I seem to have been working with grief and loss quite a lot recently. At any given point I am likely to have clients who are dealing with bereavement, the end of a relationship, redundancy or some other kind of profound loss. Grief and loss are often evident even if that was not the initial purpose of the consultation. Of course, everybody’s experiences are different but I am also drawn to the similarities I see when women are grieving.
In 1969, after years of working with the terminally ill, and campaigning on their behalf for better understanding, the psychiatrist Elisabeth Kübler-Ross published the book “On Death and Dying”. In it, she noted that people who are dying tend to all go through a similar pattern of adjustment. She identified five key stages to this process; denial, anger, bargaining, depression and acceptance.
Later, in “On Grief and Grieving”, Kübler-Ross and co-author David Kessler, noted that those grieving the loss experienced a similar pattern of adjustment and they adapted the model accordingly. It is this pattern of similarity that I often see in my clients.
It is important to note that the model was originally developed to help doctors understand what might be going on with their patients. It is in no way meant to suggest that everybody has the same experience of grief and loss. Your loss is yours and is unique to you. Some people will experience all the stages, some will experience only three or four and some will experience extra stages all of their own. One person may sail progressively through the stages and another may get stuck at one particular point.
Over the years, additional research has shown that the same five stages seem to apply to any kind of profound loss so, if you too are experiencing grief and loss at the moment, a brief review of the Kübler-Ross model may prove helpful – not as a manual to tell you how you should grieve, but as a way of helping you to understand your grief.
During this stage you may be in shock. You genuinely cannot believe that this terrible event has happened to you. You cannot imagine being able to continue with your life without the person/situation you have lost. In a sense your unconscious mind is protecting you from the full force of your loss, allowing you to deal with it bit by bit and never giving you more than you can cope with.
People often feel incredibly guilty that they are filled with anger but it is an entirely natural and very helpful part of the process. The anger may be aimed at the person you lost or the person who you think caused your loss (perhaps the HR manager who fired you or your ex’s new partner). It may be directed at someone who just doesn’t understand your pain, someone who says “I know what it’s like”, when they couldn’t possibly.
But that anger is a connection. After the isolation of denial, anger re-connects you with people – even if it does so in a negative way. Anger, and all the other negative emotions it holds hands with, bring you back into the world.
The bargaining stage is easier to understand before the loss, when you might make deals such as “If you let X live I promise to raise lots of money for cancer research” or “If I keep my job I’ll work really hard and never ask for a pay rise again”.
After the loss, this phase is experienced more through the phrase “what if?” “What if he had never smoked?” “What if the doctor had caught it earlier?” “What if I had worked harder?” These “What ifs?” give us another focus for anger and it is common to vacillate between the two stages.
Eventually, the anger and the bargaining may give way to a sense of despair. There is nothing that can be done to change the situation and so depression sets in.
Please understand that depression is a perfectly sane and appropriate reaction to grief and loss. It does not necessarily mean that you are suffering from a mental health problem nor that you need medication to pull you out of it. In general, people (including many doctors) don’t know what to say to a depressed person, they feel awkward and instead of showing empathy they want you to be fixed and so point you towards a clinical solution.
Depression is actually the first stage of acceptance. The denial is gone, the anger is diminishing and you are no longer trying to make bargains. Depression is actually a sign that you are progressing through the stages of grief and loss. You may find that talking to a counsellor helps at this stage – not because you need to be fixed but because you need to be understood.
Of course, if the depression lasts too long, becomes increasingly debilitating or if you experience persistent thoughts about self-harm, you should seek medical advice.
The final stage in the process is acceptance. Acceptance is not the same as happiness. Acceptance does not mean that you are “over it”. You may never entirely get over the grief and loss.
However, acceptance does mean recognising that this is your new reality. From this point you can begin to countenance the idea of a future albeit a future without your loved one/a job/a partner. You may still experience anger. You may still feel sad. But somehow you can creep back towards life and find a way of being that is not clouded by denial.
These five stages take as long as they take. You cannot rush them. You can pretend that you are ok but they will find a way to expose the truth of that. Grief and loss will out.
As a society we are not very good at dealing with death and bereavement. We don’t know what to say or how to be. We expect people to “get over it” far too quickly. The Victorians used to impose a twelve month period of mourning where black was worn and social lives were curtailed. This is probably too prescriptive but it is somehow more understanding than today’s norms where workplaces often have a sliding scale of compassionate leave (a week for a spouse, 3 days for a parent etc.). Being back at work does not mean that someone should be back to normal.
I hope this blog has helped you to understand your own response to grief and loss or to understand that someone else’s response may be entirely normal given their circumstances.
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