Depression & Acceptance

On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss
by Elisabeth Kübler-Ross, M.D., David Kessler

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Depression

After bargaining, our attention moves squarely into the present. Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive stage feels as though it will last forever. It's important to understand that this depression is not a sign of mental illness. It is the appropriate response to a great loss. We withdraw from life, left in a fog of intense sadness, wondering, perhaps, if there is any point in going on alone. Why go on at all?

Morning comes, but you don't care. A voice in your head says it is time to get out of bed, but you have no desire to do so. You may not even have a reason. Life feels pointless. To get out of bed may as well be climbing a mountain. You feel heavy, and being upright takes something from you that you just don't have to give.

If you find a way to get through your daily activities, each of them seems as empty and pointless as the last one. Why eat? Or why stop eating? You don't care enough to care. If you could care about what was going on, it might scare you, so you don't want to care about anything.

Others around you see this lethargy and want to get you out of your "depression."

Depression after a loss is too often seen as unnatural: a state to be fixed, something to snap out of. The first question to ask yourself is whether the situation you're in is actually depressing. The loss of a loved one is a very depressing situation, and depression is a normal and appropriate response. To not experience depression after a loved one dies would be unusual. When a loss fully settles in your soul, the realization that your loved one didn't get better this time and is not coming back is understandably depressing.

When we are grieving, people may wonder about us, and we may wonder about ourselves. The heavy, dark feelings of depression that come with grief, however normal, are often seen in our society as something to be treated. Of course clinical depression, untreated, can lead to a worsening of one's mental state. But in grief, depression is a way for nature to keep us protected by shutting down the nervous system so that we can adapt to something we feel we cannot handle.

If grief is a process of healing, then depression is one of the many necessary steps along the way. If you have the awareness to recognize you are in depression or have been told by multiple friends you are depressed, your first response may be to resist and look for a way out. Seeking a way out of depression feels like going into a hurricane and sailing around the inside perimeter, fearful that there is no exit door.

As tough as it is, depression can be dealt with in a paradoxical way. See it as a visitor, perhaps an unwelcome one, but one who is visiting whether you like it or not. Make a place for your guest. Invite your depression to pull up a chair with you in front of the fire, and sit with it, without looking for a way to escape. Allow the sadness and emptiness to cleanse you and help you explore your loss in its entirety. When you allow yourself to experience depression, it will leave as soon as it has served its purpose in your loss. As you grow stronger, it may return from time to time, but that is how grief works.

A smart, charismatic woman, Claudia was surprised at the depth of her depression when her grown daughter was dying. She thought that was as depressing as it would get, but after her daughter died, the depression returned. "It was different than when my daughter was alive," Claudia said. "When she was fighting for her life, my depression had walls, a structure within which fights had to be fought. But after she died, the depression that returned felt like being hit with a punching bag. I was knocked down over and over, with no desire to get up again."

Claudia reported that her depression eventually passed and she began to do more and get out more. She went back to work part-time and started accepting offers from friends to do things. "Time had passed; I was better, functional and improving, when suddenly the depression returned. I'd thought I was done with it, but I guess it wasn't done with me.

"This time, I heard a loud voice, literally heralding the reality that my daughter was never coming back. This time the depression had no walls, ceiling, or floor. It felt even more endless than before and, once again, I had to deal with this old familiar guest. I learned the only way around this storm was through it."

The stages of loss — denial, anger, bargaining, depression, and acceptance — have been widely used and misused. Our society almost seems to be involved in a "stamp out depression" campaign. Sometimes intervention is vital, but most of the time, we do not allow the normal depression that comes with grief to have its place.

Clinical depression is a group of illnesses that may be characterized by a long-term or excessively depressed state. But our society often considers an appropriate sadness to be depression requiring fixing. Normal depression is the sadness we feel at certain times in our lives, the common cold of mental illnesses. We even have television advertisements offering help with it, selling pills promising to get rid of it. When a normal depression becomes a clinical depression requiring professional help, antidepressants may be helpful for a time.

When depression follows loss, there are specific sorrows that can be identified. In more serious and long-lasting depressions, it is difficult to receive support. In this case antidepressant medications may be useful, to help lift someone out of what seems to be a bottomless depression. Only a trained medical professional familiar with the griever's situation can make an accurate diagnosis.

Treating depression is a balancing act. We must accept sadness as an appropriate, natural stage of loss without letting an unmanaged, ongoing depression leech our quality of life. The use of antidepressants remains a controversial topic, especially when a loss is involved. Some people are worried that if they take antidepressants, they will miss the process of grief. If only that were so. The reality is that your grief is there and available for processing, on or off medication. Some people feel that medications simply put a floor in for them to deal with their depression. In some cases, depression may need to be managed by using a combination of support, psychotherapy, and antidepressant medications.

As difficult as it is to endure, depression has elements that can be helpful in grief. It slows us down and allows us to take real stock of the loss. It makes us rebuild ourselves from the ground up. It clears the deck for growth. It takes us to a deeper place in our soul that we would not normally explore.

Most people's initial reaction to sad people is to try to cheer them up, to tell them not to look at things so grimly, to look at the bright side of life. This cheering-up reaction is often an expression of that person's own needs and that person's own inability to tolerate a long face over an extended period. A mourner should be allowed to experience his sorrow, and he will be grateful for those who can sit with him without telling him not to be sad. A mourner may be in the midst of life and yet not a participant in all the activities considered living: unable to get out of bed; tense, irritable, unable to concentrate; unable to care about anything. No matter what our surroundings may hold, we feel alone. This is what hitting the bottom feels like. You wonder if you will ever feel anything again or if this is what life will be like forever.

Acceptance

Acceptance is often confused with the notion of being all right or okay with what has happened. This is not the case. Most people don't ever feel okay or all right about the loss of a loved one. This stage is about accepting the reality that our loved one is physically gone and recognizing that this new reality is the permanent reality. We will never like this reality or make it okay, but eventually we accept it. We learn to live with it. It is the new norm with which we must learn to live. This is where our final healing and adjustment can take a firm hold, despite the fact that healing often looks and feels like an unattainable state.

Healing looks like remembering, recollecting, and reorganizing. We may cease to be angry with God; we may become aware of the commonsense reasons for our loss, even if we never actually understand the reasons. We the survivors begin to realize sadly that it was our loved one's time to die. Of course it was too soon for us, and probably too soon for him or her, too. Perhaps he was very old or full of pain and disease. Perhaps her body was worn down and she was ready for her journey to be over. But our journey still continues. It is not yet time for us to die; in fact, it is time for us to heal.

We must try to live now in a world where our loved one is missing. In resisting this new norm, at first we may want to maintain life as it was before a loved one died. In time, through bits and pieces of acceptance, however, we see that we cannot maintain the past intact. It has been forever changed and we must readjust. We must learn to reorganize roles, reassign them to others or take them on ourselves. The more of your identity that was connected to your loved one, the harder it will be to do this.

As we heal, we learn who we are and who our loved one was in life. In a strange way, as we move through grief, healing brings us closer to the person we loved. A new relationship begins. We learn to live with the loved one we lost. We start the process of reintegration, trying to put back the pieces that have been ripped away.

Alan, seventeen years old, was thrilled to go to the basketball championship that was being held downtown in the sports arena. After the game, in the parking lot, Alan walked ten feet to his car and was randomly shot and killed by a gang member.

His father, Keith, and his mother, Donna, could not understand why their son was killed. They were filled with anger as they spent their days and nights trying to raise their other two kids, go to work, and follow the all-consuming ongoing investigation into the killing.

A close couple, friends of Keith and Donna's, became concerned because they were not available to get together for meals or anything else. One evening the couple dropped in out of concern and said to Keith and Donna, "You have to accept this loss. Your son is gone and none of this is going to bring him back. Haven't you heard about the five stages? You've done all the others. All you need now is acceptance."

Keith got angry with his friend and asked, "What part of Alan's death don't you think I accept? At his grave today, I cried like a baby. If I didn't accept it, would I go to his grave? We're not setting a place for him at the dinner table tonight. We live in reality, his room is empty every night. How much more acceptance can we feel?"

The friend looked down and said, "I just hate to see you in so much pain."

Keith replied, "Believe me, I hate to be in so much pain."

We have found that is it not unusual for people like Keith and Donna's friends to misunderstand the stages. Acceptance is not about liking a situation. It is about acknowledging all that has been lost and learning to live with that loss. It would be too soon for Keith to be able to accept this situation. He can acknowledge the reality of the loss, but it would be unrealistic to think he should have found some peace with it by then.

After closing arguments in the murder case, it took the jury only five hours to come back with a guilty verdict. The gang member who killed Alan was sentenced to life in prison, and Keith and Donna went back to their own lives.

Keith actually had a new loss to deal with, which was the emptiness he now felt without the trial to consume his time. It made the absence of his son's loss even louder.

We think it is important for people to understand that gradually, in your own time, you can begin to find some peace with what has happened. In situations such as murder, it is vital to understand we have a legal system, not necessarily a justice system. For some, the only justice would be to have their loved one back. Acceptance is a process that we experience, not a final stage with an end point.

For Keith, no one else could know how much acceptance he was capable of or how time would affect his process. After five years Keith felt he had found as much acceptance as was possible. Then he was notified that the shooter was up for his first parole hearing. Keith felt all his hard-earned acceptance drain out of him. By the time of the hearing he was once again filled with anger. The proceedings were brief and parole was denied. Keith was struck by how quickly it happened and by the tears of the shooter's father. For the first time, Keith realized there were victims on both ends of the gun.

Keith walked over to him and shook his hand. At that moment, something happened for Keith as his anger was replaced by a curiosity. He wanted to know what this other father's life was like and what led him to this same place. Over the next few years the two men formed an alliance to help gang members stop the violence and find their place in the world. They went from school to school in the inner city with their story.

Keith's acceptance was a journey that was deeper than he ever expected. And it happened over many years, not many months or days. Not everyone will or can fully embrace those who have hurt us, as Keith did, but there is always a struggle that leads us to our own personal and unique acceptance.

Keith's story is just one example of how, little by little, we withdraw our energy from the loss and begin to invest it in life. We put the loss into perspective, learning how to remember our loved ones and commemorate the loss. We start to form new relationships or put more time into old ones.

Finding acceptance may be just having more good days than bad. As we begin to live again and enjoy our life, we often feel that in doing so, we are betraying our loved one. We can never replace what has been lost, but we can make new connections, new meaningful relationships, new interdependencies. Instead of denying our feelings, we listen to our needs; we move, we change, we grow, we evolve. We may start to reach out to others and become involved in their lives. We invest in our friendships and in our relationship with ourself. We begin to live again, but we cannot do so until we have given grief its time.

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.