Table 5. Five Stages of Grief: Denial Anger, Bargaining, Depression, and Acceptance Stage Characteristics Denial • Frozen with shock or overcome with numbness.
• Unconscious ability to manage strong emotions and feelings by slowly feeling them (this is a survival technique). • Feelings of grief varied to prevent mental overload (protection). • Nature’s way of letting in only as much as we can handle. • Does not have to make sense or be rooted in reality (also has no limits). • Anger surfaces once you are feeling safe enough to know you will probably survive what comes. • Needed for healing to process. • May be reoccurring visits with this emotion. • Can lead to an uneasy or hateful feeling toward spirituality/religion. • Contrary to its negative connotations is the strength it contains to solidify the idea of void and loss. • Difficulty in feeling it without causing damage to self or someone else. • Finding avenues of release such as exercise can help externalize and explore anger (decreases the chance of bottling it all up for a explosion). • Is an indication of the intensity of love.
Anger
• Is a normal response to the unfairness of life and death. • Anger towards self is guilt; however, it is undeserved blame. • “Anger affirms that you can feel, that you did love, and that you have lost.” (Kübler-Ross & Kessler, 2005, p. 16)
Bargaining • Agreeing to anything to avoid loss prior to loss.
• Agreement to anything after a loss can look like a temporary truce. • Understand if lost in the darkness of “what if.” • Like anger, this stage can present guilt. • After a death, focus can futuristic. Depression This is a DSM-5 clinical diagnosis as well as a Kubler-Ross and Kessler stage. It will be talked about with DSM-5 criteria later. Clinic depression can lead to worsening mental health if left untreated: • Feelings of nothing and emptiness take over. • A normal response to major loss. • Can feel heavy (like hitting the bottom) and lonely. • A natural way to protect the body’s nervous system from overload by slowing it down or turning it off for processing. • A way toward healing. • Seeking a way out of depression can feel like being lost in a storm with no seeable way to escape (loss of hope). • Shift the view of depression from unwanted to invited (like a guest). • Allow the encounter with it even though it feels hard. • Use the opportunity to explore and renew self. • Society often seeks to rid someone of depression as quickly as possible. • Depression intervention can be necessary, but time can also heal if allowed an acceptable space. • Treating depression is seeking equilibrium. • View and feel sadness as an appropriate part of grief (balanced with quality of life and meeting needs). “Depression makes us rebuild ourselves from the ground up because it takes us to a deeper place in our soul that we normally would explore” (Kübler-Ross & Kessler, 2005, p. 24) Acceptance • Is not the notion of being all right or fine with what has happened (is about acknowledging all that has been lost and learning to that loss). • Healing looks like remembering–recollecting–reorganizing (RRR). • Not in a linear sequence; goal is not to arrive at acceptance (it is not a destination) rather, is a journey of healing to take, not a point. • Past cannot be altered; has been forever changed; therefore, readjust. • Slowly withdraw energy from the loss and begin to invest it in life. • Put loss into perspective. • What is lost cannot be replaced, but new connections, relationships, and interdependencies can be made. • Living begins again (but only if grief is given its time).
Note : From Kübler-Ross & Kessler (2005, pp. 7–28)
Different types of grief can be experienced. The type of grief be- ing felt can drive the responses and state of being for the older adult presenting to the healthcare worker. Uncomplicated grief is considered the normal and expected course of grief after ma- jor loss triggered by events other than death (Boyd, 2017). When initial news of loss is presented, physical symptoms are often felt such as shortness of breath, a feeling of choking, rapid heart rate, sickness in the stomach, and body weakness (Boyd, 2017). The healthcare worker can help assess and prompt the older adult to assemble their social support system. Although yearning over the
loss can occur for two years, most people do not need clinical treatment (Boyd, 2017). Complicated grief can happen when a person cannot move beyond the loss and a degradation of func- tioning occurs; however, it is only experienced by about 10% to 20% of people (Boyd, 2017). If the older adult cannot move past the loss and is overwhelmed by the change, the healthcare worker needs to intervene. Complicated grief occurs after six months of intense mourning; there is a feeling of being “stuck,” deep yearning is expressed, trust toward other people is apparent, and life become meaning-
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