Grief, Loss, and Relationship Transitions

Overview

Grief is the most universal human experience and the least adequately understood. Every life includes loss — the death of loved ones, the ending of relationships, the dissolution of marriages, the departure of children, the loss of health, identity, homeland, and dreams. Yet Western culture has remarkably little infrastructure for grief. We have hospitals for illness, courtrooms for injustice, and schools for ignorance, but for the primal human experience of loss, we offer a few days of bereavement leave and the expectation that the griever will “move on” within a timeline that has no relationship to the actual neurobiology or psychology of grief.

The science of grief has evolved significantly from Kubler-Ross’s original five-stage model (denial, anger, bargaining, depression, acceptance), which was based on her work with dying patients, not bereaved survivors, and was never intended as a prescriptive sequence. Contemporary models — particularly Margaret Stroebe and Henk Schut’s Dual Process Model and Dennis Klass, Phyllis Silverman, and Steven Nickman’s Continuing Bonds theory — offer a more nuanced and empirically supported framework. Grief is not a linear progression through stages but an oscillation between loss-oriented processing (confronting the reality of the loss) and restoration-oriented processing (adapting to the changed world). The goal is not to “let go” of the deceased or lost relationship but to transform the relationship from one of physical presence to one of internalized connection.

This article examines contemporary grief theory, the neuroscience of loss, specific types of relational loss (death of a partner, divorce, ambiguous loss), and the clinical and practical approaches to supporting people through the most painful passages of human life.

Contemporary Grief Theory

The Dual Process Model (DPM)

Stroebe and Schut’s Dual Process Model (1999) proposes that healthy grieving involves oscillation between two orientations:

Loss-oriented processing: Confronting the reality of the loss — crying, yearning, reviewing memories, experiencing the pain of absence, processing the emotional impact. This is what most people think of as “grieving.”

Restoration-oriented processing: Attending to the secondary consequences of the loss — managing finances, learning new skills (cooking, household maintenance), developing a new identity (from “wife” to “widow”), building new relationships, re-engaging with life’s demands and pleasures.

Healthy grief oscillates between these orientations — sometimes moment to moment, sometimes day to day, sometimes week to week. A bereaved person may spend the morning weeping over photographs (loss-oriented) and the afternoon negotiating with the insurance company (restoration-oriented). This oscillation is not avoidance or inconsistency — it is the natural rhythm of grief, and both orientations are necessary.

The DPM explains several grief phenomena:

• Grief bursts: Sudden, unexpected waves of intense grief that interrupt restoration-oriented activity. These are loss-oriented intrusions into restoration mode and are normal.
• Apparent “recovery” followed by relapse: The bereaved person seems to be doing well (restoration-oriented), then is suddenly overwhelmed by grief. This is not regression — it is the oscillation.
• Gender differences in grieving: Men tend to spend more time in restoration-oriented processing; women tend to spend more time in loss-oriented processing. Neither pattern is superior; both are needed.
• Complicated grief: May involve being stuck in one orientation — either chronic loss-orientation (unable to engage with the changed world) or chronic restoration-orientation (unable to process the loss).

Continuing Bonds Theory

The traditional Western grief model, influenced by Freud’s concept of “decathexis,” held that healthy grief required the bereaved to detach from the deceased — to “let go” and “move on.” Klass, Silverman, and Nickman’s Continuing Bonds theory challenged this directly, demonstrating that most bereaved individuals maintain an ongoing internal relationship with the deceased that is adaptive, not pathological.

Continuing bonds include:

• Sensing the deceased’s presence: Feeling that the deceased is near, hearing their voice, seeing them in dreams
• Using the deceased as a moral compass: “What would she think about this?” “He would want me to be happy”
• Talking to the deceased: Maintaining an internal dialogue, visiting the grave, writing letters
• Keeping possessions: Maintaining objects that represent the connection (not hoarding, but selective retention)
• Legacy projects: Doing things in the deceased’s name or honor

Research consistently shows that continuing bonds are associated with better adjustment to loss, particularly when the relationship with the deceased was secure. The goal of grief is not to sever the bond but to transform it — from a relationship based on physical presence to one based on internalized love.

Attachment and Grief

Grief is, fundamentally, an attachment phenomenon. John Bowlby recognized this early: grief is the activation of the attachment system in the absence of the attachment figure. The same behaviors seen in infant separation — searching, crying, protest, despair — are seen in adult bereavement. The bereaved person’s nervous system is searching for someone who will never return.

Attachment style profoundly influences the grief process:

Secure attachment: The securely attached griever can access their feelings of loss, seek and receive support, and gradually integrate the loss into a coherent life narrative. They grieve deeply but with a basic trust that they will survive and that life will have meaning again.

Anxious attachment: The anxiously attached griever is at risk for complicated/prolonged grief — intense, unremitting grief that does not resolve over time. Their attachment system was already hyperactivated, and the loss of the attachment figure creates unbearable distress. They may idealize the deceased, refuse to engage with restoration-oriented tasks, and become stuck in chronic yearning.

Avoidant attachment: The avoidantly attached griever may appear to cope well initially — they suppress emotional processing and focus on practical matters. But unprocessed grief often emerges later as physical symptoms, delayed grief reactions, or difficulties in subsequent relationships.

Disorganized attachment: The griever with disorganized attachment may experience grief as chaotic and overwhelming, oscillating between intense emotion and dissociation, and may struggle with the ambivalence of grieving someone who was also a source of pain.

The Neuroscience of Loss

The Brain in Grief

Mary-Frances O’Connor’s neuroimaging research has illuminated what happens in the brain during grief:

The nucleus accumbens: O’Connor found that the nucleus accumbens (reward center) activates when bereaved individuals view photographs of the deceased. The brain continues to generate “wanting” for the absent attachment figure — craving their presence in the same neural circuitry that drives addiction. This explains why grief feels like withdrawal: it is, neurologically, a form of withdrawal from the neurochemical rewards of the attachment bond.

The anterior cingulate cortex: Activates during grief processing, reflecting the pain component of loss (the same region activated by physical pain and social exclusion). Grief literally hurts.

The prefrontal cortex: Shows reduced activation during acute grief, reflecting impaired executive function — the “grief brain” phenomenon of difficulty concentrating, making decisions, and managing daily tasks.

The amygdala: Shows heightened activation to reminders of the loss, reflecting the threat-detection system’s response to the catastrophic change in the relational environment.

Grief and the Immune System

Bereavement is associated with measurable immune suppression — reduced natural killer cell activity, altered T-cell function, and elevated inflammatory markers. This is the mechanism behind the “broken heart syndrome” observed in epidemiological studies: bereaved spouses have a significantly elevated mortality risk in the first year after loss, particularly from cardiovascular events and infection. The immune effects of grief are mediated by HPA axis activation (elevated cortisol), sympathetic nervous system activation, and the disruption of circadian rhythms that accompanies insomnia and disorientation.

Types of Relational Loss

Death of a Partner

The death of a life partner is consistently rated as the most stressful life event on the Holmes-Rahe scale. It involves:

• Loss of attachment figure: The primary source of emotional regulation, physical comfort, and felt security is gone
• Loss of identity: “Wife/husband” was a central identity; “widow/widower” is an unwanted replacement
• Loss of daily structure: The thousand small routines that organized daily life around the partnership dissolve
• Loss of future: The planned retirement, the grandchildren to be shared, the growing old together — all lost
• Practical upheaval: Financial changes, household management, social network disruption (couples-oriented friendships may fade)
• Loss of sexual and physical intimacy: The body’s hunger for touch, closeness, and sexual connection does not cease with bereavement

The bereaved partner may also experience complicated grief reactions including guilt (about things said or unsaid, about survival itself, about eventual feelings of relief if the illness was prolonged), anger (at the deceased for “leaving,” at God, at the medical system), and ambivalence (particularly if the relationship was conflicted — grief is complicated when the relationship was complicated).

Divorce and Relationship Ending

Divorce involves a particular kind of grief that is complicated by several factors:

Ambiguity: Unlike death, divorce involves a person who is still alive, still visible, and often still involved (through children, shared property, or mutual friends). The loss is not clean — it is ongoing and ambiguous.

Rejection: Death does not involve a choice to leave. Divorce (at least for one partner) does. The experience of being left is qualitatively different from the experience of losing someone to death — it involves the wound of rejection, the questioning of one’s worthiness, and the knowledge that the person who vowed to stay chose to go.

Lack of social support: Western culture has elaborate rituals for death grief (funerals, condolence cards, memorial services) but virtually none for divorce grief. The bereaved divorcee may encounter judgment (“What did you do wrong?”), unsolicited advice (“You’re better off without them”), or minimization (“At least they’re not dead”).

Legal and financial conflict: The practical dimensions of divorce (property division, custody, support) create an adversarial process that occurs simultaneously with emotional processing, forcing the grieving person to negotiate with the person who is the source of their pain.

Identity reconstruction: After a long marriage, the sense of self is deeply intertwined with the partnership. Divorce requires not just mourning the loss of the relationship but rebuilding an individual identity that may be decades out of practice.

Ambiguous Loss

Pauline Boss’s concept of ambiguous loss describes two types:

Type 1 — Physical absence with psychological presence: The person is physically gone but their status is unclear. Missing persons, soldiers MIA, kidnapped children, dementia (the person is physically present but psychologically absent — this is also Type 2). The ambiguity prevents closure and freezes the grief process, because the bereaved cannot fully grieve someone who might return.

Type 2 — Physical presence with psychological absence: The person is physically present but psychologically or emotionally absent. Dementia, traumatic brain injury, addiction (the person is present but “not themselves”), severe mental illness. The bereaved is grieving the loss of the person they knew while the body remains present, creating a dissonance that can be profoundly disorienting.

Ambiguous loss is particularly resistant to resolution because the ambiguity prevents the cognitive processing that normally accompanies loss. The brain cannot update its model of the world because the reality is genuinely ambiguous — and so the grief remains unresolved, often for years or decades.

Disenfranchised Grief

Kenneth Doka’s concept of disenfranchised grief describes losses that are not socially recognized, validated, or supported:

• Death of an ex-spouse
• Miscarriage and stillbirth
• Loss of a pet
• Death of a same-sex partner (in contexts where the relationship is not recognized)
• Loss of a friend (not “just a friend”)
• Loss due to suicide (complicated by stigma and blame)
• Loss of a child to estrangement

Disenfranchised grief is particularly painful because the griever lacks social permission to grieve — they cannot take time off work, they may not be included in rituals, and their pain may be minimized or dismissed.

Clinical and Practical Applications

Assessment of Grief

Clinical assessment should distinguish between:

Normal grief: Intense emotional pain, yearning, preoccupation with the deceased/lost relationship, functional impairment — all of which gradually (over months to years, not weeks) diminish in intensity and frequency, with increasing engagement in restoration-oriented activity and the emergence of a continuing bond with the lost person.

Complicated/prolonged grief disorder (recognized in DSM-5-TR and ICD-11): Intense, persistent yearning, preoccupation, and emotional pain lasting beyond 12 months (6 months in ICD-11) with significant functional impairment. Affects approximately 7-10% of bereaved individuals.

Depression co-occurring with grief: While grief and depression share symptoms (sadness, sleep disruption, appetite changes, social withdrawal), they differ in important ways. Grief involves waves of pain interspersed with positive memories and occasional joy; depression involves pervasive anhedonia. Grief preserves self-esteem; depression involves worthlessness and self-blame. Grief is focused on the loss; depression is self-focused.

Therapeutic Approaches

Meaning-making: Robert Neimeyer’s constructivist approach to grief therapy focuses on helping the bereaved make meaning of the loss — finding significance, benefit, or identity change in the wake of loss. Research shows that the ability to make meaning predicts adjustment better than time elapsed since the loss.

Narrative therapy for grief: Helping the bereaved construct a coherent narrative that integrates the loss into the ongoing story of their life. “How does this loss change who you are? What does it mean for who you’re becoming?”

Complicated grief treatment (CGT): Katherine Shear’s evidence-based treatment combines elements of attachment theory, cognitive-behavioral therapy, and interpersonal therapy. It addresses the dual processes of loss-orientation and restoration-orientation directly, using exposure-based techniques for loss-processing and behavioral activation for restoration.

EMDR for grief: Addressing traumatic aspects of the loss (the death scene, the moment of being told, the funeral) that may be preventing normal grief processing.

Rituals and ceremony: The absence of ritual in modern Western grief is itself a source of suffering. Creating meaningful rituals — memorial ceremonies, letter-writing to the deceased, anniversary observances, symbolic acts of release — provides structure for the expression and containment of grief.

Supporting the Bereaved

What helps:

• Physical presence without the pressure to talk
• Simple practical help (meals, childcare, household tasks)
• Saying the deceased’s name (the bereaved desperately want their loved one remembered)
• “I don’t know what to say, but I’m here”
• Allowing the griever to tell the story as many times as they need to
• Checking in at the 3-month, 6-month, and 1-year marks (when others have stopped calling)

What does not help:

• “Everything happens for a reason”
• “They’re in a better place”
• “At least they’re not suffering anymore”
• “You need to move on”
• “I know how you feel”
• “Be strong”
• Avoiding the bereaved because of discomfort with grief

Four Directions Integration

• Serpent (Physical/Body): Grief lives in the body with extraordinary intensity — the physical ache of absence, the heaviness in the chest, the fatigue that no amount of sleep relieves, the immune suppression that makes the bereaved vulnerable to illness. The Serpent path honors the body’s grief: allowing the tears, providing the nourishment the body needs to survive this assault, supporting sleep through whatever means are necessary, and recognizing that the body’s timeline for grief is longer than the mind’s or the culture’s.

• Jaguar (Emotional/Heart): Grief is the price of love. The Jaguar does not run from this truth — it embraces it. The depth of grief is the measure of the depth of love, and to suppress the grief is to betray the love. The Jaguar path involves allowing the full range of grief emotions — not just sadness but rage, guilt, relief, confusion, terror, and even moments of unexpected joy — without judgment. Every emotion in grief is valid. Every emotion in grief is information.

• Hummingbird (Soul/Mind): The Hummingbird seeks meaning in the midst of meaninglessness. Not the false consolation of “everything happens for a reason” but the genuine meaning-making that transforms loss into wisdom: What did this person teach me? How did loving them change me? What am I being called to now? The Hummingbird path involves constructing a narrative that integrates the loss — not as the end of the story but as a chapter that changes everything that follows while preserving everything that came before.

• Eagle (Spirit): Every culture and every spiritual tradition has a framework for understanding death and loss — and every framework agrees on one thing: love does not end with death. Whether through continuing bonds, ancestor veneration, reincarnation, resurrection, or the recognition that consciousness is more than the body that contained it, the Eagle sees beyond the horizon of physical loss to the enduring connection that transcends form. Vietnamese ancestor veneration (tho cung to tien) is not mere tradition — it is the lived expression of continuing bonds, the recognition that the dead remain part of the family system and that the relationship continues in a different form.

Cross-Disciplinary Connections

Grief and loss connect with attachment theory (grief as attachment system activation, attachment style predicting grief trajectory), neuroscience (reward system activation in grief, immune effects, cortisol dynamics), narrative therapy (meaning reconstruction, continuing bonds), psychoneuroimmunology (grief-related immune suppression, cardiovascular risk), cultural anthropology (death rituals, mourning practices, ancestor veneration), and existential psychology (confrontation with mortality, meaning-making, the human condition).

Functional medicine addresses the physical toll of grief — cortisol elevation, sleep disruption, immune suppression, inflammatory signaling, appetite dysregulation — through targeted nutritional support, adaptogenic herbs, sleep hygiene, and stress management. Somatic therapy works with the body’s grief — the chest tightness, the heaviness, the holding patterns — that talk therapy alone may not reach. Mindfulness supports the oscillation of the Dual Process Model, helping the bereaved be present with whatever orientation is arising without resistance or clinging.

Key Takeaways

• Grief is not a linear progression through stages but an oscillation between loss-oriented and restoration-oriented processing — both are necessary
• Continuing bonds with the deceased are normal and adaptive; the goal of grief is not to “let go” but to transform the relationship from physical presence to internalized connection
• Attachment style profoundly influences the grief trajectory — anxious attachment increases risk of complicated grief; avoidant attachment may produce delayed grief
• The brain processes grief through the same circuits that process addiction withdrawal — grief is neurologically a form of withdrawal from the attachment bond
• Grief suppresses immune function and increases mortality risk, particularly from cardiovascular events — the “broken heart” is not metaphorical
• Ambiguous loss (missing persons, dementia, addiction) is uniquely resistant to resolution because the ambiguity prevents cognitive processing
• Disenfranchised grief (socially unrecognized losses) compounds suffering through isolation
• Meaning-making is the strongest predictor of grief adaptation — not time, not social support, but the ability to find significance in the loss
• Supporting the bereaved requires presence, not platitudes; saying the name, not avoiding the topic; long-term commitment, not short-term sympathy

References and Further Reading

• Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197-224.
• Klass, D., Silverman, P. R., & Nickman, S. (Eds.). (1996). Continuing Bonds: New Understandings of Grief. Taylor & Francis.
• Boss, P. (2006). Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss. W. W. Norton.
• Neimeyer, R. A. (Ed.). (2001). Meaning Reconstruction and the Experience of Loss. American Psychological Association.
• O’Connor, M. F. (2022). The Grieving Brain: The Surprising Science of How We Learn from Love and Loss. HarperOne.
• Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372(2), 153-160.
• Doka, K. J. (Ed.). (2002). Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice. Research Press.
• Worden, J. W. (2018). Grief Counseling and Grief Therapy (5th ed.). Springer.