Grief isn’t just about death

Grief and loss.

No one is safe from it. At some point we will all experience a loss and the subsequent grief that follows. Grief is how we cope with that loss. 

Have you ever stopped to think about all the things you can lose, and not just through death. We can lose our jobs, our homes, our health, our pets, our friends, the list is truly endless. 

I could go on a serious rant about the lack of respect the American culture gives to the bereaved and grieving. There are some people who don’t or can’t take time off work for bereavement, others only get limited time. Like 7 days is long enough to mourn the loss of a loved one and get back to “business as usual.”

We are so adverse to death in Western culture, we fear it and shy away from it, rather than lean into it.

I had the privilege of facilitating a grief support groups while I was working at Stanford, and found a whole new love and respect for end of life care and the end of life process. At this point in my life, I have held the hand of someone as they’ve died, I’ve sat with family members as their loved one transitioned. I’ve sat with more death and participated in more conversations about death than I could ever have imagined, and I am so grateful for this shift. However, it doesn’t make me immune to grief, I am just so much better at naming it now.


The first time I met grief, I was 7. My friend, Tyler, was 9; he died in a bicycle accident in the neighborhood. I remember where I was when I heard he died, and how painful it was. I remember when we talked about it at school, I was sent to the guidance counselor because I had a full breakdown talking about him in my first grade class. As I write this, I think about how I had my own rituals for grief, even back then. For a long time I talked to him, and found little ways to honor him or think about him. It was a big loss to my young 7yo world. 


I was safe from loss like this for years, but over the last few years, grief has been a constant. My husband and I talk about the differences in our loss experiences. He lost much of his family early, and has buried more friends than I could ever imagine. 

In my family, the biggest losses occurred before I was born. I am named after my Papa and my Uncle Robert, my dad’s father and brother. 


In the last four weeks, I lost my Uncle (paternal), my Granny (paternal), and my Great Aunt (maternal). They were all fortunate to live mostly long and healthy lives. Even still, the grief was heavy. Especially my Uncle. So much of my childhood came rushing back, memories made, time spent, time lost, and time we’ll never get to share. My great Aunt represented the last of a generation. I’ve been going to her house on Christmas Eve for the last 34 years. That tradition ending deserves its own mourning process. Before these losses, grief and loss had started to be a constant. From people in my own life to my patients, grief has been there, ever present in the background.


It got me thinking about all the things we grieve when people leave our lives. 


Grief is a real fucker, and it shows up far more often then we let ourselves believe. Grief doesn’t always have to follow loss through death, it can show up with any loss. Like grieving the loss of that job, the community you made, the stability of a paycheck, your identity, your sense of purpose. All of that requires and deserves a grieving process.

When we lose people, we aren’t only grieving their physical absence, but everything that comes with relationships. We grieve the future, we grieve the dreams that will never come true, the experiences that will never be had. Traditions that can no longer exist, wisdom that can no longer be shared.

I think some of the hardest grieving we’ll do is grieving the loss of relationships not ended by death, but by betrayal. I know that is some of the hardest grief I’ve faced. I recently realized that it's been almost 10 years since I ended a 20 year friendship. It’s one of those complicated, layered, compounded friendship losses, but it had to happen. Grieving the living is a wild thing. 

No matter who or what you’re grieving. All loss is worthy of grieving. 

Some clinical info:

There are cases when grief has progressed beyond normative grief, where intervention from a licensed therapist is advised:

Persistent Complex Bereavement Disorder (PCBD):

PCBD involves chronic, intense grief that persists for more than 12 months (6 months in children) and causes significant distress or impairment.

Core Symptoms:

  • Intense yearning or sorrow related to the deceased

  • Preoccupation with the person or the circumstances of the death

  • Difficulty accepting the death

  • Avoidance of reminders of the loss

  • A diminished sense of identity or purpose

  • Emotional numbness or detachment

  • Feeling life is meaningless without the deceased

Prolonged Grief Disorder (PGD)

PGD is now a formal diagnosis, recognizing that some individuals experience grief so persistent and disruptive that it becomes a mental disorder.

Diagnostic Criteria (DSM-5-TR):

  • The death occurred at least 12 months ago (6 months for children/adolescents)

  • Ongoing grief response includes intense longing, sorrow, preoccupation with the deceased

  • Symptoms occur most days for at least 1 month

  • Clinically significant distress or impairment in social, occupational, or other areas of functioning


Facts about Grief:

Psychological Impact

  1. Grief & Emotional Pain

    • Studies liken friendship loss to grief or heartbreak. Just like romantic breakups, losing a close friend can trigger deep sadness, denial, anger, and acceptance (Bowlby, 1980; Adams & Blieszner, 1994).

    • Especially in adult friendships, people may not anticipate the loss, which can deepen the shock and emotional fallout.

  2. Depression & Anxiety

    • Friendship loss is associated with increased depressive symptoms, especially when the relationship was long-standing or emotionally intimate.

    • One longitudinal study (Umberson et al., 2010) found that social losses, especially those involving close friends, predict higher depressive symptoms over time.

  3. Shame & Self-Doubt

    • People often internalize the loss and blame themselves, especially if the friendship ended in conflict or “ghosting.”

    • This can trigger a crisis in identity or self-worth, particularly if the friend played a central role in one’s social support system (Hartup & Stevens, 1997).

 Physiological Impact

  1. Stress & Health Consequences

    • The body perceives social loss as a threat. Stress hormones like cortisol spike in response.

    • Chronic social stress can impair immunity, increase inflammation, and contribute to conditions like heart disease or sleep disruption (Holt-Lunstad et al., 2010).

  2. Brain Activation Similar to Physical Pain

    • Neuroscience research using fMRI (Eisenberger et al., 2003) has shown that social pain (e.g., rejection or loss) activates the same brain regions as physical pain (like the anterior cingulate cortex).

    • That’s why social rejection “hurts” — the brain interprets it similarly to a physical wound.

      3. Loss of Social Identity and Belonging

  • Friendships often support our sense of who we are. When that’s lost, it can destabilize identity, especially in adolescence or major transitions (Pahl & Spencer, 2004).

  • Humans are wired for belonging — and when we lose a core part of our social fabric, it can create feelings of isolation or loneliness (Cacioppo et al., 2006).

 Long-Term Consequences

  1. Loneliness and Social Isolation
    Chronic loneliness — often triggered or deepened by friendship loss — has been linked to poorer mental and physical health outcomes, including cognitive decline in older adults (Hawkley & Cacioppo, 2010).

  2. Trust and Vulnerability
    After friendship loss, especially due to betrayal, people may be less likely to trust others or form new close bonds — impacting future relationships (Rotenberg, 1994).

    Protective Factors and Recovery

  1. Reflection and Meaning-Making
    Journaling, therapy, or self-reflection can help reframe the loss and make meaning out of it, reducing the emotional sting over time.

  2. Social Buffering
    Having other supportive connections — even if not as close — can soften the blow. Social support helps reduce cortisol and buffer stress (Cohen & Wills, 1985).

  3. Self-Compassion
    Studies (Neff, 2003) show that being kind to oneself during difficult interpersonal experiences aids emotional recovery and resilience.

And most importantly, because grief can be so uncomfortable, we fail to show up for those who are grieving. Here’s how to change that—

Supporting others:

Hold Space, Don’t Fill It

  • You don’t have to say the “right thing.” You just have to be there.

  • Silence is okay. Your quiet presence is more powerful than forced comfort.

Instead of “Everything happens for a reason,” try:
“I don’t have the right words, but I’m here with you.”

 Acknowledge Their Pain — Don’t Minimize

  • Avoid silver linings or comparisons.

Instead of “At least they lived a long life,” try:
“I can see how much they meant to you.”

 Let Grief Be Nonlinear

  • Don’t expect someone to “move on” or “get over it” quickly — or ever.

  • Grief can resurface unexpectedly, even years later. That doesn’t mean someone is “stuck.”

Ask, Don’t Assume

  • Everyone grieves differently. Some want company; some want solitude.

Try asking:
“Would you like me to check in tomorrow?”
“Would it be helpful if I just sat with you today?”

Offer Specific Support

General offers like “Let me know if you need anything” are kind — but rarely taken up.

Instead, try:
“Can I bring you dinner on Thursday?”
“Want me to help with errands this week?”

Use Body-Based Support When Words Fall Short

  • Grief lives in the body. When someone can’t talk, offer grounding:

    • Sit quietly with them

    • Play soft music or sound healing

    • Offer a weighted blanket or gentle touch (with consent)

Keep Showing Up

  • Most support fades after the first week or month — but grief doesn’t.

  • Set a reminder to check in 2 months, 6 months, even a year later. That’s often when it hits hardest.

Be Okay With Your Own Discomfort

  • You can’t take away their pain, but you can choose not to abandon them in it.

  • Let your love be bigger than your fear of saying the wrong thing.

Final Reminder

You don’t have to be perfect to be supportive.
You just have to be present, patient, and willing to stay. That alone makes you a powerful presence in someone’s story.

I wrote about grief in my newsletter this week. If you missed it, make sure you’re signed up so you don’t miss the next one. If you want to receive a copy, send me an email at wavesofchangecoal@gmail.com and I’ll forward it to you.

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