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Five
Stages of Grief
When someone is dying, or going through the death of a loved one, or some
other traumatic event, such as the loss of a job, their behavior can be
difficult for us to understand, or even hard to accept. Dr. Elisabeth
Kubler-Ross identified five stages of grief experienced by people going
through a significant period of loss. These stages are described as:
denial, anger, bargaining, depression, acceptance
1. Denial and Isolation Stage
Denial and isolation are usually
the first reactions in the grief process, but we should remember that
human beings are individuals and may not go through the stages of grief in
the expected order. Denial and isolation reactions are include when the
affected individual talks only about the future, avoids talking about
their or their loved one's illness or loss, avoids family and friends,
blames others such as the doctor, or the boss, and refuses to return phone
calls to friends and loved ones
It’s hard to know what to do when talking to a grieving person, but it
helps to remember that denial acts as a buffer against the shock of dying
or loss. Sometimes friends and family members think it’s best for the
person to face reality, but pushing the person in this direction too soon
can do real damage. Denial and isolation may be the individual's way of
learning how to cope with traumatic news. To provide support to someone in
this phase, be nonjudgmental of their behavior, don’t take anything
personally, and be a good listener when they want to talk
2. Anger Stage
Knowing what to expect from a dying individual and their family; or from
anyone else experiencing a traumatic loss will help you cope with their
reactions. Of all the stages in the grieving process, anger can be the
most difficult for a friend or family member to understand. Typically, an
individual moves from the denial stage to the anger stage when he or she
realizes that death or loss is probable. During this stage the person may
ask" Why me?”. They may be angry that they are dying while others
are allowed to live. They may also question their religious beliefs and
accuse family members or friends of being uncaring.
Family members also go through intense anger during this phase. Like all
the stages in the grieving process, anger can occur after any traumatic
event. Anger has the power to tear families and friendships apart. In
addition, dealing with an individual in this phase can cause feelings of
anger in yourself.
The best way to deal with this stage is to remember that the anger is not
directed at you, but at the situation. You may also want to visualize how
hurt you would be in the same situation, and accept the behavior as part
of a process and a sign of change. Don’t allow the anger to alienate you
from those who are important in your life. Also, it can be wise to allow
yourself a break from the person, but assure them that you are not
deserting them
3. Bargaining
Stage
After the dying person or
family member, or person who has sustained a loss has vented his anger at
friends, family and at God, he or she enters the bargaining phase. This
stage is seen as an attempt to enter some agreement or to finish an
important task to prolong life.
During the bargaining stage, the affected person makes promises to God or
other higher power, agrees to change their lives if allowed to live, asks
for an opportunity to do something special before they die or face a
disability or additional loss.
Remember promises may be associated with a quiet guilt. Allow the grieving
person to express these feelings and talk them out. Too many times family
and friends try to brush the statement aside and don’t give the person a
chance to talk about their feelings.
4. Depression Stage
After going through the bargaining stage, the individual or family members
usually becomes depressed. This is the beginning of realization that death
or loss is inevitable. If the person is going through an extended illness,
the realization comes after symptoms worsen and a sense of great loss
occurs. Patients in this stage are usually weaker and unable to perform
even the simplest of tasks.
Dr. Kubler Ross stated that there were two types of depression:
reactionary and preparatory. Reactionary depression occurs because there
are additional losses of finances, job, independence, family role, and
intimacy. Preparatory depression is related to the impending loss, or the
death of the individual. Not only is the person depressed because of the
impending death but often they question their significance in life. It’s
common for a dying person to think that their life has been all in vain.
The first reaction that caregivers generally have toward this stage is to
try to cheer up the depressed individual and encourage them to look at the
bright side of things. This may work somewhat for reactionary depression,
but preparatory depression is more complex. A grieving person will find
more comfort in expressing him or herself. Often this just means being a
good listener. This stage of grief tends to be a quiet one, and sometimes
all someone needs is your presence. Take the time to tell the person what
they have meant to your life and urge others to recall the individual's
good qualities.
5. Acceptance
Stage
Acceptance
is considered the final stage in the grief process. Some family members
and friends see this as a happy time of resolution. However, according to
Dr. Kubler-Ross, it also demonstrates a time when a dying person is void
of feeling and begins to concentration on the inner self. Many
professionals feel that this stage comes as a result of the dying person
becoming physically weaker. This stage is usually only seen in individuals
who have enough time to work through the other stages of grief.
During this time, the dying individual exhibits a decrease in interest in
worldly events, a desire to be left alone, a decreased desire for
communication, an increase in detachment from loved ones For family
members, this stage can be very stressful. Family members may want to use
this time to clear the air before their loved one dies, and they become
frustrated when the dying individual wants to be alone. Some may interpret
the expected detachment as rejection
If you are helping someone through this stage, you can help to respect the
dying one's wishes by:
limiting the number of visitors, showing non-verbal signs of affection,
and reassuring the person that it’s all right not to talk. Often, it’s
enough just be hold the person’s hand.
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