How accurate are the "5 stages of grief" to model behavior during the loss of an important person?

Submitted by pororoca_surfer t3_ylpbyw in askscience

Described as "denial, anger, bargaining, depression, acceptance", these are the common five stages of grief that are very popular among people.

But how well does it relate to reality? Do people really show defined stages during grief? And are these stages well defined for us to be able to characterize them as "anger" and "bargaining" and "acceptance" etc?

If not:

  1. How it became so popular?
  2. What are the most modern model for grief that we know?
  3. Could you share some articles about it?
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Comments

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matchstick_s t1_iv09vpq wrote

Radiolab did a great podcast episode about this - it's actually not very applicable at all! Little known fact is, the five stages model was designed not as a model of grieving for a loved one at all, even though it was then largely misrepresented as such. They actually refer to how their creator, Elisabeth Kübler-Ross, described what people close to death experience when facing their own mortality and how they grieve about their own upcoming loss.

Here's a link for those interested: Radiolab - The Queen of Dying

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cryptotope t1_iv0wg7j wrote

>Radiolab did a great podcast episode about this

And once you listen to that episode, go ahead and listen to pretty much their entire back catalog of episodes. It's all really good, really well-produced stuff.

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uniace16 t1_iv1bg7k wrote

RadioLab has great content but the nonstop sound effects are grating and make it hard for me to listen to.

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smokingloonth t1_iv1gylc wrote

I feel the same way after listening to them again after many years off. I really enjoy Stuff You Should Know now. They're great!

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meme_streak t1_iv32w1r wrote

The problem is that one of the creators and hosts does the sound effects as a hobby.

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Grinagh t1_iv123ng wrote

Yeah, we all muse about not knowing how much time any of us have, but when it's spelled out by a doctor, suddenly the tragedy hits home and people breakdown because, "how could this happen to them!"

PS the same 5 stages are felt when you have no tp in a public bathroom

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victorywulf t1_iv0odp6 wrote

i love that this was the first comment i saw because i came here to recommend that episode!

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JoshKerwinMusic t1_iv0tiu7 wrote

Beat me to it. This is a must listen podcast, not only episode but series in general.

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beleaguered_penguin t1_iv64k1a wrote

> described what people close to death experience when facing their own mortality and how they grieve about their own upcoming loss.

Having gone through some scary medical issues - not life threatening but potentially severely shortening my life expectancy - I do agree and I went through them all

Denial: It's probably because I do <X> and not an actual underlying issue (I was wrong...)

Anger: Why has the NHS failed me and let me get to this stage? Why aren't the doctors doing anything (I complained to my GP at this point about the hospital treatment)

Bargaining: Ok but there has to be something the doctors can treat me with. Maybe if I did X exclusively I will see results (I actually ran several experiments myself and paid for blood tests out of pocket to see if they were working)

Depression: Self explanatory...

Acceptance: This is just what's left after the depression fades

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ZSpectre t1_iv49vqr wrote

Thanks a lot for this as I'm someone who's trying to learn as much about the grieving process and how much it may or may not apply to a person's ability to accept tough truths in general.

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Maya_ha t1_iv06um4 wrote

A French doctor in psychiatry has made a video on the subject: https://youtu.be/QE7tW63riRE

Another one about prolonged grieving: https://youtu.be/KkXaM240AKQ

Idk if subtitles are available but, in a nutshell, his conclusion was that these phases exist but people don't necessarily go through them all and not in a specific order. Also there's no clear cut definition of a healthy or complete grieving process. The best you could do is determine if people are mentally well or not and how negatively the grieving process impacts their life. Some people can even appear to grieve forever by building rituals around a specific death/loss but still be okay.

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[deleted] t1_iv0hzwk wrote

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ThomasHL t1_iv08tdn wrote

They're also not an exclusive list of phases either - there's lot of other ways to grieve. So as a model it's not particularly great, being neither in order nor exclusive nor inclusive.

Which is unsurprising as they weren't even invented to explain grief, but rather coming to terms with a person's own death

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thrownkitchensink t1_iv1mda9 wrote

>Idk if subtitles are available but, in a nutshell, his conclusion was that these phases exist but people don't necessarily go through them all and not in a specific order.

Wasn't this what Kubler Ross wrote too?

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WrongSubFools t1_iv0aczg wrote

The five stages were initially never about grieving the loss of a loved one. Instead, they were supposed to be about accepting your own impending death.

Denial, for example, is a normal response when you learn you a disease will kill you but is not a normal response to a loved one dying. (If someone insists their spouse isn't actually dead, that is not normal grief but a severe delusion.) Bargaining, similarly, makes sense when facing your own death—you believe that if you make some changes, you will live, despite what doctors say—but has no actual equivalent when grieving ("maybe we can bring them back" is not a reasonable response).

The Simpsons interestingly enough got this exactly right, applying it to Homer learning of his impending death rather than to grief after loss:

https://www.youtube.com/watch?v=jYN4CllWuiM

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aris_ada t1_iv0l9mk wrote

> is not a normal response to a loved one dying. (If someone insists their spouse isn't actually dead, that is not normal grief but a severe delusion.)

I agree with all you said especially that the "stages of grief" have been widely used out of any scientific context. But I definitively remember being in denial of my father's death during half of the car trip. I did not try bargaining obviously, after I saw his body all I had was sadness and anger.

However I think these stages work with other emotional events like a separation. Bargaining is definitively within the range of emotional responses to your partner's announcing they're leaving, along with anger, sadness or denial.

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WrongSubFools t1_iv0n7qc wrote

Oh, I think it makes sense to react with denial to the news of a loved one's death. Just not to the death itself. I suppose when TV etc portrays the five stages, they too are talking about reacting to news, initially unconfirmed, of the death.

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PurpleHooloovoo t1_iv1b48t wrote

I think there is a bit of denial, in that the brain sometimes doesn't really process it. You don't really truly believe it, even after you've seen irrefutable proof, because to acknowledge it is to bring about that grief.

It isn't a logical, true, actual denial, but a (subconscious) denial by the brain of dealing with it. I've seen that personally happen. Rationally you know, but that pain is so great, the brain doesn't want to go there right away.

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mcnathan80 t1_iv26eea wrote

"Honey sit down. So-and-so is dead"

"WhAt!?!?" [denial]

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Rosemarin t1_iv1yrq4 wrote

I believe the five stages apply better to the "death" of a relationship, for example a divorce. Especially when one partner wants to end it and the other don't. The one who wants the relationship to continue often experience these five stages, although not necessarily in that particular order.

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[deleted] t1_iv08ujy wrote

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ablativeyoyo t1_iv0a68c wrote

Regarding modern models of grief, one concept I have come across is "delayed grieving".

When a person encounters loss, some people suppress the feelings - often using drugs or alcohol - so that years later they still linger unresolved. A counsellor can guide a person to revisit these feelings. In some cases this can result in the person going through a period of grief many years after the loss - and ideally this results in resolution and more comfortable feelings.

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stantheman1976 t1_iv16ndt wrote

There's also a concept called anticipatory grief. When you have someone close who has a terminal illness or condition you know will be fatal you can begin dealing with the "grieving process" before their death. Since it will be expected in theory your grief should be less complicated to deal with.

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mfukar t1_iv0e96f wrote

Can you point to some reading material?

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[deleted] t1_iuzsyu7 wrote

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[deleted] t1_iuzu5jb wrote

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fell_while_reading t1_iv0d3ri wrote

This topic was covered in depth on the Radiolab podcast entitled The Queen of Dying. It discussed how Elisabeth Kubler-Ross originated the theory of the five stages of grief through her work. Her radical idea was to talk to dying patients about dying at a time when most doctors wouldn’t even tell a patient that he/she WAS dying. Out of that work, she developed her theory about the five stages of grief to describe how people experience the process of dying. The podcast concluded that many people don’t experience grief as the five sequential steps described. The phases may come out of order, or people may cycle through one phase multiple times, etc. BUT, it also pointed out, and this is important, that the model was meant to describe the process a person goes through when they know they are dying. It’s clean and concise so it’s been generalized in media to apply to all forms of grief, but that wasn’t what it was ever meant to do. It was meant to describe a very specific moment in life, not life in general. The podcast made a strong argument that no one who’s grieving should feel like they’re doing it wrong because their experience doesn’t match the model because it’s just a theoretical model and a very specific one at that.

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arrob_adventures t1_iv1279u wrote

The book “Its Ok You’re Not Ok” covers this topic really well. The stages were never meant to be linear. They are stages that people go through but the order can be any combination and you can move forward and backward. As someone who has been through intense grief, yes experienced all the stages but not in a specific order and once I gained acceptance I didn’t just stay there. I am still going through the stages in random combinations.

https://refugeingrief.com/book/

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dr_clocktopus t1_iv3qyck wrote

They should really be referred to as The 5 Symptoms of Grief instead. "Stages" leads to much misinterpretation.

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Seffaf t1_iv06ehv wrote

Well, I will share what I know unless someone who is more experienced on the comes forth. Actually the wikipedia page provides valuable insight to the matter. The model was based on people who were experiencing death themselves, not grieving for a loss. Additionally, you don't go through these emotions step by step. Instead, they act like different sets of emotions that can occur throughout the grieving period. That means you can be in denial and anger at the same time, and be in acceptance and anger the next day. The thing is, since the theory wasn't based on people who were grieving, it would be wrong to apply the theory to them. I don't think there is a model for this, it may lead to psychopathology of course and then it would be within the realm of clinical psychology at that point. Anxiety, depression, or emotion regulation problems for instance.

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ogfuzzball t1_iv15rdf wrote

Also the stages are not a linear model as they are popularly portrayed, and that an individual may not experience all of them, and could repeat some stages. Pop-sci culture created something that wasn’t quite true. Much like the 8 glasses of water a day.

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Whydogamerslovepie t1_iv1uze2 wrote

Licensed therapist here: I didn’t know about the radio lab podcast (sounds fascinating) but in practice, we do not explain the five stages as linear. You could be feeling any of those things, a combination, or none at all any given day. We use it most to describe grief for those going through it, as a tool to recognize their emotional states, and feel less “out of control”. It’s useful tool to differentiate when someone is going through intense grief or other mental health symptoms are starting to appear as an outcome of grief.

Some practitioners would suggest there is one more stage “to make meaning” of the loss. This is more applicable in life, but not everyone’s worldview needs meaning. So this additional stage is still up for review and debate.

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patrickrussell2 t1_iv25i17 wrote

I lost a student to suicide a few years ago and it wrecked me for a long time. I’ve also delivered eulogies and met with families who lost children unexpectedly.

Grief doesn’t work on a timeline. Especially at first. Imagine a washing machine with a glass window on the side. Inside that machine is every emotion possible. Grief, anger, guilt, denial, acceptance, etc. The washing machine is turned on and the emotions are spiraling inside. Every now and again one gets pressed against the glass and you see it. Then it’s ripped away and another replaces it.

In the cases of unexpected loss that I’ve witnessed, their loved ones are literally swirling in emotions so violently you’d never be able to isolate anything as a “stage”.

I would argue that to really understand grief you have to see and go through it. The most rational, balance person can become an irrational mess for years due to grief.

It’s just horrible and I wouldn’t wish it on anyone.

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No_Street7786 t1_iv162gj wrote

People are talking about this being how people near death cope with their upcoming death, but it also can apply to people who are going through a major or unexpected life change. Happened to me after I abruptly got married and uprooted my whole life to move to a tiny town and then the world went into lockdown. I started journaling about all of my feelings which were widely varying and then I noticed the pattern. I talked to a therapist about it and she confirmed.

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wisefoolhermit t1_iv12kuk wrote

I recently read an article in the Atlantic that I resonated with very much. It offered a very interesting take on the five stages of grief-theory that, I think, pertains to your question:

‘After losing her son, a scientist and science writer takes a closer look at grief:

The five-stage model wasn’t generated from data. It’s a theory, developed by the psychiatrist Elisabeth Kübler-Ross and published in 1969, that explains how people come to terms with their own impending death. I remember watching Kübler-Ross on television when I was a young teenager, absolutely enthralled, and later buying some of her books. By the time her second one was published, in 1974, Kübler-Ross had expanded her claims, such that the five stages would apply to the grieving process too. Families go through them once while their loved one faces death, she argued—and then they may again when that person has died. Though I’d been a fan of Kübler-Ross’s work, mentions of this theory caused me stress when I was in extreme grief. Was my denial “stage” over yet? If not, how long did I have before I’d turn into a rage monster and scare my grandkids? Some grief websites warned that people can move backward and forward through the stages as they grieve—an idea that made me worry that the all-consuming despair could return. That possibility nipped at any sense of hope and encouragement I could muster: My anxiety would ebb, but then the internet whispered, It won’t last.’

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black_kyanite t1_iv32hna wrote

It's not exactly current anymore, but J. William Worden's model outlined in his book discusses the four tasks of morning:

  1. Accept the reality of the loss.

  2. Work through the pain associated with the loss.

  3. Adjust to a world without the deceased.

  4. Find an enduring connection with the deceased amidst moving on to a new life.

This was the model used when I was a professional grief counselor. I think it still holds up pretty well.

Worden also had some thoughts on complicated bereavement and I think there were some chapters on specific losses such as suicide, child loss, or if you loved one goes missing.

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pororoca_surfer OP t1_iv33lw0 wrote

Thank you for the reference and the comment, I will look into that.

A lot of comments here, albeit valuable and interesting, are leaning towards personal experience. Which is valid and I shouldn't be skeptical just because. But it is nice, at least in this sub, to have some fundamental to look into. Thanks!

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black_kyanite t1_iv34w6s wrote

You're most welcome. Irvin Yalom, a psychiatrist in California, has also written extensively on death, dying, and other existential concerns in many of his books. His nonfiction is best. I liked Creatures of a Day. He also co-wrote A Matter of Death and Life with his wife Marilyn while she was dying of cancer. It blends his personal and professional experience with grief and loss. Psychology is a pretty soft, pretty new, pretty inexact science, but he's a tenured Stanford professor, so it's pretty safe to say he knows what's up. I'd recommend it if you want a book that has less of a clinical/textbook vibe than J.W. Worden's.

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Oudeis16 t1_iv0ufj2 wrote

The actual study was for people who themselves had been diagnosed as terminally ill and the stages they went through accepting their own death. It was badly reported and misrepresented and somehow people got the impression that it was how everyone deals with all grief, but it's not especially accurate.

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Marchello_E t1_iv1fgra wrote

It's not necessarily grief, but more about the emotions of letting an attachment go. Makes more sense when you imagine a kid that is no longer allowed a second lollypop ("I always have two"). Or replace it with the frustration of a sudden disability and where you no longer can do that thing you always loved doing in the same refined way or never more.

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mylittlewallaby t1_iv1revr wrote

Its accurate but slightly limited. The model usually get interpretted as law. Though people judge themselves or become confused when they find themselves cycling through the stages randomly. In the acute moment of grief, the stages do typically appear in order. However sometimes circumstances complicate that, such as anticipatory grief or ambivalent grief. During the chronic phase of grief, the healing process, these stages are much less clear and ordered. People can find themselves all over the place. Cycling through all the stages in one day, only to have to start fresh the next day. Its complicated and messy to heal chronic grief.

The model is handy, understandable, easy to remember and easy to explain. I also think it is slightly limited and simplistic and we can do better. I am developing a grief theory thar relates to the love languages. I believe there is a parallel in the way we love and the way we grieve and understanding our language can reduce family conflict.

Credentials: decade in deathcare.

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Vladtheimpailer72 t1_iv29taa wrote

Having experienced several deaths of people close to me I generally find myself experiencing all the stages except bargaining. That said, I don’t believe Kubler-Ross intended her frame work to be followed in sequence in each stage only once. People go thru some of the stages frequently or repeatedly and sometimes skip around.

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Mikomau t1_iv2igqv wrote

So not everyone goes through all the stages and they don’t have any specific order. So for example denial it’s not unusual to respond to the strong and often sudden feelings by pretending the loss or change isn’t happening. Like for instance a job loss They were mistaken. They’ll call tomorrow to say they need me.” The stages aren’t always for a loss of someone, as stated they can be a loss of other experiences. Here’s a good link to explain it simply https://www.healthline.com/health/stages-of-grief#background

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Squidy_The_Druid t1_iv2mh4e wrote

I think anyone who spends a little time reflecting on their life can pinpoint people they know who do seem to go through something “like” the stages of grief.

I doubt it was ever intended to imply someone goes through all 5 in that exact order for every grieving scenario. But it’s clear people go through different processing periods when experiencing loss.

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thinthehoople t1_iv2xaf1 wrote

Pretty accurate, but not in a linear way, nor an all-encompassing one.

My own experience is that it helps give name to various difficult paths and feelings that one must deal with when losing someone close.

Another observation would be that it was and continues to be one of the only socially acceptable and widespread ways to talk about grief and loss, at least in western culture.

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Dapper_Particular_51 t1_iv3abnm wrote

Those 5 stages are only linear when in reference to someone with a terminal illness.

While those 5 phases are applicable to other forms of grief, you can visit and revisit each one in varied orders. It's all normal, and it's normal that it hurts.

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KaizenPax t1_iv3qeim wrote

Speaking as a widower, I have experienced elements of those stages along with many other emotions. They are constantly mixed and not in a particular order. When first learning about them, I never thought I’d experience denial or bargaining. Denial was different than I’d expected. It wasn’t that I denied she was gone, it was more the frequent feeling that I’d see her when I turned a corner or hear her reply to something the way I’m used to her doing.

I think you become so accustomed to a person’s presence in your life that part of your brain continues to expect/ anticipate their reaction.

I don’t think I’ve experienced bargaining, but I’ve seen other widows do it. I believe she is where she belongs and I would never want to rip her from that paradise for my own selfish needs. I only wait until I can join her again.

The anger is real, it peaks at one point, but like the pain and depression, it never completely goes away and they flare up from time to time, even after acceptance.

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Shienvien t1_iv41mse wrote

These stages were supposed to refer to having a terminal illness, not about the death of an important person. As with many things, popular media has misrepresented them so much that even some professionals and halfway professionals have gotten things mixed up (call it "the psychopaths and the bumblebees" effect, if you might)... And even that popular misconception aside, the research was slightly doctored to be more supportive of the hypothesis.

That said, you can experience some form of all of these when losing a loved one. Maybe not all, maybe not in this order, and probably also some that are not mentioned in that list. (Incidentally, I would also differentiate shock from denial and sadness from depression.) If your loved one was ill/injured before death, you may start grieving before they are gone, which can give the process a somewhat greater resemblance to coming to terms with your own impending death (although the final outcome of bereavement will likely be going back and forth between sadness and acceptance, rather than firmly staying as acceptance; the sadness becomes less intense over time, but will still be there). For example, after a reasonably expected death that was not someone's fault, a person might only experience numbness(shock), emptiness and sadness, in roughly this order...

In general, the more unexpected the death, the stronger and more prolonged the shock/disbelief at their passing will be. Basically, people feel numb, surreal, shocked at first and (except for cases of pre-emptive grieving) the actual sadness may follow hour or days, sometimes weeks later. (Sidenote: in extreme cases, shock may yield anything from screaming and scrambling to see the dead person to just shutting down for an extended period of time.) The general feeling of emptiness and, if formerly seeing frequently/living together, the acute awareness of the interruption to your life in the person's absence causes are common for both unexpected and expected death. https://www.ncbi.nlm.nih.gov/books/NBK217845/

Anger is one which is most dependent on manner of death. Bargaining is probably the least likely to be expressed (since unlike when living with terminal illness, the subject is already dead). Some people can feel relieved at death if the loved one was suffering. Guilt is very common, but not even mentioned in the terminal illness grief list. ("What if I had done something differently?" - could be anything from convincing them to not go base jumping to seeing them more often during their last year of life. These being examples of self-blame and regret respectively. Here is one article dealing with the connections between guilt and bereavement in a bit more elaborate fashion - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018291/ ).

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abeeyore t1_iv42x09 wrote

They are a pretty good catalog of the emotions that we deal with, but that’s about the extent of it… you don’t progress neatly from one to the next, and they don’t come in an order. You usually experience all of them, a lot, at different times, sometimes more than one at once.

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braize6 t1_iv4q6ie wrote

It's just something psychologists come up with for buzzwords and talking points. Then you have people going along with it and saying things like "yup, that's me. I did that. I felt that way before." When really, this is no different than a horoscope. What? People don't want to believe it when a loved one is going to, or has passed away? YA DONT SAY! lol......

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Malinut t1_iv2t8cp wrote

Also, "denial, anger, bargaining, depression, acceptance" is the sequence many go through when confronted with certain death; the sequence can be extremely rapid leading to acceptance in moments. Personally speaking the enlightenment that comes with the final stage is somewhat blissful.
FWIW I was saved by surgical intervention following a massive injury.

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guanyu15 t1_iv1to6n wrote

It's absolute sheeeat!

You want to know a modern model for grief. Here it goes.

Pain, sadness, loss, anger, pain, denial, pain, pain, pain, loss, anger, more anger, lots of anger, anger where you are ready to burn the world down, loss, crying constantly, confusion, loss, anger some more... realization that she's gone, getting to be OK with that, hating yourself for being OK with that, doing your best to remember her through her love... start crying because although its been 7 years, you still can't believe this is the worst timeline. repeat and mix as you do.

Anyone that says grief can be put into little boxes that you move for can bite my ass. Still miss you baby.

#perislove

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