Grief and Loss Healing Protocol: The Wound That Opens the Heart

Beyond the Five Stages

Elisabeth Kubler-Ross changed the Western world’s relationship with death. Her 1969 book On Death and Dying introduced the five stages of grief — denial, anger, bargaining, depression, acceptance — and gave millions of people a language for an experience that had been largely unspeakable in modern culture. She was a pioneer, and her contribution is immeasurable.

But the five stages were never meant to be a linear prescription. Kubler-Ross developed them from interviews with terminally ill patients — people facing their own deaths, not the bereaved. She described patterns she observed, not a mandatory sequence. In the decades since publication, the five stages have been widely misunderstood and misapplied, creating a cultural expectation that grief follows a predictable path from denial to acceptance, and that deviation from this path signals failure.

Grief does not follow a path. Grief is the path — unpredictable, non-linear, recursive, and utterly individual. Understanding this is the first step toward healing.

The Dual Process Model: Oscillation as Health

Margaret Stroebe and Henk Schut, researchers at Utrecht University in the Netherlands, proposed the Dual Process Model of Coping with Bereavement (DPM) in 1999, and it remains one of the most empirically supported models of healthy grief.

The DPM describes two orientations that the grieving person oscillates between:

Loss-oriented coping: Focused on the loss itself. This includes grief work in the traditional sense — crying, yearning, reviewing memories of the deceased, processing the pain of separation, confronting the reality that the person is gone. This is the territory of the broken heart.

Restoration-oriented coping: Focused on the practical and psychological changes that follow the loss. This includes adapting to new roles (single parent, sole provider, widow), developing new skills (managing finances, cooking, navigating loneliness), building new identity elements, and engaging with life’s ongoing demands.

The crucial insight of the DPM is that healthy grief oscillates between these two orientations. The bereaved person does not stay in loss-orientation indefinitely (which would be chronic, debilitating grief), nor do they stay in restoration-orientation indefinitely (which would be avoidance of grief). They move between them — sometimes within the same hour.

The oscillation is itself adaptive. It provides natural dosing (the person cannot grieve every waking moment without breaking down, so restoration-orientation provides respite). It prevents the cognitive and emotional depletion that comes from sustained focus on loss. And it ensures that both tasks — mourning the past and building the future — receive attention.

This oscillation often confuses the bereaved and those around them. “I was laughing at dinner with friends last night, and this morning I couldn’t get out of bed.” This is not inconsistency. This is the dual process working as designed.

Continuing Bonds: The Dead Are Not Gone

For most of the twentieth century, Western grief psychology was dominated by Freud’s concept of “grief work” — the idea that the task of mourning was to withdraw emotional energy (cathexis) from the deceased and reinvest it in new relationships. The goal was detachment. Holding on to the deceased was viewed as pathological, as “unresolved grief.”

Dennis Klass, professor emeritus at Webster University, along with Phyllis Silverman and Steven Nickman, challenged this paradigm in their landmark 1996 book Continuing Bonds: New Understandings of Grief. Through cross-cultural research, they demonstrated that maintaining a continuing relationship with the deceased is not only normal but beneficial in many cases.

The bereaved parent who talks to their deceased child, the widow who consults her late husband’s memory when making decisions, the adult who feels their dead grandmother’s presence during a crisis — these are not signs of pathology. They are expressions of an ongoing bond that has transformed from physical presence to symbolic presence.

Continuing bonds are adaptive when they:

• Provide comfort and connection
• Support the bereaved person’s ongoing identity
• Help with decision-making and meaning-making
• Are held flexibly (the person can engage with the bond and also disengage)

Continuing bonds become problematic when they:

• Prevent the bereaved from engaging with life
• Maintain the fiction that the person is not really dead
• Interfere with new relationships
• Are rigidly maintained to avoid the pain of loss

Many Indigenous cultures, including the Q’ero of Peru, the Dagara of West Africa (as described by Malidoma Some), and the Buddhist traditions of East Asia, have always understood what Western psychology is only now catching up to: the dead remain in relationship with the living. The bond transforms. It does not end.

Complicated vs. Uncomplicated Grief

Not all grief follows a natural course. The DSM-5-TR (2022) introduced Prolonged Grief Disorder (PGD) as a diagnostic category, recognizing that for approximately 7-10% of bereaved individuals, grief becomes persistently disabling.

Uncomplicated grief (normal grief) involves intense pain, disrupted functioning, and significant distress that gradually — over months to years — integrates into a new normal. The person continues to miss the deceased but can engage with life, experience pleasure, form new connections, and function in daily roles. The pain does not disappear. It becomes bearable.

Complicated grief (Prolonged Grief Disorder) is characterized by persistent, intense yearning and preoccupation with the deceased that persists beyond 12 months (for adults) and significantly impairs functioning. Hallmarks include:

• Intense, persistent yearning for the deceased
• Preoccupation with the circumstances of the death
• Emotional numbness or inability to experience positive emotions
• Difficulty accepting the reality of the death
• Identity disruption (“I don’t know who I am without them”)
• Avoidance of reminders of the loss, or compulsive proximity-seeking (visiting the grave daily, refusing to change anything in the deceased’s room)
• Marked difficulty engaging with ongoing life

Risk factors for complicated grief include: sudden or violent death, death of a child, pre-existing insecure attachment, history of depression or anxiety, social isolation, multiple concurrent losses, and the nature of the relationship (highly dependent or conflicted relationships carry higher risk).

Treatment for complicated grief typically involves specialized approaches such as Complicated Grief Treatment (CGT), developed by M. Katherine Shear at Columbia University, which combines cognitive-behavioral techniques with attachment-informed interventions.

Disenfranchised Grief: The Losses That Are Not Allowed

Kenneth Doka, professor of gerontology at the College of New Rochelle, introduced the concept of disenfranchised grief in 1989 — grief that is not openly acknowledged, socially validated, or publicly mourned.

Disenfranchised grief occurs when:

• The relationship is not recognized: The death of an ex-spouse, an affair partner, a pet, a therapist, an online friend, a celebrity who shaped your identity.
• The loss is not recognized: Miscarriage, stillbirth, abortion, loss of a dream, loss of a homeland, loss of ability, loss of identity (coming out, divorce, career loss).
• The griever is not recognized: Children (“they’re too young to understand”), elderly people (“they should be over it by now”), people with intellectual disabilities, prisoners.
• The type of death is stigmatized: Suicide, overdose, AIDS-related death, death during illegal activity.
• The manner of grieving is not sanctioned: “You should be over it by now.” “At least they’re not suffering anymore.” “Be strong for the children.”

Disenfranchised grief is doubly painful because it combines the pain of the loss with the isolation of not being allowed to grieve. The person suffers and cannot show it. They mourn and are told they should not.

Healing disenfranchised grief requires, first, the recognition that the grief is real — that it deserves the same respect and space as any “legitimate” loss. Often, this recognition must come from the griever themselves before anyone else will offer it: “This loss matters to me. I am allowed to grieve it.”

Somatic Grief: Where Loss Lives in the Body

Grief is a whole-body experience. It is not merely an emotion experienced in the mind. It is a physiological event with a distinct somatic signature.

The chest: Grief’s primary residence. The heavy, aching, hollow feeling in the chest is not metaphorical. It reflects changes in cardiac function (the “broken heart syndrome” — Takotsubo cardiomyopathy — is a real medical condition in which acute grief causes temporary heart muscle dysfunction), respiratory constriction (grief literally takes the breath away), and fascial tension in the pericardium and thoracic diaphragm.

The throat: The lump in the throat during grief is the cricopharyngeal muscle contracting — the body’s attempt to hold back the cry. Chronic suppression of grief can produce chronic throat tension, difficulty swallowing, and vocal constriction.

The belly: The gut as emotional brain (the enteric nervous system contains approximately 500 million neurons and produces 95% of the body’s serotonin) responds to grief with nausea, loss of appetite, digestive disruption, and the deep, visceral ache of separation distress.

The eyes: Tears of grief have a different chemical composition than tears of irritation. Emotional tears contain higher concentrations of stress hormones (cortisol, ACTH) and natural painkillers (leucine enkephalin). Crying is literally a detoxification process.

The limbs: Grief can produce heaviness, weakness, and the sensation that the body is too heavy to move. This is dorsal vagal shutdown — the collapse response activated by overwhelming loss.

Somatic grief practices:

• Place a hand on the chest and breathe into the space beneath it. Let the chest expand. Make room for the grief without trying to fix it.
• Open the throat by humming, then letting the hum become sound, then letting the sound become whatever it wants — a moan, a cry, a wail. Controlled vocal expression of grief is one of the most powerful release mechanisms.
• Rock the body gently, as one would rock a child. This bilateral rhythmic movement engages the ventral vagal system and provides self-soothing.
• Move the body. Walk. Dance. Swim. Grief is immobilizing, and movement is its physiological antidote — not to escape the feeling, but to prevent the freeze response from becoming chronic.

Rituals for Grief

Every human culture has developed grief rituals, and every grief therapist knows why: ritual provides a container for an experience that otherwise feels unbounded and overwhelming.

Fire ceremony: Write the name of the deceased, or a letter to them, on a piece of paper. Burn it in a fire or candle flame. Watch the smoke rise. This is not destruction — it is transformation. The Andean tradition of despacho (offering ceremony) includes this element, releasing grief to the fire as an offering to Pachamama.

Altar creation: Dedicate a small space to the deceased. Place their photo, a meaningful object, a candle. Visit it daily. Speak to them. This is the material expression of continuing bonds.

Anniversary ritual: On significant dates (death anniversary, birthday, holiday), create intentional space for grief. This can be as simple as lighting a candle and sitting in silence, or as elaborate as preparing the deceased’s favorite meal and sharing it with loved ones.

Water ritual: Grief and water are ancient companions. Crying is the body’s water ritual. Bathing, swimming, or sitting by moving water can support the grief process. In the Dagara tradition of West Africa, as described by Malidoma Patrice Some in The Healing Wisdom of Africa (1998), grief rituals involve water — the element of reconciliation and emotional release.

Community grief: Grief shared is grief that can be borne. The Irish wake, the Jewish shiva, the New Orleans second line, the Dagara grief ritual — all create communal space where grief is witnessed, shared, and held by the collective.

Anticipatory Grief and Collective Grief

Anticipatory grief is the grief that begins before the loss occurs — during a terminal diagnosis, during the slow decline of dementia, during the disintegration of a relationship, during the approach of a major life transition. It is real grief, not premature grief. It deserves the same respect and support.

Collective grief — the grief of a community, a nation, or a species — has become increasingly relevant. The collective grief of a pandemic. The ecological grief (sometimes called solastalgia) of witnessing environmental destruction. The ancestral grief carried in the body from generations of oppression, displacement, and cultural erasure. These are not abstract concepts. They are felt in the body, transmitted through epigenetic mechanisms (research by Rachel Yehuda at Mount Sinai demonstrated epigenetic changes in the children of Holocaust survivors), and embedded in cultural memory.

Healing collective grief requires collective processes. Individual therapy is necessary but not sufficient. What is needed is what the Dagara call “community grieving” — ritual spaces where a people can come together and allow their collective sorrow to move through them, witnessed and held by the group.

The Grief That Heals

There is a grief that breaks you and a grief that opens you. The difference is not in the loss — it is in the relationship to the loss.

Grief that breaks you is grief that is resisted, suppressed, isolated, rushed, or judged. It hardens into depression, bitterness, chronic pain, or numbness. It becomes a wall between you and life.

Grief that opens you is grief that is felt, expressed, shared, ritualized, and allowed to take the time it takes. It softens the heart rather than hardening it. It deepens empathy rather than narrowing it. It reveals, beneath the rubble of what was lost, the bedrock of what cannot be lost — the capacity to love, which is the capacity to grieve, which is the capacity to be fully human.

The Jaguar of the West does not flinch from loss. She has “stepped beyond death” not by avoiding it but by walking through it with open eyes. She knows that every loss is a doorway — not to a better place (spiritual bypassing) but to a deeper place, a more honest place, a place where the heart is broken open rather than broken apart.

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What grief have you been carrying that is waiting for your permission to be fully felt?