‘Like Being in an Ocean’: The Many Stages of Grief

‘Like Being in an Ocean’: The Many Stages of Grief

‘Like Being in an Ocean’: The Many Stages of Grief

By Lisa Marshall

Source: WebMD

Around 2 a.m. on April 28, 2016, Cathy Semeria made a call no mother should ever have to make.

Her son Nick had been awoken by a friend with troubling news of a fatal crash the night before that involved five University of Georgia students — possibly including his sister Christina. Nick urged his parents to call Athens Regional Medical Center near where she went to school. Hands shaking, Cathy dialed the number.

“I said, ‘You just need to let me know that my daughter is OK,’” she recalls. “There was total silence on the other end.”

She threw the phone at her husband and collapsed in disbelief.

In the coming days, as news unfolded about the accident that killed 19-year-old Christina Semeria and three friends and left another critically injured, Cathy waded through waves of shock and daze. At first, she couldn’t cry. “Was that normal?” she asked herself. Six weeks later, she started crying and couldn’t stop.

Today, she has found solace in her community, and through carrying on “Tini’s” legacy via social media. But when a friend of her daughter — the youngest of her four children — gets married or graduates from college, the pain pulls Cathy under again.

“Grief is like being in an ocean and you don’t know when a wave is going to hit you, or how high it is going to be, or how long you are going to get caught in the riptide,” she says.

While Cathy’s journey may sound familiar to some, it is — new research suggests — wholly her own.

Fifty years after psychiatrist Elisabeth Kubler-Ross introduced the now iconic five stages of grief — denial, anger, bargaining, depression, and acceptance — scientists in the growing field of bereavement research say it’s not so simple.

Grief changes the body in different ways, too: People who grieve longer have different brain activity, different hormone patterns, and a higher risk of bereavement-related health problems.

“There has been this idea in the past that grief proceeds in the same somewhat lockstep sequence for everyone,” says  David Feldman, PhD, a professor of counseling psychology at Santa Clara University in California. “We now know it just doesn’t work that way. People often attack themselves for doing grief wrong when, really, we are all entitled to our own way.”

The Truth About the Five Stages

David Kessler, who co-authored several books with Kubler-Ross, says her work has been “widely misunderstood.”

He says that when she introduced the stages in the 1969 book On Death and Dying, they were intended to describe the emotional process of a dying person at the end of life.

In 2004, On Grief and Grieving, by Kessler and the late Kubler-Ross, was published. The book formally adapted the stages to the bereaved, and the authors included an often overlooked notice on Page 1.

“We explained that they are tools to help us frame and identify what we may be feeling, but they are not stops on some linear timeline,” Kessler says.

That said, he still uses the stages in his workshops and on his website,, to describe what many go through.

Denial, which sometimes shows up as shock, helps us pace our grief, he says, letting in only as much pain as we can handle. Anger is “pain’s bodyguard,” letting have connections without being too vulnerable.

“A connection made through the strength of anger feels better than nothing,” he says.

Bargaining helps us make a plan to climb out of grief — we’ll volunteer in our loved one’s name or vow to live our own lives more fully. Depression is a given, he says, once we let the reality of the loss sink in.  Then there is acceptance.

“Not everyone goes through all the stages, and they are not in any prescribed order,” he stresses.

The Broad Spectrum of Grief

George Bonanno, PhD, a professor of clinical psychology at Teachers College at Columbia University, says he has seen no evidence that these stages are universal among the grieving and, in fact, the five-stages theory has in some ways done more harm than good.

“In the ’90s, the idea was that everyone must go through this painful, elaborate working-through process, and if they didn’t, either they didn’t care about the person or they were in denial and needed treatment,” he says. “A lot of people were getting treatment when they really didn’t need it.”

In one groundbreaking study of 205 widows and widowers, he found 46% showed little depression, intense yearning, or longing in the 18 months after the death of their spouse. Ten percent actually had improved mental health, as the chronic stress of caregiving subsided. Another 2015 study — of 2,512 people who had lost spouses or children — found that 69% were “resilient,” having little depression at three follow-up time points.

As Bonanno writes, “These individuals are not cold and unfeeling or lacking in attachment but, rather, are capable of genuine resilience in the face of loss.”

On the other end of the spectrum is complicated grief, also known as prolonged grief disorder.

“Imagine feeling the way you felt in the early days after a friend or family member died, only it is years later,” says Katherine Shear, MD, founding director of the Center for Complicated Grief at the Columbia School of Social Work.

About 7% to 10% of the bereaved struggle with it, but it’s more common among those who have lost a loved one to homicide, suicide, or other violent incident. About 24% of parents who have lost children and 23% of military families have it.

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