The Stages of Grief Model Acceptance

Elisabeth Kübler-Ross used the model of five stages of grief to explain the phases people experience when diagnosed with a terminal illness. It's understandable that these people would find acceptance difficult. Naturally, they would hope for an error in the diagnosis, seek a second or third opinion, explore alternate treatment options and, for those that are religious, pray for a different outcome. Accepting that your life is coming to an end can be an extremely difficult pill to swallow.

Most people recognize early on that whatever emotional event that they experienced caused a change in the story of their life. It may be a change they were expecting, such as a promotion or move to a new home. Many times, they are changes of a less positive nature, such as the death of a loved one (human or pet), a divorce or break up of a relationship, or any other negative event. In either type of situation, these changes can be fraught with elements of grief, since they will include changes from familiar behaviour patterns.

For people grieving any of these other changes in their lives, the concept of “acceptance” can have entirely different ramifications. The problem they face is in defining just what it is that they are accepting. Some may say that they are accepting the loss as having happened. A large share of grievers, however, are likely to feel that they instead must accept that the emotional pain with which they are now dealing is going to be a permanent part of their lives. They are accepting that “their new normal” is to be one with a broken heart.

Availability of information has changed with time, but the griever’s ability to find the best information is limited. Since most grievers have a reduced sense of concentration, coupled with little education on dealing with the emotional pain of loss, they often find themselves lost. Most are looking for simple or logical solutions for their grief. The trouble is grief is neither simple nor logical. It's emotional.

The model of “the five stages of grief” can look like an easy solution. The problem is that the average griever doesn't understand that this research first developed after interviewing those diagnosed with a terminal illness. They also fail to grasp that, even in this original application, the subjects of study didn't always follow these stages in a linear order. For the average griever, their study stops with the listing of the stages, and they try to make those stages work, even if they don't help them successfully move through the emotional pain they are experiencing.

Every change we experience in life can bring with it elements of grief. If, with each change, we simply accept that any emotional pain we experience is something that we will carry with us for the rest of our lives, it's understandable that our pain load will continue to intensify with each new loss. With time, that pain load becomes so overwhelming it cannot help but impact ongoing relationships, our ability to form new successful relationships, our ability to function at work, or any other aspect of our lives.

Rather then just accept that pain, a better solution would be to work through it. Almost a day doesn't pass that we hear of another terrorist attack. When reporters speak with the victims, it's not unusual to hear the comment that it will take a great deal of time for these victims to “get over their pain and move forward”. This simply reinforces in grievers minds the concept that time can make them somehow better. As a result, many simply just begin to accept that this pain will forever be part of their “new normal”. People never “get over” a loss, but, given the proper tools, they can learn to survive, and thrive, in spite of it.

Stages of Grief: Depression

This is the fourth of five posts focused on “The Stages of Grief”. In this one, we will be looking at depression, which can create a great deal of confusion for grievers.

The problem for many of us who suffer a loss is that the majority of us have had little or no training of any value regarding how to handle grief. While we may have had a lifetime of experience with how to accumulate new things, we have very little education on how to deal with the emotions associated with loss. When we are suddenly faced with grief causing experience, we are lost.

Some friends will respond to grievers with cliché ridden advice about keeping busy or suggestions why they should not feel sad. These suggestions may seem logical, but grief is hardly logical. It is emotional. No amount of logic can truly overcome emotional pain.

Eventually, some well-meaning friend will mention the stages of grief, including the stage of depression, as a way of defining what a griever must experience. Most grievers are so desperate to feel better, that they never question the viability of this model as related to their particular situation. What they hear is that they must go through each step, in the order presented, to recover.

The first place most people depend on today when they discover that their friends’ suggestions on how to cope with their loss don't seem to make things better, is the Internet. Since most grievers suffer from a reduced sense of concentration, they are not looking for extensive studies, but rather short and simple answers.

If they search the word “depression” on the internet, one of the first things they will encounter is “clinical depression”. Grief is the normal and natural reaction to any change in our lives. It's a normal reaction, not a mental illness. However, the griever doesn 't understand this distinction and may self-diagnose themselves as clinically depressed on some level.

It's understandable that grievers don't understand the difference between true depression and the overwhelming feelings of loss associated with grief. They simply know that something is not “right”, and will often call their regular physician.

Sadly, while general practitioners and internists have extensive training in medical issues, most have very limited knowledge concerning grief and loss. It's highly likely that the stages of grief concepts were presented at some point in medical school, but it's equally likely that they never fully explored this subject unless they went on for advanced studies in psychiatry or mental health.

The symptoms of grief are similar to that of depression and other medical issues. Grievers have a reduced sense of concentration and often have trouble focusing, suffer sleep-related issues, find completing tasks difficult, and are easily upset. It's also common for them to self-identify as being depressive since they have been told by others that this is a “stage of grief”. Given the shortage of time most physicians face and the desire they have to treat what has been presented to them as a medical issue, it is not uncommon for them to prescribe a mood-altering medication.

Doctors may even prescribe antidepressants when they are fully aware of all of the details. These physicians are trying to help in the best way they know-how. Dealing with the intricacies of grief is not necessarily in their medical training. The problem comes in when they are treating the presenting symptoms, without dealing with the underlying issues of what is causing the pain of the emotional loss.

The emotional pain of any loss can be intense. Whether we try to deal with this pain by hiding our feelings or by medicating them, to make them less intense, still does nothing regarding processing them. At the end of the day, that pain is still there if we take no substantive action.

Telling a griever that, in the stages of grief, depression is a step that may or must be experienced, simply gives them a label for these feelings. It may not even be an accurate one. It does nothing to help them move beyond those feelings. It actually may serve as a stopping point to their moving forward since they can now just tell people that they are in a stage or state of depression, and since it was due to a loss, there is not a cure.

Grief is not, in and of itself, a medical condition. It cannot be cured in a medical sense. It can, however, be something through which we pass if we are willing to realize that it is directly related to the unfinished business with the relationship lost.

If the griever is willing to take action to identify this unfinished business, and take additional action to deal with that business, there is hope for a better and happier tomorrow. A permanent solution cannot be accomplished with a pat on the head or a pill, but rather requires honest work in dealing with these feelings in their rawest form.

Stages of Grief Bargaining

Elisabeth Kübler-Ross understood that the five phases are not strictly encountered in a linear manner and that the person dealing with their own impending death may jump back and forth between them.

There is the general misunderstanding that these steps, in this exact order, are required to progress to any sense of recovery. That is what leads to a great deal of confusion, and often to frustration.

This is certainly the case with the stage labelled as “bargaining”. It's understandable that the person facing a terminal illness might fall into this phase. They might promise the deity they worship that they will be a better person if this diagnosis is reversed. If they are not a person of faith, they may promise themselves that they will make better choices in the future if they survive their illness. It's not unusual, especially if the impending death is that of a child, for a parent to wish or pray that the illness is transferred to them instead. This is the basic concept of bargaining and one that you would expect a person facing death to try.

The problem with trying to use this concept, when a loved one dies is that there is little likelihood of application. While the griever may wish that they could turn back time, so that they would not be facing this loss, that would better be described as regret than as any form of bargaining.

When a griever is dealing with any loss that they have experienced, regret is a common thread. They often think of how things might have gone differently in that relationship and things they may wish they had said or not said. It may be regret over actions taken by the other party in that relationship. They may regret that they didn't have more time to complete the unfinished business of some kind. They may regret that this relationship isn't going to continue in the future in the way they hoped, dreamed, or planned it would.

In the perfect world, no one would have regrets! We would think with perfect clarity before we ever spoke or took any kind of action. The problem is that no one lives in a perfect world. We often speak or act spontaneously, without thought of how others might interpret what we say or do. Compounding this problem, others do exactly the same thing. This can often lead to regrets.

If a relationship has ended by death, these regrets can literally come back to haunt us. If a relationship has ended with estrangement or someone moving away, finding a way to deal with these regrets can be complicated. Each and every loss presents its own problems in dealing with this unfinished business. While we may do some internal “bargaining” in an attempt to deal with the loss, the problem is that, without direction and support, we are still left at a loss.

Perhaps the best "bargain" a griever can make with him or herself is to actually choose to take action, rather than having their life limited by the emotional pain of their personal loss!

Stages of Grief Anger

Elisabeth Kübler-Ross identified anger as the second phase of grief that people experience when they are diagnosed with a terminal illness. Some people may experience periods of anger, for one reason or another, but anger as part of grieving is not guaranteed.

This isn't to say that some people may not become angry at some point after experiencing a loss. Most of us have had the experience of seeing a parent running up and down the aisles of a store frantically looking for a child that has wandered away. When those parents find their children, do they calmly tell the child that they should not do this? More often than not, they grab their child’s arm and start yelling at them. Why? It's because they are scared. Anger is the most common response to fear.

Dealing with grief can be a scary experience. As was mentioned previously, the emotions we may experience when grieving any loss can be overwhelming. These are feelings that we cannot control. That loss of control can be scary. Occasionally, that fear is displayed as anger.

Every major change in our lives can result in a person feeling a sense of grief. When someone goes through a divorce, there might be an element of fear about how the future will be different than the one that was originally planned. This fear may be displayed in anger. It's also possible that their former spouse did something that justifiably resulted in them feeling angry!

When a relationship ends, or there's a change in the workplace, or with any major life change, we may experience anger. Certainly, if someone we care about dies in an accident or some needless reason, we may be angry with the situation or whoever caused it. In no way are we saying that anger isn't a possible result of a loss.

The problem with labelling anger as a definite stage that must be experienced with any grief producing loss is that it isn't guaranteed. There are situations where anger just doesn't exist for the griever on any level. Does this mean that something is wrong with the griever?

Whether a griever experiences anger or not has nothing to do with their recovery. There is any number of different emotions that may confront a griever dealing with a life-changing event. Anger may or may not be one of them. Each emotional relationship is different, which means that the emotions felt by the griever will be different for each loss experience.

Too often, grievers have well-meaning friends and family tell them what they should or shouldn't be feeling. Telling a griever that, as a part of going through the stages of grief, anger is a stage they must experience, is just another example of people telling them what they must feel. Most of us do not want to do that but helping by presenting a plan of action might help.