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Thursday, 30 June 2011

An Outline of the Work of Grief

Many years ago, Dr. Elizabeth Kubler-Ross proposed 5 stages of death and dying: anger, denial, bargaining, depression, acceptance. While others have since used, abused, criticized, and added to her stages, the fact remains that she was the pioneer in helping us understand that momentous life events do not elicit simple, straightforward responses. She was unrelentingly willing to stay present to hundreds of people as they died, and by doing so, she paved an indisputably important path. Her work gave voice to the complexity of human responses in the face of death and dying. People finally had language to express the myriad of emotions both they and their loved ones were experiencing as death became forcefully part of life.

Kubler-Ross understood that the stages she outlined were not meant to imply a linear pathway. She realized that individuals moved into and out of, and into again, the various stages in her schema. What she was able to demonstrate and document was that each stage, when encountered, brought with it a different range of emotions, and demanded different responses from the individuals in those stages. A person who is dealing with denial will feel, think, and act differently from one who is dealing with anger or bargaining. Through her work she taught us that there was important emotional, psychological, and spiritual work to be done in different ways, in different stages.

The stages of death and dying remain a place to begin when trying to understand what we are talking about when we speak of the work of grief. From the time of diagnosis, or the time of trauma from sudden death, we will face a wild ride on an emotional roller-coaster. Denial, anger, and bargaining all consume us in equal parts, as we feel ourselves spinning out of control. The fact is, we are out of control. The death, present or impending, is beyond our control and so are our responses.

Likewise, there are predictable stages of grief, with attendant emotional, psychological, and spiritual work to be done during each stage. Like the stages of death and dying, they do not happen in a linear way, and they do not come with a road map or GPS. Rather than envisioning a straight path through grief, it is probably more helpful to picture a spiral, a path that continually doubles back on itself as we revisit the stages over time.
While time does not heal grief, it does lend perspective, and the perspective means that we are different when we revisit stages of grief we have previously passed through.

As a simple outline, which I will enlarge upon in time, the stages of grief are stages of integration: of the facts; of a new reality; of the deceased in our living; of others. In the case of multiple bereavement grief, which occurs when we have lost two or more significant people within two years, there is an added, prolonged time of grieving that I call entombment. In the unique situations where death has been by suicide, or where we are outside the grieving community for whatever reason, there are additional challenges inherent in the grieving process. All of these I will write about over the course of the next few months.

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