What Are The Five Stages Of Grief, And Does Everyone Go Through Them?
While there are many ways of discussing the process of grieving following a significant loss, the most well-known might be the “five stages of grief.” Originally described by psychiatrist Elisabeth Kübler-Ross, the five stages generally describe several common emotional responses to bereavement or terminal illness. Misconceptions surrounding the stages of grief can be common, leading many people to worry that their experience of loss and sorrow is somehow abnormal or pathological. What can psychology tell us about the grieving process, and where do the five stages fit in?
The five stages of grief, as typically described, are denial, anger, bargaining, depression, and acceptance. While these tend to be common reactions to a painful loss, there’s little evidence that everyone goes through them or that people experience them in a linear fashion. Instead, emotions surrounding grief are often complicated and hard to predict. Adapting to loss doesn’t necessarily require progressing through a distinct set of stages. Developing effective coping strategies and finding meaning in a life impacted by loss may be more important for moving forward. If you’re struggling to move through grief on your own, you may find it helpful to work with a licensed mental health professional.
Defining the five stages of grief
The five stages of grief are often referred to as the Kübler-Ross model, named after Elisabeth Kübler-Ross, the psychiatrist and grief researcher who first outlined them in her 1970 book On Death and Dying. This work describes her observations of the emotional reactions experienced by patients diagnosed with terminal illnesses. In subsequent works, she and her co-author David Kessler expanded this model to encompass other forms of loss, such as divorce, bereavement, job loss, and displacement.
The Kübler-Ross model groups reactions to these events into five distinct categories, as discussed below.
Stage 1: Denial
The first grief stage postulated by this model typically involves a refusal by an individual to accept what has happened or is happening. In the case of a deadly disease, they might insist that the diagnosis can’t be correct. The person may also try to avoid thinking or talking about the loss and go about their life as if nothing has changed.
Denial may help a person avoid severe negative emotions and carry on with life in the short term. However, research suggests that persistent denial is one of several forms of avoidance that can increase the risk of depression following bereavement.
Stage 2: Anger
During the proposed stage of anger, a bereaved or dying person may feel angry at many different people or things associated with the loss. They may be mad at themselves, friends and family members, doctors who couldn’t prevent the loss, or larger forces or powers, such as God, fate, and the natural world.
Anger can be an understandable and natural reaction to the emotional pain of a major loss. Persistent or excessive anger can put a person at risk for psychological illness, though, especially self-directed anger.
Stage 3: Bargaining
The bargaining phase is said to involve vows to make positive changes if the loss is somehow reversed or negated. This could take the form of explicit prayers to a higher power involving promises of better behavior, but it might also involve fantasies or imagined scenarios.
For example, a person might imagine waking up to find that their spouse’s death was a bad dream. They might mentally resolve to appreciate their loved one more and treat them better as a result.
Stage 4: Depression
This stage is typically said to involve a variety of negative emotions, including depression, sadness, and apathy. In general, the person is no longer trying to negate what’s happened, but they also may not see how they can keep going in the wake of their loss.
While these emotions may resemble those experienced in clinical depression, research suggests that there tend to be significant differences between the symptoms of major depressive disorder and the features of typical grieving. Pathological symptoms of depression may be more intense, debilitating, and consistent, with a greater sense of hopelessness, self-blame, and despair.
Stage 5: Acceptance
The acceptance stage doesn’t necessarily indicate that a grieving individual no longer feels upset about their loss. Instead, it’s usually meant to denote that the person has integrated the experience into their life story and is attempting to move forward with their new reality.
Is there a sixth stage of grief?
David Kessler, a psychiatrist who helped Kübler-Ross update and expand on the five-stage model, published an updated work in 2019 entitled “Finding Meaning: The Sixth Stage of Grief.” This book suggests that there’s an additional phase of grief in which an individual reconstructs their understanding of their life’s meaning and purpose following the often-devastating effects of loss. This may involve reflecting on lessons learned from bereavement, reaffirming core values, and finding ways to honor those you’ve lost.
Limitations and misunderstandings of the five stages of grief
Instead, many bereaved people alternate repeatedly between psychologically healthy responses, such as acceptance, and maladaptive feelings, such as denial and anger. You might jump between one “stage” and another several times a day and bypass other stages altogether.
Treating the five stages of grief as a checklist that must be completed to achieve healing after a loss can cause unnecessary confusion and distress. People may worry that they’re not “grieving correctly” if they don’t encounter one or more of the stages, or if they go through them “out of order.” They may regard their natural responses to bereavement or misfortune as unhealthy, potentially leading to attempts to suppress their feelings instead of accepting and working through them.
The five stages model may also push some people into adopting potentially maladaptive grief coping strategies out of a belief that they’re necessary. For instance, dwelling on angry thoughts because you believe it’s important to express anger might increase the risk of prolonged, excessively distressing grief.
Finding value in the five stages model of grief
Despite the potential downsides discussed above, the five-stage model of grief may be helpful if it resonates with your experience of loss. Understanding that processes like bargaining and denial can be natural responses to bereavement may help you contextualize them as part of how your mind is coming to terms with what’s happened. You may get the most out of the Kübler-Ross model if you view it as a description of some common (but not universal) thoughts and feelings that can arise during the grieving process.
For example, the following quote from Kessler on the “anger” stage may help readers understand the psychological function of rage following bereavement:
“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.”
Thinking about what purposes your seemingly irrational emotions could be serving in your time of grief may help you process them more effectively.
Adaptive ways to cope with grief
Research on the kinds of coping mechanisms employed by people who’ve lost someone close to them has identified several types of strategies that appear to support better mental health outcomes. Adopting these strategies may reduce your chances of developing prolonged grief disorder, a condition in which intense negative feelings following a loss persist for a long time and severely impact your well-being and ability to function.
Potentially helpful coping mechanisms include the following:
- Acknowledging and reflecting on your emotional responses rather than trying to push them aside
- Proactively seeking support from those close to you when grief is particularly hard to manage
- Engaging in active coping efforts, such as adopting emotion regulation techniques, practicing self-care, and seeking therapy
- Finding meaning in life after loss through methods like reflection on life, sharing stories of the deceased, and engaging in spiritual practices you find meaningful
In contrast, attempts to cope with grief that involve dwelling on the circumstances of your bereavement or surrounding yourself with reminders of who or what you’ve lost can be counterproductive. While it may be unhealthy to avoid thinking about or acknowledging your feelings, focusing too much on the newfound absence in your life can also exacerbate negative mental health symptoms.
Getting professional help to manage feelings of grief
Psychotherapeutic methods like cognitive behavioral therapy may be useful for developing healthy coping strategies and working through your emotions. This approach may protect against psychological illnesses like depression.
Many people seek help online when looking for therapy in person seems overwhelming. Online psychotherapy platforms can connect you with licensed mental health professionals who suit your preferences and needs, which can increase your chances of finding a therapist with whom you can work effectively.
Internet-based therapy can often have beneficial effects on mental health. While there’s not yet much research on the use of online treatments for grief, a 2021 analysis of existing studies found evidence that internet psychotherapy could produce significant reductions in symptoms of depression and post-traumatic stress disorder in grieving individuals.
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