The Five Stages of Grief

January 16, 2014

The reality of death has to sink in, and this is a process we undergo as events and realities trigger the question. I share what has been to me some of the most helpful insights into this process, with the hope that you can be encouraged in your own struggle to find acceptance of your own death (or perhaps in the interim, the death of a loved one).

During the 1960s a Swiss psychiatrist working at the University of Chicago hospital observed a progression of emotions experienced by dying patients.  Dr. Elisabeth Kübler-Ross, M.D., conducted seminars in which the dying were interviewed regarding their feelings and concerns about death.  As a result of this research, which, at the time, outraged the medical establishment, Dr. Kübler-Ross identified five “stages of grief.”  In the subsequent decades, her formulation has been confirmed and its application expanded, since those in the helping professions further observed that persons facing a loss of any major kind go through the same five stages.

Think about a loss you have experienced in your life, and see if you can recall going through these five stages:

Denial, or “No, not me”

Shock and disbelief are the immediate reactions to a loss.  It is the body’s way of protecting a person from an overwhelming reality.  The door to reality slams shut temporarily, and as the person is ready to face the news, the door cracks open gradually to let its import seep in.  This may manifest itself in the insistence that something is not true, that it hasn’t happened, that life is going on normally, or some other similar protest.  It might also appear as isolation or separation from particular reminders. People need denial to varying degrees and for various lengths of time, but eventually will begin to indicate an awareness of what has happened.

Anger, or “Why me?”

Whittled down to its essence, anger is a reaction to not getting one’s way.  A loss, by definition, denies a person his way.  A person wants life to go on, wants to keep his or her job, wants to have relationships, wants to feel self-reliant, dignified, and healthy.  When it strikes that something we want has been denied, we get angry.  “What did I do to deserve this?  It’s outrageous!” is a typical reaction.  An observer might judge this behavior harshly—anger is, after all, one of the “seven deadly sins”—but there is another way of looking at this powerful emotion, invited by the Apostle Paul’s exhortation, “’In your anger do not sin’: Do not let the sun go down while you are still angry,” (Ephesians 4:26).  This suggests that anger is the beginning of a process, which should (according to Paul) be expedited, but it is a process nonetheless.  It is possible to be angry without sinning.  This stage can be ugly, as a person gets mad at the one who has died, or shakes a fist at God, or kicks the cat. 

Bargaining, or “Why now?”

When anger is in play and a loss is impending, the person might feel that “asking nicely” can prevent or at least postpone the inevitable.  Bargaining is employed, for instance, by the terminally ill person trying to eke out a few more days, weeks or months of life.  According to Kübler-Ross, the patient makes promises of “good behavior” in exchange for a guaranteed life extension or relief from pain. Martin Luther’s famous oath on a dangerously stormy night was a bargain of desperation, “If you get me out of this storm alive, I will go into the priesthood.”

There is usually some deadline involved, like making it to a son’s wedding or Thanksgiving.   Though not always, the promises of good behavior can point to a guilty place in a person’s heart.  For example, a bargain with God taking the form, “God, if you heal me I will go to church every Sunday,” may in fact be pointing to unfinished spiritual business producing guilt. Bargaining is helpful to the patient for a relatively brief period, but can be renewed with further promises and goal dates, to a point.  And then, the next stage of grief looms.

Depression, or “Yes, me”

Everything has been tried, every veil pulled down, every topic avoided, every person blamed, every promise made, and still this loss looms.  There is no longer any way to deny the reality of what has happened or is happening—it is really happening to me.  Depression expresses itself in feelings of sadness, lethargy, hopelessness, and psychological pain.

In this stage there are two types:  reactive depression and preparatory depression.   The first type of depression comes as a direct result of circumstances that make life difficult. But the second type of depression, preparatory depression, is a necessary step the dying person must take in order to approach his or her own death with acceptance.  The world must shrink and the focus of attention narrow.  There is a desire to disengage from unnecessary distractions, to pare down the number of relationships and give energy only to those most important.  Family members often perceive this process as either rejection or  “giving up,” because it is often accompanied by withdrawal and silence. The dying are preparing to let go of everything and everyone that have ever been close, and this makes them sad.

Acceptance, or “It’s OK Now”

A quiet peace, a serenity, characterizes the final stage of grief.  More than an intellectual justification, this kind of acceptance is experienced deeply at the emotional level.  One yields to the forces at work and embraces them wholly without a fight or fear.  This is different from resignation.  Remember your teenager who, when grounded and denied use of the car, stomped out yelling “OK, fine!”  There’s plenty of fight left in that statement of resignation! Acceptance, in contrast, is characterized by a sense of quiet victory and confidence.  Fear is gone, and dying is “a positive submission to things we cannot change.” [Kübler-Ross, Living with Death and Dying, p. 48]

The five stages of grief described in simple terms here become evident usually in a less tidy fashion in real life.  One moves through these stages in fits and starts, sometimes “regressing” to a previous stage for a time until it can be abandoned completely.  We are simply encouraged to hang in there with the one who is going through a painful process.  If the expressions of denial, anger, bargaining, and depression can be understood in their context, and not taken personally, you can be a tremendous support on this journey toward acceptance.

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