Loss is an inevitable part of life and we all respond to loss differently depending on our beliefs, values, social expectations, religions, cultures, etc. Grief, bereavement or mourning is the response to the loss of anything of which we have assigned significance or importance and/or the response to the loss of that which we have developed a significant and meaningful emotional bond or attachment. Examples of grief can include the death of a loved one, the loss of a relationship, loss of a pet, loss of a personal item of sentimental value or even the loss of employment or financial/social support.
Within scholarly literature and the mental health profession, grief, bereavement and mourning is typically referred to as ‘uncomplicated’ (typical grief) and ‘complicated’ (atypical grief). Uncomplicated grief is grief which is of short duration and is the grief which is felt by the vast majority of people. Long-term, persistent grief, bereavement or mourning is referred to as complicated grief. If left untreated, complicated grief can lead to conditions such as bereavement disorder, major depression and other such conditions.
Swiss psychiatrist, Kübler-Ross first introduced her five-stage grief model (denial, anger, bargaining, depression and acceptance) in her book ‘On Death and Dying’. Kubler-Ross’ grief model is often misunderstood as people often make the mistake of applying the five stages in a sequential order which is an erroneous way of applying the model. People can experience the five stages in any order and may indeed repeat or re-experience any of the five stages a number of times. I will now discuss the five stages and provide an example of stage as they relate to a relationship break-up and the death of a loved one.
Denial can be used as an ego defence mechanism. Denial can work against us if we allow ourselves to be in complete denial for too long a period of time. Whilst complete denial is a buffer against loss, it can also prevent us from processing the loss properly and, as you may already know, if loss and trauma are repressed and left unprocessed, they will find a way of resurfacing when you least expect it. Partial, short-term denial however allows us to ‘trickle feed’ the upsetting and discomforting reality of a loss. Partial denial can prevent us from becoming suddenly overwhelmed to the point of shut down.
Example 1: “They didn’t mean to break up with me. They will be back tomorrow”.
Example 2: “This can’t be happening. Surely there must be a mistake”?
Anger is not a denial of reality. Anger is the response to an undesirable and unwanted reality. Anger is a responsibility displacement mechanism (“They are 100% to blame. I did nothing wrong”). Anger is often one-sided and anger inevitably shuts down empathy and understanding. A person’s anger about the relationship ending or the death of a loved one may be directed towards the person they broke up with (or the persons who died) or it may be directed towards friends, family, work colleagues, etc.
Example 1: “How dare they break up with me. They will be sorry when they see what they missed out”.
Example 2: “How could [insert higher being] take them away from this world. They were such a good person”.
This stage is about false hope and can be regarded as the ‘guilt ridden’ stage. Here the person is becoming aware of the role that they played in the relationship breakup or death (real or imagined). The intention behind bargaining is to ‘replace’ the current reality with a reality which is ‘more desirable’ and a reality in which the pain, misery and guilt ends.
Example 1: “If you come back, I promise to change all of my ‘bad’ ways”.
Example 2: *Praying to higher being “If you bring them back to life, I promise I will become a better person”.
Example 2(a): “What if I encouraged them to see a doctor as soon as they noticed the lump. Take me instead. I am to blame”.
Here reality really sets in. The person becomes acutely aware that the loss is irreversible and unchangeable. Depression reflects the inner emptiness that the loss has created. A person may find themselves withdrawing from their family, friends, work, etc, so that they can process their grief. Depression which is experienced daily and uninterrupted for two weeks or more may require therapeutic intervention. The same applies if you engage in self-harm or experience suicidal ideation.
Example 1: “It’s really over. I’m alone again. I will never find anybody to love me”.
Example 2: “They’re really gone. They are not coming back. How can I live without them”?
Acceptance is the full understanding of the loss and the period when the painful thoughts and emotions begin to subside and stabilise. A person begins to accept their ‘new’ reality and they begin to see how they can continue interacting within this new reality without the person they have lost. Acceptance is not about falsehood and pretending that ‘everything is awesome’. Acceptance is the realisation that yes, the loss is painful, yes, the loss may continue to feel painful but the loss is not the complete end of the world and even with loss, happiness can still be experienced.
Example 1: “I am sad and disappointed that the relationship ahs ended but that doesn’t mean that I am unworthy of love or that I cannot enter another relationship”.
Example 2: “Their death was a hard loss. I will always keep them in my memory and I will live the life they would have wanted me to live”.
The grief, bereavement and mourning process is a highly individualized one. There is no one way of grieving. The process of, and response to grief can be influenced by religion, culture, society, age, gender, beliefs, etc. It is always important to validate other people’s expressions of grief regardless of how the loss (or their reaction to the loss) is perceived by you. If the grief is atypical and enduring (atypical being grief experienced beyond the norms of the culture, society, religion, etc), therapeutic intervention may be necessary.