Grief is one of the great paradoxes of the human condition. It’s something that, alas, everyone will experience — and more than once in the average lifetime. And yet, despite its commonality, that experience will be different for everyone.

In fact, it can be different each time the same person experiences it, depending on the type of loss and when it happens. Dealing with grief has stages, and each stage has a different impact for everyone.

The Stages of Grief

Although the process of grief is unique for each of us, it is indeed a process with certain similarities, something that psychiatrist Elisabeth Kübler-Ross understood. In the 1960s, her professional experiences with terminally ill patients not only led her to be a champion of hospice and palliative care — a woefully understudied and undervalued branch of medicine at the time — but also resulted in her writing the landmark 1969 book On Death and Dying.

It’s in this book that Kübler-Ross first articulated what would become known as the five stages of grief. Over time, these stages would come to be applied not just to the terminally ill (and their families) faced with the imminent reality of death, but to anyone coping with loss in their lives, whether they were bereaving the death of a pet, the breakup of a relationship, the termination of a job, or some other form of loss. These stages would also be expanded in a variety of ways over time.

What are the 5 Stages?

Ever since these stages were first articulated, critics have decried them as inconsistent, lacking in empirical evidence, and limited in scope. Kübler-Ross herself acknowledged some of these complaints and never intended for sufferers or doctors to view the stages as sequential steps that everyone must follow. In fact, the classic five stages, like grief itself, are far from linear.

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People may experience them in any order, may not experience certain stages at all, or may circle back to different stages multiple times, depending upon where they are in the coping process. Yet these stages are common enough that they can offer some guidance to doctors, therapists, and individuals working through grief. According to the original Kübler-Ross model, the five stages are as follows:

1. Denial

Generally considered the first stage, denial is an almost instinctive this-isn’t-happening response that desperately tries to refute the reality of the situation. Denial could mean simply deciding that a diagnosis was incorrect, someone made a mistake. Or someone could outright refuse to acknowledge or discuss the situation.

It’s a normal reaction to news of a terminal illness or the ending of any previously stable situation in life upon which the subject depended or had faith in.

2. Anger

Anger usually (but not always) comes next, as reality begins to sink in for the sufferer or people close to them, and they become angry or frustrated.

The blame game can be strong here, and people may lash out at caregivers and even family members for the circumstance they find themselves in. Those with religious beliefs are also likely to blame their church, spiritual advisors, or even God for failing them.

3. Bargaining

Bargaining occurs as the grieving individual strives to get some handle on, or seek to attain some level of control over, the event causing the loss. “If I do X, then Y [the traumatic event] won’t happen, or at least won’t be that bad” is about the simplest representation of this stage, whether the bargaining occurs at the medical, social, or religious level.

Bargaining seems rational, but this phase also tends to indulge in a lot of magical thinking that can get in the way of the next phases, which include accepting the reality of a given situation.

4. Depression

Depression is just that: despondency and feelings of defeat and resignation to one’s circumstance. This too is a phase that those who grieve may visit or revisit more than once. Depression is a normal and natural response to being confronted with a serious or especially terminal situation or diagnosis.

5. Acceptance

As an individual recognizes the reality of the situation, though, they come to a place of acceptance. It’s during this period that a person with a terminal diagnosis may focus on embracing the inevitable, while trying to make the most of the time they have with friends and family. This could also be when terminal patients get serious about planning for funerals and memorials, as well as seeing to their other affairs, both emotional and material.

For other types of loss, the grieving person who reaches acceptance may still have sorrow, or revisit the other stages, but has come to some kind of recognition that it’s time to move forward into a phase of life after the event that caused their grief.

Are There 7 Stages of Grief?

In the years since the five stages were first popularized, other models of grieving have been introduced, including some that expand the original five stages to seven.

These expanded models may encompass such additional phases as shock (separate from denial), pain and guilt, and processing grief, among others. Even with different models, experts acknowledge that there will never be a universal, one-size-fits-all listing of the various stages.

The Impact of Grief

Meanwhile, medical experts do recognize that there are certain common and significant impacts that the experience of grief can have on the mind and body of someone dealing with it. In fact, researchers have found that the grieving process can affect emotional processing and cognitive function as profoundly as if you’d suffered a traumatic physical injury to your brain.

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Stress hormones and other chemicals can be released during the grieving process that cause the brain to go into a kind of extreme filtering mode, trying to minimize overwhelming negative emotions at the expense of compromising normal mental functions.

Nevertheless, some feelings, especially depression and anxiety, can become more pronounced. Normally smooth thought processes can become jumbled and cognitive decline can occur.

Can Grief Make You Sick?

Just as the brain is affected, so too is the body. Grief places strain on various physical functions just as surely as an ailment or injury might. According to the National Institutes of Health, common physical issues related to the process of grief include insomnia, headaches, digestive issues, and more.

Some serious physical issues can include increased risk of cardiac problems, ranging from high blood pressure and irregular heartbeat to heart attack and more (this is especially true in those who already have heart problems). The immune system can also be affected, leaving you more susceptible to infection as well as inflammation.

Coping with Grief

In the end, grief and how one handles it will vary widely from person to person. And there is no official clock on bereavement, no standard length of time by which any one person should be expected to “get over it.” It takes as long as it takes.

And for a profound loss, such as the death of a family member or loved one, grief and feelings of sadness can resurface now and then for the rest of someone’s life. It may be a difficult truth to accept, but it’s also a normal part of being human.

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That said, medical experts do recognize a condition known as prolonged grief disorder, which is defined as a persistence of intense feelings of grief (and any physical or emotional problems that go along with it) significant enough to interfere with daily life. The length of time typically given to consider a diagnosis of this disorder is if adults are still experiencing profound effects of grief at least one year after the loss (six months for children) without any signs of abatement of symptoms, or a sense that one is progressing in any way towards acceptance of the loss.

Such a condition can affect as many as 10 percent of grieving individuals. Behavioral therapy, support groups, and other medical interventions can be helpful in such circumstances.

How to Help Someone with Grief

Meanwhile, whole books (and lots of them) have been written on the topic of coping with and processing grief, and no single article could possibly cover this subject in any definitive sense. However, according to Harvard Medical School, some of the most important elements of helping someone to deal with grief include (but are by no means limited to) these guidelines:

Take the initiative: Touch base regularly, even if it’s just to say hello and see how they’re feeling that day. Don’t expect them to call you — that’s asking a lot of the bereaved. Be a regular presence in their lives, but be mindful that there are times when they feel they need some space.

Offer a sympathetic ear, not unsolicited advice: Being a listener is more important than being a counselor or half-baked therapist. Don’t offer advice unless asked. Instead, focus on being understanding and present.

Don’t judge: As much as you might want your grieving friend or family member to start rounding the corner, it is not your place to tell them when and for how long to grieve. Again, lend an ear, but don’t try to impose limits on their bereavement.

Be willing to help in specific and active ways: Expressing such classic sentiments as “Let me know if you need anything” or “If I can help in any way” are ultimately not that helpful for someone who is processing a loss. That just puts the onus on them to think of ways to put you to work so you can feel better about helping out. Instead, be an active observer, and offer specific things you can do to be useful, such as meal planning, baby- or pet-sitting, running errands, or any number of other basic but nevertheless helpful tasks.

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