Paula L. Casey, M.A., LMFT

Child Therapist, Licensed Marriage & Family Therapist Anacortes, Oak Harbor, Bellingham, WA
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Grief and Loss
Grief and loss are a part of life. We have all experienced it. It is only when we are unable to pass through and complete the stages of mourning that we many need support and counseling. The grieving period varies greatly between individuals. The following are general guidelines for you to consider if you are having extended difficulties.

Five Stages of Grief and Loss

(Elizabeth Kubler-Ross, M.D.), On death and dying: What the dying have to teach doctors, nurses, clergy, and their own families, Touchstone, 1969.)  These stages may progress one after the other or some may be experienced simultaneously.

 

  - First Stage: Denial and Isolation - Often our initial reaction is shock and numbing resulting in denial. Denial is usually temporary, being replaced very gradually with partial acceptance. However, if there has been a history of trauma or loss and/or a history of resistant denial, this stage may be more difficult to transcend and may lead to more severe isolation.

   - Second Stage: Anger - Denial gradually gives way to anger, rage, envy and resentment. This stage can be very difficult for family and friends to cope with. However, with patience, listening, understanding and respect, family members and friends can help the transition through this stage as well.

   - Third Stage: Bargaining - In this stage, we revisit our childhood tendencies to bargain: If you do this, then I'll do that! However, its really an attempt to postpone the inevitability of the loss or trauma. "I won't be angry at you God, if you show me the reason he died." It also works subtly as a defense against any guilt we may be experiencing.
   - Fouth Stage: Depression - This is the stage that the greatness of the loss begins to be experienced. However, this loss can have many, many faces. It is not only the initial loss or trauma, but subsequent loss such as financial, friends, lifestyle, luxuries and necessities, court, trials, government systems, loosing a home, education and dreams. This is also the stage that excess guilt or shame can set in with loss of self-esteen. If the person "is allowed to express his [her] sorrow [s]he will find a final acceptance much easier, and [s]he will be grateful to those who can sit with him [her] during this stage of depression without constantly telling him [her] not to be sad," (Kubler-Ross, M.D.) 

   - Fifth Stage: Acceptance - The person will reach a stage where he is neither depressed nor angry about "fate." Previous feelings have been expressed and losses mourned will result in weakness and the need for naps or additional rest or sleep. This is not avoidance or hopelessnes, but rather an "indication of the beginning of the end of the struggle." This is a stage where one is almost void of feelings, "the final rest before the long journey." This is a time for non-verbal support and silent acknowledgment of the "monumental task required to achieve this stage of acceptance." (kubler-Ross, M.D.) 

 DSM-IV-TRtr

 (Diagnositic and Statistical Manual of Mental Disorders, Fouth Edition, Text Revision, America Psychiatric Association, 2000)

 

The DSM-IV-TRtr states that "As part of their reaction to the loss, some grieving individuals present with symptoms characteristic of a Major Depressive Episode (e.g., feelings of sadness and associated symptoms such as insomnia, poor appitite, and weight loss). The bereived individual typically regards the depressed mood as "normal," although the person may seek professional help for relief of associated symptoms such as insomnia or anorexia.

 

The duration and expression of "normal" bereavement vary considerably amont different cultural groups. The diagnosis of Major Depressive disorder is generally not given unless the symptoms are still present 2 months after the loss. However, the presence of certain symptoms that are not characteristic of a "normal" grief reaction may be helpful in differentiating bereavement from a Major Depressive Episode.

 

These include 1) guilt about things other than actions taken or not taken by the survivor at the time of the death; 2) thoughts of death other than the survivor feeling that he or she would be better off dead or should have died with the deceased person; 3) morbid preoccupation with worthlessness; 4) marked psychomotor retardation; 5) prolonged and marked functional impairment; and 6) hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.