There’s no way around it: Grief is never easy. And though we tend to associate grief with death, other life events can trigger grief, too — from the end of a relationship to the loss of a job to financial hardships.
“Grief is a natural response to any kind of loss,” says clinical psychologist Regina Josell, PsyD. “People experience it in different ways, but typically, it includes a variety of intense emotions, like sadness, anger, irritability and guilt.”
Dr. Josell explains the five stages of grief, including what they are, how they manifest and when to seek support from a therapist who can help you cope.
What are the five stages of grief?
Swiss-American psychiatrist and researcher Elisabeth Kübler-Ross first outlined five stages of grief — sometimes called the Kübler-Ross model — in her 1969 book “On Death and Dying.”
“Dr. Kübler-Ross spent her career studying the dying process and the impact of death on survivors,” Dr. Josell explains. “She outlined a five-stage protocol of dying to help us understand the process.” This protocol was later applied to those impacted by someone else’s death.
Keep in mind that these stages are meant to be descriptive and don’t necessarily apply to everyone or happen in the order presented. The five stages of grief can be summarized as:
You’re let go from your job, but the next day, you still get up early and start to get ready to head into the office, just in case your boss changes his mind. Your grandmother recently passed away, but you still feel like she might pick up the phone if you call to say hello.
“Denial refers to the difficulty comprehending the reality of a loss,” Dr. Josell says. “It can take a while to wrap your head around the fact that you’ve experienced a significant loss — that things are different, and they’re not going back to the way they were.”
Symptoms of denial during the grieving process might include:
- Believing that there’s been a mistake and your loved one isn’t actually gone.
- Refusing to discuss your loss or acting like everything is OK when you do.
- Busying yourself with work or other things so you don’t have to confront your feelings of loss.
- Pretending like your loved one has gone on a vacation or will be back soon.
- Continuing to speak about your lost loved one in the present tense.
“Anger is a perfectly natural response, and in the case of loss, it can be directed at a variety of sources,” Dr. Josell says. It can also manifest as blame — the feeling that someone else is at fault for your loss.
You might feel angry with yourself for some perceived role in the loss, or even at your loved one for dying. Maybe you’re mad at doctors or first responders for “letting” your loved one die, or at God for letting something so unfair and tragic happen.
As with every other stage of grief, these emotions can be experienced in reaction to non-death losses, too. Say you lost your job and feel angry at the co-worker who took on your workload. Or you couldn’t afford your mortgage and had to sell your family home, leaving you feeling angry with politicians about the state of the economy.
Your anger could also be less targeted, less sensible. “Sometimes, you’re just angry at innocent bystanders, like the guy in the checkout line at the grocery store who looked at you funny.” Dr. Josell says. “It’s not always rational.”
The bargaining process sometimes happens before your loss has fully occurred, like when you think, “If I recover from cancer, I promise I’ll start going to go to church every week,” or “If my husband pulls through after his heart attack, I’ll never argue with him again.”
But it can take place afterward, too, in the form of “if only” thinking:
- “If only we’d gone to a different doctor, maybe she could’ve been treated in time.”
- “If only we hadn’t gone on vacation, he wouldn’t have contracted this disease.”
- “If only I’d gotten my dog an electric collar, she wouldn’t have run out into the street.”
This may not look like bargaining, but Dr. Josell says the thinking is similar. “We engage in a type of mental gymnastics to try to undo something that we can’t undo,” she explains.
It’s natural to be sad when someone you love dies or when you’ve experienced another major loss. Symptoms of the depression stage of grief can include:
- Loss of hope about the future.
- Feeling directionless, lost or confused about your life.
- Difficulty concentrating.
- Difficulty making decisions.
Grief-related depression can cause physical symptoms, too, like aches and pains and changes in sleep patterns. Studies show that it can even cause increased inflammation in your body, which can worsen existing health issues and lead to new ones.
The depression stage of grieving isn’t the same as major depressive disorder (also known as major depression or clinical depression), a mental health condition that combines a number of emotional, cognitive and physical symptoms.
“However, grief can turn into clinical depression, so it’s really important that you address your grief while you’re experiencing it,” Dr. Josell advises.
The sadness and sense of loss of grief may never fully fade. But the acceptance stage represents learning to live with the loss — a newfound ability to acknowledge the reality of your loss and to allow sorrow and joy to live alongside one another.
In this stage of grief, you’re no longer immobilized by your sadness. For example, you can hear a song on the radio that reminds you of your loved one without bursting into tears.
“Acceptance is a sense of understanding that there is a finality to what has happened,” Dr. Josell says. “You can hold onto your sadness while still experiencing good memories of the past and maintaining hope for the future.”
How long does grief last?
There’s no set timeline for grief, and anyone who tells you to “move on” or “get over it” is underestimating and misunderstanding the weight of loss.
That said, the length of your grieving process depends on what kind of grief you’re experiencing.
- Uncomplicated grief: Sometimes referred to as “normal grief,” most of the symptoms — including the five stages — happen within the first two years of loss.
- Complicated grief: This type of profound, intense grief extends for a prolonged period of time and can be debilitating.
In some sense, of course, all grief is complicated, stirring a tide of emotions that feel anything but straightforward. And many of the signs and symptoms of complicated grief are the same as those of uncomplicated grief. In uncomplicated grief, though, the intensity of those reactions softens with time. Complicated grief, on the other hand, is more intense, persistent and prolonged, significantly interfering with a return to “normal” life.
When to ask for help
If you’re experiencing intense emotional distress or struggling to return to your regular routine after your loss, consider seeking the help of a therapist. Talking about loss, sharing your distress and having your grief witnessed can significantly facilitate the healing process.
The bottom line, Dr. Josell says, is simple: “If you feel you’re suffering, go talk to somebody.”