The Five Stages of Loss

Dealing with a major change in your life is a loss experience because you move away from life as you once knew it. It can produce the same process as experiencing a death. Elizabeth Kubler-Ross, MD, talks about 5 stages that someone goes through when dealing with the process of loss. Dr. Kubler-Ross’ very powerful research was done based on her experiences with patients who were terminally ill. However, we have learned over time that these stages apply to people dealing with loss. With chronic illness, we experience loss of our health and lives as we once knew it and have to process this very difficult transition.

Stage I: Denial and Isolation

Denial is a typical initial process of a person who is experiencing this bad time in their lives. It involves suppressing real feelings and emotions about the illness. People who deny may pretend that the problem is not there and avoid reminders that there is a problem, such as avoiding doctors’ appointments or not following through with testing. Denial can happen to the person with the illness or to loved ones, such as the caretaker or spouse, family member or friend. These people may tell you to “get over it or move on”. Or, they may avoid you when you are having a rough day or time. Patients may pretend to be well with others who can not tolerate or handle seeing them sick or talking about their illness. Denial is usually a temporary experience and there may be intermittent periods of partial acceptance. When denial can no longer be used, it can be replaced by behaviors of isolation. Isolating one self from friends, family, loved ones, and anyone who may elicit feelings of having to deal with this transitional period.

Stage II: Anger

Kubler-Ross (2003) states that “when the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentment. The logical question becomes, ‘Why me?” (p. 63). We express anger at other people and God.

Questions that may come up for the person who is angry include, “why didn’t this happen to that evil person?”, “why is the person who hurt me so terribly so healthy?”, and “Why would God allow me to go through this?”

Anger is displaced in all directions. We can project this anger onto others. Some people don’t understand the anger and take it personally. The person who is angry will respond favorably if he/she feels valued as a person, respected, and understood. When family, loved ones, or others react personally to the anger, however, they respond with increasing anger on their part, “only feeding into the patients hostile behavior” (Kubler-Ross, 2003), Empathy on the part of loved ones is the most effective way to deal with this process (p.65). There are a number of reasons for the anger including loss of control over ones life, loss of independence and increased dependence on others, feeling weak, feeling like lie is unfair, and the lack of understanding from others including doctors. For many of us, we ask the question, “why did it take so long to get diagnosed and treated?!”
This current stage in life may unconsciously bring up past hurts and disappointments from childhood or other developmental relationships.

Stage III: Bargaining

When anger no longer works, we may turn to bargaining. We think that if we do something, we will get something in return. We think we may be rewarded for “good behavior”. We bargain with other people and with God. We may ask ourselves, “What if I did things differently? I might not be so sick”. Shame or guilt may cause us to bargain. “Maybe I am sick because I did…” or “Maybe I deserve to be sick”.

Think about some of the ways that you have used bargaining to deal with your situation. Did you bargain with doctors, loved ones, family, spouses, children, God?

“If I only did _______________________, then I wouldn’t have ___________________”

“Maybe this happened because _______________________________________”

“God, if I am a better person or go to church more can you please __________________”

Think about it. But, we soon realize that we did not cause this. Bargaining doesn’t work.

Stage IV: Depression

When the person can no longer deny the illness, the anger and bargaining are replaced with a sense of great loss (Kubler-Ross, 2003). Uncontrollable events begin to happen: when forced to undergo more surgery, have more hospitalizations, begin to have more symptoms or reoccurrence of symptoms, become weaker and rapidly symptomatic. (p. 99)

Loss is experienced in many forms including:

•    Physical changes
•    Loss of function such as developing reproductive problems
•    Financial loss due to mounting medical bills and other expenses
•    Loss of job or career (medical leave)
•    Loss of maintaining the same role as a wife and mother (needing help with the care of the children or spending less time with them because of illness), thus leading to increasing guilty feelings

Depression can worsen because of a lack of awareness and understanding of our needs on the part of those in our environment, including immediate family and friends. Depression is parallel with increasing problems in ones life. For instance, as the symptoms worsen, the depression may worsen. Or as the losses increase, such as having to go on medical leave and stop working or put a career on hold, the depression may increase. (p. 100).

Sharing ones meaning of life, dreams and aspirations, and feelings about the process with loved ones may help to decrease depressive feelings. (p. 120).

Stage V: Acceptance

This is the stage when one accepts what is happening. It is not to be confused with being happy with what is happening. However, the denial, anger, bargaining, and depression no longer exist.

Think about whether you have come to acceptance with any aspect during this process. If so, write down 5 things you have come to acceptance about.

1. I have come to acceptance with ____________________________________________

2. I have come to acceptance with ____________________________________________

3. I have come to acceptance with ____________________________________________

4. I have come to acceptance with ____________________________________________

5. I have come to acceptance with ____________________________________________

A Note about the 5 Stages

These 5 stages are not always linear. They can last for different periods of time and will replace each other or exits at times side by side (p. 148). According to Dr. Kubler-Ross (2003), the one thing that usually persists through all these stages is hope. For some, the hope serves as a rationalization for suffering. For others, hope is a form of temporary but needed denial. (p. 148). Hope is maintained during especially difficult times. When we still need hope, it can be painful to be met with a lack of hope from family, loved ones, or doctors. (p. 149).

Are you able to identify any familiar feelings from these stages when reflecting on our first interactive exercise?

What, if any, of the stages have you experience?

Have you experienced a stage more than once or any of the stages at the same time?

The stages that I have experienced from the 5 stages of loss include:

Kubler-Ross, E. (2003). On death and dying: What the dying have to teach doctors, nurses, clergy, and their own families. New York, NY: Scribner.