What Grief Really Is — and What It Is Not
In everyday life, grief is often treated like a medical problem: something you get through, close off, put behind you. That is wrong. Grief is not an illness but the natural response to the fact that someone or something important is no longer there. It hurts, it changes the body, it changes the way we think — and it follows no textbook.
The most important message up front: if you are grieving right now and wondering whether something is wrong with you, the answer is almost always no. Trouble sleeping, loss of appetite, the feeling that a pane of glass separates you from the rest of the world, sudden anger at the person who died, guilt over trivial things — all of this is grief, not pathology. Only when these reactions last for months and permanently block your daily life is a professional assessment worthwhile.
The Myth of the Five Stages
Almost everyone knows them: denial, anger, bargaining, depression, acceptance. The five stages of grief according to Elisabeth Kübler-Ross (1969). What many people do not know: Kübler-Ross described these stages for the dying, not for the bereaved. She was a researcher on death and dying at a time when patients were not allowed to talk about their impending death — her work was revolutionary, but the five stages were later wrongly applied to those who grieve.
Research since the 1990s paints a different picture. Most grieving people experience acceptance from the very beginning, alongside pain and longing. Anger rarely appears as a stage of its own, but rather in isolated moments. Bargaining belongs to the dying process rather than to the grief of the bereaved. And "depression" as one of five stages is diagnostically misleading — many people grieve intensely without becoming clinically depressed.
What research describes instead is the so-called dual process model of grieving (Stroebe and Schut). According to it, grieving people constantly swing between two states: confronting the loss (crying, remembering, missing someone) and restoring everyday life (working, being able to laugh, building new routines). Both matter equally, both happen in parallel. Anyone who forbids themselves to laugh prolongs their grief. So does anyone who forbids themselves to cry.
What Happens in the Body
Grief is also a physical process. In the first weeks, the stress hormone system is altered — many grieving people show a flattened daily cortisol profile, the immune system powers down, the heart beats more irregularly. In the first week after the death of a partner, the risk of heart attack doubles (Carey et al. 2014). This is distinct from takotsubo syndrome — colloquially known as "broken heart syndrome" — a dysfunction of the heart muscle triggered by acute emotional stress, without any blockage of the coronary arteries.
Typical physical symptoms in the first months:
Trouble falling and staying asleep, waking early
Loss of appetite or, conversely, ravenous hunger and eating for comfort
Tightness in the chest, shortness of breath, seemingly groundless palpitations
Difficulty concentrating, forgetfulness, the feeling of "not being able to think clearly"
Increased susceptibility to colds and infections
Worsening of existing physical complaints (back, migraine, stomach)
All of this is normal and usually passes with time. A check-up with your GP after three to four weeks is still a good idea — not to pathologize the grief, but to make sure nothing else is being overlooked.
When Grief Becomes Complicated
About 7 to 10 percent of all grieving people develop what is known as prolonged grief disorder — recognized since 2022 as a diagnosis in its own right in the ICD-11 (code 6B42), and since March 2022 in the DSM-5-TR (Text Revision) as well. It differs from normal grief in duration and intensity: when, after six months (ICD-11) or twelve months (DSM-5-TR), there is still daily, severe longing, the sense of self is profoundly shaken, and everyday life remains noticeably blocked, we speak of a distinct illness.
Risk factors that make it more likely:
Sudden or violent loss: suicide, accident, murder, sudden cardiac death — anything that allows no goodbye
A very close bond: long-term partnerships, parent-child relationships, dependent constellations
Social isolation: by far the biggest modifiable risk factor
Earlier unprocessed losses or traumas
Pre-existing mental illness (depression, anxiety disorder, PTSD) before the loss
Disenfranchised grief: losses that those around you do not recognize as worthy of mourning — miscarriages, the suicide of a loved one, the death of a pet, the death of an ex-partner
If, after three to six months, you notice that you are "stuck" in your grief — no movement, no swinging between the two poles of confrontation and restoration — a professional assessment makes sense. Not because you are doing something wrong, but because there are effective treatments.
What Really Helps in Everyday Life
There are no grief tips in the sense of "do this and it will pass." Grief does not pass; it becomes part of life. But what does help, empirically, can be boiled down to a few principles:
Talk, even when it hurts. Silence prolongs grief. A person you can talk to without censoring yourself — no advice, no "but you really should" — is protective factor number one. If that person is missing, grief groups or therapy are the substitute.
Protect your routine. Getting up, getting dressed, eating, sleeping — even when everything feels pointless. Structuring your day is not the enemy of grief but its anchor. It forces nothing, but it keeps you from slipping.
Movement. Walking regularly (30 to 45 minutes a day) is the only non-drug intervention that, in randomized trials, measurably improves sleep, mood, and cortisol levels in grieving people.
Allow memories, do not force them. Photos, letters, favorite places — whenever you want, not when others think you should. "Letting go" is not a goal of grief. Staying connected beyond death (continuing bonds) is now recognized as a healthy, not pathological, part of processing loss.
Cut back on substances. Alcohol, sleeping pills, and sedatives numb you in the short term but demonstrably prolong grief. They postpone the pain instead of processing it. That also applies to the sleeping pill a doctor prescribes after the initial shock — it makes sense as a stopgap, not as a solution for weeks or months.
Be patient with other people's pace. Siblings grieve differently, partners grieve differently, colleagues all the more so. Expecting one another to grieve at a "fitting" pace is one of the most common sources of conflict in the first months.
When Professional Support Makes Sense
Studies from the 2000s and 2010s (Larson and Hoyt 2007; Schut and Stroebe 2010) produced an uncomfortable finding: for grieving people without elevated risk, routine early interventions in the first weeks show no benefit and, in some cases, can even prolong grief. Where risk factors are present (see above), this does not apply — there, early, targeted therapy genuinely helps. Concretely, it is helpful when one or more of the following situations apply:
Suicidal thoughts that do not subside or that take hold (see the note box at the end of this article for acute crises)
Trauma connected to the loss: sudden death, suicide, murder, an accident you were involved in
Three to six months after the loss, still no movement in the symptoms, and lasting impairment at work or in relationships
Pre-existing mental illness that becomes acute because of the loss
Substance use that has risen sharply since the loss and cannot be stopped
Signs of prolonged grief disorder beyond six to twelve months
Effective psychotherapeutic approaches for complicated grief include, in particular, specialized Complicated Grief Treatment (developed by Shear), cognitive behavioral therapy with a grief focus, and EMDR for traumatic losses. Duration: usually 16 to 25 sessions, considerably shorter than commonly assumed.
Where to Turn in Austria
Before you go into therapy, it is worth looking at low-threshold, often free services. For many grieving people they are the better first step:
Hospice associations: offer grief support in every province — both in the phase of saying goodbye before death and in the months afterward, even if the person who died was not in a hospice. Contact through the umbrella organization Hospiz Österreich
Grief groups: open groups in every larger town (Caritas, Diakonie, Rainbows for children), usually free or by donation
Telefonseelsorge 142 (telephone counseling): free and anonymous, around the clock — low-threshold even for nighttime waves of grief when sleep will not come
pro mente: psychosocial counseling in every province, often free and low-threshold
Psychotherapy: covered by insurance when prolonged grief disorder or accompanying depression is diagnosed. Waiting times for insurance-covered spots are long — elective therapists are often available sooner. In 2026 the ÖGK reimbursement is 33.70 euros per session, while BVAEB and SVS pay more; with actual session costs of 90 to 130 euros, a co-payment remains
What Remains
Grief does not end when the pain disappears. It ends when the loss is integrated into life. Most people get through it without therapy — with time, with people who listen, with routines that carry them. Those who do not get through it have no character flaw, but a treatable complication of a normal reaction. Both are legitimate, both deserve respect.
If, after reading this article, you feel that you need professional support, talk to your GP or look directly for a psychotherapist. If you are unsure whether you need anyone at all, a grief group or a hospice association is the gentlest way to start. And if you are currently supporting someone who is grieving: stay present, even after three months. Even after six. Even after a year. Grief has a long echo, and the people around a grieving person are often the first to turn away.
