Understanding the stages of grief

Question:

Our family is reeling from my father’s recent terminal cancer diagnosis. The nurse told us that we’d go through different emotional stages of handling my father’s end-of-life care. I’d like to get a better understanding of those stages. Can you help?
 

Answer:

None of us is truly prepared for what we’ll feel and do when a loved one is given a life-ending diagnosis. Even the life of a beloved centenarian feels short under these circumstances. But it does help to know how to navigate your own emotional journey.
 

Your father’s nurse was likely referring to the most well known description of what people feel when they are confronted with a life-ending illness. In her groundbreaking book “On Death and Dying,” psychiatrist Elizabeth Kubler-Ross introduced what is now known as the five stages of the grief cycle – or five stages of loss. Grief also is a psychological response to death, as well as other emotional trauma such as divorce, loss of job or a major catastrophe.
 

Your family, your father and you will likely go through one or all of these stages – and each at your own pace. Kubler-Ross never meant for the stages to be taken literally; we don’t go through them step by step or in the order she presents them. Some of us move in and out of various stages, some remain trapped in one, others revisit them, and some might skip stages altogether. But all in all, her model provides a worthy guide based on years of study and experience that might help you better understand and appreciate the barrage of emotions coming your way.
 

Kubler-Ross’ model is sometimes referred to by the acronym DABDA, which stands for denial, anger, bargaining, depression and acceptance. Here’s how a person’s emotions play out when coping with grief, according to her model:
 

Denial: “I’m OK. This really isn’t happening to me.” Denial is a natural reaction to information that’s catastrophic and life-changing. It’s the mind’s buffer to a terrible reality allowing you a “time-out” and a chance to re-group. Because the reality can’t be escaped when it comes to dying and death, it serves as a temporary defense against an impending crisis.
 

Anger: “Why me? It’s just not fair!” The mere act of asking this question signals that an individual is no longer in denial. But the reality makes the person angry, volatile and upset. The person might displace anger by finding fault with others, act out against any form of treatment or turn inward and blame him or herself. You’ll need to be understanding and allow your loved one to vent anger without taking it personally. It’s a trying stage for everyone.
 

Bargaining: “If I make amends or do something good, then maybe I can buy more time.” This stage starts with an internal conversation with whomever the person believes is his or her God or higher power. The hope is that if certain favorable actions are taken, the reward will be more time or beating the odds of dying altogether. It’s not uncommon for the bargaining to be linked to surviving long enough to attend a significant life event such as a daughter’s wedding, the birth of a grandchild or the completion of a major project.
 

Depression: “I’m so incredibly sad. Why go on?” During this stage, the dying person begins mourning his or her own death and the loss of all he or she knows. Some experts refer to this as “anticipatory grief.” Regret, fear, crying and wanting to be alone are all psychological responses that can be expected. It is a heartbreaking, necessary process and not something you can simply treat with cheerful encouragement.
 

Acceptance: “It’s my time, and I’m OK with it.” Reaching this stage is expressed in as many ways as there are fingerprints. But underneath it all is a deep sense of having come to terms with one’s mortality. For some, it might take the form of a sense of peace and calm, while others see it as their fate and see no reason to fight it. It’s not unusual for the dying person to reach this stage long before his or her family members. As a result, it might appear to those who are still struggling that their loved one has become emotionally detached.
 

It’s not surprising that such a daunting, life-changing event leads to such a wide range of emotions, and why it’s so unlikely that you and your family will be on the same page throughout the process. Many liken it to a roller-coaster ride and there’s no getting off. Be patient with one another. If someone is angry, let the person express it, and don’t take it personally. If another is in denial, let the person remain in the “unrealistic” cocoon until he or she’s ready to cope with the harsh reality that lies ahead. Grieving is natural. Don’t suffocate it by avoiding the sadness and pain that comes with loss.
   
Hospice care can be a compassionate and learned resource for all of you. Be sure to seek it out.