What the 5 stages of grief are, and how to get through them

By Kristen Rogers, CNN

When someone you love dies , the world as you’ve known it is totally
upended .
One way people cope , 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 “five stages of grief” over 50
years ago and hasn’t yet let up, said David Kessler, who
founded grief.com , a resource aiming to help people deal with uncharted
territory related to grief . Kessler coauthored “On Grief and Grieving ” with
the late Dr. Elisabeth Kübler-Ross .
A Swiss American psychiatrist and pioneer of studies on dying
people, Kübler-Ross wrote “On Death and Dying ,” the 1969 book in
which she proposed the patient-focused, death-adjustment pattern, the
“Five Stages of Grief .” Those stages are denial, anger ,
bargaining, depression and acceptance.
“In the actual book, she talked about more than five stages,” Kessler
said. “Think about the context of 1969 — doctors and hospital personnel
were not talking about the end-of-life process. … Elisabeth really hoped
‘On Death and Dying’ would start the conversation.”
Since then, there has been extensive media coverage of the five stages;
use in television shows including “Grey’s Anatomy ” and “House ”; 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’t Kübler-Ross’ intentions, and
she stated these caveats on the first page of the book, Kessler said.
While there’s debate among experts about the stages of grief , “people
who are in the pain of grief are just saying, ‘Help me,’ ” Kessler said.
Here’s what the five stages of grief are, and how you can consider and
process them in whichever order you experience them.

1. Denial

In denial there is grace, in that we can’t 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’t dead, an inability to comprehend
the loss for a while is healthy — not something you need to snap out of
quickly, he added.
If you’re struggling with overwhelming denial, you can try to stop fighting
the reality you’ve been presented with, said Cormier, who is also a
bereavement trauma specialist and consultant.

2. Anger

Anger is another natural reaction to loss, whether it’s anger at the cause
of death, the deceased, the god of your religion, yourself or the
randomness of the universe, Kessler said.
“Anger is pain’s bodyguard. It’s how we express pain,” he said. “That
stage gives people permission to be angry in healthy ways, and to know
it’s not bad.”
Anger “can be an anchor, giving temporary structure to the nothingness
of loss. At first grief feels like being lost at sea: no connection to
anything,” according to Kessler’s website. “Then you get angry at
someone, maybe a person who didn’t attend the funeral, maybe a person
who isn’t around, maybe a person who is different now that your loved
one has died. Suddenly you have a structure — your anger toward them.”
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.
“Our minds would always rather feel guilty than helpless,” 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’t personally done to you, Kessler said.
“The reality is the death rate in families is 100%,” he said. “Everyone is
going to die eventually, but our minds just can’t fathom that.”
Allow yourself to express anger in healthy ways, Kessler advised,
whether it’s “grief yoga ,” screaming in your car, using a punching bag,
running or other forms of exercise.

3. Bargaining

Often also stemming from guilt, bargaining after a loss typically involves
“if only” statements, focused on regrets about what you did or didn’t do
before the person died, Kessler said.
“We may even bargain with the pain. We will do anything not to feel the
pain of this loss,” Kessler’s site says. “People 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.”
Remember that we live in a world where sometimes bad things happen
despite our best efforts, Kessler said.
4. Depression

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’ve 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’t 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 “is really an expression of, ‘my loved
one is gone and not coming back,’” Cormier said.
But those feelings shouldn’t always be labeled as clinical depression,
Kessler said. If you think you’re depressed around a death, see a
psychiatrist for an evaluation, he advised.
To cope with sadness, you can also seek support from friends, family or
grief support groups, and regularly practice self-care , Cormier
suggested.

5. Acceptance

Acceptance doesn’t mean you’re OK with your loved one being gone. “It
just means that I now accept the new reality of my life. I’m a widow, I
live alone. I don’t have siblings to call up anymore. I don’t have parents to
call up anymore,” said Cormier, who wrote “Sweet Sorrow: Finding
Enduring Wholeness After Grief and Loss ” after losing her husband and
immediate family.
Acceptance isn’t grief’s end, either. You might have many little moments
of acceptance over time, Kessler said, such as when you plan and attend
the funeral.
“One of the questions I get asked most is, ‘When will this grief be over?’”
Kessler added. “Very gently, I’ll ask, ‘How long is the person going to be
dead? Because if the person is going to be dead for a long time, you’re
going to grieve for a long time. It doesn’t 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.”
Arriving at acceptance means you’re healing, Cormier said. But if you
can’t 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’t after some time has
passed, is known as prolonged grief disorder, according to the American
Psychiatric Association . 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’s 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’t think we ever “get over” grief. Our task is different than
moving on — it’s learning to integrate the loss into our lives so that we
can move forward with a new reality, she added. “It’s sort of offensive to
grievers to say, ‘Oh, you’ve really moved on.’ No, I don’t think grievers
move on. We move forward.”

The new sixth stage: Finding meaning

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’s work on meaning, and
wondered how meaning related to grief — which inspired his book
“Finding Meaning: The Sixth Stage of Grief .”
Meaning didn’t eliminate Kessler’s 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.

https://edition.cnn.com/2021