Kubler-Ross, a Swiss psychiatrist, first explained the five phases of grief in 1969 by postulating the progression of emotions experienced by patients diagnosed with terminal illness and loved-ones after bereavement (Kübler-Ross " Kessler, 2014). The phases of mourning and grief are universal since people across different cultures experience them. Grief occurs in response to the loss of life, terminal illness, or loss of a close relationship. Kubler proposed five stages of grief commonly shortened as DABDA, which entails denial, anger, bargaining, depression, as well as acceptance (Mahmood, 2016). During bereavement, people spend varying periods going through the stages with different intensities. The steps may not necessarily follow one another in a particular order. However, people often move through the phases before attaining the acceptable peace of grief.
The grief cycle starts with the denial that always associated with confusion, avoidance, shock, and fear after being informed about the demise of a loved one or terminal illness (Mahmood, 2016). Denial can be followed by anger, which is depicted through frustration, anxiety, and irritation since the truth starts to sink. At the bargaining stage, one strives to gain emotional support by reaching out to others, explaining what happened to friends and colleagues, and attempting to find meaning or implications of the phenomenon. It is followed by depression where one feels helpless, overwhelmed, hostile, and frightened (Stillion " Attig, 2014). Acceptance is the last stage that involves exploring new options, putting new plans in place, and moving on with life. Nevertheless, depression and acceptance phases require guidance and direction to ensure that the victim is not carried away with the turn of events to cause harm to oneself or others.
Denial
The initial reaction to knowing about the chronic illness or demise of a loved one is to reject the truth of the situation. Most people tend show disbelief that they are faced with challenging times. It is always a normal effect to rationalize the devastating emotions. Denial is a defensive mechanism, which buffers the unexpected shock of being bereaved or sick by numbing the emotions (Stroebe, Schut, " Boerner, 2017). Individuals start to believe that life is meaningless and nothing is valuable anymore. For many people going through grief, denial is a temporary stage that carries them through the first phase of pain.
The world becomes empty since the shock is overwhelming and life does not make sense. It is common at this stage to wonder how their lives will continue with the illness or without their loved one. People are distressed since life, as they once knew it had changed abruptly. Those diagnosed with chronic diseases often consider the news as incorrect by clinging to the false hope that there must have been a mix-up or confusion of blood samples. Moreover, if people are given information about the demise of a loved one, they tend to believe that the informer might have identified a wrong person. One starts to wonder why s/he should continue living and denial helps the individual to cope with the situation at the moment and making survival possible.
There is always grace in denial since it allows a person to let in only what s/he can handle. In the denial phase, the victims live a preferable reality rather than the actual reality. Nevertheless, denial assists in pacing one’s feelings of sorrow by staggering the full effect of grief. The healing process starts once the shock and denial begin to fade. Victims begin to be strong and the suppressed feelings begin to surface. Most patients diagnosed with terminal illness utilize denial since it is often a quick shock response to the bad news. Seclusion arises mainly from people including close relatives by avoiding the person on a deathbed or the deceased. People often move back to denial stage if there is a new development or individuals feel they cannot cope.
Anger
As the results of denial start to go away, the reality, as well as pain, resurface, but the victim is not ready. The intense feeling is deflected from the vulnerable core, redirected, and shown as anger (Stillion " Attig, 2014). Anger has no limits, and it may be directed at family members, friends, strangers, or inanimate objects. Furthermore, it can be channeled to the deceased or the dying person. Victims rationally understand that other people should not be blamed, but they may detest the individual causing them pain due to emotions. During grief, people find it incomprehensible of how such a terrible occurrence could befall them (Stroebe, Schut, " Boerner, 2017). Christians tend to start questioning their belief in God because they believe He would not allow them to suffer.
Anger is an essential stage of the healing process and victim should be willing to let out their fury even if it may be endless. The more anger one honestly feels, the more it will dissipate leading to better feelings. The victim's rage is accompanied by pain making one feel abandoned and deserted. Anger is a natural strength that can act as an anchor, but the society fears it (Stillion " Attig, 2014). When people are grieved, they think that their life is shattered with no solid support. They resort to anger as a linkage to the reality and other people. Resentment becomes a bridge over an open sea, a link between the victim and society. It is always easy to suppress anger than experiencing it. Nonetheless, rage is just a sign of the intensity of one's love to the lost loved one.
Kubler-Ross indicated that research confirms her argument that anger is an essential phase of grief (Kübler-Ross " Kessler, 2014). Grieving individuals tend to envy others who are moving on with their lives. It makes the bereaved or the terminally ill person to start asking why some people seem not to care about them or why others are not dying. Even though bereaved families and chronically ill individuals may seem to be in an endless cycle of anger, they will be relieved after some time (Walter " McCoyd, 2015). Besides, the more they depict the anger, the faster the healing process. The anger allows individuals to direct their sorrow to others without necessarily causing harm to themselves or other people.
Bargaining
Before a loss, people often seem like they would do anything only if their lives or the life of their loved one is spared. They would pray to God negotiating for the good health of their close relatives. Bargaining stage offers false hope since people might mistakenly make themselves believe that the grief can be avoided through some form of negotiation (Walter " McCoyd, 2015). They promise to change their way of life if their situation is altered. People become desperate to get their life back to the way it was before the demise or illness, and they are willing to make major life changes in an attempt to move towards normality. Guilt is the most common factor considered during bargaining. Victims begin to blame themselves for the incident because they believe that they could have done things differently.
The bereaved can bargain even with the pain by promising to do anything provided they are relieved of the pain (Walter " McCoyd, 2015). Therefore, they cling to the past trying to negotiate their way out of the pain. The typical response to feelings of vulnerability and helplessness is always a need to regain control of the situation. For instance, they often think that things would have been different if they sought medical attention earlier, obtained a second opinion from a different doctor, or tried to be better people towards the others (Mahmood, 2016). They secretly make deals with supernatural power in an effort to push the inevitable and associated pain. Nonetheless, bargaining is a weaker line of protection to defend oneself from the disturbing reality.
Depression
After the bargaining stage, attention is focused on the present moment. Empty emotions set in and grief gets into victims’ lives on deeper levels than they ever imagined (Stroebe, Schut, " Boerner, 2017). The depressive stage feels as though it will never end. However, the depression should not be assumed to be a sign of mental illness. Dejection is an appropriate reaction to a great loss or terminal illness because the person withdraws from life due to intense sadness and wonders if there is anything left for them in this world (Kübler-Ross " Kessler, 2014). Although depression can be perceived as unnatural and can be fixed, the demise of a loved one or being in a deathbed is a stressful situation. Hence, it is normal to feel depressed after being diagnosed with a terminal illness as well as losing a friend, relative, or family member.
Terminal illness and mourning are often associated with two forms of depression. The first form is a response to realistic implications concerning the loss or the disease, and it is often characterized by regret and sadness. People worry about the treatment and burial costs. Besides, they are concerned that they have spent less time with those who depend on them. The stage can be eased by reassurance and simple clarification. Patients and their family members require kind words and beneficial cooperation (Stroebe, Schut, " Boerner, 2017). The second type of depression is considerably more subtle and private since it involves preparation to disconnect and bid farewell to the loved ones. At this stage, individuals need to be shown compassion and simple gestures such as a hug.
The realization that a loved one will not come back is reasonably depressing. Many people associate depression with grief since it symbolizes the emptiness that people feel. They live in reality but recognize that their loved one is gone forever. In this phase, people often withdraw from life, live in confusion, feel numb, and want to remain in bed for long (Stillion " Attig, 2014). The world seems overwhelming and they prefer to remain in solitude. Moreover, the victims have a feeling of hopelessness and do not want to talk. Their minds may be filled with suicidal thoughts because they do not want to move on with life.
Acceptance
The last step of grief is acceptance. It does not mean that people are okay with the demise, but they accept the reality that their condition may not get better. The reality cannot be improved, and the individuals have to move on with their life (Walter " McCoyd, 2015). They learn to exist with it and live in a world where their family members are missing. Some people tend to resist the new norm and struggle to imagine that they can get in touch with their loved ones. However, the passage of time allows them to recognize that they cannot keep the past intact since it has changed forever and they have to readjust.
Reaching the stage of acceptance in grief is a gift not offered to everyone. Death can be sudden, and most people may never go beyond the stages of denial and anger. Acceptance phase is characterized by calm and withdrawal. Nonetheless, the acceptance stage is not a phase of happiness, and it should be differentiated from depression (Stroebe, Schut, " Boerner, 2017). Family members who are aging or terminally ill go through a period of withdrawal. It does not necessarily mean that they are aware of their impending fate, but the physical decline is enough to create a similar response. Their deeds imply that it is possible to reach a stage where social interaction is significantly limited.
The acceptance stage involves reassigning of roles to others or taking them, which permit people to have better days. Nevertheless, people feel that they are betraying their loved one by starting to enjoy life and living comfortably. It is not possible to replace those who have been lost, but individuals can create new connections, meaningful relationships, and inter-dependencies (Kübler-Ross " Kessler, 2014). Therefore, people should listen to their needs and move on instead of denying their feelings. Acceptance may entail reaching out to others and getting involved in their life by investing in friendship and relationship with others because one’s emotions start to stabilize.
People come to terms with the new reality that they will succumb to their illnesses or loved one is not coming back. Even though it is not a good thing, people have to live with the reality. Individuals have to understand that there are good and bad days in life. However, the good days tend to outnumber the worst days and acceptance requires one to come out of the fog (Mahmood, 2016). The bereaved should begin to engage with friends again and may build new relationships over time. They understand that the family member cannot be brought back, but they grow, move, and evolve into the new reality.
Opinion about Death
Dealing with the demise of a family member is one of the most difficult challenges that many people face in life. The grief is particularly intense when people lose their spouses, parent, or siblings. The most common response to information about the death of a loved one is the shock. It is always accompanied by grief symptoms that can present themselves spiritually, physically, or socially. They include crying, sleeping difficulty, headaches, frustration, anxiety, guilt, fatigue, loss of appetite, anger, stress, loneliness, and questioning one's religious beliefs. Although death is a natural phenomenon, the bereaved family is always overcome by confusion and shock leading to extended periods of depression and sadness. The intensity of their sadness reduces as time passes. Nonetheless, grieving is a crucial process since it helps people to overcome their sorrow and to continue to embrace the time, they had together with their loved one.
People react to death differently and use individual coping mechanisms during mourning. Although individuals can pull through anguish by the passage of time, they need social support as well as healthy habits since there is no specified period for grieving. Life changes abruptly after the loss of a loved one and most people are always in shock because they are not sure how to respond. Human beings are considered naturally resilient since they can overcome the loss. However, some individuals can struggle with it and feel unable to accomplish their daily activities due to complicated grief, which requires the assistance of a psychologist.
People's reactions during mourning vary significantly depending on different factors. These include the type of relationship with the dead, gender, age, and cultural background. Relationships often influence the intensity of grief since the new loss may remind people of the earlier losses they have had making the individuals grieve for them again. Men are likely to express their anguish through physical activity while girls would prefer sharing their feelings with other people by crying more openly or talk about the incident. Besides, different cultural groups handle stressful situations in various ways. Rituals and ceremonies can accompany the demise of a person as well as observing different rules considered respectful. Younger children may not be aware that the deceased will not come back and their reactions will be different since they do not understand the situation.
People who have lost their loved ones may use different strategies to overcome their grief. It is important to talk about the death with colleagues and friends since it will be a way of remembering the deceased and helps one to comprehend what happened. Denying the loss is a faster way to isolate oneself, but it can frustrate the support system of the bereaved. Moreover, grieving individuals should accept their feelings including anger, sadness, fatigue, and frustration because they are typical emotions during this period. They need to take care of their families and themselves by exercising, eating well, and getting enough sleep, which is crucial in moving forward. Helping one another cope with the loss can be enhanced through sharing of stories about the deceased. Additionally, bereaved families should celebrate and remember the life of their loved one by framing photos of their fun times, naming children after the deceased, or planting a garden in remembrance.
Conclusion
Kubler-Ross helped to revolutionize the care of dying individuals and dealing with sorrow. She postulated the five phases of grief, which include denial, anger, bargaining, depression, as well as acceptance. The first reaction to information of looming death or loss of a loved one is the denial that serves as the defense mechanism. It is followed by feelings of resentment or anger, but the caregivers should not respond to the rage of the dying person with returned rage or avoidance but instead through support. Bargaining is the third stage in which the person tries to negotiate with God or physicians for a cure, less pain, or additional time with family. Depression sets in when the person realizes that death is imminent and grieves the separation from loved ones. The final phase is acceptance, which is associated with calm and peace since people embrace the reality. Terminal illness and loss of a loved one are often accompanied by grief symptoms that can present themselves spiritually, physically, or socially and may include frustration, anxiety, anger, stress, loneliness, loss of appetite and questioning one’s religious beliefs.
References
Kübler-Ross, E., " Kessler, D. (2014). On grief and grieving: Finding the meaning of grief through the five stages of loss. New York: Simon and Schuster.
Mahmood, K. (2016). Dr. Elisabeth Kubler-Ross stages of dying and phenomenology of grief. Annals of King Edward Medical University, 12(2).
Stillion, J. M., " Attig, T. (2014). Death, dying, and bereavement: Contemporary perspectives, institutions, and practices. New York: Springer Publishing Company.
Stroebe, M., Schut, H., " Boerner, K. (2017). Cautioning health-care professionals: Bereaved persons are misguided through the stages of grief. OMEGA-Journal of Death and Dying, 74(4), 455-473.
Walter, C. A., " McCoyd, J. L. (2015). Grief and loss across the lifespan: A biopsychosocial perspective. New York: Springer publishing company.
