Chapter 7 Linda Gask1 and Carolyn Chew-Graham2 1 University of Manchester, Manchester, UK 2 Research Institute, Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, UK Grief is a universal human experience following the loss of someone or something that is important to a person. It is sometimes confused with depression but may coexist with it. In discussing depression and anxiety, we need to clarify exactly what grief is and how and when it should be treated. Different terms are used, in everyday life as well as in the literature, to describe the experiences and tasks involved. We find the following definitions useful: We never ‘get over’ the death of a person who meant a great deal to us, but we learn how to live with the reality of it. Our relationships with people around us help to give our lives meaning, and are a source of support and pleasure. Acute grief is extremely distressing and a time of intense and painful feelings. At first there may be a sense of disbelief and shock but this is followed by a range of different emotions (see Box 7.1). The acute period of grief can be difficult to distinguish from depression (see below). Over time, the intensity of the emotion begins to lessen. What is important to remember is that there is no universal rule about which ‘stages’ of grief the person will pass through and in what order. Five stages were famously described by Elisabeth Kübler-Ross: denial, anger, bargaining, depression and acceptance – but not everyone experiences these, and they were actually observed in people who were coming to terms with their own impending death (another form of loss), rather than the death of another. There is also no rule about how long it takes to pass through the acute stage of grief, certainly not the rule of ‘3 months’ often cited in healthcare settings. The DSM-5 criteria allow for a diagnosis of depression just 2 weeks after a bereavement, and have been widely criticised as being over-simplistic and leading to the over-medicalising of a normal response to loss. Practitioners should appreciate key is the trajectory is towards lessening of the intensity of the grief as the weeks and months pass, and with time, a gradual moving towards re-engagement with what is going on in everyday life. Positive memories of the deceased can be recalled, and new memories can be incorporated into how we remember them. Jess (see Box 7.2) is experiencing many of the features of acute grief following the death of her mother. She is able to gain some benefit from talking with her boyfriend about how she is feeling, but she also goes to see her GP.
Bereavement and Grief
Understanding bereavement, grief and mourning
What happens when someone grieves?
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