Our grieving is as individual as our lives.”

Elizabeth Kubler-Ross, M.D.

Joan Didion’s Story

After suddenly losing her husband John, the author Joan Didion eventually wrote the book, “The Year of Magical Thinking.” She describes that in the first several months her thoughts became “magical.”

She is convinced that if she could reverse time and had said or done something differently, she could have changed the outcome and prevented John’s death (sounds like bargaining). Although she states that “to the average observer I would have appeared to fully understand that death was irreversible,” she could not give away her husband’s shoes because he would need them when he returned.

Her memoir illustrates poignantly how grief affected her, disconnecting her from reality and making her feel vulnerable. Grief, she says, is “a place none of us know until we reach it.” All the bits and pieces of her story are shared with honesty, humor and love.

Although grief is a universal experience, how it impacts each of us is incredibly personal and unique. It has been described as “where love used to be.” It is the response and the impact that losing a loved one has on the family and friends left behind.

Many variables can influence our grief: the relationship with the person who died, how the person died, our coping strategies, cultural background, religious beliefs, previous losses, and the list goes on.

Is there such a thing as “normal” grief? Author and grief counselor David Kessler emphasizes that there is no one way or right way to “do” grief and that there are no rules. With time, we are often told our grief will heal, but how much time? Actually, it is a process with no final outcome and no timeline. It has been estimated by some that it can take at least a year or even longer for grief to lessen and for the individual to reach not normal, but maybe a “new normal.”

Some may keep their grief quietly inside, and others may be open and share it. Either way can work, but talking about it tends to be helpful and is encouraged with grief work.

A person who is grieving may find that their energy level and mood can fluctuate day to day. This variation in intensity and duration of emotions can feel like a roller coaster. Certain sounds, songs, smells, or memories can trigger intense and sometimes unexpected sadness. These experiences have a name – grief bursts – and they can occur indefinitely.

Grief can also lead to physical symptoms with changes in appetite, difficulty sleeping, difficulty concentrating, restlessness, and it can even weaken the immune system. Taking good care of one’s health is especially important during this time.

Dealing with death and dying may deepen the faith of some and reinforce their beliefs. Others, depending on the circumstances, may begin to question their religious or spiritual backgrounds. Cultural rituals and customs practiced before, during and following a death can offer structure and support to a grieving family.   

Based on her experience, the psychiatrist Elisabeth Kubler-Ross was the first to describe five stages of grieving. The first stage is denial and, as the reality begins to sink in, this is followed by the second stage, which is anger. This anger might be directed at oneself, the person who died, the circumstances or even God.

The third stage she outlines is bargaining, and here the individual is still trying to hope for and picture a different outcome. For example, “if only I had insisted on a second opinion, this would never have happened.” The fourth stage is depression, when the reality of the loss is truly settling in.

Kubler-Ross’ fifth and final stage is acceptance. This acceptance does not ignore the loss, but it reflects the ability to realign expectations and begin to look to the future.

Recently, David Kessler M.D. suggested adding a sixth stage, defined as “finding meaning.” He states that this is “where the healing often resides.” It may include feelings of gratitude for the love shared, lessons learned through the experience, or finding ways to honor and commemorate a life well lived.

Not everyone will experience these stages or do so in any particular order. They provide a framework for identifying many of the feelings associated with grief, despite the fact that there is no typical or predictable response to loss.

When a death is expected, perhaps with a prolonged illness, grieving may start even before the death, and this is called anticipatory grief. It is often unrecognized and rarely discussed. This is a normal reaction and can be another part of the grief process. The emotions that are felt are quite similar to those experienced after a death. It might not feel right to be mourning someone who is still among the living, but anticipatory grief may provide motivation to address unfinished business, say good-bye or thank you.    

Repeatedly, experts in the field of grief work recommend that whatever emotions come up — feel them all. It is OK to fall apart and then begin the slow process of healing. “Grief is Hard Work” will be the title of Part II in this series and will discuss recommendations and resources for coping with loss and grief.   

Bonnie Evans, RN, MS, GNP-BC, lives in Bristol and is a geriatric nurse practitioner and End of Life Doula. She can be reached at bonnie@bonnieevansdoula.com.