Grief is a natural human response to the loss of a loved one. It can show itself in many types of grief reactions.

It's normal for both the dying person and the survivors to feel grief. For survivors, the grieving process can take many years. The challenge of accepting death and dying as the end stage of life is what the process is all about.

• Anticipatory grief. This happens when someone has a long illness and the patient and the family look ahead to death. This can be just as painful and stressful as actually losing that person. It allows the family to prepare for the coming death. It can be a time to resolve issues and concerns and to seek the support of spiritual leaders, family, and friends. It's also a time to clarify the loved one's wishes for funeral and burial arrangements and other end-of-life issues.
• Sudden loss. This is a death that happens unexpectedly and suddenly, like a fatal accident or heart attack. It can leave survivors feeling shocked and confused. Loved ones are often left with many questions, unresolved issues, and a range of emotions. These include anger, guilt, and pain. Support from family, friends, and clergy is important to people experiencing sudden loss.

Many, although not all, people facing their own death are willing to discuss issues of death and dying. It can be a time to discuss spiritual issues, resolve family concerns, reflect on a loved one's life and accomplishments, and express gratitude. It also provides time to put practical matters in order. These include the following:

• Can funeral expenses be prepaid?
• Which funeral home would the person prefer to handle arrangements?
• Can the person help with obituary information to make sure it's accurate and complete?
• What are their specific funeral wishes?
• If a religious service is planned, can the person facing death help plan favorite scripture passages or hymns?
• Is cremation or burial preferred?
• Has a cemetery plot been purchased?
• Does the person wish for memorial contributions to be made to a charity or other organization?
• Can the person tell others about important practical matters? These include wills, bank accounts, lawyer's name, pension plans, retirement funds, and life insurance policies.

For both the person facing death and the survivors, it's natural to have many symptoms of grief. These can include:

Physical symptoms:

• Lack of energy or fatigue
• Headaches and upset stomach
• Excessive sleeping, overworking, or excessive activity

Emotional symptoms:

• Memory lapses, confusion, distraction, and preoccupation
• Inability to concentrate
• Irritability
• Depression or feelings of euphoria
• Extreme anger or feelings of being resigned to the situation

Spiritual symptoms:

• Feelings of being closer to God or feelings of anger and outrage at God
• Strengthening of faith or questioning of faith

It's natural for people who are facing death, and those they leave behind, to have different types of grief reactions. Public and private grief reactions are based on a complex mixture of a person's personality, spiritual beliefs, cultural background, and family and community dynamics. For survivors, the grieving process can last for months or years. Types of grief reactions include:

• Shock.
• Depression.
• Physical symptoms, such as headaches, body aches, or stomach distress.
• Feelings of panic.
• Guilt.
• Anger.
• Inability to return to daily routine.
• Return of feelings of hopefulness.
• Acceptance.

If you or a loved one is grieving longer than you feel is normal, you may want to seek professional counseling to help you through the process. Or, if appropriate, you might make suggestions to your loved one. Your doctor may be a good referral source. You may also want to speak with your spiritual leader (priest, rabbi, minister, etc.) for advice.

Bereavement is the period of time a person feels sadness after a loved one dies. There are many things you can do to help a bereaved person. They include:

• Sending cards or flowers.
• Preparing food.
• Providing childcare.
• Doing household chores.
• Contributing to a cause that is meaningful to the family.
• Offering transportation.

You may also consider these when helping the bereaved:

• Be available. Sometimes, when people are grieving, they don't want to talk or listen. They simply want you to be there for them.
• Let the grieving person express the full range of their emotions. These include anger and bitterness, which may sometimes be expressed against the doctors, God, or even the loved one who has died.
• Be patient and understanding. But don't patronize them. Don't claim to know how the other person is feeling. Don't force them to talk or share feelings.
• Don't worry about mentioning the deceased person's name or sharing a fond memory of the person while you're with the bereaved. They, too, are thinking about their loved one. It's natural to bring the name into conversation.
• Remember that grieving takes time. It's a natural human process. No matter how much you want to "stop the hurt," the bereaved must endure the grieving process. Allow them time and care for them as they move through it.

The primary doctor can help the bereaved person adapt to their loss. Even when they have ill health, people with abnormal bereavement are less likely to use health services. Because of this, outreach by family and friends is important to help those who need these services. Depression, suicide, and anxiety are the most common problems linked to loss. Prolonged grief disorder refers to a situation where a grieving person still yearns for the deceased at least 12 months after their death. Other emotions can include feeling life is unbearable, having preoccupying thoughts of the deceased, and feeling intense loneliness. In these cases, professional grief counseling can be very helpful.