Home » Misc » List stages of grief

List stages of grief


The Stages of Grief: Accepting the Unacceptable

June 8, 2020

Posted by Caitlin Stanaway, Psy.D., Licensed Psychologist, UWCC

The pandemic has impacted our routines, social lives, school, work, and more. It has caused the loss of lives around the globe, as well as the loss of normalcy. The recent death of George Floyd has put police brutality, murders of Black and Brown people, racial and social injustice into the spotlight. There are many losses to grieve amidst the intensity of civil unrest, on top of more typical stressors like taking finals and looking for a job.

Elisabeth Kubler-Ross developed the five stages of grief in her 1969 book, On Death and Dying. Grief is typically conceptualized as a reaction to death, though it can occur anytime reality is not what we wanted, hoped for, or expected.

Persistent, traumatic grief can cause us to cycle (sometimes quickly) through the stages of grief: denial, anger, bargaining, depression, acceptance. These stages are our attempts to process change and protect ourselves while we adapt to a new reality. While there are consistent elements within each stage, the process of grieving looks different for everyone.

When you combine experiences of stress and trauma to grief, it is overwhelming. It takes a toll on our mental and physical health. Our minds and bodies are consistently being impacted by the stress response, a nervous system reaction to feeling threatened. It triggers the release of adrenaline and cortisol, impacting sleep, appetite, making it difficult to function at your best.

Symptoms of anxiety and depression may develop, as well as trauma symptoms like intrusive thoughts, nightmares, feeling disconnected from self. Trauma related to racial injustice is chronic. Resources for Black healing, including crisis support, self-care, and reducing cortisol levels in response to racial stressors can be found here.

Being aware of the grief stages and how you uniquely experience them can increase self-understanding and compassion. It can help you better understand your needs and prioritize getting them met.

Denial

can look like: can feel like:
avoidance shock
procrastination numbness
forgetting confusion
easily distracted shutting down
mindless behaviors
keeping busy all the time
thinking/saying, “I’m fine” or “it’s fine”

 

Anger

can look like: can feel like:
pessimism frustration
cynicism impatience
sarcasm resentment
irritability embarrassment
being aggressive or passive-aggressive rage
getting into arguments or physical fights feeling out of control
increased alcohol or drug use

 

Bargaining

can look like: can feel like:
ruminating on the future or past guilt
over-thinking and worrying shame
comparing self to others blame
predicting the future and assuming the worst fear, anxiety
perfectionism insecurity
thinking/saying, “I should have…” or ”If only…”
judgment toward self and/or others

 

Depression

can look like: can feel like:
sleep and appetite changes sadness
reduced energy despair
reduced social interest helplessness
reduced motivation hopelessness
crying disappointment
increased alcohol or drug use overwhelmed

 

Acceptance

can look like: can feel like:
mindful behaviors “good enough”
engaging with reality as it is courageous
“this is how it is right now” validation
being present in the moment self-compassion
able to be vulnerable & tolerate emotions pride
assertive, non-defensive, honest communication wisdom
adapting, coping, responding skillfully

 

Generally, if we are not in the stage of acceptance then we are in some way fighting against or avoiding reality. We might start sleeping more. Our mood or anxious thoughts might become the focus of attention, distracting from external stressors. We might use alcohol or drugs to avoid or disconnect from reality. We might keep our focus on tasks, responsibilities, or the needs of others – staying busy as much as possible to avoid feeling distress.

Acceptance doesn’t mean not experiencing distress, emotions or trauma. It does not mean you condone what is happening. It means noticing what you are fighting against, validating your desire to fight against it, and re-orienting yourself to the reality of the moment you are in. It means not getting stuck, or getting un-stuck, from other stages. Mindfulness and a non-judgmental, curious attitude can be a big help.

Acceptance might look like saying to yourself: “If I sleep too long today I’ll keep sleeping through the mornings. I’m going to prioritize getting my schedule regulated.” It might look like noticing: “I’m directing my anger and sadness about what’s going on toward myself and ruminating on self-criticisms. I’ll acknowledge my anger and what it’s really about.” Or reflecting, “how could I not be angry about ___? Who wouldn’t be anxious about ___? Of course it’s extremely hard to accept ___”; It might look like checking in on yourself: “If I keep neglecting my own needs and focusing on work/others, I’ll end up feeling burned out and exhausted. I’ll take time to assess how I’m doing and what I need.”

It is rare to move through the stages in a linear way. It is normal to experience ups and downs in mood, thoughts, attitudes, and behaviors. It can be difficult maintaining acceptance while things feel so unacceptable.

If you are feeling overwhelmed by grief, loss, trauma you do not have to go through it alone. The Counseling Center can offer culturally-sensitive support and guidance through the grieving process.

How to Understand Your Feelings

Grief is universal. At some point, everyone will have at least one encounter with grief. Elizabeth Kbler Ross wrote in her book “On Death and Dying” that grief could be divided into five stages. They were originally devised for people who were ill, but these stages have been adapted for coping with grief in general.

Grief is universal. At some point, everyone will have at least one encounter with grief. It may be from the death of a loved one, the loss of a job, the end of a relationship, or any other change that alters life as you know it.

Grief is also very personal. It’s not very neat or linear. It doesn’t follow any timelines or schedules. You may cry, become angry, withdraw, or feel empty. None of these things are unusual or wrong.

Everyone grieves differently, but there are some commonalities in the stages and the order of feelings experienced during grief.

In 1969, a Swiss-American psychiatrist named Elizabeth Kübler-Ross wrote in her book “On Death and Dying” that grief could be divided into five stages. Her observations came from years of working with terminally ill individuals.

Her theory of grief became known as the Kübler-Ross model. While it was originally devised for people who were ill, these stages of grief have been adapted for other experiences with loss, too.

The five stages of grief may be the most widely known, but it’s far from the only popular stages of grief theory. Several others exist as well, including ones with seven stages and ones with just two.

According to Kübler-Ross, the five stages of grief are:

  • denial
  • anger
  • bargaining
  • depression
  • acceptance

Here’s what to know about each one.

Stage 1: Denial

Grief is an overwhelming emotion. It’s not unusual to respond to the strong and often sudden feelings by pretending the loss or change isn’t happening.

Denying it gives you time to more gradually absorb the news and begin to process it. This is a common defense mechanism and helps numb you to the intensity of the situation.

As you move out of the denial stage, however, the emotions you’ve been hiding will begin to rise. You’ll be confronted with a lot of sorrow you’ve denied. That is also part of the journey of grief, but it can be difficult.

Examples of the denial stage

  • Breakup or divorce: “They’re just upset. This will be over tomorrow.”
  • Job loss: “They were mistaken. They’ll call tomorrow to say they need me.”
  • Death of a loved one: “She’s not gone. She’ll come around the corner any second.”
  • Terminal illness diagnosis: “This isn’t happening to me. The results are wrong.”

Stage 2: Anger

Where denial may be considered a coping mechanism, anger is a masking effect. Anger is hiding many of the emotions and pain that you carry.

This anger may be redirected at other people, such as the person who died, your ex, or your old boss. You may even aim your anger at inanimate objects. While your rational brain knows the object of your anger isn’t to blame, your feelings in that moment are too intense to act according to that.

Anger may mask itself in feelings like bitterness or resentment. It may not be clear-cut fury or rage.

Not everyone will experience this stage of grief. Others may linger here. As the anger subsides, however, you may begin to think more rationally about what’s happening and feel the emotions you’ve been pushing aside.

Examples of the anger stage

  • Breakup or divorce: “I hate him! He’ll regret leaving me!”
  • Job loss: “They’re terrible bosses. I hope they fail.”
  • Death of a loved one: “If she cared for herself more, this wouldn’t have happened.”
  • Terminal illness diagnosis: “Where is God in this? How dare God let this happen!”

Stage 3: Bargaining

During grief, you may feel vulnerable and helpless. In those moments of intense emotions, it’s not uncommon to look for ways to regain control or to want to feel like you can affect the outcome of an event. In the bargaining stage of grief, you may find yourself creating a lot of “what if” and “if only” statements.

It’s also not uncommon for religious individuals to try to make a deal or promise to God or a higher power in return for healing or relief from the grief and pain. Bargaining is a line of defense against the emotions of grief. It helps you postpone the sadness, confusion, or hurt.

Examples of the bargaining stage

  • Breakup or divorce: “If only I had spent more time with her, she would have stayed.”
  • Job loss: “If only I worked more weekends, they would have seen how valuable I am.”
  • Death of a loved one: “If only I had called her that night, she wouldn’t be gone.”
  • Terminal illness diagnosis: “If only we had gone to the doctor sooner, we could have stopped this.”

Stage 4: Depression

Whereas anger and bargaining can feel very active, depression may feel like a quiet stage of grief.

In the early stages of loss, you may be running from the emotions, trying to stay a step ahead of them. By this point, however, you may be able to embrace and work through them in a more healthful manner. You may also choose to isolate yourself from others in order to fully cope with the loss.

That doesn’t mean, however, that depression is easy or well defined. Like the other stages of grief, depression can be difficult and messy. It can feel overwhelming. You may feel foggy, heavy, and confused.

Depression may feel like the inevitable landing point of any loss. However, if you feel stuck here or can’t seem to move past this stage of grief, you can talk with a mental health expert. A therapist can help you work through this period of coping.

Examples of the depression stage

  • Breakup or divorce: “Why go on at all?”
  • Job loss: “I don’t know how to go forward from here.”
  • Death of a loved one: “What am I without her?”
  • Terminal illness diagnosis: “My whole life comes to this terrible end.”

Stage 5: Acceptance

Acceptance is not necessarily a happy or uplifting stage of grief. It doesn’t mean you’ve moved past the grief or loss. It does, however, mean that you’ve accepted it and have come to understand what it means in your life now.

You may feel very different in this stage. That’s entirely expected. You’ve had a major change in your life, and that upends the way you feel about many things.

Look to acceptance as a way to see that there may be more good days than bad. There may still be bad — and that’s OK.

Examples of the acceptance stage

  • Breakup or divorce: “Ultimately, this was a healthy choice for me.”
  • Job loss: “I’ll be able to find a way forward from here and can start a new path.”
  • Death of a loved one: “I am so fortunate to have had so many wonderful years with him, and he will always be in my memories.”
  • Terminal illness diagnosis: “I have the opportunity to tie things up and make sure I get to do what I want in these final weeks and months.”

The seven stages of grief are another popular model for explaining the many complicated experiences of loss. These seven stages include:

  • Shock and denial: This is a state of disbelief and numbed feelings.
  • Pain and guilt: You may feel that the loss is unbearable and that you’re making other people’s lives harder because of your feelings and needs.
  • Anger and bargaining: You may lash out, telling God or a higher power that you’ll do anything they ask if they’ll only grant you relief from these feelings or this situation.
  • Depression: This may be a period of isolation and loneliness during which you process and reflect on the loss.
  • The upward turn: At this point, the stages of grief like anger and pain have died down, and you’re left in a more calm and relaxed state.
  • Reconstruction and working through: You can begin to put pieces of your life back together and move forward.
  • Acceptance and hope: This is a very gradual acceptance of the new way of life and a feeling of possibility for the future.

As an example, this may be the presentation of stages from a breakup or divorce:

  • Shock and denial: “She absolutely wouldn’t do this to me. She’ll realize she’s wrong and be back here tomorrow.”
  • Pain and guilt: “How could she do this to me? How selfish is she? How did I mess this up?”
  • Anger and bargaining: “If she’ll give me another chance, I’ll be a better boyfriend. I’ll dote on her and give her everything she asks.”
  • Depression: “I’ll never have another relationship. I’m doomed to fail everyone.”
  • The upward turn: “The end was hard, but there could be a place in the future where I could see myself in another relationship.”
  • Reconstruction and working through: “I need to evaluate that relationship and learn from my mistakes.”
  • Acceptance and hope: “I have a lot to offer another person. I just have to meet them.”

There’s no one stage that’s universally considered to be the hardest to endure. Grief is a very individual experience. The toughest stage of grief varies from person to person and even from situation to situation.

Grief is different for every person. There’s no exact time frame to adhere to. You may remain in one of the stages of grief for months but skip other stages entirely.

This is typical. It takes time to go through the grieving process.

Not everyone goes through the stages of grief in a linear way. You may have ups and downs and go from one stage to another, then circle back.

Additionally, not everyone will experience all stages of grief, and you may not go through them in order. For example, you may begin coping with loss in the bargaining stage and find yourself in anger or denial next.

Avoiding, ignoring, or denying yourself the ability to express your grief may help you dissociate from the pain of the loss you’re going through. But holding it in won’t make it disappear. And you can’t avoid grief forever.

Over time, unresolved grief can turn into physical or emotional manifestations that affect your health.

In order to heal from a loss and move on, you have to address it. If you’re having trouble processing grief, consider seeking out counseling to help you through it.

Grief is a natural emotion to experience when going through a loss.

While everyone experiences grief differently, identifying the various stages of grief can help you anticipate and comprehend some of the reactions you may experience throughout the grieving process. It can also help you understand your needs when grieving and find ways to have them met.

Understanding the grieving process can ultimately help you work toward acceptance and healing.

The key to understanding grief is realizing that no one experiences the same thing. Grief is very personal, and you may feel something different every time. You may need several weeks, or grief may be years long.

If you decide you need help coping with the feelings and changes, a mental health professional is a good resource for vetting your feelings and finding a sense of assurance in these very heavy and weighty emotions.

These resources can be useful:

  • Depression Hotline
  • Suicide Prevention Lifeline
  • National Hospice and Palliative Care Organization

Five stages of grief. The Rise and Fall of Kübler-Ross

  • Lucy Burns
  • BBC

Image copyright Getty Images

Denial. Anger. Finding a compromise. Despair. Adoption. Many people know the theory according to which grief, when receiving unbearable information for a person, goes through these steps. The scope of its application is wide: from hospices to boards of directors of companies. nine0018

A recent interview with a psychologist in English on the Internet proves that the perception of the current quarantine is subject to the same rules. But do we all experience the same?

When Swiss psychiatrist Elisabeth Kübler-Ross began working in American hospitals in 1958, she was struck by the lack of methods of psychological care for dying patients.

  • A method that can predict your death

"Everything was impersonal, the attention was paid exclusively to the technical side of things," she told the BBC at 1983 year. “Terminally ill patients were left to their own devices, no one talked to them.”

She started a workshop with Colorado State University medical students based on her conversations with cancer patients about what they thought and felt.

Author photo, LIFE/Getty Images

Photo caption,

Elisabeth Kübler-Ross talks to a woman with leukemia in Chicago, 1969. Seminar participants observe through a special mirror glass

Despite the misunderstanding and resistance of a number of colleagues, soon there was nowhere for an apple to fall at the Kübler-Ross seminars.

In 1969 she published a book, On Death and Dying, in which she quoted typical statements from her patients and then moved on to discuss how to help doomed people pass from life as free of fear and pain as possible.

Kübler-Ross described in detail the five emotional states that a person goes through after being diagnosed with a terminal diagnosis:

  • Denial: "No, that can't be true"
  • Anger: "Why me? Why? It's not fair!!!"
  • Bargaining: "There must be a way to save myself, or at least improve my situation! I'll think of something, I'll behave properly and do whatever is necessary!"
  • Depression: "There is no way out, everything is indifferent"
  • Acceptance: "Well, we must somehow live with this and prepare for the last journey"

difficult situation. nine0011

A separate chapter of the book is devoted to each of the stages. In addition to the five main ones, the author identified intermediate states - the first shock, preliminary grief, hope - from 10 to 13 types in total.

Image copyright Getty Images

Elisabeth Kübler-Ross died in 2004. Her son, Ken Ross, says she never insisted that every person must go through these five stages in sequence.

"It was a flexible framework, not a panacea for dealing with grief. If people wanted to use other theories and models, the mother did not object. She wanted to start a discussion of the topic first," he says. nine0011

  • Last will: how did the photo of a dying American touch the world?
  • "You hear everything, Fernando." How was the evening in honor of the terminally ill football player

The book "On Death and Dying" became a bestseller, and Elisabeth Kübler-Ross was soon inundated with letters from patients and doctors from all over the world.

"The phone kept ringing, and the postman started visiting us twice a day," recalls Ken Ross.

The notorious five steps took on a life of their own. Following the doctors, patients and their relatives learned about them. They were mentioned by the characters of the series "Star Trek" and "Sesame Street". They were parodied in cartoons, they gave food for creativity to the mass of musicians and artists and gave rise to many successful memes. nine0011

Literally thousands of scientific papers have been written that have applied the theory of the five steps to a wide variety of people and situations, from athletes suffering career-incompatible injuries to Apple fans' worries about the release of the 5th iPhone.

Image copyright, Getty Images

Skip the Podcast and continue reading.

Podcast

What was that?

We quickly, simply and clearly explain what happened, why it's important and what's next. nine0011

episodes

The End of History Podcast

Kübler-Ross's legacy has found its way into corporate governance: Big companies from Boeing to IBM (including the BBC) have used her "change curve" to help employees at times of great business change.

And during the coronavirus pandemic, it applies, says psychologist David Kessler.

Kessler worked with Elisabeth Kübler-Ross and co-authored her latest book, Grief and How We Grieve. His interview with the Harvard Business Review at the start of the pandemic garnered a lot of attention online as people everywhere searched for solutions to their emotional problems. nine0011

"And here, first comes denial: the virus is not terrible, nothing will happen to me. Then anger: who dares to deprive me of my usual life and force me to stay at home?! Then an attempt to find a compromise: okay, if after two weeks of social distancing it gets better, then why not? Followed by sadness: no one knows when it will end. And, finally, acceptance: the world is now like this, you have to somehow live with it, "describes David Kessler.

"As you can see, strength comes with acceptance. It gives you control: I can wash my hands, I can keep a safe distance, I can work from home," he says. nine0011

"It's a roadmap," says George Bonanno, professor of clinical psychology and head of the Loss, Trauma, and Emotion Laboratory at Columbia University. "When people are in pain, they want to know: how long will it last? What will happen to me? something to grab on to. And the five-step model gives them that opportunity."

"This scheme is seductive," notes Charles Corr, social psychologist and author of Death and Dying, Life and Being. "It offers an easy solution: sort everyone, and it takes no more than the fingers of one hand to label each one." . nine0011

George Bonanno sees this as a possible harm.

"People who don't fit exactly into these stages - and I've seen the majority of them - may decide they're grieving the wrong way, so to speak," he explains.

According to him, over the years he has seen many cases when people themselves inspired that they must certainly experience this and that, or they were convinced of this by friends and relatives, but they did not feel it and decided, that they need a doctor.

Experimental evidence of the existence of the five stages of grief is not enough. The longest and most extensive bereavement interview was conducted in 2007.

According to him, the most common state at any time is acceptance, only a few go through the stage of denial, and the second most common emotion is longing.

However, according to David Kessler, while scientists debate the nuances and terms, people who experience grief continue to find meaning in the Kübler-Ross scheme. nine0011

"I meet people who tell me, 'I don't know what's wrong with me. Now I'm angry, and a minute later I'm sad. I must be crazy.” And I say, “It has names. These are called the stages of grief.” The person says, “Oh, so there is a special stage called 'anger'? It's about me!" And feels more normal."

Image copyright, Getty Images

"People need catchy statements. If Kübler-Ross hadn't called it stages and stated that there are exactly five of them, then she probably would have been closer to the truth. But then she would not have attracted to attention," says Charles Corr. nine0011

He believes that talking about the five stages distracts from the main scientific legacy of Elisabeth Kübler-Ross.

"She wanted to take on the topic of death and dying in the broadest sense: how to help terminally ill people come to terms with their diagnosis, how to help those who care for them, support these patients and cope with their own emotions, how to help everyone live a full life, realizing that we are not eternal,” says Charles Corr.

"The terminally ill can teach us everything: not only how to die, but also how to live," said Elisabeth Kübler-Ross at 1983 year.

During the 1970s and 1980s, she traveled the world, giving lectures and giving workshops to thousands of people. She was a passionate supporter of the hospice idea pioneered by British nurse Cecily Saunders.

Kübler-Ross has established hospices in many countries, the first in the Netherlands in 1999. Time magazine named her one of the 100 most important thinkers of the 20th century.

Professor Kübler-Ross' scientific reputation was shaken after she became fascinated with theories about the afterlife and began to experiment with mediums. nine0011

One of them, a certain Jay Barham, practiced non-standard religious-erotic therapy, in particular, he persuaded women to have sex, assuring that he was possessed by a person close to them from the afterlife. In 1979, because of this, a loud scandal arose.

In the late 1980s, she tried to set up a hospice for children with AIDS in rural Virginia, but faced strong local opposition to the idea.

In 1995, her house caught fire under suspicious circumstances. The next day Kübler-Ross had her first stroke. nine0011

She spent the last nine years of her life with her son in Arizona, moving around in a wheelchair.

In her last interview with the famous TV presenter Oprah Winfrey, she said that at the thought of her own death she feels only anger.

"The public wanted the famed expert on death and dying to be some kind of angelic personality and quickly get to the stage of acceptance," says Ken Ross. "But we all deal with grief and loss as best we can."

The theory of the five stages of grief is not widely taught in medical schools these days. It is more popular at corporate trainings under the name "Curve of Change". nine0011

Since then, there have been many theories about how to deal with your grief.

David Kessler, with the consent of Kübler-Ross's family, added a sixth stage to the five: the understanding that everything that is done makes sense.

"Understanding can come in a million different ways. Let's say I've become a better person after losing a loved one. Maybe my loved one passed away in a different way than it should have happened, and I can try to make the world a better place to this has not happened to others," says David Kessler. nine0011

Charles Corr recommends the "double process model". It was developed by Dutch researchers Margaret Stroebe and Nenk Schut and suggests that a person in grief is simultaneously experiencing a loss and preparing himself for new things and life challenges.

George Bonanno talks about four trajectories of grief. Some people have great stamina and do not fall into depression, or it is weakly expressed in them, others remain morally broken for many years, others recover relatively close, but then a second wave of grief rolls over them, and finally, the fourth becomes stronger from the loss. nine0011

Over time, one way or another, the vast majority of people get better.

But Professor Bonanno admits that his approach is less clear-cut than the five-stage theory.

"I can say to a person: 'Time heals.' But that doesn't sound so convincing," he says.

Grief is difficult to control and hard to endure. The thought that there is some kind of road map that suggests a way out is comforting, even if it is an illusion.

Elisabeth Kübler-Ross, in her latest book, Grief and How We Grieve, wrote that she did not expect to sort out the tangled human emotions. nine0011

Everyone experiences grief in their own way, even if some patterns can sometimes be deduced. Everyone goes their own way.

how to help a person at every stage

home / Blog / 5 stages of mourning: how to help a person at each stage

Reading time: 5 minutes

|

May 23, 2022

Get our articles in messengers

nine0008 The article was created with the participation of an expert

Barinova Oksana Vladimirovna

Practicing psychologist, trainer, specialist in family counseling. Candidate of Psychological Sciences, professor. Author of more than 150 scientific papers.

Experiencing grief, a person often goes through 5 stages: shock, anger, bargaining, depression, acceptance. Each of them is important and has its own characteristics. Oksana Vladimirovna Barinova, our teacher-expert, practicing psychologist, specialist in family counseling, candidate of psychological sciences, professor, spoke about how to help a person at each stage of mourning. nine0011

Read in the article:

  • Shock (denial)
  • Anger (guilt)
  • Trade
  • Depression
  • Acceptance

When providing psychological assistance to people who have experienced loss, it is important to consider at what stage of experiencing the loss they are.

In the initial stages, you need to tell a person about what the process of mourning is and what its structure is. The psychologist is encouraged to use the active listening technique to reflect the feelings and emotions associated with the loss. This will help the client understand what is happening to him and help establish a trusting relationship. nine0011

In the later stages of mourning, focus on the specific negative consequences of the loss. And based on this, select the appropriate methods of psychological assistance.

The process of mourning is complex, and there are actually more than five stages in it. On average, a person goes through all the stages of mourning in 1–1.5 years. But the path can be bumpy. The mourner can skip stages, go back, go in his own order and pace. For example, sometimes there is no stage of denial or anger. If you or your client is not moving according to the scheme, then you need to remember that this is natural and normal. nine0011

Most people go through 5 main stages, so we will analyze them in more detail.

Cycle of grief

Shock (denial)

Peculiarities of the stage. The person acts detached or as if nothing has happened.

Learn more