Stages of Grief and Depression
Steven G. Rise, PhD, LCSW-R
Most of us, in some capacity and on some level, have experienced grief and loss. As a child, the first loss may have been the death of a pet or a grandparent; or perhaps it was the loss of a parent due to a divorce. In adulthood we may have experienced the loss of romance, of a potentially brilliant career, a spouse, our health, and on and on.
Whenever someone suffers a significant loss he or she must go through the stages of grief. The significance of a loss is very often a subjective experience. The major contributors to the level of significance we place on a loss stems from several different factors. As unique beings with differing perceptions, personalities, and cultural upbringings, we often respond to the same losses differently. Thus, what one person considers to be a loss issue might not be deemed so by another, and if it is, it might not be as severe. So then, the most important point to remember is to be sensitive to other people who are grieving issues that may seem minor in severity to you because, for whatever their reasons are, they might hold a greater importance to him or her.
The stages of grief were first clearly identified by Elizabeth Kubler-Ross in her 1969 book On Death and Dying (Macmillan, 1991). We grieve all losses in our lives to some degree, depending on the personal impact that we experience. In some cases, the process moves quickly, almost without notice. In other instances, the loss drastically changes our lives and the grieving process moves slowly and painfully as we try to regain a solid footing after our lives were left so deeply wounded.
1) Shock or Denial-– This is the natural unconscious defense mechanism that our mind employs to protect us from the apparent emotional overload that would otherwise overwhelm us. The shock or denial enables our minds to adjust to and absorb our loss slowly. In this initial phase, our mind is telling us: “Nothing has happened. My world is still the same.”
2) Anger– As our minds start to process the loss, we first seek to blame an external source for our deficit. Anger includes feeling a personal attack against our sense of self-worth, needs, or convictions; or a strong emotional reaction that results from a sense of being wronged, threatened, or hurt. We become defensive and look to protect our wounded hearts—which has closed up to protect itself. In this phase, we are trying to protect ourselves; we are saying: “This situation is not fair—and it is your fault.”
At times we blame God because we know that He could have prevented our loss. Many people, however, believing anger to be a sin, quickly repress the anger that they feel toward God or toward other people without even realizing that the anger is still alive within them. Here is where the danger lies—in going from denial to repression. If a person gets “stuck” in this phase, clinical depression may result because of the person’s inability or unwillingness to process the loss.
3) Depression— During this phase, our anger is turned inward. This is often the initial opening of our hearts where we look for our responsibility in the situation. Sometimes this leads to healthy reflection, and other times to unwarranted self- blaming. The grieving person feels guilt—authentic guilt, false guilt, or a combination of the two. We ask ourselves at this stage: “How was I to blame?”
It is important to understand that the depression component of the grief reaction is not a true clinical depression, even though it carries some of the same features. It is a temporary stage in a normal process that we all must go through before we can reach emotional recovery. But if the person “gets stuck” in the anger and depression stages for an extended period of time, clinical depression can settle in.
According to Ephesians 4: 26, anger in and of itself is not a sin. Thus, the anger that follows a loss is not a sin, it is a normal human emotional response to a situation that we are trying to adjust to. By God’s grace, we can move through our anger to a place of acceptance and forgiveness, but we should not feel guilty for the temporary feelings of anger that are a normal part of our grief response. Any guilt that we do feel should be surrendered to God as we seek His intervention in our healing process. Those who are unable to forgive themselves or others, and who feel that they need to punish and blame either themselves or others for their loss and the feelings associated with the loss, are also setting themselves up for clinical depression.
Each of the first three stages are focused on the self. As the process continues, we become more and more open to the external resources that are available to us. It is very easy to get stuck in these initial phases. It is easier to blame either oneself or another so that we do not have to relinquish the control and pain. But holding onto losses has a big price—especially when one considers the accumulative factor of a lifetime of losses. The burden gets heavy; so heavy that it must come out some how. The way that it does is often depression.
4) Bargaining– During this phase, we begin to allow our hearts to open and embrace the pain from our loss. We still employ defense mechanisms by trying to “make a deal” with God as we attempt to control this situation that is outside of our control. Much of the difficulty in this phase lies in accepting our helplessness over what had happened. It is not easy to admit to ourselves that we have no control over what has happened—that our lives can radically change so easily in a moments notice, even when we do not want it to. But here is where the Christian has his or her greatest resource—God is sovereign. He is in complete control. Let your trust lie in Him.
5) Sadness-– At this phase, we are more willing to honestly and transparently grieve our pain actively. The reality of our loss is much clearer. The defenses have dropped enough for us to understand the impact that this change will have on our lives, and we can experience the grief that comes with the readjustment and void that is left behind. As we experience the sadness, we also seek to fill the new void that is left in our lives. Take care to fill this new space with the soothing nurturance of our loving Savior.
6) Resolution and Acceptance— At this point, we are willing to re-focus from the pain and accept life without whatever was removed from us. We may still go back to reflect upon whatever was lost, but these thoughts no longer consume or haunt us. When the loss is the death of a loved one, the void is permanent—he or she cannot be replaced. But that spot in our heart can remain a special place where we can go to from time to time to visit cherished memories. We can reflect back and remember the impact, influence, and legacy that these people had on our lives and thank God for the opportunity of knowing them.