Grief and bereavement: what is normal and when to get help

Grief is the natural response to losing someone you love. There is no correct way to grieve and no deadline for it. It usually comes in waves — sadness, longing, guilt, anger, relief, numbness — that can arrive without warning, even years later on an Eid morning or at a wedding where someone is missing. For most people the waves gradually become less frequent and less overwhelming, while the love and the connection remain.

Grief is not an illness, and most bereaved people do not need professional treatment. What they need is time, company, and permission to grieve in their own way. A smaller number find that grief stays as intense as in the first weeks and stops them living their lives; for them, specific help exists and works.

There are no fixed stages

Many people have heard of the 'five stages of grief': denial, anger, bargaining, depression and acceptance. These come from Elisabeth Kübler-Ross's 1969 book On Death and Dying, which described the reactions of people who were themselves dying, not a route that bereaved relatives must travel. Grief researchers have since pointed out that there is little evidence for fixed stages and that the idea can harm people — those who do not feel 'angry' or 'accepting' on schedule start to believe they are grieving wrongly.

A more accurate picture is movement back and forth: some hours spent in the loss — crying, remembering, looking at photographs — and some spent attending to ordinary life, work and other people. Both are healthy. Laughing at a family gathering a week after a funeral is not disrespect, and weeping a year later is not failure.

What grief does to the body and mind

• Tiredness and heaviness, even after sleep
• Difficulty sleeping, or waking at the hour the person died
• Loss of appetite, or eating for comfort
• Aches, tightness in the chest or throat, a feeling of a weight on the heart
• Poor concentration, forgetfulness, going into a room and forgetting why
• Hearing the person's voice, sensing their presence or seeing them in dreams — common and not a sign of mental illness
• Guilt about what was or was not done, especially after a sudden death or a long illness

Faith, family and mourning customs

For many Pakistani families, faith and ritual are among the strongest supports in grief. Islam does not ask people to hide sorrow. When the Prophet's (ﷺ) young son Ibrahim was dying, his eyes filled with tears, and he said this was mercy; he went on to say that the eyes shed tears and the heart grieves, but we say only what pleases our Lord. Crying is not weak faith.

Islamic practice also gives mourning a structure. A well-known hadith limits formal mourning for a relative to three days, except for a widow, who mourns her husband for four months and ten days — the iddah. Around these, Pakistani families add customs that vary by region and school of thought: condolence visits at the home, neighbours and relatives sending food so the family does not have to cook, Quran recitation, the qul or soyem around the third day, the chehlum around the fortieth day, and the barsi on the anniversary.

These rituals give grief a place and bring people together. They can also bring pressures: the expectation that men should not cry, that women should show sabr quietly, or that a grieving widow must receive a stream of visitors while being unable to leave the house during iddah. The weeks after chehlum can be the loneliest, when the visitors stop and everyone else's life moves on. A widow in iddah, an elderly parent who has lost a spouse, or a young mother widowed with children may need someone to keep visiting long after the formal mourning ends.

How children grieve

Children grieve too, but differently. They may seem fine one moment and distraught the next, play at funerals, ask the same questions many times, or become clingy, angry, or unable to concentrate at school. Young children may not understand that death is permanent; teenagers may hide grief to protect their parents.

• Use clear words: 'Dadi has died. Her body stopped working and she cannot come back.' Phrases like 'gone to sleep' or 'gone on a long journey' confuse and can frighten children.
• Tell the truth, in words suited to their age. Children sense secrets and fill the gaps with worse fears.
• Include them, if they want to be, in saying goodbye — prayers, the janaza, visiting the grave, or a memory box.
• Keep routines — school, meals, bedtime — as normal as possible.
• Let them see you grieve, and tell them it is all right to be sad and to be happy.

When grief becomes prolonged grief disorder

For a minority, grief does not soften. The person remains consumed by longing for or preoccupation with the one who died, with intense emotional pain — disbelief, bitterness, guilt, feeling that part of themselves has died, inability to engage with life — and this continues far beyond what their family and culture would expect, disrupting work, relationships or daily functioning. This is prolonged grief disorderProlonged grief disorderIntense grief that lasts much longer than expected after a death and stops a person from functioning. ICD-11 uses at least six months; DSM-5-TR uses twelve months for adults.Read the full definition.

The American Psychiatric Association estimates that about 4% to 15% of bereaved adults develop the persistent symptoms of prolonged grief disorder. Risk is higher after sudden or violent deaths, the death of a child, and when the person had few other supports. Grief can also trigger depressionDepressionA medical condition in which low mood or loss of interest lasts most of the day, nearly every day, for at least two weeks, and affects sleep, energy and daily life.Read the full definition, and the two can occur together. Treatment uses grief-focused therapy with elements of CBTCognitive behavioural therapyA structured, time-limited talking therapy that helps you notice and change the thoughts and behaviours that keep a problem going. It is a first-line treatment for depression and most anxiety problems.Read the full definition; there is no medicine that treats grief itself, although a doctor may treat depression or insomniaInsomniaRegular difficulty falling asleep, staying asleep or waking too early, leaving you tired during the day. When it lasts three months or more it is called long-term insomnia.Read the full definition alongside it.

Looking after yourself while grieving

Grief is hard work for the body as well as the heart. Small, ordinary things help more than people expect.

• Keep some routine — regular meals, prayer times, a daily walk — even when you do not feel like it.
• Let people help, and tell them what would actually be useful.
• Talk about the person, and about how you feel, with someone who will listen without hurrying you.
• Expect hard days around Eid, Ramadan, anniversaries and family weddings, and plan who you will be with.
• Delay big decisions — selling the house, moving city, changing jobs — for a while if you can.
• Find ways to keep the bond: dua and charity in their name, visiting the grave, cooking their dish, telling the children their stories.
• Avoid numbing the pain with sleeping pills, alcohol or other substances; they delay grief rather than ease it.

When to get help

How to support someone who is grieving

• Say the person's name and share memories. Most grieving people want the dead to be remembered, not avoided.
• Offer specific help — cooking, school runs, paperwork, a lift to the graveyard — rather than 'let me know if you need anything'.
• Listen more than you advise. 'Allah's will' and 'be strong' are true for many people, but on their own they can close a conversation.
• Keep coming after chehlum. Mark the difficult dates: the first Eid, the anniversary, birthdays.
• Accept that they may be angry, flat, or unlike themselves for a while.
• Watch gently for signs that grief has become something more, and help them to see someone if it has.