Five Stages of Grief

Five stages of grief

You may be familiar with the five stages of grief, coined originally by co-authors David Kessler and Elisabeth Kübler-Ross (check out their book, On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss.) As a reminder, here are the stages:

• Denial
• Anger
• Bargaining
• Sadness
• Acceptance

You may have experienced this process personally after the loss of a loved one.

Grief is relevant now, too, though – even if you haven’t lost someone close to you. One thing we’re hearing from patients and others recently is a profound sense of discomfort and emotional distress. This distress is largely due to the state of the world today, and the way it’s being processed closely mimics the stages of grief.

In other words, we may be collectively going through the five stages of grief right now.

At the time of this writing, the United States alone has lost more than 100,000 people due to the COVID-19 pandemic. Simultaneously, we’re experiencing historic unemployment rates, financial distress, isolation from loved ones, and uncertainty about the future. On top of all of that, we’ve watched with agony as racial injustices have caused the killings of George Floyd, Ahmaud Arbery, and too many others, leading to protests, more violence, and even deeper divisions in the United States.

The grief we’re feeling is real.

As it relates to the COVID-19 pandemic, here’s how the stages might feel, according to co-author Kessler:

“There’s denial, which we say a lot of early on: This virus won’t affect us. There’s anger: You’re making me stay home and taking away my activities. There’s bargaining: Okay, if I social distance for two weeks everything will be better, right? There’s sadness: I don’t know when this will end. And finally there’s acceptance. This is happening; I have to figure out how to proceed.”

These stages are equally relevant to the other crises we’re facing, including financial hardships, political divides, and protests over racial inequality.

Sixth stage

Kessler recently discussed the possible existence of a sixth stage of grief – finding meaning. In his personal experience of grieving a loved one, he found himself continually wanting to reach for the meaning behind it all.

This feels familiar in the environment in which we’re all living, too. We’ve heard so many patients and friends wax poetic about the possible reasons “this is all happening.” Similarly, many have spent time thinking about what the history books will write about this period someday, garnering all the lessons there are to take from a 30,000 foot view.

From a pandemic perspective, Kessler writes, “I do believe we find light in those times. Even now people are realizing they can connect through technology. They are not as remote as they thought. They are realizing they can use their phones for long conversations. They’re appreciating walks. I believe we will continue to find meaning now and when this is over.”

From the perspective of the economic and financial crisis we’re facing, many people are also finding meaning -- finding new ways to live, identifying things they previously thought they couldn’t do without, and discovering what’s really important to them.

There may also be the beginnings of finding meaning for the George Floyd protests. Many are seeing a long-overdue breaking point, identifying others’ agony, and helping racial injustice be brought into raw, unfiltered light.

Patience and compassion

One thing that bears remembering is that each person may experience the stages of grief at different speeds, and that the grief stages themselves may manifest in different ways.

In this case, a big dose of compassion – for others and for yourself – is crucial.

Kessler says, “Everyone will have different levels of fear and grief and it manifests in different ways. A coworker got very snippy with me the other day and I thought, That’s not like this person; that’s how they’re dealing with this. I’m seeing their fear and anxiety. So be patient. Think about who someone usually is and not who they seem to be in this moment.”

Compassion toward yourself is equally important during the grieving process. Remember to remove any “shoulds” when you notice them. For example, instead of having feelings about your feelings – e.g. feeling sadness, and then rebuking yourself, thinking “I shouldn’t feel sad, I have it better than so many others in my community” – just let yourself stop at sadness. “I feel sad” – full stop.

According to Kessler: “We can — we should — stop at the first feeling. I feel sad. Let me go for five minutes to feel sad. Your work is to feel your sadness and fear and anger whether or not someone else is feeling something. Fighting it doesn’t help because your body is producing the feeling. If we allow the feelings to happen, they’ll happen in an orderly way, and it empowers us. Then we’re not victims.”

Balance

Another important healing mechanism for grief is finding balance. This includes balance in terms of your thoughts AND your actions.

According to Kessler, one goal “is to find balance in the things you’re thinking. If you feel the worst image taking shape, make yourself think of the best image. We all get a little sick and the world continues. Not everyone I love dies. Maybe no one does because we’re all taking the right steps. Neither scenario should be ignored but neither should dominate either.”

It's also important to find balance in what you do every day. Make a list of things that bring you energy, and make sure you do at least one of them every day. Perhaps you’re energized by taking a walk outside, getting in some exercise, talking to a friend or journaling If you find yourself doing too much of one thing (e.g. sitting on the couch watching devastating news, or numbing it all by overeating), make sure you counterbalance with things from your list that will bring you energy and make you feel good.

Presence

A final healing mechanism for grief is mindfulness, or, more simply stated, being present.

We may be feeling something called anticipatory grief – “that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming.”

Anticipatory grief is the most common type of grief we’ve been hearing about among our patients, and it stands to reason – many worry about a dark, grim future without knowing what, exactly, the future will entail.

According to Kessler: “Anticipatory grief is the mind going to the future and imagining the worst. To calm yourself, you want to come into the present. This will be familiar advice to anyone who has meditated or practiced mindfulness but people are always surprised at how prosaic this can be. You can name five things in the room. There’s a computer, a chair, a picture of the dog, an old rug, and a coffee mug. It’s that simple. Breathe. Realize that in the present moment, nothing you’ve anticipated has happened. In this moment, you’re okay. You have food. You are not sick. Use your senses and think about what they feel. The desk is hard. The blanket is soft. I can feel the breath coming into my nose. This really will work to dampen some of that pain.”

Other methods of being present include meditation, journaling, breathwork exercises, mindful movement, and talking to others (including your therapist, friends, or a mindfulness coach).