Grief and bereavement
For every human being, when they receive the news that a loved one has passed away, grief will take the better of them. Grief may be even more overwhelming when someone receives the news that a loved one has died as a result of an accident, or worse. The bereaved person not only mourns the death of a loved one, but also the way that person died. The world of the bereaved person is turned upside down. Grief is a complex psychological and emotional experience that can follow from experiencing several types of loss, such as a break-up with a boyfriend, losing your job, or failing an exam. Bereavement, however, is grief specifically in response to loss due to death or someone dying.

The five stages of grief
Bowlby and Parkes (1970) were among the first to propose a stage theory of grief for adjustment to bereavement. However, it was Elisabeth Kübler-Ross (1969) who became famous for the five stages of grief; she also adapted the model for people who were confronting their own death. Nowadays, the well-known model is generalized to a variety of forms of loss and is widely accepted by clinicians and the general public for all types of grief and bereavement. The five stages are disbelief, anger, bargaining/yearning, depression, and acceptance.

Individualized process
However, it would be a misconception to think that everybody goes through these stages in the same way, or that they occur in a specific order. All individuals experience grief in their own way. This is a highly individualized process. Where one person reaches acceptance in a few months, others may take years. Where some go through the stages separately and successively, others may go back and forth through stages, or have stages overlapping. Many factors influence the process of grief, such as the way we lost our loved one. Grieving after the loss of a loved one due to natural causes is thought to be most characterized by the stages yearning and acceptance. However, levels of acceptance are often lower after a traumatic loss.

Complicated grief
The most common reaction is for the individual gradually to successfully adapt to the loss. However, a minority of people are not able to adapt and are diagnosed with complicated grief. Complicated grief includes unbearable recurrent pangs of painful emotions, an intense yearning and searching for the deceased, and obsessive thoughts of the loved one. The intensity of grief symptoms is heightened and prolonged compared to people who adapt to the loss.

What happens in the brain?
During the experience of grief a distributed network is activated in the brain, involving brain areas associated with affective processing, mentalizing, (emotional) episodic memory, visual imagery, autonomic regulation, and processing of familiar faces (Gündel et al., 2003). Research has also shown that even many years after the bereavement, a picture can evoke yearning for the time when the bereaved person and his or her loved one were together. Both in people who suffer from complicated grief and in those who have successfully adapted to the loss, viewing a picture can evoke pain. The feeling of grief-related pain is associated with activation of the pain-related neural network (Anterior Cingulate Cortex, Insula, and periaqueductal gray). Interestingly, unlike people who have successfully adapted to the loss, in those who suffer from complicated grief the reward network activates when presented with grief-related stimuli (O’Connor et al., 2007). This has been interpreted as an indication that reminders of the deceased remain rewarding for those who suffer from complicated grief; such reminders may even evoke a kind of addictive feeling, or craving, which makes it more difficult to adapt to the loss (O’Connor et al., 2007).

“You say it best when you say nothing at all”
Your presence is the most important form of support you can give someone who is bereaved. Words aren’t necessary, or as Ronan Keating’s debut single put it: “You say it best when you say nothing at all” (a song not related to grief). Well-intended words such as “he is with the angels now”, or “he had a good life” have little meaning for the bereaved. On the other hand, talking about the deceased and bringing up good memories tends to be appreciated a lot. Especially weeks, months, or even years after the loved one’s death.

Many questions remain unanswered. In my own case, one thing is sure: the overwhelming surges of grief have been replaced with manageable moments of grief that may pop up when, for instance, my father’s favorite song is played on the radio. My experience of grief has changed me as a person and brought me even closer to my family than before.