In last month’s column, I introduced the topic of grief: what it is, the different ways that people grieve, and how grieving is a process, not an event. This month, I’d like to talk a little about what many people have heard of as the “stages of grief,” and about ways we can support others as they walk the path of grieving.
Stages of Grief
In her 1969 book, On Death and Dying, psychiatrist Elizabeth Kübler-Ross got Americans talking about grief for the first time, as a culture. What was revolutionary about this book was the way in which she identified the many dimensions of the experience of grief, and described grieving as a normal and important part of human experience—one that needs to be understood, honored and supported, rather than “gotten over” as quickly as possible. In particular, Kübler-Ross described what she then called the “Five Stages of Grief”. These “stages” have since been renamed as “phases,” since individuals rarely go through them in a straight line. Many people “visit” each phase several times during the process of coming to terms with loss, and not everyone experiences every stage along the way. Below is a description of the stages, along with ways that friends and family can help.
Denial has been described as “nature’s way of letting in only as much as we can handle,” while we become able to handle more. In this phase, the feeling is: “This has not really happened.” There is often a feeling of unreality about the loss during this phase; of living somewhere between “before” and “after. In this phase, the rational brain is perfectly aware of the reality that the emotional parts of the brain are not ready to accept. As friends, acknowledging how unreal it must feel is a simple, empathetic response, and probably all that’s needed.
Anger is another, often necessary, phase of the healing process. It is natural to feel angry about a loss, and to look for something or someone to be angry at. Blaming someone or something for the loss provides both a sense of control and a means of emotional release, as we adjust to the uncontrollable. “Don’t feel that way” is not a helpful thing to say to oneself or others in this phase. While it is equally important not to “feed the fire” of the grieving person’s anger, it is important to accept the behavior itself as a normal part of the grieving process. Remember: anger is just another indication of the intensity of someone’s love.
Bargaining is the phase of grief in which we cope by hoping to strike a deal that will allow us to somehow reverse the loss, even just in the imagination. Fantasies may take the form of “If I do [x], maybe I will wake up and it will all have been a bad dream.” Or, we may spend a lot of time imagining how the loss might have been avoided if we had done something different. “If only” and “What if ” are the kinds of thoughts that are typical of this phase. We want to go back in time: find the tumor earlier, stop the accident from happening. This is the stage in which people may feel a lot of guilt, since the “if onlys” cause us to find fault in ourselves. That said, the “bargaining” phase also temporarily helps us cope until the loss can be accepted. Friends can help most by accepting and empathizing with the behavior of bargaining (“It must be hard not to think about what might have been different”), without getting involved in arguing with the specifics of the “if onlys” themselves. Remember: for all the regrets and self-blame involved, thinking about what might have been or what could be done may be what the person needs at the moment to distract her/himself from a worse thought: the loss itself, and the finality of it, now.
Depression. This is this phase in which feelings of absence and emptiness present themselves, and the feeling of deep sadness may set in. This phase can seem unbearable, and as though it will last forever. It’s important to understand that grief-depression is not a sign of mental illness, but a normal response to great loss. Feelings of sadness, fatigue, social withdrawal, loss of a sense of meaning, inability to enjoy life, and other experiences may last for some time, and are not something to expect oneself or someone else to “snap out of.” Instead, remember that “grief itself is the cure for grieving,” meaning that if we allow ourselves and others to feel our feelings at this stage, without avoiding or repressing them, or rationalizing about how the person who died “is in a better place,” we are doing our part to allow healing to proceed naturally.
This is also the phase in which it is often important to the grieving person to talk about the person who has died, even though there is sadness when they do. Remember that the tears shed in talking are helpful, not hurtful. “Let yourself weep, let it water your soul,” is a saying from the Chinese, and this quote reminds us of the cleansing power of tears. So instead of being careful not to bring up the person who has died with someone who has experienced a loss, friends can help by being open to listening to memories and stories, which is how a loved one who has died lives on in the present.
The fifth phase, “Acceptance,” is often confused with the idea of “getting over” the loss. Far from it. “The reality,” Elizabeth Kübler-Ross has said, “is that […]you will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.”
This phase, then, is about accepting the reality that our loved one is physically gone. We never have to like it, but eventually we find a way to re-engage with life in a way that includes the reality of it. Acceptance may be about having more good days than bad ones, and about taking on (or giving over) tasks and roles that belonged to the person who died. Initially, it may feel as though we are betraying our loved one in doing this, so it is important to remember that we are not replacing what has been lost, but simply allowing ourselves and our lives to grow and evolve, just as we would have if the person were still alive.
A note on the difference between grief and depression:
Distinguishing between grief and clinical depression isn’t always easy, as they share many of the same symptoms, but there are ways to tell the difference. One way to assess the difference yourself is to remember that grief is like a roller coaster: lots of difference emotions and a mix of good and bad days. Depression, however, is more like a train in a long, dark tunnel: no light at the end, and no light along the way. If you are unsure, a mental health counselor can help you make the distinction, and can also connect you with resources to help with navigating grief and depression, both.
Grief is one of the most painful experiences that we go through as humans, so it is good to remember that it is also one of the most meaningful.
“The most beautiful people we have known,” says Kübler-Ross, “are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.”