Stages of Grief

Stages of grief, diagram

Because of the commonality and universality of grief, it is one of the most studied areas in the field of psychology today. Even though grief is a normal – even healthy –response to loss, it is also terribly painful and confusing.

Grief brings out a wide range of expected emotions, including sadness, anger, numbness, isolation – and eventually acceptance. Individuals also experience physical symptoms related to grief. Loss of appetite, a change in sleeping patterns, vivid dreams, and disorganized thoughts are all within the range of normal grieving patterns.

Every culture has norms associated with grieving and ways of dealing with—and expectations of—the bereaved. In the past, and still today in many cultures, the bereaved or grieving person was comforted through his or her family or religious system. But over the past 40 years in the United States, much psychological research and debate has focused on understanding the grieving process to guide those suffering through a loss. The best-known theory that provides a framework for psychologists, counselors, and therapists who work with grieving individuals is called the “Five Stages of Grief.”

The “Five Stages of Grief” are now almost universally applied to the emotional reactions that follow a significant loss. The stages are typically defined as: Denial, Anger, Bargaining, Depression, and Acceptance, or DABDA. Psychologists, grief therapists, counselors, and laypersons trained in grief counseling all utilize these five stages in their approach to overcoming grief.

It is important to note that these stages of grief were originally developed as the “Stages of Dying,” introduced in 1969 by Elisabeth Kübler-Ross in her acclaimed book “On Death and Dying.” The research and findings were based on an observatory study of hundreds of terminally ill patients by Kübler-Ross and her students. The Stages were then expanded to include any form of traumatic personal loss, such as loss of a parent, a home, or a companion. Over the next 30 years, the Stages became more and more popularized and applied to all types of grievers. They have become ingrained in the training of grief counselors at almost every level.

As a person seeking grief counseling, an individual will find that some counselors adhere religiously to the theory of stages, while others use them as a general guide. Even Kübler-Ross herself offers a disclaimer on this broad application and adherence to these stages: “The five stages…are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief. Not everyone goes through all of them or in a prescribed order. Our hope is that with these stages comes the knowledge of grief ’s terrain, making us better equipped to cope with life and loss.”

Tips for Dealing with Grief

Grieving is a normal process involving a number of emotional and physical reactions. Ignoring or bottling up these reactions can lead to a number of serious physical and mental health issues. Understanding the possible stages and symptoms of grieving is helpful, but it does not take away the pain of the loss.

Dr. Edward Creagan, with the Mayo Clinic’s division of medical oncology, offers the following ideas on for how to make the grief process easier:

  • Actively grieve and mourn.
  • If you don’t face your grief, your wounds may never quite go away.
  • We grieve alone, but we heal in community.
  • Don’t make major decisions while grieving.
  • Surround yourself with people who care about you.
  • Take care of yourself.
  • Time helps, but it may not cure.

The Stages of Grief

The following explains the stages of grief based on research by Kubler-Ross:

Denial. It is normal to have a reaction of denial when hearing about a terrible accident, sudden death or diagnosis of a disease. At first, it seems unbelievable. Shock and numbness are two other emotions commonly used to describe this stage. Pain, sadness, and guilt can be associated with this stage after the initial shock wears off.

Anger. The most difficult stage to manage, anger comes when the surviving individual realizes denial is no longer an option. People in this stage may lash out at those around them that are trying to provide support. Human nature wants to blame someone or something for the loss. It is at this stage that people often ask, “why me?”

Bargaining. This stage is more common in a person diagnosed with a terminal illness than with someone who has experienced a death in the family. However, according to Kübler-Ross and her followers, it is still part of the grieving process and typically follows a stage of anger. Bargaining almost always involves a conversation with a higher power.

Depression. This fourth stage has the most potential for developing into debilitating grief. In the terminally ill, it is at this stage that the person realizes his or her certain death, and may see the situation as utterly hopeless. In the grieving person, it is most important to realize the distinction between normal sadness due to a loss and clinical depression. Even if depression comes later than people think it should, or lasts longer than others wish it would, it is a normal stage in the grieving process and, according to Kübler-Ross, must be worked through. Emotions such as despair, emptiness, and feelings of isolation and extreme sadness are common during this stage.

Acceptance. Acceptance is the final stage in the grieving process. This is the place that everyone experiencing grief strives to reach. For the dying individual, this is the stage in which one accepts things for what they are, makes peace with the world, and prepares for a dignified passing. For the loved ones left behind, individuals will make peace with the deceased, accept the loss as a part of life, and move on with their life, although it may be in a different way.

An Opposing Point of View

In contemporary research, these five stages are now being debated – even hotly contested. Some in the psychiatric community even believe the Stages have done more harm than good.

“Somehow, over the years, the real virtues inspired by her work have been subordinated to the inaccurately named, largely imaginary stages,” explains Russell Friedman and John W. James, authors, and founders of The Grief Recovery Institute in Sherman Oaks, California. “Grief is the normal and natural emotional response to loss. Stage theories put grieving people in conflict with their emotional reactions to losses that affect them. No matter how much people want to create simple, iron clad guidelines for the human emotions of grief, there are no stages of grief that fit every person or relationship.”

Friedman and James warn that the diagnosis of a stage can often lead to a self-fulfilling prophesy for patients and create a clinical condition which did not actually exist. Professor of Clinical Psychology at Columbia University George A. Bonanno, also argues in his book “The Other Side of Sadness” that grief is so highly individualized and personal, that no two people grieve in the same way.

Although the “Five Stages of Grief” theory may not be considered the gospel it once was, “On Death and Dying” did serve to bring more awareness and sensitivity to the terminally ill and in turn to grieving individuals universally. When the book was published in 1969, the medical—and psychiatric—communities had a somewhat cold outlook and treatment for terminally ill patients. “The lessons Kubler-Ross learned from those dying people, coupled with her compassionate regard for them, became a focal point of the emergent Hospice movement,” concede Friedman and James.

Despite continuing research and differing viewpoints on the subject, Kubler-Ross’s theory remains the most widely accepted. The Stages give individuals, counselors and psychologists guidelines for knowing what can be considered mentally healthy during the process of dealing with a significant loss.

To learn more about the Stages of Grief and grief counseling, look into degree programs in your area that offer specializations in psychology and mental health counseling. Help others who have suffered a personal loss by becoming a mental health counselor or therapist. Learn more about the psychology career licensing processes and the state requirements for licensure at: Psychology Career Licensure.

What Happened to the Stages of Grief?

Many of us who read the book “On Death and Dying” by Elizabeth Kübler-Ross are familiar with her five stages of grief: denial, anger, bargaining depression, and acceptance. Health care workers, mental health professionals, and psychologists have long referred to these stages to help explain the grief process.

The theory states that individuals can get stuck in a stage, and passing over a stage results in longer periods of suffering.

According to George A. Bonanno is a clinical psychologist at Columbia University and author of The Other Side of Sadness: What the New Science of Bereavement Can Tell Us about Life after Loss, the research on bereavement doesn’t reveal anything even similar to the five stages of grief.

Writing on his blog for Psychology Today, Bonanno said that he and his colleagues studied those in bereavement for long time periods. His findings show that how people adapt and cope with loss is highly variable, meaning it’s a very individual and personal experience. No two people grieve in exactly the same way.

However, Bonanno and his colleagues did find patterns or common characteristics as to how people grieve, and they identified the patterns accordingly:

Prolonged or chronic grief. According to Bonnano, prolonged grief afflicts about one in every 10 individuals who has suffered a loss through death. Prolonged grief can go on for years, and even gets worse over time. Prolonged grief becomes problematic, causing individuals to struggle with everyday functioning for years.

Recovery pattern. Those individuals who fall into this category – also one out of 10 – suffer intense grief from a few months to a year, and then begin to steadily suffer less. However when the researchers talked with these individuals years after the loss, they all said similar statements, such as a person never really gets over a death, and a loss is forever.

Resilience. From one-third to two-thirds of those who have suffered a loss fall into this grouping, the most common category of those in Bonanno’s study. Those that the researchers label “resilient” have acute, intense pain for a few days to a few weeks, and then begin to suffer less.

Bonanno states on his blog that “it is not that they don’t grieve, or that they didn’t care; far from it. Rather, they are able to put the pain aside when they need to and they continue to meet the demands of their life. They work, they take are of loved ones. They even laugh and experience moments of joy. They accept the loss, readjust their sense of what is, and move on.”

The researchers found these patterns in other groups they studied as well, and also in grief patterns associated with those who have gone through a divorce and lost a job. He said they also found these patterns among those who experienced the World Trade Center terrorist attacks of September 11, 2001 (either in the buildings or those on the ground near the buildings).

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