Loss is an inevitable part of life.

However, although some losses may be understood and accepted as normal, necessary to the healthy process of growth and development, others may present us with a far greater challenge.

Whilst most would regard the loss of childhood's naivety as the normal and necessary cost of life experience and maturation, other losses, especially those suffered outside of life's natural process, are often much harder to come to terms with.

These losses may present a greater challenge due to their perceived abnormal or unnecessary nature. Other losses, despite their apparent 'normality', may still present to us substantial obstacles. The extent of the disruption to our lives that such losses incur may be profound and enduring.

Normal loss and grief

Whether we are bereaved by the loss of a significant person in our life, the loss of a significant role, or the loss of health, we are left bereft of the meaning that that relationship with life, others and the world provided to us and the value we derived from it. It is at this point that we commence the process of grieving for our loss.

As the writer and academic Rachel Naomi Remen noted: "Grieving allows us to heal, to remember with love rather than pain". When we suffer significant loss, we inevitably experience grief in some form. In the normal process of grieving we adapt over time to the loss suffered and are enabled to functionally accommodate the changes wrought by the loss and to effectively proceed with our lives.

The normal grief reaction to significant loss is composed of a number of phenomena which we may experience to differing extents and intensities and for greater or lesser periods of time following loss, depending upon the nature of the bereavement suffered.

Our experience of grief, most particularly in the initial weeks following loss, may often resemble that of depression. There are, though, distinct and fundamental differences between the normal process of grieving and a depressive episode. Those in early-stage grief will often suffer intense sadness, related low mood and motivation loss, and possibly sleep and appetite disturbance, such as may be present in depression. Those grieving tend not, though, to experience severely and/or persisting disrupted sleep, low energy, significant changes in their eating pattern or other significant physiological symptoms. Neither will the grieving individual commonly suffer with the distressing and persistent self-critical narratives and suicidal thoughts that may be experienced by those in severe depression.

What is complicated grief?

It is an unfortunate fact, however, that some of us who do suffer significant loss find also that they experience depression as a consequence of that loss. There are many factors that may dispose the bereaved to developing depression through what is termed complicated grief. These may relate to the circumstances of the loss, the relationship with the deceased, the individual's life experiences, their emotional resilience and coping skills, social support, and concurrent life stressors.

The following are common symptoms that we may still experience many months or even years after a significant loss has occurred, as a consequence of complicated grief:

• We find ourselves unable to refer to the deceased, circumstances or nature of the loss without significant distress, usually we will become tearful.
• We often refer to or reflect upon historic loss in such a way as to suggest that it remains experienced by us as possessing contemporary power. Common phrases are still not being able to "cope" with or "get over" the loss, or that we still "cannot believe" it has happened.
• We still find significant difficulty in talking about aspects of the loss and recall not having felt able to seek support or to talk about the loss with friends or family members at the time it occurred.
• We recurrently find ourselves experiencing the 'presence' of the deceased, hear our name called by the deceased, see the deceased in a crowd, pick up the phone to call the deceased, or momentarily expecting the deceased to be the reason for the phone ringing or there being a knock at the door.
• We experience an exaggerated and distressing reaction to witnessing other loss or trauma events that should normally be expected to have a limited or transient impact.
• We notice ourselves dwelling not only upon our own loss but also upon the losses of others and the theme of loss in general.
• We have hoarded the deceased's possessions or objects related to our loss or the opposite, immediately removed all reminders of the deceased or loss.
• We significantly overvalue certain of the deceased's possessions or other objects related to our loss, often reflecting to ourselves or others, "I don't know what I'd do if I lost that!"
• We experience unexplained physical symptoms that may resemble the cause of death of the deceased or other health or physical characteristics relating to them.
• We are preoccupied with anniversaries relating to the loss and may suffer a worsening of our depression symptoms at those times.
• We have undergone significant personality change or imitation of the deceased's behaviour since the loss - something that may also have been remarked upon by others.
• We suffer with phobia or panic symptoms related to the illness or circumstances contributory to the death of the deceased and with onset around the time of the loss.