The 5 Stages of Grief: Anger

As I mentioned in my previous post on denial, there is an accepted pattern in the stages of grieving that the dying and their loved ones will go through as they journey through the dying process. Dr Elisabeth Kubler Ross was the first to describe these 5 stages of grief and labeled them as denial, anger, bargaining, depression, and acceptance. She further noted that it is very natural for people to move back and forth between the stages, or even skip stages, with the greater point being that understanding these stages would give the rest of us a starting point on how best to relate, approach, and reach out, to someone in the midst of their dying journey. Those of us who work with patients and families experiencing the 5 stages of grief, know that the anger stage can be loud, ugly, trying and hurtful.

Occasionally when I entered someone’s home to provide care for a dying patient, I would be greeted with open hostility by family members, their visitors, or by the patient themselves. There were spouses who complained about having to accommodate for the hospital bed or bedside commode, and patients who angrily pushed away any offering of physical assistance. One daughter flew into a tirade at the hospice house after learning that her mother had received a Tylenol the night before. Another daughter, furious with her sister for supporting their mother’s decision to sign a DNR (do not resuscitate), began berating her loudly in the hallway outside their mother’s room. Another patient of mine, a man who lived alone and was admitted into the hospice house after sustaining an injury from a fall in his home, said to me “Get your kicks out of helping old men to the bathroom, do you?”

Another frequent manifestation of anger was noted when family members who lived far away from the dying person would come to visit. Sometimes the local family member would voice their anger of having to deal with the logistics of caring for their dying parent. Other times it was the family member from away who arrived with nothing but criticisms and snide remarks for the person who was providing care. Or the patient themselves made their caregiver feel that nothing they ever did, or said, was right. There were times even, when the friends of the dying person would harass the family members for ‘not doing more’.

So how then do you deal with someone in the angry stage of grieving? Advice given to every hospice person from day one in orientation is to never take things said to you in anger, by patient or family, ¬†personally. Easier said than done at times, but still great advice. A bit trickier for family members as they have a complicated history of experiences which color and motivate responses. Families tend to know each other’s buttons and which ones to push for greatest effect.

Anger is a strong emotion, a powerful release, and sometimes screaming ‘I hate this!’, ‘Why me?’ or a simple ‘Leave me alone!’ can be a release valve for the pent up frustrations needing to be unleashed, and who safer to vent to than those who love you the most. Those who love you the most, know who you are every day, through every stage, through every disappointment, through every victory. And because they know all of who you are, they can still be there for you after the angry stage. That doesn’t mean their feelings don’t get hurt, or they may take what is said to heart. Your loved ones need to know that this behavior, although hurtful, is a normal part of this grieving process, and that there is nothing they can do to fix or hurry the situation other than just letting the person go through it. As for the rest of the world who doesn’t share that long shared history with you? Well, we can best deal with you in this stage by taking a minute before snapping back with a biting response, giving you an empathetic ear as you unload on us, walking away and not engaging when it is best to do so, helping in the areas that we can offer help, but most importantly, recognizing that although this can be a very difficult stage, it is also a very normal one shared by many as they attempt to navigate the very bumpy road of death and dying.

For more information on the 5 stages of grief read here…

 

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