Traditionally, over the last four or five decades we have diagnosed the stages of grief to include denial, anger, bargaining, depression and acceptance (in no specific order). We have come to find out that those early stages and diagnosis actually were derived primarily from people anticipating loss and not always from those actually experiencing grief due to loss. More contemporary psychologists and counselors now have lists that may include anywhere from nine to twelve, even up to twenty various “stages” or “phases” of grief that may be scrambled up in various orders and repetitions.

Some counselors now speak of grief in "phases" rather than stages. Examples may be the "yearning" phase, where there is a desire or longing for things to return to an acceptable or normal mode. This phase often reaches deep into the grief stricken mind and stimulates the needed processes for healing in the griever’s personal life. In this phase healing and a return to normalcy in life may seem to be a very far off, but they are not out of sight psychologically.     

The "numb" phase is often a self induced form of protection from further loss or even the grief process itself. In this phase the person experiencing loss pulls inward to themselves. They are often very quiet, and typically avoid former social situations that they were familiar with and comfortable in prior to their loss. Many times they will privately self medicate with alcohol, drugs or food. On the other side of the spectrum, those who experience an intense form of this numbing phase may refuse to take prescribed medications and fast for long periods of time so as to isolate themselves even further.     

The "disorganization" phase describes the chaotic or fracturing aspects to the personal life of one who is experiencing grief due to some form of loss. This phase can be very noticeable in post divorce environments. It is also obvious where someone has lost a spouse in death and there was a high amount of co-dependency connecting the two of them. It is also a familiar phase in the grief and loss of people involved in relationships where attachment disorders are part of the dynamic interaction. For them, life is fragmented and greatly disturbed because of their loss of relationship. This causes a heightened sense of disorder, mentally and often physically.       

The "despair" phase is best summed up by a feeling of hopelessness. Many times someone in this phase of grief will make statements about not seeing any “light at the end of the tunnel.” This phase may also become coupled with the numb phase previously discussed. They may often project the finalization of various aspects of their life. There is often a careless attitude toward life because their sense of hope is no longer obvious. They may experiment in various indulgences of self medication attempting to recreate a new life of hope. In worse case scenarios they may project the early warning signs of suicidal tendencies. If these signs are obvious in a griever’s personality, we must not ignore them. An adequate honest response coupled with the true compassion coming from qualified and genuine caregivers will help stimulate the hope that a person needs to survive their loss.      

Some of the latter phases in the grieving processes may include "reorganized behavior" or the "recognized hope" phase. These phases recognize progress and the initial acceptance in some of the various aspects surrounding the grief experience. Usually there have been some obtainable goals set and the person in grief begins to see the light at the end of the tunnel. They may still experience set-backs and “bad days”, but when all is said and done, the net gain in progress is always a positive number.

In this phase we may see them get "ambushed" in their grief progress unexpectedly. They might feel that they are making some headway through their loss and grief issues when something unexpected will happen. They may wake up one day and realize that was six months ago or one year ago to the day that they suffered the loss. Or, they may hear a song on the radio or watch a movie or a rerun on television that reminds them of the relationship that they once had with a person who is no longer in their life. They may even reflect very powerfully in an emotional outburst. These incidences can sometimes re-open the wounds of the loss that they suffered months and maybe even years ago, despite the fact that they had made notable progress through them. Be certain to assure them that there will come a time when things will once again take on a more normal form. Remind them gently that they are living in the present moment and what they are experiencing is a memory-triggered response. Sometimes a gentle nudge in thinking ahead, or a planned event in the future will slowly help them take the focus off of the current pain that they are re-experiencing in that ambush experience.

Regardless of whether or not we refer to these times as stages or phases, the process of grief is still one that is necessary, natural and as we previously discussed, very normal.

It is necessary because in the journey of grief there needs to be a release and expression of our grief from loss through the bereavement process. It is natural simply by the fact that we have to work at suppressing our reactions to loss in our lives. We have previously discussed that grief is normal for all humanity, and no one is exempt or immune to its potentials.

People will typically go through theses stages or phases usually with much overlap of the processes and at various paces. There may be times where the progress of someone’s grief process regresses or may even appear to be degenerating. Sometimes the old saying "two steps forward three steps backwards” isn’t all wrong unless of course that grief process equation continually repeats itself. Sometimes people need to go backward for a brief time period in their grief process to catch a detail they didn’t deal with or experience when they initially passed through those thoughts or processes. It is then that the griever must be assured that it is permissible to do that as long as they realize that they should eventually once again move forward.

Some therapeutic ideas which can be suggested that may help someone travel more effectively through the grief process may include such things as writing a letter or a poem. If they are artistic, they may want to create a painting, sketch or compose a song that would express their feelings about the person or relationship that has been lost. Some people may need to visit a gravesite with someone, or even go back to a favorite restaurant or vacation spot with different people.

Good communication skills should include questions as to how or what progress they feel they are making in their journey through the grief process. Give them plenty of time to analyze their progress in your conversations with them. As caregivers, we should always allow their memories to be an integral part of any conversation we have with them. Even memories which may have a negative implication can sometimes be helpful as a learning experience for them. Make sure they can verbally identify the point of growth and what they have learned from such experiences.    

Memories are the fuel of eternal life, especially in the mental context of the grief experience. We learn more about our own life, and we learn to love others more through the things we remember about them. When proper memory utilization processes are practiced in a balanced manner, over time, the important and healthy memories should naturally align themselves in a positive and helpful system of importance and recall to the person experiencing grief.

We must remember that there is no end, final stage, phase or cure for grief itself. That should not a negative statement, but rather a very positive one. An end to grief should never be expected or desired, even tough graduated relief from the initial anxiety and pain is the goal.            

The process, through proper development and time should become less painful and more of a productive resolution in the griever’s life. To end grief would be to end the memory of the loss and the ability to grow and learn from that specific experience. The positive attitude and valued learning experience that one experiencing grief is willing to accept, will make all the difference in whether or not the end result will enhance or erode their life.

If someone who has experienced a loss claims to "be over it" or says that they are no longer grieving, they will more than likely require more care and help through the grieving process. These types of statements typically identify that they may have just re-entered the numb phase or that they are in denial of certain aspects of their personal grief and loss circumstances. These responses might also very well be indicative of very discreet forms of "self-medication" as they attempt to avoid or delay the pains of the grieving process.

The griever may also be yearning for some form of unobtainable normalcy to return back to their lifestyle. In these situations it may be good to ask them to define what they perceive “normal’ to be. Their definition of “normal” and ours as a caregiver may be two completely different definitions. Sometimes a balanced suggestion or a subtle perspective on what “normal” really may be, will help them rethink their definition and become more comfortable with where they are actually at in the process of grief.  

The classical case scenario is the lady who experiences a catastrophic divorce, and three months later finds herself in a wedding chapel in Gatlinburg, Tennessee saying "I do". She says she is "over him" (the ex-husband). But in fact, she has actually produced a "quick cure” that generally produces a very similar loss to what she originally experienced. She is actually desiring her life to become normal again, but not allowing her grief to transact a healing and learning experience the way that it should.  

The re-marriage of a widow or a widower within a year of death generally holds about a 90% chance of failure. Accepting grief slowly and not pushing for radical life changes such as new personal relationships or changing geographic locations or making career changes generally tend to produce a more solid recovery and return to normal everyday life.

Helpful Suggestions

      Here are some helpful ways in which we can encourage those around us who are experiencing grief to work toward a more comfortable position in grief by how they live their daily lives. They are simple suggestions that by themselves will probably do very little good. But when these suggestions are coupled together in various combinations, they may become very effective in a daily routine.

1). Encourage them to eat regularly scheduled nutritious meals. If someone is more systematic in their nutritional intake it will not only aid their digestive processes, which are often affected by intense grieving, but it will also help balance the body’s metabolism and chemistry in a predictable and measurable manner. Many times people suffering from fresh or initial grief may not have any desire to eat. If they can be encouraged to take several small portions of food over the course of a day, it will generally help keep their metabolism balanced to some measure better than if they do not eat at all. The intake of water and fluids should also be encouraged. Many people become dehydrated because they do not drink any water or fluids due to the consuming feeling of their grief experience. Often times a glass or two of water will help ease the pressure of a headache.

2). Encourage them to get plenty of sleep. Even though in the initial phases of grief sleep may be hard for them to experience, you should encourage them to at least lie down, be still, and rest. Quiet times help the body and mind rejuvenate together, even if long periods of sleep are unobtainable. Visualization and meditation during these periods of rest are also options that the caregiver may want to use to help the griever relax and find some quiet time. A caregiver should not use these methods unless they are trained and somewhat experienced with them on a personal level.

3). Discourage them from taking non-prescription drugs or casually consuming alcoholic beverages at will. It is sometimes very easy for people experiencing grief to become dependant on such substances or develop harmful habits in the pattern of consuming these products. These are also indicators and displays of potential serious tendencies toward self medication as we have previously discussed. If a person has been prescribed medication by a physician or psychiatrist, encourage them to continue their prescribed dosages at proper intervals. Never encourage them to “double up” dosages because their grief becomes more intense. Encourage them to consult  their physician or psychiatrist for such advice or changes.      

4). Encourage them to guard against over extending their schedule or over participation in rigorous activities. Their physical body is affected by grief also. Therefore, it needs time to re-adjust to the pace and activity that it was once involved with prior to the experienced loss. This re-adjustment is one from a mental perspective also. The body and the mind need time to rejoin and regain combined strength from the stress of a loss and the grieving experience. Sometimes a minimal exercise regiment may help the griever build back into a regular routine of activity.   

5). Encourage them to continue the practice of their faith. Remind them that their spiritual and religious convictions are there to help strengthen their mentality and outlook on life in general. Loss always has a spiritual side to it that needs care and attention. If they are people who have participated in a religion or a faith experience, encourage them to spend time with others of like faith and spiritual convictions. When it comes to the spiritual issues of life, there is strength in numbers. If you as a caregiver practice a different faith or religion, you should never try to convert them or sway their thoughts during these times of grief. People experiencing grief are generally not capable of making accurate major life decisions, or understanding them if they attempt to such decisions.    

As sincere caregivers we can offer these suggestions and helpful ideas without forcing those afflicted by grief to consider or practice them. They may graciously decline some or all of your suggestions, or they may even react strongly and emotionally against your expressed compassion. Give them time and space if they need it. But, do not neglect another attempt at a later time. Do not abandon them. Attempt to find the balance between leaving them alone and being there for them within their own personal comfort zone.    

We must also be diligent to help those in grief who are expressing the emotion of visible and definable anger. There are situations where the energy we encounter from the anger involved in the grief process can be properly directed towards productive activities which can change situations and circumstances in someone else’s life. An excellent example of this is when the mother of a student who was killed by a drunk driver took that energy through the anger she experienced in grief, and formed the proactive national organization we now know as MADD (Mothers Against Drunk Drivers).

Be patient with those experiencing an intense form of grief. Time and quality communications with caring people will help them start to walk through the grief and on to long term healing. Don’t set time frames or firm sequential orders around the stages or phases of the grief process. Some people are able to deal with a large portion of their grief issues in a couple of months. But for many, it is a much longer period that may extend up to several years. Be patient and show them the care and the love (commitment backed up by actions) that you would appreciate if you were in their condition.