The gravity of grief and how we deal with it

MsT delves into this debilitating emotion to understand the different ways in which we cope with it

Whether we lose a loved one or fail at something our heart is set upon, everyone of us knows grief at some point in our lives. Interestingly, however, we all react to it differently.

Even though most of us know little about psychology, we have all heard plenty about depression and grief and how they manifest themselves. One can argue that the suicide of renowned comedian Robin Williams sparked a much-needed debate on the dark side of human psychology.  Most recently, Bollywood starlet Deepika Padukone has come forth and confessed to suffering from depression. Thanks to this exposure, our eyes have been opened to some disabling emotions but unfortunately, most of us are simply aware of the general theme only. Hardly anyone knows that grief and depression have certain stages they manifest themselves in, the number of which remains undetermined.

According to most experts, grief begins with denial and ends at acceptance, with a myriad of stages in between. Swiss-American psychiatrist Elisabeth Kubler-Ross made things clearer back in 1969 by devising what we now refer to as the Kubler-Ross Model. “This model highlights a series of emotional stages experienced by individuals who survived the death of a loved-one,” explains Sumira Siddique, who holds an M Phil in Psychology and currently works as a Student Wellness Counselor at the Ghulam Ishaq Khan Institute in Khyber-Pakhtunkhwa. Ever since its publication in Elisabeth’s book On Death and Dying, the Kubler-Ross model has become the definitive model to treat grief (induced by the death of a loved one).

“It deals with grief related to death of loved ones, or loss of any important figure in one’s life,” adds Sumira. In a nutshell, the Kubler-Ross Model divides grief into five main stages: denial, anger, bargaining, depression and acceptance.  It is, however, crucial to note that the stages have evolved since their introduction and even been misinterpreted over the past three decades. For instance, Sumira claims that the model wasn’t meant to compress a mess of emotions into stringent packages. “We need to understand that every person is different,” she explains. “Every person has a different response to the situation they face. Everyone reacts differently.”



In fact, Elisabeth has busted a key myth that is associated with her model herself: there is no set order in which human beings react. Contrary to popular belief, the stages Elisabeth denoted can occur in any random order as there is no set pattern to them. They do, however, help patients and doctors classify the problems at hand. Additionally, people often think of the stages as momentary lapses in otherwise normal behaviour. But in reality, any one stage may last minutes, hours, weeks or even months. One may weave in and out of stages multiple times or exhibit two stages simultaneously.

Zohaib Rana, a researcher at Agha Khan University Hospital in Karachi lends credence to this, saying, “Not everyone goes through all of the stages or exhibits them in a prescribed order.” He draws on his own experience of losing his father and shares, “When my father passed away, I went into denial first. Once circumstances began to sink in, various emotions exploded within me. Depression, anger and bargaining all came simultaneously for me.”

In her book, Elisabeth has also suggested that the stages are not a complete list of all the emotions one could possibly feel. Not everyone who experiences a life-threatening or life-altering event will experience all five of the emotions. The stages are but natural responses to loss that most people have but there is not a typical response as there is no typical loss — every situation is different. Homemaker Afzal Naeem, for instance, recalls the pain she felt after losing her first-born during childbirth. “It is impossible to classify the emotion a mother feels when she loses a child,” says Afzal. “I remember I was in so much shock in that moment that my blood pressure dropped. Later on, all throughout my second pregnancy, I was terrified that history would repeat itself and I would lose my second son too.”

Telecom engineer Suleiman Khan and his brother Adnan provide an interesting take on grief after surviving a devastating car accident. “My car drove off a mountainside in Islamabad,” says Suleiman. “I was severely injured and bedridden for weeks. But despite that, I felt none of the five stages at all, not even one. What happened was tragic but we shouldn’t dwell on tragedies.” Adnan, on the other hand, lost consciousness upon seeing his brother wounded so badly. “I fainted at the sight!” he says.



Interestingly, Suleiman’s take on grief and emotions in general is echoed by American psychologist George Bonanno, who teaches clinical psychology at Columbia University. In his book The Other Side of Sadness, George claims that natural resilience is a main component of grief and trauma reactions. His work demonstrates that an absence of grief or trauma symptoms is actually a healthy outcome, rather than something to be feared, as has been suggested by the Kubler-Ross model. Bonanno is also the genius behind the phrase “coping ugly” which suggests that some forms of coping with grief may seem counter-intuitive. These could range from unexplained laughter, celebration or an overall happy mood.

Sumira also points out some external factors play a key role in determining our reactions to difficult situations. She believes that the current turmoil in Pakistan is slowly habituating our responses to grief. “The constant stream of terrorist-related activities is making our society immune to violence, fear and loss,” she explains, “There is an immediate need to educate people. Worryingly, we are beginning to confuse resilience with apathy and indifference.”

There are many like American clinical counselor and author of wellness blog Modern Loss Megan Devine, a clinical counselor, who criticise the Kubler-Ross Model for being too stringent in nature. In an article she wrote for The Huffington Post back in 2013, entitled “The 5 Stages of Grief and Other Lies That Don’t Help Anyone,” Megan argues that unlike what the model suggests, dealing with grief has no finish line. She also asserts that many people often revert back to grief (any of the five stages) after getting out of it, concluding that no emotion can be put within a framework or clustered into a set pattern.

The common narrative, therefore, would be that most people have misinterpreted grief completely. The Kubler-Ross model unfortunately, doesn’t provide any milestones in the path of relieving grief. Rather, our grief is as individual as our lives. In another book, titled On Grief and Grieving, published a decade after her death last year, Elisabeth has expressed her regret over publishing the model as people misunderstood the five common stages as five definitive experiences. As she said in the last few days of her life, “I am more than these five stages. And so are you.”

Kubler-Ross model

The five stages, as described in the book On Death and Dying:

Denial

In this stage, a person prefers a false or preferable reality. Denial helps us pace our grief and suppresses other emotions. When one is in shock and denial, they go numb and don’t feel anything. Instead, we go directly to moving on without processing the loss properly. Many people simply live on a daily basis. Denial and shock help us to cope and make survival possible. But it is only after we accept reality that we begin the healing process. As the denial fades, one feels stronger in dealing with the pain.

Anger

When our denial starts to dissipate, we grow frustrated, especially at people in close proximity. Common psychological responses of a person undergoing this phase include ‘Why me? It’s not fair!’ or ‘How can this happen to me?’ One should be willing to feel their anger, even though it may seem endless. It express whatever we are holding inside. Many experts take loss-induced anger as an indication of love.

Bargaining

The third stage involves the hope that we can avoid a potential cause of grief. Most commonly, people negotiate with a higher power and request a positive change in exchange for a reformed lifestyle. Similarly, an individual may use anything valuable against another human agency to extend or prolong life. People facing less serious trauma may choose to bargain or seek compromise. Often, we beat ourselves up over the ‘what ifs’ and the ‘if onlys’ which causes us to find fault in ourselves.

Depression

During this stage, we focus on the present and become distressed by the eventuality of death. Herein, we may become silent, reclusive and spend much of our time feeling sullen. Common questions that arise during this phase include ‘I’m so sad, why bother with anything?’ or ‘I’m going to die soon so what’s the point?’ A lot of people who lose an intimate partner question whether they should continue living or not. It is completely normal to experience depression after the death of a loved one.

Acceptance

Acceptance is often confused with the notion of being alright with what has happened but that is hardly ever the case. Most of us never come to terms with the loss of a loved one. On the contrary, this phase is about accepting the fact that our loved one is physically gone and recognising that this new reality is, in fact, the permanent reality. In this last stage, individuals embrace mortality and the inevitable future. People dying may precede survivors in this state, which typically comes with a calm, retrospective view for the individual and stable emotions.

Published in The Express Tribune, Ms T, April 5^th, 2015.