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The five well-know "Stages of Grieving" (Denial, Anger, Bargaining, Depression, and Acceptance) were first discussed in the writings of Elisabeth Kubler-Ross in the 1960s and 70s. However, her stages were sometimes too limited to describe the complex potential reactions that people may have in response to severe stress, change, trauma, or loss. Every person has their own pattern of defenses and emotional tendencies, so there is no "standard" course of stages in regard to coping.
The list of emotional reactions mentioned below may be useful in describing the thoughts and feelings that follow a difficult event or loss. The specific sequence that any one individual will go through will be somewhat unique, based on individual factors discussed later in this paper.
An updated, more comprehensive list of the "stages" of reaction and coping could be:
1. Shock/Numbness/Dissociation: ("I feel numb; I don't know what to think or feel.")
2. Denial: ("This can't be true. It must be a mistake. I am just going to block it out and not think of it or talk about it.")
3. Anxiety/Panic/Obsessing: ("Oh my God, this is horrible. I am so scared and nervous, I don't know what to do. I just keep worrying and thinking about this.")
4. Dependence: ("I need another strong person or people (or substances like drugs or alcohol) to help me make decisions and to comfort me or distract me.")
5. Anger/Blaming/Hostility/Irritability: ("This must be someone's fault, and they should be punished.") This stage may also include increased suspiciousness and distrust.
6. Bargaining (e.g. "If God will cure me (or my loved one), I promise to give more money to charity").
7. Grief/Sadness/Depression/Guilt: (I feel hopeless. Nothing is fun or worthwhile. I must have done something to cause this or to deserve this.")
8. Philosophical or Spiritual Interpretations: ("Maybe this is God's will or the nature of human life.")
9. Positive Planning, problem-solving, and coping strategies. ("What can I do to steer this situation and to cope with the consequences in the most practical way.")
10. Acceptance (and regaining a balanced emotional feeling and a balance of activities). ("There are many parts of life, positive and negative, and I need to accept what happened and move on in a realistic and positive way.")
11. Personal Growth and Insight about one's life and the human condition. ("Now I understand myself and my life better, and that death and loss and disappointment are normal parts of life. I can also enjoy the pleasant and wonderful parts of my life and of my experiences in a more well-rounded and realistic way.")
One of the positive aspects of the "stages of coping" viewpoint is that it emphasizes a healing process that progresses over time; a process that leads traumatized people to eventually feel better. The intensity of a person's emotional response and the length of time that it takes to go from the beginning to the end of the individual's sequence depends on a number of factors, including:
a) the severity of the trauma;
b) whether the trauma is sudden (e.g. the unexpected, rapid death of a loved one) or whether it is lingering and chronic (e.g. an injury that results in long term pain and eventaul death;
c) whether it is a temporary loss vs. permanent loss;
d) the interpretations of the traumatic situation by the individual;
e) cultural attitudes about the traumatic issue or about grieving and coping styles;
f) previous exposure and experiences with similar incidents;
g) the underlying personality traits and resilience of the individual.
Different individuals may go through some or all of the stages mentioned above, in different orders of sequence, and may sometimes get "stuck" in one or more stages for periods of time. They may also return to stages that they previously experienced. The tendency to strongly express one stage or another, or to stay stuck in one or more stages, may be based on the underlying personality style of the individual, e.g. a person who usually tends to get angry and blame or punish others will probably use that style strongly when faced with a new traumatic situation. In contrast, a person who usually reacts to stress with anxiety or sadness will tend to accentuate those stages when faced with traumatic experiences. Despite their individual tendencies, people can learn to moderate their reactive habits.
It could be said that some goals of counseling are to help the client become aware of: 1) their usual response and coping tendencies; 2) alternative reactions and coping strategies that may be more helpful; and 3) the belief that they will make gradual healing progress and eventually will regain a sense of resolution, peace, and enjoyment of life.
The time course of grieving: It is overly simplistic and over-generalizing to predict how long it might take an individual to complete their sequence of healing stages, but I often see individuals who feel much better: a) in one to three months after a relatively mild loss (e.g. loss of a friendship); b) in three to six months after a "moderate" loss, e.g. the loss of a job or dating relationship (as long as there are not major complications such as being unable to find another job or serious financial stresses); and c) in six months to eighteen months after a major loss, e.g. a difficult divorce, or the loss of a loved one or family member (once again, as long as there are not lingering or chronic complications). Occasional "relapses" after the major healing has been accomplished are normal and should be expected, especially when triggered by situations such as anniversaries of the loss, or when similar situations arise.
As I said, these time estimates are gross generalizations, and individuals may vary tremendously within these ranges. However, it is helpful to have some general expectations or "ballpark estimates" to help the clinician know when a client is having particular difficulty with coping (versus going through the normal sequence of grieving in a timely manner). It is also re-assuring for the client to know that there is an emotional healing process in humans that has an understandable sequence of gradually improving feelings.
It should also be mentioned that all of us are biological as well as psychological people, and sometimes our coping ability should be assisted with the use of modern medications such as anti-depressants. People who have gone through loss or trauma are encouraged to speak with their Medical Doctor about any serious emotional reactions that they are having.
8/30/06
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