Grief is an emotional reaction that follows loss of someone or something of great value. Mourning is the psychological process that occurs when you experience loss.

There is a difference between normal sadness and grief. Normal sadness is your emotional response to most losses, disappointments, and frustrations in life. When you experience normal sadness, you are able to:

• describe why you are sad

• respond to your environment in a normal way

• get over your sadness in a relatively short period, usually less than a month.

Grief is intense emotional and psychological response to a loss. For those vulnerable to depression, grief can evolve into a major depression requiring medical and psychological treatment. When you have mixed feelings about someone who has died (anger but also a sense of loss), or feelings of abandonment, your reaction to that person's passing may be more complicated than normal.

Grief is associated with:

• loss of a loved one (either through death or other means, such as divorce)

• a change in body appearance with loss of a body part (for example, after removal of a breast or amputation of a leg)

• loss of the ability to maintain a physical function (for example, when you can no longer walk)

• loss of a job or of social status.

The grief and mourning process associated with the loss of a loved one (especially if it was unexpected) often has the following three stages:

• Stage 1: Shock and Disbelief

  During this stage there may be a wish to deny the importance of the loss. Events may seem unreal and you may feel numb at first. This may last a very short time or as long as a few days. During this time you deal with your need to deny the loss. Common behavior in this stage includes crying, showing anger, even screaming. You should allow yourself these expressions of your feelings. In the case of the death of a loved one it is important, if at all possible, to attend the funeral.

• Stage 2: Developing Awareness

  The second stage may last 3 to 12 months. It usually includes the following:

  • preoccupation with the loss

  • anxiety and restlessness

  • difficulty sleeping

  • physical symptoms including loss of appetite, digestive problems, and fatigue

  • anger

  • guilt

  • identification with the lost loved one

  • occasional experiences of thinking you have seen the person who has died or heard his or her voice

  • a possible depressive response on the anniversary of the loss.

  During this stage awareness of the loss settles in. You also notice the consequences of your loss. Mood swings are common. During this time you should share your feelings, especially with family members and compassionate friends. Direct your efforts toward caring for yourself and planning positive lifestyle changes. Although this stage may last for months, you should gradually feel better month by month. If you are not gradually feeling better, you may be developing a complicated grief reaction, which will require professional help.

• Stage 3: Resolution

  Resolution may begin anytime from three to 12 months after the loss. You begin to recover by incorporating new habits and lifestyle changes and by making plans for the future. Gradually you take charge of your life and resolve the loss through activity, readjustment, and education. Some of your fears and confusion about care, medication, and checkup schedules can be answered by your doctor.

In addition to medical and emotional help from your family doctor, help is available through professional counselors, your clergyman, or support organizations. You should seek professional help if you cannot return to work or deal with routine tasks after a few weeks.

There are ways to help yourself deal with grief and loss. These include:

• engaging in 20 minutes or more of physical activity at least every other day

• pursuing recreational interests at least once or twice a week

• making time for hobbies and listening to music

• having talks with friends and family

• doing daily progressive relaxation exercises (tensing and relaxing muscle groups to relieve tension and anxiety)

• breathing exercises during times of high stress

• getting 6 to 8 hours of rest a night

• eating balanced, nutritious meals

• avoiding an increase in the amount of alcohol you drink

• avoiding major decisions or life changes (such as selling your home and moving) until your judgment and perspective return.

You can also try:

• developing and maintaining the attitude that things will work out

• asking for help at home and work when your load is too much for you to handle alone

• seeking professional help for dealing with life events that produce anxiety, and learning positive methods of coping.

Seek professional help for complicated grief reactions.

During the first few weeks after the loss of a loved one, almost any type of reaction is possible and normal. In most cases, with love and support from your family and friends, you will gradually feel better without professional help. However, any of the following signs suggest that a normal grief reaction has become complicated and requires special treatment for the best recovery:

• You are unable to function adequately at work.

• You have extreme feelings of guilt or worthlessness.

• You have unexplained physical symptoms.

• You have feelings of depression or nervousness that are getting worse rather than better after a month or so.

• You have persistent and severe trouble sleeping (lasting 4 to 6 weeks), particularly with early morning awakening from which you cannot get back to sleep.

• You have lost more than 10 to 15 pounds.

• You have suicidal thoughts you cannot get out of your mind.

Once symptoms like these develop, you cannot 'think yourself out' of the complicated grief reaction. You are not weak for having these symptoms. Getting help really can help.