The five stages of grief proposed by Elizabeth Kubler-Ross in her book On Death and Dying in 1969 have become the go-to model for understanding grief and loss. In this blog post, you’ll learn about the stages of grief proposed by Kubler-Ross as well as the current understanding and research on grief, and how to cope with loss.
The Stages of Grief: On Death and Dying
As described in On Death and Dying, the five stages of grief are denial, anger, bargaining, depression, and acceptance. However, there are some misconceptions about this model. The first and most obvious is that the stages of grief were never proposed to happen in any particular order. Someone suffering loss may return to a stage multiple times, or skip a stage all together. Also, the five stages of grief may apply to more situations than death; it may apply to the loss of a job, divorce, the loss of a home, or other situations.
Are the Five Stages of Grief Accurate?
Though the five stages are well-known, there is some debate about whether or not the model accurately represents how people deal with loss. Though these stages can be helpful for understanding and making sense of difficult challenges, it is important to remember there are some caveats to this model.
- Broad descriptions: All of the five stages of grief are broadly described, and not given many concrete definitions. One person may have different thoughts and behaviors than another, even if they are going through the same stage.
- Mixed emotions: It’s natural to have mixed emotions about a loss. The five stages of grief indicate that people deal with each emotion separately and in sequence, when this is not usually the case.
- The “right way” to grieve: The five stages of grief indicate that there is a “correct” process for how to cope with loss, which this is not the case. Each person will feel, think, and behave differently. The goal of coping with grief is to reduce the damage to your lifestyle, self-esteem, and relationships, and to eventually carry on with a productive, happy life. Any grief process that does not negatively impact your life or others’ is likely to be a healthy process.
What Are the Five Stages of Grief?
Denial occurs when a person dealing with loss either cannot or chooses not to acknowledge how their life has changed or the events that have occurred. They might seem numb, or they might appear strangely unaffected, as if nothing has changed. Someone in denial will probably not want to talk about what has happened. They may seek out distractions, either keeping themself very busy or watching a lot of movies or TV.
Denial is not necessarily an unhealthy coping mechanism. Denial is thought to be the mind’s protective response to too much emotion or shock. Refusing to deal with some emotions allows you to deal with others. Denial can be unhealthy if your view of reality becomes permanently skewed and disrupts your life, such as relying on a deceased spouse for everyday activities.
Anger, like denial, can also serve a purpose as an individual deals with loss. It can also be an unhealthy coping mechanism. Anger is a natural response when an individual feels wronged, and it can give us the drive and energy to correct an injustice. When dealing with death or another loss, an individual’s anger can go in many directions; towards the lost loved one, towards someone else involved, or towards oneself, in the form of guilt.
If a situation cannot be corrected, which is usually the case when dealing with loss, it can be difficult to know how to deal with anger. Healthy coping mechanisms might include writing an angry letter, venting to a friend, making artwork or music, or doing physical activity. Unhealthy coping mechanisms might appear as substance abuse, breaking things, or hurting others.
The bargaining stage might be interpreted as trying to fix what seems to be a problem with no solution. As someone grieves a loss, they might wonder what they could have done differently, or how the event could have been avoided. This stage might also include bargaining with a higher power, or “deals with god.”
This stage can be helpful as a means to reflect on life. It might encourage you to make necessary changes to your life, or inspire positive activities, like charity work. However, bargaining can also backfire. If someone feels they’ve “made a deal,” but their loss or unhappiness continues, it can cause them to lose faith.
During, or as a consequence of bargaining, some people may lose faith in things they once believed, such as religion, good karma, honesty, or fairness. When a great loss occurs, things that once made sense no longer do, and this can start to unravel even the most concrete convictions. At this stage, it is important to stop rumination and “thought spirals” before they become destructive. A death or loss, though very difficult, is a single event, and it should not be misconstrued with a higher power, moral balance, or universal fairness.
Depression is perhaps the most recognizable of the five stages of grief. Though it can be difficult to watch a loved one go through depression, it is normal for someone to be depressed after a loss. It is only when depression lingers or becomes destructive that it can become an unhealthy stage of the grief process. We will talk about severe depression or “complicated grief” later in the post.
Depression is usually expressed by a lack of interest or energy. Someone who is depressed may feel that they are in a fog, numb, or tired all the time. It may be difficult to get out of bed, leave the house, or take part in everyday activities. In depression, it can seem that feelings of sadness and hopelessness will never lift.
In most cases, depression lifts as the shock of the loss fades and lifestyle changes become more manageable. Support from friends and family can help. If depression continues for long periods, thoughts of suicide start, or other destructive behaviors or thought processes take hold, it is important to see a therapist immediately. If you or a family member is suffering from depression that won’t go away, make an appointment with a therapist, see a doctor, or talk to a trusted friend.
Accepting loss does not mean you are unaffected by it; it means that you have found a way to cope and continue with your life. It is normal to miss your loved one, and some memories, events, or thoughts may bring back feelings of sadness or regret. You may feel that you have accepted the loss, but then anger, depression, or another stage may return sometime later. Remember that it is okay to feel this way. Give yourself time to heal.
Acceptance means returning to a comfortable, healthy lifestyle. Though you may still miss your loved one, you have found healthy ways to cope with sadness or longing. If your life changed after the loss, you have found ways to accept or even enjoy your new lifestyle. Remember that everyone is different, and acceptance may come sooner or take longer for you.
Why Do We Use the Five Stages of Grief?
While the five stages of grief can be a guide for understanding loss, it is not the only model or even the most effective model used by grief counselors. The five stages of grief have earned mass appeal most likely because they help to organize and simplify a complicated emotional challenge. Loss can make our lives seem senseless and can destroy patterns that give our lives order. As a person struggles with complex emotions, it can be difficult for friends and loved ones to understand. The five stages of grief model helps to make grief more understandable, even if the model is not completely accurate.
Other Ways to Cope With Loss
Since On Death and Dying, other researchers have studied the effects and patterns of loss, and developed other methods to help patients cope. Other models for categorizing and treating grief focus less on a particular feeling—anger, depression, denial etc.—and more on the intensity and time it lasts. From this, therapists can decide whether a patient’s grief is “common” (also called “acute), or complicated and potentially harmful.
Common or Acute Grief
Despite the name, common grief may still take many forms. This relatively new model for studying and treating grief allows for a wide range of behaviors and feelings. Shock, disbelief, depression, anger and other extreme emotions are still expected for those experiencing common grief symptoms.
Though everyone is different, researchers report that common grief affects 50% to 85% of people coping with loss. Common grief, also called acute grief, generally resolves within a year or two. Though emotions may be extreme at first, and may interfere with everyday activities, common grief symptoms slowly improve as time passes. With common grief, emotional outbursts will lessen and the intensity of depression, anger or other emotions will decrease.
Complicated or Prolonged Grief
The American Psychological Association reports that approximately 15% of people will express “complicated grief” symptoms following a loss. Complicated or prolonged grief appears differently than common grief, and symptoms are more severe and long-lasting. A person dealing with complicated grief may not show any symptoms at the start; their reaction may be delayed or inhibited. Grief that does not resolve and continuously affects a person’s life may also be complicated. Finally, grief with intense, atypical symptoms may also be complicated.
Complicated grief can be assessed using a series of criteria. How intensely the patient feels, how often, and for how long will play a role in determining whether or not the grief is complicated. The following are paraphrased criteria for determining complicated grief. Complicated grief symptoms are persistent, usually occurring daily, and do not improve over periods of months.
- Pointlessness: After the loss, it feels as though nothing has meaning or importance anymore.
- Loss of control: Belief or confidence in trust, power, or control has gone.
- Hopelessness: It feels as though the future has nothing to offer.
- Numbness: Friendships, hobbies, work, and other activities seem useless.
- Disbelief: The situation does not feel real, or cannot be real.
- Anger: It is hard to stop from lashing out at others.
- Harmful behavior: Actions related to feelings of loss have been dangerous or harmful.
While it may be normal to feel any of the above immediately following a loss, complicated grief occurs when these feelings do not stop and do not improve. If you or a loved one feels this way, schedule a consultation with a therapist right away. A grief counselor can help you construct healthy coping mechanisms and start feeling like yourself again.
Who is Likely to Suffer From Complicated Grief?
Complicated grief can become an anxiety disorder or major depressive disorder if it is not treated. Some people are more likely than others to suffer from complicated grief, and some risk factors can increase the chances of complicated grief occurring. The following factors may mean you are more susceptible to complicated grief.
- History of anxiety disorders, depression, or other disorders.
- The loss was sudden and unexpected.
- Lack of social support.
- Low income.
- The loss or other current life events are stressful and severe.
- Low self-esteem or lack of control
- Under 60 years old
How to Cope With Grief
In the days and months after a loss, it can be difficult to take part in everyday routines and to return to normal life. However, there are a few activities that may help to improve recovery after a loss. Taking part in these activities as much as possible can reduce the chances of suffering from complicated grief, and can help make healing easier.
- Stay Healthy: Maintaining a normal sleeping, eating, and exercising schedule as much as possible can help to decrease the intensity and length of grief. It can be helpful to rely on friends and family for help, such as making appointments to take a walk with a friend or visit for a healthy lunch.
- Honor the Lost Loved One: Recovering from a loss does not mean you have to stop thinking about your lost loved one. It can be helpful to keep positive memories of the person in mind, and to take part in an activity that honors their memory or legacy. Be careful not to let this become rumination on longing.
- Be Kind to Yourself: There may be days that it is hard to get out of bed, and you may feel guilty for neglecting some responsibilities. Remember that it is okay to have a bad day and it is okay to mourn the loss of your loved one. Give yourself time to mourn and heal.
- Maintain Social Connections: Support from friends and family are an essential part of getting over a loss, but they can only support you if you let them. Do your best to see your friends and family, and be honest about what you do or don’t want to talk about related to your loss.
- See a Therapist: Even if you feel like you are coping with the loss in a constructive way, it can still be helpful to speak with a counselor. A counselor or therapist can be a listening ear, a supportive friend, and an expert who can give you coping strategies.
Understanding the five stages of grief as well as other, more recent models can help make loss less confusing. Remember that there is no “right” way to grieve, and that each person is different. Whatever your grieving process looks like, it is important to stay healthy and safe. If you, a friend or a family member is struggling with grief contact us today to make an appointment for grief counseling in Bloomfield Hills or Taylor, MI.