In opposition to tendencies in recent studies to equate grief and depression, it is proposed that differentiating grief, pathological grief, and depression is essential for diagnostic and therapeutic reasons. Freud's distinction is reconsidered in the light of recent research. Illustrated by case vignettes, clinical criteria are proposed. These include specific affective expression, countertransference reactions, quality of object relation, regulation of self-esteem and guilt, generalized inhibition, helplessness, and hopelessness. The role of processes of introjection and identification are discussed, as well as determinants and consequences of complicated grief.