A shared universe › Blog › How long does grief last? · Español
“I should be better by now.” Many people say this to themselves after a few months, and others hear it from the people around them. Behind it lies a question that is rarely asked out loud: how long is it normal for it to hurt?
Grief has no end date. What researchers have seen is that it changes shape. The psychiatrist Katherine Shear, who founded a centre for complicated grief at Columbia University, distinguishes between acute grief and integrated grief. Acute grief is that of the first weeks and months: it takes over everything, your sleep, your eating, your thoughts. Integrated grief comes later, little by little, when the person who died stops filling every minute and finds a quiet place inside your life.
That change does not mean forgetting or loving less. You can miss someone for the rest of your life and, at the same time, go back to work, laugh and make plans. When that happens, grief has not finished: it has become compatible with living.
In the Yale Bereavement Study, published in 2007 in the medical journal JAMA, Paul Maciejewski, Holly Prigerson and their colleagues followed 233 people in Connecticut who had lost a relative to a natural death, from illnesses such as cancer or heart disease. They interviewed them several times, from the first month up to two years.
The painful feeling that came up most was not low mood but yearning: the longing for that person to come back. It reached its highest point around the fourth month. On average, the hardest feelings peaked before six months and then declined, while acceptance of the death was there from the start and grew over time.
These are averages from one particular group: most had lost a spouse, half were over 65, and the study left out deaths by accident or suicide. They do not describe the path of each individual. Nor does the pain fall in a straight line. It comes and goes, as explained in Grief does not come in stages, and it often returns with force on the dates that hurt.
In some people, the pain does not change: it stays just as intense as the months go by and makes it impossible to live. For those cases, the World Health Organization included prolonged grief disorder in its new International Classification of Diseases, the ICD-11, presented in 2018 and in force since January 2022. The American Psychiatric Association also added it to its diagnostic manual, the DSM-5-TR, in March 2022.
Both describe something similar: an intense yearning for the person who died, or an almost constant preoccupation with them, with strong emotional pain and serious difficulty in carrying on with everyday life. Among the signs they list are these:
The two manuals do not agree on the timing. The ICD-11 speaks of more than six months since the death, while the DSM-5-TR asks for at least twelve in adults. Both also require that the grief clearly goes beyond what is expected in each person’s culture and surroundings. That difference shows that the line between long grief and grief that needs treatment is an agreement among specialists, and that judging it is a matter for a professional, not for a calendar.
It is less common than many people fear. In 2017, Marie Lundorff and her colleagues brought together fourteen studies of adults who had lost someone to a non-violent death. On average, about one person in ten met the criteria for prolonged grief, and the proportion was higher in the older groups.
After unexpected or violent deaths, such as accidents, disasters or suicides, grief becomes prolonged much more often. Another analysis, pooling twenty-five studies in 2020, found this, although its authors warn that the studies were very different from one another and ask for the figure to be taken with caution. If your loss was like that, it is understandable that you are finding it so hard, and seeking help early may be a good idea.
Many things about grief are frightening and yet are part of ordinary grief, even after a year or several:
It is worth talking to your GP or a mental health professional when, after many months, the pain still takes up everything; when you cannot manage the basics, such as eating, sleeping, working or looking after your family; when you avoid everything that reminds you they have died; or when you feel that nothing has any meaning. If you are thinking about dying or about going with that person, you do not need to wait for any deadline: tell someone today. In Spain you can talk to a person at the Teléfono de la Esperanza, 717 003 717, at any time. If you are thinking of ending your life, call 024: it is free and answered 24 hours a day. If you are in another country, call your local emergency number or a helpline there.
Prolonged grief can be treated with psychological therapy. In 2005, Katherine Shear and her team published a trial in JAMA that compared a therapy designed for this kind of grief with a general-purpose psychotherapy. Ninety-five people took part, with about sixteen sessions each. 51% of those who received the specific therapy responded well, compared with 28% of those who received the other. It is often cited as the first controlled trial to show that a treatment works for this kind of grief, although its authors acknowledged that the other half of the patients did not improve enough.
Asking for that help is not giving up or ceasing to love the person who died. It is looking for a way to carry their memory without it stopping you from living. If it is hard to take the step, Asking for help when it’s hard has ideas for getting started.
In A shared universe nobody asks how long ago it was. You can light a “For someone who is gone” star three months or twenty years on, on a special day or on an ordinary Tuesday. For seven days, whoever passes by will leave a word of remembrance.