Normal grief is intense, comes in waves and gradually loosens its hold in its own time, while prolonged or complicated grief is a persistent, disabling longing and preoccupation that stays at full strength long after most people’s has eased. Diagnostic manuals do not call grief prolonged until many months have passed, so in the early period severe distress is expected and should be supported, not pathologised.
The distinction between normal and complicated grief separates the wide range of ordinary mourning from the smaller group of people who become stuck.
Normal Grief Covers A Very Wide Range
Ordinary grief includes crying or not crying, anger, guilt, numbness, sleep and appetite changes, yearning, sudden waves set off by reminders, a sense of the dead person’s presence, and difficulty concentrating. It can be intense and disabling for weeks. The central feature is that over time the waves become less frequent or less overwhelming and the person can return to some life, though the loss remains. Research on bereaved people (associated with George Bonanno and colleagues; from recollection) finds that the most common long-term pattern is resilience, with distress that is moderate or fades, and a minority show prolonged difficulty. Do not assume that a person who is not showing intense grief is hiding it, or that someone who weeps a great deal is in trouble.
What Prolonged Grief Looks Like
Diagnostic systems have recently added “prolonged grief disorder.” The descriptions, as I recall them from the ICD-11 and the DSM-5-TR, centre on:
- Intense longing for, or preoccupation with, the dead person
- Plus symptoms such as identity disruption, disbelief, avoidance of reminders, intense emotional pain, numbness, feeling life is meaningless, loneliness, and difficulty re-engaging with life
- Persisting beyond what the person’s culture expects, and causing serious impairment
- Not diagnosed until at least six months after the loss under one system and twelve months for adults under the other (stated from recollection; check the manuals if a precise rule is needed)
These are descriptions for clinicians. In a collapse, a community should use them for orientation, not to label anyone, and should remember that cultural expectations of mourning vary.
In A Collapse, Most Risk Factors Are Present
Studies find that grief is more likely to become prolonged after sudden or violent deaths, deaths of children, deaths that could have been prevented or that involve the survivor’s guilt, loss of several people, ambiguous loss, and where social support is poor. A collapse supplies many of these at once. High levels of distress in many people are therefore expected, and a community should assume a lot of continued need, not a few “problem cases”.
Signs That More Is Needed
- Grief that is not easing at all over a long period, with the person unable to function
- Persistent self-blame or a belief they should have died
- Refusing to speak of the dead or refusing to accept the death at all
- Withdrawal from all people
- Heavy use of alcohol or other drugs
- Any talk of wanting to die; see When Grief Becomes Dangerous
What Helps
- Sustained practical and social support, continuing past the first weeks; see Practical Support Framework.
- Routine and purposeful work, at the person’s pace.
- Chances to talk about the dead person and to hear others do so.
- Rites and memorials; see Remembrance Ceremonies.
- Specialised treatment where it exists. Therapies for prolonged grief exist and require a trained clinician.
Studies of routine grief counselling given to all bereaved people have not found it useful for those with uncomplicated grief, with benefit more likely for those with high distress or complicated grief (a conclusion associated with Robert Neimeyer; from recollection). This supports giving everyone ordinary support and focusing extra attention on those who are struggling, and argues against compulsory sessions.
Common Mistakes
- Using the stages model as a standard. It is not supported; see Grief in Survival Context.
- Setting a deadline. There is no reliable one; the manuals’ months are for diagnosis, not for ending mourning.
- Calling a person “stuck” because they speak of the dead.
- Overlooking physical illness. Poor sleep and appetite have causes besides grief.
What’s Next
- Learn next: Delayed Grief & Grief Debt — grief that seems absent, then arrives
- Combine with: Supporting the Grieving — what ordinary support looks like