By: Dr. W. Scott West, Chief Medical Officer, Nashville Neurocare Therapy
Depression isn’t always triggered by an event or circumstance, but sometimes it is. Traumatic experiences like the sudden death of a loved one, natural disasters or community violence, or neglect and abuse can absolutely lead to clinical depression. And it makes sense; these events are depressing, and depression is an appropriate response. However, just because it’s normal doesn’t mean you need to go through it alone. Understanding our grief and how to move forward can be hard when your world changes completely.
The Five Stages of Grief
Elisabeth Kubler-Ross, a Swiss-American psychologist, coined the famous five stages of grief in 1969 in her book On Death and Dying. In this work, Kubler-Ross conceptualizes grief as a response to death, though we all know that we can grieve a multitude of things in addition to death, including the loss of close relationships, the loss of a job, or the loss of what we wanted, hoped for, or expected that doesn’t come to be.
The five stages of grief are Kubler-Ross’ categorization of how we begin to navigate this life change and survive and adapt to this new reality of loss. These stages are not always linear, and each person can experience them differently. Other psychologists have also determined different interpretations of grief stages, though Kubler-Ross remains the most enduring in the zeitgeist.
Stage #1 – Denial
The first stage of grief is denial. Denial is our mind’s way of protecting us from the overwhelming shock of our grief by only letting us take in as much as we can handle in the moment. As we continue to accept the reality of our loss, the denial will fade, and we can begin to process the feelings we’ve been suppressing.
Denial can look like: staying distracted, forgetfulness, or avoidance.
Denial can feel like: shock, numbness, confusion, or shutting down.
Stage #2 – Anger
Anger might rise to the forefront as we begin to feel the feelings we’ve denied from our grief. Our culture largely fears and misunderstands anger, seeing it as destructive and senseless. Anger, however, can be helpful when we allow ourselves to feel it fully. As we’re feeling washed away by the flood of emotions accompanying grief, anger offers us structure and gives us a starting point to begin making sense of our pain.
Anger can look like: cynicism, blame, sarcasm, or irritability.
Anger can feel like: frustration, resentment, rage, or feeling out of control.
Stage #3 – Bargaining
In the bargaining stage of grief, we are wrestling with the pain of the past. The more we process our grief, the more we may dwell on what we could have and should have done to avoid or prevent what happened. This stage can take the form of “what-if” and “if-only” or even look like more literal bargaining with God or another deity to make things right or remove the pain.
Bargaining can look like: perfectionism, comparison, overthinking or assuming the worst.
Bargaining can feel like: guilt, shame, self-blame, or anxiety.
Stage #4 – Depression
As you begin to really come face to face with the reality of your loss, you enter the fourth stage of grief: depression. Depression as a stage of grief does not indicate mental illness; it is an appropriate response to significant loss and does not need to be fixed, snapped out of, or erased. The situation you’ve found yourself in is, in fact, depressing, and it would be unusual if you weren’t feeling those emotions. While uncomfortable, but essential to the healing process.
Depression can look like: low energy, changes in sleep and appetite, crying, and isolation.
Depression can feel like: despair, hopelessness, overburdened, and sadness.
Stage #5 – Acceptance
As we move into acceptance, we internalize that our reality is forever changed, and our life must adjust as we continue forward. We build new relationships, make new memories, and begin to have more good days than bad days. This stage does not mean that we replace what has been lost or deny the hard feelings, but we are able to cope with it better and live our lives again. Acceptance is not bypassing the grieving process but what happens when we have given ourselves the time, space, and grace to grieve properly.
Acceptance can look like: being present, tolerating emotions, honest communication, and mindful behaviors.
Acceptance can feel like: courage, wisdom, patience, and self-compassion.
How long does it take to grieve?
While grieving, we can feel overwhelmed by the enormity of our pain. Some of us want it to be over and done with as quickly as possible. Others might feel afraid to let go of the pain, as though moving through it would betray what we’ve lost. The truth is, there is no set timeline or schedule for grief. The five stages are responses to feelings that can last for minutes, hours, weeks, months, or even years as we process our grief.
The stages aren’t meant to be prescriptive steps but rather a framework to help us understand what we may be feeling from one day to the next. We may flip back and forth between certain stages or jump over one or two altogether. There is no one correct or predictable way to grieve. What you are feeling and experiencing, no matter how painful, is normal and does not need to change. Even as you’ve begun to live in acceptance, grief will never truly leave us as we continue to honor and remember what we’ve lost.
Just because this process is natural doesn’t mean you must go through it alone. If you’re feeling stuck in a stage of grief, particularly depression, there is support available to help you process and move through it.
At Nashville Neurocare Therapy, we specialize in helping you manage depression with TMS Therapy. TMS, or Transcranial Magnetic Stimulation, is an innovative therapy that treats depression by using magnetic-pulse technology to stimulate areas of the brain with low metabolic activity or, in other words, aren’t working to their full potential.
We’ve learned that the brains of people with depression and the brains of people without depression look and function differently. Most notably, centers that regulate mood aren’t as active in a depressed brain. TMS Therapy helps encourage your brain to heal itself by building and strengthening the neural networks that help control your mood and behavior. This treatment offers real, lasting relief from depression.
TMS Therapy is proven safe and effective and is 100% drug-free. Though it’s a lesser-known therapy, most private and public health insurances cover TMS Therapy, and the American Psychiatric Association lists TMS Therapy as an alternative to antidepressants if your medications aren’t working for you. If you aren’t finding relief from your depression through talk therapy or medication alone, talk to your doctor about TMS Therapy. Treatment for depression is not one size fits all, and there is hope for you. If you’d like to learn more about TMS Therapy and how it could help you or somebody you love, please book a Free Screening. We’d love to see if TMS Therapy is a good fit for your path to healing.
About the Author: Dr. W. Scott West
Nationally recognized, board-certified psychiatrist, Dr. W. Scott West, blazed the trail for TMS therapy in Tennessee as the first physician to offer this advanced technology in 2010. With 30+ years experience in clinical depression, Dr. West leads the Nashville Neurocare team.
- Board Certified Psychiatrist
- Specialty: Certified TMS Psychiatrist since 2010
- Diplomate: The American Board of Psychiatry and Neurology
- Distinguished Life Fellow: American Psychiatric Association
- Residency: Vanderbilt University, Hospital Department of Psychiatry
- Medical School: University of Tennessee, Memphis, Center for the Health Sciences
- Hospital Affiliations: St. Thomas Hospital
