grief grief grief is the response to loss, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. while the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss. griefother namesmourning; grieving; bereavementpronunciation/ɡɹiːf/ specialtypsychology treatmentpastoral care, mental health professionals, social workers, support groups part of a series onemotions affect classification in animals emotional intelligence mood regulation interpersonal dysregulation valence emotions acceptance admiration affection amusement anger angst anguish annoyance anticipation anxiety apathy arousal awe boredom confidence confusion contempt contentment courage curiosity depression desire disappointment disgust distrust doubt ecstasy elevation embarrassment empathy enthusiasm envy euphoria faith fear frustration gratification gratitude greed grief guilt happiness hatred hope horror hostility humiliation interest jealousy joy kindness limerence loneliness love lust nostalgia outrage panic passion pity pleasure pride rage regret rejection relief remorse resentment sadness saudade schadenfreude self-pity shame shock shyness social connection sorrow suffering surprise suspicion trust wonder worry the grief associated with death is familiar to most people, but individuals grieve in connection with a variety of losses throughout their lives, such as unemployment, ill health or the end of a relationship. loss can be categorized as either physical or abstract; physical loss is related to something that the individual can touch or measure, such as losing a spouse through death, while other types of loss are more abstract, possibly relating to aspects of a person's social interactions. grieving process between 1996 and 2006, there was extensive skepticism about a universal and predictable "emotional pathway" that leads from distress to "recovery" with an appreciation that grief is a more complex process of adapting to loss than stage and phase models have previously suggested. the two-track model of bereavement, created by simon shimshon rubin in 1981, is a grief theory that provided a deeper focus on the grieving process. the model examines the long-term effects of bereavement by measuring how well the person is adapting to the loss of a significant person in their life. the main objective of the two-track model of bereavement is for the individual to "manage and live in reality in which the deceased is absent" as well as returning to normal biological functioning. track one is focused on the biopsychosocial functioning of grief. this focuses on the anxiety, depression, somatic concerns, traumatic responses, familial relationships, interpersonal relationships, self-esteem, meaning structure, work, and investment in life tasks. rubin (2010) points out, "track 1, the range of aspects of the individuals functioning across affective, interpersonal, somatic and classical psychiatric indicators is considered". all of the terms listed above are noted for the importance they have in relation to people's responses to grief and loss. a grief-stricken american soldier is comforted by a fellow soldier after a friend is killed in action during the korean war. the significance of the closeness between the bereaved and the deceased is important to track 1 because this could determine the severity of the mourning and grief the bereaved will endure. this first track is the response to the extremely stressful life events and requires adaptation along with change and integration. the second track focuses on the ongoing relationship between the griever and the deceased. track two mainly focuses on how the bereaved was connected to the deceased, and on what level of closeness was shared. the two main components considered are memories, both positive and negative, and emotional involvement shared with the decedent. the stronger the relationship to the deceased, the greater the evaluation of the relationship with heightened shock. any memory could be a trigger for the bereaved, the way the bereaved chose to remember their loved ones, and how the bereaved integrate the memory of their loved ones into their daily lives. ten main attributes to this track include: imagery/memory, emotional distance, positive effect, negative effect, preoccupation with the loss, conflict, idealization, memorialization/transformation of the loss, impact on self-perception and loss process (shock, searching, disorganized). an outcome of this track is being able to recognize how transformation has occurred beyond grief and mourning. by outlining the main aspects of the bereavement process into two interactive tracks, individuals can examine and understand how grief has affected their life following loss and begin to adapt to this post-loss life. the model offers a better understanding with the duration of time in the wake of one's loss and the outcomes that evolve from death. by using this model, researchers can effectively examine the response to an individual's loss by assessing the behavioral-psychological functioning and the relationship with the deceased. the authors from what's your grief?, litza williams and eleanor haley, state in their understanding of the clinical and therapeutic uses of the model: in terms of functioning, this model can help the bereaved identify which areas of his/her life has been impacted by the grief in a negative way as well as areas that the bereaved has already begun to adapt to after the loss. if the bereaved is unable to return to their normal functioning as in before loss occurred, it is likely they will find difficulty in the process of working through the loss as well as their separation from the deceased. along the relational aspect, the bereaved can become aware of their relationship with the deceased and how it has changed or may change in the future (williams & haley, 2017). "the two-track model of bereavement can help specify areas of mutuality (how people respond affectivity to trauma and change) and also difference (how bereaved people may be preoccupied with the deceased following loss compared to how they may be preoccupied with trauma following the exposure to it)" (rubin, s.s, 1999). while the grief response is considered a natural way of dealing with loss, prolonged, highly intense grief may at times become debilitating enough to be considered a disorder. reactions a family mourns during a funeral at the lion's cemetery during the siege of sarajevo in 1992. crying is a normal and natural part of grieving. it has also been found, however, that crying and talking about the loss is not the only healthy response and, if forced or excessive, can be harmful. responses or actions in the affected person, called "coping ugly" by researcher george bonanno, may seem counter-intuitive or even appear dysfunctional, e.g., celebratory responses, laughter, or self-serving bias in interpreting events. lack of crying is also a natural, healthy reaction, potentially protective of the individual, and may also be seen as a sign of resilience. science has found that some healthy people who are grieving do not spontaneously talk about the loss. pressing people to cry or retell the experience of a loss can be damaging. genuine laughter is healthy. when a loved one dies, it is not unusual for the bereaved to report that they have "seen" or "heard" the person they have lost. most people who have experienced this report feeling comforted. in a 2008 survey conducted by amanda barusch, 27% of respondents who had lost a loved one reported having had this kind of "contact" experience. bereavement science grief can be caused by the loss of one's home and possessions, as occurs with refugees. bonanno's four trajectories of grief george bonanno, a professor of clinical psychology at columbia university, conducted more than two decades of scientific studies on grief and trauma, which have been published in several papers in the most respected peer-reviewed journals in the field of psychology, such as psychological science and the journal of abnormal psychology. subjects of his studies number in the several thousand and include people who have suffered losses in the u.s. and cross-cultural studies in various countries around the world, such as israel, bosnia-herzegovina, and china. his subjects suffered losses through war, terrorism, deaths of children, premature deaths of spouses, sexual abuse, childhood diagnoses of aids, and other potentially devastating loss events or potential trauma events. in bonanno's book, the other side of sadness: what the new science of bereavement tells us about life after a loss, he summarizes his research. his findings include that a natural resilience is the main component of grief and trauma reactions. the first researcher to use pre-loss data, he outlined four trajectories of grief. bonanno's work has also demonstrated that absence of grief or trauma symptoms is a healthy outcome, rather than something to be feared as has been the thought and practice until his research. because grief responses can take many forms, including laughter, celebration, and bawdiness, in addition to sadness, bonanno coined the phrase "coping ugly" to describe the idea that some forms of coping may seem counter intuitive. bonanno has found that resilience is natural to humans, suggesting that it cannot be "taught" through specialized programs and that there is virtually no existing research with which to design resilience training, nor is there existing research to support major investment in such things as military resilience training programs. the four trajectories are as follows: resilience: "the ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning" as well as "the capacity for generative experiences and positive emotions". recovery: when "normal functioning temporarily gives way to threshold or sub-threshold psychopathology (e.g., symptoms of depression or post-traumatic stress disorder, or ptsd), usually for a period of at least several months, and then gradually returns to pre-event levels". chronic dysfunction: prolonged suffering and inability to function, usually lasting several years or longer. delayed grief or trauma: when adjustment seems normal but then distress and symptoms increase months later. researchers have not found evidence of delayed grief, but delayed trauma appears to be a genuine phenomenon. five stages theory the kübler-ross model, commonly known as the five stages of grief, is a theory first introduced by elisabeth kübler-ross in her 1969 book, on death and dying. based on the uncredited earlier work of john bowlby and colin murray-parkes, kübler-ross actually applied the stages to persons who were dying, not persons who were grieving. her studies involved her work with the terminally ill. the popular but empirically unsupported model describes in five distinct stages how people deal with their impending death. the five stages are: denial anger bargaining depression acceptance the theory holds that the stages are a part of the framework that helps people learn to live without what they have lost. the stages model, which came about in the 1960s, is a theory based on observation of people who are dying, not people who experienced the death of a loved one. this model found limited empirical support in a study by maciejewski et al. that is that the sequence was correct although acceptance was highest at all points throughout the persons experience. the research of george bonanno, however, is acknowledged as debunking the five stages of grief because his large body of peer-reviewed studies show that the vast majority of people who have experienced a loss are resilient and that there are multiple trajectories following loss. physiological and neurological processes "pietà" by el greco, 1571–1576. philadelphia museum of art grief in art: grave statue at vienna central cemetery studies of fmri scans of women from whom grief was elicited about the death of a mother or a sister in the past 5 years resulted in the conclusion that grief produced a local inflammation response as measured by salivary concentrations of pro-inflammatory cytokines. these responses were correlated with activation in the anterior cingulate cortex and orbitofrontal cortex. this activation also correlated with the free recall of grief-related word stimuli. this suggests that grief can cause stress, and that this reaction is linked to the emotional processing parts of the frontal lobe. activation of the anterior cingulate cortex and vagus nerve is similarly implicated in the experience of heartbreak whether due to social rejection or bereavement. among those persons who have been bereaved within the previous three months of a given report, those who report many intrusive thoughts about the deceased show ventral amygdala and rostral anterior cingulate cortex hyperactivity