The Grief Cycle

The Grief Cycle: What it Looks Like and What it Feels Like

In 1969, in her book, On Death and Dying, Elizabeth Kubler-Ross shared with the world her model of the five stages of grief for the first time. The model suggested a progression of emotional states experienced by terminally ill patients, beginning with denial and moving forward to acceptance. During Kubler-Ross’s first years in the medical field in the United States, she became increasingly disturbed by how dying patients were treated. In 1962, she moved to Colorado and began teaching at the University of Colorado’s medical school in Denver but could find nothing in the school’s curriculum that included the topics of death and dying, which surprised her.

In 1965, Dr. Kubler-Ross moved to Chicago and became an instructor at the medical school at the University of Chicago. She began to incorporate interviews with terminally ill patients into the classroom setting. She also began working on a small project about death with a group of theology students. That project grew into a very well-attended series of seminars that highlighted candid interviews with people who were dying.

Her research—including the many interviews she conducted with terminally ill individuals—led her to identify five distinct stages of grief that most patients experience when dealing with a life-limiting illness: denial, anger, bargaining, depression and acceptance. In 1969, when Kubler-Ross first published her understanding of the grief cycle in her book, On Death and Dying, the idea was a revolutionary one.

Also called the Kubler-Ross Model, the grief cycle was originally used to describe the emotions experienced by terminally ill patients in response to their illness and shortened life expectancy. It was later expanded to describe the grief cycle experienced by people who are dealing with the death of a loved one. Today, the five stages of grief as described by Dr. Elizabeth Kubler-Ross is a widely accepted model and serves as the standard for understanding and describing grief.

For a terminally ill patient, the grief cycle often begins with the news of a life-limiting illness—one that cannot be cured—one that is expected to result in the patient’s death. For someone dealing with loss, the grief cycle often begins with the death of a loved one. In either scenario, the denial stage of grief is characterized by feelings of shock and disbelief, as well as an inability to fully process the news. Denial doesn’t necessarily mean a true lack of belief that something grievous has transpired. It is more of a built-in coping mechanism that only allows in as much as a person can handle at one time. For this reason, denial can last for hours, days or even weeks as a person begins to come to terms with the reality of the news.

In the second stage of the model, the grieving person experiences feelings of anger and frustration. He might be angry at doctors, family members and friends. For someone who is dealing with the loss of a loved one, those feelings of anger might even extend toward the person who passed away. Those feelings are a normal part of the grieving process, and when they are permitted to come to the surface, they can be better dealt with, thus allowing the grieving person to eventually move forward in the cycle toward healing.

It’s important for those who are grieving to resist the urge to suppress feelings of anger. Doing so is unhealthy and can hinder the natural grieving process that ultimately leads to acceptance and healing. Fully experiencing this stage of grief—as well as the other four stages—is the key to continuing to move forward. The more honest a person is about his feelings—even angry feelings—the more possible it is for him to work through those feelings. Over time, feelings of anger begin to dissipate. In other words, the grieving person doesn’t stay angry forever.

The third stage of the grieving process is bargaining. During this stage, a person experiencing grief begins to express his yearning for circumstances to be different. This stage is characterized by making commitments to God in exchange for a different outcome—to be able to wake up and realize that the grievous scenario was all just a bad dream. It is also characterized by feelings of “what if” and “if only”—“If only I had done x, y, z, I wouldn’t be sick now (my loved one wouldn’t have died).”

Sometimes, the bargaining stage of grief can be further characterized by feelings of guilt and a tendency on the part of the grieving person to blame himself for his scenario. When guilt accompanies the bargaining stage of grief, it is often the result of a subconscious attempt to make the pain of loss subside by creating an alternate scenario in which something within a person’s control can change a situation that feels so utterly out of control. Bargaining can also stem from an inability to accept or process the idea of the finality of death.

The fourth stage of the grief cycle involves depression. It becomes part of a person’s grieving process when intense feelings of pain and loss reach into his deepest parts. Feeling depressed after the news of a terminal illness or in response to the death of a loved one is a completely normal occurrence. This response is not one that should be rushed, treated, “fixed” or “snapped out of.”

When depression occurs as a response to loss and grief, it is not a form of mental illness or mental instability. At this point in the cycle, the grieving individual is beginning to understand and accept that his loss is real, that it cannot be changed or undone and that even though life goes on, it will have to do so in a different way. For a terminally ill patient, life goes on, but in light of a terminal diagnosis and a shortened life expectancy. For someone grieving the death of a loved one, life goes on, but it does so without the person who died.

This realization can be very depressing, indeed. And while this stage of grief can be extremely difficult and painful to experience, it’s important to recognize that getting to this stage in the cycle reaffirms one’s progress in the grieving and healing process.

This stage in the cycle of grief is about accepting the reality of a grievous situation—whether that is being ill with an incurable disease or living with the loss of someone. For a terminally ill patient, it’s about accepting the illness as a part of his life now, and for the person grieving the loss of a loved one, it’s about accepting that the loss occurred, that the loved one is physically gone and that life will be different because of the loss that is the new reality.

Acceptance is sometimes confused with being ok that a loss has occurred, but acceptance has nothing to do with positive feelings about loss. Truth be told, most people don’t ever reach a point at which they are ok with their loss. A grieving individual can accept begin to accept his loss without ever being “ok” or glad that it happened.

Sometimes acceptance simply describes a person’s ability to keep going, to begin to find joy in life again and to have “good days” again. It is normal to feel guilt from time to time about being able to move on after the death of a loved one—to smile again, to laugh again, to pursue new interests, hobbies and relationships in light of that person’s death. Moving forward can feel like a betrayal of a loved one or a lack of loyalty toward that person. But there is no betrayal in accepting the death of a loved one.

On the contrary, moving on and progressing through the grief cycle toward acceptance means that the grieving individual is in a process of healing—that he is “getting better.” And it’s important to remember that a loved one who has passed away would want healing to come to the family and friends who are left behind—the same way that those who are left behind would want healing for their loved ones, had they been the ones to pass away.

Reaching the stage in the grief cycle in which one can accept his loss as the “new normal” doesn’t mean the cycle is complete. It’s referred to as a cycle because grief has a way of being cyclical, meaning that it can come in waves or in series of highs and lows (and everything in between). The grieving process is a journey—not a destination—and because of this, a person who has progressed to a point of acceptance may still have days when he feels depressed from time to time. He may experience feelings of disbelief at the loss—even years after it occurs. This doesn’t mean that he has regressed or gone backward in the healing process. It’s simply proof that the grief cycle isn’t an exact roadmap. As someone moves through the grieving process, he doesn’t move through a stage, close the door behind him and move on to the next stage. The grieving process isn’t always so neat and tidy. Within the grief cycle, there is often overlapping of the five stages. This experience is very normal and not a cause for concern.