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Tools for Coping With Loss and Tragedy

Grief is universal, but everyone grieves differently. In 1969, Swiss-American psychiatrist Elisabeth Kubler-Ross identified the five stages of grief that describe the roller coaster of emotions you might feel when grieving the loss of a loved one, grappling with a personal illness or facing other difficulties in your life. The stages are denial, anger, bargaining, depression and acceptance.

While this framework is helpful in pinpointing what emotions you’re feeling, you won’t necessarily experience the five stages of grief in order. You may bounce back and forth between stages, or not experience some stages at all. The order, severity and selection of each stage will vary by person and situation. It’s therefore more accurate to call this phenomenon a dynamic grieving process.

Grief is a dynamic process.
— Michael S. Ziffra, MD

“There is not a right or wrong way to grieve,” says Northwestern Medicine Psychiatrist Michael S. Ziffra, MD. “The five stages of grief are good for describing various reactions that someone may have to loss, upsetting news or tragedy, but it’s important to emphasize that everyone is different during the grieving process.”

Knowing the five different emotions that may arise because of grief can help you or a loved one cope during a hard time.

How to Work Through the Five Stages of Grief

Denial and Shock

“Denial is a common human reaction to upsetting news as it helps us deal with the initial emotional pain,” says Dr. Ziffra. “Our minds sometimes find it hard to understand this new reality, and we question if the tragedy is true or not.”

If you find yourself thinking, “This can’t be happening,” that’s a good indication that you’re in the denial stage of grief. A feeling of numbness is also a common sign of denial or shock.

How to support someone in denial:

  • Listen to stories about their loved one, traumatic event or diagnosis when they offer them to you. If they don’t want to talk about it, then follow their lead and talk about something else.
  • Volunteer to help them with logistics. From planning to paperwork, ask if you can help with anything they may associate with the event being “real.”

How to help yourself through denial:

  • Take baby steps to face the events and consequences surrounding the loss or upsetting news. This may mean calling people to tell them what happened, or taking the first steps toward planning a funeral or a course of care.
  • Say what happened out loud, or journal about it to help yourself process this reality.

Anger

“Flashes of anger may be frequent during the grieving process,” says Dr. Ziffra. “It’s typical that someone feels angry at the situation, perhaps their higher power, someone else or themselves while grieving.”

Anger is a natural reaction to feeling powerless. It’s okay to feel angry, but here’s how you can deal with anger in a constructive, rather than destructive, way:

  • Express your emotions without assigning blame. The way you express your anger will be unique to you, but keeping your emotions inside can be just as harmful as lashing out.
  • Recognize that your anger is temporary and does not define you.
  • Be open about your anger with those close to you so that they won’t take it personally if you lash out.

How to help someone dealing with anger:

  • Cut them some slack. Try to let your own emotions take a backseat.
  • Encourage them to express their anger constructively through hobbies, exercise or simply talking it out.

Bargaining and Guilt

“I should’ve done something differently,” and “I could’ve prevented this” are hallmark phrases during the bargaining stage of grief. With bargaining comes guilt. If you believe in a higher power, you may also find yourself trying to strike a deal: For example, “If you heal my spouse, I promise I’ll be a better person.”

Bargaining, much like denial, helps you put off grief. The best way to help yourself and others work through the guilt associated with bargaining is to avoid assigning blame. Bargaining often is done in secret, so vocalizing your bargains in a support group setting may help normalize these thoughts and help you come to terms with them.

Depression

Depression is the phase we most commonly associate with the grieving process,” says Dr. Ziffra. “Grief also can be a trigger for those predisposed to depression, so many may find themselves stuck in a depressive state after tragedy or loss.”

During depression associated with grief, you are no longer denying or postponing your emotions or reality; you recognize your reality and feel a deep sadness. It’s common for someone to withdraw during the depression phase of grief and not be up for social interactions, work or activities they enjoy. During grief-induced depression, you may also feel fatigued or foggy.

How to help someone dealing with depression due to grief:

  • Avoid clichés. “You may be well meaning, but phrases like, ‘Look on the bright side’ are not helpful for someone who is depressed,” says Dr. Ziffra. “Just like you can’t think away a medical diagnosis, you can’t just think away depression.”
  • Be there. Reassure your loved one that you are going to be around if they need you.
  • Invite them out. Someone with depression may need space, but they also often need someone to encourage them to get out and do something they like.

How to help yourself during the depression stage of grief:

  • Keep a routine. Don’t beat yourself up for wanting to stay home, but start to incorporate more tasks into your to-do list to help you resume normalcy.
  • Exercise and eat well. While comfort food on the couch is enticing, “Physical activity helps combat depression,” says Dr. Ziffra. “Start slow by going for a walk.”
  • Seek help from a mental health provider.

Acceptance

“Time is the number one factor that leads to the acceptance stage of grief,” says Dr. Ziffra. “But, you may reach the acceptance phase and then fall back into any of the other stages at any time.”

You can’t force yourself or others through the stages of grief.

“Remember: Grief is a dynamic process,” says Dr. Ziffra. “If you’re having a hard time after a substantial amount of time has passed, talk to a professional or seek out a support group.”

Where Mental Health Meets Your Life

Michael S. Ziffra, MD
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Assistant Professor, Feinberg School of Medicine
  • Primary Specialty Psychiatry
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