STAGES (or Phases) of Grief

"I myself have often longed for some structure and theory that would compartmentalize or chart my pain. But, there is no single story or timetable or passageway through sorrow."
- Helen Vozenilek, Loss of the Ground-Note

There is a strange sort of expectation that grief should conform to a general pattern or principle. There are even scientific polls of measurement — what is “normal” — what is “extreme” grief. As if individuals are not radically different, and as if even the course of a common disease, like cancer, will not manifest itself differently in different individuals.
- Joyce Carol Oates, NY Times interview

Early on, I assumed that every day would get better and easier. That doesn't happen. After the numbness wears off, and reality begins to sink in, the ride is more like a rollercoaster. (And I'm not talking the fun kind.) Definitely not linear. Some parts are level, others are scarily steep. They wax and wane. There is no predictable timeline. There are, however, some commonalities.

roller coaster.  Morgue file foto.When I was in college, I read Elisabeth Kübler-Ross's seminal work, On Death and Dying. The book was mainly about how dying patients respond to a terminal illness. For me, the most interesting part was the journey people travel to reach acceptance of loss.

Kübler-Ross's described five stages of the grieving process: waves or surges of denial, anger, bargaining, depression and ultimately acceptance (if they lived long enough.) They may be experienced in any order, and you can go back and forth between them. Progress is not always forward (or as Doug used to say, "Always Forward, Never Straight.")

In her last book, Kübler-Ross noted that the stages "were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”

I am not religious by any stretch of the imagination (and PLEASE don't try to convert me), but the Jehovah's Witness website lists other stages or emotions. They include shock, mental and emotional confusion, emotional numbness and detachment, a sense of unreality or being out of control or powerless (feeling like you are in freefall or stuck in quicksand), mania, guilt (for what you did or didn't do, for being alive and enjoying life), fear, relief, memory loss and abrupt changes in mood, flawed judgment and thinking, anxiety, reduced work capacity, irrationality (such as resentment of spouse), obsessive behavior and thoughts, magical thinking (I had the power to do XYZ and didn't do it, thus causing this tragedy), and visual or auditory hallucinations (feeling, hearing or seeing the deceased.) For me, a BIG one that is missing from Kubler-Ross's list is the gutwrenching almost unbearable PAIN of a broken heart.

There can also be physical symptoms. Appetite change, nausea and weight loss or gain. Loss of a sense of taste or smell. Insomnia or interrupted sleep, extreme fatigue/exhaustion and lethargy. Shortness of breath, chest or throat pain, muscular tension (e.g., back aches). Headaches. Worsening illness or increased susceptibility to to colds, etc., due to a depressed immune system.

In the leveling off period, there may be sadness, nostalgia, and pleasant memories tinged with humor.

  • Disbelief and Denial. The loss of Doug was so unexpected. We were all stunned. A typical reaction to an unexpected, sudden death is 'It can't be true!' That bombshell opened a wound in our hearts that is still healing, even years later." Personally, I spent I a lot of time in denial (which Doug said was a river in Africa.) For the first months, I pretended this never happened, and that Doug was away on a climbing trip. At times I can't bear to look at pictures of him. The pain of realizing I will not see him again in real life is too sharp. At some point I'm going to have to stop pretending it isn't real. However, right now it helps a lot.
  • Anger and Blame. This can come into play in a suicide, or when someone does something stupid or neglects their health, with death as the end result. Others blame themselves for their loved one's death. My mother was mad at my father for leaving her alone, even though he died in a boating accident that was not his fault. Sometimes people are mad about the financial mess they are left with. I can't be mad at Doug for leaving. I could never stay mad at him for anything for very long. And this wasn't his fault. I am mad at myself for some things (see wishes and regrets.) I am mad at the medical practice for not diagnosing the problem and preventing a fatal outcome. I find myself getting mad at people who are not more like Doug - who don't have his qualities that I miss so much. Sometimes I get mad at people who do or say the wrong thing, even though I know they are just trying to help.
  • Bargaining. I did this on the way to the hospital. (See the end.) Now that he is gone, there is nothing to bargain for.
  • Depression and Sadness. Spending a lot of time here. (See blog.) I lump a few more in this grouping. Missing the deceased, yearning for them, and the period when they were alive. A feeling of emptiness. Obsession or preoccupation with the deceased and the events leading up to their death. Guilt.
    • Ashley Davis Bush has the middle phase as Disorganization, involving a painful and sometimes terrifying physical, psychological and often spiritual breakdown.
  • Acceptance. Someday, if I live long enough, I might get to this point. I doubt the pain will ever go away, although I may bury it more. I think Doug's cousin Ellen is right. She suddenly lost her brother seven years ago. She said, "The saying that 'all wounds heal' is not true. They remain forever, but the difference, I can tell you, is that the wound moves to the inside of yourself, where others no longer will see it, and you will expose it less and less as you recover yourself to live in the 'outside' world."
    • Ashley Davis Bush refers to the last stage as Reconstruction, or rebuilding one's life without your loved one. In an attempt to avoid pain, some people attempt to rush to this stage.

I thought this was good advice, from Leavetaking—When and How to Say Goodbye: "Don't let others dictate how you should act or feel. The grieving process works differently with everyone. Others may think—and let you know that they think—you are grieving too much or not grieving enough. Forgive them and forget about it. By trying to force yourself into a mold created by others or by society as a whole, you stunt your growth toward restored emotional health."

A lot of people who have not been through this do not realize how long it can take to learn to come to terms with a major loss. The rational side of me knows there are brighter days ahead. That there will be days without tears. But it is hard to envision that early in the process.

My mom lost my dad in a boating accident at age 59. I told her that her life would never be the same again, but it could still be good. I remind myself of that now. It sure isn't fun at the moment....

"Take it slowly, take it gently, take it at your own pace.
~ Transcending Loss


07/05/2010, updated 09/15/2010

Emotionally, grief is a mixture of raw feelings such as sorrow, anguish, anger, regret, longing, fear, and deprivation. Grief may be experienced physically as exhaustion, emptiness, tension, sleeplessness, or loss of appetite.
~ Judy Tatelbaum, The Courage to Grieve: The Classic Guide to Creative Living, Recovery, and Growth Through Grief

Look on each day that comes as a challenge, as a test of courage. The pain will come in waves, some days worse than others, for no apparent reason. Accept the pain. Little by little, you will find new strength, new vision, born of the very pain and loneliness which seem, at first, impossible to master.
~ Daphne du Maurier

I don't guess people's hearts got anything to do with a calendar.
~ from the film Hondo



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