Stages of Grief as explained by Jessica Pack

The Kübler-Ross model, typically known as the five stages of grief, was first presented by Swiss psychiatrist Elisabeth Kübler-Ross in her book On Death and Dying, published in 1969. She created the model to help terminally ill patients and their family members understand the emotions they were feeling. Understanding these stages can help a grieving person work through the emotions so they can eventually find acceptance.

Though the stages were introduced in a linear way, Kübler-Ross never intended to give the impression that the stages were always experienced in a particular order. Rather, individuals may jump from any one stage to another and even after acceptance may find themselves temporarily experiencing stages they have already worked through. The five stages are: denial, anger, bargaining, depression, and acceptance.

Denial: Most common when a patient receives a terminal diagnosis, denial is the belief that the diagnosis is wrong. Those in this stage may seek additional opinions, and, though there is certainly nothing wrong with second opinions, a person may become so stuck in this cycle they are unable to make decisions regarding treatment or end-of-life care due to their belief that what is happening is not happening. Unexpected loss, such as the death of a loved one in an accident, can often feel unbelievable and people sometimes require proof to believe it has happened at all. Extreme cases of denial can result in delusions of not having symptoms, invincibility, or even attempting risky “cures.” In cases of unexpected death, some loved ones will pretend it has not happened, talking to the deceased or not allowing anyone to speak of the loss.

Anger: Anger often starts with reactions like “Why Me?” and “This isn’t fair!” There can be physical aggression or outbursts toward medical personnel or family members. Rather than pushing away the feeling, it is helpful for the person to spend some time feeling the frustration and expressing their feelings about it. Getting stuck in anger and marinating in negative thoughts and even blame, however, can be detrimental. Sometimes therapy is necessary to help someone work through their anger constructively.

Bargaining: Often, this phase takes place internally. The person experiencing it may know that it sounds ridiculous to offer to trade their life for the life of the person they love, but this reaction comes from the deep wish to negotiate a different end. The bargaining can take place with God, or doctors, or even the person who is ill. It’s usually triggered by the loss of control over the situation and the very human wish to avoid suffering and pain. To spend too much time in this phase, however, is exhausting and can lead to compulsive behaviors since the ability to make such bargains does not exist in reality.

Depression: This phase often comes after experiencing the others listed above, when the person realizes that nothing can be changed and they cannot influence the outcome. This understandable sadness, when not addressed, can lead to isolation, hopelessness, and despair. This phase is often one people reside in the longest, knowing that their life can never be as it had been before the tragedy. Depression that goes on too long can lead to self-medicating, a disconnect from important relationships in the person’s life, and other actions that negatively affect quality of life. It is important for those in this phase to have people they can talk to about their feelings, a therapist or a good friend. They need to know that what they feel is not a sign of weakness or lack of faith, but a normal experience. They should be guided toward looking to the future and finding a way out of the darkness without being judged for finding themselves in the darkness to begin with.

Acceptance: In cases of terminally ill patients, the patients themselves often come to this stage before their loved ones do. This stage is often characterized by the ability to make end-of-life plans, and extending comfort to others not yet accepting what is to come. Many times, this phase is when the person gives away their possessions, anticipating not needing them much longer. For those left behind in the wake of a tragedy, acceptance often comes in the form of being able to remember happy times with their loved one. Acceptance does not mean the person is no longer sad about the loss or has come to accept it was meant to be; rather it is defined by the ability to look into the future as well as the past without anger, depression, denial, or bargaining interfering with what is reality. It is often at this phase that the person grieving can look back and see how they have grown through the experience, perhaps feeling greater compassion for others who suffer and the ability to feel gratitude for the positive aspects of their lives.

The key to healthy healing is to identify each stage, process the grief, and gain the ability to find joy in the future despite the pain of loss. It is often helpful to think of what the loved one would want for those left behind; none of us would want the people we love to be stuck in the pain of loss. Coming to believe that they would want joy for us, just as we would want joy for them if circumstances were reversed, can be a powerful step toward acceptance.