What You’ll Learn1. Identify causes of loss and

grief. (p. 123)2. Identify symptoms of loss and

grief. (p. 124)3. Identify the five stages of loss

and grief. (p. 124)4. Discuss healthful ways to

respond when someone closeto you is dying. (p. 126)

5. Discuss healthful ways torespond when someone youknow is grieving a loss. (p. 126)

6. Discuss healthful ways torespond when you are grievinga loss. (p. 128)

Why It’s ImportantNo one goes through life withoutexperiencing loss. But, loss is anopportunity to respond by beingcaring and compassionate. It is anopportunity for each of us toreach out to one another.

k Key Terms• loss• grief• anticipatory grief• out-of-order death• invincible• empathy• five stages of loss and grief

12

Matt Meadows

Writing About Grief Suppose that your friend’s sister just died in acar accident. Your friend does not want to talk to anyone about it. In fact,she pretends it never happened. Your friend’s mother is concerned abouther, because she does not sleep more than a few hours each night. Yourfriend is constantly doing something to keep herself busy. After readingthe information about dealing with a loss on page 126, write a responseto this situation in your health journal.

122 UNIT 2 • Mental and Emotional Health

Dealing with Lossand Grief

• I will cope with loss and grief in healthful ways.

There are times in life when you have no control over events thatoccur. Something may end before you are ready for it to end.Something may happen to someone you know or to you. Although

you might not control the event, you can control the response to the event.This lesson focuses on loss and grief. You will learncauses of loss and grief that teens might experience.You will learn about the five stages of loss andgrief. You also will learn how to res-pond to loss and grief in a healthful way.

The feeling that occurs when someone dies or a life situation changes or ends is loss.

Intense emotional suffering caused by a loss, disaster, or misfortune is grief.

Grief experienced prior to a loss is anticipatory grief. It is the feelings a person has

when he or she knows someone or something that is cherished or valued is about to die or

change. No one goes through life without experiencing loss and grief.

What to Know About Loss and GriefCauses of Loss and GriefThe causes of loss and grief include achange in the family, changes in liv-ing conditions, the death of a friend,suicide, the death of a well-knownperson, tragedies in the news, andthe loss of special belongings.

Changes in the family Some familychanges that cause feelings of lossand grief might include: death of afamily member, divorce of parents,serious or terminal illness, or deathof a family pet.

Changes in living conditions A changein living conditions can trigger feel-ings of loss and grief. A family mem-ber might lose a job or temporarilybe laid off. The company the personworked for might close. There mightbe changes in economic conditionslocally or nationally. As a result, afamily’s lifestyle might change. Afamily may go from having an incomethat allowed them to live comfortablyto being strained financially. Theymay no longer be able to afford theirhouse payments, and may have tomove into a smaller house or anapartment. In severe situations, afamily might be evicted from theirhouse, apartment, or trailer, and may

become homeless or live in a shelter.Teens experience loss when theseevents take place. They grieve theselosses. They might feel angry anddepressed. Homelessness andpoverty are major risk factors forteen depression.

Death of a friend The death of afriend is very traumatic. It is espe-cially difficult when the friend issomeone your age or younger. Out-of-order death is the death of a per-son that occurs at an unexpectedtime in his or her life cycle. Out-of-order death is traumatic. You grievethe loss of a friend and at the sametime realize that you are not invinci-ble. To view oneself as incapable ofbeing harmed is to think you areinvincible. If a teen dies in an auto-mobile accident or from a terminalillness, then you realize that thiscould happen to you. You come face-to-face with your own mortality.

Suicide A suicide is the intentionaltaking of one’s own life. When a sui-cide or several suicides (known ascluster suicides) occur, it is especiallydifficult for someone your age. Youmight wonder if you could have doneanything to prevent the suicide(s).

LESSON 12 • Dealing with Loss and Grief 123Photodisc/Getty Images

Make theConnectionSuicide For moreinformation onsuicide, see page 114in Lesson 11.

healthmh.com/loss

You might feel guilty because you arestill alive. You might become angrybecause someone about whom youcared made this choice. You mightfeel sad and depressed. Most commu-nities and schools offer counselingwhen teen suicide occurs. Teens needto talk through their feelings of grief.

Death of a well-known person Mostlikely, you have seen the reaction ofthe public to the death of a well-known person. This might be a politi-cian, actress, actor, sports figure, orother person that the public hasgrown to know and love. Even thoughyou do not know someone personally,you might experience loss or griefwhen a person dies. You imaginewhat it might be like to be a familymember of the person. You feel theirsense of grief and loss.

Tragedies in the news Most likely,you watched the extensive news cov-erage of the tragedies that occurredon September 11, 2001. You mighthave watched news coverage of wars,murders, terrorist bombings, torna-does, floods, or earthquakes. Theseevents can trigger feelings of loss andgrief. You value human life and aresaddened when life and property arelost. You have empathy for peoplewho are affected by loss or death.

Empathy is the ability to share inanother person’s emotions or feelings.Your empathy for others can causeyou to experience loss and grief.

The end of something special Did youknow that you also might experienceloss and grief when something ends?For example, one day you will gradu-ate from high school. This will end aperiod of your life that has been special. Even though you look for-ward to your future, you may havefeelings of grief and loss. You are sadthat you are leaving your school andyour friends. Your parents orguardian might experience a similarloss when you move away from home.They experience emptiness becauseyou are not there. They long for thedays when you lived together andshared daily events. Yet, they lookforward to sharing new opportunitieswith you.

The Five Stages of Loss and GriefWhat happens when teens experi-ence loss and grief? Teens will expe-rience a variety of emotions thatmust be worked through before theycan accept what has happened to them.

The five stages of loss and griefare psychological stages of grievingthat include denial, anger, bargain-ing, depression, and acceptance.Refer to page 109 in Lesson 11 fordefinitions of the stages.

The amount of time you mightspend in each stage of loss and griefwill vary. You might backslide. Forexample, you might work throughyour feelings and gain acceptance,only to backslide to feeling depressed.

Holidays Feelings ofloss and grief canintensify duringholidays.

Symptoms of Loss and GriefSymptoms of loss and grief include the following:

• numbness• shock• loss of appetite• intestinal upsets• sleep disturbances• loss of energy

• shortness of breath• confusion• crying spells• moodiness• outbursts of anger• depression

124 UNIT 2 • Mental and Emotional Health

1. What isanticipatory grief?

2. What are threecauses of loss and grief?

3. What are the fivestages of loss and grief?

Mini-Review

Or you might skip one stage andmove to the next stage. Some teensget stuck in one of the five stages ofloss and grief. Teens who becomestuck in one of the five stages of lossand grief usually need help. Theseteens are unable to deal with the losson their own. Therapists can helpteens work through their feelings.

Dealing with a terminal illness Thefive-step grieving process can beillustrated by the example of peoplewith terminal illnesses. If people aretold by a doctor that they have a ter-minal illness, they may first refuse tobelieve that they are dying. They pre-tend that the information the doctortold them is wrong.

The second stage is anger. Peoplewith a terminal illness in this stagemay direct their anger at their fam-ily, friends, physicians, or other med-ical professionals.

Anger can turn into bargaining.People who are dying try to avoiddeath by making deals and prom-ises. When they realize bargainingwill not change the outcome, theybecome depressed. Once a personwho is terminally ill accepts thathe or she is dying, he or she beginsto say goodbye, share special feel-ings and thoughts with lovedones, and tries to enjoy theremainder of his or her life.

Different people may spend dif-ferent amounts of time in each ofthe stages. Some people progressthrough the stages, while othersget stuck or go backward. Familymembers and friends of peoplewith terminal illnesses may gothrough similar stages of loss and grief.

Drug and Alcohol Use and Loss and Grief

When a person suffers a loss, whether it is the death of a closefriend or a move to a new location, he or she will commonly havefeelings of grief.

Some people might self-medicate in an attempt to feel better or toescape the feelings of grief. Using alcohol or other drugs as acoping mechanism for feelings of grief is not a solution. Althoughthese substances might produce a temporary feeling of relief, thesesubstances will not help a person get through the grieving process.The feelings of grief remain after the effects of the drugs have wornoff. In many cases, these substances actually may make a personfeel worse, emotionally and physically, after their use.

Positive ways to cope with grief include talking about your feelingswith people whom you trust. Expressing your feelings in writing,such as keeping a journal, can help as well. Grief counseling with aprofessional counselor or therapist also can be helpful for someonewho is struggling with the grieving process.

Visit for moreinformation on how to deal with grief.

LESSON 12 • Dealing with Loss and Grief 125

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Gender and race of people included in projectionAlcohol abuse

Source: National Institutes of Health, 2000

Alcohol dependence Total alcohol abuse and alcohol dependence

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Analyzing GraphsStudy the graph above and answer these questions.

1. Which group is projected to have the greatest number of peoplewith alcohol dependence?

2. Which group is projected to have the least number of peopleabuse alcohol?

Projections of Alcohol Abuse and Dependence in the U.S.

healthmh.com/grief

healthmh.com/loss

The response to loss and grief differs based on

who we are, whom or what we have lost, and

how much our day-to-day life is changed. The

following information provides guidelines for responding

when someone close to you is dying, when someone

whom you know is grieving a loss, and when you are

grieving a loss. Remember, everyone responds to loss

and grief in his or her own way. If you have questions

about your responses or those of someone else, talk to

your parent, guardian, mentor, or other trusted adult.

Healthful Ways to Respond to a LossWhen someone close to you is dyingWhen this happens, both you and theperson who is dying experience antic-ipatory grief. The person who is dyinggrieves the loss of his or her life. Yougrieve the loss of the person you careabout or love. The time you have leftto be together and share becomesvery special. You can make wise useof the precious moments you have.

Suppose the person about whom

you care is in a coma. The time youhave left to be together and share isvery important. Frequent visits maybe helpful to you and to the personwho is dying. Many people who havecome out of a coma remember wordsspoken to them. They also rememberbeing comforted. You might hold this person’s hand and speak to himor her. Expressing your feelings canhelp you and the person who is in a coma.

When someone you know is grieving aloss You may know someone who isgrieving the loss of a close friend orloved one. You also can comfort thisperson. Make yourself available.Remember, friends support oneanother during difficult times.Another way to comfort the person isto do something thoughtful for theperson. You might send a card or callthe person. You might offer to helpthe person with meals or errands.You can show your support for some-one who is grieving by attendingmemorial services, with permissionof your parents or guardian.

Make theConnection

Listening Skills Formore information onusing active listeningskills, see page 41 in Lesson 5.

126 UNIT 2 • Mental and Emotional Health

What to Do if Someone You Know is Dying

• Spend time with the friend orfamily.

• Share your loving feelingsand memories.

• Share your feelings of lossand pain.

• Encourage the person to talkabout his or her death.

• Listen carefully to the person’sfeelings and thoughts aboutthe past, present, and future.

• Reassure the person withaffection, hold hands, or hug.

• Share your grief with familymembers and friends.

• Continue your daily routine ifpossible.

• Consider what you will do tokeep alive the memory of theperson.

• Allow yourself time to grieve.

There are many ways you can show your love for someone who is dying:

Photodisc/Getty Images

LESSON 12 • Dealing with Loss and Grief 127John Henley/CORBIS

LOSS AND GRIEF

The FACTS There are no rules about grieving and no“right”way to grieve. Each person experiences grief in his or her own way.Trying to behave according to the expectations of others during thisdifficult time only adds more stress to the situation. Some people suffergreatly, but they might express their feelings through art, writing, exercise,or another outlet. Other people, especially teenagers, might enter a state ofdenial and feel numb for weeks or months after a death or another loss. Asthe numbness fades, they may need support as they deal with their feelings.

The FACTS This myth is the opposite of the first one—and justas hurtful. Crying is a healthful way to express emotions and helps to releasebottled-up tension. Trying too hard to control painful emotions can blockhealing and make the process take longer. At the same time, there is no“correct” schedule for grieving. People let go of a loved one or pet or recoverfrom another loss in different ways and are ready to let go at different times.

The FACTS Talking about a loss helps people begin toaccept the new reality. If you know people who are grieving, encouragethem to tell you about the loss, including what happened, when itoccurred, how they reacted, and how they feel now. Invite them to sharetheir memories of the person or pet. If everyone avoids the subject andpretends that nothing happened, a grieving person feels alone. He or shemay think that no one else cared about the individual or pet who is gone.The grieving person also may begin to think that something is wrong withhim or her because only he or she feels sad about the loss. This isolationcan add to the person’s grief.

“If a person doesn’t cry, ishe or she really grieving?”

“Are people who cry afterlosing a loved one––or even a

pet—weak?”

“Does talking about a lossonly make things worse?”

Have empathy for the person’s loss.Do not lessen the loss by makingstatements such as, “She would havewanted it this way,” or “He is in a bet-ter place now.” Instead say, “I amsorry you feel sad. I am here to sup-port you.” If you knew the person whohas died, you can talk about goodmemories you have of that person.Often, it helps people who are griev-ing to know that others remembertheir loved one. It can also comfortthem if you help them remember goodtimes with their friend or loved one.

Encourage the person to talk abouthis or her grief, and be able to recog-nize signs of grief that are not health-ful. A person who remains severelydepressed or who relies on alcohol orother drugs may need help. Tell aresponsible adult if you notice suchbehaviors.

Remember that people deal with aloss in different ways. Some peoplegrieve publicly, while others prefer togrieve privately. Some people grievefor longer periods of time than others.Some people prefer to recall funnymemories about a loved one, whileothers may need time to deal withtheir feelings before they can do this.

When a loved one isdying, it is important tospend time with him orher, and express yourloving feelings.

There are many things people do when grieving a loss. Some people turn to unhealthy

outlets for their grief. However, there are many healthful ways to deal with grief. You

can manage grief in a healthful way.

mhhealth.com/drugs128 UNIT # • TitleDigital Vision/Getty Images

1. Talk with your parent, guardian, mentor orother trusted adult.

2. Ask your friends and family members to com-fort and support you.

3. Have someone stay by your side for a period oftime if you prefer to not be alone.

4. Give yourself time to grieve, including some“alone time.”

5. Express your feelings in healthful ways.

• Give yourself permission to cry.

• Use I-messages to express feelings (Lesson5, page 41).

• Use anger-management skills if you areangry (Lesson 10, page 98).

• Use strategies for coping with depression tohelp with your sadness (Lesson 11, page117).

• Write your feelings in a grief journal. Writingabout feelings helps relieve sadness anddepression.

6. Maintain a normal schedule and routine asmuch as possible.

• Return slowly to your normal activities anddaily routine to avoid becoming too tired.

7. Protect your health.

• Physical activity will relieve tension and willgive you a feeling of well-being. Physicalactivity can also help you deal with angryfeelings and frustration.

• Moderate your intake of sugar and caffeine.Eat a healthy, balanced diet. This reducesstress.

• Maintain your normal sleep and rest sched-ule. Go to bed when you normally wouldsleep. Wake up when you normally wouldwake up. Avoid napping when you normallywould be awake.

• Use breathing techniques. Inhale with slowdeep breaths through your nose. Slowlyexhale through the mouth. Repeat four orfive times.

• Avoid harmful behaviors as ways of coping.For example, do not smoke, drink alcohol, oruse other harmful drugs.

8. Seek professional help if you are unable tomake adjustments or have lingering anger anddepression.

• Call a crisis hotline, or make an appointmentto see a counselor. See a psychologist to talkabout your feelings. You might need to betreated for depression.

GRIEFAdvocating for Health Every day on the

national news, there is a report about someone or a group of peoplewho have experienced a traumatic event in which a loved one was lost.How are they dealing with their loss? Create a pamphlet that explainshow they can deal with their grief in healthy ways.

128 UNIT 2 • Mental and Emotional Health

Taking time to grieve willhelp you deal with a loss.Spending time alone doingactivities you enjoy canhelp you work throughyour feelings.

12STUDY

GUIDE

k Key Terms ReviewComplete the fill-in-the-blank statements with the lesson Key Terms on the left. Do not write in this book.

Critical Thinking

1. A(n) is the death of a person thatoccurs at an unexpected time in his or herlife.

2. is the ability to share in anotherperson’s emotions or feelings.

3. is the feeling that occurs whensomething ends.

4. is grief experienced prior to a loss.

5. The are psychological stages ofgrieving that include denial, anger, bar-gaining, depression, and acceptance.

6. To think you are is to view oneselfas incapable of being harmed.

7. Intense emotional suffering caused by aloss, disaster, or misfortune is called

._____

_____

_____

_____

_____

_____

_____

8. What are some causes of loss and grief inteens?

9. What are the five stages of grief?

10. How might you respond in a healthful waywhen someone close to you is dying?

11. How might you respond in a healthful waywhen someone you know is grieving a loss?

12. What are healthful ways to grieve a loss?

13. Why might teens grieve when a well-known person dies?

14. What is the difference between grief andanticipatory grief?

15. How do tragedies in the news trigger feelings of loss and grief?

16. Why does drug or alcohol use not help aperson respond to a loss?

17. Does a teen who does not cry grieve asmuch as one who does if the two experienced the same loss? Explain.

18. Why is talking about a loss important?

anticipatory griefempathy five stages of loss

and griefgriefinvinciblelossout-of-order deathsuicide

19. Why would getting stuck in one of the firstfour stages of loss and grief be harmful toone’s health?

20. Why might a person experience shortnessof breath, loss of appetite, or intestinalupsets after experiencing a loss?

21. Does grieving always involve all five stagesof loss and grief? Explain.

22. Why might feelings of loss or grief intensifyduring the holidays?

Real-Life Applications23. Why do you think an out-of-order death is

traumatic?

24. Why might a person with a serious illnessrespond by bargaining?

25. Why do you think some teens feel they areinvincible?

26. What are some causes of out-of-orderdeaths in teens? How could the risk ofsome of those causes be reduced?

Activities

LESSON 12 • Study Guide 129Matt Meadows

Visit healthmh.com/study_guide for more review questions.

Recalling the Facts

Responsible Decision Making27. Role-Play A teen’s grandmother is ter-

minally ill. The teen tells you he is uncom-fortable visiting her because he knows sheis dying and does not want to see her. Pairup with a classmate for role-play. Refer tothe Responsible Decision-Making Model onpage 61 for help.

Sharpen Your Life Skills28. Comprehend Health Concepts

The five stages of grief may be experiencedwhen a person has a loss. Select a situa-tion, other than death, which causes a per-son to grieve. Write an essay explainingwhat a person in this situation experiencesbased on the five stages of grief.

2STUDY

GUIDE

k Key Terms ReviewMatch the following definitions with the correct Key Terms. Do not write in this book.

a. good character (p. 75)

b. empathy (p. 124)

c. grief (p. 123)

d. life crisis (p. 109)

e. loss (p. 123)

f. mental disorder (p. 89)

g. mind-body connection(p. 95)

h. personality (p. 83)

i. resiliency (p. 118)

j. self-respect (p. 74)

k. stress (p. 100)

l. stress-management skills(p. 104)

130 UNIT 2 • Mental and Emotional Health

1. an individual’s unique pattern of characteristics

2. the feeling that occurs when something changes or ends

3. techniques used to prevent and deal with stress to protect one’s health

4. a person’s use of self-control to act on responsible values

5. an experience that causes a high level of stress

6. intense emotional suffering caused by a loss, disaster, or misfortune

7. a high regard for oneself because one behaves in responsible ways

8. the relationship between a person’s thoughts, emotions, and body responses

9. the ability to adjust, recover, bounce back, and learn from difficult times

10. a mental or emotional condition that makes it difficult for a person to live in a normal way

Recalling the Facts11. What is a value? (Lesson 8)

12. What are actions that show self-respect? (Lesson 8)

13. What is codependence? (Lesson 9)

14. What are signs of addiction? (Lesson 9)

15. What are signs of hidden anger? (Lesson 10)

16. What are the three stages of general adaptation syndrome? (Lesson 10)

17. What are symptoms used to diagnose depression? (Lesson 11)

18. What are warning signs that indicate a teen might make a suicide attempt? (Lesson 11)

19. What are symptoms of loss and grief? (Lesson 12)

20. What are the five stages of loss and grief? (Lesson 12)

Critical Thinking 21. How are self-respect and self-esteem related to good character? (Lesson 8)

22. Why does your social-emotional environment affect your health? (Lesson 8)

23. Why might having one addiction increase risk for development of another one? (Lesson 9)

24. Why is bipolar disorder dangerous to a person if he or she is not treated? (Lesson 9)

25. Why is it harmful to use projection and displacement to deal with angry feelings? (Lesson 10)

26. How can stress be positive? (Lesson 10)

27. How can a person with dysthymic disorder have a second form of depression? (Lesson 11)

28. How is being resilient related to good character? (Lesson 11)

29. How is health compromised if a person gets stuck in the anger stage of the five stages ofloss and grief? (Lesson 12)

30. Why do some people grieve after the death of a well-known person? (Lesson 12)

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Health Literacy Activities

What Do You Know?Critical Thinking Work with your classmates to create a Top Ten List of Stressors. Form a team with

five classmates. Compete against other teams to make a list ofunique ways to overcome the stressors on the list.

Connection to World CulturesSelf-Directed Learning People throughout theworld experience losses and life crises, such as earth-

quakes, famine, airplane crashes, floods, and deaths due toAIDS. Watch news coverage of world events, and select a lifecrisis that is happening in another part of the world. Write anews report about how the people are dealing with the crisis.

Family InvolvementEffective Communication Ask family members toparticipate in a family round table. Explain the five

guidelines for expressing emotions in healthful ways. Then askeach family member to use an I-message to share his or herfeelings about an event taking place in his or her life.

Investigating Health CareersResponsible Citizenship Select a person who has ahealth career. Interview this person and ask the fol-

lowing questions: Why did you choose this career? How did youprepare for this career? What is the most stressful part of yourjob? How do you manage stress at your job? Share the informa-tion you gathered from the interview with your classmates.

Group ProjectProblem Solving In order to improve the social-emotional environment, think of a younger person in

your community for whom you could be a mentor. Suppose youwere to spend an hour a week with this person for six weeks.On a sheet of paper, describe what you might do. Meet with agroup of classmates to brainstorm ideas. Share your plan withyour parents or guardian and consider acting on it. Visit

for more information.

Standardized Test PracticeRead the following selection and answer the questions that follow.

Can you train your mind to control bodyresponses? With biofeedback, a technique inwhich a person gets feedback on body responsesby viewing measurements on monitors or otherdevices, or hearing specific sounds, this may bepossible. Biofeedback training has been used tohelp people deal with stress. Biofeedback worksby closely monitoring body functions anddisplaying the measurements taken in differentways. The subject becomes familiar with thekinds of external forces that cause the stress.For example, blood pressure can be displayed ona chart or meter, while an elevated heart ratecan set off a bell or alarm. Then, the subjectlearns to control the body’s reactions to thestressors. Studies have shown that biofeedbackis effective in battling not only stress reactionslike high blood pressure, but also migraineheadaches and epileptic seizures.

Multiple Choice

1 In this paragraph, the word elevated means:

A lower than normal

B higher than normal

C dangerous

D changeable

2 Which of the following is a reason why people might trybiofeedback to cure a condition or disease?

A They do not like being hooked up to monitoring systems.

B They prefer to treat diseases with powerful drugs.

C Other treatments have been successful.

D Other treatments have been unsuccessful.

Open-Ended

3 Imagine you are developing a study to show the effect ofbiofeedback on stress. Write a paragraph describing a studyyou would design to test the effectiveness of biofeedback.

ReadingWriting&

UNIT 2 • Study Guide 131(l)David Young-Wolff/PhotoEdit, (c)Peter Griffith/Masterfile, (r)Digital Vision/Getty Images

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