DR. ESSLIN TERRIGHENA explains the five-stage Kuebler-Ross model of grief.
Throughout our lifetime, we go through a number of losses. Some losses are physical and tangible, including the death of a loved one. Others are symbolic, referring to a change in what was predictable, familiar and secure. This can include relationship or family separation, changes in job situation, moving location, or the onset of ill health or injury.
Physical loss and symbolic loss are often intertwined. The loss of a person goes beyond their physical absence to impact intangible parts of our lives, such as our identity, our view of the world, and the meaning this person had in our lives. Likewise, symbolic losses can involve the physical loss, for example a property or a limb. Both physical and symbolic losses can trigger grief and mourning.
While the terms grief and mourning are often used interchangeably, they identify distinct processes. Grief refers to the cognitive, emotional, behavioural, physiological, and social reactions to loss. Mourning refers to the coping strategies actively engaged to move toward accommodating and adapting to the loss. This article will focus on the grieving process, as most commonly explained using the framework of The 5 Stages of Grief Model (Kubler-Ross). For more information on the mourning process, please click here [The Six R-Processes of Mourning] or here [The Four Tasks of Mourning].
Swiss-American psychiatrist Elizabeth Kubler-Ross first identified five stages of grief in her work with terminally ill patients, but they have since then been applied to grief resulting from both physical and symbolic losses. Each of the five stages have distinct grief feelings, thoughts, physical sensations, and behavioural urges. Notably, they do not follow a linear order and it is not unusual to move through stages at random or to jump back and forth between stages over time.
Stage 1: Denial
In this stage, the news of the loss may trigger denial. We may believe that the news cannot be true, that a mistake has occurred, or that it cannot be as bad as it seems. This can come with a sense of detachment, emotionlessness, and shock. Physically, we may feel disconnected and numb. During this time, we may continue on as though nothing has changed and refuse to engage with any information that confirms the loss. The denial stage is often considered to be protective mechanism of the brain, to prevent us from becoming overwhelmed by the unexpected, devastating news. This is the stage that helps us to survive.
Stage 2: Anger
In this stage, we may experience a sense of unfairness as a result of the situation. Anger may be directed toward various systems, such as healthcare, government, or faith, or toward other people. We may be angry at friends whom we perceive to be unsupportive, the doctor who could not save our loved one, or a spiritual entity for allowing us to fall terminally ill. We may internalize our anger toward ourselves in the form of blame or self-loathing. It may even be targeted at the person we have lost – anger at them for leaving us behind. Our anger may be the effect of powerlessness or it may give us a sense of control by urging us to action. Often, in a tide of grief, anger feels like a manageable anchor, when the pain of the loss is still too overwhelming.
Stage 3: Bargaining
In this stage, we may try to make trade-offs. Some of these are hopeful, such as trying to make changes to win back the person determined to divorce us. Some of these are fantastical, such as promising to devote our lives to a good cause in return for waking up from permanent paralysis to be able to walk again. Some of these are guilt-inducing what-if ruminations – “What if we had left the house five minutes earlier, would the accident have never happened?” We may alternate between feeling desperate, hopeful, guilty, and lost. During this stage, we are no longer in denial about the news of the loss, but we may exert enormous effort to avoid the reality of the loss and negotiate our way out of pain. We may turn to faith, try alternative medicines, or ruminate on ways the loss could have been prevented.
Stage 4: Depression
In this stage, we experience the pain of loss. This can be overwhelming sadness, or a loss of hope, motivation, and pleasure in life. Physically, this can feel like fiery pain searing through our body, aches, nausea, tension, cramps, or numbness. We may experience a sense of brain fog which makes it challenging for us to make decisions, remember things, or concentrate. We may withdraw from others, hide away, experience a change in our eating and sleeping patterns, or respond with irritability. We may feel like life is meaningless and question the point of existence.
Stage 5: Acceptance
In this stage, the reality of the loss has been accepted, we have spent time acknowledging and processing the pain of grief, and we have begun to re-define the relationship with what we have lost. This can include finding meaning in the loss, or moving the connection with a deceased loved one from external to internal. During this stage, we are integrating the loss into our current life, environment, and identity, and adjusting to a world without in a meaningful and hopeful way. This stage is most commonly reached when we have gone through an active mourning process.
The Five Stages of Grief Model has been applied to a wide range of physical and symbolic losses. It has been criticised for not being comprehensive enough to cover the complexity of grief, not having sufficient empirical research to support the existence of five separate stages, and having been uncritically extracted from a relatively small sample and applied to the general population.
Despite these criticisms, the model continues to persist in grief therapy, self-help, media, and education. This is likely due to the simplicity and relatability of the model for many people going through grief. Importantly, it has allowed for emotions that are less commonly associated with grief (e.g. anger, guilt) to be expressed and normalized. In doing so, it gives grieving individuals, who often feel disconnected, drifting, lost, isolated, or confused, an anchor to help understand their conflicting feelings, and guidance in moving through their grief. While perhaps not sufficient as a stand-alone framework to understand grief, especially more complex or traumatic grief, this model provides us with a baseline to support ourselves and others during physical and symbolic losses.
If you have experienced loss and would like some guidance through the grieving process, please book a psychotherapy consultation with psychologist Dr. Esslin Terrighena, please call (852) 2521 4668 or email e.terrighena@mind-balance.org.