STAGE 1 – CRISIS:

The diagnosis of a terminal illness or a potentially terminal illness creates a crisis for the family. It disrupts the family’s balance / stability, just as a rock thrown into the middle of a still pond disrupts its balance. Factors thataffect how you may react at this stage include

• The history of as well as the current status of your relationship with the ill family member
• Whether the loved one is a spouse, a parent or a child.
• What you and the patient’s past (and current) roles in the family are.

Anxiety is the most common initial reaction to the news that a family member is terminally ill. However, if your relationship with the terminal family member has been strained or alienated, you may also find yourself feeling guilty, resentful, or angry. If the terminally ill person is a child or young adult, anger at the seeming injustice of early death may be the dominant emotion shared by family members at this initial stage.

At this first stage of the new grief, all adult family members benefit from guidance issues such as what to expect in terms of their own emotional reactions, whom to seek support from, whom to share memories and emotions, with, and what to expect when they meet with the dying loved one and other family members.

STAGE 2 – UNITY:

Reality of impending death has the effect of pressing family members to put even longstanding complaints or grudges on hold as they pull together to move into this second stage of grieving. This may be no problem for family members who have no conflicted feelings or unresolved issues of their own with the loved one, such as favoured children. On the other hand, if you feel that you were always a less favoured child (or the family scapegoat), you should not be surprised if you experience a complex combination of emotions even as you strive to be a good team member.

 In Stage 2, the needs of the dying become paramount. A major issue for all family  members in Stage 2 is how they will define their roles with respect to one another  and the terminally ill member. If they do not give some thought to this—a situation  that is quite common—they may quickly find themselves having regressed into roles  they played years earlier, as children and adolescents, but that they would not  consciously choose now.

In this second stage of the grief process the family has much work to do, including:

• Choosing and working with a medical team
• Navigating the social services maze
• Pursuing and qualifying for entitlements
• Ensuring that critical legal work (wills, living wills, and so on) is completed

How the family organizes itself so as to complete these tasks can have powerful psychological effects on each member, depending on how comfortable each feels with the role he or she is playing.

STAGE 3 – UPHEAVAL:

The family will eventually enter this third stage of grieving if the process of dying goes on for some time, which it typically does today.
At this point, the unity that characterises Stage 2 begins to wear thin as the lifestyles of all involved, whether they recognise it or not, gradually undergo some significant changes. Whereas thoughts and feelings about these changes may have have been put on the back burner, they can no longer be suppressed and begin to leak out. One such feeling is uncertainty, meaning mixed feelings that many people experience when the process of dying evolves into a protracted one in which the loved one’s overall quality of life slowly deteriorates.

Emotions such as guilt, anger, and resentment are likely to emerge in Stage 3. At this stage the most important issue becomes being able to communicate honestly with other family members and with trusted loved ones. Suppressing thoughts and feelings about such upheavals can lead to strained relationships and eventually can cause the entire family to fall apart.

STAGE 4 – RESOLUTION:

As a family moves into the fourth stage of grief, the terminally ill loved one’s health is typically marked by gradual deterioration, punctuated perhaps by periods of stabilisation or temporary improvement, and the effects of the prolonged grief process can and should no longer be ignored.

As they enter Stage 4, family members often find themselves having more memories—both good and bad—of past experiences which usually reflect relationships with the patient, these important memories are different, typically telling the story of how family members have viewed their place and role in the family. Often they point to unresolved issues. Some of these memories may evoke feelings of joy or nostalgia; others, however, may evoke anger, jealousy, or envy. Others still cause feelings of pride or, alternatively, of shame and embarrassment.

Stage 4 represents an unprecedented opportunity, if families only choose to seize it. It is an opportunity to resolve longstanding issues, heal wounds, and redefine one’s role in the family—indeed, to alter a family member’s very identity. Every family, as they say, has its share of skeletons in the closet. It is in this fourth stage of the grief process that the skeletons can be brought out of the closet, exposed to the light of the day, and cast forever into oblivion.

In particular, Stage 4 is a time when the following can be addressed and resolved:

• Old rivalries and jealousies
• Long-held resentments

These two issues stand in the way of families being able to bond together as strongly as they could and love one another unconditionally. Some family members, however, may react to this opportunity with anxiety instead of with enthusiasm. Rather than seizing the opportunity, they may try to avoid facing these issues. However, facing up to them offers the best opportunity for the family as a whole to move on together to a happier future. In this way the process of family grief can set the stage for growth and renewal for all involved.

STAGE 5 – RENEWAL:

The final stage of grief actually begins with the funeral and the celebration of the life of the now-lost family member. This is a time of mixed emotions, including both sadness and relief. If the family has successfully negotiated the previous four stages, however, this final stage also opens yet another door to family as well as personal renewal. It can be a celebration of life as much as it is a marking of a loss. It can be a time of creativity and planning, as the family decides, for example, how it will commemorate anniversaries and birthdays.

As much as Stage 5 is a time for remembrances, it is also a time for looking forward, to revitalised relationships and to new family traditions.