Hello to my website followers, today I would like to talk about the Kübler-Ross model of grief (the five stages of grief). This model of grief was originally developed by Elisabeth Kübler-Ross and became famous after she published her book on death and dying in 1969. Kübler-Ross originally developed this model to describe people's reaction to their own death following diagnosis of a terminal illness. However, over the years this model has been used to generally describe the five primary responses to any type of loss.
These stages are:
Denial,
Anger,
Bargaining,
Depression, and
Acceptance.
Someone who is grieving may go through these stages in any order, and they may return to previous stages, there is no set pattern and no ‘right’ way of grieving.
Also as the following picture shows, grief is not a smooth and straightforward process, with a smooth upward curve. It is often a tangled mess. When I used to work as a Trainee Counsellor at Cruse Bereavement Care - we would often share with our clients the idea that grief is like this tangled ball of wool. Part of the work of counselling was about trying to unpick this ball and work through the often difficult and confusing feelings associated with their own experience. Please see pictures 1 and 2 below to illustrate what I mean. You have probably heard this loads of times already, whilst there will be similarities in people's experience of grief, actually we are all individual and unique in how we will experience the grief and how long it will take us to navigate the stages.
Stages of grief (picture 1)
Reference: https://speakinggrief.org/get-better-at-grief/understanding-grief/no-step-by-step-process
Ball of Grief (picture 2)
So why am I telling you all of this?
In December of last year I developed the worst pain in my back that I have ever experienced in my whole life. The pain started in my lower back and was radiating down my left leg into my foot. I have a chronic pain condition anyway - which I have been living with for 15 years. However, up until December of last year I had been managing my chronic pain very well and was able to work, volunteer and exercise most days, moving my body and following my passions of ice-skating, running, yoga and barre classes. I went from this busy and active life to not being able to move at all without agonising pain.
I couldn't walk to start with as I couldn't straighten my spine and had severe nerve pains in my left leg. Some of the time it would be burning hot pains, then it would feel freezing cold, then there would be pins and needles. I experienced huge anxiety during this time and worried that I would never be able to walk again properly.
During my recuperation over January of 2025 I had lots of time to reflect on my current predicament. But it also took me right back to when I first developed my chronic pain condition 15 years ago in 2010.
This is where my story and the experience of many others links to the stages of grief.
One of my specialisations as a counsellor is working with people who have chronic pain and other long-term, or life changing conditions. Every-one that I have spoken with in a work capacity, and myself have experienced losses in their life and changes in their identity that have arisen from their condition. This could be a separate blog post in itself! However, in general losses could include losses, or changes in the functioning of your body as a result of your condition. For example, me losing the ability to walk as a result of my herniated disc, whilst this was thankfully a temporary loss for me, for some people these changes could be permanent. Then if you can't walk, or sit up you potentially lose the ability to work, it might be harder to play with your children, to cook dinner for yourself and your family. You might then need to rely on other people to do things for your, like helping with your personal care, helping with house work, shopping etc... For some people this loss of your previous functioning can cause a real mix of emotions which I will go into more detail below. These emotions can follow the stages of grief of the Kübler-Ross model.
In the following section I would like to go through each of the stages of grief and how this might look like in the chronic pain, long-term health client that I might work with. Where appropriate I would like to link this back to some of my own experiences of grief that I introduced above.
This grief process for me has been linked to the stages that I have gone through in my life when first developing my chronic pain condition. This happened initially in October of 2010, following a jaw realignment surgery.
Denial: "This can't be happening."
Individuals may refuse to accept the fact that a loss has occurred. They may outright deny the situation.
When I first experienced a chronic pain condition I was a fit person exercising pretty much 7 days of the week, I ran half marathons and marathons and I worked as an exercise to music instructor. My fitness was my life and a huge part of my identity. When I was in so much pain I didn't want to accept the reality of my pain condition. I stopped listening to the pain signals from my body and tried to over ride them so that I could still do what I wanted to. I tried to work harder and longer hours than any one else in order to prove to myself that I was okay.
This strategy ultimately didn't work so well for me and I ended up going into a huge burnout. I could no longer teach my classes, I couldn't run and ended up not being able to work for a time.
This leads me nicely into the next stage...
Anger: "Why is this happening to me?"
When an individual realises that a loss has occurred, they may become angry at themselves or others. They may argue that the situation is unfair and try to place blame.
If you have ever seen the Pixar film Inside Out you will have seen this angry red guy.
He really depicts anger for me and how there can be a lot of anger associated with a chronic pain, or long-term health condition. Depending on the person and the situation, this anger and frustration can be directed outwards, to friends and loved ones and maybe towards the Doctors and other services that have let you down.
For me I can remember many times in my chronic pain journey where I felt very angry, angry towards the world at some points and the unfairness of why I was suffering so much. Angry at the GP and other Hospital Consultants who were very dismissive, especially some who told me I didn't have a problem at all. Often long-term health conditions such as chronic pain are invisible conditions. As they can't see the extent of your suffering on the outside, I found that doctors didn't believe me when I tried to describe just how bad I felt. Even more recently with my disc problems it took several repeated attempts to be referred for a scan of my back to confirm the disc problem. They didn't believe that there was a disc problem because of what I was doing when the pain came on, the pain did come on suddenly, however, it wasn't associated with bending over and heavy lifting - the typical way that a disc problem usually occurs. They didn't want to prescribe me stronger pain killers because of this, even through I was in agony and couldn't walk without help. I know that I am not the only one that has struggled with not being believed by the medical profession and this can lead to incredible anger and frustration with the unfairness of it all.
I was angry at other people in the fitness industry at the start of my chronic pain journey, how comes they can work and exercise to a high intensity and I couldn't.
I was angry at 'friends' who didn't understand what I was going through and who didn't message, or keep in touch. It feels as if you don't exist anymore. People have moved on and you are left on the sidelines.
I was angry with myself for being in this condition and especially when it first started I was a mum to two very young children. I was angry with myself as I didn't have the energy, or the ability to take care of them in the way that I wanted too. I was angry at myself as this is not how my life should be. I was still in my twenties at this point, but I felt like an elderly lady who couldn't do anything anymore.
Bargaining: "I will do anything to change this."
In bargaining, the individual may try to change or delay their loss. For example, they may try to convince a partner to return after a breakup, or search for unlikely cures in the case of a terminal illness.
As the years went on and my chronic pain wasn't improving I literally tried everything that I could think of to try and improve my health. Every type of supplement that was good for pain and joint health I took it. I tried Pilates, I tried Yoga, I tried meditation, I tried counselling. In my mind if I meditated hard enough, if I did these yoga classes regularly enough I would manage to 'cure' myself. Whilst all of these interventions are great in their own rite, they didn't work straight away and give me the miracle cure for my pain that I was seeking.
I have a lot of conversations about this with the people that I work with. I would say a high percentage of my clients say their main goal for therapy is for their pain to go, for their health condition to improve straight away and to go back to who they were before this all happened. I have to say that whilst I don't have a magic wand, or a magic pill to take your suffering away. Counselling in collaboration with your other pain management strategies can help to alleviate your suffering and help you along the path to developing a life that you feel is worth living alongside your chronic condition. I will say more about this in the next section.
Depression: "What's the point of going on after this loss?"
At the stage of depression the individual has come to recognise that a loss has occurred or will occur. The individual may isolate themselves and spend time crying and grieving. Depression is a precursor to acceptance because the individual has come to recognise their loss.
Returning to the Inside Out characters, sadness really symbolises this stage of grief for me.
When I did start to work towards accepting my chronic pain and some of the things I could no longer do, such as running, or working to teach my classes. I would cry loads. I was lonely, I was sad. I missed being physically fit, my body didn't look the same, I missed my friends, I missed the people that I used to teach in my classes and I couldn't see a way forwards in my life.
Acceptance: "It's going to be okay."
Finally, the individual will come to accept their loss. They understand the situation logically, and they have come to terms emotionally with the situation.
It took me a long time to accept the reality of life with a chronic pain condition, I am not saying that this process is easy, nor does acceptance mean that I am always happy about having the condition. My pain and energy levels do vary and can cause difficulties in my functioning. However, I am happy to say that I am very fortunate to be doing work that gives my life a lot of meaning and value. I have hobbies that I enjoy and I have a lovely family that includes my husband, my two teenage children and my fur children Loki and Elsie.
Mindfulness was a huge part of my journey towards acceptance. I came across the work of my idol Vidyamala Burch by chance and downloaded her book 'Mindfulness for Health' on Audible. Practicing mindfulness was the first part of my journey of learning the skills that would help me to think about and manage my pain in a different way. For those of you that haven't read the book I would highly recommend it.
Vidyamala was one of the founders of the organisation Breathworks in 2001. They developed and run eight week mindfulness courses focused on their unique approach to mindfulness based pain management. For more details about their organisation please visit: https://www.breathworks-mindfulness.org.uk/
One of the key concepts of the course (and in their book) is shown in the following video:
Vidyamala, originally from New Zealand has spent the majority of her adult life in chronic pain. Vidyamala was a very active your person before her first spinal injury that occurred at the age of 16 years old. Following a traffic collision when she 23 years, she injured her spine further up Vidyamala became partially paraplegic and a wheelchair user. I related so much to Vidyamala's story as she was a very active person as I had been and had lost this ability through her injuries. She lives with daily pain in her spine, a paralysed bowel and bladder and neurological pain that travels down her leg - like electric shock type pains. Vidyamala learnt how to work with her mind through mindfulness.
I have heard Vidyamala give talks on her life journey, when she was in intensive care at the age of 25 years. She was in mental torment and one voice said that I can't get through the night, I can't bear it, I am going to go crazy. The second voice was saying to her, "but you have too" and the voices were at war with one another. Then a third voice came in and said "you don't have to get through to the next morning, you just have to get through the next moment and the next moment and this one and this one..." She speaks at how her experience shifted, she went from being tormented with intolerable pain - to a more spacious place. Where she just had to live in the moment.
Thinking about my own recent experience with my disc problem, I cannot tell you how much this story helped me. Don't get me wrong I was still in agony, however, I tried as best as I could to release the muscles of my hip and back and just focused on being here right now. Rather than catastrophising and thinking the worst possible scenario was going to happen. The pain getting worse and not being able to walk again.
Vidyamala talks about meeting a chaplain on the same Hospital ward a few days after being tormented by the voices in the night. She shares how he introduced her to the practice of mindfulness, by asking her to think about a time and a place where she has last been happy. She transported her awareness back to a time before her injuries and climbing a mountain, she was physically fit and happy in this memory. She talks about the rest of her life has been focused on exploring how mindfulness can change the focus of your attention and shift your subjective experience.
Vidyamala got the message from her medical team that there was nothing else that they could do to help her with managing the pain - who else can relate to this? She then decided to take responsibility for herself, rather than looking to external sources for a 'cure.' Vidyamala talks about continuing to explore mindfulness and how she was drawn to the teachings of the Buddha.
Early years on into her lift with injury/ disability - Vidyamala says that she was in denial - a reaction very common when something catastrophic has happened to us as humans. The first response is to pretend as if it hasn't happened. It is all difficult to come to terms with initially. Vidyamala says that she was very pushed and driven, tried to do everything that she could do before the injury. She strained the body and was exhausted. Vidyamala says that she couldn't be in touch with the body because then she would have to acknowledge what had happened. This stage for Vidyamala lasted about 10 years.
The next stage for Vidyamala of bargaining started after the experiences in Hospital that I have referred to above. She was doing all of the 'right' things that were good for her to bring about wellness. However, Vidyamala describes that her motivation for doing things such as yoga, meditation, eating healthily etc...were things that she was doing to get rid of the pain, so that she could then get on with her life. She felt like she was doing all the right things, but felt like she was getting it wrong all of the time, because the injuries were ultimately still there and her body was still in pain.
The acceptance phase came on gradually for Vidyamala as she learnt to get closer to her present experience and what was actually happening. She learnt how to befriend her body. A big lesson was about taking the mindfulness experience off of the mat and into her daily life. Acceptance Vidyamala says is not a passive resignation to what your experience is
Vidyamala says that acceptance wasn't the end of her experience - as shown in the 5 stages of grief model. She found that she can live a very rich and fulfilling life despite the pain. Vidyamala speaks about how her experiences went on to evolve into a stage of life that she has called 'flourishing.'
If you are interested in finding out more about this please listen to the following podcast:
This idea that my life could go on to become a life that moved beyond acceptance to one where I could flourish was very inspirational to me. I drew inspiration from Vidyamala when naming my counselling practice. Her story and my own life experience of using mindfulness and counselling has inspired me to try and live each day one at a time. I try to find moments throughout each day where I am present and can focus on the positive things that are happening and be grateful for them.
Some take home tips that you can take from this is trying to develop gratitude in your own life if this is something that you haven't tried yet. Some ways that you can start to develop gratitude in your life is to start keeping a gratitude diary.
Keeping a gratitude diary can have several positive effects on mental health. Here are some key benefits:
Improved Mood: Writing down things you are grateful for helps shift your focus from negative thoughts to positive ones. This shift can improve your overall mood and help combat feelings of anxiety or depression.
Increased Positivity: Practicing gratitude daily encourages a more positive outlook on life. By acknowledging the good things, even small ones, you begin to recognize the positive aspects of your day, which can help you develop a more optimistic perspective.
Reduced Stress: Focusing on gratitude can reduce the impact of stress. By reflecting on what you are thankful for, you can create a sense of calm and remind yourself that there are still good things happening, even during tough times.
Better Sleep: Some research suggests that writing in a gratitude journal before bed can improve sleep quality. Reflecting on positive events before sleep can help you feel more relaxed, making it easier to fall asleep.
Increased Self-Esteem: A gratitude diary helps you notice your accomplishments and the positive qualities in yourself, which can lead to higher self-esteem. Over time, recognizing what you appreciate about yourself and others can foster feelings of worth and confidence.
Stronger Relationships: Regularly expressing gratitude, even just by noting it in a journal, can enhance your relationships. Acknowledging the support and kindness of others can encourage you to nurture deeper, more meaningful connections.
Mindfulness and Present Focus: Keeping a gratitude diary encourages you to be present and reflect on the current moment. This practice helps cultivate mindfulness, which can be a powerful tool for managing stress and improving emotional well-being.
Improved Resilience: Regularly practicing gratitude builds emotional resilience. By focusing on the positives, you're better equipped to handle setbacks and challenges, knowing that good things are always around, even when facing adversity.
Increased Emotional Awareness: Writing about things you're grateful for can help you become more aware of your emotions, allowing you to better understand and regulate them.
Incorporating this simple practice into your routine can create lasting mental health benefits, fostering a deeper sense of appreciation and emotional well-being.
I hope that some of these ideas have resonated with you and have given you some inspiration to help you with your journey.
You can choose an existing notebook that you have at home. Or if you are drawn to you can buy a specific gratitude, or wellness diary from most retail shops, or online.
I found a cheap mindfulness book for £2.99 in my local Aldi store that I wanted to share with my readers to give you some idea about what kind of thing would be suitable. Please see the pictures below:
There are some great prompts in these pages to help you reflect on and identify aspects of your life to be grateful for and also some prompts on self-care. Self-care is such an important part of balancing your best possible mental and physical health that I will write a separate blog post on this.
Here are some of the prompts on another page.
As ever if you have any questions please get in contact with me, either through this website, or my email address: flourishingmk@outlook.com
Warm wishes,
Mary :)
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