What are the stages of grief?

The five stages of grieving have become a standard paradigm for the feelings and emotions that follow any major loss, such as the loss of a loved one, the breakup of a marriage, or the conceivable loss of one's health and former lifestyle to a chronic and unpredictable disease. The five stages of grief include:

• Denial and isolation: The first reaction to any major loss. This stage involves avoidance, emotional numbing, blaming the doctors, doubting test results, and avoiding friends and family.

• Anger: This stage can be difficult and frightening, and involves questioning one's religious beliefs, and asking, 'why me?' Anger can be harmful if it is not recognized and dealt with as an appropriate stage of the grieving process.

• Bargaining: This stage may involve making promises to God or thinking that changing your life will somehow result in freedom from the disease.

• Depression: A common response, but if it continues for an extended period of time and does not seem to improve, seek professional help.

• Acceptance: When you find you are again living in the present, rather than trying to reclaim the past, you have reached some degree of acceptance.

Psychiatrist Elisabeth Kubler-Ross introduced the idea that people go through five stages of grief: denial, anger, bargaining, depression, and acceptance. Although she helped legitimize the wide variety of emotions that people experience after loss, the stage model she proposed soon became a prescription for proper grief rather than a loose structure to identify broader patterns of grieving. As a result, many people mistakenly assumed they must move through all the stages and emotions, in succession, to grieve correctly or completely.

Although the stage models of Kubler-Ross and others have become a very popular way of explaining the grieving process, researchers exploring different types of loss found little evidence that people move through a consistent set of stages toward recovery. If you are familiar with the stages of grieving and are worried that you are missing a step or are cycling through one step more than once, rest assured this is not necessarily a sign that you are stuck in the grief process.

The grieving process, which may take anywhere from a couple of months to a couple of years, should help you come to terms with your loss and eventually lead you to some feeling of resolution. Without this sense of closure, you may have difficulty functioning in your daily life and may have an increased risk of physical and mental illnesses.

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There are many emotions that are common in bereavement. But whether these emotions occur in a standard sequence is subject to much debate. A frequently cited model of bereavement, the "five stages of grief," was originally described in the book On Death and Dying by Elisabeth Kübler-Ross. These stages were used to describe a five-step response of terminally ill patients to awareness of their impending death: denial, anger, bargaining, depression, and acceptance. Kübler-Ross' work helped legitimize the wide variety of emotions in people who are dying. The five-stage theory was later altered and adapted to cover many forms of loss, from divorce to death of a loved one.

Today, the concept of stages of grief or the idea that grief follows a standard pattern is not widely embraced by experts. Colin Murray Parkes, a psychiatrist who has written extensively on bereavement, proposed a variation: that people who have experienced a loss undergo phases of numb disbelief, yearning for the deceased, disorganization and despair, and finally reorganization, during which they carve out a new life. The road to this new life may be long. According to Parkes, people must go through a painful period of searching for what has been lost before they can release their attachment to the person who died and move forward. When enmeshed in disorganization and despair, people find themselves repeatedly going over the events preceding the death as if to set them right.

J. William Worden, a psychologist who taught at Harvard Medical School, suggested a model of grieving that includes certain tasks. The first three tasks are to accept the loss, experience and work through the resulting pain, and adjust to a changed world without the person who has died. The fourth and final task is to alter ties with the deceased enough that you're able to invest your love and energy in others. People may shuttle back and forth among these tasks, but Worden warns that failing to complete all of them is like healing only partially from a wound.