Health Agenda

Mental Health

COPING WITH LOSS: THE 7 STAGES OF GRIEF

Loss affects us all and is one of the most traumatic life events. Here’s how understanding the 7 stages of grief can help you with the grieving process.

When Sherene Strahan from Perth lost her elderly mother and father in the space of 2 years, she was left adrift. She personifies the stages of grief as a series of visitors who came and sat with her for different periods of time. Sometimes more than one came together, and sometimes they went away for a while, only to return unexpectedly.

“I see my grief in 2 worlds,” says Sherene. “First, there’s shock and denial, then guilt that keeps resurfacing. I was close to my parents and I miss them terribly. But second, there’s the reflection, and the hope and acceptance that I’m going to be ok without them. My experience is not extraordinary – rather it’s about learning to live with the sadness and loss.”

Sometimes, time does not heal all wounds. As of April 2022, prolonged grief, also known as complicated grief, is officially recognised as a mental health condition. Prolonged Grief Disorder (PGD) was discussed in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — the guidebook used by healthcare professionals around the world.

Those suffering PGD are defined as people who are unable to resume their daily lives a year after their loss. While some may start to feel better in a matter of months or even weeks, others find the process ongoing and debilitating.

There is no timetable for grief. But there are some common stages that you may experience along the way.

What are the stages of grief?

American-Swiss psychiatrist Elisabeth Kübler-Ross first highlighted 5 stages of grief in the 1960s. Since then, her approach has been adapted and extended to 7 stages, and within that there’s still room for debate.

“One of the most commonly known theories about grief is that we go through ‘stages’,” says grief counsellor Nathan MacArthur. “But more recent research – and my experience of working with people who are grieving – would suggest grief is messier than that. We can feel we’re starting to become more accepting of the reality of a loss, then unexpected waves of emotions come over us – when we see someone who looks like the person who died for example, or a particular piece of music comes on.”

Do the stages of grief happen in order?

Grief is a universal experience and can be a response to losses of many types. “All of us experience some level of loss throughout our lifetimes,” says grief counsellor Wendy Liu. “These include the breakdown of a relationship, miscarriage, death, divorce, the loss of a pet, losses through changes in the workplace, loss of sexual intimacy, or loss of independence through illness or injury.”

What’s important to note is that everyone’s grief journey is unique. And, while referred to as ‘grief stages’, it’s important to note they aren’t set in stone: sometimes the stages overlap or are skipped altogether. However you experience them, understanding these 7 elements can be helpful in identifying some of the emotions you may experience.

The 7 stages of grief

1. Shock 

Feelings of shock are unavoidable in nearly every situation, even if we feel we have had time to prepare for the loss of a loved one. We know it’s going to happen, but not right then, not on that day. People in shock often appear to be behaving normally without a lot of emotion, because the news hasn’t fully sunk in yet.

“Often there is a sense of numbness and a self-protective detachment from your feelings, because they are too intense to deal with,” says Nathan.

2. Denial

Many people experience denial after a bereavement: they know something has happened but it doesn’t feel real.

“For me, the denial was not that I didn’t believe it – it was more a sense of, ‘But how can they not be here? How can they have been here, and now they aren’t?’” says Sherene.

In addition to experiences of shock and denial, people often describe having a ‘mental fog’, says Nathan. “This can include forgetfulness, lack of concentration, sleeplessness, lack of motivation, repetitive thoughts and inability to make a decision.”

3. Anger

It’s perfectly normal to feel anger in times of loss, but often people try to keep this stage of grief hidden.

“Anger is a difficult emotion to deal with and can be minimised by others,” says Nathan. “But it’s important to find someone with whom we can connect in an honest way.”

“I felt frustrated that my experience of grief was different to that of those I was close to,” says Sherene. “I was angry with myself – that I was taking too long, and wanting to talk about Mum and Dad to people who felt I should’ve moved on.”

4. Bargaining 

The bargaining stage is about making promises to yourself or a higher being, asking the universe for a chance to put things right. A bereaved person may seek reason where there is none, and may feel guilty about how they behaved, or feel in some way to blame.

“There’s a sense that, ‘Maybe I could have done things differently’,” says Nathan. “If only I’d stopped them leaving the house or I knew more about their medical condition, I could’ve intervened. We may feel helpless and hopeless, and consumed by thoughts of, ‘What if?’”

5. Depression

The jumble of emotions that usually accompanies the grieving process can typically lead to feelings of depression, isolation, anxiety and a feeling of dread. Sometimes the suffering seems too much to bear. “Someone may question the meaning of life, or feel they want to be reunited with the person that’s died,” says Nathan. In cases like this, it’s so important to ask for help.

“People are often unsure of how to help us in our grief, so if you can accept an offer of help or ask for help, it will have the effect of strengthening those friendships,” he adds.

6. Acceptance and hope

Humans, by nature, crave contact, connection and support, and at some stage in the grieving process will want to engage with friends and family again. Acceptance is about realising you can’t change the circumstances, but that you can gain some control over how you respond.

“At times, we may need to distract ourselves from the grief, or place it to one side, so we can get on with work or social situations,” says Nathan.

But this is also a stage where you might slip backwards and find yourself feeling overwhelmed from all the emotions again. It’s normal to move between any of the stages of grief from hour to hour, or even minute to minute.

Says Sherene: “I gave myself permission to grieve. I felt that patience was a gift to myself.”

7. Processing grief

There is no right or wrong way to grieve – the process is highly individual. In addition, there’s no quick fix; the healing process takes time and varies from person to person. Importantly, there is no “normal” timeframe, so be patient with yourself.

Wendy also suggests the following coping strategies that you may find helpful.

  • Express your grief in words or another creative outlet, such as painting or drawing.
  • Connect with others – this can be loved ones or community support groups.
  • Ask for help, in whatever form.
  • Practise deep breathing regularly.
  • Set small, realistic goals.
  • Ensure you’re getting enough sleep and aim for some form of movement each day.
  • Eat a healthy, balanced diet and keep hydrated.
  • Rehearse how you respond to questions and new situations.

Getting help with grief

At HCF, we're trying to make it as easy and fast as possible for you and your family to access the mental wellbeing support you need. PSYCH2U mental wellbeing and navigation services give eligible HCF members* access to video consultations with psychologists, psychiatrists and other allied health professionals.

If your child needs support in dealing with grief, HCF members with hospital or extras cover have access to Calm Kid Central^, an online educational and support program to help kids aged 4-11 manage tough life situations.

If you're struggling with depression or anxiety, and need to speak to someone now, call Lifeline on 13 11 14.

Words by Shonagh Walker and Sara Mulcahy
Updated May 2022

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If you're struggling with depression or anxiety, and need to speak to someone now, call Lifeline on 13 11 14. If you’re experiencing any type of loss, you can call Griefline for support on 1300 845 745.

* Must have HCF gold level hospital cover for at least 12 months. Other eligibility criteria apply.

^ Excludes Accident Only cover and Overseas Visitors Health Cover.