person goes through a certain stage of this process, but then returns to it again. And so in a circle. All repeats.

Common reactions to bereavement:


Anxiety; anger; anxiety; depression; guilt; feeling of loneliness; sense of relief


Despair; low self-esteem; self-criticism; a feeling of unreality of what is happening; social isolation; suspicion; longing for the deceased


Alcohol abuse; increased fatigue; tearfulness

Physiological changes

Dry mouth; hair loss; headache; indigestion; insomnia; loss of appetite, weight loss; muscle pain; cardiopalmus; dyspnea; stress-induced disease, infection; the use of psychoactive substances; visual impairment

Therefore, one should not make hasty judgments about the stage of grief that a bereaved person is or should be in. Personal characteristics are of great importance. For people who rely primarily on their feelings, the experience of grief tends to be more in line with traditional patterns, while for people who tend to make sense of what is happening first, it becomes more of a cognitive process. To cope with a situation, such people search for information, think about problems, take action, and look for ways to distract themselves - this model is not necessarily associated with difficulties. In addition, the manifestation and expression of grief is culturally determined. In the UK and the US, self-confidence and independence are highly valued, which forces grieving people, especially if they are male, to suppress their emotions and not show that they are suffering.

The traditional model

The traditional model states that the process of grief consists of certain stages, but in reality one stage can occur simultaneously with another and unexpected changes are possible.


The first reaction is shock and distrust, accompanied by a feeling of the unreality of what is happening and the mechanicalness of life (existence "on autopilot"). Somatic symptoms may or may not be present.

Separation and pain

The numbness gradually gives way to intermittent intense melancholy, anxiety, tension, anger and self-criticism. There is an irresistible desire to return the deceased. This can manifest itself in dreams and in the fact that a person hears the deceased and feels his presence, or excessively indulges in memories. There may also be an obsession to re-analyze the circumstances of the death. Somatic symptoms are common.


This stage comes when the realization comes that the dead person will not return. There are signs such as poor concentration, apathy, social withdrawal, lack of purpose, and deep sadness.


Despair gradually gives way to acceptance of the loss. Acceptance of the irreparable situation first occurs at the intellectual level, and later at the level of feelings. Sadness and emotional shifts can last for more than a year.

Decoupling and reorganization

Eventually, the grieving person begins to adapt to life without a deceased loved one: he rebuilds his personality and redefines goals, acquires new skills and assumes new roles. Gradually, lighter feelings appear, energy returns, new hobbies arise and relationships are born. At the memory of a departed loved one, emotions are no longer overwhelmed, however, anniversaries and memorable days cause a temporary aggravation of grief.

The normal course of life is interrupted by loss, which primarily causes shock, as well as numbness and denial. What follows is protest, accompanied by anger and guilt, followed by disorganization, as well as sadness, a feeling of loneliness and emptiness. And finally, a reorganization takes place, thanks to which a person can return to the original level of functioning, often changing his attitude to life and acquiring new values.

Bilateral process model

This model illustrates that the bereaved person oscillates between two extremes: bereavement activities (e. g., thinking about the deceased, yearning for them, reminiscing, expressing their feelings) and recovery activities, in which a person is looking for a way to distract himself in order to cope with everyday life (for example, suppresses memories, controls emotions, finds a business for himself).

Orientation towards restoration allows a person to adapt and acquire a new self-identity, but since in everyday life there are many reminders of loss, he rushes between two types of behavior. The predominant behavior and degree of fluctuation of each individual will depend on personality factors, gender and cultural background. Over time, a person usually shifts from bereavement behavior to recovery behavior.

This model helps to understand why one day a person can look great and the next day he is grieving. Difficulties arise when a person tends to experience loss exclusively (chronic grief) or only to recovery behavior (absent grief).

Grieving parents may choose different types of bereavement experiences: one will be primarily bereavement-oriented, and the other will be recovery-oriented. This leads to tension between them as they cannot understand how each of them deals with grief.

Bereavement assistance

The basis of bereavement support is overall quality care during the life of the patient, well-established communication and trusting relationships built with the family. The promptly carried out procedure for ascertaining and registering death, the removal of equipment and medicines from the house, and the willingness to answer questions help to alleviate the pain of loss in many ways.

Some of the health professionals who can provide bereavement care are general practitioners, community nurses, community palliative care nurses, and various bereavement support organizations.

There are special support groups for survivors of trauma or suicide of a loved one, stillbirth or death of a child, and support groups for bereaved children. After the death of a patient who was under the care of a hospice, for relatives of a patient with an increased risk of complicated grief, assistance in experiencing loss is officially provided.

For most people, it is enough to give them the opportunity to express their grief and support them by offering to talk about their feelings and listening carefully. This is of great therapeutic value and belongs to the mandatory skills of every medical worker. By far the most beneficial influence on bereavement outcomes is family and friends, who provide the necessary support and allow the person to express grief and speak freely about their experiences for as long as they need it.

The main task is to help a person find strength in himself and find his own ways to overcome it. Because some people are reluctant to ask for help, it's important to ask how they are coping with the situation. Often they need someone to confirm that their experience of grief is normal.

Bereavement reactions are either immediate or delayed; both short-term and long-term; both moderate and strong. Most bereaved people go through this period with the support of family and friends, and a healthcare professional who is willing to listen to them. About 10% need the help of a volunteer bereavement team or support group, and about 5% have complicated (pathological) grief that requires the participation of a psychologist or psychiatrist.

In addition, it is important to provide support not only to family members, but also to caregivers, especially if the death was traumatic. For most of them, it is enough to give them the opportunity to express their grief in an atmosphere of support.

Complicated grief

Complicated grief is grief that leads to long-term physical and mental health problems.

His risk factors are listed below:

premature and sudden death;

• death too severe;

• highly dependent, conflicting or difficult relationship with the deceased;

• poor social support;

• inability to talk openly with anyone and prepare for

• anger, if it makes it difficult to provide support and leads to social isolation;

• Life circumstances that take away time and opportunity to deal with loss, such as financial hardship, lack of employment, needy children or elderly relatives;

• loss of loved ones in the past;

• the presence of a somatic or mental illness;

• history of alcoholism, drug addiction or suicidal behavior .

Complicated grief usually takes the form of extremes of normal grief. Formal criteria for complicated grief remain controversial. In addition, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer includes complicated grief as a psychiatric diagnosis, but it also no longer lists bereavement as an exclusion criterion. major depressive disorder.

Complicated grief requires the help of psychologists and psychiatrists. In particular, the following treatments are possible: guided mourning; interpersonal (interpersonal) psychotherapy, cognitive-behavioral psychotherapy and family-oriented grief therapy.

Short-term treatment with benzodiazepine hypnotics may help, but it is important to carefully monitor these prescriptions to prevent dependence.

For those who develop an apparent psychiatric disorder (eg depression, anxiety disorder, substance abuse, post-traumatic stress disorder, psychosis), treatment will be provided in accordance with standard psychiatric practice.

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