Grief is deeply personal and individual. It isn’t one emotion but a process that can be complex and unpredictable. Although we hear about the stages of grief, we don’t all grieve in a uniform way. We may feel many emotions at once, or sometimes just numb. We can feel “stuck.”

Feelings of anger, disconnection, and sadness are part of the classic stages of grief. However, the way we experience grief is not always in this tidy order. Sometimes more than one stage may occur at the same time. Feelings of sadness can co-exist with guilt or anger. Some people may skip stages but experience another with another for a long time. There are situations where it might seem like grief is bypassed altogether. Often, it is a long process that takes time.

Grief can come early. When we know that someone we love has a terminal illness, we may begin the grieving process even if they are still with us for months or years. When we have an unexpected loss, grief can start suddenly or be delayed. None are easy. Whether our loss is a loved one or a beloved pet, or the loss of a valued relationship, it can feel like we have lost a part of ourselves. We grieve for what was and what won’t be.

Recognizing the limits of our control in life, no matter how much we care for someone, can be paralyzing. Feelings of helplessness can come with seeing someone we care about struggle with addiction or chronic illness. An unexpected death can shake our sense of predictability in life and leave us struggling with existential uncertainty. We may have to face anxieties about our mortality in ways we never had before. These difficulties can also help us assess our values, purpose, and meaning in life. When grief becomes healing, it can provide in-roads to being present and fully engaged in our own life. However, those challenges can become overwhelming and are never easy. The grief process may become complicated or sometimes stalled.

If we have carried conflicting emotions about the one we lost, grief can become complicated or derailed. This is not unusual when there was childhood abuse from a parent or a long history of problematic behavior from a friend or relative. There can be feelings of guilt or remorse for the lack of emotion when someone passes. Anger may arise at the lack of resolution or a healthy relationship that was denied. When the one that was lost brought both love and pain, there can also be intense, overwhelming feelings of sadness and anger when they are no longer present. It can be very valuable to have someone to support us in sorting out the layers of complex emotions. We may also need support to give ourselves permission to see that person as a complex human, flaws and all.

For a few patients, the grief process can feel like it becomes “stuck” and doesn’t seem to improve over many months. Prolonged grief disorder is a form of grief that persists unabated a year after a loss. These patients experience intense longing and may feel like they “no longer know who they are” after the loss. The intensity remains significant and can interfere with daily activities and quality of life. Prolonged grief disorder is diagnosed by a professional and can benefit from skilled intervention.

There are reasons and situations where seeking help for grief is critical. For some people, grief can interfere with performing day-to-day activities. This can include things like eating, bathing, and managing finances. Professional help is needed if this is severe enough or lasts long enough to negatively impact health, safety, or the ability to live independently. Grief can co-exist with conditions such as Major Depressive Disorder, anxiety disorders, alcohol or other substance use disorders, Bipolar Disorder, and PTSD. Suicidal thoughts should always be taken seriously and should be discussed with a professional such as a doctor, therapist, local crisis services, or emergency service (911). If you feel you need to talk with someone right away, the National Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255.

It is natural that we grieve, but we don’t have to go through it alone.