A recent inCYST post on grief really resonated with me. Perhaps it’s because I’m a Certified Bereavement Facilitator, so a lot of the work I do is directly related to grief, particularly “out of order” deaths such as suicide, homicide, and miscarriage loss. Or perhaps it’s because there’s so much sadness and loss surrounding chronic illness that, for me, the issue of PCOS cannot be addressed without looking at the issues of loss. In any case, I want to introduce a commonly used model for grieving, since I’ll be talking in more detail about it over the next few weeks, and relating the elements back to PCOS.
Elizabeth Kubler Ross was a physician who worked with terminally ill patients. The model was first described in relationship to terminal illness, and the process that patients go through as they struggle to reach acceptance of their situation. It has come to be applied extensively to grief therapy work. The model is known as DABDA, which stands for denial, anger, bargaining, depression, and acceptance. I’ll be devoting a post to each of these five items.
The first thing to know about grieving is that grieving is a non-linear process, with unpredictable timelines and variables, and that no two people grieve the same way. It’s estimated that most people grieve adequately and appropriately on their own, but about 30% would benefit from the assistance of a professional grief counselor. All of those phases of grieving – denial, anger, bargaining, depression, and acceptance – may occur in order, out of order, simultaneously, repeatedly, in an overlapping fashion, or perhaps not at all before you finally reach a state of peaceful resolution around the loss.
Also, the “normal” grieving process may go awry if you have multiple losses, too many losses occur in a short period of time, or you’re not permitted to grieve openly. For example, your mother dies, and then three months later your sister and brother-in-law are killed in a car crash. Or you’re close to 40, and end up having five IVF cycles in the space of eight months, and five miscarriages. Then you have something called “complicated bereavement.” Complicated bereavement typically needs some outside help to work through.
Grieving doesn’t just take place in the context of death or a diagnosis of terminal illness. Grieving can occur in relationship to chronic illness, loss of finances, sexuality, spouse, freedom of movement, employment, and even in response to seemingly positive situations, such as the birth of a child, which also means leaving something else behind. There may be grief associated with graduating from school, leaving a job or a neighborhood, or a myriad of other situations.
In reference to PCOS, losses may include loss of femininity, loss of reproductive capacity (infertility, miscarriage), loss of health or the illusion of health, loss of freedom (all of the things you can’t or shouldn’t do if you want to be healthy), finances (the money spent on non-covered health practitioners, supplements, special dietary items, personal trainers, etc.), sexuality, relationships, and many other things. There is often a great deal to be grieved, which contributes to the chronic low-level sadness that accompanies many PCOS patients. You may not have labeled what your feeling as grief, but that may in fact be precisely what you’re feeling and doing.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.