The 5 Stages of Grief: Wrongly Labeled
“You're still in the denial stage,” my therapist told me. It had been four months since Joe’s death.
“I am?” I asked. “What am I denying? I know Joe is gone and not coming back. So where’s the denial? I may have said, at times, I can’t believe he’s gone. Is that denial? I may be saying that for years to come. Will I still be in denial then?”
Have you been labeled as being in one of the “5 Stages of Grief” since your loss?
I was first introduced to Dr. Elisabeth Kubler-Ross’s book, On Death and Dying, written in 1969, when I was a freshman in college working on my B.A. in nursing. There have been numerous times since then that I have encountered a reference to her concept of “5 Stages of Grief”. It has been my argument for years, as stated by Dr. Ross herself, that these stages are not meant to be complete or chronological. The stages have come under a great deal of scrutiny, and using them can have a negative effect on the person grieving. It is not that we don’t experience some of the emotions similar to those listed in the stages, but in my experience, denial, anger, bargaining, depression, and acceptance are not necessary steps needed in order to move through your grief. Nor are these emotions experienced in any particular order.
Stage 1: Denial
Denial? Here is how one resource describes this first stage:
Denial-”this can’t be happening to me”, looking for the former spouse in familiar places, or if it is death, setting the table for the person or acting as if they are still in living there. No crying. Not accepting or even acknowledging the loss.
How many times have you gone to pick up the phone to call your deceased husband/partner? I know I reached for it quite frequently. I was not denying Joe’s death; it was a habit to share things, by phone, over the course of the day. Setting the table is denial? I know every now and then I counted out 5 dishes instead of the now needed 4. Denial? I think not. My action was more out of habit. I’m not a psychiatrist, but what I do know is that acting “as if” Joe were still alive and living with us would definitely have required a psychiatric evaluation. I have never spoken with a widow who behaved in such a manner. As far as crying after loss, not every person cries. Grief, and the experience following a loss, is unique to each individual. Lack of tears is not a form of denial.
Stage 2: Anger
Here I do have to admit that I have heard widows speak of anger with God for the death of their loved one. However, it was a statement, not a deep down "I hate God" that continued for any length of time. And yes, there could be anger in wishing things had been different if the relationship with the deceased partner was a good one. This is an emotion usually expressed and not a “stage” to pass through.
Here is one interpretation I found of this stage:
Anger-”why me?”, feelings of wanting to fight back or get even with spouse for death, anger at the deceased, blaming them for leaving.
I have never encountered this type of anger from a client.
Yet another interpretation:
Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Anger can manifest itself in different ways. People can be angry with themselves, or with others, and especially those who are close to them. It is important to remain detached and nonjudgmental when dealing with a person experiencing anger from grief.
What this is saying is that moving from one stage to the next is an intellectual decision. “I’ll stop my denial now and move into anger.” And I have never met a widow who was in a state of rage following her loss-- frustration yes, rage no.
Stage 3: Bargaining
This stage I actually remember hearing from a terminally ill patient years ago. It was more of a promise to change her ways and lifestyle if she could only have another chance.
When applied to grief following loss, here are some explanations of this so-called stage:
Bargaining — “I’ll do anything for a few more years.”; “I will give my life savings if…”
The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, “I understand I will die, but if I could just do something to buy more time…” People facing less serious trauma can bargain or seek to negotiate a compromise. For example “Can we still be friends?..” when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it’s a matter of life or death.
Bargaining-This often takes place before the loss. Attempting to make deals with the spouse who is leaving, or attempting to make deals with God to stop or change the loss. Begging, wishing, praying for them to come back.
The first explanation never addresses using bargaining during grief after loss so, does it apply? The second definition so poorly defines bargaining, and to me it is considering prayer a form of bargaining. Who, when losing a loved one to a terminal illness doesn’t, in whatever why they choose, ask a “high power” to intercede if possible. I cannot see bargaining as a “stage."
Stage 4: Depression
“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 the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed. Depression could be referred to as the dress rehearsal for the "aftermath". It is a kind of acceptance with emotional attachment. It’s natural to feel sadness, regret, fear, and uncertainty when going through this stage. Feeling those emotions shows that the person has begun to accept the situation--Elizabeth Kubler-Ross
Depression: overwhelming feelings of hopelessness, frustration, bitterness, self pity, mourning loss of person as well as the hopes, dreams and plans for the future. Feeling lack of control, feeling numb. Perhaps feeling suicidal.
Once again, this “stage” is presented as relating to the dying patient, not the loved one moving through the grief process. I have never heard, although it s not unheard of, a grieving person state, “I miss my loved one, why go on?” We are creatures who, even with the loss of our loved ones, want to live and one day live as fully as possible once again. Are we sad? Absolutely. The label “depressed” is used to loosely in our society and as a result physicians are far to quick to prescribe anti-depressant medication, putting a Band-Aid on your wound and not supporting your grief.
Stage 5: Acceptance
I struggle with this stage as much as I do with Stage 4, depression. Why would acceptance be the last “stage” in grief? Here are two definitions of acceptance related to the 5 stages:
Acceptance: “It’s going to be okay.”; “I can’t fight it, I may as well prepare for it.”
In this last stage, individuals begin to come to terms with their mortality, or that of a loved one, or other tragic event. This stage varies according to the person’s situation. People dying can enter this stage a long time before the people they leave behind, who must pass through their own individual stages of dealing with the grief.
Elizabeth Kubler-Ross: Acceptance-there is a difference between resignation and acceptance. You have to accept the loss, not just try to bear it quietly. Realization that the person is gone (in death,) that it is not their fault, they didn’t leave you on purpose. (Even in cases of suicide, often the deceased person was not in his or her right frame of mind)
I believe most grieving individuals “accept” the finality of a loss when it occurs. To say, “This can’t be true, this couldn’t have happened” would be a normal outcry to a sudden loss. However, to categorize accepting a death as the final stage of the grieving process, to me is saying you’re done with your grief. Through experience both personally and professionally, I know that grief changes over time but doesn’t end. After 21 years I still grieve, on some level, the loss of my husband. I’m saddened by his death. I’m happy with all aspects of my life BUT it is sad that his life ended too early.
Audrey Pellicano R.N., M.S. is a Health Counselor to widowed women, working with them to help them the courage to create a new role for themselves and face the world again without pain. She has been in the health care industry for 37 years as a Registered Nurse and Case Manager with a Masters degree in Health Science. Through her 20 years of widowhood, Audrey has experienced the lack of attention and knowledge given to widows. Her unique approach encompasses utilizing the dynamic tools that she knows work, including visualization and meditation. Please visit www.wisewidow.com. You can contact Audrey at firstname.lastname@example.org.
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