On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Lossby Elisabeth Kübler-Ross
Shortly before her death in 2004, Elisabeth Kübler-Ross and David Kessler, her collaborator, completed the manuscript for this, her final book. On Grief and Grieving is a fitting completion to her work. Thirty-six years and sixteen books ago, Kübler-Ross's groundbreaking On Death and Dying changed the way we talk about the end of life. Now On Grief and Grieving will profoundly influence the way we experience the process of grief.
On Death and Dying began as a theoretical book, an interdisciplinary study of our fear of death and our inevitable acceptance of it. It introduced the world to the now-famous five stages: denial, anger, bargaining, depression, and acceptance. On Grief and Grieving applies these stages to the process of grieving and weaves together theory, inspiration, and practical advice, all based on Kübler-Ross's and Kessler's professional and personal experiences, and is filled with brief, topic-driven stories. It includes sections on sadness, hauntings, dreams, coping, children, healing, isolation, and even the subject of sex during grief.
"I know death is close," Kübler-Ross says at the end of the book, "but not quite yet. I lie here like so many people over the years, in a bed surrounded by flowers and looking out a big window....I now know that the purpose of my life is more than these stages....It is not just about the life lost but also the life lived."
In one of their final writing sessions, Kübler-Ross told Kessler, "The last nine years have taught me patience, and the weaker and more bed-bound I become, the more I'm learning about receiving love."
On Grief and Grieving is Elisabeth Kübler-Ross's final legacy, one that brings her life's work profoundly full circle.
"Elisabeth Kuebler-Ross left us one last gift, and it's a masterpiece. Having illumined the subject of death, she has now illumined the subject of grief. She and grief expert David Kessler have written a modern classic, the kind of book that all of us will want to keep on our bookshelves because we know it speaks to our deepest hearts."
-- Marianne Williamson
"Elisabeth Kuebler-Ross deserves to be remembered because her life and work have made this world a better place. On Grief and Grieving is a heartfelt tribute to all who have lost a loved one, from a woman who changed our lives by changing our relationship to death and dying. What a wonderful book Elisabeth and David have written."
-- Caroline Myss
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Chapter One: The Five Stages of Grief
The stages have evolved since their introduction, and they have been very misunderstood over the past three decades. They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grief is as individual as our lives.
The five stages -- denial, anger, bargaining, depression, and acceptance -- are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief. Not everyone goes through all of them or goes in a prescribed order.
Our hope is that with these stages comes the knowledge of grief's terrain, making us better equipped to cope with life and loss.
Denial in grief has been misinterpreted over the years. When the stage of denial was first introduced in On Death and Dying, it focused on the person who was dying. In this book, On Grief and Grieving, the person who may be in denial is grieving the loss of a loved one. In a person who is dying, denial may look like disbelief. They may be going about life and actually denying that a terminal illness exists. For a person who has lost a loved one, however, the denial is more symbolic than literal.
This does not mean that you literally don't know your loved one has died. It means you come home and you can't believe that your wife isn't going to walk in the door at any minute or that your husband isn't just away on a business trip. You simply can't fathom that he will never walk through that door again.
When we are in denial, we may respond at first by being paralyzed with shock or blanketed with numbness. The denial is still not denial of the actual death, even though someone may be saying, "I can't believe he's dead." The person is actually saying that, at first, because it is too much for his or her psyche.
Alicia was accustomed to Matthew's being away on business trips. His work required him to travel the world, and Alicia had accompanied him on several trips that took him to places she wanted to see. She also witnessed the jet lag, hectic schedule, time changes, and delayed flights.
On his current trip, Alicia was surprised that he'd been scheduled to arrive in Delhi and he hadn't phoned her yet. After two days, he called and apologized, explaining that there were phone problems in his hotel. She understood because this often happened when he traveled to third world countries.
The next call came two days later in the middle of the night from one of her husband's coworkers. He gently told her that he had very bad news. Matthew had been killed in a car accident. He said there were very few details as yet but the home office would be contacting her.
Alicia couldn't believe her ears. After she hung up the phone she immediately thought, "Did I just dream that? This must be a mistake." She called her sister, who arrived just as the sun was rising. They waited until eight o'clock and called the home office only to find out they didn't know of any problem, much less a tragedy like this. But they said they would look into it immediately. For the rest of the morning Alicia couldn't stop wondering if she had dreamed the phone call. Was there a mistake? The next call came at noon, confirming that indeed, last night's bad news was true.
For the next few days Alicia made funeral arrangements, all the while saying, "This can't be true. I know when the body arrives it won't be him." The night before the funeral, Alicia finally saw her dear husband's body. She looked at his face to make sure it wasn't just someone who looked like Matthew, but when she saw his wedding ring, there was no more question.
During the weeks after the funeral, she would call friends and family and say, "I keep thinking he's still on the trip and he just can't get to a phone. I know he's out there somewhere trying to get home." She would usually end up crying over the reality that he was not coming home.
Alicia's story clearly illustrates how denial works. At times she thought it might be a dream, but she did the appropriate thing by calling her sister about the loss. The reality sank in even more when she saw the body and the ring on his finger. It would be easy to say that she was in denial because she kept thinking Matthew's death was not real. It would be equally easy to say she was not in denial because she kept going through with funeral arrangements. But both are true. She couldn't believe it and her mind could not fully process it. Denial helped her to unconsciously manage her feelings. Even after the funeral, she often thought he still might just be on a trip. This was still denial working very subtly, to give her moments away from her pain.
This first stage of grieving helps us to survive the loss. In this stage, the world becomes meaningless and overwhelming. Life makes no sense. We are in a state of shock and denial. We go numb. We wonder how we can go on, if we can go on, why we should go on. We try to find a way to simply get through each day. Denial and shock help us to cope and make survival possible. Denial helps us to pace our feelings of grief. There is a grace in denial. It is nature's way of letting in only as much as we can handle.
These feelings are important; they are the psyche's protective mechanisms. Letting in all the feelings associated with loss at once would be overwhelming emotionally. We can't believe what has happened because we actually can't believe what has happened. To fully believe at this stage would be too much.
The denial often comes in the form of our questioning our reality: Is it true? Did it really happen? Are they really gone? Think about the idea that you can't get over someone. It is more that you learn to live with the loss and not forget the person.
People often find themselves telling the story of their loss over and over, which is one way that our mind deals with trauma. It is a way of denying the pain while trying to accept the reality of the loss. As denial fades, it is slowly replaced with the reality of the loss.
You begin to question the how and why. How did this happen? you may ask, as you review the circumstances. You are no longer in an external story-telling mode; now you turn inward as you begin the search for understanding. You explore the circumstances surrounding the loss. Did it have to happen? Did it have to happen that way? Could anything have prevented it?
The finality of the loss begins to gradually sink in. She is not coming back. This time he didn't make it. With each question asked, you begin to believe they are really gone.
As you accept the reality of the loss and start to ask yourself questions, you are unknowingly beginning the healing process. You are becoming stronger, and the denial is beginning to fade. But as you proceed, all the feelings you were denying begin to surface.
This stage presents itself in many ways: anger at your loved one that he didn't take better care of himself or anger that you didn't take better care of him. Anger does not have to be logical or valid. You may be angry that you didn't see this coming and when you did, nothing could stop it. You may be angry with the doctors for not being able to save someone so dear to you. You may be angry that bad things could happen to someone who meant so much to you.
You may also be angry that you're left behind and you should have had more time together. You know intellectually that your loved one didn't want to die. But emotionally, all you know is that he did die. It was not supposed to happen, or at least not now.
It is important to remember that the anger surfaces once you are feeling safe enough to know you will probably survive whatever comes. At first, the fact that you lived through the loss is surprising to you. Then more feelings hit, and anger is usually at the front of the line as feelings of sadness, panic, hurt, and loneliness also appear, stronger than ever. Loved ones and friends are often taken aback by these feelings, because they surface just as you were beginning to function at a basic level again.
You may also be angry with yourself that you couldn't stop it from happening. Not that you had the power, but you had the will. The will to save a life is not the power to stop a death. But most of all, you may be angry at this unexpected, undeserved, and unwanted situation in which you find yourself. Someone once shared, "I'm angry that I have to keep living in a world where I can't find her, call her, or see her. I can't find the person I loved or needed anywhere. She is not really where her body is now. The heavenly bodies elude me. The all-ness or one-ness of her spiritual existence escapes me. I am lost and full of rage."
Anger is a necessary stage of the healing process. Be willing to feel your anger, even though it may seem endless. The more you truly feel it, the more it will begin to dissipate and the more you will heal. There are many other emotions under the anger and you will get to them in time, but anger is the emotion we are most used to managing. We often choose it to avoid the feelings underneath until we are ready to face them. It may feel all-consuming, but as long as it doesn't consume you for a long period of time, it is part of your emotional management. It is a useful emotion until you've moved past the first waves of it. Then you will be ready to go deeper. In the process of grief and grieving you will have many subsequent visits with anger in its many forms.
When Jan's husband died, all her married friends overwhelmed her with advice on how to get through it. But the women who shared loving tips of guidance had not lost their husbands. Jan would listen politely but think, "What do you know? Your husband is still alive."
Jan loved her friends and knew they meant well. She said, "The only thing that stops me from letting them 'really have it' is that I know they will understand someday too, and I know they will understand hurt better."
The truth is that anger has no limits. It can extend not only to your friends, the doctors, your family, yourself, and your loved one who died, but also to God. You may ask, "Where is God in this? Where is his love? His powerfulness? His compassion? Is this really God's will?" You may not want people to talk to you about God's plan or his mysteries. You may feel like saying, "God, my husband has died. Was this your plan?" Or "I don't want any mysteries, I just want him back. My faith feels rocked and destroyed." "I feel not given to but taken from." "God is a disappointment, and my faith feels shattered with his plan for me and my loved one."
Maybe you are angry that God didn't take better care of your loved one. It's as if you hope that in your case, God will realize some huge mistake has been made and your loved one will be returned to you. There you sit, alone with your anger, wondering how to reconcile your spirituality and your religion with this loss and anger. You may not even be interested in reconciliation. Many don't dare talk about these feelings. You think, maybe God is mad at me and this is what I get for being mad at him. Perhaps when our loved one was dying and we already experienced the bargaining stage, we asked God to intervene and save our loved one. Now after the loved one has died, we are left with a God who, in our eyes, did not come to our aid when we needed him the most.
We often assume that if we are good people we will not suffer the ills of the world. You may feel that you and your loved one honored your part of the deal: You went to church, synagogue, or your particular place of worship. You were loving, kind, and charitable. You did all the things you were told. You believed you would be rewarded if you did. Well, this loss is no reward. We also assume that if we care for our bodies, eat right, get medical checkups, and exercise, we will be granted good health. These assumptions come crashing down around us when the good, the just, the loving, the healthy, the young, and even the needed and most wanted die on us.
When Heather's teenage daughter died at sixteen, Heather was furious at God for allowing her to die so young, with a life so unlived. Heather's family were deeply involved in the church that had been a strong support during her daughter's illnesses, but they had difficulty dealing with Heather's anger. She no longer wanted to hear about the God who answers prayers, since her prayers had not been answered. She felt judged by her friends at church for having so much anger at God.
A friend said to her cautiously, "Be careful not to evoke the wrath of God."
At that, Heather was even more enraged. "What is he going to do," she retorted, "take my daughter away? What's he going to do, take me? That would be fine. I'd rather be with her than be here."
Her friend knelt down and said tenderly, "Let's pray for forgiveness."
At that moment Heather decided to leave behind her church and a number of friends. It was years before she walked back into the church.
If we ask people to move through their anger too fast, we only alienate them. Whenever we ask people to be different than they are, or to feel something different, we are not accepting them as they are and where they are. Nobody likes to be asked to change and not be accepted as they are. We like it even less in the midst of grief.
Today, most churches and clergy understand it is not unusual for people to feel anger toward God. Many churches have started bereavement groups in which priests and ministers encourage expression of all feelings. They allow it and are not put off if you speak of it. Consider talking to your church, temple, or place of worship about it.
People often wonder about their God and his role. One member of the clergy shared that he expects members of the congregation to question their relationship with God after a loss. He said that one of his goals is to help grieving members. He said, "Sometimes we do a wonderful job with rituals immediately after death, but I want my congregation to help those in grief with the day-to-day feelings of loss also. Once you allow yourself to feel and speak out the anger, you may find that your God is strong enough to handle your anger, strong enough to feel compassion and love for you, even in the midst of your anger at him."
Underneath anger is pain, your pain. It is natural to feel deserted and abandoned, but we live in a society that fears anger. People often tell us our anger is misplaced, inappropriate, or disproportionate. Some people may feel your anger is harsh or too much. It is their problem if they don't know how to deal with it. Unfortunately for them, they too will know the anger of loss someday. But for now, your job is to honor your anger by allowing yourself to be angry. Scream if you need to. Find a solitary place and let it out.
Anger is strength and it can be an anchor, giving temporary structure to the nothingness of loss. At first grief feels like being lost at sea: no connection to anything. Then you get angry at someone, maybe a person who didn't attend the funeral, maybe a person who isn't around, maybe a person who is different now that your loved one has died. Suddenly you have a structure--your anger toward them. The anger becomes a bridge over the open sea, a connection from you to them. It is something to hold on to, and a connection made from the strength of anger feels better than nothing.
We usually know more about suppressing anger than feeling it. Tell a counselor how angry you are. Share it with friends and family. Scream into a pillow. Find ways to get it out without hurting yourself or someone else. Try walking, swimming, gardening--any type of exercise helps you externalize your anger. Do not bottle up anger inside. Instead, explore it. The anger is just another indication of the intensity of your love.
Anger means you are progressing, that you are allowing all those feelings that were simply too much before to come to the surface. It is important to feel the anger without judging it, without attempting to find meaning in it. It may take many forms: anger at the health-care system, at life, at your loved one for leaving. Life is unfair. Death is unfair. Anger is a natural reaction to the unfairness of loss. Unfortunately, however, anger can isolate you from friends and family at the precise time you may need them the most.
You also may experience feelings of guilt, which is anger turned inward on yourself. But you are not to blame. If you could change things, you would, but you can't. Anger affirms that you can feel, that you did love, and that you have lost.
The more anger you allow, the more feelings you will find underneath. Anger is the most immediate emotion, but as you deal with it, you will find other feelings hidden. Mostly you will find the pain of loss. The power of your anger may overwhelm you because for some it may be in proportion to the amount of lost love that it represents. It may seem that if you go into the pain, you will never come out of it or that the pain will never end. You will come out the other end. The anger will subside, and the feelings of loss will change form again.
Don't let anyone diminish the importance of feeling your anger fully. And don't let anyone criticize your anger, not even you.
Before a loss, it seems you will do anything if only your loved one may be spared. "Please, God," you bargain, "I will never be angry at my wife again if you'll just let her live." After a loss, bargaining may take the form of a temporary truce. "What if I devote the rest of my life to helping others? Then can I wake up and realize this has all been a bad dream?"
We become lost in a maze of "if only..." or "What if..." statements. We want life returned to what it was; we want our loved one restored. We want to go back in time: find the tumor sooner, recognize the illness more quickly, stop the accident from happening...if only, if only, if only.
Guilt is often bargaining's companion. The "if onlys" cause us to find fault with ourselves and what we "think" we could have done differently. We may even bargain with the pain. We will do anything not to feel the pain of this loss. We remain in the past, trying to negotiate our way out of the hurt.
As Howard turned seventy-five, he was determined to keep himself and his sixty-six-year-old wife, Millie, in good health. He had read somewhere that walking every day would keep them fit, possibly ward off Alzheimers, and help them sleep better. Millie knew it was easier to go along with the program than to resist.
On the sixth day, after they returned from a busy morning of errands, Howard got ready for their walk. Millie looked at Howard and said, "Do we have to do this every day? A day off won't hurt."
Howard lectured, "It takes thirty days to create a habit. We have to do this every day, no matter what."
Millie rolled her eyes and said, "Can we at least wait until later? We just got in."
He grabbed her sweater. "Let's just get this over with. You'll be happy when it's done."
They walked a block and stepped into the crosswalk. When they were halfway across the street a car came barreling around the corner and struck them, Millie first, then Howard. In a moment, a disoriented Howard looked up and saw Millie lying on the pavement a few feet away. Suddenly someone was asking him if he was okay. He responded, "My wife!" The paramedics assured him that they were taking care of her.
At the hospital Howard was treated for numerous bruises and a broken arm. Millie was not so fortunate. She had sustained massive internal injuries and was taken to surgery.
Howard sat, surrounded by family, repeating over and over in his mind, "Please, God, let her live -- I'll never make Millie do anything she doesn't want to do...I'll be a better person...you'll see, I'll volunteer, I'll devote my life to you...please, not now."
The surgeon walked in an hour later and said, "I'm sorry, we couldn't save her."
People often think of the stages as lasting weeks or months. They forget that the stages are responses to feelings that can last for minutes or hours as we flip in and out of one and then another. We do not enter and leave each individual stage in a linear fashion. We may feel one, then another, and back again to the first one.
For Howard, his first days alone were a bag of mixed emotions. "She can't be gone," he'd say. Then he'd feel rage when he learned the car that hit his wife was in the process of being stolen. At bedtime, he'd bargain again. "Please, God, let me fall asleep and wake up realizing this was all a dream. I will do anything to have her back."
For the next few minutes he'd run a fantasy of waking up with Millie next to him. He tells her about the horrible nightmare he had. Over breakfast they laugh as he promises from now on they will walk only if they both really want to.
His thoughts were bargaining with all the what ifs... "What if I had said, 'Sure, we can walk later'? What if I had never read the article on walking?"
His family would have to remind him that he wasn't responsible for the accident. "You were trying to keep her healthy," they'd say, "not leading her to her death. You had no way of knowing that some reckless driver in a stolen car was about to come flying around the corner." They thought of his reaction as one of guilt.
He would tell them that he knew it wasn't his fault. Bargaining for him was his escape from the pain, a distraction from the sad reality of his life without her.
In his first six months, denial, anger, and a lot of bargaining were his constant companions. They would eventually lead him to depression, still mixed with the "if onlys" of bargaining. Acceptance came in bits and pieces over the next few years.
For Howard, bargaining was a key stage, since he was still holding a piece of the alternate future in which his wife's death never happened. Bargaining can be an important reprieve from pain that occupies one's grief. He never believed the bargaining; he just found relief in it momentarily.
In other cases, bargaining can help our mind move from one state of loss to another. It can be a way station that gives our psyche the time it may need to adjust. Bargaining may fill the gaps that our strong emotions generally dominate, which often keep suffering at a distance. It allows us to believe that we can restore order to the chaos that has taken over. Bargaining changes over time. We may start out bargaining for our loved one to be saved. Later, we may even bargain that we might die instead of our loved one.
When we accept that they are going to die we may bargain that their death will be painless. After a death, bargaining often moves from the past to the future. We may bargain that we will see our loved ones again in heaven. We may bargain and ask for a respite from illnesses in our family, or that no other tragedies visit our loved ones. A mother who loses a child may bargain that her other children remain safe and healthy.
In his well-known song "Tears in Heaven," Eric Clapton writes about his young son who fell tragically to his death. Some of the lyrics could be interpreted as the bargaining stage, when he wonders if he will stop crying once he finally gets to heaven.
As we move through the bargaining process, the mind alters past events while exploring all those "what if" and "if only" statements. Sadly, the mind inevitably comes to the same conclusion...the tragic reality is that our loved one is truly gone.
After bargaining, our attention moves squarely into the present. Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive stage feels as though it will last forever. It's important to understand that this depression is not a sign of mental illness. It is the appropriate response to a great loss. We withdraw from life, left in a fog of intense sadness, wondering, perhaps, if there is any point in going on alone. Why go on at all?
Morning comes, but you don't care. A voice in your head says it is time to get out of bed, but you have no desire to do so. You may not even have a reason. Life feels pointless. To get out of bed may as well be climbing a mountain. You feel heavy, and being upright takes something from you that you just don't have to give.
If you find a way to get through your daily activities, each of them seems as empty and pointless as the last one. Why eat? Or why stop eating? You don't care enough to care. If you could care about what was going on, it might scare you, so you don't want to care about anything.
Others around you see this lethargy and want to get you out of your "depression."
Depression after a loss is too often seen as unnatural: a state to be fixed, something to snap out of. The first question to ask yourself is whether the situation you're in is actually depressing. The loss of a loved one is a very depressing situation, and depression is a normal and appropriate response. To not experience depression after a loved one dies would be unusual. When a loss fully settles in your soul, the realization that your loved one didn't get better this time and is not coming back is understandably depressing.
When we are grieving, people may wonder about us, and we may wonder about ourselves. The heavy, dark feelings of depression that come with grief, however normal, are often seen in our society as something to be treated. Of course clinical depression, untreated, can lead to a worsening of one's mental state. But in grief, depression is a way for nature to keep us protected by shutting down the nervous system so that we can adapt to something we feel we cannot handle.
If grief is a process of healing, then depression is one of the many necessary steps along the way. If you have the awareness to recognize you are in depression or have been told by multiple friends you are depressed, your first response may be to resist and look for a way out. Seeking a way out of depression feels like going into a hurricane and sailing around the inside perimeter, fearful that there is no exit door.
As tough as it is, depression can be dealt with in a paradoxical way. See it as a visitor, perhaps an unwelcome one, but one who is visiting whether you like it or not. Make a place for your guest. Invite your depression to pull up a chair with you in front of the fire, and sit with it, without looking for a way to escape. Allow the sadness and emptiness to cleanse you and help you explore your loss in its entirety. When you allow yourself to experience depression, it will leave as soon as it has served its purpose in your loss. As you grow stronger, it may return from time to time, but that is how grief works.
A smart, charismatic woman, Claudia was surprised at the depth of her depression when her grown daughter was dying. She thought that was as depressing as it would get, but after her daughter died, the depression returned. "It was different than when my daughter was alive," Claudia said. "When she was fighting for her life, my depression had walls, a structure within which fights had to be fought. But after she died, the depression that returned felt like being hit with a punching bag. I was knocked down over and over, with no desire to get up again."
Claudia reported that her depression eventually passed and she began to do more and get out more. She went back to work part-time and started accepting offers from friends to do things. "Time had passed; I was better, functional and improving, when suddenly the depression returned. I'd thought I was done with it, but I guess it wasn't done with me.
"This time, I heard a loud voice, literally heralding the reality that my daughter was never coming back. This time the depression had no walls, ceiling, or floor. It felt even more endless than before and, once again, I had to deal with this old familiar guest. I learned the only way around this storm was through it."
The stages of loss -- denial, anger, bargaining, depression, and acceptance -- have been widely used and misused. Our society almost seems to be involved in a "stamp out depression" campaign. Sometimes intervention is vital, but most of the time, we do not allow the normal depression that comes with grief to have its place.
Clinical depression is a group of illnesses that may be characterized by a long-term or excessively depressed state. But our society often considers an appropriate sadness to be depression requiring fixing. Normal depression is the sadness we feel at certain times in our lives, the common cold of mental illnesses. We even have television advertisements offering help with it, selling pills promising to get rid of it. When a normal depression becomes a clinical depression requiring professional help, antidepressants may be helpful for a time.
When depression follows loss, there are specific sorrows that can be identified. In more serious and long-lasting depressions, it is difficult to receive support. In this case antidepressant medications may be useful, to help lift someone out of what seems to be a bottomless depression. Only a trained medical professional familiar with the griever's situation can make an accurate diagnosis.
Treating depression is a balancing act. We must accept sadness as an appropriate, natural stage of loss without letting an unmanaged, ongoing depression leech our quality of life. The use of antidepressants remains a controversial topic, especially when a loss is involved. Some people are worried that if they take antidepressants, they will miss the process of grief. If only that were so. The reality is that your grief is there and available for processing, on or off medication. Some people feel that medications simply put a floor in for them to deal with their depression. In some cases, depression may need to be managed by using a combination of support, psychotherapy, and antidepressant medications.
As difficult as it is to endure, depression has elements that can be helpful in grief. It slows us down and allows us to take real stock of the loss. It makes us rebuild ourselves from the ground up. It clears the deck for growth. It takes us to a deeper place in our soul that we would not normally explore.
Most people's initial reaction to sad people is to try to cheer them up, to tell them not to look at things so grimly, to look at the bright side of life. This cheering-up reaction is often an expression of that person's own needs and that person's own inability to tolerate a long face over an extended period. A mourner should be allowed to experience his sorrow, and he will be grateful for those who can sit with him without telling him not to be sad. A mourner may be in the midst of life and yet not a participant in all the activities considered living: unable to get out of bed; tense, irritable, unable to concentrate; unable to care about anything. No matter what our surroundings may hold, we feel alone. This is what hitting the bottom feels like. You wonder if you will ever feel anything again or if this is what life will be like forever.
Acceptance is often confused with the notion of being all right or okay with what has happened. This is not the case. Most people don't ever feel okay or all right about the loss of a loved one. This stage is about accepting the reality that our loved one is physically gone and recognizing that this new reality is the permanent reality. We will never like this reality or make it okay, but eventually we accept it. We learn to live with it. It is the new norm with which we must learn to live. This is where our final healing and adjustment can take a firm hold, despite the fact that healing often looks and feels like an unattainable state.
Healing looks like remembering, recollecting, and reorganizing. We may cease to be angry with God; we may become aware of the commonsense reasons for our loss, even if we never actually understand the reasons. We the survivors begin to realize sadly that it was our loved one's time to die. Of course it was too soon for us, and probably too soon for him or her, too. Perhaps he was very old or full of pain and disease. Perhaps her body was worn down and she was ready for her journey to be over. But our journey still continues. It is not yet time for us to die; in fact, it is time for us to heal.
We must try to live now in a world where our loved one is missing. In resisting this new norm, at first we may want to maintain life as it was before a loved one died. In time, through bits and pieces of acceptance, however, we see that we cannot maintain the past intact. It has been forever changed and we must readjust. We must learn to reorganize roles, reassign them to others or take them on ourselves. The more of your identity that was connected to your loved one, the harder it will be to do this.
As we heal, we learn who we are and who our loved one was in life. In a strange way, as we move through grief, healing brings us closer to the person we loved. A new relationship begins. We learn to live with the loved one we lost. We start the process of reintegration, trying to put back the pieces that have been ripped away.
Alan, seventeen years old, was thrilled to go to the basketball championship that was being held downtown in the sports arena. After the game, in the parking lot, Alan walked ten feet to his car and was randomly shot and killed by a gang member.
His father, Keith, and his mother, Donna, could not understand why their son was killed. They were filled with anger as they spent their days and nights trying to raise their other two kids, go to work, and follow the all-consuming ongoing investigation into the killing.
A close couple, friends of Keith and Donna's, became concerned because they were not available to get together for meals or anything else. One evening the couple dropped in out of concern and said to Keith and Donna, "You have to accept this loss. Your son is gone and none of this is going to bring him back. Haven't you heard about the five stages? You've done all the others. All you need now is acceptance."
Keith got angry with his friend and asked, "What part of Alan's death don't you think I accept? At his grave today, I cried like a baby. If I didn't accept it, would I go to his grave? We're not setting a place for him at the dinner table tonight. We live in reality, his room is empty every night. How much more acceptance can we feel?"
The friend looked down and said, "I just hate to see you in so much pain."
Keith replied, "Believe me, I hate to be in so much pain."
We have found that is it not unusual for people like Keith and Donna's friends to misunderstand the stages. Acceptance is not about liking a situation. It is about acknowledging all that has been lost and learning to live with that loss. It would be too soon for Keith to be able to accept this situation. He can acknowledge the reality of the loss, but it would be unrealistic to think he should have found some peace with it by then.
After closing arguments in the murder case, it took the jury only five hours to come back with a guilty verdict. The gang member who killed Alan was sentenced to life in prison, and Keith and Donna went back to their own lives.
Keith actually had a new loss to deal with, which was the emptiness he now felt without the trial to consume his time. It made the absence of his son's loss even louder.
We think it is important for people to understand that gradually, in your own time, you can begin to find some peace with what has happened. In situations such as murder, it is vital to understand we have a legal system, not necessarily a justice system. For some, the only justice would be to have their loved one back. Acceptance is a process that we experience, not a final stage with an end point.
For Keith, no one else could know how much acceptance he was capable of or how time would affect his process. After five years Keith felt he had found as much acceptance as was possible. Then he was notified that the shooter was up for his first parole hearing. Keith felt all his hard-earned acceptance drain out of him. By the time of the hearing he was once again filled with anger. The proceedings were brief and parole was denied. Keith was struck by how quickly it happened and by the tears of the shooter's father. For the first time, Keith realized there were victims on both ends of the gun.
Keith walked over to him and shook his hand. At that moment, something happened for Keith as his anger was replaced by a curiosity. He wanted to know what this other father's life was like and what led him to this same place. Over the next few years the two men formed an alliance to help gang members stop the violence and find their place in the world. They went from school to school in the inner city with their story.
Keith's acceptance was a journey that was deeper than he ever expected. And it happened over many years, not many months or days. Not everyone will or can fully embrace those who have hurt us, as Keith did, but there is always a struggle that leads us to our own personal and unique acceptance.
Keith's story is just one example of how, little by little, we withdraw our energy from the loss and begin to invest it in life. We put the loss into perspective, learning how to remember our loved ones and commemorate the loss. We start to form new relationships or put more time into old ones.
Finding acceptance may be just having more good days than bad. As we begin to live again and enjoy our life, we often feel that in doing so, we are betraying our loved one. We can never replace what has been lost, but we can make new connections, new meaningful relationships, new interdependencies. Instead of denying our feelings, we listen to our needs; we move, we change, we grow, we evolve. We may start to reach out to others and become involved in their lives. We invest in our friendships and in our relationship with ourself. We begin to live again, but we cannot do so until we have given grief its time.
Copyright © 2005 by Elisabeth Kübler-Ross Family Limited Partnership and David Kessler, Inc.
Meet the Author
Elisabeth Kübler-Ross, MD, [1926–2004] was a Swiss-born psychiatrist, humanitarian, and co-founder of the hospice movement around the world. She was also the author of the groundbreaking book On Death and Dying, which first discussed The Five Stages of Grief. Elisabeth authored twenty-four books in thirty-six languages and brought comfort to millions of people coping with their own deaths or the death of a loved one. Her greatest professional legacy includes teaching the practice of humane care for the dying and the importance of sharing unconditional love. Her work continues by the efforts of hundreds of organizations around the world, including The Elisabeth Kübler-Ross Foundation: EKRFoundation.org.
David Kessler is the coauthor of Life Lessons: Two Experts on Death and Dying Teach Us About the Mysteries of Life and Living. On his own, he is the author of The Needs of the Dying, which received praise from Mother Teresa and has been translated into eleven languages. He is a nationally recognized leader in the field of hospice and palliative care.
Most Helpful Customer Reviews
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I highly recommend that you read this book and that you give it to others, as personal circumstances "dictate." Kubler Ross is a legend in the field of grief counseling (she passed away within the last year) and Kessler brings remarkable humanitarian credentials of his own to the writing task. Their combined efforts results in producing a highly readable, compassionate, insightful, and useful book, nothing short of superb. The book is very humane and compassionate and "teaches with short, clear and concrete stories" that analyze some of the many possible surrounding circumstances that others have faced in losing loved ones. Potentially, we and the people we know could face such circumstances as well. In addition, with these stories, the authors provide relevant and insightful advice and the reasons for that advice.This book does a wonderful job of exploring the flood of emotions you feel after you lose someone.
After I lost my son, I searched through the grief section of barnes and noble and found this and other books. This book gave me a base of clarity and sense that helped me and is helping me through the process of grief. It is different for everyone, but for me this book helped a lot and I recommend it to all who are interested in this subject. Thanks to the authors.
A most excellent source for the grieving. It was as though someone tapped into my mind and with gentle but specific clarity, conveyed in words I could not, exactly what I was feeling, and explaining the why to my reactions to my loss. There is a process to grieving and it is not only natural but necessary to healing which allows us the ability to grow from our experience and continue to live with new strengths.
When my father died of aortic stenosis four years ago, I was devastated. I had not anticipated my loss to be felt as intensely, for my grief to be so deeply experienced, so raw and debilitating. Having been a Masters-degreed level social worker for 28 years I knew, however, that reading books about grieving, seeking out grief counseling and attending bereavement groups would be profoundly healing experiences for me. Dr Kubler-Ross's and David Kessler's book ON GRIEF and GRIEVING has been the sixth book I have read about grieving and it has been the most helpful. Their stating "we believe with all our hearts that even in death, our loved one still exists..and that "the body is just a coat, a suit of clothes that we wear during our lifetime...a shell, a cocoon..." helped me like you would not believe. I had suffered a great deal of guilt about not being as helpful and supportive to my father as I wish I could have been in his final days. The book touched my core by giving me permission to forgive myself, that regret is a part of loss and that "no matter how much you did for your loved one, how much you cared for them and loved them, there will always be something else." The book concludes that "the pain of loss is so intense, so heartbreaking BECAUSE in loving we deeply connect with another human being and grief is the REFLECTION of the connection that has been lost. Grief is the healing process that ultimately brings us comfort in our pain. That pain and our love are connected forever. To avoid the pain of loss would be to avoid the love and life we shared." I, therefore, STRONGLY recommend this book to ALL who grieve the loss of a loved one and have a need to be comforted. The Bible itself says "Blessed are those who mourn, for they shall be comforted." This book IS one of the ways that one can feel that comfort.
Not really about the stages, more about helping one realize some important truths by experiencing the grieving stories of others . Important truths that if you heard them you would say they are maybe obvious but after reading so many short stories of grieving you feel like you have permission to grieve. That it really is a sacred duty that is special and mundane at the same time.
My husband passed away almost two years ago unexpectedly while my mother was battling cancer and she died 7 months later. I read many different books on death and grief and dealing with it all. This was probably the one that made the most sense to me and I recommend it for anyone who has lost a love one and needs some reassurances.
This book was recommended to me by two different people. I read several books on grief during a difficult time, and this was the best one. I bought another copy to give to my father in law who recently lost his wife.
I lost my father 6/18/09 and my mother 8/16/09, both this summer. I wrote this to my daughter this morning, three weeks to the day of my mom's passing: "If you do pick up a book, make sure you share it with close ones around you since many will not grieve or mourn like we do and as you can already see, some want things to move forward quickly in order to move beyond these very painful and uncomfortable feelings. This book may help give them insight into your experience. Some lack empathy. Some probably want 'the old Christina' back but that is not to be. You are changed forever. On one hand, if 'they' don't want you to share this material with them or are not interested, then they probably don't factor in to your long term future but on the other hand, don't force the material either. Everyone does it differently and not always the way we want or would like or would expect. I highly recommend the Elisabeth Kubler-Ross book because she is the one who developed the original theory of 5 stages of loss. It's an easy read and you will see a lot of yourself there." Love, Dad
I just recently lost my brother in a tragic accident and have been struggling to find answers to unanswerable questions. Death is difficult enough and when it comes unexpectedly and tragically it adds another painful dimension that's hard to fathom. This book provided me a strong sense of comfort by detailing the experiences and struggles of many that have already gone down this path. This book is a must for anyone who has lost a dear one. To know that we are not alone in this inevitable life experience is comforting and I am grateful to the authors for their sage words of wisdom. I have come out of this stronger and with a more compelling sense of living.
I just cannot tell you how helpful this book was in assisting through my early grieving period after losing my daughter to breast cancer. I didn't understand why I felt so bereft but after reading the first couple of chapters, I understood that this was normal. I am buying this book for others to read when they lose a loved one. It was a lifesaver for me.