Grief doesn’t look the same for everyone; here’s what to know
Illustration by Kyla Manzutto.
Note: This interview was originally published in Doing Well, a health news outlet from ASU Media Enterprise and ASU Learning Enterprise. Subscribe to Doing Well to get interviews with health experts delivered to your inbox weekly.
Right now, many of us are experiencing some form of grief. Maybe it’s a profound loss — a family member, a pet, a job you loved, or a relationship. Or maybe it’s the heavy grief that comes from an anticipated loss or otherwise complex experiences — seeing your parents’ health decline, struggling to conceive, being diagnosed with a progressive health condition, or caring for a friend in hospice. Experiencing grief is very common, but it’s never straightforward.
In the below Q&A, Hannah Farfour, a clinical assistant professor at Arizona State University's Edson College of Nursing and Health Innovation and palliative care nurse practitioner, sheds light on the different ways we experience grief and how we can support grieving loved ones.
Note: This conversation has been edited for length and clarity.
Question: What are the different types of grief?
Short on time? Here’s what to know:
- Grief is incredibly complex and can start before a loss actually occurs. This is called anticipatory grief and can happen, for example, when someone or their loved one is diagnosed with a serious illness.
- There are many emotions involved in grief. Grief can show up differently for each person — as anger, guilt, irritability, anxiety, decreased or increased appetite, or even physical pain. It often comes in waves over time, rather than following a neat timeline.
- Instead of disappearing, grief tends to become part of you. Over time, people usually build the ability to manage it, but it can still resurface unexpectedly.
- Social isolation, loss of daily functioning, or a lack of support systems are red flags that may indicate more help is needed to manage grief.
- The most helpful support you can offer a grieving person is nonjudgmental presence, even if you don’t know the perfect thing to say. Avoiding a grieving person is often more hurtful than showing up imperfectly. Sometimes the most helpful thing you can say is simply "I’m really sorry. This sucks. I’m here with you."
Answer: Often, diagnosis with a serious illness comes with something called anticipatory grief, meaning that life as this individual knows it (will never be) the same. That can look and feel differently depending on what that diagnosis is and how it may impact their life.
Anticipatory grief can show up in ways such as this existential component of realizing that maybe death is closer than any of us would’ve hoped for. There are episodes where we’re grieving the fact we can no longer do the things we once were able to do, or we have lost our independence or the ability to work or engage in life in the ways that were meaningful for us prior to this diagnosis. For each of us it looks different. Often I see that anticipatory grief can be present with the individual with a diagnosis, but also their friends and family members. And often it is unnamed by the medical teams. Anticipatory grief is incredibly complex, under-recognized, and very commonplace within the realm of serious illness.
Q: How does that differ from grief after a big loss?
A: The grief after a big loss is almost more palpable. Many times we’re able to name the reason we are grieving because we’ve lost someone we have cared for, and we may carry that with us. In many ways, that’s the normalized form of grief. You can name the why. There’s not one emotion that manifests itself in grief — it's a lot of emotions. We know what disenfranchised grief and complicated grief look like. I often tell my patients and those I care for that grief becomes a part of you. You just grow around it and it will never disappear or go away. It can always come up in waves. Over time you develop the ability to navigate through the grief without it taking over.
Q: Since grief is really complex, how does somebody know if they’re experiencing it?
A: I often may see it in my patients or family members where they’re angry and they’re not able to name it. I encourage them to be curious about the why. Why are we feeling these certain emotions?
It can show up as increased pain. And often we find that it’s not very well treated with medications or other interventions. Existential pain often can be a form of grief.
Q: What does healthy grieving look like, especially when the experience is ongoing?
A: For each person, it looks different. Grief can come in waves. We often see it lasting for weeks to months where it’s difficult for them to engage in their life and world. Inevitably, they turn to some of the other coping mechanisms that have worked in the past for them — engaging in support groups or with friends or family. Each day is going to look and feel a little bit different.
Where we start getting concerned is when an individual (is) alone. They’re not engaging in their day-to-day activities to maintain both their physical and mental health. And they don’t seem to have peer support or religious (or) spiritual support. Complicated grief can be very common, especially if the loss was traumatic and there wasn’t support from a mental health professional or spiritual (leader) or someone who is skilled at having these conversations after that death.
Q: Are there ways that grief impacts us physically?
A: Grief can increase pain; it can affect our appetite, our immune system, our sleep. It truly can play a powerful role in how we’re doing and feeling each and every day, and that’s incredibly important to acknowledge.
Often in medicine, especially in my specialty with adult gerontology, we’ll find that if there’s been a couple that have been married for a very long time, and they may be older, say that the wife dies — we often know that the partner (can) die within months to a year, because of the physical burden of grief. That’s not uncommon. So having an awareness of the impact of all of these emotions on your physical well-being is crucial, because knowing that allows you to be more intentional in self-care.
I often reframe it as caring for yourself as if that loved one was still here and as they would want you to care for yourself. Sometimes that takes that burden off of that individual, and they’re seeing it as a way to honor that loss and help gain a sense of meaning and purpose. That is incredibly crucial to giving us resilience and strength despite all the things that may happen to us.
Q: How might we support someone who is grieving? It can be hard to know what to do.
A: Sometimes silence and presence is the best gift. Your job is not necessarily to fix that grief, but being that soft landing pad or safe space where someone can say, "I’m feeling angry that this has happened to me, or I’m mad I have to do all of these tasks every day ... but I feel really guilty that I’m feeling mad," or whatever the emotion may be. Being that presence that doesn’t ask anything of the individuals experiencing the grief is a true gift.
Sometimes we get caught up in the right words to say and then we actually become avoidant. Because if you don’t know what to say, then you don’t want to say something wrong, and it’s just easier to disengage. Truly, I think that’s the most hurtful thing to do. Sometimes what we say can not land right. But if our intentions are there and we’re not just there trying to fix, I think they’re able to look past that. What they don’t look past is feeling like they’re abandoned or brushed to the side when they’re grieving. So holding space, holding presence (and) knowing that you can’t fix (it).
I also find ways to try to figure out something they may be looking for and having that meaning and purpose. Trying to reframe a conversation when the timing is right — and that becomes (an) art form: "Hey, you know, I’m missing this person today too. How about we go out and have their favorite food together?" Sharing that space I think is a huge gift.
Q: Yes, I think many people can relate — you don’t want to say the wrong thing. You get paralyzed by what exactly to say. So then you just delete the text message, you don’t call and you’re like, "Actually, I’m just going to avoid this because I don’t know how to be perfect here."
A: I do think there are some things to not say — don’t give false reassurance: "You’re going to be okay. You’re going to get through this." Sometimes the things I say (are) like, "This sucks, I’m so sorry. I wish there was a way I could make it a little bit better."
In our world in palliative medicine, we say the phrases like, "I wish, I worry, I hope." Sometimes I say things like, "Man, I wish I could make this a little bit easier. I wonder if we could maybe just have a coffee and share space." Something like that may land a bit differently. You can certainly Google phrases not to say and try to avoid those as well. Trying to undermine that emotion or make it about you is the wrong thing.