Grief
- olivierbranford
- Mar 19, 2024
- 16 min read
Updated: Jan 29
My mother is dying as we speak from stage 4 brain cancer. I have said my goodbyes to her. What should I expect with regards to grief when she dies in the next few days?
What are the five stages of grief? Elisabeth Kübler-Ross, the Swiss-American psychologist, described them in 1969, and became famous after she published her book 'On Death and Dying'. Kübler-Ross developed her model to describe people with terminal illness facing their own death. But it was soon adapted as a way of thinking about grief in general. Motivated by the lack of instruction in medical schools on the subject of death and dying, Kübler-Ross examined death and those faced with it at the University of Chicago's medical school. Kübler-Ross's project evolved into a series of seminars which, along with patient interviews and previous research, became the foundation for her book.
Her wisdom was beyond simply describing the five stages of grief. She also advised us on how to live. She said “It is not the end of the physical body that should worry us. Rather, our concern must be to live while we're alive - to release our inner Selves from the spiritual death that comes with living behind a facade designed to conform to external definitions of who and what we are.” So, be who you really are, take off your mask, be vulnerable, and live!
Grief
Kübler-Ross also said that “Love is really the only thing we can possess, keep with us, and take with us.” Have you connected with unconditional love yet? She reminded us that “The ultimate lesson all of us have to learn is unconditional love, which includes not only others but ourselves as well.” She taught us that life, not death, is a lesson “We're put here on Earth to learn our own lessons. No one can tell you what your lessons are; it is part of your personal journey to discover them. On these journeys we may be given a lot, or just a little bit, of the things we must grapple with, but never more than we can handle.”
My favourite quote of hers reminds us of the benefits of challenges: “Should you shield the canyons from the windstorms you would never see the true beauty of their carvings.”
As Einstein said “God does not play dice with the Universe”. Elisabeth Kübler-Ross reminded us similarly to “Learn to get in touch with the silence within yourself, and know that everything in life has purpose. There are no mistakes, no coincidences, all events are blessings given to us to learn from.”
So, according to her, death is a reminder that “It's only when we truly know and understand that we have a limited time on Earth - and that we have no way of knowing when our time is up, we will then begin to live each day to the fullest, as if it was the only one we had.” She also famously said that life is a lesson: “Learning lessons is a little like reaching maturity. You're not suddenly more happy, wealthy, or powerful, but you understand the world around you better, and you're at peace with yourself. Learning life's lessons is not about making your life perfect, but about seeing life as it was meant to be.”
Her legacy is to remind us that “The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of those depths.”
Grief
Throughout life, we experience many instances of grief. Children may grieve a divorce, a wife may grieve the death of her husband, a teenager might grieve the ending of a relationship, or you might have grieved the loss of a pet.
One way people cope is by trying to find some sort of certainty. This need for structure is probably one factor behind the popularity that latched onto the "Five stages of grief" over 50 years ago and hasn't yet let up, said David Kessler, who founded grief.com, a resource aiming to help people deal with uncharted territory related to grief. Kessler co-authored "On Grief and Grieving" with the late Dr. Elisabeth Kübler-Ross.
Kübler-Ross wrote about the "Five Stages of Grief." Those stages are denial, anger, bargaining, depression and acceptance (the acronym DABDA).
The Kübler-Ross grief cycle
"In the actual book, she talked about more than five stages," Kessler said. "Think about the context of 1969 - doctors and hospital personnel were not talking about the end-of-life process... Elisabeth Kübler-Ross really hoped 'On Death and Dying' would start the conversation."
Since then, there has been extensive media coverage of the five stages; used in television shows including "Grey's Anatomy" and "House"; clinician support; and they have had some criticism. Those five stages are what people clung to, Kessler said.
Grief and psychology experts and academics have criticised the framework for not being thoroughly supported by research, suggesting that the bereaved move through grief sequentially or implying one correct way to grieve. But these suggestions weren't Kübler-Ross' intentions, and she stated these caveats on the first page of the book, Kessler said.
While there's debate among experts about the stages of grief, "People who are in the pain of grief are just saying, 'Help me!'" Kessler said. Here's what the five stages of grief are, and how you can consider and process them in whichever order you experience them.
The 5 Stages of Grief; Remember the acronym DABDA
Phases of grieving
1. Denial
Denial is the stage that can initially help you survive the loss. You might think life makes no sense, has no meaning, and is too overwhelming. You start to deny the news and, in effect, go numb. In denial there is Grace, in that we can't fully register the total pain, shock and disbelief over our loss in one moment or day, so the pain is spread over time, Kessler said.
In this stage, individuals believe the precipitating event is somehow mistaken, and cling to a false, preferable reality. Some may also isolate themselves, avoiding others who may have accepted what is happening. This stage is usually a temporary defence, so long as the person has adequate time to move amongst the stages as they contemplate death. In her book, Kübler-Ross states that technological advancements have caused people to become fearful of violent, painful deaths; therefore, in order to protect the psychological mind, they deny the reality of their own inevitable death.
It's common in this stage to wonder how life will go on in this different state - you are in a state of shock because life as you once knew it has changed in an instant. If you were diagnosed with a deadly disease, you might believe the news is incorrect - a mistake must have occurred somewhere in the lab; they mixed up your blood work with someone else's. If you receive news of the death of a loved one, perhaps you cling to a false hope that they identified the wrong person. In the denial stage, you are not living in "actual reality," rather, you are living in a "preferable" reality.
Interestingly, it is denial and shock that help you cope and survive the grief event. Denial aids in pacing your feelings of grief. Instead of becoming completely overwhelmed with grief, we deny it, do not accept it, and stagger its full impact on us. Think of it as your body's natural defence mechanism, saying "Hey, there's only so much I can handle at once."
While denial in a literal and dysfunctional sense would be trying to convince yourself your loved one isn't dead, an inability to comprehend the loss for a while is healthy - not something you need to snap out of quickly, he added.
If you're struggling with overwhelming denial, you can try to stop fighting the reality you've been presented with, said Cormier, who is also a bereavement trauma specialist and consultant.
Once the denial and shock start to fade, the healing process begins. At this point, those feelings that you were once suppressing come to the surface.
2. Anger
Once you start to live in "actual" reality again, anger might start to set in. This is a common stage to think "Why me?" and "Life's not fair!" You might look to blame others for the cause of your grief and also may redirect your anger to close friends and family. You find it incomprehensible how something like this could happen to you. If you are strong in Faith, you might start to question your belief in God: Where is God? Why didn't he protect me?
When the individual recognises that denial cannot continue, they become frustrated, especially at proximate individuals. Some may lash out at loved ones, medical staff, and other family. In Kübler-Ross's other book, Questions and Answers on Death and Dying, she emphasises the need for people to do their best to let those who are in this stage feel their feelings and try not to take the anger personally.
Researchers and mental health professionals agree that this anger is a necessary stage of grief, and encourage the anger. It's important to truly feel the anger. Even though it might seem like you are in an endless cycle of anger, it will dissipate - and the more you truly feel the anger, the more quickly it will dissipate, and the more quickly you will heal. It is not healthy to suppress your feelings of anger - it is a natural response - and perhaps, arguably, a necessary one.
In everyday life, we are normally told to control our anger toward situations and toward others. When you experience a grief event, you might feel disconnected from reality, that you have no grounding anymore. Your life has shattered and there's nothing solid to hold onto. Think of anger as a strength to bind you to reality. You might feel deserted or abandoned during a grief event. That no-one is there. You might feel alone in this world. The direction of anger toward something or somebody is what might bridge you back to reality and connect you to people again. It is a "thing." It's something to grasp onto, a natural step in healing.
Anger is another natural reaction to loss, whether it's anger at the cause of death, the deceased, the God of your religion, yourself or the randomness of the Universe, Kessler said.
"Anger is pain's bodyguard. It's how we express pain," he said. "That stage gives people permission to be angry in healthy ways, and to know it's not bad."
Anger "Can be an anchor, giving temporary structure to the nothingness of loss. At first grief feels like being lost at sea: No connection to anything," according to Kessler's website. "Then you get angry at someone, maybe a person who didn't attend the funeral, maybe a person who isn't around, maybe a person who is different now that your loved one has died. Suddenly you have a structure - your anger toward them."
Beneath anger can be feelings of hopelessness or powerlessness, Cormier said, sometimes prompting guilt and blame that some people use to maintain an illusion of control or express frustration.
"Our minds would always rather feel guilty than helpless," Kessler said.
Depending on how your loved one died, one way to overcome guilt- and blame-related anger is by realising that as horrific as your loss is, it wasn't personally done to you, Kessler said.
"The reality is the death rate in families is 100%," he said. "Everyone is going to die eventually, but our minds just can't fathom that."
Allow yourself to express anger in healthy ways, Kessler advised, whether it's "Grief yoga," screaming in your car, using a punching bag, hitting a cushion with a tennis racket, running, or other forms of strenuous exercise.
3. Bargaining
When something bad happens, have you ever found yourself making a deal with God? "Please God, if you heal my husband, I will strive to be the best wife I can ever be, and never complain again." This is bargaining.
In a way, this stage is false hope. You might falsely make yourself believe that you can avoid the grief through this type of negotiation. If you change this, I'll change that. You are so desperate to get your life back to how it was before the grief event, you are willing to make a major life change in an attempt toward normality.
Guilt is a common wingman of bargaining. This is when you can experience a seemingly endless string of "What ifs": What if I had left the house 5 minutes sooner? The accident would have never happened. What if I encouraged him to go to the doctor six months ago like I first thought? The cancer could have been found sooner and he could have been saved.
Often also stemming from guilt, bargaining after a loss typically involves "if only" statements, focused on regrets about what you did or didn't do before the person died, Kessler said.
"We may even bargain with the pain. We will do anything not to feel the pain of this loss," Kessler's site says. "People often think of the stages as lasting weeks or months. They forget that the stages are responses to feelings that can last for minutes or hours as we flip in and out of one and then another."
Remember that we live in a world where sometimes bad things happen despite our best efforts, Kessler said.
This third stage involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made in exchange for a reformed lifestyle. People facing less serious trauma can bargain or seek compromise. Examples include the terminally ill person who "negotiates with God" to attend a daughter's wedding, an attempt to bargain for more time to live in exchange for a reformed lifestyle or a phrase such as "If I could trade their life for mine".
4. Depression
Depression is commonly associated with grief. It can be a reaction to the emptiness we feel when we are living in reality and realise the person or situation is gone or over. In this stage, you might withdraw from life, feel numb, live in a fog, and not want to get out of bed. The world might seem too much and too overwhelming for you to face. You might not want to be around others or feel like talking, and you might feel hopeless. You might even experience suicidal thoughts, thinking "What's the point of going on?"
Depression, or an acute sadness, is when the great loss begins more deeply affecting your life. Maybe the sadness feels as if it will last forever, or you've withdrawn from life or are wondering if life is worth living alone.
Sadness hits people at different times, Cormier said. She has known people who aren't distraught in the first year after loss, but by year three are consumed with sadness. Why? Because for a time, some can maintain the illusion that a loved one is away on vacation and may be returning, she said.
Often, the eventual, deep sadness "Is really an expression of, 'My loved one is gone and not coming back,'" Cormier said.
But those feelings shouldn't always be labeled as clinical depression, Kessler said. If you think you're depressed around a death, see a psychiatrist for an evaluation, he advised.
To cope with sadness, you can also seek support from friends, family or grief support groups, and regularly practice self-care, Cormier suggested.
"I'm so sad, why bother with anything?"; "I'm going to die soon, so what's the point?"; "I miss my loved one; why go on?"
During this fourth stage, the individual despairs at the recognition of their mortality. In this state, the individual may become silent, refuse visitors and spend much of the time mournful and sullen.
5. Acceptance
The last stage of grief identified by Kübler-Ross is acceptance. Not in the sense that "It's OK my husband died" but rather, "My husband died, but I'm going to be OK."
In this stage, your emotions may begin to stabilise. You re-enter reality. You come to terms with the fact that the 'new' reality is that your partner or relative is never coming back, or that you are going to succumb to your illness. It's not a 'good' thing, but it's something you can move forward from.
Acceptance doesn't mean you're OK with your loved one being gone. "It just means that I now accept the new reality of my life. I'm a widow, I live alone. I don't have siblings to call up anymore. I don't have parents to call up anymore," said Cormier, who wrote "Sweet Sorrow: Finding Enduring Wholeness After Grief and Loss" after losing her husband and immediate family.
Acceptance isn't grief's end, either. You might have many little moments of acceptance over time, Kessler said, such as when you plan and attend the funeral.
"One of the questions I get asked most is, 'When will this grief be over?'" Kessler added. "Very gently, I'll ask, 'How long is the person going to be dead? Because if the person is going to be dead for a long time, you're going to grieve for a long time. It doesn't mean you will always grieve with pain. To me, the goal of grief work is to eventually remember the person with more love than pain."
Arriving at acceptance means you're healing, Cormier said. But if you can't get there, you need to seek professional help. Intense and persistent grief that causes problems and interferes with everyday functioning, in a way that typical grief doesn't after some time has passed, is known as prolonged grief disorder, according to the American Psychiatric Association. The disorder was added to the revised Diagnostic and Statistical Manual of Mental Disorders released in March 2022.
To be diagnosed with prolonged grief disorder, a loved one's death had to have occurred at least a year prior for adults, and at least six months ago for children and adolescents, according to the association, which publishes the DSM. One symptom is difficulty with reintegration, such as pursuing interests or interacting with friends.
Cormier doesn't think we ever "Get over" grief. Our task is different than moving on - it's learning to integrate the loss into our lives so that we can move forward with a new reality, she added. "It's sort of offensive to grievers to say, 'Oh, you've really moved on.' No, I don't think grievers move on. We move forward."
It is definitely a time of adjustment and readjustment. There are good days, there are bad days, and then there are good days again. In this stage, it does not mean you'll never have another bad day, where you are uncontrollably sad. But, the good days tend to outnumber the bad days.
In this stage, you may lift from your fog, start to engage with friends again, and might even make new relationships as time goes on. You understand your loved one can never be replaced, but you move, grow, and evolve into your new reality.
"It's going to be okay."; "I can't fight it; I may as well prepare for it."
In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or other tragic event. People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the individual, and a stable condition of emotions.
In the book co-authored with David Kessler and published posthumously, Kübler-Ross expanded her model to include any form of personal loss, such as the death of a loved one, the loss of a job or income, major rejection, the end of a relationship or divorce, drug addiction, incarceration, the onset of a disease or an infertility diagnosis, and even minor losses, such as a loss of insurance coverage. Kessler has also proposed "Meaning" as a sixth stage of grief (see below).
Symptoms of grief
Your grief symptoms may present themselves physically, socially, mentally, emotionally, or spiritually. Some of the most common symptoms of grief are presented below:
Crying
Headaches
Difficulty sleeping
Questioning the purpose of life
Questioning your spiritual beliefs (e.g., your belief in God)
Feelings of detachment
Isolation from friends and family
Abnormal behaviour
Worry
Anxiety
Frustration
Guilt
Fatigue
Anger
Loss of appetite
Aches and pains
Stress
The new sixth stage: Finding meaning
After his son died at age 21 nearly five years ago, Kessler wanted something beyond acceptance. He had studied late neurologist, psychiatrist and philosopher Dr. Viktor Frankl's work on meaning, and wondered how meaning related to grief - which inspired his book "Finding Meaning: The Sixth Stage of Grief."
Meaning didn't eliminate Kessler's pain, but it did cushion it, he said.
Meaning is in what we later do or realise as the bereaved people, Kessler explained. Maybe you recognise the fragility of life, try to change a law or donate money to research so no one dies the way your loved one did, or make a change in your life.
The 'Five Gates of Grief'
The Five Gates of Grief by Francis Weller bring the soul into the grieving process:
The Five Gates of Grief by Francis Weller
If you are going through grief and loss, I hear you.
These are the emotions that I have covered for you in my series on emotions (click on the link to be taken to them):
Namaste.
Olly
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