In this article we define grief and identify seven stages we may go through after experiencing a loss.
When we think of grief, we often think of the death of a loved one. However, loss can occur in many different ways and is often the result of change. There is physical loss, such as death, economic hardship, or permanent injury, and symbolic loss, such as changes in our identity, our family context, our health status or career. Physical and symbolic losses often occur together. For example, physical loss of a limb through traumatic injury will also impact our identity and our experiences in the world as a person with a new disability.
Both physical and symbolic losses can trigger a grieving process. Grief refers to our cognitive, emotional, physical, behavioural, and social reactions to loss. Swiss-American psychiatrist Elizabeth Kubler-Ross originally identified five stages of grief that we go through: denial, anger, bargaining, depression, and acceptance. She took these from her work with terminally ill patients, and found them to also apply to other types of grief. More recently, this model has been expanded to include two additional stages: shock, and integration. Notably, grief is not a linear process and we do not experience the stages in a structured manner. Instead, we are likely to go back and forth between the various stages over time, even experiencing some concurrently.
A common first reaction to loss is shock. This can occur even if the loss was expected and we had time to prepare for it. Of course, it is typically much worse when the loss is sudden and unexpected, or otherwise traumatic. At this stage, the loss is unlikely to have fully hit us yet, and we may feel numb or detached.
During this stage, the brain may be struggling to understand the permanence of the loss. We may believe that there has been a mistake or misunderstanding, or that the loss is not real. For example, we may have the sense that our deceased loved one may walk into the room at any time or recognise them among strangers on the street. This is the time we tend to continue on with our lives as if nothing had happened and avoid any confirmation that what we have lost is truly gone.
With loss often comes a sense of injustice and anger. This can be directed at the loss itself, what we have lost, the people around us, or the wider context. It may even be directed at ourselves as blame. Anger is often a response to powerlessness. We cannot get back what we lost, so instead we may look for someone to blame or try to regain a sense of control through taking action. Anger is often a more bearable emotion than more vulnerable emotions in the grieving process, such as pain, guilt, or shame.
When loss is anticipated in the future or symbolic, we may propose trade-offs. For example, in a case of terminal illness, we may make promises to devote the rest of our lives to a charitable cause, if we can just get more time back. When loss is permanent and irreversible, bargaining may rather show up in rumination about how things happened or how they could have happened differently, and what-if questions. In this stage, we may no longer be in denial over the loss itself, but we may continue to avoid the reality of the loss through these types of negotiations.
While emotions in a time of grief can be mixed, all loss comes with some level of pain. This can be overwhelming, and we may experience strong physical symptoms, brain fog, social withdrawal, or changes in our behaviours. During the stage of depression, we may feel a sense of meaninglessness of life or experience anxiety around our own mortality.
- Reconstruction and Processing
This stage is one of processing our grief and loss, and reconstructing our lives. We start adjusting to life without what was lost, and find ways to develop a new and different relationship with what was lost. Often, rituals and connections with what was lost are developed. This is a phase of trying out various things to see what feels helpful, soothing, and meaningful. We can make a deliberate choice to engage active coping strategies at this time.
- Acceptance and Integration
Acceptance occurs when the reality of the loss and the grief process have been acknowledged, worked through, and accepted. Changes and insights that arose from stage six are more permanently integrated into our identities and lives. This is the time we can move forward in a unified way in which the loss has become a meaningful, integrated part of us.
Article written by Dr Esslin Terrighena
The stages of grief are not linear, and can feel messy and overwhelming. If you find yourself drowning in grief or painfully stuck at one of the stages, therapy can be crucial to guide you through the healing process. To find out more how grief therapy can help you, and to book a consultation call (852) 2521 4668 or email firstname.lastname@example.org.