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How to Cope with Different Types of Grief


Close-up of a sad and depressed woman deep in though outdoors.

You may be wondering, how does gynecology relate to the grieving process? Throughout the years, we have found that many patients with varying conditions have suffered from not properly going through the grieving process. 

Grieving doesn’t only happen when someone close to you dies, it can happen anytime your life takes an unexpected detour. For example, you could also grieve your health, your sexual enjoyment, or your potential to give birth to children. It’s important to practice self-care, attend therapy if you are struggling and express your emotions in a healthy way.

There are five stages of the grieving process; denial, anger, bargaining, depression, and resolution. These stages were first proposed in 1969 by Dr. Elisabeth Kübler-Ross in her book On Death and Dying. In addition to the stages, she proposed that we express each stage with varying levels of intensity and spend different durations of time working through each stage. Contrary to popular belief, the five stages of loss do not necessarily occur in any specific order and people often move between stages multiple times before achieving peaceful acceptance. It’s also important to note that everyone grieves differently, experiences the process in their own way and we shouldn’t judge others for the way they express their emotions.

The first stage, denial, is a common coping mechanism that people unknowingly use because it diminishes the shock and numbs their emotions. For many of our patients with bladder and menstrual problems, the denial stage can last for years with them constantly telling themselves, “this is gonna get better” or “this is going to go away on its own.” This is, of course, until it reaches a crucial point where they can’t manage their symptoms anymore and they realize they need help. That’s when they typically come into the office for their first appointment.

The second stage, anger, typically happens after the masking effects of denial begin to wear off and the painful reality re-emerges. The anger stage is where patients find themselves saying, “I’m not ready for this,” and “I don’t deserve this.” The intense emotions of vulnerability are redirected and expressed as anger. The anger can be aimed at inanimate objects, complete strangers, friends, or family. Remember, it’s important to give yourself permission to be angry. However, don’t take it out on your support system (your partner, family, and friends), instead, try to process it in a healthy way. 

Psychiatrists have determined that the anger stage is the most important phase for women to get through. Unfortunately, society generally looks down on women getting angry. Our society allows men to be angry and women to be sad, and not the other way around, even though both of these emotions are essential to the grieving process.

This has led me to ask myself, “How can we help our patients get through the anger phase in a healthy way?” After consulting with psychiatrists and studying the published research on grief, we have come up with a process that has worked for many of our patients. 

We recommend writing down what you’re angry about, and remember this can apply to anything that has made your life take a detour in a way you weren’t expecting.  Take a piece of notebook paper and make a bullet point list of all the things you’re angry about. You don’t need to share this list with anyone. 

This first part helps you process your anger emotionally but you also want to find a way to physically and verbally express your anger. A great way to do this is to tape your list up on a punching bag (you don’t necessarily need a punching bag, you could also use a pillow or a rolled-up sleeping bag) and hit it with a wiffle ball bat for 10 minutes a day. Every day focus on a different point on your list until you get through the entire list. This helps you express your anger physically in a safe and socially acceptable way. 

The third stage is bargaining where we try to regain control of our vulnerability. Typically, a patient will go through a series of, “if only,” hypotheses in an attempt to bargain, such as “if only I sought medical attention sooner,” or, “if only I got a second opinion from a different doctor sooner.” This is another line of defense we use to protect ourselves from the painful reality of our situation. Additionally, guilt can often accompany bargaining and we start to believe we could’ve done something differently in the past to prevent our current circumstances.

The fourth stage is depression, and this is the stage where many patients find themselves asking, “Why is this happening to me?” There are two types of depression that are associated with grief, practical and internal. Practical depression is a reaction to the practical implications of our grief. We worry about the financial and emotional strain. Many experience a variety of emotions including sadness, regret, worry, and stress. Practical depression can typically be eased by simple clarification, reassurance, and cooperation from our support system. The second type of depression is more subtle and private, it’s our quiet preparation to separate from others and process our emotions internally. 

The final stage is resolution or acceptance, and this is the stage where patients accept their circumstances. A patient with endometriosis could say, “I know that my endometriosis will never go away but I’ve learned how to manage it,” or “Endometriosis doesn’t have to rule my life. I’ve taken charge of my health and have a great medical team to help me navigate this disease.” Most people cannot reach this stage without the proper resources and support system. This phase can bring us peace, but it’s not a period of happiness. It’s a period of calm withdrawal that must be distinguished from depression.   

At the end of the day, coping with loss is ultimately a deeply personal and singular experience. This means that no one can help you go through it more easily or understand all the emotions that you’re going through. However, you can allow others to be there for you and help comfort you during this difficult time. The best thing you can do is to allow yourself to feel the grief as it comes over you because resisting it only will prolong the natural process of healing. The cause of our grief is typically not our fault, however, it is our responsibility to accept it and heal from it, no one else can do that for you.

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