Everyone deals with loss during the course of a lifetime. Grief describes the emotions, thoughts and behaviors that occur as a person deals with loss. Grief may result from the death of a loved one or a beloved pet, a broken relationship, or a medical condition that alters daily life. Psychiatrist Elisabeth Kubler-Ross outlined 5 stages of grief in her 1969 book "On Death and Dying." Other mental health experts have since proposed alternate models involving 3 to 7 stages of grief. Nursing professor Linda Rodebaugh and colleagues described 4 stages of grief in an October 1999 article in the journal "Nursing."
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A loss commonly leaves you stunned and reeling, especially when the loss happens suddenly. Rodebaugh and colleagues described reeling as the first stage of grief. Shock, denial and disbelief characterize this stage. Thoughts such as "This can’t be happening" and "There must be some mistake" are common during this stage. As with the other stages of grief, reeling can reappear even after you've come to terms with the reality of the situation. Bargaining, a stage of grief described by Kubler-Ross, might be part of your initial reaction. For example, you may come up with ideas to strike a deal with a higher power or another person to reverse the situation or loss. Reeling is often the shortest of the grief stages.
A host of powerful feelings typically occur as you negotiate coming to terms with your loss. These emotions often appear in rapid succession or simultaneously and may include: -- anger -- anguish -- guilt -- deep sadness -- loneliness -- helplessness -- detachment
As you deal with the emotional response to your loss, it is common to experience physical symptoms. For example, you might sleep more or less than usual, experience frequent headaches or decreased appetite, and feel generally unwell or fatigued. You might also temporarily withdraw from others as you grieve, as they are not currently in an emotionally comparable place.
The dealing stage of grief involves thoughts and actions to help you cope with and adapt to your loss, both mentally and practically. If a loved one has died, for example, this stage of the grief process may involve going through your beloved's clothes and other personal belongings. If you've suffered a health-related loss -- such as being diagnosed with a life-threatening or physically-limiting condition -- this stage might involve planning for future care or treatment. Dealing with the emotional aspects of your loss also commonly entails reaching out for support, which might include reading, seeking spiritual guidance or attending grief counseling.
Rodebaugh and colleagues described healing as the fourth stage of grief. This stage involves integrating your loss as part of your life journey and moving forward. For many people, this entails reengaging more actively in daily life, often in new or different ways. It also typically involves recovery from the profoundly painful feelings of sadness and anguish that can interfere with everyday life. Healing does not occur magically in a single moment. It is a gradual process that takes time. Healing is not separate from the other stages of grief, but rather occurs alongside them. Additionally, healing does not imply that the loss is forgotten. In other words, healing is not about "getting over" your loss as much as it is about learning to live with the loss.
Reviewed by: Tina M. St. John, M.D.
- Nursing: How to Handle Grief With Wisdom
- Essentials of Mental Health and Psychiatric Nursing; K.P. Neeraja
- Pediatric Nursing: The Critical Components of Nursing Care; Kathryn Rudd and Diane Kocisko
- On Death and Dying; Elisabeth Kubler-Ross