Are the 5 Stages of Grief Real?

What Are the Stages of Grief?

The five stages of grief were introduced by psychiatrist Elisabeth Kübler-Ross in her 1969 book “On Death and Dying.” These stages were originally noted as the stages that people who are actively dying tend to go through, and are not necessarily experienced in a linear or predictable order. People may also move back and forth between stages.

The five stages of grief are:

• Denial: In this stage, people often struggle to accept the reality of their situation. They may deny the truth, feeling numb or in shock.
• Anger: When the denial begins to fade, the pain re-emerges and can be expressed as anger. People may feel frustrated and lash out, asking “Why me?” and feeling a deep sense of unfairness.
• Bargaining: In an attempt to regain control and make sense of the situation, people may bargain with a higher power or make deals in their minds. They may try to negotiate a way out of the pain and despair.
• Depression: When bargaining efforts fail and the person realizes the extent of their loss, they may experience deep sadness and depression. This stage involves feelings of hopelessness, helplessness, and despair.
• Acceptance: Eventually, people come to terms with the reality of their situation. They accept the fact that death or loss has occurred and find a way to move forward. This doesn’t mean they are happy or okay with what happened; rather, they have found a way to live with it and adjust to the new reality.

Where Did the Stages of Grief Theory Come From?

Kübler-Ross developed these stages after working with terminally ill patients, primarily those facing the end of their lives due to illnesses such as cancer. She observed and documented the emotional responses of these patients as they faced their impending deaths. Through her research, Kübler-Ross identified common patterns of emotional and psychological experiences that many of her patients shared. These patterns eventually formed the basis of the five stages of grief.

Are the Stages of Grief Real?

It’s important to note that these stages are not a one-size-fits-all framework, and people may experience grief and loss in different ways and at different paces. Additionally, not everyone will go through all five stages, and some may experience additional emotions or stages not mentioned in this model.

The Potential Harm of Using the Stages of Grief Model

While the Kübler-Ross model has been widely influential and has helped many people understand the grieving process, there are potential harms associated with its application.

Some of the potential dangers of using the five stages of grief model include:

• Oversimplification: The model reduces the complex and multifaceted experience of grief into a linear progression of stages. This oversimplification can lead to misunderstandings about the grieving process, making people feel abnormal or inadequate if they don’t follow the stages exactly as described.
• Pathologizing grief: Grieving is a natural response to loss, not a mental disorder. Applying a rigid model to grief may pathologize normal emotional reactions, leading people to believe that their grief is abnormal or requires medical intervention when, in fact, it may be a healthy part of the healing process.
• Ignoring diversity: Different cultures and individuals have unique ways of coping with loss. Relying solely on a model developed within a specific cultural context may neglect the diversity of grief experiences, leading to a lack of understanding and empathy for those whose grieving process differs from the model.
• Stigmatizing non-normative grief responses: Many may experience grief in ways that do not align with the stages outlined in the model. For example, some people may find moments of happiness and relief even amidst their grief. Stigmatizing these non-normative responses can be harmful and invalidating.

Grief Isn’t Linear: How the Grieving Process Actually Works

The grieving process is a personal experience for each individual, and despite the fact that it can be overwhelmingly painful and debilitating at times, it is a natural and normal response to significant loss. The grieving process has been likened to “waves.”⁷ For some, it will feel like the waves—of sadness, shock, regret, anger, anxiety, loneliness, etc.—are pulling them under, again and again.⁸ It will take all of their strength to “keep from drowning” in their sadness and deep longing for the way things were before the loss. They will have times when they function less well than they did before the loss.

For others, the waves may instead feel like ripples of grief. The sadness and yearning is poignant, but neither overwhelming nor debilitating. At different times, people might experience each of these types of waves, and other types of waves of grief that fall somewhere in between. Fortunately, most will also experience some relief in moments of comfort, peace, and joy interspersed among the waves of grief.^8,9

How Long Do the Waves of Grief Last?

Most people tend to experience improvements in their grief symptoms, including a return to pre-loss levels of functioning, within about 6 months following the loss.⁸ It is, nevertheless, quite common for grief symptoms to intensify temporarily when important dates arise (e.g., birthdays, anniversaries of death, and special holidays) which trigger reminders of the loss.

Commonly Experienced Grief Tasks

It has been proposed that the grieving process might include working through “grief tasks,” like figuring out new ways to memorialize their loved one and letting themselves feel all the negative feelings associated with the loss. These tasks may occur in different orders.¹⁰

Potential grief tasks include:

Accepting the Reality of Loss

One of the common ways that people try to avoid accepting a loss (which some consider the acceptance stage) is by focusing on the “why?’” or “how?” a loss occurred. Initially, some will want to try to understand the factors that led to the loss in the hopes of preventing similar losses in the future (if possible) or to process the loss in their mind. It is sometimes the case, however, that no answers, or rather, no satisfactory answers will be available. At some point in time, with or without answers, one must come to terms with the fact that the loss has happened and is permanent.

Enduring and Facing the Pain Associated With Loss

The emotional and physical symptoms of grief that one experiences after suffering a substantial loss can sometimes feel unbearable, even leading to real feelings of pain. It is important to trust yourself to survive this normal—albeit, overwhelmingly painful at times—reaction to loss. Compassion, reassurance, and patience can help.

Adjusting to the New Realities Following Loss

Loss can have many levels of impact in one’s life. The changes that result can cause rippling disruptions. Loss might change what you do, and how you do it, on a daily basis. It will likely take some time to notice the changes that are required, and to figure out ways to adapt to your changed realities, so that you are eventually able to fully reengage in your life once again.

Finding New Ways to Feel Connected to the Deceased

Continuing to stay connected to a loved one who has died seems to help many to deal with their grief. Some ways that people keep the connection with their loved one alive is through memories, sentimental items, continued conversations/prayer, or continuing to honor special days related to the loved one (like birthdays and anniversaries).

Embracing a Renewed Sense of Purpose

A major loss can undermine one’s sense of purpose or meaning in life. You could wonder, “what is the point?” or feel like you’ve lost the motivation to move forward in a world in which such pain is possible. Some will find that, as their grief subsides, they will again find their sense of purpose and meaning. Others might connect their sense of purpose to the memory of a deceased loved one, or to a cause directly related to their loss (e.g., fundraising for the American Cancer Society, volunteering for the Red Cross, or pursuing a college degree).

When Grief Becomes ‘Stuck’

Approximately 20% of individuals experience neither a reduction in intensity of grief symptoms nor a return to pre-loss functioning levels within six months following the loss.¹¹ In these cases of “prolonged grief” or “complicated grief,” it appears that the grieving process has become “stuck.”

Persistent complex bereavement disorder is a diagnosis that might be made when significant, debilitating grief-related symptoms have continued beyond 12 months post-loss (PCBD is currently regarded as a condition for further study in the DSM-5). It is estimated that 5% of bereaved individuals will experience this disorder.⁹

Risk Factors for Complicated or Disordered Grief

There are a number of factors that can increase the risk that one will develop complicated or disordered grief. These include:^9,12,13

• Previous loss
• Experiencing multiple losses
• Losing a person whom one had a very close and supportive relationship with
• Death of a child
• Death of a partner/spouse
• Witnessing the death or finding the deceased
• When a loved one is missing and presumed dead, but death has not been confirmed
• Exposure to trauma – might be due to a violent loss (e.g., suicide, homicide, accidents)
• Unexpected death
• Having previously experienced mental illness
• Lack of social support following the loss

Of note, women are at higher risk of complicated grief than are men.¹²

Symptoms that Indicate Complicated or Disordered Grief & the Need for Professional Support

Within six months following the loss, if you have not noticed any improvement in your ability to function and are continuing to experience overwhelming emotional pain on more days than not, you may benefit from the support of a professional. Grief reactions that are deeply painful, debilitating, and don’t seem to begin to improve within six months post-loss could indicate the presence of complicated or disordered grief.

Unremitting symptoms that indicate complicated or disordered grief include:^{7,9,14,15,16,17,18}

• Grief reactions that are beyond what is typical within the person’s religious or cultural community and/or age group
• Deeply painful emotional distress related to the loss of the loved one
• Inability to accept the reality of the loss and adjust to it
• Loss of meaning, purpose, interest, and/or identity in life
• An unrelenting longing or yearning for the loved one who has died, which might lead to thoughts of suicide, or wishing for death, as a means of reuniting with the deceased
• Experiencing life as unbearable following the loss
• Intolerable loneliness
• Avoidance of anything that reminds one of the deceased
• Experiencing recurring intrusive thoughts and feelings about the deceased
• Persistent, distressing thoughts about the way in which the loved one died
• Inability to recall positive memories of the loved one
• Self-blame, guilt, shame, and more related to the loved one and/or their death

If you’re experiencing any of these symptoms, you may want to seek out grief counseling to help you process and move forward.

What You Can Do to Help Yourself Through Grief

If you are grieving there are some things you can do to help yourself through this difficult time, like making sure to take care of yourself physically, accepting help from others who care about you, and not shaming yourself when you feel happy.

Here are some ways to cope with grief and loss:

Be Compassionate and Patient With Yourself

Grief can be very disruptive and disabling for a time. You may have trouble thinking clearly, remembering things, and making decisions. You might also have difficulty getting through daily tasks. You could be fatigued and have little energy. These are some of the normal and natural reactions to grief. Don’t blame or belittle yourself for having them.

Take Care of Your Physical Health

Taking care of your physical health is important as you deal with grief-related mind and body reactions. Try to remember to eat regularly—even if it’s just small meals or snacks throughout the day. Drink water to stay hydrated. Rest more because your body and mind will need it. Go for walks or do gentle stretching if you are able to.

Accept Offers of Help From Others

If others are telling you to let them know if there is anything they can do for you, it is because they care about you. Consider that you have likely offered the same to people you care about when they are hurting. Accepting help from others can have at least three positive outcomes. First, it helps others to feel good about themselves because they have been able to lighten your burden. Second, you benefit because it likely lightens your burden some. Third, by accepting help, you give yourself the message that your grief, as well as your worth as a person, matters.

Allow Yourself to be Happy

Accept and embrace the moments of joy and comfort that still occur during times of grief. It is healthy and good for you to allow yourself to have moments of peace and happiness—to notice beauty, kindness, and humor in the present moment. Being happy isn’t anything to feel guilty about. It doesn’t dishonor the loss. These moments will give you strength and help you to heal.

Notice the Small Improvements Over Time

Remember the first morning you woke up after the loss? There might have been a few seconds where you had forgotten for a moment what had happened, and then all of a sudden you were knocked over by waves of shock and emotional pain as you remembered. Or, maybe you woke up crying… In the weeks and months that followed, those waves of grief in the morning should be further apart and less intense. You may notice that you are starting to eat again, able to focus on paying bills, or able to go to work or school. You may also notice that you are remembering how to laugh and hope again. All these improvements are important.

If your symptoms continue, and you experience difficulty functioning in one or more areas of your life, beyond six months post-loss, consult with your doctor, professional counselor, or psychologist.

What You Can Do to Support a Loved One Who is Grieving

When trying to offer support to a loved one who is grieving, it can be confusing to know what to do. Here are some tips that might be useful:

Listen But Don’t Try to Fix It

Don’t try to get your loved one to “look on the bright side.” Don’t try to minimize the loss. Don’t draw attention to your own stories of grief. Just listen with compassion and empathy, non-judgmentally trying to imagine what your loved one is going through.

Reflect Back What You are Hearing

Acknowledge their pain and sorrow: “It sounds like this has been really hard for you.” or “I can only imagine how painful this has been for you.” Let them know you are sorry they are hurting so much.

Offer Practical Help

Activities including making a meal for the bereaved or their family, assisting with childcare, and running errands can be a big help for people who are grieving. If you ask them what they need, they might find it hard to think of something because they are feeling so overwhelmed. By offering specific types of support, those you are grieving may be more likely to accept your offer.

Educate Yourself

Learn about grief so that you can reassure your loved one that their reactions are a normal and natural response to significant loss.

Take Good Care of Yourself

You have only so much energy and time. Supporting a loved one who is grieving will require some of your limited time and energy. Thus, you will need to take extra good care of yourself to keep yourself healthy and rested as you try to be there for a loved one who is grieving.

If your loved one’s symptoms do not seem to be improving and they are continuing to have difficulty functioning in their daily life beyond six months post-loss, encourage them to consult with a professional, like their doctor or a licensed therapist. Offering to help them to make the appointment or going with them to the appointment may give them the support they need to take this step.