By Kenneth J. Doka, Ph.D.

When their 15-year-old died in a hiking accident, the mother, Maureen, cried constantly. Maureen’s husband, Angelo, became very active in advocating for a safety rail on the trail where their daughter fell to her death.

Bonnie was very close to her mother, caring for her throughout the five months that she received hospice services. In the immediate aftermath of the death, Bonnie took care of all the details: arranging the funeral, sending out thank-you notes for flowers and attending to other memorials. She also dealt with insurance, Social Security, the will and other details. Now, six months later, Bonnie wonders why she seems to be doing worse than at the time of death.

These cases remind us that grief is a highly individual reaction. Some of us may have profoundly debilitating reactions to a loss, while others may have more muted or resilient reactions. Some reactions, such as sadness and tears, may clearly be identified as part of the grief over our loss. Others, such as an inability to concentrate, irritability or even physical reactions may be less identifiable as an aspect of our grief.

The truth is that loss can affect every dimension of our being so that the grief that results can express itself in our emotions, behaviors and thought processes. Grief can also manifest itself physically and spiritually. Some of these effects may go unnoticed or unattributed to our grief, causing concern and confusion.

Grief can be bad for our health

Physical manifestations of grief like Josephina experienced are common. Such physical reactions can include (but are not limited to) headaches, muscular aches, menstrual irregularities, fatigue, chest pains, tightness in the throat or chest, abdominal pains, shortness of breath, weakness and oversensitivity to stimuli.

While physical reactions are common in grief, they should never be ignored. Any persistent physical symptom should be checked out by a physician—one who understands that we are experiencing a loss and knows that grief has physical manifestations. The reason for this is simple: Grief can be dangerous to our health!

Years ago, Dr. Colin Murray Parkes spoke of “broken heart syndrome” in describing the increased mortality among surviving spouses. There are a number of reasons for this increased mortality and morbidity in older surviving spouses. First, many older individuals die of chronic diseases, and these diseases often are related to lifestyle factors such as diet or other habits, often shared within a marriage. For example, if one spouse smoked, the other spouse lived—at the very least—with secondhand smoke.

Second, grief is stressful. We know that stress negatively affects health, especially among individuals already experiencing the frailties inherent in aging. Finally, when a spouse dies, lifestyle practices such as diet, sleep, exercise or adherence to a medical regimen may also change, often not for the better. The wife who once made three nutritious meals each day for her husband may be eating erratically out of cans after his death.

Understanding these dangers can allow us to assess how grief may be affecting our own health and can also educate our loved ones about how to better understand and recognize these signs and symptoms. It also reminds us of the importance of self-care as we struggle with our losses. Are we experiencing any persistent physical symptoms or changes in our health? If so, they should not be ignored. Naturally, conditions that might accompany our grief, such as depression and anxiety, should be assessed and treated.

We can be proactive in our health, asking ourselves questions about what we are doing to maintain our health in a stressful time. Are we eating regularly? Have there been significant changes in our sleep patterns? Are we exercising? Are we taking medications as directed? This is especially true if our health is already challenged by chronic conditions or advanced age.

The emotions of grief and sadness, yearning and loneliness

When we think of grief, we often identify emotions such as sadness, yearning and loneliness. Indeed, these emotions are often part of the grieving experience. While these certainly are common reactions to loss, it is also important to remember that the emotions inherent in grief are far more varied. We may experience guilt or anger, relief or even fear of further loss. The emotions themselves can be challenging and complex, creating a sense of shame and isolation that can complicate our grief.

When someone experiences loss, it is natural to harbor a deep sense of sadness. We yearn for the person we loved to come back to us or for things to return to the sense of normalcy that we once felt. We may find an incredible sense of loneliness. We can deeply miss the person.

That is the heart of grief: the absence of a presence we once felt dear. While loneliness and sadness are certainly part of the emotions we may experience with grief, we can do things to help ourselves as we encounter those feelings. I once suggested to a support group of surviving spouses that they identify the times they experienced these feelings most.

One surviving spouse indicated that Friday nights were the toughest for her. She and her husband had busy, independent lives. Friday night, though, was their night. They would always meet at a local pizzeria, enjoying dinner and a glass of wine while reviewing their day. At the end of the meeting, another surviving spouse approached her and indicated that Friday nights were difficult for her as well. They decided to go out for dinner together. In the beginning, as they shared, they were lonely together. Over time, they both began to look forward to this night out, this time together.

The point is that while we have little say in how we feel and how we will experience grief, we do retain choices about how we will deal with those feelings. Even in grief, we are not without resources or devoid of any power. In acknowledging our grief and in recognizing that our emotions are normal and natural responses to our loss, we can begin to cope with the feelings we are experiencing.

Navigating guilt

While we expect to experience such emotions as sadness, yearning and loneliness, other emotions may surprise us. One of the most common—and corrosive—is guilt. It eats us up from the inside, creating pain and troubling memories.

Guilt can come in many different forms.

We may encounter role guilt—feeling we could have been a better parent, sibling or child. In moral guilt, we look at the loss as a cosmic punishment for something we have done. When I worked at Memorial Sloan-Kettering Cancer Center, parents frequently repeated the verse “the sins of the fathers will be visited on their children.” They confessed all sorts of sins: infidelity, misdemeanors and felonies of their youth and even poor attendance at their place of worship. They thought, however unfounded, their own acts might be responsible for their child’s cancer.

We may suffer survivor guilt, wondering why we are alive when someone else died. I have found this to be a very common reaction of siblings when another sibling dies. Often, the child who died can be idealized as the perfect child. The surviving siblings can easily believe it was them, the less-than-perfect children, who should have died. This can also be seen in older people when someone younger dies. Here, the older person may think they should have died instead.

Grief guilt means we feel guilty about doing so poorly with our loss. We feel ashamed at how poorly we seem to cope. Conversely, in recovery guilt, we think we are doing too well. We can experience both of those emotions.

While guilt is a common reaction in grief, it can be crippling. Once we identify our guilt, we can examine it. What is the source of the guilt? So many times, one may hold unrealistic expectations of what can be controlled or what can be accomplished. In fact, there are many things that cannot be controlled. We can ask ourselves: “Given the circumstances, what could we have done differently? How can I learn or even grow from the experience?”

Sometimes, we can gain perspective on our guilt by simply reflecting on the question, “Would others find me guilty?” Additionally, there are other ways to deal with our guilt, such as writing a letter to the deceased or creating a ritual to ask for or to grant forgiveness to the person who died. Sometimes, our faith system may have rituals or beliefs that help us cope with guilt. Many belief systems have rituals such as confession that allow us to confess and absolve our grief.

How dare you die! — anger in grief

Anger, too, is a common and sometimes confusing reaction. We expect the sadness, but we may be surprised by the anger. Perhaps we should not be so surprised. Anger is one of the many emotions we encounter in grief. The root of the actual term “bereaved” means to have something yanked out or taken away from you forcibly. It would probably be best translated by the ’70s expression, “ripped off.” It is little wonder that anger and rage are familiar responses to having someone we love and care about ripped away from us.

Sometimes, that anger is directed at a given person we hold responsible for the pain. For example, the anger may focus on a nurse or physician, perhaps a clergy person or friend who we feel was not as attentive, sensitive or supportive as we had hoped or expected. We may even be angry with the person who died, blaming that individual for not taking proper care of themselves, for dying or for leaving us alone in our grief.

At other times, the anger is cosmic. We become angry with God, a higher power or the world. We may find that our anger does not have a specific target. We are filled with a sense of rage and simply lash out at anyone in our way. Often, it is the individuals who are closest to us who feel the sting of our anger. They become safe and convenient targets of our wrath.

The problem with our anger is not that it is a natural and understandable part of the grief journey. The problem is that it can isolate us at a time when we most need support. It can drive away the very people we need most.

So how should we deal with anger? The first thing to do is to explore it. When do we get angry? What seems to trigger it? Is our anger proportionate to the cause? How is it expressed? What does it do to others?

If we find that we do have legitimate cause for our anger, we can consider how to channel that emotion in constructive ways. For example, mothers angry at lax laws and ineffective enforcement that allowed convicted drunk drivers to repeat offenses with little more than a slap on the wrist formed Mothers Against Drunk Driving, or MADD. Over the years, MADD directed that rage into changing not only our laws but also our society’s perspective on driving while impaired.

Many times, though, we may find that our anger is not really focused on any responsible person or legal inequity or injustice. As we explore our anger, we will often realize that most times we are not angry at an individual. We are angry at our own grief, loss and isolation.

Here, too, we have to consider how to channel that anger. Sometimes, physical exercise can help us cope with our anger. We may need to write a letter (perhaps unsent), talk about our feelings, punch a pillow or scream on an empty beach. Even fantasies can be an effective way to cope with anger. Irene, for example, would imagine what she would tell her husband when she met him in a future afterlife. “He will first have to hear what his death did to me. How I wished he had watched his own health better.”

Other emotional responses to losing a loved one

Anxiety and fear can also accompany us on our journey with grief. After traumatic, unexpected or sudden deaths, the world may seem dangerous and unsafe. Even after a death from a long illness, it can be frightening now to face the world alone. As with other emotions, fear can be debilitating. It can keep us from participating fully in life. We may be afraid to go out alone or engage in activities we once enjoyed. Even more dangerous is when our fears affect others.

Relief, too, is both a common and, perhaps, complex reaction to a loss. We can be relieved because that person’s pain and suffering are now over. It is difficult to watch someone we love die—to see them lose strength and weight, to watch them slowly give up the things that once held great importance. It is natural that we are relieved when that person finally dies.

It also is natural that we are relieved for ourselves. Every illness is a family illness. We all are affected. When someone in our immediate family is dying, our lives change as well. We have added responsibilities and stress. We are often in emotional turmoil. Our sleep may be interrupted. When death finally occurs, it is not selfish or wrong to feel that our suffering is now over. It is natural, and it is human.

There may be other reasons for relief as well. Not every relationship is healthy. Some individuals can seek to dominate and control others. Their caustic comments can wound. In such cases, it is not unusual that when such a person dies there may be a sense of relief that this unhealthy relationship is now over.

Here, relief is a feeling of emancipation—that we are finally free of a burdensome relationship. For example, there is research on “blooming surviving spouses.” These are surviving spouses who experience a great deal of growth, develop new skills and find fresh sources of interest. Many of these surviving partners came from relationships that they found highly constraining.

Some of the emotions we experience as we grieve may even be positive. We may have a deep sense of thankfulness that we shared our life together. We may feel proud that we held up so well or took such good care of the person as they were dying. “I do not know what is wrong with me,” Marge mused. “When my mother died, I thought I would feel this intense grief. I would even think I might feel relief that my mother’s struggle has ended, as well as my own. Instead, I feel a strong sense of pride. When will I grieve?”

Marge’s pride was understandable. For five years, she had been the sole caregiver as her mother developed Alzheimer’s disease and then cancer. Marge accomplished more than she ever thought possible. She was able to take charge: arranging respite, addressing her mother’s needs and providing exceptional care. She became active in a local support group, even going to training and becoming a facilitator. In the course of these five years, she discovered new strengths as she developed new skills. She never flagged in her commitment to her mom.

We often make Marge’s mistake. We identify our grief only as powerful and sorrowful emotions such as sadness, anger, loneliness or guilt. If we are not feeling bad, we think we are not grieving. Some emotions may surprise us. Not all of them may be painful. Like Marge, we may have a sense of pride in the relationship or what we accomplished in the circumstances. We may experience a deep and abiding sense of love and appreciation for the gift of our time together.

These positive feelings can certainly be mixed with all the complicated and sorrowful reactions that are part of the journey and process of grief. The sense of pride and love can be interspersed with feelings of abandonment and anger. Each of us experiences grief in our own unique and individual way. Not everyone experiences such strong emotions. Some of us feel in vivid colors, others in pastels. This is part of the individuality of grief.

Yet it is critical that we understand grief for what it is: a reaction to a loss. In addition, it is important that we see these emotions as a part of the journey. These positive feelings are not a betrayal of grief but part of the grieving process. They offer promise that the memories and relationship that existed will persist even as the pain of grief diminishes.

These emotions, like other types of reactions, are responses to loss that do not fit in any neat sequence. We are a hive of affect and other reactions as we grieve. One of the things we need to do as we grieve is to acknowledge and accept the range of emotions we experience. Our feelings are what they are. We cannot control our feelings, but we can make efforts to manage them in constructive ways by acknowledging that they are part of our journey with grief.

The ways we think

Grief also influences the ways we think. When we first experience a loss, we may still feel a sense of shock. Even if someone dies after a lengthy illness, we may still not expect the death to occur at this particular time. Our initial reaction, then, can be one of disbelief. We feel we are in a nightmare waiting to awaken. Every time the doorbell or phone rings, we half expect it will be that person, assuring us it was all a terrible mistake or unfortunate joke.

We also may find it hard to concentrate or focus as we grieve. It becomes very difficult to order our thoughts. We may seem confused, constantly asking the same questions of others, even while forgetting prior answers. We may go into a room looking for something, and then when we get there, forgetting why we entered. Because of the ways grief impairs our ability to think, it is not unusual for work or school to be affected. We simply cannot think or concentrate in the same ways we did prior to the loss.

We can have a sense of depersonalization—that nothing seems real, that we are simply going through the motions. We may become preoccupied with our losses and obsessively think about the person who died—wondering if we had gone to a doctor sooner or did another treatment, would they have died. We may have intrusive memories that come at all sorts of moments in our lives. We can easily fall into a pattern of rumination where we constantly review how bad we feel or become obsessed with the circumstances of the death.

We may idealize the person who died, placing that person on a pedestal that makes all others pale before them. In many ways, our society supports that idealization by constant reminders to only focus on the good. Nevertheless, there are problems with idealizing the person who died. First, idealization distorts our real memories of the individual—a living being who had good qualities and some that were not so good. This impairs the grief process. For in grief, we have to come to terms with our real loss. This means really dealing with both what we like about the person we lost as well as what we did not like, what we miss and what we do not miss.

Idealization can impair that process because we actually fail to confront our loss. Sometimes, we can even demonize the person we lost—for example, an abusive parent or spouse. Yet even here, part of dealing with our loss is acknowledging the positive moments and qualities even if they are submerged by so many negative ones. Finally, idealization complicates life for survivors who now have to compete with a deceased but seemingly perfect person.

Extraordinary experiences

We may even experience unusual cognitive reactions—what may be called extraordinary experiences. These can come in many ways. We may have a sense of the deceased person’s presence. For others, it may be an occurrence where they seem to smell, hear, see or feel the touch of someone who died. We also can dream of the deceased.

One young boy told me that after his grandma died, she was still alive in his dreams. Sometimes, dreams can be very straightforward, such as this boy’s dream. In that dream, Grandma was alive and visiting as she often did. Other dreams can be less clear, more troubling and full of symbolism. One woman, for example, recounted a dream where she was traveling on a plane with her mother. Her mother left her seat to use the facilities but never returned. Worried, the woman asked the flight attendants to check the bathrooms. The bathrooms were empty; there was no sign of her mother. Her mother’s sudden death had been a mysterious disappearance to this woman.

Sometimes, the experience is symbolic. For Maria, the sight of butterflies is a visible connection to her sister. “They seem to come at moments when I need or miss her the most.” For others, it is a third-party experience—someone else says or does something that seems like a message from the deceased.

Most of these experiences are comforting and reaffirm a sense of connection. They are also relatively common. Research suggests that almost 60% of people report one or more of these experiences. However, they are little known and occur unexpectedly. So there is often a paradox. Most bereaved individuals find such experiences comforting, yet they are afraid to discuss them, fearing the reactions of others. If the experience is disturbing, it might be well to discuss such experiences with a grief counselor.

A loss of spirit

“Where is God when you really need him—a door slammed in your face?” These dispirited words were written by no other than author C.S. Lewis. Lewis himself was a deeply religious man. Much of his writing reflects his abiding faith. Yet when his beloved wife was dying, even Lewis felt abandoned.

Lewis’ comment reminds us that there may be spiritual manifestations of our grief. While some of us may find great solace in our beliefs, others may be torn by faith struggles and beset by doubts. We can find it difficult to believe in a kind and benevolent world or a merciful deity. We may be angry at the cosmos, or fearful, wondering if this loss was a punishment or a message. Our beliefs seem to be another loss, a casualty of our grief.

We do not have to believe in a God to struggle spiritually with grief. Even if we are not religious or part of a faith community, we may still experience a sense that our beliefs in the world or humanity are challenged by our loss.

One of the biggest mistakes we can make during this period is to isolate ourselves from our beliefs. We should maintain our own spiritual discipline, whatever that is. We need instead to share our struggles within our faith community. This is a time to identify those within our faith communities or our friends who can journey with us, who are comfortable in hearing our struggles and sharing their own. Sometimes, we may have to search to find those people. Finally, it may help to read about others’ struggles. Lewis writes about his struggles in A Grief Observed; Rabbi Kushner explores grief in When Bad Things Happen to Good People.

The ways we behave

Grief affects how we behave. We associate some of our behaviors, such as crying, with grief. For some, grief may encourage us to some sort of activity—perhaps aimed at creating some memorial or hoping to avoid future tragedies. Some of us may grieve by immersing ourselves in a maze of activity—hoping to fill our time or perhaps seeking to bury our pain. Others of us may wish to withdraw. We feel we go through the motions of daily living but have little energy left for anything else. When we come home, we just want to be alone with our grief.

Both withdrawal and overactivity are understandable reactions to loss. Both are problematic. We need time alone to process our grief. However, we also need time with others—for respite, support and to share our grief and memories. The answer is to balance time alone and time with others.

Our ways of dealing with our grief may also be different, perhaps creating conflict. For example, some grieving individuals will avoid reminders of their loss, while others will seek those reminders out. One person may want the home full of photos, while another wants to put all these painful photographs away.

We may even wonder if we are doing too well. There are individuals who seem resilient even when facing a significant loss. Often, resilient grievers have fewer losses or other stresses in their lives. Generally, the death was not sudden, so there was a chance to say goodbye. Resilient grievers also tend to have an intrinsic spirituality, good psychological health and an optimistic mindset that respond to challenges with a belief that even in the worst things, they could learn and grow.

‘I am not the person I used to be’

Grief changes us. Some of this is just the way that a loss affects our behavior. Our grief can impair our relationships with others—creating conflicts with partners or family. Our once-characteristic ways of behaving can change as well. Sometimes, this is a temporary thing, as we journey with our grief. Other changes may be more lasting. We may have had to learn new skills or gain new insights as we journey with our grief. We may have had to adapt, taking on new responsibilities, roles or behaviors, as we tried to close the void filled by a death.

The personal pathways of grief

Each of us experiences grief in our own way. After all, we are unique persons with our own temperaments and experiences. Every loss we experience impacts our past, changes our present and alters a previously anticipated future. The effect of each loss is different and so is our grief. For example, our grief will be different if we lose a grandparent who was a critical influence in our life compared to one where the relationship was more distant and remote. The more we invested in the person, the more we loved that individual, the more dependent we were on that individual, the more intense our grief will likely be.

There are two other elements to attachment: ambivalence and conflict. Every close relationship has some degree of ambivalence. We love the person, but things about the person can still drive us crazy. Sometimes, the ambivalence can be intense. There are even relationships where “we can’t live with them, can’t live without them.” My aunt had that relationship with her husband. They were on again, off again. Their married life was punctuated by separations and reconciliations. In these situations, grief can be intensified by the anger and guilt inherent in such relationships.

The way a death occurred also influences our grief. In reality, there are a number of questions to consider before we can really understand the ways that the circumstances of the loss may influence our grief. One question, was the death sudden or expected, is sometimes a difficult question to answer. It is said that most people today die suddenly—even after a chronic illness. In other situations, even a death that seems sudden may not be perceived that way.

Ann’s son Paul died after a drug overdose. Paul had struggled with addiction for a long time, going in and out of recovery. As she recounted the visit of a policeman to her house to tell her that Paul had been found dead, she stated that she expected that one day this would happen. Nor is one situation necessarily easier or more difficult. They are just different.

The sudden loss of someone might surprise and shock us. It may leave us with a deep sense of unfinished business—a feeling that we left something unsaid that should have been said, something undone that we had wished to do, or regrets over something we had said or done.

Did the loss occur in isolation or a part of a chain of losses? It is difficult to grieve one loss. It is far more complex to deal with multiple losses. Sometimes, these losses can happen in a serial fashion—one after another in close succession. This often happens as we age. Over a short period, we may find ourselves dealing with the deaths of a spouse, siblings and dear friends. As one older woman told me, “Whenever I think it is beginning to get a little better, someone else dies—first my sister, then my husband, now my best friend.” At other times, multiple losses can happen all at once. For John, it was when his wife and daughter were both killed in a car crash.

Who we are naturally affects the way we grieve. Most importantly, if we had any prior mental health issues such as severe anxiety or depressive episodes, we may be especially vulnerable as grief can trigger relapses.

Our genetics and socialization experiences influence how we respond to crises. For example, one coping style focuses on emotion-based approaches. Intuitive grievers respond to loss with intense emotional reactions. Their way of adapting to grief involves the processes of these emotions. They need to examine, analyze and act upon their emotions. These are “heart” grievers. On the other end of the continuum are “instrumental” grievers. Here, emotional reactions are more muted, responding and adapting to loss involves thinking and doing. These are “head” grievers. These grieving styles can be influenced but are not necessarily related to gender.

Effective coping means we look toward all our resources in grief. These include our internal resources. What were our past coping strengths and weaknesses? What did we do well when we handled losses prior to this one? We can draw on those strengths. What did we do poorly? Perhaps we can develop strategies to avoid those pitfalls.

A number of years ago, I was asked to see an undergraduate student who had just returned to campus after his father’s funeral. We talked about his prior strengths. I also asked him if there were past coping strategies that had not worked well. He told me that after his last loss—a breakup with his high school girlfriend—he went on a drinking binge that ended with a DWI. He smiled, somewhat embarrassed, and then proceeded to tell me that I was his last stop before Foley’s, a bar near campus. Instead, he decided to seek the supportive companionship of friends.

As we examine our strengths and weaknesses, we also should examine the legacies we carry from our family history, culture and spirituality. How did our family model grief? In some families, losses are not addressed. We may learn not to trouble the equilibrium of the family—not to upset others—so we keep our feelings and reactions to ourselves in order to grieve privately. We learn not to speak of our loss.

Sometimes, this is related to the cultural background of our family. Some cultures expect and welcome open expressions of grief, while others prefer that inner feelings and reactions remain locked inside. In addition, we need to examine the ways that our beliefs—be they religious, spiritual or humanistic—speak to our loss. How do our beliefs, rituals and faith community facilitate or complicate our loss.

When Matt’s son died by suicide, his fears of his son’s eternal damnation complicated his loss. An empathic minister within his faith tradition helped him struggle with that destructive belief by pointing to a scriptural verse that indicated Sampson’s salvation, even though this Old Testament leader was both self-destructive and died by suicide. In other cases, our beliefs can comfort us and perhaps reassure us that the person is safe in some form of afterlife, relieved of all suffering or that the deceased person has left a legacy to be remembered.

This reminds us of another factor that influences our experience of grief—external support. If there are others that share our grief and support us as we process our reactions, then it will be easier to cope. Those who have support are likely to cope better than those who lack such support. Finally, in society today, there are likely to be other ways to find the support we need in the form of grief counselors or bereavement support groups.

Each of us then will experience grief reactions—reactions like no other individual. Each of our journeys will have a unique and distinctive quality. That is simply because we all are different: the losses we experience are unique, our loss and our relationship to our loss are distinctive, and we cope in different ways.

The process of grief

When we experience a loss, we may expect that we will go through some clear stages until we accept our loss and move on, or we may think that over a certain time—perhaps a year or so—we will be back to our former selves. Yet the truth is that our grief is not that predictable nor does it have a set timetable.

Coping with grief actually involves two distinct processes. First, we have to mourn our loss. Yet, second and simultaneously, we also must learn to live life now in the face of this loss. We may have to learn new skills and begin new experiences. Life is different now.

Successful grievers oscillate or move between mourning and coping. So grieving often has this uneven process—a feeling of constant moving back and forth, good days and bad days that can be unsettling. This moving back and forth in our grief is, in fact, normal and healthful. Focusing only on the past can lead to chronic, never-ending grief, and centering only on the future can delay or inhibit grief.

We can think of grief as a roller coaster—full of ups and downs, highs and lows, good and bad days. But grief may also come in waves—again moving us backward or forward. Some waves we see coming and others will take us by surprise. Some days will seem easy, while others may be more difficult.

Some days simply will be more difficult. Perhaps an event reminds us of our loss or vulnerability. Perhaps we saw someone on television or something on the street that triggered a painful memory. We may not even be conscious of why this day is more difficult than others. Any number of factors can trigger a surge of grief by stimulating memories—smells, songs or photographs. Reading about losses similar to our own, or seeing things like cars or clothes, or sharing in an experience we associate with the person we grieve, can trigger an upsurge of grief.

Life changes, such as retirement or transitional rituals like graduations or weddings, may prompt memories and a sense of grief. Times of personal crises may make us long for the presence of the person we grieve. If we suffered a loss, for example, in the early summer, we may be reminded of it by everything from summer sales to graduations, from warming weather to Fourth of July celebrations. Each day can be a distinct reminder of each moment of loss. We may remember the day the illness took a turn for the worse, the day the individual died and the day of the funeral. We may be troubled that we are feeling worse just at a time we may believe we should be doing better. After all, we think we made it through the year.

The holidays are particularly hard. They are centering moments in our lives, full of memories. We remember the Thanksgiving the oven broke down, the Hanukkah or Christmas gifts we received or gave to the person we miss so badly now, or the Mother’s Day barbecue that was invaded by wasps.

Holidays in November and December can be especially difficult. Television specials and movies celebrate families, reunions and reconciliations that accentuate our loss. Holiday tunes churn our memories. Cards may arrive from businesses or distant acquaintances still addressed to the person who died. As we shop, we may find an ideal gift for someone we grieve.

Winter holidays are full of so many tasks. When grief depletes our energy, this can be worrying. We might feel so out of step with the season, our sadness magnified against the seeming joy of others. In the midst of winter, we may also feel more isolated and alone, the deepening darkness and increasing cold a reflection of our own inner being. The very lack of sunlight may contribute to sadness.

The spring holidays, such as Easter or Passover, as well as events such as weddings and graduations, can bring unexpected plunges in mood. In these centering moments, too, losses are all still keenly felt. Some holidays, like Mother’s Day or Father’s Day, may especially sting if we are dealing with the loss of a parent or child.

That is why it is essential to plan. This does not mean that we need to spend a great deal of time thinking of holiday menus or planning the perfect gift or card. We need to plan how to get through the holidays. The danger is drift. It is easy in the stressful times of the holidays to surrender our decision-making to well-meaning others, such as the sister-in-law who will not take no for an answer. The result is that we can find ourselves drifting into activities that are stressful, tiring, painful or do not meet our needs. The first thing we need to do is to choose. Prioritize. What are the activities we really want to do? What activities do we need to do? What does not need to be done, at least for this year? We might decide that this year we will not send cards or host a large dinner.

For those activities we choose to do, it is critical to find the best way to accomplish them, consistent with our own needs and wants. For example, if we decide that we do wish to give gifts, consider how to do this. Can we simply send a check, shop from the Internet or a catalog, or shop with a friend?

Most important is the critical question: With whom do I wish to spend the holidays? Who can be present with me as I grieve? Who can tolerate and understand that I may not be my usual self? Sometimes, it is a choice not to make a choice. The holidays can be tough and unpredictable.

Toni-Ann understood that. So she decided that she would keep all her options open till that very morning. She would spend some time with her late husband’s family but would wait until that day before committing to a particular schedule. We can create some flexibility and freedom. David decided to take his own car to the party or family gathering so he could leave when he was ready, rather than be obligated to wait for others.

Once we have made our choices, we can communicate those decisions to others. Part of that communication is listening to others, which may add a third c to our holiday plans: compromise. The first Mother’s Day after her mother died, Isabella had little desire to celebrate, but she realized that her children and grandchildren needed to honor her, even more so after the death of their nana.

Rituals can sometimes help. When I was a child, one of our rituals on Mother’s Day and Father’s Day was for my parents to place flowers on the graves of their parents. After that, we would have a family meal—a celebration of our parents. It was an effective model to help us handle our losses, looking backward to what is lost while also still looking forward to the present and future.

There is no single right way to experience the holidays. While for some, the holidays are difficult and stressful, others may welcome the diversion and find comfort in the bustle of activity. Getting together with family can ease a sense of loneliness; sharing memories and reminiscences can bring comfort. After my father died, my mother noted that she found her first Christmas “surprisingly reassuring.” The shared stories of our dad made her feel closer to him and reassured her that her children and grandchildren would always remember him. That was very comforting.

There is one other critical point to make about the journey of grief. For many of us, grief’s journey is life-long. We live with our loss and carry it with us through our life. This does not mean that we live in a state of perpetual pain. Rather, we accommodate the loss, integrating our loss into the rest of our life. This means that, over time and with work, the pain of our loss lessens. For some, that might happen in the first year, but for others, the second year can be just as difficult as the first.

However, if we find that our grief becomes disabling—inhibiting us from working effectively or impairing our relationships with others, or we become self-destructive or destructive of others—we need to understand that our journey has gone off course and seek counseling.

For most of us, the intense pain of grief does not last forever—even as we occasionally experience those pangs or surges of grief throughout life. For most of us, though, in time, we can function similarly to the way we did earlier. We may even grow—mastering new skills, appreciating emerging strengths or developing deeper insights as a result of our losses. It is a process that becomes part of a new, meaningful life even as we cope with our losses. As difficult as a loss is, it is not helpful to the deceased for us to live in a state of chronic loss. Nor is it a useful legacy.