The Five Stages of Grief Is Missing a Stage: Anxiety

Health and medicine explained.
Feb. 11 2013 12:32 PM

The Five Stages of Grief Should Be Changed

My bereaved clients aren’t bargaining; they’re anxious. 

(Continued from Page 1)

In my experience, grieving individuals almost always gravitate to the five stages at one point or another. Many of my clients immediately begin to asses their current state in terms of where they are with denial, anger, bargaining, depression, and acceptance. But while the stages were meant to be helpful, this is often where people begin to get confused. I don’t think I’m following the stages correctly, they’ll admit in a worried tone.

I don’t understand the bargaining part. I’ve been depressed for too long. I skipped the anger stage—is that okay? I don’t know where my anxiety fits in. These are the kinds of things I hear over and over again. In fact, I’ve heard them so often that I’ve now come to believe that when the five stages are applied to grief, bargaining should be replaced with anxiety.

When applied to a dying person, bargaining makes sense; following a terminal diagnosis there is often a sense of desperation, of pleading for more time. However, when you’ve already lost the person you love, there isn’t much left to bargain for. In my 2012 memoir The Rules of Inheritance, I used the five stages as a framework to illustrate my own grief process. When it came to the bargaining stage, the only way I could make sense of it was to liken it to the idea of magical thinking, a condition Joan Didion has described beautifully. I wrote about how, for years, I found myself thinking that if I worked hard enough or teetered precariously on enough sharp edges, my mother might reappear from the other side to save me.

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Including anxiety in the five stages of grief would better serve the bereaved. Even more than depression, anxiety is the response my grieving clients express a desire to overcome since experiencing loss. They describe feelings of panic and obsessive thinking about their own deaths and potential illness. They tell me about bouts of helplessness and of feeling overwhelmed by life itself, about panic attacks and moments of such paralyzing fear that they pull their cars over on the way to work. I have even heard my own story about the ER told back to me countless times.

When we lose someone we love, we are thrust into a world where we feel more vulnerable than ever before. Suddenly we must face the fact that there are absolutely no guarantees in life. Everything that once seemed sturdy is now fragile, particularly the people we love. These feelings can be incredibly overwhelming and oftentimes terrifying. It takes time and work to overcome them, to feel secure again in such a now-delicate world. And for people who suffer multiple losses in a short period of time, it can take even longer.

The anxiety that comes with grief can be debilitating, but because it is not included in Kübler-Ross’ five stages, it tends to be ignored or dismissed as a different problem altogether. However, anxiety is a very real and very normal reaction to grief and it must be recognized. It is also highly treatable once it is distinguished for what it is.

There is a wonderful and unexpected gift that comes with seeing how fragile our lives are. It enables us to be more present, to feel grateful for what is right in front us, to cherish what we are able to hold onto right here, right now. But in order to reach that level of acceptance we must wade through the tremulous waters of fear and anxiety, recognizing them as a part of a larger process that will see us through to a shore where so many of us have emerged changed, if not healed.

When I look back on my frightened 18-year-old self, I’m saddened that no one was able to see what was really going on. If just one person had recognized how fragile my life had become, perhaps they could have reassured me that no matter how scared I was, I wasn’t alone.

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