"People may find themselves very emotional and frequently quite tearful," says Lawrence Martin, M.D., a psychiatrist at Mayo Clinic, Rochester, Minn. "In general, that's perfectly normal."

Anniversary reactions

The emotions and memories you experience because of such reminders are called anniversary reactions. Those reminders can make your loss painfully evident.

Even in the weeks leading up to a special day, event or anniversary, you might have the same feelings you had when you grieved the first time - sadness, loneliness, anger, anxiety, emptiness, and lack of interest in activities. You might have trouble eating or sleeping. You might start weeping suddenly. Or you might experience physical problems, including headaches, stomach pain, intestinal upset or appetite changes.

Anniversary reactions can also evoke powerful emotional memories - vivid experiences in which you recall the feelings and events surrounding a death or tragedy. You might also remember in great detail where you were and what you were doing, for instance. "Like the Kennedy assassination," Dr. Martin says. "I can tell you I was in sixth-hour geometry, 10th grade, in the first row of the classroom."

You can also have anniversary reactions about things that happened to you - you were mugged, for instance, or involved in a car crash. And disasters like the Sept. 11 attacks can cause feelings of grief to re-emerge in people who lived through previous tragedies, such as war, the 1995 Oklahoma City bombing, or plane crashes.

Some reminders are inevitable. There will be a lot of "firsts" - the first holiday after your sister has died, for instance. The first Mother's Day after losing your mom. The first anniversary of a national tragedy. Your reactions to these firsts might be intense, Dr. Martin notes, but you'll probably find it easier to cope with subsequent anniversary dates.

Reminders aren't just tied to the calendar. They can be anywhere - in sights, sounds and smells. Even in the news. And they can ambush you. You might be flooded with emotions when you drive by the restaurant your wife loved so much. Or when you see a neighbor's child learning to ride a bike and think, "That should have been my daughter." Or even when you hear a song that reminds you of a relationship that ended.

No time limit

Even years after the loss or tragedy, you can continue to feel sadness and pain anew when you're hit with reminders. "There are certain expectations, especially in Western cultures, that we should only grieve so long and then we should be fine," Dr. Martin says. "But that's just not true."

Many people welcome those feelings each year, believing it shows how important the loved one was. "We continue to grieve and re-grieve the major losses of our lives throughout our lives," says Robert A. Neimeyer, Ph.D., editor of the journal Death Studies and a professor in the department of psychology at the University of Memphis who has written extensively about death and loss.

"Would we want it otherwise?" Dr. Neimeyer asks. "Would we want to erase those loved ones and have it matter not?"

Beyond grief

Those grief reactions can become a routine part of your life, if less frequently and less intensely as time goes by. But if the special days and reminders create feelings so intense that they interfere with your ability to function in your daily life ? you miss work deadlines, have conflicts with family or friends, neglect your appearance, or stop socializing, for instance - you might have developed depression. Symptoms of depression can include feelings of guilt about the loss, self-critical thinking and even thoughts of suicide. That's when it's time to get help, Dr. Martin says. Start by visiting your primary care doctor to discuss treatment strategies, such as counseling or medication.

In some cases, new tragedies or disasters can also trigger post-traumatic stress disorder in people who survived or witnessed previous traumatic events, even years earlier, such as sexual or physical assault, war, torture, natural disasters, a car or plane crash, a hostage situation or a death camp. It can also affect rescue workers at an airplane crash site or a mass shooting or someone who witnessed a tragic accident.

Symptoms of post-traumatic stress include fear and anxiety, a lack of focus, sadness, changes in sleeping or eating habits or bouts of crying that come easily. You might have recurrent thoughts or nightmares about the event. If you have these disturbing feelings for more than a month, or if they're severe, or if you feel you're having trouble getting your life back under control, see your doctor or a mental health professional.

Finding new meanings

Knowing that you're likely to experience anniversary reactions can help you understand them and even turn them into opportunities. Some people create new holiday traditions or ways of honoring loved ones who have died.

"It's a way to make new meanings of old losses," Dr. Neimeyer says. "A grief that is symbolized, expressed and integrated is less painful than one that is denied, avoided and resisted."

That is true, too, of public memorials and ceremonies that mark the anniversary of tragedies, disasters and other events that cause significant loss of life. "There are reasons for these memorials," Dr. Martin says. "It acknowledges that this affects us all and still affects us all. One of the hardest things about tragedies is that they can make us feel all alone, or that we're the only ones feeling this way. But these observances help make us feel we are all in this together, and we're actually much closer and less self-absorbed."

You might find yourself dreading upcoming special reminder days, though, fearful of revisiting painful memories and emotions. In some cases, the anticipation can be worse than the actual day, Dr. Martin points out. "You'll often see people doing things in preparation for how difficult they anticipate it will be," he says. "They'll plan to go away or do something else. But often they discover that they've done some of the grief work during that anticipation period, so the day itself isn't as difficult as they feared."

Hope to cope with reminders

Here are some ways you can cope with reminders of loss and tragedy:

    * Plan a distraction, such as a weekend away or a visit with friends or relatives.

    * Spend some time reminiscing about your relationship with the person who died. "At this point, you're usually remembering the good stuff about the relationship itself, the time you had together, rather than the loss," Dr. Martin notes.

    * Remind yourself that anniversary reactions are normal and that the intensity of your feelings will diminish in time.

    * Change how you celebrate a holiday, perhaps only temporarily. For instance, if you've always held the Thanksgiving celebration at your parents' home, and your mother dies, consider moving it this year to a sibling's home instead.

    * Start a new tradition in your loved one's memory. Make a donation to a charitable organization in the person's name on birthdays or holidays, for instance.

    * Limit your exposure to news reports about tragic events. If you find yourself becoming more anxious, sad or distressed by news coverage, it might be time to cut back. A study published in the Journal of the American Medical Association in August 2002 found that the more television coverage of the Sept. 11 attacks someone watched, the more likely they were to have signs of post-traumatic stress disorder.

    * Draw family members and friends close to you, rather than avoiding them. Find someone who encourages you to talk about your loss. Stay connected to your usual support systems, such as spiritual leaders and social groups.

    * Allow yourself to feel sadness and a sense of loss.

    * You might feel like you shouldn't be happy or celebrate special times. You might feel guilty for having fun. But it's OK to enjoy these times. In fact, you might find yourself both laughing and crying.

"There are many ways we can honor the continued grief we have without letting it immobilize us," Dr. Neimeyer says. "It's a direct reflection of our love for that person. It's not a sign there is something wrong with us."

September 04, 2002

© 1998-2004 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.  A single copy of these materials may be reprinted for noncommercial personal use only.

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