The Ten Stages of Grief
Richard A. Feely, D.O., FAAO, FCA, FAAMA
1. SHOCK: The initial stage of grief is usually experienced even if the death has been expected, as in a long terminal illness. There is only so much physical or psychic pain which can be endured by the mind, and when that limit is reached, the mental /emotional system shuts down. There is often denial that can last for quite some time. This is expressed as “numbness,” or as a sense of unreality.
2. EMOTIONAL RELEASE: As the shock wears off, there is a need to release all the emotions that have been building up. This release may be verbal or physical, and while this is healthy, care should be taken to ensure the safety of the individual, others, or personal property. Some hospitals have recognized this stage of grief and have provided special “screaming rooms” where these powerful emotions can be safely vented.
3. DEPRESSION: There are often feelings of loneliness and utter isolation that come with depression. The feeling of “there is no help for me,” is normal and very common. There is a push/pull situation, wanting to be alone and yet feeling a need for people at the same time. This frequently produces fears of panic and impending insanity.
4. PHYSICAL SYMPTOMS OF DISTRESS: The grieving individual will often take on the physical symptoms of the illness that caused the death of the loved one. In the event of an accident, the bereaved will sometimes feel pressure in the chest or have stomach problems, and fear heart attack or cancer. This is normal and usually indicates the depth of the loss and the person wishing to “join” the deceased.
5. ANXIETY: A common response to loss is for the bereaved to experience vivid dreams of the deceased, so vivid that they believe they have actually seen or heard their loved one. Another common manifestation is that the bereaved will mistake another person for the deceased, usually on the street or in a store. This will sometimes cause great embarrassment as they may address the stranger, only to realize their mistake.
6. HOSTILITY: When a loved one has died, it is very common for the survivor to feel anger at those who were involved in the situation, especially medical personnel and clergy. There is a feeling of “Why didn't you do more?” God is a frequent target for this rage, which many people have a difficult time accepting.
7. GULT: This emotion can be imaginary or exaggerated, but should not be ignored. Following the death, it is a common experience for the survivor to remember only the negative aspects of the relationship, those times of insensitivity or harsh words spoken in anger. Seldom does the bereaved pause and remember the beautiful times when all the love and tenderness were evident.
8. HESITANCY TO RENEW NORMAL ACTIVITIES: There is often a fear of returning to the regular routine of living. This fear takes several aspects. There is concern about how people will respond to the bereaved; there is a desire to talk about the deceased but a fear of rejection; there is a pain that comes with hearing that “special” song, or seeing something in a store that brings back the memory of the loved one.
9. HEALING OF MEMORIES: There is a slow realization that the painful memories are part of the healing process and must be integrated into the life of the bereaved. It is a time of reaching out, however tentatively, to embrace fully all that has happened and to accept that life must change if it is to continue. The memories become less frightening, and the sky a bit brighter as the bereaved begins to face the world with more and more confidence.
10. ACCEPTANCE OF ONE'S NEW ROLE IN LIFE: Loss brings about changes. Whether it is the resumption of single life after years of marriage, or going on through the years without a parent, there must be the realization that a new role is to be accepted and lived. The cycle of life continues, and the bereaved can finally shed the cloak of grief and take on the robe of peace and renewal.
