Core Concepts for Grief-Sensitive Care
The Spectrum of Grief Experiences
Understanding different types of grief can support recognition of what patients, their supporters, and colleagues may be experiencing.
- A loss that lacks clarity or closure.
- Examples: A person with dementia, a child placed in foster care, or a missing person.
- Grief that begins due to an impending loss, before the loss occurs.
- Examples: Degenerative disease, life-limiting diagnosis, or high risk pregnancy.
- Grief shared by a group, community, or society in response to a shared loss or trauma.
- Examples: Natural disasters, mass shootings, or pandemic-related deaths.
- Grief that builds over time due to multiple losses occurring in close succession or without time to process.
- Examples: A provider who loses several patients in a short span, or a person who experiences multiple family deaths.
- Grief that isn’t socially acknowledged or supported. This may occur when the relationship isn’t recognized (e.g., an ex-partner or non-biological parent), the loss isn’t recognized (e.g., miscarriage, pet loss), or the griever isn’t recognized (e.g., children, coworkers). Some types of death, like suicide or overdose, can also lead to disenfranchised grief.
- A deep emotional wound resulting from the actions or inactions of oneself or others that violate one’s moral or ethical beliefs.
- Examples: Feeling complicit in systemic harm, being forced to follow policies that conflict with patient care values, or witnessing suffering without being able to intervene.
- Grief tied to life changes rather than death.
- Examples: Divorce, job loss, loss of function, estrangement.
- A loss that continues or evolves over time.
- Example: Parenting a child with a chronic condition that alters long-term expectations.
- The ripple effects of a primary loss.
- Example: Financial strain, relocation, changes in identity, or loss of social roles following a death.
- Emotional distress resulting from indirect exposure to others’ trauma or suffering.
- Examples: A clinician who experiences intrusive thoughts, sleep disturbances, or emotional numbing after caring for trauma survivors or witnessing repeated medical crises.
- A loss that is dismissed, judged, or met with shame by others.
- Examples: Suicide, homicide, overdose, incarceration.
- A term coined by Dr. Tashel Bordere to describe when grieving individuals, especially from marginalized communities, are punished or silenced for expressing grief. Often misinterpreted as defiance or dysfunction, this grief is pathologized instead of supported.
- Examples: A teen whose anger or withdrawal after a loss is labeled as behavioral rather than recognized as grief, a patient whose expressions of distress after loss are interpreted as noncompliance or hostility.
- Grief that spans generations, often connected to historical trauma, displacement, or systemic oppression.
- Example: The intergenerational impact of forced relocation, genocide, or racial violence.
- Grief that is complicated by the circumstances of the death, especially when the loss is sudden, violent, or perceived as preventable. This type of grief may include symptoms such as intrusive memories, avoidance, or hypervigilance.
- Examples: Deaths due to accidents, suicide, homicide, or medical trauma.
- Grief experienced indirectly, often by witnessing or learning about the suffering or loss of others.
- Examples: A nurse who feels sadness after supporting multiple families through end-of-life care; a social worker who experiences grief after helping a parent navigate the death of a child.
- A cumulative shift in worldview and sense of safety caused by empathetic engagement with others’ traumatic experiences.
- Examples: A clinician who begins to experience intrusive images, sleep disturbance, or a persistent sense that the world is unsafe after repeated exposure to traumatic patient stories; a therapist who finds their beliefs about safety or trust changing after years of working with trauma survivors.
These types of grief are not always distinct or experienced in isolation. A single loss may involve multiple layers, such as moral injury alongside secondary and non death losses. Recognizing how these experiences can intersect may support more nuanced and compassionate care.