Prompted by her work with an end -of -life -patient, the Swiss psychiatrist, Elisabeth Kübler-Ross, wrote On Death and Dying in 1969, where she proposed that there were five stages (Denial, Anger, Negotiation, Depression and Acceptance) in the grieving process. These stages remain popular and widely accepted, despite several critiques made over the years.
I am moved to elaborate on these stages after a sequence of major personal losses. Loss can come in many forms: a relationship breakup, divorce, death of a loved one, losing a job/career or terminal illness— to name a few. In my experience, the stages of grief are not necessarily sequential; that is, not experienced in any specific order or progression. Secondly, some people may not experience any of these stages while only some will experience a few.
Has any of your loved ones been terminally ill? The first response to such a situation might be denial: "This is not happening; everything will return to normal.” When reality is too overwhelming, denial is the mind’s instinctive, often unconscious defense which, by processing the loss over a longer period, prevents us from being overwhelmed. Some people may move in and out of denial, like the administration of an intermittent anesthesia, reducing the pain from the shocking reality that life— as we have known it— has changed. Feelings of disconnection and lack of grounding are common feelings after experiencing loss, as a person adjusts to a new reality.
Grieving can bring up feelings of vulnerability and make us feel powerless and helpless. Anger is often transformed by vulnerability. What do I mean by vulnerability? Feeling powerless, helpless, and/or defenseless. You can become angry at medical providers for not saving your loved one, or at your friends or family for their lack of emotional support (not understanding your pain) and for not helping out in the process or simply for not being present. Having a support system that allows us to express our anger is helpful.
Unlike denial— anger, being quite outwardly, allows the grieving person to connect with reality. When the world feels like a different place, expressing anger may allow the grieving person to feel more connected. Some researchers assert that anger is a necessary step in the healing process. It’s an awakening from the anesthetic denial and possibly a demonstration of the intensity of your feelings to the loss. Suppressing anger is not healthy, but this ought not be taken as a license to be violent.
How many of us, out of desperation, have ever prayed and negotiated with a higher power? Even a non-believer can use prayer as a negotiation (“Please save her/his life and I’ll believe in you”). Negotiating is also the stage of sporadic overthinking of counterfactuals, or “what ifs.” What if I would have been more available? What if I would have accompanied her or him on visits to physicians? What if I hadn’t done this or that? Such thoughts can also induce guilt, sadness and depression (which is anger turned inward).
Depression manifests itself along a spectrum: mild to moderate depression allows daily functioning, while severe depression can be paralyzing. Those who become severely depressed withdraw socially, have a hard time with daily functions and may simply remain in bed. Depression after a loss might make you feel alone, empty, lacking in motivation or even questioning the value of life itself. Life as you knew it has changed. After the loss of a loved one, your existence at times, feels different, as if a chapter of your autobiography has reached completion.
Like anger, acceptance is based upon the reality of what has happened. Acceptance may be the progressive result of a period of adjustment, mixed with depressive and/or anxious feelings. Sadness has not dissipated, but you now accept that there’s a new reality and that no negotiation will change what has happened. Accepting the finality of loss is a sad reality; nonetheless, you can begin to move forward with your life. As mentioned previously, you may not experience all of these stages, but their order and the temporal duration of time will vary. Memories, pictures, birthdays, anniversaries, music and many other nuances may trigger grief.
Psychological Resilience is not one of the five stages, but I have decided to include this it plays a significant role in the above process. In his book, The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss, George Bonanno emphasizes that “psychological resilience,” which is, one's capacity to manage adversity well, is an important part of grief. Psychological resilience brings more rapid passage to the acceptance stage described above.
Just as a loss can knock you down, resilience can resuscitate you and make you stronger. The capacity to regulate one's feelings and having a healthy support system are strong components of psychological resiliency. James Neill, author of What is Psychological Resilience? indicates that resilient individuals demonstrate dynamic self-renewal, whereas less resilient individuals find themselves worn down and negatively impacted by life stressors. He adds that resilience can hibernate but remain alive during times of difficulty and oppression, then flowers when circumstances become more favorable.
Supportive counseling might help those who are grieving. Acknowledgement and working through this process alleviate intensity. Speak to a professional who is not attached to the presenting loss and who is able to be present as you share your thoughts and feelings. Talk to your therapist about your grief and share your memories with those you trust.
It’s a process. Be kind to yourself and seek the company of others who are kind toward you. Take all the time you need to grieve.
Bonanno, A. George. (2010). The Other Side Of Sadness: What The New Science Of Bereavement Tells Us About Life After Loss. Strawberry Hills, N.S.W.: Accessible, ca. 2010.
Kübler-Ross, Elisabeth. (1969). On Death and Dying. New York: The Macmillan Company.
Neill, James. What is Psychological Resilience. http://www.wilderdom.com/psychology/resilience/PsychologicalResilience.html. April 16, 2006.