Source: Love Lives On
Dealing with grief and loss is something everybody has to do at some point in their lives.
Grief is a natural response to the loss of someone or something very dear to us.
Losses that may lead to grief include the death of a loved one or a beloved pet, loss of a marriage or job, or other major life changes like becoming an “empty nester” or retirement.
You might have heard that healing from grief happens in ‘stages’.
Case studies that highlight the typical emotions and behaviours that you can expect within the stage—as well as practical tips to help you cope—will accompany each summary.
We also discuss how long grief lasts—according to scientific researchers.
Let’s get started…
Who Came Up With the 5 Stages of Grief?
The concept that there are “stages of grief” was developed by Elisabeth Kübler-Ross and has been adopted by many health-care professionals worldwide.
Kübler-Ross was a Swiss-American psychiatrist whose work with terminally ill patients led her to become a pioneer in near-death studies.
In her book published in 1969—On Death and Dying—she argued that terminally ill patients go through 5 stages of grief when faced with their imminent death—denial, anger, bargaining, depression, and acceptance.
In a subsequent book—On Grief and Grieving—published in 2005 with co-author David Kessler, Kübler-Ross took her original concept of the five stages of grief and applied it to those who have lost a loved one.
On Grief and Grieving was written by Kübler-Ross and Kessler while Kübler-Ross was on her death-bed. The writing duo had the unique—but regrettable—position of viewing grief both from the viewpoint of the terminally ill and the survivor of loss.
How Does the Five Stages of Grief Work?
In On Grief and Grieving, Kübler-Ross and Kessler explain how the concept of the 5 stages of grief works:
- Our grief is as individual as our lives. Each person is unique in how he or she copes with feelings of grief because each person has unique DNA and a unique personal history (including their relationship with the deceased).
- Not everyone will go through all of the 5 stages of grief.
- Not everyone will go through them in a prescribed order. In other words, the five stages of grief do not have a predictable, uniform and linear pattern.
- You can switch back and forth between each of the five stages of grief.
- The 5 stages of grief are simply tools to help us frame and identify what we may be feeling.
According to the Hospice Foundation of America, it is helpful to think of the 5 stages of grief as: “a roller coaster, full of ups and downs, highs and lows.
“Like many roller coasters, the ride tends to be rougher in the beginning, the lows may be deeper and longer.
“The difficult periods should become less intense and shorter as time goes by, but it takes time to work through a loss.
“Even years after a loss, especially at special events such as a family wedding or the birth of a child, we may still experience a strong sense of grief.”
The ‘Denial’ Stage of Grief
The first reaction to learning about the terminal illness, loss, or death of a cherished loved one is to deny the reality of the situation.
“This isn’t happening, this can’t be happening,” people often think.
It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock of the loss.
We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.
On pgs. 8 to 11 of On Grief and Grieving, Kübler-Ross and Kessler explain that being “in denial” doesn’t mean that you aren’t aware of the reality of the situation.
It means that your psyche shuts down because you simply cannot fathom the enormity of the loss and aren’t ready to deal with it.
So when people say comments like, “I can’t believe he’s dead,” it does not mean that they literally don’t know that their loved one has died.
It means that they are still paralyzed with shock and that the reality is too much for their psyche to handle.
On Grief and Grieving, pgs. 10 & 11: “Denial and shock help us to cope and make survival possible. Denial helps us to pace our feelings of grief.
“There is a grace in denial. It is nature’s way of letting in only as much as we can handle. …
“As you accept the reality of the loss and start to ask yourself questions, you are unknowingly beginning the healing process.
“You are becoming stronger, and the denial is beginning to fade. But as you proceed, all the feelings you were denying begin to surface.”
Denial: Case Study 1
Kübler-Ross and Kessler use the story of Alicia to illustrate how denial works.
Alicia’s husband, Matthew, often travelled overseas for work and it was not unusual for her to not hear from him for a couple of days if the country he was visiting had a poor communications network.
During a trip, Alicia received a phone call from one of Matthew’s coworkers. He told her that Matthew had been killed in a car accident.
Alicia couldn’t believe what she had heard. In fact, she initially thought she must have dreamt the conversation or that it was a case of mistaken identity.
She spent the next several days making funeral arrangements, all the while saying: “This can’t be true. I know when the body arrives it won’t be him.”
When she finally saw her dear husband’s face and his wedding ring, she knew there could be no doubt it was Matthew.
During the weeks after the funeral, she would call friends and family and say: “I keep thinking he’s still on the trip and that he just can’t get to a phone.”
Kübler-Ross and Kessler comment on pg. 9 that: “It would be easy to say that [Alicia] was in denial because she kept thinking Matthew’s death was not real.
“It would be equally easy to say that she was not in denial because she kept going through with funeral arrangements.
“But both are true.
“She couldn’t believe it and her mind could not fully process it. Denial helped her to unconsciously manage her feelings.
“Even after the funeral, she often thought he still might just be on a trip. This was still denial working very subtly, to give her moments away from her pain.”
Denial: Case Study 2
Andrew’s wife, Betty, was killed in a hit-and-run accident at a pedestrian crosswalk.
When the police arrived at Andrew’s home to tell him the news, he couldn’t believe that it was Betty that had been killed. “There surely is some mistake,” he repeated over and over.
When Andrew saw his wife’s body for the first time after the accident, there was no longer any question that it was Betty.
He wanted to know all the details the police knew about the accident: which crosswalk; who were the witnesses; what type of car hit her?
Months after the funeral had taken place, Andrew would find himself reaching for Betty during the night while he was in bed, and would then wake up startled.
He would sometimes “forget” that she had died and expect her to be home when he walked through the front door. The realization that she was no longer there would hit him hard.
Andrew would also tell the story of the hit-and-run accident to anyone who would listen.
Kübler-Ross and Kessler comment on pgs. 10 & 11 that: “People often find themselves telling the story of their loss over and over, which is one way that our mind deals with trauma.
“It is a way of denying the pain while trying to accept the reality of the loss. As denial fades, it is slowly replace with the reality of the loss.
“You begin to question the how and why. How did this happen? you may ask, as you review the circumstances.
“You are no longer in an external story-telling mode; now you turn inward as you begin to search for understanding.
“You explore the circumstances surrounding the loss. Did it have to happen? Did it have to happen that way? Could anything have prevented it?
“The finality of the loss beings to gradually sink in. She is not coming back.”
6 Tips For Dealing with the Denial Stage of Grief
- Understand that denial is normal, especially when a loss is recent. It serves an important, protective function and is your mind’s way of protecting you from more pain.
- Understand that it is normal to not “fully get” that a loved one is gone. Your mind is not yet able to comprehend a life without that person.
- Be open to seeing reminders about your loved one, even if the experience is painful, as it will help you move through the denial stage of grief. As examples: view your loved one’s body; visit the grave site; reread old letters; smell a favorite cologne; look at photographs; go to church; listen to songs; gather meaningful sayings and phrases; visit special places; or wrap yourself in your loved one’s clothing.
- Don’t pretend that things are all right when they are not. Be honest with yourself and others. Cry freely and let others see your tears. Distractions may keep you occupied, but don’t help you move toward resolution.
- Understand that there is no specific time frame for denial to be dissolved. However, your long-term goal is to accept the reality that your loved one has passed away.
- Seek professional help if you are unable to move past the denial stage of grief. You will need professional support if you are unable to function in your everyday life.
The ‘Anger’ Stage of Grief
This stage of grief is where we search for blame, feel intense guilt, and lash out.
As the numbing effects of the denial stage of grief begins to wear off, the pain of loss starts to firmly take hold.
But you may still not be ready to deal with the reality of the situation, so you express your intense pain as anger.
Your anger may be directed at your dying or deceased loved one.
For example, you may be mad at him for dying, even though you may intellectually know that he didn’t want to die.
You may be angry with your loved one for not taking better care of herself. You think to yourself: “It’s her fault that she got sick and died and left me with all this pain to deal with.”
We feel guilty for being angry with our loved one, which in turn makes us feel even angrier.
Your anger may also be aimed at complete strangers, friends or family, the doctor who diagnosed the illness and was unable to cure the disease, and even inanimate objects.
You may also be angry with God for taking your loved one from you and for not sparing your loved one and you from suffering. It is not uncommon for grieving people to go through a spiritual crisis.
Finally, you may be angry with yourself and struggle with guilt for not being able to save your loved one, or for the relationship that you had with him while he was alive.
There is no limit to the depth of your anger or to whom or what it may be directed.
On pg. 11 of On Grief and Grieving, Kübler-Ross and Kessler explain: “Anger doesn’t have to be logical or valid. …
“It is important to remember that the anger surfaces once you are feeling safe enough to know you will probably survive whatever comes.
“At first, the fact that you lived through the loss is surprising to you.
“Then more feelings hit, and anger is usually at the front of the line as feelings of sadness, panic, hurt, and loneliness also appear, stronger than ever.
“Loved ones and friends are often taken aback by these feelings, because they surface just as you were beginning to function at a basic level again.
“Anger is a necessary stage of the healing process. Be willing to feel your anger, even though it may seem endless.
“The more you truly feel it, the more it will begin to dissipate and the more you will heal.”
Anger: Case Study 1
Kübler-Ross and Kessler use the story of Heather to illustrate the anger stage of grief.
When Heather’s teenage daughter died at the age of 16 after a long illness, Heather was furious with God for not curing her and for allowing her to die so young.
Heather’s family had strong ties to their local church, with church members providing strong support during her daughter’s illness.
However, after Heather’s daughter died, Heather no longer wanted anything to do with God.
Her friends at church warned her against turning her back on God, cautioning: “Be careful not to evoke the wrath of God.”
This caution made Heather even more enraged.
“What is He going to do,” she retorted, “take my daughter away? What’s he going to do, take me? That would be fine. I’d rather be with her than be here.”
She was enraged when a church friend suggested that they pray for forgiveness for Heather’s anger. She subsequently left church and didn’t speak to her church friends for many years.
Kübler-Ross and Kessler state on pg. 14 of On Grief and Grieving: “If we ask people to move through their anger too fast, we only alienate them.
“Whenever we ask people to be different than they are, or to feel something different, we are not accepting them as they are or where they are.
“Nobody likes to be asked to change and not be accepted as they are.
“We like it even less in the midst of grief.”
Anger: Case Study 2
Bill was married to Angela for 40 years.
When she died after a 5-month battle with cancer, the normally docile Bill was filled with rage.
He was angry with their family physician for not diagnosing her illness sooner. Bill transferred to a new clinic soon after Angela’s funeral.
He was furious with Angela’s sister for not visiting more often during her last few months of life and refused to speak to his sister-in-law for a few years after his wife’s death.
He was also angry with himself for every cross word he had ever spoken to his wife during their long marriage.
Bill’s friends, family and neighbours thought he had lost his mind when he dug up his wife’s garden—she had been an avid gardener—and paved it over with concrete.
They tried to talk him out of doing so, saying that Angela would be “disappointed” with him for destroying something she loved.
But their comments only made Bill angrier. “Why don’t they realize that the garden is a constant reminder that Angela is no longer here to tend to it?” he said to himself.
Kübler-Ross and Kessler state on pg. 15 of On Grief and Grieving: “Underneath anger is pain, your pain.
“It is natural to feel deserted and abandoned, but we live in a society that fears anger.
“People often tell us our anger is misplaced, inappropriate, or disproportionate.
“Some people may feel your anger is harsh or too much. It is their problem that they don’t know how to deal with it.
“Unfortunately, for them, they too will know the anger of loss someday.
6 Tips For Dealing with the Anger Stage of Grief
Kübler-Ross and Kessler provide us with practical advice on how to deal with the anger stage of grief on pgs. 15 to 17 of On Grief and Grieving:
- Your job is to honour your anger by allowing yourself to be angry. Scream if you need to. Find a solitary place and let it out. You can even scream into a pillow if it helps you feel better.
- Don’t bottle your anger up inside. Instead, explore it in a way that is not harmful to you. Your anger is just another indication of the intensity of your love.
- Share the reasons why you are angry with family and friends. Don’t hide your true feelings for fear of being perceived as ‘negative’, ‘over-emotional’ or ‘crazy’.
- Try venting your frustration and anger with aerobic exercise like walking or swimming. You could also join a group sport like rugby or football.
- Join a support group. Grief can feel very lonely, even when you are surrounded by family and friends. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counselling centers.
- Talk to a trusted spiritual counsellor, a family physician, or a certified therapist about how angry you are.
The ‘Bargaining’ Stage of Grief
When we face a painful loss, we may try to make a secret deal with God or a higher power in an attempt to postpone the inevitable.
Bargaining is the “What if….” stage of grief.
“What if I devote the rest of my life, God, to helping others? Can I then wake up and find out that this has all been some terrible dream?”
The bargaining stage of grief serves an important purpose. It provides temporary escape from one’s pain and provides hope. This gives a person time to adjust to the reality of the situation.
Attempting to bargain with God is often accompanied by feelings of guilt.
“What if we had sought medical attention sooner?” “What if we had gotten a second opinion from another doctor?” “What if I had tried to be a better person?”
In On Grief and Grieving, pg. 20, Kübler-Ross and Kessler state: “When we accept that they are going to die we may bargain that their death will be painless.
“After a death, bargaining often moves from the past to the future.
“We may bargain that we will see our loved ones again in heaven.
“We may bargain and ask for a respite from illnesses in our family, or that no other tragedies visit our loved ones.
“A mother who loses her child may bargain that her other children remain safe and healthy.”
Bargaining: Case Study
Kübler-Ross and Kessler use the story of Howard to illustrate the bargaining stage of grief.
When Howard turned 75 years old, he was determined to keep himself and his 66 year-old wife, Millie, in good health.
Much to Millie’s chagrin, he insisted that they both start a daily walking program.
One morning, Millie wanted to skip the walking and take the day off. But Howard insisted that they go.
While out on their walk, Millie was hit by a car and rushed to hospital.
While she was in surgery, Howard made all sorts of promises to God, if only he would spare Millie’s life.
Tragically, the surgeon was unable to save her.
For the first few days after Millie’s death, Howard would bargain with God: “Please God, let me fall asleep and wake up realizing this was all a dream. I will do anything to have her back.”
He would also spend a lot of time ruminating the “what if’s” …. “What if he hadn’t insisted that they had started a walking program?” “What if they had skipped their walk on that fateful morning, like Millie wanted to?”
His family would have to constantly remind him that he wasn’t responsible for the accident.
Kübler-Ross and Kessler comment on pg. 19: “For Howard, bargaining was a key stage, since he was holding a piece of the alternate future in which his wife’s death never happened.
“Bargaining can be an important reprieve from pain that occupies one’s grief.
“He never believed the bargaining; he just found relief in it momentarily.”
3 Tips For Dealing with the Bargaining Stage of Grief
- Understand that bargaining is normal and serves an important purpose. It provides temporary escape from one’s pain and provides hope. This gives a person time to adjust to the reality of the situation.
- Talk to family and friends about your bargaining hopes, or join a support group. They may be able to provide you with some perspective, as well as support you if your hopes are disappointed.
- Seek the help and support of a professional counsellor if you are struggling.
The ‘Depression’ Stage of Grief
Depression may occur when reality really sinks in.
During this stage of grief, intense sadness, decreased sleep, reduced appetite, and loss of motivation are common.
In On Grief and Grieving, pg. 20, Kübler-Ross and Kessler state: “After bargaining, our attention moves squarely into the present.
“Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined.
“This depressive stage feels as though it will last forever.
“It’s important to understand that this depression is not a sign of mental illness. It is the appropriate response to a great loss.”
Kübler-Ross and Kessler say that depression is one of the many necessary steps in the healing process.
“As tough as it is, depression can be dealt with in a paradoxical way.
“See it as a visitor, perhaps an unwelcome one, but one who is visiting whether you like it or not.
“Make a place for your guest. Invite your depression to pull up a chair with you in front of the fire, and sit with it, without looking for a way to escape.
“Allow the sadness and emptiness to cleanse you and help you explore your loss in its entirety.
“When you allow yourself to experience depression, it will leave as soon as it has served its purpose in your loss.
“As you grow stronger, it may return from time to time, but that is how grief works.”
It should be noted that the type of depression that Kübler-Ross and Kessler are talking about does NOT have sustained functional impairment and is NOT accompanied by suicidal thoughts.
If your depression is impacting your ability to cope with everyday life over a sustained period of time—or if you are experiencing suicidal thoughts—please consult your family physician or a mental health professional immediately.
Depression: Case Study 1
Kübler-Ross and Kessler use the story of Claudia to illustrate the depression stage of grief.
Claudia first experienced depression when her grown daughter was dying.
After her daughter’s death, the depression returned, though it felt different to the depression she had experienced before. Her depression now felt “endless”, whereas before it felt “contained”.
Over time, Claudia’s depression eventually passed and she began to get out of the house more. She even went back to work part-time.
Since she was functioning better and more engaged with family and friends, Claudia felt like the depression had passed.
But then the depression suddenly returned. Nothing specific had happened to trigger it.
“I thought I was done with it, but I guess it wasn’t done with me,” said Claudia.
The battle this time around felt even harder. But Claudia learned that: “The only way around this storm was through it.”
Depression: Case Study 2
Marsha was always a happy person who loved life.
But when husband Victor died unexpectedly after a heart attack, she was plunged into a depression that felt bottomless.
She had a hard time getting out of bed in the mornings. Activities that previously gave her joy felt pointless. She lost 12 pounds.
Concerned about how Marsha was coping, her sister convinced her to join a support group for people that had lost a spouse.
Marsha found it helpful to talk to people that understood what she was going through.
After a few months, she felt the fog of depression lifting. She found herself even looking forward to Christmas when her daughter and grandchildren would be visiting.
But as she was getting ready for the holidays, her depression hit her again and hit hard.
This would be her first Christmas without Victor.
She reached out to her support group and discovered that her friends there were also struggling with the holidays.
Marsha now feels that her depression has mostly passed, but knows that she can still suffer from bouts of it, especially around special holidays and anniversaries.
8 Tips For Dealing with the Depression Stage of Grief
- Give yourself permission to “feel your feelings”. Don’t let anyone tell you how you should feel or that you should “get over it” or “move on”.
- Don’t try and suppress your grief. In order to heal, you have to acknowledge your pain. Avoiding your grief on a long-term basis can lead to complications such as clinical depression, anxiety, substance abuse, and other health problems.
- Express your feelings to others. This includes friends and family, church members, clergy, bereavement support groups, family physicians, or professional counsellors.
- Express your feelings in creative ways. As examples: write a letter to your loved one telling her how much you miss her; keep a journal detailing how you feel; draw or paint pictures; create a photo album or scrapbook celebrating your loved one’s life; create a playlist of music that captures the spirit of your loved one; volunteer your time to a cause that was important to your loved one; or create a special and unique post for Facebook to let your online community how much you love and miss that person.
- Avoid negative behaviour that can harm your health. For example: don’t try and numb your pain by abusing alcohol and prescription drugs.
- Set a small exercise goal each day. For example: “Today, I will get out of bed and walk around the block once.” According to Dr. John Ratey, the author of Spark, scientific studies show that aerobic exercise significantly alleviates the symptoms of depression. In Britain, doctors now use exercise as a first-line treatment for depression, but exercise is vastly under-utilized in the United States.
- Plan ahead for grief “triggers”. Holidays, anniversaries, birthdays, and other special dates and events reawaken memories and feelings. It is completely normal for you to revisit your grief during these times. If a significant date or event is approaching, anticipate that you will struggle emotionally. Ask your family and friends for support beforehand, and work with them to create strategies to help you cope during this time, as well as to help you honor the person you loved.
- See a medical doctor if the pain of your loss is so constant and severe that it keeps you from resuming your life, or if you have suicidal thoughts. Only a medical doctor is able to appropriately diagnose and treat grief and depression that is beyond what is considered “normal”—referred to as “complicated grief” and “clinical depression”.
The ‘Acceptance’ Stage of Grief
In this stage of grief, the bereaved person accepts the reality of their loss and the fact that nothing can change that reality.
Acceptance does NOT mean that the person is “okay” with the loss.
“Most people don’t ever feel okay or all right about the loss of a loved one,” states Kübler-Ross and Kessler on pg. 25 to 28 of On Grief and Grieving.
“This stage is about accepting the reality that our loved one is physically gone and recognizing that this new reality is the permanent reality.
“We will never like this reality or make it okay, but eventually we accept it.
“We learn to live with it. It is the new norm with which we must learn to live.
“This is where our final healing and adjustment can take a firm hold despite the fact that healing often looks and feels like an unattainable state. …
“Acceptance is a process that we experience, not a final stage with an end point. …
“Finding acceptance may be just having more good days than bad.”
Acceptance: Case Study
Kübler-Ross and Kessler use the story of Keith to illustrate the acceptance stage of grief.
Keith’s son was randomly shot by a gang member while walking home from a sports arena.
In the months that followed his son’s death, Keith and his wife were consumed with anger as they spent their days and nights investigating their son’s murder.
A well-meaning friend tried to tell Keith that he needed to “move on” and “accept” his son’s death, which only further angered Keith.
While Keith could acknowledge the reality of his loss, it was unrealistic for his friend to think that Keith should have found some peace with it so soon after his son’s death.
After the killer was caught, Keith became consumed with the trial.
After the trial was over and the killer was convicted, Keith had to contend with his grief and emptiness. There was no longer a trial to distract his attention.
In the 5 years that followed, Keith found acceptance, or so he thought. He felt the acceptance drain out of him when he heard that his son’s killer was up for parole.
By the time the parole hearing rolled around, Keith was once again filled with anger. He attended the parole hearing and was struck by how quickly it was over.
He saw the tears of the killer’s father when parole was denied. For the first time since his son’s death, Keith realized that there were other victims of this crime.
And for the first time, his anger was replaced by curiosity. Keith approached the killer’s father. He wanted to learn about the killer and what had led him to this place.
Over the next few years, the two fathers formed an alliance to help gang members stop the violence. They visited many inner city schools to share their story.
On Grief and Grieving, pgs. 27 & 28, Kübler-Ross and Kessler write: “Keith’s acceptance was a journey that was deeper than he ever expected.
“And it happened over many year, not many months or days.
“Not everyone will or can fully embrace those who have hurt us, as Keith did, but there is always a struggle that leads us to our own personal and unique acceptance.”
5 Tips For Dealing with the Acceptance Stage of Grief
- Understand that acceptance is learning to live with your new norm where your loved one is no longer here. Understand that you will never be okay with the fact that your loved one died. Acceptance is a process that we experience, not a final stage with an end point.
- Be patient with yourself and don’t expect yourself to reach the acceptance stage of grief quickly. The process could take years. You could also ebb in and out of the acceptance stage.
- Keep a gratitude journal and write in it daily. Make a note of anything that gave you even the briefest moment of relief from your pain. As examples: a memory of your loved one that made you smile; a visit from a neighbour to see how you are doing; a beautiful sunrise or sunset. Keeping a gratitude journal will help you look for things in your day that are positive, no matter how small they may seem to others. As you read back through your gratitude journal, you may find yourself growing in your “gratitude attitude”. Remember, acceptance may simply be having more good days than bad.
- Find ways to commemorate the life, love and legacy of the person that you miss.
- If a year has passed since the day your loved one died, but you still feel “stuck” in your grief—your mourning still feels intense—see a professional therapist.
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