Sunday, January 8, 2012

The 5 phases of grief

It is hard to deal with getting a life altering diagnosis, you must grieve the loss of your healthy self.  Knowing that you will not be able to do certain things or as many things as you used to do can be very difficult to accept.  Even when not terminal or not dealing with a death, I think the 5 phases of grief can help us to deal with a serious disease.  I still go through all the phases at different times, and sometimes being strong means dealing with your sadness and accepting that you may never be that same "healthy" person again.  I am praying and hoping for a cure but in the mean time, I am going on with my life the best and most positive way I can, while still being realistic.

The Five Stages of Grief? 

The stages of grief have been a topic of debate in grief counseling since their introduction in 1969 by Elisabeth Kubler-Ross, in her book “On Death and Dying”.  These stages of grief can be loosely described as a cycle of emotions that humans can expect to feel, resulting from some type of unexpected loss.  Grief and loss is very normal process, and something most people will be forced to cope with at some point in their lives.  However, to categorize each person’s feelings into an arbitrary set of stages would not be realistic.
In general, the five stages of grief are described as Denial, Anger, Bargaining, Depression, and Acceptance.  The bereavement community has been quick to accept and assign grief in stages, most likely to lend a sense of hope to those who are grieving and might feel this is an endless proposition. In that regard, the five stages of grief are extremely helpful because they reaffirm the fact that grief is normal, and has been experienced and resolved successfully by countless people.
Although these stages of grief appear somewhat simple, it is doubtful that most people will ascend through them as they are laid out.  That is the danger of the existence of these type of scales.  Offering someone who is grieving the idea that their emotions can be corralled into five equal stages of grief, and that in time they will successfully complete a stage and move onto the next one, can put an extreme amount of undue pressure on an individual.
It should be pointed out that there is no right or wrong way to grieve.  Further, the types of emotional reactions and behaviors that people exhibit as a result of loss will differ depending upon the type of loss they have suffered.  Mourning over a relationship breakup can produce grief, but it will be much different than the grief and loss experienced from the loss a child.
Stages of Grief

Below are the Five Stages of Grief:

1.  Denial – The first stage of grief is Denial.  It is really the first of our reactions to any form of sudden loss.  Depending on the relationship we share to the subject of our loss, the more our lives may be uprooted or altered.  It is very common for people to try and initially deny the event in order to subconsciously avoid sadness, or the thought of pending mental struggles.  People in denial often withdraw from their normal social behavior and become isolated.  Denial has no set time frame, or may never be felt at all.  However, it is considered the first stage of grief.
2.  Anger – The second stage of grief is Anger.  People that are grieving often become upset with the person or situation which put them in their grief state.  After all, their life could now be in complete disarray.  The path of least resistance is anger as opposed to facing the consequences of a loss head on.  In the case of death, the anger is often focused toward the deceased for leaving that person behind and unable to cope.   Other times people become angry at themselves if they feel they could have done something more to stop the loss from happening.
3.  Bargaining – The third stage of grief is Bargaining.  This is when those who are grieving are reaching out to the universe to make the pain go away.  It is actually very normal, and largely considered to be a sign that they are beginning to comprehend their situation.  People will often try to make a deal, or promise to do anything, if the pain will be taken away.
4.  Depression – The fourth stage of grief is Depression.  Contrary to popular belief, depression is something that may take some time to develop. We often think we are depressed when a grief event first occurs, but there is usually a lot of shock and other emotions present before any real depression can set in.  The signs of depression due to grief usually appear when a sense of finality is realized.  This is not to be confused with clinical depression, which may be chronic.  Depression due to grief is technically episodic, even though it may last for a lengthy period of time.
5.  Acceptance – The fifth stage of grief is Acceptance. This is the point where the person experiencing grief no longer is looking backward to try and recover the life they once had with the deceased, or other cause of their grief episode.  It is not to say that they no longer feel the vast array of emotions brought on by their grief, but they are ready to embrace the idea that they are reaching a new point in there lives.  At this point, they are beginning to understand that there is a new beginning on the horizon.
Acceptance should not be confused with healing or recovering from the loss, since that would put an enormous amount of pressure on people experiencing grief.  Acceptance is really the beginning of the real healing process.  It is the point where recovery becomes about the person left behind, and not about the person being mourned.

Unfortunately, There’s No Simple Answer

The stages of grief should not be taken as a literal guide to healing or ascending through grief, because in reality, life does not fit into such perfect stages.  Most people and their grief episodes are different, so recovery is usually not as simple as posting a few stages on the refrigerator and hoping you will quickly move from one to the other.
In fact, many grief counselors and psychologists debate the effectiveness of the stage theory, and often wonder if the idea can be counterproductive.  Our nature suggest that arranging the expectations of what we may feel during perceived hopeless situations may serve to provide a “light at the end of the tunnel” scenario.  However, applying this to extreme episodic grief due to loss is not always a path to success.
An persons emotions and reactions to grief may run the gamut of each stage, but it is doubtful each will arrive at the gateway of the next stage with all aspects of the previous stage completed.  Also, there is no guarantee that anyone shall arrive to any of the stages of grief in chronological order, nor should they be expected to display behaviors associated with one stage at a time.  There is simply no reasonable expectation to assume that any one person will naturally adhere to this formula without psychological coaxing.
However, the five stages of grief do provide an excellent guide for grief support, as well as assessing the condition and mental state of patients through relating them to a chart of commonalities.  The most important part of recovering from grief, especially bereavement, is to seek out help and realize that grief is normal and fully expected.  There is no shame in grieving or mourning, even for extended periods of time.  Simply referring to the five stages of grief, and the debate about how they relate to the grieving process, should help reaffirm the notion that feeling grief is completely normal.  It also requires attention and action on the part of those who are suffering in order to effectively heal.

It's not unusual to feel somewhat overwhelmed and have a wide variety of emotions when you find out that you have a chronic condition like lupus. For example, anxiety, sadness, confusion, anger, uncertainty about the future, relief at having a diagnosis. People often worry and have thoughts such as, "lupus will become the constant focus of my attention"; "lupus will define who I am"; "my life will be forever limited by having lupus".
While these feelings, reactions and thoughts are all 'normal' when someone is faced with lupus, anxiety, sadness, anger and negative self-talk can take a toll on your mental and physical health if they persist over time or worsen in degree. For example, sadness and anger can worsen into depression. Anxiety, worry and negative self-talk can contribute to insomnia and a worsening of fatigue.

Below you will find some tools that you may want to explore to help you to understand and deal with the feelings and concerns that you have about having lupus.
You may want to explore Kubler-Ross's work on grieving. The stages of coming to terms with loss apply to the loss of health as well as the loss of a loved one. It may help you to understand the various stages of grief (denial, anger, bargaining, depression, and acceptance) as you move through them, and possibly return to some of them over time, in the course of dealing with lupus.
Recommended reading: 'On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss' (2005) by Elizabeth Kubler-Ross and David Kessler.

You can't get rid of all the stress in your life - stress is a natural part of living.
"A certain amount of opposition is a great help to a man. Kites rise against, not with the wind."

- John Neal
But too much stress or stress that isn't managed effectivly can have a negative impact on your physical and emotional health. See: MyHealth AB - signs of stress. Stress can also contribute to a worsening of lupus symptoms, or trigger a lupus flare, so finding ways to help manage your stress is a very important part of living well with lupus.
Not everyone will choose to manage stress in the same way. Here are some suggestions that may appeal to you:
  • Take the time to 'tune-in' to your body and how you are feeling on a regular basis (at least daily). For example, does the neck and shoulder tension that starts at work develop into a headache in the evening? Are you snapping at the kids and your spouse when you're tired and hungry after work? Ask yourself,"What can I do to deal with this stress so that it doesn't ruin my evenings? Could you improve the ergonomic set up of your work environment or do some simple stretches during the day to reduce the muscle tension in your neck? Could you keep a snack in the car to eat on the way home to boost your energy and blood sugar level? Being more aware of your stress level will help you to take early steps to reduce it or prevent it from spiralling out of control. Take the Canadian Mental Health Association Stress Test.
  • Look closely at your lifestyle and see what could be changed to reduce your overall level of stress.
  • Consider how much of your stress is caused by your own unrealistic expectations of yourself and what it would be like to 'cut yourself some slack'.
  • Learn to be more 'assertive'. Being assertive, as opposed to being 'passive' or 'aggressive' will help to reduce your stress. It allows you to say 'no' when you need to and to set boundaries on your time and energy to ensure that your essential needs are met. See: MyHealth AB - Reducing Stress By Being Assertive. Recommended reading: 'Your Perfect Right: Assertiveness and Equality In Your Life and Relationships - Ninth Edition' (2008) by Robert E. Alberti and Michael L. Emmons
  • Don't overextend yourself; be protective of your need for breaks, vacations, rest and good quality sleep.
  • Take people up on their offers of help.
  • Be a planner as much as possible - rather than 'flying by the seat of your pants'.
  • Learn to manage your time more effectively by setting priorities, breaking large overwhelming tasks down into smaller tasks that can be accomplished over time, and deciding which tasks are absolutely essential during times of stress.
  • Avoid procrastinating - putting things off just keeps them 'niggling' at the back of your mind; it's unfinished business that can contribute to your level of stress.
  • Keep a 'to-do' list. This can help you to feel like you are on top of things (less likely to forget things that are important) and it provides a feeling of satisfaction to be able to cross things off when they are done
  • Develop good communication and organization systems for your home (with clear responsibilities for yourself and family) so that things don't fall through the cracks. For example, develop a recognized system for dealing with phone messages and bills, and deligate and schedule chores.
  • Get rid of the clutter! While some people seem to thrive in cluttered environments, most people find them to be overwhelming and stressful.
  • Increase your level of physical activity.
  • Explore some of the techniques that promote relaxation such as progressive muscle relaxation, deep breathing, massage, and yoga. See: Simon Fraser University's 'Positive Coping with Health Conditions' - Relaxation Method Audio.
  • Get out into 'Nature' - studies have shown that being out in natural green settings can reduce stress, reduce anger and aggressiveness, improve immune function and improve mood.
  • Take 'mini-vacations' from your cares and concerns - read a book, watch a movie, play a game, take a long hot bubble bath, or listen to your favorite music.
  • Laugh! - laughter has been shown in studies to reduce levels of stress hormones, relieve pain, improve a sense of well-being and improve immune function.
  • Reach out to help others - activities such as helping a neighbour or volunteer work can help to get your mind off of your cares and concerns and increase your level of satisfaction.
  • Become more aware of the positives in your life. What's going right for you? What do you appreciate? You may want to consider keeping a 'gratitude journal' where you write down the things you are grateful for on a daily basis.
  • Share and explore your thoughts, feelings and ideas with people you trust (e.g. family, close friends, professional counsellors, Lupus Society of Alberta staff). It's important to feel connected to others and it is often helpful to get a fresh perspective.
  • Consider keeping a journal of your thoughts and feelings. Studies have shown 'journaling' to be helpful in dealing with difficult experiences and the thoughts and feelings associated with those experiences. In therapeutic journaling, in addition to descriptions of your experiences, it's important to write down your thoughts and feelings about what has happened. Recommended Reading: 'With Pen In Hand: The Healing Power of Writing' (2003) by Henriette Klauser.
  • Avoid the use of alcohol, drugs, tobacco and stress-based eating (especially excess sugar and fat) to try to cope with stress. The longer term result is often an increase in your stress level.
  • Consider learning to meditate. No longer just for 'hippies' and 'New Agers', meditation has been rigorously studied and found to have many health benefits (e.g. relaxation, reduced heart rate and blood pressure, reduced levels of the stress hormone cortisol, reduced pain, and reduced irritability, anxiety and depression. Meditators report feeling happier and generally more emotional stable. And you don't have to belong to any particular type of group (religious or other) to do it - all you need is you, your mind and a quiet place to practice. See: 'Live Mindfully: reflections on mindfulness, psychology and mindful living' for a selection of excellent meditation mp3's that you can listen to. Recommended reading: 'Meditation for Dummies: The Down-to-Earth Guide to Balance and Wellbeing' (1999) by Stephan Bodian.
  • Explore Mindfulness-based Stress Reduction (MBSR) - a stress reduction program which includes mindfulness meditation (one type of meditation). MBSR has been studied extensively and found to have many beneficial health effects. Dr. Jon Kabat-Zinn, who founded MBSR in 1979, has been involved with many scientific studies of MBSR and teaches mindfulness meditation as a technique to help people cope with stress, anxiety, pain and illness. Recommended reading: 'Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness' (1990) by Jon Kabat-Zinn, Ph.D.
If you have found yourself caught up in a vicious cycle of anxiety, worry, and negative self-talk you may want to explore some of the cognitive-behavioural therapies that have been scientifically studied and shown to have value in helping people deal with difficult emotions, depression and chronic disease (i.e. Cognitive-Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT)). You may like to start by reading some of the books, written for members of the general public, that describe these therapies. Or you may want to find a health care professional, such as a psychologist, to work with you in this regard.
Recommended reading for CBT: 'The Feeling Good Handbook' (1999) by David D. Burns, M.D.
Recommended reading for ACT:
"Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy' (2005) by Steven C. Hayes.
'The Happiness Trap: How to Stop Struggling and Start Living' (2008) by Russ Harris.

Continue setting goals for yourself (in spite of the unpredictable nature of lupus). Try not to let lupus take control your life or 'call all of the shots'.
Goals are essential to moving ahead in a direction you value, as opposed to just bobbing along like a cork on an ocean, at the mercy of the winds and the currents.
Write your goals down and review / update them regularly. When you write down your goals, make sure that:
  • they take you in a direction that you value
  • they clearly describe what you plan to do. For example, What are you going to do? How are you going to do it? When are you going to do it and for how long? Who are you going to do it with? etc.
  • they are realistic for you to accomplish.
  • you have considered some of the potential obstacles to reaching your goals. Plan for ways to deal with these obstacles.
  • you can tell when you have either reached your goals or made significant progress towards reaching them.
Recommended reading: 'Suceed: How We Can Reach Our Goals (2011)' by Heidi Grant Halvorson Ph.D.

1 comment:

  1. Articles and content in this section of the website are really amazing. Great ideas indeed! I will surely keep this in my mind!

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