Grief, Loss and Bereavement


Loss and Mourning

Carol E. Watkins, M.D.

Glenn Brynes. Ph.D., M.D.

Baltimore, Maryland


Must We Grieve?


Loss and Stillbirth


An Adolescent Dies


a Meaningful Memorial for Your Friend


Families Mourn Together


To Others About Your Illness



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Why Must

We Grieve?

Glenn Brynes,

Ph.D., M.D.

When we love someone and they die,

it can feel devastating. This seems to be a universal part of our human

experience. But why do we have to suffer like this?

If we humans lived our lives

separately from others, needing and relying on no one but ourselves, then the

loss or death of another would have little impact. But we are social creatures.

Compared to other animals, we spend a remarkably long period of our lives—18

or more years—living with and depending on our parents. We are born into

families. We grow and live surrounded and supported by our social environment.

We make friends with, go to school with and work with our neighbors. It is part

of our makeup to form strong bonds of caring and affection with other people.

The forces that draw us to others are so deeply entwined in our nature. We

respond to these forces in powerful and seemingly involuntary ways. We feel

these pressures keenly when we are lonely and bereft of companionship; when we

feel ashamed and fear social disapproval; and especially when we fall in love

and long for the love of another person.

At their best, these deeply rooted

feelings encourage us to help and protect each other. The resulting bonds bring

us help when we need it. It is precisely these feelings that have made our

incredibly rich, complex human culture possible. Without it we would be spending

our lives trying furtively to gather and hunt enough food to keep ourselves

alive from one day to the next. We would have neither the reason nor the ability

to pass on what we have learned to others. If we were hurt, we would have only

the wisdom of our bodies to heal us.

But we are not solitary, and the

price we pay for our attachments is vulnerability—the risk of loss. Because we

depend on other people—because they do matter to us—they occupy a special

place in our hearts. They are like a part of ourselves and cannot be

replaced…any more than our hand or some fond memories could be. When someone

we love is gone from our lives, it is as if a piece of us has been torn away.

The loss rends the fabric of our lives and the wound must be repaired. Grief is

that process by which our minds heal this hurt. For us to go on with our lives

and again risk caring about others, we need to let go of those we love who are

no longer with us. Through this process of mourning, we gradually accept the

loss. We allow the dead to be gone from our lives.

At the end of mourning, there is

still sadness, but it is a wistful sadness that is tempered by the happy

memories that we still possess.

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Empty Womb: Pregnancy Loss


E. Watkins, M.D.


Pregnancy is often

a time of great hope for the future. The parents decorate a nursery, pick out

names and fantasize about future years as their baby grows from childhood into

adolescence and adulthood. The start of a new generation may draw in special

attention from extended family. The traditions and expectations of relatives add

drama and complexity to the process.


More often than

one might expect, the dream is shattered. Something goes wrong and the family

suffers a miscarriage or a stillbirth. About one in four women miscarry at some

stage in their lives. Many people feel that a miscarriage or stillbirth is going

to be less distressing than the loss of an older child. After all, no one has

gotten to know the unborn child. The miscarriage may mean different things to

particular families. To some, the loss feels much greater because they

experience the loss of a whole lifetime of memories that will never be. 

Often the mother feels isolated in her loss. No one else felt the early

physical changes, or the first tiny kick. The mother may also feel that her body

has somehow let her baby and her family down. Her husband and relatives may not

have experienced the baby as a separate person.


In the case of a

stillbirth, it often helps the parents to see their baby, hold her, take

photographs and give her a name. Even a deformed or premature baby may have

features that resemble a parent or relative. If the pictures cause too much

pain, they can be stored away and revisited later. Religious rituals associated

with birth and death express love, and honor the uniqueness of the lost child.

Relatives should

ask the parents how they could help. Unless the parents ask, relatives should

not try to smooth things over by disposing of the nursery items. Some parents

may experience this as a denial of the reality of the loss.


Friends should not

expect the parents to grieve on any given schedule. Pregnancy loss means

different things to different couples. For some, the grief continues at an

attenuated level for years or even a lifetime.

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Friend is Still a Kid: Kids Don’t Die!

Carol E.

Watkins, M.D.

Your friend, is dead. The words

sound so final, so cold. Maybe it was your classmate, boyfriend or confidant.

Maybe he died from cancer, a car accident, or by his own hand. Somehow you

can’t bring yourself to believe it. He wasn’t even 18. Aren’t your parents

and grandparents supposed to die first?

If you lose a young friend, you may

feel a mixture of emotions that will come as a surprise to you. Some feelings

and thoughts are fleeting, and some may stay with you for a lifetime. Everyone

experiences grief differently, but many pass through several stages of grief.

These are denial, anger, bargaining, depression and acceptance. Some people

cycle through some of these stages several times as different experiences or

phases of life remind them of the loss.

Some who are experiencing denial or

anger may want to rid themselves of possessions that remind them of the lost

friend. If you can’t stand to look at certain objects, put them away for

safe-keeping and wait a few weeks or months before deciding what to do with

them. These mementos may be a source of comfort later. Talk to friends. Share

funny and happy stories about your friend’s life. This helps make the loss

more real and helps make sense of the death by celebrating the life. If you have

questions about how the death occurred, ask the friend’s family or the school


You may feel plagued by feelings of

responsibility or “What ifs?” Tell yourself that you are not responsible for

your friend’s death. Cry and shout if you need to do so. Some find comfort in

action. Join with others to create a memorial or to raise awareness about the

illness that led to your friend’s death.

Take care of yourself. Some

adolescents become depressed and even suicidal themselves after the death of a

friend. Talk, write or compose music. Keep active. If you feel that you are

losing control, seek adult guidance.

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a Meaningful Memorial for a Friend


E. Watkins, M.D.

Often it is

difficult to make sense of the death of a child or adolescent. One of the ways

to deal with grief is to take action. By doing so, you can celebrate and

memorialize the life of the friend you have lost. 


There are many

kinds of memorials. Every culture, from ancient to modern, has developed unique

ways for the living to pay tribute to the dead. Some believe that these rituals

give special benefits to the deceased, but others see the funeral and memorial

arrangements as powerful source of comfort and support for the living. The most

common in our culture is the grave marker, which provides a specific place for

family and friends to visit. But there are many other types of memorials that

you can create yourself. These may be based on your interests and talents or

your relationship to your dead friend.


You and your

friends may organize your own meaningful memorial service with different

individuals providing anecdotes, and simply a place to weep and laugh together.

Photographs, videotape, or sports items may serve as reminders of your

friend’s life.


If you are

artistically or musically talented, you might compose music or a painting to

express your grief, anger or love. A particular painting or musical arrangement

may evolve and change as you move through your grief. If you write, you may

embark on a series of stories or poems.


Your school or

place of worship may allow you to build a memorial garden. Working in the earth

can be therapeutic, and planting can express hope in the future. 

If you do build a garden, be sure that someone makes a commitment to

maintain it. Weeds and neglect do not make a good memorial.


Anger is a form of

energy. Can you transform this energy into something strong and positive? You

might organize a group to promote awareness of the condition that caused the

friend’s death. If he died as a result of drunk driving, you might promote

SADD (Students Against Drunk Driving.) You might organize discrete rides home

for classmates who become intoxicated at parties.


Celebrating and

commemorating a friend’s life may not mean that you agree with the way he

died. Seeking to understand someone’s reasons for drunk driving or suicide is

not the same as condoning a self-destructive act. 


Finally, your own

life can be a memorial.  You bear

within you the rich, bittersweet lessons learned from your friend’s short life

and death. 

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Families Mourn Together


Brynes, Ph.D., M.D. 

Carol E. Watkins, M.D.

In order to

understand bereavement, we need to make the distinction between grief and

mourning. Grief is a person’s internal experience, thoughts and feelings

related to the experience of a great loss. Mourning is the external expression

of one’s grief. Thus, a person may experience extremely painful grief but,

because of a need to appear stoic, may not mourn.


Grief and mourning

are intensely personal and unique experiences. We often refer to stages of

grief, but these often do not occur in an orderly progression. Depending on the

situation and the individuals involved, one may not experience some stages, or

may cycle in and out of the same emotional state several times.


A major loss often

brings up echoes of past losses. If the family members still have intense

unresolved grief, it may complicate the way that they mourn..


Loss often happens

in a family context. The family members grieve and mourn individually and as a

group. The method of death, sudden or the culmination of a long illness is an

important factor. A sudden or violent death may be particularly difficulty for

the family to process because of the intense anger often involved. “It

didn’t have to happen.” However even if the death is the long expected

release from a painful illness, it can still be a powerful experience.


If a parent dies,

the children may experience a double loss. One parent has died and the other is

too overwhelmed to provide much nurturance. At this time, extended family and

the community can step in to support the grieving family.


Marriages may be

strained and even fall apart under the strain of death and mourning. Spouses may

grieve differently and may resent the way that the partner behaves. Each may be

too overwhelmed to reach out to the other.


Those in

non-traditional family structures may face additional complexities in their

process of mourning. They may be denied legal protection afforded to other

families. Church and extended family may not recognize their grief.


Mourning, though a

painful process can also be a way for families to grow together. Petty conflicts

seem less important in the face of loss. Relationships seem more precious

because they are fragile and impermanent. Family members may learn to support

each other and truly listen.

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To Others About Your Illness


E. Watkins, M.D.

When you first hear the news that

you have a serious illness, the first reaction is often to shut it out of

awareness. Denial is not all bad. In limited amounts, it may serve a protective

function. However, you must eventually take a careful look at the situation. At

such a time, it may become helpful and even necessary to talk to friends and

loved ones about your illness and your life plans.

Many of us are not used to sharing

deeply personal feelings with others. Our society has tended to avoid open

discussion of illness and dying. Should you share your concerns with others? If

you express your fears, will it make them come true? Will your talk of illness

and medical procedures burden your friends and relatives? Will they become

embarrassed if you start to cry?

Many people are loath to reveal

their true wants and needs. However, you may discover that others may be

wondering what you want. They are often happy to get a clear message from you.

They may be at a loss as to what to say to you. If you bring up the subject of

your illness, it breaks the ice and may eliminate an awkward barrier. You may

start to cry. This is not necessarily bad. It may actually make it easier for

both of you to express your intense emotions. Discussing your illness or

impending death with someone else may lead to a new and special sense of

closeness. Crises can strip away artificial barriers and help us focus on what

we really value in each other.

When you confront a serious health

crisis, you need support. Friends and relatives can provide that. Some of your

thoughts and feelings may seem grotesque or morbid. If your friend is able to

hear your concerns, he or she may reassure you that these concerns are normal.

You may have to make significant life decisions. Discussing these decisions

aloud with a confidant may help you clarify what you truly want to do.

When you talk to someone about your

illness, be open about any strong feelings you experience or that you feel your

friend is showing. This ultimately eases any sense of awkwardness. You do not

always have to use words to express your thoughts or feelings. Silence, hugs, or

holding hands may express a great deal. Tell the other person what he or she has

meant to you. Be open about any regrets for past actions or omissions.

Every moment in a person’s life

carries the potential for growth and a new sense of meaning. You always hope for

a reprieve or even a cure, but whether or not it comes, you can still experience

growth personally and in closeness to others.

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Phone: 410-329-2028

Web Site

Copyright 2001


E. Watkins, M.D.

Glenn Brynes, Ph.D., M.D.