Sunday, October 28, 2012

THE FIVE STAGES OF GRIEF


As a (former) medical student, I used to learn about the stages of grief. It was in the study guide as part of our professional development. The purpose is so that we doctors will be able to be as empathic as possible with patients or relatives who are in their stages of grief. 

Those patients who have just been told that they are suspected to have appendicitis which will be cured after an appendicectomy, a simple daily most common surgical procedure, or those patients who have just been diagnosed with a stage 4 malignancy with only few months to live. Those parents who were told that their children have just died following motor vehicle accidents, or those wives whose husbands just presented with heart attacks and that CPR is ongoing, then asked if CPR should be continued for another 30 minutes or otherwise stopped if no signs of life present soon enough. Let it be benign nor malignant, let alone the patients themselves or their relatives. All of them will eventually face these stages of grief.

What we sometimes overlook is how this teaching actually applies to many other situations that may occur to anyone, any day. Sad things happen everyday. Unpredictable things happen everyday. Sometimes they occur in your lives, some other days they befall upon me, and some other days they happen in some other people's lives. So everyday there must be certain someone who is at these different stages of grief. 

The five different stages of grief. Denial, anger, bargaining. The first three stages that may bring you so many unanswered questions; that you would do many impossible ridiculous things you would regret later on just to have these questions answered. 

Then there is depression. When you would ridiculously torture your own selves for something you should not, be it either you have no appetite for food causing you loss of weight despite busy occupying yourselves with baking new recipes just to get rid of those memories that brought you to your grief; or be it you have no energy to smile that your colleagues would query and whisper among them why have you become someone different; or be it you cannot sleep, only you are so lucky to know some medications that have their sedative effects then wrongly use them to help you sleep rather than for their own indications; but even with this abuse you would still have interrupted sleeps that is most definitely unhealthy; or worse, at this point of grief some people with no faith would just succumb to ending their own lives a a shortcut to end the misery and pain they were going through. And this is where I think the challenge is for the psychiatrists - to differentiate whether the depression is pathological and needs treatment, or whether it is just a physiological stage of grief which is completely normal and needs only time to heal, hence treating this with medications would only cause a disaster and is inappropriately necessary.

And then, comes the final stage. Acceptance. Only if you handle the depression well enough to come to this stage. And you will never know how long to go until you come to this stage. 


I used to read a really wise book entitled Don't Be Sad, or rather known with its arabic title, La Tahzan; which also has its Indonesian translation - Jangan Bersedih. I used to read it halfway through, never did I finish it, had you known me, you would know I like to read, but I always stop halfway through. I know it definitely is not a good thing, but reading it the second time at time, I will try to finish it and hopefully not only to finish reading it, but also will be able to take in and hold firmly all the advice close to my heart.

I am no where near to the middle pages, I cannot promise that I will finish reading the whole book cover to cover (it's an old habit that is hard to change of course, and promise is not something you should play with), but I can promise that reading the first few chapters would have given those in grief (or not) soothing words of wisdom and hope. Hope that should only be leaned to Him, as to Him alone do we all return. The words that bring you closer to Him, that hopefully will lead you to be able to deal with the griefs or tests in the best possible way.

Every word written is so true. Reading too much into the past is a waste of the present. Sometimes, you want answer for things that happened, but maybe not knowing the answers is the only way you can live better, you never know, but He knows. Enough with all the ridiculous things you have done in the past; denying, being angry, bargaining. Former days are gone and done with, and you benefit nothing by carrying out an autopsy over them, by turning back the wheels of history. 

Depression brings you to idleness and idleness would furthermore brings you to depression - as nicely written in the book; When you find yourself to be idle, prepare for depression and despair, because idleness allows your mind to wander in the past, the present and the future, with all their difficulties. Idleness is an expert thief and your mind is its victim.  It says ' Get up now and say a prayer or read a book; praise your Lord, study, write, organise ... and loads more, so that you can put and end to your inactivaty.' Tossing and turning around your bed, thinking too much about the past would bring nothing other than torments. ...and hence the writing after one year of silence =)

And these are my favourite quotes from the book so far: 

"The pen has dried, the pages have been lifted: all events that shall come to pass have already been written. Whatever has befallen you was not meant to escape you, and whatever has escaped you was not meant to befall you."

As a weak human being going through difficulties, those awful feeling will always haunt you and put you in sorrow and trouble, and studies have extract out this common stages of grief which should be a normal reaction towards letting go. As those who believe, we will never completely feel at ease until we firmly believe that Allah has preordained all matters. It is the 6th pillar of faith anyway. Easier said than done of course, and once in a while even if you agree and are comforted by the preordainment, those things that happen to you will always haunt you because it is your past. Just wish that it will not haunt you too much and be thankful that your life is much better than some other people.

So yes, every day some certain people are at grief. Sad things happen every day. Unpredictable things happen every day. But good things also happen every day. And unpredictable things can happen in good ways. Grief is a normal process, just pray that it will not take too long to destroy you  apart. 

I pray that my faith, our faith will always lead us to the betterment. No, I pray that we always have faith, as once we have the true faith and we believe, this will always lead to betterment =) So my friends, (and a very sincere advice to my own self of course), HAVE FAITH because He is The All-knowing.