anxiety grief

The Missing Stage of Grief: Anxiety

When Elisabeth Kübler-Ross debuted the five stages of grief in her book On Death and Dying, published in 1969, they were intended for people facing their own deaths. Kübler-Ross later went on to apply these same five stages to the bereaved, to people who had lost a loved one, but upon closer inspection, I’m not sure they work as well. Losing a loved one is not the same as losing your life. Grief thrusts us into an uncertain world where anxiety often reigns supreme. Yet anxiety is the very element missing from Kübler-Ross’ stages.

anxiety grief

I had my first panic attack when I was 18. It happened on a road-trip the summer after my senior year of high school. My boyfriend was behind the wheel, driving toward Washington, D.C., and suddenly my heart did a funny flip-flop thing.

I unbuckled my seatbelt, flailing about for something to hold onto, and in between gasps, instructed my boyfriend to find an emergency room. For several months I’d been experiencing moments of breathlessness and lengthy episodes of heart pounding, but this time it felt different. As we hurtled toward the nearest exit, my heart took dramatic pauses, did jack-knives inside my chest and then cascaded into what felt like triple-beats. I was certain I was about to die.

Twenty minutes later I was hooked up to an EKG in a curtained-off portion of a hospital emergency room in Virginia. Beside me, my worried boyfriend murmured into the phone to my father as we watched, with rapt attention, my now-normal heartbeat creating perfect dips and arrows on the long, thin printout unspooling from the machine. Afterward, I sat on the exam table and answered the doctor’s questions.

Do you smoke? Yes.

Do you drink? Not really.

Do you do any drugs? No.

Take any medications? No.

Any history of heart problems? No.

Do you exercise? Fairly regular jogger.

The list went on and on. So far everything was pointing toward me being perfectly healthy, but I was determined to leave with an explanation. Instead, the doctor simply told me that I was among the one out of 10 people who experience heart palpitations. (And that I should quit smoking.)

As we drove away from the hospital, I stared out the window at the warm summer landscape, thinking about all the questions he didn’t ask.

Are you thinking of breaking up with your boyfriend? Yes.

Are you about to leave everything you’ve ever known behind and go off to college two thousand miles away? Yes.

Is your mother dying of cancer? Yes.

I was only 18, but that was old enough to feel painfully aware of the mind-body connection. Although I couldn’t define my problem in clinical terms, I knew that what was wrong with me might not be physical. I’m now certain that if the doctor had asked me just a few questions about my personal life, he could have easily identified my symptoms as a classic example of a panic attack.

My anxiety worsened six months later when my mother died. The panic attacks came with startling frequency, seemingly brought on by nothing at all. I could be pumping gas or lying in bed and suddenly the world would begin to swirl around me, my breath would thin out, and the only thing I felt sure of was that I was dying. But instead of dying, for the next three years I walked through my life paralyzed by debilitating anxiety. Sometimes I wished I would actually die rather than live in such a nervous state.

It’s now been close to 15 years since that ER visit, and I’ve become a therapist specializing in grief. When I look back on that time in my life, it’s easy for me to recognize how my anxiety was linked to the loss of my mother. In fact, anxiety is the most common symptom of grief that I see in my practice. But I also know that it’s often one of the most overlooked aspects of bereavement, so much so that I find myself constantly wishing that Elisabeth Kübler-Ross had included anxiety as a stage and saved us all a lot of, well, grief.

In my experience, grieving individuals almost always gravitate to the five stages at one point or another. Many of my clients immediately begin to assess their current state in terms of where they are with denial, anger, bargaining, depression, and acceptance. But while the stages were meant to be helpful, this is often where people begin to get confused. I don’t think I’m following the stages correctly, they’ll admit in a worried tone.

I don’t understand the bargaining part. I’ve been depressed for too long. I skipped the anger stage—is that okay? I don’t know where my anxiety fits in. These are the kinds of things I hear over and over again. In fact, I’ve heard them so often that I’ve now come to believe that when the five stages are applied to grief, bargaining should be replaced with anxiety.

When applied to a dying person, bargaining makes sense; following a terminal diagnosis there is often a sense of desperation, of pleading for more time. However, when you’ve already lost the person you love, there isn’t much left to bargain for. In my 2012 memoir The Rules of Inheritance, I used the five stages as a framework to illustrate my own grief process. When it came to the bargaining stage, the only way I could make sense of it was to liken it to the idea of magical thinking, a condition Joan Didion has described beautifully. I wrote about how, for years, I found myself thinking that if I worked hard enough or teetered precariously on enough sharp edges, my mother might reappear from the other side to save me.

Including anxiety in the five stages of grief would better serve the bereaved. Even more than depression, anxiety is the response my grieving clients express a desire to overcome since experiencing loss. They describe feelings of panic and obsessive thinking about their own deaths and potential illness. They tell me about bouts of helplessness and of feeling overwhelmed by life itself, about panic attacks and moments of such paralyzing fear that they pull their cars over on the way to work. I have even heard my own story about the ER told back to me countless times.

When we lose someone we love, we are thrust into a world where we feel more vulnerable than ever before. Suddenly we must face the fact that there are absolutely no guarantees in life. Everything that once seemed sturdy is now fragile, particularly the people we love. These feelings can be incredibly overwhelming and oftentimes terrifying. It takes time and work to overcome them, to feel secure again in such a now-delicate world. And for people who suffer multiple losses in a short period of time, it can take even longer.

The anxiety that comes with grief can be debilitating, but because it is not included in Kübler-Ross’ five stages, it tends to be ignored or dismissed as a different problem altogether. However, anxiety is a very real and very normal reaction to grief and it must be recognized. It is also highly treatable once it is distinguished for what it is.

There is a wonderful and unexpected gift that comes with seeing how fragile our lives are. It enables us to be more present, to feel grateful for what is right in front us, to cherish what we are able to hold onto right here, right now. But in order to reach that level of acceptance we must wade through the tremulous waters of fear and anxiety, recognizing them as a part of a larger process that will see us through to a shore where so many of us have emerged changed, if not healed.

When I look back on my frightened 18-year-old self, I’m saddened that no one was able to see what was really going on. If just one person had recognized how fragile my life had become, perhaps they could have reassured me that no matter how scared I was, I wasn’t alone.

Originally published at

Grieving in the New Year | Claire Bidwell Smith

Grieving in the New Year

If you're like me, the new year always brings an opportunity for renewal and a fresh start. Except when you're grieving. When you've lost someone you love - recently, or even years ago - the new year can bring on a tidal wave of emotions and expectations. The idea of starting over in the new year can feel unwanted or even just overwhelming.

Grieving in the New Year | Claire Bidwell Smith

New Year’s Resolution: Be less sad.


If you have this one on your list strike it out right now! I've heard so many clients tell me stories of trying to "quit" grieving at the beginning of the year, only to have this resolution fall flat on its face.

New Year’s simply looks different for those who are grieving. You may find yourself feeling more alone than ever as you watch your friends and loved ones carry on celebrating and making resolutions to embrace the year ahead. Because when you’re grieving there is a poignancy that comes with the passing of time, and nothing feels like more of a reminder of this than the new year.

I’ll never forget the first new year after my mother died. She had been gone for almost a year but when the clock struck 12 that night and the minutes carried forth into a year in which she was not alive, I literally sank to my knees in pain in the back hallway of a nightclub.

The intense pain I felt in that moment was unexpected for me. For most of that first year, I had felt numb. But when the hands of the clock began to move forward and I realized I was entering a year in which she would not be a part of, I felt overcome with searing grief. The club patrons carried on celebrating around me and I curled into a corner of the hallway sobbing into my hands, missing my mother more than I could stand, and not knowing how I would get through an entire lifetime without her.

Allow Grief to be Part of Your New Year

Be kind to yourself in the new year. You don’t have to make the traditional fresh start, embrace diets, work out regimes, or start a daily gratitude list. Whether this is your first year without your loved one or whether it’s been many years since the loss, it’s important to honor your feelings and give yourself the proper time you need to grieve. There will be other years in which you can feel celebratory again. But this year be gentle with yourself.

Let your resolution be one of vulnerability. So many of us are afraid to feel all the big emotions that come after a loss. These feelings can be overwhelming and also make you feel like you are not functioning like everyone else around you, but let that be okay for now.

I’ve had many people tell me years after a loss that they feel they missed an opportunity in their grief - that they did not let it in when given the chance, and that it hardened something about their relationship with their loved one.

Use the new year to take a deep breath and to embrace who you are in this moment. We change so much more than we realize. So remember that you will not always be in this space, but while you are, allow yourself to feel all that comes with loss.

There is undeniably an identity shift that comes with losing someone close to you. Be it a friend, family member, spouse, or child, their absence in your life will force change upon your soul. Most of us try to resist that change, thinking that the answer to getting through the pain is to try to remain exactly the same, to try to retain the person you were before the loss. But in fact, the opposite is true.

When we can allow ourselves to let the loss shape us and change us, we will grow with experience, rather than against it. And whenever we stop resisting something then we can give ourselves the opportunity to heal.

The Year of Letting Go

Let this be the year of letting go. Not of your loved one, but of your expectations of yourself. You will never get over your loved one and you do not ever need to let go of them, but in order to heal you do need to release the idea that you can remain unchanged.

Each time you find yourself judging your grief process - whether it’s thinking you are too sad or too angry or simply too consumed by it all - let go and know that whatever you are feeling right now is normal and natural. You will eventually reach a state of less pain and sadness and anxiety. You will find a new normal. Until then, be gentle with yourself.

Meditation for the New Year

I want to walk you through a simple meditation that you can do anytime you have a quiet and private space for 5-10 minutes. Don’t worry if you’ve never meditated before. Just give it a try.

First lie back in a comfortable position and close your eyes. Then take a moment to simply breathe and become attuned to your body. When you are ready I want you to imagine that you are rising up above yourself and looking down.

Take note of everything that you are experiencing in this moment in time. Do not resist what you see. If you think you are too sad, or too heavy or too scattered or too whatever I want you to let yourself see it and accept it anyway. This is who you are in this moment.

Take another moment to imagine reaching down and stroking your own head in a loving way. Forgive yourself for anything you think you are doing wrong and just for this one moment, during this meditation, let yourself feel real love and compassion for who you are, right here and right now.

Give yourself a message of reassurance and love. See yourself as you would see a friend or a child, and meet yourself with true compassion.

When you are ready, return to your body and take some slow, deep breaths before you open your eyes.

Do this meditation as often as you need. It will help keep you present and balanced in the new year. And remember, the path to healing starts with giving yourself space to grieve.


The Conversation: Stories that Matter

My discussion on grief and anxiety after loss at The Conversation: Stories that Matter at the HBO Theater in NYC.

Surviving the Holidays When You're Grieving

The holidays can be an especially difficult time when you are grieving. The feelings around any significant loss are heightened during this time of year, whether the loss is recent or even years out. Holiday traditions and festivities serve to illuminate the absence of someone you love, making your feelings of grief and loss grow even stronger. It can be hard not to look around and see everyone else with their seemingly happy, intact families. You can't help but feel that you are lacking in some way, that someone is missing, and that things just aren't the same.

If you're feeling this way and if you're cycling through a roller coaster of emotions, know that you're not alone. It is completely normal to feel this way. This month every single one of my clients has been experiencing a tumultuous range of emotions. And I've lived through it myself.

I like to believe that two things can be true at once. When you are grieving, the holidays can still be sweet and fun and nostalgic, but they can also be bitterly painful. You do not have to choose one way or the other.

My mother loved the holidays and the first year after she died was brutal – every single festivity was a reminder that she was gone and that my life was never going to be the same. I felt angry at all the people around me who didn't even seem to realize how great their lives were and how much they had. And I felt sad that I would never again share these traditions and events with her. An otherwise fun or meaningful holiday moment often put me into a sorrowful or angry mood.

It took a while for me to be able embrace them again. Time went by before I was able to resurrect the festive rituals my mother had loved. And even more years had to pass for me to stop feeling the sweetness of enjoying a rich and complex life, and also wincing from the pain of it.

Now the holidays feel different. Even when I don't have family around me, my daughters and I cook and decorate and laugh, and it’s not what it would have been were my parents still been alive. But it is also good and meaningful and I strive to embrace the essence of what my mother always loved about every holiday.

If this year is your first or second year without a loved one, give yourself a pass. Let it be okay to not feel like you're in the holiday spirit. Enjoy bright moments here and there, but don't expect the overall experience this year to be what it has been in the past. Know that it won’t always feel so painful and lonely. In time you will find ways to feel joy and cheer again, and that finding ways to evoke your loved one over the holidays will make you feel closer to them.

If your loss is an older one, or even for those whose are recent, try to think of ways to draw your loved one close this season. Either by talking about them and telling stories with family members or recreating traditions that were important to them.

Overall, be kind and compassionate with yourself during these last days of the year.

Welcome to the Sunday Mourning Podcast

Welcome to the Sunday Mourning Podcast with Claire Bidwell Smith. In each episode Claire explores different topics related to grief – everything from guilt and anxiety to the afterlife – bringing on various guests, and revealing more of her personal journey and insights. Join Claire as she helps you explore grief and loss in a way that makes your heart feel whole again.