Jane V. Bissler, Ph.D., LPCC-S, Fellow in Thanotology
I had the privilege of sitting with Dr. Elsabeth Kubler-Ross at a conference in 1990. At that time she was receiving a lifetime achievement award from the Association of Death Education and Counseling in Miami, Florida. To say the least, I was star struck. Here was this diminutive Swiss powerhouse sitting in a concurrent session like the rest of us. It seemed dichotomous to say the least!
As the presentation had not yet begun, I had the opportunity to ask her what the greatest achievement had been in her life. She responded in a thick Swiss accent that she wouldn’t discuss her accomplishments but would share with me her greatest disappointment. I was aghast. The doctor Elsabeth Kubler-Ross had a great disappointment? I listened as she told me that her stages of dying had been “taken over” by the thanatological community and was made into the stages of grief. She shook her head negatively and looked filled with despair. I told her I was aware that this was accurate and told her I would do my best to never use this information incorrectly and when I had the opportunity I would correct the belief. She patted my hand and looked at me as if I was a young child. I knew then that these stages had more power as stages of dying than I would ever be able to extinguish. It hasn’t stopped me from trying.
Dr. Kubler-Ross’ five stages were defined in her book, “On Death and Dying” published in 1969. She identified and discussed these as the process that many terminally ill people go through upon learning of their terminal illness. Although there is a significant grief response for those who are learning to assimilate the news of a terminal illness, it is not the same grief as someone experiences after a significant death of a cherished loved one. I believe the bereavement community took on these five stages of dying because it made a process that was not easy to understand or quantify into a linear progress of controlled emotion and satisfactory results. When you were done, you were done! Of course, nothing could be farther from the truth.
The stages one goes through in order to assimilate the process of dying do have some similarities to the phases of grief. I like to use the analogy of losing the keys to your car. For example think about a normal work day in your life. You arise at the normal time and go through your normal morning routine. As you ready yourself to head out the door you go to where you always keep your car keys. You are shocked when they aren’t hanging on the keyboard, in the key drawer, in your purse or coat pocket. You can’t believe your eyes. 1. DENIAL – “No, it can’t possibly be. I know I put them right here last night.” You look everywhere! You check every nook and cranny in your home. You search your car. You go back into the house and look everywhere you have already looked! 2. ANGER/BLAMING -- “It isn’t possible! My keys were just here! I never lose my keys. I take such good care of everything and I am always so careful.” You rant and rave that your keys can’t be lost and if they are, it isn’t your fault. It’s your stupid husband, wife, son, daughter, houseguest, cleaning lady, or dog. 3. BARGAINING – “Keys, if you just show up I promise to be more careful next time.” You make a deal with God, the house ghost, or the keys themselves to be found so that you can be on your way. 4. DEPRESSION – “I can’t believe I’ve lost my keys. I’m going to be fired, I am going to be demoted, and everyone is going to know that I am irresponsible and a loser. How could I be so stupid?” 5. ACCEPTANCE – “Well, I’ve lost my keys. I’m going to be late for work. I need to make a decision on what to do next. I can and will deal with the consequences.” These are the stages of dying. Some relate these to the stages of all kinds of loss. I don’t believe this is accurate. Well, at least for the loss of a pet or loved one. You may go through this process when you lose you keys, your golf ball or your job. However, the losses that we experience which are personal and profound do not allow for the luxury of controlled, linear emotions. I like to look at the phases of grief a bit differently. It is true that many people experience the feelings of denial. Our brains are powerful and rely on past experiences to make sense out of this world.
A client of mine whose husband had died after eighteen years of marriage, shared a story which proved to her that she was losing her mind. “My husband, Al, died almost three months ago. It was a terrible car accident and he was here one moment and gone the next. I have been attending grief counseling and a grief group and while I am not myself, I felt I was functioning pretty well. However, this morning I got the proof I have been so afraid of.” My husband worked nights and I worked days. We always enjoyed a lovely breakfast when he returned home from his night shift and before I left for my day of work. This morning I actually set a place at the table for him. It’s been three months! I am losing my mind.”
This act of denial is normal, upsetting and devastating, yes, but normal. When my client shared this story with me she was sure that I would know she was crazy and would have her “committed”. It took a long time to help her realize that this happens to many people who are grieving. I explained that her mind would always go back to what it felt was normal. I also explained that part of the task of grieving was to help create a new normal. Some grieving people feel anger regarding their loss and others do not. This is one way that the model described above does not work for those who are grieving the loss of a loved one. For those who have anger, it is my experience that this anger is expressed in many ways throughout the grieving process and is not a phase or a specific task. Bargaining is not something that can be done when death happens. Death and the loss we are left with is a permanent state and there is nothing to bargain for. The loss is permanent and we know that nothing will ever bring this loved one back into our lives in the same way. Depression is a definite part for the vast majority of grievers. I am not referring to the clinical diagnosis of depression. For many there is not a change in their brain chemistry which creates this illness. No, it is a feeling of emptiness, of pining for the loved one, and a melancholy that robs one of energy. It is pervasive and at times devastating. It is like being stuck in thickening Jell-O or wet concrete. Everything that happens does so in slow motion. Nothing seems to make sense anymore. What you could always depend on, you can no longer do so. Acceptance is a word that creates much discussion among the grieving community. What are we really asking them to do? To accept that their child, husband, loved one has died and it was right? Create a life without that person without looking back? Ignore the aching in our hearts that provide us proof that a hole is there that can never be filled? No, this is not possible! We are not grieving the loss of our car keys, car keys that can be replaced. We do have a hole in our hearts and although it can be surrounded by the love and support of others, education and counseling that we obtain, and time wielding experience, the hole cannot be filled. Most grieving people don’t want it to be filled. If it were to be, the special person who occupied that space would be gone and forgotten. That is not acceptance, that is replacement!