We tend to think of grief and bereavement as something we experience only when someone close to us has died, but the bereavement process can happen with any deep and significant loss: the death of a person, the end of a relationship, significant loss of health, the loss of a limb, the end of a career, etc.
This article outlines what to expect in any grieving process. My aim is to show that difficult experiences are normal processes of adjustment to a new situation involving loss.
In the 1960s, Elisabeth Kübler-Ross undertook ground-breaking research, interviewing 200 dying patients about their experiences of loss around their impending deaths. The result was a delineation of 5 stages of grief in her book, On Death & Dying (1969, New York: Scribner). She made clear that the 5 stages of grief are not necessarily consecutive. Not everyone goes through all 5 stages, and an individual may start, for example, at the third stage, then the first, the second, the fourth, before finally reaching the fifth stage. And, as we will see, not everyone reaches the fifth stage: some people get stuck in their grief.
The 5 stages of grief
The 5 stages of grief described by Elisabeth Kübler-Ross are as follows, with examples and commentary of my own.
Denial is typified by phrases such as ‘This can’t be true’; ‘There must have been a mistake’; ‘The doctor has got it wrong’; ‘But I’m healthy and have a healthy lifestyle’; ‘I’m too young’; ‘I have too much to live for’; ‘But we’re happy together’.
The surviving person may have dreams of the dead person being alive, or ‘see’ the dead person in the street. Similarly, after a relationship break-up, the bereaved partner (because bereavement may be experienced after the death of a relationship as much as after the death of a person) may find that everything reminds them of the person they miss to the extent that they feel they are still around. They may dream they are still together; an amputee may dream they still have their missing limb; a sacked or unhappily retired person may dream they are still at work.
The reason for denial is that bereavement signals a fundamental change, an adjustment to a new identity, without the loved person, or limb, or career. At first, this can be too radical, too much to take in, so it is rejected. This question of identity re-emerges most clearly at the depression stage.
Anger can arise because of a loss of control over one’s life, body or decisions; anger at the loss of one’s own life or another’s life slipping away.
In this stage, a grieving person may be angry without a person to aim the anger at, with generalised thoughts and feelings of ‘Why me? This is so unfair.’
When the anger does have a target, it can be aimed at almost anyone, sometimes without a logical process: it is my wife’s / husband’s / partner’s fault for not looking after our child / parent / sibling properly; it is the doctor’s fault for not acting more quickly; it is my fault for not noticing the illness or the problems in the relationship.
Displacement anger happens because one cannot be angry at an illness, or it feels wrong to blame the person we’re angry with, so others are blamed: loved ones, strangers, events, sometimes inanimate objects, which receive the brunt of the person’s anger.
Sometimes, to express anger, an ‘opposition’ is created: the healthy deserve anger because my loved one is dying; happy couples deserve anger because my relationship is lost; people in general deserve anger because they carry on with their lives and I cannot carry on with mine; or the dead person deserves anger for leaving me.
Bargaining may be described as the ‘if only’ or ‘I wish’ stage of grieving.
Bargaining can be retrospective: If only I had … driven the car instead of her / taken those pills the doctor gave me / exercised more / been kinder to my partner … then this wouldn’t have happened.
Bargaining can be here and now. Perhaps the inevitable loss will go away if I … change my diet / take up homeopathy / pray / become a better person. In a relationship break-up where one person wishes the relationship to continue, bargaining often takes the form of promises to change to try and convince the partner to stay.
Bargaining can be prospective, haggling for more time, looking forward to events to live for and experience before life can be let go: I will live until I have … seen my daughter married / reached my 50th birthday / made amends for my wrongs.
In the depression stage, the fighting of denial, anger and bargaining stops: it is the beginning of adjustment to the reality of profound loss, the start of letting go.
This is characterised by deep sadness, missing and yearning, or emotional overwhelm resulting in an emotional blankness. The energy for emotions, thinking and physical tasks is greatly reduced. The smallest task can feel like a great effort.
One aspect of grieving not described by Elisabeth Kübler-Ross, but which I have witnessed many times, emerges most clearly in the depression stage: loss of identity. The question of identity arises because of the enormity of the adjustment: if I am no longer the deceased person’s wife / husband / partner (etc.), then who am I? What is my role in life now? This question can arise not only in the event of a physical death, but on the death of a relationship, a break-up or divorce. It is also true of someone who, for reasons of severe injury or illness, undergoes a significant physical change: if I no longer have this limb, or can no longer walk unaided, or can no longer participate in my favourite activity, then who am I now? In the depression stage, the grieving person understands the weight of the question, and that it can no longer be avoided.
Now denial is seen as unreal; anger is spent or seen realistically as misplaced; bargaining is recognised as a fantasy; depression has been experienced and adjustments to reality made; and this leads to acceptance.
Life is different now: the loved one, relationship, limb, career, etc., has gone and appropriate realistic adjustments have been made. The perspective on life has been updated to account for the new circumstance. The loss is not rejected, the past situation is not idealised, and the lost loved one, relationship, limb, career, etc., can be considered realistically.
The experience of grief, relapse and recovery
Of course, the model above is a neat abstraction: in reality, mourning can be much messier, jumping from one stage to another and back again, some adjustments never fully made.
When we grieve, it can fill our whole experience so that nothing else seems to exist: the emotional pain is intense, and thoughts of loss dominate our waking thoughts, and sometimes our dreams. This is the inner circle on the right: grief fills our experience.
If we stay in denial, anger, bargaining, or depression, and actively reinforce this stage, then we cannot grow, but remain in the inner circle, stuck in grief. A famous example of this is Queen Victoria. After the death of her husband, Prince Albert, in December 1861, she wore black mourning clothes for the remaining 40 years of her life. She ordered that Albert’s residences were maintained, frozen in time, his clothes hung in wardrobes, just as if he were to return at any moment. Her servants were made to bring hot water into his dressing room each day for his morning shave, just as if he was still alive. The majority of her days were spent in seclusion in Windsor Castle and Balmoral, the places she had formerly been happiest with Albert. She was stuck in denial, unable to face the fundamental question of adjustment: If I am no longer Albert’s wife, who am I now?
If denial, anger, bargaining and depression are acknowledged as normal processes leading to acceptance, each allowed its passage of time with patience and understanding, then the grieving person can grow around the experience of grief and trauma, gaining new self-understanding, having new experiences which build up adaptations to the new reality. This is represented by each successive circle (above right). Each circle does not represent a particular passage of time: how long growth and adaptation takes is personal to each individual’s experience, and their ability to pass successfully through the stages of grief and grow around the loss.
Certain events can create a relapse. This may be meeting a person who reminds you of the person who is missed; or a dream reminding you of difficult events; or a special time of year such as a birthday with the key person missing; or apparently unrelated events such as a stressful time at work which lowers emotional resilience. At such times, we may revert to a previous stage of growth, or even return to the grief as if it had just happened. This is represented by an arrow back to a previous circle (above right). Though this may be distressing, it does not wipe out the progress made and, in most circumstances, previous growth helps us return within hours or days back to the previous point of recovery achieved.
Growing beyond grief does not mean forgetting the person or relationship we have lost. For some, this is a sticking point: it can be as if grieving is all that is left of the person, so it seems that to stop grieving is to lose them completely. Thus the person becomes stuck.
Growing beyond grief means valuing and holding dear what we had in the past, while living in the present and adapting appropriately and realistically to the changed situation. This takes time and patience. Find support. Be gentle with yourself.
About Ian Pittaway
Ian is a psychotherapist and writer with a private practice in Stourbridge, West Midlands. Ian’s therapy is integrative, chiefly comprising key elements of transactional analysis, object relations, person centred therapy and self-psychology. Ian has a special interest in trauma recovery and bereavement.
To contact Ian, call 07504 269 855 or click here.