Stages of Grief

I would imagine you have heard of the stages of grief, you may have even seen it acted out on television shows such as Frasier and Scrubs. In the Frasier episode entitled "Good Grief", Frasier is coping with the loss of his job. The Scrubs episode entitled "My Five Stages" deals with the main characters facing the loss of their favorite patient as she nears death. The shows demonstrate how the grief process affects other aspects of our lives and illustrates each of the five grief stages . By understanding the stages of grief, you may be able to process through your experiences a bit better.

Please remember that there is no cookie-cutter approach to this process. Each time you face a loss, the process may be different. For example, you may find in one circumstance in your life that you never experience bargaining, but you face anger over and over again. In another situation, you may go through each grief stage as they are presented here. The key is to understand where you are in the process, and why you are there in order to survive your grief.

Let's begin:

In 1961, Elisabeth Kubler-Ross identified five stages of grief while working with cancer patients. She identified these in her 1969 book entitled "On Death and Dying". She identified these as:

Denial: This is the initial "shock." You are in a state of disbelief and may even feel like you are shutting down. In a way, this is true. Denial allows your body to shut down until it is able to process what it experienced. You may start to feel like you are slowly "waking up", remembering things a little at a time.

While denial is a normal part of the grief process, remaining in this (or any of the stages of grief) too long can prove to be detrimental. Too often people remain in the denial stage of their illness. After completing treatments, they may feel they have cheated death and deny that they were ever ill. What they don't realize is that, by not accepting what has happened to them, they are not able to move forward. When they finally do accept what has happened, it is too late.

In the case of dealing with the terminal diagnosis of a loved one, denial, masking or repression can result in unexplained medical conditions (such as chest pain, stomach discomfort, or hypertension) which may or may not have a psychosomatic connection.

Not wanting to accept the severity of your loved one's condition, you may not understand or accept their request for hospice. It may be hard for you to accept when your loved one requests to be assigned to hospice.

Anger: Questions you may ask are "why is this happening or who or what can I blame?!" For some reason, understanding the "why" of things can help bring you a certain peace. It gives you something to crusade against. But what if there is no "reason", what if there is no one to "blame"? What if there is no one person or thing to blame?

You may find you are directing anger at those who are really "innocent". You may feel anger towards those you perceive as not hurting as much as you. You might feel anger towards the doctors, hospitals or medical system. Displaced anger can hide the pain. Even if you weren't religious before, you may find yourself becoming religious; if, for no other reason than to blame God.

Processing through the anger can help you uncover the pain or fear. And, it is this pain or fear that you will have to face in order to reach the level of peace and acceptance.

Bargaining: You are now able to acknowledge what is happening is "real" but, you want to play "let's make a deal" with the purpose of buying more time. Here's an example "Once I see the birth of my grandchild I can die in peace." Here's the thing; only one of your 12 children are married and that one child has no intention of every having children! Another spin to this is, you think your bargaining has worked because the milestone of being able to attend your child's wedding (for example) was reached. Bargaining can also include promises such as giving up a bad habit or volunteering your services to a worthy cause with the hope that, if you "change your evil ways", you will be saved.

Depression: You are so sad that you don't have the energy to even go to the bathroom. You can't eat. You are exhausted but you can't sleep. The pain is so deep that it physically hurts. You may feel like you are in a brain fog; you can't remember things. You have difficulty focusing. You may not see the point of trying to do anything since the end result is death. This is all part of the process. You need to feel the pain and process through the loss during this grief stage. The pain is another emotional expression, like anger or love. When you are angry or depressed it may be difficult to see the light is a lantern and not an oncoming train. This is where strong support comes in.

Acceptance: This is the ultimate goal of the stages of grief! Acceptance doesn't mean that you like what is happening or what did happen. Acceptance means that you are able to acknowledge that something did or will happen. You have found some form of peace. You are no longer spending all your energy in denial, or bargaining. You are no longer depressed or angry. You are now able to live each moment to the fullest.

Acceptance does not mean you "gave up." It means that you are able to see through the fog of depression, pain, fear and anger and see the bigger picture. You are able to see that bad things happen to good people and bad people. As much as you may not like it, you realize that death is an expected part of the "circle of life." And with all this realization, you are now able to just move on and do what you want and need to do.

It is my humble opinion that Randy Pausch, the Carnegie University professor, provides examples of what can be achieved in the stage of acceptance. His book entitled “The Last Lecture, Achieving Your Childhood Dreams” is truly inspirational and should be required reading for old and young alike. Despite his diagnosis, he teaches through example how to live each day to the fullest.

Reaching acceptance opens up your mind to the memories you may have blocked because they were too painful. You are able to focus on what matters the most and move forward with your life.

While Elizabeth Kubler-Ross' five stages are the most well known out there, you may see other "stages of grief". The following are examples of another way of looking at the stages of grief:

Shock/Disbelief: This is similar to denial. You may find it difficult to focus on simple tasks. You may feel like you are in a fog and that none of this is really happening. It feels like a bad dream. You may not be able to acknowledge what happened or what will happen.

Suffering: After the shock clears, the pain sets in. This pain, this suffering may be in waves and last for years. Physical symptoms of suffering include but are not limited to loss of appetite, sleeplessness, even chest pain. It may also take on behavioral symptoms such as withdrawing from society, mood swings or poor concentration. This phase is similar to Kubler-Ross' anger and depression.

Recovery: Recovery occurs when you are able to reconnect with the things that bring you joy and interest you. You still have "pain." You still miss your loved one but you are able to move on and function. This is similar to the "acceptance" stage in the stages of grief.

How do you know this is grief and not something else?

Return to Coping With Grief

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Continue to Grief Versus Depression

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