Core Concepts for Grief-Sensitive Care
The Emotional Experience of Grief
Grief is Not a Single Emotion
Grief is often conflated with depression or sadness, but it is more complex. It can involve a wide range of emotional responses, including sadness, relief, numbness, gratitude, guilt, anger, fear, or moments of joy, sometimes experienced at the same time.
It is common to notice emotions that seem to contradict one another. While grief can involve the full range of human emotion, certain emotional responses commonly emerge.
Anger
The Cambridge English Dictionary, defines anger as “a strong feeling that arises in response to something perceived as unfair or unkind.” When loss disrupts a sense of fairness, safety, or control, anger may surface alongside other grief responses. Recognizing anger as part of grief can help reduce shame and support more compassionate understanding.
Anger is sort of the hidden emotion in grief. A lot of grieving people are incredibly angry for a lot of different reasons.
Grief-related anger may sometimes be expressed openly by patients or supporters and can include raised voices, strong language, or visible agitation. In interactions with colleagues, it may appear in more subtle ways, such as impatience, shortened responses, or sarcasm.
Anger Can Even Be Surprising for the Person Who is Grieving
People who are grieving may be surprised by how frequently or unexpectedly anger surfaces. In this clip from Speaking Grief, griever Zee Wolters reflects on her experience with anger following her mother’s death.
In healthcare settings, recognizing that anger is a common and often misunderstood expression of grief can improve communication and reduce harm.
How Anger Can Show Up
Grief-related anger may be direct and intense with patients or their families and may include behaviors like yelling, cursing, or physical agitation.
Among colleagues, it often presents more subtly, through impatience, curt replies, or sarcastic remarks.
Anger can show up in different ways. Some expressions are more visible and intense, while others are quieter and less direct. Both can reflect underlying distress and unmet needs.
- Hot expressions of anger involves overt, intense reactions, such as shouting, slamming doors, or physical agitation.
- Cold expressions of anger tends to be more restrained and indirect, and may include sarcasm, withdrawal, silence, or passive resistance.
Navigating Grief-Related Anger in Healthcare
Something that I struggle with is when the grief is expressed through anger from the patient or the family.
When anger feels disproportionate, it can be helpful to pause and consider whether grief may be influencing the response. Acknowledging the underlying distress, while also setting clear boundaries around harmful behavior, can support safety and more constructive communication.
These responses validate distress without escalating conflict, normalize grief-related emotion, and maintain clear expectations for respectful communication.
Try to Stay Curious
Staying curious about grief-related anger can help shift the focus from judgment to understanding, allowing people to notice what the anger may be protecting or expressing. In this clip, Dr. Anne Chiang highlights how listening, acknowledging frustration, and offering a sincere apology can support grief-sensitive care when anger surfaces.
Curiosity supports grief-sensitivity via mentalization by helping individuals reflect on their own thoughts and feelings, as well as those of others, rather than reacting automatically. This reflective stance can create space for more flexible, compassionate responses during moments of intense emotion.
Grief-Sensitive Boundaries
Acknowledging anger can sometimes help reduce its intensity and support de-escalation. Boundaries can be set in ways that remain grief-informed and compassionate, such as:
“I can see how hard this is. I want to support you, and we also need to keep this a respectful space.”
While grief may help explain strong reactions, it does not excuse harmful or abusive behavior. Clear, consistent boundaries help support safety and effective care for everyone involved.
Fear
Fear is common in grief: fear of life without the person, fear of forgetting, or fear of what lies ahead. For many people, grief can unsettle what once felt predictable or secure, making uncertainty more present in everyday life.
“No one ever told me that grief felt so like fear.”
Fear in Patients and Their Supporters
Uncertainty is often at the root of grief-related fear, especially in healthcare settings. This may include uncertainty about prognosis, treatment outcomes, or what life may look like after the death of a significant person.
In this from The Apologies Podcast, pediatric ICU nurse Hui-wen Sato shares how her breast cancer diagnosis gave her a deeper understanding of how overwhelming uncertainty can feel from the patient’s side.
Clear communication, patience, and transparency can help reduce distress and support a sense of safety when fear is present. Fear may show up as anxiety, avoidance, or anger. Recognizing fear as part of the grief experience can support more compassionate, responsive care.
Fear in Healthcare Professionals
Fear of the unknown can be part of the grief experience for healthcare professionals, particularly when there is concern that engaging more fully with someone’s pain may feel overwhelming or difficult to contain.
Naming this fear and reflecting on where it comes from can support greater steadiness, confidence, and presence in care. With this understanding, approaching grief is less likely to feel consuming and more likely to support meaningful connection with patients and supporters.
Fear of Failure
For many healthcare professionals, fear is closely tied to another unspoken concern: failure. Even when outcomes are medically inevitable, the death of a patient can feel personal, particularly within systems that prioritize cure over comfort.
“Every time a patient dies, a part of me feels like I failed.”
Healthcare professionals may experience pressure related to outcomes and outward presentation. This pressure can be intensified for those in leadership roles, where steadiness is often expected, as well as for trainees and early-career professionals who may be concerned about how their capacity to “cope” is being perceived.
When fear of judgment or perceived failure is not acknowledged, it can make grief more difficult to recognize, name, and respond to in oneself and others. Reframing outcomes and normalizing the challenges that can come from working in high-stakes environments can help mitigate these fears.
Joy
Grief is often assumed to involve only sadness, anger, or despair, but the emotional experience is more layered than that.
People may also experience moments of levity, laughter, gratitude, or joy alongside grief.
These moments do not mean grief has ended or been resolved; they reflect the complexity of adapting to loss.
People only think ‘sad,’ like, ‘you’re sad.’ But I feel like feeling happiness of memories is part of it, too.
Be Mindful of Assumptions
The presence of joy does not negate the pain that may still be part of a person’s grief experience. Patients, supporters, and colleagues may smile or laugh while also carrying deep loss, and some may use humor as a way of coping. These expressions do not mean someone is “fine” or has moved on. Many people feel pressure to appear okay, which can lead them to mask ongoing pain in response to perceived expectations.
Jack StockLynn is a bereaved son who was interviewed for Speaking Grief. Courtesy of WPSU.
Zee Wolters is a bereaved daughter who was interviewed for Speaking Grief. Courtesy of WPSU.
The Dual Process Model of bereavement can help contextualize the back-and-forth between grief and moments of joy. For healthcare professionals and caregivers, recognizing this duality means welcoming moments of joy without assuming that grief has resolved or that support is no longer needed.
Sadness
Sadness is one of the most commonly associated emotions of grief, though it does not always appear in expected ways. Some people cry easily, while others may feel detached, restless, or weighed down without tears.
In healthcare settings, sadness may show up quietly through a clenched jaw, a heavy sigh, or a wave of fatigue after an encounter or shift. However it is expressed, sadness can be a natural response to loss and reflects the meaning, love, or connection that has been disrupted. Allowing space for sadness, without rushing to fix or avoid it, can support a more compassionate grief experience.
Grief and depression can share overlapping features, such as sadness, changes in sleep, or loss of interest, but they are not the same. Research, indicates that antidepressants do not significantly reduce core grief symptoms such as yearning, loss-specific sadness, or emotional pain related to missing the person.
If a grieving individual shows signs of sustained despair, self-harm, or significant disengagement from daily life, a mental health assessment may be appropriate.
Numbness
Numbness can be a common and often overlooked emotional response within the grief experience.
Feeling emotionally neutral, distant, or detached does not mean the loss has not mattered or that something is wrong.
At times, numbness may reflect the mind and body’s way of creating temporary space until more emotion can be safely processed.
In healthcare settings, this can be especially common, as the demands of the work often require compartmentalizing emotions in order to continue caring for others.
No One Way to Feel
The thing to remember is that anything a person feels inside their own, personal grief journey is correct.
Grief is a multidimensional experience that can include many emotions at once, some of which may feel contradictory. There is no single emotional path through the emotional landscape of grief, and understanding this range can help normalize experiences and support more compassionate responses to ourselves and others.