Exploring Five Stages Model to Make Meaning of Grief

Grief and loss are common human experiences that touch us all at some point in our lives. Death is one of the universal givens of life, and no-one is immune from the pain and sorrow of bereavement.  Likewise, we all face a myriad of losses as we journey through life – the loss of health, of a job or of the hopes and dreams we had, for example.

In the first of five blogs, we began the process of exploring the depths of grief and finding words to speak about grief. We considered some of the forms grief can take, as well as the impact and effects of loss for many people. In this second blog, we look at one of the models or frameworks often used to help explain grief and loss. We’ll look at other models in subsequent blogs. These models can be helpful in making meaning of the experience of loss. That said, they never eradicate or remove the pain of grief. Grief and loss remain one of the biggest hurdles that, as a human being, we all face.

Death in the Sickroom

Before we dive into the first of models of grief, let’s take a moment to pause and consider how grief has been expressed through the medium of art.  Perhaps you are familiar with the Norwegian painter, Edvard Munch? His best-known work, The Scream, is one of the art world’s most iconic and recognisable images.  Edvard's mother died of tuberculosis when he was 5 years old. His older sister Sophie also died from the same illness in 1877, when Munch was a teenager. A number of his paintings touch upon the theme of grief and loss – in particular, his 1893 work, Death in the Sickroom. This painting was produced 4 years after Munch also experienced the death of his father. It portrays a family overcome by the death of Munch’s sister, Sophie. In it, we see the raw pain of loss, as each of the characters seem frozen and lost in their own inner world, silenced by grief. One figure, with hollowed eyes looks pale, drawn and almost ghost-like. Heads bowed, each of the characters refrain from connection and eye contact, and some even seem to need support to stand as they lean against a chair, a wall.  This painting, for those familiar with grief, helps to convey something of the loneliness and agony of loss.  This image is a helpful reminder that grief and loss are debilitating and impact us, no matter our age, economic status or privilege. 

Edvard Munch’s 1893 work: Death in the Sickroom

Stages of grief

One way to think and talk about grief is to consider different stages that a person typically experiences when they are grieving. The Five Stages of Grief is a model that many people have heard of. This model was first proposed by Elizabeth Kübler-Ross in the 1960’s. Kübler-Ross worked with terminally ill patients, and she began to observe that - faced with death - these patients often faced isolation and emotional neglect, and showed common emotional responses. This led her to develop her Five Stages of Grief model (1969), with the Five Stages being:

• Denial

• Anger

• Bargaining

• Sadness

• Acceptance

Is it helpful to think in terms of stages?

Of course, there is no one way to grieve and people’s grief journey is unique to them. So, whilst it can be helpful to recognise common phases within the grieving process, it is also important to recognise grief is rarely a predictable journey. Everyone is unique and everyone’s grief is unique too. There are no set stages of loss that everyone must pass through, no neat way to move through grief. However, most people do experience some or all of the Five Stages at various points and to varying degrees during their journey with grief.

Grief is a personal and unique experience

Most people do, however, experience some or all of the Five Stages at various points and to varying degrees during their journey with grief.

Let’s look at each of the Five Stages of Grief from Kübler-Ross’ model to gain a better understanding of these different aspects of grief.

Denial

Denial after loss can present itself as a numb feeling. It may involve you carrying on as if nothing has happened. Even though we logically understand a loss has occurred, denial makes it hard to believe this in our hearts. You might feel as if soon you’ll will discover it was all just a bad-dream of that there has been an error or mistake. With loss that involves death, it’s also very common to feel the presence of someone who has died, hear their voice or even see them.

The short-term benefits of denial.

Other people may not understand your denial. However, denial is a helpful short-term coping mechanism that gives you time to adjust to distressing situations. If you're in denial, you're trying to protect yourself by refusing to accept the truth about the loss that's happening in your life. Denial can be seen as a normal and natural response to loss and part of the grief process. You don’t need to force yourself or be forced out of your denial.

Whilst denial can offer short-term benefits, it is also perfectly normal to not experience denial after a loss. Remember, everyone’s journey and process through loss is different.

Anger

Anger is one of the stages of Kübler-Ross’ Five Stages of Grief model

Many people experience anger when facing loss - anger at others, anger at self, anger at systems, processes and the world

Anger is a completely natural emotion that humans experience as part of life. In life, we often get angry when we can't control what's happening to us. Anger lets us know something is not okay, or unfair, or unjust. Anger can be expressed in ways that are productive and cathartic – such as speaking with a supportive person.  Anger can also be dealt with I ways that are less helpful – such as taking out our anger on others, using violence or turning our anger inwards and attacking ourselves.

Anger after loss

Anger is common response after a loss, in that loss often involves a situation that we don’t have control over. Whether that is a death, a redundancy or loss of social connection due to circumstances outside of your control, anger can be a common response. Loss can seem cruel and unfair and impacts our plans and hopes for a dreamed for future. We may look to blame or direct our anger towards someone or something – God, the person who has died, the NHS, the Government, cancer, etc. We may feel intense anger towards ourselves and direct that anger inwards.

Anger isn’t always understood.

Feelings of anger as part of the grieving process are common. Anger was identified as one of the stages of grief in Kubler-Ross’ model. Yet, feelings of anger can be misunderstood by others, and can be difficult to talk about. Perhaps people around us expect us to feel sad, lonely or tearful. They may be confused or frightened if we express feelings of anger. They may try to reason us out of our anger. The emotion of anger can be seen as a normal and natural response to loss and part of the grief process. You don’t need to force yourself or be forced out of your angry feelings. Equally, if you don’t feel angry, that’s okay too. Remember, everyone’s journey and process through loss is different.  

Expressing anger after loss.

If you feel anger after loss, the following considerations may be helpful:

• It’s common to feel angry and ask why you face this loss.

• It’s possible you may find yourself taking out your frustration on family and friends.

• You may feel overwhelmed with a deep sense of resentment.

• In the case of death, your anger might be directed at the person who's died for leaving you.

• You may feel anger towards family members, medical staff, God, illness or even yourself. 
  

• Anger can be experienced at any point during the grieving process.

• If you’re unable to express your feelings in a way which feels safe, feelings of anger may increase.

• Even the most supportive people around you may not expect anger as a part of grief, and might not know how to deal with it.

• A grief counsellor or supportive listener may be able to help you to acknowledge and explore your feelings of anger. 
  

Bargaining

Kubler-Ross included bargaining in her Five Stages model. The pain of loss and grief can leave you feeling desperate. It is a common experience for people experiencing grief to express that they’d be willing to go to great lengths if it means they no longer had to experience the pain of loss.  If you’re facing loss, you may feel willing to do almost anything to alleviate or minimise the pain. We can make bargains with ourselves to try to avoid the pain we are experiencing.

People can begin to make “promises” as a form of bargaining, that include:

• “I’ll never argue again with my Mum if she recovers from her terminal illness”.

• “I will never get angry again if it means the pain will go away”.

• “I’d do anything just to see my family members”.

• “I’d take their place any day, if I could just bring them back”.
  

Bargaining with a Higher Power.

Bargaining can be directed towards a Higher Power, and many people report questioning their faith or religious beliefs after experiencing a significant bereavement. Their world view and belief system may adapt and change as a result of the loss. For example, they may have prayed: “God – please heal this person”. They may also have included bargaining in their prayers - “I’ll do anything, God, if you just make them better”.

It can be devastating, then, when prayers seem to be unanswered, or seem to be answered with a “no” and you experience loss all the same.  That can lead a person to question their faith or belief in a Higher Power. This can complicate feelings of loss and grief further.

Asking “what if…..?” questions are a common aspect of the grief process

We can think of “what if…..?” questions as a form of bargaining - one of the Five Stages of Grief

What if” questions.

Another aspect of bargaining includes asking “what if” questions that centre around our personal faults or regrets. “What if I’d never said that….”, “What if I’d made different financial choices…”.  Guilt and bargaining often go hand in hand. We may wish we could go back and behave differently. We might ask “what if” to express the assumption that if we had acted differently, we would not be experiencing this pain now. 

Some of the “what if” questions you may find yourself answering in this bargaining stage include:

• “What if I hadn’t said that?”

• “What if we never visited that place on that night?”

• “What if I’d managed to get her to the hospital sooner?”

• “What if I’d saved more money before the Pandemic?”

• “What if I’d never let my family move away from the local area?”

• “What if I’d worked harder, or put in longer hours at work?”

Sadness

Loss involves sadness. We grieve because we have lost something important and significant to us, and that involves sadness and longing. Many people also become more acutely aware of their own mortality, which can also prompt sadness. Sadness is an emotion that many people anticipate and expect during the grieving process. Of course, that doesn’t mean it is easy to experience.   

The Kübler-Ross Model includes depression or sadness as one of the five stages of grief. Such grief can be both reactive or anticipatory. We can react to losses we have experienced. We can also anticipate loss and experience grief as we prepare to face such loss. This is common when we are anticipating our own death, or the death of someone we love who has a terminal illness, or some degenerative condition such as dementia.   

For some people, a journey through loss can involve both reactive and anticipatory loss. For example, if you are living or caring with someone with dementia, you will experience a number of reactive losses as you adapt to their many changes and loss of abilities. You will also be aware of their eventual demise and death as a result of the dementia. If you are facing the loss of retirement, you may begin to feel a sense of loss months before the actual date of retirement.

Sadness associated with losing a sense of purpose

The sadness and depression associated with loss can be very intense and come in waves over many months or even years.  Whatever the form of loss, if we have loss something important to us, it is normal and natural to feel sadness. Life can feel like it no longer holds any meaning or purpose. In this way, we can lose touch with our own joy and vitality in our loss.  To engage in activities that we enjoy can evoke feelings of guilt.  Our loss is now present and unavoidable. 

The isolation of sadness when grieving

People experience sadness and low mood as a result of loss may seek to retreat from the world.  Socialising can feel very difficult in this stage. This stage of grief can feel very isolating.

The sadness stage of grief can be extremely painful and feel very isolating

It is important to look after yourself and be kind and compassionate to yourself if you are feeling the weight and depth of the sadness that is part of grief

The difference between sadness in grief and depression

Although the Kübler-Ross Model speaks of depression, some people note that the sadness associated with loss is not necessarily the same as clinical depression. There are many similarities, but also differences between grief and depression.

Grief is an entirely natural response to a loss, while depression is an illness. People who are grieving find their feelings of sadness and loss come and go, but they're still able to enjoy things and look forward to the future. In contrast, people who are depressed find it difficult to connect to joy or optimism about the future. If you feel your experience of sadness does feel overwhelming or you are concerned you might be depressed, you can seek support from your GP. Talking therapies are available on the NHS, or you can seek support via a private counsellor.    

Acceptance

Acceptance is one of the Five Stages in the Kübler-Ross model.  When Kübler-Ross first created her model to explain the process that people with terminal illnesses often faced, she noted that some people were able to come to terms with the prospect of their own death and felt a sense of peace about the future.  Many people do find that they find ways to live alongside and around their grief. They can live well with their grief, and practice the art of radical acceptance of what is. That can take time.

Acceptance of other forms of loss

Nowadays, the Kübler-Ross model is used to help make sense of other forms of loss.  When we think about the grief and loss we face after the death of a loved one, a retirement, or other form of loss, the idea of peaceful acceptance can feel appealing.  It may also seem like an impossible dream.

Acceptance as a gradual process

For many people, grief comes in waves, and it can feel like nothing will ever be right again. Whilst we may identify with some of the themes in Kübler-Ross model, it would be unusual if we experienced our grief in a way that neatly follows the five-stages in the order in which Kübler-Ross presented them. Grief can be messy and confusing. However, gradually - over time, many people find that the pain eases to some degree, and it is possible to accept what has happened. We may never ‘get over’ the loss, but we can learn to live again. It is possible to feel that you have begun to accept the loss one day, and then feel sadness, anger or some other emotion another day. Remember, everyone’s journey through loss is unique. 

The mourning process can be helpful in supporting people to begin to move to acceptance.  In time, many people do reach a state of acceptance of their loss.  Some people find creative ways to express their experience of loss, as Edvard Munch did through his painting. Some people benefit from additional support from a grief counsellor or other professional to help them in the process.  

In subsequent blogs, we will consider other models of grief and also look at support for people looking to find a way to live alongside grief the experience of loss and grief.

Next steps?

If you have been impacted by any of the themes or topics in this blog, please reach out for support.  One of the ways you can do this is by speaking to a the bereavement charity, Cruse via their volunteer run helpline. You can also speak to your GP, or consider bereavement counselling or therapy for grief.

If you’re interested in scheduling a free intro call to ask any questions you might have about starting counselling to explore your grief and get therapeutic support as you grieve, I welcome you making contact with me, Claire Law.

I’m a BACP Senior Accredited Psychotherapist offering professional counselling and psychotherapy in Preston, Lancashire and online for adults based in the UK.

I offer a simple, no-pressure approach to people who are considering counselling for grief - and can chat through how I work, and to share with you my availability for new clients for either:

• In person grief counselling at my therapy room in Preston.

• Online grief counselling via MS Teams.

References:

Kübler-Ross, E. (1969). On death and dying. Macmillan.