Are there really five stages of grief?

by Russell Friedman for griefrecoverymethod.com

Many years ago Elizabeth Kubler-Ross wrote a book entitled On Death and Dying. The book identified five stages that a dying person goes through when they are told that they have a terminal illness. Those stages are: denial, anger, bargaining, depression, and acceptance. For many years, in the absence of any other helpful material, well-meaning people incorrectly assigned those same stages to the grief that follows a death or loss. They simply called them the 5 stages of grief. Although a griever might experience some or all of those feeling stages, it is not a correct or helpful basis for dealing with the conflicting feelings caused by loss.

Are there really 5 stages of grief?
It is our experience that given ideas on how to respond, grievers will cater their feelings to the ideas presented to them. After all, a griever is often in a very suggestible condition; dazed, numb, walking in quicksand. It is often suggested to grievers that they are in denial. In all of our years of experience, working with tens of thousands of grievers, we have rarely met anyone in denial that a loss has occurred. They say “Since my mom died, I have had a hard time.” There is no denial in that comment. There is a very clear acknowledgment that there has been a death. If we start with an incorrect premise, we are probably going to wind up very far away from the truth.

What about anger? Often when a death has occurred there is no anger at all. For example, my aged grandmother, with whom I had a wonderful relationship got ill and died. Blessedly, it happened pretty quickly, so she did not suffer very much. I am pleased about that. Fortunately, I had just spent some time with her and we had reminisced and had told each other how much we cared about each other. I am very happy about that. There was a funeral ceremony that created a truly accurate memory picture of her, and many people came and talked about her. I loved that. At the funeral a helpful friend reminded me to say any last things to her and then say goodbye, and I did, and I’m glad. I notice from time to time that I am sad when I think of her or when I am reminded of her. And I notice, particularly around the holidays, that I miss her. And I am aware that I have this wonderful memory of my relationship with this incredible woman who was my grandma, and I miss her. And, I am not angry.

Although that is a true story about grandma, it could be a different story and create different feelings. If I had not been able to get to see her and talk to her before she died, I might have been angry at the circumstances that prevented that. If she and I had not gotten along so well, I might have been angry that she died before we had a chance to repair any damage. If those things were true, I would definitely need to include the sense of anger that would attend the communication of any unfinished emotional business, so I could say goodbye.

Unresolved grief is almost always about undelivered communications of an emotional nature.
There are a whole host of feelings that may be attached to those unsaid things. Happiness, sadness, love, fear, anger, relief, and compassion are just some of the feelings that a griever might experience. We do not need to categorize, analyze, or explain those feelings. We do need to learn how to communicate them and then say goodbye to the relationship that has ended.

It is most important to understand that there are no absolutes. There are no definitive stages or time zones for grieving. It is usually helpful to attach feeling value to the undelivered communications that keep you incomplete. Attaching feelings does not have to be histrionic or dramatic, it does not even require tears. It merely needs to be heartfelt, sincere, and honest.
Grief is the normal and natural reaction to loss.

Grief is emotional, not intellectual. Rather than defining stages of grief which could easily confuse a griever, we prefer to help each griever find their own truthful expression of the thoughts and feelings that may be keeping them from participating in their own lives. We all bring different and varying beliefs to the losses that occur in our lives, therefore we will each perceive and feel differently about each loss.

QUESTION: Is there some confusion between anger and fear as they relate to The Grief Recovery Method?

ANSWER: A primary feeling response to loss is fear. “How will I get along without him/her?” Anger is one of the most common ways we express our fear. Our society taught us to be afraid of our sad feelings, it also taught us to be afraid of being afraid. We are willing to say “I am angry, rather than saying “it was scary.” It is possible to create an illusion of completion by focusing on the expression of anger. Usually anger is not the only undelivered feeling relating to unresolved grief.

Difference Between Hospice & Palliative Care

Hospice and palliative care both offer compassionate care to patients with serious illnesses, but they are not interchangeable. Palliative is always a component of hospice care, but palliative care is also a separate specialty.

Definitions
Palliative care focuses on relieving symptoms associated with the patient’s condition, for example pain, nausea and constipation. Hospice takes a holistic approach and addresses the patient’s physical, emotional and spiritual needs.

Timing

Hospice is reserved for terminally ill patients when treatment is no longer curative. Patients can receive palliative care while they continue to undergo active treatment for their condition.

Treatment

While in hospice, patients receive medications necessary to relieve pain and other symptoms, but they do not receive treatment for their condition. Patients may continue to receive regular treatment while receiving palliative care.

Prognosis

Patients enter hospice when they have a life expectancy of 6 months or less. Patients with serious illnesses may receive palliative care at any time, regardless of their prognosis, according to the American Cancer Society.

Emotional Care

Palliative care focuses on making the patient comfortable. Hospice, as part of treating the whole patient, also offers mental health and spiritual counseling. Hospice also offers counseling and bereavement services for family members.

When to Start Hospice Care

The time to begin hospice care is a difficult and personal choice. Hospice care often involves an individual or family choosing to decline receiving further treatments that might cure an individual and instead begin focusing on making a person comfortable and as pain-free as possible. The right time to start hospice care is something only a family and an individual can determine. Although doctors and health-care professionals might give advice, the decision is ultimately not up to them.

Considerations
Although people often put off hospice care until the final few weeks or days of care, there are advantages that can be gained from using hospice care earlier.

For example, a patient who enters hospice care earlier has the opportunity to make use of the pain and symptom management practices that hospice care can offer.

Similarly, a family that chooses hospice care for a loved one is able to transfer some of the responsibility for day-to-day care to the hospice team instead of doing it themselves. This allows the family to focus more on enjoying time with the patient than on caring for the patient.

This does not mean that you cannot do some of the things to care for a loved one that you have previously done. If you and the hospice patient have a certain activity or exercise that you do to bond, there are things that can still be done together. Simply let the hospice care team know what these activities are. Comfort is at the core of hospice care. Hospice care teams will work to make sure that both families and patients are comfortable with the delegation of duties.

An earlier decision to elect for hospice care can also be advantageous because it allows the family and the patient more time to become comfortable with a hospice care worker. The better a family and a patient knows a hospice care worker, the more comfortable the patient will be when he ultimately reaches his final few days. Having this initial relationship is also advantageous because everybody is more comfortable with one another when more intimate and intensive care is needed from the hospice staff.

Time Limits
In general, there is a six-month rule for people to use hospice care. This rule states that those who are terminally ill and are expected to live for six months or less are welcomed into hospices. One of the main reasons for the six-month rule is because Medicare has set this as a timetable for which it and other insurers cover hospice care.

There are situations when a person’s condition starts to deteriorate quickly in which people can be allowed into hospice programs more quickly. Once a person is admitted into hospice, he can stay until the time of death–even if death ultimately doesn’t come until years after being admitted. Patients who get better while in hospice can leave hospice care if they choose.