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Stages of Grief-Acceptance

Stages of Grief- Acceptance

Acceptance.  It’s something that seems impossible when in the midst of grief.

It doesn’t ignore the loss, it is certainly not about forgetting and moving on.

It is far more about accepting that the past cannot be changed and accepting the need to explore what your new present now looks like.

There may be more good days than bad, your roles and responsibilities may change and you may start to reach out to those who you distanced yourself from while in other stages of grief.

Guilt

Guilt can be an ever-present companion throughout the grieving process.  It is a voice that can be particularly loud in the acceptance stage and is often a burden we put on ourselves rather than something other people cause us to feel.

When we lose someone we try to understand the process and ask ourselves lots of questions like “what if” and “if only” but all this serves to do is to help us feel that we are somehow to blame for the death.

In doing so we ignore all the other factors that contributed to the tragedy and take on the guilt of this ourselves.

This guilt is often compounded when we realise that we have enjoyed ourselves on a night out and not thought about our loved one for a few hours.  When we smile or laugh and immediately feel guilty because we “should” be feeling sad or when we realise that we are having more good days than bad.

So how do we manage our guilt?

  • Guilt keeps us from moving on and acceptance is not about forgetting but about forgiveness. We need to forgive ourselves for whatever we did or did not do. Part of being human is making mistakes and recognising that we did the best that we could. Some circumstances are out of our control.

 

  • If the guilt is related to unfinished business such as not being able to say goodbye, then find a way that works for you to resolve this. When mum died, we found a tree (and had to fly it over from Japan) that was named after my mum. This tree gave us a place we could go to feel closer to mum and to talk to her if we needed to. Some people write letters, others brew beer and name it after their loved one…find something that makes sense to you.

 

After 9/11, Her Majesty, The Queen gave a speech. Her quote is so poignant about grief and guilt.

“Grief is the price we pay for love. We would always choose to keep a loved one alive and with us, so rather than focusing on guilt focus on the love that you gave and received”.

Grieving for yourself

Part of my acceptance stage was grieving for the person that I was before I lost my mum.

I spent most of my grieving period wanting to “feel normal” again and to get back to doing and being who I was before.

My whole grief journey (and it took many years) was about accepting that who I was before, was gone.  I needed to re-shape who I was now in light of my loss.

In all honesty this took me over 5 years, and once the pain had diminished, I was able to do a before and after comparison of who I was and who I am now.

Before grief- I was protected from the harsh realities of life due to the unconditional love of a person.  I had a relationship safety net, a completely biased support system, financial support and I was never alone.

After loss and through the grieving period I discovered:

  • I am stronger than I ever thought possible
  • I am more empathetic

I became:

  • Less judgemental,
  • Someone who could make decisions on my own,
  • More aware of other people’s inner struggles,
  • More patient

I learnt to value the fragility of life and live for every moment…because there will never be another moment like that one.

Now, many years on, I would not want to go back to the person I was before loss, nor would I want to take the pain away because as tough as this experience was, I am able to go forward, knowing that I am the person I am today because I was loved, and grief is as much part of this journey as life and love.

 

Stages of Grief-Depression

Stages of Grief-Depression

If denial, anger and bargaining are all stages of self-protection initiated by our bodies to protect our minds from becoming overwhelmed when we experience death; when these come to an end and we realise the finality of the situation, the ‘depression stage’ can hit like a tsunami.  As we can no longer pretend or bargain and we are faced with the reality and certainty that death is final – the one or thing (as this stage very much occurs with the loss of a job, or career for example) we love, will not be coming back.

This stage can feel very confusing because it is filled with vast emptiness.  As we work to understand our lives without that person, coupled with the lifting of the emotional fog, an immeasurable sadness sets in for the foreseeable future.

This sadness permeates every thought and action and it can feel like you are going through the motions of everyday life.

I remember going back to work after my mother’s death, doing exactly the same tasks as I had before, but I felt like a different person. Gone were my little breaks where I would chat with colleagues, planning ahead was not an option as I could not look beyond the task I was currently working on, and there were times when I was so overcome by my sadness that I would sit in the toilets and cry.

Getting home after work was not much better as I would then cry because I had managed to get through another day, but that was another day that I had lived through without my mum and I did not know how to carry on without her.

Sadness changes your behaviour.  During this period it is not unusual; to cry, withdraw from those around you, to withdraw from society, become irritable, lose sleep, sleep too much, eat more, eat less.

There is no right or wrong way to deal with this and it very much depends on the type of relationship that you had with the person you lost and our own personalities of how we respond to change and loss.

This stage lasts as long as it needs to, and it is entirely possible to keep dipping back into this sadness, especially as the first year of losing someone is not so much about celebrating their life, but a constant reminder of how long it has been since you last saw them. Their birthday, Christmas, and other significant events become a symbol of loss which only serves to strengthen the feelings of grief.

It is very easy to say “that it takes as long as it takes” but how does this work out practically, in the real world?

I remember attending a family gathering, a little more than a year after my mother had died. For me, this was the first time that I had been with my mother’s side of the family and I was not prepared for how much this affected me.

I kept looking around for her as she could always be found in the kitchen talking her sisters.

During this evening, a family member asked how I was doing and I found myself being unusually honest and saying how difficult I was finding it being here.

The response of “It’s been ages since she died, you should have got over that by now” was something of an unexpected response.

These responses are not uncommon from family members, work colleagues and others and although they can seem hurtful, it is important to remember that for those individuals the loss may not have been as significant.  They may have moved through their grief journey quicker or they may be refusing to acknowledge their grief.

Everyone’s journey is different and no one else has the right to tell you when your journey is over – equally, and perhaps painfully – I had no right to demand that this family member still felt the pain I felt – regardless of how insensitive their comment was at the time.

You may have noticed that I have not referred to this stage of grief as depression.

There are many reasons for this, perhaps personal to myself and outlook as a therapist.  The first being that using the word depression does not feel right to me.

Kubler-Ross, the Swiss Psychiatrist who was responsible for identifying the five stages of grief, originally worked with terminally ill patients and noticed that these were stages they appeared to transition through while processing their terminal diagnosis.  I am not convinced that the word ‘depression’ translates across, to adequately explain the depth of emotions that a person feels while processing the death of a loved one. It is not depression but more of an innate sadness.

Secondly, the use of the word ‘depression’ is synonymous with the clinical diagnosis of low mood episodes, however grief is so much more than low mood and to diagnose it as such trivialises this grief stage and reduces feelings to symptoms. I am not saying that grief cannot lead to clinical depression, but we mustn’t ignore the need to work through emotions associated with grief which can present as similar to depression rather than going straight for a diagnosis of depression because it fits.

Although I did not realise this at the time, this whole period was about re-defining myself and learning who I was now after this loss.

My experience of grief started a metamorphosis. Living was so painful but looking back, there was a beautiful fragility about all of my experiences.

I absorbed every conversation with my dad and friends and remembered every smile because I was aware of how quickly life can change. I prioritised spending time with those who were important to me over unnecessary work commitments because time became something that was limited.

My focus changed, money, a career, possessions; all became less important and I wanted to experience having children, something I had been putting off until later in my life, believing I had all the time in the world to do these things. Memories of loved ones help us remember we were loved, the crazy rollercoaster ride I took with my mum where she sung “I will survive” by Gloria Gaynor all the way round, much to the amusement of everyone around her and its these memories that I pass onto my children to ensure that they know what a lady their nanna was.

The innate sadness of grief can feel like it lasts a lifetime, but amongst that sadness, life becomes about living rather than just existing.

Stages of Grief – Bargaining

“Bargaining is when you wish, pray or hope that your loved one will be saved in exchange for something”

The Bargaining stage is your mind’s way of protecting you, a coping mechanism, from facing the reality of a world without your loved one in it and can feel like despair and anxiety all rolled into one stage.

This stage is defined by your struggle to retain a sense of control as you grieve. In some cases, particularly when a terminal diagnosis is given, our brain cannot process the depth of emotional turmoil, and we need to explore all other options before we are willing to concede to the diagnosis given.

Self blame, “what if’s” and buying time are all parts of this stage.

When I spoke to the coroner after my mother’s autopsy, one of the things he said stuck with me. He said that three out of four of my mum’s arteries were completely blocked and the fourth was 50% blocked and he could not believe that she did not show any symptoms prior to her death.

For months, his words ran around my head and fed my self-blame;

“how did I not notice anything was wrong?”

“If I had tried harder to make my mum give up smoking, would this have saved her?”

“Why didn’t I make a doctor’s appointment for her when she said she didn’t feel well weeks earlier?”

The reality of the situation is that nothing I did would have changed the outcome, because my mum had the autonomy to make choices and she did not choose to make any of those changes herself.

Bargaining can take the form of:

  • Offering to be a better person, either by volunteering somewhere or donating money to a “good cause” if your emotional pain is taken away.
  • Offering yourself in place of someone else as they don’t deserve to be in their position.
  • Bargaining with a “higher power” for healing or a miracle.

I have to confess that, looking back I seemed to slip back into the bargaining stage more in the first year after my mother died, than at any other grieving period.  I suffered a great deal in the first year with unresolved grief, not being able to say goodbye, worrying about whether my mum suffered, where she was now. This was also compounded by a miscarriage 8 months after burying my mother, the baby was a complete surprise, and for me, symbolised a gift from my mum, something that would give me some joy back in my life.

I became consumed with searching for a sign that my mum and baby were ok and were happy together. I bargained with higher powers to give me a sign, a dream, a feather, anything to let me see both of them one last time. Those people around me at this time were well-meaning and suggested that “my mum was looking down and was proud of me” but these comments only served to fuel my anger. I wanted to believe them, but part of me couldn’t understand why, if my mum could see how much pain I was in, then did she not just give me one visit.

Something for us to be mindful of, is during grief, particularly in the bargaining phase, people are looking for anything to hold onto and those people who are supporting their friends, family or loved ones through grief need to be aware of the impact that words or phrases can have on a soul that is temporarily lost.

We want to bring comfort to those who are grieving, which is why we search for the right words to say, but in some situations, there are no words and all people need is someone to sit beside them while they grieve.

The Stages of Grief – Denial

Before we take a look at the process of grief, I feel that it is important to acknowledge that the order in which I am exploring the stages of grief are not necessarily the order in which individuals might experience them.  Grief is an individual journey and everyone will start and finish at different places and at different times. It is not a race, there is no prize for first place and rushing this process may result in prolonged grief

According to the urban dictionary, “denial is a self-defence mechanism employed by aspects of the subconscious mind in an attempt to protect emotional and psychological wellbeing”.

I remember the day I was told that my mum had died of a heart attack at the age of 46.

A knock at the door, followed by my tearful brother-in-law, unable to look me in the eye, telling me that my mum had suffered a heart attack and was taken to hospital but they were unable to save her.

I stood there and my mind immediately discredited this information – I had dinner with her yesterday evening and she was fine – but my body still involuntarily moved towards the car to make my way to hospital. My internal monologue, during this journey, was deafening in the silence of the car. “They have made a mistake, when i get there she will be hooked up to machines and the doctors will say she was incredibly lucky”. Despite all of the evidence, including distraught relatives, my inconsolable dad and seeing my mother’s cooling body, on returning to the house after the hospital, I convinced myself she was at work, and my mind told me this for the next two weeks, despite planning a funeral and picking out clothes for my mum to wear.

I believe that denial is a crucial part of coming to terms with a loss and is our body’s way of protecting our minds from overload. In that moment of learning about my mum’s death, my mind couldn’t comprehend the million different questions, past memories, future milestones that I would never experience with my mum, grandchildren that my mum would never meet…the list was endless.

My mind just pulled everything back to allow me to get through this day. Denial, attempts to take us through the initial period of loss one step at a time rather than risk feeling overwhelmed and unable to cope.

Denial is often associated with feeling numb, this is a common self-preservational response to receiving a shock. Your life as you know it has changed in an instant and to try and process this new reality without the presence of your loved one in it would be too painful.

People often report feeling numb for weeks after suffering a loss, and for me this was certainly true for many weeks after losing my mum. The condolence cards remained unopened because, subconsciously, to read messages about my mum describing her in the past tense would have been too much for me at that moment. Even planning a funeral was completed under a blanket of numbness, I remember the undertaker asking “what flowers we should have for the funeral” and I distinctly recall turning round to look at where my mum used to stand propped up against the kitchen cupboard to ask her.

“Just get past the funeral then begin to grieve”. This phrase was spoken to me many times over the two weeks that we waited to bury my mum. At first I thought that they were telling me to hold it together until after the funeral, but with hindsight, I can see that behind those words was a wealth of pain and experience from those who had experienced grief before me and knew the drill. After all the sympathies had been given, all the funeral preparations made and the ‘send off’ of your loved one completed, denial had done its job and now the real work of grieving was beginning.

Stages of Grief – Anger

“For many, being angry is more acceptable than being sad; Sad comes from hurt and we don’t want to hurt anymore”.

When we lose someone,(or indeed, something – a job, our home, anything we hold dear) our whole world instantly changes.  This brings with it a period of chaos and confusion which we try to bring order to, by looking for answers.

“Why did they have to die?”

“Did we miss signs that something was wrong?”

“Is there an organisation or doctor that did not do their job?”

“This should never have happened!  This is not fair or just.”

Our natural response is to search for an explanation that provides us with something tangible on which we can focus our feelings because that’s easier than processing what our lives are going to look like without our loved one in it.

In some cases there may be a legitimate need for an investigation into malpractice, but it is important not to use the investigation process as a way or preventing you from processing your anger, which is very much a part of the grieving process.

I have lived through two very different grieving processes, one which focused intently on anger and one, in which anger did not even feature. The sudden death of my mother left, not only me, but the medical profession, with many questions due to the age at which she suffered her heart attack. There was also the unanswered question as to whether her death was due to an undetected genetic fault and whether that gene had been passed down to me. The autopsy showed that it was a combination of high blood pressure, smoking and stress, in fact when I spoke to the coroner, he expressed his surprise that my mum was smoking as she had been on blood pressure tablets since 18 years old and was already at a high risk of heart problems because of her health condition.

It was at that point that I distinctly remember the overwhelming feeling of anger directed at my mother. Why would she continue to do things that may result in her dying prematurely? Was I not enough for her to stop doing these things? In contrast to this my father was diagnosed with stomach cancer before the age of 80 and he was given weeks to live, my family and I accepted this easily and set about making sure that the next 6 weeks of my father’s life were comfortable.

Could anger within the grieving process stem from a perceived injustice in the system that we call life, after all “bad things shouldn’t happen to good people?”  The 2 year old boy who died from cancer or the friend who has never smoked a day in her life ends up with terminal lung cancer. All of these examples go against our innate need for life to be fair and when it isn’t anger is a normal response to grief.

Anger is one of the most misunderstood emotions, as a society we are told to “walk away from situations” to avoid getting angry, and in certain situations, this is totally the right response.

It is probably not a good idea to tell your boss exactly what you think of them in the middle of a disagreement, however to apply this philosophy to every situation teaches us to perceive anger as a negative emotion that we should not express.

Three things can happen if we do not learn to acknowledge and express anger appropriately,

  1. Individuals can become stuck in a cycle of grief and look to substances such as drugs, alcohol or medications to help alleviate their anger/pain.
  2. Individuals can become so full of anger that they can overreact and cause injury to themselves or others.
  3. Uncontrolled anger can cause a grieving person to become isolated from those around them as they will often lash out and try to hurt others, which results in withdrawal of support from loved ones.

Anger is just as important as any other emotion – it is your body’s natural reaction to threat, Someone died or you lost something integral to life as you knew it – there is nothing more threatening, so how do we handle anger from grief?

  • Recognise that you’re not yourself at the moment – You have just gone through a life changing event and this comes with intense emotions, questions and thoughts. Be gentle and try not to hold yourself to the high expectations that you may normally have. It is ok to feel angry at your friend who may be discussing a difficult situation they are facing at the moment, with little realisation of how you feel like exploding because at this moment, to you, there are more important things in the world. This does not make you a bad friend. One of the most important pieces of advice I was given when my mum died was don’t make any important decisions in the first 6 months after a loss. For me, this was a life saver because, had I not have taken this advice, I would have moved house (trying to escape painful memories that eventually became a comfort), destroyed all photographs with my mum in them (and I now look at these photos and see memories) and cut all contact with my mum’s relatives ( I can still learn new things about my mum’s lives from her sisters and brothers).
  • Express your anger- Once we become comfortable with feeling angry, we then need to figure out how to constructively express that anger. This is a personal choice, some people like to go to the gym, box, or take up an exercise class. Others take up poetry, journaling, drawing and some put on music and dance around the house. It is finding something that allows you to release these feelings and feel less burdened. If people ask you how you feel, try to be honest rather than just giving the expected response of “you know…as well as can be expected” By opening up and being honest you can potentially start dialogues that can create a society where people start talking honestly about how they are feeling, which decreases the isolation that grieving people can find themselves in,
  • Apologise- In the anger period, it is more likely that we might engage in behaviour that is not “the norm” for us, for example drinking, emotional outbursts, isolating ourselves. This does not make us bad people, we need to recognise that we may not be ourselves for a while. However it is also important to acknowledge that there are consequences to every decision that we make, even while grieving, therefore if we might need to apologise – it is good practice to do this in order to protect and possibly repair relationships with those closest to us.

What is Grief?

This blog is the first in a series exploring different topics centred around grief. I hope to be able to share some of my personal experiences of grief, look at different types of grief and most importantly to generate some discussions so that people realise that they are not alone in whatever situation they are currently facing. As humans we are all individual and unique but are inextricably linked by the fact that all of us will inevitably experience grief throughout our whole lives.

What is the difference between grief and bereavement as these two words are used together all the time?

Bereavement is the period after loss during which grief is experienced and mourning occurs. When we suffer a loss, we go through a bereavement period but experience grief. In its simplest form grief is feeling the loss and we can all relate to how deeply painful grief is.

This particular series of blogs is going to focus on grief in relation to death, but i feel that it is important to acknowledge that people can feel grief over a loss of a job, a house, a relationship, a favourite toy that gets lost (as a parent I experienced this many times with my son and his favourite snoopy toy, I spent hours scouring Ebay looking for an exact replacement which was inevitably rejected by my son for “not smelling the same”)

Grief is not just about death but about the emotional journey that people take to cope with a loss.

Grief is personal and unique, no one person will experience the same grief or level of grief, so it is important not to compare your journey to your family members or friends. Well meaning friends, family, complete strangers will inevitably share their grieving experiences with you as a way of saying “you are not alone” in this, but please do not compare where you are and what happened to them. Grief takes as long as it takes and there is no set time or period as to when you come out of survival mode and start to think about what next.

There are so many different types of grief, so I am only going to mention a few here, but I want to show you how much, we as a society, have simplified grief into just that one word of GRIEF:

  • Anticipatory Grief- This type of grief can start long before a person dies. It is normally associated with a diagnosis of terminal cancer or an illness such as Alzheimers. People struggle with this type of grief because the person is still alive but the process of grieving for the person they knew before the illness takes them starts from diagnosis.
  • Delayed Grief- The grieving process is not started following a death, but is delayed until a later date (and is normally triggered by another life event that can seem unrelated)
  • Complicated Grief- is when grief becomes severe and significantly stops a person’s ability to function. This is often associated with a sudden or violent death.
  • Disenfranchised Grief- can be felt when a person experiences a loss, but others around them downplay the significance of that person. This can happen with the death of an ex-colleague, ex-partner or pet.

I remember watching a news programme, as a child, where a funeral was taking place in Syria and I watched as the poorly made wooden box was lowered into the ground and women and men fell to the ground, screaming and crying with such anguish and pain etched on their faces. Contrast this with burying my mum at the age of 24, I remember sitting in the crematorium, dressed smartly in black, looking at a beautifully crafted coffin, trying not to cry, remembering those women and men who freely expressed their pain as a whole community, while i tried so hard to “put on a brave face” and people congratulated me on “doing so well”. There was a freedom of expression in that Syrian community that we in our society lack.

Society places conditions on grief. If we do not cry at a funeral we are not affected enough, or if we are still emotional 12 months later, we get told that “we need to move on”. Emotional displays are met with uncomfortable silences or people begin to cross the road when they see you just to avoid that awkward conversation. Society also places a time limit on grief, illustrated by the maximum of two weeks compassionate leave often given by employers.

Experts say that grief is a process and cannot be rushed, yet society shares a different message, so how do we process our grief, in our own time, while not giving in to society’s expectations?