On Death and Dying: Stages of Grief

Depression is one stage of the grief process.Until the 1970s, many physicians were intent on keeping the living alive, rather than listening to patients’ death wishes. That changed when Elisabeth Kubler-Ross began to listen to the dying and to their family members. Her extensive work led to the book, On Death and Dying, in 1969.

Dr. Kubler-Ross first introduced and explored the idea of the five stages of dealing with death. Through sample interviews and conversations in this book, she provides the reader with a better understanding of how death affects the patient, the patient’s family, and the professionals who serve the patient. Now, Kubler-Ross’ stages of grief are used in many situations where a person deals with real or imagined loss – including alcohol and drug rehabilitation, post-traumatic stress disorder (PTSD) and amputation.

Here are the five stages of grief, along with a brief explanation on how a person who has been diagnosed with a terminal illness might react:

Denial and Isolation: When a person faces news that is a shock, such as a diagnosis of a terminal illness, the first reaction is denial. This is the body’s natural reaction to news that proves unbearable. Some patients, for instance, may react by ignoring treatments or by ignoring a doctor’s advice. Family members may become frustrated or frightened over the patient’s cavalier attitude during this phase. The patient also may try to isolate others, so that patient cannot hear the truth from others.

Anger: Once the patient begins to experience symptoms of that disease, or once the reality of treatment options begins to sink in, the patient may become angry. “Why me?” is the question, and no amount of comfort may dent this anger. Anger is an emotion that arises when someone wants something to change, but a terminal illness is difficult to change. On the bright side, a terminally-ill patient who shows anger means that this person has moved beyond denial.

Bargaining: When the patient realizes that anger isn’t going to change anything, a phase begins where a patient begins to bargain against the problem. A religious person might bargain with God, asking for a cure if only the patient changes his or her ways. Other patients may begin to explore other treatment options in hopes that alternatives will cure them. Family members may become worn out during this phase, as the patient often becomes peevish or overactive in their search for a way out of the disease.

Depression: All phases of grief are heartbreaking to the family member, but this phase, perhaps, is the most disheartening. The patient loses interest in treatment and sincerely doesn’t care about the present or the future. Guilt also figures in this phase, as the patient begins to feel responsible for the sadness and, even for the disease. Guilt is anger turned inward, against the person who feels it. Depression is a result of deep guilt and anger. While family members may feel as helpless as the patient at this point, remember that this is the last stage before the patient accepts the current situation.

Acceptance: A patient can reach acceptance at any point, but some people take longer than others to reach this goal. Family members may need to face the possibility that their loved one may never reach this phase before death. On the other hand, acceptance of death and dying may come months before the actual death and it may come on the actual deathbed. In this phase, the patient is ready for whatever happens next.

Remember that family members also go through the five stages of grief upon news about a family member’s illness or death. This is why many professionals suggest counseling for entire families that are involved intimately with death and dying. This counseling is affective even for those who have lost a limb or mobility or for family members who face difficulties dealing with their loved ones’ losses.

To get ‘stuck’ in any one of the phases is a possibility as well, so counseling can help many people move into the next phase. Grief, after all, is a healing process and – like any other healing process – progress can move forward and backwards at unpredictable rates. But, one of the best medicines for moving forward (even for the terminally ill patient) is to take care of yourself with good self-care habits.

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