Naturally, we all want to believe that nothing bad can happen to us. In the subconscious part of our mind, we might even believe we are immortal. In 1969, a Swiss psychiatrist, Elisabeth Kübler-Ross in her book, “Death and Dying,” described the five stages of coping with the final days of life.
The findings in the book, described the stages people go through when they learn that they (or a loved one) are dying. These stages include:
Over the years, different school of thought have criticized the Kübler-Ross model of the 5 stages of grief.
This was because people studying her model mistakenly believed this is the specific order in which dying people grieve and that everyone in their final days of life go through all stages.
Kübler-Ross however, noted that, the five stages of grief are unique for each person facing loss, illness, or death.
For this reason, not everyone experiences the 5 stages of grief. And in the same vein, those who experience these 5 stages, do not all follow the stages in a linear pattern.
Kübler-Ross and the Five Stages of Grief
It is natural for a person diagnosed with a terminal illness to enter a stage of denial and isolation. Some people out right disbelieve what the doctor is saying. You should always seek out second and third opinions when your life is of concern.
Some people may even demand a new set of tests, with the belief that the results of the first one were false. Other people may isolate themselves from their doctors and will refuse any further medical treatment for a while.
This stage of denial does not usually last long. Soon after entering it, many people in their final days of life begin to accept their diagnosis as reality. Hence, the patient may come out of isolation and finally resume medical treatment.
Some people, however, will use denial as a coping mechanism. They will use it long into their illness, through their final stages of life and even to their death. An extended denial is not always bad, because it does not always bring increased distress.
However, once the denial and shock start to fade, the start of the healing process begins. But at this point, those feelings, once suppressed, begin to resurface.
Anger is the stage where the bottled-up feelings of the previous stages of denial are released. In this stage, lots of frustration and yelling get released from the grief patient to anyone who happens to be in the way.
Nurses and doctors get yelled at in the hospital and family members are greeted with little enthusiasm. Strangers may even receive a dose of the yelling act of anger.
It is vital to understand where this anger proceeds from. A person in his final days of life may watch TV and see people laughing and dancing and become angry. These scenes portray reminders, showing their inability to do any of those things anymore.
When you are experiencing a grief event, you might feel disconnected from reality. You might feel life has shattered and there is nothing solid to hold on to.
However, think of anger as a strength to bind you to reality. See it as something to grasp onto – a natural step in healing.Throughout life, people in their final days of life experience many instances of grief. Kübler-Ross identified these five areas of our common grief stages.
When something bad occurs, have you ever caught yourself making a deal with God?
Something like, “Please God, if you just save me from this mess, I will be an exceptionally good person. In fact, I will never lie or doubt you again.”
This is bargaining. In a way, this stage of grief is false hope.
For example, you hear people say, “If you change this, I’ll change that.” At this stage, the patient is so desperate to get things and life back to its formal state.
For this reason, an endless amount of “what if” statements begin to pop up. Statements like, “What if I left the house 10 minutes sooner, maybe the accident may not have never happened”.
What if I encouraged him to go to the doctor three months ago like I first thought – maybe the cancer would have been discovered earlier and he could have been saved.
After experiencing many of these types of thoughts, not knowing what to do next, a patient might falsely make himself believe he can avoid the grief with a type of negotiation. A negotiation that favors him.
The implied desire indicates that they would not ask for anything more if only their pleas for this disastrous condition to be reversed could be granted.
However, the grief patients who enter this stage quickly learn that bargaining does not work. For this reason, they inevitably move on (usually to the depression stage).
Depression is a form of grief commonly accepted by everyone. It portrays the emptiness people feel when they are living and realize the person or situation is gone or over.
Kübler-Ross explained that there are really two types of depression in this stage. The first depression which she called “reactive depression” happens as a reaction to past and current losses.
The second type of depression she termed as “preparatory depression.” At this stage, a person must deal with the impending future loss of anything and anyone they love.
Many persons usually spend this time of grieving in quiet thought, as they prepare themselves for a complete loss.
In this stage, the person might withdraw from life, live in a fog, feel numb and not want to get out of bed.
Sometimes, people at this stage do not even want to be around others or talk to anyone. And in worst case scenarios, may even contemplate suicide. But if they can move past that point in their stages of depression for the final stages of life, then they can also gradually move toward the final stage – acceptance.
The last stage of grief identified by Kübler-Ross is acceptance. Of course, it is not meant in the sense that “it’s okay I lost my husband” rather, “I lost my husband, but I’m going to be okay.”
In this stage, the grieving patient’s emotions may begin to stabilize. They may appear to be coming back to a sense of reality and normality.
Here, the patient comes to terms with the fact that the “new” reality is true. For example, they may begin to have an acceptance that a lost loved one will never come back to life or begin to accept that to a deadly illness is upon them or their loved one and that person may be in their final stages of life.
However, they may start to feel okay about all of this and more levelheaded.
The acceptance stage does not mean bad days will never come again – days where you are uncontrollably sad. Instead, it focuses on the fact that good days will outnumber the bad days.
In this stage, a grieving patient may lift from his fog, start to engage with friends again, and even make new relationships as time goes on.
The person understands that his loved one can never be replaced, yet move, evolve, and grow into your new and better person.
Grief and Bereavement Counseling
Grief can be caused by situations, relationships, or even substance abuse.
A wife may grieve the death of her husband, children may grieve a divorce, a teenager might grieve the ending of a relationship, etc. Similarly, a person who receives terminal medical news can begin to grieve and plan their final days of life.
It is important to remember that some people will experience all the stages. Others, however, will not experience the stages in a linear order and some may not even experience it at all.
In the same manner, some people who are diagnosed with life-ending illnesses or injuries may experience only a few of the stages and others may simply get stuck in one and never move forward.
The most important thing is to ensure that a person in his last days of life is properly helped to deal with grief. Provide all the support you can: Seek counseling. Ask a professional.
Do whatever you can to help them work through the steps of grief normally found in the final days of our lives and to understand that the time they have left is best used in a positive manner than taking an opposing position.
Acceptance is key and at Ameri Prime Hospice, we can work with patients who are struggling or going through these stages of grief. As always, we are here for you. If we can be of any help at all – we are ready to assist you.