When someone , the world as you鈥檝e known it is .
One , psychologist Sherry Cormier said, is by trying to find some sort of certainty. This need for structure is probably one factor behind the popularity that latched onto the 鈥渇ive stages of grief鈥 over 50 years ago and hasn鈥檛 yet let up, said David Kessler, who founded , a resource aiming to help people deal with uncharted territory related to grief. Kessler coauthored 鈥溾 with the late Dr. Elisabeth K眉bler-Ross.
A Swiss American psychiatrist and pioneer of studies on dying people, K眉bler-Ross wrote 鈥,鈥 the 1969 book in which she proposed the patient-focused, death-adjustment pattern, the 鈥.鈥 Those stages are denial, , bargaining, and acceptance.
鈥淚n the actual book, she talked about more than five stages,鈥 Kessler said. 鈥淭hink about the context of 1969 鈥 doctors and hospital personnel were not talking about the process. 鈥 Elisabeth really hoped 鈥極n Death and Dying鈥 would start the conversation.鈥
Since then, there has been extensive media coverage of the five stages; use in television shows including 鈥溾 and 鈥溾; clinician support; and criticism. Those five stages are what people clung to, Kessler said.
Grief and psychology experts and academics have criticized the framework for not being thoroughly supported by research, suggesting that the bereaved move through grief sequentially or implying one correct way to grieve. But these suggestions weren鈥檛 K眉bler-Ross鈥 intentions, and she stated these caveats on the first page of the book, Kessler said.
While there鈥檚 debate among experts about the , 鈥減eople who are in the pain of grief are just saying, 鈥楬elp me,鈥 鈥 Kessler said. Here鈥檚 what the five stages of grief are, and how you can consider and process them in whichever order you experience them.
In denial there is grace, in that we can鈥檛 fully register the total pain, shock and disbelief over our loss in one moment or day, so the pain is spread over time, Kessler said.
While denial in a literal and dysfunctional sense would be trying to convince yourself your loved one isn鈥檛 dead, an inability to comprehend the loss for a while is healthy 鈥 not something you need to snap out of quickly, he added.
If you鈥檙e struggling with overwhelming denial, you can try to stop fighting the reality you鈥檝e been presented with, said Cormier, who is also a bereavement trauma specialist and consultant.
Anger is another natural reaction to loss, whether it鈥檚 anger at the cause of death, the deceased, the god of your religion, yourself or the randomness of the universe, Kessler said.
鈥淎nger is pain鈥檚 bodyguard. It鈥檚 how we express pain,鈥 he said. 鈥淭hat stage gives people permission to be angry in healthy ways, and to know it鈥檚 not bad.鈥
Anger 鈥渃an be an anchor, giving temporary structure to the nothingness of loss. At first grief feels like being lost at sea: no connection to anything,鈥 according to Kessler鈥檚 website. 鈥淭hen you get angry at someone, maybe a person who didn鈥檛 attend the funeral, maybe a person who isn鈥檛 around, maybe a person who is different now that your loved one has died. Suddenly you have a structure 鈥 your anger toward them.鈥
Beneath anger can be feelings of hopelessness or powerlessness, Cormier said, sometimes prompting guilt and blame that some people use to maintain an illusion of control or express frustration.
鈥淥ur minds would always rather feel guilty than helpless,鈥 Kessler said.
Depending on how your loved one died, one way to overcome guilt- and blame-related anger is by realizing that as horrific as your loss is, it wasn鈥檛 personally done to you, Kessler said.
鈥淭he reality is the death rate in families is 100 per cent,鈥 he said. 鈥淓veryone is going to die eventually, but our minds just can鈥檛 fathom that.鈥
Allow yourself to express anger in healthy ways, Kessler advised, whether it鈥檚 鈥,鈥 screaming in your car, using a punching bag, running or other forms of exercise.
Often also stemming from guilt, bargaining after a loss typically involves 鈥渋f only鈥 statements, focused on regrets about what you did or didn鈥檛 do before the person died, Kessler said.
鈥淲e may even bargain with the pain. We will do anything not to feel the pain of this loss,鈥 Kessler鈥檚 site says. 鈥淧eople often think of the stages as lasting weeks or months. They forget that the stages are responses to feelings that can last for minutes or hours as we flip in and out of one and then another.鈥
Remember that we live in a world where sometimes bad things happen despite our best efforts, Kessler said.
Depression, or an acute sadness, is when the great loss begins more deeply affecting your life. Maybe the sadness feels as if it will last forever, or you鈥檝e withdrawn from life or are wondering if life is worth living alone.
Sadness hits people at different times, Cormier said. She has known people who aren鈥檛 distraught in the first year after loss, but by year three are consumed with sadness. Why? Because for a time, some can maintain the illusion that a loved one is away on vacation and may be returning, she said.
Often, the eventual, deep sadness 鈥渋s really an expression of, 鈥榤y loved one is gone and not coming back,鈥欌 Cormier said.
But those feelings shouldn鈥檛 always be labelled as clinical depression, Kessler said. If you think you鈥檙e depressed around a death, for an evaluation, he advised.
To cope with sadness, you can also seek support from friends, family or grief support groups, and regularly , Cormier suggested.
Acceptance doesn鈥檛 mean you鈥檙e OK with your loved one being gone. 鈥淚t just means that I now accept the new reality of my life. I鈥檓 a widow, I live alone. I don鈥檛 have siblings to call up anymore. I don鈥檛 have parents to call up anymore,鈥 said Cormier, who wrote 鈥溾 after losing her husband and immediate family.
Acceptance isn鈥檛 grief鈥檚 end, either. You might have many little moments of acceptance over time, Kessler said, such as when you plan and attend the funeral.
鈥淥ne of the questions I get asked most is, 鈥榃hen will this grief be over?鈥欌 Kessler added. 鈥淰ery gently, I鈥檒l ask, 鈥楬ow long is the person going to be dead? Because if the person is going to be dead for a long time, you鈥檙e going to grieve for a long time. It doesn鈥檛 mean you will always grieve with pain. To me, the goal of grief work is to eventually remember the person with more love than pain.鈥
Arriving at acceptance means you鈥檙e healing, Cormier said. But if you can鈥檛 get there, you need to seek professional help. Intense and persistent grief that causes problems and interferes with everyday functioning, in a way that typical grief doesn鈥檛 after some time has passed, is known as prolonged grief disorder, according to the . The disorder was added to the revised Diagnostic and Statistical Manual of Mental Disorders released in March 2022.
To be diagnosed with prolonged grief disorder, a loved one鈥檚 death had to have occurred at least a year prior for adults, and at least six months ago for children and adolescents, according to the association, which publishes the DSM. One symptom is difficulty with reintegration, such as pursuing interests or interacting with friends.
Cormier doesn鈥檛 think we ever 鈥済et over鈥 grief. Our task is different than moving on 鈥 it鈥檚 learning to integrate the loss into our lives so that we can move forward with a new reality, she added. 鈥淚t鈥檚 sort of offensive to grievers to say, 鈥極h, you鈥檝e really moved on.鈥 No, I don鈥檛 think grievers move on. We move forward.鈥
After his son died at age 21 nearly five years ago, Kessler wanted something beyond acceptance. He had studied late neurologist, psychiatrist and philosopher Dr. Viktor Frankl鈥檚 work on meaning, and wondered how meaning related to grief 鈥 which inspired his book 鈥.鈥
Meaning didn鈥檛 eliminate Kessler鈥檚 pain, but it did cushion it, he said.
Meaning is in what we later do or realize as the bereaved people, Kessler explained. Maybe you recognize the fragility of life, try to change a law or donate money to research so no one dies the way your loved one did, or make a change in your life.
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