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The 5 Stages of Grief


A person faced with the reality of a terminal disease or a personal tragedy, will experience at least two out of the five stages of grief

Receiving bitter news or the diagnosis of a terminal illness, is a blow that leaves us exposed and lacking the framework of our lives as we knew it. The five stages of grief are tools that help us cope and learn to live within a new framework. They are tools to help us identify our feelings and equip us to cope with what we are facing.

In 1969, Elizabeth Kübler-Ross, a Swiss psychiatrist, published the stages of grief in her model of coping with death. In her biography, Kübler-Ross describes her experiences as a young girl in post-World War II Europe. It was during a visit to the Majdanek concentration camp in Poland, that her awareness of questions of mortality, loss and cruelty began. It was an awareness that influenced the course of her life.

As a young physician Elizabeth lived and worked in the United States of America . She formulated her model based on years of work with terminally-ill patients and their families. The stages of grief relate to the ability of an individual facing terminal illness or catastrophic loss, as well as their family and social circles, to cope with the situation and the possible loss of their loved ones.

The Five Stages In The Process of Coping With Death:

Stage 1 – Denial and isolation

“No, not me! This can’t be happening to me.”

At this stage, the patient and his family do not believe the announcement of impending death. They often believe that a mistake has been made in the diagnosis.

Kübler-Ross viewed this reaction as a type of shock absorber, necessary in order to deal with the devastating news. Denial grants the patient time to gather him or herself, harness available resources and gradually substitute this adamant position with less extreme defense mechanisms, ones that will enable the individual to cope, even if only partially, with the situation.

Denial is for the most part a temporary defense, one that gives expression to the hardship entailed in coping with reality. Denial lets us cope with only what we can handle.

Stage 2 – Anger “Why me?

Most people can’t continue denying impending death or the loss of a loved one for very long. Denial soon gives way to feelings of anger, rage, jealousy and hatred.

For the person who has experienced a great loss and for people in the terminally ill patient's environment, this is a particularly difficult stage to deal with. The person's anger is directed outward. It can extend from the immediate family, to medical professionals, to friends as well as to God. At times it may seem arbitrary and indiscriminate. However, it is important to remember that underneath the anger is pain.

Understanding and acceptance on the part of those close to the patient, will help bring about acceptance. A negative reaction will lessen the chances of acceptance and bring about feelings of isolation.

Anger gives the patient structure, one that replaces the structure he lost when he was diagnosed. It gives him a way to still feel connected to those around him at a time when he is feeling lost.

Stage 3 – Bargaining “I’ll do anything, just grant me a few more years”

This stage is characteristic of terminally ill patients who are coping with the inevitability of impending death and with gradual loss. The patient tries to delay the end by bargaining, in an attempt to avoid the unavoidable.

The bargain generally entails a "payment" by the patient in exchange for a postponement of the sentence, or a fulfillment of last wishes. The patient may also bargain about things like pain, whether physical or emotional.

It is important to remember that often, guilt comes along with bargaining. People often go down the path of "What if.." or "If I only…", finding fault in themselves and things they have done.

Stage 4 –Depression “Everything is useless now, why bother with anything? Why go on living?”

This step focuses on a deep sense of loss, it is felt in varying degrees from person to person. Depression replaces the anger and the attempts at bargaining. With it comes forlorn thoughts of the future, feelings of guilt and shame, failure and regret.

Kübler-Ross does not advise trying to cheer up or calm the individual steeped in depression. It is not worth trying to encourage feelings of “all will be well.” She claims that feelings of depression are an important part of the emotional process, and that it facilitates progress towards acceptance and peace. Despite the hardship of this stage, it is necessary to support the individual with compassion and understanding.

Depression is an important part of the grief process. When you are faced with a loss, it would be unusual not to experience depression.

Stage 5 – Acceptance

Acceptance is the final stage. It is about accepting the new reality.

In this stage the patient ceases his or her fight against fate, letting go of all personal battles with one’s past and surroundings. At this point, the patient or the griever is able to express the various feelings experienced in the previous stages, and can come to terms with mortality and with the need to part from loved ones.

Gradually, words are replaced by soft touches and tender glances, and the individual draws inward, emptied of painful emotions, relinquishing the fight against the painful reality.

In this stage the individual may feel exhausted and in need of repose and will prefer not to be bothered with affairs of the world. Acceptance of this situation by the individual and his or her close ones facilitates leave taking.

A majority of patients arrive at this stage, but there are a few individuals who continue to struggle against death and to deny it. They will not manage to attain the peace that comes with accepting the reality of the situation.

It is important at this stage to distinguish despair and surrender from peace and acceptance.

The grief process is highly personal. It should not be rushed. It is important to keep in mind that not everyone goes through all five stages of grief and certainly not all people go through the stages in the same order. For some people, certain stages may last only minutes or hours. We also see people moving back and forth through stages they have already experienced.

There are no hard and fast rules when it comes to grief. What is important to remember, is that every stage is legitimate. As hard as it is, people going through these stages need the time to grieve and cope. Most of all they need our love, patience and understanding.

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