When Elisabeth Kübler-Ross debuted the five stages of grief in her book On Death and Dying, published in 1969, they were intended for people facing their own deaths. Kübler-Ross later went on to apply these same five stages to the bereaved, to people who had lost a loved one, but upon closer inspection, I’m not sure they work as well. Losing a loved one is not the same as losing your life. Grief thrusts us into an uncertain world where anxiety often reigns supreme. Yet anxiety is the very element missing from Kübler-Ross’ stages.
I had my first panic attack when I was 18. It happened on a road-trip the summer after my senior year of high school. My boyfriend was behind the wheel, driving toward Washington, D.C., and suddenly my heart did a funny flip-flop thing.
I unbuckled my seat belt, flailing about for something to hold onto, and in between gasps, instructed my boyfriend to find an emergency room. For several months I’d been experiencing moments of breathlessness and lengthy episodes of heart pounding, but this time it felt different. As we hurtled toward the nearest exit, my heart took dramatic pauses, did jack-knives inside my chest and then cascaded into what felt like triple-beats. I was certain I was about to die.
Twenty minutes later I was hooked up to an EKG in a curtained-off portion of a hospital emergency room in Virginia. Beside me, my worried boyfriend murmured into the phone to my father as we watched, with rapt attention, my now-normal heartbeat creating perfect dips and arrows on the long, thin printout unspooling from the machine. Afterward, I sat on the exam table and answered the doctor’s questions.
Do you smoke? Yes.
Do you drink? Not really.
Do you do any drugs? No.
Take any medications? No.
Any history of heart problems? No.
Do you exercise? Fairly regular jogger.
The list went on and on. So far everything was pointing toward me being perfectly healthy, but I was determined to leave with an explanation. Instead, the doctor simply told me that I was among the one out of 10 people who experience heart palpitations. (And that I should quit smoking.)
As we drove away from the hospital, I stared out the window at the warm summer landscape, thinking about all the questions he didn’t ask.
Are you thinking of breaking up with your boyfriend? Yes.
Are you about to leave everything you’ve ever known behind and go off to college two thousand miles away? Yes.
Is your mother dying of cancer? Yes.
I was only 18, but that was old enough to feel painfully aware of the mind-body connection. Although I couldn’t define my problem in clinical terms, I knew that what was wrong with me might not be physical. I’m now certain that if the doctor had asked me just a few questions about my personal life, he could have easily identified my symptoms as a classic example of a panic attack.
My anxiety worsened six months later when my mother died. The panic attacks came with startling frequency, seemingly brought on by nothing at all. I could be pumping gas or lying in bed and suddenly the world would begin to swirl around me, my breath would thin out, and the only thing I felt sure of was that I was dying. But instead of dying, for the next three years I walked through my life paralyzed by debilitating anxiety. Sometimes I wished I would actually die rather than live in such a nervous state.
It’s now been close to 15 years since that ER visit, and I’ve become a therapist specializing in grief. When I look back on that time in my life, it’s easy for me to recognize how my anxiety was linked to the loss of my mother. In fact, anxiety is the most common symptom of grief that I see in my practice. But I also know that it’s often one of the most overlooked aspects of bereavement, so much so that I find myself constantly wishing that Elisabeth Kübler-Ross had included anxiety as a stage and saved us all a lot of, well, grief.