Shortly before her death in 2004, Elisabeth Kübler-Ross and David Kessler, her collaborator, completed the manuscript for this, her final book. On Grief and Grieving is a fitting completion to her work. Thirty-six years and sixteen books ago, Kübler-Ross's groundbreaking On Death and Dying changed the way we talk about the end of life. Now On Grief and Grieving will profoundly influence the way we experience the process of grief.

On Death and Dying began as a theoretical book, an interdisciplinary study of our fear of death and our inevitable acceptance of it. It introduced the world to the now-famous five stages: denial, anger, bargaining, depression, and acceptance. On Grief and Grieving applies these stages to the process of grieving and weaves together theory, inspiration, and practical advice, all based on Kübler-Ross's and Kessler's professional and personal experiences, and is filled with brief, topic-driven stories. It includes sections on sadness, hauntings, dreams, coping, children, healing, isolation, and even the subject of sex during grief.

"I know death is close," Kübler-Ross says at the end of the book, "but not quite yet. I lie here like so many people over the years, in a bed surrounded by flowers and looking out a big window.... I now know that the purpose of my life is more than these stages.... It is not just about the life lost but also the life lived."

In one of their final writing sessions, Kübler-Ross told Kessler, "The last nine years have taught me patience, and the weaker and more bed-bound I become, the more I'm learning about receiving love."

On Grief and Grieving is Elisabeth Kübler-Ross's final legacy, one that brings her life's work profoundly full circle.

Chapter 1

Denial, Anger, Barganing, Depression,
and Acceptance

The stages have evolved since their introduction, and they have been very misunderstood over the past three decades. They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grief is as individual as our lives.

The five stages — denial, anger, bargaining, depression, and acceptance — are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief. Not everyone goes through all of them or goes in a prescribed order.

Our hope is that with these stages comes the knowledge of grief's terrain, making us better equipped to cope with life and loss.

Denial

Denial in grief has been misinterpreted over the years. When the stage of denial was first introduced in On Death and Dying, it focused on the person who was dying. In this book, On Grief and Grieving, the person who may be in denial is grieving the loss of a loved one. In a person who is dying, denial may look like disbelief. They may be going about life and actually denying that a terminal illness exists. For a person who has lost a loved one, however, the denial is more symbolic than literal.

This does not mean that you literally don't know your loved one has died. It means you come home and you can't believe that your wife isn't going to walk in the door at any minute or that your husband isn't just away on a business trip. You simply can't fathom that he will never walk through that door again.

When we are in denial, we may respond at first by being paralyzed with shock or blanketed with numbness. The denial is still not denial of the actual death, even though someone may be saying, "I can't believe he's dead." The person is actually saying that, at first, because it is too much for his or her psyche.

Alicia was accustomed to Matthew's being away on business trips. His work required him to travel the world, and Alicia had accompanied him on several trips that took him to places she wanted to see. She also witnessed the jet lag, hectic schedule, time changes, and delayed flights.

On his current trip, Alicia was surprised that he'd been scheduled to arrive in Delhi and he hadn't phoned her yet. After two days, he called and apologized, explaining that there were phone problems in his hotel. She understood because this often happened when he traveled to third world countries.

The next call came two days later in the middle of the night from one of her husband's coworkers. He gently told her that he had very bad news. Matthew had been killed in a car accident. He said there were very few details as yet but the home office would be contacting her.

Alicia couldn't believe her ears. After she hung up the phone she immediately thought, "Did I just dream that? This must be a mistake." She called her sister, who arrived just as the sun was rising. They waited until eight o'clock and called the home office only to find out they didn't know of any problem, much less a tragedy like this. But they said they would look into it immediately. For the rest of the morning Alicia couldn't stop wondering if she had dreamed the phone call. Was there a mistake? The next call came at noon, confirming that indeed, last night's bad news was true.

For the next few days Alicia made funeral arrangements, all the while saying, "This can't be true. I know when the body arrives it won't be him." The night before the funeral, Alicia finally saw her dear husband's body. She looked at his face to make sure it wasn't just someone who looked like Matthew, but when she saw his wedding ring, there was no more question.

During the weeks after the funeral, she would call friends and family and say, "I keep thinking he's still on the trip and he just can't get to a phone. I know he's out there somewhere trying to get home." She would usually end up crying over the reality that he was not coming home.

Alicia's story clearly illustrates how denial works. At times she thought it might be a dream, but she did the appropriate thing by calling her sister about the loss. The reality sank in even more when she saw the body and the ring on his finger. It would be easy to say that she was in denial because she kept thinking Matthew's death was not real. It would be equally easy to say she was not in denial because she kept going through with funeral arrangements. But both are true. She couldn't believe it and her mind could not fully process it. Denial helped her to unconsciously manage her feelings. Even after the funeral, she often thought he still might just be on a trip. This was still denial working very subtly, to give her moments away from her pain.

This first stage of grieving helps us to survive the loss. In this stage, the world becomes meaningless and overwhelming. Life makes no sense. We are in a state of shock and denial. We go numb. We wonder how we can go on, if we can go on, why we should go on. We try to find a way to simply get through each day. Denial and shock help us to cope and make survival possible. Denial helps us to pace our feelings of grief. There is a grace in denial. It is nature's way of letting in only as much as we can handle.

These feelings are important; they are the psyche's protective mechanisms. Letting in all the feelings associated with loss at once would be overwhelming emotionally. We can't believe what has happened because we actually can't believe what has happened. To fully believe at this stage would be too much.

The denial often comes in the form of our questioning our reality: Is it true? Did it really happen? Are they really gone? Think about the idea that you can't get over someone. It is more that you learn to live with the loss and not forget the person.

People often find themselves telling the story of their loss over and over, which is one way that our mind deals with trauma. It is a way of denying the pain while trying to accept the reality of the loss. As denial fades, it is slowly replaced with the reality of the loss.

You begin to question the how and why. How did this happen? you may ask, as you review the circumstances. You are no longer in an external story-telling mode; now you turn inward as you begin the search for understanding. You explore the circumstances surrounding the loss. Did it have to happen? Did it have to happen that way? Could anything have prevented it?

The finality of the loss begins to gradually sink in. She is not coming back. This time he didn't make it. With each question asked, you begin to believe they are really gone.

As you accept the reality of the loss and start to ask yourself questions, you are unknowingly beginning the healing process. You are becoming stronger, and the denial is beginning to fade. But as you proceed, all the feelings you were denying begin to surface.

Copyright " 2005 by Elisabeth Kübler-Ross Family Limited Partnership and David Kessler, Inc.

About the Author

Elisabeth Kübler-Ross earned a place as the best-loved and most-respected authority on the subjects of death and dying. Through her many books, as well as her years working with terminally ill children, AIDS patients, and the elderly, Elisabeth Kübler-Ross brought comfort and understanding to millions coping with their own deaths or the death of a loved one. Dr. Kübler-Ross, whose books have been translated into twenty-seven languages, passed away in 2004 at the age of seventy-eight. Before her death, she and David Kessler completed work on their second collaboration, On Grief and Grieving.

David Kessler is a journalist, motivational speaker and the author of Life Lessons. David has helped hundreds of men, women and children face death with peace, dignity and courage. His experiences with end of life care and death have taken him from Auschwitz concentration camp to Mother Teresa's Home for the Dying Destitute in Calcutta, India. His services have been used by Elizabeth Taylor, Carrie Fisher and Marianne Williamson when their loved ones faced death. He also worked with Anthony Perkins, Michael Landon and billionaire Armand Hammer when they faced their own deaths.