NCI Stages of Grief for Cancer Patients and Their Families

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Here is a link from the National Cancer Institute on the stages of grief for cancer patients and their families:

http://www.cancer.gov/cancertopics/pdq/supportivecare/bereavement/Patient/allpages#Section_11

Here is another excellent article dealing with the specific stages of grief experienced by cancer patients written by Judy Bear:

We've all experienced grief. We've all felt those intense rolling waves of emotion. But, do we all experience the same feelings each time we lose a loved one?
What Are The Stages of Grief?

Many people have tried to explain what grief is; some have even identified certain stages of grief.

Probably the most well-known of these might be from Elizabeth Kubler-Ross' book, "On Death and Dying." In it, she identified five stages that a dying patient experiences when informed of their terminal prognosis.

The stages Kubler-Ross identified are:

* Denial (this isn't happening to me!)
* Anger (why is this happening to me?)
* Bargaining (I promise I'll be a better person if...)
* Depression (I don't care anymore)
* Acceptance (I'm ready for whatever comes)

Many people believe that these stages of grief are also experienced by others when they have lost a loved one.

Personally, I think of these definitions as emotional behaviors rather than stages, per se. I believe we may certainly experience some of these behaviors. But, I believe just as strongly, that there is no script for grief; that we cannot expect to feel any of our emotions in a particular set pattern. I do agree that acceptance is probably the last emotion felt, and in some instances it may be the only one.

A lesser known definition of the stages of grief is described by Dr. Roberta Temes in the book, "Living With An Empty Chair - a guide through grief." Temes describes three particular types of behavior exhibited by those suffering from grief and loss. They are:

* Numbness (mechanical functioning and social insulation)
* Disorganization (intensely painful feelings of loss)
* Reorganization (re-entry into a more 'normal' social life.)

I am better able to relate to this definition as it seems to more accurately reflect the types of behavior I have experienced and observed. Within these types of behavior might well be most of the feelings described in Kubler-Ross' writings as well.
Which List Is Right?

In my opinion, both of these lists, and many others that we've all seen, are all descriptive of some of the emotions and functions we go through when we lose a loved one.

I believe that grief, like so many other things in our complex lives, can't be reduced to a neat list with absolute definitions, timelines, strategies, goals, and completion dates. Would that it were so easy

Grief is as individual as those of us who feel it, and as varied as the circumstances of death which occur.
Will I Go Through Every Stage?

If a 98-year old grandfather died in his sleep I think there would be different stages of grief and loss experienced than if a two-year old child were run over by a car and killed.

If a person has had a long life, death is somewhat expected as the natural scheme of things. There will be emotions of grief and loss but they might be more for what we will miss.

If a young life is cut short unexpectedly, there may well be feelings of denial, anger, bargaining, depression, and in some cases acceptance.

Just as we have different emotional reactions to anything that happens in our lives, so too, will we experience grief and loss in different ways. I think the important thing to remember is that there is a wide range of emotions that may be experienced; to expect to feel some of them and to know that we cannot completely control the process.
When Will I Be Through Grieving?

Grieving used to be much more ritualistic than it is today. In generations past there were set periods of time when certain customs must be observed:

* Widows wore all black clothing for one year and drab colors forever after.
* Mourners could not attend social gatherings for months.
* Laughter and gaiety were discouraged for weeks or months.

Today we are unfettered by these restrictions and might even be confused about when we should be done grieving.

Actually, we'll probably never be done.

We'll never forget the person we grieve for. Our feelings may be tempered more with good memories than sadness as time passes, but that isn't to say that waves of raw emotion won't overcome us way after we thing we should be done.

I think the trick here is to understand that the feelings will occur, try to keep them in perspective, try to understand why you feel a certain way, and if there are any unresolved issues that cause particular emotional pain, forgive yourself and others and if necessary talk with someone about it.

There is no completion date to grieving...let your emotions flow through the stages of grief.

Look through our resources on
grief and loss

By Judy Bear
First published in MSN Cancer Forum

http://www.cancersurvivors.org/Coping/end term/stages.htm

Love, Courage, and Compassion!

Rick

AnnaLeigh

Intense Emotions
Rick,

First of all, thank you for such a wonderful post and opening a discussion for all of us to be able to understand what we are going through.

The cancer patient can also experience grief after diagnosis and while undergoing treatment. There can be a feeling of loss for all of the hopes, dreams and visions they had for the future as well as grief for the loss of a lifestyle they previously enjoyed and can no longer participate in. This will be evidenced by all of the stages you mention above.

There is not an appropriate time to START the grieving process either. This process can start while your loved one is still alive. After the initial shock of the diagnosis wears off and the uncertainty of their mortality sets in, family members can feel a grief so deep that it becomes almost debilitating. Which may explain why certain members of the family or close friends will appear as if they are unable to cope with being around the cancer patient.

Certain stages of grief will appear and we will think we have moved on to the next stage, when unexpectedly, one of the earlier stages will appear again. We can move in and out of these various stages and they need not appear in a specific order. Some people will also skip an entire stage or move back to the first stage just when they think they have made it to the acceptance level.

Humans want to have some predictability in their lives and grief is not something that fits any sort of predictable action. As you say - recognizing that grief is a process, forgiving yourself, and letting the emotions flow without judging the "rightness" or "wrongness" will ease the transition because we never get over the loss of our loved one - we just incorporate that loss into our lives.

Compassion for ourselves will bring us out the other side of pain into joy. Joy for having had this person in our lives and the memories we hold.