Stages of Grief Explained

Published by Aaradhana Reddy

Counselling Psychologist (M.Sc Counselling Psychology)

Grief can be a time of overwhelming emotions and psychological distress. Everybody deals with grief differently and there is not rigid structure for grief responses. But it is helpful to understand the emotions and stages that people commonly experience. Stages of grief was proposed by Elizabeth Kubler-Ross, in her classic book On Death and Dying in 1969. It was conceptualized based on her extensive interviews with people facing terminal illness. But it has now been applied to all types of bereavement and grief. In this article we will go through the original model and also the newer stages that are added to fit grief and loss better.

Stages of Grief

Ross postulated that people go through grief in stages. In her book she mentioned that people go through 5 stages of grief:

Stage 1: Denial: Hearing the news of loss of a significant other/family member/friend/child can be met with denial. Individuals may sometimes even believe that the deceased will come back. Denial may include saying and believing that there must be a mistake made, pushing down yearning, overwhelming sadness and refusing to speak about the loss. It may also include throwing oneself into rituals, funeral planning etc. to get away from grief.

Initial denial and shock are common, but extension of denial even after months of the loss may lead to delayed grief responses. It may also lead to absent grief or inhibited grief. See types of grief. Unexpressed and internally held grief without expression may lead to prolonged and complicated grief. It is associated with long term mental health complications such as prolonged grief disorder, anxiety, sleep disturbances and depression.  It is also linked to physical health issues such as pains, headaches etc.

Stage 2: Anger: Anger is when someone in the grieving process assigns blame to other people, doctors and even themselves. Anger and blame can be directed at others for causing the death. It could be anger at doctors and nurses for letting the person die or not paying close attention. It could be at themselves for not reacting quickly or for not doing enough. Anger at God for letting this happen is also another common response. In other situations, like a divorce, it could involve blaming the partner or oneself for not putting in effort.

Stage 3: Bargaining: Bargaining can happen both before death and after. Bargaining is when an individual offers to do something or give up anything in exchange for the life of their beloved. Before the bereavement it can involve saying things like “I will pray to god and do rituals everyday if he/she survives”. We commonly see this in India where we offer to do some rigorous religious ritual if things turn out fine. Bargaining is not exclusive to bereavement or loss, it is also observed during other stressful times like sickness, job loss, marriage, financial troubles etc.  Bargaining after death involves notions of giving up everything to have a chance at being with the loved one again.

This stage can also involve guilt of not spending enough time or saying what you wanted to say and express gratitude/love to the deceased. It also involves if only or why me thoughts. “If only we went to another doctor”, “If only we communicated more often, clearly and honestly our relationship would still stand”, “If only I didn’t leave for a vacation, my dog would still be here”. Why me thoughts include questioning why this is happening to them, what they did to deserve this etc.  

Stage 4: Depression: Depression here does not necessarily mean depression in the clinical sense; that is major depressive disorder. Although if grief is not dealt with it can turn into major depressive disorder. Depression here refers to feeling hopeless, helpless about the loss and the future. It can involve confusion, lack of direction, apathy, numbness, problems with decision making etc. It can also manifest physically in the form of pains and inflammation.

Stage 5: Acceptance: The last stage involves accepting the loss, nature of finality and looking ahead coping with life in the absence of your loved one or divorce from your spouse, financial loss etc. There is never closure to grief, this stage does not mean that an individual stops grieving; it is more about grief not consuming their present and are able to look towards the future.

It is also important to note that loss and grief are something we live with, where with time we are able to be reminded of memories or events of the loved one without breaking apart. The sadness is something we carry with us while also cherishing the memories and times we were able to spend and share time with them. In my counselling practice I often notice that grief comes in waves and people mistake it for being unable to move on. But it is a normal aspect of grief. In times of birthdays or anniversaries, grief responses rise and afterwards they go down; just like a wave. Initially these waves have high peaks with similar grieving responses at the time of loss and with time these peaks are lower and softer.

Criticisms

• The model has been criticized for its linear model that an individual will go from stage 1 to stage 2. These stages is not linear and individuals may go back and forth or even skip certain stages. Grief, again is very personal, complex and different from individual to individual.

• Another is the simplification of grief. Grief is a complex construct with responses varying according to the type of loss, culture and the individual. There may be many experiences and responses apart from the ones mentioned in the stages, which a theory simply cannot accommodate.

Despite all the criticisms, the stages of grief model was the first to ever give us a rough blue print on how grief works. Although all experiences may not be captured, some responses mentioned in the theory apply to most of us.  

The model was developed based on the experiences of people with terminal illness. Applying this model to all other types of loss and grief may not be relevant. Newer models of grief were developed to fit in better with other types of loss.  

7 Stages of Grief

The 7 stages of grief model was developed to include other experiences during loss and grief. Many experts extended the 5 stage model to add two other stages of shock and testing.

Stage 1: Shock

Stage 2: Denial

Stage 3: Anger

Stage 4: Bargaining

Stage 5: Depression

Stage 6: Testing

Stage 7: Acceptance

Shock is the first stage, which involves experiencing shock at hearing the news of loss. This is followed by denial, anger, bargaining and depression.

Stage 6 is testing. In testing, the individual finds and tests strategies of coping and solutions aimed at moving on with life without their loved one and facing life/financial issues due to the loss etc. In grief people generally oscillate between grieving and moving ahead or coping with future without their loved one. These are two orientations called the loss orientation and restorative orientation. Loss orientation involves dealing with the loss, grieving, expressing their emotions etc. Restorative orientation is looking towards the future, coping and adjusting. It might involve going back to work, moving to another place and getting back to a new routine etc. These are all strategies and coping mechanisms people employ during the testing stage. In the initial stages, people are generally in the loss orientation. Towards the later stages they maybe oscillating between the two and as time passes the oscillation reduces. The individual has accepted and moved on. After which is the final stage of acceptance.

When to seek professional help for Grief?

If your grief is interfering with your work/education, personal relationships and social life; you must seek help. If you feel like you are unable to express your grief or your grief is not being acknowledged or validated and this is causing you significant distress and you feel stuck with no support; it is important to seek professional help to process your grief in a healthy way.

At Safe Space Counselling, we provide safe spaces for expression of grief and provide counselling and emotional support for people dealing with bereavement, traumatic losses and other situations causing grief.

To understand more about our approach to grief, you can visit our grief services page.  

Alternatively, you can also reach to us or chat with us.  

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 ABOUT

Aaradhana Reddy is a Counselling Psychologist with over 8 years of experience with both adolescents and adults. She specializes in adolescent mental health concerns and in dealing with various mental health disorders and other psychological concerns. She is a trained and experienced Cognitive Behavior Therapist and a passionate writer about mental health and well-being. She aims to raise awareness on mental health through her practice and blog.

FAQs about Stages of Grief

What are the 5 stages of grief?

The 5 stages of grief are denial, anger, bargaining, depression and acceptance. They were developed by Elizabeth Kubler-Ross based on her interviews with terminal illness patients. These stages are now applied to grief in general, which describe experiences and responses of people after a significant loss.

Do people experience the stages of grief in order?

No people do not experience grief in order or in a linear fashion. Grief processing varies from person to person. An individual may skip certain stages, deal with multiple stages at a time and may even go back and forth between stages. 

How long do the stages of grief last?

Grief does not have a set timeline. How long grief lasts is dependent on the individual, how the person is processing and coping with grief, their culture, type of loss and the availability of social support systems.

Can you experience the stages of grief more than once?

Yes, you can experience certain stages of grief more than once. It is normal to do so. You may revisit these stages during anniversaries, birthdays or other events. Certain situations or places may also remind you of the loss, which may take you back to the stages.

Can grief return years after a loss?

Yes, grief can return years after loss. You may experience grief responses during major life events, anniversaries, birthdays etc. But if you are experiencing intense and overwhelming grief similar to at the time of loss; you may be experiencing delayed grief and/or prolonged grief. In such cases, please seek professional help to manage your grief effectively and to cope and move towards the future.

How do you know if you are grieving normally?

Grieving differs from person to person. So, instead of normalcy we can look at healthy ways of grieving. Healthy grieving process is when you are able to express your grief healthily, you are able to manage your emotions effectively, have found coping strategies to deal with the loss, grief not interfering with daily functioning and you are slowly moving towards a new routine and future.

Is everyone affected by all five stages of grief?

No, not everyone is affected by all stages of grief. Some individuals may skip and not experience some stages at all. It is normal because grief is very personal. Individuals may also go through certain emotions and experiences which are not covered by the stages at all.

What happens after the acceptance stage of grief?

Once the individual reaches acceptance, they are able to now look towards and start trying to coping and deal with the future without the deceased. They may be able to go back to daily activities, work etc. It does not mean that they have stopped grieving or forgotten. It means that their grief responses are manageable, are not all consuming and are letting them move forward.  

What is the hardest stage of grief?

The hardest stage of grief differs form person to person. Most people find anger, bargaining and depression to be the most difficult stages. This may be due to the intense and overwhelming emotions experienced during these stages.

What is the longest stage of grief?

Longest stage of grief depends on the individual, type of loss, type of grief, how an individual is processing and expressing grief, social support systems available and also how their culture perceives what an appropriate response is and how it perceives the loss

What are the signs that someone is moving toward acceptance?

Signs that someone is moving towards acceptance may include moving to a new routine, trying to cope and adjust with future and daily functioning without the deceased, going back to work and ability to manage their grief responses and emotions effectively. It might also include re-engaging with family and friends.

Can grief affect physical health?

Yes, grief can affect physical health. Grief and especially unexpressed complicated grief are associated with pain, sleep disturbances, low appetite, fatigue, weak immune system etc.

When should someone seek therapy for grief?

If you find that your grief is affecting your daily functioning, facing overwhelming and distressing emotional responses, you are feeling helpless and hopeless you should seek professional help. In cases of your grief is being unacknowledged, invalidated, which is leading to unexpressed or suppressed grief, please seek help.

How can therapy help with the stages of grief?

Therapy can provide a safe and supportive environment and help with the distressing and overwhelming emotions experienced during the stages of grief. Therapy can also help with healthy coping strategies to settle into new routines, daily functioning and moving towards the future without the deceased.

Are the 5 stages of grief scientifically proven?

Yes, the 5 stages of grief were formulated as a result of Kubler-Ross’s extensive research and interviews with individuals dealing with terminal illness. The stages have also undergone minor proven additions to apply to other types of grief and loss as well.