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    Study Examines 'Normal' Grieving

    Emotions Typically Peak Within 6 Months

    Talking About Death

    Sudden death was associated with a higher degree of disbelief among survivors. While this finding is not surprising, Prigerson says it too has major implications for clinical practice.

    Terminal illness was the cause of the vast majority of deaths in the study. Researchers found that having knowledge of a diagnosis for six months or longer was associated with higher levels of acceptance among survivors.

    "We know that very few doctors discuss life expectancy with their terminal patients and their loved ones," Prigerson says. "That is a hard conversation to have, but it is an important one."

    Prigerson acknowledges that the grief model may not apply to other populations, such as survivors grieving deaths from unnatural causes like car crashes and suicide, or parents grieving the loss of a child.

    But the researchers point out that more than nine out of 10 deaths in the U.S. are the result of natural causes, and the vast majority of these deaths occur among middle-aged and elderly people like the ones reflected in the study.

    Grief counselor David Fireman says even among this population it is difficult to characterize what it normal when it comes to reactions to the death of a loved one.

    Fireman is director of the Center for Grief Recovery in Chicago.

    "Grief is very personal and many variables are involved," he says. "Grief is a process, not a condition, and from my perspective there is no correct timetable for the waves of grief that people feel."

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