The Stages of Grief, Loss, and Depression

Feeling pain after you lose someone or something you care about is ordinary. The trickier question is where ordinary grief ends and the kind of depression that comes with it begins. Grieving itself is a healthy process. When it swallows everything, though, and you start to feel defeated, worn down, and worthless, that is the moment to bring a doctor into the conversation.

So what is grief, exactly? It's the natural reaction of deep mental suffering that follows death, hardship, or loss. The point of it is to let you mourn properly and then recover. The process moves along better when you name what you're feeling, lean on people around you, and give it the time it needs to run through.

Losing a close family member touches somewhere between 5% and 9% of people every year, but that is far from the only trigger. Grief can follow a separation from someone you love, or the loss of a job, a title, or a paycheck. A pet that dies or wanders off can set it off. So can the big turns in a life: a divorce, a move, retirement, kids packing up and leaving the house.

We all go through loss, and yet no two people handle the feelings the same way. Some keep up with their daily responsibilities while they grieve because they have steady, healthy ways of coping. Others lack those habits, or the support network, and the grieving gets stuck.

How do people typically react? There's a set of common stages, and they describe the reactions many of us have while trying to make sense of what happened. Feeling the emotions that come with a loss, and accepting them rather than fighting them, is a big part of getting through it. The stages tend to look like this.

1. Denial, numbness, and shock. Denial can shield you from the full force of a loss. Going numb after a death is normal, and it should not be read as not caring; it's the body dialing down a pain that would otherwise be overwhelming. That numbness can actually be useful when you have things to do, like arranging a funeral, phoning relatives, or sorting through paperwork. As you move forward and start to take in what has really happened, the disbelief and the numbness begin to loosen.

2. Bargaining. Thoughts about what you could have done differently come back around, over and over. Some people get stuck turning over the exact steps that might have saved the person or kept the loss from happening. This stage has to be worked through, otherwise the guilt or anger can dig in and get in the way of recovery.

3. Depression. This sets in as the true size of the loss lands. You might see trouble sleeping, a poor appetite, fatigue, no energy, and bouts of crying. Self-pity, loneliness, a sense of being cut off, emptiness, and anxiety often show up too. Moving your body, eating well, and keeping a regular sleep schedule can keep the depression from hardening into something that needs clinical treatment. Sometimes antidepressants are needed anyway.

4. Anger. This tends to surface when we feel exposed and weak, so a loss can leave us feeling abandoned and furious. The anger gets aimed at all sorts of targets: a higher power, the medical team that treated the person, life in general. It's a natural response, and it eases off over time.

5. Acceptance. Eventually you learn to carry the emotions that the loss stirred up. Healing starts once the loss settles in among the rest of your life experiences.

What gets in the way? Keep in mind there are no rules here and no deadline. Everyone's path is their own, and you may slide back into an earlier stage like anger or depression. A few things can stall the process or shut it down: brushing your feelings aside or shrinking them, burying yourself in work, and reaching for drugs, alcohol, or other substances to numb the hurt.

Are there things that help? Yes. Try to notice and accept your feelings, the good ones and the bad ones. Give yourself room and time to sit with your thoughts. Talk to someone you trust and say what you actually feel. Look into bereavement groups where others have been through similar losses, and remember that crying can be a release. Above all, get professional help if the feelings are more than you can carry.

What if it won't lift? If the grief drags on and turns into a long, heavy depression with physical signs such as poor sleep, loss of appetite, weight loss, even thoughts of suicide, you could be dealing with complicated bereavement or depression. Talk to your doctor right away. The ordinary sadness of grief should ease over several months. But a major depression can grow alongside the normal sadness. Major depression is a medical disorder, distinct from ordinary grief, and it can hit at any point, even right after a death or loss. It won't resolve without treatment.

- Jeff Stein

Depression. (n.d.). Retrieved December 27, 2014, from http://www.m.webmd.com/depression/guide/depression-grief