Loss, Grief, and Bereavement (cont.)
What are the signs, symptoms, and stages of grief?
Perhaps the most well-known model for understanding grief was developed by
Elisabeth Kübler-Ross, MD, in her 1969 book titled On Death and Dying. The five
stages that she outlined are
- denial,
- anger,
- bargaining,
- depression, and
- acceptance.
She described the stage of denial as the bereaved having difficulty
believing what has happened, the anger phase as the survivor questioning the
fairness of the loss, the bargaining stage as wishing to make a deal with fate
to gain more time with the one who was lost, the depression stage as the period
when the bereaved person gets in touch with how very sad they are about losing
their loved one, and acceptance as feeling some resolution to their grief and
more ability to go on with their own life.
Kübler-Ross apparently felt these phases can be applied to any significant
personal loss (for example, of a job, relationship, one's own health, anticipating one's
own death), including the death of a loved one. It also seems that she believed
these stages don't all have to occur, can take place in different order, and can
reoccur many times as part of an individual's specific grief process. Other
grief experts understand the grief process as taking place in seven stages,
including
- shock or disbelief,
- denial,
- bargaining,
- guilt,
- anger,
- depression, and
- acceptance/hope.
The shock or disbelief stage is understood as the numbness
often associated with initially receiving the news of the death of a loved one.
The guilt stage of grief refers to feelings of regret about difficult aspects of
the relationship with the deceased.
In addition to the emotional pain already discussed, symptoms of grief can be
physical, social, or religious in nature. Physical symptoms can range from mild
sleep or appetite problems to heart attack. Social symptoms of bereavement include isolation from
other loved ones and difficulty functioning at home, school, and/or at work.
For children and adolescents, reactions to the death of a parent or other
loved one tend to be consistent with their reaction to any severe stress. Such
reactions usually reflect the particular developmental stage of the child or
adolescent. For example, since infants up to about the age of 2 years cannot
yet talk, their reaction to the loss of a loved one tends to involve crying and
being more irritable. They further show physical symptoms of sleep or appetite
problems, changes in activity level, and being more watchful of (vigilant
toward) their surroundings. Since preschoolers from the age of 3 to 5
years old begin to be able to remember the one who died but have not yet
developed the ability to understand the permanence of death, they may believe
they somehow magically caused the death and can make the person come back. In
addition to showing signs of grief that are similar to infants, they may have
more difficulty separating from caregivers. Early school-aged children, from 6
to 8 years old, more likely understand that death is permanent compared to
younger children, often feel guilt about the death of the loved one, become
preoccupied with memories about the departed, and try to master the loss they
have suffered by talking about it frequently. While symptoms of grief in
school-aged children from
9 to 11 years old are quite similar to those of early
school-aged children, this older group is more vulnerable to a decrease in self-esteem because they feel different from their peers if they have experienced the
loss of a loved one. They are also more likely to defend against their feelings
of loss by becoming engrossed in school, social, and/or extracurricular
activities. In keeping with their budding need for independence, young
adolescents 12 to 14 years of age may experience mixed feelings about the
deceased individual and exhibit a wide range of emotions. They may avoid talking
about the loss. Older teens usually experience grief similarly to adults,
enduring sadness, anxiety, and anger. They are more likely to deny their
feelings of loss to parents but discuss them in detail with peers. For children,
adolescents, and adults, as with any major stress, grief may cause a person to
regress emotionally, in that they go back to former, often less mature ways of
thinking, behaving, and coping.
Symptoms of complicated grief include intense emotion and longings for the
deceased, severely intrusive thoughts about the lost loved one, extreme feelings
of isolation and emptiness, avoiding doing things that bring back memories of
the departed, new or worsened sleeping problems, and having no interest in
activities that the sufferer used to enjoy. Teens tend to react to the loss of a
loved one that died through suicide similarly to the ways in which adults
experience complicated grief.
Regardless of age, individuals who lose a loved one from suicide are more at
risk for becoming preoccupied with the reason for the suicide while wanting to
deny or hide the cause of death, wondering if they could have prevented it,
feeling blamed for the problems that preceded the suicide, feeling rejected by
their loved one, and stigmatized by others.
Next: How is grief assessed? »
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