Grief may result from losses such as severe illness, death of a loved one, or a major change in life circumstances. Life is altered in some way and we are confronted with new realities. Grief is a natural healing process that should not be blocked or interfered with. Understanding the emotions of grief and its feeling and symptoms are important steps in healing. “What you feel you can heal.”
Stages of grief
When a person suffers a major loss, he or she goes through certain stages of grieving in order to heal. The grieving process can be described as a series of emotional states in a downward curve that bottoms out before the process of recovery begins – called the “grief cycle”.
In 1969, based on her years of working with terminal cancer patients, psychiatrist Elisabeth Kübler-Ross introduced what became known as the “five stages of grief.” While these stages represent the feelings of people who were themselves facing death, many people now apply them to experiencing other negative life changes (a break-up, loss of a job) and to people facing death or experiencing the death of loved ones. Kübler-Ross proposed these five stages of grief as the following:
1: Shock and denial: “This can’t be happening to me”
2: Anger: “Why is this happening? Who is to blame?”
3: Dialogue and bargaining: “Make this not happen, and in return I will…”
4: Depression & detachment: “I’m too sad to do anything.”
5: Acceptance: “I’m at peace with what has happened.”
Kübler-Ross did not intend for these stages to be a rigid framework that applies to everyone who mourns. “It was not intended to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”
The cycle of grief
The expanded cycle of grief can be generalized in terms of the following phases:
A. Impact
Shock, denial, numbness and disbelief
The initial reaction to an unexpected or a life-changing event is that of shock, confusion, surprise, numbness and disbelief. Even if a death is anticipated, there may be disbelief at its finality. Other emotions may include numbness, confusion, disorientation, crying and listlessness. Physical reactions include paling of the skin, shortness of breath and lack of appetite. Pain avoidance is a temporary retreat; we tend to deny the loss has taken place, and may withdraw from our usual social contacts.
Anger, bitterness, sadness, frustration
The frustrated outpouring of bottled-up emotion can include anxiety, irritation, embarrassment and shame. Anyone may be blamed and the phrase ‘Why me?’ is repeated endlessly. The emotional release may include crying, hysteria and a tendency to blame everyone else and lash out at them. Symptoms experienced may include lack of energy, headaches, fatigue, tension, vulnerability to illness. In the social life it may include loss of interest, indifference, withdrawal and avoidance and being hyper-sensitive to others.
B. Disorganization and pain
Denial, uncertainty and confusion
Denial softens the immediate blow of a death. People may know their loved one has died, but some part of them can’t yet accept the reality of the death. Yearning and longing for “the way things used to be.” There is uncertainty about the future, and questions such as “Will I be next?”
Panic and guilt
A survivor may experience feelings of guilt and regret. “I should have done more”. He feels responsible for the loss or death even though he had no control over it. It may include wishful thinking or regret.
Physical distress
People have trouble thinking clearly and cannot plan effectively, not knowing what to do. They may feel and show physical signs of stress such as sleeplessness and stomach problems, a feeling of weakness, or that their strength has been drained way. Physical distress can include digestive upsets, loss of appetite, high blood pressure, rapid heart beat, or change of body temperature.
C. Anger, bargaining & resignation
Anger, hostility and resentment
Anger is normal. It may be directed at the deceased for leaving and causing a sense of abandonment, or at the doctors and nurses who did not do enough. People of faith may feel anger at God, for allowing so much pain and anguish. Anger may also be directed at oneself for not saving the life of the loved one. It can test one’s faith in religion or even in the goodness of life. Anger is an important part of the recovery process. It can be positive - use it to gain energy to cope with the situation.
Bargaining
Now the grieving person may make bargains with God, asking “If I do this, will you take away the loss?” The person is seeking for a way out, to avoid having the bad thing happen – a vain expression of hope that the bad news is reversible. It may entail reaching out to others, telling their story and struggling to find meaning in what has happened.
D. Resignation, sadness and depression
Resignation and sadness
In the final realization of the inevitable, the person may be overwhelmed, feels down, lacks energy, and experiences helplessness. The inevitability of the situation sinks in and the person reluctantly accepts what is going to happen. In turning in towards himself, he turns away from solutions others can give him.
Sadness and even hopelessness may set in. Sadness is the most inevitable emotion of grief. It is normal to feel abandoned, alone and afraid. A person may have little energy to do even the simplest daily chores. Crying episodes may seem endless.
Depression and loneliness
Hitting rock bottom, he may experience depression and apathy. Everything seems pointless and he may lack self-confidence. This stage can last a long time, and is characterized by a sense of loneliness, worthlessness and alienation from others and God. It seems that nothing will ever change and life is hopeless. There is an inability to return to the normal routine.
E. Reconstruction & Integration
Acceptance and finding peace
The final stage is back to one of stability, where the person is ready and actively involved in moving on to the next phase of their lives. The bereaved starts to adjust to a life without the deceased, reinvesting in life and the turn upward begins.
Acknowledging the loss and experiencing the pain free the survivor from a yearning to return to the past. Adjustments are made and you start taking on a positive attitude. Sadness gives way to a new perspective about the future. It does not mean forgetting, but rather using the memories to create a new life without the loved one.
Reorganisation means finding new meaning in life and a willingness to face reality. Hoping for things to be as they were is now replaced by a search for new relationships and new activities.
People start to feel in control of their lives again. The loss is still a part of their lives but does not dictate their actions. Energy is directed into new places—new interests, new friends and taking good care of the self.
F. Integration
Looking forward, the person starts taking new risks, taking responsibility, reconstructing his life, looking forward, doing things for himself, exploring new interests, and renewed interest in personal growth.
Grief is a chance for personal growth. For many people, it may eventually lead to renewed energy to invest in new activities and new relationships. Some people seek meaning in their loss and get involved in causes or projects that help others.
Some people find a new compassion in themselves as a result of the pain they have suffered. They may become more sensitive to others, thus enabling richer relationships. Others find new strength independence and emotional resources that had not been apparent before.
In exploring new options there is a future orientation, self-efficacy, optimism, initiative, confidence, excitement and enthusiasm.
Return to a meaningful life
The person returns to a meaningful life having been transformed and experiences empowerment, security, self-esteem and meaning.
In our acceptance of the reality of our loss, we must develop new skills and interests to fill the void, as we begin taking responsibility for our new circumstances.
Negotiating the curve
These stages are depicted in the diagram below. (Click the diagram for a larger version.)
Being aware of these emotional states can assist us in working through the grief and continue towards recovery.
Although some people move from one phase to the next in sequence, life is rarely that simple. The cycle of grief does not necessarily occur in sequence, and oftentimes a person can experience a stage several times. The grief process is an individual experience without a deadline or timetable.
It’s not unusual to move back to a previous phase for a time and it is extremely common to go through some phases more than once.
A person stuck in denial may never move on to acceptance, reconstruction and optimism about the future. Another trap is that a person may move on to a next phase without completing an earlier phase. Some may move backwards in cyclic loops that repeat previous emotions and actions.
It is important to grasp that to reach a new plateau of hope and affirmation, we cannot attempt to walk around grief - we must walk through it. It is therefore important to allow ourselves to feel what we are feeling, to cry when we must, and to feel the pain of sorrow.
When people don’t deal with the emotions of grief, the pain remains with them, and can turn up in unrecognizable and sometimes destructive ways.
