Almost everyone has heard of the Five Stages of Grief made famous by Dr. Elizabeth Kübler-Ross. Many of you may also have heard that she presented this as the grief process related to those who receive a terminal diagnosis (and those who love them) and NOT the grief of the bereaved who are mourning the death of a loved one. Somehow, these stages have been adopted as the five stages for all grieving.
I, however, see the process of grieving differently when it is anticipated pre-death grieving versus post-death bereavement.
Understanding The Basics
As discussed in The Thing About Grief… grief is experienced all the time over losses that are a part of life, such as empty nest syndrome, losing a job or planned retirement. In those cases, many of the stages of grief listed below would not naturally occur. Those are different kinds of grief.
Anticipatory grief is just as its name suggests; grief over a loss that is anticipated-though-unexpected, and hasn’t happened yet. Basically speaking, a loss through death via terminal illness or resulting from injuries sustained in a traumatic incident. Anticipatory grief begins the moment a terminal prognosis is made.
Denial – Denial is devastation. A gut punch to the stomach. “Nope. Nope. Not me. Not this. It can’t be.” The resistance to the evidential facts. “The doctors are wrong. They made a mistake.” One may go about their daily lives as if nothing at all is wrong. Others may obsess with seeking second, third, even fourth medical opinions that might change the prognosis. In discussion, phrases like “don’t talk like that,” “don’t think that way,” and “we have to stay positive,” indicate denial.
Anger – Anger is the first sign that the diagnosis/prognosis is sinking in. After all, you can’t be angry at something that you deny exists, right? So it is natural to think that anger would not come before denial. Anger may be directed at the medical community, especially if the patient was one to frequent doctors and feels like their complaints had been dismissed on one or more occasions. It may also be directed at the patient (or self) if said patient did not seek medical attention at first onset of concerning symptoms. Or if they engaged in behaviors/activities you feel may have contributed to the prognosis. It may also be directed at Life in general, or one’s higher power. Feelings of “why me” or “what did I do to deserve this?” indicate anger. Anger is resistance.
Bargaining – Bargaining is dealing for a better outcome. Making deals with one’s body, Life, God, etc. in order to undo the current situation. This often shows up between denial and anger in the form of “if I just drastically change my eating habits maybe it will eradicate the issue before my second (third or fourth) opinion”. Loved ones might bargain with God, or a Higher Power, on the patient’s behalf. “If You heal him/her I’ll go to Church every Sunday.” Somehow, the connection is made that if you become a “better person” you will be able to effect a “better outcome”.
Depression – Depression is prolonged, profound sadness. It is the indicator that the diagnosis/prognosis is recognized as truth and the full impact is setting in. Depression is evidence of two things: 1) the recognition/realization of the scope of loss; and 2) the resistance to it. Depression is understanding the upcoming losses combined with the desire for it to be different. Upcoming losses: the loss of independence; the loss of quality of life; the loss of interaction; the loss of functioning, etc. And then there are the losses of presence as well; holidays, major milestones in one’s life or the life of another, and the loss of the opportunity to grow old and witness the lives of children and/or grandchildren. It is identified with a great desire for things to be different. For the prognosis to be undone. For the now impossible future to be possible once again. A mournfulness for the things that no longer are, and things that never can be. This is active grief. We can liken it to an open wound bleeding profusely.
Acceptance – Acceptance is simply embracing the loss. It doesn’t mean grieving has stopped. It doesn’t mean that one is ok with the impending loss. It means one is shifting energies and transitioning to a new chapter in life instead of trying to reclaim the old one. It is a time when one begins to seek meaningful ways to interact, engage, and live the rest of their life within the new parameters of the diagnosis/prognosis. Phrases like, “If cancer will take my body, it won’t take my spirit along with it” and “I won’t live the rest of my life just waiting to die” are indications that one has moved into acceptance.
Bereavement is grief resulting from the loss, through death, of a loved one. It begins the moment death occurs. In an anticipated death, anticipated grief shifts to bereavement at the time of death. When talking about grief, nothing is ever said to be ‘easy’. I hate to even say that one is easier than another, however, in my own experience, I have found that the longer opportunity for anticipatory grieving, the smoother bereavement goes. While I fully understand death as a natural expected part of life, sudden loss is traumatic for me, just as it is for everyone.
When I’ve experienced anticipated grief, I still experienced all the stages of bereavement described below, however they’ve been shorter in duration and less intense than the times when I’ve suffered a traumatic sudden death.
Shock – Shock is overwhelm. It is complete numbness. It is seeing all the facts in front of you, yet unable to somehow absorb them. It is disbelief. Often, “I don’t know what I’m supposed to do” and “it can’t be true” are heard from someone in shock. There are not many things that change our lives instantaneously like death does. Literally, one minute your loved one is present and the next they have transitioned. There is nothing else quite like it. One feels numb, unable to focus, to think, to make small talk, make decisions, or even to do daily tasks. Sadly, this is often the time when one is required to make many decisions regarding funeral/memorial arrangements.
Sorrow – Sorrow is a deep feeling of distress over the loss. It is relentless sadness burrowing down to the bones. It is uncontrolled weeping at times, then feeling like you couldn’t cry another tear. There is little predictability with sorrow. Sorrow will come in like a huge wave and knock you flat one day. Then other days, later down the road it will start rolling up less violently, just enough to wobble you, but not knock you over. Then much further down the bereavement road it will just sweep up over your feet, causing you to pause, before it laps back into the collective grief residing within you. Sorrow is what we most think of when we think of grief.
Anger – Just as in Anticipated Grief, anger may be directed at the medical community, the caregivers, the one who died, a Higher Power, or just Life in general. Often times, anger in bereavement is a front man for guilt. It is easier to direct anger outwards than to deal with the guilt you are directing inward. The underlying belief that you have some responsibility for the death. Anger is largely the feeling that someone is responsible. It is a false way to feel powerful in a situation where you are utterly powerless. Again, anger is resistance.
Guilt – Guilt is the counter part to Anticipated Grief’s ‘bargaining’. There is no bargain to be made now to change the outcome. Now there is guilt for things done or not done that could’ve, maybe, affected the outcome. This is evident in the ‘I wish I would’ve/I wish I could’ve’ thoughts and feelings that arise. Guilt may come before or after anger, but they usually travel together. There may be guilt for not ‘doing’ more. There may be guilt for not visiting more often. There may be guilt for not having made it to the bedside before death occurred. There may be guilt for giving that last does of Morphine. There may be guilt for the last conversation having been an argument. The common premise is the belief that you have some sort of responsibility concerning the outcome. The one piece of guidance I give my clients is this: if it could’ve happened any other way, it would’ve.
Acceptance – Acceptance is resigning to a ‘new normal’. It doesn’t mean the grieving ends. In fact, with acceptance comes more release. Once the resistance to the loss has subsided, then the release of tears and sobbing may flow more freely than before. Acceptance doesn’t mean that one is ok with the loss; it means one is fully understanding the impact this loss has had and will continue to have. It also means that one is shifting energies and transitioning to a new chapter in life instead of trying to reclaim the old one. It is a time when one begins to seek meaningful ways to interact, engage, and live the rest of their life given the new circumstances. Phrases like, “he would want me to be happy” or “she would want me to go on living” are indications that one has moved into acceptance.
Integration – Integration is realizing that you don’t ever get over the loss of someone, but walk with them the rest of your life in this new way. Integration is healing. I think integration is an important missing stage of grief. Integration means your love for the lost person transcends death and you honor the place they still hold in your life. You never stop loving someone, just because they die. That love lives as long as WE do. Many times I hear the phrase, “I loved (insert person’s name) so much.” But the truth is love does not end at death, we just call it grief. Finding the way to move forward, while taking the love of those who have died with us, is key to integration. Feeling free to talk about their lost loved one and sharing memories without breaking down, indicates that one is integrating the loss.
Let’s explore that a little more…
Life With Grief
Grief is always with us. Once we experience loss, of any kind, we never walk without grief again; So in fact there is no life AFTER grief, there is only life WITH grief. This is why understanding the ‘integration’ stage is so important.
Each loss impacts you differently because grief is cumulative. Even if -or maybe especially if- you have been diligent in your processing of your grief, it will change you. That is what grief does. It is literally grief’s job to change you.
It is your job to allow it. It is not your job to compartmentalize and say ‘This is me and this is my grief over here.’ Or even to say ‘I am done grieving now.’ I think that is where people get the notion they are doing it wrong, because years later they still feel grief. But as I said earlier…grief is just what we call love after death. If we could get to the place where we can say “I love her” rather than “I loved her” after someone dies, we might have an easier time navigating the grief landscape. “I love her and I miss her” is an appropriate statement. Saying you ‘loved’ someone implies you no longer love them, yet grief is the evidence that you do.
I used to say we store grief in sort of a Pandora’s Box inside. Every time we experience loss, that grief is placed in the box combining with all the other grief we’ve experienced.
I no longer see it that way, though. Yes, this is one way to deal with grief. To keep it locked up and only opening up on the occasion of loss or when you revisit old memories. But I think that is the old way of grieving.
Our lives are great works of art and we are the Creators.
Grief is a paint color added to our artist’s palette. It stays on our brush and adds dimension to every stroke to every tile we make after it. We still paint with all the other colors, but there is always that small tinge of grief that adds depth, or breadth, to the tone of each piece. This is ‘integration’. With each loss a slightly new shade of grief gets added to the palette.
If we look at ourselves like Mosaic works of art we can see our lives as Masterpieces.
For awhile after a loss, the tiles are predominantly painted with the new grief shade. Each time we pick up a new tile and our brush we reach first for the grief shade. However, with time and care we will begin to choose one of the other colors first, but the grief shade will always be present somewhere.
Our lives are Mosaics; Collections of memory tiles we paint one by one. And we never know at the time how one tile will affect the whole picture.
“See this blue & black & yellow piece here? That’s when my grief took me to that little lake, and I had the inspiration for that poem. I shared that poem and it helped a lady deep in her loss. Then she became my friend.”
Each tile is a story in and of itself while at the same time contributing to the entire picture.
The grief pieces are integral parts of the Masterpiece.
I love you.