Many contemporary theorists and thanatologists have misinterpreted the intent of Kubler-Ross' stage theory.  It was not intended to be an immutable, linear template, but rather a cyclical guide to potential responses for a diverse group of mourners.  Personal history, culture, religion, ancestral 'collective unconscious,' family of origin responses to death, and many more factors will affect the manner in which an individual responds to death.

However, understanding some various potential aspects of mourning may help increase awareness and understanding of the grief process. Remember that a person may or may not exhibit some of these responses and that it is unlikely to be in a static sequence:

1.     Denial, Shock, and Numbness: This responsehelps buffer the full extent of the loss. The inability to accept the reality of the death may result in the lack of outward motions. Mourners may be experiencing denial, a ‘nightmare-like’ quality during the initial event. Other normal characteristics include: disorientation, difficulty focusing, impaired decision-making and attention span, resistance to or over-reaction to stimuli, and time confusion. This is a critical time for family education; to inform them about community support groups and resources that can help them through this difficult time.

Cody suffered through so many things, chest tubes, two different arterial lines put in, being kept paralyzed and sedated for over a week, to watch him was a mother's nightmare. I have no idea how I made it through. I was on autopilot. I remember thinking many times, " I cannot do this."

2.     Anger: Anger comes with blame and guilt which can debilitate and impede a person’s ability to cope with tedious day-to-day routines. These emotions are often difficult to dispel into positive channels and thus, many bereaved can find themselves ‘stuck’ in this phase. Characteristics of this phase include high irritability, sleep disruptions, isolation, provocation, apathy, irrationality, and discordant mood swings. It is important to remember that these emotions are a natural part of the process and the expression of these characteristics does not necessarily indicate pathological or protracted grief.

I was at work all day and when I came home it was almost time for my wife to go and have the baby…After the longest 30 minutes of my life, the doctor said our son had died. So many emotions filled the room and so many tears too. Being a firefighter I knew everyone who worked in the ambulances and requested they stay with us. She gave birth to our dead son after six hours of labor. What was supposed to be the happiest day of my life turned out to be the absolute worst…My life has changed in the worst way. I am not a proud father…I am an angry man, full of resentment, jealousy, hate and fear. I have been cheated and robbed. I have to sleep with the lights on now. I am afraid of the dark. I am nervous all the time and sleep very little, especially when I am working night shift.

3.      Bargaining: This is a point in grief where the bereaved often struggle with the reality of their death. Parents feel heavy, burning arms and physical body aches and pains. Often, they feel guilt about going on with their life, what they think they should have done to prevent their child’s death, and they often re-live the events leading up to that tragic day. Emotions such as anger, guilt, blame, irritability, spiritual crises, resentment, depression, as well as physical symptoms such as shortness of breath, frequent sighing, dryness of mouth, muscle weakness, blurred vision, headaches, lack of or excessive appetite, lethargy, and mood swings are very common and certainly normal for a grieving parent. They may isolate themselves from family members, friends, or co-workers. Some express a strong desire to die. This is often used as a metaphor to express that the pain is so debilitating that they just want the grief to end.

I wanted to die…even contemplated suicide. I didn’t know how to pull myself out of the depression.

4. Depression:  Acceptance of reality and self-talk such as "Yes, it really did happen to me and now what?"  Depression is a normal response when an individual faces their own death or the death of a beloved.

5.  Acceptance:  This includes reorganization and hope. These emotions are not usually noted until well into the process of grief. Most physical manifestations of grief have subsided. Some bereaved choose to become and stay involved in support groups to help others and they take a more proactive role in their healing.

It’s been three years. Now we are involved as volunteers because they were there for us when Zach died. It is our turn to give back.

My child's greatest gift to both my husband and I is that we now realize what is important in life. We realize time is short. We also have more empathy for people than we have ever had in our lives. We care when someone is hurting no matter what the reason. It really hits us in the heart because now we have felt the most intense pain a person could ever feel.

It is important to understand grief as part of the human experience.  If you are grieving, some things you can do to help yourself include:

    -Attending support groups in your area
            Many communities have secular and faith based support groups focused on spousal, parental, and child death.
 
    -Therapy with a psychologist or other qualified mental health professional
            Therapy can be helpful in many ways especially when combined with a support group.  Some things to consider when looking for a therapist:
 
1.  Caveat Emptor:  Consumer beware! When a child dies, not just any therapist will understand the complexities and challenges of grieving family members.  It is critical to find a mental health professional who specializes in thanatology, or death issues.
 
Even the best mental health professional cannot take away the stinging pain of a child's death.  An effective grief-trained therapist will walk with you, help you connect with your feelings, and help you discover ways to cope with the overwhelming sense of loss.
 
If you are not comfortable with the therapist, find another.  Sometimes, clergy are helpful in a counseling role, however, for most, it also helps to have a secular vantage point in addition to their faith counseling.
 
2.  Why is therapy necessary?  Organizations like the MISS Foundation are here to provide a support network for you and your family.  However, we are not a therapy-oriented group. 

Many people seek counseling and therapy to help them balance their ongoing lives with the chaos of emotions after a child has died. Combining therapy with support groups, either online or in person, are very effective techniques to help your family.

Therapy can also address past events that negatively affect your daily functioning and further add to the trauma of your child's death.

Therapy should be a safe place in which to talk about your issues and generate some useful ideas in dealing with the immense sorrow and trauma you face after your child's death but it can also help to heal old wounds, likely to resurface during times of crisis.

3.  You should know your rights as a patient, ask questions, and be well-informed.

Client Rights

• You have every right to expect your therapist to display respect for you and to convey this respect by keeping appointments as scheduled, by contacting you if scheduling changes are necessary, and by giving her/his complete attention to you during therapy sessions.
  
• At any point during therapy, you are encouraged to ask questions regarding your therapist's qualifications, training, experience, specialization areas and limitations, and personal values. You will receive thoughtful and respectful answers.
  
• Since your needs are primary to your treatment, you are encouraged to negotiate therapeutic goals, and renegotiate them whenever you wish. You are further encouraged to ask questions regarding the therapy process, specific treatment methods, therapy fees, methods of payment, estimated length of treatment, office policy and practices, and diagnosis.
  
• You may refuse any intervention or treatment strategy suggested by your therapist and you may refuse to answer any questions.
  
• Within the limits of published ethical standards and the law, information you reveal to your therapist will be maintained as confidential and will not be communicated to another person or agency without your written permission. The rare legal limits to confidentiality will be clearly described at your intake session, and you may discuss any aspect of your treatment with others, including consulting with another therapist.
  
• Your therapist adheres to the American Psychological Association and your State Board of Psychology Ethical Standards for Psychologists. If you have a doubt or grievance regarding your therapist's conduct, you may solicit assistance from these organizations. Under no circumstances are "dual relationships" permitted between therapist and patient, especially including business, social, romantic, or sexual contact of any kind.

4.  You can expect to meet with an individual who has been through many years of academic and professional training. You can and should expect your therapist to listen, truly listen.

• An effective therapist will ask you some questions about your background and life experiences as well as personal beliefs, mores, and values.
• Most sessions are once per week for about 50 minutes. Due to the traumatic nature of child death, the visits may be more frequent depending on familial and community support available to you.  Therapists styles will vary from person to person.

5.  It is never too late to seek therapy. Whether it is a child's death that occurred 10 or 30 years ago, or some other very traumatic event, it is never too late to seek help.  Old wounds open easily and at times, therapy is the only way to help yourself deal with those wounds.  Pain from the past can interfere with decisions, patterns of behavior, self-esteem, and many other aspects of your life.  Please seek help.

 
    -Journaling
            Writing is a catharsis for many!  We recommend beginning to journal every evening before bed as soon as the child family member dies.  It is extremely helpful even if at first, it seems too painful.  Just write, even if it is one sentence, or even a single word.
 
    -Eating well
            It is important to eat healthy foods and take supplements.
 
    -Exercise
           Take walks or work out: jog, aerobics or a spring-cleaning week will do as well. Physical exertion is a great stress reliever and may afford you some time alone to gather your thoughts in the process.
 
    -Get enough rest
            Give yourself plenty of time to rest. Grief drains your emotional battery and you will need to recharge more often. If you simply don't want to get out of bed in those early stages of grief, then don't!

    -Reading and learning about death-related grief responses
            Knowledge helps people regain a sense of control over their experiences and environment and helps reduce feelings of vulnerability.
 
    -For some, seeking solace in the faith community
            It can be helpful for some to seek the wisdom and comfort that churches, synagogues, temples, mosques, and other places of worship provide.
 
    -Seek comforting rituals
            This include funerals and memorial services, planting gardens and trees, donating to a cause, and other comforting and culturally appropriate ritual
 
    -Allow emotions
                Tears can be healing.
 
    -Avoid major changes in residence, jobs, or marital status
                Major changes can be too burdensome during grief.  Wait for about one year after the death of a loved one before making any major changes.
 
    -Participate in the International Movement "The Kindness Project"
 
One of the most difficult losses to endure is the death of a child.  One book, "On Children and Death," by Dr. Elisabeth Kubler-Ross deals with this topic in a very helpful way. I highly recommend this book for bereaved parents.  "Dear Cheyenne" is another book which many have called 'awakening.'
 
Parents experiencing the death of a child can find great comfort in connecting with others who have also gone through that tragedy.  You can do that online or in support groups in your area.
 
There are several support groups which provide this solace to families:
 
The MISS Foundation helps families experiencing stillbirth, infant, and toddler death and also provides thanatological training for caregivers and public policy analyses.
 
The Compassionate Friends is a broad support organization.
 
Befrienders is an organization specific to suicide prevention and support.
 
Parents of Murdered Children focuses on those suffering from their child's death as a result of homicide.
 
Some type of counseling or therapy may also be helpful to families experiencing child death.  Bereaved children should see a good therapist at least three times.  It is very difficult to understand the way children grieve.  Often, they are overlooked in the grief journey. While it may seem that they are doing "okay" and they may not be expressing strong emotions, we recommend at least three therapy sessions to assess a child's true emotional and mental state after such a traumatic event. Often, family members are not trained to recognized children's grief responses. It is very important that children have a safe place to share and discuss their feelings.  Take care of their grief issues now so that they can grow up to be emotionally healthy adults.
 
Here are some helpful resources for grieving children
 
(Adobe Reader Required to View):
Helpful books for the Grieving Child:

• What Color is Death, Daddy?
  An interactive book for children ages 3-7
  
• The Kaleidoscope of Grief: When Children Experience Death
  An interactive book for Children ages 7 and up
  
• Kaleidoscope book En Español
  
• Helping Grieving Children- A helpful brochures to help others understand how to help children

Supporting yourself, and eventually reaching out to other bereaved is part of healing. I'm reminded of the words of Elle Wiesel, who said "Whosoever survives a test, whatever it may be, must tell their story. That is his duty."

 
This page is copyrighted by the MISS Foundation and may not be reprinted or copied in its entirety or its part without express written permission.
 
Various excerpts are:
(c) 2003 by Joanne Cacciatore-Garard, MISS Foundation
All Rights Reserved Including Excerpts from "The Power of Compassion: A New Attitude in Healthcare," (c) 2002, 2003 by Joanne Cacciatore-Garard, preface and inspiration by Elisabeth Kubler-Ross, M.D.