Founder
Dr. Roland Segal is a leading psychiatrist with extensive experience and is the Managing Partner and MD Psychiatrist at Legacy Recovery Center. After earning his medical degree from the University of Arizona, College of Medicine, he completed general psychiatry training at Banner Good Samaritan Medical Center in Phoenix, Arizona, and advanced his expertise through a forensic psychiatry fellowship at USC’s Keck School of Medicine.
With over a decade of diverse experience in clinical, administrative, and forensic psychiatry, Dr. Segal is double board-certified in General and Forensic Psychiatry. His previous roles include Chief Medical Officer at Valley Hospital in Phoenix, Arizona, and president of the Arizona Psychiatric Society. He has also served as the legislative committee chair and contributed to numerous state and national boards, committees, and organizations. Additionally, Dr. Segal teaches as a clinical assistant professor of psychiatry at the University of Arizona, College of Medicine, mentoring medical students and residents.
Dr. Segal acts as an expert psychiatry consultant for multiple superior and regional courts, including those in Maricopa and Yuma counties, Salt River, as well as city governments like Phoenix, Lake Havasu, and Mesa. He also consults for prominent organizations such as the United States Postal Service, Social Security Administration, Immigration Health Services, and the U.S. Departments of Justice and Homeland Security.
Guided by principles of objectivity, ethics, mindfulness, and cultural awareness, Dr. Segal remains dedicated to providing compassionate, inclusive psychiatric care, impacting lives across Arizona and beyond.
Loss is a universal human experience, whether it be death, divorce, or trauma of a spouse, family relative, friend, or member of your community. The pain can be profound and often disorienting as our world suddenly changes, plunging us into the experience of grief.
Grief is deeply personal. You may cry, become angry, withdraw, or feel empty. These are all normal and expected responses to loss. The “7 Stages of Grief” is a common framework that helps make sense of the emotional chaos. These stages are not linear, nor prescriptive, and not a checklist. But they are a way of coming to grips with loss and making meaning of the experience.
In this article, I outline each of the seven stages, their meaning and feelings, and thoughts that may occur.
A Tool, Not a Timeline
The 7 Stages of Grief model expands on the famous psychiatrist Elisabeth Kübler-Ross’s original 5 stages of dying, to better capture the nuanced emotional journey after significant loss. Grief is more like a spiral or a rollercoaster than a straight staircase. You may revisit stages, experience several at once, or skip some entirely.
This model can, however, help to normalize complex feelings and provide a vocabulary for the internal experience, reducing the isolation of grief.
The 7 Stages of Grief
While there a number of ways to describe each stage, they typically include the following [1] [2] [3] [4]:
1. Shock and Denial
The Emotional Buffer: Shock acts as the brain’s self-defense system to help cope with a difficult loss, and can cause someone to deny what has happened. This is a state of disbelief and numbed feelings. It’s a defense mechanism against overwhelming pain. Typically, it brings feelings of numbness, disbelief, sadness, confusion, and mourning.
- “This can’t be happening.”
- “There must be some mistake.”
- “They’ll come back tomorrow.”
This stage gives you time to understand what has happened and slowly adjust to the new present.
Manifestations: Feeling detached, robotic in tasks, and avoiding the reality of the loss. It provides necessary psychological protection.
Normalization: This stage is nature’s way of letting in only as much as you can handle.
2. Pain and Guilt
The Emotions Open: As the shock diminishes, the pain of loss emerges. Often it is accompanied by guilt (“If only I had…”), regrets, or a sense of emptiness. You might regret not being able to prevent the loss, or have remorse about the relationship with the deceased.
Manifestations: Sadness, physical aches, self-blame, or focusing on past mistakes may be overwhelming. Feeling this pain is an important part of healing, so it shouldn’t be suppressed. Life may feel scary during this time. Other common emotions may include desperation, sadness, and guilt.
Normalization: This intense pain is a testament to the love that existed. Feeling it is part of healing it.
3. Anger and Bargaining
Externalizing the Pain: Frustration at the helplessness of loss erupts as anger—at fate, at others, at the deceased, at oneself, or at institutions (like hospitals). You may lash out, telling God or a higher power that you’ll do anything they ask if they’ll only grant you relief from these feelings or this situation. You might feel especially resentful during this time.
Bargaining: This is the “what if” and “if only” phase. You may attempt to negotiate with God or a higher power to reverse or mitigate the loss.
Normalization: Anger gives a passing sense of control. It’s a necessary, if difficult, part of releasing buried emotion.
4. Depression (The Quiet Reflection)
The Empty Present: Not a mental illness, but a natural, appropriate response to a great loss. The fog of deep sadness, withdrawal, and confronting the void left behind. Depression stems from internalized or repressed anger in this stage.
Manifestations: You may experience fatigue, hopelessness, loss of interest in life, and the inability to feel pleasure. You may feel a heaviness or emptiness. You may be overwhelmed by the practicalities of living without the person. Your concentration may be reduced, and you may be unable to sleep, or you may sleep too much.
Normalization: This is not a sign of weakness, but of the depth of your attachment. It signifies you are no longer fighting reality but beginning to process it.
5. The Upward Turn
A Gentle Shift: You may enter into a period of calm and adjustment as the initial pain of depression starts to ease. You begin to see that you have survived the loss and have a future to live.
Manifestations: A light appears as the emotional intensity diminishes. Physical symptoms may lessen, you find moments of peace, and start to manage daily life with more ease. The loss feels less sharp and more integrated. You might start to also feel an increase in motivation and energy.
Normalization: Healing is not about forgetting, but about your life slowly reorganizing itself around the loss. You feel occasional happiness and look to the future.
6. Reconstruction and Working Through
Active Rebuilding: You feel less overwhelmed by emotions created by a major loss. Your mind becomes more functional. You can begin to put pieces of your life back together and move forward. You start to problem-solve, make practical decisions about your new life, and reclaim a sense of agency.
Manifestations: Seeking new ways to live, exploring new roles or routines, starting to carry the loss with you rather than being stopped by it. You’ll always have some grief but feel hope, too.
Normalization: You learn how to live with the loss as you begin to piece together a new identity.
7. Acceptance and Hope
Integration, Not “Moving On”: This is about accepting the reality of loss, not just being “okay” with it. It comes with a deep understanding of the impact of your loss and a sense of optimism from a realistic assessment of life.
Manifestations: You find lasting meaning again. You can remember with more love than pain. You honor the past as you move forward again with your life. Sustained hope returns. You recognize you are entitled to create a different life, offering yourself a measure of contentment.
Normalization: Acceptance is where you can hold both the sorrow of the loss and the possibility for future joy. The loss becomes a part of you, but not all of you. “It feels scary to go on the dating scene again. I miss my wife, but I know I’m ready for a new relationship.”
Understanding the Grieving Process
The grieving process is a complex and deeply personal journey, not a linear path. It is the painful work of adapting to a world forever changed by loss. Models like the seven stages of grief provide a helpful map of common emotional terrain, but they are not a rigid checklist.
You may move through these feelings in any order, revisiting stages long after you thought you’d left them, or experience a whirlwind of conflicting emotions all at once.
There is no “right” way to grieve, nor is there a schedule to follow. Some days may feel like a step forward, while others are a plunge back into sadness. The process is about integration, not blocking the range of feelings that may arise.
It is usually slow work as you weave the reality of your loss into your continuing life, learning how to carry both love and absence. It can be reassuring to know this work is a universal, necessary part of healing and that you are not lost in your grief, but are actively finding your way.
Types of Grief and Loss
While often associated with death, loss takes many forms, each triggering a unique grieving process. All grief is valid. The experience of any loss is personal. No one type is “better”. Each requires compassion, for oneself and others.
1. Anticipatory Grief
This occurs before an impending loss, such as during a terminal illness. It involves mourning the future and the gradual changes in a loved one, and sadness is mixed with preparation.
2. Complicated Grief
This intense, prolonged form of grief, where healing feels stuck, is known as persistent complex bereavement disorder. Symptoms are severe, and do not diminish over time. Professional therapy is required to overcome it.
3. Disenfranchised Grief
This is a type of loss that isn’t widely acknowledged (e.g., the death of a pet, an ex-partner, a miscarriage, or a non-death loss like job loss or dementia). Due to the lack of recognition, feelings of isolation can be intensified and invalidate the mourner’s pain.
4. Ambiguous Loss
This is a loss without clarity or closure and has two forms: Physical Absence with Psychological Presence, such as a missing person or an adoption, and Psychological Absence with Physical Presence, such as dementia or severe addiction. Grieving is challenging due to its unresolved nature.
5. Collective Grief
This is when grief is shared by a community, nation, or group following a tragedy, disaster, or public figure’s death. It creates a shared mourning period but can also feel overwhelming due to its scale and public nature.
6. Cumulative Grief
When many losses happen in quick succession, giving little time to process one before the next occurs, the overload from grief can be exhausting and complicate the healing of each individual loss.
Grief and Depression: When Grief Becomes More Severe
Grief and clinical depression share deep sadness, but key differences indicate when grief becomes more severe. Normal grief comes in waves, often mixed with positive memories tied to the loss.
Complicated grief or major depression requires compassionate professional support, when these signs are present:
- A persistent numbness with no relief
- Complete loss of self-worth
- Suicidal thoughts focused on joining the deceased
- An inability to function for an extended period.
Practical Advice for Coping With Grief
The following tips may help:
- Your Feelings are Valid: It’s possible to heal.
- Your Process, Your Way: There are no “right” timelines. Each person’s grief is unique.
- Find Support: Talk with friends, family, support groups, or a grief counselor.
- Take Care: Look after your basic needs such as sleep, food, and gentle movement.
- Express Yourself: Try journaling, art, or conversations to work through your feelings.
- Seek Help: If feelings become overwhelming, or you have thoughts of self-harm. Seek professional help immediately.
How to Support Someone Who Is Grieving
Just offer your quiet presence. Focus on listening without judgment. Offer a safe space for them to express their emotions, or just sit in silence. Avoid clichés like “they’re in a better place”.
Provide practical help such as bringing a meal, handling an errand, or simply saying, “I’m here, and I’m so sorry.” Grief has no timeline, so your ongoing support is the most important gift you can bring, especially after the initial shock subsides.
When to Look for Professional Care and Assistance
When grief significantly impairs daily functioning for an extended period, professional help is strongly recommended when:
- The person can’t perform basic self-care or work duties.
- They are staying in isolation.
- They have persistent feelings of worthlessness or hopelessness.
- They are having suicidal thoughts.
If grief feels “stuck” and shows no signs of releasing over many months, or if you’re using substances to cope, seek a therapist or grief counselor. Professional guidance can help to process this profound pain.
Integrated Mental Health and Grief Support at Legacy Recovery Center
Legacy Recovery Center is a highly rated, premier addiction and mental health treatment center in Arizona. Legacy is owned and operated by two psychiatrists with over 40 years of combined experience, as well as a robust therapeutic team.
We’re unique among residential treatment centers thanks to our ability to help people suffering from mental health and/or substance abuse issues. Our expert psychiatric team is equipped to treat multiple issues concurrently, focusing on your specific needs.
Sources
[1] Holland, K. 2024. The Stages of Grief and What to Expect. Healthline.com.
[2] Waicher, I. 2023. 7 Stages of Grief: Examples & What to Expect. ChoosingTherapy.com.
