Grief and mourning rituals: what rituals do, and where grief becomes a clinical question

Why grief belongs in a library about catharsis

Grief is the situation in which the idea of emotional release seems most natural. Popular advice tells bereaved people to “let it out”, to “work through” the loss, and warns that grief held in will return later in a worse form. Mourning customs across cultures also involve intense, often collective, expression: weeping, lament, music, gathering. It is therefore reasonable to ask what the evidence says about grief and about the rituals that surround it, and whether their value lies in discharge or somewhere else.

This note is written with a particular caution. Many readers of a page about grief are grieving. Nothing here can say how a particular person’s grief is going, whether it is “normal”, or what they should feel. The evidence describes groups of bereaved people under particular conditions. The last sections describe when grief becomes a clinical question and when to contact a professional; those are general signs, not an assessment.

What grief usually looks like

Stroebe, Schut and Stroebe (2007) reviewed the relation between bereavement and physical and mental health. Two findings sit side by side in their review. Bereavement is associated with an excess risk of mortality, particularly in the early weeks and months after a loss, and with decrements in physical health, visible in symptoms, illnesses and use of medical services. At the same time, grief is not a disease, and most people adjust without professional psychological intervention. For a few people, mental disorders or complications in the grieving process follow, and the authors conclude that intervention should be targeted at people at high risk and those with complicated grief or bereavement-related depression and stress disorders.

The second finding runs against a common expectation. Bonanno and colleagues (2002) had an unusual opportunity: prospective data on 205 people collected several years before the death of their spouse, followed by assessments 6 and 18 months after the loss. This design allowed them to see grief trajectories against each person’s own pre-loss state instead of reconstructing it from memory. They identified five core patterns: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. Common grief, the pattern of marked distress that gradually subsides, was relatively infrequent. The resilient pattern was the most frequent. Chronic grief was associated with pre-loss dependency, and resilience with pre-loss acceptance of death and belief in a just world.

Two cautions keep this finding in proportion. The sample was older adults who lost a spouse, and trajectories after the sudden death of a child, a violent death or a death in a pandemic may differ. And “resilience” in this study describes a pattern of measured symptoms and functioning; it does not mean that those people did not miss their partner or were untouched. The practical point is narrower: the absence of intense visible distress is not in itself a sign that grief is being suppressed or delayed.

From “grief work” to oscillation

For much of the twentieth century, the dominant idea in bereavement theory was the grief work hypothesis: that bereaved people must confront the loss and work through their feelings about it, and that avoiding this work leads to worse outcomes. The idea is close to the hydraulic model of emotion that this library examines elsewhere (Research note 01).

Stroebe and Schut (1999) criticised the hypothesis on several grounds: imprecise definition, failure to represent the dynamic character of grieving, lack of empirical evidence and validation across cultures and historical periods, and a narrow focus on intrapersonal processes. In its place they proposed the dual process model. It identifies two kinds of stressors. Loss-oriented stressors concern the loss itself: yearning, reminders, the relationship with the person who died. Restoration-oriented stressors concern the secondary consequences: new roles, practical tasks, a changed identity and daily life. Adaptive coping, in the model, is an oscillation between confronting and avoiding each kind of stressor, and it includes what the authors call dosage: taking respite from both as an integral part of coping.

The model is a theoretical proposal, and the paper discusses rather than pools the supporting evidence. Its importance for the catharsis question is conceptual. It treats time away from grief, including distraction and ordinary activity, as part of healthy grieving, not as avoidance to be overcome. It also treats continuous confrontation with the loss as potentially problematic, a point that connects grief to the research on rumination (Research note 15).

Continuing bonds

A second change in bereavement theory concerns the relationship with the person who died. Older models tended to treat detachment as the goal of mourning. Later work described continuing bonds: ongoing inner relationships with the deceased, expressed in memories, conversations, keeping possessions, or a sense of their presence.

Stroebe, Schut and Boerner (2010) observed that the scientific literature lacked clarity about whether continuing or relinquishing bonds is adaptive, and that it was unclear which kinds of bonds, or which underlying processes, relate to better or worse outcomes. Empirical research had rarely been theory-driven. They proposed an integrative model grounded in attachment theory, using the dual process model to link ways of coping with the bond to outcomes and mental representations theory to describe cognitions about the deceased. The model is meant to guide research; it does not itself establish when a continuing bond helps.

The honest summary is that a continuing bond is common and is not in itself a sign of a problem, and that the evidence does not support a single rule, in either direction, about how attached a bereaved person should stay.

What rituals do: experimental evidence

Norton and Gino (2014) tested the psychological effects of mourning rituals in three experiments on different kinds of loss, which the title summarises as losses of loved ones, lovers and lotteries. Participants were either directed to reflect on rituals they had performed after past losses or assigned to complete novel rituals after experiencing a loss. In both cases they reported lower levels of grief. Increased feelings of control after the rituals mediated the link between rituals and reduced grief. The benefit was not confined to people who professed a belief in the effectiveness of rituals; those who did not believe in them also showed it.

The authors note that the specific rituals people perform after losses vary widely by culture and religion, and among their own participants, and they interpret their results as suggesting a common psychological mechanism: regained feelings of control.

Several features limit what this can show. The outcomes were self-reported grief measured shortly after the manipulation. Two of the three kinds of loss (a relationship and a lottery) are not bereavement, and the bereavement data rely on recalled losses and recalled rituals. The experiments do not show what rituals do for grief over months, whether they change the risk of prolonged grief, or whether a funeral works the same way as a private ritual invented for a study. They are consistent with a modest, short-term benefit that does not depend on belief.

The observational picture

Field data on real funerals give a more cautious picture. Mitima-Verloop, Mooren and Boelen (2021) surveyed bereaved people in the Netherlands six months and three years after a loss (552 and 289 respondents). Participants generally considered the funeral and the rituals they used to be helpful. Yet no significant association was found between how they evaluated the funeral, or how much they used grief rituals, and their grief reactions.

The two findings can both be true. Something can be experienced as helpful without that experience predicting the course of grief months or years later; this library meets the same gap between felt benefit and measured change in other domains (Research note 04). A correlational design also cannot separate the effect of rituals from the reasons people use them: those most distressed might use rituals more, which would mask a benefit. The honest conclusion is that the evidence for rituals improving the longer-term course of grief is insufficient, while the evidence that people value them is consistent.

Why rituals might help: a framework

Hobson, Schroeder, Risen, Xygalatas and Inzlicht (2018) reviewed research on rituals across social psychology, cognitive science, anthropology, behavioural economics and neuroscience and proposed a framework with three regulatory functions: regulation of emotions, of performance goal states and of social connection. They distinguish bottom-up processes, which arise from the physical features of rituals such as fixed sequences and repetition, from top-down processes, which arise from what a ritual means to the people performing it.

Applied to grief, the framework suggests several routes, none of which is discharge. A structured sequence of actions may restore a sense of control at a time when control has been lost, which is what Norton and Gino measured. Shared rituals gather people and make support visible. And rituals give meaning to a transition: they mark that something has ended and that the relationship has changed form. The framework generates predictions; it does not show which route matters for a given loss.

Rituals are not discharge

The contrast with the hydraulic view is worth stating directly. The mechanism supported in the experiments is a sense of control, not the emptying of emotion. Many mourning rituals involve strong expression, but they are also highly structured: they have a beginning, a sequence and an end, they are shared, and they place the loss in a larger frame of meaning. These features resemble the processes that other research in this library links with benefit, such as social support and meaning-making, more than they resemble venting.

This also means that there is no evidence-based reason to press a bereaved person to express more grief than they do, or to participate in a ritual they find alien. The experimental benefit appeared with rituals people chose or recalled, and with novel rituals that were brief and simple.

The clinical boundary: prolonged grief

For a minority of bereaved people, intense grief persists and becomes disabling. Prigerson and colleagues (2009) interviewed 291 bereaved respondents three times, between 0 and 24 months after the loss, to test criteria for prolonged grief disorder. The proposed criteria required yearning for the deceased together with at least five of nine further symptoms (such as feeling emotionally numb or that life is meaningless, bitterness over the loss, difficulty accepting the loss, identity confusion, avoidance of the reality of the loss, or difficulty moving on) experienced at least daily or to a disabling degree, present at least six months after the death and associated with functional impairment. The authors report that these criteria appeared able to identify people at heightened risk of enduring distress and dysfunction. Prolonged grief disorder has since been introduced in ICD-11 (Johannsen et al., 2019) and in DSM-5-TR, where the adult duration threshold is 12 months since the death rather than six, and current criteria should be taken from clinicians and current manuals rather than from this 2009 proposal.

How common is it? Lundorff and colleagues (2017) meta-analysed 14 studies of non-psychiatric adult populations after non-violent bereavement and found a pooled prevalence of 9.8% (95% CI 6.8 to 14.0), higher with higher mean age. The authors caution that the studies were methodologically heterogeneous and of limited representativeness, and that the finding should be interpreted cautiously.

These criteria are described here so that readers understand where the clinical boundary lies, not so that anyone can apply them to themselves or others. Intense grief in the first months is not a disorder, and a list of symptoms read on a website is no substitute for an assessment by a qualified professional who knows the person and the circumstances.

What helps whom

Currier, Neimeyer and Berman (2008) meta-analysed 61 controlled studies of psychotherapeutic interventions for bereaved persons. Overall, interventions had a small effect at post-treatment and no statistically significant benefit at follow-up. Interventions that exclusively targeted people displaying marked difficulties adapting to loss had outcomes comparable with psychotherapies for other difficulties. The authors suggest that the discouraging results for studies that did not screen for distress could be explained by a tendency among untreated controls to improve naturally over time.

Johannsen and colleagues (2019) meta-analysed 31 randomised controlled trials of psychological interventions for grief in adults. The pooled effect on grief symptoms was g = 0.41 after the intervention (0.31 when adjusted for possible publication bias) and g = 0.45 at follow-up across 18 trials. Effects were larger for individually delivered interventions, for participants at least six months after the loss, and for participants included because of high baseline symptoms. The trials were heterogeneous and of varying quality.

Read together, these reviews are consistent with the dual process view. Offering routine therapy to everyone who is bereaved adds little on average, because most people improve without it. Structured help for people whose grief remains intense and disabling is supported by trial evidence. This mirrors the lesson of psychological debriefing after trauma, where a well-intentioned intervention for everyone did not deliver the expected protection (Research note 08).

When to seek professional help

These are general indications drawn from the sources above and from the site’s clinical boundary. They are not a test.

• Grief that remains intense and consuming many months after the loss, and that makes it very hard to carry out work, care for oneself or others, or maintain relationships, is a reason to talk with a general practitioner, a psychologist or a bereavement service.
• Persistent low mood, loss of interest, inability to sleep or eat, or heavy use of alcohol or other substances to cope are reasons to seek help at any point, not only after a set period.
• Thoughts of ending your life, or of not wanting to go on living without the person who died, warrant contacting a professional without delay; if you are in immediate danger, contact local emergency services.

Seeking help is not evidence that grief has “gone wrong”, and not seeking it is not evidence that it has gone right.

Limits of the evidence

The experimental evidence on rituals rests on one set of three experiments with short-term self-report and largely non-bereavement losses. The field study found no association between rituals and grief reactions. The dual process model and the continuing bonds framework are theoretical. The trajectory evidence comes from spousal loss in later life, and the prevalence estimate pools heterogeneous studies of non-violent deaths. Cultural variation in mourning is large and mostly not captured by these studies. The evidence ledger records how each claim in this note is graded and when it will be reviewed.