Topic: 20

Grief: The Stages and How to Cope

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What You Need to Know

Are you feeling grief now before something has even happened?

If so, you may be grieving for what is.

Are you feeling grief now for what was?

Are you feeling grief now for what was hoped for?

If this all sounds familiar then you may be experiencing anticipatory grief.  

 

What is Anticipatory Grief?

Grief can be felt in anticipation of a loss that will eventually occur. It is a way of dealing with a crisis that cannot be solved that threatens people’s life goals---a way of striving for balance. Holding onto hope must be balanced with finding ways to let go. It is important that as a caregiver you not detach emotionally from the person that you are caring for even when that person begins to withdraw.

Anticipatory grief is not entirely directed towards the future. It also includes grief for the past and present losses. People grieve for the life, abilities, health and all the other things that have been lost because of a life-threatening illness.

(Unconscious preparation for a status change or death, Corles 2015, Oxford Textbook of Palliative Nursing)

What is Grief?

Grief is a natural response to loss. There is no right way to grieve and no set timetable for grieving. Everyone is different. For some people, grief is an intense, emotional, all-consuming experience. For others it is a rather mild process. Ethnicity, gender, culture and age all impact how people grieve. If mourning is the outward expression of sorrow often shared in a social setting with others, then grief is the inward, solitary or private response.

Grief can be:

  • Physical (crying, insomnia, weight change, tightness in the throat, hollowness in the stomach, weakness in the muscles)
  • Psychosocial (poor concentration, withdrawal)
  • Emotional (sadness, anger, loneliness, depression, blame, relief)
  • Spiritual (questioning one’s beliefs)

It takes a great deal of energy to grieve and people need time to work through it. As someone moves through the various phases of grief, less energy is spent on the grief itself and more is spent on survival and life enhancement.

Stages of Grief

There are many theories about the stages people go through when they grieve. S.A. Berger identifies stages:

  • Nomads: grief has not yet been resolved
  • Memorialists: are dedicated to preserving the memory of the loved one that they have lost
  • Normalizers: committed to re-creating a sense of family and community
  • Activists: committed to helping other people who are dealing with the same disease
  • Seekers: adopt religious, philosophical, or spiritual beliefs to create meaning in their lives

( Berger, S. A. (2009). The Five Ways We Grieve: Finding Your Personal Path to Healing After the Loss of a Loved One. Boston : Shambhala Publications, Inc). George Bonanno outlines four trajectories of grief:

  • Resilience: ability to maintain relatively stable, healthy levels of psychological and physical functioning
  • Recovery: normal behavior is replaced by depression or Post-Traumatic Stress Disorder
  • Chronic dysfunction: prolonged suffering and inability to function
  • Delayed grief or trauma: adjustment seems normal but then distress and symptoms increase months later.

(Bonanno, George A. (2004). "Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?". American Psychologist)

Elisabeth Kübler-Ross introduces the five stages of grief in her book entitled On Death and Dying. These stages are identified for anyone experiencing a loss and learning to live with it. She says that the stages weren’t necessarily intended to be chronological or that all people would experience all five stages.

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

(On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss by Elisabeth Kubler-Ross) In The Truth about Grief author Ruth Davis Konigsberg argues that the Kubler-Ross model stresses the negative over positive emotions. Instead, Davis Konigsberg emphasizes the power of human resilience. Konigsberg’s book is based on recent studies which show that those who’ve experienced a loss actually “accept” the death of their loved one quite early, and are more likely to experience yearning and longing for the loved one than anger or depression. It should be noted that this is a fairly new theory, and the majority of grief resources continue to subscribe to a model similar, if not identical, to that of Elisabeth Kubler-Ross.

Regardless of which theory you find most applicable, it is important to remember that grieving takes place over an extended period of time, and there are different feelings that go with early, middle and later grief, although often people go back and forth between these stages.

Early Grief–When a death occurs (walking the edge)

As you accept the fact of the death of someone important, you will feel shock, numbness and disbelief that this has happened. Panic and strong physical and emotional reactions are common:

      • upset stomach
      • low energy, weakness and restlessness crying, sobbing, wailing
      • indifference, emptiness ("can’t feel anything") outrage and helplessness
      • confusion, forgetfulness and poor concentration
      • denial and daydreaming
      • continually thinking about the person who died and/or the death
      • blaming God or life
      • feeling a lack of meaning, direction
      • wanting to join the person who died
      • withdrawal from others
      • unrealistic expectations
      • poor judgement about relationships
      • shortness of breath and heart racing

Middle Grief–Adjusting to Loss (entering the depths)

Later, as the numbness goes away, you will deal with what this loss means to you and the pain of grieving. The strength of feeling may surprise and frighten you, but it is natural and you will move through it.

You may experience:

      • changes in appetite and sleep
      • shortness of breath and racing or pounding heart
      • upset stomach
      • strong and conflicting emotions
      • problems remembering
      • problems with concentrating or understanding
      • vivid dreams or nightmares
      • feeling the presence of the person who died
      • continued lack of meaning
      • rushing into new relationships
      • wanting company but unable to ask
      • continued withdrawal and feeling alone
      • feeling self-conscious

Later Grief–As Life Goes On (mending the heart)

As you adjust to life without the person who died, you will begin to re-connect with the world around you. You have more energy for family friends, work and other interests.

You may experience:

      • Sleeping/eating are more settled
      • Gut-wrenching emptiness begins to go away
      • Emotions are not so strong
      • Feeling of fogginess subsides
      • More peace; less guilt
      • Concentration improves
      • Fewer dreams and nightmares
      • Reconnect with spiritual beliefs
      • You may feel new purpose
      • Acceptance of death as part of life
      • More interested in daily life
      • Able to reach out and meet others
      • More energy for social events

(Adapted from Victoria Hospice Bereavement Program pamphlet: Dealing with Grief)

 

1. Which of these statements about grief are in fact myths?

Read each statement for yourself and decide if they are fact or fiction. Then check the correct response below.

Fact or Fiction?

Answer: All of the statements found above are myths or fiction.

 

Use these additional resources to learn more about the topic of the stages of grief.

Two Big Myths about Grief
https://www.scientificamerican.com/article/grief-without-tears/

Bereaved Families of Ontario
http://www.bereavedfamilies.net/

Grief Treatment Centres in Ontario
https://www.psychologytoday.com/en-us/ca/treatment/grief/ontario

My Grief 

http://www.mygrief.ca/

Grief and Bereavement 

Intimacy After Death 

What To Do When a Loved One Dies 

Closure After Death Occurs 

Funeral Planning